Chap­ter 1: Lessons from Viet­nam Vet­er­ans. In the late 1970s, the author began their work as a psy­chi­a­trist at the Boston Vet­er­ans Admin­is­tra­tion Clin­ic, encoun­ter­ing a patient named Tom, a Viet­nam War vet­er­an. Tom’s sto­ry unfold­ed over the course of his ses­sions, reveal­ing a man deeply scarred by his expe­ri­ences in Viet­nam. He had joined the Marine Corps out of duty and ide­al­ism, ris­ing quick­ly to the role of pla­toon leader. After sur­viv­ing a har­row­ing expe­ri­ence dur­ing the war, where he wit­nessed the deaths and injuries of his pla­toon mem­bers, Tom returned to civil­ian life, hop­ing to leave the past behind. How­ev­er, his attempts to inte­grate back into soci­ety were unsuc­cess­ful. His nights were plagued by flash­backs and night­mares, which were trig­gered by the sounds and expe­ri­ences that remind­ed him of Viet­nam. His behav­ior became errat­ic, and he often found solace in alco­hol or reck­less motor­cy­cle rides, as he strug­gled to man­age the over­whelm­ing mem­o­ries of war.

Tom’s response to his trau­ma was not unique. As the author lis­tened to Tom’s sto­ry, mem­o­ries from his own child­hood emerged, evok­ing reflec­tions on how war and trau­ma left marks on gen­er­a­tions. The author had grown up in post­war Hol­land, where the effects of wartime expe­ri­ences had pro­found­ly shaped their fam­i­ly. Like Tom, both the author’s father and uncle had been affect­ed by the trau­ma they expe­ri­enced dur­ing war. The rage and emo­tion­al numb­ness that char­ac­ter­ized their behav­iors mir­rored Tom’s strug­gles, reveal­ing a pat­tern of unre­solved trau­ma that spanned gen­er­a­tions. As the author learned more about Tom’s con­di­tion, it became clear that the psy­cho­log­i­cal scars of war were not just about the mem­o­ries of spe­cif­ic events but were deeply root­ed in the very fab­ric of one’s iden­ti­ty. This real­iza­tion would shape the author’s under­stand­ing of trau­ma and its long-last­ing effects.

While Tom was not the author’s first encounter with trau­ma, his case illus­trat­ed the com­plex­i­ty of post-trau­mat­ic stress dis­or­der (PTSD). In med­ical school, the author had been taught to approach trau­ma pri­mar­i­ly as a psy­cho­log­i­cal issue, but Tom’s expe­ri­ence revealed how trau­ma could phys­i­cal­ly alter a person’s abil­i­ty to func­tion. The mem­o­ries of war were so ingrained in Tom’s psy­che that they dic­tat­ed his actions, ren­der­ing him unable to escape the trau­ma. The author’s ear­ly psy­chi­atric train­ing focused on symp­toms and diag­noses, often treat­ing the sur­face issues with­out delv­ing into the root caus­es. How­ev­er, Tom’s case chal­lenged this con­ven­tion­al approach and led the author to recon­sid­er the role of trau­ma in the men­tal health field. Over time, the under­stand­ing of PTSD would evolve, becom­ing a focal point in trau­ma research, and the author would con­tin­ue to learn from vet­er­ans like Tom, as well as oth­er patients suf­fer­ing from emo­tion­al and phys­i­cal scars.

Through Tom’s sto­ry, the author dis­cov­ered the deep con­nec­tion between trau­ma and the body, an insight that would lat­er con­tribute to their work in under­stand­ing PTSD. This con­nec­tion high­lights how the body holds onto past pain and dis­tress, often man­i­fest­ing in phys­i­cal symp­toms. The trau­ma that Tom expe­ri­enced, like that of many vet­er­ans and vic­tims of abuse, was not con­fined to the mind but seeped into every aspect of his being. As Tom sought ways to cope with his pain, he found it dif­fi­cult to express the emo­tions that he had buried, which led to increased iso­la­tion and self-destruc­tive behav­iors. This is a com­mon response to trau­ma, where indi­vid­u­als dis­con­nect from their emo­tions in order to sur­vive the over­whelm­ing expe­ri­ences. The chal­lenge, there­fore, was not just to address the psy­cho­log­i­cal symp­toms but also to help these indi­vid­u­als recon­nect with their emo­tions and rebuild a sense of safe­ty and con­trol in their lives. In recent years, stud­ies have shown that trau­ma can affect the brain’s neu­ro­chem­i­cal bal­ance, par­tic­u­lar­ly in areas relat­ed to fear and mem­o­ry. Under­stand­ing this has led to a more holis­tic approach in treat­ing PTSD, com­bin­ing ther­a­py, med­ica­tion, and new trau­ma-informed care prac­tices.

As PTSD aware­ness grew, it became clear that trau­ma impacts more than just sol­diers return­ing from war. The same pat­terns were seen in sur­vivors of domes­tic vio­lence, child­hood abuse, and oth­er trau­mat­ic expe­ri­ences. The trau­mat­ic effects of war, abuse, and vio­lence shape how indi­vid­u­als per­ceive the world, often caus­ing them to view every sit­u­a­tion through the lens of past trau­ma. The devel­op­ment of PTSD is linked to changes in brain activ­i­ty, par­tic­u­lar­ly in the amyg­dala, which process­es emo­tion­al respons­es to per­ceived threats. This insight has led to the under­stand­ing that trau­ma rewires the brain’s response to dan­ger, mak­ing it hard­er for indi­vid­u­als to reg­u­late their emo­tions and reac­tions. For many, recov­ery requires not just the removal of symp­toms but a com­plete reor­ga­ni­za­tion of their per­cep­tions and sense of self. New ther­a­pies have emerged that focus on help­ing indi­vid­u­als process these trau­mat­ic mem­o­ries in a way that allows them to regain con­trol over their lives. The road to heal­ing from trau­ma is often long and com­pli­cat­ed, but with the right sup­port and treat­ment, indi­vid­u­als can begin to reclaim their sense of self and move for­ward from the past.