Every first appointment with a new clinician, every first review after being admitted to a psychiatric ward, I spent less time thinking about what I wanted to say and more time wondering how I was going to answer the question I knew was coming. The question that always left me silent. The question that left me feeling as if I had already failed the conversation before it had even begun. The question that stole the rest of the day before it had even begun. The question that left me walking out of the review room feeling more alone, more misunderstood, and more hopeless than before I went in. The question that everyone assumed would have a simple answer. For someone living with trauma, it rarely did.

“What’s wrong?”

It sounds like it should be one of the easiest questions to answer, but I never could. I remember sitting across from all kinds of different health care clinicians, and they would be asking me question after question, not necessarily just about what was wrong, but other questions about my life, my family, my childhood, what had led me to where I was. As each question was asked, they would become more and more annoyed that all I would respond with was “I don’t know” or “It’s complicated.” And then they would begin wondering why I became withdrawn or distressed the more they spoke.

It wasn’t because I felt uncomfortable or triggered. It wasn’t because I was wanting to be difficult. It was because they assumed there was a simple answer to what they asked. Even the simplest questions I didn’t know how to answer.

“Do you have any siblings?” I don’t know.

“Where are you from?” It’s complicated.

I desperately wanted to answer the questions being asked, but trauma doesn’t always leave you with neat explanations. Sometimes it leaves you with feelings that make perfect sense when you know the history but seem impossible to explain to someone who has only read the last chapter. And for me, having no answers to questions which should be easy, I am left watching the person opposite begin to lose patience, which then brings up feelings like guilt, not being good enough, being a disappointment, being a waste of their time and energy.

I often felt like I was being asked to explain the ending of a story to someone who had never read the beginning. The questions weren’t wrong; they just started too late. Without understanding what had happened to me, I didn’t know how to give answers that made sense, even to myself. For me, trauma didn’t just change my memories. It changed the volume at which I experienced the world.

When people hear the word trauma, they often picture nightmares, flashbacks, and panic attacks. Sometimes trauma looks nothing like that. Sometimes it quietly changes the way your brain processes emotion, stress, and communication.

Trauma doesn’t just leave people with flashbacks or panic attacks. Reactions to situations or even being told no after asking a simple request can seem completely disproportionate to what’s happening, because, often, their nervous system isn’t responding only to the present moment. It’s responding to experiences that nobody else can see, and sometimes even they can’t fully understand themself.

People living with extreme trauma histories don’t experience emotions at the same level as the average person. Everything can feel like it has the same weight.

For the majority of people, if they trip over or lose a pair of socks, they’ll move on with their day. For me, everything carries the same weight. Not being able to find my hairbrush in the morning triggers me the same way a long-term relationship ending would. I react the same way to both, and even though it’s not logical, it’s what my brain understands.

For me, self-hatred became my brain’s default response to stress. It wasn’t a conscious decision. It wasn’t something I believed was reasonable. It was simply the pathway my brain had learned to take. Just like any other habit-forming thing, it becomes something automatic. It’s not because they’re weak, it’s not because they want attention, it’s because that’s how their brain and their nervous system have learned to survive.

I remember moments of distress when, instead of remaining curious about what had led to the distress, nurses often just searched for an explanation, looking through my medical record or reading over the previous handover. If I had been distressed yesterday because of one thing, there would be an assumption made that it must be the same reason today.

When people don’t have answers, it’s human nature to fill the empty spaces with assumptions. But trauma often leaves more empty spaces than answers. Those assumptions can become incredibly dangerous because they shape the way someone is treated before they’ve even had the chance to explain themselves.

Assumptions can feel harmless to the person making them. To the person they’re being made about, they can be devastating. Because once someone believes they know your story, it becomes much harder to show them the parts they’ve missed. And it can feel like you’re slowly disappearing behind a version of yourself that isn’t true.

People often assume that if someone needs help, they’ll ask for it. Or that if someone offers help, they’ll simply say yes. Trauma doesn’t always work like that.

From the outside, it can look like someone is refusing help. From the inside, it can feel like you’re trapped between desperately wanting help and being completely unable to reach for it. There were times I shook my head when someone offered medication. There were times I said, “No.” There were even times I told people to leave me alone. From the outside, those words probably sounded clear. Inside, they couldn’t have been further from the truth. Inside, every part of me was screaming:

Please don’t leave. Please don’t stop trying. Please help me.

It felt like my mouth and my mind were having two completely different conversations. The words coming out weren’t a reflection of what I wanted; they were the only words my overwhelmed brain seemed capable of producing.

Imagine screaming at the top of your lungs without making a single sound. Imagine every muscle in your body tensing as though you’re trying to escape your own skin. While the only word anyone hears you say, or sometimes even yell, is, “No.”

That is the push and pull of trauma. My mouth was pushing people away while every other part of me was pulling them closer. That’s one of the cruelest parts of trauma. The more overwhelmed I became, the harder it was to accept the very help I needed.

If nobody recognized what was happening beneath the surface, my distress often grew. What might begin as crying, pacing, or withdrawing could continue to escalate, not because I wanted to become more distressed, but because my nervous system was becoming increasingly overwhelmed. From the outside, it could look irrational. From the inside, it felt like I was running out of ways to communicate that I wasn’t OK.

During one of my admissions, less than thirty minutes after I had been restrained and given an injection, I sat down in my room and wrote two posters. I wasn’t writing a book. I wasn’t writing an article. I wasn’t writing for social media.

I was writing for the nurses.

I wanted them to understand that when I said “I don’t know,” it wasn’t because I didn’t want to answer. It was because trauma hadn’t left me with words. I wanted them to understand that asking “What’s wrong?” or “What can I do to help?” wasn’t always something I could answer, no matter how much I wanted to. I wanted them to understand that my behavior wasn’t communicating what they thought it was.

One poster said, “Sometimes ‘I don’t know’ is the most honest answer I can give.”

The other said, “I may shrug or say no even if I do want it. I can’t accept help no matter how much I want or need it.”

And underneath I wrote, “Use nursing judgement. Pick the PRN that you think will work best for me and encourage me to take it.”

That wasn’t me refusing help. It was me trying to explain why I couldn’t always ask for it. It was me trying to explain why my mouth was pushing people away while every other part of me was pulling them closer. I didn’t write those posters to explain what had already happened. I wrote them because I hoped that the next time I became distressed, someone would understand me before things reached that point again.

Before my silence became assumptions. Before my behavior was mistaken for defiance. Before I experienced another traumatic intervention.

Trauma-informed care isn’t simply about knowing that someone has experienced trauma. It’s recognizing what trauma can look like before it escalates. Sometimes it looks like someone who can’t tell you what’s wrong. Sometimes it looks like someone who can’t answer simple questions. Sometimes it looks like someone saying “no” while every part of them is silently begging you not to walk away. Sometimes it looks like someone who can’t ask for help, can’t accept help, and can’t find the words to tell you that they need it more than anything.

Trauma rarely fits into neat explanations. Neither do the people living with it.

The next time a patient says, “I don’t know,” or pushes your help away, pause before assuming you understand what their behavior means. Sometimes the most important part of their story isn’t what they’re able to tell you; it’s what trauma has taken the words away from.

Melanie Allsop is an Australian author, lived experience educator, and mental health advocate whose work helps clinicians and students understand the person behind the diagnosis. After spending much of her adolescence and young adulthood in psychiatric hospitals, she now builds resources and delivers presentations aimed at improving health care education. She holds a Certificate III in Community Services and is currently completing a Certificate IV in Mental Health at TAFE NSW.

She is the author of Beyond the Medical Record: Understanding Mental Health Care Through the Eyes of a Patient (2026) and the forthcoming memoir For the Girl I Used to Be. Her writing on patient experience, mental health care, and clinician education has appeared in Mamamia and on KevinMD.

Every resource, presentation, and book she creates is dedicated to the younger version of herself, and to every young person who deserves to be seen, heard, and understood. She shares her work on LinkedIn and Instagram.