The word psychosomatic gets a bad rap. It literally is defined as the interaction between mind and body, and is used to describe a physical affliction that’s caused or aggravated by internal stress.

That’s a fancy way of saying that if there’s nothing obviously, tangibly, medically wrong, it must be all in our heads.

Is this oversimplifying? Of course it is, and even worse, it’s invalidating. The medical field makes billions of dollars a year off of dismissing the physical manifestation of emotional trauma and pain. I’m sorry, but no amount of physical therapy is going to change the fact that I’ve carried what felt like the weight of the world on my shoulders (and in my joints, and down my spine) for my entire life.

I had assumed for years that chronic fatigue was just always going to be part of my “normal” life. It took some time, once I started therapy, to realize that this was no run-of-the-mill “stress is wearing on me” kind of tired, that I’d lived with for time out of mind. I would feel so worn out from therapy sessions – during sessions – I would be talking about something particularly difficult or trying to remember about something really painful, and it would suddenly be like fighting through dense fog. My brain would actively try to power off and put me to sleep. It was then that I realized that this was my oldest and most executive defense mechanism. I wasn’t just tired from the stress; my reaction to the stress was to deliberately make me tired, reducing consciousness in order to protect my mind from further harm. In terms of “fight or flight”, my body has been taking flight from pain and trauma for so long that it had become an innate response to coming anywhere near such triggers. I would start physically shutting down to go into safe mode, to use an antiquated computer technology reference. This was a very real physical experience that had no physical source; it was truly psychosomatic, and fighting it was legitimately painful. Fatigue is a trauma response – who knew! Well, my therapist did. She taught me how to pay attention to what was happening in my body and with my mentality, as those are two halves of the same whole self, and if one side is feeling affected by something, it’s likely mirrored on the other side in some way.

As such, this was also how we figured out the root cause of my (seemingly) irrational anxiety over going to the dentist. Now, anxiety about dental visits isn’t unusual. I don’t think I know anyone who particularly enjoys going to the dentist, and there are plenty of people who get nervous about it. But I was experiencing debilitating PTSD symptoms there in the dentist’s chair – a reaction that had always seemed displaced, until my therapist and I figured out it wasn’t. Sure, the dental work itself is unpleasant, but what was triggering for me was, in point of fact, the need to be reclined so far back in the dentist’s chair so they could do their work. This position reminded my body of severe trauma that had been inflicted on it while being that prone, and muscle memory would inevitably take over and prompt intense panic attacks, which I did my best at first to hide from the dentist and hygienist because I was embarrassed. My therapist eventually convinced me that if I explained the situation to the staff ahead of time, they could work with me to try to make the experience more comfortable (reclining the chair no more than necessary, allowing me to sit up for breaks when needed, talking me through every step of their process as they do it). My body was remembering something extremely painful, that my brain has worked very hard to keep fuzzy and far from conscious thought, so it took a long while for me to put two and two together and understand my issues at the dentist were PTSD-related – psychosomatic, if you will. Happy ending: once this was all figured out, and I did talk with my dentist and hygienist about what I needed, my visits to their office got much better with time; I still need to use grounding techniques a little bit, but I no longer have full-blown panic attacks there.

Is it all in my head? Sure. But that doesn’t make it any less real. It doesn’t make my pain and weariness illegitimate. And providers aren’t absolved of their duty to “do no harm” when supporting patients who don’t require straightforward medical treatment. Doctors need to be okay with admitting they don’t have an answer, rather than presuming that if they don’t have one, there must not be one. Emotional stress and trauma are valid causes of physical ailments and experiences. The best doctors (and dentists) will work with you holistically to give the support you need to access treatment for both physical and mental health. If your doctor doesn’t do that, or disregards what you need when you advocate for yourself – find a new one who will.

Trauma fucking hurts. And unfortunately, the only way out is through.

Please pass the coffee. Don’t worry, I’ll brush my teeth afterwards.