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There has always been a tension in the ISTSS, a tension for the most part creative. The Society originated from the turbulent atmosphere of the 1970s and 1980s social movements and the active advocacy efforts of many founding members. But the credibility of the ISTSS as the foremost authority on evidence-based approaches to the understanding and treatment of posttraumatic stress disorders derives from the careful scientific and clinical efforts of its members. The dialectics between science and practitioner, research and advocacy have always been present, and with the release of Childhood Remembered: A Report on the Current Scientific Knowledge Base and Its Applications, members can see a fine example of the synthesis of the two.

The mid-year board meeting addressed many issues, including a report of the significant progress of the Practice Guideline Committee under the leadership of Edna Foa; the further development of a plan for the distribution of the memory pamphlet and a discussion about the June press briefing organized by Laurie Pearlman; the formation of a Task Force on Multicultural Membership chaired by John Briere; and a NIH restructuring update by Virginia Cain from the Office of Behavioral and Social Science Research.

Within the last 15 years, an explosion of knowledge about the traumatic stress field has occurred and in some areas -- particularly crime victimization -- enormous problems have been acknowledged and funded nationally and internationally. Trauma professionals are confronted with many concerns, some of which represent a backlash against this explosion of knowledge and its implications for the Society. In the managed-care environment that now dominates the practice of medicine and mental-health delivery in the United States, trauma professionals witness the degradation and minimization of service for trauma victims while around the world, human-rights violations continue to fuel the intergenerational transmission of trauma.

Several members pointed out that the forces at work here cannot be understood entirely through rational processes. However, trauma professionals can develop hypotheses about these forces by using examining experiences with patients. For patients exposed to interpersonal or state-supported violence, a dynamic to their victimization hinges on the abuse of power. To the extent that trauma professionals represent them, they too can become victimized by that dynamic -- it is not a neutral scenario.

From Janet through Kardiner to the present, efforts to bring into cultural awareness the reality of trauma have met with denial and suppression and will do so again unless the Society succeeds in establishing a permanent, enduring organization that will survive the expected counterattacks, denial, and repression about knowledge of traumatic stress.

Some members recalled that in the struggle to create and maintain veterans counseling centers, the better we did, the more intense were the attacks. This rang true to those working with victims of childhood abuse. It seems that the more effective intervention strategies have become, the more economically, legally, and socially difficult it has become to provide those interventions. It is helpful to see this struggle in a larger historical context in the hope that a repeat of the past can be avoided.

Along these same lines, other members pointed out the constraints that our professional disciplines and integrity place on our ability to respond to attacks. Often we are not on a level playing field because we must always use information responsibly and treat other people respectfully regardless of how much we disagree with their facts or innuendos.

Among the board members, there existed a general consensus that the Society's strength lies in using the evidence provided by science and clinical practice to fulfill its mission of disseminating information about the effects of trauma. There was also a consensus that publishing scientific findings in academic journals is necessary but not sufficient. To have a more significant impact, trauma professionals must get the information to colleagues as well as the public.

This movement from theory to research to clinical practice to public policy is one that is also consistent with the present emphasis at the NIH of considering the implications and end value even of the basic sciences. This emphasis on getting the word out, for some members, was considered best stated as dissemination of knowledge rather than advocacy while others considered it the best form of advocacy. It was clear that though we may differ on the words we use, we are not beyond reaching a consensus on actual action.

"For me the question isn't to advocate or not, but how we advocate and what will we advocate for ... Part of maturing as an organization is looking beyond at other issues affecting our patients and our members. How can we, in a data-based empirical way, bring our influence to bear in a way that improves peoples' lives?...Even good science must be defended," one member says.

Another member pointed out that in the real world, vital decisions are made based on how a position is presented and who presents it.

"I strongly support advocacy because it is the way society allocates resources and decides what to take seriously. But it should be data and information-based advocacy. If we don't make the case for us, no one else will," the second member says.

It also became clear that we would prefer to be in a proactive rather than a reactive position to issues that affect traumatic stress studies.

"Part of the dissemination process therefore is going to necessitate active debate and we are going to have to actively debate it. People won't just come to the knowledge. You can be moderate, be reasonable, do good science and still get killed," the second member continues.

One of the European members pointed out a difference between the Unites States and some other European countries in that in the United States the clients have no voice, no power. He urged that the Society consider ways to actively involve consumers in efforts to restore mental-health funding. The discussion expanded to the need to develop alliances with similar organizations nationally and internationally to use the influence of size to get the message across. Another board member urged us to consider how we can best develop stories that reflect our knowledge and how to creatively grab the public's attention.

After the round-table discussion, Jeanine Cogan, SPSSI public policy scholar for the American Psychological Association Public Policy Office, discussed how professional organizations can responsibly provide education to public officials and inform public policy. Cogan urged the board members to consider developing relationships with the government through personal visits and Congressional briefings. As a result, the board voted to form a Task Force of Public Policy, chaired by Bessel van der Kolk. The task force will look into the development of a public policy initiative by the ISTSS. As a distinguished researcher and clinician, van der Kolk will provide valuable leadership to this effort.