Ressler couldn't shake the feeling that trauma was important here, and in 2003 he teamed with psychiatrist Ann Schwartz and psychologist Bekh Bradley to determine the prevalence of undiagnosed PTSD among mental health patients at Grady. Although PTSD was noted in only 6 percent of the charts, they found that 40 percent of patients met criteria for lifetime or current PTSD.

The three launched the Grady Trauma Project (GTP), today led by Ressler, which has been assessing environmental and genetic risk factors for PTSD in a broader sample of Grady patients since 2005. A team of trained interviewers, most of them students from Atlanta area colleges and universities, have collected saliva samples and conducted extensive interviews with more than 2,500 low-income, primarily African American, men and women waiting for primary care or ob-gyn appointments at the hospital.

Nearly 90 percent of GTP participants have been exposed to significant trauma, mostly interpersonal violence, at some point in their lives. Rates of emotional, sexual, or physical abuse during childhood are high; later in life, assaults by intimate partners or others are commonplace. The lifetime prevalence of PTSD is 46.2 percent among these Grady patients—as high as in combat veterans—Ressler's team reports in the November 2009 General Hospital Psychiatry.

As these findings indicate, however, not every traumatized child or adult develops PTSD. With support from the National Institutes of Health, Ressler and his colleagues are searching for gene-environment interactions that may help explain why some suffer more than others. They started with some of the “usual suspects,” including genes involved in the glucocorticoid-mediated stress response. So far they've identified four single-nucleotide polymorphisms, tiny variations in the FKBP5 gene that appear to interact with severe child abuse trauma to predict adult PTSD symptoms. These findings were reported in The Journal of the American Medical Association in March 2008. Additional studies are under way to identify novel genes that affect who develops PTSD and who does not.

Although Ressler can offer no guarantees, he is hopeful that basic science findings—taken to the streets—could have an enormous public health impact. PTSD is associated with intergenerational violence, poverty, teen pregnancy, broken families, and a host of maladies both physical and mental. Therapies that unshackle people from some of their worst fears and help them establish new emotional habits might relieve some of the human misery that Ressler confronted as a resident in the Grady Hospital emergency room.

There's little doubt that Ressler's experiences at this battered landmark helped forge who he is today. As a raw newcomer, he began each shift “with a sense of dread, because there would be so much work to do and some of the stories would be so hopeless. But I always left in a really good mood, because we did help people and it was not all hopeless.”

Today, knowing what he knows, he still says “I am a pretty optimistic person.”

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