The psychiatrist treating James Holmes before his deadly attack on a Colorado movie theater said Tuesday that he complained of homicidal thoughts, but never revealed any specific targets, plans or coherent reasons for carrying them out.
Patients sometimes talk about killing people, Dr. Lynn Fenton said, and therapists in such cases should determine if they have a plan: "If they're taking any steps to carry out any action that is related to these thoughts, and if the homicidal ideation is directed at any targets."
He answered "no" to both questions, she said, and this became an ongoing theme during their five sessions together: Holmes remained very guarded, and deflected most of her efforts to probe his thinking.
"I thought he had social anxiety disorder," she said. "I was hoping to have a working alliance with him so he would keep coming back ... I was worried that he might drop out of treatment at any time."
At one point, Holmes told her he had a "biological problem," and that the solution to it was homicide, she said.
But he also said "you can't eliminate everybody, so it's not an effective solution," she added. "He seemed to be dismissing the idea of a homicide as an effective solution."
She told District Attorney George Brauchler that this gave her some assurance Holmes wasn't about to kill anyone.
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But she remained concerned about his mental health, and upped his prescription to 150 milligrams daily of sertraline as well as klonopin and propranolol, she said.
The prosecutor repeatedly quizzed Fenton about whether Holmes revealed anything about the arsenal of weapons he was buying, the gas mask he would use, or whether he showed since of depression, mania or suicidal behavior. She kept answering "no."
But he did show his temper, she said.
When Holmes couldn't refill his prescription at one point when she wrote the wrong name on the form, Holmes sent her an email with an emoticon he said signified him punching her, to vent his anger for the inconvenience. She apologized, but carefully noted the exchange.
During another session, "He angrily was asking me, 'Why won't you tell me what your philosophy of life was? I told you all of my ideas.'" Fenton's notes that day said Holmes might be engaging in "psychotic level thinking."
Defense attorneys say Holmes is schizophrenic and was in the grips of a psychotic episode as he carried out the July 20, 2012 attack. Two other psychiatrists appointed by the court to examine Holmes concluded he was legally sane when his gunfire killed 12 people, wounded 58 and left 12 others injured in the chaos.
In the end, Fenton saw Holmes five times in 2012 while he was a neuroscience graduate student at the University of Colorado. By pleading not guilty by reason of insanity, he waived his patient-client privilege and opened the door for her testimony.
Their final visit was on June 11, when he told her and another therapist she brought in, Dr. Robert Feinstein, that he had just failed his final exam and dropped out of the neuroscience program.
"Most students who failed a test like this would be very upset, and he seemed relaxed ... inappropriately nonchalant," she said. "We asked if he had a plan," and he described some logical steps, like meeting with an adviser and finding a job.
"It was all sounding like he was functioning well and looking forward to the future and had plans to get by," she said.
Fenton has directed the Student Mental Health Service at the University of Colorado's Anschutz Medical Campus in suburban Aurora since 2009. She oversees the psychotherapy and medication of 15 to 20 graduate students a week, teaches psychiatry and is a researcher with a particular interest in schizophrenia, according to the school's website.
But Holmes said he pointedly kept Fenton uninformed of his murderous plots, and he quit seeing her when he withdrew from school more than a month before the attack. His elaborate schemes and to-do lists were kept in a journal that he didn't mail to her until hours before the assault.
That notebook — including $400 in burned $20 bills to show that he could no longer afford her therapy after withdrawing from school — lingered in a campus mailroom for days thereafter.
His list for their sessions included: "Prevent building false sense of rapport ... deflect incriminating questions ... can't tell the mind rapists plan."
Others have testified that Fenton contacted a campus threat assessment team in June 2012, and told a campus police officer about her concerns after the threatening email, but decided against the officer's offer to arrest Holmes and place him on a 72-hour psychiatric hold, according to a civil suit that accuses her of not doing enough to prevent the attack.
Two years after the shooting, Holmes told a court-appointed examiner, Dr. William Reid, that he kept Fenton in the dark. "I kind of regret that she didn't lock me up so that everything could have been avoided," he said in a video that was played for the jurors.
