The Dark Knight was the most highly anticipated movie of the summer. Across the country, excited crowds gathered at theaters, securing their seat to enjoy the film's opening midnight screening.

Ten minutes into the movie in an Aurora, Colorado theater, a lone man entered an exit door which he had previously propped open. In a scene that many observers thought was part of the hype, this man threw a canister of tear gas into the theater, shot at the ceiling to get everyone's attention, then methodically and with purpose, opened fire into the terrified crowd. 

Minutes later, James Holmes, 24, was arrested in the theater parking lot without incident. He had a 12 gauge Remington shotgun, an AR-15 assault rifle and two Glock .40 handguns. Dressed all in black, he wore a ballistic helmet, gas mask, bullet proof vest, ballistic leggings, throat protectant, groin protector and ballistic gloves. While he was protected from head to toe, his victims unfortunately, were not.

His prey ranged from three months to 51 years of age. People were there to just see a movie, but in the end they were part of a living nightmare. 71 people were shot—12 dead and 59 injured, making it the largest mass shooting in U.S. history. At the time of this writing, the baby was released from the hospital. One little 6 year old girl was not so lucky.

In the aftermath of this tragedy, the question everyone wants an answer to is, WHY? Why would a seemingly 'normal', 24-year-old honors student open fire in a packed, sold out theater? What was his motive? Whatt—or whot—is to blame?

While it may take days and weeks for all the answers to emerge, I believe that Holmes was psychotic, and while it’s true that you can’t make that diagnosis based on news reports, here are some things to consider:

• Holmes dropped out of school a month earlier. He was on a highly coveted and competitive academic scholarship, yet towards the end of this first year he started having academic problems. Onset for schizophrenia is the late teens to early twenties and it can be a fairly sudden onset with a rapid decline in function.

• He was dressed like the Joker, even having his hair dyed red. His first words to the police reportedly being "I am the Joker", both are suggestive he was delusional.

• Holmes was mainly a loner, but even more so in the last few months. Friends in high school described him as shy and nerdy, but he did have friends. As the illness progressed, as is common, he gave up socializing, preferring to be alone.

• A neuroscience faculty member said when he heard of the shootings, he immediately thought of Holmes. He added that before dropping out, Holmes had become "very quiet, strangely quiet in class" and seemed "socially off."

• Holmes' mother, when she heard who was in custody, was not surprised either. She was quoted as saying, "you have the right person."

• A man by the name of James Holmes, with a picture matching the suspect complete with orange-  red dyed hair, posted a profile on AdultFriendFinder.com on July 5. At the top of the profile is the question, "Will you visit me in prison?"

• On June 25 Holmes emailed an application to join the Lead Valley Shooting Range, causing the owner, Glenn Rotkovich, to repeatedly call to invite him to a mandatory orientation meeting. He described Holmes' voice mail message as rambling and incoherent, "bizarre on a good day, freakish on others." He told his staff to ban him from the range.

A few myths to dispel: Those who claim a mentally ill person could not plot such an intricate plan the way Holmes did are simply wrong. A psychotic brain, especially early in the illness, can indeed fixate and obsess on a plan to perfection. Scary? You bet.

Likewise the fact that he was an honors student and therefore could not be psychotic is ridiculous. As Oscar Levant stated, "There's a fine line between genius and insanity." This appears to be a new onset psychosis. And, as the symptoms worsened, he was unable to continue with his studies. But before the illness, he could well have been of exceptional intelligence.

This tragedy appears eerily similar to the Jared Loughner case. In a blog, It's The Mental Illness, Stupid!, I made many of the same points that Loughner was psychotic—and he was indeed eventually found incompetent to stand trial. (For those of you that don’t recall, Loughner planned and carried out a similar shooting in Tucson, critically wounding Congresswoman Gabrielle Giffords and killing Chief U.S. District Court Judge John Roll and several others).

As an aside, the gun control advocates are once again politicizing a tragedy and screaming the way to prevent these types of shootings is to make private gun ownership illegal. Consider this: Anders Behring Breivik, the Norwegian shooter who murdered 67 people, accumulated his arsenal despite Norway's much stricter gun control laws.

So, how can we protect ourselves from a deranged, psychotic killer who has no motive and simply wants to go on a killing spree? Checkpoints on the roads? Metal detectors in all buildings? Random stops to check for weapons? Airport style security at every event? Armed guards in all public spaces? Be careful what you wish for. The price of a free society is the acceptance of a certain amount of risk—we can’t be protected from everything and still be free.

If there is one thing that can help prevent these types of tragedies it’s the early detection and treatment of mental illness. If anyone had taken the time to talk to Holmes, to note his change in behavior, to question his sudden withdrawal from both school and other people, it is quite possible this could have been prevented.

Actions like this are usually preceded by strong signals that all is not right, and unfortunately, these actions usually go unreported. They only come to light after the fact and then everyone is screaming why didn’t anyone do anything, it was so obvious? As always, hindsight is 20-20.

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