EDITOR'S INTRODUCTION

Adolescent Psychiatry, 2003 by Flaherty, Lois T

Much of this volume of Adolescent Psychiatry focuses on trauma and violence. These are not new issues to psychiatrists, especially those who work with adolescents. Indeed, they are hardly new issues for the world. What is new is a growing awareness of the psychological, biological, and social impact of trauma on its victims, especially on the young. What awaits is the translation of this new knowledge into public policy, so that the effects of trauma can be mitigated and, ultimately, so that children and adolescents can be protected from harm.

The two Schonfeld Award papers in this volume deal with violence. Michael Kalogerakis has devoted much of his career to developing programs for violent youth in New York, where he served as Commissioner of Mental Health. He reviews the history of the pendulum swings in juvenile justice, revealing how far we have come from the original aims of the juvenile court. At the same time, the link between trauma and violence in adolescence is now firmly established, and there are programs that have good data for their effectiveness. My paper on terrorism attempts to show the appeal of ideologies that espouse violent revolution to young people.

Christopher Thomas et al. present a study from their groundbreaking work on youth violence in Galveston, Texas. The study links gang membership with serious violent crime, and by demonstrating the importance of the peer group, it points to ways that youth can be socialized away from gang membership.

The federal regulations on seclusion and restraint in inpatient settings that went into effect in 2001 were greeted with much apprehension. The study by Theodore Petti et al. shows that effective interventions can reduce the use of seclusion and restraint even with the most difficult state hospital adolescent populations. Most crucial to their findings is the importance of staff support.

Mani Pavuluri and colleagues present a comprehensive review of what we know about early-onset schizophrenia and bipolar disorders.

They discuss differential diagnosis and treatment strategies, with emphasis on newer pharmacological agents.

A series of papers by the Committee on Adolescence of the Group for the Advancement of Psychiatry deals with the nature, scope, and impact of trauma as well as implications of what we know for training and public policy. Freud's early discovery that histories of psychic trauma were prevalent among his patients-later put aside as he developed his theory of unconscious conflict-has been rediscovered as we have become aware of the appalling prevalence of child abuse and its lasting impact on its victims. Epidemiological studies have shown that traumatic stress is so prevalent in many societies and in subcultures of our own society that it can almost be considered a normative part of growing up. In areas as disparate as the inner cities of the United States and war-torn countries throughout the world, adolescents are traumatized by man-made violence. Natural disasters and disasters caused by human negligence take their toll everywhere.

Thanks to developments in neurobiology, we now have compelling evidence that this impact is in part mediated by measurable changes in brain function, as Patricia Lester et al. discuss in their paper on neurobiology and trauma. Cultural and gender issues are equally important in understanding the impact of trauma, as Warren Gadpaille demonstrates. These new awarenesses are being translated into clinical practice, as Monica Green's paper on intervention discusses. Finally, in this section, Max Sugar looks at the vulnerability of a particular group-late adolescents-to combat-related posttraumatic stress disorder, linking their vulnerability to developmental features of this period. His findings have particular significance for public policy, as late adolescents and young adults make up most of the frontline troops in combat.

Saul Levine dissects a multitude of self-deceptions and myths that he sees as having infected the mental health professions. Some of these involve beliefs (or purported beliefs) on the part of policymakers and funding agencies, others have been accepted uncritically by professionals themselves. All, in his view, have led to neglect of appropriate therapeutic care for adolescents.

James Gilfoil discusses the importance of families' attitudes toward psychotherapy in the outcome of therapy with teenagers. His paper includes a series of illustrations that constitute clinical pearls for the adolescent psychiatrist.

The final section consists of a resource paper on youth violence written by Charles Huffine, chair of the ASAP Topical Studies Council. This paper, which discusses the contributions of societal attitudes about youth to the perpetuation of violence and lack of appropriate interventions, was adopted as an official American Society for Adolescent Psychiatry (ASAP) position paper.