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Steve? I would agree that Oppenheimer feels guilt, and we do not necessarily disagree if we introduce the idea of moral self-injury-- that he is aware of having transgressed his own values. Seghal's focus is on the single early event as explaining everything about character.

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This is another example of people in our field and in the public arguing about something that they all define differently, or use several definitions at once. Sort of like "depression, " which is a symptom, not a disorder. Surely there is no comparison in somatic impact between having been severely abused as a child and being offended at someone's political opinion.

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Years ago there was use of the term "kindling" to describe trauma that is the outcome of cumulative unrelenting stressors none of which would alone meet the single variable catastrophic definition of trauma as DSM originally framed it. I do think it is valid to question over use of the trauma description of otherwise unexplained suffering: the term having entered common discourse often makes it reductive At the same time, cumulative trauma can be obscured if the

definition narrows. I am thinking particularly of people who live with relentless, insoluble, conditions that episodically rise to crises (examples: parents and partners caring for those with persistent mental illnesses; people dependent on others who are chronically abusive). Seeking alliance with a supportive and perceptive therapeutic person or group can ameliorate deterioration of psychological as well as neurological health when recovery from each event is incomplete enough to leave growing vulnerability and/or rigidly problematic defenses.

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Years ago there was use of the term "kindling" to describe trauma that is the outcome of cumulative unrelenting stressors none of which would alone meet the single variable catastrophic definition of trauma as DSM originally framed it. I do think it is valid to question over use of the trauma description of otherwise unexplained suffering: the term having entered common discourse often makes it reductive At the same time, cumulative trauma can be obscured if the

definition narrows. I am thinking particularly of people who live with relentless, insoluble, conditions that episodically rise to crises (examples: parents and partners caring for those with persistent mental illnesses; people dependent on others who are chronically abusive). Seeking alliance with a supportive and perceptive therapeutic person or group can ameliorate deterioration of psychological as well as neurological health when recovery from each event is incomplete enough to leave growing vulnerability and/or rigidly problematic defenses.

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You pose some fundamental questions that Mad in America also explores regarding how the medicalization of mental health has been configured currently. My book Erase Ger: A Survivors Story addresses the effects of conversion so-called therapy on teens-as a form of child abuse.

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Hi Steve

Alway enjoy reading your columns...thank you. I think differently about Oppenheimer. I do not think he suffered from trauma but from the burden of enormous guilt at "what he had done". This is I think what Seghal is driving at when she says that the term PTST "flattenns and distorts character to symptoms". I wonder if we could describe th earchitects of the Viet Nam war at suffering from trauma or Othello, when he realizes what he has done?

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