Growing up in India, I have heard this sentence in some form in almost every house I have been in.
My shoulder hurts. My back is tight. My chest feels heavy. My stomach has been off for weeks. I went to the doctor, they ran the tests, everything came back clear, and they told me nothing is wrong.
And then the pain continues, exactly as before, while the person carrying it now has an extra problem: nobody believes them, including, eventually, themselves.
I want to talk about that, because it is one of the most common and least discussed things in Indian families, and because the way we usually explain it is both wrong and unkind.
First, the pain is real
Let me say this before anything else, because everything after it depends on it.
“The tests are clear” does not mean “you are imagining it”. Those are two completely different statements and we collapse them constantly.
A clear scan tells you there is no structural damage in the tissue. It tells you nothing about whether the person is in pain. Pain is produced by the nervous system, not read off the tissue like a measurement. A nervous system that has been running at high alert for months can produce genuine, physical, measurable muscular tension and genuine pain with nothing torn and nothing inflamed.
The shoulder is not lying. The shoulder is reporting accurately. It is just reporting on something the scan was not looking for.
Why this shows up so much in our families
There is a body of work in cross cultural psychiatry, including a lot from Laurence Kirmayer, looking at how distress gets expressed differently in different cultures. One of the consistent findings is that in many cultures, including much of South Asia, distress is more likely to be presented and experienced in the body than described in emotional vocabulary.
I find the usual framing of this slightly patronising, as though some populations have simply failed to learn feelings words. I think a better way to put it is this: people express distress in whatever language gets a response.
Think about what that means in a typical Indian household.
“I am exhausted and I do not want to go to work” gets you a lecture.
“My shoulder is killing me” gets you attention, a hot water bottle, and permission to lie down.
Nobody in that house is being dishonest. There is no conscious calculation happening. Over years, a family teaches its members which complaints are receivable, and the body learns the dialect. The somatic version of the sentence is simply the one that works.
And it is not only about how it is received. Many of us were never given the vocabulary in the first place. If nobody in your childhood ever named what they were feeling out loud, you do not grow up with those words available. The sensation still arrives. It just has nowhere verbal to go.
What is actually happening in the body
The mechanism is not mysterious and it is not mystical.
When a person is under sustained stress, the body does what it is designed to do: it braces. Muscles tighten, particularly around the neck, shoulders, jaw and lower back. Breathing gets shallower and moves higher into the chest. Digestion, which is not a priority during a threat, gets deprioritised.
That whole arrangement is meant to be temporary. It is a system built for a short emergency followed by a return to normal.
The problem is that it has no way of distinguishing a genuine emergency from six months of a job you dread, or a family situation with no resolution, or an exam year, or a grief you never got to put down. So the bracing does not switch off. It just becomes your default posture, and after long enough you stop noticing it as bracing and start experiencing it as a shoulder that hurts.
Bessel van der Kolk’s work, which a lot of people have now read, makes this point at length for trauma specifically. But you do not need trauma for the basic version. Ordinary sustained pressure does it too.
What this does not mean
It does not mean “it is all in your head”. The bracing is in your muscles. It is physical.
It does not mean you should stop seeing doctors. Please get the tests. Rule things out properly. This piece is about what to do after the tests are clear, not instead of them.
It does not mean you can think your way out of it. You cannot reason with a nervous system. It does not take arguments.
And it does not mean the person is weak. This is one of the most common patterns in medicine worldwide. It is not a character flaw.
What tends to actually help
I am going to be careful here, because I am not going to hand out a treatment plan on the internet.
What I can say is what the direction of travel usually looks like.
It is generally bodily, not just verbal. Approaches that involve the body directly, breathing work, gradual movement, physiotherapy alongside psychological support, tend to do better with this than talking alone, because the pattern is held in the body.
It usually involves noticing before it involves changing. A lot of people genuinely cannot tell you whether their shoulders are up or down right now. Building the ability to notice the bracing as it happens comes before any attempt to release it.
It takes longer than people want. A pattern built over five years does not resolve in a fortnight, and expecting it to is a good way to conclude that nothing works.
And it usually needs somebody qualified. If this has been going on for months, the useful next step is a professional who works with this specifically, not a reel and not a website.
If it is not you, it is your parent
Most people reading this will not be thinking about themselves. They will be thinking about a mother or a father who has been saying their back hurts for eleven years.
A word of caution. Do not diagnose them. Telling your mother that her shoulder pain is actually stress is one of the fastest ways to be told to mind your own business, and she would be right, because what she hears in that sentence is that you do not believe her.
The thing that helps is much less impressive. Believe the pain out loud. Ask what was going on in her life when it started. Ask whether it is worse on particular days and what happens on those days. You are not treating anything. You are helping somebody notice a pattern they have been too close to see.
Why I care about this
I worked on this connection in my graduate studies, and I keep coming back to it, because it sits exactly on the line between two things our families treat as separate: health, which is taken extremely seriously, and emotional life, which is often treated as a luxury.
The body has been arguing that they are the same thing for a very long time. We have mostly just been reading the message as a shoulder problem.
What you have just read is psychoeducation: general information and reflection, written for a lot of people at once. It is not therapy, an assessment, or a diagnosis, and it is not advice about your particular situation. Reading it does not make us a practitioner and a client.
If you are carrying something heavy, please talk to a qualified mental health professional who can actually see you and your circumstances. And if you are in crisis or thinking about harming yourself, please do not start here. In India, Tele-MANAS is free and open 24 hours on 14416, in English and 20 other languages. Anywhere else, findahelpline.com has the number for your country.
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