Fifth ESTSS Conference: Traumatic Stress, Health and Narrative Communities -- A Transgenerational Perspective from Maastricht

Roderick Orner, President, ESTSS

The legacy of European Conferences on Traumatic Stress (ECOTS) spans almost 10 years, with venus spanning Norway, England, The Netherlands and France. This most recent Maastricht congress of nearly 400 delegates may prove to be the one that saw European trauma conferences come of age.

Coincidentally, the same may be the case for the European Society for Traumatic Stress Studies. On the strength of achievements linked to presidential terms of Wolter de Loos and Stuart Turner, the ESTSS has evolved into a viable professional society. Its growing membership, efficient secretariat and active board of directors are well placed to promote psychotraumatology in Europe.

So, the question arises -- what are the distinctive conference ingredients that helped effect these transformations? Probably not the conventional scientific program structure comprising conference plenary sessions (controversies and dilemmas in psychotraumatology, traumatic expectations and family dynamics, gender and the process of coping with traumatic stress, amnesia and discovery in the study of trauma) presented by internationally recognized experts. Nor the well trodden path of specialist symposia (UN peacekeeping, trauma in the etiology of anxiety disorders, outcome studies, child sexual abuse, torture, aging, psychosocial interventions in war stricken areas, debriefing, counteracting cycles of inter ethnic violence, neurobiological correlates of stress on memory, treatment of refugees and asylum seekers, traffic accidents and EMDR). Not even parallel paper sessions on such broad themes as occupational trauma, family and culture, diagnostic concepts, trauma in somatic medicine, healing, psychobiology and public health.

Workshops were not markedly different from those held at previous European conferences with respect to issues addressed, namely traumatic stress reactions after fatal accidents in the workplace, poetic communication with torture victims, language as a change indicator in narratives of trauma, applying breaks in therapy, hypnosis in PTSD, the impact of trauma on content and group processes in Balint groups, guilt, biodynamic analysis, play and drawings with traumatized children and preventative group work with war veterans.

But conference arrangements were at all levels informed by a concerted resolve to approach learning and sharing from the distinctive perspective of "narrative communities" ("Erzahlgemeinschaften"). Narrative communities are project-focused groups that effect change through problem-oriented learning. Members typically start by sharing personal experiences and impressions of subjects or issues under consideration. This in contrast to taking lecture notes and rote memorizing of textbook summaries. It is learning through personal experience referenced by evidence. Daily plenary sessions were used to good effect to mold the conference into a narrative community. Here particular prominence was given to salutogenic reactions to trauma; the hitherto largely unexplored potential of traumatic stress to engender health, personal growth and constructive social or political action.

Thematic poster sessions provided further daily opportunity for narratives to develop. Each had a designated moderator, and rather than rely on a sequence of formally delivered lectures, the stimulus for discussion was invited poster presentations on themes such as coping with torture, theories about traumatic stress and their relationship to prediction and outcome, the sense of varied therapy modalities, psychobiology, working with traumatized children and their families in cases of child abuse, support within the family and resources in clients and therapists.

Around these themes, narratives developed recognizing the capacity of trauma to disrupt and cause suffering -- especially so when denial and refusal to acknowledge the evidence available to our senses is a feature of the recovery and readjustment environment. Set against this grim scenario stands the spectre of salutogenic factors that may be introduced to engender healthy functioning and awareness raising.

As the scientific program unfolded, issues of pathogenesis and salutogenesis made their distinct impressions on the ethos of the Fifth European Conference. Opportunities arose to confront and share the potentially inhibiting ramifications of denial (e.g., with respect to the human capacity for sins of commission and omission). The occasional extremely uncomfortable reactions engendered among conference delegates were counterbalanced by the recognition of what can be achieved through remembering and not turning away from evidence.

During the closing session, the conference recognized the scope and direction for growth that may be possible in the wake of trauma. This is so not only at the individual level or that of a whole nation, but also for the crucial processes of regional transformation being promoted through the European Union.

The opening sessions of the conference featured keynote speakers from outside the field of psychotraumatology. Rita Sussmut, president of the Deutsche Bundestag and patroness of the Fifth ECOTS, Shevach Weiss, deputy speaker of the Knesset, and Els Borst-Eilers, Dutch minister of health, welfare and sports (surely, a salutogenic ministerial brief) set the theme of salutogenesis by speaking of their resolve to stand up against the forces that maintain states of denial. This was elaborated upon during keynote addresses on subsequent days of the conference. Trude Simonsohn, chair of the Council of the Jewish Community in Frankfurt spoke of her experiences of living in Germany during the Nazi era. Her reflections on the predicament of being a Holocaust survivor now provides the material for speeches to German audiences.

Simonsohn aims to create opportunities for those present to develop their own narratives on this aspect of European history and the continuing impact this has on their lives more than 50 years after the end of the Second World War. A Swiss author, Professor Adolf Muschg used literary references from The Red Knight, his own rewriting of W. von Eschenbach's Percival, to allude to the massively destructive consequences that arise from denial and a refusal to know. But his text also conveyed the restorative, health-enhancing and salutogenic potential of being open to truth and letting narratives develop from it. On the final conference day two filmmakers from Europe, Katrin Seybold and Tom Verheul demonstrated how their medium lends itself to challenging the apparent disinclination of Europe's vast television audiences and media empires to lend their attention to the 'trauma realism' of recent European history.

Legacies of relatively recent instances of state-sponsored violence were linked to the processes by which transgenerational perpetuation of violence can occur. The filmmakers brought a recognition that campaigners against denial assume the mantle of resistance workers. Each age sees individuals unwittingly cast in the role of resistance workers and their movements are as diverse as the democracies that foster them are tolerant of evidence-based narratives.

In the closing session conference delegates could appreciate how the narrative community they had helped create delivered a challenge to all involved in the field of psychotraumatology not to be silenced. We came to this realization at a time when opportunities for publicly proclaiming the nature of evidence about trauma and the many issues that arise from it are more favorable in Europe than any other time this century. The purpose and aims of future ECOTS will be defined in full recognition of the costs associated with silence and denial. In turn the ESTSS has an opportunity to frame policies and action plans that foster narratives rooted in evidence.