Why Are Soldiers with PTSD Not Eligible for the Purple Heart?

On October 22, 1967, General William C. Westmoreland paid a surprise visit to the 93rd Evacuation Hospital near Long Binh, South Vietnam. He had come to distribute Purple Hearts. To his chagrin, he arrived first at a medical ward where soldiers were convalescing from various tropical diseases and infections. "Medical wards!" the General yelled. "I don't want to see medical wards. I don't want to see those fakers." Westmoreland's classless quote is recalled by doctors and nurses at the 93rd who were then treating those "fakers" and was recorded for posterity in David Maraniss's Vietnam epic, They Marched Into Sunlight. The message was simple: When it came to the suffering of U.S. soldiers, bombs and bullets were honorable; mosquitoes and microbes were not.

Now that the Pentagon has ruled explicitly to exclude victims of post-traumatic-stress disorder (PTSD) from eligibility for the Purple Heart medal -- unless, of course, they have PTSD in addition to some other bleeding or broken or punctured malady -- it seems that General Westmoreland's callousness, out of touch forty years ago, still pervades the armed forces. Unless you bleed -- really bleed -- then you're a "faker." The "band of brothers" within the armed forces is taking a decidedly unbrotherly view of the debate over the Purple Heart, as comrades in combat have taken to implicitly rating their "brothers'" wounds: if there's not enough gore involved, then the awarding of the medal becomes the subject of tawdry pettiness.

"Every badge hunter and his brother will have this distinguished award in their sights," Army Captain Matthew Nichols wrote in a letter to the editor of Stars and Stripes last spring, when the specter of thousands of emotionally wounded teenaged and twentysomething veterans became an issue too pressing to ignore. Joe Palagyi, national adjutant of the Military Order of the Purple Heart, equated psychological trauma to "almost getting wounded." In other words, if a soldier's postwar life is emotionally shattered directly because of his service to his or her country, then it's their own damn unsoldierly fault; any heroism or quick thinking that led to one's almost -- as opposed to actually.--.getting wounded is not triumphant but rather a gateway to mockery.

The Department of Defense's ruling comes at an odd time. By 2007, only two states -- Idaho and Wyoming -- didn't maintain some sort of mental health parity law (complete, limited or otherwise), and companies like GlaxoSmithKline (GSK) were using thirty-second advertising spots to promote -- and then promise the cure for -- a raft of psychological afflictions. In GSK's case, a frequently aired campaign glossed the symptoms of social anxiety disorder and then promoted Paxil as a remedy. Those Dickensian stigmas associated with psychological disease, it would seem, were receding: you wouldn't make fun of a fellow on crutches; why make fun of one on Klonopin? Moreover, in a sidebar to the '08-'09 economic crisis, the $700 billion bailout package passed by Congress in October also included the Paul Wellstone Mental Health and Addiction Equity Act, which, when implemented nationally in 2010, will require insurers to treat (and pay for) mental afflictions on a par with physical afflictions. Even insurers in Idaho and Wyoming will have to pay for a couple of Effexor or Clonazepam prescriptions here and there.

But the armed forces don't take such a tolerant view of mental hygiene. The problem, according to the Military Order of the Purple Heart, a Pentagon-supported group, is that awarding the decoration for psychological afflictions would "debase" the medal, like a kid watering down the lemonade so he can make more profit. After all, how would an amputee feel if he had to share his honor with someone who's merely suffering from a shattered psyche? It simply wouldn't be fair. Then again, it's not really fair to have our veterans searching for solace in suicide, either, which is what's happening at an increasingly alarming rate among veterans returning from Iraq and Afghanistan. A 2007 CBS News investigation deemed suicide to be "epidemic" among returning veterans, which found their suicide rates to be twice that of non-veterans.