PRESIDENT'S COLUMN

Terence Keane, PhD

Plans for the 13th Annual Meeting of the ISTSS are virtually complete as I write this column. The Montreal conference promises to be our biggest and best yet. And with the end of the conference comes the completion of my year as president of the Society. It has been extraordinarily gratifying for me to serve
in this capacity. The Society has matured into a wonderful clinical and research forum for the study
of psychological trauma.

To highlight this I wanted to share with you a recent experience. Intermittently, I am asked to write chapters on PTSD for text books in mental health. Recently I was invited to update a chapter that I had written in 1990 for a text on adult psychopathology. Thinking that revising a chapter would be a relatively easy task, I assigned only a few days for it. I was startled at the realization that the entire chapter needed rewriting. The advances in the field were so profound that many references and almost all conclusions needed to be changed. Things that were speculation seven years ago are now established facts.

These advances are in many different areas: psychological treatments, psychobiological correlates and bases for symptoms, new assessment instruments, identification of risk factors, epidemiological evidence for the pervasiveness of trauma exposure and PTSD, information processing deficits, etc. I would rate the advances made in our understanding of PTSD over this seven years on par with that of any other psychological condition and exceeding most. Yet there are some concerns about our progress.

Most of the major studies on the topic of PTSD received funding support from the National Institute of Mental Health (NIMH) or the Department of Veteran Affairs. For many legitimate reasons (including the "reinvention" of the U.S. federal government), the NIMH is undergoing restructuring in the hope of gaining efficiency. Part of this effort is to subsume the Violence and Traumatic Stress Research Branch under another branch charged with HIV prevention. As well, there is discussion (as there is with many other panels) of dissolving the VTS Review Group. For those of us who were involved in research on PTSD during the 1980s, this is worrisome. Few grants were funded and expertise on PTSD was often lacking on Review Groups to which our grants were submitted. Once, in a VA review section, all 12 grants on PTSD were summarily dismissed because PTSD didn't exist. Could this happen again?

We must remain vigilant to ensure that our work receives ample funding and that progress in the field is maintained. We owe this to the many people who are exposed to traumatic events and who develop PTSD. ISTSS is committed to its role as a stakeholder in the NIMH. The tremendous progress we have made must continue. The new administrative structures must be given every opportunity to work, but they must work. The shockingly high rates of violence and trauma in the United States are ample evidence of the need for substantive scientific work on PTSD.

In my final column as president, I would like to formally thank the members of this year's Executive Committee: Edna Foa as vice president, Sandy Bloom as president-elect, Matt Friedman as immediate past president, John Fairbank as treasurer and Sandy McFarlane as secretary. I would also like to thank all the board members and committee chairs who gave so selflessly of their time to the Society. I would particularly like to thank the members of our United Nations delegation -- Yael Danieli, Ellen Frey-Wouters, Sylvia Mandel and Joyce Braak) -- whose efforts at the UN led to the establishment of a structure for attending to the mental health needs of peoples in distress. This is a truly wonderful accomplishment. They are to be congratulated.

Finally, I'd like to thank you for the honor of being president of ISTSS. It's been a great year for me personally. I have enjoyed working for you and representing you; I look forward to actively being involved in the Society. *