Etiotropic TMT: a Strategically Human Ontological Epistemology 1979-Extant

In that title, the phrase "Strategically Ontological" turns an apparent oxymoron into a two word summary of intent, purpose and methodology for Etiotropic TMT (also referenced herein as ETM TRT). Its authors' have posited their theory in the early 1980s (see History below) that trauma's etiology is located in existential identity as trauma caused contradictions to values, belief, images and other realities representing identifiable and quantifiable elements of being. As other investigators of psychological trauma have recently focused on identity, they have argued for its complete destruction by the trauma. ETM TRT theory, on the other hand, holds 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, ontology itself is argued by the ETM TRT authors to be — 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. The construct is continued by declaring that the ontology may be facilitated and otherwise inspired to remedy the damage done by the trauma to the noted identifiable components.

According to its documentation, ETM applies that facilitation at four levels.

1. 1. It uses a meta therapy called Trauma Resolution Therapy (TRT) that functions as scaffolding 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).
   2. Some cultural influences (in Western Civilization's norms and mores described below under "Exogenous Variables") interfere with the use of ontology to provide that ready address of trauma's damage. Here, Etiotropic TMT adds to its meta therapy more structure intended to declaritively preclude those variables from interfering with the identity's ontologically focused address. That meta therapy creates the environment or clinical module where ontology can be tapped for reversing the trauma's intrusions upon existential identity's values, etc.
   3. 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.
   4. Etiotropic TMT 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 the title, "Strategically Ontological."

Introduction: Understanding Etiotropic

Taber provided the original and only definition of "Etiotropic" in 1990 by demonstrating its meaning through comparison to its opposite, the Nosotropic approach to addressing medical problems or diseases. "Nosotropic" stands for symptom focused helping methods. "Etiotropic" stood and still stands for etiology directed methods. Etiology refers to the source of a problem. Nosotropic references its consequences.

Understanding An Etiotropic Epistemological Application to Psychological Trauma

In 1990, the Etiotropic TMT's authors (This paragraph is supported under History) were the first to apply the Etiotropic term to the treatment of mental health as a contextualization for their overarching epistemology created to clinically support the implementation of Trauma Resolution Therapy (TRT). It was also developed by them (Development) between 1979-1985 originally for the treatment of psychological trauma, Post-Traumatic Stress Disorder (PTSD), co occurrence of PTSD and SUD, families affected by Chemical Dependency (now Substance Use Disorder - SUD), battered spouses and combat veterans. The significance of TRT's introduction to these affected populations is that it focused on the address of event caused damages to identity which they opined established the locus of trauma's etiology. Because the development process indicated that simultaneous identification with attempts to curtail symptoms interfered with the etiology's address, they eventually restricted the symptom of disorder hypothesis from implementation within the overall clinical setting. This restriction delineated the epistemology as Etiotropic as the clinical model was distinguished from its Nosotropic counterparts, particularly Behavioral and Cognitive Behavioral philosophies and methodologies.

Controversy Sharpens Etiotropic vs. Nosotropic Distinctions

Cognitive Behavioral Therapy (CBT) identifies symptoms of most disorders. When applied to psychological trauma, symptoms present as thought and behavioral responses to the traumatic event's internalization. The helping response intends to assist the trauma affected person in first becoming aware of, then, changing, removing or in other ways just simply controlling the symptoms so that they no longer trouble that individual. Trauma affected patients are encouraged to adapt fairly rigorous and intrepid attitudes that provide a lifetime of motivation to apply themselves to recovery from the mental illness. Thus, CBT exemplifies for the trauma treatment field the Nosotropic approach to the address of psychological trauma and the disorder (PTSD) that often attends a trauma's occurrence.

Further sharpening the Etiotropic Trauma Management and Treatment option delineation from that sample Nosotropic application, a primary outcome (but not goal as described in "ETM Goal" below) of etiology reversal with TRT is that neither the trauma nor symptoms require continuing life management coping skills. That consequence is argued to support the natural medical word usage axiom when administered within treatment to the same injury or disorder:

1. Etiology and symptoms are mutually inclusive; you can't have one without the other.
2. Symptoms cannot exist without an etiology; and, if etiology is not wholly removed, symptoms will continue.
3. Although symptoms can be dissipated by removing etiology, the original trauma's introduction of etiology cannot be removed by changing or controlling symptoms as they are caused by, not causal of, the initial etiology.

Albeit that syllogism on the functional relationship between the two medical words used for framing psychological trauma as a problem is not too controversial, the next hypothesis stated by the authors as immutable fact is. However, despite any discord caused by the conflict it also offers substantial value as a delimiter of Etiotropic vs Nosotropic epistemological and methodological differences. Quoting Etiotropic TMT's authors who originated the term's application in the psychotherapy arena,

"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 neuromolecular 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."

To contravene that prospective phenomenon, the Etiotropic TMT authors have stipulated a methodological pillar as support for TRT's application to etiology. They seek agreement from the patient to not engage interpretive theory of any symptoms discovered during the etiology's reversal process with TRT. Therein lies the controversy and battle line delineating Etiotropic from Nosotropic foundational thought regarding the existence of psychological trauma, meaning of course, epistemology as augmented by methodology.

Returning to the Nosotropic perspective again for the sake of further delineating the controversy, professionals who have represented the Noso influence on psychotherapy have asseverated that etiology is extinguishable through symptom identification and control. Where the CBT article referenced earlier demonstrates the attitudinal development of the Noso ideology, that piece hit the controversy's nail on the head by quoting Hans Eysenck's view posited in 1960:
"if you get rid of the symptoms, you get rid of the neurosis." The term "neurosis" has been exchanged in this era for disorder. And "disorder" has in the address of Post-Traumatic Stress Disorder (PTSD) been the general reference by the Nosotropic spectrum of views as encompassing trauma's etiology, but neither focused upon in the DSM's definition nor in Nosotropically administered therapies.

As recently as 2009, CBT developers and supporting writers have begun to locus the source of trauma as a problem caused by the original trauma's destruction to identity.

The following chart displays the comparisons and controversies more emphatically distinguished by the advent of Etiotropic TMT in to the Etiotropic to Nosotropic continuum.

Etiotropic TMT Basic Components

When Etiotropic TMT is applied to psychological trauma, the treatment milieu functions to identify the elements of that etiology and then address them. To make that address, Etiotropic TMT consists of and applies where appropriate its 4 principal components: theory, epistemological environment, clinical methodology, and strategic clinical and systems management.

A. Theory

Within Etiotropic TMT theoretical base or idea regarding problems posed by psychological trauma, its etiology is defined when applied to long-term trauma in two parts as a) event (traumatic) caused contradictions to existential aspects of identity and eventually b) survival adaptive responses (to the initial event and subsequent incursions) that create additional contradictions to same and similar identity elements. Moreover, the view holds that etiology exists as a process of psychological and neurobiological extinction of memory hosting identity that existed before, and was contravened by, event. In this construct, etiology is opined to exist in memory as sequelae that lend themselves to ready address.

B. Epistemological Schema: Etiotropic TMT Administers a Firewall that Provides an Ontologically Focused Protective Module for the Address of the Trauma's Assault upon Patient Being

Although patients may be treated in the same clinic for other issues requiring different therapies, for example, the patient may be being seen simultaneously in Marital or Family therapy within the context of those relationships, or a patient may be simultaneously attending a particular self help program outside the clinic's administration, once a decision is made to address any psychological trauma within the contextual environment where TRT is applied (such as a TRT group process), the epistemological environment is established with the following administrative clinical declaratives.

Ontological Perception of a Patient Affected by a Single Traumatic Event or Multiple Events

1. The patient is seen as having been injured or wounded by an event or multiple events or even by multiple sources (next) of events.
2. The condition is conceptualized as a psychological trauma injury as opposed to Post-Traumatic Stress Disorder (PTSD).
3. The protected ontologically focused environment precludes responsibility and choice declarations, assignments, admonitions and projections by the therapist or group members.

Source of Trauma, Multiple Sources of Trauma and Arrangement of Etiotropic TMT Formula for Application of TRT to the one or All Sources Supports the Randomness of Trauma's Occurrence Epistemological Doctrine: "How not to blame the victim."

1. In Etiotropic administration language, a "source of trauma" refers to one or more events coming from a particular experience.
2. It may have been a series of events related to one life situation.
3. A single military combat tour in one theater comprising one or many events would all represent one source of trauma. A second tour in the same or another theater would be considered a second source. Being exposed to sexual abuse as a child would also represent a third source of trauma.
4. Known sources of trauma are arranged formulaicly by addressing each source in descending order, beginning with the most recently occurring source. That procedure is argued by the authors to prevent resolution of earlier sources of trauma from being seen as causal to later sources. Using the descending order application, the entropic, coincidental or randomness concept supports the address of all trauma affecting identity over the life cycle.
5. Some sources may present as the Most Pressing Trauma (MPT) regardless of the descending order formula's intents, purposes, or applications. In such instances, the epistemology setting environment is said to be maintained with a special set of rules for addressing the MPT, but without upsetting the ordered approach needed to sustain the focus on ontology.

Preexisting Variables as Earlier Occurring Trauma Where there are Instances of Multiple Sources of Trauma

1. Patients are not seen as attracting to the event in order to meet needs prospectively created by a preexisting disturbed personality disorder caused by earlier trauma (or for that matter anything else).
2. In the examples pertaining to non alcoholic spouses of Alcoholics, or in the cases where Adult Children of Alcoholics marry Alcohol or other drug dependent spouses, those patients are treated as having married into the Alcoholic relationship out of happenstance.
3. To take another example from crisis managers like law enforcement officers, emergency medical services, or military personnel, where countervailing models posit that these individuals are seeking high risk adventure "as in living life on the edge" through employment, in TRT those attraction theories are precluded by promulgation of procedures that contravene those trauma seeking concepts.

Exogenous Variables

Strengthening the Etiotropic ontological approach's epistemological module for application of TRT, exogenous variables that are said to preclude the trauma's complete resolution to the extent that it no longer has to be managed with coping adaptations are filtered, purportedly stopping them from interfering with the therapy's application and attaining its goal (described in this section next under Goal). "Exogenous variables" interchanges synonymously with “cultural variables". They are reported here as Etiotropic TMT promulgates its epistemology by filtering the following.

1. 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 even only drinks two beers on every Saturday, and no other alcohol or drug consumption occurs during the week. The Saturday use must also be discontinued. 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, head injury, and SUD or Alcohol Dependence are presenting parallel or in concert with the PTSD (where non pathological social use is treated herein as an exogenous variable that will preclude achieving the application's stated goal {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 therapist and patient abrogate their agreement to use the therapy for the achievement of its stated goal. For example, the application is made for the purpose of controlling or ending symptoms rather than for resolving the trauma completely.
   5. Special application is accorded the traumatized person who 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.
   6. A TRT psychotropically medicated, social drug / alcohol using, or drug dependent using TRT Counselor or Therapist.

Goal: What it Is and is Not

1. TRT's single application goal when applied to an individual is to resolve the trauma completely for the full source of trauma being addressed in the particular instance.
2. TRT is not administered for personal growth, nor to improve or control behavior, nor strengthen values or character, nor to in any way make patients better people, family members, or citizens.

C. Clinical Methodology: Trauma Resolution Therapy (TRT)

To facilitate the patient's negotiation of the sequelae referenced above under "A. Theory," Etiotropic TMT's professionals apply its clinical component, Trauma Resolution Therapy (TRT). It is cognitively structured with behavioral declaratives whereby both of those elements function as meta-therapy. That is, they provide a classical scaffolding that defines and protects the path into what the Behaviorist C.B. Scrignar otherwise referenced in 1987 as an "overload" of psychodynamic damage virtually unaddressable by standard psychodynamic and usually eclectically administered, for example, from Freudian Analysis to Rogerian, styles of therapies.

The TRT framework, however, was facilitated in group and individual clinical settings existentially. That process, too, was accorded considerable structure in the form of specific rules for therapist and group member feedback during the existential application. Those promulgations were named after 2 decades of honing their uses as a distinctly notable clinical process Incremental Etiotropic Fusion Induction (IEFI). Reportedly, it was intended to facilitate and enhance patient experiences of trust, safeness, congruency and accurate empathy. The purpose of the TRT clinical component was to assist the patient through the referenced extinction process with the intent of reversing, expunging or ending altogether the presence of the etiology.

The authors recognized their structure in the title of their first (1987) text, Trauma Resolution Therapy (TRT): a structured psychodynamic approach to the treatment of post-traumatic stress

D. Strategic Clinical and Systems Management

Strategic ETM (Etiotropic Trauma Management) addresses both the setup of the clinical domain for individual TRT application and the systemic aspects of trauma as they affect organizational decision making.

Families affected by Chemical Dependency (Today Substance Use Disorder 'SUD') and Psychological Trauma (PTSD)

The Neurobiology of Psychological Trauma Etiology and It's Reversal with Etiotropic Trauma Management (ETM)