Global and Social Considerations

In spite of major strides made in the study of posttraumatic stress disorder, our full understanding of trauma as a phenomenon, its mechanisms of actions, and its long-term consequences on the human brain and social behavior is limited. It appears that trauma is a virtual impact between an event (the traumatic event) and the individual (the victim). Both opponents in this impact, however, arrive with a variety of factors and may equally contribute to the outcome. Thus, trauma is an equation with two variables that determine a potential for myriad outcomes. For mental health care professionals, traumatic phenomenology ranges from organized psychiatric syndromes to individual behaviors that often shape the history and legacy of one generation.

Besides being relevant topics for the contemporary clinician, the articles that follow can be closely linked to major social-historical events of the past 100 years. As discussed in the article by Charles Portney, M.D., intergenerational transmission of trauma as a clinical manifestation became known after the Holocaust and the treatment of its survivors. The article by Rachel Yehuda, Ph.D., reminds us of the Vietnam War and the political upheavals of the 1960s and '70s, when the designation PTSD emerged. In discussing secondary traumatization of mental health care professionals and trauma and violence in childhood, Rose Zimering, Ph.D., and colleagues refer to concepts that underscore the complications of trauma treatment and the need for adequate resources for a more sophisticated mental health care system. Additionally, Yuval Neria, Ph.D., and colleagues bring us to the daunting present.

Currently, psychiatry is exploring the pathological consequences of trauma that easily fit into the DSM: PTSD and depressive anxiety and substance abuse disorders. It is time that we extend this inquiry to the more complex social and group victimizing behaviors that usually remain off-limits for the field of mental health. Some studies have pointed to the added burden on the brain of childhood trauma history in individuals with depressive disorders (e.g., Am J Psychiatry 2002;159[12]:2072-2080). This confirms suggestions that trauma per se is a pathogen that may result in a wider spectral variety of manifestations ( Psychiatr Clin North Am 2002;25[4]:775-790), some of them behavioral peculiarities encountered in society.

As the United States is once again facing another war, consideration has to be given to the long-term and long-long-term consequences of trauma at all levels. We may feel consoled to recognize that during the most perilous times, humankind has concentrated its wisdom, talent and ingenuity to circumvent the catastrophes of war. However, mental health care professionals remain responsible for objectively educating society in an apolitical manner about the effects of witnessing killing and the destruction of civilian life as well as the real effects of trauma on any nation.

Psychiatric Times gratefully acknowledges Dr. Novac for his guidance in preparing this special report section.