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Beyond mental health: write from the symptoms of trauma

Beyond mental health: write from the symptoms of trauma

This blog has a trigger warning for rape and a spoiler warning for 12 Years a Slave. Its aim is to discuss writig trauma from more than just a diagnosis.

Whenever mental health issues are a theme, the thing most people want to know is what label to put on it. When writing about mental health, it may be tempting to pick a diagnosis and go from there, but then you would miss out on a few amazingly complex consequences of trauma and mental health.

A psychologist once explained mental health to me as a big bag of symptoms. That’s where it all starts, the ‘issues’ themselves. Some symptoms have a tendency to stick together, and common combinations then get a name. Depression. Bipolar II Disorder. Avoidant Personality Disorder. A cluster of symptoms thus turns into a diagnosis.

Other clusters of symptoms are not defined as a disorder, or are no longer considered one. But, they can still come to the surface and create trouble for your character. It’s a few of these concepts that aren’t classified as symptoms but aren’t diagnoses either that we’ll delve into today.

Bodily agency

It is a truth universally acknowledged that your body is your own. That sense of agency plays an important role in cognitive development. A large part of that includes the first stage of self-awareness, which means that you experience emotions and feelings. That right is as normal as breathing air — until you lose it. This lack of bodily agency is often a result of trauma. At the core is a belief that your character is no longer in control of their body.

Some characters may describe the loss of agency as losing a part of themselves. Others feel like they only live inside their head; everything below the neck is disconnected. Which is not to be confused with a phenomena such as phantom hand. In the case of bodily agency loss, your character knows their body is one connected whole. But in truth, what’s lacking is the sense that your character have anything to say about what happens to them. This is often the result of trauma.

The loss of bodily agency is neither a symptom nor a syndrome or affliction, but a result of trauma. As a residual effect from the harm done, it’s not a theme often clear in books. However, you can find traces of it in books that talk about rape for instance. A famous example is Speak, by Laurie Halse Anderson, or books about American slavery. In 12 Years a Slave, written by Solomon Northup in 1853, the owner strips a woman named Patsey naked and whips her. Despite Patsey having recovered from previous systematic abuse, after this particular incident she lost her lust for life. She no longer bounces back and smiles and doesn’t take care of herself as much anymore.

Solomon’s account is a description of his journey and years as a slave.


Those are classic signs of depression, but also allude to her sense of agency being taken. A loss of agency is often accompanied by feelings of anxiety and unease, which are not common symptoms of depression. It can be present alongside depression, but they can occur without the other one present. In the former, a traumatic experience often lies at the base of the issue. Without therapy and/or actively working to improve on the feeling of agency, its lack remains a constant presence in the background. Depression, on the other hand, can leave your character with good days and bad ones. The loss of agency does not have to affect your character in their daily lives to the point it incapacitates them; it’s more of a decrease in quality of life.

The loss of agency can stem from a number of sources. In the case of Patsey, she may have felt that the combination of public humiliation, being called a liar, and receiving her worst punishment to date showed her just how badly a hold her owner had over her. Her master did not believe her, and most of all, she could not have avoided the punishment. Patsey had no way to avoid it or take back control. Especially that last part plays a huge role in the loss of bodily agency and the resulting consequences.

Why this can actually be a good thing

Believe it or not, there is a reason your character may prefer that lack of control. It helps establish a distance between the body and mind. In that sense, your character is attempting to preserve themselves. That wall in between helps establish that whatever happens to the body, it has nothing to do with the mind. “They’ll never have all of me,” your character may say. In that case, it’s an attempt to keep the physical and mental hurt separated. As long as one part of your character is unaffected, it means they can survive.

Another possible reason is that your character may feel the loss of agency as being able to push their emotions down. As long as the mind is able to think and survive, the body can withstand. A perfect example of this is from The Handmaid’s Tale, where Offred treats the monthly Ritual as a transaction. Thirdly, your character may feel like anyone has a right to their body. This is especially common after sexual assault and violent attacks. It may show as a lack of self-care, increased risk-taking, and increased sexual activity.

Lack of safety

Your character can develop a lack of safety, for example when your character is shot at during military deployment. There is every chance they will have great difficulty feeling safe in a US state with an open-carry gun policy. Seeing a gun then becomes a trigger that makes your character feel unsafe. Losing your sense of safety is often accompanied by fear and anger; disgust can play a role in the trauma, but is less likely a result of the loss of bodily agency. It will have more to do with the trauma and how they deal with the trauma.

Like many phobias, a lack of safety has very specific triggers. The difference is that there are more symptoms in the latter. For example, your character may cling to a person because they make them feel safe. This is reminiscent of separation anxiety, or codependency. Your character may have panic attacks, or have a general sense of anxiety. That’s much like a generalized anxiety disorder, but that diagnosis is not always applicable. So, in summary, a lack of safety as a result of loss of agency can encompass a lot of different symptoms that have a centralized cause. This does not necessarily mean there’s a diagnosis.

Lack of satefy and bodily agency

Lack of safety can exist alongside a lack of bodily agency. In some cases they meld together and form a situation where your character feels unsafe in their own body. Because of the perceived distance between body and mind, they’ll likely have trouble experiencing their emotions. Pinpointing what those are can be difficult. For example, when they feel anger this feels so explosive and unnatural that your character fears it. They are afraid it will burst to the surface and hurt those around them. Or, reversely, your character’s anger may start tearing down the wall between body and mind.

Anger is the strongest emotion and helps your character establish boundaries and take back control. And, you guessed it, that will clash with the loss of agency and/or safety your character experience. Now, this doesn’t mean that getting angry is the solution to regaining that sense of control. But there is a very delicate balancing act between old learned habits, your character’s true nature, and the emotions they won’t know how to place. This trifecta is often common in victims of (child) abuse and characters who struggle with addiction.

Survivor’s guilt

Survivor’s guilt can follow after a lot of different situations. Your character may be the sole survivor of a car accident. Or avoided 9/11 by calling in sick like in Stephen King’s short story The Thing They Left Behind. Or have survived a warzone where fellow troops didn’t make it back. Until 1994, survivor’s guilt was an official diagnosis in the DSM. In the fourth edition, they reclassified it as PTSD. But you don’t need PTSD to suffer from survivor’s guilt.

It’s a very popular occurrence. Survivor’s guilt is the main theme in Willian Styron’s 1979 novel Sophie’s Choice, in which Sophie had to choose which of her two children would survive. In book two and three of The Hunger Games series by Suzanne Collins, it occurs, too. Katniss feels remorse for surviving over the others. 

Sophie has to choose which of her children survives.

The character feels guilty over being the one who survived. They’ll tend to weigh their own worth to those who died. They’ll think they weren’t as good, didn’t have as much to live for, or any other reason that makes sense. “It should have been me” is a very common thought. I bet you can remember at least one book or TV show where a character speaks that line. Another side of that same coin is the question, “Why me?” Your character can wonder why they survived and fall into any number of responses as described above. It helps them deal with the pressure of having to live a life worth of the deceased ones, as well. 

Why these aren’t diagnoses

Compared to many STEM or beta fields of study, psychology is still a fairly young area of study. The main objective of the DSM is to aid in treating people. Insurance companies use it to provide a guideline to what therapy and/or medication may be beneficial. The important distinction that the creators make is that for a diagnosis, the issues have to impede on day-to-day life. A lack of agency and survivor’s guilt on their own often impact the quality of life, but don’t impede. When they do, there is often a diagnosis of anxiety, depression, or PTSD involved.

It is for this reason that I recommend that when you develop a character that has mental health issues, don’t start with a diagnosis. Start with the before, then move to the traumatic experience. What is going through your character’s head while it happens? What critical thoughts get ingrained? Where do they stem from?

From there you can discover the symptoms they experience, and those you can match to diagnosis. As in real life, a diagnosis should help your character through their process towards recovery. Not guide their behavior and/or symptoms. Catcher in the Rye by J. D. Salinger portrays this really well. That’s definitely an acquired taste, but it captivates a troubled mind without giving the main character a diagnosis.

After all these heavy blogs about mental health and trauma, I promise my next one will be about happy things. As always, thanks for reading and be sure to sign up for our newsletter. Follow Pine and me for more updates on Twitter.

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