PTSD and the Purple Heart

Views from the professional community

Good treatment can be hard to find, and harder to sustain

By Elvira G. Aletta, Ph.D.

Yesterday the New York Times wrote that the Pentagon “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 because it is not a physical wound.”

This is an interesting decision on many levels. My first reaction was: How typical. Go ahead and ignore all the research and data collected by psychologists, neuropsychologists and psychiatrists the world over to define and develop diagnostic and treatment protocols for this horrible condition.

On the other hand it is impressive that the Pentagon advisory group took any time to deliberate on this issue. Apparently they did leave the door open to future changes, which sounds like Bush administration code for, “I’m out of here. Let Obama deal with it.” But it leaves room for hope.

The Times article, placed on the front page above the fold, was uncharacteristically lacking in good reporting. I’d like to learn more about who was on the panel. What experts did they talk to and what are they really afraid of? Was it a hard decision to come to or a ‘non-starter’? The reporters did not have one well-qualified behavioral health specialist speak in favor of awarding the Purple Heart to PTSD victims.

How about someone from the National Institute of Mental Health? Was no one willing to go on the record? This seems strange to me. Also the NYT reporters had a layman, someone clearly against such a measure, stating, “PTSD can be serious but there is absolutely no way to prove that someone truly is suffering from it or faking it.”

Really? What makes him qualified to make such a statement? How about a rebuttal?

Addressing the issue of mental health stigma is something that the government has only recently, maybe the last ten years, had the guts to face. Congress took forever but finally came around to passing legislation that advanced third party payer parity for mental health diagnostics and treatments.

As a public service this action brought the issue of how mental health is seen and treated to the public. Stigma is all over this Purple Heart decision as illustrated in the position the Military Order of the Purple Heart takes. They are “strongly opposed to expanding the definition to include psychological symptoms, saying it would “debase” the honor.”

That’s what it is all about: the age-old mental illness fear and stigma. All other arguments are excuses for not giving wounded soldiers their due. My opinion.

Here’s an example.

Take this argument also from the Military Order of the Purple Heart :

Q: “Would you award it to anyone who suffered the effects of chemicals or for other diseases and illnesses?”

A: Sure! If it was a result of combat.

Q: “How far do you want to take it?”

A: As far as we need to to honor our veterans who put themselves in harm’s way for their country.

Living in the 21st century means having the strength to live with ambiguity. Are we going to be inclusive or exclusive? Isolationist or communal? Back in the ’90s the acceptance of gays in the military was a reflection of American society’s struggle as a whole. This PTSD and the Purple Heart thing feels similar. Some day it will be acknowledged that the nature of war and our understanding of its impact has changed radically since the Purple Heart was commissioned in the 1930s.

The people in favor of exclusivity say you have to shed blood to get a Purple Heart. What about conditions like traumatic closed head brain injury? No bloodshed there. Sometimes the injury doesn’t even show on a CAT scan. Our diagnostics haven’t yet caught up with what we know and are on the verge of proving.

Why deprive our soldiers of this deserved honor because of our ignorance? PTSD and major depression can also be fatal diseases if untreated. In other words, you can die from PTSD, through suicide, alcoholism or related illness. Not enough?

It’s hard for me not to have a kneejerk reaction to this decision. I’ve treated my share of PTSD cases, combat veterans and civilians. My patients were not faking their symptoms. If I had a doubt I referred them to a well-established expert who provided the testing and diagnostics needed for a conclusive diagnosis.

So the bad news is the Pentagon, a bastion of conservatism after all, decided against giving the Purple Heart to soldiers wounded with PTSD.

The good news is they even considered it.

Elvira G. Aletta, Ph.D. is a clinical psychologist, wife, mom to two teenagers and blogger, seeking the balance in upstate New York. To learn more about Dr. Aletta, check out



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