![handle is hein.journals/psyinjl10 and id is 1 raw text is: Psychol. Inj. and Law (2017) 10:1-23
DOI 10.1007/s12207-016-9278-y
Do the Military's Frontline Psychiatry/Combat and Operational
Stress Control Doctrine Help or Harm Veterans?-Part One:
Framing the Issue
Mark C. Russell' - Charles R. Figley2
Received: 24 September 2016 /Accepted: 19 December 2016 /Published online: 30 January 2017
© Springer Science+Business Media New York 2017
Abstract This is the first of a three-part systematic review of
the potential benefits and harmful effects of the military's
century-old doctrine of frontline psychiatry or combat and
operational stress control (COSC). Since the Second World
War, psychiatric casualties have outnumbered the combined
total of American service members both wounded and killed-
in-action. The original, explicit purpose of frontline psychiatry
programs established during the First World War was to pre-
vent mass evacuation and attrition of military personnel
experiencing acute war stress injuries by emphasizing brief,
nonpsychiatric interventions resulting in return to duty (RTD).
Although frontline psychiatry continues to evolve, these bed-
rock principles of RTD and avoiding psychiatric evacuation
remain unchanged. Today, the US military explicitly predicts
that over 95% of war stress casualties will be RTD with evac-
uation limited to those deemed either grossly impaired and/or
clear safety risks to self or others. The military justifies its
mental health policy by claiming that studies have demonstrat-
ed its health benefits to individual service members and their
families, as well as findings that medical evacuation and sub-
sequent psychiatric treatment are harmful. However, the only
systematic review of the effectiveness of frontline psychiatry
was published in 2003, warranting critical examination of the
military's claims. Specifically, the actual evidence for or
against the military's primary mental health policy has never
been fully examined, so that any conclusions are tentative.
The sheer complexity and national security implications un-
derlying the military's unchallenged 100-year doctrine
W Charles R. Figley
figley@tulane.edu
Antioch University Seattle, Seattle, WA, USA
2 Tulane University, New Orleans, LA, USA
required a three-part review. In this study, we frame the debate
on the military's frontline psychiatry/COSC by examining its
historical origins, ethical-legal controversies, and contempo-
rary program descriptions.
Keywords War stress - PTSD - Military - Veterans - Combat
stress control - Forward psychiatry - Combat psychiatry.
Combat and operational stress control
The US military's frontline psychiatry programs were formal-
ly established during WWI (WWI: 1914-1918) to eliminate
epidemics of mass medical evacuations for psychiatric disabil-
ity, or so-called evacuation syndromes, that threatened the
capacity of armies from every European power to sustain the
war effort (e.g., Jones, 1995a). Historically, this diverse set of
frontline mental health policies and programs have collective-
ly been referred to as forward, combat, preventative, and war
psychiatry (Jones & Wessely, 2003), neuropsychiatric
reconditioning (U.S. War Department, 1944), combat stress
control (CSC; Department of the Army, 1994), operational
stress control (Department of Navy, 2015), and the currently
approved designator combat and operational stress control
(COSC) to account for stress exposure in both combat and
noncombat or operational environments [e.g., disaster relief,
peace-keeping; Department of Defense (2013)].
Although technically incorrect, we use the umbrella term
frontline psychiatry to convey mental health policies and in-
terventions specifically related to war zones. Modern frontline
psychiatry/COSC programs involve a variety of specialties
and services well beyond psychiatry, such as clinical psychol-
ogy, social work, occupational therapy, psychiatric nursing,
pastoral care, primary care physicians, and enlisted peer men-
tors. Within war zones, frontline psychiatry consists of a com-
prehensive set of policies, principles, and programs
t Springer
CrossMark](ViewImageLocal?handle=hein.journals/psyinjl10&div=1&collection=&method=preview&ext=.png&size=3)
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