September 22nd, 2012
01:07 PM ET

Opinion: Brain science key in trial of alleged 'Batman' shooter

Editor's Note: Dr. David Eagleman directs the Eagleman Laboratory for Perception and Action at Baylor College of Medicine in Houston. He is the subject of Sunday's episode of "The Next List," on CNN at 2 p.m. ET.

By David Eagleman, Special to CNN

(CNN) - In the wake of the Aurora, Colorado, movie theater shooting, many people are asking the same questions: What kind of derangement is revealed by the alleged acts of James Holmes, who has been charged with murder and attempted murder in a massacre during a showing of "The Dark Knight Rises"? What is wrong with the brain that concocted this plot? How will information about Holmes' mental state play out in the courts?

My goal here is to bring a perspective on this tragedy from the point of view of a neuroscientist.

Few facts are publicly available about Holmes’ mental health background. Despite the dearth of data, however, several issues can be clarified and discussed.

To begin, it’s critical to understand the difference between two words: psychotic and psychopathic. These are two similar-sounding terms that commentators sometimes use interchangeably.

But, in reality, they are entirely different.

A person with a psychosis is disconnected from reality. For example, a homeless person arguing with himself is typically suffering from a psychosis such as schizophrenia. Someone with this sort of mental illness is termed “psychotic.” A person with a disorder of mood such as bipolar disorder (in which one alternates between depression and mania) can also have associated psychotic features such as hallucinations and delusions.

In contrast, a person with psychopathy has low empathy and low remorse. The psychopath can be smart, glib, charming and blend in perfectly with the society around him, but he lacks compassion and guilt. Behind his “mask of sanity” lurks a manipulative creature who can hurt others without compunction. A psychopath (or, synonymously, a sociopath) is someone like Jeffrey Dahmer or Ted Bundy. They are termed “psychopathic”.

Which, if either of these, was Holmes? If convicted of the crimes, did he suffer from a psychosis, or was he instead a cognitively intact but emotionless sociopath? When Colorado Rep. Ed Perlmutter told the media that Holmes was “a psychotic son of a bitch," it’s safe to guess that his statement stemmed from a confounding of the terms rather than a specific diagnosis.

The facts about Holmes’ mental state are almost entirely under gag orders, so it is impossible to make a diagnosis at a distance. But my purpose here is to sketch the various scenarios which could happen in the courtroom.

First, if Holmes is found to verifiably suffer from a psychosis (especially with a historical medical record to back up the diagnosis), then his attorney likely will plead not guilty by reason of insanity. If the plea is successful, he would be committed to a mental health institution, presumably for life.

Historically, the public finds a successful insanity plea unsatisfying. However, even the ancient Greeks recognized that someone disconnected from reality cannot be treated the same way as someone with normally functioning cognition. In other words, when people are disconnected from reality as the product of a mental health disorder, moral blame traditionally does not attach itself to the person in the same way.

A recent New York Times article reported that Holmes felt he might have dysphoric mania, a term that describes the presence of depressive symptoms hand-in-hand with the elation, agitation and flight of ideas that characterize a manic state. (Dysphoric mania is sometimes called “mixed mania,” “depressive mania” or “agitated depression.”) This type of mania is commonly accompanied by psychosis, which would make it eligible for the insanity defense. It has not yet been made public whether Holmes was professionally diagnosed with a mixed mania or if instead he made the supposition himself.

It is of interest that Colorado is one of only a few states in which the burden of proof lies on the prosecution for an insanity defense. In other words, the state must establish from other clues that Holmes could indeed distinguish right from wrong and understood the nature and consequences of his alleged actions. This argument will be made from a careful examination of Holmes’ other behaviors around that time. A typical example of this sort of investigation looks at issues of whether he, for example, changed his behavior or hid his actions around authority figures. If so, that would be used to build a case that he understood the morality and effects of his choices.

Now let’s turn to another scenario: Suppose that instead of having a psychosis, Holmes had a psychopathy. In that case, he would not be able to plead insanity. For insanity defense purposes, one must have a mental illness, and psychopathy does not qualify. This is because psychopaths fully understand the nature and consequences of their crimes; they commit their acts simply because of a lack of compunction and remorse.

As more data emerge about Holmes’ past and present, the question of his mental condition will be clarified. Of course, his problem could be something other than psychosis or psychopathy.

One suspect in bizarre acts like this is the presence of drugs (specifically, psychoactive drugs, or those that affect the brain and can change cognition and behavior). But a drug-induced mental state seems less likely given his allegedly meticulous, months-long purchases of weapons, ammunition and explosives.

Another root of incomprehensible behavior can be a brain tumor, such as the small tumor that grew in the brain of Charles Whitman, the shooter in the 1966 University of Texas tower massacre. Let me be clear that I see a brain tumor as an extremely low probability explanation in Holmes’ case, but nothing should escape scrutiny in a case like this. In the unlikely event that Holmes has a tumor (and one which could be plausibly argued to have steered his behavior), this could serve as a mitigating factor during sentencing. Presumably, such a scenario would leave a bitter taste on the public tongue. On one hand, everyone would agree that a behavior-changing tumor would not be his fault. On the other hand, the direct link between brain and behavior tends to go underappreciated in powerful emotional winds, and the desire for punishment is understandably strong. Therefore, the discovery of a brain tumor would test our capacity to deal with such a horrific act in the light of modern biology.

One does not have to be an expert to surmise that something appears to be wrong with Holmes’ brain, but it makes a difference what that problem turns out to be. The answer navigates his possible outcomes in court.

The opinions expressed in this post are solely those of David Eagleman.

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soundoff (35 Responses)
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    March 30, 2013 at 5:16 pm | Reply
  5. Trudye

    This was a fascinating piece. I have long thought the brain was the key to solving our social and health issues. I believe that since the brain controls the body it also controls disease. particularly auto-immune diseases. There has to be a way to program the brain to fight diseases and abnormalities in our bodily functions.
    For instance Parkinson’s disease is the bodies’ failure to produce enough dopamine. It seems to me the brain could be re-programmed to make that adjustment. That would eliminate the need for medicine (which is why the pharmaceutical companies would never let it happen).
    I don’t know if it’s true you did not address it in your piece. But the myth is man only uses 10% of his brain. If there was a way to increase that to say 50%, I shudder to think of the possibilities.
    Dr. David Eagleman please keep up the good work. I know we will reach a point where the body will police and correct itself. Maybe not in my life time but it is coming.

    September 24, 2012 at 4:55 pm | Reply
  6. RustyHinges8

    My money is on Holmes being psychopathic. As the article stated, he was “meticulous, making month-long purchases of weapons, ammo and explosives.” He planned and created booby-traps in his apartment. He wasn’t disconnected from reality like a psychotic, and I doubt he was talking to himself while tinkering with the detonation wires where he lived. He had major plans and was carrying them out. THEN, he decided to “look” crazy….like a psychotic, and not what he really was, a psychopathic. So, he chose the Batman movie, and what better crazy character….the “Joker”. But what’s the connection to himself and the “Joker? He understood the full nature of his crimes, because all of his actions were premeditated. The Batman movie served as the stage for his plan, with lots of people….all that was left was that twisted touch of humor….”Joker”.

    September 23, 2012 at 5:30 pm | Reply
    • Elizabeth Manuel

      People keep pointing out that James stockpile of weapons prove his sanity, this is an incredibly common misconception of how the brain works. People play instruments while sleep-walking whilst unable to consciously control any of their actions.

      http://www.sciencedirect.com/science/article/pii/S0926641096000547 James showed NO psychopathic tendancies, his behaviour altered very suddenly and amid all his 'plans' he left a path of evidence against himself so he obviously was NOT thinking of the consequences of his actions – just on auto-pilot like a sleepwalker! He has no motive (he withdrew his own college application and was turned down on the other due to his SUDDEN bizarre behaviour) His behaviour changed due to mind-altering prescription meds! This is a case with OBVIOUS answers and all the talk about him being a psychopath is ridiculous given the evidence to show he was suffering side-effects and temporary discontinuation psychosis from prescription medications!

      September 28, 2012 at 3:45 am | Reply
      • Peri Bear

        Indeed.

        January 6, 2013 at 6:54 pm |
  7. Thomas G Shafer MD

    I have worked as a psychiatrist with NGI seeking clients in a state forensic hospital..

    In the US only about 4% of defendants who attempt a Not Guilty by Reason of Insanity defense acheive their goal. Sometimes mental illness may be used as a factor to lessen or mitigate a sentence. In most states though the only lesser sentence availble in capital murer cases is life without parole.

    If there is the slightest evidene of premeditation and/or planning the crime, the defendant is not found NGI.

    Remember too this man is a near fully trained doctorate level neuropsychologist. If he is sociopathic and not psychotic he could do a credible job of faking psychosis.

    Dr. Shafer

    September 23, 2012 at 4:27 pm | Reply
  8. furianxo

    This guy is no different than the man who pushes buttons and kills a couple of toddlers. Both are murderers, and both deserve to be punished for their crimes. Why must we find a answer to these problems when we as a society have justifications for murder? When big brother (the government) stop doing it, then maybe, just maybe, society will too.

    September 23, 2012 at 4:23 pm | Reply
  9. Spych

    First, MRI apparatus, only scan the surface activity of the brain, they cannot looks at the brain activity deep in the brains' tissues.
    Second, Are brain and our really is the world is also shaped by our lives' experiences. meaning what we experience in out life time might be normal to us, but it would not be normal to other individuals.
    Third, how we interpret our surrounding will significantly be different from other individuals.
    We cannot judge this case uniformly, each case and each individual involve in the case are differently and should be looked at as a SINGLE, INDIVIDUAL CASE.

    September 23, 2012 at 4:17 pm | Reply
  10. smokin1011

    Guns don't kill people, they just make it easier for psychopaths to kill people.

    September 23, 2012 at 3:44 pm | Reply
  11. CJ Topspin

    The only reason why ANY of this would matter is if we could find some kind of associated genetic trait or physical brain abnormality that would prevent this from happening in the future. The fact he is psychotic or psychopathinc doesn't change the fact that the people he killed are still dead. Lives are still ruined. He is still dangerous. Stage 4 lung cancer and stage 4 colon cancer may be different kinds of cancer...but they still kill you in the end.
    So, when it comes to sentencing, it shouldn't matter.

    September 23, 2012 at 3:32 pm | Reply
  12. mary keaveny

    thank you. well done and much appreciated. mary keaveny

    September 23, 2012 at 3:24 pm | Reply
  13. The Social Briton

    Liking David Eagleman a lot. But, I must admit – I think L. Ron Hubbard is far more clever – and I'm no where near a "Scientologist" ... still Hubbards tree-branch concepts usually stem from more focused research done by folks like Dr. Eagleman. The best thing about Dianetics approach is that all "insanity' is somehow curable, or reconcilable, at least. In modern psychology(and anthropology, these days), mental diagnosis are probably tainted by fear, avarice and jealousy – and there are no variables to represent these biases, conveniently(?) ... Question: are post modern westerners stacking a new totem pole of elitism? sigh – could be.

    September 23, 2012 at 3:11 pm | Reply
  14. Mark S

    Nice article. I admire the author's prudence in not jumping to conclusions – and his effectiveness in outlining the most common diagnoses and their application to existing law, using past examples when appropriate. A calm, deliberated approach is the best thing for these sorts of sensational cases.

    September 23, 2012 at 2:47 pm | Reply
    • thewarpedpen

      I agree. I feel like a lot of cases involving mental health issues have been confusing because the differences between disorders have not been completely explained.

      September 23, 2012 at 3:15 pm | Reply
  15. Anthony Gordon

    when they say people associate colors with words and numbers and such. I have always associated numbers to masculinity my entire life.

    1 = male
    2 = female
    3 = male
    4 = female
    5 = male
    6 = female
    7 = male
    8 = male
    9 = female
    10 = male

    They also have characteristics lol.

    September 23, 2012 at 2:22 pm | Reply
    • RT

      8 is a female for me.

      September 23, 2012 at 2:49 pm | Reply
      • rhmendelson

        I applaud Dr. Eagleman for speaking out and clarifying these psychological profiles. However, as a resident of Colorado sandwiched between Columbine and Aurora, we've seen enough violence here. It doesn't really matter what someone's motives are, they're wrong. Therefore, this case should be tried as expediently as possible, and this person should be taken out of society – permanently. More than likely, that will happen. The people within this area of the state have had enough; there is no chance to find an impartial jury...anywhere. This man will be convicted, and the rest of us will peacefully get on with our lives.

        October 3, 2012 at 3:42 pm |
  16. kent norton

    IT IS Not the physical brain; yet the esoteric mind that lacks compassion; a Buddhist trait that can be taught. we have to stop labeling mental states as if nothing can be done.

    September 23, 2012 at 2:08 pm | Reply
    • Wisski

      Wow, yeah, all we need to do is make sure people's chakra's are aligned! YOU SIR ARE BRILLIANT.

      The existence of the mind is an illusion. There is only 1 organ in your head, and that's the brain.

      September 23, 2012 at 2:30 pm | Reply
      • longtooth

        The point is that the mind is not an organ. You have a brain, as you have a liver. How can you be what you possess?

        September 23, 2012 at 2:53 pm |
  17. pooh2

    What I am surprised at is that there were no words about the guy who jumped in the the tiger's den because he "wanted to be one with the tigers," if he was insane or not. His act did not seem premeditated, and he did not hurt anyone, only himself. Will his mental state be subjected to the same scrutiny as that of Holmes?

    September 23, 2012 at 1:46 pm | Reply
  18. J.

    I enjoyed this article, but find it strange that the courts don't accept a insanity plea for people who are sociopaths/psychopaths. Isn't the inability to feel compassion or remorse a sign of a serious mental issue atypical for the average person? PsychCentral has a good blurb about this issue: http://psychcentral.com/blog/archives/2010/03/23/a-psychopaths-brain-on-fmri/

    September 23, 2012 at 1:37 pm | Reply
    • Elizabeth Manuel

      As unpalatable as these facts are, they are nonetheless FACTS and I am glad someone has the nuts to point them out in the face of extreme hostility towards a boy that quite obviously was not in control of his own body/brain. Hopefully one day such brain dysfunction can be screened for and eradicated without the sick lynch mob mentality that keeps this world in a moral and psychiatric dark age and ensures that lessons are not learned from tragedies and therefore ensures that such tragedies will happen again.

      September 23, 2012 at 1:56 pm | Reply
    • Alip

      You just expressed my thoughts/questions exactly. A sociopath obviously has a disorder in his/her own right and it appears that it is biological like someone who is psychotic. Good point!

      September 23, 2012 at 2:31 pm | Reply
    • Chris

      I think it does qualify as a mental disorder, but as far as the law is concerned, if you understand your actions as right or wrong, then it doesn't really matter. The offender's lack of empathy is irrelevant, he still knew what he was doing was wrong or immoral, he just didn't care.

      September 23, 2012 at 3:40 pm | Reply
  19. Patrick

    Since both psychopathy and psychosis are maladaptive brain conditions beyond the will of the afflicted, I fail to see the distinction in terms of moral culpability. How different is a brain tumor to a brain wired to feel no remorse or sensitivity when it comes to the concept of freewill and moral responsibility? Of course this sort of reasoning is beyond the ignorant, slobbering masses crying for blood. No sympathy of the devil it appears.

    September 23, 2012 at 1:21 pm | Reply
    • JCR

      The problem is really that we even have an archaic idea like "free will" in our vocabulary. As long as we continue to encourage that kind of outdated thinking in the general population, we will have moral systems based on outdated science.

      September 23, 2012 at 1:28 pm | Reply
      • Poltergei

        Morality isn't based on science. If it were we'd be dissecting his brain so we could get some better resolution scans and some handy research data on the mind of a killer. Because science just deals with the acquisition of knowledge not right and wrong.

        October 3, 2012 at 7:09 pm |
      • Elizabeth Manuel

        http://www.psmag.com/science-environment/whipping-up-kindness-in-the-lab-11133/ Think again Poltergai!

        October 4, 2012 at 6:07 pm |
  20. Erin Chester

    I have dysphoric mania and it differs from the description here.

    The author is describing 'euphoric mania'. "A recent New York Times article reported that Holmes felt he might have dysphoric mania, a term that describes the presence of depressive symptoms hand-in-hand with the elation, agitation and flight of ideas that characterize a manic state. (Dysphoric mania is sometimes called “mixed mania,” “depressive mania” or “agitated depression.”"

    Here is a correction definition: "In the context of mental disorder, a mixed state, also known as dysphoric mania, agitated depression, or a mixed episode, is a condition during which symptoms of mania and depression occur simultaneously, such as agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid or suicidal ideation, panic, paranoia, pressured speech and rage. Typical examples include tearfulness during a manic episode or racing thoughts during a depressive episode. One may also feel incredibly frustrated or be prone to fits of rage in this state, since one may feel like a failure and at the same time have a flight of ideas. Mixed states are often the most problematic period of mood disorders, during which susceptibility to substance abuse, panic disorder, commission of violence, suicide attempts, and other complications increase greatly",

    I was upset to read this incorrect description. I barely survived a horrible dysphoric mania. 'Elation' never once came into play. Anger, rage, paranoia certainly did.

    The bipolar disorder I deal with is not as common as the 'euphoric' variety, in which a person experiences a 'highly elated' state at times. It was extremely difficult for me to get on a medication that got things stable, because I was not diagnosed correctly for a fairly long period of time. I had a doctor earlier on tell me I was 'bipolar', but he offered no explanation of what that meant. I just knew they classic bipolar definition, such as this author describes. I refused that diagnosis, and ended up suffering much longer.

    If James Holmes does have what I call 'irritable bipolar', if he is put on the correct kind of mood stabilizer he can think clearly and understand right and wrong. Before I was correctly medicated, I was convinced I was a dangerous serial killer, and a menace to society. Now I am back to being sweet, non confrontational and myself generally. The medication side effects are not good (esp. for women, the one I take) but they keep me home and alive.

    September 23, 2012 at 1:21 pm | Reply
    • lancet98

      Thank you for pointing out one of the errors in the article.

      What the article didn't explain is why psychopaths are not considered in the same light as the mentally ill (the term psychopath/sociopath no longer exists in the professional vocabulary, by the way, the correct term is APD – antisocial personality disorder) is this one fact. A person who is psychotic may not be able to distinguish what is real and what is not. A psychotic person also may not be able to control his own behavior, simply due to the illness he or she has.

      However, a person with anti social personality disorder, knows what he is doing is wrong; he just doesn't care. He realizes he's committing a crime, he realizes it's morally wrong, he isn't seeing his crime in the same way as a psychotic person might.

      One psychotic person might kill someone because he simply has a completely out-of-the-blue impulse and could not control it. Another may kill someone because the voices he hears, which he believes are God's voice, ordered him to. One psychotic person I knew made a 'citizen's arrest' (chased someone through a city park and knocked him down) because he believed the person had probed his mind and implanted evil thoughts in his mind. Those symptoms can be lessened and managed with treatment.

      On the other hand, there is no definitive treatment for people with anti-social personality disorder. Some researchers believe that people with antisocial personality disorder have brain dysfunction (brain cells are gone, damaged, not connected properly to other cells in the brain), and that the are no different from others with a brain dysfunction (psychosis is a brain dysfunction as well).

      Given the kind of horrific things some people with antisocial personality disorder do, given that they do not show remorse, given that they show little concern for others, given that they have no distortion of reality and understan what they did, it is unlikely that society will take pity on them or treat them differently.

      The treatment of the mentally ill offender, however, isn't much to be proud of. Fortunately we're a country of laws and what role a mental illness may have played in this tragedy will be determined in court – however flawed and imperfect that process may be, it is better than fanatical vigilantism.

      September 23, 2012 at 2:50 pm | Reply
  21. Tr1Xen

    After we execute this nut, we can dissect his brain. Great idea.

    September 23, 2012 at 12:40 pm | Reply

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