The trial of the man accused of killing Chris Kyle opens this week with a legal question wrapped in Hollywood irony.
Will post-traumatic stress syndrome become the legal defense for murdering the "American Sniper" — a man who helped other veterans battle the same affliction?
Attorneys for defendant Eddie Ray Routh, an Iraq War veteran, have asked prospective jurors whether they would consider an insanity defense. Moments after the 2013 shootings of Kyle and a friend, Routh's family told police that Routh was diagnosed with PTSD and stayed at a mental hospital.
Among hundreds of thousands of Iraq and Afghanistan veterans living with PTSD, some openly worry that a weighty trial built on an insanity defense will reignite PTSD's social stigma.
And they fear that any case linking PTSD to the attack on a hero to many Americans will deepen misconceptions about the disorder — false associations that worsened veteran unemployment and made some service members reluctant to seek help.
"We don't want the civilian world to be intimidated by us, to be scared or to wait for us to come in and shoot up people. I feel like that's what this is going to do," said Andrew O'Brien, a former Army convoy gunner who served in Iraq in 2008 and 2009, surviving an IED blast. He attempted suicide in 2010. He was diagnosed with PTSD and now speaks at military bases about his survival.
"It's such a big case that it's going to make us look like we're crazy, and we're not," added O'Brien, 26. On his first post-military job interview at a Texas ranch, the owner looked the veteran over and asked: "Do you have PTSD?"
"I've talked to a lot of people with PTSD. It's my job. After every speaking engagement, people come tell me their stories," O'Brien said. "They never tell me: 'I've had homicidal thoughts' or 'I thought of hurting someone.' It was always, 'I thought of hurting myself.'"
Kyle, a former Navy SEAL sniper, similarly had devoted much of his post-combat life to helping veterans with PTSD. He helped launch an organization that provided fitness equipment to wounded warriors.
And Kyle, 38, reportedly agreed to work with Routh, then 25, by taking his fellow veteran to a shooting range near Fort Worth, Texas. Routh is accused of turning his gun on Kyle and Chad Littlefield, 35, killing both. "American Sniper," an Oscar-nominated movie about Kyle's experiences in combat and upon returning home, has grossed more than $200 million, further elevating his stature.
While Routh's defense team may introduce the defendant's PTSD struggles, a leading expert on the disorder emphasized that homicidal urges are not a known part of the syndrome.
"They don't generally don't get guns and shoot people," said Dr. Harry Croft, a San Antonio-based psychiatrist who has treated veterans for combat-related anxiety and substance abuse.
The core symptoms of PTSD include irritability, agitation and anger, Croft said.
"But they get angry at other stuff, and tragically, usually, if there is any physical part of that anger, it's unfortunately with family members, especially with spouses and people close to them. But rarely even then is it murder," Croft said.
"Even in the combat zone, [troops with PTSD] don't just shoot indiscriminately. They follow orders, and they do what they're supposed to do. And post-combat, people have nightmares and flashbacks, true, but they don't do this kind of behavior."
Also vital to understand, Croft said: Insanity is not a medical term. It's a legal term.
But PTSD arising from recent combat has been used as a legal defense for murder.
In 2008, Jessie Bratcher, an Army veteran who served in Iraq, shot and killed an unarmed man after he returned to Eastern Oregon. Then 26, Bratcher committed the act during a PTSD-triggered flashback, his lawyer argued. He was found guilty but insane and sentenced to the jurisdiction of the state Psychiatric Security and Review Board for life, as long as he was mentally ill.
In February 2014, Bratcher was released after a hearing determined that he no longer suffered from PTSD. His case was the first instance in which PTSD was used legally to mitigate a murder conviction, said Markku Sario, the veteran's attorney.
Today, Bratcher is feeling well, Sario said, but declines interview requests.
"We spoke today," Sario said last Thursday. "He said he just doesn't want to be the poster boy for PTSD anymore."
Jurors tend to be skeptical of insanity defenses, including those in a case involving a combat vet with PTSD, Sario said.
"Mr. Bratcher had been getting [PTSD] disability payments from the VA for 2½ years before the shooting. So there was no question about it," Sario said. "His Humvee was blown up by an IED. His best friend was killed in front of him. He saw horrible things."
During his five years confined to the hospital, Bratcher underwent 3,000 hours of PTSD treatment.
"In this anxiety condition, everything is a threat. These guys are walking on fight-of-flight syndrome. I would suggest that, in people with PTSD, their perception of threats is damaged," Sario said. "But even if that perception is wrong, all their military training kicks in and says: 'Eliminate the threat.'"