Most of us have a narrow view of trauma. We think of trauma as an extreme, eruptive and dramatic experience. It comes to mind when we hear about acts of violence, natural disasters or loss of loved ones. Yes, this is trauma. No doubt.

But trauma has also an unfamiliar face. One that is subtler, less ostensible, and often unrecognized even by those who are most affected by it.

It turns out many diverse experiences of our lives (emotional neglect, for example) can be equally traumatic and have long-lasting and profound repercussions.

And so, the experience of cancer and its treatment.

I see it with many of my patients. The diagnosis of cancer, quietly discussed in a consultation room, is a life changing experience that can be and often is a source of trauma for many patients. Cancer is a life-threatening event profoundly affecting one’s many spheres of life. Also, cancer is no longer the same explosive disease it used to be, but it rather unfolds over a long period, sometimes years, which cumulative force can be equally crippling. For many, the root of the cancer-related psychological trauma is the experience of loss or threat of loss. Loss of physical function, loss of quality of life, loss of the future we once imagined, loss of our finances or professional lives.

Trauma has strong neurobiological underpinnings. Victims of trauma have abnormal activation of the insula. Insula is a brain structure within the cerebral cortex that integrates and interprets information from sensory organs. Insula can signal amygdala which activates the flight-and-fight responses. These processes happen under the surface, and yet have profound effects for the way we feel, process emotions and information, think and act.

In other words, the body keeps the score.

Without us being aware of it, the experience of trauma shapes us from within, and then manifests without. Here is a great infographic illustrating trauma’s impact on the brain and memory.

I encourage you to read Dr. Bessel van der Kolk’s book. He is a psychiatrist and a researcher who spent years studying it, and his book is a must-read for anyone interested in learning about the trauma more deeply. It will open your eyes.

The experience of trauma is universal. We all need to be better at recognizing it and addressing it in our own lives.