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Conflicted control systems: The neural architecture of trauma
Carey, T. A., Mansell, W., Tai, S. J., & Turkington, D.
The Lancet Psychiatry. 2014;1(4):316-318.
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Abstract
It can be difficult to make sense of the fact that some, but not all, childhood trauma leads to severe mental illness. We introduce the hypothesis in this article that trauma which results in later mental ill-health has an underlying internal conflict whereas people who were traumatised in childhood but go on to lead functional lives are not conflicted about the trauma they experienced. This hypothesis is supported by a proposed neural organisation in which control systems are arranged hierarchically and in parallel. We use clinical examples to illustrate this formulation and suggest that mental illness is maintained, at least in part, by avoidance of both sides of the conflict with the implication being that the treatment of trauma may be enhanced by focussed awareness on all of the conflict.