Military Psychiatrists Research Articles

Expériences et enjeux de la psychiatrie militaire en opération

For the French army, Afghanistan is a new challenge, especially for the French health service. That theatre is very different from other which the army knows better like Africa or Yugoslavia. The threat is constant, provided by fight, improvised explosive device, terrorism in the cities and rockets aiming the bases. Since 2009, a French military psychiatrist is based with the NATO Hospital at Kabul Airport. The mains problems are the consequences of three threats: fight with Talibans, risk of explosion on the road by improvised devices and attack by rockets on the camps. For each, the psychic reactions are different. Combats provide among the men postoperational stress and for some of them a risk of moral disengagement. But for the most part of them theses symptoms disappears quickly. The improvised explosives devices are the threat feared the most by troops, especially for the logistic convoy. The frequent symptoms are burn out, exhaustion and stress. Rockets like explosives devices are a blind threat and aren’t feared. But when some of them fall on a camp, the people presents sleep troubles, continual stress and PTSD. Alcohol or moral disengagement are not specific of Afghanistan but constitute other challenges. Each of the cases we described is an illustration of these observations of our experience during three months in Afghanistan.

Le SMPCAA : un espace pour les combattants de l’air

The SMPCAA, a service of psychology applied to aeronautics, was created in 1963 by General André Missenard, military psychiatrist, who wished to receive aviators in a specific medical space (fighter or transport pilots, helicopter pilots, flight engineers and other combat systems officers) in difficulty or in suffering in their professional activity. Since that time, several generations of psychologists and psychiatrists took turns to continue this mission and to support these air fighters, relentlessly and in any circumstances, in peacetime (the training) to war. From the common suffering of everyone (but which prevents to cope with the requirements of military aeronautics) to the war psychic disorders, the SMPCAA is a unique place where anything may be said and heard, with often the sole intention of flying to complete the mission.

P02-470 - War psychic disorders treatment: Current perspectives

BackgroundThe confrontation with extreme events, such as a death threat, may release acute psychiatric troubles named “acute stress disorders” in the DSMIV-TR. Current operational context in Afghanistan is unpredictable and leads military surgeons to support soldiers facing major psychic suffering. Clinical practice confronts them with the difficulty to decrease the symptoms often strong, especially sleep disorders. Circadian rhythm disruption, lack of recovery may be at the origin of somatic and mental exhaustion.MethodsWe propose a debate about the principles of a medico-psychological handling based on the current operational experiences of the French military psychiatry. Special operational circumstances led military psychiatrists to prescribe an antipsychotic, small-dose, in the evening.ResultsUnexpected results are observed on some symptoms like sleep disorders (improvement of sleep disorders, less traumatic nightmares, sensation of restorative night) and hyperarousal.ConclusionsThis clinical discovery leads to a reflection on physiopathological and pharmacological perspectives and to engage an observational study over 30 clinical cases and clinical trial project. Identifying, preventing, and treating operational stress at battlefront can provide the opportunity not only to improve operational performance, but also possibly to improve case by case the mental health.

Conflicts Between Ethics and Law for Military Mental Health Providers

Military mental health providers routinely experience mixed-agency ethical dilemmas when obligations to patients and the military conflict. Particularly difficult mixed-agency dilemmas occur when a military psychiatrist, psychologist, or social worker encounters an apparent conflict between an ethical obligation--enumerated in a professional code of ethics--and a federal statute. This article explores ethical-legal conflicts for uniformed mental health providers. Three case vignettes illustrate situations in which military providers may find themselves stuck between incongruent ethical and legal demands. The authors conclude with several recommendations designed to prevent and resolve ethical-legal conflicts for military mental health providers.

La notion de simulation des troubles psychiques dans les armées. Évolution des idées

For a long time, psychiatrists and military physicians have been deeply concerned about the issue of faking (malingering) mental disorders so much so that a constant suspicion hung over military patients who showed unexpected and inexplicable behavior. This was due to a lack of psychopathological debate both at the individual and institutional level. The dual role of expert and caregiver held by the military physician had without doubt fuelled this suspicious attitude for a long time. Fortunately, the manner in which the issue of malingering is approached has changed considerably as military psychology has developed. Nowadays, the term “malingering” no longer appears in military psychiatry books. Inappropriate conduct in the field continues to interest military psychiatrists. If it is not the symptom of a characterized psychiatric condition, it is considered nowadays to reflect more an individual and sometimes institutional deficit than a conscious manipulation. This progress has enabled military physicians to find clinical markers and particularly ethical markers when confronted with a suspicion of malingering. This debate is of interest to all psychiatrists in their daily practice since it offers interesting openings for care giving.

BATTLE EXHAUSTION: THE DILEMMA OF PSYCHIATRIC CASUALTIES IN NORMANDY, JUNE–AUGUST 1944

ABSTRACTDuring the Second World War, controversy surrounded not the inevitability of psychiatric casualties but the extent to which they could be minimized by selection, training, morale, and leadership. By early 1944, when planning for the D-Day landings was advanced, the problem of the psychiatric battle casualty was considered manageable by careful preparation and clinical understanding. The campaign to liberate Europe offered the newly formed Directorate of Army Psychiatry an opportunity to demonstrate its effectiveness. Psychiatric services were deployed to Normandy to maximize the return of front-line troops to duty. Commanders, however, entertained doubts about the value of military psychiatrists. By offering a sanctioned escape route from battle, some believed that their mere presence undermined the fighting spirit of combat troops. The records of 32 General (Psychiatric) Hospital have been analysed to discover categories of troops most vulnerable to breakdown and to assess the impact of front-line treatments. Infantry soldiers, those most likely to be killed, were disproportionately represented amongst admissions. Senior non-commissioned officers were also at elevated risk of breakdown, some being war weary from earlier campaigns. Probably 36 per cent of admissions returned to combatant duty, and 53 per cent were evacuated to the UK. The scale of psychiatric casualties revealed failures in pre-deployment screening.

Military psychiatry in India

Military personnel, because of the unique nature of their duties and services, are likely to be under stress which at times has no parallel in civilian life. The stress of combat and service in extreme weather conditions often act as major stressors. The modern practices in military psychiatry had their beginning during the two World Wars, more particularly, the IInd World War. The GHPU concept had the beginning in India with military hospitals having such establishments in the care of their clientele. As the nation gained independence, many of the military psychiatrists shifted to the civil stream and contributed immensely in the development of modern psychiatry in India. In the recent years military psychiatry has been given the status of a subspecialty chapter and the military psychiatrists have been regularly organizing CMEs and training programs for their members to prepare them to function in the special role of military psychiatrists.

Soldatische Angst im Ersten Weltkrieg

No AccessSoldatische Angst im Ersten WeltkriegDie Karriere eines Gefühls in der Kriegspsychiatrie Deutschlands, Frankreichs und RusslandsSusanne Michl, Jan PlamperSusanne MichlSearch for more papers by this author, Jan PlamperSearch for more papers by this authorPublished Online:Apr 2014https://doi.org/10.13109/gege.2009.35.2.209SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail About Previous article Next article FiguresReferencesRelatedDetailsCited byDie Janusköpfigkeit militärischer Gewalt: Zur Einhegung von Verletzbarkeit und Verletzungsmacht durch mexikanische Soldatinnen*11 May 2020 | FEMINA POLITICA - Zeitschrift für feministische Politikwissenschaft, Vol. 29, No. 1-2020Mapping the war: gender, health, and the medical profession in France and Germany, 1914–191813 October 2014 | Medicine, Conflict and Survival, Vol. 30, No. 4Emotion, Habitus und Erster WeltkriegSabine A. Haring, Helmut Kuzmics29 April 2014Literatur29 April 2014 Download book coverVolume 35Issue 2November 2009 ISSN: 0340-613XeISSN: 2196-9000HistoryPublished online:April 2014 PDF download

Challenges Presenting in Transference and Countertransference in the Psychodynamic Psychotherapy of a Military Service Member

Complicating the management of the transference-countertransference set for the military psychiatrist is the dilemma of dual agency. This can be a hidden force in the work of most psychiatrists but it is continuous in the field of military health care. The military clinician must candidly engage with this dilemma as it is intrinsic to the mission, "to conserve the fighting strength." In the conduct of a dynamic psychotherapy, the military psychiatrist must craft ways simultaneously to attain both the needs and interests of the individual patient and those of the organization of which he or she is a member. Presented in this article is a case in which the dual agency dilemma manifested itself between the patient and military therapist within the transference-countertransference set. The discussion will center around (a) how this ubiquitous dilemma may present and affect the progress of a psychotherapy, and (b) interventions that will help resolve the conflict. Time honored psychoanalytic principles guiding these interventions include maintenance of therapeutic neutrality, recognition of the therapist's bright and blind spots, and awareness of patterns in the patient's current and past relationships.

Fear: Soldiers and Emotion in Early Twentieth-Century Russian Military Psychology

This article provides an analysis of the locus of fear in military psychology in late imperial Russia. After the Russo-Japanese War and the 1905 Revolution, the debate coalesced around two poles: “realists” (such as the military psychiatrist Grigorii Shumkov) argued that fear was natural, while “romantics” upheld the image of constitutionally fearless soldiers. Jan Plamper begins by identifying the advent of modern warfare (foreshadowed by the Crimean War) and its engendering of more and different fears as a key cause for a dramatic increase in fear-talk among Russia's soldiers. He links these fears to literature, which offered—most prominentiy in Lev Tolstoi'sSevastopol Sketches(1855)—some of the vocabulary soldiers could use to express their fears. Mikhail Dragomirov's fear-centered military theory during the Great Reforms was the next milestone. Plamper closes by sketching the history of fear after World War I, from Iosif Stalin's penal battalions to the rehabilitation of military psychology under Nikita Khrushchev and beyond.

A Career in Military Psychiatry

Corresponding Author: Surg Cdr N Greenberg, Senior Lecturer in Military Psychiatry, Academic Centre for Defence Mental Health, Weston Education Centre – KCL, Cutcombe Road, London SE5 9RJ Email: sososanta@aol.com Introduction...

Frontline: Franklin Delano Jones, M.D., and War Psychiatry

Through a long career that spanned three wars and important changes in patterns of health care, Franklin Delano Jones (1935-2005) provided medical and psychiatric care to the most vulnerable members of our society, civilian as well as military. Recognizing that individuals tend to forget lessons learned in stressful situations, he compiled and codified the essential practices of wartime psychiatry into comprehensive and accessible texts. His neutrality, persistence, and sharp intellect stabilized and strengthened American military psychiatry in the post-Vietnam era. His culminating achievement, War Psychiatry, which is the codified clinical intelligence of several generations of military psychiatrists, is an essential foundation for clinical practice and for research. This article explores Jones'ss contributions, particularly the variations in the presentation of combat stress, the efficacy of the principles of forward treatment, and a comprehensive understanding of posttraumatic stress disorder.

Comment on CME Courses

Back to table of contents Previous article Next article Letters to the EditorFull AccessComment on CME CoursesHENRY B. NELSON M.D.,HENRY B. NELSON M.D.Search for more papers by this author,Published Online:1 Jan 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail [I] wanted to pass on my thanks for this CME product. It’s straightforward and easy to use. I am a military psychiatrist in Iraq for 6 mo[nths], and to know I can easily and cheaply pick up 3 CME hours per mo[nth] is a Godsend. Keep up the good work. Thanks again.LSA Anaconda, IraqReprints are not available; however, Letters to the Editor can be downloaded at http://ajp.psychiatryonline.org. FiguresReferencesCited byDetailsCited ByNone Volume 164Issue 1 January, 2007Pages 175-175THE AMERICAN JOURNAL OF PSYCHIATRY January 2007 Volume 164 Number 1 Metrics PDF download History Published online 1 January 2007 Published in print 1 January 2007

John Rickman, Wilfred Ruprecht Bion, and the origins of the therapeutic community.

The history of psychiatric therapeutic communities is complex and obscure. Nevertheless, one can make a reasonable case for saying that the first true therapeutic community was created at Northfield Military Hospital, Birmingham, England, in 1945. That community had its origins in the thought and practice of two British psychoanalysts, John Rickman and Wilfred Ruprecht Bion. Accordingly, in the present article their careers and the social and intellectual influences bearing on them are discussed. The article then continues by describing Rickman's work as a military psychiatrist, Bion's prototype of a therapeutic community, and the therapeutic community that was eventually created at Northfield. It is hoped that the article will provide some of the groundwork for an adequate history of the therapeutic community.

The Psychology of Killing: The Combat Experience of British Soldiers during the First World War

The hypothesis that soldiers took pleasure in killing during the first world war is assessed in the light of particular forms of evidence and the reports of military psychiatrists. The impersonal nature of combat and motives of snipers are also explored. An analysis of admissions to a shell-shock treatment unit suggested that soldiers exposed to the greatest risk of being killed were particularly prone to breakdown in battle. An outlet for aggressive instincts did not protect individuals against psychological disorders. Because of the taboo surrounding killing even when sanctioned in war, personal motives and emotional responses remain areas of uncertainty.

Early Career Professional Development Issues for Military Academic Psychiatrists

Academically motivated graduates of military psychiatric residency programs confront serious challenges. In this article, the authors present a junior faculty development model organized around four overlapping domains: mentorship, scholarship, research, and career planning/development. Using these four domains as a platform for discussion, the authors focus on challenges facing academically oriented early-career military psychiatrists and provide guidance. The authors believe that a proactive stance, skillful mentoring, self-awareness through conscious planning and effort, ability to capitalize on existing opportunities for growth, and attention to detail are all vital to the junior military psychiatrist.

Les facteurs de risques psychosociaux des sapeurs pompiers : prise en charge, prévention et formation

Neuf cents cas de syndrome de stress post-traumatique (SSPT) ont été identifiés en dix ans au sein de l’armée française (2013). Pour les traiter, le service de santé des armées a développé un parcours de soins continu depuis la zone de combat jusqu’au retour en France. Mais cette prise en charge globale peut être interrompue partiellement ou complètement si le sujet quitte l’institution, ou s’il souhaite ne pas consulter un médecin militaire par crainte d’une appréciation défavorable sur son aptitude. Les policiers, pompiers, diplomates et personnels des ONG sont également exposés au traumatisme psychique au cours de leur engagement. La prise en charge du syndrome de stress post-traumatique devient de facto interministérielle. Ainsi un centre de référence interministériel sur le SSPT et le stress opérationnel piloté par le ministère de la Défense pourrait proposer une réponse structurée et adaptée avec un maillage territorial de professionnels militaires et civils spécialisés et bien au courant des incidences tant de maintien dans l’armée que de réinsertion dans le monde civil.Nine hundred cases of post-traumatic stress disorder syndrome (PTSD) have been identified these last ten years within the French army corps (2013). This pathology described since Antiquity, was the object of famous works by military psychiatrists (Barrois, Crocq, Lebigot). The various armed conflicts of the last years saw the fighters suffering from psychic wounds further to the fights. For their treatment, a psychic trauma plan builds a way to military care starting from the battle zone. This consideration of the PTSD by the Ministry of Defense is essential in the process of acceptance of the wound by the soldier and in his (her) process of reconstruction. Indeed it gives a sign of gratitude and solidarity to the wounded person. But, this global treatment can be partially or totally interrupted if the subject leaves the army or if he or she wishes to quit and his family wants him to quit the military institution, fearing an unfavorable valuation of his aptitude. In this case, the soldier and his family can be made a break by symptoms which can appear years after the initial trauma, not knowing towards which healthcare professional they can be addressed. Policemen, firemen, diplomats, customs officers, staff of the NGO can, during their functions, be exposed to a traumatic event. The current event demonstrates unfortunately that the exposure in the trauma can take place as much on the national territory as abroad, and thus concern a very important number of people belonging to very different circles. The civil offer of care is heterogeneous and not always visible for a not warned public. Every ministerial structure develops its own model of care. Yet the “Livre blanc” (White book) 2013 on the Defense and the National Security recommends a solidarity and a commitment for all the military and civil staffs who make a commitment in the service of the State. The treatment of PTSD becomes de facto interministerial, and both a civil and a military matter. In fact, managing crises requires multidisciplinary competences. Therefore, an interministerial PTSD reference Center under the guidance of the Ministry of Defense would be a very well structured and adapted response to the issue, with an territorial implantation of military and civil specialized professionals well knowing incidences of maintaining in the army or reinserting in the civil word. This center would be federative of an innovative approach to assure the continuity of treatments. It would allow to develop a common doctrine on the psychic trauma from the exchanges of experts.

“Dykes” or “whores”: Sexuality and the Women's Army Corps in the United States during World War II

When the Women's Army Corps (WAC) was founded in the United States in 1943, utilizing American womanpower was a matter of military expediency. At the same time, military service provided many women with mobility, education, and greater economic and personal autonomy. Women soldiers were subject to rumors and hostility by the public and media that found the stereotypical ‘feminine’ to be irreconcilable with the stereotypically masculine ‘soldier’ and considered both lesbian and heterosexual women's sexual agency a threat to military masculinity and established gender roles. Archival records of the US Army show that women's sexuality was controlled by discourses of desexualization and/or hypersexualization, by policies denying their sexual agency and of their victimization. The WAC leadership created an image of the “respectable” female soldier based on assumptions about the class and race nature of sexual morality. During the Second World War (WWII), military psychiatrists' focus on homosexuality shifted from criminal to medical concepts. Concerns over lesbianism in the Corps, which was the apotheosis of cultural anxieties over women's entrance into the military, highlight the performative nature and the close connections between the categories gender and sexuality.

La antorcha de Cupido: eugenesia, biotipología y eugamia en Argentina, 1930-1970

The goal of this work is to prove —through the legal analyse of matrimonial institution— the coercitivity that characterized to Argentine Eugenics and its reformulation «from the left to the right» from 1930, with the appointment of its more influential intellectuals to Biotipology. This «science» was systematized by the fascist Italian physician, Nicola Pende, and it was adopted, too, in the «Spain of Franco» by the military psychiatrist, Antonio Vallejo Nágera. That coercitivity was instrumented for legitimate classification, hierarchization and exclusion politics but it’s ignored, yet, by local historiography. It says that the catholic influence had a moderating function of «authoritarian » or «Anglo-Saxon» Eugenics. We’ll see, on the contrary, that the «Latin Eugenics» didn’t represent a soft modality of the politics of «betterment of race» orchestrated at the beginning of the XX century in the United States of America and in Germany, but it was the theoretical reason of a similar pseudoscientific delirium headed by Mussolini and quickly accepted in a country of South America.

Military Psychiatrists Key Part Of Trauma-Treatment Team

Back to table of contents Previous article Next article Professional NewsFull AccessMilitary Psychiatrists Key Part Of Trauma-Treatment TeamChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:19 Sep 2003https://doi.org/10.1176/pn.38.18.0005Wounded U.S. soldiers returning from the war in Iraq are receiving mental health treatment from consultation-liaison psychiatrists at Walter Reed Army Medical Center in Washington, D.C.AP Photo/Gerald HerberteWhen U.S. soldiers are severely injured while stationed in Iraq or Afghanistan, once they are stabilized overseas, they are sent for surgery and rehabilitation to Walter Reed Army Medical Center in Washington, D.C. The teaching hospital has earned a reputation in the military for providing high-quality patient care.Members of the psychiatric consultation-liaison (C-L) service visit the soldiers daily to establish a therapeutic relationship.“We want the soldiers to see us as an ally that they can turn to for help,” Harold Wain, Ph.D., chief of the psychiatric C-L service told Psychiatric News. “We thank the soldiers for serving their country and introduce ourselves as members of the trauma-treatment team. We reassure them that we ask all injured soldiers the same questions.”The average length of stay at Walter Reed is two weeks to one month for most injured soldiers, said Wain. The main types of injuries are shrapnel wounds and severely damaged limbs that require amputation, he said.Wain estimated that more than 200 U.S. soldiers had been treated at Walter Reed from March, when Operation Iraqi Freedom (OIF) began, to last month. That estimate includes about 40 soldiers from the conflict in Afghanistan.Wain uses brief therapeutic interventions with the aim of preventing psychiatric stress disorders three or four months later. He honed this approach after the Pentagon was attacked in 2001. He and Maj. Geoffrey Grammer, M.C., an Army C-L psychiatrist, met with hospitalized civilian patients bedside and asked them about their experiences in a nonconfrontational and supportive manner.“We also used an array of medications and brief interventions including hypnotic and cognitive reframing techniques,” said Wain.“We focus on a person’s positive traits during brief psychotherapy to reinforce their resilience. For example, a soldier whose hand was blown off by a rocket-propelled grenade thought to pick [the hand] up and put in his gas mask for safekeeping so we could later reattach it. Another soldier who came under hostile fire remembered to put a tourniquet around his injured leg bone. Having a sense of humor also helps soldiers cope with their injuries,” said Wain.Walter Reed is receiving between 30 and 40 OIF casualties a week. Many soldiers display symptoms of acute stress disorder including hypervigilance, startle responses, flashbacks, and sleep disturbances, said Wain. The C-L staff explain to injured soldiers that these are normal reactions to a traumatic event and should disappear soon with treatment.“If the symptoms become more frequent or severe, we ask them to contact us, and we can provide a referral to a local psychiatrist. We also call soldiers 30 and 90 days postdischarge to get an update,” Grammer told Psychiatric News.The C-L service has diagnosed a handful of soldiers since March with posttraumatic stress disorder (PTSD). “They had severe injuries and prolonged stays in the intensive care unit,” explained Grammer.He uses hypnotic techniques including visual imagery to augment analgesics for soldiers experiencing uncomfortable physical sensations after their limbs are amputated. “One soldier who experienced ‘phantom limb’ said he felt his toes were crossed and he couldn’t uncross them. I taught him a hypnotic technique that distracted him from that sensation,” said Grammer.Amputees typically have to adjust their daily routines and activities once they return to their communities. “We help them anticipate what chores or athletic activities they can’t perform and suggest alternatives,” said Grammer.He talks frequently with family members who are staying near the hospital. “I ask them about the soldier’s circumstances and how they’re coping. I give them permission to take care of themselves because they can be so focused on their loved one that they forget about their own needs. I also mention the family support group to them to help ensure they can support the soldier’s recovery,” said Grammer.The C-L service also provides support groups for recovering soldiers, in addition to individual counseling. ▪ ISSUES NewArchived