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The trauma we experience in life changes us, for better or worse. In a small or large way, it has an effect.

Getting bitten by a dog can cause a fear of dogs. If you almost drowned, you might be afraid of water. Trauma can create fear that usually stems from survival instincts and are natural in their own ways. Most of these types of fears go away on their own as time goes on. They can be cured, or at least lessened. We all experience fear — it’s a natural and helpful emotion. There are always many degrees of fear, but then there is what can develop from this fear — post-traumatic stress disorder (PTSD).

When you experience trauma — when you live through an extremely traumatic event, something scary or shocking — the changes can go deeper. It can go past the rational and plunge into irrational — from that natural fear that might go away over time into a potentially debilitating disorder. It can cause PTSD. It’s important to note that not all PTSD is chronic; some can disappear after a few months or with treatment even sooner, plus not everyone who has been through a high level of trauma will develop PTSD.

One thing I’ve run into with this disorder is that many people have the notion it’s something only soldiers face, or only those who have experienced something physical, such as a car accident, a gunshot, the tragedy of sexual assault, accidents or disasters. Something dramatic that would be on the news.

In fact, PTSD can arise from many other situations. The trauma might be suddenly losing a loved one, seeing someone else hurt, losing a job, emotional or domestic abuse — many events that to an outside view might not even seem that traumatic. Even that dog bite can cause PTSD.  When others don’t understand these are real causes, it can become even harder for those living with it.

Friends and family may question or doubt what you’re feeling and how you’re struggling — that what you’re going through can’t be that bad because you haven’t been to war, or been in a car crash, etc. What they don’t seem to realize is that PTSD can’t be explained or rationalized away. It can’t be excused or discredited; it’s real and it can happen to anyone. When you invalidate someone’s struggle, you’re shutting them down, forcing them to feel defensive, belittling them, causing them to question themselves enough to not reach out for help they desperately need, or even silencing them when they need to speak out. This is why it’s so important to inform people about this disorder and how deep it can seep into someone’s life and their ability to function.

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It’s important to recognize and see PTSD for what it is — a mental illness. It’s not someone being dramatic, not an overreaction, not attention seeking; it’s a real disorder that causes great pain and changes someone’s life. It’s an awful feeling when you’ve been triggered, are breaking down, falling apart, melting into panic, and then someone says this is not important — that what has triggered me is no big deal, that it’s “normal” and I shouldn’t be having the reaction I am. Because then I’m not only struggling with this disorder; I’m feeling ashamed or feeling I’m at fault. It may seem like nothing, but with PTSD the smallest nothing can be the biggest something.

When someone tells you they have PTSD, don’t ask them to justify it. Don’t tell them they’re being silly, that other people who have the same experience are fine so they should be too. Don’t belittle or judge, because it’s a very real and serious disorder. It’s not silly or invalid. They’re not overreacting. They aren’t going to be fine just because you think they should be. Instead, offer judgment-free support, listen to them, ask them how you can help, maybe even do some research and learn more about it. Be there for them, and above all — recognize PTSD is not a choice, it’s a mental illness.

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It’s about 5 p.m. as we arrive to the side entrance of the arena, my medication bag in hand. For me, attending an event such as a concert can be an anxiety-inducing experience and one I would rarely consider. Carrying the weight of severe pain from several chronic illnesses and the thought of standing in long lines seems impossible. Add to that the concern of being in large, loud groups with strangers pressing against you from behind — a real trigger when you have post-traumatic stress disorder (PTSD) like I do.

However, on this day I am lucky enough to use a quiet side entrance without any lines. As we walk towards the two metal detectors I open my medication bag and hand it to the security staff. She is so kind as she looks through the bag gently confirming what is inside. There are no other concert attendees in this area at this time to look over my shoulder as my medications are examined. There are no whispers or agitated people behind me wanting to know what the holdup is. It is just quiet and calm. We walk over to a small table where we check in and get our VIP badges (a price worth paying for me to be able to be here) and are escorted up to a room with comfortable couches. As I sit down looking around at the people smiling and laughing as they are sipping their drinks, I take a breath and think, “I made it. I am actually here and I am feeling so peaceful in this moment.”

On a table towards the middle of the room is a picture of Lady Gaga with her head up, wearing a pink cowgirl hat. A replica of that hat sits on a pedestal nearby. Under the hat stands large block letters that spell out “Joanne.”

The concert is, of course, amazing. Lady Gaga, as always, does not disappoint. The voice of an angelic powerhouse fills the arena. The choreography of the dancers, costume changes and special effects all make for an incredible show. However, the moments of the evening that are the most powerful are those where Gaga speaks about Joanne. She talks to her audience as if she was just leaning up to one person telling them a story.

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“Joanne,” the title of Gaga’s current album and tour was also the name of Lady Gaga’s aunt on her father’s side. She was taken from this world when she was only 19 years old from Lupus, a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs.

Though Joanne died prior to Gaga being born, she tells the story of how her aunt has been one of the biggest influences in her life. During the concert she speaks very openly about the affect the death of her aunt made on her family. She talks about how the grief was so deep it became generational. A pain so visceral that it almost seemed to pass into her bloodline. Lady Gaga was even given the middle name Joanne in honor of her aunt.

As she tells this story, the entire arena is silent as you can feel the very real pain Lady Gaga is speaking of. Being a huge fan of Gaga myself, I was already aware of the story of Joanne and had felt a deep connection to it. However, my spouse (also a big fan), was not aware of the story and as Gaga was speaking, I felt a hand grab mine and whisper in my ear, “That is your story.”

My sister Amy died when she was only a little over a year old. She drowned in only a couple of inches of water in a freak accident in our home. Though my sister died two years before I was born — like Joanne to Gaga — Amy has been one of the biggest influences in my life as well. My sister and I even share the same middle name. I knew from a very early age from comments that had been made to me (sometimes by those in an inebriated state), that I was conceived because my parents wanted some sort of relief from their grief. They had three sons that they needed to carry on for, but their grief was all-consuming. I was aware of my sister and how she had died from as long as I could remember. A large painted portrait of her in a little pink dress (a dress that currently hangs in a closet in my home) sat in my parents’ room like a shrine. A photo of her with her actual hair clip attached to the frame sat on their dresser through every passing year. The portrait and photo are now on a wall in my business with a brief story of why I dedicate my business (a company that teaches others to save lives) to my sister. I tried to take on the grief caused by the loss of my sister from as early of an age as I could. I even went as far as writing her name on my schoolwork instead of my own when I was only 7 years old. I could see and feel the pain her death had caused my mother and wanted so desperately to remove it. My parents have now both passed on but the pain of losing my sister was held in them both well into the last moments of their lives. I carry my sister with me every day of my life, even though we never met.

Like Gaga, I also experience both chronic pain and PTSD as well. I had a traumatic brain injury when I was only 17 years old after being attacked — a story few know and one I prefer not to discuss beyond the walls of a therapist’s office. In my adult life, I worked both on an ambulance and in a children’s hospital seeing things most people could not even imagine, which further powered my PTSD. I started having chronic pain around age 11 and received my first diagnosis of Ankylosing Spondylitis when I was only 18. I have been diagnosed with a handful of additional diseases since then — including two extremely severe forms of nerve pain in the face and head. Lady Gaga has also spoken of the challenges she has faced suffering from chronic pain, as well as PTSD.

Gaga experienced a severe trauma at age 19 that forever changed her as well.

I do not know Lady Gaga personally, but I am so very proud of her. I know the very difficult challenge of carrying on when your body and brain feel broken and exhausted. I understand the burden of keeping not only your own pain, but the pain of others as well. I feel that struggle to want to save the world when you yourself are hurting so significantly. I too feel so very blessed and empowered when I receive love and support and I send that to her and to everyone who struggles with mental and/or physical pain.

“I believe that the most inexpensive and perhaps the best medicine in the world is words. Kind words…positive words… words that help people who feel ashamed of an invisible illness to overcome their shame and feel free.” — Lady Gaga

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Since I started college three years ago, I have pushed myself past what I could bear, and it has caused my three-year degree to take four years. I never planned to, but I have accepted the fact my post-traumatic stress disorder (PTSD) makes certain things harder than they were. I only wish I could feel I had my professors on my side.

Ever since I started, every time there was something I was having a hard time with, my teachers told me “Just try a little harder” or even “Maybe you should focus more on school, and drop some of your hobbies.” My hobbies include trying to handle my symptoms, and every now and then spending time with my friends. I wish every teacher and professor would understand that advice is not helpful!

Living with mental illness is a struggle most people cannot see. So when I ask for help, please at least hear me out. I worked up my nerve for more than six months before I was able to open up to my professor, and the answer I got was, “Then maybe you should find something else to do?” It felt like a punch in the face.

So to every teacher. If you chose to be an educator, you must have had a wish to lead students through their education, whether they are in kindergarten or in college. So I ask you to try. Try to understand the struggle we face, being a student and having a mental illness. And if we ask for help or tell you we are having a hard time, ask us back: “What can I do to make it easier?”

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Editor’s Note: If you’ve experienced sexual abuse or assault, the following post could be potentially triggering. You can contact the National Sexual Assault Telephone Hotline at 1-800-656-4673.

“When I was 15, I was raped by four older guys, who then proceeded to follow me home in their car calling me a “slut.” When I reported it to the police, my entire community of peers turned against me and alienated me to the point where I wouldn’t leave my house. But that was a long time ago, I’m OK now.”

This is how I usually open the conversation about my rape. A lot of people find my bluntness and openness about my rape to be off-putting and uncomfortable, but what I find more uncomfortable is not telling people I’m getting close to this vital piece of information about who I am.

What happened to me eight years ago shaped my life. I struggle with depression and pretty major PTSD — even typing out the first paragraph of this story made my hands shake. It’s brutal, it was brutal, but it’s important.

There are a lot of good reasons to open up about my rape, one being the fact that we need a more open dialogue about these kind of crimes — especially in cases of brutal victim blame like I experienced. And while that cause is incredibly important to me, it’s not the reason I’m so blunt about my life experiences.

What happened to me as a teenager triggered a string of bad decisions from drugs to older men and everything in between. It caused issues I still work on to this day. But in order to understand me as a 20-something-year-old woman, I need people to understand who I was as a 15-year-old girl.

Talking about my life experiences with new people I bring into my life allows me to feel like I’m able to share a true version of myself. I may have spent my teenage years hiding away, but I’m going to spend the rest of my life in the open, and I’ll never let anyone tell me I shouldn’t.

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If you or a loved one is affected by sexual abuse or assault and need help, call the National Sexual Assault Telephone Hotline at 1-800-656-4673 to be connected with a trained staff member from a sexual assault service provider in your area.

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Editor’s Note: If you’ve experienced sexual abuse or assault, the following post could be potentially triggering. You can contact the National Sexual Assault Telephone Hotline at 1-800-656-4673.

I have had something to say for a long time, but I’ve been afraid. I was scared no one would believe it, because for so long I myself couldn’t even believe it for more than a few thoughts at a time. Every day I would have to cope with whatever I believed about my rape at that moment (ex: It was all my fault. It wasn’t abuse. He planned this out. He wanted to hurt me. It was just a teenage mistake. We were both wrong.  I shouldn’t even be thinking about this anymore).

I am finally just barely at a place where I can say it’s true — it’s rape. But the journey I’ve been on to reach this point, a journey I’ve been on for five and a half years, is important. I feel obligated to share it with this confession.

I didn’t say “no” to my rapist. I didn’t fight him. In fact, I continued to show up places alone with him, subjecting myself to further abuse. I did what he told me to. I wore what he requested. At the time, I knew I didn’t enjoy what I was doing, but I couldn’t even consider the option that he would do anything bad or wrong to me. After all, he was a very good friend of mine for years, and besides the orders he gave that kept me isolated, he did continue to act like a friend sometimes. He would hold me when I cried, so I forgot he was the reason I was crying. He said he was feeling guilty and ashamed too, so I believed my feelings were normal and acceptable. He told me sex was supposed to hurt right now because he was stretching me, so I thought it was normal. After all, he would know, and I wouldn’t. He knew I trusted him. 

But it’s complicated. I was insecure, and whether he exploited that or not I can’t know, but my insecurity allowed me to latch on to the idea that because he wanted me, I could feel better about myself. Granted, it wasn’t true — I never felt shame like I did being with him. But I convinced myself this was good for me and my self-esteem, and because of that, I was desperately trying to make sure I didn’t do anything that would cause him to not want me anymore. Because of that, I lied to him. I could not hide the fact that his having sex with me caused me physical pain, but I told him it was also good, like he wanted. Just like he wanted me to wear short dresses and heels to school.

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Is it confusing to you yet? Are you blaming me at all? Are you questioning my use of the word “rape”? I can’t know what you think, but I can tell you some of this has left me questioning myself for a long time. I hope it is just me. I hope you have faith in my feelings and you see how he was wrong and must have known a little better. But maybe you have the voice in your head like I did. 

Sometimes that voice came from the things I would read and hear about other people discussing their support for rape victims or just general feminist rants. People say things like, “It’s black and white, there is no gray. Rape is rape.” And that left me feeling worse. I thought, If that’s true — if I was actually raped — I would never question it. It would be obvious. But mine wasn’t.

I can tell it in a simpler way. Someone who I guess I willingly made out with one time before, put his penis inside of me and didn’t bother to ask if it was what I wanted. When my clenching vagina tried to keep him out, he did everything he could to get it in, and eventually he did. I never offered my consent, and he never asked if he had it. And he didn’t have it, though I didn’t express that. Sexual intercourse without consent. Rape.

Many rape victims do not say “no,” and they don’t fight. Instincts tell us not just “fight or flight” but also “fight, flight, freeze or fawn.” Many rape victims freeze. I froze. You can’t say “no” when you’re frozen. 

The law does not require affirmative consent. While I sympathize with lawmakers needing to have proof for a person to be prosecuted, and while I acknowledge this is a crime that is so often hard to prove, I believe the definitions of the laws themselves do impact our social understanding of crimes as well as our behavior. I believe affirmative consent says “no means no” is not enough; “no means no” presumes silence as yes. Affirmative consent says “yes means yes,” and that’s that. Affirmative consent would not replace laws which govern when one is able to give consent — a yes from a minor, somebody who is mentally or physically incapacitated, somebody who is under the actor’s care or supervision. These would still be invalid, and those scenarios would still be rape. But when consent is legally valid, it must be actively given, not simply implied, inferred or acquiesced to.

Educating and enforcing affirmative consent would remove the gray area so many deny or fear. People who are raped by their spouses or people they have previously had consensual sex with would be much more easily protected but more importantly, validated. I would not have needed half a decade to accept what happened to me was rape if I didn’t have to blame myself for not expressing my “no.” I can’t understand why it should fall on me to say “no,” but it shouldn’t fall on him to ask. But that’s the world we live in, a world where he doesn’t actually have to, a world where for a lot of people, they’ve never needed to be asked so bluntly. 

I don’t live in that world. I live in a world where he didn’t ask. He didn’t give me a chance to consider what I wanted, so I didn’t either.

Was he supposed to know that? Maybe he did try to read the signs, but he read the wrong ones. Maybe he read my body’s lubrication as a sign it’s what I wanted. Maybe he didn’t know that rape victims are still humans and human bodies react to stimuli. Maybe he didn’t know that some rape victims actually orgasm, and that doesn’t mean it wasn’t rap, or traumatic, or that it couldn’t ruin the victim’s life.

We went to a high school in a state with some of the most progressive sexual education laws in our country, and I didn’t know all of these things. I had to learn them in order to understand why I felt like I was raped, why I feel like I have PTSD and realize I had vaginismus and sexual aversion and social anxiety. I questioned myself until I learned all of this and more, until I spent years researching, working through a self-help book called the Sexual Healing Journey by Wendy Maltz (which I highly recommend both to survivors and people interested in educating themselves) and writing essays and poems to only myself because I didn’t feel safe to share them.

 It took me five and a half years to share the fact I was raped. It has been five and a half years of being completely alone, of eventually telling select people all the details and wishing they would see what I felt, and no one did. Thankfully, I am no longer in a place where I need to hear it from somebody else. Now I’m telling you: I was raped. I’m still dealing with so many of the consequences of this. I still have flashbacks. I still need to be reminded that I am safe and that my friends are here for me. I still struggle to bring it up to people who already know because I still feel pressure to be over it. But I understand better why I’m not. And my hope is that you can understand too, and if God forbid you are with me in the gray, that you feel comforted in knowing I see you. You shouldn’t have to be afraid to admit it. Gray can be rape, and it is just as brutal, traumatic, violating, degrading, damaging and real.

If you or a loved one is affected by sexual abuse or assault and need help, call the National Sexual Assault Telephone Hotline at 1-800-656-4673 to be connected with a trained staff member from a sexual assault service provider in your area.

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Post-traumatic stress disorder (PTSD) is a mental health condition caused by exposure to trauma or severe stress, characterized by hyperarousal, avoidance symptoms, re-experiencing symptoms and severe stress, along with psychotic symptoms according to professionals and therapists.

Meaning: PTSD and psychosis often occur together. Not all the time — not every case of PTSD is a psychotic-related case, and certainly, this article is not seeking to strike fear in the hearts of those with PTSD or for the loved ones of those with PTSD to be concerned about psychosis. But it is seeking to educate about the possibility of a connection between psychosis and PTSD because it is a lot more common than people know or have come to believe.

PTSD-related psychosis is a widely misunderstood issue and I’d like to educate people further, particularly because PTSD is common and psychosis can develop if PTSD is left untreated, if it worsens or the trauma is pervasive and complex PTSD is present. It is often a reason for misdiagnosis of other psychotic disorders, when really the reason is trauma-related and is instead PTSD-related psychosis.

I was hospitalized for PTSD-related psychosis. It is a cause near to my heart because I know what it is like to hear voices or become someone you are not, all due to a trauma you have experienced. I know what it is like to not know why it is happening, and have it deeply affect both your life and the lives of those around you.

An expert in PTSD, whom I have spoken with on this subject, said she believes individuals with PTSD often hear voices or experience psychosis directly related to their trauma (or traumas), and that this psychotic behavior will surface in times where they feel threatened, afraid, fearful or triggered. Working directly on the trauma(s) will address these symptoms in addition to necessary medications.

According to a research study at the University of Manitoba, Columbia University and the University of Regina, of just over 5000 people across the United States, 52 percent experience positive psychotic symptoms with PTSD.

In this study, the most common symptoms in those with PTSD and psychosis were:

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1. Believing people are following or spying on them.

2. Seeing something others could not see.

3. Having unusual feelings inside or outside of their bodies, such as touch when no one was there.

4. Believing they could hear others thoughts.

5. Being bothered by some strange smell.

6. Believing their thoughts were being controlled by some other power or force.

Flashbacks and dissociation, which occur commonly in PTSD, also share some features of psychosis. They have been compared to the psychosis featured in PTSD but are not the same thing. In a severe flashback, a person may actually experience things that are consistent with hallucinations (smell, sight, tactile features, etc.) and believe they are re-experiencing the event from which they were traumatized. A PTSD flashback is typically caused by a trigger associated with the event.

However, PTSD psychosis is different than a flashback. In PTSD-related psychosis, this can mean the psychosis is triggered by trauma-related events, events that remind the person of the trauma or just periods of high stress.

It has been years since I was hospitalized for psychosis and related PTSD, but like the experts claim, in times I am stressed or feel triggered I do still experience some varied symptoms. I know how to handle them now and they do not interfere with my life anymore, but I remember how scary it was to not know and not understand what was happening.

I hope that, in the near future, there is a greater understanding of the connection between PTSD and psychosis, because for people to recover themselves there needs to be better and faster care available. This won’t be possible until more is known and it can be talked about openly.

If you have PTSD, it is important to know the typical symptoms of psychosis. If you start experiencing anything out of the ordinary, get additional support for yourself before it worsens. Tell your family members if you can about what you are experiencing, and make sure they are aware of your triggers, how to support you and how to support your PTSD recovery. Make your voice heard so you can get the best help possible and be on a quick road to recovery. PTSD is a scary issue and can often feel isolating, but speaking up — while difficult — is the best thing to do.

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