Saint Louis University Journal of Health Law & Policy

Document Type



“Diseases of despair” is a conceptually broad category used to describe the phenomenon of premature mortality caused by suicide, drug poisoning, and alcoholic liver disease. Central to this conceptualization of mortality is that death occurs too early in an entire population of individuals infected with social despair. Implicit in the diseases of despair construct is a powerful normative claim about the manner and time of death—that death is bad if it is contextualized in unwanted conditions and happens before reaching midlife. As such, diseases of despair ought to be reduced, if not eliminated. Interestingly, military medical research on combat casualties abides by a comparable normative understanding of mortality—that combat provides a less than optimal context in which to die and that those who die on the battlefield do so too young. In response to this implicit normative ideal, military medical research and practice have made major strides in developing effective life-saving interventions in the past twenty years. Service members’ lives are saved after catastrophic injury due to advances in the combat damage control medical paradigm. The achievements of this paradigm are enshrined in an overall ninety-two percent survival rate for service members injured in Iraq and Afghanistan and have initiated interest in achieving zero preventable deaths after catastrophic injury in both military and civilian medicine. While medical achievements in Iraq and Afghanistan are laudable, primarily focusing on achieving zero preventable combat deaths constructs a military-medical culture wherein the despair of death is implicitly woven into military health policy, training, and organizational culture. This article will explore the complex challenge of addressing death despair in combat casualty management. I develop a modest argument suggesting that to effectively shift expectations relative to death and dying in casualty management, the Defense Health Agency needs to support interdisciplinary research that focuses on strategic second-order organizational change before developing health policy and medical training in preparation for future large-scale combat operations. In specific, I suggest that this interdisciplinary team needs to be led by academic experts in anthropology, history, and political science in collaboration with military medical and strategic experts.