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Before the 6th European Conference on Traumatic Stress in Istanbul, the ISTSS board held its midyear meeting. This timeless city, which truly sits at the crossroads of Europe and Asia, represented an ideal venue for a meeting of ISTSS.

Professor Sahika Yuksel organized the conference, and the attendance expressed a solidarity for colleagues in Turkey who have made important contributions to human rights through their scientific work and investigations on the effects of torture. Although, an official complaint was made against the conference for threatening the unity of Turkey, fortunately, the government dismissed the complaint. But it emphasizes the personal and professional stakes which members of the society, from time to time, have to face.

Professionalism is at the core of the motivation to act and advocate in such circumstances. One of the most important features of a profession is that it acts with a sense of fiduciary, namely, to put the welfare and benefit of the client or patient above and beyond self-interest. This involves an active process of empathy, advocacy and duty. A critical characteristic of a professional is that he or she act out of altruism. Also implicit in the nature of professions is having a specialized knowledge or area of interest that cannot be critically judged or regulated by people outside of that group.

Professions have increasingly been under attack because of the perception, both real and at times manufactured by competing structures that they often act out of paternalism and self-interest rather than the interest of their client. Regulatory bureaucracies often use this argument as a justification for removing self-regulation from professions and handing it to bureaucracies. In part, professions have been undermined by the economic rationalism to pursue profit, rather than altruism. The irony is that the bureaucracies put in place to monitor and regulate the delivery of health care are inherently self-interested and even less motivated by the needs of the patients or clients.

The regulation of managed care organizations provides a good example. Here, bureaucracies actively intervene in the provision of health care, limiting the available procedures and resources to patients based on spurious notions about what are acceptable numbers of consultations for a given disorder, or the appropriate investigations for a given condition. Their driving force is clearly financial with the needs of their shareholders the paramount motivation for their actions and decisions.

It is in this environment that ISTSS emerged as an organization. The society does not represent a particular profession, but rather, ironically, the members have come to act as collective advocates for a range of groups of trauma survivors, and a sense of professionalism is a central element of both the ethos and roles undertaken by ISTSS.

For example, the production of the Childhood Trauma Remembered was motivated by the need for a document expressing a view that could be used by individuals challenged about the voracity of these phenomena. The development of the treatment guidelines also has been an attempt to indicate that the society sees itself as a provider for public direction and information about treatment. Whilst there are many appropriate anxieties and apprehensions about the development of such treatment guidelines, the guidelines play an important function in defining the public role of the society as an organization that wants to define professionals, or professional standards. A similar activity, defined by a spirit of altruism, is the involvement of the ISTSS in the United Nations. The initiative, being headed by Matt Friedman and Terry Keane and assisted by John Fairbank, Ellen Frey-Wouters, Bonnie Green, Joop de Jong, myself and Susan Soloman, is a noteworthy example of the desire to inform the international community about the trauma field and its relevance to refugees, victims of war, the homeless and a number of other disadvantaged groups. It is about the conversion of knowledge into public policy and health care practice. This is clearly not done for the financial gain of individuals, but because of concern about the broader social values and well being of the international community.

These activities are very important for defining the future direction and aspirations of the society. Ultimately the question emerges as to what privileges and acknowledgments the society might be offered for taking on these roles. In a world where there are many competing organizations and professional structures wanting to seek the privileges of professionalism without necessarily contributing to the public good, many uncertainties exist. However, the time given by members and their willingness to take on these roles are critical to the society's claim to have a right to speak on behalf of people who have been traumatized. The collective spirit of generosity and willingness to take on these roles is critical. Thus, whilst individual disquiets may exist about these enterprises, what they say about the public face of this organization must not be underestimated.