Thursday, January 8, 2009

Stigma Reinforced: Purple Hearts and PTSD

What does this news item from the New York Times say about our view of mental illness?
The Pentagon has decided that it will not award the Purple Heart, the hallowed medal given to those wounded or killed by enemy action, to war veterans who suffer from post-traumatic stress disorder because it is not a physical wound.
On the one hand, it is yet another example of how our society feels that mental illness is just in the same class as physical illness; even when clearly inflicted by the by enemy action,  damage to one's psyche is simply not in the same class as a bullet in the great toe.  Traumatic brain injury and post-traumatic stress disorder are the major wounds inflicted in the this war, but our returning veterans struggle to in much the same way our children have struggled, with inadequate screening and assessment and overextended treatment facilities within the VA system.
On the other hand, it is a sign of how far we have come that the Pentagon even asked the question.  PSTD has been a consequence of warfare for generations;  in the Civil War, it wasn't spoken of;  in the Great War (WWI), it was lumped together with Combat Stress Reaction and called "shell shock", felt by many to be a sign of weak character.  In the Second World War, it morphed into "battle fatigue", which, because it was often treated with "rest", had an underlying sense of weak character to many (but not those who experienced it).  No one, I think, even considered giving a Purple Heart for those conditions.  Now, we have a relatively well defined set of clinical conditions that accept the notion that the brain, the most complicated organ in the body, can be injured and malfunction in the course of a life.  What we don't have yet is the sense to honor those who undergo such injury in our name.  When we are able to do that, we will actually have achieve mental health parity.

But at least we are finally asking the question.
The New York Times opined today;  similar observations on a national scale.

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