Writing the Book on Military Mental Health

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Dr. Elspeth Ritchie

The literature of war can be literature — think Stephen Crane’s The Red Badge of Courage (Civil War), Erich Maria Remarque’s All Quiet on the Western Front (World War I), or Neil Sheehan’s A Bright Shining Lie: John Paul Vann and America in Vietnam. And sometimes it’s less lit and more textbook. That’s surely the case with the publication of Combat and Operational Behavioral Health. Catchy title it’s not.

It’s edited (and contributed to) by Battleland’s own Dr. Elspeth “Cam” Ritchie, and because she’s too modest to toot her own horn, we’ve decided to blow it for her. The Army’s former top psychiatrist, she and 152 of her colleagues, largely from the field of military mental health, have just released the latest medical science on the mental challenges associated with combat. They spent six years writing (and rewriting) chapters dealing with everything from post-traumatic stress disorder, suicide, drug dependency, and all of the pathologies we’ve come to associate with a decade of non-stop war. But they also write about good things: the important role played by chaplains in keeping military minds healthy, for example, and the need to develop ways of improving troops’ mental resilience.

We’re asking Dr. Ritchie about the book, published by the Army’s Borden Institute (its contents can be downloaded — for free  — here):

Why is this book important?

Let me first give you some background. The Army Medical Department has been publishing Textbooks of Military Medicine for many years. The last two on mental health, War Psychiatry and Preparing in Peace for War, were published in 1994 and 1995. However the lessons learned in these volumes essentially didn’t include much that happened after World War II.

We have now been at war in Iraq and Afghanistan for 10 years.  When I proposed the book to the publishers, it was in 2005, and I felt that we needed a volume which would cover the psychological effects of asymmetrical warfare, then called the “Global War on Terror.” Obviously that includes combat and improvised explosive devices, head trauma and post-traumatic stress disorder, and the effects of repeated deployments on families.

Why is it appearing on the 10th anniversary of 9/11?

In many ways that is coincidence, but a fortuitous one. 9/11 was the attack that led to Operation Enduring Freedom in Afghanistan. There have been numerous other terrorist incidents and natural disasters over the last 20 years. The military is indirectly or directly involved in many of these. There are chapters on disaster psychiatry and the response to the 2004 tsunami, for example.

What does the title — Combat and Operational Behavioral Health — signify?

Combat is obvious. Operational refers to the numerous operations that are not technically warfare, such as providing humanitarian assistance after earthquakes and floods. We also wanted to broaden it to include all disciplines. In the military, psychiatrists work closely with psychologists, social workers, psychiatric nurses and occupational therapists. All the different disciplines are represented in the 47 chapters, along with all the services — Army, Navy, Marines, Air Force — and the Public Health Service.

There’s a chapter on Vietnam. But that war ended 40 years ago…

Although America’s war in Vietnam led to the recognition of post-traumatic stress disorder (PTSD), there is also actually little written about psychiatry in Vietnam. The author of this chapter, Norm Camp, surveyed psychiatrists who had served there. It is probably the most comprehensive account of psychiatry in Vietnam that exists.

What else would you highlight?

Dr. Steve Cozza was the section editor for the families’ section, which includes five chapters covering the effects of the deployment cycle and support to families of the wounded and deceased. There is a very interesting chapter, from the Air Force, on the aeromedical evacuation process from the theater of operations to Landstuhl [in Germany] to Walter Reed [in Washington, D.C.]. Chris Warner has a great one on consultation with commanders. A new topic for many in our mental health community is the effects of combat stress on teeth. The chapter has some gory pictures!

But I could go on and on. I think it is a great book. The neat thing is that you can download any of the chapters as pdfs, for free.