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
Leave a replyComments (840)
  1. river January 27, 2009 at 6:19 pm

    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. . .

  2. superdestroyer January 27, 2009 at 7:59 pm

    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.

  3. DdW January 27, 2009 at 8:05 pm


    I am not a “neuropsychologist” (is there such a person?), but you bring up a good point.

    I understand that, because traumatic brain injuries (TBI) can be readily “seen” in an MRI, such head injuries received in a combat zone do qualify the injured to receive the Purple Heart. This, even though often the effects of TBI are not that much different from the effects of PTSD.

    The Pentagon/VA “problems” with PTSD go beyond the Purple Heart issue. While they finally came around to consider PTSD a disability, they still refuse to consider it an injury. (It is an “illness”). Even in reviewing and determining disability rating percentages (important for benefits) for post-traumatic stress disorder, the VA has been very slow to come around and following provisions of the 2008 Defense Authorization Act in this area

    The following quotes I came across in several blogs perhaps illustrate some of the reasons (right or wrong) given against awarding the Purple Heart to for PTSD:

    “Opening up the Purple Heart to PTSD sufferers would bastardize the award. PTSD is simply too subjective and can be easily faked. Those fictitious Soldiers that want sympathy and attention will be tripping over themselves to get the privileges and rights that come with an award they didn’t earn.”

    “It seems like servicemembers are divided on this, too. And actually, there’s some real animosity toward people who want a Purple Heart for mental injuries. There is a debate out there about how much PTSD is faked: Because you cannot quantify it, there is suspicion in the ranks that some servicemembers are faking PTSD largely to get a higher disability rating. Would they fake it to try to get a Purple Heart?”

    “Recent veterans of Iraq or Afghanistan will tell you that the military stigma against mental illness has not abated, that the combat ethos — suck it up, soldier — persists and that some officers continue to belittle the severity, and even question the existence, of post-traumatic stress.”

    If there is a genuine belief that awarding the Purple Heart for PTSD will “demean” or “cheapen” the award, my suggestion would be to come up with a different but appropriate medal for PTSD, and I definitely would not view it as this one blogger so callously did:

    ” If our leaders honestly think that a medal would encourage more troops to seek help, just create a PTSD Sufferer Medal!! On the front could be a picture of human brain with a large hole in the middle and on the back we could inscribe the words “Awarded For Bravery In Seeking Mental Help” or “I Fought For My Country And All I Got Was PTSD”.

  4. river January 27, 2009 at 8:25 pm

    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. . .

  5. DdW January 27, 2009 at 9:49 pm

    Again, not being a neurophysiologist, a lot of what you cite is “above me,” but I do notice that there have some MRI measurements of PTSD effects.

    Still, and as Superdestroyer hints at, as long as “no blood is drawn,” (i.e. no physical injury–albeit the injury can be very minor),rightly or wrongly, no Purple Heart. The fact that physical injuries can be “seen” makes it theoretically impossible to “fake them,” while in fact, again as SD implies, PTSD is more difficult to recognize, evaluate, measure and “quantify.” even for the process of assigning disability ratings.