This is not the final word; it is the predictable final word of this administration. The President elect can change this with the sweep of a hand.

I do hope some brings this to Obama's attention so that he'll reverse it, because, really, what's the downside of giving Purple Hearts to veterans with PTSD. As you said, it can't do any harm, and certainly serves the purpose of getting these soldier's home communities to realize that soldiers who come home with mental illnesses have been injured as surely as ones who gets a hand blown off.

I'm just imagining, too, how much comfort a Purple Heart could give to the family of a veteran affected by PTSD; in a way it'd be an acknowledgment of the sacrifice they're making, as well.

While I don't agree with this decision, I can imagine a certain logic with the decision. Since the number of soldiers coming back with PTSD could easily be as high as 20+% (or 1 in 5), awarding the Purple Heart to this many soldiers might "rob" it some of its perceived "hallowed value". It becomes a little too common.

Where I disagree with the decision is that since PTSD (or variations of stress induced psychic trauma) is *hugely* more common than is generally understood, disqualifying soldiers who show major symptoms of traumatic stress (not being able to sleep, recurring nightmares, substance abuse, violence, etc.) is exactly the wrong way to promote acceptance of this traumatic injury.

When I was an intern as a trainee psychologist, working with a psychologist and a psychiatrist in an emergency trauma unit in France, we saw quite a number of non-combat related occurrences of potential PTSD sufferers. Early treatment in France of "potentially traumatizing life events" is considered primordial to help the affected individual avoid becoming a full-blown PTSD sufferer. Early treatment is *hugely* more effective than treatment after symptoms have manifested and had time to set in.

The huge advantage of awarding Purple Hearts to PTSD sufferers would be (as has been pointed out by others) that anyone who suffers from this debilitating condition could get help earlier rather than later because the condition would be recognized as a *common* medical condition. We saw people who suffered from potential PTSD who had "just" witnessed fatal bicyclist-car accidents (which is nowhere near the potential trauma of wartime). The disadvantage, from the Bush regime's point of view, is that veterans would actually have to be taken care of responsibly. Unfortunately, I can't say I find this cruel decision surprising.

Ah the bleeding heart left, so charming in its predictability. Awarding medals to "help" is bollocks, good thing your defence minister did not go down that empty feel good path. Never mind the idiocy of awarding for a common stress condition of namby pamby weakminded fools. Bike accidents...

Thanks, "The Lounsbury", for channeling General Patton. . .

How the DoD and the Right honor our soldiers: chew 'em up, spit 'em out.

Oh, and Collounsbury*? You're still one incredible mixture of sharp mind and monumental prick.

*Different place, slightly different name, but same guy.

Awarding medals to "help" is bollocks, - Lounsbury

Even worse is when the bleeding heart right push for more death penalties, so the victims' families can "get closure."

I think part of this is economics. SO many soldiers suffer from PTSD. I know the cost of making a medal isn't that consequential, but between the thousands from this war, and any remaining survivors of other wars (or the families of those no longer with us who feel their PTSD is just as valid), and the logistics of getting them all out to their recipients, that's money the military can use to uparmor Humvees!

I mean...they WON'T...but they COULD...

The reasoning behind the Pentagon's cowardly decision is twofold:

The Purplr Heart Medal comes with financial incentives - lower co-payments and higher disability ratings and reimbursement for a wider and deeper array of health services. More medals= higher cost outlays for healthcare services.

Mental health is still seen as a malingerer's excuse to shirk duty. The two class system of considering physical and mental illnesses as distinct, with physical considered legitimate (since it can be seen) and brain injuries suspect, the Pentagon simply makes transparent the discrimination and stigma still placed on people who suffer from brain injuries and illnesses.

But lest you stand too high on the self-righteous pedestal, progressive stigmatize those with mental illness every time slang terms are used in ad hominem fashion - against neocons, conservatives, corrupt media reporters, corrupt politicians, etc.

Every time you slur against them using derisive terms for people exhibiting signs of impaired judgment, reasoning or function from mental illness, you perpetuate the stigma, the ostracism and the discrimination.

There is an excellent website which discusses resources and symptom management of PTSD called PTSD Combat. It's hosted by Ilona Meagher, and it has support from major veterans groups. I suggest some thoughtful reading and placing energies into local volunteer support to those who suffer from it (not just veterans - anyone who has experienced a significant trauma is at risk, and the vast majority of sufferers are untreated or undertreated).

I disagree. I'm a Vietnam vet (No Purple Heart, thank goodness) who was diagnosed with PTSD more than ten years after my return to the States. PTSD wasn't acknowledged by the military at the time I was discharged so I, and those around me, were subjected to some interesting times until I was diagnosed and received help.
Nonetheless, I feel that the Purple Heart should be reserved for physical damage caused by enemy action. Very, very few who serve in combat are unaffected by it - shouldn't they all get Purple Hearts? Probably not: there are already medals for serving during time of war, for simply being shot at, and for serving in a theater of combat operations.
PTSD puts you into your own personal hell. It can be difficult to diagnose, particularly when there's an institutional bias against diagnosing it. Better than awarding Purple Hearts would be pressure from Congress to force the military to be more open to the diagnosis and to fund effective care for the condition.

I think it is worth adding that a Purple Heart does not require a serious wound. My uncle--an interrogator in WWII who didn't get too close to the front lines--got his Purple Heart when an artillery shell exploded. The shrapnel wounded him, but he was lucky. The wound was a literal scratch. That rated a Purple Heart.

Reluctantly, I must agree with Louns - No, Shrub should not have been rushed to the head of the queue at Walter Read after falling from his 10 speed tricycle and injuring his immense ego.

This decision reeks of cutting costs and ducking any responsibiliy by the current, soon to be long gone, so-called government. President Obama and Gen Shinseki, we await you

As an Iraq veteran (no Purple Heart, thankfully) who, like Reverend Dennis @ 8:24 a.m., has carried around PTSD baggage, I have to agree with him.

PTSD can be caused by combat, but usually what it is caused by is the stress attendant to combat, often triggered by seeing someone killed or wounded (or killing or wounding another).

Combat by its very nature is stressful. Yes, as Joe S. pointed out, a lot of Purple Hearts are awarded for trivial wounds, but trivial or not (at least one of John Kerry's was trivial) a wound is a wound. But to award the Purple Heart for PTSD would essentially make everyone eligible for the award -- and that would, oddly enough, undermine the very reason why some PTSD proponents want the PH authorized in the first place -- as a distinguishing mark.

Do I have baggage from the war? Yes, but on balance no more than that carried by any other war veteran of any era of any nationality, if their memoirs are to be believed. There has to be a line separating PH from non-PH. I think the decision is fair.

Perhaps this could be resolved by offering the purple heart only to soldiers who suffer irreparable damage? Missing limb, damaged or scarred organ, etc.? Because it does seem ridiculous to offer it to someone who's received a minor flesh wound (Joe S. @ 8:45)and yet not to someone who has PTSD.

Okay, non-military types. Listen to Rev. Dennis and Hemlock, then check out of the debate. The point of the PH for a "trivial wound" is that even if a flying piece of shrapnel just nicks your thigh, you're less than three inches from completely severing an artery, losing a leg, and potentially dying. PTSD from picking up pieces of suicide-bomb victims, or from being two HMMWVs away from the kill area of an IED just doesn't rate a PH. Lack of treatment and failure to recognize the sacrifices of those who endure the horrors of PTSD is criminal, but a PH is not the right avenue to address such a deficiency.

Paging Dr. Amen, Dr. Daniel Amen, please call your office. I think his clinic could clear up this dispute in about two days by running SPECT brain scans of veterans diagnosed with PTSD. Dr. Amen has demonstrated beyond serious doubt that emotional disturbances like depression and anxiety have measurable, observable physical effects on brain activity. I think brain scans of the limbic systems of these men should answer the question -- yes, it is a physical wound.

PTSD is not baggage and I highly doubt that vast numbers of veterans would rush to get themselves diagnosed with PTSD just to get a PH considering the stigma that is attached in this society to mental illness. The fact is people dont take seriously/believe that mental illness is real. A psychic wound is just as real as a 'real' wound.

I appreciate your erudite comments, Hemlock and Rev. Dennis, but, I view this decision as a means to limit the requirements of the Veterans Millenium Health Care and Benefits act of the late '90s. That act expanded Group Level 3, thus dropping co-pays and expanding coverage for combat vets. By denying the awarding of the PH, it will be tougher for many to qualify for the Group 3 level. With the heavy influx of older vets without health care coverage into the VA system, as well as the the many younger combat wounded and maimed returning from the Middle East, and with limited funds, the VA system is being stretched. This is a way to curtail costs. Sort of a financial triage, as it were.

I may be a 'prick' or however you may want to phrase it, but the fuzzy minded feel-goodism whinging on about mental illness being stigmantised as an argument (and citing trautamisation from witnessing a cycling accident, however horrible) is weakminded confusion. Contra Patton, your charming General of warmongering, I do not see genuine war shock as mere weakness. However, as the arguments already advanced in 'favour' the agenda "pro" is rather more concerned about mental illness as such than the value and role of a war medal, and few (ex the actual war veterens) seem to have the slightest understanding of the potential impact, nevermind of course that the potentially generalisable nature - a wound is a clear line in awarding a war medel. Mental damage, there are not by its nature clear lines (else American mafia defendants in criminal cases would be able to fool their psychs [presuming they are indeed fooled] less often).

The real complaint about the decision is about recognition of mental baggage from war, that is not something best addressed by changing standards on war medals, but changing treatment and budgeting. As usual, the fuzzy minded left mistakes the symptom for the actual problem.

I am of two minds about this. I strongly agree with Hemlock and Rev. Dennin that it 'cheapens' the award, and that all soldiers suffer from some form of PTSD -- unless they start out as psychopaths. (It is, after all a new phrase for what was called 'shell shock' or 'battle fatigue' after previous wars.)

On the other hand, I don't think anyone has caught what seems to be the obvious reason for the Bush Pentagon to rule this way. There have been numerous stories of soldiers with PTSD returned to Iraq time after time. It strikes me the Pentagon would make itself more vulnerable to suits for damage caused -- to themselves or others -- by such soldiers if they ruled this way.

But I'm not a lawyer, however much at times I like sounding like one -- so, does anyone out there know if I'm right on this?

I'm not up on the diagnosis of PTSD, but is it always clear what actual events causes it? That is, if it's hard to track it directly to combat rather than other events, that might be considered to be disqualifying by purists. Say, if a soldier were both in a combat situation and a victim of a violent crime and then develops PTSD, can you say unambiguously that the condition was the result of military action?

I'm asking because I don't know, not because I think PTSD victims should not be considered eligible - I don't know enough to actually have an opinion at this point.

Lounsbury:
As usual, it is you fuzzy-minded cynics -- who usually self-describe as 'realists' -- who get things wrong, because you fail to understand the importance and 'real existence' of symbols. In fact, changing the name of this 'syndrome' from 'battle fatigue' to 'PTSD' -- which wasn't cheapening the lasnguage, both are merely symbols for the same syndrome which hasn't, itself, changed -- has had 'real world' results in the way sufferers are treated by society and on the chance of them getting help.

While I still side with Dennis and Hemlock, please keep talking. You might end up convincing me to support the idea by opposing it.

But I'll still welcome you here and sincerely hope you stick around. Yes you are generally wrong, and, as 'low-tech cyclist' says, a bit of a prick, but you do express yourself so well (Great mind? or just Great writng? Who knows?) you force us to reexamine our positions and 'keep us on our toes. And certainly we have enough '
psuedo-realists' on our side, it's good to see one on the other side.

(One OT quickie, but can anyone name the "Golden Age" British detective who suffered from PTSD under the name it was then called?)

Prup - didn't Lord Peter Wimsey have recurring bouts of 'shell shock'?

Yep! I thought it'd be easy, but one minute! A Stan-Lee autographed no-prize is heading your way.

(No I'm not, just met the guy and had him on my college radio show 40+ years ago.)

So, Lounsbury: I write an argument based on consistency, and toss in, at the end, that doing this (e.g., treating mental illness in ways that are not consistent with the way the military treats physical illness) is not a good way to deal with mental illness more effectively. What about this argument makes you think it's about giving out medals just to help?

Primo, with respect to Prup, I do not miss the value of symbols for leveraging change. I, however, recognise that not every such symbol has equal leverage over a said subject, and some human prejudices run rather deeper than mere language. The example of mental retardation (of which, as combat zones, I have some direct experience), where merely changing the language has seen the prejudice shift with the words. Symptoms, not the root causes (of the deep running human prejudice).

Most of the 'argumentation' contra the US defence department decision focuses on extraneous, 2nd order issues (2nd order to the decision, not per se importance to soldiers as such), as the access to medical care, etc. That is pure fuzziness - however much Hilzoy supra wishes to whinge as the rationale for changing the standard boils down to the essential of wishing to valorise mental impacts.

However, first, military tradition has its own logic, and medals have internal to military service (as the veterans supra have hinted at) their own value; one may add that widening the scope of the medal is rather more likely - as in most 'elite symbols- to devalue the symbol rather than revalue the 'problem' (mental damage versus physical to soldiers).

Until mental illness sources, impacts and diagnoses are as clear, evident and importantly as raised by Arachnae, clearly tied to combat (versus other issues [or a mix...], again the examples cited by Bruce B, and his arguments generally) expansion of war wound medals to cover inherently ambiguous (important but AMBIGUOUS) mental issues would only serve to cheapen one kind of award to the likely detriment (see e.g. debates re political correctness) to advancing the real core issue.

That Hilzoy just whinged that treating mental illness is treated differently only tells me the woman has never been in a situation of sustained physical danger, combat... There is no "consistency" issue for medals, as physical wounds, as veterans supra have noted, are of a different order (firstly easier to establish - not easy always, but easier) and allowing for abusive awards, generally imply just a bit higher exposure to death and maiming (as sorry, mental damage sans getting your bloody hand, or kidney or etc blown out is not the same bloody thing, stress in combat zones is endemic and no one comes out clean). Intellectual, airy, theoretical arguments on consistency are bollocks. Her argument in giving out combat medals for combat stress (or whatever fashionable name), inherently opens up an elite medal to a substantially (given a lack of an objective measure, versus physical wounds, however defective a measure) wider population, a population that might well include most combatants.

It is not necessary to label military traditionalists, etc. as Pattons (or Commonwealth equivalents, sadly more prevalent), as there is ample room to see mental impacts of combat zones as substantial (although inherently difficult to quantify, and frankly generalised to all combatants).

Rather than pushing for a change that is more likely to be seen as (i) political and namby pamby Left whinging, and (ii) a violation of tradition , it would be rather more intelligent to take the argument to argue for more support and benefits to military staff in live fire zones, and potentially provide some means of recognition (for of direct combat stress, and access to further services). Although it implies tedious bureaucracy, allowing for (and this may be the case in the US military already) citation for exposure to direct enemy action / fire and thus extra service would be a clean means of providing for what most of the "prop" commentators ask for without debasing a long tradition with an ambiguous and uncertain standard.

I don't think the claim that injuries are not what the enemy intends, that the people who set IEDs are only interested in killing soldiers and injuries are just a result of near successes, is true. It is a truism that inflicting injuries is much more debilitating to an enemy army than inflicting deaths is. It is much easier to take care of the dead than it is to take care of someone who has lost their leg, and a soldier who loses a leg is no more of a threat than a soldier who is killed. We tend to focus more on the number of dead (understandably, since they are our dead), but every seriously wounded soldier is just as much a little victory for the enemy.

I think the way the military handles PTSD needs to change completely, but I can see reserving a specific medal for being wounded by the enemy during combat.

Arachnae - There are specific criteria for PTSD, and they can be found here.

What causes PTSD?

The person has been exposed to a traumatic event in which both of the following have been present:

1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

2. The person's response involved intense fear, helplessness, or horror.

Nothing I'd wish on anyone. If Lounsbury saw his mother or his child dying in agony from a cycling accident, he could easily become one of the "namby-pamby weakminded fools" he sneers at.

You could change the military attitude towards PTSD without Purple Hearts. Are there good reasons to skip something so simple and effective? So far, the arguments against are the same they used against allowing women to vote or interracial couples to marry: "We've never done it before, and people might abuse it somehow, and it just doesn't seem right".

Why not trivialize the PH to one’s heart’s content? The republicans have already done so: remember the “purple owie� and that disgusting creature with the bandaid on her cheek? Why should we bother to honor the sacrifices of flesh, blood, mind and spirit that the members of our military make on our behalf? When it is convenient the wounds and those who suffered them will be ignored, or trivialized, or grossly insulted. Better far that our military should absorb the one great lesson of the 2004 election: they will be cherished only as symbols, not as living human beings; honored only with words and not with actions; respected only in the abstract and never in person; and spent recklessly with no regard for their value.

Use the PH. Create another award. Insist on the loss of a limb. Give one to everyone who serves. It will not matter.

Really cheapen the PH--give one to the sufferer-in-chief, the deciderer, for his lost guard service.

It no longer matters.

First Johnny you have no idea what I have seen with my own eyes. Taking the mental suffering from an accident and putting it with long term combat is an inanity.

As for "so simple and effective" - rest my case, the do-gooder left sees an "easy" tool to latch unto for unrelated goals, and thinks not of unintended consequences. The arguments against changing military war medals standards are not in any way like interracial marriage - there is a substantive difference between mental injury and physical as described above.