Monday, February 2, 2009

PTSD and the Purple Heart

PTSD and the Purple Heart
By Elvira G. Aletta, Ph.D.

Major Hanafin Asks Anyone: Has the DOD, traditional Veterans Organizations [or those intimately linked with the VA], and the VA been in cahoots to downplay PTSD as evidence by this suggestion by VA leadership? More to the point is the VA actually still implementing this suggestion as the Obama administration begins?

For those of us almost legally blind, and for the record above is an extract of an email circulating within the VA medical and mental health community that was used by various forward thinking, and younger Veterans organizations, to highlight how the VA senior management made downplaying PTSD a government recommendation if not policy decision, and I quote:

“Given that we are having more and more compensation seeking veterans, I’d like to suggest that you [medical claims examiners that is the physicians and VA mental health experts, not clerks] refrain from giving a diagnosis of PTSD straight out. Consider [as the Pentagon is doing] a diagnosis of Adjustment Disorder, and R/O [translation rule out PTSD]. Additionally, we [the VA] really don’t or have time [or money] to do the extensive testing that should be done to determine PTSD. Also, there have been some incidence [note some incidence NOT a flood of fakers as opponents of PTSD recognition in anyway inaccurately proclaim] where the veteran has a C & P (Compensation and Pension examination), is not given a diagnosis of PTSD, then the veteran comes here [you name the VA Hospital or Clinic location is irrelevant to the focus], and the veteran appeals his [her] case based on our assessment.

This is a suggestion for the reasons listed above. [Translation: We can’t cut costs and support the VA Claims adjustors in denying claims if we give a diagnosis of PTSD that warrants compensation, so don’t do it. We must downplay PTSD to save money, let the Pentagon worry about having enough bodies for combat positions, those guys aren’t veterans YET, so they are the Pentagon’s problem].

TAX TIME AGAIN: Here we have a case where VA upper-level management has been misusing and abusing OUR TAX DOLLARS since the War on Terror began, to cheat veterans in every way imaginable, then proponents of cost savings on the back of America’s veterans use the Fake Veteran or Fake Illness smoke screen to divert outrage from where it really belongs – our government and the VSOs that support hypocrisy.
Remember that next time any VSO, even Iraq and Afghanistan Veterans groups take positions that enhance the stigma against PTSD in our society. Remember also that the Obama administration will be under more pressure than the Bush admin ever was to CUT COST on the backs of America's Veterans, but for different motives, and with a more humaine approach of WE CARE ABOUT OUR VETERANS AND TROOPS BUT,we have to cut the national deficit somewhere, and the VA is viewed as an entitlement program NOT an earned benefits program.

Just like the massive corruption and misuse of tax payer dollars for US to subsidize America Supports in order to SELL the logo, NOT SUPPORT OUR TROOPS, the relationship between traditionalists, DOD, and the VA requires an intensive Congressional Investigation or at least the new and improved White House needs to have someone Obama trusts (and who is actually trustworthy) take a microscopic look at how and why PTSD is being downplayed by all concerned.

Robert L. Hanafin

Major, U.S. Air Force-Retired


When the New York Times wrote that the Pentagon “decided that it will not award the Purple Heart, the hallowed medal given to those wounded or killed by enemy action, to war veterans who suffer from post-traumatic stress disorder because it is not a physical wound.”

Professional Clinical Psychologist Dr. Elvira G. Aletta, Ph.D, who is not controlled by the Pentagon, found this is an interesting decision on many levels. Her first reaction was, well putting it mildly, anti-DOD or as proponents of Stolen Valor would call her a 21st Century liberal psychologist out to begin a plot with other liberal shrinks and such at the VA and elsewhere to rip off the American tax payer with compensation for a flood of fake veterans with fake illnesses, and I quote: "How typical. Go ahead and ignore all the research and data collected by psychologists, neuropsychologists and psychiatrists the world over to define and develop diagnostic and treatment protocols for this horrible condition."

However, Dr. Aletta tempered her liberal reaction if you will with a fig leaf to the Pentagon establishment by saying. "On the other hand it is impressive that the Pentagon advisory group took any time to deliberate on this issue. Apparently they did leave the door open to future changes, which sounds like Bush administration code for, “I’m out of here. Let Obama deal with it.” But it leaves room for hope.

That is IF and only IF the vastly superior (in number) mental health professional community outside the Pentagon (or beltway) step up and stand up for all out recognition of PTSD in any way, shape or form. That is the only way our society and the Armed Forces that reflect it are going to deal with STIGMA that they create.It surely is going to be the only way to get more public attention than traditionalist Veterans groups could ever muster. Major Hanafin.

The Times article, placed on the front page above the fold, was uncharacteristically lacking in good reporting. [The public, especially the professional medical community,would] "like to learn more about who was on the [Pentagon] panel? Why? Because both the Military Medical Community and worse yet the Mental Health professionals in uniform appeared to be proactively MISSING IN ACTION?] .

What experts did [the Pentagon awards panet] talk to and what are they really afraid of? The Military Order of the Purple Heart, come on now, they are mental health professionals?

Was it a hard decision to come to or a ‘non-starter’? Why even raise the issue or waste the panels time if traditionalism, flag waving, and glorifying war made the queston a non-starter to begin with? If younger Iraq and Afghanistan Veterans groups had consulted with reputiable and credible mental health esperts on just what value (if any) giving a medal or ribbon to PTSD patients within the military was or was not to identifying patients, getting troops out of denial, or even at a minimum dealing with stigma within the Armed Forces then they should have taken an educated, professional position, instead of joining in a politcal decision. Major Hanafin

She then goes on to take the New York Times reporters to task for lack of, well investigative reporting. "The reporters did not [interview or] have one well-qualified behavioral health specialist speak in favor [or against] awarding the Purple Heart to PTSD victims. How about someone from the National Institute of Mental Health? Was no one willing to go on the record? This seemed strange to Dr. Alleta, but the point is just how strange will this seem to most mental health professionals outside the Armed Forces? Keep in mind that with the exception of medical and mental health military personnel who aspire to be Colonels, Generals, or Admirals, the vast majority of uniformed professionals are going to have to return to a civilian community that looks down upon their SILENCE while in the Armed Forces. This is something us line officers rarely would have to deal with IF we placed promotion as a priority or not.

Also the NYT reporters had a layman, [biased at that] someone clearly against such a measure, stating, “PTSD can be serious but there is absolutely no way to prove that someone truly is suffering from it or faking it.”

Really? What makes him [her] qualified to make such a statement? How about a rebuttal?Well, Doc, I'll do my best, but I also am not a mental health professional, I'll let you guys and gals figure that one out, and I'll report what you say, even those of you within the Armed Forces not placing promotion above eithical patient care. Major Hanafin

Addressing the issue of mental health stigma is something that the government has only recently, maybe the last ten years, had the guts to face. [Reluctantly debate over dowplaying PTSD escalated as more troops were needed, and expected to return to combat duties, obediently, and with no questions asked. Questioning governmetn policy of sending sick people back into combat over and over was something that only outside resources could do and can do. Peer pressure, legitimate focus on the mission over people, and stigma enhanced by the military attitude and environment make dealing with stigma within the Armed Forces near impossible]

Congress took forever but finally came around to passing legislation that advanced third party payer parity for mental health diagnostics and treatments. As a public service this action brought the issue of how mental health is seen and treated to the public.

This is what bothers Major Hanafin the most IF I were pro or con on awarding ribbons or medals for PTSD. A piece of metal regardless how noble is no treatment or cure for PTSD. Dr. Aletta, and rest assured the vast majority of Mental Health professionals outside the Armed Forces, are going to view, "Stigma was all over this Purple Heart decision as illustrated in the position the Military Order of the Purple Heart [[and like wise other traditionalist VSOs] took. They were “strongly opposed to expanding the definition to include psychological symptoms, saying it would “debase” the honor.”[Translaton: bring their STIGMA to the medal instead of the Medal lessening the stigma, that views speaks volumes about just how serious most VSOs really take PTSD. There are a few exceptions, to find them just investigate which one's have placed significant resources into dealing with PTSD let alone the stigma associated with it. If the website or newsletter of a VSO says more about Americanism than it does about PTSD rest assured that VSO cares nothing about PTSD." Major Hanafin

Civilian professionals at least GET IT. Now, they have to take the lead with the few VSOs, especially younger one's that take PTSD serous, because, "That’s what it is all about: the age-old mental illness fear and stigma. All other arguments are excuses for not giving wounded soldiers their due. Dr. Aletta’s personal opinion."

Here’s an example. Take this argument also from the Military Order of the Purple Heart [She picks on the MOPH, but the American Legion, VFW, and VoteVets the politcal arm of Iraq and Afghanistan Vets of America (IAVA) takes the same old fashion stand: Q: “Would you award it to anyone who suffered the effects of chemicals or for other diseases and illnesses?” A: Sure! If it was a result of combat. Q: “How far do you want to take it?” A: As far as we need to to honor our veterans who put themselves in harm’s way for their country.[The first response WAS an answer, the second was flag waving or raising the fake vet flag to not give an answer].

Point:Living in the 19th or 20th century, with a traditionalist mentality and attitude, nationalist, if I may, is not way to deal with stigma in our society or the military representative of it. This decison for now will do more to discourage active duty troops from coming out of denial let alone seeking treatment once their baloon does bust, and eventually it will. History of the Vietnam Veterans movement has proven this true if we now wave flags or not. More to the point from a professional view.

Dr. Aletta show common sense lacking in most traditonalist VSOs, "Living in the 21st century means having the strength to live with ambiguity. Are we going to be inclusive or exclusive? Isolationist or communal? Back in the ’90s the acceptance of gays in the military was a reflection of American society’s struggle as a whole. This PTSD and the Purple Heart thing feels similar. Some day it will be acknowledged that the nature of war and our understanding of its impact has changed radically since the Purple Heart was commissioned [what way back] in the 1930s.

The people in favor of exclusivity [opponents] , including some Iraq and Afdghanistan Vets, say you have to shed blood to get a Purple Heart.

What about conditions like traumatic closed head brain injury? No bloodshed there. [Professional Medical Opinion inside the Military and out is that] Sometimes the injury doesn’t even show on a CAT scan. "Our diagnostics haven’t yet caught up with what we know and are on the verge of proving."

Why deprive our soldiers of this deserved honor because of our ignorance? [Major Hanafin prefers our desire to remain ignorant for socio-cultural, and political reasons having nothing to do with professional medical ethics or methods. Why do readers think that mental health experts within the military have little to say on this nor want to?]

The worse part of our desire to remain IGNORANT is that Major Hanafin knows that PTSD is a Killer. "PTSD and major depression [ARE] fatal diseases if untreated. In other words, you can die from PTSD, through suicide, alcoholism or related illness. [How many veterans awarded the purple heart have been so just from a cut or bleeding wound, because their wound happened to be in a combat designated zone? Does the questions over Senator Max Cleland's or Senator John Kerry's, or even Senator Johm McCain's injuries and treatment in enemy capitivity come to mind, they should, because they are the epidimy of OUR DESIRE TO REMAIN IGNORANT.

Dr. Alleta, though never have worn a uniform, shares a deep and intimate sensitivity and concern anyone dealing with mental illness, stigma or disability in general. That is if there is not enough blood letting, not the adequate loss of an arm or leg, or half one's brain blown away, then there's not enough blood to quench our thirst. Not enough?

She as a professional has a hard time not to have a kneejerk reaction to this decision based on ignorance and a call for more blood. "I’ve treated my share of PTSD cases, combat veterans and civilians. My patients were not faking their symptoms. If I had a doubt I referred them to a well-established expert who provided the testing and diagnostics needed for a conclusive diagnosis." [I would add as a politcal laymen that yes there are professionals that are not immune to having partisan political views, however the ethical burden is on their shoulders to not let their political views get in the way or shape patient care or endanger a patient].

So the bad news is the Pentagon, a bastion of conservatism [and traditionalism] after all, decided against giving the Purple Heart to soldiers wounded with PTSD.

The good news is they were even open minded enough to consider it [and that gets to the jest of the debate, what and how significant were the motivations for raising the debate NOW - TIMING when the most traditonalist, bordering on fascists government was leaving office? And what were the factors that motivated the Pentagon to be, well, open minded at all? Thank God, we have not seen the last of this debate, because the War on Stigma has just begun and it is more credible than any War on Terror will ever be thanks to the lies of the Bush administration, even if Obama continues to condone the lies. Major Hanafin]

Elvira G. Aletta, Ph.D. is a clinical psychologist, wife, mom to two teenagers and blogger, seeking the balance in upstate New York. To learn more about Dr. Aletta, check out
PTSD and the Purple Heart

Please go the the web site and see the now infamous "Norma Perez" e mail

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