Purple Hearts for PTSD?

June 29, 2012— -- When Ron Morton returned from Vietnam in 1976, he abused drugs, attempted suicide and failed as a husband, unaware he was suffering a classic case of post-traumatic stress disorder from the near-fatal accidents he witnessed and experienced on the flight deck of the USS Ticonderoga. Today, the former Navy captain advocates making military members with post-traumatic stress and other invisible war wounds eligible for the Purple Heart.

"These are wounded people who deserve to be acknowledged for their efforts via a Purple Heart," Morton, 60, of Knoxville, Tenn., said Thursday from the national convention of the National Alliance on Mental Illness (NAMI) in Seattle. "We want parity for mental illness, for combat-induced mental wounds. We want to be treated the same way as someone who has been shot in the arm or in the leg."

In a report, "Parity for Patriots," issued earlier Thursday, NAMI called mental health disorders like PTSD "signature injuries" of the wars in Afghanistan and Iraq, warning that the United States faces a deluge of new cases from scheduled troop draw-downs. The nation's largest grassroots mental health organization recommended that military commanders at all levels be accountable for suicide prevention and eliminating the stigma keeps some active duty troops and veterans from seeking care.

Bob Corolla, a NAMI spokesman, said the organization had delivered a copy of the report to U.S. Sen. Patty Murray, D-Wash., chairwoman of the Senate Veterans' Affairs Committee and author of the proposed Mental Health Access Act of 2012, which would improve care and access to care for service members and veterans.

Morton, the director of recovery and resiliency for Tennessee's Medicaid program, promotes programs that help people "recover from mental illness so they can have productive lives." He's all too aware that within military ranks, men and women remain reluctant to seek treatment because of a deeply ingrained culture of toughing it out.

"We don't think we deserve treatment for these things. We don't think we deserve acknowledgement of these things," he said.

Military officials have disputed the notion that troops suffering from post-traumatic stress disorder should be eligible for the Purple Heart.

"PTSD is an anxiety disorder caused by witnessing or experiencing a traumatic event; it is not a wound intentionally caused by the enemy from an 'outside force or agent,' but is a secondary effect caused by witnessing or experiencing a traumatic event," Defense Department spokeswoman Eileen Lainez told Stars and Stripes in 2009.

Many military personnel also fear that acknowledging a problem could damage their professional reputations, he said.

He recalled a conversation a couple of years ago with a helicopter pilot who flew combat missions in Iraq and said, "I know I have symptoms of PTSD. I won't come forward. I won't seek treatment because they'll ground me."

Morton said, "Our desire now is to reduce the stigma around mental illness," and to acknowledge military heroes whose sacrifices are psychological as well as physical.

One way that some psychiatrists have proposed reducing the stigma of a PTSD diagnosis is by dropping the use of the term "disorder" and calling it post-traumatic stress, or a post-traumatic stress injury, said Dr. Amir Afkhami, assistant professor of psychiatry and global health at George Washington University in Washington, D.C. "The disorder is associated with a kind of weakness, which goes against the culture of strength and, 'What does not kill you makes you stronger' that pervades the military.

"If I was a policy maker, one way I would approach this issue, rather than focus on the redefinition of the diagnosis, is focusing on education, both in terms of educating troops to what PTSD is; what are the biological causes of PTSD, and educating the leadership of the military to recognize the long-term importance of treatment of post-traumatic stress."

Military Needs to Change Culture So PTSD Isn't A Scarlet Letter

He also said the U.S. military needs to come up with "creative ways to encourage folks to stay in treatment" because PTSD, which can produce a range of symptoms of varying degrees, is a chronic condition. He also noted that because it can go into remission, those who get treatment "shouldn't see the diagnosis of PTSD as a scarlet letter" that closes doors to them if they want to stay in the military.

Dr. Afkhami welcomed the idea of honoring invisibly wounded war heroes with the Purple Heart, saying that "any reframing of our view of post-traumatic stress, including recognizing it as a war wound worthy of a Purple Heart, certainly can help the process, but it's not the solution. ...When we do give a Purple Heart for PTSD, we should have another medal for people who go through treatment, because they rendered service not only to the Army, but also to society at large."

In its 17-page report, NAMI said 1 in 5 active duty military personnel have had symptoms of PTSD, depression or other mental health conditions. An active-duty soldier dies from suicide every 36 hours and a veteran dies by his or her own hand every 80 minutes.

Suicides are on the rise within the National Guard and Reserves, even among those who haven't been called up, the NAMI report said.

Families on the home front suffer depression and post-traumatic stress at about the same rates as service members, according to estimates cited by NAMI. More than one-third of military husbands and wives have one or more mental health problems, while one-third of children suffer from depression, anxiety or acute stress reaction.

NAMI encourages current and former military members or families in distress to call The National Suicide Prevention Hotline at 1-800-273-8255, which can transfer them to military and veteran crisis lines.