A high-profile trial that opened today in Texas is set to reignite the debate over post-traumatic stress disorder and its devastating effects on veterans of war — but some experts fear the case risks clouding the American public's understanding of a complex condition that affects a growing number of returning soldiers.
Eddie Ray Routh, a Marine veteran, is accused of killing Navy SEAL legend Chris Kyle — better known as the American Sniper, the title of Kyle's autobiography and a recent Clint Eastwood film about his life — and Kyle's friend Chad Littlefield. In a sense, the trial pits two narratives of return from war against each other.
Kyle, who rose to fame as America's most lethal sniper after killing at least 160 people during a decade of tours in Iraq, had a hard time readjusting to civilian life, but devoted himself to helping struggling veterans through the same process.
Routh, a Marine with a history of mental illness, including PTSD, was among those Kyle tried to reach. Routh killed Kyle and Littlefield in February 2013 at a gun range where the two had taken him to help him cope with his troubles.
Prosecutors are seeking life in prison without parole for Routh, if he is found guilty.
In his opening remarks today, Routh's lawyer Tim Moore said his client was not guilty by reason of insanity.
"When he took their lives, he was in the grip of a psychosis, a psychosis so severe that he did not know what he was doing was wrong," Moore said. He added that, shortly before the shooting, Kyle texted Littlefield about Routh, writing "this dude is straight-up nuts."
"Watch my six," Littlefield replied — slang for "Watch my back."
Moore talked about Routh's PTSD as one of his many mental health problems. Prosecutors said Routh knew what he was doing.
"He admits that he murdered these two men, that he used drugs and alcohol that morning, and he knew what he was doing was wrong," District Attorney Alan Nash said. "The evidence will show that mental illnesses, even the ones that this defendant may or may not have, don't deprive people from being good citizens, to know right from wrong."
Routh's lawyer declined to comment on the ongoing case. The Routh and Kyle families did not respond to requests for comment by VICE News.
Routh's parents have said previously they struggled for years to get their son the mental health care he needed.
"We lost three people that day," his father, Raymond Routh, said. "How do I explain I want justice for my son too?"
But Kyle's family and supporters said PTSD is an excuse. "I know people with PTSD, and it's very real and very hard," his widow, Taya Kyle, said. "But it doesn't change your core character."
Outside the courtroom, the debate about PTSD's role in the case is already raging, including within the veteran community.
"You have a lot of people who want this to be PTSD, they want him to have an excuse, because they want an excuse for the stuff they have done," Spencer Walker, board chairman of the Warfighter Foundation, a charity that suppors combat veterans, told VICE News. "And then you have the other side who's like, 'There is no excuse for this, and PTSD is definitely not one."
An American Tragedy
The fact that Routh's trial is unfolding while the Oscar-nominated blockbuster film about Kyle's time in Iraq is still in theaters adds a layer of complexity to the tragic story.
The film and case have reignited debate not only on mental illness and war, but also about the moral ambiguities that reward some killing as heroic and some as criminal.
The film glorifies Kyle's career but doesn't delve into the tragedy of his death at the hands of another US soldier. Critics say the buzz around the movie will make it harder for Routh to get a fair trial.
"Now with the movie everyone worships this guy, and with the fact that he was murdered trying to be a good guy, it's going to be very difficult to get anyone to listen and understand PTSD," Floyd Meshad, the founder of the National Veterans Foundation, told VICE News. "Juries get emotional, and it's gonna be hard to find a jury that doesn't know the story and that the movie is out for an Academy Award."
Meshad, a pioneer in the study of war-related mental illness, recognized that the film also rekindled controversy surrounding Kyle's legacy, both at war and at home. Back in the US, Kyle claimed that he killed two wannabe carjackers at a gas station, and 30 people in the chaos that followed Hurricane Katrina in New Orleans. The claims were never verified, and skeptics regularly questioned the veracity of Kyle's stories.
None of that complexity makes it into the film, which ultimately sets the "record" on Kyle for much of the general public, critics said.
"You have the guy who murdered this guy that everyone is in love with," Meshad said, adding that Routh's defense would have a good case to plead insanity but for the fact that he is "going up against a hero."
Kyle's supporters say that the hype and controversy surrounding the movie have made the trial even more polarizing.
"Now you're either on this side and you hate Chris Kyle or you're on this side and you're patriotic and you support Chris Kyle, you're with us," Walker said. "Basically what they said is, pick a side."
Schizophrenia or PTSD?
The Warfighter Foundation has made it a point to counter the argument that PTSD was a factor in Routh's actions. The organization published the results of a lengthy investigation into the Marine's past that included interviews with people who recruited him and served with him. The report claimed Routh has "paranoid schizophrenia, not PTSD."
The group said Routh couldn't have developed PTSD because he never served in combat and never left his base, though psychologists say the disorder can be triggered by exposure to a variety of traumatic experiences.
Routh reportedly talked to his father once about killing "a kid" while on patrol in Iraq. In 2010, he was deployed to Haiti in the aftermath of a devastating earthquake, and helped load dozens of bodies into dump trucks headed to mass burials.
Routh's family has said VA doctors diagnosed him with PTSD. The agency does not comment on the treatment or medical records of individual patients. Reports have said Routh was hospitalized repeatedly, drank heavily, and threatened to kill himself and his family.
"We don't think he has PTSD at all because he never did anything," Walker said. "The VA will diagnose anybody with PTSD… You can get diagnosed with PTSD for holding a pen the whole time you're in the Marine Corps."
Robert Stanulis, a neuropsychologist who has worked on several trials involving veteran defendants, warned against reducing Routh's trial to a question of whether or not he had PTSD.
"There's stuff in there that suggests that there are other things going other than PTSD — possibly a psychosis, schizophrenia," he told VICE News, cautioning that his assessment is based on reports on Routh's history, not direct evaluation. He also noted that "insanity" is a legal concept — not a medical one.
"A veteran who killed a veteran is a shocking case — we'd like this kind of case to be black and white," Stanulis said, arguing that public debate should focus instead on the high suicide and incarceration rates for veterans.
"Everyone wants to go to the sexy explanation, PTSD, when for all I know this is a man that went into the military and became psychotic because that was his genetic destiny," he added. "I don't know. The question should be, what are the possible ways in which one could explain this behavior, and how does the data support or not support each of those hypotheses? And then you have to translate psychology and psychiatry into the law."
A staggering 22 vets take their lives every day, according to government data, and while most are veterans of earlier wars, experts say the problem has been compounded by the multiple tours served by soldiers during the wars in Iraq and Afghanistan.
On Thursday, President Barack Obama is set to sign the Clay Hunt Suicide Prevention for American Veterans Act. The law aims to provide better care for suicidal vets and others suffering from serious mental illness. The bill is named after an Iraq vet who took his life after struggling for years with depression of PTSD.
Can PTSD Make You Legally Insane?
Though they are popular in the public's imagination, insanity defenses are very rare. According to Stanulis, they only come into play in less than one percent of all felony cases. And, while lawyers and jurors are learning more about the disorder, PTSD has rarely been mentioned during trials for violent crimes.
So far, there's only one known case where a military veteran with PTSD was sentenced to a psychiatric hospital instead of prison for murder. Markku Sario, the attorney for Jessie Bratcher, successfully argued in 2009 that PTSD caused the homicide committed by his client.
"A problem with insanity defenses, generally, is that unless someone is drooling in the corner, jurors are skeptical," Sario told VICE News. "They'll say, 'Yeah, sure, he says he's crazy but is he really?'"
'You have a lot of people who want this to be PTSD, they want him to have an excuse, because they want an excuse for the stuff they have done.'
Sario explained that PTSD doesn't have overt symptoms.
"It's not like someone is delirious or not making sense or obviously insane," he said. "But PTSD is very viable, especially in veterans — because the army has gone out of its way to train soldiers and Marines to be very aggressive, they go out of their way to dehumanize the enemy."
Bratcher killed a man who allegedly raped and impregnated his fiancée. Sario convinced a jury that Bratcher reacted with deadly force because the army trained him to eliminate any perceived threat — but never deprogrammed him for civilian life.
"This kind of training to rewire your brain to eliminate threat is extremely effective, it really works," Sario said. "And there's no counter-training when one gets out of the service, they don't say, 'Okay, it's time to be a civilian now, don't react violently to threats.' "
Dealing with Trauma
Kyle himself described experiencing symptoms of trauma, but felt only a veteran could help another veteran readjust to civilian life.
"He had 160 confirmed kills, probably a lot more," Walker said. "He carried a way larger burden on his shoulders than Eddie Routh, and he wasn't going around burning veterans — he was helping them." Walker said he believed Kyle "definitely" had PTSD.
The defense's claim that his PTSD contributed to Routh's actions has angered some veterans struggling with the disorder. Stigma and fear still surround PTSD, he said, affecting veterans looking for jobs.
"When the defense said [Routh] had PTSD, that's when they crossed the line," Walker said. "I don't wanna walk around as a veteran having someone say, 'Hey you have that PTSD, are you gonna kill me if you work here?' "
"Nobody, not even a psychologist, unless they've experienced it themselves, is gonna understand a veteran saying they have PTSD like another veteran, which is why we confide in each other," he added.
Some psychologists disagree with that, and say Kyle was not trained to understand PTSD's complex manifestations and deal with their severity. Bringing a severely traumatized person to a firing range was a recipe for disaster, they say, because gunshots can trigger flashbacks and prompt defensive reactions.
Meshad said "it takes professionals" to deal with PTSD, and that many veterans fail to understand the full extent of the problem. "The sad part of it is when we don't respect the severity of something like PTSD and then this terrible situation happens," he said. "It would be like letting a kid who likes to handle snakes or has an interest in them take in vipers. He gets bit and dies."
The Warfighter Foundation blamed the many professionals who worked with Routh for failing to raise a red flag, and also criticized his mother — who sought Kyle's help — for failing to explain the full extent of her son's problems. Walker said if Routh's mother had warned Kyle, "he would have never put a gun in Eddie's hands."
"There were so many people involved," Walker said. "Somebody could have done something, but nobody did."
Black and White
Routh's trial is expected to last two weeks and promises a heated battle of narratives over his past and the failures of the system that was supposed to care for him.
"I worry about cases like this that are so high profile because they tend to cement people into emotional positions that are counterproductive," Stanulis said. "Everybody wants a quick answer and obviously with the movie coming out this has become a flash point. The problem is that nobody wants to deal with the complexity; it's not black and white."
The psychological cost of war is more nuanced and complex than a guilty or non-guilty verdict.
"Are there things that you may see in a war that may not cause PTSD, but maybe moral injury? Do we maybe get PTSD when we see or hear about, for example, civilian casualties that include children?" Stanulis asked. "That's one of the issues here: Do we medicalize the costs of war?
The neuropsychologist raised questions about "the moral dilemmas of war," describing the dissonance that comes with awarding medals for some killings and sending people to prison for others.
"That's the moral dilemma and I think that's really one of the issues we don't like to talk about," he said.
A trial that, like the film about Kyle's life, simplifies narratives is unlikely to answer those questions.
Follow Alice Speri on Twitter: @alicesperi