Bessel van der Kolk: Trauma isn't the event, it's the response

"In the preamble to the definition of PTSD, we write, these people have been exposed to an extraordinary event that's outside of normal human experience. So it turned out that this is not an unusual experience at all. One of the largest mitigating factors against getting traumatized is who is there for you at that particular time. I did the first study on Prozac for PTSD, the first study for Zoloft for PTSD."

"The trauma is not the event that happens. The trauma is how you respond to it. The degree to which when you're traumatized, your body keeps mobilizing itself to fight. You have all kind of immunological abnormalities, you have endocrine abnormalities, and that really devastates your health, your physical health. Has a long range, oftentimes the physical problems are longer lasting than the mental problems."

PTSD arises not solely from extraordinary events but from the individual's physiological response, which can chronically activate fight-or-flight mechanisms. Chronic mobilization produces immunological and endocrine abnormalities that devastate physical health and often outlast psychological symptoms. Presence of supportive people during or after the event is a major protective factor against trauma. Early clinical trials of conventional antidepressants such as Prozac and Zoloft for PTSD demonstrated limited benefit. Combat veterans frequently experience persistent nightmares, intrusive memories of dead comrades, emotional numbing, social disconnection, and lasting somatic changes including tense posture and altered voice.

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