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Purple Heart for PTSD?

A quick question tossed at Defense Secretary Robert Gates — Should veterans with post-traumatic stress disorder receive the Purple Heart? — has created a maelstrom in the blogosphere.

It seems the reasoning behind the idea — to lessen the stigma of mental health disorders — also works against the proposition.

“It would lessen the meaning of the award,” a Marine said about the military’s oldest combat medal.

“I’d be ashamed to wear it,” chimed in a soldier.

“It’s an insult to those who have suffered real injury on the battlefield,” wrote an Army intelligence officer.

The dust-up began May 2 when Gates was on a visit to Red River Army Depot, Texas. During a brief media availability, a reporter asked Gates if the Pentagon might consider awarding Purple Hearts to troops with combat-related PTSD.

“It’s an interesting idea … I think it’s clearly something that needs to be looked at,” Gates said.

John Fortunato, who directs the Restoration and Resilience Center in Fort Bliss, Texas, added fuel to the fire by saying the medal could help service members understand that PTSD is a common by-product of war.

“These guys have paid at least as high a price, some of them, as anybody with a traumatic brain injury, as anyone with a shrapnel wound,” Fortunato said, adding that not recognizing PTSD as a wound deserving of the Purple Heart “says this wound isn’t worthy.”

Fortunato made his comments to the Pentagon’s internal American Forces Information Service, which folded them into an article posted May 5 on the official Defense Department Web site. But by Thursday, calls to Fortunato were being referred to the Pentagon — he was no longer talking about the issue.

At a news conference Thursday, Pentagon spokesman Geoff Morrell said Gates will, in fact, look into the issue.

“I should point out that they’ve looked at this before and they determined ... that it was not appropriate to make PTSD a qualification for the Purple Heart,” Morrell said. “But I can tell you that the department is exploring PTSD as a qualifying wound through the [Defense Department] Awards Advisory Group. There is no timetable at this point for them to provide a recommendation.”

Gen. George Washington created the Badge of Military Merit to honor anyone who served with distinction during wartime. In 1932, Gen. Douglas MacArthur decided it would go only to those wounded or killed in action. Rules for who may receive it are strict: The injury must occur during combat, can’t be self-inflicted and can’t result from an accident.

But illnesses don’t qualify — and PTSD is considered an illness, not an injury.

“I thought it was a brilliant idea when it first came up,” said Charles Figley, who co-edited “Combat Stress Injury Theory Research,” and is a professor at the Florida State University Traumatology Institute. “But the science is just not there to be able to determine if there was an injury.”

Figley had hoped that considering PTSD a combat injury would reduce some of the stigma associated with it. In fact, many of the bloggers attacking the idea say it would denigrate the medal — and they don’t consider PTSD the same thing as a battle wound.

“It’s not like you come down with PTSD in the middle of a battle,” said Maj. Brian Stoll, an Army reservist who works as an engineer and in civil affairs. “It’s after the fact. It’s not caused by combat — it’s caused by the stressors surrounding combat.”

Of course, if the 300,000 service members with symptoms of PTSD and major depression cited in a recent Rand Corp. report hadn’t gone to combat, they wouldn’t have combat-related PTSD. But Stoll said the criteria should be “that you bled for your country.”

Stoll also noted that not everyone who experiences combat gets PTSD, so “it’s a result of how you react to stress, and it goes back to your upbringing and what kind of family you had.”

Stoll was diagnosed with PTSD after a tour in Iraq in 2003-04. But he said he is cured and believes PTSD is preventable.

“All you’re doing is you’re giving that soldier an identity as someone with a mental issue,” he said. “They’re not as resilient. I guess I’m a traditionalist — I don’t believe PTSD is a combat wound.”

Figley strongly disagreed.

“There has to be something tangible, something to show recognition that it’s real,” he said. “There needs to be an indication that they put their lives at risk — mentally. There should be some kind of red badge of courage.”

The next step, he said, is finding biological markers so PTSD is more easily assessed, as well as changing the attitude about PTSD.

“We need to keep the conversation going rather than pushing this to the side,” he said. “That’s the important thing.”

DISCUSS: Purple Heart to validate PTSD?