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Psychological trauma is a significant portion of all medical casualties in combat and peacekeeping operations. Significant resources are dedicated to its prevention and treatment, and yet, rates for incidence and recovery basically have remained unchanged over the years. This is particularly evident in chronic, treatment-resistant patients. One of the major difficulties in managing post-traumatic stress disorder (PTSD) is the failure to grasp the meaning of "trauma" for the patient. Practitioners have assumed that the trauma the wounded experiences is the direct effect of the "traumatic event" and no further inquiry is necessary or warranted. Evidence however, points to the contrary, as not all individuals exposed to a traumatic event develop PTSD, and the majority of those who develop symptoms will recover within a relatively short period of time. ' But what about those who do not respond to treatment? There is no clear understanding of the reasons or conditions that adequately explain this outcome. However, it is the author's experience, that individual factors in the context of a specific socio-cultural context set the stage from where the trauma is experienced and lived. Efforts at treatment focusing in targeting symptom relief only will have limited impact. The author will present a review of the literature, his experience treating chronic PTSD patients from various countries including Colombia, Argentina, and the US, and will argue for the need to develop a comprehensive model for its understanding and treatment.