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Ronald Lee Haskell, 33, who is being held without bond, was in court for a hearing after being charged on Thursday (local time) with capital murder and multiple murders of his former wife's relatives.
Haskell, who suffers from mental illness according to his attorney, was expected to face a hearing on his mental capacity and will eventually face a grand jury that will decide whether he will be tried for capital murder, which carries the possibility of the death penalty.
Haskell, wearing orange prison attire, said "Yes, sir" to the judge after his rights were read and then fainted as details of the crime were read. Bailiffs had to pick him up and wheel him out in an office chair.
Haskell is accused of fatally shooting two boys ages 4 and 14, two girls ages 7 and 9, and their parents Stephen Stay, 39, and Katie Stay, 33. Five of them were dead when found and one of the children died after being air-lifted to a hospital for treatment.
Cassidy Stay, 15, survived the attack on Wednesday afternoon, the Harris County Sheriff's Office said.
Harris County prosecutor Tammy Thomas told the judge that Haskell methodically executed the family, tying them up and then firing two bullets into each of them, starting with the mother.
Haskell, posing as a delivery man, entered the home when Cassidy told him to wait while she got a pen to take down his name and number, Thomas said.
The teen did not recognize her uncle, who had grown a beard in recent months, until after Haskell told her his name, Thomas testified. He then pulled a gun and ordered her to assemble the other children in the living room before tying them up as they lay on the floor, Thomas added.
Their parents were confronted when they returned from a trip to the bank, according to the prosecution.
When the family was together in one room, Haskell began to shoot them in a brazen attack that showed elements of planning, said Thomas, who appeared distraught after reading details of the crime to the court.
"Maybe reality is finally settling in," she told reporters afterwards when asked what prompted Haskell to collapse.
"It makes no difference to me if he understands how much trouble he is in. We'll get a jury to do that for him."
Doug Durham, Haskell's public defender, said his client had been in and out of hospitals in Utah and California with a history of mental illness and that he was not taking prescribed medication at the time of the murders.
"The evidence will show he was suffering from a mental illness at the time of this incident," said Durham.
A neighbor previously told Reuters that Haskell was angry with the family for facilitating the divorce.
The suspect's former wife did not live at the house and was not harmed in the incident.
Cassidy Stay, left for dead, called police and alerted them to the shootings and said that Haskell was on his way to the home of more of his former wife's relatives. Police intercepted him before he got to the home.
Cassidy is expected to make a full recovery from a gunshot wound to the head, her relatives said in a statement.