Page 114 - JSOM Winter 2024

receiving, and understanding the message that is being con- References
veyed by others is paramount. 1. Grossman DA. On Killing: The Psychological Cost of Learning to
Kill in War and Society. Revised edition. Little, Brown and Com-
As misaligned categories, affiliations, and positions exist more pany; 2009.
in contemporary versus historical society, there should be an 2. Wisco BE, Nomamiukor FO, Marx BP, Krystal JH, Southwick
SM, Pietrzak RH. Posttraumatic stress disorder in US military
avoidance of labels, identities, and other efforts of individ- veterans: results from the 2019–2020 National Health and Resil-
ualism and separation beyond that for character, merit, and ience in Veterans Study. J Clin Psychiatry. 2022;83(2):20m14029.
respect. Instead of looking inward, individuals should look doi:10.4088/JCP.20m14029
outward and focus on the needs of others and the greater good 3. Tully J, Bhugra D, Lewis SJ, Drennan G, Markham S. Is PTSD
of society. More people need to express gratitude rather than overdiagnosed? BMJ. 2021;373:n787. doi:10.1136/bmj.n787
grievance. An appreciation of others and their contributions 4. Grossman DA, Christenson LW. On Combat: The Psychology
and Physiology of Deadly Conflict in War and Peace. Third edi-
to society must outweigh criticism and protest. All must take tion. Warrior Science Publications 2008.
ownership of their own lives and life choices while also being 5. Kotwal RS, Montgomery HR, Miles EA, Conklin CC, Hall MT, Mc-
tolerant of others. Chrystal SA. Leadership and a casualty response system for elim-
inating preventable death. J Trauma Acute Care Surg. 2017;82(6S
Basic tenets of humanity and a civilized nation must be per- Suppl 1):S9–S15. doi:10.1097/TA.0000000000001428
ceived as important to the individuals living within that society. 6. Howard JT, Kotwal RS, Stern CA, et al. Use of combat casualty
care data to assess the US military trauma system during the Af-
Being honest and having integrity are both levels of truth and ghanistan and Iraq conflicts, 2001–2017. JAMA Surg. 2019;154
a foundation for trust that should be maintained. As integrity (7):600–608. doi:10.1001/jamasurg.2019.0151
is a deeper level of truth that is defined by what is done when 7. Flanagan SC, Kotwal RS, Forsten RD. Preparing soldiers for
no one is looking, true character will be defined by how indi- the stress of combat. J Spec Oper Med. 2012; 12(2):33–41. doi:
viduals act at these moments, and it will be through discipline 10.55460/RPAT-ESAK
that the right thing is done. Discipline can prove difficult in a 8. Berwick D, Downey A, Cornett E eds. Committee on military
society that promotes individualism over selfless service, honor, trauma care’s learning health system and its translation to the Ci-
vilian Sector, National Academies of Sciences, Engineering and
and the greater good; thus, the population needs a greater good Medicine (NASEM) report. A National Trauma Care System: in-
to exist as a guiding star. Throughout all, we must hold one tegrating military and civilian trauma systems to achieve zero pre-
another accountable for social and cultural stewardship and ventable deaths after injury. 2006. The National Academies Press.
retain the strength and courage to defend civic virtue and du- Accessed November 7, 2023. https://nap.nationalacademies.org/
ties. We must preserve basic morals, values, liberties, and free- catalog/23511/a-national-trauma-care-system-integrating-
military-and-civilian-trauma
doms that are innate to a civilized society, as to do otherwise is 9. Howard JT, Stewart IJ, Amuan M, Janak JC, Pugh MJ. Associ-
to invite chaos. As strength also comes from unity, prevailing ation of traumatic brain injury with mortality among military
cultural trends and the trajectory of society must be redirected veterans serving after September 11, 2001. JAMA Netw Open.
toward commonalities, a shared identity, and unifying efforts 2022;5(2):e2148150. doi:10.1001/jamanetworkopen.2021.48150
that enable, support, and coalesce the current generations of 10. Howard JT, Stewart IJ, Amuan ME, Janak JC, Howard KJ,
our populace so that we may save lives, defend our nation, and Pugh MJ. Trends in suicide rates among post-9/11 US military
cohesively preserve the fundamental tenets of our society. veterans with and without traumatic brain injury from 2006–
2020. JAMA Neurol. 2023;80(10):1117–1119. doi:10.1001/
jamaneurol.2023.2893
Author Contributions 11. Centers for Disease Control and Prevention. Wide-ranging ON-
RSK conceived the concept and design of the manuscript. line Data for Epidemiologic Research (WONDER). Drug and
RSK, RLM, and JTH assisted in the acquisition, analysis, and alcohol, homicide, and suicide rates per 100,000 population. Ac-
interpretation of data, contributed to the initial draft of the cessed October 23, 2023. https://wonder.cdc.gov/Deaths-by-Un-
manuscript, revised the manuscript for critically important in- derlying-Cause.html
tellectual content, and approved the final version of the man- 12. Centers for Disease Control and Prevention. Pregnancy mortal-
ity surveillance system. Maternal mortality rates per 100,000
uscript to be published. live births. (Includes late maternal deaths from 43 days to 1 year
postpartum.) Accessed October 23, 2023. https://www.cdc.gov/
Disclaimer maternal-mortality/php/pregnancy-mortality-surveillance/index.
The views, opinions, and findings contained in this commen- html
tary are those of the authors and should not be construed as 13. Hoyert DL. Maternal mortality rates in the United States,
official or reflecting the views of the Department of Defense 2021. NCHS Health E-Stats. Published February 16, 2023. doi:
10.15620/cdc:124678
unless otherwise stated. This commentary was approved for 14. Case A, Deaton A. Rising morbidity and mortality in midlife
public release by the Public Affairs Office and the Operational among white non-Hispanic Americans in the 21st century. Proc
Security Office of the Defense Health Agency on November Natl Acad Sci U S A. 2015;112(49):15078–15083. doi:10.1073/
14, 2023. pnas.1518393112
15. Bor J, Stokes AC, Raifman J, et al. Missing Americans: early
death in the United States-1933-2021. PNAS Nexus. 2023;2(6):
Disclosures pgad173. doi:10.1093/pnasnexus/pgad173
The authors have nothing to disclose.
PMID: 39621005; DOI: 10.55460/XLYN-MH81
Funding
No funding was received for this work.

112 | JSOM Volume 24, Edition 4 / Winter 2024