The first thing I notice about a man, when he walks into my Oakland office for the first time, is his breath.
Not his words. Not his clothes. Not his story. The breath. Where it lives in his torso. How high it sits. How quickly it moves. Whether it stops, for two or three seconds at a time, when he talks about something that frightens him. Whether it is symmetrical, side to side, or whether one side of his rib cage moves and the other does not. Whether he is breathing into his belly, or has not, in the conscious memory of his nervous system, ever breathed below his sternum.
Most of the men who come to me, when I first meet them, are breathing in the top third of their chest. The diaphragm is, in clinical terms, restricted. In ordinary English: they have been bracing, in the body, for something, every day, for thirty or forty years. The bracing has become so familiar it has stopped registering as bracing. It has become posture.
I have been a somatic therapist for fifteen years — Somatic Experiencing trained, with continuing work in sensorimotor and polyvagal-informed approaches. The literature I work from is, broadly: van der Kolk on how the body keeps the score, Peter Levine on the freeze response and titrated release, Pat Ogden on movement and trauma, Stephen Porges on the autonomic ladder. The clinical work, for the men in my practice, is much smaller and quieter than the books suggest. It is mostly: noticing the breath. Noticing the jaw. Noticing the feet.
I want to write down what I have learned, because I think most men — and most clinicians, including therapists who do not do somatic work — do not yet have an accurate map of where trauma lives in male bodies.
Trauma, in any body, lives in the autonomic nervous system. That is not a poetic claim; it is a physiological one. When something overwhelms the system's capacity to process it in the moment, the system does what it is designed to do: it stores the unprocessed activation in the body, and it suppresses the conscious access to it, so the person can keep functioning. This is not pathology. This is, in evolutionary terms, a feature.
The pathology arrives when the storage becomes permanent. The activation stays held. The suppression stays in place. Decades later, the body is still bracing for an event that ended in 1987, or in 2003, or last week — and the man's life is being organized, without his awareness, around not feeling that held charge.
Where the charge gets held varies by person, by event, by developmental stage at the time. But in fifteen years of practice, I have come to recognize patterns in male bodies that are different — not categorically, but distributionally — from what I see in female bodies, and that have specific clinical implications.
The jaw, first. Most of the men I work with hold significant chronic tension in the masseter and temporalis muscles. Many grind their teeth at night. Many have dental work that has been redone two or three times because the bite is, in the most literal sense, too forceful. The jaw, in my reading, is one of the primary places American men store the swallowed anger of a childhood in which expressing it was unsafe, the swallowed grief of adolescence in which feeling it was forbidden, and the swallowed fear of adulthood in which naming it was professionally costly. The jaw becomes the vault.
The shoulders, second. The traps, the levator scapulae, the rhomboids. Men come in with shoulders that are, often, three or four inches higher than where their nervous system would actually like them to be. I have, more than once, watched a man's shoulders drop two full inches in the first ten minutes of a session, as he begins to feel safe in the room. He does not, before the drop, experience his shoulders as raised. They are, to him, where shoulders go. The dropping is, in his report afterward, often more disorienting than the raising had been familiar. I didn't know they could go down, a man said to me last month. He was forty-three. He had been carrying his shoulders at his ears since approximately third grade.
The breath, third. As I said. High, fast, restricted, often asymmetrical. A male client with PTSD will, in many cases, hold his breath entirely when he gets close to a piece of the unprocessed material. The held breath is the body's do not move; the predator is still here. We work with the held breath gently, not by ordering him to breathe, but by inviting him to notice the holding, and to let the body resume on its own when it is ready.
The gut, fourth. The enteric nervous system, the vagus nerve. Men with chronic anxiety, in my practice, very often have chronic GI symptoms that they have not connected to their anxiety, because no one has connected them for them. The gut is, in some cases, more reliable than the cortex about reading social danger. Many men have been trained, by professional life, to override the gut's signal. Years of override produce IBS-spectrum complaints that no gastroenterologist can fully resolve, because the gastroenterologist does not have a tool for unprocessed cumulative interpersonal danger.
The pelvic floor, fifth. This is the one men least want to talk about and that, in my practice, has the largest clinical payoff once we do. The pelvic floor in men is a major holding tank for shame, for sexual trauma, for chronic anxiety, and for the freeze response. ED, premature ejaculation, urinary urgency, chronic pelvic pain — these are, in many men, somatic expressions of unprocessed material that is being held in muscles the man has never, in his conscious life, been invited to notice. A good pelvic floor PT, working in conjunction with somatic therapy, is one of the single most clinically useful referrals I make.
The feet, last. This sounds small. It is not. Men, far more than women, in my practice, do not know they have feet. They use their feet to walk. They have not, in the conscious nervous-system sense, inhabited their feet in decades. Asking a fifty-year-old man, in session, to feel his feet on the floor — the temperature, the pressure, the texture of the sock against the skin, the position of the toes — is, very often, the first time in his adult life that his attention has gone all the way down. The reports afterward are striking. I didn't know I had feet, exactly. I knew I had feet. I didn't know they were there.
The difference I notice most, between how trauma shows up in male versus female bodies in my practice, is the difference between dissociation via the body and dissociation via the mind.
This is a generalization. It is statistical, not categorical. Plenty of women dissociate via the body. Plenty of men dissociate via the mind. But the distribution, in my caseload, is real.
Women, on average, when overwhelmed, more often leave the body and stay present in the mind. They feel less. They float. They observe themselves from the corner of the room. The dissociation is, in clinical terms, depersonalization or derealization.
Men, on average, when overwhelmed, more often shut down sensation in the body itself. They stay in the body, structurally — they are not floating — but the body becomes, functionally, numb. They report not feeling. They report being fine when the heart rate monitor disagrees. They report not being angry while the jaw is clamped shut. They report not being sad while the eyes are wet. The dissociation is somatic. It is a shutdown of the afferent signal. The man is, in a real sense, no longer in residence in his own house, even though the lights are on.
The clinical implication is significant. You cannot, with a somatically dissociated man, do the kind of talk therapy that works for a cognitively dissociated woman. Talk therapy that asks the man to describe his feelings will produce, accurately, the report I don't feel anything. He is not lying. He is reporting the truth from inside a body whose signal has been turned down. The work, with these men, has to start with rebuilding the signal. Feet on the floor. Hand on the chest. Notice the breath. Notice the jaw. Notice, before anything else, that there is a body to notice.
This is slow work. It is also, in my fifteen years of doing it, the only work that durably changes the men who come to me with the kind of emotional numbness that has, in their report, defined their adult lives.
I want to describe one session, in detail, to make the work concrete. The client has given me permission. Details are changed enough to protect him.
He is fifty-one. A veteran. He had come to me, originally, for what his wife described as he is here but not here. He had been to two previous therapists. He had, by his own description, talked about Iraq exhaustively. He had not, by either of our descriptions, felt anything about Iraq. He could narrate the worst night of his life with the affect of a man reading a tax document.
I asked him, in our fourth session, to put his hand on his chest. He did. I asked him what he noticed. He said: nothing.
I asked him whether his hand was warm or cold. He said, after a long pause: warm.
I asked him whether his chest, under his hand, was rising or falling. He paused longer. He said: rising. Slightly.
I asked him whether the rising was symmetrical or whether one side was rising more. He paused for a full minute. He said, in a different voice, lower: the right side is rising. The left side isn't moving.
I asked him whether he could remember, at any time in his life, the left side of his chest moving.
He started to cry. He did not know why he was crying. He cried for about three minutes. He said, when he could speak: my buddy was on my left. The night it happened. He was on my left.
He had not, in three previous therapists and in twenty years, accessed that piece of information consciously. It had been held in the left side of his ribcage, since 2004, in the form of a half-frozen breath. The breath had, on its own, when invited, returned to the left side, and the left side had told him the rest.
We did not solve his PTSD in that session. The work continued for two more years. But that was the session in which his nervous system began to trust me enough to start, gently, defrosting. Everything after that session moved differently.
The body had known the story the whole time. The body had been waiting, for twenty years, for someone to ask the left side of the ribcage what it remembered.
If you are a man reading this, and you have spent decades feeling either nothing or only certain narrow allowed feelings, the door back into your body is not, mostly, the door of intellect. It is the door of attention. The micro-attention of the feet. Of the hand on the chest. Of the jaw, when you notice the jaw. Of the breath, where it lives in your torso right now, as you read this sentence.
You do not need a somatic therapist to start. (You may need one to go far. But you do not need one to start.) You can sit, for two minutes, twice a day, and ask your body where it is right now. Where the tension is. Where the breath is. Where, if you scan slowly from your feet up, the signal is loud, and where it is silent. The silent places are not empty. They are the places that have been told, somewhere upstream, that they were not allowed to speak. Inviting attention to them is, in itself, the beginning of giving them permission.
If the practice surfaces something larger than you can hold alone — and for some men, it will — find a somatic therapist. SE-trained, sensorimotor-trained, or a Hakomi practitioner are all reasonable starting points. The trauma-focused therapist list for Oakland includes clinicians I have personally trained with or referred to. If you are not local, search for somatic experiencing practitioner + your city, or sensorimotor psychotherapy + your city. The conversation rehearsal tool can help you draft the email asking for an intake.
If you are the partner of a man whose body is holding more than he is able to access — the "when he won't cry" response and the "he came home from war different" walkthrough were written for exactly the kind of somatic shutdown I describe above.
The body is patient. The body has been waiting, often for decades, for the man inside it to come home. The good news, in my fifteen years of practice, is that the body almost always opens the door when knocked on. The bad news is that no one taught most men the knock.
This is, in some sense, the entire work. Teaching the knock.
If something in this piece surfaced a memory or sensation that feels too large to sit with alone, please reach a trauma-trained clinician. The trauma-focused therapist list for Oakland includes SE and sensorimotor practitioners. National hotline: 988. For acute trauma flashbacks, the SAMHSA Disaster Distress Helpline is 1-800-985-5990. The somatic literature referenced: Bessel van der Kolk, The Body Keeps the Score; Peter Levine, Waking the Tiger and In an Unspoken Voice; Stephen Porges, The Polyvagal Theory. None of those books are substitutes for clinical work, but they are excellent maps.