Purple Hearts & PTSD ?

PTSD And The Purple Heart

New York Times
Jan 12, 2009


The Pentagon’s recent decision not to award the Purple Heart to soldiers suffering from post-traumatic stress disorder strikes us as reasonable and well considered. This is not to say that the result was uncomplicated or unlikely to cause understandable sadness and pain.

The military has always honored the sacrifice of veterans who are wounded in its wars. But it has been slow to recognize that those wounds can include invisible injuries: the nightmares, rages and terrors of PTSD, which are as real as any scar or missing limb.

PTSD can be difficult to diagnose, with symptoms that can arise later in life, far from the battlefield and are not necessarily linked to any specific actions of an enemy. So the Pentagon contends that it has no choice but to exclude its sufferers from the Purple Heart, given to those whose injuries result from direct and intentional action by the enemy. Doing so would not debase the medal, as some defenders of the Purple Heart callously put it, but it would change it, perhaps in unintended and unwelcome ways.

The main criterion for awarding the Purple Heart has always been bloodshed. Those looking for absolute fairness in this distinction will never find it: a soldier who cowers or blunders into harm’s way will receive his medal just as surely as his quick-thinking, unscathed buddy will not. A soldier whose lacerations heal completely will wear the same medal as someone who has lost a limb or been paralyzed for life.

None of this relieves the military of its duty to fully honor those whose injuries are unseen. A Purple Heart may not be the answer — not until, perhaps, advances in brain science bring full objectivity to the diagnosis of mental injury. But PTSD sufferers surely deserve medical care every bit as diligent and excellent as what their fellow veterans receive for more visible injuries. The Pentagon has been prodded to do so by the deadly innovation of the current war: the bomb blasts that have exacted such a deadly toll in brain injuries.

The military is, in fact, moving forward merely by mentioning PTSD and the Purple Heart in the same breath. Imagine Gen. George Patton, who so notoriously slapped a quivering enlisted man, learning that his beloved Army was even considering giving medals to those whose combat tours left them mentally shattered.

But there is far more to do. Recent veterans of Iraq or Afghanistan will tell you that the military stigma against mental illness has not abated, that the combat ethos — suck it up, soldier — persists and that some officers continue to belittle the severity, and even question the existence, of post-traumatic stress.

At least 300,000 service members who were in Afghanistan or Iraq show symptoms of PTSD. They know a truth their forebears of Vietnam, Korea and World War II have lived with for years: war injures everyone it touches.