James Holmes trial puts sanity on the stand

The murder trial of alleged Aurora, Colorado shooter James Holmes would seem an open-and-shut case.

The trial, which starts on April 27 in Arapahoe County District Court, begins with all sides in agreement that Holmes burst into a packed movie theater in the Denver suburb of Aurora, tossed tear gas canisters into the crowd and opened fire, killing 12 people and injuring 70 others.

Holmes is charged with 24 counts of first degree murder, 140 counts of attempted murder and one charge of possession of explosives. And Holmes’s own lawyers admitted that their client committed the horrific crime in pretrial court filings. So did Holmes’s parents in a widely published statement.

Much of US popular opinion has also already condemned Holmes for the crime. Blogs, tweets, and articles define Holmes as a “lunatic” with “crazy hair” and “crazy eyes” who “deserves death.”

The desire to see justice done runs high, and understandably so.

Holmes, however, has pleaded not guilty by reason of insanity, meaning that jurors will be asked to determine his mental state at the time of the killings.

If the jury finds that Holmes was sane at the time of the shooting he could face the death penalty. Indeed, the court required that jurors voice a willingness to impose death in order to be seated at the trial. If found insane, Holmes will be committed indefinitely to a Colorado state mental hospital.

Yet the task facing jurors as the case unfolds over the coming months is anything but straightforward.

Jurors will likely be presented with several conflicting notions of sanity and insanity over the course of the trial. And they will be forced to confront widely held cultural assumptions about mental illness and violence.

The jury box in Courtroom 201, where the Holmes trial will take place.Brennan Linsley/Pool/Reuters

Judging sanity and insanity

Colorado, like many states, prohibits the execution of people with serious mental illness – a position also supported by the American Bar Association, the American Psychiatric Association, the American Psychological Association, and the National Alliance on Mental Illness.

In a traditional “insanity defense” trial alleged perpetrators attempt to prove that they were “insane” at the time of a crime and thus not fully culpable. But in Colorado the burden is on the prosecution to demonstrate that defendants were “sane,” if even fleetingly so, when planning and executing murders.

Prosecutors will thus argue that Holmes launched a methodical, premeditated plan that only a sane person could muster, while the defense will present evidence that Holmes was in the “throes of a psychotic episode” and unable to discern right from wrong. At stake is Holmes’s life.

This format will likely lead to an intricate series of in-court machinations in which prosecutors will attempt to show a method to Holmes’s madness while at the same time discounting the assessments of mental-health experts who treated Holmes in the months before the shooting.

The defense team will likely highlight the downward spiral of a defendant who at one time was a brilliant neuroscience student.

Not a diagnosis.Dictionary page via www.shutterstock.com.

Insanity is a legal term, not a psychiatric diagnosis

Complicating matters further, we might assume that psychiatrists and other mental health professionals determine sanity and insanity.

But in a courtroom, sanity and insanity are legal terms that link to culpability, not to psychiatric diagnosis. Legally, sanity (or compos mentis) implies that a person is of sound mind and therefore can bear responsibility for his or her actions. It is often defined as the absence of insanity (or non compos mentis).

While mental health experts often weigh in on insanity cases, they generally do so using legal frameworks. That’s because the term insanity does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), psychiatry’s diagnostic bible. The DSM also contains no guidelines for assessing mental health rather than mental illness. In other words, in a traditional mental-health framework psychiatrists have neither means nor methods to define someone as normal.

While some psychiatric diagnoses might be linked to the impairment of “reality testing,” the function by which a person recognizes that their observations and perceptions adequately reflect what is actually happening in the real world, there are no diagnoses that predict violence or crime before they happen, nor are there psychiatric criteria for discerning something called sanity.

Given this terrain, jurors might be faced with the complex task of making life-or-death decisions about criminality and mental illness based on information about which even highly qualified legal and mental health expertsdo not agree.

Stereotypes about mental illness and violence

Jurors will also be asked to check their assumptions about violence and mental illness at the courtroom door.

US popular culture frequently associates severe mental illness with violence and aggression, and these associations are given even more authority in the aftermath of mass shootings.

Yet research consistently shows that assumptions about insane violence are often based on stereotypes. As an aggregate group, people with mental illness are overwhelmingly more likely to be the victims of violence, including gun violence, rather than the perpetrators of it.

A focus on mental illness as causal in crime often leads people to overlook other, plausible risk factors for gun violence, such as drugs or alcohol, past histories of violence, or ready access to guns.

Here as well, the framework of the trial may present jurors with complex and seemingly contradictory positions.

Lawyers defending Holmes might invoke problematic stereotypes of crazed violence in order to reinforce the notion that their client was mentally ill.

The prosecution team, on the other hand, may ask jurors to transcend their stigmatizing assumptions about violence and mental illness – indeed the very assumptions that advocates for mental illness justice often ask society to critically address – in order to convict and condemn a man who has a history of mental illness.

When mental health expertise collides with legal expertise

None of this in any way excuses Holmes’s actions or minimizes the unimaginable suffering that they produced. And yet, as the courtroom drama plays out over the coming months, it seems incumbent on us to recognize that the trial will ask jurors to make decisions about sanity and insanity that, in the context of the courtroom, are highly nuanced and potentially contradictory.

Prosecutors will argue that a man with a history of mental illness was sane at the time of the shooting, while attorneys charged with defending their client will do so by depicting him as stereotypically mentally ill. Mental health expertise will collide with legal expertise. And deeply embedded cultural assumptions about violence and mental illness will be called into question.

The ways jurors navigate these complex issues will go a long way toward determining the outcome of the trial and the larger meanings that we take from it.

If handled fairly, then a proceeding that aims to mete out retribution will also provide an object lesson in justice.

But if man who is revealed over the course of the proceedings to have been severely mentally ill when he committed a crime is put to death, then the legacy of an unconscionable act of savagery will be marred by one final act of barbarism.

Jonathan M Metzl does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.