Psychiatry and the Military: An Update Elspeth Cameron Ritchie, MD, MPH a,b, * , David Benedek, MD a,b , Ricky Malone, MD, MPH b,c , Rosemary Carr-Malone, MD, LCDR, MC, USNR b,d a US Army Surgeon General’s Office, 5109 Skyline Pike, Skyline 6, Room 684, Falls Church, VA 22041, USA b Department of Psychiatry, Uniformed Services University, School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA c Department of Psychiatry, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307-5001, USA d Inpatient Psychiatry National Naval Medical Center, Adult Inpatient Psychiatric Ward, 8901 Wisconsin Avenue, Ward 7-West, Bethesda, MD 20889, USA T he United States has been a nation and an army at war essentially since September 11, 2001. Not surprisingly, rates of posttraumatic stress disor- der (PTSD) and other psychological consequences of combat are increas- ing. Service members with mental health consequences from impact the military justice and disability systems. To complicate matters, PTSD, although a well-recognized and validated psychiatric disorder, has also long been a disor- der associated with malingering, both for the purposes of allegedly avoiding prosecution or punishment and to obtain increased compensation. Mental health professionals’ task is further complicated by the ‘‘signature wound’’ in this ‘‘global war on terror’’: traumatic brain injury. There are many causes of head trauma, including blast exposure, gunshot wounds, motor vehicle injury, and other accidents. The severely wounded are routinely screened for head trauma. However, others may simply be knocked uncon- scious and not present for treatment. They may develop difficulty concentrat- ing or irritability and be misdiagnosed or not receive any medical treatment. Military forensic psychiatrists currently serve in the Army, Navy, and Air Force. Forensic psychiatry in the military has many similarities to forensic psy- chiatry as practiced in the civilian world, with some key differences. This article accentuates some of the differences, especially those heightened by the global war on terror. It opens with a description of military law and the role of psy- chiatry in the courts-martial system. The next section deals with the disability *Corresponding author. E-mail address: elspeth.ritchie@amedd.army.mil (E.C. Ritchie). 0193-953X/06/$ – see front matter ª 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.psc.2006.04.008 psych.theclinics.com Psychiatr Clin N Am 29 (2006) 695–707 PSYCHIATRIC CLINICS OF NORTH AMERICA