By: Mathew Kunnath John, MSW, MPhil.
The primary purpose of publishing this blog is to dismantle the widespread, simplistic stereotype of how trauma manifests. By leveraging powerful, real-world stories—with all identifying details altered to protect client privacy—the post educates a broad audience on the complex and often silent or “atypical” ways people respond to profound suffering. It seeks to replace judgment with empathy, validate the experiences of survivors whose reactions don’t fit a cinematic mold, and advocate for more patient and humane systems of care that prioritize trust-building and individual stories over quick diagnoses. In essence, it ethically uses narrative to call for a more compassionate and accurate response to human suffering.
Trauma is a personal earthquake. While its impact ripples outward, the aftershocks are unique to each individual. We often expect suffering to look like it does in movies—overt tears, vocal distress, and visible anxiety. But in the reality of conflict, disaster, or crisis, pain is far more complex and subtle.
There is no hierarchy of suffering or a correct way to grieve. To truly support the hurting, we must abandon our preconceptions and learn to read the silent, confusing, and often contradictory language of trauma.
The Myth of a Monolithic Trauma Response
It’s a common and culturally reinforced belief that trauma manifests in loud, visible ways. We expect to see crying, overt panic, anger, flashbacks, and other clear signs of distress. While these “fight-or-flight” reactions are valid and frequent, they represent only a fraction of the human experience of trauma. A significant number of individuals who have endured profound adversity do not display these overt symptoms. Instead, their trauma expresses itself in quieter, more insidious ways that are often misunderstood or missed entirely.
The reasons for this are as varied as the individuals themselves:
- Survival Mode: They may still be in the process of understanding the situation, operating in a state of shock where the primary focus is survival or protecting others, such as their children or family.
- Masked Emotions: Other powerful emotions like deep-seated fear and a complete lack of trust in their surroundings or the people trying to help can effectively mask the underlying trauma.
- The Weight of Despair: They may be developing feelings of profound helplessness and hopelessness, sinking into a depressive episode that silences rather than activates.
- Paranoia and Mistrust: The traumatic event may have shattered their ability to trust, leading them to become paranoid and withdrawn from everyone around them.
- Externalized Pain: Sometimes, the internal turmoil becomes unbearable and is externalized as extreme irritability, aggression, and even violent tendencies, including self-harm and, in some cases, homicidal ideation.
Portraits of Pain: Stories from the Frontlines
To understand the varied nature of trauma, we must look at the real-world experiences of those who have endured the unimaginable. The following case examples, drawn from emergency and crisis settings, paint a vivid picture of this complexity.
Theme 1: Conflicting Priorities in the Midst of Chaos
Often, a person’s actions are driven by desperate, conflicting responsibilities that override their own emotional expression.
Imagine a mother keeping a tense vigil at her child’s hospital bedside. Her entire being is focused on the small, injured form in front of her, praying for every breath. But in the quiet moments, a silent war rages within her. Her mind is not here; it has fled to the chaotic shelter or the dangerous streets where she was forced to leave her other children.
This is the hidden tragedy we witness all too often. The immediate crisis of one child’s injury masks a greater fear of a family disintegrating. We’ve seen the heartbreaking conclusion to this story: a child is finally nursed back to health, only to discover their family is now untraceable, lost in the upheaval.
For this mother, her most desperate need is not just to heal the child she is with. It is to find and save the ones she is without. True healing, we must understand, is not just about mending a single body, but about reuniting a family torn apart.
Consider an individual bringing a wounded relative to a clinic where communication systems are non-existent. Even as they face the immediate crisis, their mind is consumed with anxiety for family they were separated from during their escape. This communication blackout traps them in a painful limbo—a state of agonizing uncertainty about the fate of their other loved ones. This illustrates a profound, often overlooked aspect of humanitarian crises: the devastating mental toll of not knowing.
Theme 2: The Language of Silence, Fear, and Misdiagnosis
Silence in the face of trauma is not emptiness; it is heavy with unspoken pain.
The profound importance of contextual awareness in mental health is powerfully illustrated by the story of ‘Mina,’ a young, unaccompanied minor found by community volunteers. When she arrived at the clinic, her complete silence and withdrawn demeanor led to an initial assessment of ‘psychosis.’ However, through patient and compassionate engagement, the mental health team uncovered a different truth: Mina was not psychotic, but utterly terrified and unable to speak the local language. Her silence was not a symptom of a disorder, but a protective shield she had raised against a world that felt overwhelming and threatening. This case serves as a critical reminder that we must look beyond the presenting symptoms to understand the full human story, ensuring a cry for safety is not misdiagnosed as a sign of illness.
The devastating impact of trauma is poignantly illustrated by the case of a mother of four whose life was shattered by a catastrophic flood. After losing her husband, she witnessed the rising waters sweep away the rest of her family. Rescuers later found her clinging to a tree, holding one of her children who had already perished. In the aftermath, she was brought to a hospital where she fell into a profound silence, refusing to eat and experiencing bouts of agitation. Her muteness was not simply an absence of speech, but a visceral response to a loss so complete and overwhelming that words could no longer contain the depth of her grief and shock.
Theme 3: The Calculated Response – When Symptoms are a Survival Strategy
Perhaps the most crucial lesson is that some trauma responses, while appearing as severe mental illness, are in fact a logical, albeit desperate, survival strategy.
In a powerful illustration of trauma’s complexity, consider the case of a 30-year-old woman who was brought to a humanitarian hospital by aid workers with her children. After witnessing her husband’s murder, she became non-communicative and sat passively on her bed. The initial diagnosis leaned towards a severe depressive episode with psychotic features, yet she showed no improvement with medication and insisted on remaining hospitalized, even after many weeks. It was only after the mental health team invested significant effort in building trust that she revealed the profound fear driving her state: she believed that if she “got better,” the aid staff would deem her “fine” and abandon her and her young children, leaving them without support. This startling revelation reframed her entire condition; her behavior was a desperate survival strategy to ensure the safety and care of her family. This case underscores the critical importance of looking beyond clinical symptoms to understand the deep-seated fears and environmental realities that shape a patient’s presentation.
The Unseen Battle: When Trauma Masked by Physical Symptoms and Somatic Manifestations
1. Somatic Symptoms: The Body’s Unspoken Distress
Somatic symptoms are physical sensations and complaints that do not have a clear, identifiable medical cause. In the context of trauma, the body is in a state of chronic hyperarousal, leading to very real physical consequences.
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How They Manifest:
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Chronic Pain: Headaches, migraines, back pain, and widespread muscle aches
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Gastrointestinal (GI) Issues: Nausea, stomach cramps, diarrhea, and constipation
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Neurological-like Symptoms: Dizziness, numbness, tingling, fatigue, and a feeling of weakness.
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Cardiopulmonary Sensations: Non-cardiac chest pain, shortness of breath, and heart palpitations.
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A person experiencing these symptoms naturally assumes they have a physical illness. They will typically consult a primary care physician, a gastroenterologist, a neurologist, or a cardiologist. The medical system is designed to investigate and rule out organic disease. The patient is focused on the pain or discomfort, seeking a medical explanation and cure. It is often easier and more socially acceptable to have a “real” physical illness than a psychological one.
2. Panic Attacks: The Body’s Misguided Alarm System
A panic attack is a sudden, intense surge of fear or discomfort that feels life-threatening. In the context of trauma, these attacks can occur as part of conditions like anxiety disorders, PTSD, or depressive episodes. They are often triggered by something that reminds the person, consciously or unconsciously, of the traumatic event.
How They Manifest:
- Pounding heart or accelerated heart rate
- A feeling of choking or shortness of breath
- Chest pain or discomfort
- Dizziness, lightheadedness, or feeling faint
- An intense fear of dying, losing control, or having a heart attack
The physical symptoms of a panic attack are so severe that they can closely mimic a medical emergency, particularly a heart attack or respiratory failure. As a result, individuals experiencing them often seek medical support instead of psychological care.
3. Flashbacks: Re-experiencing Trauma Physically
Flashbacks are a hallmark symptom of PTSD, where a person feels as if they are reliving the traumatic event. Crucially, flashbacks are not just mental images; they are intense sensory and physiological experiences.
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How They Manifest:
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A flashback can be a full-blown re-experiencing, but often it is more subtle and fragmented. It can present as:
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A sudden, unexplained wave of heat, cold, or a specific pain that was felt during the trauma.
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Unexplained sensory input (e.g., smelling smoke, hearing a specific sound).
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Sudden dizziness, disorientation, or a feeling of being detached from one’s body (depersonalization).
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An abrupt, overwhelming emotional state (e.g., terror, helplessness) with accompanying physical sensations (e.g., paralysis of the “freeze” response).
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Since these experiences can be fragmented and non-narrative, individuals may not identify them as actual memories. When they attempt to share them with relatives, friends, or even healthcare workers, their feelings are often dismissed as fear that will simply fade over time. Unfortunately, many medical professionals, including physicians, also fail to recognize the significance of these symptoms and the need for psychological care.
The Unchartable Territory of Loss and the Delicate Art of Healing
These personal stories underscore a fundamental truth: trauma cannot be measured on a universal scale, and comparing one person’s journey through sorrow to another’s is not only counterproductive but deeply invalidating.
Trauma, in its many forms, is a powerful catalyst that can fundamentally alter an individual’s psychological trajectory. It can act as a precipitating factor, triggering the onset of a new mental illness; a perpetuating factor, entrenching and worsening an existing condition; or a predisposing factor, heightening an individual’s vulnerability to future psychological distress. While common associated diagnoses include depression, anxiety disorders, Post-Traumatic Stress Disorder (), and dissociative disorders, these clinical labels are merely signposts. They can never capture the full, nuanced narrative of a person’s shattered sense of safety and self.
The path toward diagnosis and, more importantly, healing is a slow, delicate process built upon three essential pillars:
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Time:
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Healing is not a linear progression but a recursive one, often involving spirals of progress and retreat. Reaching a true understanding of an individual’s experience is a commitment that unfolds over days, weeks, or even months of patient, consistent interaction. Rushing this process can cause more harm than good.
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Trust:
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The establishment of rapport and a palpable sense of safety is the absolute priority. This connection, known clinically as the therapeutic alliance, is the most crucial predictor of positive outcomes. It is the bedrock upon which all healing is built, especially in high-stakes situations, such as convincing a traumatized family that their child requires a life-saving amputation—a decision that can only be made from a place of profound trust.
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Communication:
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Language is the bridge to understanding, but it is often a bridge that must be built with care. In emergency settings, where individuals may speak a language unknown to staff, translators are not merely logistical tools—they are lifelines. They function as both linguistic interpreters and cultural brokers, essential for building trust and eliciting the true signs and symptoms hidden beneath a surface of fear and confusion. The most vital communication, however, is often non-verbal: the ability to sit with silence, to read the language of the body, and to convey empathy through presence alone.
As we encounter those scarred by trauma, let us remember that their reactions are their own—a valid and intricate response to their unique experience. Their journey is not for us to judge, compare, or rush. Our role is to become a patient, non-judgmental presence, to bear witness to their pain without flinching. It is our duty to listen—not just to the spoken words, but to the profound grammar of their silences—and to cultivate a space safe enough for their unseen scars to finally be held, acknowledged, and begin to heal.
Need support or more information? We’re here to help.
Feel free to reach out to us through any of the channels below:
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Website: mananmentalhealth.com
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Email: manancalicut@gmail.com
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WhatsApp: +91 97092 88932
About the author:
- Mathew Kunnath John is a highly experienced Psychiatric Social Worker and Mental Health Professional with over 13 years in the field. He established mananmentalhealth.com, offering secure online therapy to a diverse global clientele.
- Since November 2018, Mathew has completed five international missions with Doctors Without Borders (MSF), serving in Jordan, Sierra Leone, Ethiopia, Libya, and South Sudan, addressing critical mental health needs in conflict and crisis zones. He is also a prolific researcher, covering topics such as the impact of COVID-19, explanatory models of mental illness, social connectedness, gender discrimination, and psychological distress.
