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January 09, 2009

No Heart for PTSD Sufferers - UPDATED
Posted by Michael Cohen

There was a rather dispiriting item in the New York Times today about the Pentagon's decision not to award Purple Hearts to soldiers suffering from post-traumatic stress disorder. According to the Pentagon, those affected by PTSD do not merit recognition because "the condition had not been intentionally caused by enemy action, like a bomb or bullet, and because it remained difficult to diagnose and quantify."

This is just an astounding statement - not intentionally caused? If the point of enemy action is to cause soldiers injury and harm - either by death or by wounding - than how does PTSD not qualify? Oh right, because those afflicted with PTSD aren't tough enough: they just need to "man up" and the they'll be fine.

A reflection of this disturbing mindset can be seen in the comments of one John E. Bircher III, director of public relations for the Military Order of the Purple Heart, a Pentagon-supported service group. According to Bircher, who apparently is a few credits short of a medical degree,  awarding the Purple Heart to PTSD sufferers would "debase" the award because “You have to had shed blood by an instrument of war at the hands of the enemy of the United States,” he said. “Shedding blood is the objective.”

Simply because their wounds are not evident to the naked eye does not mean they are not real and debilitating. In many respects, those who suffer from PTSD never truly recover and suffer through all sorts of deep psychological trauma. And as for the notion that it's difficult to diagnose; perhaps the people who made this decision should crack open the latest copy of the DSM.

One would hope that in the 21st century, with all we've learned about the debilitating nature of mental illnesses, that these sort of simple-minded and uninformed characterizations of "war injuries" would be restricted to the peanut gallery. But instead they are seemingly driving Pentagon decision-making.

This failure to recognize PTSD has real consequences. Not only will those who are suffering not receive the added -- and much-needed -- medical benefits that come to Purple Heart recipients, but the stigma around mental illness in the military is only perpetuated by this action. One can only imagine the chilling effect that this decision will have on soldiers already uncomfortable about facing mental illness.

Perhaps what is most disturbing is that only a week ago the New York Times ran another in a series of troubling pieces about the rising number of violent crimes being committed by service members who have returned from Iraq suffering combat trauma and stress.  Mental illness is a serious and growing problem in the military. Story after story has chronicled the rising levels of PTSD among returning Iraqi vets. Given a unique and important opportunity to begin confronting this challenge, the Pentagon has done a real disservice to its fighting men and women.

UPDATE: Several people have written about this post and made the oft-heard complaint that some PTSD sufferers may be "feigning illness" or that any diagnosis is based on the "claims of the sufferer" and thus cannot be completely trusted. Just to make clear, PTSD is a clinically diagnosable disease with specific criteria in the DSM-IV. Moreover, the effects of PTSD can last for months and even years; sometimes longer than those who actually shed blood in combat. I've pasted the DSM definition below:

The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).

Read the whole definition here.


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You have important points about the need to provide better care for soldiers returning with PTSD and other trauma induced problems, but by tying those points to the matter of whether the purple heart should be awarded for PTSD sufferers. It seems like you are trying to run off some of your potential allies and supporters for improved care by picking an argument with them.

As a Purple Heart recipient I fully support the Pentagon's decision not to award the Purple Heart for PTSD.

I am very sympathetic to those who suffer this terrible disorder and agree fully that the Military and the VA need to do more to recognize and treat our many soldiers and Veterans who suffer from this debilitating condition. More recently, they have become more aware of its effects and are offering treatment.

The criteria for this particular medal, however, is the suffering of physical wounds on the battlefield as the result of combat action by the enemies of the United States. There are many other kinds of injuries on the battlefield -- someone can have a leg crushed by a vehicle, you can be injured by friendly fire, you could be exposed to chemical or biological agents, you can even contract a life-long disease. After Vietnam, for example, those soldiers exposed to Agent Orange are now suffering from many diseases, including Diabetes. After the first Gulf war, many suffer from “Gulf War Syndrome.” Where do you draw the line? Moreover, PTSD is a treatable disease -- loss of a limb, or any combat wound for that matter, is permanent. And, what about those who feign the illness just to receive VA medical treatment; or, what about a group who witnesses a battlefield trauma together, but only one or two suffer from PTSD; should they all receive the Purple Heart?


Just for the record, this is not a new phenomenon, it just has a new name. Soldiers have suffered from "Shell Shock", "Combat Fatigue", and other symptoms since the beginning of warfare.

Since its inception in 1932, this Medal honors those who have spilled their blood or given their lives in the defense of their country. Expanding that criteria only denigrates its honor and those who wear it proudly.

As a sufferer of PTSD who does not have a purple heart, I also support this decision. PTSD is every bit as much of a wound as any physical one. However, PTSD can really only by diagnosed by the claims of the sufferer. If we allowed the purple heart to be awarded for PTSD, what would stop every soldier who deploys from claiming to suffer from it. whether they do or not, in order to receive a purple heart?

this is worth a look:

Or, instead of advertising our superior morality by finding fault with the military's adherence to the traditional criteria for the Purple Heart, we could address the reason mental illness is a "growing problem" in the fighting services -- frequent deployments to Iraq by the same units, deployments that for some soldiers began at such a early age and were so often repeated that normal civilian life in the United States seems scarcely real to them.

Now that their man has won the election, self-styled progressives have gone pretty quiet on this subject. The incoming administration appears poised to pursue a smaller, "smarter," but just as durable commitment in Iraq, but change is still coming, you bet. We can get the Purple Heart awarded to soldiers with PTSD! Ah, the spoils of victory.

I'm sure I'll be laughed off, but as a boyfriend of a PTSD sufferer from Iraq, this condition is much more debilitating than any physical injury. At least with physical injury, you get sympathy rather than fear. And at least with a physical injury, you have a much higher chance of getting disability payments. Plus, most likely with a physical injury you will still be able to work at a good job and your company will accommodate your disability. And suicide is a lot higher with PTSD (there's some blood for you!). But what more can we expect from the backwards macho idiots that run the Pentagon? Another slap in the face....

I know PTSD is a diagnosable injury. But think about this. Suppose I want a purple heart. After my deployment, I go to mental health and tell the psychiatrist I have night mares, jump at loud unexpected noises, have panic attacks in crowded rooms and while driving, etc. You see, anyone who has deployed has been around someone with PTSD and received countless briefings on the subject. You know what it is, and it wouldn't be that hard to get the diagnosis just for the award. This is why most Vets, including those like myself who have PTSD but no purple heart, feel a purple heart should not be awarded for PTSD.

Besides, a purple heart is just a metal. We need treatment, not awards.

PTSD is not easy to fake. You'd have to be a masterful actor for that. My boyfriend gets about $150 a month for his disability. He has a college education and the only jobs he can get are as a security guard for $10/hour. This is why we're retaining a lawyer and suing the military.

It would be difficult to fake living with PTSD, but it wouldn't be difficult to fake it for an hour in a psychiatrists office.

I am a rating specialist with the VA. I see probably ten or so PTSD cases a week. Some are pretty hair-raising, like guys getting blown up by IED's in Iraq, or even old guys that hit Omaha beach or fought at Iwo Jima. (Not too many of those anymore.) Then there are the guys who claim their stressor was seeing body bags, or hearing about a combat death in their unit even though they didn't participate in the operation. The most common among Vietnam vets is being on a base when it was rocketed. This can be pretty traumatic if your foxhole was hit, but what if you were a cook at Danang, which was a pretty big base, and it never came near you? I had one guy who was traumatized by digging a cat hole and finding a metal object which wasn't ordinance and didn't explode. But he thought it would. In all these cases, PTSD was diagnosed. To whom would you give a Purple Heart?

Not every case of trauma is the same, and IMHO, giving a Purple Heart for PTSD will make the medal meaningless. It is intended for those who suffered combat-related bodily injury or death. Period.

Cowards are human, they suffer and, thus, deserve our sympathy, but to reward them with positive recognition is to embrace cowardice as a value and correspondingly devalue courage and, indeed, sympathy itself.

For this act you have my sympathy, but, as a human, you are sadly lacking. I am sorry for you, my brother.

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