This is an archived article that was published on sltrib.com in 2010, and information in the article may be outdated.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 by Elizabeth Smart and Wanda Barzee, visit http://www.sltrib.com/topics/mitchell.

A psychiatrist continued his testimony in the Brian David Mitchell case a day after the defendant suffered an apparent seizure in the courtroom.

Mitchell sang Christmas songs again and was again removed from the courtroom.

Paul Whitehead, a forensic psychiatrist who had interviewed Mitchell during his time at the Utah State Hospital, said he believed during the time he was monitoring Mitchell that he was mentally ill.

"I thought he had a major psychiatric illness that I thought was described by delusional disorder," Whitehead said, but added that he believes it is difficult to diagnose a personality disorder while a delusional disorder is ongoing. Whitehead said he thought he would have been able to get to the root of the problem if he would have been able to medicate Mitchell.

"In my experience, once you remove the overshadowing the effects of the psychological illness, you get to see what is really happening," he said.

He said in his 13 years this was the first time he was unable to medicate a patient who he felt should have been medicated to figure out more about him.

"We really never did the treatment I thought he needed," Whitehead said. "This is really the first time I thought this situation has happened."

Whitehead said his conclusion was that Mitchell suffered from a major delusional disorder which may have also been coupled with schizophrenia.

"I think it is important to note that diagnosis is not an event, it is a process and can be modified over time," he said.

Delusional disorder is different from schizophrenia because it is based on one thing: having a delusion. Those with grandiose delusions often preach on the streets or join religious cults, Whitehead said. However, people with delusional disorders also can encapsulate their delusions, meaning they appear quite normal except when discussing their delusions. They do not have the same personality issues as a schizophrenic.

After reading police reports and Wanda Barzee's journals, Whitehead concluded that manipulation was not the overarching reasoning behind Mitchell's behaviors. He pointed to the fact that Mitchell's first felony-level sexual offense didn't happen until his 40s, which is when the onset of delusional disorder occurs. He also said Mitchell's family shows a strong family history of delusional disorder.

Whitehead said Mitchell and Barzee's relationship was "toxic" and Barzee's journals "details a gathering storm."

He pointed to the couple's travel to Philadelphia, New York and Boston to play organ concerts to empty halls and the danger they put themselves in while there.

"They put themselves in strange situations out of this ostensible obedience to god," he said.

He also talked about several of the visions Barzee wrote about, from seeing herself being replaced by another woman to seeing three women in cloaks living in the mountains.

"I took this to be Ms. Barzee pouring gas on Mr. Mitchell's delusions," Whitehead said.

He also said that one of Mitchell's clear motivations in his sexual abuse was reproduction. He said Smart was chastised about not wanting to have kids and was told she would be reunited with her family in 10 years with a 10-year-old child.

"Mr. Mitchell was talking with Ms. Smart about having babies. I think at that point Ms. Smart had picked out a name," Whitehead said.

Smart, sitting in the audience, shot Whitehead a sharp look and then stormed out of the courtroom. He apologized for the strong nature of his testimony, but continued, saying that most sex abuse was about power, control or sex and not reproduction.

"Sorry," Whitehead said after Smart left. "Some of this stuff is graphic."

She later returned with her parents after a court break. Her eyes were red, and she appeared to have been crying. She still appeared upset.

Whitehead did not say where that information came from, though he had complete access to documents in the case as well as other interviews.

He estimated he had about 32 hours of face-to-face interview time in the 3 years and 2 months Mitchell was in the hospital. He also spoke with law enforcement officers, Mitchell's parents Shirl and Irene, and evaluators who were involved in competency hearing, and other family members.

"I assiduously read the charts and called in staff over anything that was controversial and wanted to make sure they were calling it the way it was," he said. "As you can imagine, everyone had an opinion on Mr. Mitchell. When I felt something was particularly charged, I'd make sure it was correct."

Mitchell never seemed interested in what was written in his charts or what the staff's opinion of him was, Whitehead said.

Whitehead said while many have found Mitchell manipulative and crafty he would quickly disagree with those perceptions.

"I know he seems to be a master manipulator, but I was just not seeing that in reading the police reports," Whitehead said.

Mitchell's alibis were weak, and he "wasn't all that sophisticated," Whitehead said. He said Mitchell only had limited arsenal of religion and a different name and where Elizabeth Smart came from as his alibis.

While testifying, Whitehead explained why he thought Mitchell's plan of attack wasn't very calculated or impressive as many may think. He said many of Mitchell's plans were more strange and "fairly low-risk," and not consistent with what a "good psychopath" would do.

In reading the book of Immanuel David Isaiah written by Mitchell, Whitehead said delusion became more apparent over time rather than all at once. He said Mitchell had the attitude that there was no accident, that every coincidence had a meaning.

"In my reading of the journal, this didn't happen overnight, it was something that was incremental," Whitehead said.

During testimony, Whitehead also said typically a psychopath will have many follow him, however, he wasn't aware of anyone other than Elizabeth Smart, or Wanda Barzee, who were "impaired" at the time who willfully followed Mitchell.

"To my knowledge there is no one out there claiming him as their own," Whitehead said. "It doesn't appear in his own family that anyone is on board, or has been with his beliefs."

Whitehead said people like the ones who followed the Heaven's Gate Cult bought off on some pretty strange things, however, he said, "I didn't see Mr. Mitchell was able to do that."

Whitehead also went on to testify that the tactics Mitchell used weren't high-risk and that there were many "red-flag nuances that moved toward the diagnosis of delusional disorder."

Mitchell was not a good psychopath, according to a Whitehead who said a good one "might have not confessed to what would be a felony crime," referring to when police found Mitchell passed out in a church house in San Diego. He also said Barzee was angry with Mitchell many times and normally someone angry would present a high-risk to someone trying to get away with something, because they might tell police. Whitehead added that while Barzee had vulnerabilities, she was by no means not able to hold her own.

"I didn't think she was a push over though," Whitehead said, noting a time in Miami when Barzee refused a revelation from Mitchell about playing six recitals in seven cities.

He also said Mitchell exhibited a lot of attention by wearing robes and not having identification on him. He said tactics like that would draw more attention, rather than blending in with the general public.

Whitehead said he was very surprised while reading through police reports of what people viewed Mitchell as. Everyone from Wal-Mart door greeters to fast food workers described Mitchell's appearance to police as if he was part of a terrorist organization. One woman who took video of Mitchell with Barzee and Smart even nicknamed him "Osama Bin Dairy Queen."

Whitehead said a true psychopath would have a good read on what others had to say about him, however he thinks Mitchell "does not seem to be seeing this ... he seems to be oblivious to what everyone else is saying."

But he also said, "apparently he can talk himself out of a jam."

Whitehead continued to point to examples of times that Mitchell failed at manipulating someone.

In San Diego, Mitchell encountered a group of hikers, and within an hour, one woman did not believe Mitchell's story. She ended up calling police and asking a friend to do an Internet search for missing children.

"Mr. Mitchell was not able to put up a smokescreen and lie his way out of it," Whitehead said.

He also said Mitchell was a one or two on a manipulation scale of zero to 10. Mitchell attempted to get the two highest-ranked people in the hospital to let him out, which is not what a manipulator would do, Whitehead said. Instead, he should have picked the "weakest link" at the hospital.

Mitchell did strike up a relationship with the staff dietitian, but she said Mitchell would talk about the Garden of Eden and gorillas and lions living off grass alone.

At one point during Mitchell's three years and two months in the state mental hospital, Mitchell and another patient who came from the prison struck up a close relationship. Mitchell looked at the man as a prophet, and Mitchell changed his appearance and teachings to better match this man's beliefs.

"We see this fairly often. Even though these delusional guys are entrenched in their belief system, they are fairly naive with other people," Whitehead said. "And that's what we saw with this peer."

Defense attorney Parker Douglas asked Whitehead whether he instructed his staff to selectively document Mitchell's behavior.

"That's baffling to me," Douglas said. "The staff were instructed to keep the charting professional and keep it to the facts."

Whitehead also told Douglas he has received no reimbursement for testifying.

During cross-examination, prosecutor Alicia Cook asked Whitehead to talk specifically about what kind of delusional beliefs Mitchell had.

"That he was a messenger or prophet between God and mankind," Whitehead said,describing his main delusional ideas that included waking up society "from a state of apostasy and facilitate a new stake of Zion."

Cook asked if there was anything else that was a delusional idea, and she said when she said the word "ideas," which Whitehead called them, she meant "beliefs."

"We have a difference of opinion on these things, is that fair?"

"We didn't used to," Whitehead responded, but added that the statement was fair.

Whitehead said he believes that Mitchell did more acting than talking.

"I think Mr. Mitchell is more of an action guy and would test his beliefs through action," he said.

Cook asked Whitehead if Mitchell ever used the word revelation when explaining his beliefs.

"I think revelation is our word [those at the mental hospital,] I can say with some sureity he never came out and said those words," he said.

After about eight months at the hospital, Whitehead said he felt Mitchell should take anti-psychotic medication. "When he first got there I didn't think he needed it," he said.

While around half of Whitehead's patients do "forced," or involuntary medication, while at the hospital, Mitchell never was medicated.

Whitehead said he spent some time thinking about how a similar diagnosis was made by doctors back in 1951 for Mitchell's grandfather Franklin Mitchell.

He said the doctors that talked about Franklin Mitchell's condition had the same type of conversations as Whitehead and his colleagues were currently having, and how Mitchell and his grandfather were around the same age when diagnosed and both seemed to have delusional disorder.

Cook asked Whitehead to talk about a pre-admission assessment that was done on Aug. 11, 2005, when Mitchell was once again admitted to the state mental hospital. Whitehead said at that time Mitchell was "more cooperative than I thought he was going to be." However, he mentioned there were some things Mitchell was not cooperative with.

Whitehead said there were certain things Mitchell was willing to submit to and do during the assessment, and other things he was not. Mitchell was also said to remember the names of staff and patients who had been there two years earlier when he was in the hospital in 2003.

Mitchell was observed to sit calmly in his chair, and did not "appear overly suspicious or paranoid," Whitehead said, noting that when coming into the hospital "he didn't look startled or panicked, which a suspicious person would look like."

Mitchell also made requests to the staff for exercise shoes and also dental work that needed to be completed.

He had also gained six pounds since coming to the hospital.

During the mental health exam, which is initially done to get a benchmark of the patients cognitive thought process and background, Whitehead said Mitchell "seemed to be intelligent," compared with the average range of people who were admitted to the hospital. When questioned, he would give lengthy, one-sided, 20-minute answers and would not engage with Whitehead. He also denied ever being neglected or sexually abused as a child, when questioned.

Cook said Mitchell had abilities to recognize delusion in other patients at the hospital and he even remembered staff names from the hospital and even where certain snacks were stored from his stay two years earlier.

Whitehead agreed with the statement, but also added that most patients coming back to the hospital remember staff and the unit they were at.

"He is not a confused, babbling individual that sits in the corner," he said.

Cook asked Whitehead if there were certain questions he was not able to get Mitchell to answer.

"Yeah, I didn't try that hard, but that was some of the difficulty," Whitehead said.

For the entire three year period Mitchell refused any psychological testing. There was only one day when Mitchell met with a psychologist at the beginning and never had any more testing for the remainder of his stay at the hospital.

"I would never say 100 percent that Mr. Mitchell would have a delusional disorder, though the majority of information would show that," he said.

Mitchell often refused to speak with therapists and others on his treatment team, though one such time he still reported being threatened by a fellow patient.

Mitchell never graduated from the lowest privilege level at the mental hospital because he refused to participate, including refusing to go outside to the courtyard.

Whitehead also told the prosecution that Mitchell was only moderately convicted to his beliefs, and that he even changed his Book of Immanuel David Isaiah after meeting with a transfer patient from the prison who espoused religious beliefs. However, Whitehead said he thought the behavior would worsen if Mitchell were not in the controlled environment of the hospital.

Whitehead confirmed to prosecutor Cook there was no way to differentiate between extreme religious beliefs and delusion, and that if Mitchell had extreme religious beliefs, he was not mentally ill.

"If someone were to commit terrorist acts on behalf of an organization, that's not a mental illness," Whitehead said.

Whitehead said when the prison-transfer patient came to the hospital, Mitchell became his "handservant" and radically changed his appearance by cutting his beard and hair and dressing in Oxford shirts, sweaters and khakis. For the first time, Mitchell also started asking to see his family members.

"It actually gave us hope that we could do something to change his thinking, but with the prison-transfer patient, it was not toward the direction of health," Whitehead said.

Mitchell and the other patient bonded on more than just religious beliefs: the prison-transfer patient was incarcerated for rape of a child.

Cook homed in on the contradictory behavior of Mitchell while he was in the mental hospital.

In one instance, he refused to fill out paperwork to have a window cleaned, saying he'd wait 10,000 years rather than fill out the paperwork, but then he'd go through the paperwork process to check out books from the library.

He also initially said television was against his religious beliefs, but then he was regularly watching television and movies, including "Charmed," "What About Bob," "Ella Enchanted," "A Beautiful Mind" and "50 First Dates."

Mitchell also wouldn't participate in therapy groups, but was part of more informal activities, including singing karaoke to John Denver songs.

In the Book of Immanuel David Isaiah, it says never to turn to medical treatments, but rather turn to one another and herbs, fruits and gentle foods. However, Mitchell took Tylenol, Miralax and a medication to treat wax buildup in his ears. He also saw the dentist about eight times, accepting Lidocaine. He also "deviated" from his strict dietary rules, Whitehead said.

Cook also asked how much time Mitchell spent preaching or focusing on religion. Whitehead said it was maybe three hours a day, but he made time for other, non-religious activities.

Mitchell's defense team has said that the street preacher sings in court because it he is stressed out over the trial. However, Whitehead confirmed that Mitchell told him he was under great stress at the hospital, with staff watching all of his behavior and prohibiting him from doing certain activities.

"That never erupted into anything big, yelling and all that stuff," Whitehead said.

Whitehead also testified that Mitchell did not show a lot of signs of something called "referential thinking," meaning putting great significance in coincidence.

At one point at the hospital, a tent pole was caught in a wind and struck Mitchell in the face during a barbecue. His response was, "Maybe God is punishing me," but he had few moments of attributing good or bad things happening to him to the will of God, Whitehead testified.

Cook asked Whitehead if he saw any kind of "significant clinical change" with Mitchell.

Whitehead said Mitchell began to be cooperative at the beginning, however worsened over time.

"He was flexible. He let us take his blood and then he got more entrenched, I think, over time," Whitehead said.

Whitehead said Mitchell became more animated when talking about religious business.

Cook asked Whitehead to describe what caused or triggered Mitchell to become more animated.

"When you talk about the delusion, they [people who are delusional] get fired up about it," Whitehead said.

"We don't know what triggers it, but when the topic of religion was brought up he would change."

There was a conversation Whitehead had with Mitchell about another patient who might have been a threat to Mitchell.

Whitehead said he asked Mitchell if he was concerned or threatened by the patient. Mitchell said the patient was being "volatile and delusional" and would avoid him until he settled down. Cook asked Whitehead if Mitchell seemed well-grounded and understanding and aware of this patient.

"He was experiencing some pretty crazy behavior and identified it as such," Whitehead said.

Even though Mitchell lost weight before leaving the hospital, Cook asked Whitehead if this lower weight was a choice for Mitchell.

"He preferred to be around 130 pounds," Whitehead said, and added that Mitchell would tell him that if others obeyed God's laws they could live to be 900 years old.

Whitehead said he described Mitchell as naive and inept at times.

Between evaluating Mitchell and Barzee, Whitehead said he would describe Mitchell as someone who didn't have as many talents as his wife.

"I think in a lot of respects she [Barzee] had a lot going for her and of the two, she was the more talented," Whitehead said.

Whitehead said he thought it was "unusual" for someone to change from a successful way of not getting caught doing illegal activity to do something more high risk, like what Mitchell seemed to do.

"A sex offender is looking for a vulnerable person," Whitehead said.

Cook asked Whitehead if what Mitchell did goes beyond molesting a child.

"Yes. That is extreme, very disturbing behavior," Whitehead said.

Cook also asked Whitehead if what Mitchell was doing were not delusions, but rather self justifications.

"I think that is a difficult question to answer, it is not the usual self-justifications we see, which tend to be different ways of explaining his behavior. Believe it or not, he has a rationalization for that [why he does what he does]." Whitehead referred to when Mitchell would say he needed to bring himself below all things by consuming alcohol after going dry for seven years.

"I don't know if I can say it was complete self-justification," Whitehead said.

Cook focused again on Mitchell's motivation for child sex abuse in order to procreate. She repeated testimony from Elizabeth Smart, when she told Mitchell she had not yet started her period, but he raped her anyway. He also forced her to have oral sex, which Whitehead confirmed had no reproductive value. When Smart did start her period, Mitchell still raped her, but would ejaculate into Barzee.

Whithead simply acknowledged that was Smart's testimony.

Cook also pointed out that Whitehead had spent no time with Mitchell during the time he held Smart captive, while Smart and Barzee spent the vast majority of the 6,480 hours with him.

On re-cross examination, defense attorney Parker Douglas also focused on the rapes, having Whitehead confirm that ejaculating into Barzee for the reason of having children to populate Zion despite her hysterectomy and age was a religious delusion.

Whitehead also cited several instances that staff documented Mitchell preaching to uninterested patients about his religious beliefs.

However, Whitehead has only worked with six people who have been diagnosed with the rarely appearing delusional disorder. Along the Wasatch Front, only between 500 and 2,000 people would be deemed delusional. He said it would be difficult to know whether a delusional person could identify other patients' delusions as Mitchell did.

However, he said he was worked with patients under religious delusion who had pulled out their own eyes or castrated themselves because of their interpretation of the Bible. —

Competency findings stipulated

Judge Dale Kimball then read a stipulation to the jury regarding Mitchell's previous competency hearings.

Jurors were told that after Mitchell was arrested in 2003, the state of Utah charged him with several crimes. In 2005, he was ordered incompetent and sent to the Utah State Hospital, where he refused treatment. In 2008, the federal government charged him. Then in 2009, the federal court system found him competent for trial.

Kimball told jurors they are responsible to find if he has a mental disease or defect and, if so, because of that was unable to determine if his actions were wrong.