Purple Hearts And PTSD

Via Michael Cohen at Democracy Arsenal, the NYT:

“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 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 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.

In May, Defense Secretary Robert M. Gates said awarding Purple Hearts to such service members was “clearly something that needs to be looked at,” after he toured a mental health center at Fort Bliss, Tex.

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

OK, let’s parse this. You can only get a Purple Heart for something that is “intentionally caused by enemy action, like a bomb or bullet”. How specifically does an enemy have to intend the consequences of his or her action in order for those consequences to warrant giving someone a Purple Heart? One might say that if the enemy intends something very broad, like “harm”, then any soldier who suffers harm (or: harm of sufficient magnitude) as a result of what the enemy does is eligible for a Purple Heart. In that case, someone who got PTSD as a result of enemy actions aimed at causing harm would qualify.

Alternately, you could say that the harm someone suffers has to match the enemy’s intentions more narrowly. For instance, it seems unlikely that people who plant IEDs want (in particular) to blow a soldier’s arm or leg off, or to cause PTSD. More likely, the enemy wants to kill soldiers. Suppose that’s right: then a soldier who got PTSD as a result of an IED would not be eligible for a Purple Heart, since s/he did not suffer a harm that was “intentionally caused by enemy action” (on this construction). But a soldier whose arm or leg was blown off by an IED would not count as suffering a such a harm either, nor would s/he be eligible for a Purple Heart.

I don’t see any way to argue that when an enemy intends to kill a soldier and that soldier is not killed but wounded, the enemy has “intentionally” caused the soldier’s harm, but that if that same soldier got PTSD, that would not count as a harm the enemy “intentionally” caused.

The idea that PTSD is more “difficult to diagnose or quantify” than other things for which purple hearts are awarded is wrong as well. As Cohen points out, PTSD has clear criteria. I’m not sure what it means to “quantify” PTSD, but then I’m not sure what it means to quantify serious back pain or recurring headaches either.

Later in the story, someone tries a different rationale:

“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 shedding blood is not a condition of eligibility for a Purple Heart: “A physical lesion is not required”. That’s a good thing: if shedding blood were a necessary condition for being eligible for a Purple Heart, then soldiers would not be eligible if their bones were broken in combat, or if they suffered internal organ damage, or if their lungs were destroyed by chemical weapons, so long as they did not actually bleed. And that would be insane.

I really can’t see any reason for this decision other than the idea that mental illness somehow isn’t real, or isn’t a real consequence of enemy action, or wouldn’t have happened if only the soldier who got it had been tough enough. That’s wrong, and it’s needlessly cruel. Moreover, holding onto these false ideas about mental illness will not help the military to deal more effectively with the psychiatric problems of its members. And that harms everyone.

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