No Purple Heart for PTSD

The Pentagon recently decided not to award the Purple Heart to military personnel who develop Post Traumatic Stress Disorder (PTSD) as a result of combat. This has been an issue of significant contention within the military community due to there being a variety of opinions on the issue. One side believes that soldiers deserve recognition for their wounds, be they physical or mental. The other side argues that the venerability of this award would be eroded by the influx of recipients who do not necessarily suffer as a direct result of the actions of the enemy.
In making a decision on this issue, I feel that it is first important to understand what the Purple Heart is. The medal bears the face of George Washington. Washington established the award, originally called the “Badge of Military Merit,” during the Revolutionary War to honor persons who are “wounded or killed in any action against an enemy of the United States or as a result of an act of such an enemy or opposing armed forces.” It is this description that makes the Purple Heart unlike any other military decoration. It is not earned through merit, but by meeting the aforementioned criteria. There are also perks to be had through receiving this distinction that don’t come with other awards, such as scholarships for the recipient’s immediate family and medical coverage for life.
The matter at hand requires understanding how PTSD fits into this framework. PTSD is an anxiety disorder that occurs as a result of a stressful or terrifying life event. Some of the more common symptoms in combat veterans appear to be intrusive thoughts or memories, inability to sleep, restricted range of emotions, detachment from others and heightened levels of anger and vigilance that persist for more than six months. While not everyone diagnosed with the disorder has every symptom, with the degree to which each symptom manifests itself varies from person to person, the most interesting fact is that while two people may experience the same traumatic event, both will not necessarily develop PTSD. Certain factors, such as greater age and education, appear to act as buffers against this disorder, while others, such as injury as a result of the event, seem to increase the likelihood of symptoms. Indeed, it isn’t entirely understood what, aside from the event itself, causes the individual to develop this disorder.
This last piece of information is quite important, as the Purple Heart requires the injury to have resulted from the actions of the enemy. Moreover, for persons who develop PTSD, the symptoms do not always surface right away. Because of this, it could be months or years before the disorder is recognized. This being the case, it may become difficult to establish satisfactorily the precipitating event. This further muddles whether the enemy is to blame and creates a logistical nightmare for the departments responsible for reviewing award eligibility. The most sensible thing to do would be to either deny this award from all combat veterans who would be eligible only because of their development of PTSD or to deem each case of PTSD in combat veterans the direct result of enemy action.
As a veteran who has struggled with PTSD as a result of combat exposure, I still find that I am in agreement with the Pentagon’s judgment on this matter. While it would certainly be great for me and other PTSD sufferers to receive further recognition of our service, along with the perks that come along with it, I am a bit of a purist. I believe that the Purple Heart was established to recognize those service members who were physically wounded in battle and that adding anxiety disorders to that list does indeed detract from its original purpose. It must be noted that I do not mean to infer that anxiety disorders are not serious or should not be recognized in some official way by the military. PTSD afflicts many combat personnel in ways that destroy or alter their lives forever and is not to be taken lightly, which is why the military often provides disability compensation to those who suffer.
However, the true deciding factor ultimately lies in the details. While Washington and his staff may have included PTSD as a qualifier had they possessed our contemporary knowledge of psychology, I do not believe that all of the facts with regard to this affliction are in just yet. Perhaps future research will tell us more about who develops PTSD and why. If there comes a day that we are able to say with confidence that enemy action is overwhelmingly to blame for this disorder on a case-by-case basis, then I will certainly side with my opposition. Until this data is made available, however, I will have to continue to agree with the Pentagon’s decision.

Erik Christensen was a soldier in the 101st Airborne Division and provided convoy security to the First Marine Expeditionary Force throughout the invasion of Iraq in 2003. He was medically discharged from the Army in 2007. He is also a fourth-year psychiatry and human behavior major and can be reached at ejchrist@uci.edu.