Trauma & Dissociation in the News

World Refugee Day

Mary-Anne Kate, PhD

World Refugee Day, held every year on June 20th, commemorates the strength, courage and perseverance of millions of refugees, shows support for refugees, and requests that governments work together and do their fair share for refugees.

Who is a refugee?
A refugee is a person who has been forced to flee their country because of persecution, war or violence. Refugees by definition are traumatised individuals, with the legal criteria for refugee status requiring the person to have a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group and that, for these reasons, they are unable to return home or are afraid to do so. The right to seek asylum was enshrined in the 1951 Geneva Convention in the aftermath of World War II. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries.

Parallels between the refugee experience and dissociation
Having worked in the refugee and migration field for over a decade and then completing a PhD about childhood trauma and dissociation, I find the similarity between the situation of refugees and individuals with Dissociative Disorders striking. Both have been traumatised by the actions (or inactions) of the very people who are responsible for protecting them, and this frequently results in the fragmentation of their identity. On one hand, refugees may find it difficult to continue to align themselves with their national, cultural, social or religious identities, as these are also aligned to those who persecuted them. On the other hand, they may continue to cling to these aspects, which forms a core part of their heritage and personal identity.

Furthermore, their new lives may be so discordant from their old, that they barely recognise themselves. This echoes the experiences of people who dissociate to cope with abusive and frightening caregivers, who they may continue to have love for, and loyalty to, even though their caregivers have harmed them in unspeakable ways. It is not surprising then that, like people who suffered chronic abuse at the hands of their caregivers, refugees have high rates of dissociation.

Refugees: a global perspective
There are 25 million refugees worldwide. Two-thirds of all refugees worldwide come from just five countries: Syria, Afghanistan, South Sudan, Myanmar and Somalia. In addition to refugees, there are 40 million Internally Displaced People (IDP) worldwide who have been forced to flee their home as a result of civil war, internal strife or natural disasters.

While many people in the West feel that their country is shouldering the burden of refugees this is far from the truth as 85% of refugees and IDPs reside in developing countries such as Uganda and Pakistan. Turkey alone hosts 3.5 million refugees. In comparison only 24,000 of these refugees were resettled in Europe in 2017. The most generous Western countries for refugee resettlement when the population of that country is taken into account, i.e. number of refugees resettled per thousand residents, are Monaco (.59), Norway (.53), Sweden (.34), and Luxembourg (.31), which is higher than the traditional refugee resettlement countries of Canada (.24) and Australia (.16) and the US (.08).

Seeking asylum in western countries
Only 1 in every 21 refugees residing in the country they fled to, who are in need of resettlement to a safe third country, will be given that opportunity due to the very limited number of resettlement places offered internationally. With scant opportunities for resettlement, it should not be surprising that many refugees and IDPs undertake a frequently perilous journey to seek asylum in a safe country. While we may have the impression of all asylum seekers heading to Western countries, this is incorrect as half seek asylum in developing countries. In 2017 over 3 million people were awaiting decisions on their asylum applications.

Memory, credibility, shame and disclosure
Research suggests that refugee status decision-makers typically have unrealistic expectations of what people can reasonably remember. They assume that the person should accurately recall dates, frequency, duration and sequence; and even peripheral information and verbatim wording of verbal exchanges. If the asylum-seeker cannot give a detailed account of events then their claim may be deemed not credible. These expectations about memory recall are too high for even normal events and do not take into consideration the neurobiology of traumatic memory or dissociative amnesia.

Having personally conducted several hundred refugee status determination interviews in North Africa, I often found the interviewees who could provide a detailed narrative of their experiences were the ones whose claims I found were not credible (which would become clear to me when I focused on their life generally outside the refugee claim and the two accounts would not match up).
I also noticed how shame, trauma, and a lack of trust and rapport also prevented genuine claims from being disclosed. Not unlike an initial therapy session for a dissociative client, there is little more than an hour to build rapport with a person that is fearful and distrustful of authority figures and to uncover the kernel of their story.

I recall interviewing a journalist who had been tortured for weeks and witnessed his cell mates killed in front of him. This man was physically and emotionally broken, could barely speak, and had no wish to recount his horrific and humiliating experiences. I interviewed three young women huddled together who were shaking in fear so intensely that I did not follow the normal protocol of separating them. I remember a woman telling me about being held captive by a ‘bad man’ and I strongly suspected she had been raped, but I knew she could not disclose that to me – rape is not only shameful, but a cultural stigma that can lead to a woman being outcast by her husband and her own family. However, if she had been able to tell me, it would have made her claim stronger. There is no way I could do justice to these people’s experience in the hour or so that I had with them. For the record, I did grant refugee or humanitarian status to these people who could then start a new life in Australia, but I knew that the outcome may have been different if the interviewer had been someone that was not as attuned to trauma as I was.

National asylum policies: a trauma-creating approach
Western countries are spending hundreds of billions of dollars on additional measures to stop asylum seekers reaching their soil. Many compete with each other in a race to the bottom to be the least desirable destination, sacrificing human rights in the process. For example, since 2001 the Australian government has prided itself on its initiatives to “stop the boats” to prevent the arrival of asylum-seekers in Australia, regardless of the strength of their refugee claims.

Australia began processing asylum-seekers off-shore on small islands in the pacific to avoid its responsibility under the Geneva convention. The detention centre on Manus Island, Papua New Guinea, was found to be illegal and unconstitutional and the Australian government was forced to pay a settlement to nearly 2,000 refugees and asylum-seekers for illegally detaining them in horrific conditions. Amnesty International reports also found that asylum seekers in detention on the island nation of Nauru were subjected to humiliation, neglect, abuse and poor physical and mental health care.

In the US, President Trump signed executive orders affecting asylum-seekers and refugees, including the proposal for the wall to be built along the USA-Mexico border; allowing the forcible return of asylum-seekers to their home country; and the increased detention of asylum-seekers and their families; and children being forcibly separated from asylum-seeking parents. In dealing with vulnerable and traumatised populations a trauma-informed approach is needed, but a trauma-generating approach has been implemented as the asylum-seeking process becomes a traumatic experience in itself, making individuals more traumatised.

When the ‘safe’ country doesn’t feel safe
Like dissociative clients who have been abused by caregivers and develop a conceptual template that people and the world are unsafe, many refugees have a similar experience. To heal from trauma, one needs to feel safe. Most refugees have learned to be distrustful of authority, and too often the refugees are further traumatised, not only by their refugee journey, but by authority figures implementing the policies of the ‘safe’ countries to deter asylum-seekers. How then does a refugee feel safe in their host country?

Furthermore, a number of countries offer temporary, instead of permanent, protection which means that the refugee is living in limbo and not able to feel secure and settled given at any time they can be returned to their home country should the authorities deem it is safe to return.

Refugees and asylum seekers are our responsibility
“They have no business coming here” is a common phrase heard when the public are discussing asylum seekers whilst seemingly ignoring the right to do so that is enshrined in the Geneva convention.

The truth is that we are all responsible. International organizations, Western governments and their citizens all contribute to, or help to alleviate, the factors that create the conditions for refugees and IDPS. If people are living in a time of war or insurgency is military intervention protecting them from violent oppression, or creating greater dangers; and are there effective peacekeeping forces and diplomatic resolutions? If people are suffering as a result of war or natural disaster, is humanitarian assistance alleviating this? If people are living in abject poverty with little or no access to basic services such as water, health and education, is development assistance making their situation more tolerable? Are the goods and services produced for Western countries or the tourist market helping to provide locals with a basic income? Is the environmental inaction of Western countries (or our demand for products produced in that country) creating dangerous levels of pollution, or leading to desertification or coastal flooding in the area in which they live? Is their country struggling to cope with the ‘brain drain’ of professionals such as health care workers and engineers who are now working in our countries?

Hence, policies at the national and supranational level, and the decisions of individual consumers on what they buy and what charities they support contribute to strengthening or weakening push factors in the refugees’ countries of origin.

What would happen if these hundreds of billions spent on border security around the world were spent addressing the root causes of migration and refugee movements? Surely, if people had safety and reasonable future prospects they would not be desperate to flee their own countries in incredibly dangerous circumstances.

Community support
Refugees need a lot of support when they arrive in the host country. This may include assistance in finding suitable housing, tuition to learn the host country’s language, education and training, including getting recognition for qualifications and skills acquired in their home country, arranging schooling for children, and addressing unmet and ongoing health issues. When these needs are met, the person become more involved in the wider community (and their own cultural community) through employment, education, volunteering and civic engagement. It is through these wide range of experiences and interactions with the host society that a refugee may begin to feel safe in their new country. For refugee settlement to work well, there needs to be goodwill and practical support as well as protection from racism and other forms of discrimination.

Despite trauma being at the core of the refugee experience, mental health is rarely systematically addressed. Refugees may not seek mental health treatment as they are not aware of its benefits, are distrustful of it, lack access to it, or avoid it due to a cultural stigma surrounding mental health problems. Access to trauma-informed mental health care should be a priority for refugees, their families and their communities. Training and community education is equally important to ensure that services to refugees are delivered in a trauma-informed framework, including one that addresses dissociation.

Resources
Dissociation in refugees:
https://www.ncbi.nlm.nih.gov/pubmed/25415764
Refugee interviewing, credibility and memory:
https://academic.oup.com/ijrl/article-abstract/22/4/469/1520136
The responsibility of Western countries:
https://www.researchgate.net/publication/274007389_Kate_2011_’The_EU_migrants’_pathways_and_EU_policy_responses’_in_Ed_Novotny_Opening_the_door_Immigration_and_integration_in_the_European_Union_Centre_for_European_Studies_Brussels_ISBN_978-2-930632-11
Amnesty International:
https://www.amnesty.org/en/countries/
UNHCR statistics:
https://www.unhcr.org/en-au/figures-at-a-glance.html
https://www.unhcr.org/en-au/publications/fundraising/5a0c05027/unhcr-global-appeal-2018-2019-full-report.html
https://www.unhcr.org/en-au/protection/resettlement/5b28a7df4/projected-global-resettlement-needs-2019.html
https://www.unhcr.org/5b27be547.pdf

About Mary-Anne
Before specialising in Dissociative Disorders, Mary-Anne worked in the migration and refugee field for over a decade, including as a diplomat managing Australia’s refugee and migration programmes for North Africa; coordinating Australia’s National Integrated Settlement Strategy for migrants and refugees; and as a researcher and analyst for Europe’s most influential think-tank on migration and equality where she wrote policy for the European Commission. Mary-Anne completed her Master of Science at the University of Edinburgh and her dissertation on the inequity of protection for asylum seekers in Western countries was published by the United Nations High Commission for Refugees (UNHCR).

Committee Spotlight

Scientific Committee

Vedat Şar

Scientific Committee Chair, Vedat Sar, MD at ISSTD Annual Conference, 2018

ISSTD Scientific Committee has been active since 2012. Members of the Committee are selected for a three year term, which can be extended. One third of the Committee is replaced every year, enabling continuity. It is international and global in composition, and both clinicians and researchers are represented.

Former presidents of ISSTD, Vedat Şar, MD (Turkey) and Warwick Middleton, MD (Australia) serve as Chair and Vice-Chair of the Committee. Current Committee members are Ruth Blizard (USA), Bethany Brand,PhD (USA), Paul F. Dell, PhD (USA), Martin J. Dorahy, PhD (New Zealand), Benedetto Farina, MD PhD (Italy), Heather Hall, MD (USA),Mary-Anne Kate, PhD (Australia), Milissa Kaufman, MD PhD (USA), Marilyn Korzekwa, MD (Canada), Christa Kruger, MD (South Africa), Andreas Laddis, MD (USA), Lauren A.M.Lebois, PhD (USA) Alfonso Martinez-Taboas, PhD (Puerto Rico), Dana Ross, MD (Canada), Adah Sachs, PhD (United Kingdom), Michael Salter, PhD (Australia), Adriano Schimmenti, PhD (Italy).

Scientific Committee Vice Chair, Warwick Middleton, MD with fellow committee member Martin Dorahy

In the seven years since its establishment, committee members have been able to publish several reviews and opinion papers on trauma and dissociation which are products of collaborative efforts.

A current project is a collaboration between the ISSTD and ESTD Scientific Committees. Review articles are being prepared on six dissociation-related topics which are considered strategically important.

Committee Members Heather Hall, MD and Michael Salter, PhD presenting at ISSTD Annual Conference, 2019

The Committee discusses future possible activities which usually emerge through spontaneous proposals from its members. In this context, the Committee has decided to organize a two-hour face to face meeting during the 36th Annual Conference of ISSTD in San Francisco. The agenda of this meeting will cover identification of the research areas which are strategically important for the field; ways of expanding the representation of research output in the annual conference programs; potential projects of editorial books; and programs to reach out to emerging researchers and clinicians, among other topics which will emerge during preparations. Thus, proposals by ISSTD members about topics to be covered are also welcome.

Scientific Committee members Michael Salter and Paul Dell at the ISSTD Annual Conference, 2019

The experience of seven years in the Scientific Committee has led to the conclusion that Dissociative Identity Disorder, the prototype diagnostic category of our field, is no longer a subject of prejudice and stigmatization. What we need, now, is to continue to focus on how to serve our patients to the highest standard.

The work of the field still only represents a tiny portion of all research production (approximately 3,600 published papers listed by Science Citation Index over 45 years). However, this field has immense potential. It is hoped that the work of the Scientific Committee will play a role in facilitating the study of dissociation to enable an expansion into many areas of mental health (clinical psychiatry, psychology, neurobiology, pharmacology etc) which would enable researchers and clinicians to influence the wider mental health field.

Letter From The President

International Day of Living together in Peace

Christine Forner, President

May 16th was the International Day of Living Together in Peace and I thought this would be a timely topic to reflect on. I do not think that commenting on the state of the world is off limits for trauma researchers and therapists. I would actually reach out and make the statement that it is, in part, our responsibility to assist in researching the effects of not living together in peace, spreading the information that we have learned, and use this knowledge and wisdom to effect policy.

The ISSTD has had an interesting past. We are the world’s oldest organization dedicated to working with those traumatized individuals who, historically, have been most isolated and silenced. What we know is not something that gets discussed openly. In reality, what we witness, research and assist with is that which most ails the current human condition: interpersonal violence and relational injury.

The ISSTD has been witness to the horrors of human to human harm. We have worked tirelessly in learning and examining what hurts people, what this injury does to the person and what needs to be done in order to properly heal the injury. I don’t think it is random that our Society has been attacked several times by various groups that have a vested interest in our silence. Over the last 36 years we have continued to treat individuals, couples and groups of people who have been through every type of violence one could possibly imagine and, perhaps violence many cannot imagine.

We have researched what violence does to humans. We have questioned almost every possible variation of human psychological injury. Our researchers have examined the impact of violence on individuals, families and communities. Researchers have established the reliability and validity of complex trauma and dissociation. We have consistently found the prevalence of dissociation and dissociative disorders in clinical and general populations. Our researchers have been able to help us to have a better understanding of the neurobiological impact on humans when they are hurt and not living in peace.

Indeed, researchers have detected that physical and sexual violence and neglect, a passive form of violence, are the lead cause of many of the ills in society.

Our researchers have discovered, with very little doubt, that being yelled at, hit, kicked, ignored, isolated, impoverished, sexually assaulted, enslaved, belittled, gaslighted, tortured, bullied, controlled or neglected create an enormous amount of damage. Researchers have discovered that these types of interpersonal violence can lead to all sorts of physical ailments, mental illness, drug addiction and even more violence. Interpersonal violence can also cause people to become abusively greedy, to be paralyzed in life, to be harmful towards oneself, or to neglect one’s own children.

Our researchers have shown how much interpersonal violence costs each individual, couple, family or community. The cost to society is enormous, not only in monetary terms, but also in lost human ingenuity, work force, community vibrance and collective vitality. Our researchers have found that when a human is fighting to stay alive it will not, at the same time, freely live. A human being, when fighting to stay alive and/or when experiencing constant violence will naturally dedicate all of its resources to not dying. Researchers have also shown that this type of stress is very toxic and corrosive to the human. Humans fighting to not die cannot fully thrive and be alive. The human defence system cannot both defend death and foster life. Our research has shown that when a human is safe and secure they work very differently than a human who is not. Humans who are provided with fundamental basic human needs thrive in very non-selfish, non-destructive ways.

Our clinicians in turn have worked directly with the most challenging aspects of human existence. They have learned what it takes to help someone go from a life filled with terror, panic, anger and violence to a life filled with hope, joy, and self love. Our clinicians have shown that a traumatised person, when given proper care, can become someone who is resilient and vibrant.

Our clinicians can teach others what it takes to heal. I would venture that most of our clinicians would say that healing is the most difficult thing a human can do. It may actually be easier to get to the moon than it would be to heal our collective wounds. But they would also be the first ones to tell you that even though it is hard, it is not impossible. They would eagerly tell you that bearing witness to a human who is healing is one of the most painful and beautiful things one can see. Our clinicians can explain that change is very hard, but so very worth the effort. Our clinicians can also attest that when an individual, couple, or community learns the skill of regulation and healing their internal wounds, then they can thrive in ways that were not even remotely imagined.

We, as a group, are leaders in the field of interpersonal violence, but we are also much more than that. We could be leaders in healing the collective injury that we all carry. We can lead in influencing policies that educate others in what we have learned. We can teach about the power of safe and secure childhoods and relationships. We can inform others of how valuable and necessary peaceful human relationships are. We can encourage donors to put money towards research projects that shine more light on what human to human harm and neglect really does to people. We can encourage others to support the ISSTD so that we can use our collective experience to continue to help change the realties of those who have been hurt.

The ISSTD has amazing knowledge about what can be done to help others change, why they should change and what makes humans happy. We know that there is an unwritten human-to-human contract of compassion, dignity and presence. These three items are so very needed in creating change. These three items are what every human thrives on.

My dream is that this finally becomes implemented policy in every facet of human experiences. I am a very proud member of the ISSTD and I thank all of you for your time, energy, and tireless effort in helping make the world a more peaceful place. Keep going, keeping doing what you are doing.

News You Can Use

News You Can Use

Kate McMaugh, Editor, ISSTD News

Trauma Informed Couple Therapy Manual Published

The book includes an evidence-based framework which emphasizes the importance of containing conflict and helps clients to build emotional regulation and mentalizing skills. The framework is an invaluable asset to all clinicians working with traumatised couples who may not be able to benefit from traditional forms of couple therapy due to challenges which limit their capacity to engage in relationships and couple therapy.
The chapters guide you through the four key stages of therapy: Psychoeducation, Building Capacity, Dyadic Processing, and Consolidation. Each stage has accompanying activities and narratives in which to engage traumatized couples and includes a variety of case transcripts to illustrate the approach. Throughout the manual the author provides the reader with:

  • insights from real-world scenarios based on her extensive clinical experience;
  • worksheets that can be used as part of the therapeutic process;
  • systematic analyses of the therapeutic process from the therapist’s point of view;
  • comprehensive recommendations for further reading so that you can develop your expertise in any area of DCTCT.

The book is available from Routledge and from Amazon.

Doctoral Student Seeks Therapists who have experienced Indirect Trauma for Research Project

Sam Golden, Doctoral student at Rutgers University is seeking therapists who have experienced indirect trauma. A copy of Sam’s recruitment email follows. All those interested in participating contact Sam on the email provided.

Recruitment Email
Seeking licensed therapists who have experienced indirect trauma while working with trauma survivors

Hello,
        My name is Sam Golden and I am a doctoral candidate at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. I am seeking therapists who have experienced indirect trauma (vicarious trauma, secondary trauma, compassion fatigue) while conducting therapy with trauma survivors and who would be willing to share how the experience personally affected them.
       Therapists licensed in the United States in fields such as psychology, psychiatry, clinical social work, mental health counseling, and marriage and family therapy may all meet inclusion criteria for the study. Participation will involve one 60 to 90-minute interview to be conducted either in person in the New York City area or via secure telehealth video-conference. Participants will additionally be asked to complete a brief demographic questionnaire. The interview will ask open-ended questions regarding the development and course of the therapist’s indirect trauma, the way that the therapist’s personal and professional relationships were affected at the time, and the therapist’s views of themselves and their work in relation to this experience. All interviews will be audio recorded to ensure accurate transcription and all identifying information will be kept confidential by using pseudonyms and altered demographics. Participants may discontinue their participation in the study at any time. Please note that there is no compensation for participation in this study.

If you or anyone you know may be interested in participating, or if you have any questions, please contact me at Samuel.Golden@gsapp.rutgers.edu or (914) 960-2204.

Thank you,
Sam Golden, Psy.M.
Graduate School of Applied and Professional Psychology, Rutgers University

Welcome ISSTD’s New Members in May!

PROFESSIONAL MEMBERS
Debra Ayer
Michele Beal
Philip Bohlander
Willoughby Britton
Amanda Budwine
Jo Clarkson
Catia Fath
Mary Ferguson
Marlene Furey
Anna Jannack
Andrea Knestel
Ariel Lublin
Rebecca McCullough
Lynn Meredith
Deborah Mizell
Kristen Nasse
Claire Scigliano
Susan Simonds
Phoebe Webber
Dawn Weisenberger
EMERGING PROFESSIONAL MEMBERS
Robert Chester
Shaun Gray
Abigail Morales                                                                                                                                                            STUDENT MEMBERS
Mary Bernard
Lily Defriend
Natina Demetriou
Najia Malik

Do You Have News ISSTD Members Can Use?
We need your help to make NYCU a great feature, full of news and sharing the activities of our community members.

Do you have a book or book chapter coming out that you wish to share? Have you received an award for your work in the field? Have you been part of developing a new website or training course? Have you had a chance to develop something creative and unique that you wish to share with others in the field? If so, we want to hear from you! Don’t be shy, submit your news to us so that we can share with other members. (Please be aware: we do not offer book reviews, but a chance to share with others that your book has been published.)

Submission Deadline: 20th of the month
Send to ISSTD Editor, Kate McMaugh: katemcmaughpsychology@gmail.com

Clinical E-Journal

JTD & Frontiers Table of Contents (May 2019)

Journal of Trauma & Dissociation

Check out the entire library online of the Journal of Trauma & Dissociation – your member benefit – now!

Table of Contents
Volume 20, Issue 1
Volume 20, Issue 2
Volume 20, Issue 3
Volume 19, Issue 4
Volume 19, Issue 5

Are you interested in auto publication alerts?
To set up a quick and each way to get a ‘new content alerts’ for JTD, go to the JTD page at Taylor & Francis and click the ‘Alert me’ button under the graphic of the JTD.

For full access to the entire library of the Journal of Trauma & Dissociation (your member benefit) visit the Member Resources page of ISSTDWorld. Need help to access? Call ISSTD Headquarters at 202-803-6332, or email info@isst-d.org for assistance.

Frontiers in the Psychotherapy of Trauma & Dissociation

Table of Contents

2019

  • Mindful Attachment: An Organic Way to Work with Children Who Have Been Through Complex Trauma and Neglect (Christine Forner)
  • The Memory Wars in England: A Personal and Professional Experience (Valerie Sinason)
  • The First Individual with Dissociative Identity Disorder (DID) That One Knowingly Diagnoses and Treats (Warwick Middleton, MB, BS, FRANCZP, MD)
  • Envisioning and Embodying Empowerment in Dissociative Identity Disorder: A Case Illustrating the Two-Part Film Technique (Sarah Y Krakauer, PsyD)
  • Editorial: How are Memories of Entrapment in Abuse Born? (Andreas Laddis, MD)
  • Commentary: Therapeutic Neutrality, Ritual Abuse, and Maladaptive Daydreaming (Alison Miller, PhD)
  • Rejoinder: Maladaptive Daydreaming and Therapeutic Neutrality (Colin a Ross, MD)
  • Commentary: On Dissociative Identity Disorder and Maladaptive Daydreaming (Eli Somer, PhD)
  • Rejoinder: Maladaptive Daydreaming and Dissociation: Both a Continuum and a Taxon (Colin A Ross, MD)
  • Commentary: Understanding Reports of Satanic Ritual Abuse (Warwick Middleton, MB, BS, FRANZCP, MD)
  • Commentary: Truth and Neutrality in the Treatment of Extreme Abuse (Michael Salter, PhD)

2018

  • From Proximity Seeking to Relationship Seeking: Working Towards Separation from the “Scaregivers” (Orit Badouk Epstein)
  • The Relationship of Mental Telepathy to Trauma and Dissociation (Sharon K Farber, PhD)
  • A Simple Algorithm for Medication of Patients with Complex Trauma-Related Disorder (Andreas Laddis, MD)
  • Healing Emotional Affective Responses to Trauma (HEART): A Christian Model of Working with Trauma (Benjamin B Keyes, PhD, EdD)
  • Eye Movement Desensitization and Reprocessing (EMDR) in Complex Trauma and Dissociation: Reflections on Safety, Efficacy and the Need for Adapting Procedures (Anabel González, MD, PhD)
  • Cross-Cultural Trauma Work With a Tribal Missionary: A Case Study (Heather Davediuk Gingrich, PhD)
  • The Potential Relevance of Maladaptive Daydreaming in the Treatment of Dissociative Disorder in Persons with Ritual Abuse and Complex Inner Worlds (Colin A. Ross, M.D.)
  • Neuroaffective Embodied Self Therapy (NEST): An Integrative Approach to Case Formulation and EMDR Treatment Planning for Complex Cases (Sandra L. Paulsen, Ph.D.)
  • The Case of the Shaking Legs: Somatoform Dissociation and Spiritual Struggles (Alfonso Martinez-Taboas, Ph.D.)
  • Treatment Outcomes Across Ten Months of Combined Inpatient and Outpatient Treatment In a Traumatized and Dissociative Patient Group (Colin A. Ross, M.D., Caitlin Goode, M.S., and Elizabeth Schroeder, B.A.)
  • Maladaptive Daydreaming: Ontological Analysis, Treatment Rationale; a Pilot Case Report (Eli Somer, Ph.D.)

2017

  • Editorial: How Close Encounters of the Completely Unanticipated Kind Led Me to Becoming Co-Editor of Frontiers (A. Steven Frankel, Ph.D., J.D.)
  • Editorial: Sources for Psychotherapy’s Improvement and Criteria for Psychotherapy’s Efficacy (Andreas Laddis, M.D.)
  • Trying to Keep It Real: My Experience in Developing Clinical Approaches to the Treatment of DID (Richard P. Kluft, M.D., Ph.D.)
  • Expanding our Toolkit through Collaboration: DIR/Floortime and Dissociation-Informed Trauma Therapy for Children (Joyanna Silberg, Ph.D. and Chevy Schwartz Lapin, MA)
  • From Passion to Action: A Synopsis of the Theory and Practice of Enactive Trauma Therapy (Ellert R.S. Nijenhuis, Ph.D.)

Please note that Frontiers has moved to the Member Resources area of ISSTDWorld. You must be logged in as a member in order to view the articles. To access please log in to isstdworld.isst-d.org using your member credentials. Once you are logged in, click on the Member Resources tab in the navigation bar at the top of the page. The archive will be located under the Publications section of this page. For questions or assistance please contact ISSTD Headquarters at info@isst-d.org

Board Briefs

The Latest News From Your Board

Willa Wertheimer, PsyD

What a wonderful start to the year! This January, we welcomed new Board Members Rosita Cortizo, Tally Trip, Valerie Sinason, and returning members Christa Kruger and Lynnette Danylchuk. Our diverse perspective and skills has truly contributed to a great team.

Our Annual Conference in New York was a spectacular success and was the most well-attended conference for many years. We enjoyed amazing plenary speakers as well as the shared expertise of our colleagues. The Big Apple promised shows, sights and great food, and did not disappoint.

This is also the only chance of the year when all the Board meets face to face. We spent an intense and exciting few days prior to the conference discussing all the developments in ISSTD and making plans for the year ahead.

As you have noticed, we have a new internet platform, which is able to support many online communities. This has greatly increased all the ways we can connect, share knowledge and find resources. It has been long in the works, and the rollout has been very exciting.

Education, outreach and support are the cornerstones of our ISSTD community. We are always thinking of new ways to bring the latest innovations in research and clinical intervention to the fore.

We now have open registration for ASCH Intermediate Training, planned for October 18-20 of this year.
Registration is also open for the Austin Regional Conference, on October 4th. In addition, there is a regional conference in November in Christchurch, NZ. There are many rich opportunities for support and education.

We have been hard at work, creating ways to offer interesting and valuable experiences to each member. If you would like to be a part of this endeavor to help clinicians around the world, volunteering to be part of a committee would put you in the midst of all the projects we have in development. Just complete this form and we will be in touch with you. It’s always the right time to make a difference!

Looking forward to the year that comes.

Focus on ISSTD History

An Interview with Frank Putnam, Part I

An Interview between Warwick Middleton, MD and Frank Putnam, MD 

Part One: The Early Years: Child Abuse Research, Dissociation and the Formation of the Society

WM: Let me start Frank by asking how you became involved in this area of dissociative disorders, complex trauma and the long-term outcome of child sexual abuse?

FP: I did my psychiatry residency at Yale University from 1976-79. That was before PTSD was officially a disorder. We had a large number of young Vietnam vets who were quite hyperactive and somewhat aggressive. I was very fortunate to be supervised by Art Blank, a Vietnam veteran himself … an army psychiatrist in Vietnam. Art really understood PTSD. So, I saw a lot of PTSD, including abreactions and flashbacks.

I didn’t really want to specialise in PTSD but Art kept sending me cases. I didn’t see PTSD as a career. I was interested in biological psychiatry – especially in the circadian rhythms of people who were bipolar and rapidly switching. After I finished my residency I did a clinical research fellowship at the National Institute for Mental Health (NIMH). I stayed on at the NIMH for 20 years.

Frank Putnam, Bethany Bjur and Warwick Middleton, Zoom interview, February 2019

At NIMH we had a ward of rapid cycling bipolar patients. They were moving back and forth – sometimes every couple of days – between episodes of mania and depression. I was seeing all of these amazing mood state transitions. What I discovered as I talked with these bipolar patients was how many of them were traumatised, especially (with) histories of childhood maltreatment. I think I was able to recognise their trauma because of my experience with Vietnam veterans.

Serendipitously, I turned up a case of DID, as we call it now, a woman who was in a wheelchair. She had a classic “hysterical paralysis” and couldn’t walk…but every once-in-a-while the nurses would find her curled up across the room from her wheelchair and talking like a little baby. In group therapy I observed dramatic switches in her and wondered – what could this be? The switches were far too rapid to be bipolar disorder. That led me to investigate the possibility that it was…Multiple Personality Disorder.

It turned out that was correct and it solved the problem … we were able to successfully discharge her from the hospital and into an outpatient treatment program. She subsequently did quite well. I thought that was amazing, but doubted that I’d ever see another case of this rare disorder. Very shortly, however, I had turned up two more. Of course, I was immediately accused of causing them!

WM: That’s a familiar pattern Frank!

FP: I’m afraid so! That first case led to my beginning to look for MPD cases systematically. I saw maybe 10 or 12 clinical cases over a short period of time and I began to do the neurophysiology studies with them. I began … looking at the personality states much like we worked with the bipolar mood states – looking at the psychophysiology of one state versus another state.

I learned that they all had histories of severe childhood maltreatment and said that they had been multiple since childhood. I thought – well if this is true, I should be able to find child multiples. So, I went looking for child cases. … We developed a profile of what a child with a dissociative disorder might look like to a teacher, social worker, counsellor. We created a child MPD profile, which later became the basis of the Child Dissociative Checklist. I took that initial profile and circulated it to child protection services in the Washington DC metro area. I asked to see any of their kids … who fit this profile. Then I saw a series of child protection-referred abused children.

At that time, I was not trained in child psychiatry. I was still an adult psychiatrist. I had a child psychologist or a child psychiatrist with me when I saw these kids. I became convinced – not only that a few of them were dissociative – but that many of the children were disturbed or abnormal in other ways. I became interested in looking at these adverse effects prospectively because it seemed so complicated to retrospectively disentangle the outcomes.

That led me to start a prospective longitudinal study with a developmental psychologist, Penelope (Penny) Trickett. Penny and I started the study with 100 sexually abused girls and 100 non-abused comparison girls aged 6 – 15 years. We had a great deal of trouble convincing the leadership at the NIH to fund us. Eventually they said: “you can do this study but we won’t pay for it, and you can’t do it on the NIH campus.” So, we had to go outside of the NIH and ask a private foundation to give us money to do a study at the NIH, which was unheard of!

We were most fortunate to have a paediatrician, Robert Haggerty, president of the W.T. Grant Foundation. Dr. Haggerty was concerned about the effects of sexual abuse on children. He gave us a grant and we rented offices off the NIH campus. We recruited our abuse subjects from child protection agencies and matched controls from social service agencies..

We started that study in 1986. It still continues today. Now we even have grandchildren of our original children enrolled in the study. We have published at least 40 or 50 papers from the study (search Penelope Trickett, Jennie Noll and/or Frank Putnam). We looked at the biology, the psychology, and the sociology of this sample from pre-puberty into adult/motherhood. It was the first study to prospectively demonstrate the powerful, life-long, pervasive effects of sexual abuse on biological development.

WM: Frank, just to put it in the context, the world literature in that area when you undertook that study was..?

FP: There was nothing, basically. (Laughs) There was a little bit on the biology of trauma through the Vietnam veterans. There was a researcher, John Mason, who had done some research looking at the parents of children with cancer. He was able to follow their emotional swings by looking at changes in stress markers such as cortisol, but that was about the sum total of the biology of trauma at that time.

We began looking at cortisol, but also several other stress markers. (We also) looked at endocrine hormones – FSH, LH and oestrogen etc. and how sexual abuse effected female pubertal development. We found that sexually abused girls went through puberty about nine months earlier than our control girls. Much of that difference was explained by their trauma histories.

WM: One of the things that you did Frank, which was remarkable, is that in furthering your credentials in the field as a researcher on child abuse that you undertook training as a child psychiatrist at that stage of your career.

FP: That was a very busy time in my life. When I look back: I got married, I had children, I went back to

Standing Ovation Frank’s ISSTD Lifetime Achievement Award, Annual Conference, Baltimore, 2013

into training doing a Fellowship in child psychiatry. I ran the prospective study pretty much by myself because

Penny had married and moved to Los Angeles. … Also, I became very ill in the middle of this with a mysterious infection that put me down for about six months with four hospitalizations. It took about two or three years to

feel normal again. It is amazing that we got as much done as we did, but I had a really, really good staff who were mostly volunteers, or graduate students – very, very dedicated. At times they worked for weeks without pay until I could score another grant.

 

WM: What was your evolving relationship with the NIH etc.?

FP: Well, very interesting. I was repeatedly told that I was pursuing a social problem, not a scientific problem. Basically, I could only do what I could accomplish on my own. I wasn’t given any institutional resources. So, we had to go outside of the NIH for money. We had to rent our research space off campus. But we were able to use some of the benefits of the NIH such as paying our subjects for their participation and transportation. I was left alone a fair amount of time, however, which was a good thing.

Then two things happened that I’ve never quite understood.

One was that the National Association of Social Workers prevailed upon the U.S. Congress to allocate a one-time sum of $40 million for research on child maltreatment. Congress also mandated that the NIH Director brief Congress on what NIH was doing about child maltreatment. As I was the only one at NIH who knew anything about child maltreatment, they dragged me over to the NIH Director’s office. I worked with his staff for weeks to write the Director’s remarks to Congress. I was thrilled that the NIH Director was going read my comments into the Congressional record when he testified. In reality it was just placed in Congressional record … It just part of an informational package they sent over to Congress. At one level I thought, now we are finally getting recognition. The NIH Director is paying attention. Boy, was I wrong!

The other thing was that I gave a public presentation at the NIH on our sexual abuse research. Afterward, a group of people came up to me. They told me about what sounded like a child sexual abuse ring, based on the NIH campus. It was all hearsay, but I took it to a District Attorney whom I had worked with on other cases.

Shortly thereafter, they arrested and charged a NIH Nobel Prize winner named Daniel Carleton Gajdusek, who was known for the discovery of Kuru. At the trial he clearly got a very special plea deal. He was allowed to first resign from the NIH and therefore keep his government pension. Although at least 40 children were known to be involved, he was only charged with one minor count. He served a short time in prison. On release, he was picked up at the prison gate by a limo and flown to Paris. He lived the reminder of his life in Europe as an unrepentant paedophile.

Frank Putnam, Screen shot, from interview – 19th February 2019

WM: What year was this Frank?

FP Roughly about 1995/1996. (Gajdusek was arrested in April, 1996). After that I was suddenly in big trouble. I got a terrible internal scientific review. They decided to terminate all child abuse research at NIH. I was fortunate to be able to transfer the prospective longitudinal study to my former project manager, Jennie Noll, who continues to direct it from Penn State University. But it was impossible to save all the data, records, and biological samples etc. A lot was lost.

Fortunately, I found a very good position elsewhere. In many ways it was one of the better things that happened to me career -wise, but at the time it was devastating to lose control of that work and become a persona non grata.

Now I believe that this was in retaliation for causing the arrest and conviction of a NIH Nobel Prize winner. I moved to Cincinnati Children’s Hospital in July 1999, where, as a Professor of Paediatrics, I worked on developing child abuse treatment and prevention programs.

WM: While all this was going on you were evolving an interface with Dissociative Identity Disorder, as it is now known. You published in 1989 what was then the most comprehensive text book on the diagnosis and treatment of DID or MPD. Can you lead us through how that book came to be?

FP: Well my first definition of an “expert”, is somebody who knows slightly more than the people in the audience asking questions. My more serious definition of an expert is somebody who knows what they don’t know, as well as what is not known by the field as a whole. So, although I was viewed as an expert – whether I was or not – I found myself in a situation where I was doing a lot of case consultations. I ran a study group in the evenings for therapists who were treating dissociative patients…I also was consulting with experts …

As a result of this immersion, I began to see common clinical threads and thought – the field needs a book. So, I eventually said to myself, “OK I’ll write that book .” (Putnam, FW 1989) I finished it in early ‘87 but it wasn’t published until ‘89 because of that mysterious infection which hobbled me for a couple of years. The book is a compilation of what were considered best practices at the time. I don’t claim unique ownership. I just pulled together the knowledge in the field and organized it into a book.

WM: It would be remiss of me not to ask you about the evolution of the Dissociative Experiences Scale in which you played a significant role.

FP I concluded, very early on, that we need a dissociation scale. I was presenting some of our early brain scan work to a psychology colloquium at American University. On my way out, standing by my car, was a young lady, Eve Bernstein Carlson. She said, “What you need is a dissociation scale.” … Eve was a first-year graduate student. We started working on the dissociation scale … we worked on the scale for multiple years until she was ready to defend her PhD dissertation. … I was told that I could copyright the DES, but I chose not to. I chose to aggressively support the scale, to send it out free to people. … Now it has four or five thousand citations in peer-reviewed journals.

WM: You were one of the foundation committee members that met and formed what became known as ISSTD. Can you tell us about your perspective of how that came to be?

FP: Sure. There were several us who thought there should be a dissociative disorders Society, with its own journal. There was another dissociative disorder group run by George Greaves who also believed this. At the multiple personality disorder meetings in Chicago, these two groups came together. At first the two groups were competitive, but after we all sat down for dinner at Mama Leonie’s – where we had her famous pizza – we decided that it would work better as a single Society … I’m not sure we were quite as far-sighted as it’s been made to seem retrospectively, but we did manage to get the society off the ground and the first journal, Dissociation, published.

What I am most happy about is that I was able to work with Jennifer Freyd to digitally archive Dissociation at the University of Oregon Library. So, all those old issues, which contain some seminal studies, are still available online for free.

Read more about Frank and past, present and future directions for ISSTD in Part 2.

References

Putnam, FW (1989). The Diagnosis and Treatment of Multiple Personality Disorder.  Guilford Press, New York.

Focus on ISSTD History

An Interview with Frank Putnam, Part II

An Interview between Warwick Middleton, MD and Frank Putnam, MD 

Part Two: Reflections on The Society, Research and the Future

WM: What is your perspective of the early years of the Society? You are a particularly notable contributor here because, not long after the Society formed, you took a stand on the issue of recovered memories, particularly as they pertain to alleged satanic ritual abuse … warning people not to go beyond the verifiable data in making generalised statements. I guess that you again found yourself in the cross hairs of a polarisation.

FP: At the beginning, I believed that these were credible reports. I was swayed by supposedly hearing the same things from everybody.

Frank Putnam – ISSTD Annual Conference, Baltimore, 18th November 2013

I was joined by an anthropologist, Dr. Sherrill Mulhern. She studied dissociation as it was manifested in religions like Voodoo and in African ritual ceremonies. She had been studying Pentecostal churches and speaking in tongues. She asked if she could observe me. I said, “Yes.” I have always been open. Of course, this was long before medical privacy concerns … Sherrill shadowed me for about a month and we spent time talking about dissociative phenomena. She asked me questions about satanic ritual abuse that I couldn’t answer because the data weren’t there. Mulhern followed a half dozen major SRA presenters from conference to conference documenting how they increasingly aligned their stories often borrowing details from each other. So, of course, they all told the “same” stories.

As a result, I began to look more critically at the data put forth to support satanic ritual abuse stories. At the time a relatively few people were describing huge satanic masses in which scores to hundreds of children were sexually abused and murdered. I have been involved in the investigation of at least a hundred abuse-related child deaths – I never kept count. There is always some form of physical evidence. Hundreds of children don’t disappear without a trace. Law enforcement at numerous level from local police to the FBI investigated and found absolutely no evidence that these orgies were happening. Importantly, given the huge numbers of alleged victims, no bodies were ever found. That ultimately led me to conclude that this was an unfortunate rumour process sweeping the field.

At MPD meetings … there were heated arguments. I was accused of disrespecting victims. It culminated in a plenary session at a 1990 Society meeting in Chicago. I organized a plenary session in which presenters offered alternative explanations of the satanic ritual abuse allegations. It led to quite a shouting match…Anyone who expressed incredulity about these allegations was branded as part of the SRA conspiracy. I was called a Satanist many times.

It is a mistake to conflate reported use of religious symbols or rituals by an abuser as evidence that there are large SRA cults carrying on massive child sexual murders. I wrote a paper on this issue in 1991 on SRA, published in Child Abuse & Neglect (Putnam, FW 1991).

WM: What is your perspective on the subsequent history of that debate?

FP: I spent more than a decade doing child abuse forensic evaluations at Cincinnati Children’s Hospital. Thousands and thousands of child abuse cases came to our centre and I never saw one that had any credible satanic components. I did see what we would call “clergy abuse” now. So, there is clearly that sort of institutional abuse going on which we are learning more about … there are religious groups responsible for systematic sexual abuse of kids, but there’s been no credible evidence for a mass of satanic worshippers abusing and murdering children.

WM: Can you tell us about your relationship with ISSTD? I guess that in taking stands on key issues, that led you to take a bit of a parallel, or different path?

FP Yes, I think I felt alienated after the Society conference I referenced, where I moderated the alternative satanic ritual abuse plenary. I got a lot of grief. Some of it very

Frank Putnam, Bethany Brand and Karen Putnam, ISSTD Baltimore Regional Conference, 2017

inappropriate – intended to be physically intimidating.

I felt alienated, but at the same time I was also feeling the tug of child abuse, which is its own world. I was identifying more with that area. I saw dissociation as a very serious outcome of child abuse, but only one of many bad outcomes. I was shifting my limited time and ability to attend meetings and participate in working groups to other professional societies. … We continued to measure dissociation in our studies and to publish and collaborate on dissociation-related projects. But I really moved much more into the paediatric child abuse world. When I was at Cincinnati, I was a professor of paediatrics and directed child abuse clinical, forensic and trauma treatment training centres in the children’s hospital.

WM: I’m wondering from your perspective now, where do you see the Society going and what’s your impression of how it has evolved over time?

FP: Well, I have to say, I haven’t been to a meeting for a while but the last time I went back I was thinking – it’s still very much clinically-orientated, single case-orientated. It hasn’t moved along in some ways, the ways I had hoped. I think, on the other hand, it provides a refuge and a place to talk about difficult cases. That is a very important role. But it hasn’t advanced the science as much as I had hoped.

Ironically, I think the saving grace is the adoption of this new PTSD dissociative sub-type diagnosis in the DSM-5. It suddenly makes dissociation important to an influential group of people. They are finding out that dissociation predicts treatment refractoriness to a number of conventional therapies that work for PTSD. I think in a way that will ultimately bring more attention to dissociation.

It would be important for the Society to get out in front and lead on this issue, to develop PTSD dissociative sub-type expertise under the umbrella of the Society. It is something the Society should seek to take leadership of. This is the chance to say OK we got PTSD, and we’ve got PTSD dissociative sub-type. What are the differences? What are the important roles of that dissociation plays here? However, I think that to some people this will still be as threatening as DID.

WM: How threatening is that, Frank, still in 2019?

FP: I think DID remains quite threatening to many people – this idea that people could have multiple personalities and switch back and forth. … I think unfortunately the media has created a stereotype, often a violent stereotype. So that’s part of what is frightening to people.

Also, there are a lot of people who just simply can’t believe it. How could this be!? It doesn’t make sense to them, and they miss it, even when it’s right in front of them. I certainly have seen DID patients switching away and the interviewer having no idea that this is going on or asks a vaguely-perceptive question like, “Did you just hear an hallucination?” Something like that. They recognise that something changed in the patient but they attribute it to more “conventional” symptoms like hallucinations.

WM: Frank, one of the underlying parts of your research from early on has been an interest in states of consciousness. Can you run us through how that interest developed and your work in defining such states?

FP Well as I mentioned, I was first working with traumatised individuals and saw abreactions, flashbacks – those sorts of powerful experiences. On the NIH rapid cycling bipolar research unit, I saw many, many switches between mania and depression, frequent anxiety attacks, cases of catatonia. In each case these were pathological states that seized control of the person’s mental and physical behaviour. I really began to see that there were similarities across these states … a property that I would call “stateness” to all of them, even though the states themselves were quite different.

I began to ask the question, “What are the commonalities among different states of mind/being – including normal states like sleep which consists of a cyclic series of discretely different states – Stages I-IV and REM?

Working with infants, I became interested in infant states and discovered there was a whole literature on infant states. The idea is that – in a healthy newborn – we come into this world already organised with a series of discrete behavioral states – typically about five different states that the infant recurrently cycles through. These discrete behavioral states underlie the well-recognised sleep-wake-fussy-feeding-quiet alert-drowsy-sleep-wake-etc. cyclic behaviour of a newborn infant.

When you began to look at collections of different mental/physical states you realise how they all share a set of common properties. They tend to occur in cycles that are predictable, the transitions are generally short, and marked by changes in affect, facial expression, alertness, cognition, memory, changes in posture and muscle tone, brain activity patterns and other kinds of changes. They often have a rapid onset and a slower offset, there are differences in what people remember about a given state. Most people don’t realise they have switched states until later.

I became interested in the idea that states are a basic unit of behaviour, a fundamental unit of consciousness that explain a lot of things that were here-to-fore inexplicable in traditional psychological theories. That is the essence of my last book, The Way We Are: How States of Mind Influence Identities, Personality, and Potential for Change (Putnam, FW 2016).

The Way We Are looks at numerous examples of different types of states and switches to extract the commonalities. The book outlines a state-based theory of the development and expression of “personality”.

WM: One of the things you actually said in that book was, if you had 5 minutes to tell someone the most important things to know about you, and the course of your life, what would you say? You were pointing out that depending on the time or the day or the date you may say different things. If I was to pose that same question back to you right now, what would you say today – the 19th February 2019?

FP: Well, I would say that I am satisfied with the journey that I went on. I followed whatever was interesting to me. I feel like I have come up with some answers, at least for myself, in terms of understanding these things. I’ve made certain kinds of contributions. Eventually people will pay more attention to the state model. I believe that it is important to be looking at states and understanding human psychology from a state point of view.

I’m at peace with having a terminal illness and I’m trying to get the max out of it. I’m still publishing papers. I continue to work in the child abuse area, working on the effects of different of combinations of maltreatment – trying to identify synergistic combinations of ACEs that are especially pernicious. We could use this knowledge to identity people who are at higher risk – particularly still asymptomatic young children who are at much higher risk. Then we would target them for special prevention activities.

Frank’s long term collaborators Rich Lowenstein & Bethany Brand, ISSTD Annual Conference, New York, 2019

WM: You mentioned publishing papers and that brings up your collaborations with Bethany Brand and Rich Lowenstein and others. Would you like to comment on that line of research that you and your colleagues have been involved in?

FP: Richard Lowenstein and I have been friends since residency. We were co-residents at Yale. At the NIH, I discovered two cases of MPD and Richard identified a third case. That made the first paper we wrote about MPD/DID – these three cases. We worked together and have stayed in the loop over our careers.

Bethany started out as a research assistant on the longitudinal research project that Penny Trickett and I were doing. She was one of our first research assistants. She got a master’s degree with us. Then she went off and got a PhD in Psychology and did her internship on Richard’s Dissociative Disorders Unit at Sheppard Pratt Hospital.

Bethany is a real go-getter! She gets things done. I love to let her bounce ideas off me. We sort of plan something theoretically and then she goes out and makes it happen. She is very effective, very creative – especially given the limitations on resources in the DID research field. I feel that Bethany has really advanced the research – especially on treatment – in many, many ways. She has also been a great mentor to many students.

WM: Where do you see the field in ten years’ time? You’ve laid out some challenges for us.

FP: Again, I really feel like the field needs to take advantage of the DSM-5 diagnosis of PTSD Dissociative sub-type – even though I’m not terribly happy with the criteria. It doesn’t look at the amnesia component as much as I think it should. Nonetheless, I think that diagnosis is an important foot in the door that will help to normalise the dissociative disorders for people who right now can only see them, at best, as very weird or strange.

In 10 years, we should have some pretty good interventions for dissociation. We should be identifying more dissociative children … be looking for early pathological dissociation in children and adolescents. I think pathological dissociation is probably the most treatable in young children. We must do that kind of early intervention/prevention work. The earlier that we can identify victims, the more prevention of future trauma and dissociation that we can do. The more we can save people from painful, dysfunctional lives.

Right now, prevention programs are everywhere – but they are not coordinated. We must learn to consolidate these, especially the ones that address a shared risk factor such as maltreatment. I think that the prevention of child maltreatment is importantly involved in the prevention of substance abuse, for example. … Childhood maltreatment is also a huge risk factor for domestic violence in adulthood – both as victim and perpetrator. There’s a relationship between childhood maltreatment and cardiac health.

If we could do better at integrating different prevention programs, especially focusing on the role of child maltreatment, we could dramatically increase the health of the general population. I tend to think about ACEs from a public health point of view.

WM: Are there particular issues or points that you would like to have your say on?

FP: My interests now are mostly in prevention and thinking about large scale ways to prevent child maltreatment. I feel there’s a lot that needs to be done.

I was very involved in the development of the National Child Traumatic Stress Network (NCTSN). The NCTSN is a network funded by the U.S. Congress – around $60 million a year. It has over a hundred centres across the U.S. that work with traumatised children. The centres collaborate. We have been able to get some large data sets. The NCTSN has developed or adapted many good, evidence-based treatments for children and families for a variety of types of trauma. The pressing question now is how to get these interventions out to the rest of the world in some organized and quality assured way.

References

Putnam, FW (1991) The Satanic Ritual Abuse Controversy, Child Abuse & Neglect, Vol 15, pp. 175-679. 1991

Putnam, FW (2016). The Way We Are: How States of Mind Influence our Identities, Personality and Potential for Change. IPBooks, New York.

Creative Space

The Art of Collaboration

Noula Diamantopoulos

Oh, how I love when two become something new, something that did not exist in the one or the other.

That’s how it felt this time for me when I read Na’ma’s poem The Critic and immediately one of my sculptures from an exhibition called Breathing Space stepped forward and said, ‘You called on me Breathing Space, the preparatory void and I emerge as an idea not yet engaged with my surroundings, eyes open but unreceptive, my arrival was born of breath and breath alone’.

We are invited here. And we are here to create our own pathway of belonging. But we are not warned that in our life lurks an inner critic that traps us to feel the security of the unending circulating hampster’s wheel, a cage in reality, and we become unconsciously stuck.

Noula

Poetry by Na’ama 

Sculpture by Noula 

Committee Spotlight

Member Engagement Committee

Lisa Danylchuk

The Member Engagement Committee serves the membership by connecting new members, and those interested in becoming more involved, with Committee Chairs who are seeking assistance. We seek to match the talents of our membership with the needs of leadership, to help move the organization and its members forward together.

ISSTD is an organization hugely dependent on the involvement and assistance of its membership. Without our volunteers – which include our entire Board, our Presidents, all our Committee Chairs and all our Committee Members – ISSTD would not function the way it does now. With the help of members who volunteer their time, we are able to do so much more than would be possible with our very small team of paid staff (as wonderful as they are).

Our members assist in many ways from serving on Committees, through to volunteering at a conference, helping with some marketing ideas, or editing a draft document. It’s a great opportunity to give back, develop networks in our field and learn new skills.

However, the Membership Engagement Committee is in need of members and is also seeking a Committee Chair. If you are interested in networking throughout ISSTD and have an interest in volunteer support this could be the Committee for you. If interested contact myself (Lisa Danylchuk): lisa@howwecanheal.com.

If you are interested in becoming more involved with the other areas of ISSTD, I encourage you to explore some of the committee needs here.

If you see something that interests you, or you’re keen on getting more involved, you can fill out a member engagement form here.

Your passion and skills can make a big impact! Thanks to all of you who are contributing your time and energy; you help make this international organization thrive.

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