PTSD 101: What You Need to Know

Brennan C. Mallonee, LMHC • Individual Counseling in Cambridge, MA

I was recently featured in an article on Brit + Co exploring what PTSD (Post-Traumatic Stress Disorder) looks like in people who have experienced sexual assault.  I’m so glad to see more and more media outlets discussing this, as it’s all too common and has often been swept under the rug in the past, leading to devastating consequences for survivors.  In fact, this radio silence about what the aftermath of sexual assault looks like can compound the original trauma by leaving survivors feeling isolated, misunderstood, or even questioning whether they are “overreacting” to what they experienced.  Recent articles demystifying survivors’ experiences are doing a valuable service of not only teaching, but hopefully also making it easier for more survivors to start healing.

There are some different approaches to conceptualizing and treating trauma, whether there is a formal diagnosis of PTSD or not.  People seeking professional help in dealing with the fallout of a sexual assault or other traumatic incident should choose a therapist who they feel safe working with and whose perspective on trauma they feel comfortable with.  Some of the perspectives in this recent article are incompatible with the way that I practice trauma therapy and reflect a different way of approaching this complex issue.  Here I’m going to talk about my philosophy when it comes to trauma and outline how I approach it in my work.


Brennan C. Mallonee, LMHC • Individual Counseling in Cambridge, MA

Trauma is in the experience, not in the event itself.  Although there are broad categories of phenomena that often lead to trauma symptoms, what is traumatic for one person might not be for another.  Each individual’s personality, their thoughts and emotions during the event(s), their beliefs about their safety and the nature of the world, their baseline level of anxiety - in short, their perception of the event - determines whether or not that event is traumatic for them.  

While formal diagnostic criteria for PTSD are somewhat narrower, I am less concerned in my practice with finding a diagnostic “label” (unless that is helpful for the client!) than I am with finding the best way for my client to come to terms with their own story and find peace within themselves.  My job begins with believing my client when they say that their experience was traumatic.  Then we can begin the journey of healing together.


Our brains have an elegant built-in system for managing situations that we perceive as threatening to our life or well-being.  This built-in system is the result of millions of years of evolution and its goal is to help you survive in the short-term.  It’s quite good at doing this.  What it’s not as good at is helping you to manage long-term, after the initial threatening event(s) is past.

Brennan C. Mallonee, LMHC • Individual Counseling in Cambridge, MA

Here’s what this looks like in practice.  Your brain has certain structures dedicated to recognizing potential danger.  These structures are located in a very old part of the brain, colloquially known as the “lizard brain” due to the fact that we share this part with reptiles as well as other mammals.  Your lizard brain is tasked with the automatic functions of life: heart rate, metabolism, breathing, and surviving danger.  You have very little, if any, conscious control over this part of your brain, and this is for a very good reason: if you had to think about making your heart beat and extracting energy from food, you wouldn’t survive very long.  

The lizard brain is excellent at keeping you alive.  It is also much, much faster at processing information than your conscious brain, something that comes in handy when facing danger and making split-second choices about how to stay safe.  When you are in a situation that your lizard brain perceives as dangerous, it notes this potential danger long before you’re consciously aware of it.  As soon as it does, it starts a process meant to keep you alive.

At this point, the lizard brain has three different choices for paths it can take to get you through the next few moments.  It makes this decision automatically, without any conscious input from you.  It will choose either:

Brennan C. Mallonee, LMHC • Individual Counseling in Cambridge, MA

•Fight (fighting the danger)

•Flight (fleeing the danger)


•Freeze (freezing until the danger is past)

Chemically, the lizard brain triggers a cascade of stress hormones including adrenaline and cortisol that help drive fight, flight, or freeze mode.  At the same time, it brings other, more conscious parts of the brain “offline” in order to ensure that you don’t get distracted from the crucial work of surviving this moment.  

People who go into fight mode often experience unusual strength, such as in stories you occasionally hear about mothers who are able to lift cars off of a trapped child, or they become more aggressive in self-defense.  People who go into flight mode find that they are able to run faster than typical for a short burst of time, fueled by adrenaline.  And people who go into freeze mode often find that they cannot physically move, cannot speak, or cannot put together a coherent thought.

Freeze mode often leaves survivors confused and angry at themselves.  It’s hard to understand why you weren’t able to fight back or even speak up for yourself when you were in danger.  Others may question, “well, why didn’t you fight back?”.  It can feel as though your body betrayed you when you most needed to help.  Freeze mode means you had no choice.  You could not physically fight back, you could not speak up even to say no.  

Freeze mode makes sense from a biological and evolutionary perspective (it’s especially adaptive for children, who aren’t big enough to fight or flee effectively), but after the crucial moments of survival are done, it can leave you feeling devastated and confused.  If you’ve experienced this, it’s important to understand that this is an automatic biological reaction and that it is not your fault and does not mean you are to blame for the trauma.  It means your lizard brain was working overtime, doing the best it could to get you through of a dangerous situation, even if it’s not the choice you wish it had made in retrospect.  


Brennan C. Mallonee, LMHC • Individual Counseling in Cambridge, MA

Dissociation is a psychological phenomenon where our mind separates from our body.  We all experience this to some degree from time to time.   Highway hypnosis, where you’re driving and then suddenly realize you’ve passed several exits you don’t remember, is a common example.  Another is getting lost in a good book and being startled when a noise or touch brings you back to the present.  Daydreaming is another pleasant example of dissociation.

When we experience something traumatic, our brain deploys this ability to dissociate to help us survive the event psychologically.  When something painful or frightening is happening to us, dissociation is a way for our brain to protect us emotionally from the impact of what we’re going through.  People who have dissociated during a trauma often report feeling as though they were watching what happened from far away, or that they were floating above their body, or that time slowed down and things felt unreal.  This allows us to avoid the full emotional impact of what we’re experiencing in the moment and ideally to process it later, when we are safe.


The lizard brain works elegantly in the moment to save us from short-term danger.  It does not prepare us to deal with the long-term effects of having lived through this danger.  After the fact, many trauma survivors find that states of fight, fight, or freeze persist, coming up at times when they are not actually in danger.  For example, sexual assault survivors often find these reactions occurring during consensual sexual encounters.  Others may find themselves becoming angry or aggressive more often as they dip back into fight mode when their lizard brains perceive even minor threats.  Dissociation can sometimes become more persistent, especially after severe or repeated trauma, and can leave survivors feeling fragmented and cut off from their own self.  This situation where a survivor’s lizard brain continues to live in a state of high alert and danger after the real danger has passed is how PTSD occurs.  PTSD is the reasonable, understandable response of a brain that has been exposed to unreasonable, even horrifying circumstances.


This crash course in the neurobiology of trauma is really important for debunking certain myths about sexual assault, myths that stigmatize survivors and make it harder for them to start the healing process.  

Myth 1 : If you didn’t fight back then it wasn’t really a sexual assault.

FALSE : Many, many people not only don’t fight back when sexually assaulted, they are physically unable to in the moment due to the automatic, biological survival response of the lizard brain.  Whether or not you fight back or even verbally say “no” has no bearing on whether what happened was sexual assault.  Instead, lack of consent is the defining characteristic of a sexual assault.  

Myth 2 : Most sexual assault is violent and forceful.

FALSE : Most sexual assault is not violent.  The stereotypical violent stranger-rape makes up a minority of sexual assaults in this country, while most are perpetrated by someone the survivor knows personally - a date, a friend, an intimate partner.  Physical violence or force is not necessary for it to be sexual assault.  All that is necessary is that the survivor did not consent to the sexual activity, whether because they were incapacitated by substances, frozen in fear, or anything else.  Most sexual assaults occur when the perpetrator pushes ahead with sexual activity without regard for whether the other person is consenting and comfortable with the situation.  People who do not fight back against a sexual assault most often are frozen due to going into freeze mode, rather than due to being physically overpowered by the perpetrator, which, again, is rare.


So what does this mean for healing from trauma?

I practice something called phase-based trauma treatment.  In phase-based treatment, we start with the crucial task of rebuilding your own inner and outer feeling of safety and we work on this for as long as we need to before getting into talking about the trauma itself.  In fact, it’s not always necessary to go over the where, how, who, and so on of a traumatic incident in order to get relief. 

The biggest struggle survivors often face is the lack of safety they feel, both in the world and inside themselves, and rebuilding your ability to keep yourself safe and your trust in yourself to be able to do this is essential.  When you feel safer within yourself and confident that you can get back to safety even if something big comes up within you, then you may find yourself at a point where you’re ready to tell your story.  If that happens, then my job is first to listen, so that you no longer have to hold the truth of what happened by yourself, and second to help you find a way to own your own story and put it in the past - something that happened, that hurts, but that no longer rules your life.


Brennan C. Mallonee, LMHC • Individual Counseling in Cambridge, MA

Healing from trauma is possible.  It’s kind of like grief - the event never goes away, it’s always a part of your history, but eventually it doesn’t hurt so much.  It becomes tolerable and pops up less often and you learn how to manage it when it does.  It turns into one little piece of your life rather than the all-encompassing reality of it. 

Here’s to all of the survivors, fighting one moment at a time to rebuild a meaningful, healthy life after the unimaginable.


Brit + Co: This Is What PTSD Looks Like for Sexual Assault Survivors