When Trauma Becomes Pathologised

By Karie Rohrlach · Counsellor & Psychotherapist · Adelaide & Online

There is a moment in everyone's life where life hits like a train.

One minute you are functioning. The next, you are overwhelmed, dysregulated, and unable to reconcile what is happening inside you. You can't think straight. You don't recognise yourself. You may feel disconnected from your surroundings, distrustful of others, or lost in a confusion that has no words.

It might be triggered by something significant — a loss, a rupture, a moment of acute threat. Or it might be triggered by something that looks, from the outside, like nothing much at all. A smell. A tone of voice. A look across a room. Something that shouldn't have the power to undo you — and yet, here you are.

I have sat with many people who have arrived in my room after one of these moments. And what I notice — again and again — is that by the time they reach me, something has already happened to the story of what they experienced.

They have been given a label. A diagnosis. A medication. A framework that may or may not fit.

And I find myself wondering — quietly, and with genuine respect for the complexity of crisis care — whether what was witnessed in those moments was always understood for what it might have been.

A question I keep sitting with

I am not a crisis clinician. I don't work in emergency settings or acute mental health. The people who do that work are carrying enormous responsibility under enormous pressure, and I hold deep respect for what that requires.

But I do work with the people who come afterward. After the crisis. After the admission. After the label. And in that space, I have found myself returning to a question that the literature I've been shaped by keeps asking:

In that moment — was this a psychiatric episode? Or was it a trauma response?

Because they can look remarkably similar from the outside.

Confusion. Disorientation. Emotional flooding. Disconnection. An inability to communicate. The presentation can look, in the language of a crisis system, like a breakdown. Like something that needs to be contained, assessed, categorised.

And sometimes it does. That assessment matters and should never be bypassed.

But sometimes — and I say this not as a clinical pronouncement but as a reflection from my own corner of this work — what was happening was something the available categories didn't quite hold.

I'll say upfront that diagnosis sits outside my scope as a counsellor. And if I'm honest, I hold the whole diagnostic framework somewhat loosely — I tend to be more interested in what a person's experience means, and what it is trying to tell us, than in which box it belongs in. But I also recognise that PTSD and DID are themselves diagnoses — and in many of the situations I'm describing, they are the more accurate ones. The problem isn't naming what's happening. It's when what's happening doesn't get named accurately at all.

What the research helps me understand

Two bodies of work have shaped how I think about this more than almost anything else — and I return to them often, not as authority but as a lens.

The first is Bessel van der Kolk's The Body Keeps the Score. Van der Kolk writes about how trauma is not simply an event in the past — it is an imprint left on the mind, brain, and body, with ongoing consequences for how we survive in the present. Trauma lives in the nervous system. It doesn't sit neatly in memory. And when something in the environment activates it — a sound, a sensation, a quality of presence that echoes something old — the body responds as though the original threat is happening now. Not then. Now.

The second is the work of Suzette Boon, Kathy Steele, and Onno van der Hart — particularly Coping with Trauma-Related Dissociation. Their framework describes something I recognise constantly in the room: the distinction between the part of us that manages everyday life, and the part that gets pulled back into a traumatic experience when something activates it. In trauma time, we are no longer fully here. We are back there — in the body, in the experience, in the moment that was never safely processed. And our nervous system responds accordingly.

From the outside, that can look like someone who has lost their mind.

From the inside — and from where I sit — it is the body doing exactly what it learned to do to survive. It is not madness. It is memory. It is the past arriving in the present, uninvited and overwhelming, because it was never given the conditions to settle.

What I have witnessed

The people who find their way to me after a crisis have often been through something disorienting — not just the original experience that broke them open, but the experience of being responded to in a way that didn't quite fit what was actually happening.

They carry a label that doesn't sit right. A story about themselves — often absorbed from the systems that tried to help them — that has added another layer of confusion to an already confusing experience. A quiet, persistent belief that something is fundamentally wrong with them.

When what may have been closer to the truth is that something happened to them. And their body, their nervous system, their whole being — was responding to it in the only way it knew how.

That's not a disorder. That's a response. And there is a profound difference between the two — even when, from the outside, they look the same.

This isn't me dismissing the value of understanding what someone is experiencing, or giving it a name that opens doors to support. Sometimes a diagnosis of PTSD or complex trauma is exactly what someone needs to hear — because it locates their experience in something real and recognised, rather than leaving them to wonder what is wrong with them. That naming can be a relief. A permission slip. A way back to themselves.

What I am pointing to is something more specific: the moments when a trauma response gets read through a framework that doesn't account for trauma at all. When the language used to understand and treat what happened doesn't fit — and the person leaves carrying a story that makes them harder to heal, not easier.

What can help in those moments

When what is happening is a trauma response — a flooding, an activation, a collapse into trauma time — what helps is often more human than clinical.

Grounding. Orienting to the present. A calm, regulated presence alongside. A gentle reminder of where and when we are. The simple naming of what is safe in the immediate environment. Slow breath. Physical contact where it is wanted and appropriate.

These are not soft or peripheral responses. They work because they speak directly to the nervous system — the part of the person that is activated. They offer the body evidence that the danger has passed. That this is now, not then.

Having someone alongside who can hold that space — without rushing to categorise what they see, without needing to contain or explain it away — can be profoundly stabilising. Not because that person has answers, but because their regulated presence gives the activated nervous system something to come back to.

A necessary word

None of this is an argument for avoiding professional help. It is, if anything, the opposite.

If you or someone you love is in crisis, please seek support. The distinction between a trauma response and a psychiatric episode is not always clear, cannot always be made quickly, and requires proper professional assessment. Please do not use this piece as a reason to avoid that.

What I am hoping this piece might do is something smaller and more personal. I am hoping it might offer a different lens to someone who has been through the system and come out the other side still carrying questions about what actually happened. Someone who received a label that didn't quite fit. Someone who is trying to understand why that moment unfolded the way it did — and why the help they received didn't quite reach the thing that needed reaching.

If that's you — the question you're carrying is worth bringing into a therapeutic space. Not to go back over what happened, but to make sense of it. To build a story about yourself that is more true, and more useful, than the one you may have been handed.

The distinction that changes things

There is a difference between something is wrong with me and something happened to me, and my body is still carrying it.

That distinction is not small. It doesn't invalidate the need for support, or the value of understanding what's happening in clinical terms. But it changes the starting point. And the starting point matters — because it shapes everything that follows.

It is often where real healing begins.

If you are trying to make sense of a past crisis — or of responses in yourself that don't seem to fit a simple explanation — I'd welcome the conversation.

A free 15-minute consultation is available. No pressure. Just a place to begin.

Book a Consultation

Zanti Counselling | Adelaide CBD & Online | zanti.com.au

Further reading:

• Bessel van der Kolk — The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014)

• Suzette Boon, Kathy Steele & Onno van der Hart — Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists (2011)

Karie Rohrlach is a counsellor, psychotherapist, and trauma-informed practitioner at Zanti Counselling, Adelaide. She works with adults navigating trauma, complex trauma, anxiety, and the responses that don't always make sense until their origins are understood — in person at 71 Angas Street, Adelaide CBD, and online. PACFA registered.