This is an archived article that was published on sltrib.com in 2010, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
For past coverage of the trial, including transcripts of testimony from Elizabeth Smart and Wanda Barzee, visit http://www.sltrib.com/topics/mitchell.
Noel Gardner, an adult psychiatrist who runs the South Valley Mental Health, is the only witness scheduled by the prosecution to testify Tuesday in the Brian David Mitchell case.
Gardner — a psychiatrist with an extensive religious background in the Seventh Day Adventist religion — spent 30 minutes detailing his education and career background.
After Judge Judith Atherton of the state's 3rd District Court ordered Gardner to evaluate Mitchell in 2003, Gardner diagnosed him with a narcissistic personality disorder and said he was competent.
On Tuesday, Gardner began by discussing the differences between personality disorders and severe mental illness. He said those who suffer from personality disorders, which are not deemed a mental illness, are capable of understanding their world and its consequences.
He said that a tiny fraction, about three in 10,000, have a delusional disorder, which is what psychiatrist witnesses for the prosecution have diagnosed Mitchell with.
Prosecutor Diana Hagen asked Gardner whether he thought Mitchell had a severe mental illness.
"He does not meet that criteria," Gardner said.
Gardner said in 2003, he viewed all the documents related to Mitchell and Wanda Barzee, including the Book of Immanuel David Isaiah and Barzee's journal. He said he also was able to view video of the interrogation Mitchell had with investigators in Sandy in 2003. After reviewing these materials, Gardner said he was given an opportunity to interview Mitchell, but it didn't go as he had planned.
"I attempted to interview the defendant," Gardner said.
He said Mitchell was brought into the room in shackles, whereafter Gardner said he "attempted to engage him," but realized after 15 to 20 minutes that it wasn't going anywhere.
"He immediately sat down and deeply stared into my eyes and said not a word ... it was an incredibly intimidating stare," Gardner said, adding that there was "absolutely no response, [just] intense deep staring into my eyes."
Gardner said he attempted to write down everything Mitchell was wearing and everything he was doing if he wasn't going to talk. For a short portion of time, Gardner said he tried to stare back at Mitchell, but that quickly ended.
"It was clear I was no match for this guy," Gardner said.
While the staring match was uncomfortable for the doctor, he said what he discovered was "diagnostically useful," because it helped him understand what Mitchell wasn't. He wasn't schizophrenic, he said.
"It is completely outside the experience with a schizophrenic," Gardner said of Mitchell's consistent, intimidating staring.
From 2003 to the present time, Gardner said he has read every bit of material related to the case that authorities have in their possession, including law enforcement documents from San Diego, Sandy, interviews with family members, mental health evaluations done in the 1970s and even many of the religious books Mitchell read and referred to in his book.
In diagnosing Mitchell, Gardner relied on the "Three D's" — whether Mitchell had delusional, devout or delinquent ideas. Gardner said he had to decipher if Mitchell was just being a devout religious extremist, or if he had a personality disorder, or if neither of those applied.
Hagen asked Gardner if the two diagnoses given earlier in testimony by other psychiatrists were at all related.
"Both have delusions ... that are held with great intensity," Gardner said, adding there are many similarities.
The official definition of delusion in the Diagnostic Statistical Manual, used by mental health experts, is explained as a false belief based on a reality, despite what constitutes obvious proof to the contrary.
Gardner said delusions are fixed false beliefs, but are something that could conceivably occur in the real world. Gardner said what Mitchell has is not a delusion, but an overvalued idea. The difference between the two is that an overvalued idea is not as tightly held as is a fixed belief in a delusion.
He gave an example of Mitchell's father, Shirl Mitchell, who could put aside his overvalued ideas while writing his own book about the "Infant God or Goddess" and go back to attending to his family and regular duties. Gardner said Brian David Mitchell also held onto certain ideas, like his father, which many would eventually let go of.
Gardner said Mitchell's ideas of religion and health and wellness were "overvalued ideas," but they "are not delusions and not psychotic."
After a half-hour break, Gardner quickened the pace of his testimony, shortening answers and using less technical terms. During his earlier testimony, at least one juror had nodded off and the jury seemed restless.
Gardner testified that if Mitchell were delusional, he would not have been able to hide away his religious beliefs when it served him.
Instead, Gardner said Mitchell had several personas he would present in different situations.
He listed "The Intimidator" used to kidnap Elizabeth Smart and to push away prying eyes when confronted in both Utah and San Diego. He also named the "Humble Penitent" persona, which Mitchell used when ministering to the poor and when he was testifying in San Diego, apologizing for breaking into an LDS Church. That persona is also evident in Mitchell's song selection during court, which includes many LDS hymns that are sung in preparation for the sacrament.
The "Clever Magician" was another persona Gardner described when Mitchell would "wear Middle Eastern robes and use archaic language to give the appearance of religious devotion or to distract people from what's going on."
Another persona was that of the "Religious Chameleon," which could be seen when Mitchell pretended to one family that he had no knowledge of the LDS Church, or would be deeply interested in the teachings of the Seventh Day Adventist he met.
Gardner also detailed what he calls Mitchell's "Sadist" persona, which he broke down into three subpersonas: the Humilator Sadist, the Torturing Sadist and the Religious Sadist.
The Humiliator Sadist, Gardner testified, could be seen when Mitchell made Smart walk around the camp naked while shackled or when he would force her to drink, smoke or view pornography. It was also evident when he would force her to participate in oral sex and watch Mitchell and his wife, Wanda Barzee, engage in sexual intercourse.
The Torturing Sadist was evident when Mitchell threatened to kill Smart and her family, or forced her to burn her pajamas and other links to her life at home. It was also shown earlier in his life, when Mitchell would place dead mice in the oven to torment his wife or when he found it humorous that his stepdaughter was tricked into eating her pet rabbit.
The Religious Sadist, Gardner said, manifested itself at times when he would pervert traditional religious practices. For Smart, that meant making her drink wine as part of the sacrament, something not practiced in the LDS Church, or citing the Melchezidek priesthood as giving him power to marry and then rape her. He also would show pornography to his stepdaughter during family prayer.
"It is simply impossible, in my opinion, for a person with a severe mental defect to do this range of very clever, very successful, very situationally attuned presentations in ways that are consistently self-serving."
Hagen asked Gardner to talk about individual diagnoses that were made by other doctors.
"Did you take culture and sub-culture that Brian David Mitchell was involved in into account?" Hagen asked.
"I did," Gardner said.
He said if the doctors making a diagnosis weren't able to understand the cultural differences between religious beliefs, then they may just couch something as a bizarre delusion. Gardner said as an example that most religious beliefs that reference a miracle would be seen as an obvious bizarre idea or illusion. He said such a misunderstanding of Mitchell's sub-culture could lead to a misdiagnosis.
"It would be very easy [to misdiagnose]," Gardner said.
Hagen had Gardner piece by piece rule out that delusion could have been a case for Mitchell. The only other possible mental illness to eliminate was schizophrenia.
There are five subsets in diagnosing criteria for schizophrenia: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (things that should be there that are missing, such as a person missing motivation or becoming withdrawn and not talking).
Gardner said two or more of the five symptoms of schizophrenia needed to be identified in a patient for proper diagnosis. The only exception where one symptom is acceptable is if the patient has a bizarre delusion or if they hear voices, neither of which Mitchell exhibited, Gardner said. He added that Dr. Richart DeMier made a conclusion based only on Mitchell having bizarre delusions, when in reality they were just cultural differences and extreme religious beliefs.
"When one has a religious fundamental view, then those religious ideas can be mistaken as being delusional if you don't understand how those ideas occur," Gardner said.
Hagen asked Gardner to describe how Mitchell formed his religious ideas. Gardner said Mitchell took information in the same way manner many people take in information. Mitchell grew up in the LDS environment, converted, then became active and took on leadership roles.
"He marinated his brain in these ideas," Gardner said.
Then as Mitchell moved away from mainstream LDS ideals, Gardner said, he became involved with fringe groups, but "he processed the information like every normal brain does."
Gardner said he noticed Mitchell would pull out or put away certain personas or religious ideals as they benefited him.
Mitchell showed ideas of reference that most people use, Gardner said, and that he either uses religious situations for his purpose, or he can decide to simply allow what is happening to have no particular impact on him.
"He does not have delusions and does not meet the criteria for either of these diagnoses," Gardner said, discounting previous doctors' diagnoses for Mitchell of paranoid schizophrenia or delusional disorder.
"He appeared on the surface to be very impaired, but he really has the capacity and the capability to do many things," Gardner said. "He has the ability to read situations extremely well," Gardner said adding that he may go about it in different ways than most people, but "he clearly has the ability."
Hagen had the court play a portion of a video-recorded interview with Mitchell while in an interrogation in Sandy with federal investigators.
After viewing the clip of Mitchell providing his name and date of birth and other routine information at the beginning of the interview, Hagen asked Gardner to describe what he saw in the video.
"I notice his body language," Gardner said. "He is very causal going back and forth."
He said Mitchell provides his own answers, but does respond to investigators in the way they would like.
"He clearly understands the question," Gardner said. "We know he is taking in the information." He added that if a person immediately said Mitchell is non-psychotic, then the rest of the video would be viewed in a completely different way.
Gardner said Mitchell uses religious language as an explanation for what he has done or as an attempt to change the course of the conversation. He said it would be simple to immediately also assume that Mitchell has a thought disorder. Gardner said Mitchell does what he does during the interview in order to deflect the conversation.
"It is either a justification or a derailment for the interviews so he doesn't have to be held responsible for what he has done," Gardner said, adding that Mitchell's tactics convey a very sophisticated style.
Hagen played another portion of the video interrogation where Mitchell becomes more defensive after the questioning becomes more intense and directed to Mitchell.
Gardner said in the second clip, a very obvious "bait and switch" being used by Mitchell after feeling attacked. His body language also adapted to the situation.
"There is a change ... it is dynamic," Gardner said. "If you watch the body language, it has changed. He attempts to switch the conversation."
The bait and switch Gardner was talking about referred to Mitchell's comments saying the FBI was being unfair to him. He said this tactic is used by somebody who was once in a powerful situation, and is trying to regain control by suddenly playing the victim.
"If you look at it, it seems off the wall, but it is a classic bait and switch," Gardner said.
Hagen asked, "Is this bait and switch something that psychotic people do?"
"Absolutely not," Gardner answered.
Another clip played from a court proceeding while Mitchell was in San Diego for breaking into a church. In the video Mitchell tells the judge that "for the first time in 22 years, I got drunk that night and that night was a nightmare ...that night was like Jonah getting swallowed by the whale." Mitchell told the judge in the video that he realized at that point he needed to turn his life around and do what God wants and that "nothing like that will happen again. I can assure you."
Gardner said the story Mitchell made up about what happened and how he and Barzee and Elizabeth were staying with friends was very believable, but it was false. He said Mitchell read the situation and reported himself to the judge is a very calm manner, while most people would be stressed in a courtroom.
"He is not overwhelmed by the stress of the situation," Gardner said, noting that Mitchell has the opportunity to stray from his religious ideas, but restrains his emotions.
"He has this social cognition," Gardner also said of Mitchell's calm demeanor while being charged with a crime. "That is not only good, but almost better than most people do [in that situation]."
Gardner wrapped up his questioning by the prosecution by saying that Mitchell suffered from antisocial personality disorder, narcissistic personality disorder and pedophelia, but none of those qualified as a severe mental illness that would prohibit Mitchell from understanding the consequences of his actions.
He testified that Mitchell did not inherit a mental illness from his grandfather or father because Mitchell's grandfather was misdiagnosed during a timeframe that hadn't even yet created medicine to treat schizophrenia. Even if Mitchell's grandfather had schizophrenia, Mitchell had only a 5 percent chance of inheriting the disease.
His father's odd behavior also was not a result of mental illness, Gardner said.
"They shared a common environment that fosters personality disorders," Gardner said.
Mitchell took on leadership positions in the LDS Church to increase his authority and power, and once he started living outside social norms, he "could exercise that authority with complete license," and would do so to get drugs, alcohol and sex.
Mitchell shows classic signs of antisocial personality disorder, Gardner said, including a failure to conform to social norms and abide laws, a reckless disregard for the safety of others, the decision to not maintain consistent work and a lack of remorse for victims.
He also shows several signs of narcissistic personality disorder, which includes a grandiose sense of self, has a sense of entitlement and has haughty or arrogant attitudes. Gardner said Mitchell has the most severe form of narcissism because other people suffer due to it.
Mitchell also has shown the symptoms of pedophelia, including being sexually aroused by prepubescent children and acting out on sexual fantasies involving children, Gardner said.
He said other mental health experts who have concluded Mitchell has a delusional disorder or schizophrenia likely have misdiagnosed Mitchell because they ignored some evidence and instead drew a conclusion and then subconsciously dismissed evidence that didn't fit with their diagnosis.
He said his is very confident in his diagnosis of personality disorders and sexual deviance rather than a severe mental illness.
"In all my cases I've been involved with, I'm most certain about this case because I've spent the most time and done the most meticulous work," Gardner said.
Parker Douglas began cross examination with Gardner by pausing for a moment and commenting that after a long day of testimony, it was difficult to figure out where to start first.
Douglas asked Gardner how he came to the conclusion that what Mitchell did showed he was not devout to his religious beliefs.
"If they really abuse it then they are not really devout," Gardner said.
Douglas asked Gardner to define what kind of conditions would promote a change to someone's thought process. Gardner said one condition that causes someone to change is if they feel an attack on their self and who they are. He said the narcissist is one that develops an explanation in order to make up for the inadequacies they see in themselves.
Gardner said under a "severe stressor" a person may develop a delusional disorder, but it is quite rare.
It appeared to become difficult for jurors to pay attention as the afternoon drew on, and Douglas attempted to accelerate the pace of the testimony.
"The lawyer in me was tempted to cut you off, but the student in me was happy for you," Douglas said after Gardner finished a very thorough clarification of how a delusional disorder can be developed after specific threats to the self.
The defense was trying to get Gardner to agree with the possibility that symptoms of narcissism and delusional disorders can overlap and be mistaken for one another and possibly be misdiagnosed.
"They could, and [do] overlap in some limited ways," Gardner said.
Douglas asked if Gardner was discounting other doctors diagnoses.
"I'm not criticizing Dr. DeMier," Gardner said, noting that he was just backing up what the requirements were in the mental health evaluation manual and they information in the manual is "quite clear."
Gardner said DeMier may have believed Mitchell had bizarre delusions, because he did not understand the fringe religious groups.
"I believe he looked at Mr. Mitchell's extreme religious ideas that they are expressions of religious ideas" from his past and he turns them on or turns off "whenever they are useful."
Douglas asked Gardner if he had the impression that Dr. Whitehead had a confirmation bias going into the process of diagnosing Mitchell. Gardner said he believed both Whitehead and DeMier diagnosed Mitchell with less information than he had. Gardner also said when someone is already treating a patient they have become biased toward them and seeing what they want.
"There is an inherent cognitive bias when treating a patient," Gardner said. "You become an advocate for the patient."
Gardner told the court he was an independent person involved in evaluating Mitchell, while Whitehead had already been interacting with Mitchell while he was at the state mental hospital.
"It is very obvious that there is a potential for a bias," Gardner said relating to Whitehead's diagnosis for Mitchell. He said because Whitehead was working as a training physician at the time conflicted with giving a non-biased expert opinion on Mitchell.
Gardner described Mitchell as taking control of the interrogation FBI investigators did in Sandy in 2003.
"This is what I would call the ultimate stress test," Gardner said, noting that Mitchell was very in control under stress and not visibly shaken like someone who was psychotic may be while being interrogated. "He was the matador driving the process and derailing it along the way." Gardner said.
There was so much evidence that showed Mitchell "didn't behave the way a psychotic would," Gardner said, "... and I didn't find any information to the contrary."
Sir Arthur Conan Doyle's Sherlock Holmes became a point of reference numerous times in the testimony as Gardner noted that the writings of Doyle was the most important thing he learned in medical school. He said Doyle's writings reminded him to gather all the evidence and make a conclusion with that. Gardner said there was a lot of information that DeMier didn't look through before interviewing Mitchell and possibly entered the interview less-prepared than he could have been.
Gardner said after reviewing all the documents up to that point, he saw a man that is behaving one way at a state mental hospital and then turned on another persona while in a federal mental hospital in Missouri.
To put delusional disorder in perspective, Gardner said, the illness occurs typically later in life and in only three people per 10,000, or roughly 300 people out of 1 million people have a serious psychotic disorder.
What Gardner said he finds particularly "extraordinary" is Mitchell's ability to find a way to panhandle so well that he was able to afford traveling "from Miami to Hawaii, and to do it without being picked up."
Gardner mentioned Mitchell displayed time and again that he made a choice to do what he did and it was a conscious decision.
"He had the choice to plunder and do all the panhandling that he did as opposed to getting a job," Gardner said.
Mitchell seemed to be a normal LDS member, Gardner said. He dressed to impress the Smart family into thinking he was trustworthy and upstanding so he could do work for them at their home in 2001. The way he appeared was one thing, "but he had already been excommunicated, but had the capacity to turn on what appeared to be [the persona of] a very normal guy," Gardner said.
Douglas asked if Gardner was pretending to know why Mitchell was using priesthood authority.
"I don't pretend to know," Gardner said. "He used it for a purpose that is completely inconsistent for the situation. It was clearly used to control a devout believer which he had under his control, which was his wife Wanda."