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Traumatic events confront people with horror and threat and present situations that a person's imagination can only partially be prepared for. They inflict both an external and internal reality, which attacks ideals and beliefs about safety, control, and freedom from pain. External realities of danger and events that cannot be controlled have a capacity to kill, maim, brutalize, and destroy. The events also bring an internal reality of fear, horror, and lack of control. This leads to a sense of fragmentation, as well as a constant retraumatization by the memories triggered by reminders of the event. These are events that previous life knowledge does little to equip people for.

Working with the victims of trauma is a demanding process. Even the best intellectual defense does not prevent the permeation of these experiences into the lives of professionals working in this field. Maintaining our sense of sustenance and personal renewal is a critical need if we are to maintain our sensitivity and empathic holding of survivors of traumatic experiences. Relationships and professional support provide the critical carriage to sustain us in the face of this work.

Traumatic experiences are often not part of day-to-day language. Society and trends often revile and withdraw slightly at the discussion or advocacy of these issues. This not only isolates the survivor, but also the clinician. A critical role of ISTSS is to create the cradle where professionals can share such narratives and where a sense of energy and willingness to struggle with eternally difficult issues exists. The society also creates an environment of intellectual rigor trying to understand the scientific basis of the human response to trauma and the optimal treatments.

It is necessary to have an international organization that embraces these interests to provide cohesion and support, which can become too inwardly focused in national organizations. ISTSS supports professions where such issues are often not truly conveyed by the mass media. As J. G. Ballard, the author of Crash wrote, "In the past we have always assumed that the external world around us has represented reality, however confusing or uncertain, and that the inner world of our minds, extremes, hopes, ambitions, represented the realm of fantasy and imagination. These roles, it seems to me, have been reversed. The most prudent and effective method of dealing with the world around us is to assume that it is a complete fiction -- conversely, the one note of reality left to us, is inside our own heads. We live inside an enormous novel. It is now less and less necessary for the writer to invent the fictional content of his novel. The fiction is already there. The writer's task is to invent the reality."

The trauma therapist faces a similar challenge of understanding and documenting. The clinician and social scientist working in the field of trauma often is a critical culture carrier who has to chronicle and interpret the lives of trauma survivors. These are too readily paraded and trivialized in the world at large. This task equally depends upon the sensitive insights of the clinician and the empirical neuroscientist. The strength of the field depends upon the integration of these perspectives.

ISTSS is an unusual organization. This was reflected during the 14th annual conference where such diverse interests, ranging from the consideration of issues of reconciliation and forgiveness to developments in neurobiology, were discussed.

At the 15th annual conference, the program will focus on the need to integrate the different polarities of the society, between the advocate clinician and the researcher. There is a great deal of energy within the organization that can be enhanced to this end. I feel it is one that is constantly presenting new challenges. One of the engaging characteristics is the willingness of the organization to embrace these issues in a flexible manner.

ISTSS is at an important point in its history. It is now moving into a stage of increasing maturity. Many members who were instrumental in developing the initial enthusiasm for the field are no longer involved with the board of directors. To maintain this institutional memory, a past president's council has been set up to advise the organization on strategic issues. One component is how to embrace the newer members and ensure that they have an active voice and are embraced by the aims and aspirations of the society. This will ensure we remain an intellectual, vigorous, and professionally supportive organization that continues to meet the challenges of a changing field.