'You can get better': A trauma specialist's advice for starting the recovery process

Editor’s note: This story contains descriptions of rape and sexual assault.

Find out more about our mental health series here.

When Karestan Koenen was working for the Peace Corps in Niger in 1991, she was brutally assaulted and raped.

Upon returning home, she fell into a severe depression that was compounded by callous government officials.

“One of the people I talked to immediately blamed me and said that women who come back from the Peace Corps and say they were raped, it's their fault,” Koenen says. “Another person I saw who was actually a medical doctor was really more concerned about my sexual history than what had happened to me. That was actually much more damaging probably than the assault itself.”

She worked hard to find a path out of her depression and eventually soared to the top of the therapy field. She’s now a trauma specialist and head of the Biology of Trauma Initiative at the Broad Institute of Massachusetts Institute of Technology and Harvard University.

Her new research shows that some people may suffer from trauma more than others because of a genetic link to other generations of sufferers in their families. She has dedicated her life to helping others recover from violence and trauma like she did.

“Something everyone should know is that we do have treatments for PTSD that work. They're called trauma-informed therapies,” Koenen says, “and you can get better.”

On the suffering she endured after being raped 

“I felt like I was going down a dark tunnel, and there was no light at the end, and I couldn't stop thinking about what had happened and what people had said to me about it. I felt like a complete failure. I 100% believed my life was over, which is, it's hard to think about that now because I'm 55. But I believed my life was over and I had no future.

“I had nightmares. I would occasionally have situations where I would make myself go out and I see something that reminded me and I [would] think it was happening again. I couldn't work. I didn't want to see friends because I felt so embarrassed and ashamed. So I basically stayed up in bed in a room above my parents' garage. And it was hard to get me to do anything with anyone.”

On how seeing a therapist helped her out of that depression 

“That was the first time I was really in therapy because at that time, it's not something my family did or people did.

“I remember the therapist just being this warm, supportive presence and said, ‘Let's talk about what's going on.’

“She began with that and then she started really just helping me to function again, to think about things I might like doing, kind of start to nudge me to start doing them. And then once I started developing more of a relationship with her, we talked about what had happened: the rape, the experience I had after getting help, how I was treated.

“And that really turned everything around for me. It was finally someone was willing to listen to all the details without judgment. And I started feeling like it wasn't my fault and I started seeing that things could get better.”

On how she became interested in studying trauma through going to therapy 

“Well, once I started learning about my own experience … I read a book called ‘Trauma and Recovery,’ which was written in 1992 by Judith Herman, a psychiatrist. And it really tied together the experience of trauma across Vietnam veterans, women who experience domestic violence, women who were raped, people who experience child abuse and how there are commonalities in the response to those things.

“And I started seeing what I was experiencing as part of this common picture that even people in my family, like my grandfather who was wounded in World War II had, although it was never ever diagnosed.

“That really got me interested in this question of how does trauma get under the skin and sort of cause these things, these symptoms, these mental health symptoms? And why do some people react differently than others given the same experience? Which really led into my research.”

On what her recent research shows about the possible genetic links to developing PTSD

“Our recent genetic research, the idea behind that is given the similar trauma … how people respond is influenced by their genetic background. And people sometimes find that shocking, but similar genetic risk for PTSD is similar to genetic risk for, let's say, heart disease or diabetes. And of course, you need the traumatic experience. Without that, you wouldn't have the PTSD. But your genetic background shapes some of how you respond to that experience.

“There are personality traits that are genetically influenced and other factors and they partially influence how we respond to trauma. And I think in the long run, what we can learn from this genetic research is that it will help us identify biological pathways that can be used to develop new treatments, interventions, perhaps that can even prevent PTSD after trauma. So a lot of it is around understanding the biology of PTSD so that we can do something about it in the future.”

On her advice for people who are struggling with trauma

“I would say for people thinking about this, the first thing to think about is what do you want to share and what do you want from the people you're sharing with, and think carefully about who you share what you experienced with. Pick people that have been supportive of you in the past that you trust.

“There are also all kinds of resources … in Boston, there's a Boston Area Rape Crisis Center. There's national hotlines. So that's always a reliable place to start talking about your experience with people who are trained to listen, know how to ask the right questions, and you can guarantee we'll help you find further resources.”