Tuesday, January 6, 2009

On Purple Hearts and PTSD: Pentagon Says Stress Injury Does Not Merit Award; Defense Department Language Betrays a Preconceived Mindset to Dismiss

The Pentagon confirmed yesterday that it will not award the Purple Heart for combat-induced Post Traumatic Stress Disorder. Defense Department spokeswoman Eileen Lainez announced that the affliction, which even struck Achilles, is "not a qualifying Purple Heart wound.”

Technically, DoD is correct. The Purple Heart guidelines specify that the award be given to servicemembers whose injury "...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, by definition, is a "secondary effect."

However. And there is a big "however." The evidence shows unequivocally, PTSD can wreck lives. My own father was awarded the Purple Heart for wounds sustained in combat in Korea. He recovered well. But I am convinced that PTSD, for which he received no medal nor treatment, had a hand in his death.

I understand that much stigma is attached to the PTSD label. Troops remain reluctant to acknowledge symptoms. In addition, both society and the military leadership view the disorder with mixed feelings. Is PTSD an easy out for malingerers? If you have it, does it mean you're nuts? If we admit that combat is bad for the troops' mental health, does this mean we can't ever go to war? The short answer, to all three, is a resounding "no."

Nevertheless, we remain faced with the question: Should we acknowledge PTSD within the context of an award? The Pentagon has issued its ruling. But in doing so, DoD also has used code words that betray its prejudice:

"Historically, the Purple Heart has never been awarded for mental disorders or psychological conditions resulting from witnessing or experiencing traumatic combat events — for example, combat stress reaction, shell-shock, combat stress fatigue, acute stress disorder, or PTSD."

In dredging up these highlighted terms, some of which have been used in prior wars as dismissive sobriquets, this particular Pentagon commission reveals a preconceived mindset: Do you have PTSD? Get over it.

I don't pretend to know what's best in terms of a PTSD award. I never have served in combat, and I never have been faced with the question of whether to announce my injuries to the world at large. The PTSD-award decision is best left to the troops themselves. I'd very much like to see their thoughts on this matter.

This blog has addressed PTSD at length. You can view the full collection here.


Bouhammer said...

As a veteran of two wars and someone who has been diagnosed with PTSD, I agree with the DOD. It does not warrant the awarding of the Purple Heart. As MOH Winner Paul Bucha told me, everyone who engages in combat comes back with some level of PTSD. The last thing we need is a whole bunch of fobbits running around with PH plates talking about how that rocket that landed 500 meters away from them gave them PTSD and a PH.

Mrs Greyhawk said...

I think you'll find many veterans will agree with Bouhammer.

Susan Katz Keating said...

Many thanks, Bouhammer and Mrs. G. Your comments carry considerable weight.

Some Soldier's Mom said...

I have a son who has a PH for the wounds he received in Iraq. He also was medically discharged for chronic and severe PTSD from which he still suffers and for which he still receives treatment. When this proposal was originally raised, he unequivocally and without hesitation stated that the PH s/ NOT be awarded for PTSD. He feels that because PTSD can also be caused by non-combat traumas and is difficult to pinpoint exactly when/how it develops, it would diminish the awarding of the PH for combat wounds. He also believes that most soldiers would not wear a PH if awarded for their PTSD for the same reasons. And stigma is only part of it.

On a first-person basis, our family can personally testify as to the effects of PTSD and we concur with our son.

CJ said...


I've taken a lot of flack for my stance on this as well. I've also been diagnosed with PTSD (though it took me 4 years to even see someone and only then because I was forced) and I agree with the DoD. I even wrote a piece on this on ASP last year when it first came up as an option.

I agree with Bouhammer that it's not what the Purple Heart was intended for. War sucks and affects EVERYONE. No one comes back from combat the same person they left as. What's next? Purple Heart for people who can't socialize because they're afraid of everyone? I can't see how you can compare someone who was shot, mortared, lost an arm, leg, etc and someone who can't sleep at night as deserving.

And how do we draw the line of what is "combat-related PTSD"? Rolling a vehicle off a bridge or barely escaping a drowning truck could cause someone to experience PTSD. Do they get a PH? I was robbed at knife point and suffered PTS on an assignment in a foreign country. Do I get one for that?

The regulations is very specific that the PH is presented to those that have "been wounded or killed, or who has died or may hereafter die after being wounded." Since when does any medical professional characterize a disorder as a wound.

Wounds are defined as "an injury to any part of the body from an outside force or agent sustained" during combat operations against an enemy. People get PTSD from being in car accidents!!

I'm glad the DOD came to this conclusion. It was the right choice.

Bill and Bob's Excellent Adventure said...

I'm with Bouhammer and CJ on this one, Susan. Your concern for this issue is admirable. The Army is doing a considerable amount to raise awareness, but in the end the perception of soldiers and leaders concerning PTSD is one of education vs prejudice. Keep in mind that PTSD is also the poster-child of those who would label soldiers as "victims," something that I'm particularly opposed to. Evidence of this can be seen in last year's series of articles in the NYT by Lizette Alvarez, which had a particularly nasty slant against combat veterans, evoking a "Deer Hunter" mentality towards veterans. Combat action badges and ribbons demonstrate that a soldier or Marine has been through the stress of combat, and we are learning that it affects all of us to one extent or another.

CJ said...

I'd like to add a caveat, if I may. While I don't think the PH should be given for PTSD, that doesn't mean that I don't think PTSD is a legitimate issue. It's very important that we treat is as a serious threat to the lives of our troops. Just as we don't award a PH to sufferers of asthma to those who have suffered from the smoke of burning buildings brought on by enemy bombardment or a burn pit but treat it medically, we should pay attention to the effects and causes of PTSD. Thanks for hearing me out.

Anonymous said...

From "Grumpy"-

This is a very complex subject, we need to walk with respect for both the "Purple Heart", but we also need to respect the disorder. DoD has an all or nothing attitude about many things, this is just one. It appears to be saying, PTSD can not even be on the table of consideration. IMHO, I believe we should NOT give the Purple Heart for PTSD, ALONE. But it should be on the table for consideration, with other Purple Heart Qualified Wounds.

Removal of PTSD from the table, attacks the honor or truth of the system. As George Washington rightly warned us 1789, this will influence the young in their choice to join the Military. I respectfully ask you to walk very carefully.

As always,

Anonymous said...

Grumpy says,

"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the veterans of earlier wars were treated and appreciated by their nation" -George Washington 1789

This is the reason I asked for caution in our considerations.

V/R Grumpy

LT Nixon said...

Good ruling on the DoD's part. It might lead to people in the service fudging their condition to shrinks to get it awarded, which would take away from bona fide Purple Heart winners.

@thepointyend said...


I must agree with comments made by Bouhammer and others. As a veteran of 28 years, with two tours in Iraq and a PH recipient, I can tell you that most of our young men and women who are "in the fight", and by that I mean those whose lives are at risk - on or off the FOB - come home with some level of PTSD.

Contrary to your perception of the DOD's preconceptions, I believe that the Department is keenly aware of the pervasiveness of PTSD in the force and is trying to do something about it. Regulations have been changed so that soldiers applying for clearances don't have to mention seeing a mental health professional regarding combat-related issues. And the briefings, counselings, and questionaires required to both get into theater and return are numerous. I'm not suggesting that DOD is doing enough, but I don't they thier approach is "Get over it."

The challenge, as with many mental health issues, is predicting and measuring individual responses to the same stimulus. I've been back a month and still flinch at every loud noise. At the same time, despite the number of wounded and dead that I've seen, I had no problem dealing with an ER visit for my youngest while home on leave, even though he was bleeding profusely after a fall. Others might have just the opposite reaction to those to stimuli after having similar experiences in Iraq.

DOD and the VA must redouble their efforts to commit resources to the study and treatment of PTSD, and recognize it for what it is - a NATURAL reaction to the violence and carnage of war. Don't stigmatize PTSD or the soldiers who have it. Treat them.

Anonymous said...

My father who earned the PH for sevice in viet nam and also suffered from PTSD said to me that he recovered from the wound that gave him the PH. But thought It should more so be given for the wound that never healed and disabled him for life

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