The VA and the Pentagon have come a long way in considering post-traumatic stress disorder as a disability. But despite the fact that the post-traumatic stress was acquired in combat or in a war zone, they decided recently not to consider it an injury.

If they did, they would have to award the Purple Heart to people with PTSD.

While visiting a mental health center in Texas last year, Defense Secretary Robert Gates said the Purple Heart needed to be revisited as it pertained to servicemembers suffering from PTSD. But the Pentagon decided against doing so because the condition “had not been intentionally caused by enemy in action, like a bomb or a bullet.”

So, must injuries be seen before they can be acknowledged?

I honestly don’t know.

Would a separate award for servicemembers with PTSD be a solution, or would it continue to stigmatize emotional injury?

Some of the branches give out awards like candy — you know who you are! They’ll give out unit awards even when some of the recipients were not directly involved in an operation, for example. And every servicemember gets a national defense medal.

But the Purple Heart really is a special award. It symbolizes sacrifice — that you were willing to lay down your life for your country — and perhaps the recipient did make the ultimate sacrifice. It’s also very prestigious — you notice the Purple Heart on someone’s rack.

But as one traumatologist said, blood must be shed before the award can be given.

Many of us have seen behavioral changes in people with traumatic brain injuries. The effects of a TBI are not that much different from PTSD, it’s just that one can be readily seen on an MRI. And because it can be seen, the head injury received in a war zone qualifies for the Purple Heart.

The military has come quite a ways in recognizing the mental damage caused by war — and how could it not? It’s always been a factor, even though it’s been given different names: shell-shock, combat fatigue. And it’s prevalent: The New York Timesreported that one in five servicemembers — 300,000 men and women – struggle with PTSD or major depression.

They know what it’s like: You come back from war and you can’t hold down a job or maintain a happy home life. You can’t control your mind, you can’t shake those disturbing thoughts, and it causes you to go into a terror, to avoid going out in public, to not feel safe behind the wheel of a car.

Isn’t that damage from the war? In my mind it is — but is it Purple Heart material?

I don’t know.

And apparently the Pentagon isn’t ready to make it so.

It seems like servicemembers are divided on this, too. And actually, there’s some real animosity toward people who want a Purple Heart for mental injuries. There is a debate out there about how much PTSD is faked: Because you cannot quantify it, there is suspicion in the ranks that some servicemembers are faking PTSD largely to get a higher disability rating. Would they fake it to try to get a Purple Heart?

PTSD is stigmatized. A person who suffers from it doesn’t come home as an injured war hero– they don’t have a battle scar to show. They have nothing to point to to say this is what war did to me. It’s in their behavior, and their behavior can be frightening to others and undefined. It’s lumped into this huge category called PTSD, and you don’t know how it’s going to turn out. It’s an unpredictable, unseen result of combat.

A servicemember with conventional injuries from war might walk with a limp. Maybe when it starts to rain it hurts. But there’s a beginning and an end to the injury, whereas PTSD can be a lifetime of pain that in some ways is a worse injury to come home with. And then there’s the stigma of being mentally weak.

I think we have a hard time defining what we can’t see.

I really would like to know what Oklahomans think about this. Please let us know your views.