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To agree or disagree, that is the question. Do we sustain our relationships by focusing on the issues of mutual acceptance or by struggling with the points of difference? These questions are relevant to both the formations of social structures and personal relationships.

ISTSS is an organization forged out of disparate social groups. As Sandra Bloom has characterized in her recent history of the origins of the society (See Traumatic StressPoints, Vol. 12, Nos. 2 and 4; Vol. 13, No. 1 ), ISTSS emerged from an unusual conglomerate of social and clinical advocates. They were bound together by focus and the issues could be stated unambiguously. The social forces and prejudice that had to be overcome tightly bound this coalition.

Growth means divergence. The emergence of knowledge only increases ignorance and uncertainty. Parents of adolescents know the difficulty reining the burgeoning enthusiasm and rebellion against authority that comes with maturation. A major challenge of ISTSS is how to maintain group identification without constraining individuality.

The spirit of this struggle has been in part reflected by the development of the Treatment Guidelines Committee. The process of achieving a consensus around issues of treatment involves the collision of science with art, opinion with fact and advocate with skeptic. The debate and tensions surrounding the development of the treatment guidelines are a test of the maturity of the ISTSS and its members.

The 15th annual conference in Miami will focus on how to maintain the bridges between the competing needs of different groups. In the treatment arena, the evidence for the effectiveness of treatment lags behind clinical practice. Furthermore, much of the treatment literature is based on studies conducted by groups of experts in highly selected subsamples of populations.

While the findings of this research are critical to evidence-based practice, their applicability to general clinical settings and the demonstration of similar effects in general clinical samples is an underdeveloped area of research. This is particularly relevant with traumatized patients because their distress significantly disrupts their ability to hold themselves in treatment relationships. The treatment setting demands confrontation with memories when the individual's characteristic way of adaptation has often been to avoid recall of the trauma. The ability to cope with intense affect in close personal relationships is also often fractured.

The treatment setting for a significant percentage of patients is a highly aversive environment. The clinical process necessary to modulate these patterns of response and draw the patient into an effective treatment relationship is complex and largely unexplored. The recognition that a significant percentage of patients do not do well in treatment also can provoke an intense sense of nihilism in combination with the need to contain the accounts of the patients' traumatic experience. It is not surprising that therapists who have explored and discovered new and potentially promising treatments come to advocate them with considerable enthusiasm.

Novel treatments need to be tried and further developed before they can be subjected to more rigorous scrutiny. Here a seeming collision of sentiment can occur. The scientific method involves a system of negative, rather than positive proof. The essence is to find the observation that does not confirm the hypothesis being tested, rather than to accumulate positive evidence. To some this approach can seem to be unreasonably negative.

Naturally, therapists are protective about critique of their clinical skills. Scrutiny can be unsettling. This may seem as though the purpose of research is to discredit and dismiss, rather than demonstrate the benefits of a treatment approach. Therapists may not necessarily welcome research that is less than embracing with any sense of enthusiasm and will seek to discredit the methodology rather than contemplate the possibility that the findings are valid. A tolerance of these different truths depends upon a healthy capacity to contain divergence.

A further dilemma is that the rigor of descriptive science based on statistical methodologies does not capture the essence of the humanity of suffering. Research in its most distilled form is a highly objective observation that is apolitical. Yet these data are frequently used to political ends and advocacy reasons. In the process, often data is interpreted beyond a point that is justifiable from a scientific perspective.

The strength of ISTSS depends upon the ability to recognize that the divergences within our group are less than the shared values. We should not forget that trauma still remains a very individual and in some ways isolated way of looking at psychological suffering and the human condition. We need to struggle with the unknown in our field. With increasing knowledge our ignorance can only grow. As our ignorance and uncertainty becomes more apparent, we need to accept the ambiguities, face and explore them. We need to trust the sentiments of our colleagues.

It is always easier to fight with those closest to you rather than to see the lurking and divisive skeptics who sit well beyond our midst. We should remember that the skepticism of those beyond is very different from the careful critique of those who share a passion for the same interest.

Trauma is a particular perspective of life and history. It is about advocating the nature of the reality of human experience that dissects the normal exaggeration and deception that is readily epitomized by the popular sentiments of the media. Speaking about trauma is respecting the human condition and the courage of people to exist in the powerful uncertainty of the future. We have a responsibility to document and speak for the suffering of people because we know these truths. This has major implications for the quality of the social institutions whose role it is to care for the citizens of our respective nations. ISTSS is part of this cultural matrix which aims to highlight respect for the individual and to represent the value of human suffering as a positive force in social regeneration.