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Wed February 6, 2013

Shooting Of 'American Sniper' Raises Questions About PTSD Treatment

Originally published on Wed February 6, 2013 1:12 pm

Police in Texas have charged Eddie Ray Routh, a 25-year-old U.S. Marine reservist, with capital murder. Arrest records indicate that Routh had been twice taken to a mental hospital in recent months, and had told police he was suffering from post-traumatic stress disorder.

It's not clear whether a doctor had diagnosed Routh with the disorder before he allegedly murdered Chris Kyle and his friend Chad Littlefield. Kyle, a retired Navy SEAL and author of the book American Sniper, had taken Routh to a shooting range apparently as a form of therapy.

A few hours later, Routh's sister Laura Blevins called 911. In a recording of that call, she said: "My brother just came by here ... He told me that he just committed a murder."

She then put her husband, Gaines Blevins, on the line.

"He said he killed two guys at a shooting range," he said. "But he's recently diagnosed with PTSD, and he's been acting real weird."

Police later apprehended Routh driving Kyle's pickup truck.

Working With Troubled Veterans

Todd Vance, who is also an Iraq War vet, coaches a mixed martial arts group for veterans in San Diego. He says many veterans see hiking, hunting or shooting as a way to re-create their military experience, but without the danger. Vance, who's getting a degree in social work, has also received treatment for PTSD. Now, he says fighting in the gym helps him.

"Everybody deals with it differently," he says. "Somebody could look at me and say, 'You get punched in the face seven days a week — that seems like pretty risky behavior, as well.' But in reality, it's keeping me out of trouble."

Vance says what he does is a perfectly normal activity, and that it could even be used as a form of exposure therapy, one of the cognitive therapies known to help with PTSD. The idea is to help a patient remember traumatic events without re-experiencing the trauma.

It's not clear that's what Kyle was trying to do by taking a fellow veteran to the shooting range — and any sort of therapy is meant to be done with a doctor's supervision.

Cognitive therapies and a limited number of drugs are the only treatments for PTSD backed by empirical studies. But with hundreds of thousands of veterans suffering, there are a lot of experimental methods out there.

"The big challenges here ... [are] what we know that works doesn't work for everyone," says Dr. Farris Tuma, with the National Institutes of Health. "And there's limited availability of the things we know do work. "

Treatments include everything from virtual reality to yoga, and even spending time with dogs or horses. Doctors sometimes try other drugs, from antipsychotics to the recreational drug Ecstasy. Tuma just wishes he had evidence to say what helps and what hurts.

Many suffering from PTSD are "essentially using their own experience and maybe something they've read about," says Tuma. "But the bottom line is ... we don't have good guidance for them."

The Pentagon has financed a major study, due out next year, to assess all these treatments. Sandro Galea, the head of the epidemiology department at Columbia University, is leading the effort, and he says there's new funding, new understanding of PTSD, and new research on how the brain works.

"So there is a lot going on, and it is that depth of activity that makes me say I'm optimistic," Galea says. "There's a lot of effort invested by practitioners of all stripes to deliver PTSD care to those who need it."

Galea says he hopes the public will soon see PTSD as an injury — like a broken arm — that can be treated. But destigmatizing PTSD has already had another effect: A lot more people are seeking treatment.

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Transcript

AUDIE CORNISH, HOST:

There are still many questions about the double murder that occurred this past weekend near Fort Worth, Texas. Among them: Is a shooting range a safe place for a disturbed war veteran? The vet turned his gun on two men, including Chris Kyle, a former Navy SEAL. Kyle wrote a best-selling book, called "American Sniper," that helped to fund his charity work with other veterans. As NPR's Quil Lawrence reports, the crime has raised concerns about treatments for post-traumatic stress disorder.

QUIL LAWRENCE, BYLINE: Eddie Ray Routh, a 25-year-old Marine reservist, had been checked into a hospital twice in recent months. Former SEAL Chris Kyle, and his friend Chad Littlefield, had taken Routh to a shooting range, possibly as a form of therapy. Hours later, Routh's sister called 911.

(SOUNDBITE OF 911 CALL)

LAURA BLEVINS: My brother just came by here. I wasn't - he's now left, but he told me that he's committed a murder.

LAWRENCE: Routh's sister then put her husband on the line.

(SOUNDBITE OF 911 CALL)

UNIDENTIFIED DISPATCHER: Go ahead and tell me what he says. (Starts typing)

GAINES BLEVINS: He said he killed two guys at a shooting range. But he's - he was recently diagnosed with PTSD, and he's been acting real weird.

LAWRENCE: Police later apprehended Routh driving Chris Kyle's pickup truck. Kyle's death has inspired tributes and eulogies, but also questions about whether a firing range is a good place for a disturbed veteran.

TODD VANCE: Yes, that seems perfectly normal to me.

LAWRENCE: Todd Vance is also an Iraq war vet. He coaches a mixed martial arts group for veterans in San Diego. He says many veterans see hiking, hunting or shooting as a way to re-create their military experience but without the danger. Vance, who's getting a degree in social work, himself got treated for PTSD. Now, he says fighting in the gym helps him.

VANCE: Everybody deals with it differently. You know, somebody could look at me and say, well, you get punched in the face seven days a week. That seems like pretty risky behavior as well. But in reality, it's keeping me out of trouble. And who knows, you could be used as human exposure therapy.

LAWRENCE: Exposure therapy - that's one of the cognitive therapies proven to help with PTSD. The idea is to help a patient remember traumatic events without re-experiencing the trauma. It's not clear that's what Chris Kyle was trying to do by taking a fellow veteran to the shooting range. And anyhow, it's meant to be done with a doctor's supervision.

Some cognitive therapies, and a limited number of drugs, are the only treatments for PTSD backed up by empirical study. But with hundreds of thousands of veterans suffering, there are lots of experimental methods out there.

DR. FARRIS TUMA: The big challenges here, overall - is that what we know that works, doesn't work for everyone.

LAWRENCE: Dr. Farris Tuma is with the National Institutes for Health.

TUMA: And there's limited availability of the things that we know do work.

LAWRENCE: Treatments include everything from virtual reality to yoga; spending time with dogs or horses. Doctors sometimes try other drugs, from anti-psychotics to the recreational drug ecstasy. Dr. Tuma just wishes he had the evidence to say what helps, and what hurts.

TUMA: It's not that people are by choice flying by the seat of their pants. They're essentially using, you know, their own experience and maybe something they've read about. But the bottom line is, we don't have good guidance for them.

LAWRENCE: The Pentagon has financed a major study - due out next year - to assess all these treatments. Sandro Galea, head of epidemiology at Columbia University, leads the effort. He says it's an auspicious time with new funding, new understanding of PTSD, and new research on how the brain works.

DR. SANDRO GALEA: So there is a lot going on, and it is that depth of activity that makes me say I'm optimistic. There's a lot of effort being invested by practitioners of all stripes, to deliver effective PTSD care to those who need it.

LAWRENCE: Galea says he hopes the public will soon see PTSD as an injury, like a broken arm that can be treated. Quil Lawrence, NPR News.

(SOUNDBITE OF MUSIC)

ROBERT SIEGEL, HOST:

This is ALL THINGS CONSIDERED, from NPR News. Transcript provided by NPR, Copyright NPR.