Ronald Lee Haskell, accused of killing six relatives, including four children, collapsed during his first court appearance and had to be taken out in a wheelchair.
Haskell, 33, is charged with one count of capital murder/multiple murders. He is being held without bond.
A seventh victim survived Wednesday's shooting spree.
Haskell collapsed in court as the charges were read and deputies had to pick him back up, according to Jeff McShan, the spokesman for the Harris County District Attorney's Office, and KHOU-TV in Houston.
The color drained from his face and he began to shake, according to the Houston Chronicle. Courtroom bailiffs surrounded him when he bent forward and put his head down. The bailiffs caught him before he hit the ground when his knees buckled, the newspaper reported.
After the brief hearing, Haskell's court-appointed attorney says his client has a mental illness and isn't fully aware of his actions, KHOU-TV in Houston reports. The station reports that prosecutors are seeking a grand jury capital murder indictment.
As friends remember the family of seven shot execution-style, details of the alleged shooter's turbulent life came to light.
Haskell has a troubled history that has left a trail of violence in three states, according to law enforcement and court records.
Less than a week before the attack, Haskell's mother took out a restraining order against her son. The San Diego County, California sheriff's office said the mother reported an argument with her on on July 2 at her home in San Marcos. She reported that Haskell physically restrained her when she tried to leave the house to call for help. He finally left the house after a few hours and his mother called 911, the sheriff's office said in a statement. The incident remains under investigation.
Haskell is accused of killing his ex-wife's sister, Katie Stay, 33, her husband, Stephen, 39, their two boy, ages 4 and 14; and two girls, ages 7 and 9. Police say he tied them up and laid them face-down on the floor of their home in Spring, Texas.
Police said Haskell demanded to know the whereabouts of his ex-wife, Melanie, Katie Stay's sister. Police said he shot each in the back of the head after the family refused to tell Haskell where he could find his ex-wife.
The lone survivor is the couple's 15-year-old daughter, Cassidy. The bullet grazed her head, according to a family statement, that hails her a hero. The teen waited until the gunman left the home, then called police to warn them that he was heading to her grandparents' home.
Long before he was charged with the killings, there were signs of violence 1500 miles away.
Haskell lived in Logan, Utah with his wife Melanie and their four children. Court records show a troubled, sometimes, violent 11-year marriage.
In 2008, he was arrested for simple assault and domestic violence in the presence of children for hitting his wife on the head several times. He pleaded guilty in abeyance, which is a legal term allowing him to complete probation and later dismiss charges on his record.
"She alleged that he had dragged her by her hair, out of the bedroom, and assaulted her hitting her in the head," said Captain Tyson Budge of Logan City Police, according to KHOU-TV in Houston. "And then he did it again later in the evening she was in the children's room by her hair, and hit her."
Then in 2009, Haskell called police claiming he found a suicide note by his wife, Budge said. In 2013, Melanie Haskell filed a protective order against her husband. The couple finalized their divorce in February of this year.
She moved to Houston and he followed.
A neighbor of the Stay family said the Haskell marriage was so rocky that Stay went to Utah last fall to help her sister escape the relationship and start a new life in Texas.
Stay "was very instrumental in helping her sister get here so she could have a fresh start. Katie's a spitfire. She has energy to stand up for what she believes is right and true," Verena Beckstrand, a neighbor who choked back tears as she talked about the family, told the Associated Press.