AURORA | The first two psychiatrists to testify in the Aurora theater shooting trial told jurors roughly the same thing: James Holmes was delusional and mentally ill when he opened fire on a packed movie theater, but that didn’t make him criminally insane.
“Despite having a mental disorder or defect, Mr. Holmes had the capacity to tell the difference between right and wrong,” Dr. Jeffrey Metzner said. Metzner later said he was “extremely confident” in his finding that Holmes knew right from wrong and that he had the capacity to be culpable for his actions.
That lines up with testimony from Dr. William Reid last week, who said Holmes knew right from wrong despite some delusional thoughts.
But the doctors’ diagnoses varied on what exactly Holmes’ condition is. Reid said he has a schizotypal personality disorder, while Metzner said Holmes has schizoaffective disorder — two similar ailments.
That type of disagreement is typical, experts say, and in this case, jurors will have to consider even starker differences from one doctor to the next as the trial moves on.
“It’s pretty common that there is at least subtle disagreements with regard to diagnosis between experts,” said
Andrew Donohue, a Delaware-based forensic psychiatrist, has conducted thousands of evaluations like the ones Metzner and Reid did on Holmes.
Donohue, who is on the faculty at Drexel University in Philadelphia, said unlike other medical conditions, like a broken leg, a psychiatrist’s diagnosis is subjective, which can lead to some disagreement.
“Most of the diagnosis we make can’t really be confirmed or anything through X-ray or any type of laboratory test. They are a little more subjective than other medical diagnosis,” he said.
Liza Gold, a forensic psychiatrist and professor at Georgetown University Medical Center, said that while Reid and Metzner may disagree on Holmes’ diagnosis, their findings aren’t too far off.
“Those aren’t really very different conclusions,” she said.
Schizotypal and schizoaffective disorders are very similar, she said, and have a lot of overlap. Both can lead to delusions, but schizoaffective is a more serious diagnosis.
Still, Gold said, on the big issues — if Holmes is competent to stand trial, if he was sane, and if he was delusional — the doctors agree.
“Those are the big questions and that doesn’t make him legally insane, but it doesn’t make him mentally ill,” he said. The disagreements between Reid and Donohue — who were both prosecution witnesses — could seem insignificant in the coming weeks when the defense calls its own experts. One of those experts diagnosed Holmes with schizophrenia and said he was insane.
Another factor could play into the varying diagnosis: Holmes told different stories to different doctors.
He told Reid he had visual hallucinations, particularly black shadows. The shadows appeared a black blobs on a desk or table, Holmes told Reid, and they split into two, or one would gobble up the other.
But a year earlier, when he met with Dr. Jeffrey Metzner, Holmes never mentioned the blobs or any hallucinations.
Holmes also told Dr. Raquel Gur, a defense expert who has yet to testify, that he didn’t think he would kill people in the theater, Metzner said. But when he spoke to Metzner, he said he wanted to shoot as many people in the theater as possible.
“That’s a pretty big difference,” Metzner said.
Gold said that is a common challenge for a forensic psychiatrist in these types of cases. Unlike a doctor who sees a patient regularly in a clinical setting, these doctors only get a few hours or days with them. Even in the case of Reid, who interviewed Holmes for 22 hours over the course of a few days in July 2014, Holmes’ recollections could be different than they were when other doctors saw him, she said.
“It is still sort of one moment in time,” she said. “That’s part of the challenge.”
Donohue said a subject’s psychosis also complicates what they tell a doctor because it may lead them to hold back information, especially from a doctor they just met or only spent a brief period with.
“Sometimes what you see with psychotic illnesses is that they learn you don’t go around talking to people about your hallucinations,” he said. “They learn to keep those symptoms to themselves.”