When Everything Hurts: Using Physical Pain to Show Emotional Trauma

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As writers, we accept that we have to put our characters through the wringer. Difficulty makes for a more compelling story and helps our readers relate to and root for our heroes. Those conflicts can be physical, emotional, mental, interpersonal, or some combination of a few or all of these. Many of those challenges will have occurred in your protagonist’s past, helping to create their current personality and some – if not all – of their future challenges.

But how do you realistically portray those painful events and emotions? In a post on Writers Helping Writers, Lisa Hall Wilson offers her advice.

Commonly, writers will have their character think about their problem or will clue the reader in through flashbacks. That’s fine, but Hall Wilson says there’s another – maybe better – way. “Trauma (past or present) should be felt in the character’s whole body, and pain is one of the devices that is often overlooked to show that trauma, to show increasing tension, to show internal conflict and build character arc,” she writes.

You don’t need to write a clinical diagnosis, but you should be aware of how emotions – good and bad – affect the body. “Show how that trauma makes every decision more difficult because going against whatever revives the emotional pain or creates a sense of being ‘unsafe’ is essentially creating an internal war the character feels they can’t win,” Hall Wilson explains. “How does the trauma affect the character’s thinking, priorities, choices and decisions, confidence, energy levels, goals – everything?”

Past physical trauma will often result in long-term affects and pain. However, emotions also affect the physical body. “Writers often overlook physical pain as a sign that trauma memories and emotions are being suppressed or denied, how long-term trauma responses take a physical toll on the body, and how thoughts or patterns of thinking can create pain in the body,” Hall Wilson notes. “Pain from emotional trauma is the body’s desperate attempt to warn us that something isn’t right and needs our immediate attention. Use this natural function to SHOW your reader that everything is not okay.”

Think about ways you react to stress. Does your stomach hurt? Do your shoulders tense or hands shake? Do you get a headache or acid reflux? You can use that for your character’s physical response to negative emotional stimuli. But there’s more, Hall Wilson adds.

“Try using pain that gets ignored, suppressed, or self-medicated without seeking treatment,” she suggests. “Consider illness or pain that has no medical explanation (psychosomatic or psychogenic), or a series of worsening symptoms and diagnoses. It’s important to show the character’s thinking behind the pain (their internal reaction to it) for the reader to understand what’s going on. It’s a great use of subtext.”

Also consider psychosomatic pain that mimics a real-life health scare, but is triggered by bad memories or certain conflicts. Some ailments can be actual, but triggered or worsened by stress or distress, such as fibromyalgia. Cortisol, the primary stress hormone, can alter immune system response and suppress digestion, reproduction, and growth. High levels of prolonged stress can affect your characters’ well-being even if you never mention cortisol in your story (and you probably don’t need to…)

And finally, trauma pain can cause a chain reaction, triggering additional stress, trauma, or pain. Even simple exhaustion or dehydration can be debilitating. Those compounded physical effects make life even harder for your protagonist as they try to get through their day. In many cases, it means critical tasks don’t get done or are done poorly.

“The body’s response to trauma is very unique and individual, but when we use it strategically, it’s a great way to show not just past trauma, but internal tension, characterization, and conflict, as well,” Hall Wilson says.