Having little to do with the understanding of organizations but interesting in its reflection of one organization’s decision:
Are mental disorders as important as physical injuries? Many advocates say that they are and that we should treat them accordingly. Most of the fight is over insurance coverage of mental health. But part of the action is in the U.S. military. There, the question has been whether to award the Purple Heart for post-traumatic stress disorder. This week, the Defense Department announced its decision: No.
Eight months ago, when we first checked in on this debate, I was skeptical for two reasons. One was that PTSD would turn out to be widely overdiagnosed. In general, mental wounds are harder to define and identify than physical wounds are. There are obvious cases, but there are also fuzzy ones. Where do we draw the line? How do we keep the Purple Heart from being cheapened?
The second reason was that the Purple Heart, unlike basic health insurance, isn’t a policy instrument. It’s an honor. Officially, it denotes “meritorious action.” And honor isn’t the first step in a cultural transformation, no matter how worthy that transformation may be. It’s the last.
I’m cautiously supportive of awarding the Purple Heart for PTSD. Saletan makes a valid argument that those who suffer from mental ailments meet the three-pronged test set out by Defense. It’s in the caution that the debate lies, though. Mental illness and damage can be far more difficult to diagnose than physical ones; for example, the average time for an accurate diagnosis of bipolar disorder is over a decade. What is not at issue, though, is that mental illnesses and their causes are real, and that those who do what the rest of us are unwilling or unable are subject to being harmed by them in the field of battle. Absence of evidence is not evidence of absence.
