Post-traumatic Stress Injury is now a known, but still elusive, concept. It can happen to anyone at any time. In warfare it can be expected. Still, only relatively recently have we began to embrace the reality and consequences of this too often fatal wound.
At the outset, reaction can be merely sleepless nights and hyper-vigilance, but allowed to progress it can move the injured into a state of despair where he or she feels separation and a deep sense of failure. As human beings one of our most primal and vital needs is that of attachment. The sudden inability to cope with anxiety, to join in the defense of one’s fellow service members, to soldier on, can quickly lead to self-exile. The unnecessarily added perception of being unworthy further subscribes to this disposition of failure and detachment. This descent into self-doubt is the desperate departure down the slippery slope to suicide. We believe the Purple Heart can and should be employed as a logical instrument of counterbalance. It can be used to confer acceptance and neutralize despair.
On Nov 3, 2008, the Department of Defense concluded, “[PTSD is] not a qualifying Purple Heart wound,”
On Jan 5, 2009, the Department of Defense announced, “advancements in medical science may support future re-evaluation.”
Our immediate objective is to formulate a deployable agendum which will expedite action at the time of bio-marker acknowledgement.
Unlike all other military decorations the Purple Heart is authorized not by commendation, but by entitlement. The Purple Heart was created and implemented to recognize valor and foster healing – it is an honor but not a privilege.
We are not advocating authorization of the Purple Heart for comprehensive Post-traumatic Stress Disorder as defined in DSM III, IV and V. We are only calling for authorization for the subgroup of Combat Stress Injuries received in action against an opposing armed force of a foreign country in which the US Armed Forces are or have been engaged.
The Brain Sciences Center of the University of Minnesota and Psychiatric Residency Research Track of the University of Michigan, under the authority of the Veterans Administration, are at present jointly conducting a clinical trial to evaluate Synchronous Neural Interactions for Post-traumatic Stress Injury (bio-markers) measured by fMRI and or MEG with very positive and promising results.
With these possibly soon to be verified bio-markers, invisible wounds can then be considered to adequately qualify under the present Title 32 of the Code of Federal Regulations with the exception of Subsection 578.17(b)(5)(ix) which groups post-traumatic stress disorders in with frost-bite, heat stroke, and food poisoning as “injuries which clearly do not qualify”. Before all else, this subsection would have to be amended.
We believe authorization of the Purple Heart can provide service members and veterans suffering from Combat Stress Injury, and their families, with a sense of belonging and pride not presently procurable. Further, it makes a clear and explicit statement about the Armed Services’ regard for the invisibly wounded and wound alike – affirming respect for the bearer and adding dignity where it has for so long been denied.
This newly demonstrated appreciation will transfer into the civic sector for all forms of Post-traumatic Stress Injury, subsequently benefiting victims of abuse, crime, and natural disaster – and ultimately, raising awareness of all mental illness and injury.
Authorization of the Purple Heart for Combat Stress Injury can significantly elevate the social and military acceptance of Post-traumatic Stress Injury as a natural and sometimes honorable human condition.
Tom Mahany started a hunger fast in 2009 to draw attention to posttraumatic stress (PTSD). He fasted again in 2012 when he learned that the number of suicides among veterans had doubled from June to July.
Now Mahany heads up the veterans’ advocacy group Honor for ALL, which organizes an annual event, Visible Honor for Invisible Wounds, to raise awareness about posttraumatic stress.
This year’s event recognized the passing of legislation introduced by U.S. Senator Heidi Heitkamp designating June 2014 as National Posttraumatic Stress Disorder Awareness Month. JB Moore, NAMI Manager for Military and Veterans Policy and Support, represented NAMI at the event.
Though usually held in Washington, D.C., Visible Honor for Invisible Wounds took place in New York City on Saturday, June 28, 2014 and was co-hosted by the Mental Health Association of New York City. The scope of the program was expanded to include first responders and victims of abuse.
The keynote speaker Staff Sergeant Ty Carter, who has struggled with PTSD, was the 2013 recipient of the Congressional Medal of Honor. When awarding the Medal of Honor, President Obama described SSgt. Carter this way, “He’s as tough as they come. And if he can find the courage and the strength to not only seek help, but also to speak out about it, to take care of himself and to stay strong, then so can you.”
In addition to SSgt. Carter, officials included commissioners from the New York City police and fire departments, representatives from the Chiefs of Staff of the Army and Navy; the Wounded Warrior Project; Iraq Afghanistan Veterans of America (IAVA); Service Women’s Action Network.
“It is reprehensible that an estimated 22 veterans take their lives each day”, declared JB in her remarks. “Posttraumatic stress is treatable. Let’s eradicate stigma!”
According to Mahany, “There was an unmistakable message from the event. Posttraumatic stress is an injury that needs to be accepted and honored as such. If we don’t attend to it, it will be allowed to progress into a disorder.”
Earlier this year, the Senate Armed Services Committee passed the Jacob Sexton Military Suicide Prevention Act of 2014 – introduced by U.S. Senator Joe Donnelly (D-Ind.), as part of this year’s National Defense Authorization (NDAA) bill. If passed, this legislation will: (1) Require annual mental health assessments for all service members-Active, Reserve, and Guard; (2) Establish a working group between the Department of Defense and Department of Health and Human Services; and (3) Require an interagency report to evaluate existing military mental health practices and provide recommendations for improvement.
According to Mary Giliberti, NAMI’s Executive Director, “The National Alliance on Mental Illness strongly supports the Jacob Sexton Military Suicide Prevention Act of 2014 and applauds Senator Donnelly for his recognition that suicide rates among active duty service members, National Guardsmen and Reservists are unacceptably high and in dire need of attention. This important piece of legislation advances NAMI’s goals of parity, accountability, collaboration and action.”
Honor for ALL is already at work organizing next year’s National Posttraumatic Stress Awareness activities. Events will be held in New York, Michigan, San Diego, and Indianapolis, all on Saturday June 27, 2015.
Tom Mahany believes the sure sign of true awareness about posttraumatic stress will be when Major League Baseball plays with purple bats for the month of June
Visible Honor for Invisible Wounds 28 June, thank you.
- Joe Geraci and Tim O’ Connor of Battle Buds introduced the concept of posttraumatic growth in which the individual who has been exposed to mental trauma now has the infrastructure and foundation to build a new understanding of life and personal development
- Ty Carter advance the idea of post-traumatic stress is something that we all experience to some extent at some point or points in our lives; and it is, beyond being distasteful and harrowing, an opportunity to learn and adjust.
- Dr. Frank Ochberg emphasized the idea that post-traumatic stress is an injury and for the benefit of the injured it needs to be referred as such.
- JB Moore of NAMI bolstered the need for parity between visible and invisible wounds and called for the establishment and entitlement of the Purple Heart for post-traumatic stress incurred in combat in order to curb the current discrimination against those who have incurred battlefield traumatic stress
- Deputy NYPD Commissioner Susan Herman stressed the need to end the stigma of mental trauma among first responders and victims of crime
The keynote address at this year’s Visible Honor for Invisible Wounds ceremonies will be delivered by Staff Sargent Ty Carter, recipient of the Congressional Medal of Honor in 2013.
He will be joined at the podium by representatives from the offices of: the Chiefs of Staff of the Army and Navy; Iraq Afghanistan Veterans of America; the Wounded Warrior Project; Service Women’s Action Network; the FDNY Commissioner and NYPD Commissioner; individuals from the national healthcare sector, and last, but certainly not least, individuals among us now dealing with the everyday consequences of post-traumatic stress.
Our goal is to reduce suicides among veterans, first responders, victims of abuse and others caused by misunderstanding and prejudice applied to post-traumatic stress injuries, known to most Americans, unfortunately, as a disorder.
Discovery and resolution of a bio-marker will reduce stigma and lead to better understanding of the consequences of modern warfare, occupational trauma and abuse.
In the Executive Summary of the National Research Action Plan, dated August 2013, the Administration has made it clear that it considers the replication and confirmation of biomarkers for PTSD and the identification of the blast pathology for TBI to be preeminent in the research priorities of the National Research Action Plan (NRAP) to aid in the prevention, diagnosis and treatment of mental health issues among service members, veterans and their families. Accomplishment of this directive will lead to greater understanding of mental injury and illness which will in turn, benefit those now suffering in inequitable silence.
Key Themes Specific to PTSD, TBI, and Suicide Prevention Research -
Beyond the research priorities spanning conditions (presented previously) and looking deeper into specific research needs for PTSD, TBI, and or suicide prevention, the themes highlighted here are examples of topics described in greater detail in the full report. Please note that the bullets under each research area are organized along the Interagency Research Continuum Approach, described earlier, and are not placed in order of importance or priority. Also note that all of these research areas are expected to include consideration of co-occurring disorders, including substance use disorders.
PTSD: Biomarkers, Mechanisms, and Treatment Research -
• Replicate and confirm emerging data on promising biomarker candidates and other diagnostic tools for PTSD, including genome-wide associations, plasma molecules, and methylation patterns.
• Optimize risk and resilience screening tools and test new PTSD prevention and treatment interventions that target underlying mechanisms and causal pathways.
• Enhance current PTSD evidence-based treatment delivery to be briefer, more durable, and more efficacious in treating service members, Veterans, and their family members, including individuals with multiple mental and physical health issues, including substance abuse.
TBI: Biomarkers, Diagnosis, Mechanisms, and Treatment Research -
• Determine whether blast-induced TBI is a unique pathobiological entity and, if so, define the neuropathology of blast injury and in a subsequent step evaluate appropriate imaging technologies for their ability to identify the blast pathology in histologically characterized brain tissue. Utilize these imaging tools in service members and Veterans to determine whether blast, or repetitive blast injury, is a risk factor for chronic neurodegeneration or other chronic neurologic disorders.
• Develop a more precise system for classifying and staging TBI to enhance diagnosis and prognosis and enable targeted therapies and personalized medicine.
• Support validation studies of proteomic, imaging, neurophysiolo
research to rapidly translate what is learned into new effective prevention strategies and clinical innovations: biomarkers to detect disorders early and accurately; and efficacious and safe treatments”
To attain these goals, the Order urged research agencies to improve data sharing as appropriate and with appropriate privacy and confidentiality protections, and harness new tools and technologies
The Order also calls for the establishment of a comprehensive longitudinal study of 100,000 service members focused on PTSD, TBI, and related injuries