Here in the United States of America we treat children who have been traumatized by sexual assault, domestic violence, child abuse and child sexual abuse. We treat these children in multidisciplinary ways to increase or improve attachment issues that might result from trauma. Children who have been abused or traumatized often suffer from Post Traumatic Stress Disorder (PTSD)or develop more serious mental health problems such as attachment disorders or personality disorders. One of the common symptoms in both PTSD or Borderline Personality Disorders is emotion regulation deficits.http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml

These disorders are often associated with violence. The violence can be self directed or other directed. People with Borderline Personality Disorder (or Insecure Attachment Disorder) sometimes engage in self harming behavior and cut on themselves. They will often exhibit problems with impulse control that make stopping this behavior very difficult. They may not just engage in self harm but also struggle with parasuicidal behavior and make repeated attempts at suicide that are unsuccessful. These people sometimes spend their lives in and out of hospital as a result of their mental illness.

Not only can the violence be directed inward, but sometimes the violence is directed outward toward others. Such is the case in Domestic violence where it is estimated that 30-60% of the men who batter meet criteria for Borderlin Personality Disorder (insecure attachment) or depression (a mood disorder).Shttp://www.kwantlen.ca/__shared/assets/abusive_men_subtypes1302. Dutton makes the argument that there is an abusive personality disorder that shares symptomology with Borderline Personality Disorder, Narcissistic Personality Disorder, and Impulse control Disorder. One common thread is emotion regulation problems.

There is a cyclical nature to violence that most of us accept on the individual level. Somehow we know that an abused child might be at an increased risk for suicide or domestic violence of a partner or getting into fights at school or becoming a bully. That is common sense for most of us. We accept and aknowledge that trauma has an affect on children and puts them at high risk for mental health problems in adulthood. How far fetched is it that a whole culture could develop symptoms that increase the likelihood of violent solutions to social problems?

If a person grows up with emotion regulation problems, what are some of the behaviors we might see? Folks suffering from deficits in emotion regulation often develop depression or mood disorders. They can also develop relationship problems and have difficulty getting along with others or maintaining healthy long term relationships in employment or family. They can develop substance abuse problems as a result of attempts to regulate mood with substances. This complicates and often exacerbates impulse control problems related to violence, creating a double whammy of being born with a smaller ability to regulate impulses, trauma that may damage impulse control and the use of substances which may further damage impulse control.

So people who have been traumatized are at an increased risk to suffer from impulse control problems that feeds into or exacerbates substance abuse problems and subsequently criminal behavior. Most of this is fairly common knowledge accepted by most clinicians, teachers, pediatricians, psychologist, and psychiatrists. http://www.sciencedaily.com/releases/2000/08/000814021300.htm

Ann Kaplan has written a book that expands this idea of trauma and it’s symptoms to whole cultures. http://books.google.com/books?hl=en&id=bhA0i8yqB2UC&dq=Ann+kaplan+and+trauma&printsec=frontcover&source=web&ots=qh_RZTcBQ&sig=KPkg8axTSu5oEoIJikD0dbXuRxE&sa=X&oi=book_result&resnum=1&ct=result#PPP1,M1 She lays out the argument that because of the media and our more global ties, catastrophes now affect more of us. She suggests that whole groups of people are affected by a large scale trauma like 9/11 and that the symptoms of these traumas can be pervasive over a life time.

If it is true that some of the people in any given population that is traumatized by terrorizm or war, might have long lasting psychological symptoms is it not possible that these symptoms might have long lasting implications in regard to whole cultures of people and their interactions with other each other, and also other countries? For instance, if we accept that little girls who are sexually abused and then invalidated by mom regarding the abuse (perhaps because mom was sexually abused and untreated as a child) and we accept that this has a correlation to her development of a personality disorder then why couldn’t we posit that whole cultures or countries or regions might develop symptoms of such psychological disorders.

Symptoms associated with Borderline Personality Disorder (or Insecure Attachment Disorder) are:

1) emotion regulation problems
2) interpersonal choas
3) impulse control problems
4) identity disregulation
5)cognitive disorders.

We know that sometimes a child that has never been sexually abused, but is raised by a mother who was sexually abused can exhibit some of these same problems in adulthood. The idea is that being raised in such an environment means that a child might learn these behaviors without having ever been traumatized. This means that the affects of the trauma and violence can be perpetuated from generation to generation.

This is not to say that every culture inundated with violence develops the symptoms of a personality disorder but that some of the symptoms or characteristics associated with trauma survivors, people with PTSD and the development of personality disorders might be exhibited cross culturally.

It is not my concern that we "properly diagnose" any given country, but that we aknowledge that the consequences for violence and trauma could be widespread and perpetuated generationally over time. If one of the most pervasive symptoms correlated with exposure of trauma is emotion regulation deficits, then could we not teach emotion regulation skills in schools?

Dr. Linehan, the developer of Dialectical Behavior Therapy (DBT a very successful treatment for Borderline Personality Disorder)thttp://behavioraltech.org/index.cfm?CFID=11489918&CFTOKEN=21748446 suggests that people do not end up divorced because they didn’t learn geography. Perhaps we are missing the boat by not recognizing the need and then not teaching the most important skills for surivival in very traumatic and violent times. Could we not increase the chance for peace if we were teaching children and adults how to successfully regulate emotion?

Linehan’s approach to Borderline Personality Disorder is interesting because she suggests that the client and the clinician must learn the skills. The Clinician learns emotion regulation to successfully cope with the client while the client is learning the skills. This concept when applied to a global level would suggest that the skills of the diplomat are just as important as the skills of the country in negotiation. Let’s say we are dealing with a country that is impulsive, has trouble regulating emotion, exhibits symptoms of paranoia. (Iran?)Linehan would suggest two things, one, the country would have to want help and want to change. (this "want" is created through diplomacy and trade) The other thing Linehan might say is that the country interacting with Iran must have the skills of emotion regulation, impulse control, interpersonal effectiveness and wise mind while dealing with Iran. This is to prevent a "borderline" response like terrorism, (the equivalent to self harm? or parasuicide?) or war (the equivalent to battering).

The skills we teach our clients not only change them, but us as well. Over time as the clinician and client become more skillful, the skills become generalized beyond the therapy session. We do not evaluate a decision based on the clinicians wise mind but on the use of skills to develope the wise mind solution. (this therapy is not ethnocentric, it’s structure works in many countries).

The skills that we teach include meditation, nonjudgmental stance, emotion regulation skills that include accepting emotions instead of numbing or ignoring them (which might lead to antipathy or a lack of empathy). We teach these skills and aknowledge that some mental illnesses require medication but many are improved when the clients use these skills. The treatment is successful based in part on how well skilled the therapist is in keeping them committed to the therapy or change. The idea is providing the motivation to learn and use these skills, and then validating their use and effectiveness. Why couldn’t this be done at the United Nations. What if the United Nations required a commitment to learn and exhibit these skills? What if we engaged in helping the leaders of nations make skillful wise mind decisions for their country? What if instead of uing fear and power and control we used effectiveness as the carrot?

If there is interest, we could discuss emotion regulation skills. We could define them, teach them and discuss how they might be applied in intercultural or global settings.