Radical Civility

Cross-posted from Blog Them Out of the Stone Age

Does the “red badge of courage” — Stephen Crane’s famous phrase for a wound suffered in battle — have to be literally red?

Maybe. Maybe not.

Today’s London Daily Telegraph has an article that states, somewhat misleadingly, Traumatized US Soldiers to Get Purple Hearts.

Actually, as the article makes clear, that’s far from certain. The idea is on the table. Whether it will become reality is another matter.

American soldiers who suffer post traumatic stress disorder would be awarded Purple Heart medals, usually given to those who are wounded in action, under a controversial plan being actively considered by the Pentagon.

Nine decades after soldiers were executed for “cowardice” brought on by what was then called shellshock during the First World War, veterans of Iraq and Afghanistan may be the first to have their mental injuries treated the same as battlefield wounds.

US Defence Secretary Robert Gates has urged Pentagon advisers responsible for battlefield awards to study the proposal after Army psychologists said widening the criteria for a Purple Heart would increase the acceptance of soldiers suffering from PTSD, and persuade more to seek help for their problems.

Pentagon figures show that 40,000 troops have been diagnosed with post traumatic stress since 2003 but it is classified as an illness not an injury, making it ineligible for a Purple Heart under current rules.

Officials say one in eight combat troops in Iraq and one in six of those in Afghanistan are taking prescription antidepressants like Prozac or sleeping pills.

John Fortunato, a military psychologist at Fort Bliss, Texas first suggested Purple Hearts for PTSD last month. “These guys have paid at least as high a price as anybody with a traumatic brain injury, as anybody with shrapnel wound,” he said.

Mr Gates immediately proclaimed it an “interesting idea” that needed to be looked into.” But the plan has sparked a fierce and impassioned debate among the US military, with a flurry of comments in the pages and on the websites of publications like Stars and Stripes and the Army Times.

Ray Kimball, an Army major who helped found the Iraq and Afghanistan Veterans of America support group, is a strong supporter. He believes the move would have “huge impacts on the perception of mental health issues in both the Armed Forces and society as a whole”.

He said: “PTSD is a combat wound. We already treat it as such for the purposes of medical evacuation, readiness for combat, and post-service disability assessments. So let’s take it one step further.”

But an anonymous Army intelligence officer told Army Times: “It’s an insult to those who have suffered real injury on the battlefield.”

“An insult to those who have suffered real injury”? That’s strong stuff, and might be dismissed as a fringe opinion. Unfortunately, it isn’t.

Maj. Ray Kimball, the proposal supporter quoted above, is a founding member of Iraq and Afghanistan Veterans of America. He has written about this issue on the IAVA Blog and in a piece that appeared last month in Military.com:

PTSD is a combat wound - we already treat it as such for the purposes of medical evacuation, readiness for combat, and post-service disability assessments. So let’s take it one step further - make anyone with a diagnosed manifestation of PTSD that in any way impairs function eligible for the Purple Heart.

The current criteria in existence for the Purple Heart would not have to be changed - nowhere do those criteria specify severity of wound, or how the wound was physically inflicted. They only require that the servicemember be wounded or killed in action - in fact, the criteria spend far more time spelling out which “actions” qualify than in addressing the character of wounds. Nor would this action debase or cheapen the Purple Heart - in fact, the award has already evolved significantly from its original establishment in 1782 as a Badge of Military Merit. Whether the change was including wounds wrought by terrorist acts or allowing awards for friendly fire, the changes each addressed an overlooked aspect of the wound that needed to be honored by the nation.

PTSD has remained a hidden wound for too long. DoD’s new campaign is a huge leap in the right direction of erasing the stigma of this affliction, and properly recognizing this hidden wound with the Purple Heart is the next logical step.

Kimball went on to invite comment on the Military.com Discussion Board. He got it — most of it sharply critical and even contemptuous of the very idea that soldiers with PTSD should get the Purple Heart.

The objections, generally speaking, are emotionally charged and have a knee-jerk quality that I’ve often seen in connection with civilian psychiatric disorders. The not so subtle message is that physical illnesses and injuries are “real,” whereas psychological illnesses and injuries are not, but are instead attempts to throw the cloak of illness / injury over what are “really” defects of character. This, in turn, testifies to the persistence of the idea of the mind/ body split. In scientific and medical circles the idea of such a split was exploded decades ago, but it remains firmly embedded in everyday, “common sense” perception.

One reason for this is the denial of what is otherwise a highly disquieting thought: that physical changes — specifically biochemical changes — affect the functioning of the brain and therefore, it is supposed, of one’s basic identity. To admit this connection is to admit the possibility that it can happen to anyone, and I suspect the most vociferous opponents of awarding the Purple Heart to soldiers with PTSD are, at bottom, more fearful of this possibility than most.