CENTENNIAL, Colo. — James Holmes may have been sedated. He may be psychotic. Or he already may be trying to improve his chances in court by playing the part of the loopy, unhinged maniac.
A notebook may hold some of the answers.
Since his quirky court appearance Monday — drooping head, dyed reddish-orange hair, vacant eyes and dazed demeanor — all manner of experts, analysts and Internet posts have buzzed with speculation about the mental state of the only suspect in the Aurora theater massacre and what role it will play in legal proceedings.
Dr. Harry Croft, medical director of the San Antonio Psychiatric Research Center, said Mr. Holmes' manner was consistent with someone who on the eve of a court hearing usually are drugged only if they present a threat to themselves or others.
"This is a bright guy. I don't know that he's not trying to look crazy," said Dr. Croft, author of "I Always Sit With My Back to the Wall" (Stillpoint, 2011). "If he knew how to rig those bombs in his apartment and acquire all those weapons, it's not unreasonable to believe that he might have looked up the insanity defense."
Kim Gorgens, a clinical associate professor at the Graduate School of Professional Psychology at the University of Denver, said her initial reaction upon seeing Mr. Holmes on television was that he had been medicated.
"But then you have to look at the broader context," Ms. Gorgens said. "You have to be wary of the fact that this may be a calculated attempt to portray himself in a certain way. He may be looking at an insanity defense or a competency hearing down the road."
She added that defense attorneys are often reluctant to have their clients medicated, given that a sedated defendant may be too impaired to assist them with the case.
Mr. Holmes, 24, is scheduled to be charged Monday and faces at minimum first-degree murder charges in the Friday morning massacre at the Century 16 theater, where 12 people were fatally shot and 58 more wounded.
Fox News reported Wednesday that Mr. Holmes mailed a notebook "full of details about how he was going to kill people" to a University of Colorado at Denver psychiatrist before the attack. The parcel sat in the mailroom for up to a week before it was discovered Monday.
The university confirmed later Wednesday that it had received a suspicious package Monday and turned it over to authorities, but had no comment on what was in it.
Dr. Croft said such a notebook could be crucial in determining Mr. Holmes' mental state before the shootings.
"To know in advance what he's thinking of, that would be very interesting from a psychiatric and investigative standpoint," he said.
Mr. Holmes may be trying already to raise doubts about his mental state to avoid, for example, a death sentence. Working against any argument about his sanity or competence are his months of calculated preparation before the shootings, including his construction of an elaborate booby trap in his apartment.
"He might be paranoid or have a psychotic illness, but I doubt that the insanity defense is going to work, given the amount of planning that went into this," Dr. Croft said. "It may be the best they can do is show reasons why he did these horrible things in hopes of getting a lesser sentence or avoiding the death penalty."
Mr. Holmes is likely to undergo a mental health evaluation before trial to determine whether he is insane or incompetent to stand trial.
"What he shows now is not nearly as important as what he shows when he's being evaluated later by a professional," Dr. Croft said.
Although his bewildered appearance Monday may have no bearing on the psychiatric evaluation, it could influence viewers who ultimately might wind up in the jury pool, Ms. Gorgens said.
"In terms of whether the defense team elects to pursue 'not guilty by reason of insanity,' his appearance is posturing in a way. It paints him in a certain light in front of all these potential jurors," she said. "There could be an element of theater or PR here."
If Mr. Holmes is found incompetent to stand trial, he likely would be assigned to the Colorado Mental Health Institute until he is found competent and able to assist with his defense. If found guilty but insane, he would be judged not criminally responsible for his actions and therefore not eligible for the death penalty.
Ms. Gorgens said such a scenario is unlikely. "Insanity defenses are successfully raised in something like 1 percent of cases," she said. "It's a hard sell to juries."
Another possibility is that the defense could argue that Mr. Holmes was legally sane before the crime but that the shootings may have caused him to lose his grip on reality.
"I understand he's acting really weird in jail. Is that because he's trying to get people to think he's psychotic?" Dr. Croft said. "Or is it because he did such a horrible act that he's actually become psychotic?"
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