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A group of Marjory Stoneman Douglas High School students has captivated the nation with their tenacity and eloquence as they advocate for gun reform. This, in the throes of grief.

After many witnessed their friends killed by gunfire, they leaped into action to protest, some even taking a bus from Florida to Washington, D.C.

Their response to trauma is not to shut down, but to speak up.

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Psychological trauma is surprisingly common. At least once in their lifetime, most Americans will experience a traumatic event. As defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), that means exposure to actual or threatened death, serious injury or sexual violence.

“Most of us who face a cataclysmic, traumatic event may have intrusive recollections, intrusive thoughts, nightmares, and a constellation of negative emotions,” said Lawrence Calhoun, Ph.D., professor emeritus in the Department of Psychological Science at UNC Charlotte.

A combination of these symptoms, and others, lasting for at least one month is consistent with PTSD, posttraumatic stress disorder. PTSD is a potentially debilitating condition that affects nearly 7 percent of Americans.

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But if trauma is so common, shouldn’t the rate of PTSD be higher?

Not necessarily. People may be more resilient than they realize.

Psychologically speaking, resilience comes from whatever buffers someone from the negative effects of trauma, helping them “bounce back” and successfully adapt when horrible events shake them. Supportive relationships, optimism and good problem-solving skills, among other factors, help people “bend but not break” after traumatizing experiences.

Some people bounce back from trauma, and others can even grow from it.

Posttraumatic growth (PTG) -– a theory developed by Calhoun and Richard Tedeschi, Ph.D., professor of psychology at UNC Charlotte -– explains how people who struggle with the negative effects of trauma can ultimately experience positive growth. They find a way to thrive after stressful events through their ability to appreciate life, see new possibilities, understand personal strengths, form closer relationships and deepen spirituality.

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It’s not uncommon for people to turn tragedy into activism –- they don’t want their experience or the loss of loved ones to be in vain. Tedeschi noted that many social movements can be traced to trauma survivors who decided to bring about social change. Mothers Against Drunk Driving was founded by a mother whose child was killed by a drunk driver.

But people need to affect change at their own pace.

Tedeschi said: “Some people very quickly decide, ‘I’m going to do something.’ Some people have to go through quite a soul searching for a while.”

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Deciding to act and achieving change are two separate things.

“Having passion and being on a mission is one thing, but turning it into practical results is dependent on a whole other set of abilities,” Tedeschi said. “Trauma does not necessarily inform people of how to do that.”

Expecting people to become activists immediately following trauma isn’t just unrealistic — it’s harmful. Calhoun emphasized that PTG is “something for most people that unfolds over time.”

He cautioned against therapists introducing the topic of posttraumatic growth to people too soon after traumatic events because it puts unnecessary pressure on them.

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“I wouldn’t say anything,” Calhoun said. “I would listen. One of the mantras we have [is to] listen without necessarily trying to solve.”

And, of course, just because some good may eventually come from trauma, doesn’t mean that trauma is good.

“Posttraumatic growth comes at a high price for most people,” Calhoun said. “It’s a terrible gift.”

Christy Duan, MD, is a psychiatry resident physician at Zucker Hillside Hospital in New York and a resident at the ABC News Medical Unit. Read more of her work at www.christyduan.com.

Vasilis K. Pozios, MD, and Praveen R. Kambam, MD, are forensic psychiatrists and founders of Broadcast Thought (www.broadcastthought.com).

A judge overseeing a class-action lawsuit over the quality of health care in Arizona’s prisons will hold hearings this week to determine whether to fine the state for falling short in improving care for inmates.

U.S. Magistrate David Duncan also will examine an allegation that the inmate-care provider skirted a promise Arizona made when it settled the lawsuit by denying care to an inmate to avoid paying a fine.

The hearings on Tuesday and Wednesday were called after the judge repeatedly voiced frustration over what he described as the state’s “abject failure” to carry out improvements it promised three years ago when it settled allegations that inmates were receiving shoddy health care.

Duncan has threatened to hold Corrections Director Charles Ryan and another prison official in civil contempt of court and fine the state $1,000 for each instance of noncompliance in December and January.

The state has acknowledged more than 1,000 such instances in December, meaning it could be fined as much as $1 million for that month alone. Arizona faces a Monday deadline for revealing instances of noncompliance in January, though the judge is letting some of that information be filed next month.

The areas in which Duncan is requiring improvements include ensuring newly prescribed medications be provided to inmates within two days and making medical providers tell inmates about the results of pathology reports and other diagnostic studies within five days of receiving such records.

Andrew Wilder, a Department of Corrections spokesman, declined to comment on the upcoming hearings.

Ryan said at a Feb. 13 hearing at the Legislature that his agency is making progress in complying with the settlement and that the state doesn’t plan to pay any fines that might be imposed.

“I’ve already made it perfectly clear to the vendor (that) you’re on the hook for that, not the state of Arizona,” Ryan said.

Corizon Health Inc. has served as the health care provider for Arizona’s prisons for the past five years. The company isn’t a target in the lawsuit.

Corene Kendrick, one of the attorneys representing more than 33,000 inmates in the lawsuit, said having the contractor pay would undermine the purpose of the fine, which is to force the state into improving care.

Kendrick said lawyers found an additional 420 instances of noncompliance that the state didn’t report to the court.

It’s up to Duncan to decide what to do with the fines. Kendrick said the proceeds would not end up in the hands of prisoners or their lawyers.

The judge’s frustrations with the state grew in December when an email surfaced in which a Corizon employee asked a doctor to cancel infection-disease consultations for an inmate because the company didn’t have a provider to send him to. The Sept. 18 email alluded to the judge’s threat to impose fines.

“After 30 days we get nailed for 1000 bucks a day until they are seen,” the Corizon employee wrote.

After a news report by National Public Radio member station KJZZ-FM revealed the email, Duncan said the comments looked like an end-run around the court’s efforts to ensure the state is making the improvements.

A lawyer for the state acknowledged last month that the email is authentic but said there was a rational explanation for the comments.

“We feel confident that evidence will be presented in court next week that will discredit those allegations,” Corizon spokeswoman Martha Harbin said.

The 2012 lawsuit alleged that Arizona’s 10 state-run prisons didn’t meet the basic requirements for providing adequate medical and mental health care. It said some prisoners complained that their cancer went undetected or they were told to pray to be cured after begging for treatment.

It also alleged that the failure of the medical staff at one prison to diagnose an inmate’s metastasized cancer resulted in his liver enlarging so much that his stomach swelled to the size of a pregnant woman at full term. Another inmate who had a history of prostate cancer had to wait more than two years for a biopsy.

The state denied allegations that it was providing inadequate care. The lawsuit was settled in 2014 without the state acknowledging any wrongdoing.

This isn’t the first time the Corrections Department has faced criticism from the judge.

Over the summer, Duncan grilled Ryan in court over whether he tried to undermine an order that prohibited retaliation against prisoners who participated in the lawsuit.

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Follow Jacques Billeaud at twitter.com/jacquesbilleaud. His work can be found at https://www.apnews.com/search/jacques%20billeaud .