War Trauma, Politics of Recognition and Purple Heart: PTSD or PTSI?

Abstract

This paper discusses the exclusion of veterans with combat PTSD (CPTSD) from eligibility for the Purple Heart (PH). The main argument is that this exclusion is unjustified and that it strengthens the stigma attached to the traumatized veterans, with detrimental implications to their wellbeing. In the context of the politics of recognition, the history of the term PTSD, and with support evidence from brain studies, the paper contends that in the case of combat veterans, posttraumatic stress should be termed PTSI (posttraumatic stress injury) rather than PTSD (posttraumatic stress disorder). The proposed alteration in terminology may enable eligibility of posttraumatic combat veterans' for the Purple Heart, and consequently mitigate the stigma of their wounds, help to deconstruct their misrecognition as inferior to physiologically wounded, increase their willingness to seek aid, and improve their chances to heal.

The Making of Compassion Stress Injury: A Review of Historical and Etiological Models toward a De-Stigmatizing Neurobehavioral Conceptualization

“…As a way of unifying these definitions, and to better address emerging evidence for the biopsychosocial processes and outcomes associated with this phenomenon, we propose the use of the term compassion stress injury (CSI), which will be used throughout this article [1]. Our assertion of CSI is intended to convey an actual mind-body "wounding" not dissimilar to physical injury versus mere fatigue or other abstraction [1,19,20]. This conceptualization follows recent efforts by military groups around the world to avoid stigmatizing terminology including the U.S. military dropping the "D" in post-traumatic stress disorder (PTSD) to embrace post-traumatic stress (PTS); the Canadian Armed Forces (CAF) adopting the term "operational stress injuries"; and the Israel Defense Forces (IDF) considering PTS (I-injury) versus PTSD [19,20].…”

“…Our assertion of CSI is intended to convey an actual mind-body "wounding" not dissimilar to physical injury versus mere fatigue or other abstraction [1,19,20]. This conceptualization follows recent efforts by military groups around the world to avoid stigmatizing terminology including the U.S. military dropping the "D" in post-traumatic stress disorder (PTSD) to embrace post-traumatic stress (PTS); the Canadian Armed Forces (CAF) adopting the term "operational stress injuries"; and the Israel Defense Forces (IDF) considering PTS (I-injury) versus PTSD [19,20]. These changes and ongoing debates have sparked heated medico-legal and political discourse about the authenticity of psychological wounds compared to physical injuries [20].…”

“…Research has found that the prevalence of CSI amongst helping professionals is notable: 40-80% across various occupations, including therapists, police officers, military psychologists, emergency department workers, child welfare workers, hospice care providers, and other people working with vulnerable and/or traumatized populations, suffer from CSI [15][16][17][18][19][20][21][22][23][24][25]. Because of this high prevalence, it is important for us to understand the historical origins and contemporary understandings of CSI to inform interventions and research aimed at increasing the resiliency and protection of this population, whose work is invaluable across multiple fields.…”

“…When combined with "stress"-"a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation"-and "injury"-"an act that damages or hurts" (see Merriam-Webster at http://www.m-w.com)-we have the makings of CSI. Use of the word "injury" is also supported by scholars and clinicians who have sought to reduce the potential stigmatization caused by the use of "disorder" in diagnostic language, and the use of "injury" has been proposed, though not yet adopted, for use in the DSM-V [19]. While previous models have utilized "fatigue" in an effort to reduce stigmatization of those suffering from CSI, these and other euphemisms minimized the specific outcomes of compassion-related stress injury including structural changes in the brain and other organ systems that vary from the impacts of fatigue, and are unique to compassion and empathy [1,8,40,41,43].…”

Rural clinical social work practice: Self-care and compassion fatigue prevention.

“…The results of the scans are a good example of why post-traumatic stress disorder should be re-named Post-Traumatic Stress Injury (PTSI). According to Keynan and Keynan (2016), changing the term to PTSI from PTSD would make combat veterans eligible for the Purple Heart in the U.S., and help deconstruct the existing stigma that surrounds PTSD. Keynan and Keynan's notion is that changing the term will help begin to eliminate the stigma surrounding PTSD (2016).…”