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August 2017

Lessons from “American Sniper”; citizen of the world; trauma journals


When President Trump declared the opioid crisis a national emergency earlier this month, I planned to write about that in this month’s  Tips &  Topics. However I am commencing this edition on a 13-hour plane ride back from Australia. That may sound like a long trip you wouldn’t want to make. Yet I’ve done it so many times- a couple of movies, a couple of meals, a few hours’ sleep and presto! You’ve arrived in San Francisco, non-stop from Sydney.
One inflight film I watched changed my whole plan for  Tips &  Topics. I am in awe of the impact a well-written, well-directed and acted movie can have to raise awareness, educate and catalyze empathy and understanding….in just over 2 hours. Not a brand new movie; just hadn’t yet gotten around to seeing it despite its excellent reviews.
Insights, information and inspiration I gained from the 2014 film “American Sniper”
Bradley Cooper’s portrayal of US Navy SEAL Chris Kyle in “American Sniper” is praised as one of his best performances. That is fitting since the life of Chris Kyle, if the movie accurately portrayed him, was also outstanding. Even if there were Holly wood inaccuracies, the messages and impact remain authentic for me.
Here, in no specific order, is a list of what touched me :
1. The total barbarity of war – the wars in the Middle East (and elsewhere) have been going on for so long, that news of another serviceperson’s death barely raises a flicker emotionally, I am sad to say.
2.  “People are dying and we’re going to the mall” – It was words to that effect in the movie that reminded me how untouched most of us are by the wars. Fortunately now we treat the courage of all who serve in the military with great respect, unlike what happened in the Vietnam War; or as those in Vietnam call it “the American War”. But is it enough to let service people board the plane first ahead of even the most frequent flyers, honor them at the beginning of ballgames, and say “Thank-you for your service”? I know I am really am grateful for their service, but is that just because I’m glad it’s not me?
3.  Posttraumatic Stress Syndrome  I thought I knew PTSD and what active duty and returning military personnel go through. But this movie ‘hit me in the gut’- what it’s really like for the person, spouse, partner, children plus friends and extended family:
  • To be emotionally present: how incredibly hard is for the service person returning from a tour of duty, to try to live a regular life after the terror and trauma of war.
  • To simply hear ordinary sounds and experiences: These can so easily trigger rage, fear, and automatic aggressive reactions – e.g. the sound of the car mechanic’s drill triggering the memory of the terrorist’s drill torturing a child; a convoy of commercial trucks sounds like the beginning of a military operation; playful wrestling between the family dog with a child at a barbeque looks like the child is under attack.
  • The pain for loved ones to understand what is going on: It is so hard for the serviceperson to talk about what has happened to them and what is changing in their thoughts, feelings and behavior.
  • The partner’s pain: How painful it can be to love and be with the person who is not now the one you loved and married.
4. Trauma of the victims of war – Seeing what the citizens of the war-ravaged countries experience at the hands of both our military and the terrorists is heartbreaking. Both sides in the conflict believe they are doing “God’s work”. The civilians caught in the middle have no say, are at the mercy of their inability to flee and escape the unthinkable conditions I doubt I could survive.
5.  Camaraderie and the mission – When there is a sense the mission is noble and worth dying for to protect home and country, the bonds formed in the military sustain the courage and grit needed to face the physical, mental and emotional demands of war. When the belief in any mission fades, only fear, tiredness and disillusionment is present.
6.  Emergency services in the battle and healing support on return 
The courage and sheer will it takes to be on the frontline is remarkable. In addition, there are so many others giving so much to save the lives of the wounded. For returning veterans, especially those with PTSD, they need easy access to all the services necessary to reintegrate back to “normal” life – housing, jobs, mental health services, physical health care and rehabilitation. Veterans Health and the Veterans Administration (VA) have such an important role.
7.  Restoring hope – When Chris Kyle thought the only way to save more lives was to return to a fifth tour of duty in Iraq and kill the enemy, an astute clinician offered an alternative. He walked Chris through the halls of the VA to meet those who’d lost limbs, self-confidence, hope and health. There, he found a different, but equally effective, way to ‘save lives’ in service to returning vets. This not only restored hope for those he served, but also restored himself. His wife and family got back the one they loved.
8.  War at home – I still believe there has to be a way for people to come together……come together not just in the big wars of the Middle East and North Korea and the many other hotspots of the world. But come together in the battles between:
  • White and black; white supremacists and multiculturalists
  • The different colors of race, religion and ideology
  • Climate change deniers and believers
  • Republicans and Democrats
  • Factions in Congress
  • The President and many of the citizens he serves
And the wars at home between:
  • Spouses and intimate partners in daily physical, mental and emotional battles
  • Siblings who don’t talk
  • Parents and estranged children
  • Grandparents separated from their grandchildren
  • The lonely, isolated and abandoned people at war with their depression and pain.


I am also in awe of the actors’ skills to make fact or fiction come alive on the Big Screen. They make us think, laugh, cry, horrify or inspire us. We work in the behavioral health field; here’s a few thoughts on our skills important to our mission and what we do.
Consider: what can you think, feel and do to help people thrive in the battles with addiction and mental illness?
Here, in no specific order, is a list of what comes to mind :
1. Nonviolent Communication
I have written before about understanding that behind violent words, behaviors and thoughts are universal feelings and needs to be recognized addressed and satisfied.
Tips &  Topics, February 2007
Tips &  Topics, March 2010
2.  Keep an open mind to other methods, theories and practices
How aware are you of other treatment models and strategies different from your own training and experience? Do you fervently defend your approach out of ignorance, fear of feeling incompetent in other methods, or because this is what worked for you in recovery? In addiction and mental health, we have the battles between:
  • Medication in addiction treatment and abstinence-based treatment:
    “We don’t believe in medications here – it is just substituting one drug for the other.”
  • Harm reduction and abstinence-mandated services:
    “Harm reduction is a last resort for people who fail abstinence.” Do you think harm reduction is a good thing or bad?
  • 12 Step approaches and Moderation Management or behavioral therapy to teach controlled use.
  • A focus on psychotropic medication versus psychosocial and community-based interventions:
    Why is Pharma called “Big Pharma”?
  • Treatment and prevention:
    Where do the majority of funds go to: treatment or prevention? How much does lifestyle affect chronic disease development and healing?
3.  Posttraumatic Stress Syndrome  Fortunately there is an increased awareness, education and skills in building trauma-informed services and systems. Films like “American Sniper” and talking with those suffering with PTSD and their families connect us to the full impact of the human experience.
4. Trauma of the victims of war 
I have not personally worked with refugees of war-torn countries and immigrants settling into the United States. We have so much to learn from those who work in this arena. In the current political climate, it is disturbing to me how little empathy we have for these victims of war. What can our country, rich in resources and opportunities, do for so many people whose lives have been devastated by the guns, bullets and bombs of us and the terrorists?
5.  Restore hope and a sense of mission  Many we serve have lost hope and any optimism they can recover. They doubt they can change and overcome their loss of control of substances, gambling, depression or mood swings. Having a sense of hope has more positive impact in treatment than even the evidence-based practice used. Guiding people to take even ‘baby steps’ of success can build hope for recovery.
Holding onto hope and retaining a sense of mission can be challenging for clinicians themselves faced with:
  • Increasing case-loads
  • Decreasing funding
  • A rapidly changing healthcare system with performance measures, electronic health records, strict managed care, productivity expectations and population management
  • Compassion fatigue and burnout
Who helps the helper? Who supports and nurtures the carer? What can you do to stay centered, empowered and hopeful? What are you doing to handle and resolve the battles and conflicts at home with your loved ones, estranged friends or family and at work with supervisors, colleagues and administration?
6.  Holistic whole person care
Treatment isn’t just about abstinence, faithful support group attendance, medication adherence, psychosis stabilization and staying out of the hospital. Just as important is paying attention to the following:
  • Does your client have a safe place to live? – maybe a Housing First service takes priority over getting abstinent and sober first.
  • Do they have transportation, money to buy food, a drop-in center to feel a sense of community?
  • Can they access physical health care for their blood pressure which hasn’t been checked for years or for teeth unattended to in decades?
  • Will the person be bounced between addiction, mental and physical health systems when they need integrated co-occurring or complexity capable services?


In many ways, I consider myself a citizen of the world. Growing up as an Australian-born Chinese kid in a then predominantly white Australia (they even had an explicit “White Australia” policy from 1901 which officially ended 1973), I had to learn my place in that world. I love foreign travel and the stimulation of experiencing different cultures and customs.
However I also have two countries I call “home” and two passports to prove it – an Australian passport for my country of birth; and a US passport for my adopted country where I have lived almost twice as many years as Australia. As I return now from Australia, I smile at the little things I always look forward to experience nostalgically when I return home:
  • Eating an Aussie meat pie – so much better than an American pot pie
  • Eating a lamington – even a lot of bakeries in Australia have stopped making them: sponge cake covered in cocoa or chocolate topped off with desiccated coconut, cut up into little rectangles or squares of about 3 by 4 inches. But the size varies, so that’s also part of the fun.
  • Aussie hamburgers – Of course McDonalds and Burger King’s equivalent called Hungry Jacks are everywhere. But a real old-time hamburger has handmade hamburger with lettuce, tomato, beetroot and a fried egg between a mouth-widening bun.
  • Vegemite in both my “home” countries – we always bring back some jars so we can have toast spread with Vegemite and avocado in both Australia and the USA.
There’s more eating memories, but onto a few other animal experiences you could relate to as a tourist: the huge variety of birds from colorful lorikeets, flocks of white cockatoos, laughing kookaburras and many more birds; cuddly sleepy koalas on our hikes. You have to watch out for kangaroos at sundown just like avoiding deer on the highways.
  • Aussie beaches – wide, long expanses of sparsely trafficked, fine
    Brunswick Heads, New South Wales

    sandy beaches. No pebbly, rocky, narrow, coarse sand beaches for me!

  • Australian currency – besides an exchange rate with the US dollar favorable to the US visitor, the actual notes and coins are both attractive and practical. There’s a one and two dollar coin – no $1 or

    $2 dollar notes. All the Aussie notes are brightly colorful, easy to distinguish. Somehow they’re manufactured with material that’s always so smooth, durable and new-looking. They don’t crinkle up as they get old; they stay flat and compact in your wallet. Take a look at your US dollars and see if they meet the same criteria.

Well that is surely enough of what I look forward to. Thanks for indulging my nostalgic experiences. They are certainly not enough for me to up and leave all the stimulating and gratifying experiences of my adopted home.
In this world of ours, so torn by conflicts and wars and pain and suffering, how could we all become citizens of the world? What would it take to be proud of our country while also shunning intolerance, isolationism, hate and bigotry? How might we embrace empathy, inclusion, community and the fulfillment of universal human feelings and needs?
I know I am naïve and idealistic.
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