Is psychological turmoil deserving of a Purple Heart?

The Pentagon has diagnosed roughly 40,000 troops with post traumatic stress disorder (PTSD) since 2003, and tens of thousands of others are dealing with it on their own or ultimately will be diagnosed. With the war taking such a heavy psychological toll, some inside the military are starting to ask if men and women who become mentally injured in the service of their country deserve the Purple Heart. To some traditionalists, the idea is absurd on its face, but it is not a theoretical debate —the Pentagon is now weighing a change in policy that would make PTSD, in a term only the military could invent, a "qualifying wound" for the medal.

The Purple Heart, created by General George Washington in 1782, has historically been limited to those physically wounded or killed in combat. The Army classifies PTSD as an illness, not an injury, which means it doesn't qualify for the honor. But John Fortunato, an Army psychologist at Fort Bliss, Texas, argued in early May that PTSD affects soldiers by physically damaging their brains, making the condition no different than conventional wounds. Soldiers with PTSD often have suffered as much "as anybody with a traumatic brain injury, as anybody with a shrapnel wound," he said. Their ineligibility for a Purple Heart "says this is the wound that isn't worthy, and it is." Advocates of the change like Fortunato believe it would help encourage soldiers with symptoms of PTSD, many of whom are afraid of being blacklisted and having their chances for promotion limited, seek out the help they need.

The suggestion has garnered high-level Pentagon attention. "It's an interesting idea," Defense Secretary Robert Gates recently noted. "I think it is clearly something that needs to be looked at." The Defense Department's awards advisory group, which previously ruled that PTSD doesn't merit a Purple Heart, is now studying the issue again.