UPDATE, May 21, 2:01 p.m.: On Monday, Colorado Fourth Judicial District Chief Judge William Bain once again ruled Dear to be mentally incompetent for trial, according to the Colorado Springs Gazette. The judge based his decision on the latest report from Dear’s doctors, finding, according to the newspaper, that Dear “does not have a ‘rational’ understanding of the court process.”

Five days after Christmas in 1994, 22-year-old John Charles Salvi III put on black clothes and entered a Planned Parenthood clinic in Brookline, Massachusetts, carrying a duffel bag over his shoulder.

The day after Thanksgiving in 2015, 57-year-old Robert Lewis Dear Jr. put on a bulletproof vest he had made out of duct tape and silver coins and entered the parking lot of a Planned Parenthood clinic in Colorado Springs, Colorado.

Two people, two decades apart, both arrested for murder in the name of anti-choice ideology. But only one, thus far, was deemed mentally competent to be tried for his crimes.

Salvi, according to media reports and court records, asked 25-year-old receptionist Shannon Lowney if he was at a Planned Parenthood. She said yes, so he shot her dead with the semiautomatic rifle he had taken out of his duffel bag. He wounded more people, then got in his car and drove two miles to Preterm Health Services, another reproductive health clinic that provided abortions. Right before he killed her, Salvi asked 38-year-old receptionist Leanne Nichols if he was at Preterm. She said yes, and he said, “This is what you get! You should pray the rosary!” as he shot her repeatedly, according to witness testimony.

Dear had gotten lost on his way to Planned Parenthood, even though he had a road map. He told police he stopped at several places to ask for directions and eventually called the organization’s national hotline for the exact address of the Colorado Springs clinic. When he got there, he parked in the lot, took out his Soviet-style SKS semi-automatic rifles, and approached passengers getting out of a car. One of them would later tell police that Dear told them they shouldn’t have come today.

Dear has since been charged with shooting Samantha Wagner and her friend Jennifer Markovsky, wounding the former and killing the latter. Dear also admitted to fatally shooting police officer Garrett Swasey and Ke’Arre Stewart, who was outside the clinic calling his bank while his wife, a patient, was inside. Dear has been charged with injuring eight more people that day, in addition to Wagner. Dear also told police that he tried—but failed—to blow up propane tanks on Planned Parenthood’s property.

Salvi fled his crime scenes and cut his hair. He was arrested the next day while shooting up (this time not fatally) another abortion clinic in Norfolk, Virginia. Salvi’s lawyers used an insanity defense and pleaded not guilty. Salvi went along with that defense; however, during psychiatric interviews and later at his sentencing, he maintained that he shot and killed the receptionists intentionally, because they worked at abortion clinics. A jury convicted Salvi of two counts of first-degree murder and five counts of armed assault with intent to murder.

“As you know, I haven’t pled guilty though I am against abortion,” Salvi told the court before being sentenced to life in prison without parole, according to the Washington Post. “My position is pro-welfare state, pro-Catholic labor union and basically pro-life.”

Dear finally surrendered at the scene—apparently convincing himself to “give up” by flipping a credit card, much the way Javier Bardem’s character in No Country for Old Men would flip a coin before deciding the fate of his victims. Police records indicate Dear shouted “no more baby parts!” as an officer escorted him inside a police car, a reference to an anti-choice smear campaign against Planned Parenthood involving unfounded allegations the health-care network was illegally selling fetal tissue. Ever since, Dear has claimed that he attacked the clinic as a “warrior for the babies.”

For the past two-and-half years, the victims of this attack, their families, and the reproductive rights community at large have been waiting for Dear to face justice. And many remain befuddled as to why a Colorado district court has—multiple times now, by two different judges—ruled Dear mentally incompetent to face the 179 felony charges he incurred on November 27, 2015.

Though Dear has expressed ideas that appear imbued with delusions or some type of mental disorder, so have anti-choice killers before him—especially Salvi, whose past behavior and methods seems to most closely resemble Dear’s. They both have espoused beliefs in conspiracy theories, and neither specifically targeted doctors that provide abortions, as has been the modus operandi of previous anti-choice killers.

The state’s next opportunity to bring Dear to trial is May 21. Ahead of this next competency trial, Rewire.News is seeking clarity about what sets Dear apart from the killers he says inspired him. Rewire.News has analyzed Dear’s past statements and behaviors alongside those of some of the most violent anti-abortion radicals and found an unmistakable pattern: of total conviction that abortion is murder, early anti-choice activism that eventually escalated to violent crime, and inspiration from those who encourage murder in the name of opposing abortion.

A ruling of mental incompetence is ultimately up to judicial discretion, though heavily informed by the evaluations of multiple psychiatrists, generally chosen by both the defense and the prosecutors. It’s worth noting the cultural context surrounding Salvi’s trial versus Dear’s. Salvi’s shooting spree coincided with a crime wave targeting abortion clinics and abortion providers. Michael Griffin had killed a doctor in Pensacola, Florida, the year before, and Paul Jennings Hill had gone to a nearby Pensacola clinic and murdered another doctor and his bodyguard just a few months before Salvi pulled his trigger.

By contrast—although clinics have reported a rise in violence and threats in the last few years—six years separate Dear’s murders from the last abortion-related murder, in which Scott Roeder went to Dr. George Tiller’s church and shot him point-blank.

And area reproductive rights activists say in this case, Dear’s extreme ideology is being mistaken for mental incompetence by the state.

“I believe that Robert Lewis Dear committed this crime with intent, and that as an anti-choice activist he should be held responsible for the charges,” said Karen Middleton, executive director of NARAL Pro-Choice Colorado, in a phone interview. “I think they are conflating mental competency and rabid anti-choice views as a reason not to move forward, and I am troubled by that.”

What Does “Mentally Incompetent” Mean?

Court records and media accounts have effectively portrayed the now-60-year-old Dear as a man who likely does suffer from mental illness. Every 90 days, the state re-evaluates whether Dear has become mentally fit to face trial. At each hearing, the judge determines Dear’s competency based in part on the psychiatric evaluations of his doctors. During previous hearings, the state of Colorado determined that Dear cannot separate his delusions from reality and cannot make rational decisions, because—among other things—he thinks the FBI has been pursuing him for decades.

In a handwritten letter to Rewire.News in response to an interview request, Dear doubled down on his belief that the FBI has been monitoring him as part of a nationwide conspiracy.

“I would have liked to talk to you about the FBI, silver mercedes van who arrived 10 min before me at the Planned Parenthood but they denied me my rights to talk to anyone,” Dear writes. “Check the parking lot video.”

In this brief letter, Dear also disputes previous media reporting that he has a history of violence against women. “I was married 3 times, a total of 40 years of being with 100’s of women and not one Domestic Violence Charge,” he writes.

However, advocates believe Dear appears to meet the state’s minimal competency requirements: that he understands his crime and the criminal charges he faces. Dear has, in fact, consistently insisted he committed mass murder to stop the Planned Parenthood he visited from performing abortion and selling “baby parts.”

It bears mentioning here that mental illness is frequently tossed around—by the media, by representatives of the criminal justice system, by politicians—to explain away mass shootings. In reality, people who are mentally ill are much more likely to be the victims of gun violence than the perpetrators, and even more so if they are not white. In other words, if Dear does suffer from a mental illness, it does not mean that’s what led him on the shooting spree for which he was arrested.

Furthermore, under Colorado law, having a mental illness does not necessarily make you incompetent to stand trial. Rather, a defendant is determined “incompetent to proceed” if, due to a mental or developmental disability, they do not have “the sufficient present ability” to consult with their lawyer with a “reasonable degree of rational understanding in order to assist in the defense,” or if they do not have a “rational and factual understanding of the criminal proceedings.”

As Rewire.News Vice President of Law and the Courts Jessica Mason Pieklo explains, this essentially means that to be considered incompetent to proceed to trial, a defendant must lack the ability to talk to his lawyer or to rationally understand the proceedings against him. “For example, does he understand his charges?” Pieklo writes. “Can he participate in the court hearings as his case proceeds? Again, not ‘does he want to,’ but ‘can he?'”

Pieklo contends the evidence disclosed in Dear’s case so far does not suggest a person incapable of meeting that criteria. Among other things, Dear has articulated a consistent motive for strapping on a homemade bulletproof vest, seeking out a Planned Parenthood, and unloading his weapons. In court—shortly after his arrest—Dear proclaimed himself “guilty” and argued that Planned Parenthood “kill[s] the babies.”

The finding of mental incompetence is rare, particularly in high-profile murder cases. Dear’s lawyer, Daniel King, also represented James Holmes, who was charged with killing 12 people and injuring 70 at a movie theater in Aurora, Colorado, in July 2012. Holmes surrendered at the crime scene. He had a competency trial, during which his psychiatric evaluators testified that he had long suffered from a mental illness and was experiencing a psychotic episode when he committed the mass shooting. The judge, however, ruled that he was fit to proceed. A jury eventually sentenced him to life in prison.

Of course, a ruling of competency does not prevent a defendant from pleading insanity—as Holmes did. If a court agrees with such a plea, the defendant will likely receive psychiatric treatment at a hospital. Many mental health and legal experts agree that prison is not necessarily the best place to treat criminals who suffer from mental illness.

David Cohen, a law professor at Drexel University’s Thomas R. Kline School of Law who has written a book about anti-choice terrorism, told Rewire.News in a phone interview that he hopes to see Dear’s case move to trial because, he said, closure is important for the victims and for future terrorists motivated by anti-choice ideology.

“We want to have the recognition from the government that this is a crime and that it should be treated seriously, both to show the victims and potential future victims that their concerns are legitimate and also to show people who might do something like this in the future that there’s ramifications and hopefully to deter,” Cohen said. “We know the criminal justice system is an imperfect vehicle for doing both of those things, but it does help.”

The lawyers of several previous anti-choice killers have pleaded not guilty by way of insanity, thus far unsuccessfully. And Dear’s lawyers reportedly intend to do the same should he be found competent to stand trial—though Dear has publicly expressed that he does not want to do so.

Instead, as with previous anti-abortion killers, Dear believes his crime was not only justified but noble. He’s eager to testify in court and explain his reasoning—as he’s already demonstrated with outbursts he’s made during his competency hearings. “Anybody want to know why I did it?” Dear called out during one on May 11, 2016. He was escorted out of the court before he could answer his own question, reported the Denver Post. He’s made additional outbursts during other competency hearings, and has spoken of conspiracies relating to the federal government.

Salvi, too, had a mental competency trial, about seven months after his shootings. In his case, too, some of the psychiatrists who evaluated him argued that he likely suffered from schizophrenia and experienced hallucinations. He was therefore unfit to stand trial, they said. They testified that Salvi believed he was the thief crucified next to Jesus Christ, and that the Mafia and the Ku Klux Klan were after him. It was not a consensus among all of the psychiatrists, however; one agreed Salvi likely had a mental disorder, but one that wouldn’t undermine his ability to participate in a trial.

And Salvi also had a penchant for outbursts during his competency hearings, during which he would rant about Catholic conspiracy theories. Salvi maintained that he didn’t want to plead insanity; he wanted to testify about the evils of abortion during the trial.

In the end, the judge ruled that Salvi was competent, and a jury eventually convicted and sentenced him to two terms of life in prison without parole. About eight months into his sentence, Salvi died by an apparent suicide. Prison officials reported he was found alone in his cell with a plastic garbage bag tied around his neck. The New York Times reported that Salvi had made at least one previous suicide attempt. Salvi’s lawyers told the Times they had predicted Salvi’s suicide given his mental state and believed he needed to be hospitalized rather than imprisoned.

Dear now lives at the Colorado Mental Health Institute Pueblo, where a court ordered he undergo medication to treat his delusional disorder, against his will. He could remain there indefinitely. Other reasons Dear’s doctors cite for his mental incompetence to stand trial include his belief that former President Barack Obama might be the antichrist, and for thinking he’s a “warrior for the babies.”

The former theory—that Obama might be the antichrist—was once shared by one in four Americans. The latter—the notion that abortion is murder and someone who intervenes is doing a heroic deed—is one that has been espoused, to varying degrees, by many in the anti-choice movement.

Killing in the Name of “Life”

Journalist Amanda Robb—whose uncle, abortion provider Dr. Barnett Slepian, was murdered at home in front of his wife and sons by sniper killer James Charles Kopp in 1998—wrote a masterful portrait of Dear for the New Republic in December 2016. In the profile, she describes the paranoia and delusion she sees in Dear. But she also shows him to be a dedicated believer who is happy to have sacrificed for the anti-abortion cause.

“The things he said to me veered between raving paranoia—government agents had broken into his home and left behind a feather—and more lucid diatribes about abortion,” she writes.

Dear was tired of running from the FBI, he told Robb. So he decided to make, as Robb puts it, “his last stand” at what he considered to be “the most evil place on earth.” According to his favorite news sources, this was the nearest Planned Parenthood clinic. From there, Robb writes, Dear’s actions were deliberate and thought out.

What Robb concludes in her deep dive into Dear’s motivations is that the right-wing media, anti-choice groups, and websites for militant anti-abortion terror cells, such as the Army of God, helped radicalize Dear—someone with a reported history of anger and domestic violence—to become a self-proclaimed anti-abortion warrior.

After Dear’s arrest, the Washington Post reported that Dear’s actions were reminiscent of a “radical, unrepentant ideology” shared by several abortion-clinic killers, among them Paul Jennings Hill, whom Dear identified to police as his hero and role model.

While the majority of abortion opponents publicly claim to oppose violence in their movement, many equate abortion with murder and abortion providers with killers. Over the decades, that message has moved hundreds of activists to bomb and burn clinics. And it’s prompted a half-dozen to kill.

“It’s irrational to say abortionists are murderers and then reject the means necessary to restrain them,” said Hill the day before his execution, during a videotaped interview with Texas-based anti-choice group Life Dynamics. Hill was the first and only person executed by a state government for an abortion-related murder.

As Boston University professor and terrorism expert Jessica Stern has written in her 2003 book Terror in the Name of God: Why Religious Militants Kill, “This is a group phenomenon. Once inside an organization whose goals include killing, ordinary people can commit seemingly demonic acts. According to psychiatrist Robert J. Lifton, who has studied Nazis and other violent, fanatical groups, cult members become two people: the self they were, and the new, morally disengaged killer self. Some people are more susceptible to such doubling than others.”

The murderous element of this extremist movement arguably started with Michael Frederick Griffin, who on the morning of March 10, 1993, donned a suit before taking his regular post in front of the Pensacola Women’s Medical Services in Pensacola, Florida. This time, though, instead of holding a sign describing the clinic’s abortion provider as a murderer, the 31-year-old Griffin reached inside his suit pocket to clutch a gun, which he eventually used to shoot Dr. David Gunn three times. “Don’t kill any more babies,” he reportedly yelled before he started pulling the trigger.

Griffin immediately confessed to the crime, as would Rachelle “Shelley” Shannon on a summer day later that year right after shooting Wichita, Kansas, abortion provider Dr. George Tiller in both arms. She wounded, rather than killed, Tiller. Scott Roeder fatally shot Tiller a decade and a half later at the doctor’s church, in front of his congregation. Roeder immediately confessed too. Witnesses on the scene said Roeder shouted that Tiller was a murderer.

Hill promptly confessed as well, when, in July 1994, he murdered Dr. John Britton and Britton’s bodyguard, James Barrett, and wounded Barrett’s wife, June.

Dear’s predecessors have never shown remorse for their deadly crimes. On the contrary, they claim they acted righteously, in defense of the “unborn.” Because abortion is murder, they say, anything that halts abortions—either by destroying a clinic or ending the life of a doctor who provides abortion—is a good deed.

But it’s not only the lack of remorse that is characteristic of anti-abortion terrorists; they frequently share the belief that they will be rewarded in a Christian afterlife.

Until his eventual execution in 2003, Hill gave multiple video interviews from death row and wrote prolifically about his belief that God would reward him in the next life for willingly leaving behind his wife and three children for his anti-abortion cause.

Hill told a reporter in 2003: “I expect a great reward in heaven,” and “I am looking forward to glory. I don’t feel remorse.” Hill told a filmmaker, meanwhile, that he believed God would reward him for sacrificing the life he would spend with his three children. At the time he committed the murder, they were 3, 6, and 9 years old. “It occurred to me that I was making a sacrifice—thinking about the promise made to Abraham that if he was willing to sacrifice his son, that God would bless Abraham and grant to him descendants as numerous as the sands in the seashore and the stars in the sky,” Hill said.

Dear, too, has told journalists his fantasy that God will reward him in heaven, where aborted fetuses would thank him for what he did. He’s also said he hopes, while detained, to receive photos of babies whose abortions he prevented that day.

Escalation to violence is also a common trait among anti-abortion terrorists.

Most of them did not wake up one morning and decide to shoot a doctor or bomb a clinic. They joined activists picketing clinics; they read and wrote about anti-choice ideology; some escalated from just protesting outside clinics with signs to blocking entrances, jamming door locks, and destroying clinic property. Dear was no different.

Upon arrest, he told police he had picketed a South Carolina abortion clinic years before the rampage, before going on to glue the same clinic’s locks, as Roeder and sniper shooter James Kopp had done before escalating to murder.

Carole Joffe, a sociologist and professor at Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco, told Rewire.News that she believes it wasn’t just radical groups that revved up Dear to murder, but also congressional representatives like Rep. Marsha Blackburn (R-TN) and former Republican 2016 presidential hopeful Carly Fiorina, who repeatedly and publicly repeated unfounded claims that Planned Parenthood profits from the donation of fetal tissue.

“The Dear case to me really raised [anti-abortion-related murder] to another level,” Joffe said in a phone interview. “This was not just a mentally disturbed person who decided to shoot up anything. He chose to shoot up a Planned Parenthood clinic because he had been deluded into thinking they sell ‘baby parts.’ … When you go back and look at the tragedies we’ve had before—you know, David Gunn, Dr. John Britton, the people who were killed in the attack by Eric Rudolph—these were horrible tragedies. They also involved very irresponsible people preying on the emotions of unstable individuals. But it wasn’t candidates for presidents of the United States.”

Despite this pattern, the focus in the courts has continued to be on Dear’s competency, about which some anti-abortion activists have themselves expressed doubts. However, their justification is unsettling—and they have refused to distance themselves from his admitted crimes.

Take Donald Spitz, who runs the website for the Army of God, a loose coalition of extremist anti-abortion activists who advocate for the use of force against abortion providers. As far as Spitz is concerned, Dear does not fit the mold of the anti-choice terrorists affiliated with his group. Spitz wrote to Dear shortly after his attack at the Planned Parenthood clinic to praise him for his action. After communicating with Dear, Spitz believes he is “off the wall”—partly from his letters, but partly because he didn’t target an abortion provider or a clinic staff member when he shot up the Planned Parenthood clinic.

“He was trying to save babies,” Spitz said. “He’s claiming to do that, which is good, and I believe him that that’s what his purpose is. But the way he was doing it wasn’t the proper way to do it. The way he was doing it made no sense.”

“By taking innocent lives—emphasis on the innocent—that have nothing to do with the operation of that abortion clinic, there’s no purpose in that,” Spitz continued. “If the people had worked for the abortion clinic, it would be something different.”

In other words, Spitz would have apparently embraced Dear murdering people who worked for Planned Parenthood.

But Joffe believes she understands the purpose of Dear’s actions. “This wasn’t a random target; it was a very deliberate target,” she said. “If you target people who are providing abortions, that’s terrorism. If you are targeting people who happen to be at a facility that among other things provides abortions, that’s terrorism on steroids.”

And for all of Spitz’s criticisms of how Dear went about his massacre, Spitz defends Dear. His website still honors Dear as a “warrior for the babies.” He told Rewire.News that he doesn’t plan to contact Dear again until after his trial, as he doesn’t want to interfere with his legal case. If Dear eventually moves into a prison cell, Spitz says he’ll reach out and try start a friendship with the admitted killer.

If that day will ever come remains unknown. Next week, the Colorado Fourth Judicial District Court will determine whether Dear will spend the following 90 days in a mental institution again or preparing to face a judge and jury. Planned Parenthood of the Rocky Mountains, the parent organization of the clinic Dear attacked, declined to comment for this story because Dear’s criminal case is ongoing.

That this process has taken nearly three years disturbs NARAL Pro-Choice Colorado’s Karen Middleton, who told Rewire.News there are open questions about Dear’s crime and any potential involvement with other anti-choice activists that could come out in the trial’s discovery process. The public and the survivors deserve to know exactly what happened and who might have influenced Dear, she says.

“I do believe it is a miscarriage of justice,” Middleton said. “The fact that no trial has taken place because [Dear is] rabidly anti-choice is not the same thing as [him] being incompetent. It sounds like his anti-choice views—being spewed loudly—equal mental incompetence. We’re really interested in seeing [the trial] go forward.”

Joffe, too, thinks it’s high time Dear’s case goes to trial. Like Middleton, she’s hoping the activists and politicians who she says helped influence Dear, by repeating the idea that Planned Parenthood is literally evil, will have to face public scrutiny.

But she’s also hoping for an answer for all of the survivors involved.

“I think it should go to trial in deference to the many, many victims, not just the relatives and loved ones of the three people who were killed, but the whole clinic staff, the constituency of that particular Planned Parenthood clinic,” Joffe said. “You know, 65-year-old women who would routinely go to that clinic for cancer screenings no doubt were terrified to go there again.”