Life | Work is a series focused on the personal side of Harvard research and teaching.

Karestan Koenen didn’t offer the most uplifting message when she addressed students at her Montclair, New Jersey, high school in 2017, but she did offer hope.

“Bad things are going to happen to you,” Koenen, who had returned to her alma mater to receive the school’s distinguished alumna award, told the audience. “Some of you may already have experienced such things or are experiencing them now. We cannot completely control what happens to us, but what we can control is how we choose to respond. And what we choose makes all the difference.”

“Such things” had happened to Koenen decades before. In 1991, she joined the Peace Corps, fulfilling a dream of her youth. She saw her posting in Niger, one of the world’s poorest countries, as a step toward a career in international development. The assignment would enhance a resume that already included a trip to Kenya, college courses in economics and African history, an internship at the U.S. Agency for International Development, and a yearlong job evaluating developing nation debt at the Federal Reserve Bank of New York.

But just months later, having quit the Peace Corps and abandoned her plan to work in international development, she fell into a period of severe depression marked by suicidal thoughts, sleeplessness, and nightmares linked to the rape she experienced while on a holiday trip with her visiting sister.

“I remember feeling like I was in a dark tunnel and I could see no light,” Koenen said in a recent interview. “It was just getting darker and darker, no matter what I did.”

Koenen would eventually recover, but it wasn’t easy and she needed help. In the process, she became curious about the healing process itself and how she might support others similarly shattered. She wondered why some people healed quicker than others, and why, for some, healing never seemed to come.

Today, Koenen doesn’t shy from sharing the darker parts of her story, knowing that she’s not alone. A professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, she is one of the nation’s top experts in trauma and post-traumatic stress disorder. As the leader of a new initiative at the Broad Institute of MIT and Harvard exploring the biology of trauma, she hopes to increase understanding of the condition, unlocking new treatments.

“The big question is how traumatic experience can get under the skin and cause disease,” she said. “PTSD and trauma have been linked to cardiovascular disease, diabetes, autoimmune disease. How does that happen? The idea is that understanding more will help us intervene better.”

‘People wrote me letters. I didn’t write back.’

 The assault happened in December 1991 in the Sahara Desert city of Agadez. Soon after, Koenen was sent back to the U.S. in what the Peace Corps called a “medevac.” When she arrived in D.C., she expected to follow the agency’s protocol for sexual assault victims before returning to her post.

It didn’t happen. Instead, there were weeks of meetings, physical examinations, and counseling, none of them helpful. By February, Koenen was living at her parents’ New Jersey home, sleeping in a room over the garage. When her request that the rapist be prosecuted was denied by officials in Niger — dismissed as “he said, she said” — any thoughts of returning to the country evaporated.

“I just thought, ‘I’m done,’” she said. “I totally cut off everything from Peace Corps. Except for one person, I did not stay in touch with anyone. People wrote me letters. I didn’t write back.”

At age 23, Koenen found herself profoundly disillusioned. Her early taste of development work had awakened her to the field’s challenges: stifling bureaucracy, poor project design, mismatches between donor intent and on-the-ground realities. The attack and its aftermath crushed the last of her idealism. She spent days sleeping, lying in bed, and walking the streets of her parents’ neighborhood. She felt aimless and suicidal — classic signs of post-traumatic stress disorder she would instantly recognize today.

One day, a friend of Koenen’s mother invited her over for dinner. She told Koenen that she had been raped in high school, and that the attack had left her pregnant. The friend had endured the same nightmares, the same sleeplessness, the same terror that her young visitor was experiencing. She too had played the attack over and over in her mind. She lost the baby when she intentionally crashed her car into a tree.

Until now, the woman said, she had told no one but her husband about the attack. But keeping it hidden hadn’t helped. Instead, the rape had plagued her, affecting decisions she made every day. She wanted Koenen to avoid the same fate. As the conversation ended, the friend said she had already made Koenen’s first appointment with a therapist.

“I didn’t grow up with people doing therapy,” Koenen said. “But by the time she talked to me, I would have done anything.”

The therapist diagnosed post-traumatic stress disorder, and pointed out that the rapist had done more than attack Koenen physically — he had stolen her future. As she began to rebuild her life, therapy included aptitude and occupational tests to help her envision a new beginning.

At home, Koenen pored through books about rape, trauma, and PTSD. She also started to view her family in a new light. Her father, a Vietnam-era veteran, had friends who’d been scarred by combat. During long talks with her grandmother, she got to know her late grandfather, who had been wounded in World War II and endured decades of regular nightmares.

“He probably had PTSD his whole life, although I never knew that’s what it was until after he died,” Koenen said. “The men that I grew up around were veterans. I heard their stories and I actually think that probably set the stage for me in a way that I didn’t realize until later.”

Koenen set a new goal: to help others who had suffered trauma as she had. She went back to school, studying for a master’s degree in developmental psychology from Columbia University. After Columbia, she headed to Boston University for a doctoral program in clinical psychology.

At BU, Koenen connected with Professor Mike Lyons, who was investigating substance abuse and mental illness using a database of Vietnam veteran twins. If Koenen would work with him on his research, he said, she could use the database for her work on PTSD. Koenen agreed, and that project would provide her an early chance to explore the genetics of trauma.

“She’s been a real pioneer in looking at the genetic influences of PTSD and responses to trauma,” said Lyons, who retired from BU in July. “She’s a wonderful person. She’s very open, very engaging, very committed to social justice, committed to survivors of trauma. There’s perfect overlap between the substance of her scientific work and her values as a human being, as a survivor herself.”

‘I didn’t have to pretend anymore.’

Several years later, in 2011, Koenen was an assistant professor at Harvard when a friend told her about a segment she’d seen on ABC’s “20/20” in which six women described experiences with the Peace Corps that were strikingly similar to Koenen’s.

In the days after the attack, Koenen had been seen by a Peace Corps physician who also opened her house to her and her sister. But her treatment at the agency’s hands went downhill from there.

Back in D.C., she endured an uncomfortable pelvic exam, conducted by a male gynecologist, who, when she complained, told her to stop being hysterical, she would later testify. She was treated by a therapist who seemed to know little about trauma, Koenen recalled, pushing her to disclose more about her emotions than she was comfortable with and threatening that she wouldn’t be able to return to Niger if she didn’t comply.

Koenen also met with an official from the inspector general’s office, whom she remembers casting doubt on her account of the rape. In the end, Koenen would describe her treatment by the Peace Corps as even worse than the assault.

After viewing the “20/20” episode, Koenen wrestled with what to do. Over the years, when people asked how she became interested in PTSD, she never included her own ordeal in her answer. This time, she decided, she had to speak up.

Koenen connected with a friend of a friend who worked as a producer for “20/20” host Brian Ross. Soon after, she told her story in an interview that aired on “Good Morning America.” Later the same day, Congress held hearings on safety in the Peace Corps, with Koenen on the witness list. She offered the House Foreign Affairs Committee not just her story, but a list of ways the system could be reformed.

Increase the number of victim’s advocates, she said. Provide travel companions for those returning to the U.S. Scrap a training video in which victims apologize for causing their own rapes. Fire any staff member who blames the victim.

Later in the hearing, then-Peace Corps Director Aaron Williams said Koenen and the other witnesses were “courageous” and pledged major changes to the agency’s handling of such cases.

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Karestan Koenen testifies before Congress in 2011 about the Peace Corps’ response to her sexual assault. Her testimony begins at 19:05.

As she navigated the publicity around her story, Koenen realized that the attack wasn’t actually behind her. It didn’t make sense, but she still carried shame over what had happened, over her subsequent depression and thoughts of suicide. But she was hardly aware of the burden. Not until she jumped in a cab after a CNN interview and felt as if a weight had been lifted.

“I didn’t have to pretend anymore,” Koenen said during her 2017 talk in Montclair. “The worst thing that had ever happened to me was out there for everyone to see. … And I was OK. More than OK, really. I felt better.”

Koenen was recruited to Columbia as an associate professor of epidemiology. Four years later, she returned to Boston as a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, an institute member of the Broad Institute of MIT and Harvard, and an investigator in psychiatry at the Mass General Research Institute. At the Broad, she is a member of the Stanley Center for Psychiatric Research, led by former Harvard Provost Steven Hyman.