The Body Keeps the Score

When I began studying trauma, psychiatry was still largely blind to its existence. In the 1970s, my colleagues and I were witnessing an epidemic of suffering among Vietnam veterans. These men were plagued by nightmares, flashbacks, violent rages, and emotional numbness, yet our diagnostic manuals offered them no name, no structure for their pain. They were often misdiagnosed as depressed, antisocial, or substance dependent.

It was only through listening carefully to their stories that a new understanding began to crystallize. We realized these reactions were not simply psychological weakness but biological consequences of exposure to overwhelming danger. Our studies, alongside those of researchers in the wake of the women’s liberation movement uncovering the realities of rape and domestic abuse, solidified a new diagnosis: post-traumatic stress disorder (PTSD). For the first time, the psychiatric community acknowledged that external events—the violence of the world—could fundamentally alter the internal landscape of the brain and mind.

This realization was revolutionary. It shifted focus from character flaws to adaptive responses. A flashback, we discovered, is not madness; it is the brain’s memory system struggling to complete an unfinished survival response. Hypervigilance, emotional numbing, and avoidance are not voluntary but automatic physiological states. Recognizing this changed everything about how we approached treatment. No longer could we simply interpret trauma away through analytical talk. The task became to understand the biological roots of terror itself.

When trauma strikes, it engraves itself into the brain’s architecture. Three regions are particularly affected: the amygdala, the hippocampus, and the prefrontal cortex. The amygdala is the brain’s alarm system; it reacts instantly to danger. In trauma sufferers, it becomes hyperactive, signaling threat at the faintest reminder. The hippocampus, which gives context and sequence to memory, can become compromised. Traumatic events are remembered in fragments—sounds, smells, body sensations—rather than coherent narratives. Meanwhile, the prefrontal cortex, responsible for rational thought and self-regulation, often shuts down when the amygdala flares. This explains why trauma victims feel hijacked by emotion and why telling the story may not immediately relieve suffering.

Brain imaging studies revealed that, under stress, people with PTSD show reduced activity in Broca’s area—the part of the brain responsible for speech. This is why they often say, “I can’t put it into words.” Traumatic memory is stored not as language but as bodily sensation and visual image. To heal, one must access not only the verbal but the sensory and emotional domains where these memories live. Neuroscience has provided us with maps of how terror reshapes neural pathways, but equally, it shows us the possibility of rewiring them through safety, rhythm, and focused awareness.

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