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An excerpt of a page from James Holmes’ notebook.

Diary of a Madman?

A psychiatrist analyzes the notebook of James Holmes.

Prosecutors in the Colorado theater shooting case last week finally introduced into evidence the ballyhooed "notebook" that James Holmes sent to his psychiatrist shortly before he shot 12 people dead and wounded 70 others shortly after midnight on July 20, 2012. The diary includes grim details of the run-up to Holmes's attack on moviegoers and is a central piece of evidence in the capital trial. Prosecutors have told jurors that Holmes' writings and drawings evince clear criminal intent — and methodical, reasoned preparation for mass murder. Defense attorneys, on the other hand, have told the panel that the contents of the diary instead are evidence of deep mental illness, a form of psychosis that suggests Holmes was legally insane at the time of the shootings. How the jury evaluates this document likely will determine whether Holmes is guilty (and perhaps given a death sentence) or not guilty by reason of insanity.

We asked Dr. Jeffrey Lieberman, a prominent psychiatrist and the former president of the American Psychiatric Association, to read through the notebook and offer some expert analysis and perspective on what he saw. Lieberman is no stranger to public comment about mass shootings, and he has commented on the Holmes case before, both publicly and privately. In fact, in March 2013, he was asked by attorneys for the University of Colorado Board of Regents to evaluate the procedures employed by the school’s health services personnel when they treated Holmes. Keep in mind as you read his comments that this is just one man's opinion, that many other doctors have come to differing opinions about Holmes's mental state. Lieberman has neither treated nor interviewed Holmes or otherwise been close to this case.

Lieberman’s assessment

This notebook provides a revealing narrative of a confused, distressed, and troubled young adult. It begins with him trying to find solace through soul-searching and philosophical musings, but then segues into what he regards as behavioral imperatives to discharge or resolve volatile feelings. In the interim, he seeks and receives help from professionals associated with the University of Colorado student mental health services, but he does not sufficiently disclose his ailments to the doctors.

Having failed to relieve his mental turmoil, he feels empowered to act on his feelings and proceeds to devise a plan. Throughout he never mentions friends, family or his education or professional aspirations (other than the brief reference to friends on page 4). It is interesting that his anger is not directed at anyone in particular but at people in general.

The overall scheme and its depiction in this fragmentary and rambling style does several things: It reflects Holmes’s sense of and need for organization and logic in the world that he inhabits. It provides a veritable confession of what he intends to do and why. It also could be seen as a plea for sympathy and understanding to mitigate the heinous crime that he would ultimately commit. Whatever the case, it seems clear that he realizes what he is doing and is willing to face the consequences.

In terms of his mental state and diagnosis, the dominant theme of the writings in his notebook is that of a tormented person struggling with issues of identity, alienation, and how to manage his emotions and fulfill his needs. The nature of these conflicts and tensions is existential and characteristic of youth. The narrative content reflects thoughts that are organized, coherent, grammatically and linguistically correct, albeit disturbing and often bizarre. His references to being crazy or having a broken mind are also not pathognomonic, as insane people generally don’t think or know that they are insane.

His chief complaint and reason for seeking help at the university health center was related to interpersonal issues and anxiety. He does not reveal what would be considered psychotic symptoms. The major issues are his alienation, disaffection, isolation, fear and anger. No mental disorder is clearly apparent.

Explore James Holmes' notebook through the analysis of noted psychiatrist, Dr. Jeffrey Lieberman.

View Dr. Jeffrey Lieberman's review of the notebook of James Holmes, on trial for the mass shooting in an Aurora, Colo. movie theater in 2012.