During my initial interaction with Ram, I noticed he carries an infectious smile and a vibrant personality. I learned that he has a well-balanced life, a vast social circle, a stable relationship, switches jobs when needed, follows instructions, meets his friends and family, and so on.

However, behind his cheerful facade, Ram seems to carry a heavy burden, a burden of taking long to fall asleep.

"I don't know, I just find it incredibly difficult to sleep anymore. It's been happening for over a year," he says.

I wondered, what that may look like - the prelude to when he finally does get sleep.

How is your work? I ask

"Work is easy for me," he replies. "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 says 

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

 “Yes”! He exclaims. 

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

 “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 will handle those scenarios” 

After a long pause, he responds slowly, "I would feel a loss of control, and I would experience anxiety in my body."

"It almost sounds like you're constantly on high alert, even when there's nothing to do. It's like soldiers at war, you know? 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 discovered

“I remember you mentioned your home environment being “traumatic”, your family members were constantly fighting..” I recalled.

“Yes... I was always constantly on alert then too..preparing for the next fight at home..” He recalls

“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..” I explained