Should Troops with PTSD Get The Purple Heart?

Here’s an issue that’s been near to my heart for a while. My bachelor’s degree is in psychology, and I strongly considered becoming a psychologist as late as my senior year of college. In grad school, I worked on a short-form documentary about milblogging – military blogging – and one of the main goals was to explore why it was a growing phenomenon. One of the reasons we uncovered was that blogging is a catharsis, and due to the high prevalence of post-traumatic syndrome in veterans, journal-writing is a self-therapy employed by many.

If you’d like, you can watch the documentary here.

According to multiple sources, the Pentagon has reached a decision not to award the Purple Heart to active-duty members or veterans of our military who suffer with PTSD.

Their rationale?

“The Purple Heart recognizes those individuals wounded to a degree that requires treatment by a medical officer, in action with the enemy or as the result of enemy action where the intended effect of a specific enemy action is to kill or injure the service member.”

“(PTSD) is not a wound intentionally caused by the enemy from an outside force or agent, but is a secondary effect caused by witnessing or experiencing a traumatic event.”

“Based on the definition of a wound, ‘an injury to any part of the body from an outside force or agent,’ other Purple Heart award criteria, and 76 years of precedent, the Purple Heart has been limited to award for physical wounds, not psychological wounds.”

“Current medical knowledge and technologies do not establish PTSD as objectively and routinely as would be required for this award at this time.”

I would, of course, dispute all of these findings.

In traditional warfare, the goal of the enemy was, indeed, to “kill or injure the service member.” But tactical warfare has expanded to include psychological warfare. If our enemies are classified as “terrorists,” what is their goal? Of course – it’s to increase “terror.” That’s the primary goal, not a “secondary effect.” On the complete, polar opposite side of the spectrum, what was the goal of our “Shock and Awe” operation in Iraq? The name itself is explanatory. The goal in any modern military offensive is to strike at a psychological level first and foremost.

We also need to expand our definition of what a “wound” is. There’s not much of a debate in the medical community: the psychological is also physical. In PTSD, neural pathways are indeed rewired. Thoughts of those suffering from the disorder are processed in a different manner. There’s a physical change in levels of neurotransmitters. Ask anyone with PTSD if they have wounds. They’ll tell you that their wounds are far, far worse than any physical one. Physical wounds can ultimately be repaired (for the most part), but many with PTSD live and suffer with their wounds for the rest of their lives.

I’d also dispute the notion that there is no objective way to establish a presence of PTSD in a human being. The DSM-IV, the “Diagnostic and Statistical Manual,” had extremely objective and rigorous criteria that must be evaluated to diagnose the prevalence of PTSD. It’s quite systematic. Take a look at the criteria yourself.

Ultimately, we should look at was the original goal that was intended with the Purple Heart. My belief is that it was designed to honor courage, recognize strength through adversity, and identify those who have overcome unimaginable struggles. Is that not what military heroes who battle PTSD should be appreciated for?

One thing that I should add: although I’m disappointed by the decision, I do, however, strongly respect Defense Secretary Robert Gates’ exploration of the subject. It turns out that the notion of awarding Purple Hearts to those who suffer from PTSD was suggested as a question during a briefing back in May. That suggestion prompted this panel to explore the option. Ultimately, it was a suggestion that was taken seriously, and I commend Secretary Gates for his sincere effort in evaluating its merit.

What’s your take on this? In your view, does PTSD constitute a “wound” worthy of the Purple Heart?

~ by Brad Levinson on January 7, 2009.

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