Volume 49, Numéro 1, janvier-mars 2010
|Page(s)||23 - 26|
|Section||Psychiatrie de guerre, regards croisés américains et français|
|Publié en ligne||15 janvier 2010|
Awoman tells the doctrine: the personality of Elspeth Cameron Ritchie
Military Hospitals resident, Department of Psychiatry, HIA Sainte-Anne, BP 20545 83041 Toulon Cedex 9, France.
Elspeth Cameron Ritchie est colonel psychiatre de l’armée américaine. Formée à l’Université de Harvard et riche d’expériences sur le terrain, elle a occupé des postes à hautes responsabilités dans l’institution médico-militaire américaine dont ceux de Consultant national en psychiatrie et de Directeur des programmes de politique de santé mentale. Elle a mené de nombreux travaux contribuant à l’évolution de la psychiatrie à la fois dans le registre médico-militaire mais aussi dans les domaines médico-légaux et de santé publique. Elle se distingue notamment par son implication dans la prévention du suicide et l’étude des traumatismes de guerre.
Elspeth Cameron Ritchie is a psychiatrist Colonel in the US Army. Trained at the Harvard College and rich of experiences on the battlefield, she held leadership positions within Army Medicine, including that of Psychiatric Consultant and the position of ProgramDirector for Mental Health Policy. She led numerous works contributing to the development of psychiatry in medico-military register, forensic psychiatry and public health fields. She particularly distinguishes herself on prevention of suicide and studying disaster of war.
Mots clés : psychiatrie militaire / troubles du stress post-traumatique / suicide / santé mentale
Key words: military psychiatry / Stress disorders / Post-Traumatic / suicide / mental health
© EDK, 2010
An academic and military education
Elspeth Cameron Ritchie, Colonel in the United States Army, entered active duty in 1983. She received a Bachelor of Arts Degree in Biology, Folklore and Mythology from Harvard College and her medical degree in 1986 from the George Washington University Medical School. She did her psychiatry internship, her Resident Medical Studentship and Fellowship in Forensic Psychiatry at the Walter Reed Medical Center. Then she received a Master degree in public health after completing her first year of the Disaster Psychiatry Fellowship at the Uniformed Services University of Health Sciences. She spent her second Fellowship year doing particular research at the USUHS Center for the Study of Traumatic Stress, which especially interests her. She still works there as an associate professor of psychiatry. Her main assignments have included the psychiatric support of the Second Infantry Division in Korea, as well as the 528th Combat Stress Control Detachment in Somalia and the Restore Hope operation. Also, numerous positions at Walter Reed and at the office of Health Affairs at the Ministry of Defence. Ritchie has also published several articles on forensic, disaster and military operational psychiatry. She is the main author of the reference report published in 2002, called «Mass Violence and Mental Health: evidenced-based psychological Interventions for Victims/ Survivors of Mass Violence», a summary of the lecture on the best practices held in 2000.
Her work and implications/involvement Prevention of suicide
New programs have been put in place by the Department of Defence to identify mental health problems in Veterans recently back from Afghanistan and Iraq. Ritchie explains that the Army screen service members when they are deployed to and redeployed from the field of combat, which is called a “post deployment health assessment”, concerning both medical and physical problems. his mental health screening is available on request and any service member can always self-refer to it for an evaluation of his own mental health. She has also contributed to a program of post-deployment health reassessment, which screens all service members, including those who stopped serving, within a period of time from 3 to 6 months after being redeployed. Many reasons justify this program, according to Ritchie, mainly similar symptoms as the ones observed in the «Gulf War Syndrome» and the return home that may be a time of risk for suicidal tendencies. The factors of risk for completed suicide include failure of intimate relationships, bureaucratic and social difficulties. Soldiers may initially go through a honeymoon period when they come home, but relationship problems can surface over time. Repeated deployment does strain relationships and may be related to the increase of suicides. She has pointed out that failed marital relationships account for 55 percent of what the study terms «completed suicides» and 40 percent of attempted suicides. Through a continuous gathering and analysing of data such as the number of suicide risk factors, stressors on soldiers, motives and methods, the Army is able to go on improving and adapting its training, intervention and support programs.
Studying disaster and responding to trauma in Iraq and Afghanistan
Colonel Ritchie used her epidemiological and biostatistical skills to survey the 88 members of the Iraqi Society of Psychiatrists. She thus helped determine what mental health services the Iraqis need in light of 30 years of conflict, sanctions and limited resources. This information has been handed over to individual and organisational stakeholders (as Iraq is reconstructing itsmedical and mental health system). Ritchie visited Iraq in October 2008, where she led a team assessing the mental health care available to soldiers. After conducting interviews and meeting experts and soldiers of all ranks, the team developed 55 recommendations to improve the training and care of suicide prevention. It occurs that previous training attempts, which focused on stateside, garrison environment, were not effective in the actual field of combat. Soldiers want to know how to recognize problems and what to do to help their buddies. The Army hopes the Battle Buddy System will help: all soldiers receive an ACE of hearts game card to carry with them. The card acts as a reminder to soldiers to care enough and have the courage to find out what is going on and never to leave soldiers alone who might harm themselves and even to get help. ACE stands for: Ask your buddy, Care for your buddy, Escort your buddy. Battle mind training, which is required both before and after deployment, also reminds soldiers who may be having a hard time that they are not alone. It tells leaders, soldiers, family members and even Army civilians howto recognize soldiers in distress and how to get them help.
The terrorist attack on 11 September 2001
EC Ritchie helped to coordinate the psychological response in the difficult weeks following the attack. She has written several pressarticles and a book chapter on the mental health response to the Pentagon attack and was Chief Editor of a book devoted to this topic while serving as Program Director for Mental Health Policy and Women’s Health Issues. She also worked on a report with the National Institute of Mental Health that proposed early interventions for people suffering from PTSD (posttraumatic stress disorder).
Program Director for Mental Health Policy and Women’s Health issues at the Department of Defence
She has contributed to health issues that affect women during deployment, including hygiene, pregnancy screening and earlier pap testing. According to Ritchie, this study led to «increase availability of good care and research into women’s health during deployments » and raised safety concerns about military deployment policies that require women in the same unit as men to sleep in separate locations. She worked on harassment issues and pointed out that isolation can be a contributing factor in the military. The Defence services work hard to educate both possible victims on their rights and potential offenders on the consequences of such actions. Thus, the Department of Defence increased training to alert investigators to be more sensitive to victims and healthcare providers to be more effective in gathering physical evidence.
Forensic psychiatry has been a long standing interest of Ritchie’s
She has testified for both defence and prosecution in more than 28 trials in military and civilian courts. Her area of expertise include reactions to rape, posttraumatic stress disorder, child sexual abuse and delusional disorder. According to her, a significant forensic accomplishment was getting the Army to change its policy on psychological autopsies. «They no longer require routine psychological autopsies after any suicide, except when the cause of death is equivocal», Ritchie said.
An action to destigmatize mental health
She noted there is still a stigma about the treatment of mental illnesses. The stigma, Ritchie said, is both the most difficult and the most important obstacle to overcome when it comes to helping soldiers. Commanders can legally request access to the patients’ records. There is indeed a legitimate need for them to know if a service member is dangerous to himself or others or to combine efficiency and security in case of extreme circumstances. But Ritchie emphasizes to service members that mental health professionals are discreet and that it is in their own best interest to seek treatment before a situation becomes critical. To keep pace with changes in civilian medical policies, if there is a court-martial pending and soldiers need treatment, they can request it without fear that their records are going to be used against them.
Colonel Ritchie is thus an internationally recognized expert in psychiatry. She’s a strong will-powered person with an adventurous side, and she has sometimes exposed her life to danger. She has held numerous leadership positions within Army Medicine, including that of Psychiatric Consultant and the position of Behavioural Health Director at the office of the US Army Surgeon General. She is the recipient of the William Porter and Bruno Lima awards which recognize outstanding contributions of District Branch Members to the care and understanding of victims of disaster.
- Shubert J, Ritchie EC, Everly GS Jr, Fiedler N, Williams MB, Mitchell CS, Langlieb AM. Amissing element in disaster mental health: behavioral health surveillance for first responders. Int J Emerg Ment Health. 2007 Summer; 9(3): 201-13. [Google Scholar]
- Ritchie EC. Update on combat psychiatry: from the battle front to the home front and back again. Mil Med. 2007 Dec; 172(12 Suppl):11-4. [Google Scholar]
- Benedek DM, Ritchie EC. “Just-in-time” mental health training and surveillance for the Project HOPE mission. Mil Med. 2006 Oct; 171(10 Suppl 1): 63-5. [Google Scholar]
- Cardona RA, Ritchie EC. U.S. military enlisted accession mental health screening: history and current practice. Mil Med. 2007 Jan; 172(1): 31-5. [Google Scholar]
- Ritchie EC, Benedek D, Malone R, Carr- Malone R. Psychiatry and the military: an update. Psychiatr Clin North Am. 2006 Sep; 29(3): 695-707. [Google Scholar]
- Ritchie EC, Friedman M, Watson P, Ursano R, Wessely S, Flynn B. Mass violence and early mental health intervention: a proposed application of best practice guidelines to chemical, biological, and radiological attacks. Mil Med. 2004 Aug; 169(8): 575-9. [Google Scholar]
- Ritchie EC, Owens M. Military issues. Psychiatr Clin North Am. 2004 Sep; 27(3): 459-71. [Google Scholar]
- Riddle JR, BrownM, Smith T, Ritchie EC, Brix KA, Romano J. Chemical warfare and the Gulf War: a review of the impact on Gulf veterans’ health. Mil Med. 2003 Aug; 168(8): 606-13. [Google Scholar]
- Ritchie EC, Keppler WC, Rothberg JM. Suicidal admissions in the United States military. Mil Med. 2003 Mar; 168(3): 177-81. [Google Scholar]
- Ritchie EC, Gelles MG. Psychological autopsies: the current Department of Defense effort to standardize training and quality assurance. J Forensic Sci. 2002 Nov; 47(6): 1370-2. [Google Scholar]
- Ritchie EC. Psychiatry in the Korean War: perils, PIES, and prisoners of war. Mil Med. 2002 Nov; 167(11): 898-903. [Google Scholar]
- Milliken CS, Leavitt WT, Murdock P, Orman DT, Ritchie EC, Hoge CW. Principles guiding implementation of the Operation Solace plan: “Pieces of PIES”, therapy by walking around, and care management. Mil Med. 2002 Sep; 167(9 Suppl): 48-57. [Google Scholar]
- Hoge CW, Orman DT, Robichaux RJ, Crandell EO, Patterson VJ, Engel CC, Ritchie EC, Milliken CS. Operation Solace: overview of the mental health intervention following the September 11, 2001 Pentagon attack. Mil Med. 2002 Sep; 167(9 Suppl): 44-7. [Google Scholar]
- Baer HU, Ritchie EC, Mott R. Caring for civilians during peace keeping missions: priorities and decisions. Mil Med. 2002 Aug; 167(8 Suppl): 14-6. [Google Scholar]
- Ritchie EC. Psychological problems associated with mission-oriented protective gear. Mil Med. 2001 Dec; 166(12 Suppl): 83-4. [Google Scholar]
- Ritchie EC. Issues for military women in deployment: an overview. Mil Med. 2001 Dec; 166(12): 1033-7. [Google Scholar]
Les statistiques affichées correspondent au cumul d'une part des vues des résumés de l'article et d'autre part des vues et téléchargements de l'article plein-texte (PDF, Full-HTML, ePub... selon les formats disponibles) sur la platefome Vision4Press.
Les statistiques sont disponibles avec un délai de 48 à 96 heures et sont mises à jour quotidiennement en semaine.
Le chargement des statistiques peut être long.