The Best Defense

A new treatment for PTSD emerges

By Dr. Elspeth Ritchie

Best Defense guest columnist

Psychiatric Annals recently published the second in a series on new and innovative treatments for PTSD. The series focuses on so-called complementary and alternative medicine (CAM) used in the Department of Defense. I say "so-called" because no one quite agrees on the name; it is also called integrative medicine and/or holistic medicine. CAM generally includes acupuncture, herbal techniques, and meditation. I add canine-assisted therapy, virtual reality, and other innovative therapies in this series in Psych Annals, of which I am the guest editor.

PTSD is an immense problem in the military after 11 years of war. The military is also leading the way in developing new therapies. This article focuses on stellate ganglion block, which is an anesthetic technique traditionally used to treat pain. In brief, an anesthetic is injected into the peripheral nerves. In some cases, it has been found that this technique drastically reduces symptoms of PTSD.

One of the many things that are exciting about this treatment it is that it is biologically based. So, if anyone still thinks that PTSD is "all in their head," or totally psychological, the success of this technique would seem to refute that. Another interesting point is that it seems to work in refractory PTSD that has not responded to other treatments.

This is not yet an evidence-based treatment. In other words, it has not yet been subjected to randomized clinical trials (RCTs), which are the gold standard in research in medicine. However, in the days since the on-line version was published, funders from the Medical Research and Material Command (MRMC) have been reaching out to researchers to see if they can do some of the RCTs. So exciting times in new approaches to treating an age-old problem.

Retired Army Col. Elspeth Ritchie, MD, MPH, is the chief clinical officer, Department of Mental Health, for the District of Columbia. She also is a professor of psychiatry at the Uniformed Services University of the Health Sciences.


The Best Defense

Last questions about COIN (X): Is it time for a truth and reconciliation commission?

By Major Tom Mcilwaine, Queen's Royal Hussars

Best Defense guest columnist

Question Set Ten -- Do we really want to be doing this? COIN, or whatever it is that we have been doing over the last decade, is tremendously difficult. The direction of some of these questions suggests that it might be a little bit more than that though. If what we are doing is fundamentally imperial, then it raises two extra questions. First, can we do this without using imperial methods? Second, do we want to use those methods? Is the price we might pay to alter the behavior of the population of Yemen (in terms of what it requires us to do) worth paying? If I am correct, then what we are doing perhaps takes us into some areas that morally we might not wish to go. Failing to ask ourselves some hard questions about what we have done and what we should have done will lead politicians to believe that we can somehow do it without doing bad things -- which means that they are more likely to want to do it in the future. Precision munitions surely contribute to this as they have been sold as making war clean. Perhaps we should restrict their use for COIN fights to make politicians realize that wars really are nasty? Politicians should understand that going to war is a terrible thing, something I am not sure the COIN'dinistia philosophy makes clear enough.

And that is the final issue I would like to raise: As we move away from the conflicts of the last decade it is not enough simply to return to our combined arms heritage -- however necessary that might be. Nor is it enough to log the current narrative on what is required for COIN success in our institutional memory bank, and return to it when we next face a similar threat. What is required, if we are not to make the same mistakes that we made this time, is a comprehensive examination of what it is we were trying to achieve, what we needed to do to achieve it, and whether we really wanted to travel down this path, or want to now or in the future.

A place to advocate some truth and reconciliation rather than escalating the intellectual holy war within our profession might help too.

Major Tom Mcilwaine is a British Army officer who is currently a student at the School of Advanced Military Studies at Ft Leavenworth. He has deployed to Iraq as a Platoon Commander and Battalion Operations and Intelligence Officer, to Bosnia as Aide to the Commander of European Forces and to Afghanistan as a Plans Officer with I MEF(Fwd). Consider this the standard disclaimer.