Friday, January 30, 2009

Purple Hearts and PTSD

It was recently announced that the United States Armed Forces have decided that war veterans suffering from Post-Traumatic Stress Disorder (PTSD) cannot be awarded the Purple Heart due to the fact that their injuries are non-physical in nature and difficult to diagnose. While it is true that the Purple Heart was originally created to honor combat veterans who had shed blood on the battlefield or suffered some other injury to their physical body, we must now acknowledge that the nature of warfare has changed, as has our knowledge of what constitutes an injury.

When a soldier loses a limb or experiences physical trauma related to gunfire or ordinance, it is readily clear that that individual has suffered an injury, an event that warrants special recognition by the country whom that soldier serves. However, I believe that the psychological trauma of combat can be just as devastating as the physical insults endured by the body, and the rehabilitation and recovery from such psychic wounds can be an arduous and lifelong process.

If the Pentagon is concerned about the difficulty of diagnosing PTSD, perhaps they should closely review the process through which veterans are screened for psychological damage as a result of warfare, as well as establish strict guidelines for their psychiatric teams who perform such assessments. Granted, the diagnosis of PTSD and other mental disorders is not necessarily as cut and dry as the diagnosis of a broken leg or a collapsed lung, but there are standards, protocols and various tools available for the assessment of individuals suffering from the effects of psychological trauma, and it would not be a difficult matter to operationalize such standards among the mental health professionals who work for the Armed Forces and perform such reviews.

It is my feeling that the Pentagon's misguided decision is based on the very American notion that mental illness and psychological problems are less than acceptable, and that those who experience them are somehow weak. But in the 21st century, we should finally be sophisticated enough to recognize that prior notions of mental illness as a sign of personal weakness or moral failing are as erroneous as ever, and those who suffer from such conditions are as deserving of compassion and accommodation as individuals with a physical illness or condition.

Apparently, the Pentagon is still uncomfortable with the notion of PTSD as a true injury of war, even when approximately one-third of veterans experience significant symptoms of depression or combat stress. In its decision, the Pentagon has clearly communicated---both to the public and to the men and woman of the Armed Forces---that PTSD is simply not a significant enough injury to warrant recogntion that that individual's sacrifice is worthy of our compassion and gratitude.

This unfortunate ruling sends a clear message to those who have put themselves in harm's way while serving their country, and it dishonors members of the Armed Forces who have suffered psychological injuries as a result of their service. I am very disturbed by the Pentagon's decision, and I hope that the outcry in response to such a narrow-minded definition of injury will cause a reversal of this ruling.

Psychological inuries are real, and their impact on quality of life and individual well-being is well-documented. Perhaps the Pentagon needs a thorough education about the enormous impact of PTSD and how disabling it can truly be. While a limb can be replaced with a prosthesis and rehabilitated with intensive physical therapy, damage to the brain and the psyche can be devastatingly difficult to recover from, and members of the Armed Forces who suffer such condtion as a result of combat should be properly recognized for the sacrifices they have made and the very real injuries that they have sustained, injuries which may very well last a lifetime.

(c) 2009 NurseKeith
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