During my initial interaction with Ram, I noticed he carries an infectious smile and a vibrant personality. I learnt that he has a vast social circle, was in a stable relationship, made smart career choices, followed instruction, had regular interactions with family, and so on.

However, behind his cheerful façade, Ram seemed to carry a heavy burden. He found it very hard to fall asleep. It was a long and tiresome process for him.

“I don’t know, I just find it incredibly difficult to sleep. It’s been happening for over a year,” he said.

I wondered, what that would be like — the prelude to when he finally did fall asleep.

“How is work?” I asked.

“Work is easy for me,” he replied. “I just have to show up and do the tasks. But when I’m not working, I struggle to make decisions in my life. Should I stay in this relationship? Should I go to this party? It feels endless!” he admitted.

“So, at work the decision has been made, and you just do it? And that’s easy?” I probed.

“Yes!” He exclaims.

“And during the night, when there is no work, what happens then?” I asked,

“I think at night before bed, when there is actually not much to ‘do’, my mind starts automatically creating random scenarios, and then I think and fantasize of how I would handle those scenarios.”

“And if you didn’t fantasize further, what would happen?” I asked

After a long pause, he responded, “I would feel loss of control and get anxious.” 

“It almost sounds like you’re constantly on high alert, even when there’s nothing to do. It’s like soldiers at war. After they finish the actual battle, they struggle to sleep because they have to remain vigilant in case of an imminent attack. They are in a constant state of alertness,” I explain.

“I feel exactly like that soldier, always on high alert. It’s as if my mind is constantly creating worst-case scenarios at night like I’m preparing for battle,’ he said.

I thought of how he talked about his home environment being traumatic growing up. Members of his family were constantly fighting. We went back to how that time in his life made him feel. 

“I was always constantly worried then too. I never knew when the next fight at home would erupt.” He recalled.

Sometimes we think of trauma as a single incident, but, recurring, long-term incidents can result in a trauma that’s more complex, kind of like what soldiers face and have to heal from.