The young boy couldn’t have been more than seven years old when he came into the emergency room. A scalding accident at home had left him with third-degree burns covering his forearm. As a first-year surgical resident, I knew what needed to happen next—debridement, the painful process of removing dead tissue to prevent infection and promote healing.
What struck me that day wasn’t just the physical trauma, but watching this child’s face as we prepared for the procedure. Even with ketamine providing conscious sedation, I could see something in his eyes—a fear that went deeper than the immediate pain. I wondered then what mark this experience would leave on him. Would he flinch every time he saw a stove? Would medical settings trigger overwhelming anxiety years later?
That was my first real understanding that trauma isn’t just what happens to your body. It’s what happens in your brain, your nervous system, your sense of safety in the world. And it doesn’t always announce itself in obvious ways.
The Face of Trauma We Don’t Always Recognize
When most people hear “PTSD,” they picture a combat veteran—someone who’s experienced the horrors of war and returned home forever changed. And yes, military trauma is very real and deserves every bit of recognition and support it receives.
But PTSD doesn’t only develop on battlefields. Trauma comes in many forms, and the aftermath can be just as devastating regardless of where or how it occurred.
There’s medical trauma—like that young burn patient, or someone who experienced a traumatic childbirth, or a person who survived a life-threatening illness. There’s complex trauma from ongoing abuse or neglect during childhood. There’s secondary trauma that develops from repeatedly witnessing others’ suffering, common among first responders, emergency room staff, and therapists.
All of these experiences can lead to Post-Traumatic Stress Disorder. The common thread isn’t the specific type of event—it’s what happens when your brain and nervous system get stuck in a perpetual state of threat response, long after the danger has passed.
What PTSD Actually Looks Like
Sarah came to our clinic after three years of struggling with what her previous doctor had diagnosed as “treatment-resistant depression and anxiety.” She’d tried multiple antidepressants and spent months in talk therapy, but nothing seemed to help. She still had trouble sleeping. She was irritable and on edge constantly. She avoided certain places and situations without really understanding why.
During our initial evaluation, a different picture emerged. Five years earlier, Sarah had been in a serious car accident. She walked away with minor injuries—or so it seemed. But her brain had recorded that experience as life-threatening, and her nervous system never quite got the message that the danger was over.
This is what PTSD often looks like in real life. It’s not always flashbacks and nightmares, though those certainly occur. Sometimes it’s:
Intrusive thoughts or images that appear without warning, pulling you out of the present moment and back into the past. You might be going about your day when suddenly a sound, a smell, or a seemingly random trigger yanks you back to that moment. Your heart races. Your breath catches. For a few seconds or minutes, you’re there again.
Avoidance becomes a way of life. You might avoid specific places, people, activities, or conversations that remind you of the trauma—even indirectly. You might avoid thinking or talking about what happened, pushing it down so hard that you can’t access those memories even when you want to. This avoidance might provide temporary relief, but it narrows your world bit by bit.
Hypervigilance means your nervous system is always on high alert, scanning for danger. You startle easily. You have trouble relaxing. You might check locks multiple times, sit with your back to the wall in restaurants, or feel exhausted from constantly monitoring your environment for threats that aren’t actually there.
Negative changes in thoughts and mood can make you feel like a different person. You might struggle to remember important details about the trauma. You might develop persistent negative beliefs about yourself, others, or the world—”I’m damaged,” “No one can be trusted,” “The world is fundamentally dangerous.” You might lose interest in activities you used to enjoy or feel emotionally numb, unable to access positive emotions even when good things happen.
The Neuroscience of Being Stuck
Understanding what happens in your brain during and after trauma helps explain why PTSD isn’t something you can simply “get over” or “move past” through willpower alone.
When you experience trauma, your brain’s threat-detection system—centered in the amygdala—goes into overdrive. This ancient part of your brain is designed to keep you alive by rapidly detecting danger and triggering your fight-flight-freeze response. During trauma, the amygdala essentially hijacks your system, flooding your body with stress hormones and creating a powerful emotional memory.
At the same time, the hippocampus—which normally helps contextualize and process memories, marking them as “this happened in the past”—can become impaired during overwhelming stress. This is why traumatic memories often feel different from normal memories. They’re not properly filed away as “something that happened.” Instead, they remain vivid, present, emotionally charged, as if they’re still happening.
Meanwhile, the prefrontal cortex—your brain’s executive control center that helps with reasoning, perspective, and emotional regulation—may become less active. This explains why trauma reactions can feel so out of your control. The thinking part of your brain that would normally say “I’m actually safe right now” gets overridden by the emotional brain screaming “Danger!”
In PTSD, these changes become persistent. Your amygdala remains hyperactive, constantly on the lookout for potential threats. Your hippocampus struggles to properly contextualize traumatic memories. Your prefrontal cortex has difficulty regulating your emotional responses. You’re essentially stuck in a state of ongoing threat response, even when you’re objectively safe.
This isn’t a character flaw or a sign of weakness. It’s a neurobiological adaptation that made sense during the trauma—keeping you alive and alert to danger—but that hasn’t been able to reset once the actual danger passed.
Why Some Trauma Gets “Stuck”
Not everyone who experiences trauma develops PTSD. This isn’t about being “strong” or “weak”—it’s about a complex interplay of factors including the nature of the trauma, your previous experiences, your support systems, your genetic vulnerability, and sometimes just chance.
Some traumas seem particularly likely to lead to PTSD. Those involving interpersonal violence, betrayal by trusted figures, or ongoing repeated trauma tend to have higher rates of PTSD than single-incident traumas. Traumas that occur during childhood, when your brain is still developing, can have particularly profound and lasting effects.
But even single-incident traumas can create PTSD if they overwhelm your capacity to process and integrate the experience. Sometimes the trauma happens so quickly and intensely that your brain can’t make sense of it. Sometimes you’re alone during or after the trauma without support to help process what happened. Sometimes shame or guilt gets tangled up with the traumatic memory, making it harder to face and work through.
And here’s what many people don’t understand: you can know intellectually that you’re safe now and still experience PTSD symptoms. That’s because trauma lives in the body and the emotional brain, not just in your thoughts and rational understanding. You can logically know the war is over, the abuser is gone, the accident happened years ago—and your nervous system can still be responding as if the threat is present and imminent.
This is why traditional talk therapy, while valuable, isn’t always sufficient for PTSD. Talking about trauma engages your prefrontal cortex—the thinking brain—but trauma is stored in deeper, more primitive areas. To truly heal from PTSD, you often need interventions that can access and reprogram those deeper neural circuits.
When Traditional Understanding Falls Short
For decades, the mental health field has recognized PTSD, but our understanding has evolved significantly. We now know that trauma isn’t just about specific diagnosable events. Complex PTSD—resulting from ongoing, repeated trauma, particularly in childhood—presents somewhat differently than PTSD from a single traumatic incident.
We understand that trauma can be developmental, shaping how you see yourself and the world during critical periods of brain development. We recognize that trauma can be cumulative, with seemingly smaller events building up over time to create a significant impact. We acknowledge that trauma is subjective—what’s overwhelming for one person may be manageable for another, and that’s okay. Neither response is more valid.
We’ve also learned that trauma isn’t just psychological—it’s physiological. Bessel van der Kolk’s groundbreaking work, “The Body Keeps the Score,” illuminated how trauma lives in your nervous system, your muscles, your gut. This is why people with PTSD often experience physical symptoms—chronic pain, digestive issues, immune problems—alongside the psychological ones.
As a trauma surgeon, I witnessed this connection between physical and psychological trauma countless times. I’d treat the visible wounds, the broken bones and torn flesh, but I knew that what wasn’t visible—the fear, the helplessness, the loss of control someone experienced during their injury—might leave marks that took far longer to heal.
My own journey with anxiety during medical school and residency, though not PTSD, gave me some insight into what it means to feel unsafe in your own mind. The constant vigilance about making mistakes, the fear of being “found out” as not belonging there, the inability to trust my own capabilities despite evidence to the contrary—that persistent sense of threat, even in objectively safe situations, was exhausting. I can only imagine how much more intense that experience becomes when it’s rooted in actual trauma.
Moving Beyond Survival Mode
If you’re living with PTSD, you know that it’s more than just memories of something bad that happened. It’s about feeling like you can’t fully trust the present because the past keeps intruding. It’s about exhaustion from being perpetually on guard. It’s about the frustration of knowing intellectually that you’re safe while your body and emotions insist otherwise.
You might have been told to “just face your fears” or “talk about what happened” or “let it go.” You might have tried—genuinely tried—and found that it didn’t work the way it was supposed to. You might be wondering if you’re somehow doing recovery wrong, if maybe you’re just not trying hard enough.
Please hear this: If traditional approaches haven’t worked for you, that doesn’t mean you’re failing at healing. It means you need a different approach, one that can access the deeper levels where trauma is stored and help your nervous system finally get the message that the danger has passed.
In our next article in this series, we’ll explore why standard PTSD treatments work for some people but not others. We’ll look at the established approaches—exposure therapy, EMDR, medications—and examine their strengths and limitations. We’ll discuss what it means to have treatment-resistant PTSD and why that’s not the end of the road.
More importantly, we’ll begin exploring how emerging treatments like ketamine therapy offer new possibilities for people who’ve been stuck in trauma responses for years, providing access to neural circuits that traditional therapies may not reach.
You Deserve More Than Survival
PTSD can make you feel like you’re just surviving—making it through each day, managing symptoms, avoiding triggers, trying not to break down. But you deserve more than survival. You deserve to feel safe in your body again. You deserve to be present in your life rather than constantly pulled back to the past. You deserve to build a future that isn’t dictated by what happened to you.
Understanding that PTSD is a neurobiological response to overwhelming stress, not a personal failing, is the first step. Recognizing that your symptoms make sense given what your brain and nervous system experienced is validating and important. But understanding alone doesn’t heal trauma.
Healing requires interventions that can help your brain and nervous system recalibrate, that can update the threat detection system with current information, that can help you process what happened and integrate those memories in a way that allows you to finally move forward.
Whether your trauma stems from combat, assault, accidents, medical experiences, childhood adversity, or any of the countless ways that life can overwhelm our capacity to cope—you’re not alone, and you’re not without options.
The past may have shaped you, but it doesn’t have to define your future.
Key Takeaways
PTSD develops from many types of trauma beyond combat, including assault, accidents, medical trauma, childhood adversity, and secondary trauma from witnessing others’ suffering. The disorder involves neurobiological changes in the amygdala, hippocampus, and prefrontal cortex that keep your nervous system stuck in threat-response mode long after danger has passed. PTSD symptoms include intrusive memories, avoidance behaviors, hypervigilance, and negative changes in thoughts and mood that persist despite knowing intellectually that you’re now safe. Not everyone who experiences trauma develops PTSD, and the condition is influenced by trauma type, timing, support systems, and individual factors. Traditional talk therapy, while valuable, isn’t always sufficient because trauma is stored in deeper neural circuits beyond the rational thinking brain.
About the Author
Dr. Rivas is a ketamine specialist and board-certified acute care and trauma surgeon with over 12 years of experience in ketamine administration. Before founding Innerbloom Ketamine Therapy in 2022, Dr. Rivas served on the frontlines of emergency and trauma medicine in Santa Maria, CA, and Austin, TX. Dr. Rivas applies his extensive medical expertise to provide safe, evidence-based ketamine treatments for mood disorders, including depression, anxiety, PTSD, and chronic pain. His passion lies in helping patients find relief and rediscover hope through personalized, compassionate care.
Innerbloom Ketamine Therapy is a San Luis Obispo-based clinic offering IV and IM ketamine, SPRAVATO®, and ketamine-assisted psychotherapy. We specialize in treatment-resistant depression, anxiety, PTSD, and chronic pain—helping people reconnect with themselves and reclaim their lives through evidence-based, transformative care.
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