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Purple Cortex

Purple Cortex

            The Purple Heart Military Award “is awarded in the name of the President of the United States to any member of an Armed Force or any civilian national of the United States who, while serving under competent authority in any capacity with one of the U.S. Armed Services after April 5, 1917, has been wounded or killed, or who has died or may hereafter die after being wounded in any action against an enemy of the United States.” For a more in depth definition go here.

            The pentagon recently ruled that Purple Heart will not be awarded to soldiers suffering from post-traumatic stress disorder (PTSD).  Was this the right decision? My answer right now is, “I don’t know.”  I’m going to spend the next couple of posts meditating on this complex question. I hope to challenge our thought about general health, mental health, medicine, and disease. 


            When thinking about the question, one thing that might come to mind is whether or not PTSD is an “injury” in the same sense a bruise or a scrape would be an “injury.”  In short: are wounds of the mind different in any significant way from wounds of the body?


In one sense, no.  Contrary to what someone like Tom Cruise might say, an ailing mind is the result of some very real physiological phenomena.  Studies have shown that people suffering PTSD do have neuroanotamical differences from controls, and so you might argue that calling PTSD a “disease of the mind” is to ignore the fact that mental suffering has its neurological correlates.  And doesn’t a bruise on the arm work the same way?  We feel pain – which is of the mind – and the pain has its vascular correlate (the damage of capillaries) which manifest as a black and blue mark. 


But this, so far, is a simplification.  There are differences between diseases of the mind and the body. One difference is that our knowledge – this includes the sufferer’s knowledge as well as what we know as scientists and doctors – of mind diseases is generally speaking gleaned from sufferer’s experience, and her telling us about the experience.  In corporeal diseases we generally speaking know about the disease through physical examination of the body. 


Hold on a second though.  Just because we generally speaking know about mind diseases from the sufferer’s verbalization doesn’t mean we couldn’t come to know about the diseases through, say, examination of the brain.  Such things are usually not done, of course, but that doesn’t reflect on whether the disease, in its essence, is physical or mental; it reflects on our choices for examination and on our technological capabilities.  It is plausible that in the future psychiatrists will just use technologies like MRIs, fMRIs, EEGs etc. to diagnose mind diseases like PTSD.  So on reflection this first distinction seems superficial. 


A second difference is that mind diseases, unlike corporeal diseases, can have psychological cures. Techniques like cognitive behavioral therapy and exposure therapy are two examples of how mind diseases can be cured without any chemical or physical therapy.  The argument goes that corporeal diseases are the inverse:  they can only be cured with chemical or physical therapy.  Of course, counterexamples abound: placebo effect, social support, and mental well-being all have been shown to have very real benefits in the treatment of so-called corporeal disease. 


So while we can’t put a band-aid on our brain to cure depression, and while we can’t use will power to make a bruise evanesce from our arm, the differences between mind diseases and corporeal diseases seem to have more to do with the examiner than the examinee.  But still, these differences might have significant implications for the question at hand.  I think this will touch on exactly what we mean by “injury,” “disorder,” and “disease.” I will meditate on that in the next post. 

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3 comments

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9:01AM PST on Feb 5, 2009

This post was quite the noggin-scratcher. My gut reaction would be to reward the Purple Heart to veterans with PTSD, but I do have some reservations. How much PTSD is required before a Purple Heart is rewarded? Is it enough to be awoken by nightmares, or must the veteran face constant anxiety throughout the day? Of course, the issue of degree is also applicable to physical injuries, but psychological disorders present even tougher decisions because of their intangible qualities.

The other issue that troubles me with PTSD is its extremely high prevalence among veterans. A quick glance at Wikipedia reveals that the lifetime prevalence of PTSD among Vietnam War veterans was around 30%. The reality is that serving in a war will impart psychological harm to great number of soldiers. Awarding the Purple Heart to veterans with PTSD would change the nature of the award. An increase in the number of recipients would probably be an unwelcome change, but the question should be whether it would be an unwise change.

4:41PM PST on Feb 3, 2009

I agree that there needs to be a fundamental change in the way that we view mental illness before the Purple Heart can be awarded for PTSD. There is a taboo, obviously extremely wrong, that things in the mind can be just controlled by the mind. For lack of a better term, people could just "sack up" and not be so afraid. However, this mindset regarding mental illness is inherently flawed and must be changed. Just because you can't see something physical, like a bruise or a missing limb, doesn't mean that something is not wrong with a person. Even having seen something like the Russian Roulette scene in "The Deer Hunter", it is hard to imagine people NOT being extremely traumatized by the horrors of war. And this trauma can seriously harm lives in terms of functionality on return to the US, and as is such I agree the Purple Heart should be awarded for PTSD.

10:35AM PST on Feb 3, 2009

Interesting points, to be sure. I'd be inclined to consider PTSD a condition worthy of the purple heart. In many instances, it can be far more devastating than a more conventional combat casualty (e.g. John Kerry's handful of Purple Hearts. Not that they were undeserved, but his injuries didn't really change his life).

However, I find it hard to conceive of a world in which this policy would be implemented. I think for such a thing to happen, we'd need to see a sea change in the way people view mental health. Because, like you mention, there's no easily observable (to the naked eye) correlate to a disease of the mind, people tend to consider it somehow "less real" or more in the control of the afflicted party. This is, in my opinion, a grave misunderstanding of how the mind works, one that should remedied. Handing out Purple Hearts to those who suffer each day as a result of their service might be a good start.

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