Sunday, July 22, 2012

James Holmes, Mental Illness, Colorado Shootings, Not Guilty By Reason of Insanity

Could James Holmes Be Seriously Mentally Ill?
It is too early to tell, but he could be. There are three reasons people do these things.
  1. Lack of maturity (ex. desire to get attention or get back at someone); 
  2. Political reasons (terrorism);
  3. Their brain was malfunctioning due to mental illness. 
I guess mental illness, and may be wrong, but here's why I think that, based on media reports:
  • James Holmes is 24, the age at which schizophrenia starts. 
  • He is delusional, i.e, believes he is the Joker. 
  • He was "normal" and then became withdrawn. Withdrawal is a common reaction to hallucinations.
  • NY Daily News reported he has lack of affect ("shows no remorse")
  • He is acting crazy spitting on everyone in jail.  
  • The owner of a shooting range reported Mr. Holmes' voice message was "bizarre"
The fact that he was highly educated, and the attack was well planned, does not rule out mental illness. The disease often starts after the education. The Unabomber was also highly educated and planned his attacks well.

If James Holmes had a mental illness that caused the shooting, what could have been done to prevent it?
Probably not much. While there are many (albeit, unused) legal procedures to help people who already have serious mental illness and a history of violence, it is much more difficult to help someone prior to a first episode without violating their rights. (Put another way: the law requires dangerous behavior rather than prevents it). One possible approach might be to make it easier to have someone undergo a 'capacity' or 'competency' hearing. These hearings determine whether someone is rational and can make their own decisions. They are frequently held for people with Alzheimer's, dementia, or developmental disabilities, but rarely for people with mental illness. If someone is found to lack capacity or competency, then someone else can be appointed to make decisions for them, which could include treatment. 

What happens if James Holmes is found Not Guilty By Reason of Insanity for the Colorado Shooting?
(Excerpted from op-ed I wrote a few years back in Wall Street Journal)
If he is found Not Guilty By Reason of Insanity (NGRI) he will be put in locked psychiatric hospital. But theoretically, when sanity is restored, he can be released. As a practical matter, few judges are willing to risk that on their watch, so even when sanity is restored—he will likely be kept committed.

To protect against the possibility of NGRI acquitees going free, some states replaced NGRI with "guilty because of mental illness." Individuals found guilty because of mental illness go to a hospital until their sanity is restored and then to jail to finish out their sentence. This forces individuals who had no culpability for their actions to go to jail at the exact time it's not needed—when they've regained their sanity. For these individuals being mentally ill is the same as being guilty: either way, they go to jail.

Our current system incarcerates people who have no culpability for their actions. It keeps sane people involuntarily committed, and gives potentially violent mentally ill individuals the right to go off violence-preventing medications. That's not justice, it's mayhem.

To correct that, we have proposed that individuals found NGRI be 'sentenced' to treatment for the maximum amount of time they would have received had they been found guilty. This treatment could be in a locked ward if needed or in the community if safe. Treatment would be monitored (much like Parole). The individual could be moved back and forth between inpatient and outpatient treatment as needed with no further court proceedings necessary. This would keep them safe, save money, and keep communities safer.

Learn more
The relationship between untreated serious mental illness and violence
Noncompliance in people with serious mental illness

For more on mental illness and violence visit or follow us on Facebook or Twitter.


  1. This is a very thoughtful and sensible piece. Thank you for the good information.

    1. tx. see this Open letter to Arlene Holmes, mother of James Holmes. Brilliant! Please share

  2. Thank you for being the voice of reason in this debate! I read your piece in the Washington Times (via your facebook page) and was appalled at the vitriol that was flung at you by people who clearly have no direct experience with the mentally ill.

    1. Open letter to Arlene Holmes, mother of James Holmes. Brilliant! Please share

  3. I am reluctant to say Holmes suffered from mental illness because do not want to feed into stereotypes about people w/ MI being violent. But just like we're talking about gun control and even terrorism, we have to discuss our collective treatment of mental illness when discussing prevention.

    1. Tx. I tried to subscribe to your blog, but I think I messed up. Will try again. tx Open letter to Arlene Holmes, mother of James Holmes. Brilliant! Please share

  4. A link between antidepressant use and violence needs a plausible clinical mechanism through which such effects might be realised. There are comparable data on increased rates of suicidal events on active treatment compared to placebo . In the case of suicide, several explanations have been offered for the linkage. It is argued that alleviating the motor retardation of depression, the condition being treated, might enable suicides to happen, but this cannot explain the appearance of suicidality in healthy volunteers. Mechanisms linking antidepressant treatment, rather than the condition, to adverse behavioural outcomes include akathisia, emotional disinhibition, emotional blunting, and manic or psychotic reactions to treatment. There is good evidence that antidepressant treatment can induce problems such as these and a prima facie case that akathisia, emotional blunting, and manic or psychotic reactions might lead to violence.

    When psychiatric drugs made me suicidal they of course blamed my "mental illness" not the drugs that caused the irrational thinking. Call your doctor if...

    1. This is interesting, thanks for writing/highlighting this.

      The whole James Holmes situation has started me thinking more about mental health issues and I'm realizing just how complex it is, especially when coupled with everything else in life and society.

      Pip, Melbourne