TUCSON, Ariz. -- Court proceedings Tuesday shed new light on how Tucson gunman Jared Loughner made what the judge called "measurable progress" with his mental state.
The 23-year-old is still "severely mentally ill," according to forensic psychologist Dr. Christina Pietz, but he is competent enough to understand the charges against him, weigh his options and decide to plead guilty.
Pietz has been treating Loughner for more than a year at a prison psychiatric ward in Springfield, Mo., and was the only person to testify in court at his competency hearing Tuesday.
Loughner developed normally until the age of 16, Pietz told the court. She believes his initial depression was prompted by a breakup with a girlfriend and the death of his grandfather. After showing up drunk at high school during his junior year, Loughner was evaluated and diagnosed with depression, but he never took the prescribed medication.
Loughner finished his senior year at an alternative school. Friends began describing him as "odd, eccentric and with a disorganized thought process," according to Pietz. She also said Loughner's condition worsened and he developed signs of schizophrenia, one day asking his parents if "they heard the voices, too?" Still, he went untreated.
Loughner enrolled in classes at Pima Community College where he was known to yell in class, and write incoherent babble on the chalkboard. Parents and friends, at this point, feared Loughner would commit suicide, according to Pietz, but no steps were taken to improve his mental health.
Loughner never showed signs of violence in college or threatened any friends, according to Pietz, but his acquaintances became fearful of him. "He was ostracized. His friends didn't understand his behavior and alienated him," Pietz said.
Shortly after Loughner dropped out of Pima Community College, he began making videos. Pietz said in one video Loughner said he wanted to kill himself. In another, he said he wanted to assassinate someone. That video was made a few months before Loughner set out to kill Congresswoman Gabrielle Giffords on Jan. 8, 2011.
In the months following the shooting and Loughner's arrest, Pietz said she would often find Loughner pacing, upset and crying. He initially refused medication, but later agreed to take pills.
Once on the medication, Loughner began making comments about his attack.
"He suggested he was remorseful for what he did," Pietz told the court. "He told me he wanted to be executed." Loughner made those statements in July 2011.
Loughner made special mention of the youngest victim of his attack, 9-year-old Christina Taylor Green, who went to meet Giffords at her "Congress on Your Corner" event.
"I especially cry about the child," Loughner told Pietz and began sobbing.
Pietz took this as a sign.
"He was becoming human and felt badly," she said.
Still, Loughner remained delusional, insisting he killed Giffords. Even after he was shown security video from the Safeway store of the attack, he said it was a fake.
"He believed Ms. Giffords was deceased and that he'd killed her," Pietz told the judge. "He said, 'There's no way anyone could have survived that shot to the head.'"
Months of therapy followed. Loughner, who'd been kept completely separate from all other inmates at the psychiatric hospital, was allowed in an outdoor recreation program. He was still segregated, but doctors believe his minimal interaction with others helped his mental state.
Late in the summer of 2011, Loughner was put in a group of four, where members are allowed to discuss any life issues. Loughner told the others about his crime.
In November 2011, Loughner added recreational therapy, including art and games, again with a small group. They also learned about court, the role of a judge and jury, and how a defense strategy works. Doctors say these activities helped bring him to mental competency.
This spring, Loughner began working in the prison. He makes "towel rolls," which consist of a towel, shirt and underwear, which are given to inmates after they shower. He also stamps return addresses on envelopes.
"He loves his jobs," Pietz said, "and he's disappointed when he doesn't get to work.
As his mental state improved, Loughner started believing on a more consistent basis that Giffords survived the shooting. While he has shown remorse over the shootings, Loughner is also depressed about them.
"He's disappointed," Pietz said. "It's another failure in his life. He set out to do this and failed. He'll say, 'Jared is a failure.'"
By April 26, 2012, Pietz reached the conclusion that Loughner was mentally competent to stand trial. She notes: his obsessive behavior has improved, he no longer paces, and he can sit and have a conversation.
In addition, Loughner never speaks of "voices" coming out of the television in his cell, which would be a sign of schizophrenia. He is no longer restrained when he meets with his defense team and has been able to talk about his options in court. He talks more about regret.
"He said, 'I wish I didn't have those thoughts. I hurt people. I hurt my mom and dad. Don't do the crime if you can't do the time,'" Pietz recalled.
Loughner is also reportedly concerned about his behavior in prison.
"He's concerned about doing the right thing and not getting in trouble in the prison system," Pietz said.
Loughner remains on suicide watch.
"He told me one day, 'I'm 23. This is it. This is my life,'" Pietz said. "He understands he'll never get out, and that's depressing to him."
Pietz ranks Loughner as "one of the worst" cases of mental illness she has dealt with.
"He has a chronic mental illness, a severe mental illness," she said and voiced concern as to whether his mental state could remain steady through a lengthy trial.
"There's no guarantee," the doctor told the judge, who agreed Loughner's mental state, at this point, is competent.