You’re Not Lazy or Weak—You’re Carrying Too Much, Too Quietly

caulocare
Jun 23
5 min read

**How Smiles Can Mask Silent Trauma: The Biology Behind Emotional Denial**

By Dr. Phumlarp Caulo/ Caulo Care Forest Hills, New York/ June 23, 2025

"Everyone says you're strong, capable, and calm. But no one knows that behind your smile lies a mountain of stress, fear, and words you’ve held back for far too long."

For many high-functioning individuals, emotional suppression has become second nature. They excel at work, smile in public, and take care of others — all while concealing deep emotional distress. Over time, this silent burden doesn't just weigh on the mind; it begins to disrupt the body in profound ways.

When the human body is exposed to chronic emotional stress without proper release or therapeutic resolution, critical hormonal systems become imbalanced. This imbalance may result in physical symptoms such as weight gain, insomnia, fatigue, and digestive issues, as well as mental health challenges like anxiety, depression, and emotional burnout.

1. Traditional Chinese Medicine (TCM) Perspective: What is Liver Qi Stagnation?

In Traditional Chinese Medicine, the Liver is believed to govern the smooth flow of Qi (vital energy) and emotional regulation. When emotional expression is stifled, Qi can become obstructed, especially within the liver meridian.

Liver Qi Stagnation is a condition where:

Emotional energy becomes "stuck" in the body due to unexpressed stress, anger, resentment, or sorrow.
Qi fails to circulate freely, leading to physical and emotional symptoms.

Common clinical manifestations include:

Tightness or discomfort in the chest and rib cage
Bloating and digestive discomfort
Irritability or mood swings
Irregular menstruation (in females)
A sensation of throat tightness or difficulty speaking — “a lump in the throat”

According to Traditional Chinese Medicine (TCM), individuals who rarely express their emotions and carry their burdens alone are the most susceptible to Liver Qi Stagnation.

2. Western Medicine Viewpoint: Chronic Stress and Neurochemical Disruption

From a biomedical standpoint, chronic emotional stress activates the HPA Axis — the Hypothalamic-Pituitary-Adrenal system. This triggers a cascade of hormonal responses, including elevated secretion of cortisol, the primary stress hormone.

Prolonged activation results in:

HPA Axis Dysregulation – the body can no longer properly regulate cortisol, leading to systemic dysfunction.

Key physiological consequences:

Brain:

Shrinkage of hippocampal neurons (affecting memory)
Hyperactivation of the amygdala (heightening fear and anxiety responses)

Cardiovascular system:

Hypertension
Arrhythmias

Gastrointestinal system:

Irritable Bowel Syndrome (IBS)
Gastroesophageal reflux disease (GERD)

Immune system:

Impaired immunity
Delayed wound healing
Increased susceptibility to inflammatory and autoimmune conditions

3. Psychiatric Insight: Suppressed Emotions and the Psychosomatic Link

"Emotion suppression is a silent trauma." Mental health experts have long observed that people who habitually suppress emotions are more likely to develop:

Major depressive disorder
Generalized anxiety disorder
Psychosomatic conditions, such as chronic headaches, unexplained gastrointestinal discomfort, or breathlessness without an identifiable organic cause.

These patients often present with a “strong but silent” profile. They don’t cry, don’t complain, and rarely seek help—until physical symptoms emerge that even advanced diagnostic tools fail to explain.

4. Pioneers in the Field of Psychosomatic Medicine

Several influential thinkers and physicians laid the foundation for the modern understanding of mind-body connections:

1. Sigmund Freud (1856–1939) – Founder of Psychoanalysis

Proposed that repressed emotions could manifest as physical symptoms (e.g., functional paralysis without structural damage).
His case study with Josef Breuer on "Anna O." marked a milestone in linking psychological trauma to physical illness.

2. Franz Alexander (1891–1964) – Father of Psychosomatic Medicine

Coined and formalized the field in the United States.
Suggested that unresolved inner conflicts could trigger physical diseases:
- Repressed anger → hypertension
- Anxiety → asthma
Founder of the Chicago Institute for Psychoanalysis

3. Helen Flanders Dunbar (1902–1959)

Psychiatrist and theologian
Popularized the term “psychosomatic”
Co-founder of the American Psychosomatic Society (APS)
Introduced the concept that personality types (e.g., Type A) might predispose individuals to physical disease

4. George Engel (1913–1999) – Developer of the Biopsychosocial Model

Proposed that effective medical treatment must integrate biological, psychological, and social factors
This model underpins much of today’s holistic and integrative health care, particularly for disorders like IBS and fibromyalgia

5. Neurochemical Pathways: The Biology Behind the Breakdown

Chronic emotional stress alters the balance of essential brain chemicals and hormones. Here's how:

1. Cortisol – The primary stress hormone

Elevated during ongoing stress
Chronically high levels lead to:
- Central weight gain
- Hypertension
- Insulin resistance
- Insomnia and fatigue

2. Serotonin – The mood-stabilizing neurotransmitter

Regulates emotion, sleep, and digestion
Deficiency linked to:
- Depression
- Migraines
- IBS

3. Dopamine – The motivation and reward neurotransmitter

Regulates desire, satisfaction, and productivity
Low levels associated with:
- Burnout
- Apathy
- Anhedonia

4. GABA – The calming neurotransmitter

Helps suppress excessive neural activity
Low GABA results in:
- Chronic anxiety
- Panic attacks
- Hypervigilance

5. CRH (Corticotropin-Releasing Hormone)

Triggers cortisol release under stress
Chronically elevated CRH suppresses immunity and fuels inflammation

6. Who Is Most at Risk?

Working women aged 30–55 who bear the emotional and financial burden of their families
Men are raised to suppress emotion due to cultural norms of masculinity
Healthcare professionals, teachers, and therapists who absorb the emotional distress of others while neglecting their own
Trauma survivors who have never received appropriate mental health support
Isolated individuals who fear burdening others and keep everything inside

7. Integrated Healing: Bridging East and West

Traditional Chinese Medicine (TCM)

Acupuncture to restore Liver Qi circulation
Herbal remedies such as Chai Hu and Xiang Fu
Breathwork, self-massage, and expressive therapies (e.g., journaling or talking with a TCM practitioner)

Western Medicine

Mental health counseling or psychiatric evaluation
Cognitive Behavioral Therapy (CBT)
Mindfulness training and stress-reduction techniques
Dietary changes – reducing caffeine, refined sugars, and inflammatory foods

🔍 Final Thoughts

"Not all illnesses stem from bacteria or viruses — some begin with unspoken pain, suppressed grief, and silent suffering." If you are someone who “looks fine” on the outside while struggling on the inside, this article is a gentle reminder:

You do not have to carry everything alone.

Listening to your body — and your emotions — is not a sign of weakness. It is the beginning of deep healing.

Dr. Phumlarp Caulo LAc,MsAc,OM,DAHM,Pre-RN

Integrative Medicine Practitioner, bridging Eastern and Western Wisdom.

“Rooted in ancient wisdom, guided by modern science

On this page, we look back at history so you can move forward with health.

I believe in Mother of the Earth, the timeless healer of body and soul.”

This information is only educational and should not be construed as medical advice.

Everything must be balanced, and the suggestions may not apply to you.

A specialist doctor should be consulted for any medical advice or diagnosis.

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