DEAD — a grave threat to global health
An uncommon but severe disorder that has been present for over half a century but is not yet officially classified is an under-recognised threat to global health. It relates to the most powerful weapons ever created, nuclear weapons, which have the potential to indiscriminately destroy most forms of life on earth. I propose the term Destruction of Everything Addiction Disorder (DEAD) to describe the condition of those who refuse to give up their reliance on these weapons despite overwhelming evidence of the harm they cause.
The importance of recognising this condition lies not so much in treatment for the affected individuals, but in the protection of global health from their actions.
The number of individual cases of DEAD globally is not known, as sufferers almost universally deny their condition and refuse any interventions. Despite the extreme risk this condition poses for others, there is no mandatory reporting of individual cases. However it is well established that the condition occurs in clusters, and these clusters are found in the USA (where the condition was first recognised), Russia, the UK, France, China, India, Pakistan, Israel, and North Korea. In addition, there was a small cluster in South Africa during the 1970s, but this represented the only recorded instance thus far of resolution of the condition.
Although the condition had its origins in 1945, its most severe form became apparent by the early 1960s, when addicts in Moscow and Washington were amassing vast stockpiles of nuclear weapons, sufficient to destroy the Earth several times. This habit was labelled “Mutually Assured Destruction” or MAD.
A milder form of the condition has also been observed in Australia, Japan, South Korea, and a number of European countries. While these countries do not possess nuclear weapons, individuals in these clusters claim that US weapons are valuable in some circumstances, and call this variation “Extended Nuclear Deterrence” or END. Hence their condition is called DEAD END.
Thus all sufferers lie somewhere between MAD and DEAD END.
Despite early predictions that DEAD would spread uncontrollably throughout the world, this has not happened. Many governments have taken collective action with neighbouring governments to create nuclear-weapons-free zones in their regions, but they remain threatened by the effects of nuclear weapons elsewhere.
Unlike some other addiction disorders, DEAD addicts are practically all in upper socio-economic groups in their respective countries, and are fully employed in positions of power and responsibility, generally in government, military, or industry positions. They tend to rationalise their habit as being beneficial to society and, as mentioned below, a propensity for secrecy and lying helps preserve this façade and prevents scrutiny of their behaviour.
As with addictions to other substances, the key feature displayed by DEAD sufferers is a continuation of their addictive behaviour despite overwhelming evidence of the harm that it causes. They refuse to give up their chosen substance. The harm caused by the possession of nuclear weapons has been repeatedly documented by a number of high level reports [1-4], which conclude that:
- The possession of nuclear weapons by anyone is a stimulus to others to acquire them.
- The weapons will be used again unless they are abolished.
- Any use of nuclear weapons would be catastrophic.
Despite this uncontested evidence, DEAD addicts continue their habit. In addition, they display many of the following features:
Anti-social or psychopathic tendencies
Addicts maintain plans and preparations to commit acts of the most extreme and indiscriminate violence, such as the incineration of cities, and they lack the appropriate sense of revulsion, horror, remorse, and shame at such plans. For example, during the 1970s DEAD sufferers in the UK chose the Trident weapons system because they estimated it could kill up to 10 million Russians and inflict unacceptable damage .
Disregard for the law
DEAD addicts routinely treat the law relating to nuclear weapons with contempt. The 1970 Nuclear Non-Proliferation Treaty calls for nuclear disarmament. In 1996 the International Court of Justice stated unanimously that there was an obligation to ban nuclear weapons . Contrary to these obligations, most DEAD addicts are upgrading their stockpiles.
The policy of “deterrence” is often used by addicts to sanitise and legitimise their weapons, as if a threatened action is legally and ethically neutral. Courts, however, do not overlook threats of violence simply on the basis of whether a threat is carried out or not.
Delusions of grandeur
DEAD sufferers believe that they have a right to decide the fate of millions of people, and that they are not bound by the ethical and legal standards that apply to the rest of society. In addition, some believe that they are appointed to decide who else may keep nuclear weapons and who may not .
Most nuclear-weapon states have amassed numbers of weapons far exceeding any possible number of enemy targets. Even if the weapons had a legitimate purpose, current stockpiles of approximately 17,000 weapons globally would greatly surpass any conceivable requirements.
There have been a number of occasions of greatly heightened risk, such as the 1962 Cuban Missile Crisis, when millions of lives were on a knife edge for 14 days. Addicts in the USA and Russia still keep thousands of their weapons on high alert status, increasing the possibility of accidental nuclear war.
Lack of problem-solving skills
DEAD addicts lack the skills needed to address relationship problems without the threat of extreme violence. Their threats, stated or implicit, of mass destruction take the place of more constructive and far less costly approaches to conflict resolution.
Compulsive lying and excessive secrecy
Many addicts lie about their nuclear weapons-seeking behaviour, generally to deflect criticism. Weapons upgrades are hidden from scrutiny. Populations are kept in the dark about nuclear weapons risks, and debate is stifled. During the Cold War, school-children in the USA were drilled in the “duck and cover” routine which promised them survival from a nuclear blast if they hid under their desks. Similar practices occurred in other countries.
Any use of nuclear weapons would be an act of terror with incalculable public health consequences. Our profession would have little to offer most of the survivors . At Hiroshima and Nagasaki, approximately 210,000 people had died by the end of 1945 from the effects of two atomic bombs  Even limited use of nuclear weapons could lead to climatic change, agricultural decline and global famine with a possible death toll of 2 billion people . The economic costs of nuclear weapons, even before detonation, are severe. Each year, DEAD addicts spend more than $100 billion globally on maintaining their habit .
A new approach—call it a new treatment— is needed. Thus far, approaches to managing the problem of nuclear weapons addiction have focussed mainly on harm minimisation, with the goal of preventing the spread of the weapons. Unlike the situation with other addiction disorders, however, DEAD places the lives and health of whole populations at risk. For this reason, a policy of zero tolerance, or abstinence, is needed.
A number of forms of treatment could be considered, such as:
- Group therapy, in the form of Nuclear Weapons Anonymous (NWA) modelled on the Alcoholics Anonymous program, where addicts confess their need for help and willingness to receive it.
- Interpersonal skills and conflict resolution training, to help addicts resolve disputes without resort to the threat or use of mass murder.
These require the willing cooperation of the addicts, however, which is unlikely given their lack of insight. Similarly, a program of mandatory reporting and prolonged detention to separate addicts from their ability to do harm, while an attractive option, would require cooperation from the very governments that support the addicts’ habit.
The new approach focusses primarily on the need to protect the public from the actions of DEAD addicts rather than on the rehabilitation of the addicts themselves.
Following the example of attempts to control alcohol and tobacco addiction, where the glamour promoted by vested interests is replaced by images of irresponsibility, ugliness, and ill-health, a similar approach could be taken with DEAD addicts. The image of nuclear weapons must be changed from one of powerful and respectable status symbol to one of unparalleled stigma, the sort of stigma that one would expect to be associated with anti-social plans to blow up cities.
For that reason, a treaty to ban nuclear weapons—including research, manufacture, trafficking, possession, and use—has been proposed. While addicts themselves would initially resist such a ban, the purpose would be to stigmatise and de-legitimise the weapons. Treaties set a benchmark, a standard by which behaviours can be judged as civilised or barbaric.
As a global health initiative, the removal of this threat would be of historic significance. The health of the world’s people should not be left in the hands of those addicted to the means of destroying it. Such an initiative is long overdue.
 Yokoro K and Kamada N. The public health effects of the use of nuclear weapons. Chapter 6 in War and Public Health, Eds Levy BS and Sidel VW, Oxford University Press in cooperation with the American Public Health Association. New York and Oxford, 1997, p 69
 Helfand I. Nuclear Famine: Two Billion People at Risk? IPPNW/PSR. 2013.