Jared Loughner is facing another four months of mental-health treatment at a prison hospital in Springfield, Mo., as part of an effort to make him competent to stand trial on charges related to the Jan. 8 shooting rampage.
Loughner, 23—wearing a white T-shirt and khaki pants, and sporting short brown hair—sat shackled at the defense table with a blank look on his face throughout most of the federal court hearing in Tucson last Wednesday, Sept. 28.
His somber appearance was a stark change from his earlier court appearances, when he often sat with a broad smile. During his last appearance, in May, Loughner disrupted the courtroom with an incoherent outburst that led to him being removed from the courtroom.
U.S. District Court Judge Larry A. Burns had ordered the hearing to determine whether further treatment would get Loughner to the point where he could assist in his defense against the 49 counts he is facing in federal court stemming from the shooting spree. Six people were killed, including federal Judge John Roll and 9-year-old Christina-Taylor Green; 13 others were wounded, including Rep. Gabrielle Giffords, who is still recovering from being shot through the head.
Loughner can't face trial unless he is competent to assist in his defense against the charges; the current proceedings are separate from a possible insanity defense at trial.
After a 7 1/2 hearing, Burns ruled in favor of prosecutors, who had requested that Loughner continue to receive treatment—but he shortened their request for eight months of treatment to just four months.
"The court finds that measurable progress toward restoration has been made," Burns said.
Burns said he was relying on the likelihood of a "substantial probability" that they would be able to get Loughner to a point where he could understand the charges against him and assist in his own defense.
Burns noted that Loughner's smirk was gone, and he seemed to be paying attention to the proceedings.
"He appears to be more connected," Burns said.
After Burns' ruling, Loughner's legal team, led by attorney Judy Clarke, filed an emergency motion to block Loughner's transfer back to the Missouri facility, claiming that Burns had failed to consider whether the side effects of Loughner's treatment would interfere with his ability to assist attorneys in his defense, and that Burns had failed to properly link the four-month extension to a specific treatment plan or the amount of time it will take to restore Loughner to competency.
Burns rejected that motion on Monday, Oct. 3, writing that the defense motion was "quibbling with the language the court used to justify its decision. This approach, in the court's view, elevates semantics over substance and ignores the import of the medical opinion testimony that was presented, which the court found was corroborated by its own observations of the defendant during the lengthy and, at times, tedious hearing."
Much of the testimony in that lengthy hearing came from Dr. Christina Pietz, a psychologist who has been treating Loughner for undifferentiated schizophrenia. Her testimony provided a window into Loughner's life since Jan. 8.
Pietz said that when Loughner first arrived at the prison hospital, he was reluctant to get out of bed or converse and often rambled incoherently—a sign of schizophrenia she described as "word salad" or "poverty of speech."
He suffered from auditory and visual hallucinations, rarely established eye contact and expressed a severe distrust of his attorneys, saying that he believed they were out to blackmail or extort money from him. On one occasion, he spat at a member of his legal team.
Loughner speaks to Pietz and other prison staff members through bars in a window into his cell, which includes a bed, shower, bathroom and recreation area. He meets with Pietz almost daily; their sessions can be just a few minutes or up to an hour, depending on Loughner's level of engagement.
Pietz said Loughner was "devastated" when she told him he suffered from mental illness.
"He didn't want to be mentally ill," she said.
After the prison staff started medicating him against his will on June 21, Pietz said, she saw some slight changes in Loughner's mood, but "nothing significant."
After a federal appeals court ordered the prison staff to stop the treatment on July 1, Pietz said, Loughner became "much worse." He would sob uncontrollably and pace in his cell for hours on end. He developed a blister on his foot that became infected; the infection spread up his leg before he'd allow the prison staff to treat it.
At one point, he went 50 hours without sleeping. He began to exhibit poor hygiene, refusing to dress himself, penetrating his anus with a finger or a spork and smearing feces on his bed and clothes.
Loughner's breakdown grew so severe that prison staff concluded he posed a danger to himself or others, and began forcibly medicating him again with a cocktail of anti-psychotic and anti-depressive drugs. Pietz said that Loughner was "passively cooperative" about taking the medication; although he objected to needing to take it, he would still swallow it each day.
Pietz said the medication has improved Loughner's mental state. He now converses with his doctors and is allowed to have a television in his cell to provide him with stimulation. When prison officials provided him with a television before he was being medicated, he asked that it be removed, because he said he was receiving messages from it.
"He's not where he should be ... but there's certainly improvement," Pietz said.
For example, Loughner now understands that Giffords survived.
"He's less-obsessed with that," Pietz said. "He understands that he murdered people, and he talks about that. He talks about how remorseful he is."
On cross-examination by Clarke, Pietz said that she thought the fact that Loughner now trusted his legal team was a sign his mental state was improving.
"The mere fact that he visits with you indicates that's improved," Pietz said. "Previously, when he was unwilling to go visit with you, it was because he was paranoid."
A second psychiatrist, Dr. James Ballenger, testified that Loughner is developing the ability to converse with others and demonstrate a concern for his appearance.
"His humanity is coming back," Ballenger said. "One of the saddest things about this disease is that it robs you of your humanity."