The Purple Heart Should Be Given to Veterans Suffering from PTSD

Essentially the Pentagon believes that if a wound cannot be seen, then it cannot count as fully real:

The Pentagon has decided that it will not award the Purple Heart, the hallowed medal given to those wounded or killed by enemy action, to war veterans who suffer from post-traumatic stress disorder [PTSD] because it is not a physical wound.

The decision, made public on Tuesday, for now ends the hope of Iraq and Afghanistan veterans who have the condition and believed that the Purple Hearts could honor their sacrifice and help remove some of the stigma associated with the condition.

The criteria for excluding PTSD seems to be the following. First, PTSD cannot be accounted for in terms of the enemy's intentions:

But a Pentagon advisory group decided against the award because, it said, the condition had not been intentionally caused by enemy action, like a bomb or bullet...

It's odd that the Pentagon would give so much authority to the enemy in deciding which veterans get the award. But on its face this criterion is clearly mistaken. When an enemy beheads, dismembers, and booby traps soldiers, their clear intention is to wound soldiers psychologically.

Second, PTSD is difficult to diagnose:

...and because it remained difficult to diagnose and quantify.

It's not exactly clear what the Pentagon means by “difficult” in this statement, but that PTSD has definitive symptoms is largely uncontroversial:

The disorder, which may go unrecognized for months or years, can include recurring nightmares, uncontrolled rage and, sometimes, severe depression and suicide. Soldiers grappling with PTSD are often unable to hold down jobs.

Moreover, physical wounds can sometimes be difficult to diagnose and quantify. Consider back pain. The cause, timing, nature and location of back pain can often be difficult to diagnose and quantify. This especially true when trying to determine if a patient is shaming it, as will be discussed further below.

Third, awarding the Purple Heart for psychological disorders runs contrary to precedent:

"Historically, the Purple Heart has never been awarded for mental disorders or psychological conditions resulting from witnessing or experiencing traumatic combat events," said Eileen Lainez, a Pentagon spokeswoman.

So what? The criterion assumes the precedent is adequate and sufficiently broad. Besides, the diagnosis of psychological disorders is largely a 20th century phenomenon. One would expect that the criteria for the award in the past would lag behind the science. But there is little excuse for continuing the lag when a psychological condition is largely established and known as PTSD is.

Fourth, PTSD can be faked:

But many soldiers do not feel that way. In online debates and interviews they expressed concern that the Purple Heart would be awarded to soldiers who faked symptoms to avoid combat or receive a higher disability rating from the Department of Veterans Affairs.

But so can back pain. Did the bomb explosion really cause the soldier back pain? Or is the soldier faking it. I once met a Viet Nam vet who claimed to receive the Purple Heart because of chronic back pain. He alleged that a bomb explosion threw him off a tank, injuring his back. That sounds plausible, but I used to play tennis with him on occasion.

Fifth, granting the award to PTSD creates a slippery slope for granting the Purple Heart to veterans suffering from other “controversial” injuries and would “debase” the honor.

But a Pentagon-supported service group, the Military Order of the Purple Heart, has strongly opposed expanding the definition to include psychological symptoms, saying it would "debase" the honor.

"Would you award it to anyone who suffered the effects of chemicals or for other diseases and illnesses?" John E. Bircher III, director of public relations for the group, said Wednesday. "How far do you want to take it?"

Frankly, I am willing to take the ride down the slope. If a veteran does suffer from a prolonged injury incurred from chemical exposure, I see no reason not to award the honor to the veteran. I am also a bit concerned about the drive to keep the recipients of the award as members of an exclusive club. It sounds a tad elitist.

Finally, the award should go to those who shed blood for their country:

There have been recent changes in awarding Purple Hearts. The criteria was expanded in 2008 to include all prisoners of war who died in captivity, including those who were tortured. "There were wounds there," Mr. Bircher said.

"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."

But not all torture involves the shedding of blood and not everyone who dies in captivity has shed blood. So the blood criterion already suffers from dilution from recent expansions of the criteria. Besides,

For some soldiers suffering from the disorder, the historical distinction between blood and no blood in an injury fails to recognize the depths of their mental scars. A modern war - one fought without safe havens and with the benefit of improved armor - calls for a new definition of injuries, some veterans say.

While one can grant that diagnosing both physical and non-physical injuries can often be difficult, it seems that a workable criterion for awarding the Purple Heart can be found. Off the top of my head, I would look in this direction: Did the veteran incur a prolonged and debilitating injury during or as a result of combat?
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