hi, my name is nate and i have a lot wrong with me. chiefly, i have severe ptsd (or complex post-traumatic stress disorder when the provider feels comfortable dipping into the icd-11). i was diagnosed when i was 19 and i’ve been inpatient six times. i feel the need to speak my piece. my ability to write has gone downhill in the past two years as my mental and physical health have gotten worse, but i feel like this is something i need to articulate. the modern mental health movement is failing those of us with more severe experiences.

informal mental health spaces and the terminology we use to discuss our lives are drastically changing with the spread of information about mental illness, mental health, and all associated topics. i have found that these changes are not wholly positive at all– in my experience as someone with severe mental health issues including ptsd and psychosis, it is rather dire. i want to discuss my experience in a longform piece of writing, since there are so few places to discuss my life and this topic requires nuance and discussion at length.

as mental health awareness has increased on social media and in real life, there has been a shift in the past few years in which language around trauma has filtered into the mainstream. one can go on tiktok right now and be told that liking animals means you have autism and that reading is dissociation, and that overworking is a hypervigilance trauma response from the F.O.G. of your Nparent's attachment style or some other string of terms. you can see discussions of self care, which originated as a concept for how to live as a marginalized person of color in a broken and racist world, co-opted by businesses to encourage people to buy face masks. these labels are appealing because they can be used to market products and services at people– remember betterhelp’s trauma scale that artificially weighted surveyor’s experiences as always at least moderate-to-severe, to induce buying their products.

in the process making psychiatric disability and mental health issues marketable, terms that were previously only really used so often by more frequent flyers of iop programs and inpatient stays have been manipulated. this dilution of language is in the interest of targeting the broadest audience possible for self-care baskets, supplements, fidget spinners, therapy help apps, trendy shirts, stuffed animals based on psych disorders, chakra alignments, and much, much more. anyone can fit one of these now-marketable labels, as long as they contain at least one human trait. like harry potter houses, these terms sort vast bulks of humanity into boxes more easily sold stickers to decorate the walls.

there’s also the added impact as the world moves away from communities and society fails us, labels like this are more appealing to explain and soothe the hollow meaninglessness at the center of White culture in america. the homogenization of individual cultures (Polish, Finnish, Irish, Italian, etc) into one big beige homogenous Whiteness at the cost of traditions has created a big hole of meaning in the center of White american culture. this is a topic for another day, but that is the summary of it. additionally we are losing third spaces, chances to bond in real life, and turning into a country of nomads who don’t have connection to the land we live on and move states multiple times. people are watching climate change disrupt the future and present, watching the west descend into fascism, and many get the majority of their social interaction from a screen that sells them items all day. people are miserable and terrified, and the fastest way to find community is to adhere to a political or medical label, and one of those spaces is much kinder than the other.

and of course, mental health awareness has also led to an increase in people who have more mild symptoms figuring out their shit, and joining and creating spaces for their mental health issues; a not-small number of these are those who have no awareness that there are others who experience symptoms more severe than mild GAD and mild endogenous depression. they simply have not gone places where they would meet people like that– being homeless, being inpatient at the right time, support groups for psychosis. this change has tipped the severity scale of experiences and symptoms for the median user who access disability spaces for mental health reasons, at least those on social media. which, unfortunately, is where most disability spaces are now. i currently live in a progressive blue megacity and can’t find a single support group in real life for non-veteran post-traumatic stress disorder… but i hear the terms “trauma dump” and “ptsd” used for trivial things multiple times a day now, and have to drive past ads for fashion brands called things like “#TRAUMATIZ3D;P” and repeatedly argue with my friends not to joke about my life in ways they previously would never have dared to.

i hear jokes about it a lot now, from all corners– people in real life, podcast episodes, youtube shows, mmo chats, social media comments. and– and it’s almost worse– if i try to use the same language i have used for a decade to explain my situation, i end up in situations where people think when i say dissociation, i mean that i read a book or zoned out, not walked into traffic in a fugue state. when i say i have ptsd, they think i mean i have bad anxiety from my parents divorcing or a sense of apprehension after a bad friend breakup. when i say i have cptsd, a diagnosis which was originally created to describe people with severe ptsd + other symptoms as a result of SEVERE long-lasting trauma in an entrapped and constellationed context, people assume i have it simply because i was bullied in school. i've had people tell me that flashbacks can't look like being huddled on the floor screaming while you fall through time, and that i must be lying when describing my experiences. they confidently claimed that flashbacks are more like bad memories, and don’t involve hallucinations or even thinking you’re back there. at best, emotional flashbacks are stated to be what flashbacks “really are.” we are losing terminological coherency in support spaces where knowing what words mean precisely is the difference between someone’s life being saved or not.

hell, i can't even get away from references to trauma outside of mental health awareness spaces; i hear my symptoms being used as marketable buzzwords and joked about all the time and it's so hard to grit my teeth and ignore it. i’ve had to fight with my friends, people who have known me half a decade, that suddenly joking about the hell i’ve been forced to live through isn’t okay, people who went years without ever daring to joke about it. it feels like a knife in the back.

searching for threads about accurate depictions of ptsd in movies yields, for example, reddit posts “debunking” what people get wrong about ptsd. and the comments are mostly things like “flashbacks don’t actually involve hallucinations or thinking you’re somewhere else!” “it’s really rare to actually have nightmares about the trauma,” “we aren’t dangerous! startling us is fine, idk who started that idea!” these are the hallmark symptoms of post-traumatic stress disorder being described.

it's not just ptsd either, but other mental illnesses as well. another quick example: there was a screenshot of a discussion making the rounds among us more seriously mentally ill people online. a twitter user was shocked upon learning that one of the most common ocd thoughts was the topic of p/dophilia and harming children, and called everyone with this symptom psycho freaks; they refused to believe people talking about their own experiences with this while still trying to be a ~mental health awareness~ type. this is absolutely not a one-off and a similar discussion has played out time and time again regarding the real definition of intrusive thought. i've experienced this with my ptsd-- i mention something alluding to my symptoms to someone who tells me they also have ptsd, and they look at me like i have three heads because they are used to subclinical experiences being as bad as it can get.

as a direct result of their lack of experience with those with more severe symptoms or more traumatic experiences, the newbies don't even realize how insensitive they are. over the past few years, those of us with severe mental illness have less and less places to go to talk about our experiences and not be looked at like we are freaks. my chances of receiving advice in psych support spaces on social media that completely fails to grasp or believe the severity of symptoms have never been so high. in their eagerness to help and lack of understanding regarding those of us on the severe end of the spectrum are hearing more over-assumptions of our abled-status than ever before.

if you try to engage with the people earnestly using these psych terms inappropriately or discussing mental illnesses in ways that don’t make sense, they just tell you "omg don't play oppression olympics" or "everyone's trauma is valid!" which. well duh. that just has nothing to do with the conversation we're having about this trend of encouraging the misuse of medical terminology wrong hurting the most vulnerable parts of a community. triage exists in emergency care for a reason; those who are most ill cannot be continually shoved into the back corner over and over, as their condition will degrade more rapidly than those are less severely impacted.

coming back to the example of emotional flashbacks versus “classic” flashbacks, there’s an even more eerie and sinister aspect to the incoherent babble that discussing symptoms has dissolved into. in these social media-dominated disability spaces, there is an echo chamber effect. i’ve had many earnest conversations with others, chiefly discussing the twin definitions of cptsd at the moment, and been starkly confronted by an issue i have not really encountered in inpatient. it is an issue that forces those who are more severely impacted to continually now need to not only disclose, but argue with peers as to the legitimacy of our experiences.

i had long considered circles of traumatized people to, despite the rest of our myriad interpersonal issues, be one of the few spaces where no one assumes they and their experiences are the worst in the room. if they do, it is not readily apparent and does not seem to rise to the level of causing problems in group discussions, not in the way it does with non-traumatized people.

but something has shifted. gone seems to be the wary awareness that despite the fact you, for example, were beaten as a child, there may be someone else in the room with you who backed over their own toddler whose death was slow and loud. the idea that there may be people with a range of experiences in the room and that you may not be the most severe case has been swept away. there are bulls in the china shop and thumbs on the light end of the scale, and they consist of people who create entire online communities revolving around cptsd, without ever having met someone with worse life experiences than theirs. the confidence is complete; when discussing the icd-11 criteria for complex post-traumatic stress disorder and how that might look in real life, i mentioned the example of a child solider forced to kill others. in response, it was earnestly suggested to me that a child whose abuse consists entirely of being yelled at could rise to the same level of trauma if they felt really scared.

the echo chamber is such that people who fit the criteria for icd-11, classical definition cptsd have next to nowhere to go. i’ve had plenty of therapists tell me they’ve had to ask their mentors for advice on how to even begin treating me– that was the exact phrasing. therapists also usually let on to me that i’m one of the most severely symptomatic and traumatized people they work with; this is not said like a validating ass-pat, and more as a reminder to come back to reality. i find myself often comparing myself– and absolutely constantly being compared by others– to my more normal peers around me, and constantly criticized for global failure to function to some degree in all realms of life. my ability to receive kindness and accommodation from other people is waning; if they know four other people who have cptsd from bullying at work and they all work full time and have very little loss of global functioning, what the fuck is my problem? i must just be lazy and love my own misery. if their friends with ptsd who never experience flashbacks or cut themselves and have never needed inpatient say jokes about it are fine, what's my problem? why would I be so sensitive? it's not like it ruined my life or anything.

the problem is that people like me are not able to self-advocate the same way and push back to make more room for ourselves. we are not as common as those with more typical life experiences, and we are busy carrying a much larger backpack of symptoms and usually live in much worse conditions. in the same way that peak twitter and tumblr trans community tended to be dominated by white trans people in the global north and west (and more specifically, blue bubble cities) who have steady internet access, relative financial privilege, and ample free time to discourse on the internet, mental health awareness spaces are shaped, guided, and most loudly contributed to by the same caliber of person– white and housed in the global north and west, with relative privilege. people who are soundly traumatized and deeply dysfunctional have a lot of trouble maintaining thousands of followers, a medium blog, a tiktok, a small youtube channel, and a patreon– we are busy attempting suicide a second time this week, or in a sedative-induced haze struggling to feed ourselves for the first time in two days. and largely, we are HOMELESS. in the same mechanism by which an impoverished trans sex worker in the global south is not going to be heard from because of their relative lack of privilege, free time, and access, so too are are the more severely psychiatrically disabled trampled over. malice or intent need not even be involved; it is by pure dint of who has the time and ability to take up the space.

circles of traumatized people used to contain more people like me. homeless on and off, often trapped in abusive relationships or bouncing from strange living situation to strange living situation, with layers and constellations of issues that impede even the simplest of quality of life improvements. people with incomprehensible lives, who take six hours to get through the list of their Traumatic experiences during a new intake, who can barely step through the bramble of triggers and pain to do basic functions, much less work or keep friends.

people who have been deeply traumatized in a way that is rare to see anywhere but a horror movie or a few older books of case studies deserve to be able to meet others like us. being unable to really know ANYONE who is on the other side of this pain, seeing them only in vague references in anonymized case studies, true crime cases, or horror films is terrible for the mind. imagine only seeing people whose lives even look vaguely like yours in their very shape and base order of events in films made to shock, disgust, and scare. and imagine almost never seeing someone who has managed to live beyond this pain, often only meeting them when you are both drugged and institutionalized for being too close to death, and will be going back to abuse or homelessness and a despairing life after the week is over.

every single time i have been inpatient, the thing that really helped me was not medication or the short, uncomfortable visits with the psych. it wasn’t having books and my pants taken away. it was finally, finally, finally being able to meet other people with lives like mine, even in such a setting. the constant question i’ve always asked professionals is not necessarily “how do i get better?” because that is a given but instead “are there other people like me?” and “what happens to people like me?”

i’ve had therapist friends talk to me about how they see other licensed therapists beginning to use language like this; not just pathologizing subclinical experiences, but also saying jokes like “wow, i have ptsd from how awkward that social interaction was.”

is that the future of psychiatric care for us more severely mentally ill? it’s never been good by any measure for us, but i can imagine situations where it’s worse. where therapists are even worse to me, not just cracking their gum, rolling their eyes, and asking if i mean zoning out when i describe clinical dissociation. rather, maybe they openly make jokes about the horrible things done to me and that i have been forced to do, and tell me i’m too sensitive when i ask them to stop. i already struggled for months to find a residential program nearby that accepts traumatized people who are not addicts like myself, finding only trendy resorts costing thousands that claim to use yoga and akashic records access to girlboss my cptsd away. i can see a future where someone on a dating app says they think ptsd is hot.

i can see a future where, instead of creating another diagnostic category to address lower levels of traumatic experience, ptsd is changed in the dsm and icd specifically to drastically lower the threshold on symptom severity, making it even more difficult to access quality care for those on the severe end. i can see a future where i am confronted with shirts with catchy, girlbossy slogans about the disorder that ruined my life not just on obscure etsy shops, but also at walmart while i’m struggling to buy food past my own mental hell. i’m already seeing a life where i turn away from most of mindless, silly comfort media i would watch to try to distract myself from my life– after ptsd jokes on several Try Guys episodes, followed immediately by two podcast episodes of Normal Gossip all within the same month, i’m left with less and less media i can consume without feeling a jolt of pain and exhaustion randomly. less friends i can talk to, less things i can watch, less places i can go on social media. i’ve watched the circle i’ve learned to develop my life into something marginally more livable inside shrink, and shrink, and shrink over time. it is so small.

i’m a pretty anxious and pragmatic person, so my thinking keeps turning towards the future. where do we go from here? what happens? will the circle close to a pinpoint as we lose what little faith in doctors the american people has left and go straight to pseudoscience and magical thinking about mental illness? what will the future of online mental health support forums look like (rip crazymeds, you were so useful)? and should we do like people with OCD have done, and just reply to every single instance of misuse of terms with the facts and shut it down immediately? so far, that one hasn’t worked for me; people argue in favor of joking about ptsd terms in this way far, far harder than they ever did for using ocd terms and they seem to take extreme personal offense at being asked not to trivialize the ruination of me. should we create new language– replace terms like trauma, flashback, et cetera, and hope they catch on from-the-ground faster than they can be appropriated? how would that even work without using social media in a capitalist world, the very vector making this disintegration happen? do we somehow find the time to have this conversation about social media and clinical severity with every single provider we see to make sure they understand what we mean when we describe a symptom, and hope they don’t make jokes about us? how will we explain our needs and experiences to those around us that we rely on to some degree for our safety?

i don’t know. the few other people with severe ptsd in my life don’t know either, but we are all worried.

in the meantime, if you want to help… if you hear someone make a ptsd joke, please call it out. don’t make us have to.

thanks for reading. this has been a daily contemplation and discussion for almost a year now, trying to figure out how and why this is happening and what to do about it for my own sake. there’s a read more down below with books i recommend, but most of this is from lived experience that i’d be happy to talk about as and when i have time and ability.

P.S.: personally, i suspect a good resolution to some of the unintentional misinformation with regards to the use of cptsd as a diagnostic label could be solved fairly easily by splitting ptsd into three disorders: the current definition of ptsd for single-context Traumas; the icd-11 definition of cptsd; and a third category more akin to a developmental trauma disorder, to encapsulate the clearly-harmful situations the modern definition of cptsd seems to seek to capture. but that's something that might become a whole other piece of writing, and necessitate a lot more citations at the end.

• mad in america, by robert whitaker.
• this book is excellent and covers the history of mental health treatment in the west (usa and uk largely).
• the evil hours: an autobiography of post-traumatic stress disorder by david j. morris.
• a grand and sweeping book about the history and future of ptsd, through the lens of the author's own experience. incredible book. read this to better understand ptsd.
• icd-11 listing for cptsd
• read this to better understand the definition of cptsd