Shadow Wars by Clyde Farnsworth

Dr. Ritchie is a forensic psychiatrist with especial expertise in military and
veterans' issues. She retired from the Army in 2010, after holding numerous leadership positions within Army Medicine, to include the Psychiatry Consultant. Most recently she was the Chief Clinical Officer, Department of Behavioral Health, for the District of Columbia. An internationally recognized expert, she brings a unique public health approach to the management of disaster and combat mental health issues.

She trained at Harvard, George Washington, Walter Reed, and the Uniformed Services University of the Health Sciences, and has completed fellowships in both forensic and preventive and disaster psychiatry. She is a Professor of Psychiatry at the Uniformed Services University of the Health Sciences, Georgetown and Howard Universities. Her assignments and other missions have taken her to Korea, Somalia, Iraq, and Cuba.  

Her over 200 publications are mainly in the areas of forensic, disaster, suicide, ethics, military combat and operational psychiatry, and women's health issues. Major publications include the Military Medicine Textbook on Combat and Operational Behavioral Health, The Mental Health Response to the 9/11 Attack on the Pentagon, Mental Health Interventions for Mass Violence and Disaster, Humanitarian Assistance and Health Diplomacy: Military-Civilian Partnership in the 2004 Tsunami Aftermath, and the 2013 series on The Use of Complementary and Alternative Medicines for the Treatment of PTSD in Military Service Members.  

She is the senior editor of the forthcoming volumes: Forensic and Ethical Issues in Military Behavioral Health, Women at War, and Post-Traumatic Stress Disorder and Related Diseases in Combat Veterans: A Clinical Casebook. Under development are Intimacy After Injury: Restoring Sexual Health on Return from Combat and Personal Experiences of Psychiatrists in the Combat Zone.


Dr. Ritchie's
newest book

Forensic and Ethical Issues in Military Behavioral Health

available on amazon.com

Women at War
EC Ritchie, AL Naclerio - 2015

available on

In the very first text of its kind, Women at War brings together all available information and experience on women's physical and mental health in one resource to enlighten the practitioners caring for them. Our US Department of Defense is approximately 15%


click here for preview of:

Elspeth Cameron Ritchie's book

Tearing through the Moon

available through AMAZON.COM






News and Current Events

HLN Report

November 15th, 2017

Link to "Army Recruits Prior Mental Healath Addiction Issues"
with New York Daily News

1. Does accepting people into the army with mental health issues pose any risks?
If so, what?

2.Why would the army choose to allow more waivers?

3.What was the Army's old policy when it came to applicants
with mental health issues?

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November 15th, 2017

Interview with USA Today
USA Today logo
Army Lifts Ban
recruits - history - self mutilation - other mental health issues

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October 11, 2017

Book Review

By: Leslie Hartley Gise, MD

Elspeth Cameron Ritchie, Christopher H Warner, Robert N McLay,
Psychiatrists in Combat: Mental Health Clinicians' Experiences in the War Zone
Cham, Switzerland, 2017, Springer International Publishing AG

Reading this book is like stepping through the looking glass. Itís unreal. Things change. Rules are followed, rules are broken. Itís a different world, unless, of course, youíve been in combat. The authors describe the stresses of leaving home and family, interrupting training, unimaginably harsh living conditions and weather, and the constant risk of being bombed. Elspeth (ìCamî) Ritchie is a retired Army Colonel and the book is about the wars in Iraq and Afghanistan.

The twenty-two chapters tell completely different individual stories by mental health clinicians who have a tremendous variety of backgrounds and perspectives. Some chapters are intense and specific, others are more mellow and vague. Some are personal war stories and a few include authorsí feelings and emotions. Most of the authors are medical doctors, but a psychiatristís wife and writer, Mary El Pearce, is particularly enlightening. An occupational therapist, Shannon Merkle, tells of being attacked and describes her concussion while simultaneously running a Concussion Care Center.

The book illustrates that the key to enduring the hardships and maintaining mental wellbeing in a combat environment is building positive relationships with fellow soldiers. Several examples of this idea include the comment that, "we fight more for each other than for any higher cause", and the book's highlighting of concepts of camaraderie, humor, "lightening the mood," "moral boosting," and "smoking and joking."

The importance of "kinship—bonding" and "unit cohesion" was illustrated by finding "profound psychological injury" among those guarding detainees. These soldiers were predominantly reservists and service members on temporary duty assignments, used to fill shortages, who were "plucked from their military family—cleaved from the comfort and support of their organic command." Psychiatrist Robert Koffman insightfully describes the horror, complexity and psychological consequences of Abu Ghraib. He learned to "never identify a problem without also identifying a solution," and out of this disaster, Mobile Care Teams were born.

Losing soldiers and attending memorial services were among the greatest challenges. A color picture that will stick in my mind is, "a fallen soldier battle cross: "a pair of boots with a rifle stuck in them with a helmet on top, sometimes with dog tags. It has an American flag in the back.

The principles of military mental health were discovered over one hundred years ago during World War I, but they have had to be relearned many times. What is now called "Combat Stress Controlî was previously called "Shell Shock," "Battle Fatigue," and the "Thousand Yard Stare." The basic principles include quick treatment, returning soldiers to duty, and keeping them as close to their unit as possible. We had to relearn "to keep the providers with the troops they serve." When the war in Afghanistan began, "there weren't any psychiatrists at the front lines." Psychiatrists had to build "rapport with soldiers," volunteer to serve with medics on patrols, and establish credibility with troops by going out on missions to small outposts. Psychiatrists learned to do "therapy by walking around." In response to new problems, there have been more advances in military behavioral health in the past 15 years than in the prior 100 years.

Psychiatrists had to go beyond mental health care to be in charge of other doctors, the team, and burnout. For example, psychiatrist Christopher Warner wrote that when a "convoy was hit with an improvised explosive device, killing and wounding several soldiers including our most senior medic—his loss—hit me hard—I found myself very afraid—I assessed each of the team members and could see the fear and panic on their faces. I met with the Battalion Commander—we—agreed that we needed to get them back out there as soon as possible." It was decided to drive the convoy team to "visit—the 3 members of the team who were wounded but survived." Multiple leaders thought the team needed rest and "weren't ready." To approve the visit, it took a shouting match with leadership and Warner's joining the convoy, but the soldiers enjoyed the visit and the next day "were more cohesive and motivated—to continue their mission—."

Military mental health providers are tasked with "agonizing choices—between doing what is best for the mission and what is best for their people," "when to keep a stressed soldier with his unit, when to send a Marine who is suicidal home." Most evacuated troops had "suicidal thoughts serious enough to make them a liability on the battlefield." Psychiatrist, Rohul Amin, describes military culture and the difficulty treating suicidal patients: "The most significant thing that made managing psychiatric patients in a combat zone very different from those outside a combat zone, was that every patient was carrying a weapon at all times with a full magazine of ammunition." Other challenges include the difficulties of women, including sexual assault.

There is some repetition and itís not surprising that there are a tremendous number of acronyms. It would have been helpful to have a glossary in the back of the book. But these stories have not been told before; it is worth reading them.


July 26, 2017

Dr Ritchie was asked to comment on President Trump's tweet
stating that transgender persons cannot serve in the military.

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April 26, 2017

Psychiatrists in Combat

The Ebook is now online on www.springer.com

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Cameron Ritchie

Cameron Ritchie 2

February 23, 2017

Dr. Ritchie's article in The Atlantic regarding military women and birth control

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March 2017

BOOK PARTY! Several weeks sooner than expected! Book party is on the birthday of Clyde's father, Thursday, March 23, 5pm onward, for both TANGLED BYLINES and my two published in 2016, BABUSHKA'S BEADS and REFLECTIONS: POEMS ON PAINTING, A POET'S GALLERY. Also celebrating Cameron's birthday, and her own many books.


Tuesday, January 24, 2017

Dr. Ritchie's latest article on addressing sexual health patients.

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December 19, 2016

Appearing in Directions in Psychiatry, Volume 36, 2016, Number 4, page 235:

The "Three Buckets" Model for Treating Posttraumatic Stress Disorder (PTSD):
Medication, Therapy, and Everything Else

PTSD is a complex psychiatric disorder with common comorbidities that can be difficult to treat. Conventional evidence-based therapies may not be tolerated or referred for many individuals for a variety of reasons, or they may only be partially effective. This lesson reviews the basics of complementary and alternative medicine which include various meditation practices, animal-assisted therapy, acupuncture, and TMS and potential ways they can be incorporated into practice.

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December 15, 2016

Dr. Ritchie's latest article in Clinical Psychiatry News about Asking Service Members about anxiety disorders.

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October 24, 2016

A recurring question at many of the talks I give on posttraumatic stress and related topics is: "How can civilian providers relate to military service members and veterans?"
There are now online and in-person courses on this topic. The Center for Deployment Psychology in Bethesda, Md., and Massachusetts General Hospital in Boston are two of the better sources for these. Here, I would like to offer my condensed version.

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Tuesday, October 18, 2016 LIVE
Interview on Doctor Radio Channel
with past president of the American Psychiatric Association (APA), Dr. Carol Bernstein.

The show airs on SiriusXM110 - Doctor Radio, which broadcasts LIVE from the lobby of the NYU Langone Medical Center in NYC, provides 8 hours of live programming each day, with shows in all areas of medicine.


Link: www.siriusxm.com/doctorradio

Twitter: twitter.com/NYUDocs

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July 21st, 2016

Here and Now interview on veterans and violence:

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July 17th, 2016

intimacy post injury

Flyer for upcoming book: Intimacy post Injury

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June 27th, 2016

Dr. Ritchie will be participating in the


JUNE 27, 2016
Whittall Pavilion
Thomas Jefferson Building
Noon to 1 P.M.

Veterans History Project
Library of Congress
101 Independence Avenue, SE
Washington, DC 20540-4615
Phone: (888) 371-5848
Website: http://www.loc.gov/vets

The panel discussion brochure:

June 8th, 2016

Three buckets for treatment of PTSD blog post

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May 18th, 2016

Treating sexual dysfunction in military medicine

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Photo of Dr. Ritchie and other presenters, presenting on Women at War at the APA in Atlanta, GA

Dr. Ritchie with other presenters at the APA in Atlanta, GA.
Dr. Ritchie gave a presentation on Women at War.

Women at War
EC Ritchie, AL Naclerio - 2015

available on amazon.com

About the book:

Women at War brings together all available information and experience on women's physical and mental health in one resource to enlighten the practitioners caring for them.

Women at War reviews the epidemiology, changes in policy, and demographics of women in the services; the factors affecting their health and health care while serving in austere environments; issues related to reproductive and urogenital health; and how health care providers can help prepare and prevent illness.

Presenting this Sunday, April 17th, 2016

Nation's Experts on Gun Violence Prevention To Meet in Chicago April 16-17

Press Release:

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Featured on Playboy:

Can a Single Injection Save Soldiers Suffering from PTSD?

By Matt Farwell

March 23, 2016

"The mental health of our troops is very much a national security issue,"
says Dr. Elspeth Ritchie, a former military psychiatrist who held the top
mental-health job in the Army. "If we don't take care of our veterans,
people aren't going to want to sign up and join the military."

read it now

February 29, 2016

TIME article on female service members

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Women at War is now available to order in paperback!
Click here for more information

February 19, 2016

COL (ret) Ritchie quoted in a Kaiser Health News article on military care for PTSD and depression.

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February 18, 2016

COL (ret) Ritchie quoted in a US News article on reducing mental health risks for children in military families.

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January 28, 2016

COL (ret) Ritchie quoted in a US News article on reproductive issues for military women.

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Broad Influence : How Women Are Changing the Way America Works

Wednesday, January 20, 2016

09:00 AM — 10:30 AM

New America

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More coverage on the Broad Influence event
was just syndicated in the Pacific Standard.

read it now

Tue, Jan 12, 2016 at 7:09 PM
Military Women's Health Issues

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Discharge Of Soldiers With Mental Health Issues Questioned | Here & Now
Dec 9, 2015

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Smart Women, Smart Power

By CSIS | Center for Strategic and International Studies

CSIS Smart Women, Smart Power is a speaker series on women in international business and global affairs. The weekly podcast features leading women from the corporate, government, and national security worlds discussing top international issues. This podcast series is made possible with support from Citigroup.

Health Challenges of Women at War
Dec 10, 2015 csis.org podcast

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Dec 10, 2015 itunes podcast

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Cautious optimism on "No Exceptions" with important caveats
By Elspeth Cameron Ritchie and Anne L. Naclerio
December 10th 2015
"As pleased and excited as I am, by Ash Carter's announcement, that women will be allowed in all military occupational specialties, I am also concerned that we do it right. Otherwise we may have public failures that cause people to question the decision..."

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Women's Health Issues Compounded When Serving In Military Occupations

Last month the Pentagon announced all combat jobs in the military will be open to women. Dr. Elspeth Cameron Ritchie has been researching health needs specific to women on the battlefield.


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National Museum of Health and Medicine (NMHM):
New book details health issues facing female service members

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ptsd book


Published in October, 2015, this newly released book by Dr. Ritchie is available through Springer, designed for the medical profession, how to treat patients returning from active war zones.




Posttraumatic Stress Disorder and Related Diseases in Combat Veterans

Editor: Ritchie, Elspeth Cameron (Ed.)

This book takes a case-based approach to addressing the challenges psychiatrists and other clinicians face when working with American combat veterans after their return from a war zone. Written by experts, the book concentrates on a wide variety of concerns associated with posttraumatic stress disorder (PTSD), including different treatments of PTSD. The text also looks at PTSD comorbidities, such as depression and traumatic brain injury (TBI) and other conditions masquerading as PTSD. Other subjects: returning veterans, including pain, disability, facing the end of a career, sleep problems, suicidal thoughts, violence, and mefloquine ìtoxidromeî. Each case study includes a case presentation, diagnosis and assessment, treatment and management, outcome and case resolution, and clinical pearls and pitfalls.

Federal Practicioner features Dr. Ritchie and Dr. Naclario (co-editors Women at War)

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Espeth Cameron Ritchie treats psychological issues in veterans with a wide variety of conditions. HCP Live. Medical News.

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Women at War

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Fight not yet over for US military women in battle for equality - Channel NewsAsia

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Two women make US military history by passing tough Ranger School

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Dr. Ritchie in Current Psychiatry Reports

View the podcast

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This is a link to a production by UDC TV on Veterans' and Mental Health.

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Coming up on July 28th

women at war july 28th

women at war promotion

Col Ritchie and fellow Women at War authors and guests

COL Ritchie and fellow Women at War authors and guests after a seminar
at the Bethesda MD USO. Copies of the books were raffled off for
service member and veteran participants.

video links

VIDEO: Military psychiatrists balance difficulties of deployment while helping soldiers maintain hope, positivity

see it now

TORONTO—In this video, Elspeth "Cam" Ritchie, MD, MPH, a forensic psychiatrist and former chief clinical officer for the Department of Mental Health in Washington, DC, speaks about a session here that explored personal experiences of psychiatrists who deployed with the military to Iraq and Afghanistan.

VIDEO: Physical, mental challenges of deployed female soldiers

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TORONTO — Elspeth "Cam" Ritchie, MD, MPH, a forensic psychiatrist and former chief clinical officer for the Department of Mental Health in Washington, DC, discusses her recently published book, titled Women at War, that explores the physical and mental challenges female soldiers encounter when deployed.

The book will touch on various topics, including how to manage motherhood during deployment, how to avoid urinary tract infections and maintain cleanliness while dehydrated or in areas with low water supply, sexual assault and more.

"Women in the military are by and large in their reproductive years [while deployed], so it can be a real challenge to manage deployment along with reproductive and gynecologic issues. Nevertheless, women do it and they do it well," Ritchie said. "I hope this conversation will lead to more conversations about how to do it and what kind of tricks these women can learn to function and function well."

VIDEO: Health care coverage for military veterans lacks integration, requires improvement

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TORONTO — There are significant gaps in health care coverage for military veterans, particularly mental health care, that need to be addressed, according to Elspeth "Cam" Ritchie, MD, MPH.




Elspeth Cameron Ritchie | Home Page| Forensic Psychiatrist | Author | Speaker | Media |CV | Contact Me

website updated May 20th, 2016 | shelden studios