DENVER (CN) - Questions about Planned Parenthood shooter Robert Dear's mental competence arose at his hearing Wednesday, complicating the prosecution of the self-described "warrior for the babies" who killed three people and injured nine at a Colorado Springs clinic.
Dear allegedly muttered "no more baby parts" to an officer who arrested him after a six-hour standoff on Nov. 27, and he ranted in court Wednesday, calling himself a "warrior for the babies."
Dear was charged with 179 criminal counts Wednesday, including the first-degree murders of University of Colorado police Officer Garrett Swasey, Iraq war veteran Ke'Arre Marcell Stewart, and Jennifer Markovsky, a mother of two, and the attempted murders of nine people who were injured in the rampage.
The Justice Department is considering whether to add federal charges of terrorism, due to the apparent political motivation of the slaughter.
At the Wednesday hearing, Dear's public defender Dan King said he had "serious concerns," about Dear's mental health, and suggested he needed a psychological evaluation. King defended "Batman" movie mass murderer James Holmes at trial this year. Holmes was sentenced to life in prison without possibility of parole.
Dear on Wednesday said he would refuse to be evaluated. He also said, "I am guilty. There is no trial;" denied that King was his attorney; refused to accept the authority of the judge; and said that King, or the court, or someone, had "drugged" Holmes at his trial, and "that's what they want to do to me."
Dear's ex-wife Pamela Ross described him as a "family-oriented" man, but reporters have unearthed a number of Internet posts from him, including religious rants about the end of the world and a search for partners for sadomasochistic sex.
"Aids, hurricanes, we are in the end times," Dear posted in 2005. "Accept the LORD JESUS while you can."
Neighbors near Dear's dilapidated shack in North Carolina said they kept their distance, remembering him as a ranting survivalist and political polemicist.
Dr. Neil Gowensmith, director of the University of Denver's Forensic Institute for Research, Service & Training, said he expects Dear's prosecution will parallel that of Holmes, whose schizoaffective disorder helped him escape the death penalty - a punishment that remains a possibility for Dear.
"What I don't want to have happen is that people start to equate violence with mental illness," Gowensmith told Courthouse News.
"People with mental illness are routinely less violent than people without mental illness. I want to make sure that people aren't equating, 'Oh there's gun violence, therefore it must be a crazy person.' That's just not the case. It happens, but it's not the rule."
Gowensmith, a psychologist and professor at Denver University, said the court system and mental illness have had a complicated relationship.
"It's born out of a context where there's a lot of problems, a lot of challenges, a lot of stigma and misinformation about mental illness, and the unfortunate reality is that the criminal justice system is the largest mental health provider in the country," Gowensmith said.
According to The Treatment Advocacy Center, there are 10 times more mentally ill people in prison than in hospitals: an estimated 356,000 mentally ill people in American prisons in 2012. The Treatment Advocacy Center, founded in 1998, is a nonprofit devoted to getting care for the mentally ill.
"With that kind of backdrop, where things have not gone well, over the past few decades there are places where it is improving, slowly but surely," Gowensmith said. "Things hopefully will start to get better over time."
But in the case of Dear - whose anti-abortion rants draw a clear line to the place he chose for the murders - Gowensmith said medical and legal issues are cloudy.
"There's a big difference between clinical insanity, clinical mental illness and legal insanity," Gowensmith said.
"People were fairly unanimous in their opinion about Mr. Holmes, that he had a legitimate mental illness. The question was, did that rise to the level of the legal definition of insanity?
"Regardless of how you think the trial played out ... it was very clear to me that they did it the right way. They considered the impact of mental illness, they were very thorough, they looked at it from several different angles with lots of collateral information. That's what the Constitution and due process in the court system requires.
"That's what's going to have to happen here. They're going to have to figure out: Mr. Dear, does he have a mental illness? What are the symptoms of mental illness? How do those impact his behavior? Is that separate from his political agenda, or inextricably combined? And then they'll have to consider the insanity defense at that point."
Dear has yet to be psychologically evaluated. His next hearing, set for Dec. 23, is expected to address that issue, and his mental stability.
"It's very possible it could go either way, several ways," Gowensmith said. "Maybe he's not mentally ill and he's just purely motivated by some kind of political ideology and very voluntary in his behaviors. Maybe he does have a mental illness. Perhaps his symptoms of mental illness were so strong and so pervasive they overpowered his ability to reason from right or wrong.
"We don't know yet, but it's important for the court to spend as much time as necessary in answering that question correctly."
Prosecutors have not yet said whether they will seek the death penalty, though at his initial appearance, by video camera from jail on Nov. 30, El Paso County Chief Judge Gilbert Martinez said Dear could face the death penalty if convicted of first-degree murder.
Read the Top 8
Sign up for the Top 8, a roundup of the day's top stories delivered directly to your inbox Monday through Friday.