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American Sniper; A Combat Veterans Tale
Christa K. Pera
Marriage Family Therapy, Alliant International University
PSY63110: Introduction to Psychopathology
Dr. Shalini Middleton
February 25, 2021
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American Sniper; A Combat Veterans Tale
For decades films have been used to bring awareness to societal issues of various kinds.
In this final project for Introduction to Psychopathology, we will perform an assessment and
diagnosis of a specific movie character portrayed. The author chose to assess Chris Kyle's
character in the movie American Sniper (Eastwood, 2014). Within these writings, we will
discuss the primary diagnosis and causation. As we seek to understand the manifestation of the
illness and its effects on Kyle, his family, and the community, we explore the onset and
prevalence of symptoms. Looking at diversity factors helps give greater context to the situation
and formulate treatment plans. We will examine risk and resilience factors associated with the
mental illnesses addressed. Treatment options for the diagnosis and the author's reactions will be
included, and a conclusion of the findings.
Diagnosing of Posttraumatic Stress Disorder
Research has shown that higher numbers of cumulative combat experiences were directly
related to lower performance and conduct and a greater likelihood of anxiety, depression, and
posttraumatic stress disorder (PTSD) (Reed‐Fitzke & Lucier‐Greer, 2020). This writer's
opinion is that the primary diagnosis given to Chris Kyle is Posttraumatic Stress Disorder
(PTSD). PTSD is induced by exposure to actual or threatened death or serious injury. Exposure
must include one of the following; directly experiencing the trauma or witnessing, in person, the
event as it occurred to others. Learning that a violent or accidental trauma occurred to a close
family member or a friend or experiencing repeated or extreme exposure to aversive details of
the traumatic event (American Psychiatric Association, 2013). Kyle completed four tours for the
united states military during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom
(OEF). In this position, Kyle served as a sniper responsible for 160 confirmed kills. His first
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targets were a woman and a child who threatened the Marines' safety, whom he was ordered to
protect. Kyle was also exposed to traumatic events as he watched his "brothers at arms" sustain
severe injury or lose their lives in combat. He was involved in several operations that entailed
prolonged exposure to combat.
Symptoms of PTSD include recurrent, involuntary, and intrusive distressing memories of
the event. Recurrent distressing dreams in which the content and or affected of the dream are
related to the traumatic event. Dissociative reactions such as flashbacks in which the individual
feels or acts as if the traumatic events are reoccurring. Intense or prolonged psychological
distress at exposure to external or internal cues that symbolize or resemble an aspect of the
traumatic event. Physiological reactions to internal or external cues that symbolize or resemble
an aspect of the traumatic event (American Psychiatric Association, 2013).
Chis Kyle exhibited all of the symptoms mentioned above of PTSD. Disassociative
amnesia, negative mood alterations, distorted cognitions, diminished interest in activities,
detachment, and estrangement from others are a few of the behaviors portrayed by Chris Kyle's
character. In one scene, Kyle responds to a car lawnmower with a startling response. When his
daughter was born, Kyle went to the nursery window to visit her. As she was safe in her crib, she
began to cry. The nurse was tending to the need of another infant. Kyle was agitated by the
staff's delayed response and yelled and banged on the window to get their attention, exhibiting
marked alterations in arousal and reactivity.
These symptoms began early on in Kyle's military career. One could argue the triggering
moment was his first kill of a woman and a child. Following that moment were many more
traumatic moments in which Kyle was directly involved. These symptoms were present for more
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than one month and cause Kyle and his family significant distress and negatively affect Kyle in
social and occupational areas.
Diversity and multicultural factors
PTSD in prevalent among military personnel, especially those with combat exposure.
Research has confirmed the adverse effects of combat exposure on a person's mental health. For
example, U.S. Vietnam War veterans exposed to combat had much higher rates of posttraumatic
stress disorder (PTSD) than both noncombat veterans of the same era and civilians (Jordan et al.,
1991). The United States military has a culture in and of itself. This culture promotes loyalty,
cohesion, self-sacrifice, discipline, and a fighting spirit (Understanding Military Culture, n.d.)
amongst other values. These core values can help alleviate and aid in the road to recovery for
many service members working through PTSD, as we will address in detail below. These values
can also deter military personnel from seeking the help they need because, in doing so, they feel
disloyal or weak.
There are also several different branches of the military and varying commitment levels.
Each of these factors plays a role in the diversity of the military. There is a sense of superiority
amongst different branches, which creates an environment of rivalry at times. Reserves and
National Gaurd have a lesser commitment requirement, and often these men and women live a
civilian lifestyle for much of their lives. A struggle with identity or belonging may impact their
lives as they juggle the differing roles between civilian life and military responsibilities
(Understanding Military Culture, n.d.). There may be concerns among service members about
the therapists' ability to understand the military culture and, therefore, the client. Cultural
training and awareness are imperative for clinicians working with military personnel.
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Risk and resiliency factors
In recent research concerning PTSD in the United States military, biomarkers are being
studied to establish the pathophysiology of PTSD. The research has shown no single biomarker
but several biomarkers that may indicate clinically significant PTSD symptoms associated with
risk for PTSD following trauma exposure and predict or identify recovery (Lehrner & Yehuda,
2014). Perturbations in the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic
adrenomedullary system, and alterations in brain structure and function have been associated
with risk for development of PTSD following trauma exposure, with PTSD symptoms and
diagnosis, and with recovery (e.g., Pitman et al., 2012; Schmidt, Kaltwasser, & Wotjak, 2013).
Spirituality can correspond to both risk and resiliency. On the one hand, exposure to
potentially morally injurious events (PMIEs) and/or trauma-related spiritual distress has been
associated with more severe and longer duration of posttraumatic stress disorder (PTSD)
symptoms and increased suicide risk (Bryan et al., 2018; Currier et al., 2014, 2015; Schorr et al.,
2018). Military personnel often face incongruent experiences with their morals and values,
especially in combat situations. These create areas of risk. On the other hand, spirituality can also
lend to resiliency in persons with PTSD as they lean on spiritual tenents to cope.
Additionally, unit cohesion may have a positive effect on mental health. The connection
between unit cohesion and positive soldier outcomes is well-established. In a meta-analysis that
examined 39 studies, unit cohesion was significantly connected to individual performance and
well-being across military branches and countries (Oliver, Harman, Hoover, Hays, & Pandhi,
1999, as cited in Reed‐Fitzke & Lucier‐Greer, 2020). In the film, Kyle's team played a large
part in loyalty and a sense of responsibility to each other.
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Treatment options
Current trends in treatment for Posttraumatic Stress Disorder in military personnel
include but are not limited to Prolonged Exposure Therapy, Internal Family Systems Theory,
Cognitive Behavioral Therapy, and Eye Movement Desensitization and Reprocessing. Albeit
there are more than the two treatment modalities, we will present on Prolonged Exposure
Therapy and Internal Family Systems.
Prolonged Exposure (PE) treatment consists of manualized, ninety-minute weekly
treatment that utilizes psychoeducation of trauma and treatment, self-assessments, repeated
exposure to avoided situations, and repeated prolonged exposure to traumatic memories by the
telling of and processing through with patient and therapist. In PE sessions are usually
audiotaped for patients to review outside of the session (Yoder et al., 2012). Homework is given
for clients to complete during the week. By retelling traumatic events, veterans can return to the
moments in a safe space and see the situation with an outside observer (the therapist). The
therapist can draw out experiences and truths that the client may not have actualized.
Internal Family Systems (IFS), a systemic form of therapy, provides an effective
treatment for combat veterans who suffer from PTSD (Lucero et al., 2017). According to the
U.S. Department of Veteran Affairs, 11 – 20% of veterans have PTSD (National Center for
PTSD, 2014). IFS seeks to acknowledge, understand and validate all parts of the self. Exiles,
managers, and firefighters are parts that take on roles that serve and protect the self. Just as our
servicemen and women serve to protect our country, these parts serve to protect the self. During
deployments, the ability to process traumatic events may not be fully realized. Upon
reintegration into civilian life, servicemen and women may find difficulties as memories of war
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experiences come up from the deep. IFS aims to address the parts that hold the pain and bring a
connection to the core self.
The less-pathologizing approach of IFS honors veterans' sacrifices and bravery to enter
potentially traumatizing situations by acknowledging and giving space to define what
post-deployment life looks like, rather than being focused on returning to "normal"
civilian functioning (Lucero et al., 2017).
Personal reaction
My reactions to the movie American Sniper (Eastwood, 2014) and Chris Kyle's character
are multifaceted. I have many friends and family members who have served in the United States
military. I enlisted at one point and began basic training. Due to extreme insecurity and possibly
some unresolved trauma of my childhood, I did not complete basic training. I can now say I have
no regrets about this reality. I have a heart for our servicemen and women as they sacrifice much
for their country and our freedoms. As I consider the atrocities of war, I can understand why the
brain is triggered and how posttraumatic stress disorders occur. Couple a disorder with the shame
of needing mental health care, and we have a recipe for disaster. I am a huge proponent of
helping end the stigma surrounding mental health, including within the U.S. military.
Because of my history, I must remain aware of my biases and my potential to become
emotionally over-involved when working with military personnel. I must remain open to my
client's desires and requests even when they do not align with what I would consider best
practice. Should I work with a client such as Chris Kyle, I would use an eclectic approach
working with PE and IFS with him and his family should they be willing. By choosing to explore
traumatic moments with a client, we can help them realize aspects of the event that they have not
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had the space to acknowledge. In doing so, I hope to assist my clients in developing their new
"normal" so that they can live their best lives.
Conclusion
Posttraumatic Stress Disorder has the potential to affect all individuals involved with the
person suffering from the disorder. The disorder is multifaceted and multilayered, and its impact
is vast. Our combat veterans are at the most significant risk and complexity of contributing
factors of PTSD. Until we no longer need combat veterans, it is our job as those in the helping
profession to continue educating and advocating for our servicemen and women who lay their
lives on the line daily for our freedoms.
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References
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