I just participate in the excellent webcast with Bessel van der Kolk on Complex Trauma and was moved and enlightened. His presentation of Complex Trauma was among the finest I have heard. I found his sharing insights into the machinations of DSM-V politics to be true and demoralizing. I am engaged in a similar battle with the DSM-V Committee over ADHD and have encountered to same cultural orthodoxy and ideological rigidity.
Missing for me in the mornings (PST) discussion was the neuroscience of self-regulation. The ambiguous symptoms of dysregulation Bessel was referring, are impairments in high-order executive functioning. The neuroscientific operational definition for human volitional consciousness is our frontal lobe system of executive self-direction. The VM-PFC mediates amygdala imputes into self-efficacious agency control of the inhibitory processes. Psychotherapist need to understand that self-regulation is a genet Universal deep structure and not the exclusive result of ma maternal bond.
I identify with Bessel van der Kolk’s frustration with the DSM-V process. Just as ADHD is no longer understood to be a Disruptive Behavioral Disorder by the NIMH and NIH, the DSM-V Committee insisted on continuing to use the phrase “Disruptive Behavioral Disorder and ADHD,” flatly contradicting their own policy and science. In 2008, NIMH and NIH clarified that the symptom cluster previously termed ADHD, was in scientific actuality, and neurodevelopmental disorder of self-regulation resulting from down regulation of DA/NE tonic modulation. They insist on referring to “impulsive decision making,” when the morphology of dysfunctional cognition is well documented with great specificity. ADHD is distinctive in non self-efficacious temporally mediated decision-making; with separate the symptoms from Complex Trauma, Depression, Anxiety, Personality Disorders, and other mood disorders.
I will follow his suggesting of with the DSM-V site and submit today, his imputes on adjusting Complex Trauma, being conscious of the April 20th deadline. I am already signed in on the DSM-V web site because of my interest in ADHD. The larger problem for psychotherapist in the country is their scientific ignorance reguarding self-regulation neurology.
If clinicians had knowledge of high-order executive functions, they would be more equipped to characterize accurately, maladaptive symptom presentation. The PFC serves to mediate amygdala into adaptive self-regulation. If the clinician is lacking in awareness of 21st century neuroscience of volitional agency, than the default of personality attributions made to define disruptive, inattentive, non self-efficacious behavior is mistakenly used to diagnose and treat the problem.
There seems to be a lag in clinical understanding of the paradigmatic shifts over the past thirty- years of neuroscientific achievements, which allow for coherently conceptualizing affect, social, self-care, and anomalistic symptomatic presentations. The risks of not understanding the science of human volition self-directedness has psychotherapists relying upon heuristic attachment theory, which misses the neurology of the impairment. The proponents of attachment theory have inadvertently bamboozled California psychotherapist in believing Self-regulation is acquired through acculturation. The three universal genetic endowments that our species benefit from possessing, are “deep structure” for formal language acquisition, social attribution (ToM), and executive agency top-down control. Self-regulation, except in extreme cases of early abuse, neglect, or institutionalization, is a Universal epigenetic endowment exactly like formal language acquisition.
The differential diagnoses of various executive functional impairments require knowledge of Universal Linguist Grammar and Universal Ethical Grammar, the evolutionary consequence high-order executive functioning. Neurofeedback, EMDR, cognotropic medications, and empathically attuned, cognitively resonant, psychotherapeutic relationships, all are top-down interventions that build upon agency control of affect, cognition, interpersonal sensitivity, and behavioral comportment.
I fear American psychotherapists will remain unaware of the significant transformation, presented by the 21st century neuroscience, and our profession is doomed to becoming marginalized because of basic scientific ignorance.
John Schureman