A recent conversation I had with a well known trauma researcher:

Me: "So how would you diagnose him?"

Him: Laughing briefly and ruefully, "I don't think there is a diagnosis."

Although in a way this may be uniquely true for our international patient, I want to suggest that it is always true. We are never treating anything so discreet as a singular mental illness. The brain does not parcel its problems that way. It struggles with its origins, its developmental impacts and errors, its many discontents, but these are manifest as problems in circuitry, in connectivity and in amplitude. We look to history and symptoms as a way to begin a conversation with our patient but even more so with his brain and to guide our protocols. In the case of our international patient, we don't have enough reliable history, but we can see that he is driven by overwhelming affect particularly anger, shame and fear; that his affect overwhelms thought and memory and makes it impossible to think; that he demonstrates poor executive function which we see in primary process lying, limited cause and effect relationship and inability to understand the consequences of his actions; and failure of the self/other system as shown in all of the above as well as in his truncated capacity for empathy.

In Part Two, Session Three of the webinar on Developmental Trauma we discuss a model that links arousal in the brain to affect, state and trait, and look at the nature of state dependence and what we now consider personality disorders. 

For more information go to www.trainingtrauma.org