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I went into this conversation about the Purple Heart/PTSD/closed skull brain injury controversies with the feeling that it was a classic case of the need to achieve more general recognition that all behavioral changes are changes in the brain and needed to be dealt with simiilarly.  I still think that's so, but acquired an entirely new and somewhat unsettling perspective on the Purple Heart controversy.  Thanks all.

The issue of physical versus mental damage is actually irrelevant to the Purple Heart policy.  What is relevant is socialization: the practice of encouraging people to behave in particular ways by giving symbols of social validation to people who the social group can say as unambiguously as possible display the behaviors one wants to encourage.  The problem with PTSD and closed skull brain injury is that many people are unsure whether one can distinguish between people actually "injured" and people who are instead either "faking it" or displaying an undesireable lack of self-discipline/will.  Presumably this will change as people become more familiar with the evidence of brain changes associated with trauma.

What's more unsettling though is the need to recognize that in important senses we all do what the military does in awarding Purple Hearts.  We all "validate" behaviors in others that we can readily identify as "positive" (by whatever standards we happen to use) and, without intending it, we also fail to validate not only behaviors we don't approve of but those we have trouble evaluating.  People in grey zones tend to get lumped in with those we know we don't want to validate.  How to avoid that particular sin is an important and interesting challenge that I need to think more about.