A. Well, Mr. Kinkel qualifies as a classic individual with psychosis. The content of his psychosis has a great, strong paranoid flavor. It also has a strong connection to affective illness. He becomes sicker when he's depressed. So there are components of both paranoia and depression in his clinical presentation.

And did you do a mental status workup or question him about hallucinations or delusions?

A. Yes.

And what did you learn in that regard?

A. Well, I focused on those issues twice. The first time in March, and then again in the second time in May, I found that he began to hallucinate with voices when he was in the sixth grade. He describes the initial hallucinatory event in a very specific manner. He knew quite where he was. He was on the driveway after school. He was very specific about its onset. And then I wanted to trace it over the next three years, and attempted to do that up until the -- up and through May 20th and into the present time. So I found him to be hallucinating pretty consistently over a three-year -- at least a three-year period. And in addition, there were several delusions of a paranoid nature that I discovered.

Can you describe those briefly?

A. He had an idea that Disney World was going to take over, that we would not have a dollar bill with a president on it, but it would have a picture of Disney and a Disney mouse. This, to him, was a very sinister, evil symbol, and he had quite an elaborate delusion of how this was going to happen.

The second delusion was that he thought that China would invade the United States, and he had to be ready for that. That's why he stocked up weapons, explosives over a period of time. As he told me, there are two hundred million soldiers in China, more than the population of the United States, and we've got to be ready. I think he told me that he wanted his dad to buy gas masks and tents and meals and things to get ready for this.

Third delusion was that he thought he had a chip in his brain that was -- this was a delusion that came out of the initial hallucinatory experience. He tried to make some sense of why these voices were intruding on his otherwise logical thought processes. They were male voices. They were putting him down, calling him names, telling him to kill people. He was trying to make sense out of that, and he thought, well, maybe this is a chip in my brain that maybe the government or somebody has implanted there.

The fourth delusion was something that happened during my second interview with him. He was very upset that when he was imprisoned, people were allowed, visitors were allowed to walk past his cell and look at him. And he had the thought that maybe they had cameras in their glasses and they were photographing him as well as just peering in his cell.

There is one more hallucination -- I mean, delusion. The fifth one is, he had some worries that the medication that we started him on could be containing poison and might be harmful to him. That's a classic paranoid delusion. You see it all the time. Sometimes they think food is poisoned, but he didn't worry so much about the food. But he did worry initially about the medication.

I want to return to a discussion about the medication, but you mention the hallucinations and a period of time that he discussed that they prevailed. What was the content specifically that he discussed with you of the hallucinations?

A. Well, these were three voices. The initial voice would put him down, call him names, make fun of him, deride him. The second voice would tell him to kill. And the third voice would kind of comment on the two other voices, so there were three different voices. They were male voices. They tended to come when he was either stressed or depressed. And he did have symptoms of depression, both a longstanding, chronic depression as well as a more severe major depression during his freshman year in high school that lasted about three months during the fall of -- I believe it was '97.

Was there anything about the content of his hallucinations that was diagnostic of schizophrenia?

A. Yes. They were persistent, they were command hallucinations, and they were hallucinations commenting on his behavior. Those are all classic for -- as part of the profile or syndrome of paranoid schizophrenia.

What was his affect, and was that a consideration in your diagnosis?

A. ... He was tense. He didn't like to talk about the voices. He did talk about them, and when he did, he was subdued, anxious, with a real severe, stricken look on his face when he had to go into some of these details about the voices. It was not obviously a pleasant experience for him to be sharing this.

Is it your experience generally that it's easy to diagnose fifteen- and sixteen-year-olds?

A. No. Fifteen- and sixteen-year-olds are in the process of -- they're in a developmental process, and they are an emerging adult, and so symptom pictures can change. And they are not a fixed -- that's why we avoid -- we tend to avoid making personality diagnoses with adolescents because they don't yet have a formed personality. So teenagers are emerging adults, but their symptom profiles can change as they continue to develop.

So as I understand it, the full extent of the pathology hasn't revealed itself and onset doesn't occur until into adulthood; is that a fair statement?

A. I think that's a fair statement, yes.

Can you discuss a little more the schizoaffective component and what you mention in your report as a major depression component to your observations of his mental illness and help us understand with best certainty your diagnosis.

A. Well, as I say, I can't be absolutely sure whether he might eventually fall into the schizoaffective category. That simply means he has schizophrenic symptoms that are often accompanied with depressive symptoms or manic symptoms. He does not have any mania that I was able to determine, but he does have depressive symptoms.

In order, technically, to be diagnosed with schizoaffective, you have to have a period of psychotic symptoms where you were not depressed, but you often have symptoms of a mixture of the depressive and psychotic symptoms. And I thought that he probably would qualify for that diagnosis, technically, as well.

The reason I lean more to the paranoid schizophrenia was the content of his illness was so classically paranoid. But I think he falls somewhere in between those two domains. And whether this is simply a psychiatric technicality, I don't know. Certainly he was psychotic, floridly psychotic, whether he falls into one of these groups or the other.

Do you have an opinion as to what effect, if any, his mental disease had on his conduct on May 20th and May 21st of 1998?

A. I feel that his crimes and his behavior on those two days were directly the product of a psychotic process that had been building intermittently in him over a three-year period and suddenly emerged and took over control of his ego, and he became a very dangerous individual.

Have you had the opportunity and have you been presented with data on Mr. Kinkel's family history of mental illness?

A. Yes.

And did you find that significant in terms of converging with your diagnosis or contributing to your diagnosis?

A. It certainly substantiated the fact that this boy had some genetic loading that moved him towards a psychotic process. This obviously wasn't the only factor that resulted in his psychosis, but it certainly could have been an important contributing factor. He had major mental illness on both sides of his family tree.

Can you help the court understand to what extent that might have contributed to his potential to inherit a gene for mental illness? As I understand it, in the general population, the rate is one in a hundred are mentally ill. And although I stated this wrong the other day, in our community of 200,000, that would mean there are 2,000 people who are mentally ill. How would his odds have changed? And perhaps you can't put a number on it, but describe what the implications are.

A. I think, Counsel, one in a hundred means the prevalence of schizophrenia in our population is one in a hundred, you're right.

Oh, I see.

A. And with a positive family history, it goes up. I can't give you a percentage. If one parent has schizophrenia, the child has a tenfold increase of a chance of inheriting that. It's not a hundred percent, and so it falls somewhere between one percent and ten percent. But there is an increased likelihood of a mental illness.

Did you conduct a validity analysis on the research that you obtained and the clinical data that you obtained regarding Mr. Kinkel?

A. Well, I kept asking myself, am I -- you know, am I getting a story of this boy's real inner life or is this a fabrication? Is this an elaboration? And I found a number of factors that made me feel comfortable that I was getting an accurate picture.

First of all, as I mentioned before, Dr. Bolstad's information and mine converged towards the same diagnosis. We had lunch together. We both said "paranoid schizophrenia" practically simultaneously at lunch as we began to discuss the case together. That's one factor. The second was internal validity: watching his facial gestures, his mannerisms, and seeing if they squared with the content of his information. And of course, since I've done a lot of sexual abuse interviews, I'm very aware that people can fabricate sexual abuse for a variety of secondary gains, so I'm alert to -- I'm looking to see what the non-verbal gestures and mannerisms are in addition to the content of what I hear. Third, the thing again I mentioned is the other interviews subsequently done later this year were very, very similar to what I obtained.

And then finally, I sent my interview notes, typewritten interview notes to you, Mr. Sabitt, and I think you showed them to Mr. Kinkel. And he went over them and he corrected some minor errors that I had made during the interview in a way that was not favorable to himself. He said -- I had taken a history of alcohol use, and I think I put in my notes that he was drunk twice. He crossed that out and said no, I was drunk more like eight times. I had not gotten a full history of his stealing, and he included that in his amended critique of my interview notes. So I didn't think this was a boy who was trying to paint a rosy picture or cover over something else. I think he was trying to be almost too scrupulously honest in giving me this information.

Those are some of the factors. And of course I had Dr. Bolstad's information on his very elaborate analysis of malingering. He sent me his 40-page discussion of that issue from his test data, which were also compatible with my clinical observations.

Have you helped to recommend medications for Kip?

A. Yes. It was right after the Littleton incident. Mr. Kinkel heard of that while he was incarcerated, and his psychologist counselor I think discussed it with him.

Upon hearing of that incident, he -- his voices exacerbated. He became very troubled. The voices told him, "Now see what you've done. You've killed another 25 people." They became very accusatory. He became much sicker, and I felt at that point, even though all the evaluations had not yet been completed, it would be ethically wrong not to treat him with medication.

So I recommended an antipsychotic and an antidepressant medication, and I think it was in June when those were started. And I had not been managing the medicine. I made an initial recommendation. I have not been involved in monitoring or managing the medication, but I did concur with those medications.

What medications were those?

A. Olanzapine and Zyprexa, I believe. It's our newest antipsychotic. It's called an atypical antipsychotic medication, yes.

And are you aware of how he has responded to those meds?

A. He had been on the olanzapine ten days when I saw him the second time. And he reported to me that the voices had come back one time since he was started, but they were more muted. They were less screaming and reproachful. And he was pleased that he was getting some relief. And that was -- but that was only ten days after the medications started.

Are you hopeful about the treatment perspective for Kip?

A. Well, his illness is a treatable condition. I can't claim that it's curable, but it's certainly treatable. And I think if I can just quote our bible here, DSM-IV, which we use to make diagnoses and which guides us in our treatment plans, the DSM-IV says: Some evidence suggests that the prognosis for paranoid type of schizophrenia may be considerably better than for the other types of schizophrenia, particularly with regard to occupational functioning and capacity for independent living.

My footnote to that would be the tragedy of his illness is that, on the one hand, it allowed him to plan in a methodical way, because his cognitive structures were relatively intact compared to other forms of schizophrenia. I think our common notion of schizophrenia is a disheveled person walking down the street, talking incoherently. That is schizophrenia, but we're talking about a different kettle of fish here. This is paranoid schizophrenia. These people can look very normal.

So on the one hand, the illness had caused him to commit these tragedies. Also, it's the illness that responds better to treatment and has a better prognosis in general than the other forms of schizophrenia. That's the ironic tragedy of the whole thing.

Have you noted some positive prognosticators regarding his potential for successful future treatment?

A. Yes. I would say the positive prognostic factors are, one, his IQ score. He's cognitively bright, above average. Even though he has a learning disability, his overall IQ is high, and we know that high cognition is a good protective factor, a good prognostic factor.

Secondly, he has -- now that the voices are known -- we know that paranoid schizophrenics are secretive. They don't like to talk about voices, and particularly teenagers, because teenagers think in terms of their own identity. "If I tell somebody this, that means I'm crazy." And I think that was one of the reasons he couldn't tell anybody is, he was a teenager. And I've seen this in other cases of teenage psychosis. It can go on for years before it becomes apparent.

So I think he's open now. He's using counseling. He's taking the medication. His symptoms are improving. He is cooperative. He is not a behavior problem. And all of those things I think bode well for his future.

Can you tell this court with medical, at least, optimism that at some remote time in the future -- twenty-five or thirty years from now -- you think there is a potential for Mr. Kinkel to be a safe member of our community?

A. Yes, I think that if Mr. Kinkel takes medication, is consistently cared for by a psychiatrist that he trusts, in 25 or 30 years, I think he can be safely returned to the community. I would be happy to have him as my next-door neighbor if those conditions were met, that he was under good psychiatric care and that he was taking medication and his symptoms were obliterated. I don't think he would be a danger to society.

I want to backtrack a little bit, Doctor,and ask you about some of the issues regarding Mr. Kinkel's conduct on May 20th and May 21st of 1998. And there has been evidence presented to this court that in the interim, between the deaths of his parents and going to school the next morning, he had what appeared to be some lucid moments when there were telephone conversations he was involved in and some conduct around the home. Can you comment on that behavior and relate it to the mental illness you diagnosed and the symptoms of that mental illness generally?

A. Let me start by -- in response to your question, Mr. Sabitt, by reading the first sentence from the description of paranoid schizophrenia that exists in our DSM manual: The essential feature of the paranoid type of schizophrenia is the presence of prominent delusions or auditory hallucinations in the context of a relative preservation of cognitive functioning and affect.

It's possible for a paranoid schizophrenic to plan and execute awful things because his cognitive processes aren't as affected as they are in some other forms of schizophrenia. That's point one.

Point two, Dr. Bolstad, who took him through this time and in a much more specific fashion told me this week that Mr. Kinkel was hearing voices while he was on the phone with his friends -- that is secondhand information; I did not ask Mr. Kinkel specifically those questions. So I think it's quite possible -- I think -- my personal, clinical opinion, he was quite psychotic during that time, even though he was able to carry on a phone conversation with peers and schoolteachers.

Some seemingly ordered behavior during the course of a psychotic episode?

A. Yes. He could look so normal and be so sick inside. And this was true not only on the two days of the awful events of May 20th and 21st, but it was true for three years, that he was fighting off an inner mental illness and nobody knew it.

Do you think the shootings of May 20th and 21st would have taken place were it not for Mr. Kinkel's mental illness?

A. I don't think he would have killed anybody had it not been for the mental illness, no.

Is there another possible explanation for these acts? And what I'm thinking of is psychopathy. Is this kid -- based on your meetings with him and the data you have reviewed and the information you have learned about him -- a psychopath?

A. Well, as I mentioned earlier, I took him through the section on conduct disorder from the Kidde-Sads, and he did not qualify for a conduct disorder. Truly he has had some antisocial behavior, and I am aware of that, but he does not reach threshhold for a conduct disorder that I could find, talking with him. Now, I didn't have all the information. But secondly, there is no evidence that this person was in the juvenile system prior to his -- I mean, he was in the juvenile system briefly had he had -- with the rock-throwing incident. I've seen about two or three hundred kids at MacLaren. A lot of those are sociopaths or psychopaths. They leave a trail of consistent behavior, antisocial behavior, in their pathway. That was not true with Mr. Kinkel. And so I don't feel that he is a psychopath. And I'm sure that at times he wasn't a hundred percent honest, but I could not -- the crimes themselves are so bizarre that psychopathy doesn't help me, and I found no evidence of it.

If Kip Kinkel would have probably been identified as mentally ill and properly treated for mental illness several months prior to these acts, in your opinion, would he have committed these acts?

A. I think if he could have been under treatment with appropriate medication and appropriate followup, he would not have committed these acts. That's my impression, yes.

If a parent brought a child in to see you and described that there had been some issues regarding a fascination with explosives and a fascination with firearms and some violent behaviors and some law-breaking behaviors and a problem with the folks in relating at home, what would your response to that have been in terms of the workup you would have done on him?

A. I think in listening to such a story, I would have had an internal shiver up my spine. I think I would have done a very thorough mental status exam and possibly hospitalized somebody. Because those are all danger signs, signals that something more than the average distressed youth was facing me here.

Did Mr. Kinkel explain to you why he chose, when he was shooting at the school, not to kill his friends?....What did that imply -- knowing that he had warned off his friends immediately prior to executing Ben Walker, to stay away from the cafeteria, don't go to school today, and picking a friend to tell that to, and then immediately killing another youth at the school in the presence of his friend -- imply that he still has control, some control over who he chooses to kill and not kill?

A. Well, I mean, it would certainly imply that -- as I had mentioned to the court before, this is the awful, tragic thing about paranoid schizophrenia. They have full, functioning, cognitive processes at work here. It's not like he is just out of touch completely with reality. He is out of touch in the sense that he is terribly paranoid, but he can make those kind of choices and still be very psychotic. And beyond that, I can't tell you why he picked one and not the other. I don't know.

...let me back up a minute, Counsel. If you've been hearing voices -- and you know, it's hard for us to empathize; we've never heard voices ourselves. It's hard to understand what an experience is like to have a voice saying kill, kill, kill, and for that to go on for three years, and to be more persistent and louder and louder, and you're feeling depressed -- I mean, it's very difficult to understand what a psychotic person is going through.

We would like to explain it on a rational basis. And I can't explain it on a rational basis. The crime itself is so bizarre, and it so fits with what we know about paranoid schizophrenics, who are dangerous people.

So what happens if you take away his self-reporting that he has had voices for the last three years, saying over and over again, kill, kill, kill? What happens if you, just for the moment, take that out of the equation?

A. Well, I think if we took away the voices and we're taking away part of his psychotic process, that I don't think he would have killed anybody.

So you're saying that but for the voices --

A. Voices, the whole paranoid scheme that was developing over time, this idea that the world is hostile, he has to be on guard -- I mean, all this process was building in him over a period of time. And the voices were certainly the most prominent feature, because they were the most painful aspect of it, I think.

What if he were lying about voices saying kill, kill, kill -- not to say maybe he was lying about hearing voices, but voices that commanded him to kill?

A. If he were lying, then he would be the best actor that I have ever seen. I've seen people try to play psychotic, psychosis on stage -- they're not convincing. I mean, real schizophrenia on psychiatric wards is nothing like Ophelia in Hamlet. You know, this -- I've tried to answer your question, Counsel, that I did not think this boy was lying. And I tried to lay out the reasons why I didn't think so. But if he were lying, he fooled me.

My question is a little more pointed. Not that he is lying about hearing voices or that he is definitely mental -- there is a mental process going on, but that he is lying about the content of the voice, that the voice said over and over again, kill, kill, kill, and had been saying that over and over again over the three years. What if he was lying about that?

A. Well, Counsel, all I can say is that on that driveway in the fall of the sixth grade, when he first heard the voice, that voice said "kill." And that was the very first voice he heard. It was three years prior. I mean -- you know, it was -- it would be a very elaborate fabrication for him to have invented that and to tell that story so consistently and with such appropriate affect. Anyway, if he -- all I can answer your question, Counsel, is that if he were fooling me, I stand fooled. And that's the best I can do with it.