Purple Heart Day: Honoring Trauma, Grief, and the Unseen Wounds of War

Each year on August 7, the United States observes Purple Heart Day, a time to honor those wounded or killed in combat while serving in the U.S. Armed Forces. While the medal itself recognizes physical injury or death at the hands of the enemy, Purple Heart Day also offers a deeper opportunity for mental health providers: to reflect on the emotional and psychological toll of war—and to recommit to culturally responsive, trauma-informed, and grief-aware care for veterans and their families.

For those who carry this recognition, the journey rarely ends with the injury itself. Many live with invisible wounds—post-traumatic stress, moral injury, traumatic grief, and survivor’s guilt—that don’t appear on discharge paperwork but remain etched in the nervous system, relationships, and spirit.

Understanding Trauma in the Context of Combat

Trauma disrupts a person’s sense of safety, belonging, and meaning. For combat veterans, it’s not only the life-threatening events that leave lasting effects—it’s the moral complexity of war, the loss of fellow soldiers, and the shifting of identity during the transition from military to civilian life. The pain of physical wounds may be recognized, but psychological wounds are often silenced by a culture of toughness and stoicism. Purple Heart Day invites us to acknowledge this complexity and offer care that goes beyond the surface.

Best Practices for Trauma Treatment: Evidence-Based Modalities

Working with veterans and Purple Heart recipients requires not just empathy, but evidence-based, trauma-informed clinical tools tailored to their unique needs and experiences. Below are some of the most effective modalities supported by current research and veteran-serving systems like the VA and Department of Defense:

Core Evidence-Based Approaches

Prolonged Exposure (PE): Helps clients gradually approach trauma-related memories, feelings, and situations they’ve been avoiding. Strong evidence base in combat-related PTSD.

Cognitive Processing Therapy (CPT): Focuses on modifying unhelpful beliefs and thoughts about the trauma. Especially helpful for moral injury and guilt/shame-related responses.

Eye Movement Desensitization and Reprocessing (EMDR): Uses bilateral stimulation to process distressing memories without extensive verbal retelling. Supported for veterans with complex PTSD.

Written Exposure Therapy (WET): A brief, structured writing-based protocol shown to reduce PTSD symptoms—helpful for clients who are reluctant to engage in talk therapy.

Adjunctive and Integrative Modalities

Somatic Experiencing & Sensorimotor Psychotherapy: Addresses how trauma is stored in the body and helps restore a sense of physical safety and agency.

Acceptance and Commitment Therapy (ACT): Helps clients move toward values-based living even in the presence of difficult emotions or traumatic memories.

Mindfulness-Based Stress Reduction (MBSR): Enhances emotional regulation, interoception, and present-moment awareness—particularly helpful for hypervigilance and chronic pain.

Narrative Therapy: Supports meaning-making and identity reconstruction post-trauma. Useful for exploring stories of service, sacrifice, and resilience.

Implementation Tips

Start with stabilization: Many clients need support with nervous system regulation, sleep, and basic functioning before engaging in trauma processing.

Offer choice and transparency: Explain treatment options clearly, and let clients have a say in how and when they engage in trauma work.

Address co-occurring issues: Substance use, depression, traumatic brain injury (TBI), and chronic pain often co-occur and require coordinated care.

Use a team-based approach when possible: Collaborate with peer specialists, primary care, spiritual care providers, and case managers when available.

Effectively supporting veterans and Purple Heart recipients means combining clinical expertise with approaches that respect their lived experiences. Evidence-based therapies like PE, CPT, EMDR, and WET address the core symptoms of trauma, while integrative modalities such as somatic work, ACT, mindfulness, and narrative therapy offer pathways for healing that honor both body and mind. Successful care involves a foundation of stabilization, informed collaboration with interdisciplinary teams, and empowering clients with choice and transparency throughout the therapeutic process.

Making Room for Grief—In All Its Forms

Grief in military life is often layered, ambiguous, and disenfranchised. While we commonly associate grief with death, veterans and their families may also grieve:

The loss of those they served alongside—through combat, suicide, or illness
The loss of physical or cognitive ability after injury
The loss of identity, community, or purpose
The loss of faith or trust—in themselves, institutions, or humanity

These losses are not always socially or clinically acknowledged. As providers, we have a responsibility to make space for these grief experiences.

Best Practices for Supporting Grief in Veterans and Families

Normalize the full spectrum of grief: Validate both visible and invisible losses. Use language like, “That sounds like a real loss. How has that shaped you?”

Create grief-literate spaces: Avoid minimizing language (“moving on,” “at least…”). Introduce practices like journaling, storytelling, or somatic grief rituals to support emotional expression.

Acknowledge identity loss and moral injury: Ask questions like, “What part of yourself did you have to leave behind?” or “What values did this experience challenge in you?”

Be patient with emotional expression: Many veterans have been conditioned to compartmentalize emotions. Grief may show up somatically, behaviorally, or through avoidance before becoming verbal.

Support meaning-making: Help clients integrate loss into their personal narrative. Honor their resilience without bypassing pain.

Grief is not always loud or linear—especially in the lives of veterans and their families, where loss often takes ambiguous and invisible forms. As mental health providers, we must go beyond traditional grief frameworks to recognize how identity, trust, and purpose can be casualties of service, too. Creating a grief-literate culture means cultivating spaces where emotional pain isn’t pathologized, but honored as a natural response to profound disruption. It requires slowing down, listening with attunement, and giving clients permission to name what’s been lost—even when the world around them hasn’t.

Practicing Cultural Humility with Veterans and Their Families

Cultural humility is not about having all the answers—it’s about committing to ongoing learning, accountability, and respect. It’s not the client’s job to teach us; if we choose to serve this community, we must do our homework.

Best Practices for Cultural Humility

Do the work ahead of time: Learn the basics of military structure, terminology, deployment cycles, and the diverse experiences within military service. Don’t rely on clients to educate you—invest in trainings, books, veteran-led resources, and reflective practice.

Recognize the diversity within military culture: There is no monolithic “veteran experience.” Identity is shaped by race, gender, branch, rank, era of service, and more. Honor the complexity.

Name power dynamics and systemic harms: Veterans may carry grief or rage related to institutional betrayal, racial inequity, military sexual trauma, or unmet promises. Acknowledge these truths. Say, “You’re not alone in feeling let down—and your pain is valid.”

Be transparent and consistent: Build trust through clear communication about your role, confidentiality, and what to expect from therapy. This can feel grounding for clients used to command structures.

Engage in ongoing self-reflection: Ask yourself:

What assumptions am I bringing into this space?
How is my own identity showing up here?
Am I truly centering the client’s values and worldview—or my own?
Seek supervision or peer support, especially when working through moral injury or complex trauma narratives.

Cultural humility is not a one-time competency but an ongoing professional commitment grounded in respect, critical self-reflection, and accountability. For clinicians who choose to work with veterans and military families, it is essential to invest time and effort in understanding the cultural norms, language, values, and systemic influences that shape military life. Building therapeutic trust requires more than empathy—it demands transparency, consistency, and a willingness to acknowledge both individual identity and institutional harm. When providers come prepared, clients are relieved of the burden of having to educate or justify their experiences. In doing so, we create the conditions necessary for genuine connection, safety, and healing.

In closing, our work with veterans and their families must be grounded in both clinical expertise and cultural humility. Evidence-based treatments like Prolonged Exposure, Cognitive Processing Therapy, EMDR, and integrative mind-body approaches offer powerful tools for addressing trauma—but their impact is magnified when delivered in a context that also honors grief and identity. Veterans may carry visible and invisible wounds, as well as layered, often unspoken losses that extend beyond the battlefield. To truly support healing, we must recognize the diverse realities of military life, invest in understanding the culture we aim to serve, and create grief-literate spaces where pain can be acknowledged rather than pathologized. This Purple Heart Day, let us reaffirm our commitment to trauma-informed, grief-aware, and culturally responsive care—so that those who have borne the weight of service are met not only with skill, but with compassion, dignity, and the possibility of restoration.

References

Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, 12, CD003388. https://doi.org/10.1002/14651858.CD003388.pub4

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003

Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, 93. https://doi.org/10.3389/fpsyg.2015.00093

Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., … & Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA, 314(5), 456–465. https://doi.org/10.1001/jama.2015.8361

Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635–641. https://doi.org/10.1016/j.cpr.2010.04.007

Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., … & Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM-5. Depression and Anxiety, 28(2), 103–117. https://doi.org/10.1002/da.20780

U.S. Department of Veterans Affairs & Department of Defense. (2023). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress reaction. https://www.healthquality.va.gov/guidelines/MH/ptsd/

U.S. Department of Veterans Affairs. (n.d.). National Center for PTSD. https://www.ptsd.va.gov

Purple Heart Day: Honoring Trauma, Grief, and the Unseen Wounds of War

Understanding Trauma in the Context of Combat