The psychiatrist who treated James Holmes in the months before the shooting massacre at an Aurora, Colorado, movie theater said she was concerned about his homicidal thoughts, but had no evidence he was an immediate threat.
Lynne Fenton testified Tuesday in the trial of Holmes, who is accused of killing 12 people and attempting to kill 70 others during the July 2012 premiere of The Dark Knight Rises. He has pleaded not guilty by reason of insanity.
It was also the first time Fenton had spoken about Holmes' mental health and her opinions at the time on whether he was dangerous. After the shooting, she received a notebook Holmes had mailed detailing some of his plans, as well as his philosophy that his own life could gain value by killing others. Holmes also later told another psychiatrist that the medication he took before the shooting may have alleviated his anxiety to a level that he was able to follow through with his plans.
A civil lawsuit filed against her by the families of Holmes' victims — who believe she holds responsibility for not stopping him — is currently pending.
Fenton said that Holmes told her he thought about killing people three or four times a day. The homicidal thoughts were first brought up as he sought to make his first appointment, and at no point during treatment did he say they went away, Fenton testified.
Fenton said she has had other patients with homicidal thoughts before, but not all of them seek to act on them.
"I try to understand if they have a plan, if they’re taking any steps to carry out any action that is related to these thoughts," she said.
When she would ask if he had a plan to kill or a specific target, Fenton said Holmes sometimes would say no. Sometimes, he wouldn't answer.
When she asked for more information, Holmes rarely said much. In fact, in many of their interactions, Fenton described Holmes as hostile and guarded. She didn't force him to answer questions, she added, because she feared he might then pull out of treatment.
"I was hoping to have a working alliance with him, so he would keep coming back, so I would have a chance to understand this and be able to help him," Fenton said.
She prescribed sertraline — also known as Zoloft — and gradually increased the dosage. She also prescribed an anti-anxiety medication. But when she and another psychiatrist suggested he go on an anti-psychotic, Holmes refused.
After several meetings, Fenton said she began to believe Holmes had psychotic-level thinking, or thoughts that were out of touch with reality. It could be a sign of a schizotypal personality disorder, or a frank psychotic disorder, she testified.
Their last meeting took place June 11, 2012, just over a month before the shooting. By this time, Holmes had began making detailed plans and accumulated a number of weapons, prosecutors said.
When Holmes revealed that he was leaving his neuroscience graduate program after failing an important exam, Fenton said told the court that he seemed inappropriately calm about the development. However, she added, he seemed to be making realistic plans for the future. He mentioned his savings account, the support of his family, and that he planned to find a job and stay in Colorado at least until his lease ran out in November, she said.
Though Fenton offered to continue seeing him, he refused and abruptly walked out, she said.
That same day, she contacted the campus' behavioral and environmental threat assessment team and Holmes' mother, even though he had not given permission for her to contact family members. But campus police could find no evidence of a threat, she said, and the conversation with Holmes' mother left her feeling less sure his behavior could be a sudden, psychotic break.
"He never met criteria for me to hospitalize him," Fenton said.