All essays in the column section were requested by people I know.

I was asked by a friend to write to his girlfriend, addressed under a pseudonym, who's struggling with PTSD to help her understand the need for therapy.

How to be okay with needing therapy

Dear Amanda,

I don’t know how you feel. I can’t. I’m not you. No-one feels exactly like you do. The problem with life is that you can only empathise and connect with that which you have experienced yourself, so there is no point in sharing my own traumatic experiences with you. Instead, I will talk about the consequences of trauma, as they are shared by those affected. I will walk you through a series of states of being and add context only when it is necessary.

Each chapter highlights a different aspect of recovery. The first speaks directly from the perspective of the hurt child, which isn’t necessarily true anymore. The second from the perspective of a growing man reaching his point of no return, to connect the metaphorical with the descriptive, demonstrating depression’s relentless conquest for a way out, and the third from of a man who has bridged the chasm between PTSD-hell and recovery. Combined they lay bare what is essentially inexpressible.

Each section should feel jarring, both alien and familiar. I used different “voices” to emphasise the chaotic and disturbing nature of going from a traumatic state to a neutral one. I tried to keep any triggering content to a minimum without sacrificing the chance to make an impact; exercise caution all the same. The essay is only as long as it needs to be, because I don’t want you to feel overwhelmed. Stay safe. Stop when you need to.


The Hollow Chorus of Shame

Whenever I catch a glimpse of myself I see a loathsome stranger whose looks do not match the beauty I see inside. Terror strikes me like lightning on a clear day and shame washes over me in disgust. All bodies are revolting when you feel profoundly unloved, which means I can’t stand being around humans for very long. I feel hollowed out; whittled down to the bone by the fury of an abandoned child. I’m unable to look myself in the eye, because the sight of my own skin makes me instantly suicidal.

I maintain meticulous hygiene standards and despise everyone who doesn’t. I must wear clean clothes every day. I can’t really go anywhere without fighting constant disgust. Meeting new people induces mind paralysis for that very reason, which makes me anxious about meeting them in the first place, because I come off as an uninterested robot without wanting to. When I do meet them, their words become muted. I can hear them speak, but can’t make out the words. I stay silent, feverishly hoping they won’t take offense or notice my discomfort.

When I can’t take care of myself physically, disgust turns into rage. Rage against the self. I think that’s what depression is. Showering never helps. I feel dirty no matter how long I shower. I feel their eyes on my body. I don’t want them there. Can’t make them stop. I feel hands touching my skin. I don’t want them there. Can’t make them stop. I constantly feel like vomiting everywhere, with rage chipping away at my sanity. Nobody understands just how deeply disgusted I am.

I feel rage crawling underneath my skin at every hour of every day. If life were a prison, then shame is my bondage. Trauma imprisons you, like wounds that fail to heal, ripped open anew at the slightest touch. You are dropped into an inescapable cellar and are forced to relive the haunting sorrows of defeat, humiliation and powerlessness every fucking day.

Shame sings to me on a daily basis. I cannot escape her attention. She is like a shadow, but of a different nature, like echoes from places where life cannot spring into being, compelling you to act. The voice I hear is as relentless as my bully’s violence has been towards me. Being repeatedly humiliated erodes trust, and like rust, it eats away at you until there’s nothing left. You are confined to a prison in which every facet of life is tainted by the hollow chorus of shame.

When Death Comes Knocking

“Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.” – Andrew Solomon

The first time I felt the stench of death permeating the air around me was after four years of non-stop terror and parental neglect as I wandered the streets alone as a young boy. I had lived in mortal danger, without anyone intervening or paying enough attention to warn the authorities. My bully’s thirst for cruelty and depravity knew no bounds. He had terrorized me into an empty shell of a person, triggered by the slightest sign of danger. Every emotion had become life-threateningly dangerous to express. In came depression to save the day.

In the words of Andrew Solomon, ‘The opposite of depression is not happiness, but vitality’. On the outside it would seem like I was calm and collected, except I wasn’t. There was no life left within me. My bully and his cronies would escalate their violence towards me upon showing any emotion or resistance whatsoever. Depression saved me from inciting my abusers unnecessarily because it prevented people from asserting my feelings, saving my ass in the process. I’m certain I survived because of my depression, not in spite of it.

I had grown to look emaciated by the time I hit puberty. I looked like a twig, but no-one concerned intervened. The world had transformed into a muted place of grays, life an unfeeling array of meaningless experiences, interspersed with long stretches of loneliness and sorrow. I had long pretended to be blind towards death’s perverse attempts at negotiating an early grave, even when I would fall down on my knees upon waking because my legs were too weak to carry me. I told the counsellor at school at sixteen, and wound up staying back a year.

People often mistake prolonged periods of sadness with depression, but it’s not even remotely the same. Depression is the equivalent of a recurring emotional tsunami wrecking everything in its path, but calls itself apathy. Whenever people attempt to understand, they are met only with indifference and a sinking feeling of hopelessness digging ever deeper into my heart. Complex waterworks are needed for the emotional bloodletting to diminish in intensity, but are rarely afforded in a society that values human life only to the extent of their worth to the economy.

Sex in my mid-twenties led to a resurgence of trauma-symptoms and the quest for help. I would bawl and panic at the sight of my own skin and couldn’t touch anything or anyone without succumbing to madness. I destroyed virtually every friendship I held dear because talking to people had become pointless. I recognized the words, but they had lost their meaning. My studio had transformed into a garbage dump because I was no longer able to take care of basic necessities. I was chained to my bed, forced to endure the unrelenting pain all by myself, slowly eroding my will to live.

That which saved me from annihilation is simultaneously the thread I desperately wished to sever. I survived the early stages of this illness because I happened to meet my best friend’s family at the apex of my depression as a teenager. I survived the second bout because a college friend happened to understand what I was going through when I needed it the most. When death came knocking a third time at twenty-seven, rendering me virtually incapable of speech from the pain, I survived solely because my doctor finally took notice. There is a relational component to mental health that is always overlooked, but not by therapists.

Why Therapy Works

image called full of terror

Where am I now?

I’m thirty-two years old. I have survived the point of no return. I’m no longer in pain every second of the day. I have experienced an abundance of emotion for the first time in my life. I have woken without wanting to die. The night terrors have gone. The nightmares have become infrequent. I have stopped feeling disconnected from humanity. I can feel the world when it’s quiet outside without becoming overwhelmed. I have felt safe and comforted by another’s presence instead of being wrecked by anxiety. I feel like an actual person now, even happy, but there is still plenty of progress to be made.

How did I get here?


I couldn’t look my therapist in the eye when we met. I felt profoundly ashamed of being there. I didn’t want her help, but I was running on fumes and out of options. I stayed, but not without making her life difficult. Whenever we met I would mutter a few words here and there, wrought with rage and condescension. I would wake up screaming almost every day, not knowing where I was, drenched in sweat, bones aching, virtually unable to move, head spinning with unrelenting rage. I barely had the strength to go see her, but she expertly navigated the crushing pain I was in, weighing my safety against the threat of hospitalization.

I don’t need a therapist to do my thinking for me, which good therapists understand. I need(ed) one to fill the gaping holes left by my peers and family. Sometimes she’s the mother I needed when I was still a boy. Sometimes she’s the awesome friend who lets me be me without the expectation of punishment or cruelty. Sometimes she champions me to take the plunge into the unknown. Sometimes she’s a guide, who helps me navigate the painful mess that’s trauma reprocessing. She is whatever I need her to be. The relationship itself is what’s most transformative.

We seek therapy when our relationships suffer. We address our needs and rebuild them in therapy. Your therapist becomes whatever building block is missing or damaged, or mediates between them. Treatment success is largely determined by the quality of your relationship with your therapist. I quote: ‘Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship’. It is vital you pick someone with whom you vibe well.

Trauma is devastating precisely because it destroys the trust mechanism required to have your needs met. As Vonnegut put it in his book Slaughterhouse Five, you are severed from time itself. The past is your present, the future a short-lived flickering of the terrors to come, the present is all at once. What’s real? There’s nothing you can trust while traumatized, not your senses, not your feelings, not your thoughts. Reality has become distorted. You can’t make your way out of Hell without an outside pair of eyes serving as your guide for things to trust.

Trust is built and destroyed by whatever it is you’ve been exposed to. Think of the poor. People who grow up without means continue to expect their fortunes to abandon them, even when they move into middle-class, hence their overwhelming anxiety to hold on to things, because they, or their friends and family, may need it later. Our environment shapes how we feel, react, and think, with the need for trust at the center of everything; yours was obliterated and must be rebuilt. You can’t do that alone.

Parting Words: Not Your Fault

Trauma plunges you into a world that suddenly feels chronically unsafe, on top of living in one already rife with chronic stressors we never faced before. All natural systems break under enduring stress in absence of adequate time for recovery, and like rust, it spreads until you die from it. We need to be removed from life itself when our bodies and minds have seen too much, taken care of by our tribe until our wounds have healed. Yet the world of today affords us no such necessities, save for the lucky few with great support systems and excellent insurance.

We move back and forth between recovery and relapse, exemplified by the three perspectives above: one narrated by the child within, sometimes still current, one from the perspective of the narrator observing his own depression, and finally, from within the chasm that lies between the first step of recovery and feeling like you have recovered. The best you can hope for is acceptance and peace. There are, however, no guarantees. My therapist told me that progress comes in waves. Sometimes you drown, sometimes you get to ride the wave for a long time.

The recovery process is brutal, unpredictable, and unique to you and you alone. Don’t take that to mean to go at it alone, because you will fail. Make unburdening yourself your priority. Worry about thriving later. Trauma robs you of the ability to trust in yourself and the people around you, on which your sanity and sense of control depend. It’s not your fault. You will heal if you embrace therapy and the therapeutic relationship within it. Over time you will become less and less afraid to express how you feel. That is when you know you’re winning.

Last modified on April 1, 2022
Published on May 1, 2018