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.

Comments

[Caitlyn]

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.

[John Bircher]

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?

NO!

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.

[Richard Smith]

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: http://www.vetvoice.com/showDiary.do?diaryId=1248

[Zathras]

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.

[Chris]

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....

[Richard Smith]

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.

[Chris]

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.

[Richard Smith]

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.

[deb]

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.

[ThomasS]

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.

[Michael Paprocki]

I think I agree with not giving the Purple Heart to PTSD sufferers ... for an odd and dfferent reason. I don't think I would endorse or honor the mindset of those who created and award the Purple Heart by awarding it to more soldiers. I agree with one of the commentors (who has PTSD), that they need treatment, not medals. By putting such high value on being injurded in war - you are just glorifying war. Nothing about war should be glorified. It is in all respects a sad part of the human experience.

Michael Paprocki

[avedis]

This thread might be passe by now, but thought I'd throw in my 2 cents anyhow.........the purple heart for PTSD is a ridiculous notion contrary to the intended purpose of the decoration and contrary to military culture.

Anyone who has been in combat, especially intense combat for an extended period of time, is forever changed by the experience. Everyone comes back with some degree of emotional distress, disturbing memories, nightmares, etc. That is to say that just about all have some form/amount of PTSD. Combat arms personnel know this all too well.

Most managed to deal with all of this somehow and get on with life. Some adjust less well and a very few become too disfunctional.

So, from a practical standpoint, where do you draw the line to award the purple heart? How do you filter out those that would have become psychiatric cases even without combt experience? The age cohort of 18 - 25 - the age of the typical person serving in a combat zone at the tip of the spear - is exactly the age range when mental illness tends to manifest.

You can't. Nor would most military men want you to even if you could. Who would want to wear a purple heart if it could be mean that the wearer is veering towards a section 8?

That is why there are campaign ribbons and such. When these are worn on the uniform anyone who knows what they mean (i.e. military personnel) recognizes where the wearer has been and done. If the observer has, himself, been in combat he knows the traumas the wearer has lived through (as well as the bravery, the victories, etc).

These are symbols and messages for miltary personnel; not civilians. Civilians should stay out of the policies that lie behind the awards because they don't - can't, really - understand.

The purple heart is the military's way of letting an observer (looking at the uniform of someone he has just met) know that not only has the wearer seen and done some shit, but got wounded in the process.

The awards/ribbons are mostly not meant to be compensation. Rather a means of conveying quick recognition - like a resume - so men don't have to ask questions about another's military experience.

The military - especially combat arms - is a warrior society. It is about training to kill and then steeling one's mind and going out there and doing it; meaning rough men doing savage things. This should be obvious and I shouldn't have to state something so patently obvious. However, with posts like like Hilzoy's, I have to wonder if a reminder is perhaps needed.

Getting wounded in combat is a tough warrior thing to do. That is something that the society wants to share. Cracking up due to the stress of being in a combat zone is not a tough characteristic and the warrior culture eschews it.

After some of things I did and saw in the gulf war I could not eat red meat for two years. The sight of hot dogs frying on a grill brought back terrible memories (think about the photos you may have seen of massive slaughters on the hiway leading out of Kuwait. I once vommitted at a cook out because of this.

Should I be awarded a purple heart? Absolutely not. I know many other veterans who would feel the same if the question was posed to them though many have become alcoholics, have anger issues, nightmares and all that; some to this day even though their war was as far back as Vietnam.

That being said, PTSD is real, there should be an effective process for identifying it and treatment should be well funded and top notch. Any imposed stigmas should be ameliorated as much as possible. Handing out the purple heart is simply not the right way to accomplish any of this.

[Norma Molampy]

As the widow of a Vietnam vet who suffered from the effects of Agent Orange for many years, let me tell you, it would have been an easier death for my husband (and probably more welcomed), had he been killed in combat versus the Hell and debilitating diseases he went through for years before finally dying from several related Agent Orange diseases.Just to name a few, diabetes, neuropathy, heart attack, stroke and blindness. Before his death, rarely would a day go by that he would not wish for death. Even though he may not have been wounded in combat, the wounds he carried for years after (along with the pain and suffering) were just as grave as those received by his comrades in combat who were awarded the Purple Heart for their injuries. If given a choice between being shot, killed in combat, or living with the consequences of Agent Orange until it eventually drains the life out of you, I'm sure my husband and many other A.O. victims would have chosen death in combat, because life after combat, "began their real Hell". Even if our government (even to this day), does not feel the need to recognize the Agent Orange casualties with the Purple Heart, then surely, wouldn't you think that they could have at least given them a certificate thanking them for their service and acknowledging their Agent Orange diseases.However, my heartfelt thanks goes out to those folks responsible for giving our Agent Orange victims the next best thing to the Purple Heart, and that is the Silver Rose, along with a certificate acknowledging their service to their country and exposure to Agent Orange.
So... whether one died in combat, or by chemical warfare, bottome line is, they all fought for our freedom, and recognition of their sacrifice to their country should be the same.
However, this is only my opinion, and you all are more than welcomed to yours, so all I have left to say is Thank God my husband is now home with the Lord and pain free. God bless.

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[Mack B]

I am an OIF vet and work with the Wounded Warrior program and about 1/2 of those claiming PTSD were physically injured in combat. That supports a stressful event and they need support to recover. Others unwounded have proof that they were in harms way and could have PTSD, Their proof is a CIB, CAB, CMB, letters from their chain of command, etc. But for the other half of these unwounded warriers, (25% of those claiming PTSD,) They have nothing that proves they were in combat or stress. No CIB, No CAB, No CMB, No injury, No letter from someone reliable. When asked who their squad or platoon leader or Platoon or First Seargent, they suddenly cannot remember who they went to combat with that will support their story. (I remember my Plt SGT, SL and PL from 20 years ago). When the Chain of Command is contacted they usually say the soldier did not see any combat. Most (not all) of these soldiers are lying by saying "It was Horrific, I felt helpless, I don't like crowds, I dodge potholes, I hate standing in formation, ETC." all phrases they learned from fellow fakers in order to get a PTSD rating from the Army and the VA. The psyciatrists don't have time to check the soldier's background. Some of these soldiers never deployed or only deployed to Kuwait. Most never left the FOB. I truly support those who do have PTSD, but those committing fraud should be investigated and punished. But sites like this make that politically unacceptable to call a fraud a fraud.

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[Mirellys]

My dad is alive today by a miracle. Got ambushed in Vietnam, almost lost his life, was hit all over. Almost bled out to death. Still has open wounds on his right arm, a plastic major blood vesselin his neck, took a bone from his leg to save his arm, has a scar about 7-8 inches long and 1 inch thick going down his back from an entry wound scar on his neck, the blood in him today is from transfusions, etc.. I shouldn't be here. Can't believe he lived through that. He received a Purple Heart. THAT is what deserves a Purple Heart! "He who wears the Military Order of the Purple Heart has given of his blood in defense of his homeland and shall forever be revered by his fellow countrymen." So, no, PTSD does not merit a Purple Heart.

[Mirellys]

"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." - Deb

So true.

[Edward Ben Silva]

How To Earn a Purple Heart
Which injuries are medal-worthy?
By Sam Schechner
Updated Wednesday, Aug. 25, 2004, at 4:14 PM ET

In honor of war woundsYesterday, Bob Dole joined Republican critics who claim that Democratic presidential nominee John Kerry doesn't deserve the Purple Hearts he won in Vietnam. Dole said, "three Purple Hearts and never bled that I know of. I mean, they're all superficial wounds." But is bleeding even necessary? How do you earn a Purple Heart?

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Yahoo! Buzz FacebookMySpace Mixx Digg Reddit del.icio.us Furl Ma.gnolia SphereStumbleUponCLOSEA Purple Heart is awarded to any member of the armed forces (including the Coast Guard) who is killed or wounded in action; the severity of the injury isn't really at issue. According to Navy regulations, a worthy wound is merely "an injury to any part of the body from an outside force or agent, sustained while in action. … A physical lesion is not required, provided the concussion or other form of injury received was a result of the action in which engaged." The other services' regulations include similar language, stipulating, as the Army's does, that "the wound for which the award is made must have required treatment by a medical officer and records of medical treatment for wounds or injuries received in action must have been made a matter of official record."

In other words, a Band-Aid boo-boo is fair game, so long as enemy action is somewhere obvious in the causal chain. Bruises from bailing out of a plane that's been shot down could count; training injuries could not. (Interestingly, the Army rules that post-traumatic stress disorder doesn't count either.)

[Edward Ben Silva]

You dont have to shed blood!! It's combat, and anything the enemy does to disable/injure/kill the U.S. Troops is considered a combat related injury.....and therefore should qualify for such an award.

[Edward Ben Silva]

What about the Sarine Gas that was used on us in the first Gulf War? Research shows that were are starting to see a new phase of mental injuries starting to arise. Hell, our own U.S.D.A wouldn't even approve the nerve agent pills that were administered to us.... What does that tell you??? Can you say Fucking-Guinea pigs!!!

[Edward Ben Silva]

Heeello!!! Are you people serious!!! According to Navy regulations, a worthy wound is merely" an injury to ANY part of the body from an outside force or agent, sustained while in action..... A physical lesion is NOT required, provided the concussion or other form of injury recieved was a result of the action in which."
Oh... it gets better! The Army's requirements for a P.H. is just for the wound for which the award is made must have required treatment by a medical officer and records of medical treatment for wounds or injuries recieved in action must have been made a matter of official record." G-T-F-O-O-H!!!

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[LR]

I am a Vietnam veteran. I have a service connected PTSD disability rating and an Agent Orange disability rating. My PTSD history was fully documented and investigated. I had all of my after action reports, stressor letter for the action itself, and years of treatment by the VA Behavioral Medicine section. I have received weekly counseling for years and the VA says I still have long term and severe PTSD. I take medicine for it ad naseum. As for my Agent orange rating, I have survived cancer, a severe cardio infarction resulting in a quad bypass surgery, have bi-lateral peripheral neuropathy, bi-lateral sciatica, high blood pressure, diabetes type 2, and several other Agent Orange related conditions. I served my complete tour in Nam and did my duty honorably on the tail end of a four year voluntary enlistment. I've lived with these disabilities and fought with the VA disability compensation people for over 30+ years over them. Using military and VA dianoses, treatment notes, medication lists, and letters from my physicians, the VA has FINALLY decided I'm 100% disabled. My final journey on the disability road took me to the U.S. Court of Appeals for Veterans Claims in Washington D.C. with an attorney. The court reviewd ALL of my military records dating back to my draft physical and made the determination that the VA had been royally screwing me for many years. The VA was ordered to expedite a correction of the problem in my favor.

I might surprise you. I don't want a Purple Heart award. I respect the original criteria. PTSD and Agent Orange WOULD cheapen the Purple Heart award, much like changing the Army Ranger black beret to tan and giving the black beret to run-of-the-mill army personnel did (in my mind). However, I see no problem in receing a ribbon (only) for the 20+ years my life has been shortened by Agent Orange. That might be nice to pass on to my children. It would be part of my legacy (along with the burial flag). There ARE 'ribbon only' awards. I suggest something like an all black ribbon with a pewter metal caduceus device (symbol) in the center for PTSD/Agent Orange sufferers signifying their ongoing medical disabilities .

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