Tuesday, October 27, 2009

Essay: The Evidenced-Based, Cognitive Behavioral Therapy, Self Help and Government Merger: Monopolistic Cultural Infusion of Behavioral Whack-a-Mole

This post was republished to Etiotropic TM: "Revolutiona... at 10:07:29 PM 10/26/2009

Essay: The Evidenced-Based, Cognitive Behavioral Therapy, Self Help and Government Merger: Monopolistic Cultural Infusion of Behavioral Whack-a-Mole



Part One


"Treating warts on hands by amputating them,"
the hands, that is.

With good reason, this essay criticizes my competitions' encroachments. That competition is not psychiatry. Nor am I "anti-psychiatry" as that formal movement goes. This discussion is about the individual and social effects of the confluence of 4 forces: They are, respectively, Cognitive Behavioral Therapy, self help as in peer led counseling groups, the Evidence-Based modality, and government. Although that merger may generally be having either good or bad influences upon mental health services for the public, the issues to which this exposition is drafted are delimited by psychological trauma, Post-Traumatic Stress Disorder, and their co occurrences with Substance Use Disorder, particularly Alcohol Dependency. The matters drawn can be applied to most populations. However, their applications to veterans motivate this complaint. I tell the story from my experience: the inventor, administrator and disseminator over the last 30 years of an epistemology and treatment methodology that function wholly antithetically from the reference merging arrangement. And "my" symbolizes all therapists and still sane patients who've not yet joined the Vichy tide now rolling across western civilization.

The epistemology and methodology from which I write produce what few if any understand, other than therapists we've trained and their patients, a view of humans shaped by knowing how to resolve completely or ─ to speak more directly if not too sensationally ─ cure psychological trauma and its oft referenced behavioral codification, PTSD. That knowledge of the human consciousness forms another and unique paradigm which collides with those bearing the brunt of this address. They asseverate trauma's incurability, supporting in perpetuity the requirement of life coping models. Too bad about their use of that political - marketing challenge, as it requires an equivalent political competitive response. They are forcing the debate, which I am accepting, but doing so under my terms. After all, I'm the one who discovered - invented - developed the cure for psychological trauma, not them.

Moreover, what the competition of investigators of trauma don't realize is that their modality for study and investigation is the very Wiley Coyote level dilemma that precludes successful address of the issue within the clinical, or for that matter, any environment. Psychological trauma and PTSD can be cured fairly easily. And lifetime coping mechanisms support nothing more than a particular segment of the clinical, research and treatment industry's economic existence. If they were to note a cure as a competing idea with reason, then they would be interpreted out of not just a job, but the entire meaning of their lives: studying people for the purpose of making them act right, or at least better. The referenced "dilemma" dictates that you can't do that to people if you want to cure what ails them, in this instance if it happens to be psychological trauma or PTSD.

Initially, after my wife and I discovered the "complete resolution" approach thirty years ago, I published our work in concert with its natural, ethical and academic determinants of dissemination. Despite that effort, competing coping instruction ─ mostly self help at the time as the opportunists clinician positive thinkers (Rational Emotive Therapy), now just assimilated by the new Borg (the Star trek metaphor for CBTers in charge) had not yet hit their stride ─ therapies and ideologies caused patients difficulties as they adapted back into their environments. It can be challenging to get over something and then coexist where everyone else is still trying to figure it all out, again synthesized not just with simple notions of coping but with formal dictum to suck everything with a brain around them into their always upgrading Rubik's Cube puzzle hurtling through space. Therapists learning our model, which was not based on fun and mind control games, and then returning to apply it where facilities were still teaching those how-to methods, were imposed upon by a supra need to be vigorously and politically resolute in order to replicate our model within those clinics. To quote one of the more profound statements coming from an Alcoholism Counselor attending our class taught by Craig Carson at the University of Houston "To apply this model in this helping culture, you would have to be a member of 'The Dead Poets Society'." Another and slightly more dramatic interpretation by patients opined that the authors "had to function in the helping culture analogous to those comprising the French Resistance," an intended compliment referring to those who fought underground against the WWII Nazi occupation of Paris."

Rather than confront the helping competitions' epistemological and methodological shortfalls, we responded metaphorically. We said to people who had been "treated for warts on hands by amputation" ─ of the hands, not just the warts ─ "We don't treat warts that way." That policy allowed us to do our work, convey the model to others who wanted to use it with their patients, and to keep our heads.

No more. The rationale for dumping political correctness in this later millennium stems from our adjusting view that although CBT by itself and even when denominationally aligned with self help and media therapy is still not an impressive competitor, its strengthening confluences with Evidenced-Based and unfair integration with government make it a formidable opponent. And in this expression not meaning to be overly dramatic at all, if that convergence is not interceded upon through confrontive interpretation now by those who understand this challenge, it will not just invade, demolish and usurp our poor citizenry's individual ways of being uniquely human, but sunder them into a morass of irrational disordered psychobabble so fast that our national identity will never know what hit it.

Thanks to Martina McBride for her performance of "I Promised You a Rose Garden." Using cultural clichés strung together for the song's lyrics, she showed the way for writing to the genre created by the Cognitive Behavioral Therapy ─ also a composition of clichés ─ Evidenced-Based, self help, and government merger now forging its way through the total of West Civ faster than Attila the Hun razed the heart of Italy stopping only at the gates of Rome itself in 452. And he only did that because of the divinely inspired request of the Pope. Thanks be to providence, Attila died only one year later of a hemorrhaging facial component on his wedding night. Significance? He usually destroyed most everything in his path including documentations of humankind's efforts to figure itself out. So the great battle we face today coming out of the ancient's work with thought models, referring to the 1200 years of Greek and Roman thinkers' intellectual reigns, and addressed in this piece was preserved in the end by a nosebleed. Let's see what happens here, going on only a couple millennia later.


Written originally as an activist advocacy editorial from within the Etiotropic TMT context, the original title to this piece posed this: 

"Is ETM TRT a Participant in the "Evidenced-Based" AKA "Science-Based PTSD Treatment Modality, Organizational Crisis Management, and Political Movements?"

Hard to say "No!" to that question, isn't it? "Evidenced-Based" (EB) and "Science" are lofty terms, ensconced in our traditions of law and reason, science epitomizing rigorous objectivity unfettered by emotion, subjectivity and prejudice. Those words, therefore, are not easily condescended to. Further, there is no doubt that such a negative response would be seen not just as an excuse for prohibiting 3rd party scrutiny of one's performance, but as a sacrilege in today's psychological trauma and PTSD research, treatment and management worlds. Purveyors of those worlds, that is, those ideologues who function outside of the ETM TRT treatment and training environment, would ask while investigating obvious heresy, "How could anyone object to this kind of dedication to a proof of effectiveness of a mental health application conjured and implemented by our government and major powers of higher learning?" As one brochure on co occurrence principles under the Evidenced-Based construct says, EB concepts "are grounded in the field's best thinking." Hmm, I wonder what that noblesse were thinking when they designed the Iraqi Veterans treatment scandal at Walter Reed, our premier combat medical support center, in the winter of 2006 and again in June, 2007?

Well, in this instance, let me show you how, and why it has to be done, of course as always with me not just in this editorial for the sake of humankind, but for my truly beloved "Band of Brothers," American combat veterans. They get priority of focus in some federal to state grants (from SAMSHA). And they orient participation to operate within the EB modality, which fact has brought me to this subject at this time.

To comply with EB's mandate for treating this particular population, which one of the ETM Counselors in another state wants to do for her veterans, I would have to abandon ETM TRT principles and thus reduce its effectiveness ─ not to mention stop it from achieving its purpose, which is to cure psychological trauma and PTSD ─ to the level of those methodologies and ideology that spawned the need for the Evidenced-Based idea. They include a control ideology that is nothing more than the ancient Greek philosophy of Stoicism: meaning to control one's emotions in the face of adversity. That philosophy is applied through the combinations of various Behavioral and Cognitive-Behavioral therapies ─ Exposure, Rational Emotive, Wand Waiving and a few elements of the old and downtrodden styled Analysis-based methodologies that were becoming oriented toward neurosis symptom reduction.

Those approaches are said not to work, very well anyway. But, their followers keep imposing them on the culture because it fits their underlying or overaching (excuse me, I meant "overarching" as EB proponents employ the term) ideas about humankind. Where Stoicism philosophy is valuable as a control application necessary at the beginning of the trauma address cycle, and although it is an integral, as in the neuromolecular Opioid interactions with the Noradrenergic neurotransmitter systems, that is, referring to the survival component of the brain's phylogenetic integration of changes forced upon the organism, Stoicism's use must eventually be given up to the existential aspects of being human if a helper intends to cure the condition.

The noted accompanying methodology that implements that existential procedure successfully, as opposed to former non structured psychodynamic models that could not, is the Etiotropic TM's clinical component Trauma Resolution Therapy (TRT). It incorporates its structure for the purpose of keeping the focus on trauma's etiology located in identity, as opposed to behavior. To emphasize the differences between psychodynamic and this first structured psychodynamic model, I entitled it when publishing the "How To Do TRT" series and text for University of Houston students in 1987, Trauma Resolution Therapy (TRT); a Structured Psychodynamic Approach to the Treatment of Post Trauma Stress. Please note for purposes of supporting this essay later that the title purposefully omitted the term "Disorder."

Two decades later, the elitist disposition forming the Evidence-Based mental health supra management model produced an opinion that the failure of its attendant therapies or clinical applications resulted from misuse of the science provided by these scholars and implementers. Thus, the Evidenced-Based process was set up recently via the Internet to tie practioners of their helping theories back to the nucleus, the scientific literature provided in peer review psychological studies. Regrettably, the therapies - methodologies that literature supports epistemologically, and which ideologically overwhelm that body of writing, see the world only through the Nosotropic (symptom focused) perspective. To make ETM TRT comply with this new bureaucracy, I would have to adapt, as does everyone else, to the prevailing political Nosotropic way of doing things. That is, I would have to prove a level of performance by measuring the occurrence of symptoms of psychological trauma and PTSD. But if I did that, then ETM, created 30 plus years ago to stand as the only fully, meaning it only evaluated for the damages to identity resulting from the event(s), Etiotropic approach available in the secular world, would no longer be exclusively Etiotropic, which of course was the reason for the distinction by name in the first place.

Etiotropic refers to an approach that cures psychological trauma; Nosotropic refers to the learned coping approach. The latter means to focus on the problem of psychological trauma by identifying and controlling-fixing symptoms. The former does the opposite, focusing only on trauma's etiology enmeshed as an injury – wound into identity and then identifying and reversing it. This difference becomes emphasized when facilitating TRT; patients are asked to not attempt to change or otherwise control symptoms that may present during the trauma resolution process. I'll explain this most important rule later in the section pertaining to the Survivor, a salient component of psychology necessarily-logically, but with countervailing duties and functions, appearing to operate discordantly for the individual's interest, depending on the Survivor's influences by noted exogenous variables also shown later.

The evaluation for trauma's resolution, complete resolution, or cure must continue the non symptom focus if the cure is to be maintained in the appropriate clinical paradigm initiated in the first place to end the trauma's existence in memory, not teach people just to cope with its thought – behavioral manifestations. That requires balancing of all perspectives of the resolution – cure process within the full evaluative capacities available to all human beings involved, including patients, their facilitators and any third party observers. For example, participants, again to emphasize therapists or observers, used both objective and subjective perspectives ─ our criteria developed over 10 years ─ to include specific descriptions of experience of the entire identity restoration process as it proceeded through its address and reconciliation of the sequelae that had formed the etiology of trauma.

That activity is described incrementally in writing, and then shared the same with the facilitator, group members where prevalent, and the observer scientists. Total objectification, as is needed for quantification methodologies like that used by researchers contributing to the EB science, is seen as impossible because of the experiences for all involved. Nevertheless, an adequate measurer of resolution is available within the ETM modality that brings the necessary views together. Even the best auditors from accrediting institutions participated in the subjective – objective evaluation component so as to develop the sensibility required to fully understand the written corroborations and to do their compliance enforcement jobs. Speaking categorically, as in rigidly, scientists who do not have the capacity, wherewithal, opportunity or inclination to participate in the dual objective – experience evaluative process's complete resolution of psychological trauma will never understand what they are missing in their trials, always operating outside the domain of the full acumen needed for research, and thus be subject to prejudging conditions, issues and influences without any knowledge of their handicap.

I've been in this ideological fight since I discovered starting over 30 years ago that the Nosotropic concepts, which were nothing more again than being tough ─ referring again to being Stoic, but augmented with constant intellectually interpreting philosophical tricks as reinforcements, and from which I was delivered from their controlling influences possibly by divine intervention, (described in the second chapter of Due Diligence) were the principal reasons the professional world couldn't cure psychological trauma. Extrapolating it to EB's influence, the combined and now overarching modality's failures have nothing to do with poor implementation of what they should now reference fundamentally, because they don't read books anymore, as their Bible, Torah, or Koran, that is, to mean what this group calls "The Science." Rather, the failure lies in the imposition of the Evidenced-Based philosophical and methodological underpinnings of the EB evaluative theory, itself, onto patients.

The Evidenced-Based construct, which philosophical and methodical stanchions function wholly and unambiguously antithetically from those holding up the Etiotropic side of the mast, is just another experiment by Behavioral Science philosophers to not just continue to avoid doing what's obviously right ─ address the trauma's experience as manifested as a decimation of identity which is what the trauma injury is all about ─ but always and only to try to prove their theories regarding the makeup of the human consciousness and how to transform it with intellectual interpretative gobbledygook into the utopian person, rather than accept the being that is. That means that they refocus the preponderance of the methodological schema upon only what they know how to do: tell people how to act, think, feel and behave. The Behavioral Scientist teaches people how to live life by seeing the sadder parts of the world with enlightened concepts that instill happiness, changing negative feelings by reconfiguring the unnecessary thoughts that cause the hurt, interpreting the intimacy seeking but often collision elements of relationships as indications of their partners' disorders, and thus generally making these folks into better citizens, depending on how the culture sees fit.

That notion has two small complications. First, those intellectual control ideas don't fit the nature of psychological trauma's storage in the substrate of memory, much less the facts determined by trauma's complete, as in full, resolution. I'll cover that later, too. Second, the change your feelings by changing your thoughts model presumes that those doing the teaching know what they are doing, themselves, that is, behaving correctly or at least well in their own lives. Bad idea; a shaky foundation if you watch the leadership scandal headlines on the news.

That social maladaptation, that is, people who don't know how to do something, themselves, teaching others how to do it from an experiment the teacher can watch and learn to see if it might work for himself, would not be such a bad or even a difficult thing to compete against in a society where open expression rules the day. However, this time CBTer's and EBer's together have gone across the line, not just by playing like there isn't another clinical ─ in treatment as opposed to researchers at the University who have to publish something to survive ─ world outside of their particular followers' journals, but by merging their methodology with government, some serious marketing hype, and masterminding another political coup in their ever ongoing attempts to control every and any thing that they can. As my constantly replicated work from the last century no less (denoting longevity in this conversation) supports, I believe that aggressiveness is endemic to its thought and helping model. The prescience or no of that opinion will eventually come, not through shouting in the media, but when my antagonists attempt to show which of us are the true saints by testing the principles discussed ─ as I have always had to do for last 30 years ─ within the always Dracula oxidizing sunshine of complete public exposure and competition for determining truth, not just in behavioral studies where varying statistical formulas are used to razzle and dazzle into hypnotic states graduates of the humanities who didn't find a lot of meaning in the relational facts of numbers or at least the limiting concepts of Profit and Loss Statements and Balance Sheets making up the brains of their counterparts in the business schools. While wandering through that academic environment, I used to wonder, "Wonder why these two groups don't seem to date or at least talk to each other?" Well, they finally did start dating at the turn of the millennium. And today's health care management EB based application to psychological trauma symptoms quality control component disaster to the once erudite Schools for the Humanities is the outcome of the wedding. Time for divorce.

A VA Example

Worse, these social gladiators don't play fair. If you confront them regarding the logic of their notions, then they respond with Machiavelli and, groan, Nietzsche philosophy politically, which power maneuvering has nothing to do with the best interest of the veteran. Nonetheless, it is how they predominate on the scene. "What do you MEAN?!! Isn't that almost, or a little bit, untoward?"

Starting in the early to middle 1980s with newly training (in ETM TRT) counselors who were responding to our model's clinical successes and presentations to academia, such counselors from the Veteran's Affairs Administration showed considerable interest in applying ETM TRT as a prospective helping modality for their patients, most of whom were WWII, Korea and Vietnam veterans suffering the newly being recognized, at first named Post-Vietnam and then in the DSM, 1980, promulgation formally changed to Post Traumatic Stress Disorder, in the process correctly expanding the identified population to everybody who had been beaten up in their lives, not just us obviously shell-shocked combatants. After graduating from our schools in the second half of the 1980s and full 1990s, these counselors roared back to their clinical or academic domains with the greatest enthusiasm for finally bringing PTSD to an end in their institutions. These people weren't neophytes either to the epistemological wars as they were being carried on both within the VA bricks and mortar assemblages and the VA outpatient arenas.

In an attempt to summarize for this document with as few words as possible, here is what they ran in to, not just way back then during the ancient era of combatant treatments, but up to today, only using slightly different word plays. First, VA counselors returning from our professional training schools would try to explain that a cure was available in the form of a simple but extraordinary approach called TRT. The hearts and minds of the leadership of the place froze as their authorities established as biofeedback machine operators ─ then into newer eras where they have become operators of virtual reality helmets where chemical lobotomies are performed on combat veterans, during and after experiments with the new 360° surround-vision and digitized quartriangulated (at least) blaster sound with micro woofers of exciting real battle scenes and morbid carnage, etc., ─ were being challenged. "The more things change, the more they just seem to stay the same." said the African American greatest Blues harmonicist alive, played by Joe Seneca, who was on a hobo styled cross country quest to his likely fatal meeting with Scratch at a Mississippi "Crossroads," which provided the title to that lively and wonderfully entertaining 1986 movie.

Those operators, speaking slightly symbolically, ran the veteran care bureaucracies at the mental health institutions. The challenge attended by all natural counterattacks from that leadership was on. In a conference arranged by the newly trained TRT staff with the leadership of the mental health wards, it was not uncommon for that leader to begin with "I'm not even going to talk to that group (my ETM trainers who had taught the VA staff how to completely resolve combat trauma) because I'm not going to recognize the modality with my great powers inherent to my esteemed position of being in charge of this floor (in the particular hospital)." So that leader would be politely told that the Department of Defense had already done that. Second, the retort would come, "Where is the description of its theory and development?" which 10 years of answers were then immediately stacked on the desk in twelve pounds of 3 three inch thick manuals and one book, each of which included over 620 pages, with pictures no less. In the earlier days, that leadership's authority protecting defenses had not yet been prepped with the word Evidenced-Based. So they just said "Gimme sumpin with some numerals in it!" "Do you mean Roman numerals or empirical data?" our people would ask. Then, the patient educational booklets, nineteen in all, were delicately balanced on top of the pile, followed by the literature reviews with their 273 sources bibliography and attended by complete descriptions of the ideological and epistemological differences. No matter that the now teetering stack had grown to 15 inches in height of single spaced, double sided, 24 lb paper, with a few 3 inch capacity comb and 1 7/8 inch perfect bindings thrown in, and it was attended by 1524 slides in 41 lectures which filled a 5 cubic foot corner of the room ─ they were too heavy for the women to put on the desk and the male biofeedback machine – virtual helmet operators wouldn't help them to do so because the gargantuan space-taking information would increase the size of the career threatening conglomeration now confronting them and bearing only inches from their faces, and some of the materials were even in color ─ the machine operator would ask - exclaim in a voice two octaves above his normal speaking tone "Are you a PhD?" to the nicest most non threatening persons in the world, Craig Carson, MS, LPC, LMFT, LCD counselor, and other naïve TRT counselors who also had every credential and license available and then some required to treat anybody, anywhere, for anything having to do with their psychologies. Asked and answered with the additional caveat that a full 15% of trained ETM TRT counselors carried PhD certificates and that all were licensed better than was he, the operator in charge of the VA's mental health system's address of combat trauma having lost on all his sales objections would scream in glee "But have any of you been in real war combat?!!" The now hyperventilating biohelmet computer expert - operator would be told through gentle expression so as not to cause further hernia to his mind about the ETM author's USMC combat history in Vietnam and who had a VA ordained combat caused 100% disability. That is when they disappeared over the edge. The VA's leader would leap from his chair, run out the door and down the hall, therein hiding in the restroom until the intruders left the premises.

But that was not enough. As the ETM TRT reps departed the floor, shouts ─ in repeating waves of crescendos occurring in unison like the card sections at football games ─ as if each clinical office had its own teleprompter bellowed down the VA hospital's halls "NO NEW STEPS!!!" That, of course following in the tradition of all CBT intellectual limitation, refers to speaking in slogans or quoting others without reference. I mean they took that stanza, sometimes even sung in four part harmony by the CBT choir, from the newspaper headlines of one of Australia's greatest sleepers, Simply Ballroom, depicting a Rocky Balboa styled young lady's linkage as a no chance ballroom dance competitor with the sophisticated virtuoso's addition of the pasadoble during that entertainment genre's national championship. Be inspired! Do something good! Cure Shell Shock for American combat veterans! At least if you don't know how to treat the primary injury, give them real help: that starts with less flak than they got in combat!

That was the traditional VA response for the first 20 or so years and until Dole - Shalala, 2007, where in response to the malfeasance horrors of Walter Reed PTSD treatment exposed by the Washington Post, the President of the United States established the so named commission to find out what was going on with the VA and combat trauma managed by the Department of Defense. After that and by Congress's direction, the new policy at the VA was changed to acknowledge openness to the study of PTSD from the non VA community and other therapies designed and applied in the treatment of psychological trauma, at least at the front door while being interviewed for the 5 o'clock news. But, steering with alacrity the helping suckers around to the back door, they were chilled to death with demands for empirical data: triple binded, meaning quadrupally blinded studies with control groups being conducted out of the University of Ottawa, if there was such a place. Because to be fair, that is, I mean unbiased, they should fill the controls with draft dodgers and deserters who were the same ages of the combatants and who were comprised of differing philosophies about war, inner hostility and aggression and such, not to mention of whom had been traumatized themselves by being forced to abandon their country. "Well," my ETM enthusiasts said, "I guess we'll go on out and try to round those kind of folks up, if they haven't changed all their names by now. We'll be back in 18 years."

And these VA mental health care managers and leaders at the top, being nothing like their dedicated altruist doing the therapy at the lower part of the totem pole, can fly down their hallways faster than roller derby skaters to head off a person from the community trying to respond to the ever sickening veteran attitudes being expressed in the local area regarding VA mental health care. "Are you sure? Do VA CBT Psychiatrists really where roller skates? Have you measured those attitudes?!" Well, at least as well as the EBers measure symptoms of PTSD and SUD. But, before we get sidetracked into issues related to my objectivity in this matter, here is the gripe.

The VA mental health system which is now run by Cognitive Behaviorists ─ who also function as the pharmaceutical industry's wholesale outlets ─ as if no other helping thought model ever existed, is operating on Extremo Churn high speed supporting blender chopped and shredded CBT and polypharmacological autopilot. Veterans see a psychiatrist for meds for 25 consecutive minutes every ninety days. That is how they tie the patient to the program. If the patient is suffering serious suicidal or homicidal ideation(s), the psychiatrist cranks the structured talking part up and into heavy professional interaction, one serious (Still want to harm yourself?) 25 minute session every 30 days. Med dosages are adjusted after blood work analysis and by discussion of those issues causing difficulty ─ assuming they can be remembered through the drug memory immobilizer field since the last visit 3 months past ─ usually as conflict between the vet and family members. After lounging around on an 8 or 9 month waiting list, the veteran gets to go to a group therapy, which is culled in the first hour to weed out non conformers: people who otherwise respond naturally as Person Centered or Rogerian Therapy centric human beings want to talk about their feelings, like anger or sorrow. The remainders, meaning veterans who don't understand CBT group control methods which are intended to make the therapist's job easier, learn about the symptoms of PTSD and how the disorder concept works, in the VA.

That is, the veteran has caught for his or her efforts in combat a psychiatric mental illness which is thought to be manageable by the VA with education, encouragement to control their symptoms, how to fight against the occurrence of flashbacks, what medications are popular for psychotic recurring nightmares, how not to go to war movies even if they are up for best picture, how not to want to kill anyone, but in case one does, better "go grab a doctor in the hallway and tell her about it," how to stop complaining just because the drugs for PTSD make them feel like they are living underwater in the neighbor's swimming pool, how to make sure they don't drink too much because they are at risk for alcoholism, and when they get upset by antiwar protestors who call the veterans bad names, how to recognize that everybody has a right to free speech, and after all, that is what the veteran fought for to protect anyway. And when the country that sent them into the war decides after a few suicide attacks that it has had enough, that whichever war that they fought, were maimed or blown up for, was a big lie or at least a mistake, or imbecilic, or in the minimum was empire aggression that the guys sitting in the group room made possible by following illegal and immoral orders from an evil Commander in Chief whose popularity in the poles dropped a portion of a decimal point ever time one of their partners in combat were killed or are otherwise blown to pieces, vets just wonder if they really are insane, as the diagnosis stipulates. Maybe they should be treated also for having been raised by Schizoid parents: systemic trauma manipulated public opinion.

When the facilitator plays like he or she doesn't smell it, or if he does it doesn't mean anything, then vets are taught not to complain about the high levels of alcohol smell permeating the group therapy process when 2 or 3 members come in loaded. They also learn through non dialogue as in lip sync and eye winking only that they may not want to record on their drivers or hunting firearm license applications a whole lot, if anything at all, pertaining to their new mental illness status received during combat. And they might especially leave off the issue of the medications.

A social worker manages the case in conjunction with the treatment team to help with all things like living arrangements, interfacing with whatever needs interface including the address of other medical issues which are often numerous for this population. Social workers contribute to the best part of the whole care system when that professional case worker does care, which happens in 180% of the time. They are tough, sophisticatedly trained for this population and fine people who are profoundly dedicated to helping veterans. And they apply themselves exhaustively earning every dime they are paid when they work in the trenches ─ carry a full case load. Nevertheless, upper management of this and the other groups can become as in any industry extremely political and career power focused. And there are some doctors at the VA who apply themselves above and beyond within the medical traditions for which we hope provide the standard for professional help.

Because of those good men and women, I have loved the VA in the recent decade no matter the crippling management issues which comprise the basis of this essay, and regardless of the horrible experiences of disregard and abuse incurred in the 1970s. But as the educational sayings go, otherwise used to address these additional compounding trauma issues created by politics and descent, and administered by Cognitive Behaviorists who know nothing whatsoever about what to do to reconcile these additionally profound trauma causing issues, "That's water under the bridge." "What's passed is in the past and stays there!" "No sense crying over spilt milk." Hmm; maybe that is good CBT advice unless, of course, resolution of those unfortunate catastrophes for our veterans' minds tells us to stop it from happening again 40 years later. And thank God for that CBS Republican hating scandal sheet the Washington Post; or we'd probably be giving our Iraqi and Afghanistan brothers and sisters Born on the Fourth of July all over again (autobiography of spinally wounded Ron Kovic and 1989 movie starring Tom Cruise and Willem Defoe).

Non responders (who get worse and even unmanageable and not by schizophrenia) to that level of care, which is considered top notch as compared to the low notch stuff you read about in the papers causing the upheaval, may qualify for residential - inpatient. Depending on the quality (the capacity to care) and mental stability of the psychiatrist running the floor, chemically dependent and PTSD patients may get proper separation from those suffering schizophrenia where it presents. But in low down dirty dog places, the patients are first calmed down, comingled inappropriately, then managed and warehoused polypharmacologically until they are sent back out into their families, if they have any. And everything from the previous 3 paragraphs is just surface stuff as far as complaints go.

After many years of interacting ethically with the VA even while they harmed veterans through those managerial control methods, all functioning copasetically with their philosophical treatment paradigm based on CBT, I gave up that code of honor during the referenced rounds of despair caused by Walter Reed. That tragedy occurred because of the treatment – management modality, not, again and hopefully this time forevermore, a lack of people to re implement their design, which the Secretary of the DoD ordered as a quick fix as soon as the second report broke. All that more therapists and administrators do is increase replication of the same disastrous ideas. Those modalities, always based on CBT because that is the intellectual limitation of upper management, foster conveyer belt treatment, burnout, superficial understandings of combat trauma, misdirected clinical goals, polypharmacological applications for patient control and warehousing, abrogation of the contract tying employer to liability, patient stigmatization, and sometimes general malfeasance by a host of caring clinicians who otherwise would love to do the best for their veterans, just as they are ours.

CBT: The Genghis Kahn of Psychotherapy

Compounding the ideological and methodological problems, the CBT movement's leadership does not advance their cause through caring, empathy, openness, logic and reason ─ the basic tenets of helping ─ as the existential psychodynamic professionals did during their turn to lead the field. In that 60 years of the mid twentieth century, being aggressive within the ranks of therapists was seen as psychopathology. But that concept is gone today, trashed by upbeatedness, money making, and cutbacks. Instead, CBTer's impose not unlike Genghis Kahn did during the thirteenth century. I'm not speaking of the positive attributes of that leadership's establishment of the Mongolian dynasty by the Kahn and his sons, but alternatively of the greed for ideological expansion and control and the resulting deficits forced upon our populations as CBT is pounded into the unaware collective consciousnesses of traumatized people.

And given the really big view, the monopolistic anticompetitive practices of the CBT EB government merger is just another firefight on the battlefront that has existed between the ever usurping imposter therapists, Behaviorists, and their helping caring-existential-based antitheses since Skinner told the poor human race about his box used in his Behavioral experiments, the scientists destroyed the once thought wise Sophists in the times of pre Plato and Socrates in Greece, the established Behavioral-focused disorder killed the caring- love-imbuing Jesus in 33AD, and Islam started wiping out the thought competition in 622, and is still following the same directions today, depending on to whom from their camp you listen. Now there's a fine CBT, with a leaning toward the "B" component, SUD treatment program if ever there was one!

Allah's Messenger laid out the 3 step CBT based approach to Alcoholism recovery in the Al Hadith.

These seemingly irreconcilable conflicts continue even with science's backing when people rely primarily, if not only, on the cerebral - behavioral control components of their human capacities. They must project that system on to contiguous and different ideologies in order to keep the lifestyle and epistemological choice valid for themselves. It would otherwise fall due to constant epiphanies resulting from exposure to more identity- or existential-focused concepts that are introduced, led and inspired by unfettered experience of human feelings, intuition and creativity that provide the path to empathic – based truths threateningly being conveyed to their followers. I mean,

♫"How're we gonna keep them down on the farm♪,
♯♫ after they've seen Chu Lai?♪"

as US Marine Gunnery Sergeant Gratton used to sing to the WWII classic song's melody about American soldiers fighting in Europe, but sardonically substituting for parody while washing his clothes in the monsoon rain and mud, Vietnam's Chu Lai for Pari′. Today, we can just as easily end the same stanza with Fallujah, Najaf, Mosul, or Kabul, except that Fallujah, although the best known, has too many syllables. Not exactly the same metropolises as Paris; and although the Gunny's use of the song and lyrics poked fun at the other war's places for liberty, the point is the same. When one experiences other things, it is hard to remain in the Behaviorist's fold, cult, or . . .

This conflict over the ontology and management of the human consciousness was America's battle when developing its constitution and is still today's principle thought management struggle in this country. It is demonstrated in the interactions and ideological thus political conflicts ongoing in the implementations of our notions of crime and punishment influenced by extenuating circumstances pertaining to the effects of trauma on the human will. The Evidence-Basers have come square down on the behavior focused composition in the human services arena, but a little less squarely by at least calling the antagonist a disorder instead of an irreparable fall from grace, but that they only can fix, or if not going that far, effect an improved outcome anyway. Clearly, this ambiguous and renewed attempt at reconciliation of its epistemological cracks was, without serious question or hyperbole, created as an interpretative accommodating reaction to Victor Hugo's solving of the problem in 19th Century France when made known to us late 20th Century illiterates in the adapted musical "Les Miserables," with the finale suicide of its law enforcement focused Javer who didn't know how to think anymore if caring and love were shown, as it was in that monumentally efficacious work, to be more valuable than methodologically correcting behavior, whether done by repeatedly slamming a rock breaking sledgehammer or through attachment of a veteran's chest and head to a biofeedback or virtual reality surroundorama machine as he is required to watch ever enlightening depictions, in color, of real war carnage.

Well now, the Evidenced-Based modality as in a new code of law has been mistakenly, maladaptively, or idiosyncratically adopted by our governments as if the war over identification of the human being's consciousness has never existed. Hence, this essay proposes to change that error in judgment or reverse any political hegemony instigated via Behaviorism philosophers by making a simple name change to its management approach. Call it Nosotropic-Based and everything will be fine. No controversy needed. We Etiotropicers can list our already vetted services under an Etiotropic-Based heading, and then be on our way back out into the U.S. Constitution protected competitive arena controlled only by honor, ethics, recognition of and consideration for others' rights in concert with our own, consumer public image and patient satisfaction.

Part Two

Evidence-Based, Science, Stat Analysis and Symptoms of Disorder

"There are just a whole lot of people walking around who never knew what hit them."

John Updike

The word "evidence" in this discussion is not the rub, but, instead what it stands for to the ideologically suited practitioners and researchers who have borrowed the term for this particular use. They adhere to the expression for the dual purposes of following scholarly - scientific principles on the one hand, and on the little less admirable other squeezing out of competition through political manipulation those who don't agree with ─ actually they don't care about "agreement," just that you go along with what they say and not get in their way ─ their approach to helping. In either case, "evidence," as it is used here means to, among other things described also herein, focus scientifically, as my Gazelle like leaping Black Lab (dog) does on movement in a field full of jumping grasshoppers, upon the measurement of the rise and fall, and to include within that inconsistency the discombobulating effects on objective measurement by omission-based collusion through self and familial denial, and then further encumbered by more invalid observations due to sometimes presentment or no now or 40 years later or somewhere in between, of DSM recognized symptoms.

Despite the indeterminate effects that symptom non recognition, denial and inconsistency have on the degree of reliability of the evidence, changing ratios that record and then provide an interpretation for the levels of symptom presentation that follow the intervention are the determiners of the helping application's influence or no. Hence, symptoms that present or not over certain periods become the primary evidence to which the Evidence-Based (EB) movement is preoccupied. In this trauma management modality, virtually all of the work force is dedicated to proper symptom recognition and thus collection. This means monitoring symptom change with great program resources and dedication to the principle that changes will notify the performers if and when they are following the science (peer reviewed symptom studies and thoughts contained in a easily accessible database) properly and whether or not things are getting better.

Before making further negative comments about this idea, I would like to emphasize my wonderment at the scope of the whole notion, including its attempt to incorporate mathematics into their management efforts. "Evidenced – Based," when applied to recidivism measurement in the criminal justice system, Dentistry, Medical Practice, and in the treatment of severe mental health diseases such as schizophrenia, is very valuable: a bona fide expenditure of both private and community resources and a logical theory having considerable merit. The idea is to add and dictate the kinds of approaches used in the measurement of evidence, not in legal terms, but in program competition or performance of effectiveness.

The EB concept also gets not just good, but extraordinary marks for using stat analysis with computerized data management for quantifying illnesses. That concept has been a part of business schools in our universities and in thousands of corporations for many years, establishing a long track record of success at providing very accurate and rapidly needed information. Its cost and managerial accounting format has been applied in financial researching systems, albeit, not computerized until later, through Standard and Poor's and others forever. Identical measuring devices have been and are responsible for keeping track of all the twisting, entangling and blending of mathematical concepts to make sense of the work force's pension and profit sharing funds; they represent the greatest wealth ever assembled. In those configurations, statistical understanding and application accorded to the public's investors on an economic macro scale what the Evidenced-Based system is doing now in the address of quality control of mental illness. The tremendous range of mathematical computation services can mean make or break existences for fortunes. And now with the Internet, the same model is becoming a savior for personal financial stability and measured growth. The individual investor is becoming his own investment advisor, even stockbroker, but with better information than those groups had just 10 years ago.

In the mental health and other medical fields, the new but already financially tested device reflects how the various interventions, either behavioral or pharmacological, are strengthening with supercomputer speed a machinery that tightens efficacy maintenance controls of the otherwise unreliable symptom presenting data. Insights can be provided into mental health issues that instantly bring thousands of practioners up to currency with a click of a button. There is no doubt that this great advance for humankind will someday be able to solve some of the greatest problems we've faced.

But psychological trauma and PTSD aren't two of them. Having applauded the excellent components of the modality, I return to the very necessary explanation of what is so wrong with Evidenced-Based theory in this application to psychological trauma and PTSD. The statistical formulas being applied to presenting symptoms, then coordinating that correlation to articles that give sources that support its author's logic, serve as the referenced "Evidence-Based" engine. But as I'm opining in this counter to the EB movement, when applied to trauma management and treatment, the stirring of the trauma and mental health disorder symptoms' boiling pot, and even when using the great statistical stirspoon, is just the newest euphemism for Behavioral whack-o-mole.

Comorbid or Co Occurrence: Emphasizing SUD Occurring Coincidentally with PTSD

Symptom unreliability emanating from just one incident of trauma and its prospective symptoms is not the only foundational problem with EB symptom data collection and analysis. PTSD symptoms present comorbid with about a trillion other mental health maladies, with the most misunderstood, misdiagnosed, and constituency battled over being the co occurrence of Alcohol Dependence (AD), Chemical Dependency (CD) or Substance Use Disorder (SUD) with PTSD. The academically trained PTSD professional care givers, referring in this instance primarily to the throngs of new authority-based helpers coming out of graduate level counseling schools, and to even include the self helpers' approaches to PTSD, which are mostly Twelve Step ─ a recovery experienced blend of cognitive-behavioral, moral self analysis, and non secular conversion initiated by survivors of Alcoholism in its program of helping others similarly affected ─ imbued, will initiate the assessment phase within the umbrella assumption that CD's or SUD's pathological use is a symptom or simply a medicator of psychological trauma and PTSD. Except for some of the experienced based individual helpers who first applied their model where it started and faired so well in Alcoholics Anonymous, these thinkers rarely consider, or for some reason have not even heard of (means to have read), much less tried to reconcile with, the CD treatment and Alcoholism research community's antithetical ideas cogently supported, meaning at least enough to where the information should be included in the problem analysis,  by substantial research that AD, CD and SUD are caused by biogenetic factors
(select "Chemical Dependency" for a review of the literature, "Commorbidy: Chemical Dependency and PTSD") that induces biological, then turned psychological stress and identity – behavioral change.

The biggest suspected biological culprit among several noted in the literature is the manner in which some people's genetics affect the liver, which effects alter processing of the alcohol molecule in various ways, some of which are represented by rapidly increasing tolerance that is then attended by wild and other uncontrollable chemical use and bizarre behavior. Aversely, other well defined genetic markers for alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) demonstrate genetically coded liver enzymic protections, often even denoted ethnically, for literally hundreds of millions if not now billions of persons living on this planet. For the non protected, thus affected adversely in the other direction, the damaged liver begins, starting in early life (30's) hepatic encephalopathy. That means for you PTSD-causes-AD and "lets treat it all at the same time" thinkers that even in sobriety the brain still isn't going to work cognitively until the liver heals or one gets a transplant, which produces overnight the return of complete cognitive functionings. Before discovering that biological issue, everybody just concluded that the thought processing deficit was indicative of Korsakov's Syndrome. Adding to this knowledge / opinion bank, lots of new psychotherapists believed it to be representative of low self esteem, or retardation, and a little further back in history, well maybe not so far back, just a worthless personality.

When conducting my third literature review (linked above) of the biogenetics of AD 20 years ago, the gene investigative culture was looking for a single marker which would substantiate its findings related to the way different livers metabolized alcohol within the digestive system. In 2009, thirty-four total markers show unchallengeable association of the alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) with AD. And that is just the liver! We are not even talking yet about the lungs, esophagus, or much less the brain! Where are the philosophers who used to plug this kind of stuff into their formulas while trying to figure out the human consciousness? I'll add a well grounded ─ taken from training psychotherapists for 3 decades ─ guess to that later.

Unlike the SUD counselor who frequently comes from the recovering CD treatment arena, and who thinks of the uncontrolled use as a natural manifestation of such biologically affected people given the molecular structure of the alcohol molecule and their livers' particular genetic under codings, the PTSD trained and oriented practitioner will surmise that the disordered use is a characterization of a past trauma's internalized (the Behaviorists' term, not mine) retention. And sometimes also unbeknownst to the new PTSD expert is that that kind of use is preponderantly attended by bizarre behavior that contradicts the original identity that existed prior to the dramatic toxically influenced actions. That contradiction establishes the cause of a separate source of trauma when the CD person becomes sober and is confronted in an awakening nanosecond by what he or she did when using (drunk or in other ways highly drugged) the day or evening before which varies with the way that individual believed he or she should behave or otherwise represent one's self. Behaviorists or choice proponents argue, of course, and ignorantly of the biological factors, that the person puts him or herself upon the barstool without anyone's help, demonstrating choice. How could it be a traumatizing event if it is chosen, they argue? Please. I do not have time to address the full biological intricacies of the issue of choice at this time, as this exposition is going to be long as is.

However, a political brush stroke should provide at least a small highlight. The notion that Chemical Dependence (CD), the older but helpful term representing psychotropic mixes determined by sources and economics of supply, presents as primarily a biogenetic issue having physically caused psychological damage to identity in lieu of people making choices about their use, and one of the rationales for that consumption being psychological stress created by past trauma, upsets the non CD treatment community a little bit; actually, it upsets them a lot. Their training is primarily in mental health, not Alcoholism. Nevertheless, their upsettednesses that academic and discipline shortfall won't predominate unless they are able to change the U.S. Constitution to recognize them as immutable leaders-rulers of mental health care. Although they are making a good stab at it by merging CBT with Evidence-Based controls and government, eventually these Behaviorists - scientists and statisticians will learn that these drug and PTSD issues present comorbid coincidentally.

For one, the so called study correlates that conclude association demonstrates a PTSD causal relationship to CD do not account for the fact that practically everybody in this country has been very highly traumatized at one time or another. And two, drugged and drunk people are constantly causing trauma through toxic behavior, for example, by killing over 24,000 people a year in auto calamities alone, maiming multiple times that figure, and leaving behind untold numbers of surviving family members, friends, business associates, church and school members. At the same time flabbergasting numbers include those drunks being victimized, for example through rape, muggings and every kind of human exploitation, while lesser defended: easy targets for sleaze-based predators.

Although those patients are presenting as extremely harmed persons, which the Cognitive Behaviorists are finally catching on to in this later millennium on the subject, treatments of multiple sources of trauma can be ordered and all etiology completely reversed, as in CURED. The only difficulty is not for the patient, as expunging trauma's multiple etiologies in identity offers an existence of congruity not just meaningfully attended by amelioration of pain, anxiety, depression, stress, and dissociative states, but in fact cures them if trauma related, which Eric Kandel, probably the world's most prolifically published neuroscientist, says is the case in 90% of such presentations (significant loss precedes depression). It's just very difficult for untrained therapists to experience that much devastation of another human being. In this culture, that training must eventually take place as a standard, not an advanced curriculum for those so ideologically inclined, or because of my skills or lack of as a marketer of my product.

To reinforce if not prove the notion of Chemical Dependency's biogenetic likelihood of establishment prior to later occurring events, such as trauma caused by combat, rape or loss of a loved one, to be fact - not opinion or supposition, all the provider has to do is employ a systemic based Chemical Dependency assessment form that recognizes the full delusionary memory system that attends the use. That system is comprised of euphoric recall, repression and blackouts, the latter being an otherwise complete failure of the neuro synapse to record anything that happened, frequently even over long periods, days and weeks. That individual construct of hallucinatory self evaluation is supported by repression of massive amounts of trauma incurred by family members affected by the bizarre while toxic pathological behaviors over the life time of that use by the CDP (Chemically Dependent Person ─ see how much nicer that sounds than the "SUD Person," or "SUDP?").

That individual, relational and systemic trauma etiological compendium protects itself similarly as individual trauma etiology is protected. Family members and the systems while in survival on the one hand try to address the damage done to them, and on the other attempt to keep it in place. That so called duality by some thinkers manifest in numerous ways. But for purposes of assessment of CD or SUD, family members both try to get help with which to solve the problem and at the same time can act like it never happened, and worse, sabotage the assistance activities. Honesty, or lying in the contrary, important moral variables to the Behaviorists in the intrapsychic – based assessment and upon which their extensions, Cognitive Behaviorists, hinge their concepts of the human drugged consciousness and discussions, have nothing to do with the challenges to accurate assessment caused by biological attacks upon the person when toxic and the bizarre behavioral caused traumas' undermining family perspectives of what's happening.

The Johnson Institute, a central figure 40 years past in the development and international professional expression through training of the Minnesota CD treatment and medical-social management model, produced ions ago a system based assessment tool which was and is hailed by every, that is, single facility licensing auditor as absolutely the "best" and most complete approach to determining the facts pertaining to the use that they had seen in the Chemical Dependency and mental health fields. With that program's permission, we've used their design in family systems approaches for 30 years documenting the pathological, meaning obvious problems with, the use back to the first drink on almost every occasion.

Regarding "almost," if in some instance the problems with first use didn't show up at entry (but mid and later life problems triggered treatment), that documentation was continued in our family treatment regimes as a matter of fact, not guesswork, throughout the first 3 months of acute treatment for all family members (with collaborative data from pastors, priests, business associates to eventually include the prospective Chemically Dependent Person's entire universe). "Fact" means that descriptions of problem use are taken and recorded without convoluting philosophical abstractions that explain and excuse why the use was occurring. For example, a family member early on would not report an event that usually would include a full period over which like events occurred, because he or she believed that a significant loss in the family had caused the use; hence, it was understandable to that theoretical perspective. Reporting what happened without the philosophical guesswork as to psychological cause allowed collection of less tainted data. Better than that, the reporting of fact without the defending abstraction set into motion the address of the underlying trauma resulting to the family member from the use by the AD, CD or SUD affected person.

Emphasizing the thoroughness of this approach, but of course with the necessary humilities, each family member was treated for standards compliance purposes as an identified patient (IP), not just as collateral for the AD IP suffering trauma from the aberrant drinking / drug use behaviors. Of course as described below, every such trauma etiology affecting a family member was identified and reversed, giving greater clarification to the systemic assessment process. The full familial or other system member documentation post acute trauma address reveals to the psychological causal theory protagonist a grave view. He or she has not only been dead wrong, but obviously guided by some strange goings on.

How can I be that way? I mean, so curmudgeon like, opinionated, rigid, acerbic, rude, even angry sounding, and the most horrendous of all, uneclectic. Here's how. Our multifaceted and multi-therapists ─ but trauma resolution and sobriety focused and positively synergistically directed ─ facilitated family approach to CD treatment and psychological trauma removed the effects of trauma from everybody in the system, and the system relational components, allowing the data to be joined for analysis without the distortions inherently attending the pathological, more often than not, lifetime traumatizing processes. Better than that, formal treatment at the multiple, that is, intrapsychic, interpsychic and systemic levels of trauma's etiological identification and reversal lasted never less than two years, including for the record children to age 5. Additional trauma resolution activities were provided to those having been affected by traumas not occurring during the defined pathological use period. This information has been properly published since 1984 and as indicated presented in its entirety free for study, research, or reading for pleasure on the Internet since 1994.

Writing on 60 years studies, George E. Vaillant author of the landmark book, A Natural History of Alcoholism, proved beyond anyone's questions or doubts by a sane person that attempting to define pre alcoholism psychological factors after its onset and disaster upon the psychologies of the alcoholic and the family is like trying to shoot fish in a barrel of water. You can't hit them because of the "skewed effect" created by light's deflections. In practice, the deflections present as psychological trauma, which when directly addressed at etiological levels disappear, leaving only a very clear view of the facts pertaining to what happened to everyone involved. The moral is "Yes, Rodney. We can all get along. But in this family, it will only happen with no drug use!"

"Facts are ok." But, say the CBTer's, "What's theoretically or logically wrong with the current rampage for drug abuse being caused by pre, or especially in cases of sexual assault – rape of women when drunk or drugged, psychological factors? Doesn't that work?" To answer it within cognitive behavioral lingo, "Not hardly."

Only two things are important here other than desecration of truth. When pre substance use trauma is seen as the cause of the drug abuse, reconciling the previous trauma, if it can even be done within that spin, follows with "If trauma caused my SUD, and I've reconciled that trauma, then, first, I could not have been traumatized by the later use as it was chosen to meet a natural need!" ─ thus no additional trauma should be necessary to consider, which if not done supports psychological delusions of power over addiction and use behavior never to be identified, much less reconciled, by the CD patient. Second, being successfully treated for the first trauma should mean that "I now have no stressors that might cause further abuse. I can return to enjoyment of recreational drug use like the rest of the responsible social users still do within the community." Good luck America with its new psychological cure for Alcoholism caused by liver metabolism of an ingested foreign substance, just a little strange molecule!

How can these scientists turned practioners miss something this big? When they are our objective finest, why would they just read the wrong evidence? Why? Because psychotropic substance use is not an objective issue for therapists – scientists whose professions are spawned out of a super and now supra with EB ordained drinking culture where responsible alcohol use is considered to be an accepted and natural part of the human existence. Regrettably, that idea results in the assessment by the therapist, at the speed of light by the way before being saved by suppression, of the therapist's own substance use capacities, which allow for, are intended to, and do medicate for stress, not forgetting providing for relaxation and fun, onto the biologically different Chemical Dependent Person.

As the Cognitive Behaviorists live on, and draw the intellect for their theories from, adages, and for which I'm trying to accommodate them in this writing, social drinkers, as in this example of the using therapist or scientist, like to think that they are in control of their party time. The stress causes alcoholism theory supports the social drinker's notions that cognitive erudition and advanced intra and inter personal communication skills gives them immunity from the true risks of drug / alcohol use. They have carte blanch credit to medicate for happy or depressed times, or for no reason other than enjoying a particular lifestyle. And Buddha, Allah and Lord help the patient during evaluation by a therapist who is the mother of a drug addicted teenager or young adult, and especially when neither mother nor child yet know it.

Today, CD and SUD, at least for those in the know like me, should be treated behaviorally and systemically (as in identity lending groups which give a spiritual or bigger view to the formerly toxic Self), with a little once called Person Centered Therapy added with lots of education pertaining to the Disease thrown in, first to establish a non toxic biology. Using "should" here means that deep thinking ─ formerly affected by chronically drug saturated organs that affect the way the brain tries to right itself, and combined with that same brain's neurobiological disabilities occurring through degeneration of synaptic functioning after it has been decimated by the physiological damage done to it by the alcohol solubility of the complete neuron, to include drowning its most important Long Term Potentiations and Long Term Depressions of pre and post synaptic membranes' interactions otherwise scientifically known as the seat of memory and learning in the brain ─ is done for. So entreating such people to just follow directions for awhile, go to a lot of meetings (as in AA) rather than jump right into serious psychodynamic kinds of thinking and feeling that rely upon those formerly submerged synaptic processes for decision making, and supported by some great tools like Cognitive-Behavioral Therapy and of course the Twelve Step program of Alcoholics Anonymous, is really the way to go.

Emphasizing "for a while" to mean only if you want at the appropriate time to get to the trauma etiology attending the pathological use's influence, not to mention any other trauma source's etiology resulting from, say, war. That caveat notices that a bridge is required to allow a non practicing (sober) Chemically Dependent Person rebuilt under standard CDP treatment with CBT, group lent identity, some rigorous basic Person Centered Therapy groups (of course, exclude Rational Emotive Therapy from the bridge as it functions antithetically to Roger's thesis and work) and inculcated with conversion to assist the crossing into trauma's etiologies caused by at least the pathological use and who knows what else, to make the transition into the now more stabilized and consequently existentially capable neurological trauma resolution capacities. Can you identify the life trauma issues while building the bridge to the complete trauma resolution or cure work to come in Etiotropic TMT? Of course you can, but in an orderly way that assures the patient the experience of congruency in concert with the rapidly changing for the better biological realities.

When the new PTSD, but non SUD trained (by the Chemical Dependency field, not Academia's version of SUD) experts catch on to the existence of two animals instead of the one, they'll understand clearly that linking as CD causal early or parallel occurring psychological trauma produces the proverbial squirrel chasing its tail, but set to the finale of Paul Dukas' The Sorcerer's Apprentice, for emphasis of the CBT's application to PTSD as causal of SUD modality's frenetic effect upon the poor patient's mind.

After sobriety has been attained long enough for the brain and liver to at least function fairly well, which takes about 6 months in the minimum, then the extra bright CD counselor gets his or her TRT (Trauma Resolution Therapy) book out and begins to nuke that CD caused psychological trauma etiology. Following the ETM rules for addressing this kind of commorbidy, the issue becomes how and when to address each trauma source's etiological sequelae. Using ETM's Multiple Sources of Trauma formula, instead of the recent CBT mixed up notion of "complex trauma or PTSD," for treating these two sources of presenting psychological trauma, the latest occurring trauma etiology is addressed first, allowing the patient after that task is completed to return in weeks, months or years to address and reverse with TRT trauma's etiology caused by the earlier occurring event. Or if the past trauma presents as the Most Pressing Trauma (MPT) to address, then it can be worked into the milieu, but not so that it demonstrates a causal linkage to the chemical use pathology, which although exacerbated by trauma, is not the cause of the substance use pathology. They co occur as distinct variables for address, at least for those of us who know what is going on in this apparently unrelenting social management disaster.

One more quick comment about really past trauma, but to emphasize as not pertaining to cases involving psychosis as in schizophrenia. Invariably a professional would ask while I was speaking as a visiting or guest lecturer at a particular symposium, as opposed to from within our professional programs, if our formula for resolving trauma could be applied to past lives trauma. The usual case examples offered for discussion from these persons included one patient in her twenties and another in her forties. The first suffered past lives trauma (that the therapist was helping her to work through) from surviving in a life boat while watching her ship, the Titanic, sink in the North Atlantic. She was addressing in that therapy model memories of frostbite and seeing the dead still floating while frozen on debris. The later aged lady was trying, again with her channeling trauma specialist, to get over a snake bite which caused her death while she was the Queen of Egypt close to the year 42 BC. The upshot of the answer was always the same. "If I didn't get third party reimbursement, it never happened." The other answer of course is that once real or this life's trauma is resolved, Karmic needs from a past life of anything, as General Douglas MacArthur said about old soldiers while speaking before congress in his farewell address after being fired by President Truman, "They just fade away."

While mired in a vortex of sucking lava inherent to their epistemology, but thinking they are instead standing on Everest's high ground with the big view, the Behaviorists are still trying to nail down some behaviors as symptoms from something, maybe PTSD, and coming from some place such as, and not respectively stated, combat, sexual child abuse, or battering attending a first violent marriage to or adolescent upbringing by an alcoholic husband, father, brother or mother, wife or sister. It is in the end for Behaviorists somewhat like trying to diagnose the original locations of houses, autos, poor cows (am sincerely sorry for all life lost to these tragic disasters) and their parts comingled within the circulation of a tornado, but not while the scientist is standing back and making his calculations from a safe viewing area. More likely, trying to affix the roots of all those parts to previous ground locations is akin to diagnosing PTSD symptoms comorbid with CD or SUD while just trying to hold on to a windblown clipboard and mini-computer as the houses-, barns-, autos- and horrid livestock-churning cyclone is bearing straight down on our objective observer and the calamity is only 100 yards away. "Send me a sign!?" Said the lust enamored brain surgeon to his deceased wife when seeking from the spiritual world her guidance whether or not to marry the vamp played by the venerable Kathleen Turner. Following psychic howls of "Nooooo! Nooooo!" accompanied by his former wife's spinning wall hanging portrait and hurricane force winds blowing through the living room, the solemn unperturbed doctor, Steve Martin, responded in The Man with Two Brains "Any sign will do."

And that symptom focused obsession imposed by the new (adding education and a little "Interpersonal Therapy") Behaviorists who have crusaded into the psychological trauma treatment domain is, unbeknownst to its creators, followers and advocates, the Nosotropic focused academic's or scientist's downfall in program design from its inception. To wit, as ETM TRT's half gigabyte of literature on this subject emphasizes to the treatment and research worlds a 4 part immutable axiom to PTSD, hopefully to soon be PTI (Psychological Trauma Injury) treatment:

  1. trauma etiology and symptoms are mutually inclusive; you can't have one without the other, and
  2. a) Attempts to change or otherwise prevent symptomatic thought - behavior, which efforts include their interpretation as likely stemming from etiology, and / or b) evaluation by an objective observer for the purpose of improving performance of symptom control functionings, result in c) the strengthening of trauma's etiology within the domain of identity by an amount of protective neuro-molecular activity correlated positively, or better said identically, to that used by the patient to try to control the behavioral- and thought-symptoms in the first instance.
  3. Thus, the key to curing psychological trauma is to remove etiology without interpreting symptoms for patients; meaning, do not explain to the patient the DSM version of PTSD otherwise intended primarily for clinicians to help them to understand patients.
  4. And to achieve number 3, that is, removing, reversing or otherwise expunging trauma's etiology, exogenous variables like psychotropic medicating effects accepted by the culture as human necessities, must be removed (addressed below).

Hence, you don't have to be a doctorate of philosophy, inferring one to be an advocate of logical thinking, to realize that continuation of etiology will always sustain the same amount of symptoms, albeit in differing and sometimes not readily identifiable manifestations. They especially become too difficult to recognize for Behaviorists when PTSD symptoms become enmeshed with the coping teacher's educational - thought - behavioral control models. People go nearly nuts, excuse me, I meant enter a bottomless quagmire, trying to learn to identify their behaviors that they don't like as PTSD related, and as they continue to pop up or pop down, or crash in or fling themselves out for the entire life span. Or, if God forbid the PTSD is attended by CD and SUD as comorbid participants in such a case, then it really does become a trick for the patient to guess accurately whether a hard slamming refrigerator door is a PTSD representation in memory of a combat gunshot, a gamma and violent alcoholic father or husband getting another couple of beers on his way to a hard night of clobbering the populace, or a recovering CD person's quick flashes invoking the need for a cold one.

Summarizing within another axiom for comorbid PTSD with SUD, or telling you something you can hang your hat on, or take to the bank, or whichever saying best fits your needs:

Alcoholism causes PTSD all over the place.
PTSD DOES'T cause Alcoholism!

Get to the Point so that I don't Have
to Read this Whole Thing!

So, "is ETM TRT an Evidenced-Based approach to trauma treatment and management or not?" Sort of! ETM TRT is absolutely based on very solid and easily replicable evidence as provided in the book ETM Professional Due Diligence for the 1st Secular Cure of PTSD, by me. I wrote it 20 plus (as in 10) years ago for the University of Houston 3 month long course on Trauma Resolution Therapy: a structured psychodynamic approach to the treatment of Post Traumatic Stress, also written by me in 1986 and taught by our now Master ETM TRT Trainer and co developer of our professional training programs, Craig Carson, through 1990 and in other academic forums until now. That book's purpose was to show How To Do TRT. It was not to demonstrate efficacious performance. That was already done in conjunction with the patient in the highest acclaimed standards for 3rd parties from government compliance for their facility licensing mandates and JCAHO facility credentialing and controls of patient problem solving and progress charting, and etc. Instead, I wrote Due Diligence, originally published in the Development chapters of The Integrated Trauma Management System, the first text attending ETM TRT training later (1990-1994), as an accompaniment to the titles to report that evidence in that history and thus provide a solid legal mechanism for transferring from the authors to the implementing Certified TRT Counselor the means and authority to administer ETM TRT to the public. If litigation were to arise in a complaint involving TRT's application, then we did our part as the authors to ensure that everything possible was given to the new TRT Counselor that would show the courts the validity of the model in terms of our having done our due diligence in making ETM TRT available effectively, safely, and ethically to end users, the public. (I never had any such claims to address from this system, now surpassing 3 decades of care.) The students, of whom each was a licensed professional in his or her own right before studying ETM, were to evaluate this material and only apply it to patients if the professional concluded that the model was based on sound evidence and the best of research.

In approximately 2500 instances of student (professionals) course enrollments, participation and graduation, not a single professional declined to agree to administer the ETM TRT model as demonstrated in the ETM Tutorial, and in the process signifying their own due diligence in the adoption of the model. Thus, although we were applying every bit of the evidence legally necessary for the professional dissemination of ETM to consumers, with regards to the meaning of the term "Evidenced-Based" as it is currently being exploited for purposes of dawa (although Arabic, that term is used prolifically in English) by advocates of a competing ideology, the answer regarding ETM's participation in that actually delusional-based programmatic patient and population harming EB mess is an emphatic, unequivocal, non ambiguous, and forever "Not necessarily at this time!"

Actually, I've just decided that for the benefit of ETM TRT Counselors working within government programs to list ETM with SAMHSA with a special request to do so by replacing the Evidenced-Based label with one entitled Focused Caring-Based. In the clinical setting, evidence doesn't get anybody well. Caring does. But there are even better names for righting this government misdirection. Divide the services into two categories: Nosotropic and Etiotropic.

Etiotropic vs. Nosotropic

Behaviorism is a Nosotropic, as in symptom reduction focused, modality. Behaviorism acknowledges that not only has it always failed in the treatment of PTSD, but it proves its underlying and subsequently constantly obviously impoverished theory of the effects of psychological trauma on the human consciousness to the world by repeatedly replicating its failures and discussing them without any idea that something could be wrong with its characterizations and admonitions. That is, they opine, unresolved psychological trauma is an intrapsychic problem, malady or mental health disorder and illness that only science can successfully solve. "Only" justifies supremacy doctrines that aggressively preclude competition through political and exclusionary tactics. Another way of saying that, someone once said during the era attending the turn of the millennium, "It's our way or the highway."

ETM TRT's Etiotropic approach on the other hand, when indulging philosophical characterizations of the issue, views psychological trauma as a very sophisticated phylogenetic brain and perfectly logical integrative process of both psychological and neurological extinction of the identity that existed before the trauma causing event occurred. TRT proves that thesis by recording in writing etiology's acknowledged facts pertaining to the initial trauma causing event. No one makes suppositions about causes of behavior during TRT's facilitation. Thereafter, the recording of fact continues as thoughts and behavior that actually occurred at the moment survival initiated the need for some kind of protection. It, too, is facticed (new word to mean the process of recording fact) with a timely recording of the very necessary survival response. Thereafter, that factual record enlightens a third party observer of a 2nd ETM TRT axiom pertaining to the address of psychological trauma:

Every behavior, no matter its social vulgarity emanating from trauma etiology, occurs exactly as it should given the relationship of etiology to the person as a whole.

"The proof" of that statement "is in the pudding," as someone else also once said. If extinction is disrupted by exogenous variables (see below and available as a mainstay in training texts), then remove them and the extinction will continue until the integration is successfully completed. Existentially oriented caring for the trauma affected person, which one can find throughout the classic and theological literature upon which our lives have been founded, will go a long way in facilitating that process. Although that method will work, it is difficult within a behavioral performance, disorder-sin-control-obsessed, or punitive driven massive drinking and drug using culture to keep the exogenous (this culture's) variables at bay long enough to complete extinction naturally. So apply TRT's Etiotropically and TRT daedally focused written structure to facilitate the extinction naturally, but with a no-nonsense speed that gets to use the cliché "blinding" when compared to the singularly existential oriented natural approach.

When you're done, you'll see it my way no matter how ensconced you are into that natbrain program where you teach or are taught, and constantly led by cheerleaders to interpret thoughts as coming from the disorder. After being TRT cured of psychological trauma, or as another way of framing that concept ─ extirpating trauma's etiology without hypnosis, chemotherapy, rapid fire talk or other draconian modalities, quick guessing interpretations look like gumballs that roll one at a time out of its glass candy holder and drop down onto the lip where you collect your prize, just another interpretation of how one's behavior or ideas come from their incurable PTSD. And your investment is only 5¢, 2 bits, 3 bits, a dollar?! only for a single Cognitive Behavioral Therapy solution, for the moment. And I guarantee you that if you don't have the money for the CBT Gumball machine, somebody from your CBT group or self help program will slide you an after dinner Chinese cookie with the real truth printed as a slogan on a 3 inch long slip of glossy white front and back paper and prefaced with a large bold face type number between 1 to 12 telling you on which of those Steps you should be working.

I'm not hyping my own product just for saving the world and making a couple of billion along the way. Rather, there is something more important here than trivial individual advancement. I'm trying to say to you that there is a logical path that, if followed and given some cognitive support exactly as does TRT follow with parallel facilitation the natural sequelae in trauma etiology's reversal, provides the Holy Grail to the mental health field: a cure for psychological trauma. So don't think of this essay, please, as an advertisement for a money making machine. I am a bonafide altruist, and only here to help you, said the man from the government. But I don't know how to do it without demonstrating that path through the publication of my intellectual property. To that end, I've made that available to you students and experts of psychological trauma to study but not implement without training in a no charge online ETM Tutorial for 16 years. And if in the process of trying to find that free tutorial you run into dvds for sale of ETM TRT, they aren't it ─ just somebody as usual pirating the work.

ETM TRT is an absolute, meaning unequivocally accurate, accounting of the entire address of every etiological element otherwise historically thought to be unavailable for discussion with Behaviorists. Although some Cognitive Behaviorists and a few psychodynamically oriented degriefers provide an intellectual interpretation of those etiological elements, it is lip service. CBT redirects the individual out of there as a principle of theory. And its therapists are not trained with an existential acumen that will allow them to proceed in to that environment of pain and suffering with the experiential processing necessary to make the passage required to cure the trauma. Even as they try to add their latest grudging capitulation, the earlier referenced Interpersonal Therapy, at least they are catching on to the notion that maybe people do need to address the identity destruction issues, they still are only doing it for the purpose of knocking down symptoms, and horribly also now jumping up into the performance ratings, thanks be to EB. Can't wait for the auditing-for-fraud brigade to arrive to save Evidence-Based, year after year, scandal after scandal, decade after decade.

Some Cognitive Behavioral Therapists state, "I know how to do experiential processing. But I don't think it is best for the client. Better to keep them out of all that pain, and move on with the rest of their lives." You don't mean it? Emotional pain interferes with a patient's upbeatedness? Or did I mean to refer to the therapist's?

Scrignar, who according to the literature was trained by the great behaviorist Wolpe, started the rumor relating to impossibility of psychodynamic models to succeed with PTSD way back in 1987 with his infamous but sort of true statement. Therapist and patient become "overloaded" by the internal damage caused by the trauma. Showing how to really address it without all that overwhelming rough stuff, Scrignar recommended the rubberband snapping method. Put a rubberband around the patient's wrist and teach him to snap it every time a symptom pops up into his brain as a thought. Change to another wrist if one gets sore, and then move on to ankles, ears, neck and then round off to unmentionable gender specific erogenous zones, I wondered? Adding for information, TRT Counselors never become "overloaded" and neither do their patients. When confronted by that fact by a TRT Counselor in a conference for which he was the primary speaker, Scrignar is said to have responded "Well, Trauma Resolution Therapy just makes people want to sue the perpetrators."

It doesn't. But so what if it did? People who have sustained lifelong personal injury due to intent, mental illness, or gross negligence of a perp is not a litigable matter? Although that question is philosophically important to the moral definition of the world at large, the changing legal times as they address psychological trauma damages are answering "Apparently not." Legislators have begun through tort reform to write the whole destructive business off to, literally named, "Heart Balm." And they cap pain and suffering damages as if identity to a traumatized individual never existed. The American culture will rue the day for that legislative travesty.

Alternatively, and in deeper respects considering the impunity from prosecution our political and media aristocracy gets, maybe that's what us ordinaries want, too. That is, the free reign to destroy others' lives through a little thing like unilateral abrogation of commitment to agreement, regardless of whether or not it applies to sex, love, marriage or something more intriguing like how to have a relationship with honesty. But we shouldn't make it a legal norm, should we? Let's just keep it around as something that used to be a good idea, contract logic and law be interred. After all, what's wrong with living in France?

TRT further proves the relationship of etiology to non disturbed-sleep survival responses by taking direct testimony from the victim – patient documenting the known facts regarding the relationship. That fete stands in considerable contrast to Nosotropically initiated dependence on statistical correlation analysis as the only evidentiary tool supporting the theoretical link. And they are trying to get above a 62% rating of effectiveness, which I think is hyped from 18%, if that, in most cases. If after exclusion of the cultural interferences like socially medicating with alcohol they can't get a 100%, they should get out of the business. The Behaviorists, with their Nosotropic only methods of making guesswork out of prospective enigmatically presenting symptoms that are supposed to relate back to some conglomeration of destruction not even identified in the modality, except for the referenced few sharp onlookers who have surmised finally that grief has something to do, possibly, with the symptomatic behaviors, are always astonished that there is a more logical method for skinning the PTSD Tarantula? Rattlesnake? Great White? Sorry, but I do love cats, thus find that cliché application to such a fine animal unbearably repugnant for replication. But, back to this piece. Using the cliché style for defaming CBT and EB, that's something else. How about our dragging out "righteous indignation," "outrage" and so forth over fraud, failure to attribute, forming an illegal oligopoly, misrepresentation? Count on it. If I can find somebody to sue on this scam, I will.

Etiotropic TM facilitates the factual discussions of that inherently natural integrative activity by first removing the interfering variables, including the negative influences effectuated by Behaviorism philosophy and its nonsensical debates over the validity of their guesswork modality and its ever continuous proofs of failed thought in the design of their helping but now obviously simultaneously hindering notions of mental health care for trauma affected individuals. The primary and almost only thing that constant guessing game really does is objectify the whole process pertaining to the understanding of pain so that the helper feels comfortable in charging for the advertised "professional" services. It is harder to find logic for such fees when the impetus for the relationship is nothing more than offering unquestionable caring that is focused upon the incremental contradictions and subsequent losses to identity, an otherwise simple mainstay of the etiology's ever sequitur core. It is especially intriguing for the charger when finally finding out that not only is the previously disordered client probably not even mentally ill, but actually was innocent of the whole thing. But thank Moses, catchy slogans save the day again for the CBT professional: "Hey, it wasn't your fault. But it is your problem."

Countering, Cognitive Behaviorists say "Oh no! We have to teach people who've had their bells rung during combat how to live life in a more edified manner." And that erudite epiphany effect hoping Cognitive Behaviorist preacher keeps shouting her Gospels: What CBTers' have learned in college psychology and doing experiments on the student population is wrong with, excuse me again, I meant "aberrant" about, people. That will make them better individuals, that is, as made over in the Behaviorist's own image, not to mention better taxpayers, leaving patients internally traumatized forever be darned.

What a sad joke that is. Know this! Combat veterans don't need anyone to teach them how to be a better person once trauma etiology in identity has been expunged, reversed, removed, reconciled, CURED! In fact, I've never seen a combat veteran whose trauma has been reconciled need anything from anybody other than love and caring and someone for them to give the same. Cognitive Behaviorism is a clinician self flattering concept that happens to provide for a lifetime paying client for the practice, or ever attending self help group where everyone cajoles "There is no cure for PTSD; so keep coming to meetings so that you can learn how to work on yourself." Substituting the CBT disorder interpretive historic terms Family Disease and Co Dependency for PTSD at the time, albeit, they were the same malady, that song was the Al Anon and ACA (Adult Children Alcoholics) meeting ending anthem years ago. It's probably still sung today at the close. Now we have our greatest and most honored constituents, the American veteran, getting the same unnecessary defeatist – join the disordered world forever and live in serenity - altercall 30 years later! So humiliating for these prodigious defenders of the best that we are!

Not only do combat veterans not need to be taught how to live life, they also don't need to grow! They've done all that while Cognitive-Behaviorists were at the University. Just cure them of the trauma caused by combat, which includes that etiology ─ destruction to identity ─ caused in adaptation to the original trauma (as the great Dr. Bruno Bettelheim noted in his analysis of concentration camp murder victims to be while he was in the camp as one of the harrowed), because that is our liability to them as a free people benefiting from those men and women's offerings of themselves. Then, if they want to go to college and study whatever they want about human beings, or join growth groups just for general personality enhancement purposes, or find a spiritually meaningful religion, or be a non edified mechanic who loves to fix things and make the most complex technical machines run smoothly as my good friend Ray Nora, bless his magnificent fighting heart and who took one through the head in his ordered second tour, wanted to be in private civilian life when he got back home.

To make sense of their ideologically created phenomenon, and to keep funders from catching on, Behaviorists have coined and championed the same obfuscating mantra referenced earlier being sung in the Self-help Chemical Dependency Family Disease groups. Restating for emphasis this Cognitive-Behavioral perpetrated misrepresentation and fraud: "There is no cure for PTSD!" And of course that obviously is compounded into truth when treating SUD as a symptom as described above with the thought that once  the PTSD is brought under control, that maneuver will also teach people that  the resulting obsessive drug use and attendant bad behavior is not good and, too, should be controlled also. What a convoluted and unnecessary to boot mess! Are you PTSD guys trying to take us aging Chemical Dependency fighting gladiators all the way back to controlling documented pathological chemical use as manifested by Alcoholism? Sure you are, referring to the always over shouting contrarian-based bandwagon-jumping Behaviorism marketers' representing the controlled drinking establishment. Good marketing idea, changing the name back to "controlled drinking" from Moderation Management ─ kind of a catchy term, especially given the wonderment the acronym draws upon, or steals from. What a story! The only thing I wanted to source in this essay. See MM's creator, Audrey Kishline's, Dateline interview with Murray.

How do you think we were able to re codify the former Chemical Dependency's complete abstinence from all psychotropic substances approach, which was hallmarked within the helping cultures in the last half century of the previous millennium (from the 1950s until and thru the 1990s) by the disheartening but intrepidly (by the correct side) fought battles ongoing between the mental health Behaviorism-based professional and Alcoholism recovery constituencies as the latter worked their modality requiring a chemically free life into the mainstream of healthcare. Those fights occurred as very substantial conflicts, but have now been abetted into an apparent armistice where the once ferocious Chemical Dependency has been finally disabled down into a multifaceted and always confused behavioral disorder, now just lingering with lesser enthusiasm for the un cool Disease model and as only another part of the DSM. The new name has considerable political overtones pandering to this and the next generation of masters level counselors sanctioned, at least during Spring Break, by this heavy and alcoholic drinking and over drug using culture, thus always constantly producing, and assuring for infinity trauma causing events at a rate equivalent only to the nuclear fission reaction. In the plural form, the newest professional enabling nomenclature is most appropriately called SUDs.

But, what about the flashbacks and psychotic nightmares? No problem! Hit the evidenced-based GO key and up flashes the answers on the screen: Respiradol, Lamotrigine and Paxil. Whoops, there it is again, the number 1 pharmacological cure prescribed to literally thousands of our wonderful but PTSD affected Iraq War veterans on return to America even while a couple of VA psychiatrists in the know were refusing to withdraw anyone from the drug because of the enormous danger otherwise made known as far back as 1999. Oh? Then let's just ease that last little workhorse out to pasture and especially off the monitor until someone figures out how to detoxify veterans after we've made them well (well?). And on top of this potpourri for Evidenced-Basers, if the therapist is dumb enough to let the patient keep drinking during treatment of PTSD, even if not using the polypharmacological supports, then that professional and the attendant group of scientists' studying this Tomfoolery are, as the enlightened humanist and now often quoted philosopher Johnny Lee said to music, "Looking for love in all the wrong places."

The Behavioral Scientists can't see their EB strengthened system as silliness, however, without being able to cure psychological trauma or PTSD completely. From the cured perspective, when one considers the referenced constant failures' effects on individual trauma victims, not to mention the imbecilic braggadocios advertising of their hamster exerciser circular mind interrogation ─ the colloquial expression for "interrogation" or self analysis is although much rougher, also clearer in its meaning, but regrettably is not admissible here ─ treadmill approach to PTSD treatment, it does not seem so funny! The "Evidenced-Based" hegemony motivated cry of the Behaviorist – scientist of today looks, as viewed from the TRT Counselor and the TRT cured patient, not just like malpractice and malfeasance, but more like a 2 word slogan based proselytization model. It makes marketing managers for virtually all religions in the country envious. Why couldn't they, they ask, figure out how to get the taxpayer to pay for their religious-based programs, too, with direct cash no less?

Think that's over the top ranting? Say the words "complete resolution," "cure," or "etiology reversal" at a Behavioral Science leadership controlled professional conference on PTSD, and you'll find yourself trying to sink instead of float when bound and thrown into the Witch's Drowning Pool at Þingvellir. Now that was evidenced-based problem solving at its finest! As a memory refresher for those of you who've studied this precursor of the EB modality, and for those for whom this historic scientific methodology is new, Iceland tested for evidence of witchcraft and adultery by women by tying them up and throwing them into a deep pool. If during the test a woman sank and drowned, the evidence showed she was innocent. Alternatively, if she floated, then the evidence and test proved she was a witch or guilty of adultery, whereas she was then burned at the stake. The most ostensible flaw in the methodology was demonstrated by mostly thin ladies sinking, and fat ones floating, as I am told, unless of course thin women tend to be chaste and mainstream religion believers and the more robust promiscuous and spiritually wicked. That science testing apparatus was no longer usable, however, after the country outlawed capital punishment across the board in 1841. For those not getting this, that means that after the program got rolling in practice, thereafter becoming an established part of the norms and mores of the culture, evidence-baser sheep couldn't address the shortfalls in the science's theory by themselves. It took someone from outside to finally shut them down. I apologize for the slur against sheep.

In the end, psychologically oriented therapists and scholars will discover that Nosotropically based forms of objectification of the process, if carried into the treatment environment for psychological trauma, will disqualify the helper in the most stringent thought defenses deeply imbedded within the etiology protecting components of the trauma affected Survivor, strengthening them in perpetuity. Caring deeply for people at the source of trauma caused devastation to identity, on the other hand, mitigates those defenses, allowing for a cure of psychological trauma and its often enigmatic, that is, hopefully helping but quixotically always hindering symptom-codification-approach-to-human-problem-solving term, PTSD.

But still, say people who don't fight over thought models as assiduously as do Christians, Jews, Hindus, Islamists, Buddhists, Zoastrians and Behaviorists, what's the big deal over a little psychobabble? While doing the intricate logic that formed America's by-laws created during the American Revolution in 1777, a principal architect, first Vice President and 2nd President of this country John Adams, wrote to his wife, Abigail, his opinion of a formerly illiterate person's endeavors to become educated. Adams, in his time in that congress and during his representations of the revolutionary government worldwide, had held positions of great power and authority, in the process communicating constantly with the finest minds this country and others had available to it. John and Abigail were, themselves, students of the great classics, philosophers and religions of all time.

Mr. Adams, also one of the earlier Harvard graduates and a privately trained attorney, and raised on a farm in Braintree, Massachusetts, was rigorous in his constant admonitions to his children stressing academics in writing, philosophy, logic, science and art. Few people contributed as much to the formation of this country's system of balance between thought models that assured individual freedom would remain equally offset against the collective interests of the population as a whole in its needs to care for individual aspects developed under no government to speak, but simultaneously protect all from wrongdoings, which required some central social controls (employing the rule of law, that is, controls on behavior, but stipulated not to control thought or being). No one had provided more character dedicated to the discipline of objective rational thought no matter the selfish, highly emotional and deeply grieving elements that stressed the logic of the new order during the American Revolution. With that grand compendium of education and experience supporting his philosophy, here is what Mr. Adams said to his wife who was tutoring the man seeking self betterment through academia.

"But let him know that the moral sentiments of his heart are more important than the furniture of his head."

Such is the basis of the Etiotropic as opposed to Nosotropic approach, except with a caveat being that the former has incorporated a discipline into its structured thought that makes safe the total journey into complete understanding of the trauma and its effects on the existential fiber only barely separable from the ontology of the traumatized person. The idea bonds helper and victim at their moral hearts, not in the furniture of their brains, as the incomparable Mr. Adams placed the value on literacy, eventually in academia to become science, and with an extension to the Evidenced-Based concept being vetted by its competitor in this cause.

As the Evidenced-Based system of mental health management becomes established through federal grant and state funding, it will act as a huge grading machine, and not unlike Adam Smith's economic treatise for capitalism's "Invisible Hand" operating over a country graveled road always adding more base-coarse and ground rock and trying to smooth out the bumps and potholes following the last storm, but never fixing the underlying structural problems that, in these two metaphors, plague, desecrate and in the worst instances sunder seemingly completely the heart. It is this most perplexing force that cowers analysis and torpids reason making it even more difficult to mend the potholes descending into our social management models. More egregiously, those repetitiously raked and grinded rock roads and especially the recurring potholes metaphor out, not just as social management deficits, but as us governeds' brains and minds.

Although the extended meaning of that analogy would be better saved for discussion in another forum, I will give you a glimpse into its content. Curing psychological trauma, and I mean with no if, ands or buts, removes both its enabling and disabling characteristics that preclude clear views of cause and effect. That non trauma fettered perspicacity is fundamental for the maintenance of true and full intellect otherwise necessary for judicious management of not just the individual Self, but of a free thinking society as a whole. Symptom management, or in this EB application referenced as Disorder Mania, set into foundational cement as if ordained by a new great authority from the supreme technosphere, is a direct affront to and assault upon individual identity and thought, otherwise constitutionally and magnificently protected in this culture. The elements of our individualized and then collectively shared thought represent both unique and same states of being. They must never accede interpretive power and thus social control to a narrow if not myopically affected polity operating out of an elitist mentality ordered by nothing less than peer revue (not malapropism) journals: when publishing for the Behavioral Sciences, they are in the main the ruminations of psychiatrists, psychologists, scholars and other scientists vying for career advancement and prestige, and who do not as a whole have the faintest idea of the full strengths required to study the complete human condition, including those nasty, subjective, and confusing, but thank God they are only primal, emotions. That last clarifier assures for us more cerebral-based nonpareils that at least our next generations will not be so encumbered as have been we who had to work so hard to overcome them ─ those ever onerously humbling negative feelings, that is.

And even though their titles sound good, these probably fine people in their rights as citizens are more often than not, as also I will explain in another post on this issue, overwhelmingly impaired by the same illnesses – disorders, especially to include those imposed by psychological trauma and pathological chemical use. They, like the constituencies they serve, are still trying to find out what hit them, too. My contention regarding the authoritative sounding Evidenced-Based machinery being constructed by them for managing the more difficult issues harming our society is that we don't need another Supreme Court, especially one comprised of who knows what, and managed by no one who has a little plain public common sense, not to mention having a broader, as well as much more profound understanding of the human consciousness and its functionings than have those followers and advocates of Behaviorism.

Someday, estimating maybe 70 to 125 or so years from now, after psychological trauma's professional address with Nosotropic concepts underpinned by Behaviorism philosophy have been replaced with the Focused Caring-Based paradigm and epistemology that I made up, or possibly something even better might present out of the creativity patch by then, the Behavioral philosophy grafted from nearly several thousands of years old stoicism-only way of living life will be looked back upon as having been nothing more than Behaviorism advocates' needs and stalwart attempts to protect themselves from their experiences of the patients' or trauma victims' destructions to Selves caused by the apparently never ending traumatic events the professional is trying to manage, and in the process protect those kinds of helpers, understandably necessarily for them individually, from having to see similar destruction to their own lives no doubt caused by like events. That slight phenomenon requires seeing people as objects for study, and caring for them as in with a little bit of fusion, as the first professional sin. Thus, the industry is always interpreting itself out of the very and absolutely only capability it has to cure psychological trauma, the number one public enemy for humankind. Now I don't mind if they sit in that mental incubator for life by themselves and with their people with whom they come in contact. I just don't want them to interfere, as they are with mandates for EB participation, with me, my protégés', and whoever else has ascended to this level of care.

Part Three

Etiotropic TMT System Philosophy and Epistemology

That underlying and almost unknown individual devastation, whether sundering identity of laymen or professionals, does not exist in a vacuum. It connects in all and overlapping systems, starting with trauma shared in a single relationship, expanded to the next level – a family, then to neighborhoods, schools, treatment centers, combat units, EMS organizations, local communities, states and nations as a whole. As individual trauma moves down and into its farthest recesses, therein it becomes as in Zen, one with all trauma victims. In that shared world of hurt, and of course that nor any word is adequate to explain what is truly shared, everyone has been destroyed exactly the same. Believe that no matter my competitors' arguments about trauma's unique effects! In that extraordinarily pain-compounded but simple world, trauma becomes a confluence not unlike a thermo-trauma heated underground reservoir of a seemingly ─ to Nosotropicers anyway ─ impenetrable holocaust of human suffering. Regardless of the toughness of individual consciousness, their combining damages to identity flow across but underneath the surface boundaries of abstract intellect, providing the cause that binds damaged souls together and draws trauma affected therapists to their trade.

As always is the case, though, for psychological trauma's defense, and especially in its systemic sense, the unaddressed molten undercurrent precludes the affected and their helpers from knowing the full answers. Disastrously occurring and perdurably recurring bizarre, inimical, duplicitous, odious, pernicious, enigmatic, shocking, senseless and finally fatiguing behaviors exploding on the surface do not change ─ presenting and representing over generations, centuries and millenniums. But always flowing below those outward notions of confused and convoluted lives and events, and even as the edifying Evidenced-Based modality moves in to bring its new controls, in the final analysis they only form a slightly heavier manhole cover which serves to hover atop the fissures that cascade down into that ocean sized cauldron of unresolved trauma so unimaginable that it is describable only in the poet's vision of the Inferno. As long as it exists, as it has since the beginning, that unrequitable hell runs the whole internally fuelled and since before antiquity forever extant, but presenting for the Behaviorist only externally, social pathological shebang: trauma begets trauma. Not deep. But exact.

There is an answer to this: the Etiotropic epistemology. It drills down into that abominable morass, one well at a time, each sending the purest healing waters channeled from the deepest cool clear bottomless aquifer ever known, humankind's capacity to care for and love one another. And it delivers that care precisely on target at the most intense locus of combustibility ever imagined, but as if 10 billion fire hoses each manned by our bravest of firemen closing on the demon pain, pouring all that they have from their hearts into the core, turning that formally thought indomitable unquenchable catastrophe and horror into nothing but steam evaporating as condensation to perpetually refill their strength, the deep lake of human caring. As more wells resolving individual traumas go down, the liquid grace flows over and into that formerly thought to be unfillable hellhole, but now with every individual trauma cure quieting it, soothing it, cooling it, and finally sending it into an oblivion so ethereally pronounced that when the fire is out and gone, no one will even remember that it was ever there in the first place.

But, say those who argue that we can achieve the same ends through some serious education directed as fire extinguishers on the hopping hot surface, and then covering the blow off valves with a ready supply of erudite band-aids to prevent those eruptions from always exploding, at least long enough so that we don't have to think about what's down there all of the time ─ "Why would we do something apparently incongruous as you try to dramatically paint it as so repeatedly ineffectual and causal of more heartache, when we are the elite, the wonderment of men and women philosophers and students of the human being?" After all, they tell us that educating the trauma affected underprived or other bad actors so that they will choose a more edified lifestyle and stop beating up on and killing people has got to be the wave of the future! "Don't you think?" No, I don't! And this answer is very important to this ideology. But I'll have to explain that negative response to our leaders' hopes for education's social problem solving influences in the section below entitled "The Survivor." But first, next is a summary of exogenous variables and why they have to go if curing psychological trauma both individually and collectively is the goal.

Exogenous (Cultural) Variables that Preclude Psychological Trauma's or PTSD's Cure

Exogenous variables interchanges synonymously with "cultural" variables. I used the former during week long trainings because it kept the audience nonplussed until they knew what trauma resolution meant in practice. Otherwise, people think they mean prohibition. They don't.

Regardless of the prejudices carried into the ETM epistemology by professionals who are social drug users, the variables pertaining to social or medicinal use as de-stressors must be removed from the treatment environment, but always by doing so ethically.

For example, one variable that will interfere with the 100% cure expectation is application of pharmacological therapy previous to or in concert with TRT's application. The ethical issue, of course, is to not interfere with a therapy provided by alternative treatment. Consequently, people functioning under medication are referred back to that provider for continuing care. Moreover, we encourage, even require, depending on whether or not we are already involved, that the individual not attempt self detoxification for the purposes of participating in TRT.

Also, I'm presenting this summary in this essay obviously because the noted variables interact with the previously described co occurrence of PTSD and SUD.

Apply TRT after removal of the following variables, and a trauma cure will occur 100% of the time when ETM TRT's criteria for application are strictly adhered to. Certain exogenous variables and one model prospective limitation [e)] can prevent that 100% cure. If not removed from the treatment arena, the exogenous variables that will break the 100% rule are:

  1. A parallel application of psychotropic medications and previous applications of the same even though the patient has withdrawn from that use, but in the latter depending on the extent and kinds of medications used over time.
  2. Periodic social drug / alcohol use (not chemical dependency – see "c)" next), for example, the patient engages in TRT group on Wednesdays and drinks two beers on every Saturday, and no other alcohol or drug consumption occurs during the week. Of course, the non Chemically Dependent social drinker may return to that use after completing the therapy's full application to a particular source of trauma.
  3. Comorbid issues, such as Bipolar Disorder and Chemical Dependency are presenting parallel or in concert with the PTSD (where non pathological social use is treated herein as an exogenous variable that will preclude reaching the cure phenomenon {see above "b)"}, pathological drug / alcohol use is addressed as a primary issue of its own and one of the sources of trauma that should be addressed after the patient attains substantial sobriety within the ETM multiple sources definition and instruction for treatment).
  4. The application is made for the purpose of controlling or ending symptoms rather than for resolving the trauma, that is, reversing the trauma's etiologies, or the person is engaged in a rigorous PTSD Behavioral Modification or Cognitive Behavioral Therapy control program parallel to TRT's application.
  5. The traumatic event(s) occurred before the age of 3 years (not an exogenous variable, but the referenced limitation of the therapy; it can, however, possibly and even likely be addressed by TRT if done so within the multiple sources of trauma TRT application guidelines).
  6. The traumatized person is currently being exposed to an ongoing threat to the continuity of life as in the role of the battered spouse or participation in immediate combat operations by military personnel.
  7. Undefined head injury.
  8. A TRT psychotropically medicated, social drug / alcohol using, or Chemically Dependent using TRT Therapist.

As demonstrated in the ETM TRT literature, some of these variables can be circumvented or mitigated such that the quality of resolution approaches, but usually does not wholly attain the complete resolution or cure goal otherwise available without these variables' interferences with the application. TRT can produce fine results, meaning to increase substantially cognitive clarification of what happened to the person's identity because of the event(s) even when all the exogenous variables are not considered. But those outcomes based just on cognitive understandings are not what reverses trauma's etiology, thus resolving completely or curing the trauma. Instead, that requires application without a variable's interference of TRT's engine, Etiotropic Incremental Fusion Induction (EFI), in concert with the TRT's facilitating structure. In lay terms, that professional naming nomenclature provides the basis for the name we advocate for solving what CBTers call the traumatic event's "internalization" as Focused-Caring. Therefore, not addressing all the variables will not allow the patient to achieve the best that is available had the referenced variables been addressed by ETM's formulas and guidelines.

But there is bad news here also. Not addressing the variables can have in some and not necessarily always predictable application negatives that reduce performance of TRT to the level of Cognitive Behavioral Therapy, or even adversely affect a patient who has already been harmed enough by the initial event(s). Such people do not need the risk of a malfeasant therapy experience when errors can absolutely be avoided by following the directions on the box.

These issues, that is, identifying and addressing the variables that will preclude psychological trauma's optimum address, may tend to dampen one's enthusiasm for becoming a TRT clinician. They should and are placed in this essay with the intension of dissuading from participation with TRT anyone less than is the therapist who is dedicated to helping people by simply identifying the trauma's etiology and in the process removing the pain that attends it.

Incidentally, that pain is not removed by teaching people to intellectualize, condescend to or in other ways control it cerebrally. Cognitive Behaviorists, dating all the way back to the Skinner – Rogers debates, hate this answer. Nevertheless, it must be included briefly here. Emotional pain must be experienced, not as a free floating mass of explosive air bursts coming together in a giant and often hysterical catharsis, called abreaction or for us simpletons, grief. That has nothing to do with anything pertaining to resolving trauma. Instead, each feeling that is attached to each and every loss attending every single trauma intrusion on, decimation to, ripping apart of, or tearing asunder of the existentially based ─ also as beginning to be referenced now as "core" ─ elements of identity, that is, the values, beliefs, images and other realities comprising that person, must be facilitated experientially between therapist and patient and in the best application with all group members. When it is facilitated orderly, which occurs on every single occasion that TRT's structured Matrixes' organizing all that formerly, and hysterically, opined by Behaviorists to be "overload" material in an easily negotiable as in incremental manner, each emotion and its identity contradicted forming loss is identified, experienced with another person or persons through focused empathy, and then dissipated. Gone! That is what TRT does; it removes ALL of that pain when applied within the parameters described here.

From the choir, although putting up with these issues that influence the extraordinarily fine level of output one gets can be onerous in some cultures, I'll assure you that seeing an individual completely cured of a previously thought to be incurable condition, in this instance referring to PTSD occurring from whatever source, and experiencing that outcome as a facilitator of it is well worth the commitment to the discipline required to achieve that cure. That is why my wife, Nancy, Craig Carson and I have applied so much of our lives and personal resources to making this phenomenon available to those who need it. For a little more clarity with a summary of this ideological showdown, our structure, again for advertisement purposes called Trauma Resolution Therapy (TRT), has allowed the plain human sharing accurate empathy preaching Rogers to have kicked the more tightly engineered intellectualizing Skinner's butt in this survival of the fittest battle over who gifted us with the wisest interpretation of the human consciousness.

Educating the Survivor

"So what's wrong with education? That's been humankind's hope for producing better and reformed people forever." Well. It's not enough. The psychological traumatized person's Survivor filters the information in a way that precludes the trauma from being resolved. That's why B.F. Skinner said in a video interview for his latest book, whenever, "I'm disappointed! I thought if people (apparently referring to us plebeians living within the masses) were educated, they would act better." ─ or something pretty close to that.

Can't get much more educated than a psychiatrists working with PTSD and SUD affected combatants at good ole Walter Reed, again, now can we? Maybe he was part of the 200 hundred hired on by the DoD Secretary to quell the controversy after the last scandal.

If the trauma's complete resolution were allowed to proceed undeterred by cultural (interchanges with previously referenced "exogenous") variables, then what purpose would the Survivor who was created when the devastation to original identity took place, serve? None! It was only created when the traditional controller or operational aspects of identity was pretty much smashed during the event ─ then resmashed in successive ones as in repeated exposure to multiple combat traumas over a full or several tours ─ as a temporary and stalwart protector during the brain's integrative process. As the integration proceeds or progresses absent the interfering variables, that Survivor naturally losses its influence. It is needed less as the integration goes forth. To complete that function, the brain has provided copious extinction facilitating neuromolecular interactions between predominantly the Noradrenergic and Opioid neurotransmitter systems. But the Survivor, which has protected the person as needed during this activity and which maintains conscious control, filters all information, erudite education or otherwise, coming in to the organism.

So if a Behaviorist talks some poor soul of a trauma victim into changing his or her behavior before the original destruction is repaired, then the commands to change the behavior threaten not just the Survivor's abilities to the job, but induces the Survivor to conclude that his or her entire life as it is consciously understood will dissipate, leaving the trauma affected person still trauma affected and still vulnerable, the protection from which explains the Survivor's existence. Hence, the Survivor finagles the Behaviorist's shallow if not inane attempts to strengthen controls by effecting behavioral change; the Survivor appears to comply with the entreaties, but in reality only gives appearances of making changes that suggest that they are back in control and adapting changes that are acceptable to the interventionist or self helpers, depending on whom is giving the advice regarding how the trauma affected person should think, feel and act. What better way is available than adapting the model of never ending and obsessive compulsive self analysis of one's thoughts and behavior, always readily supplied by the Survivor who is consistently fueled by the continuingly stored original damage and now which is being added to in the second etiology development's case by the failed and unnaturally controlling Behavioral Modification. "Keep coming back for the rest of your life; it only gets better!"

There is an even more formidable issue for the educational solution to overcome. When a traumatic event occurs, it becomes recorded eidetically in memory. That recording is established by a hyper process of Long Term Potentiation of synaptic traces all modulated by the Hypothalamus Adrenal Pituitary Axis (HAPA) operating in full out blow and go activity simultaneous with inhibition, thus Long Term Depression, of the Synaptic traces housing the original identity existing pre event. Included with the HAPA stress response is the activation of the Noradrenergic and Opioid neurotransmitter systems, also functioning at 150% of capacity. Where they provide the substrate with HAPA of the initial shock and catharsis elements of grief, the Noradrenergic produced neurotransmitters effectuate the plasticity required for new synaptic development and modulation of the old. The intensity for this process operates at the extreme, which the brain phylogenetically provides for its integration of the rapidly imposed change.

When the cognitive component of Cognitive Behavioral Therapy is applied as education at a later time in an attempt to help people to identify and then control their thoughts, feelings and behaviors resulting from the substrate's ongoing movie replaying of the event in memory, and most of the time unconsciously, the supposedly illuminating information enters this system without a comparable HAPA charge for providing new edifying synaptic trace development. Where it is supposed to, at least as hoped for by its theorists, to provide a countervailing synaptic molecular learning experience to overcome the internalized trauma movie, the educational impetus is woefully inadequate to the challenge.

Education to the stored traumatic event is akin to slinging individual particles of bird seed at the alligator hide back of a prehistoric crocodile that is about to eat you. Throw some alcohol, opiate or Cannabis molecules into that substrate and your educational program is whistling Dixie. Worse, you are about to find yourself being rolled underwater like a mincemeat ragdoll in the jaws of a croc that otherwise is so happy and nearly fulfilled that you did not know what you were doing while wandering around in his jungle.

Objectification thru the guise of science, very frequently being administered by similarly affected scientists, which is allowed to only measure what it can see, meaning behaviors, provides a method that allows the scientists to study others without getting too close to the healers' own secrets, most notably kept even from themselves. They try to make other PTSDer's do the work so they can participate fairly closely to the real answers, but not too close. ETM TRT, which precludes any reference to or attempt to change symptomatic behaviors, neutralizes the Survivor in both patient and helping scientist / therapist, in the process providing one no uncertain path out of the negative system synergism created by the newly EB systemically contained and enmeshed horrendous pain and suffering hallmarked by sadness, loss and chaotically perplexing attempts to help, but which simultaneously torpid the polity into exacerbation.

The only helping effort that gets past the Survivor's controls is with respect to Dr. Rogers, not just "accurate empathy," but by focusing therapist and group members caring for the person directly upon ─ that means
without deflection into unrelated issues like learning someone else's notions about living life ─ the depth of the destruction to which they have been subjected. And, that level of caring has to be, if curing psychological trauma is the goal, provided no matter the untoward survival behavior emanating from the trauma's maintenance in etiology. You don't have to motivate the trauma affected to become responsible and take care of themselves, especially as therapists take care of themselves. In the case of our magnificent American veterans, anything less than this level of unqualified caring and gratitude is an affront and patent disservice to those who gave extraordinary, meaning the part of the job that calls for exposure every day to risks of the continuity of life, above and beyond the call of duty service to and for us.

"Where's the Beef?"

Asked the lady presenting her two opened and almost empty of the patty hamburger buns to the hamburger chef. It lies in the issue of control.

At the core of the address of the disorder, as opposed to the injury, is the issue of facilitating a return of thought behavioral control appearing to have been sundered by the initial experience. In CBT, that control is facilitated with the Survivor, again named that because the affected person is still in survival. As the CBT modality is discovering the decimation of identity, it tries to reconstitute it didactically. The patient while in survival listens to these instructions to figure out cognitively what he or she was so that the attending values, beliefs, images and realities can be consciously – cognitively reformed or re decided upon as appropriate individually. Sounds good, doesn't it? But it's not! As long as that conversation about reconstitution is occurring with the Survivor, the new adaptation or coping process is still vulnerable to the deepest incursions upon that identity locused in the unconscious. Thus, cognitive interpretation by the therapist and patient or Survivor in this instance will assure incomplete reconciliation of ALL identity sundered components. This is why CBT or in other terms Nosotropic epistemologies and methodologies cannot completely resolve or cure psychological trauma and especially its more entrenched behavioral manifestation, PTSD.

The beef lies in the clinical or any helping response that facilitates individual passage through that identity's destruction by assisting the person to identify and share with another person or persons, as group process is more adept at this facilitation than is individual therapy, the concomitant experience attending that identification. Don't tell them to reconstitute anything at that critical point in the resolution process (which is a structured component of our approach to this issue). Thereafter, every loss directly resulting from every contradicted or sundered value, belief, image of self or others and reality will present for experiential processing without cognitive interpretation by the facilitator. It is for the patient a passage through a vacuum of nothingness that he or she has become in direct response to the original event. Using our structure, which requires a highly disciplined and directed control of and for the temporary and incremental fusion of lended identities allows that passage through that otherwise "Valley of the shadow . . ." without uncertainty, fear or for certain without the experience of terror. The passage does not just occur once during the clinical moment. But if allowed to proceed as needed for and by the individual doing the processing, the passage will continue for a short while, but always in a time certain.

The structured resolution presents a finite ending of the loss not just at consciously identified levels, but at all those previously stored in the unconscious. For those of you who have uninstalled software on your computers, you know that the operating system only does a partial job of that removal, leaving remnants scattered throughout the system's interior. Although you may not see them in your directories made viewable by the operating system, the partial remnants exist in places like the computer system's registry. Eventually, that area clogs the system's functioning, symptomatically slowing the speed of your system's performance. Eventually you will learn, if you don't know already that special registry cleanup softwares search assiduously for those remnants, removing them as encountered, in the process restoring performance. That analogy is intended to explain how a structured approach such as we use focuses all participants' capacities to care upon that person's most profound and usually hidden locations of destruction to Self. And now you know the meaning of "complete resolution."

If not interceded upon by cognitive behavioral attempts to save the person from that journey, as do people who are still terrified of its prospects within themselves make such attempts with those around them, the brain's natural, meaning phylogenetic, capacities to do its own reintegration will fully do the job, and in accordance with that person's understandings of Self, conscious or otherwise. The previous event caused damage to identity will be gone. The manifestation is the person's complete understanding of who he was prior to the event, who she became during the event and thereafter, and who they both are now that the trauma has been resolved completely. The Survivor fades from existence as its previous underpinnings, again being the decimation to identity caused by the event, have been expunged. The Survivor is no longer needed, and again, simply because the person is no longer operating in survival. The trauma has been resolved. Control that emanates in concert with the established identity representing that individual is fully restored as naturally attends the basic characteristics of non traumatized humankind.

Etiotropic Trauma Management and Treatment is a Strategically Ontological Epistemology

In this section heading, the phrase "Strategically Ontological" is intended to turn an apparent oxymoron into a two word summary of plan, purpose and methodology for ETM TRT. As stated throughout this essay and all of our work, beginning in the late 1970s and early 80s, trauma's etiology was found to be and still is located in existential identity as trauma caused contradictions to values, belief, images and other realities representing identifiable and quantifiable elements of being. Other investigators of psychological trauma, virtually all from the CBT concept of trauma's address, have recently focused on identity, that is, beginning in 1992. But they began to argue for something slightly different as recently as 2009: the complete destruction of identity by trauma. The difference from our view is that the lesser understood aspects of ontology (or being) make available — under structured address — to the human consciousness special and more nebulously defined traits and resources such as creativity, which encompasses the experience of a broader Self or spiritually (ETM TRT is a secular based model). These brain phenomena are also of the core neurological capabilities that produce music, poetry, prose, intuition, other art forms, the capacities for empathy, fusion and other sensibilities, and love. Although these components of ontology are integrated with existential identity's values and etc that are decimated by the trauma, we've long argued that ontology itself is although quashed for long periods subsequent to the traumatic event(s) — still intact and readily available to draw upon for curative, as in epiphanologically presenting in their meaning, strengths when addressing the referenced contradictions to the more obviously sundered identifiable values, beliefs, images and other ideas and ideals. We have found that ontology may be facilitated from which activity the patient may draw upon it to remedy the damage done by the trauma to the noted identifiable components.

We have applied that facilitation at four levels.

Firstly, Trauma Resolution Therapy (TRT) functions as scaffolding, thus a meta therapy, to diffuse the effects of psychodynamic overload by organizing support for and of incremental identification and reconciliation of all intrapsychic, interactional and systemic identity elements' sundrances by an event(s).

Secondly, some cultural influences (in Western Civilization's norms and mores described above under "Exogenous Variables") interfere with the use of ontology to provide that ready address of trauma's damage. Here, ETM adds to its meta therapy more structure declaritively precluding those variables from interfering with the identity's ontologically focused address. That structure acts as an additional meta therapy which strengthens the environment or clinical module where ontology can be tapped for reversing the trauma's intrusions upon existential identity's values, etc.

Thirdly, ETM TRT supports organizational management intervention on trauma's systemic effects upon system decision making with the intent to dissipate those effects, but always through strategic application of the ontologically focused module created by blocking the referenced variables and assiduously following the TRT administration rules.

Fourthly, ETM TRT blocks perpetrator projections onto and thus subsequent exploitation of pathological systemic control dynamics of individuals and systems, the latter to include families, groups, formal organizations and entire cultures.

Hence, the term in this section heading, "Strategically Ontological."

Save the World, and Preferably America First, Now!

Rather than just tearing down the competition, and then leaving our culture with no apparent hope for getting better without the Behaviorist's rabid co contributor system of scientific racketeering styled obfuscation, try this approach. It is real and has been around for 30 years, tested, acclaimed by the highest authorities, and proven to work and in the trenches for nothing more than a few thousand dollars in training employee expense; not the jillions the CBT EB government merger will cost when it really gets off the ground.

  1. Set the ETM epistemological stage or clinical environment: establish your goals to identify and expunge trauma etiology, not teach people to live with it.
  2. Establish your management systems so that they remove the referenced exogenous variables.
  3. Identify with ETM's Multiple Sources of trauma formula every source of trauma, following directions explicitly for which source to address first and so on.
  4. Identify with TRT every trauma causing event (within every source) and its directly implanted etiology on individuals as defined in ETM TRT, and as each affected person and system presents, regardless of whether the events are long or near term in their happenings, and regardless of the number of events or myriad sources of trauma to address, or the degree of psychic devastation caused to any and all persons, and regardless of whether or not symptoms of so called true PTSD are presenting as the trigger for initiating care.
  5. Cure each and every person of all traumas' influences for the near and all time by incrementally identifying the patterns of etiology caused by each event, and then reverse, remove or expunge that hosted cause of so much protracted and previously thought to be immutable pain and suffering.
  6. Apply Strategic ETM to social business management systems, doing the same for them you do for individuals. The effects of the application on organizational functioning to emphasize decision making are also the same. Removing trauma's systemic etiology strengthens management of perpetrators and the causes of those who can be prevented from becoming such a repeating catastrophe for humankind.

"That," as the song asks, "is all there is." Can you imagine? I believe a guy wrote some lyrics about that, too. After the trauma is done, nobody will need to measure anything. No one has to manage anything. There'll be no more humongous bureaucracy that grows with every new war, overlapping drug doped bodies decimated by uncured trauma on top of each other as every new decade passes. And every political persuasion will want to fund it. Why? Because it will with assuredness, the feeling of complete satisfaction that comes with unequalled success, augmented by the congruity attending knowing what is right and doing it, and comforted by the absolute confidence that the traumatic condition once known as Post-Traumatic Stress Disorder will be gone, dissipated, over with. That is to mean, psychological trauma is no longer an unmanageable disaster for humankind, forevermore.

This counterattack by me ─ as the author of another helping paradigm ─ upon which my work has shown to be the bête noir of psychological trauma's cure, would be totally unnecessary if the federal government elevate into its principles, not just giving it "Notes" play, the use of legal definitions, that is, logic and reason as decided by a jury, for evidence of treatment effectiveness instead of those coming out of the application of laboratory styled scientific principles applied in conjuring this kind of Evidence-Based definition. Return the database of truth to the full public and free media through all publications, not that bigoted and prejudiced body of literature called peer review journals. Furthermore, the federal, treatment and academic leaderships who have conjured this bureaucratic systemic psychopathological catastrophe can be intervened upon successfully in an open forum of real discussion. In a fair arena, thanking somebody for the Internet and given that my health allows me the time, I would enjoy addressing in that debate their phony claims to intellectual ascendency. Their arrogant admonitions that they should have the exclusive right to control the time immemorial decisions pertaining to ontological definition of man- and woman-kind must be confronted in order to roll back their calamity in the making. The government's task in this instance should only be one of assuring equal rights to thought via competition of intellect, service and expression.

How can it do that?

  1. Change the identification name from the euphemistically Evidence-Based category to employ it for what it is: a Nosotropic-Based management approach. Then add the Etiotropic-Based nomenclature to the new category at the top. Or, keep "Evidence-Based" as one heading and place Focused Caring-Based alongside as the alternative.
  2. Get out of the referenced one sided "Evidenced-Based" performance measurement business for psychological trauma care and treatment issues.
  3. Don't side with ideologies, unless they are mine. They come out of the U.S. Constitution which already protects individual identity.
  4. Make the treatment trigger psychological trauma etiology (injury to identity) instead of conformance with PTSD nomenclature currently thought to be needed to initiate the helping response.
  5. Lean on the psychiatrists to change the DSM definition of Post Traumatic Stress from a disorder to an injury (Psychological Trauma Injury - PTI).
  6. Adapt Episode-Based billing practices for trauma, submitting claims for the end to end ─ thus conclusion to the ─ reversal and culmination of the existence of each source of trauma. I can tell you exactly how much it will cost per source for every type of trauma influence affecting western culture (I don't predict eastern cultures because getting through Buddhism's influence is somewhat tough).
  7. Give Purple or some other colored Hearts to trauma affected veterans signifying with a clear symbol our understanding of their wound and how proud we are of them for giving so much to our country.
  8. Hold individual providers legally responsible and monetarily accountable for their claims and performances with individual patients and organization trauma management contracts.
  9. Give value determination for treatments back to the market.
  10. Referring to CBT's wide adoption by government agencies, stop dumping "second class therapy on what the culture perceives as second class citizens."
  11. Audit for individual and facility compliance with JCAHO level standards, not the so called overarching principle of Evidence-Based management operating in the hands of our great federal and state bureaucracies.
  12. Invite Academia to participate in its traditional role as observers, reporters and the opining professors that they are, as long as they can show that their often valuable observations are not connected through systems measurement control back to individual patients, thus causing no harm by the superficial understandings and concepts of humankind and learning now representing the preponderance of academic training being provided to counselors.
  13. Institutionally disconnect symptom evaluation theory in the assessment of psychological trauma's effects from disability. Pay them instead for the damages done to identity for however long it took the government to get to their employee and address the injury. Focus upon the facts that the event occurred and may have influenced them profoundly, and that they deserve to have the effects addressed. Don't tie symptoms to the factual address of etiology by the patient, that is, if you want to remove the issue for that individual, his or her family and the community instead of putting people into group therapy for the rest of their lives trying to figure out who they are and what happened to them along the way to being that person.
  14. Don't ask combat veterans stupid questions in assessments such as "Have you had any symptoms of PTSD since you were blown up by the IED?"
  15. Give every American Veteran, before you dope them up, the choice of addressing combat related trauma by helping them to cope with it for life or have it cured immediately and forever. Let the combat veteran decide whether or not his or her trauma was cured.
  16. Make controlled drinking teaching therapists civilly responsible for any deaths or personal property damage caused by their patient when convicted of DUI occurring in concert with the catastrophe.
  17. NEVER again experiment on American Veterans affected by combat trauma without the public's vetting of the project.

Now, who are you going to believe and trust? Government, the whole of mental health academia and its treatment communities, or me, the only person from western civilization who has developed a complete secular cure for psychological trauma?

© 2009
Jesse W. Collins II

Where to Read about EB

For the study of the Evidence-Based modality from its advocates' opposing views, here below are some excellent resources. In fact, one of them even refers to itself as a Center for Excellence, which title I never understood even though I read all their principles. By the way, they are the same principles required by JCAHO and state government licensing programs, of which we had 9, every one audited annually for compliance and patient progress by the accrediting organizations. Aside from being the Chairman and CEO of all plant, I was also the compliance officer, a magnificent medical management training and learning experience working at both initializing (authoring each facility's 3 inch spiral bound operations manual comprised of 35 chapters in the original document) macro and micro levels with credentialing auditors. And because of what they taught me, free even except for JCAHO fees, I never met an auditor I didn't like, at least after being converted to their discipline of focusing every iota of teamwork on caring for the patient. But they did not use that gifted organizational management model for trying to prove to non believers from another ideology that trauma could be completely reconciled and resolved. That is irrelevant to the healer's, as of course opposed to the researcher's, task of caring preeminently for the patient instead of science.

COCE; SAMSHA's Co Occurring Center for Excellence

Overarching Principles for addressing Persons with Co Occurring Disorders focus on SUD

Evidence-Based Mental Health Treatments and Services: Examples to Inform Public Policy; Anthony F. Lehman, Howard H. Goldman, Lisa B. Dixon, and Rachel Churchill; June 2004

© 2009
Jesse W. Collins II


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