Mr Heusser, is every little thing labelled a trauma these days?
«Trauma» is a buzzword, there's no question about it. And that, in particular, is part of the problem. If a top pupil happens to get a «four» in an exam just once, that is definitely not traumatic – even if her parents might see it differently. Genuine trauma, however, particularly following experiences of violence or years of neglect, is still often criminally overlooked, and the victims are not taken seriously.
How do you know that?
Last year, in a survey conducted by the Zurich University of Applied Sciences (ZHAW), more than one in four of the 1,603 young people from Zurich aged between 12 and 14 reported having experienced sexual violence, ranging from lewd comments and exhibitionism to groping and forced penetration. And an earlier, similar study in the canton of Geneva showed that around one in three girls and one in ten boys had experienced sexual violence. Yet very few were receiving psychotherapy. It is well established from numerous studies that sexual assault, in particular, very often triggers post-traumatic stress disorder. Many so-called experts are not sufficiently aware of this issue.
I thought trauma was just a fad diagnosis.
On the contrary. If a child behaves in any way that stands out at school, they are immediately assessed for ADHD. Some psychotherapists might also suspect depression or autism. Trauma, on the other hand, is something most people don't even consider. Just recently, another 16-year-old was referred to me: suspected ADHD. Right from the first session, he told me that he'd been beaten by his father and mother throughout his childhood. He was clearly suffering from a post-traumatic stress disorder.
Perhaps it's just an isolated case.
No. A study by the University of Zurich showed that around four per cent of young people in Switzerland are affected by such a disorder. And the number of unreported cases is certainly higher. In my 20 years as a therapist, I have worked with countless children and young people whose trauma had gone unrecognised for a long time.
How do you explain that?
One factor that probably plays a part is that some symptoms resemble those of ADHD: for example, severe inner restlessness or difficulty sitting still.
What are some other typical signs?
So-called dissociative states: although the person's body is physically present, their attention seems to wander off somewhere else. In the case of a post-traumatic stress disorder, such states can last for hours. And there are many other types of dissociation: some sufferers repeatedly inflict wounds on themselves without even noticing the pain. Others suffer from so-called flashbacks: vivid memories of the traumatic event that suddenly come flooding back, particularly at night. They then feel exactly as they did at the time of the incident.
If victims quickly feel safe again after a traumatic experience, the prognosis is relatively good.
For some sufferers, dozens of different triggers are said to set off flashbacks.
Usually, there are fewer triggers. But they make life difficult. A former patient of mine was traumatised by a road accident: a white van knocked his car off a motorway bridge. He was in a coma for three days and nearly lost his life. Even years later, every car journey was a nightmare for him. After all, it feels as though white vans are everywhere on the roads.
What causes trauma?
When faced with grave danger, our bodies must choose between fight or flight. However, there is a third option. This comes into play when we feel completely helpless. We then freeze and play dead. This is a defence mechanism that probably has its roots in evolutionary history. If a prey animal stops moving, predators sometimes lose interest. Incidentally, in 2021 the Federal Supreme Court finally recognised that victims of sexual assault can find themselves in such a state. Since then, rapists can no longer simply claim: «There was no resistance, so the sex was consensual.»
But does the play-dead reflex have any adverse effects?
Very often. Figuratively speaking, it's like pressing the accelerator and slamming on the brakes at the same time. That wouldn't be good for any car either. As a result, people often suffer from dissociative symptoms, chronic muscle tension and flashbacks – and their nervous system remains in a constant state of alert.
So are those affected particularly vulnerable to stress?
It's not just about stress. Scientific research has shown that 30 to 40 per cent of all cases of depression and at least 30 per cent of substance dependencies can be traced back to early-life trauma. Furthermore, a study by German psychologists involving 156,807 adults in 2024 showed that children who have experienced trauma are at a significantly higher risk of anxiety disorders, diabetes, lung conditions, heart attacks and cancer than people without such a history.
Amazing.
People who have experienced trauma generally find it difficult to look after themselves properly and to set boundaries. This is particularly true in cases of attachment trauma, which has its roots in early childhood. If very young children are not given enough security and a sense of safety, they eventually come to regard this as «normal» and become convinced that they do not deserve anything better. This then often shapes their own behaviour.
In many cases, then, «trauma» is simply a modern term for a difficult childhood.
There are many possible causes of trauma: assaults, for example, road traffic accidents, experiences of war, torture, avalanche accidents, domestic violence – in 2024 alone, more than 21,000 such cases were reported to the police in Switzerland, more than ever before, and with a high number of unreported cases, particularly where sexual assault or childhood neglect are concerned. The good news is that even those who have experienced the most severe trauma can often regain a stable state of mind within two or three years with professional help.
Trauma therapy is about gently reducing the emotional impact of traumatic experiences.
Following a catastrophic fire such as the one in Crans-Montana, Valais, do all eyewitnesses need trauma counselling as soon as possible?
For a long time, therapists believed this: they would rush to the scene of an accident and let people talk. The aim was to prevent post-traumatic stress disorder. Since then, numerous case studies have shown that such debriefings can actually be harmful. In some cases, this approach may even have been what first instilled the trauma in people.
What is the alternative?
Whether a trauma-related disorder develops depends very much on how much support a person receives following the traumatic event. If victims and eyewitnesses quickly feel safe and secure again afterwards, the prognosis is actually relatively good. Some eyewitnesses feel the need to talk about what happened. They should be listened to. Others prefer to remain silent. Under no circumstances should they be pressured into saying anything.
Why?
Brain researchers have discovered that in the hours immediately following a traumatic event, the experience is reorganised particularly intensely in the memory and linked to other information. If, during this sensitive phase – for example through a debriefing – the memory of the fear experienced is reinforced, this increases the risk of developing a post-traumatic stress disorder. Initially, distraction is often the best remedy for those affected, even if it is through a video game.
Are some people so resilient that they cannot be traumatised under any circumstances?
I think that's unlikely. Generally speaking, one would assume, for example, that soldiers become extremely hardened during a war. However, upon their return from the Vietnam War, hundreds of thousands of US Army veterans suffered from flashbacks. Many took their own lives. It was against this backdrop that post-traumatic stress disorder (PTSD) was first recognised as a mental health condition in 1980.
Up until 2025, the International Classification of Diseases (ICD-10) essentially recognised only one post-traumatic stress disorder. The current edition, ICD-11, however, suddenly describes more than 20 different clinical presentations. How did this come about?
Trauma is now arguably the most thoroughly researched area of mental illness. Researchers have, for example, established that there are huge differences, particularly when it comes to symptoms: following road traffic accidents, for instance, flashbacks are particularly common. After sexual assaults, on the other hand, many victims struggle above all with self-hatred, shame and feelings of guilt. They feel inferior.
Why don't they direct their anger at the aggressor?
During the assault, they felt defenceless. This has a lasting effect. It is becoming increasingly clear that, in the body, the feeling of helplessness is somehow stored following a traumatic experience.
Can trauma be passed on to one's offspring?
This has been demonstrated in animal experiments: microbiologists found epigenetic methylation patterns typical of trauma – a kind of fine-tuning that helps determine whether certain genes are activated or not – in both mice that had been traumatised by an experience and their offspring, who had not been exposed to such stress, and this effect persisted across several generations. Such experiments cannot be carried out on humans, but similar consequences can be assumed. It is undisputed that trauma often has an enormous impact on parents’ behaviour. People suffering from a trauma-related disorder often find it difficult to feel and express their emotions. This frequently affects their children.
In many traumatic experiences, one feels very alone. A sense of powerlessness is the defining experience.
But probably not exactly traumatic.
If parents show no emotional expression in their facial expressions towards their baby for just one minute, all toddlers react with distress. This was demonstrated by the famous ‘Still Face» experiment of 1982. They begin to protest wildly until contact can be re-established. Now imagine that the toddler has traumatised, emotionally damaged parents. In that case, they may experience this distressing situation for years on end. It is hard to imagine that this would have no consequences.
Does therapy attempt to erase traumatic memories from the mind?
No. That would be a lost cause. Rather, the aim is to gently diminish the emotional impact of such images and other fragments of memory.
How does it work?
Often through gentle confrontation. One of my first patients who had had a near-death experience was a young woman who suffered from chronic anxiety and flashbacks. When she was five years old, she had nearly drowned in a lake. After we had built up a relationship of trust over the course of several sessions, I placed a hand on her shoulder and asked her to recount the experience in minute detail. Throughout, I kept reassuring her: «You're not alone; I'm here to support you.» In many traumatic experiences, one feels very alone. A sense of powerlessness is the defining experience.
And the woman didn't start panicking again?
No. The key thing is that patients feel safe and secure during such a confrontation. Once a good relationship has been established and a patient is no longer in the midst of an acute crisis, it is possible to face the trauma together.
What is it about such a confrontation that is beneficial?
Typically, traumatic memories are emotionally extremely distressing, but fragmented: isolated sounds, images, and smells. If the traumatic experience is worked through with patients in a safe environment, it can, over time, be re-stored in the brain as a normal sequence of events. This weakens the negative pull of the fragmented memories.
As soon as we feel, in our time of need, that we are not alone, this often triggers powerful self-healing processes.
Is it possible to treat yourself?
A few individuals manage to do this. As a rule, however, the relationship is very important. After all, we are, ultimately, highly social mammals. There is an insightful video on this: a baby elephant is walking alongside its father, stumbles over a tree trunk and lands on its back. Helpless as a beetle, it stretches all four legs into the air. Its father doesn't notice; he simply carries on walking. The little one looks utterly desperate. Then three female elephants come into view. The little elephant realises they are approaching – and suddenly manages to turn round and get to its feet. It's similar with humans: as soon as we are noticed in our distress, and sense that we are not alone, this often triggers powerful self-healing processes.
The American psychologist and biophysicist Peter Levine claims that trauma can be healed simply by «tuning in to one's inner self with mindfulness». Can this really work?
I value the gentle therapeutic approach known as Somatic Experiencing (SE), developed by Peter Levine. It is one of the most important tools in my work.
How do these meetings work?
Initially, the approach does not actually focus on the trauma. Patients direct their attention to their bodies. They feel where they are in contact with the floor, and perhaps also which muscle groups are particularly tense. After a while, some start to shake violently. Others may feel a tightness in their chest, a sense of anxiety. After a while, you can guide their awareness to see if there are any parts of their body that feel stronger or «healthier».
That sounds quite a challenge.
For some female patients, with therapeutic support, this is not particularly difficult at all. One approach, for example, is to encourage them to shift their awareness back and forth between negative and more positive sensations within their own bodies. In this way, it is possible to work through many psychological wounds that are difficult to access through talk therapy alone or cannot be recalled visually at all. And as surprising as it may sound, body awareness and emotional life can undergo lasting change through such sessions. There are as yet no medicines available to treat trauma-related disorders.
