Yesterday, in my post “PTSD and the Purple Heart,” I commented on Tyler E. Boudreau’s New York Times column “Troubled Minds and Purple Hearts,” where he makes an eloquent case for awarding the Purple Heart or a new decoration to those veterans who have suffered psychic wounds in combat.

Since then, I have come across a couple of excellent letters to the Editor of the New York Times, on the Purple Heart issue and on providing more recognition and better care to those veterans who have received such psychic wounds.

The first letter is written by Judith Broder, a medical doctor and the founder and director of the Soldiers Project in Los Angeles, which offers free psychological treatment to military service members who have served or expect to serve in Iraq or Afghanistan.

The second letter is written by Representative John J. Hall, chairman of the House Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs.

I hope that testimonials such as these will prompt the Pentagon to rethink the Purple Heart issue and related benefits matters, and also give the Obama administration the motivation to “encourage” the Pentagon to do so.

Dr. Broder’s Letter:

To the Editor:

Re ”Purple Heart Is Ruled Out for Traumatic Stress” (front page, Jan. 8):

The decision by the Pentagon to deny Purple Hearts to veterans with psychic wounds flies in the face of the many public statements from the Defense Department about the need to reduce the stigma associated with these injuries.

It is disturbing that the Pentagon needs to see blood to establish the validity of a war injury.

Those of us who treat our war veterans have no doubt that ”hidden” psychic injuries are at least as serious and potentially more devastating than more visible physical ones.

Ask any veteran or family member of someone suffering from post-traumatic stress disorder, traumatic brain injury or post-deployment depression about the reality of these wounds. They will have no trouble describing the profound consequences of these injuries and their far-reaching effects on families and communities.

The sacrifice and suffering of these veterans need to be recognized and honored.

Judith Broder
Cambridge, Mass., Jan. 9, 2009

Rep. Hall’s Letter:

To the Editor:

Re ”PTSD and the Purple Heart” (editorial, Jan. 12):

Post-traumatic stress disorder is one of the signature wounds of the wars in Iraq and Afghanistan, yet our government remains painfully slow to recognize PTSD as an injury of war.

The ways in which mental wounds affect a soldier’s daily life may be less visible than physical wounds, but the impact can be just as severe. PTSD is frequently misdiagnosed, and benefits for the condition are often denied by the Veterans Administration.

Whatever one’s position on PTSD as a qualifying injury for the Purple Heart, the debate illustrates a deeper injustice throughout the Pentagon and V.A. — the lack of parity between physical and mental injuries from military service.

Last year Congress passed a law giving Americans the right to receive equal coverage from private insurance companies for mental and physical health care. Shouldn’t we provide the same for injured veterans?

It is our responsibility to provide equal benefits for mental health injuries and physical injuries, to heal all wounds of war, both seen and unseen.

(Rep.) John J. Hall
Washington, Jan. 13, 2009

Dorian de Wind, Military Affairs Columnist
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Copyright 2009 The Moderate Voice
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This issue completely confuses me. . .The neurobiology of PTSD has been determined. . . scientific journal have been writing about this since the early 1990’s, that i am aware. . .

I do not understand why there is persistence in labeling PTSD as “only psychological” when severe stress/ trauma can produced detectable changes in the neurophysiology of the brain????. . .

I Googled the neurophysiology of PTSD and there are 64,900 plus entries. . . This rule-out seems based on prejudice rather than science. . .


You can have PTSD even if no one actually shot at you. A purple heat is rewarded for injuries due to energy action and is not something that an awards committee decides. Giving a purple heart for PTSD creates a backdoor way method of getting a purple heart through the decision of a committee.


Here is an short example of some neurophysiology research that was presented at theTrauma, Culture and the Brain Conference in California, just to show PTSD is physiologically measurable. . .

Neurobiology and Treatment of Posttraumatic Stress Disorder

Studies in animals and humans suggest that stress is associated with long-term alterations in brain function and structure. These findings are relevant to understanding the neurobiology of posttraumatic stress disorder (PTSD) and in the development of treatments for this disabling disorder. Studies in animals showed long-term dysregulation in stress-responsive systems, including the norepinephrine and hypothalamic-pituitary-adrenal (HPA) axis systems. These findings have been extended to PTSD, with, for example, findings of increased noradrenergic responsivity in PTSD. The HPA axis and cortisol systems have been shown to be dysregulated in PTSD, and glucocorticoids, which are released during stress, were shown in animal studies to be associated with atrophy to neurons of the hippocampus, a brain area that plays an important role in learning and memory. These findings were extended to PTSD, with findings of smaller hippocampal volume measured with magnetic resonance imaging (MRI) in patients with both childhood abuse and combat-related PTSD, with associated deficits in hippocampal-based declarative memory. Using positron emission tomography (PET) we showed in several studies both dysfunction of the hippocampus and the medial prefrontal cortex, an area that plays an important role in regulation of emotion. Animal studies recently found that treatment with serotonin reuptake inhibitor medications reverses deficits in hippocampal morphology associated with stress and actually promotes the growth of neurons. We recently found improvements of symptoms of PTSD and hippocampal-based verbal declarative memory deficits following one year of treatment with paroxetine. Other findings related to the treatment of PTSD will be reviewed. These results begin to map out a functional neuroanatomy and neurophysiology of PTSD which may be applicable to future treatment directions.

I wonder if there is a money angle underneath the debate?. . . Maybe i would call the award PTSD, Plenty True Soul Discerners. . I worry more about those that go through war and do not come out with PTSD. . .