The Biology of Betrayal: When the System Doesn’t Listen

8-22-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

When the healer becomes a shadow, trust fractures. In every dismissal, the body remembers. The biology of betrayal is written not only in stories—but in cells

They took my words and called them smoke,

A story spun, a wounded joke.

But the body keeps its own account—

Each silence adds, each doubt will mount.

Betrayal is no fleeting sound,

It scars the cells, it breaks the ground.

—Dr. Howard Friedman, M.D.

Beyond the VA Claim

Betrayal is more than a metaphor. When a veteran, a patient, or any human being is not believed, the body registers it as threat. Dismissal isn’t neutral; it sets off alarms. Cortisol rises, inflammation stirs, and healing slows. The nervous system learns to stay on guard, not because of a battlefield or a pathogen, but because the very people and systems meant to help have turned away.

This blog is not only about the VA claims process—it’s about the deeper wound of medical mistrust. It is about how the biology of stress intertwines with the psychology of betrayal, leaving veterans and countless others carrying a burden that is both invisible and measurable. Trust is not just a social contract; it is medicine. And when that trust is broken, the body pays the price.

The Physiology of Mistrust

The body does not distinguish between a battlefield ambush and a clinical dismissal. In both cases, the stress response ignites. The hypothalamus signals, the pituitary follows, and cortisol floods the bloodstream. This is the machinery of survival, primed to protect. But when the trigger is not shrapnel or fire, but disbelief—“It’s all in your head,” “You’re exaggerating”—the betrayal cuts deeper than words.

Each encounter like this leaves a mark. Elevated cortisol was meant to be temporary, a surge to climb the hill or escape the predator. In mistrust, it becomes a daily drip, feeding a low-grade inflammation that erodes from within. Blood vessels stiffen, wounds knit slower, pain amplifies, sleep fragments. What the patient feels as fatigue or fog, biology records as survival without end.

Trust, then, is not an abstract virtue. It is a regulator of the HPA axis, a stabilizer of the immune system. When the system doesn’t listen, the body learns not to heal.

Cortisol, Inflammation, and Slow Healing

The immune system is not confined to one organ—it is a living network, active every hour of every day until life’s final transition. Any physical or emotional trigger activates the hypothalamus–pituitary–adrenal (HPA) axis, releasing cortisol and epinephrine. This is the fight-or-flight response: the surge that once kept our ancestors alive when facing predators or natural dangers.

But what served us in the wild now lingers in the modern world, where stress is constant. Chronic stress is, in effect, chronic inflammation. The body’s stress chemistry interferes with sleep, digestion, and even the slow repair of wounds. Trust changes everything. Patients who feel safe with their caregivers consistently heal faster; mistrust and broken trust extend recovery time. In today’s world—so often described as being on fire—those without support find themselves in the company of unrelenting stress and inflammation. The biology of survival, designed for fleeting moments of danger, has become a permanent state. And in that permanence, healing slows.

The Social Biology of Betrayal

Medical care should be the steady hand that heals, but far too often it has been the hand that pushes people aside. Vietnam veterans know this well. For decades, their Agent Orange exposures were dismissed, minimized, or outright denied, and many died waiting for recognition. Gulf War veterans carry the same wound of dismissal—told their suffering was “stress” or “all in their head”—while their bodies bore the truth. Both stories are still unfolding, a painful reminder that the system rarely admits its betrayals until forced.

This pattern reaches beyond veterans. The Tuskegee syphilis study stands as one of medicine’s darkest stains, where Black men were denied treatment and used as subjects in a cruel experiment. Women, even today, are less likely to have their pain taken seriously, often told it is “anxiety” or “hormonal” while dangerous conditions smolder unchecked. Minority communities face higher rates of misdiagnosis and delayed treatment. Patients with chronic illnesses are often met with suspicion, as if their suffering were an exaggeration rather than evidence.

At the center of these failures sits money. Insurance companies dictate care through denials and delays. Hospital systems measure profitability more precisely than they measure compassion. The Hippocratic oath—“first, do no harm”—is broken every time the bottom line outweighs the patient’s life.

And the damage is not only social—it is biological. Betrayal breeds cortisol. Mistrust fuels inflammation. Healing slows when the body perceives it has been abandoned. Betrayal leaves scars not only on communities and histories, but deep within human cells.

Rebuilding Trust as Medicine

Honesty, validation, vulnerability, and empathy—these should be the foundations of every health visit. They are not just lofty ideals; they are the cornerstones of real healing. Gratitude belongs there too, because gratitude softens the edges of pain. Trust is built through actions, though it can be sparked by words—if they are meant sincerely.

This is what’s missing in our profit-driven health care system, and, truthfully, in far too many of our human interactions. Imagine if vulnerability and empathy were not seen as weakness but as strength. Imagine if honesty really was the best policy. From one person to another, gratitude carried forward can ripple outward until it becomes a movement.

It is with immense gratitude that I write and share these blogs, because trust is not soft medicine—it is medicine. Saying the simple phrase, “I believe you,” can calm the body’s stress response more than any prescription pill. It is measurable biology. It can turn down the HPA axis, reduce cortisol, and give the body permission to heal.

From Betrayal to Belief

Betrayal corrodes the body as much as the soul. When systems dismiss pain, minimize suffering, or trade care for profit, the damage isn’t only emotional—it is biological. Elevated cortisol, chronic inflammation, delayed healing—these are the scars left when trust is broken.

But the same biology shows us the way back. Validation, honesty, empathy, gratitude—these aren’t soft gestures. They are the real medicine, measurable in heart rate, in cortisol levels, in immune response. When we choose to listen, when we look someone in the eye and say “I believe you,” we don’t just honor their story—we alter their physiology.

The biology of betrayal can be rewritten into the biology of belief. It starts with one encounter, one truth spoken, one act of trust carried forward. If enough people choose this path, a movement grows—not just to repair health care, but to restore humanity itself.

Call to Action

Carry this forward. Believe someone today. You may not see it, but you will have changed their biology—and their world.

Thank you for reading.

 A wound ignored will never mend,

But truth can turn the tide again

A single word, a steady hand,

Can calm the fire, help one stand.

Belief can heal what pills forget—

The cure is trust, not just a net.

—Dr. Howard Friedman, M.D.

—Dr. Howard Friedman MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Frequently Asked Questions:

Q: How does medical mistrust actually affect the body?

A: Mistrust isn’t just a feeling—it triggers biology. When someone is dismissed or disbelieved, the body responds as if under attack. Cortisol rises, the immune system becomes inflamed, blood vessels stiffen, and healing slows. What feels like fatigue or brain fog is really the biology of betrayal playing out inside the body.

Q: Why is trust considered “medicine”?

A: Trust is more than comfort—it’s measurable physiology. When a patient feels safe and believed, the hypothalamus and pituitary stop flooding the bloodstream with stress hormones. Inflammation drops, sleep improves, and wounds repair more quickly. Saying “I believe you” is as powerful as a prescription, because it directly calms the body’s stress machinery.

Q: Can broken trust in healthcare be repaired?

A: Yes, but only through honesty, validation, and consistent empathy. When a provider listens and acknowledges suffering, it begins to reverse the biology of mistrust. Over time, trust restores balance to the nervous and immune systems. It may not erase the past betrayal, but it can transform survival mode back into healing mode.