‘Case of the Week’ 4 (Stoa): Purple Hearts for PTSD

Important Disclaimer: We pretty much just throw these together over the weekend, and don’t put a lot of work into them. Case of the Week cases are not subject to the same editorial process and stringent quality standards as the COG 2012 sourcebook, and are frequently contributed by non-COG authors. You may find material and sources in these cases that would not appear in the sourcebook. That said, we hope these cases will be useful to you; enjoy!

About the Author: Dr. Doyle Srader is Associate Professor of Speech and Communication at Northwest Christian University, where he directs the forensics team. He also records a regular video blog for NCFCA and Stoa competitors.

1AC: Grant Purple Hearts for PTSD

By Dr. Doyle Srader

My partner and I agree, and hope everyone present will join us in agreeing, with Rosa DeLauro, a member of the House of Representatives for the state of Connecticut, who wrote in August of 2010 that “We have a moral obligation to those who have risked their lives for our nation. All of our troops and veterans should be receiving the highest quality health care, and that includes mental health-no excuses or exceptions. Our soldiers have sacrificed in ways that most of us can never imagine, and it is our duty to take care of them, physically and mentally.” It is out of our agreement with Congressman DeLauro that we are Resolved: That the United States Federal Government should substantially reform its foreign military presence and/or foreign military commitments.

We will define only two terms: military presence and reform. The Oxford Essential Dictionary of the US Military, 2002 edition, defined presence as “a group of people, especially soldiers or police, stationed in a particular place.” Merriam Webster Online defines reform as “to amend or improve by change of form or removal of faults or abuses.” Our burden as the affirmative is to remove a practice that abuses American troops based overseas.

We do so with the following…

Plan

Mandate: All branches of the United States military will accept a conclusive diagnosis of combat-induced Post Traumatic Stress Disorder, sustained in a combat theater outside the United States, as a qualifying injury for awarding a Purple Heart. Congress will enact the change to United States Army regulation 600-8-22 and the Joint Chiefs of Staff will oversee its implementation.

We justify this change with three observations, each establishing a stock issue. Observation one is:

Inherency

Currently, the law forbids awarding a purple heart for PTSD.

Barrie Barber, Dayton Daily News, June 18, 2012, p. A1.

“To receive the Purple Heart, a service member must have suffered an injury in combat. The language specifically disqualifies PTSD by name.”

Beyond that, military culture discourages soldiers from seeking treatment for PTSD.

Neil Shapiro, columnist, Monterey County Herald, January 30, 2012, np.

There is a stigma in military culture, perhaps stronger than in the population as a whole, that attaches to acknowledging a need for mental health treatment. The CNAS reports that “43 percent of soldiers, airmen and Marines who took their own lives in 2010 did not seek help from military treatment facilities in the month before their deaths.” As service members return from deployment they complete a post-deployment health assessment that probes, among other things, the emotional effects of their service and their interest in treatment information. But a 2008 study found that when Army soldiers completed an anonymous survey, reported rates of depression, PTSD, suicidal thoughts and an interest in receiving care were two to four times higher than disclosed by the assessment forms. Partially because of this stigma, only half of our returning veterans who need treatment receive it, and only a quarter  successfully.

Observation two is…

Significance

The scale of this problem is enormous, and is set to grow explosively in the months and years ahead. Sit back as we document significance, inherency and solvency in a single piece of evidence:

John Nolan & Mary McCarty, staff reporters, Dayton Daily News, May 30, 2012, p. A8

“The government needs to broadly improve its services and flow of information to the growing ranks of veterans suffering debilitating mental ailments from their war experiences, according to a chorus of voices inside and outside government. Larry James, dean of the Wright State University School of Psychology, predicts that post-traumatic stress disorder will be to this generation what HIV/AIDs was in the ’70s and ’80s. “I’m very worried about it,” he said. “If people think that PTSD was a challenge in the post-Vietnam era, just wait.” The stigma of mental health treatments is one of the biggest barriers to healing, James believes: “People are afraid to seek help because they think it might end their careers.” It would help, he added, if a healthier message came from the top. “There are only two conditions for which you can’t win a Purple Heart: PTSD and hearing conditions,” he said.

The agony of living with combat-induced post traumatic stress disorder is almost beyond imagining, and the fact that we allow our veterans to suffer this torment without taking any steps necessary to address it is intolerable.

M. L. Lyke, staff reporter, Seattle Post-Intelligencer, August 27, 2004, p. A1

“Symptoms of PTSD include short tempers and erratic sleep habits. Many patients have difficulty holding onto marriages and jobs. One local counselor treats a veteran who has had 30 jobs in 30 years. Self-medicating with booze and drugs is common. So are nightmares, flashbacks and “intensive memories.’ The thwap-thwap of a news helicopter has sent more than one Vietnam vet diving for the nearest ditch. For some Iraq vets, simply slamming a door, using a nail gun or clicking a camera can unglue them. “The body remembers. It fires up without even checking in with the cerebral part of the cortex,” said Seattle clinical psychologist Thomas Wear, one of the counselors contracted to help vets through the Washington state Department of Veterans Affairs’ PTSD program. The narrowed attention, jitteriness and hypervigilance of wartime often carry over into civilian life. PTSD counselors tell of patients who walk the
perimeter of their bedroom every night or sleep with their guns. The National Guardsman with “issues” locked all his weapons away after he got home. He has learned to trust no one. Including himself. “I don’t need to carry guns,” said the sergeant, now in treatment. “I’ve pointed so many at so many people for so long that it’s too easy to put one in someone’s face and not think a thing about it.” There’s a war going on inside him.”

Fortunately, as unbelievable as it may sound, a fairly minor and low cost reform can make an enormous difference, as we demonstrate in observation three…

Solvency

The National Alliance on Mental Illness took a very public stand in favor of our plan in June of this year:

National Alliance on Mental Illness, “Parity for Patriots: The mental health needs of military personnel, veterans and their families,” June 2012, http://www.nami.org

The U.S. Department of Defense must move more forcibly to end discrimination associated with invisible wounds of war. Reducing the stigma of mental illness will enhance opportunities to deliver prompt, effective treatment to military service members and families who live with PTS, depression and other mental health conditions. Examples of immediate steps that can be taken to eliminate stigma and barriers to seeking help include:

– Military leader accountability for stigma and suicide: Military leaders throughout the chain of command should be required to focus on preventable psychological injuries and deaths, which should be part of their efficiency reporting process. Suicides are preventable just as are the heat and cold injuries of service members for which leaders are routinely relieved of command.

Purple Heart for psychological wounds: Posttraumatic stress and other mental health injuries, that are the result of hostile action, including terrorism, should be eligible for award of the Purple Heart with the same level of appreciation and recognition as those awarded to warriors with visible wounds.

The most often repeated argument against the plan is that soldiers will fake PTSD to receive a Purple Heart. This claim ignores the importance of honor and truthfulness in the military and thereby unfairly slanders our troops. Plus, the handful that do so will be caught by the counselors who treat them.

Barrie Barber, Dayton Daily News, June 18, 2012, p. A1.

“Larry C. James, director of the School of Professional Psychology at Wright State University, said some have concerns soldiers could fake PTSD to get the medal. The retired Army psychologist, however, believes few would try. “Ninety-nine percent of these young men and women are honest,” he said. “Integrity and character is part of the military.” Charles R. Figley, director of the Traumatology Institute at Tulane University in New Or-leans, believes counselors can tell if someone has combat-related PTSD.”

Independent of its effectiveness, the veterans deserve the recognition and we owe it to them.

Brian Brus, staff reporter, Oklahoma City Journal Record, July 6, 2012, np.

Being in harm’s way in service of your country and having your life changed because of exposure to trauma – I certainly think that’s deserving of a medal,” said Connie Fox, a licensed professional counselor in private practice in Oklahoma City. Some veterans she has treated haven’t been in combat and minimize the dangers they faced. It’s difficult to admit that what they’ve done is worthy of recognition because somebody else was in a worse situation, she said. “But I think we as a nation, as a community, we need to help them recognize the toll that it takes. This would help change that stigma,” Fox said. “It’s a wound, an invisible wound.

Backup: Purple Hearts for PTSD

A flood of returning veterans from Afghanistan and Iraq will suffer from PTSD

Chattanooga Times Free Press, March 11, 2012, p. A16

“About 20 percent of the 2.4 million U.S. troops who served in Afghanistan and Iraq since 2001 may meet criteria for PTSD from the chaos of wars marked by intense combat with no clear enemy lines, according to congressional researchers and the Rand Corp.”

Chattanooga Times Free Press, March 11, 2012, p. A16

“The military has 88,817 cases of PTSD among active- duty personnel after more than a decade of wars, according to Peter Graves, a spokesman for the Defense Department’s office of health affairs. An additional 223,609 veterans have been seen for the condition, according to the Department of Veterans Affairs. About 21 percent of Iraq and Afghanistan veterans who sought medical treatment from 2004 to 2009 were diagnosed with PTSD, the Congressional Budget Office said in a February report.”

Military culture discourages PTSD sufferers from seeking treatment

Donna Miles, correspondent for the American Forces Press Service, Defense Department Documents and Publications, May 5, 2008, np.

Soldiers still get laughed at for seeking mental-health services or told that it will ruin their careers, he said. Some in the force view people with PTSD as weak, believing that if those with the disease “just sucked it up and soldiered on, [they would] could get over this,” Fortunato said. “The Army is making a lot of strides toward changing that, but it’s a slow go, because it has to happen at the grassroots level,” he said. “Like any other prejudice, it’s hard to die.”

Awarding the Purple Heart to PTSD sufferers would roll back the stigma

Donna Miles, correspondent for the American Forces Press Service, Defense Department Documents and Publications, May 5, 2008, np.

“Gates’ comment followed his visit the previous day to Fort Bliss, Texas, where he toured the post’s Recovery and Resilience Center, which is using a holistic approach to treating troops with PTSD. John E. Fortunato, who conceived of and runs the center, told reporters that awarding the Purple Heart to PTSD sufferers would go a long way toward chipping away at prejudices surrounding the disease. Because PTSD affects structures in the brain, it’s a physical disorder, “no different from shrapnel,” Fortunato said. “This is an injury.” The Army classifies PTSD as an illness, not an injury, so troops with PTSD don’t qualify for the Purple Heart. That distinction is limited to troops killed or wounded in a conflict. “I would love to see that changed, because these guys have paid at least as high a price, some of them, as anybody with a traumatic brain injury, as anybody with a shrapnel wound,” Fortunato said. Not recognizing those with PTSD with a Purple Heart “says that this is the wound that isn’t worthy,” Fortunato said. “And it is.

Brian Brus, staff reporter, Oklahoma City Journal Record, July 6, 2012, np.

“There’s little doubt that PTSD should be acknowledged as a major, life-changing disruption to many veterans’ lives after military action in service to their country, said Dave Gordon, executive director at NAMI Oklahoma. And other professionals agree. “I think it is needed; I think it is a big step to de-stigmatization of mental illness,” Gordon said Friday. “Our soldiers come home with many types of injuries, and it’s high time that we recognize those who have fought for our country and now suffer from PTSD and other disorders.”

Jason Forrester, co-director of the National Guard Program at Veterans for America, NPR Talk of the Nation, January 28, 2009, np.

“The Purple Heart would change this in the sense that if we were to come to an agreement that it was a legitimate wound that deserved the Purple Heart, then that would certainly address the question that it is not a real wound, that they’re quote/unquote, “lesser heroes.” That’s certainly something that, a myth, that needs to be busted as well. As if people come back from combat and they’re having trouble adjusting to civilian life, it’s not a matter of somebody slapping him around like General Patton did or telling them to pull themselves up by their bootstraps.”


BONUS! Negative Arguments

We don’t usually include Negative arguments with these cases, but since Dr. Srader happened to cut some, here you go.

The main difficulty on Negative will probably be outweighing; “damaging the prestige of the purple heart” may not be an immediately convincing response to horror stories about PTSD, so you’ll have to craft your spin carefully. These particular disadvantages might work best as comparative advantages/competition for a counterplan, if you can propose an alternate way to help soldiers with PTSD.

Stigma isn’t the reason PTSD patients avoid treatment – it’s individualism, which awarding a medal wouldn’t change

Rob McIlvaine, senior correspondent, Army News Service, Defense Department Documents and Publications, June 20, 2012, np.

“Castro said they’ve discovered things that have nothing to do with stigma. It has to do with the culture within America and within the Army. And what is that culture? It’s one of self-reliance and self-improvement. “Fix it yourself. Don’t look for me to fix it. I mean, what is the number one genre of books? Self-help books. So a lot of Soldiers try to cure themselves. They rely on their own ability and we encourage that as a society and as a military. Take care of yourself, take care of your buddy,” he said. He said mixed signals are being sent. Culture is saying “take care of yourself,” and the Army is saying, “look, you can’t take care of yourself, you need to come in
and get some help.” Additionally, he said, a lot of people do not believe in mental health. They don’t believe that psychologists and psychotherapy is beneficial or will help them. “That has nothing to do with stigma. Those two things I just described have nothing to do with stigma, at all. It has to do with one’s personal attitudes and beliefs about themselves and their own personal responsibility, and also how they believe others can help them,” Castro said. [“Castro” = Col. Carl Castro, director of the Military Operational Medicine Research Program.]

The DOD is already combating the stigma by committing resources to treat PTSD

Pauline Jelinek, staff writer, Associated Press, January 8, 2009, np.

“The Pentagon on Thursday sought to assure troops that it takes post-traumatic stress seriously despite the recent decision not to award the Purple Heart to those with the disorder. An advisory committee concluded that troops coming home from the wars with combat stress cases collectively known as post-traumatic stress disorder will not qualify for the prestigious medal awarded to service members wounded in action. “I don’t think anybody should assume that that decision is in any way reflective on how seriously we take the problem of PTSD,” Defense Department press secretary Geoff Morrell said. He noted that the military is budgeting money for research, development, treatment and preventive measures.”

Giving Purple Hearts for PTSD crushes the tradition behind the medal, stripping it of prestige

DJ Skelton, Army captain and Purple Heart recipient, NPR Talk of the Nation, January 28, 2009, np.

“And I think the differentiation or the argument that’s being made now is George Washington’s original intent with the awarding of the Purple Heart specifically states in that order those who have shed the blood by – have shed blood from the enemy will be recognized from all of their fellow countrymen from doing that. So in that sense, we’re talking about a physical injury that has been sustained by a direct enemy, and that was their word of the qualification of the original intent. It’s been preserved for so many centuries of the Purple Heart. There’s no question amongst any of us that even without being physically wounded like I was, there is stresses on the body
that decay and deteriorate to the point where one is diagnosed as having a mental illness called the Post Traumatic Stress Disorder. And that needs definite clinical intervention and definitely needs help, and that isn’t going to go away. My nightmares are not going to go away the rest of my life. My anxieties are not going to go away the rest of my life. But I don’t think that should take away from the original intent of George Washington of why we had to recognize.”

Barrie Barber, Dayton Daily News, June 18, 2012, p. A1.

The Military Order of the Purple Heart and the Veterans of Foreign Wars say post-traumatic stress doesn’t merit the award. “PTSD is not something new,” said John E. Bircher, a Military Order of the Purple Heart spokesman in Spring-field, Va. “There’s hardly anyone who has ever been in combat, and certainly someone who has been wounded, who doesn’t suffer some form of PTSD.” Medals aren’t awarded for illness or disease, but for “achievement and valor,” said Joseph E. Davis, a VFW national spokesman in Washington, D.C. “The Purple Heart is awarded for a physical wound received while engaged with an enemy force,” he said in an email to the Dayton Daily News. “PTSD is considered an illness and not an injury.” He noted soldiers who suffered Gulf War syndrome, and Korean War veterans who had frostbite in the freezing depths of Korean winters, also didn’t qualify for the award. “Not to diminish the illness or effects of
PTSD, but it is the VFW’s belief that awarding the (Purple Heart) for PTSD is not consistent with the original purpose and would denigrate the medal,” he wrote.”

Because PTSD diagnoses are slippery, the effect of the plan is to water down the Purple Heart

Amanda Wilcox, staff reporter, Jacksonville Daily News, July 16, 2012, np.

“I am completely against it,” said Verl Matthews, MOPH Beirut Chapter Commander and a Purple Heart recipient. “You would have to have some very strict guidelines for this to work.” One in five active duty military personnel have experienced symptoms of PTSD, depression or other mental health conditions and the Veteran’s Administration has treated more than 400,000 post 9/11 veterans for mental health issues, according to the report. That’s a proposed 400,000 Purple Heart medals for veterans, in addition to the 440,000 active duty members supposedly suffering from the same mental health issues, according to the NAMI report. “If they legitimize this and make (PTSD) a Purple Heart rewardable deal, it’s going to get out of hand,” said Grant Beck, Purple Heart recipient MOPH Beirut Chapter senior vice commander. “Legitimate cases of PTSD are certainly very serious. But PTSD is very difficult to verify and I just don’t see how it can be verified in all cases.”

Giving Purple Hearts to PTSD patients alienates them from those who sustained physical wounds, which breaks up camaraderie between veterans

Barrie Barber, Dayton Daily News, June 18, 2012, p. A1.

“Vietnam veteran Ricky A. York said he’s had combat-related PTSD, but isn’t sure a Purple Heart should be given to soldiers who carry wounds, as he did, inside them. For 43 years, the former cavalry soldier avoided talking about Vietnam to his family before he wrote a book about it. “I can tell you I have injuries, but they aren’t physical,” said York, 66, of Kettering, a retired General Motors autoworker. “That’s a pretty big distinction to actually be physically wounded. There’s some ongoing suffering and pain with having PTSD, but I don’t know if I’d agree it’s the same as being shot or stepping on a mine. “I just think personally if I said I deserve a Purple Heart and there’s a veteran there with one arm or a leg missing, I don’t know how he would look at it,” he said. “I sure don’t want to offend one of those guys.”

Soldiers will fake PTSD to get the medal

Lizette Alvarez & Erik Eckholm, staff reporters, New York Times, January 8, 2009, p. A1.

“But many soldiers do not feel that way. In online debates and interviews they expressed concern that the Purple Heart would be awarded to soldiers who faked symptoms to avoid combat or receive a higher disability rating from the Department of Veterans Affairs. ”I’m glad they finally got something right,” said Jeremy Rausch, an Army staff sergeant who saw some of the Iraq War’s fiercest fighting in Adhamiya in 2006 and 2007. ”PTSD can be serious, but there is absolutely no way to prove that someone truly is suffering from it or faking it.”

Awarding medals would invade the privacy of PTSD patients who seek treatment

Brian Brus, staff reporter, Oklahoma City Journal Record, July 6, 2012, np.

“But on the other hand, psychological health is still a very private matter and a medal for PTSD could reveal too much personal information about the individual publicly, Edmond psychologist Stewart R. Beasley Jr. said. “NAMI has always been a great mental health advocate,” he said. “In this case, I’m not sure I agree with their proposal. I can’t say I’m in favor of it. ””

plan:

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One Response to ‘Case of the Week’ 4 (Stoa): Purple Hearts for PTSD

  1. Lynda says:

    I have read all these comments on PTSD and the Purple Heart award. I think this is a very real injury which no one can understand unless they suffer from it. Many years ago a friend of mine continually made sarky and nasty comments about his brother in law who suffered Clinical depression. In his opinion it didn’t exist. That changed when some years later he too suffered a traumatic experience and ended up diagnosed with Clinical depression. He was totally incapable of thinking rationally or taking care of himself or his family. Does he think it is a real illness / injury you bet he does. He knows now from experience. I have a friend now who was a serviing officer and has now been diagnosed with PTSD. This had affected his whole life and only this year did he seek help. He has scared me on occasion with his inability to sleep because of nightmares. He has passed out because of flashbacks during discussions about his war career and his marriage and a subsequent relationship ended because of mood swings and uncontrollable tempers. Since we met he has constantly told me that he thinks he will die and he has dreamt of his death. Would a Purple Heart change any of this and take it away – no it wouldn’t but maybe it would make him feel that his 20 odd years fighting for his country was appreciated.

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