What did your clinical interview of Kip reveal as far as his history of
mental illness or psychosis, if there was one?
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
And did you do a mental status workup or question him about hallucinations
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
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
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
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
Is it your experience generally that it's easy to diagnose fifteen- and
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
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?
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
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
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
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
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
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
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
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
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
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.