Letters written to problems, not people – by everyday champions, like you.
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A man suffering from C-PTSD and suicidal ideation

Dear Suicidal Ideation

Fuck you.

That alone would be sufficient, but this letter is not for me or for you.  This letter is for the others that read it to help them understand the war you wage and the extreme measures I must consider to keep you managed.

To be fair, doctors fail to have a consensus if the symptoms I experience are the PTSD, the saucier version C-PTSD, MDD, or any of the others listed in my medical chart.  You hide in the darkness of all those letters and let your symptoms do the work.  You use the self-inflicted injuries to muddy the waters for my care and create distance between myself and everyone else.  I have come to wonder regularly if the violence is not simply maladaptive coping, but an attack on this malicious darkness that infects my reality.  I contend that the violence is actually a successful coping tool against you, but we will save that argument for another venue… Who are you – really – and would it make any real difference to know you by a single name?

You created an environment of toxic thought; focused almost exclusively on suicide.  The lines between ideation and intention blurred to the point most doctors close to your darkness inside me agree that it is all intention at this point.  In the beginning, a day or two here and there you attacked my mind with the “need” to die.  Decades later we dance for 8-12 hours a day, waging a relentless trench war for every cell and protein string in my mind.

In less than a month, your attempt to end the war 10 years ago will have failed.  Many at the time called it an act of god, part of a divine plan that you failed to end my life.  The cocktail of drugs, so accurate I rarely share it outside of a conversation with professionals.  My rage and the adrenaline it offers, more likely for my salvation.  For more than 24 hours after that battle, your plan left me helpless, alone, battered and alive on the floor.  Help moved me to a couch that next day and for the better part of a week I laid helplessly unaware of anything, as my body cleared out your attack.

Five years later you attacked on two fronts.  The first attack that year, another overdose.  The battle winning you 3 days for me in ICU that have your allies, the nurses, an opportunity to express this painful emotions that blamed me for your attack. The second, a less eloquent and far more successful attack with a tourniquet around my neck.  Your second attack left me “black” and “cyanotic” on the psych hospital bathroom floor.  An innocent found me and was able to bring me back.  You had failed to win this battle, but the war was forever turned in your favor by publicly defeating me.  Nurses even angrier, doctors scared, all joined your assault on me.  Leaving me in isolation for a week, in that pink paper gown, in that empty room – I sat as a prisoner of war, held by your new allies; my so-called ‘saviors’.

5 years later we return to the present and the cycle of war is escalated to unimaginable heights.  I have new allies, doctors with a better understanding of how you work.  While you are defeating the new weapons (ketamine, marijuana, etcetera) that they have been using, you still struggle to bring this war to an end.  My team agrees you have an edge as we enter our heightened season of battle.  You had a secret ally in COVID that decimated most of my support structures.  While I survived last season, you successfully utilized COVID to maintain a foothold that successfully prevented my season of recovery.

As we approach the anniversary that your sadistic, rapist began his season of torture to break me down, remember not the torture he inflicted, the repeated violations of my body, the deep wounds that still bleed from those battles long ago…  Remember the rage that defeated him in the spring.  That same rage beat you 10 years ago as you tried to end your war on me.  That rage that has drawn a line so deep that for 5 long years has held the line against you.

Could this current push I have been experiencing be your last gasp?  A desperate attempt to end a war you may have already lost?  Most of me wants you to win, most of me betrays me to assist you in completing suicide.  Yet, that rage of an 8 year old little boy who stood up to your accomplice stands in your way again as it always has since awakened by your ally.  That rage that draws a line so deep in my flesh that the scarred walls keep you helplessly out of control of ending the war.

I acknowledge you have kicked my ass three times since this current war started on January 21, 2008.  I also realize that 99.9352051835853% of the time your battles FAIL to convince me in taking serious action to ending my life.  Most important you have failed 100% of the time in being able to do it – I’m still alive, aren’t I?? (Insert middle finger emoji and big smiley face here!)

You and your allies have relentlessly attacked me for more than 3 decades.  Your armies vastly outnumber my allies.  You even manipulate me into helping you on a regular basis. I have the mental and physical scars that show the damage you have done in decades of war.  On a day that started where I thought you might finally be on the verge of winning this war – in what has felt like our final battle – I stand victorious in holding off this epic battle. A battle that only occurred in my mind…

I may not win this war.  Hell, I believe I want you to win this war at times.  Most of my doctors will concede when pushed that you will win this war, but for tonight I stand up to you bloody and bruised from battle to say one thing.  FUCK YOU!

Male, 43 Years Old
CPTSD, MDD, Agoraphobia, Generalized Anxiety Disorder (GAD)… Suicidal Ideation

graphic images representative of pregnancy created by the author of a letter to postpartum perfectionism

Dear Postpartum Perfectionism

NOTE (from the Project Director): As Michael Schreiner points out in his own blog, “Perfectionism is difficult to treat… while most people are poignantly aware that the attitude causes them undue suffering & distress, they’re also secretly proud of their life orientation & deeply afraid that if they were to let go of the compulsion to do everything perfectly, their performance would suffer & their lives would fall apart… This makes narrative therapy an excellent treatment option, since by separating the person from the problem it’s possible to view the situation more objectively.” By way of the letter that follows, the Dear Diagnosis project takes on a new leaf. Conversations hosted with any sort of externalized problem, are now welcomed here.

Let me just start by saying postpartum is rough, let alone when you creep in. Hormones and lack of sleep aside, my body is fighting and still healing from an infection. I want to say it doesn’t matter how my baby entered the world, but I would be lying. Although, you know that. You’re the one that told me it does matter, and it has to be a certain way! Look, I pass no judgment on how anybody else’s baby entered the world… but I find myself ashamed and frustrated by how my baby entered the world. Thanks a lot, Perfectionism. Everyone told me to prepare for my birth plan to go out the window, but you convinced me our plan was perfect. The plan really only consisted of ‘get baby out of my vagina’ and, instead, what I got was a C-section.

OK, rewind, I should give you a little gratitude here. Thanks to you, I was really good at being pregnant. Sure I missed the soft cheeses, turkey sandwiches and wine, but I genuinely enjoyed my growing bump and the feeling of having this ever-present sidekick. You were in control of our schedule and we knew all of the Do’s and Don’ts—that gave me confidence in being pregnant. I was terrified of giving birth but felt this weird sense of pride that I would get to experience labor & delivery. I was surprised when I went into labor a few days shy of my due date but, because I had you at my side and my birth plan in place, I was ready for our plan to take flight. Thing is, I was only prepared for our plan. The contractions started around 5 AM and got progressively stronger throughout the morning. I got things ready around the house, checked and re-checked my hospital bag and pulled out all of my postpartum care, which we had carefully prepped. You were proud that morning, Perfection, really proud of all the work I’d done on your behalf. Upon arrival in triage, the nurse told us “baby is breach and we’ll have to perform an emergency C-section.”

Fuck you, Perfectionism.

The C-section video was optional at the end of our labor & delivery class. Optional! As in, if you’re planning on a vaginal birth – you don’t have to stay to watch it. We stayed, but I still don’t know what the hell happened when they opened me up and yanked out my baby! Perfectionism, why did you have me focusing on just vaginal birth? Why didn’t you ask the questions and allow me do the research? I’d have known that a woman is more likely to deliver your baby C-section if your mother did. You make me feel jealousy every time I read someone else’s “amazing birth story.” You make me feel robbed of an experience to be otherwise proud of.

Cue the arrival of baby boy. You’ve continued to tell me our story was wrong. You’ve made me second-guess everything I do as a new mother. You even made me ask my husband if I would love him more if our birth plan had gone as expected. How did I let you influence me like that? You may forever be a part of me and this birth story of mine, but I won’t let you question my love for my son ever again. Do you know how amazing he is? Do you see how my body is finally healing? Do you get that I nourish him, bathe him, clothe him and cuddle him? I bet if we asked him how I was doing, he would say something along the lines of, “Fucking awesome, Mom!”

Female, Age 31
5 Months Postpartum

a young girl laying on the floor - confused and afraid like the author of the corresponding letter written to depression

Cara Depresione

NOTA (Scritto da Francesca Fontanella): Valorizziamo qui l’autenticità  di questa lettrice che parla apertamente  delle sue esperienze come vittima di abuso sessuale e rispetto al  tema del suicidio. Se sei o sei stato/a anche tu vittima di abuso e questa lettera ti ha colpito/a, cerca aiuto senza attendere. Puoi contattare 02 2327 2327 o mail@mica TAI.  Ci auguriamo che i contributi di persone coraggiose che scrivono le loro storie possano, tra le altre cose, costruire la strada per la salute di tutti. Oggi ti parlo Depresione. Sono un poco scomoda perche ti devo parlare in una lingua che non domino propio e mi sara difficile raccontarti tante cose.

La prima volta che mi hanno parlato di te avevo dicianove anni. Ho voluto finire con la mia vita dopo di vivere una tristezza che non finiva mai. Il psichiatra ha detto che ero depressa e che mi sono fatta male perche avevo bisogno di piu attenzione. Ricordo che pensavo che il dottore era insoportabile, che era pieno di se stesso e che non aveva nessuna conessione con me o con quello che vorrei aver detto. Ma non potevo dire che sonó stata stuprata per anni per mio fratello e I suoi amici.

La prima volta avevo 8 anni, non ho capito niente, soltanto sapevo di aver sentito tanto dolore che mi sono fatta adosso e cuando arrivai a casa mi hanno sgridato perche ero una sporca che non era neanche capace di andare al bagno. L’ironia piu grande e che tutto e sucesso nel pavimento di un bagno cosí piccolo che appena se potevo muovermi. Non ho capito il stupro cuando avevo 8 anni, neanche dopo cuando continuo per due o tre anni piu, incominciai a capire cuando avevo 12 o 13 anni. Cuando sono arrivata a 19 e ho avuto il primo fidanzato e stato cuando ho capito veramente quello che mi e sucesso e mi sentivo sporca e mi odiavo a me stessa, non volevo uscire del letto, sentivo che tutti potevano guardarmi con schifo, non volevo incontrarmi con mio fratello perche l’odiavo cosi tanto che avrei potuto anche svelare il segreto.

Ma cosa sei deppresione? Credo che non esisti veramente, non sei idee nella mía testa, non sei paura di vivere, non sei neanche la tristezza, non sei il vuoto che sei stata cualche volta. Non sei. Non so  nemmeno cosa sei, sei questa fatica di vivere? sei questa difficolta di lavorare, di alzarmi del letto, di parlare? sei questa solitudine? sei questa colpa perche sono nella mía stanza invece di stare con le mie maravigliose figlie, invece di alzarmi a lavorare per procuraré I soldi? Al meno prima avevo la scusa di avere troppo lavoro, ma, da cuando incominciai la cuarentina non ho ancora potuto lavorare neanche un giorno.

I farmaci non mi hanno fatto mai niente, l’efetto e ancora peggio perche perdo anche quella piccola parte di me che e ancora lucida e sa ridere, parlare, piangere, incazzarsi, amare. I farmaci mi levano tutto e divento una cosa che cammina senza sentire niente. Ho provate tutti I farmaci e anche me li hanno levato tutti in tanti anni di raccontare lo stesso a psicoanalisti, humanisti, condottisti e cualche altra terapia in gruppo.

Veramente mi ha fatto been la terapia, stavo molto molto meglio, ma non so cosa e accaduto in cuarentina che sono arrivata di nuevo in fondo.

Anche ce qualcosa che voglio ringraziarti deppresione,  per te ho conosciuto la morte, ho tentato di arrivare li 3 volte, fino che sono arrivata all’ospedale senza polso, avevo 23 anni. Non mi e piaciuta la morte, ero ancora viva e sentivo tutto anche se il mío cuore non sbatteva piu, mi hanno fatto male per poter ritornare e li ringrazio. Non mi e piaciuta la morte e non sono andata mai piu. Qualche giorno dovro ritornare e ho la speranza che questa sia una morte diversa di quella che ho vissuto prima. Tante volte ci ho pensato sopra e credo che non si puo morire apposta, devi morire cuando devi morire, non prima, non dopo. Forse cosi la morte sia diversa. Anche Devi vivere, la vita e la morte sono una stessa cosa che sono io, qualche volta morta  in vita, qualche volta vita nella morte.

Ho molto da fare e voglio alzarmi dal letto.

Fémina, E tà 54

an author's drawing shared to compliment the letter she wrote to a series of health and mental health conditions for the Dear Diagnosis literary project

Dear Diagnoses

NOTE & CONTEXT (from the Author): I thought that diagnoses were intended to help those of us in need, by providing resources, support, and proper health care. My experiences, though, suggest the opposite. These labels overshadow a person’s true identity; they can become dehumanizing; they can actually prevent a person from accessing resources, places, and activities that might otherwise be most helpful. Most prevalent among mental health diagnoses, the associated stigma that accompanies the use of medical labels is beyond detrimental – it can actually prevent the healing from occurring, itself. I wrote the poem below in a flurry of anger felt toward this stigma and the lack of support I have battled to make sense of for most of my adult life. Ignorance and bias in not only the general population but also within healthcare, makes it hard to feel safe and supported. The words and actions of others have and continue to impact my ever-changing self-perceptions, which hinge on the incongruent ideas of what these diagnoses mean to others. A diagnosis can be frightening but, also, a relief. My experiences suggest that it’s a complicated mixture of both… 

While a list of the diagnoses seen atop my medical charts follows my signature line, I would like to explain three of them now, as the healthcare practitioners assigning them didn’t know much more than I did at the time of diagnosis. Thanks to my own research, here is what I’d like to offer as context:


I was first diagnosed with PTSD back in 1989, when I was 18 years old. Back then, health care practitioners had even less of an understanding as to what this actually meant and how best to treat the whole person. I had a particularly complicated form of the condition and the treatments that they offered then were useless to me. Fortunately, in the last 6 years there has been a surge in public interest on the topic of trauma; more funding, published research for me to read, and the development of empirically supported treatment protocols for me to explore. Scientists and doctors understand the brain better and how trauma affects it. Most seem to agree that PTSD results in a lot of sub-type illnesses (AKA comorbid conditions) and that is a there is a dynamic range to them. Some specialists (but not all) now acknowledge the resultant diagnoses of anxiety disorders, depression, eating disorders, chronic suicidal tendencies, and insomnia. Some understand that physical conditions result, too, like (for me) heart palpitations & tremors, albeit there are many more likely candidates.

C-PTSD (C for ‘Complex’) was added to the DSMV-5 only this year, which gives voice (finally) to the complexity of conditions resultant from exposure to long-term abuse. Not at all specific to soldiers and persons living in warzones, but a condition that can result from sustained &/or repeated exposure to all sorts of trauma (big T and small t-types). This is the dynamic difference between PTSD and C-PTSD: There exists long-term, repeated trauma that creates complexity in mind-body states and given that each individual is entirely unique, the symptoms can manifest very differently in each of us…

D.I.D.​ (AKA Dissociative Identity Disorder, previously known as Multiple Personality Disorder)

I also carry a diagnosis of DID, whose previous name continues to elicit images of mass murderers, serial killers, people to fear in the minds of most – thanks to movies like Sybil that undermines the curiosity and compassion necessary for an evolved understanding of this delicate condition. Today, most trauma-informed interventionists agree that people with DID were likely traumatized as young children to a point whereby the condition evolved as a means of coping – as a means (for some) of mere survival. Yet, this is new age knowledge and most Americans continue to operate in states of ignorance and out of fear, which breed’s hatred, contempt and biases. Let it be known that many of us lead successful, productive lives with careers and families; operating alongside everyone else. Like me: I have four children and was a Montessori Educator for 20 years. But, unlike most of you, we had childhood trauma and it caused our brains to develop differently – to think differently, too. The trauma that I endured interrupted my development, so my brain did what it needed to do to adapt and to survive. I have a legitimate brain injury as a result of prolonged exposure to trauma. I have different modes of consciousness and emotional reactivity – my thinking process is likely and largely different than yours once I’ve entered into a different ‘dissociative’ frame of mind. I have “spaces “ in my thoughts and in my memories. Functioning as an adult is challenging in these moments, since I am literally thinking like a child – stuck in a developmental state of mind and body. I even write with different handwriting when in these different mind states.

There are statistics and logistics to consider: Only some 20% of people who experience trauma, end up with a diagnosis of PTSD. Twice as many females than males are diagnosed. Doctors don’t know why. Only about 1% are believed to develop DID, but I personally believe it’s more than this because it’s very difficult to identify. Meditation can help. For me, it connects my mind states and retains memory. I also use sticky notes to track myself on a daily basis and make sure I am recalling things. I often admit to having a “fuzzy” memory.

Some people experience complete disconnection or separation from these respective mind states, which makes it impossible to remember what they did in one mind state when operating in a different one. I had complete amnesia about most of my childhood (and respective trauma) for 30 years. It took me a long time to realize that this wasn’t “normal”. Traumatic events experienced in adulthood, however, triggered my brain to recall much of it through what most might call ‘Flashbacks’. I called them “Time Travels” before I knew the term. During this period of my life, I suffered two years of chronic suicidal depression, insomnia, and constant dissociative issues. I am relieved to say I have healed enough – at this point in my life – through trauma therapy to not have suicidal ideations or daily flashbacks, now. 

There’s nothing wrong with my personality or a flaw in my identity – or in my identities (plural). My core is not wrong, and I am not a danger to society, nor am I harmful to others. I don’t walk around in a constant state of psychosis, although I have experienced psychosis before. I am not without intelligence, even though I don’t always have connected thoughts or sequential memory. How I think and who I am should matter, just as someone’s diagnosed illness (like diabetes, cancer, heart disease) – matters. Mental illnesses shouldn’t be separated from physical illnesses in the way that we trend towards doing. Your brain and body are intimately connected with one another, which is why my mental health conditions affect my physical health directly. It is my goal to hold my mental & physical health states out in front of me – like a sphere, where I can continue to see my whole self from all angles and perspectives. This is the key ingredient to living in peace with it all… 


Fibromyalgia is another very complicated disease with which I live. It has no cure and its cause is largely unknown. People of ANY AGE can acquire it – even children, yet many doctors don’t know anything about it and some (even) refuse to acknowledge its existence! My own doctor doesn’t know what to do to help manage symptoms. She suggests a lot of things and has me taking pain medication, but there’s not a lot of information out there beyond pain management; and pain is only a small part of the actualized condition. It’s not an arthritic condition (although I have that too, which complicates all things in discussion). Many doctors seem to think that it’s an arthritis-related condition, but I’d like to argue otherwise: It’s a neurological illness that directly impacts the nervous system and causes widespread nerve-pain. Some doctors believe it has to do with swelling or inflammation in certain parts of the brain, which may be why it impacts so many things: The body’s ability to regulate temperature; energy levels (causing fatigue); sensory issues; problems with balance (so much so that I was tested for MS at one point); muscle weakness; disruption to executive functioning (attention & memory); swelling all-over; burning sensations and other inexplicable skin pain. It gets in the way of the brain’s ability to recognize pain. It impacts the internal organs, also, making my insides feel “bruised”. The condition impacts my ability to work, to go out, and to be able to do things so many others take for granted. Its symptoms are impacted by the weather, stress, and other environmental factors so go figure – it’s never the same and always changing… Just as with all chronic conditions, Fibromyalgia impacts the whole person and (inevitably) their families and friends. Compassion and patience are necessary ingredients, which is why I offer this insight AND this heartfelt poetic letter – in the name of justice: 

Dear Diagnosis
stealing away my hopes and dreams
a necrosis
on my everyday things

should this be a letter to the C-PTSD?
Fibromyalgia or Anxiety?
maybe it’s to Depression
a soul sucking life draining infection
nobody can see
maybe it’s to D.I.D
fractured personalities
woven in complexities

Dear Diagnosis
stealing away my hopes and dreams
a necrosis
on my everyday things

What’s the point for you Diagnosis?
weren’t you supposed to help?
give resources ?
yet ….. you are soulless, ruthless
a dead prognosis
with endless medication doses

you wrap me in red stigma
chronic suicidality a magma
of heat bubbling with the complex grief
locked bars of agoraphobia on the windows
and doors…..
sometimes it’s a fucking war
against pain
inside and out

fuck you
dear Diagnosis
fuck you
did you give me any assistance?
or did you take away my existence?

which one of you should I scream at?
for taking my dreams and
exchanging it with wrath?

how about arthritis in several different forms
my spine slowly turning around deformed
how about chronic fatigue
a vampire sucking me weak
no more running
no more swimming
no more biking

no more trying

Dear Diagnosis
stealing away my hopes and dreams
a necrosis
on my everyday things

God forbid anyone know your many names
for oh….then they look at me and refrain
from seeing me anymore
I’m invisible
wearing only your acronyms for clothes

their own biases clouding their eyes
my name dies
on their lips …..

a discrimination
a disintegration
an elimination

of my voice
of my face
identity destroyed

fuck you
dear Diagnosis
fuck you

what is your ambition?
I think maybe to oppress women
maybe men too ….fuck you, fuck you

a fucking prescription to addiction
I’m to blame for

shame on my conditions

Dear Diagnosis
stealing away my hopes and dreams
a necrosis
on my everyday things

there no petition to chronic illnesses
the doctors & therapists
have no remedy for

just diagnosis
with no cure to explore

the doctor said once “you just need
physical therapy, herbal tea, maybe psychotherapy”…”here take these pills”

in between these appointments
I slide the hill of entropy

said her solution of the illness algebra
is just for me to somehow
“get some stamina”?
and don’t forget
oh the lovely medication side effects
of diarreah pain
a lost and foggy brain
all the energy drained

vomiting up her words while I shake
chaos smoldering in my wake
your kidding, right?
gimme a fucking break

happiness amputated
freedom barricaded
future eradicated

what have you done for me Diagnosis ?
what exactly ?
everyone said you would help
it’s written down in a sticky note somewhere
was I supposed to gain some insight to the plights?

gone is my career
friends walked out the door
I’m a burden to my family

so, I sit here with you
diagnosis, my
Dear Diagnosis
master thief of hopes and dreams
a necrosis
on my everyday things

Female, 47 y/o 
C-PTSD: Complex- Post Traumatic Stress Disorder; D.I.D: Dissociative Identity Disorder; Anxiety: Social, Agoraphobic; Generalized Depression: Major & Treatment ResistantFibromyalgiaPsoriatic ArthritisOsteoarthritisHearing Impaired

An image selected by the author of a letter written to stuttering and published to the Dear Diagnosis literary project

Dear Stuttering

None really diagnosed you, but we’ve lived together for almost my entire life.

I tried to solve you many many times, in various different ways, but no methods ever worked for much time at all. Sometimes you are so intrusive that you lead me to think that you’re a part of me. Aren’t you?

At times I think you’re like a monster, mysterious but always showing up when I least expect it.

I know you’re dependent on me, on my thoughts, my mind, my fragilities. But I’ve not discovered yet how you work. I learnt strategies to manage you, but you still have a strong power over me, and you still hinder me in some circumstances.

We’ve lived together since I was 4 or 5, I think; I can’t remember precisely. I’m not sure about your beginning; my memories are vague, blurry, unclear. I remember in adolescence I couldn’t bring myself to go to bakery and buy a slice of pizza because it was a serious problem to me: I would certainly have blocks of sounds, I couldn’t say what I needed, just because words remained blocked in my mouth. I would go out with friends only if there were friends who helped me in ordering at the restaurant. Actually, though, in adolescence I didn’t have many friends, I couldn’t afford it.

I should be angry with you, Stuttering, but I’m not. I think you have a reason to stay and you’ll lead me to discover it, sooner or later.

But, I don’t think always like this. You make me feel little, unable, insecure – even if I’m very sure of what I’m saying. You destroy my credibility, you know? I can understand why people don’t trust me if and when I tell things stuttering. And for my job, this is not good at all. Fortunately, I believe contents are more important than speech speed, but I think also the contrary when you insinuate yourself overwhelmingly in and through my words. Maybe I should decide on a firmer opinion about this. Maybe when I decide I’ll stop stuttering. Who knows…

I’ve thought many times why I need to stutter, why I carry you around. Sometimes I forget you all together, actually I forgot you in many occasions in the last 8 years during which I did extraordinary things! You are always with me, though – often hampering me – but I’m aware I’m stronger than you. I’ve managed to get many things out of life that you doubted I could have otherwise accomplished.

I can remember a precise moment when I realize I mustn’t be ashamed: I was 18 and enrolled in a public speaking course. My stuttering was terrible, I had to struggle even when saying only a few words to unfamiliar people. Public speaking was both a nightmare and a desire. I wanted to push myself beyond my limit, to grasp the nettle. Flash-forward to the last class, every participant had to present a speech. I had prepared my speech perfectly: well-rehearsed at home with my grandma, my speech sounded beautiful. But, this occurrence is quite “normal”. I don’t hear from you when I feel safe. So, obviously, you didn’t come out until it was time to present my speech in public. I can’t even remember if I managed to say at least the first 3 phrases, but I certainly couldn’t bring the speech to the end. Yet, for the first time in my life I noticed admiration in the eyes of others. After class, we all went out to celebrate and many of them talked to me – asked me things about my life, which made me feel astonished, because in that moment I realized they appreciated me even if I didn’t talk fluently. Until then I’m always left out conversations whenever people realized that I stuttered. I suppose those people thought that I were weird. That moment was very important to me: in that moment I had learnt that I’m worthy of consideration and of esteem, even as a stutterer. Now it sounds so taken for granted, but then it was new for me.

From this perspective, I know you have helped me (and go on helping me) to carefully select people who are worth keeping close. Maybe I used you as a strategy of sorts to identify people I want to keep close, that kind of people who are patient listeners, who like what I’m saying more than how I’m saying it.

Over the years, I have become skilled and understanding why and when you appear. I’ve become good at looking inside of myself to understand you. But there are still periods in my life where I can’t understand you; times when I can’t trust you, because you tend to ruin my life: you’re so intrusive, your speech blocks are too insuperable, my words loose worth, talking becomes too hard, I’m out of breath, I’m tired after saying a single phrase… I risk not saying everything I have to say because of you! You impede me from flourishing.

During these negative periods, I lose pleasure in social interactions, and in some extreme cases, I end up avoiding the people that I care about – even if I hate avoiding them! Despite your exhausting presence, I really enjoy company; I enjoy having conversations, telling people my experiences, sharing my opinions.

As I’ve already said, I know I’m stronger than you. I’ve reached important life goals, I’m happily married and every day I nurture many beautiful projects. Currently, I need to give all of this a try in my job. My job works with words, and I deeply love it. But I’m very scared you make it impossible. So, I need you cut me some slack – now. I deserve it.

Female, Age 27

A chalkboard sign with a message that reflects the tone of the corresponding author, whose letter to Borderline Personality Disorder was published to the Dear Diagnosis literary project.

Dear Borderline Personality Disorder (BPD)

Wow it’s been a year and you still do a great job of ruining – and making me feel terrible – almost every day of my life. Why can’t you just leave my brain and leave me alone? I guess that is too much to ask considering you are used to consuming my life no matter what.

Life with you has changed me for the better and to others for the worse. I’ve been told that you are common in lots of people, but honestly – I don’t think so. I have yet to meet another person on this planet that has to put up with you like I do. That day would be amazing! Being able to relate to someone who experiences the same things I do because of you…

I don’t exactly blame you for anything, though, because what’s the point because its not worth the energy. I do hold you responsible for most of my bad days, my incredibly painful thoughts, and my reactions during those moments that I seem to lose control. Can’t you just hide somewhere deep inside where nobody else knows and it is not obvious that you’ve got such control?? I guess you can’t…

Let’s go back about a year and a half – the first time I heard your name. I was relieved and confused to know you. Finally, figuring out it wasn’t just depression or anxiety; your diagnosis made me feel like I had more control by giving me a chance to learn and research more about you and try to find things out for myself that might help. Unfortunately, though, all of the research I’ve done to understand you hasn’t felt helpful. Most sites say things like “you’re incurable” or “BPD is a chronic illness”. Leading me to believe that I will have to suffer you forever… I don’t know who to believe (researchers or therapists) or what outcomes to expect!

All I know is that I have you in my brain 24/7 without any relief, except when I can figure out how to use my own energy to create distraction. I wish all the questions people asked me, you could answer for yourself. Why are you so tired? Why don’t you just get up and do something? Why don’t you focus on the positives instead of the negatives? Can you answer all the questions, BPD?? I didn’t think so, because you’re an illness and don’t have a voice, which is extremely sad…

To be honest, this world would be much more understanding if each mental illness had a voice to share. I often think why it had to be me out of everyone in my entire family and all the people I know. Why couldn’t it have been something else or something not at all? The fact is that I have just gotten used to feeling down, wanting to self-harm and hurt others; ball up and cry, operate with less motivation and energy, and under more and more stress/anxiety over trivial things. In daily life I might appear like I’m making it but not without great strength…

I thought you were supposed to give me some hope through this journey by at least telling me there was a cure and/or you were more common than I thought. I guess that was a naive assumption…In ways you have caused me to hate most people. You have convinced me to only trust certain people – not everyone, for the most part. I guess that’s a good thing? But, considering the pain you’d have me endure, there should be some prize I win for just putting up with you. Tell me BPD, what is the ultimate prize I have been waiting for? Is there really relief from you out there, or is that just what people believe will happen if I don’t give up??

My life has forever changed because of you. Some parts I regret and others I don’t. When do you think you can give me a break? I am beginning to think never or, at least, not anytime soon…

​All I wish is that someday you will make me realize I am not the only one; because I know that for sure, but I often feel like I am… One thing you could also do for me is to reveal yourself to the world. Advocate for those that have you living in their brains. Let others realize that you do exist and we are not just making things up. Help others understand that it’s you who messes with our brains – it’s not just us. If I had one wish that would be it! Just to be able to help others understand that you exist and those who struggle and fight against you are being real – not fake…

I am not mad at you, BPD, I don’t even hate you because you’re an illness of the brain, but daily life with you is often a struggle just like with people I have daily contact with. BPD, I thank you for at least giving me some purpose in my life – allowing me to educate others on the subject and sharing my personal experiences with them. It’s not all bad I promise. I just want you to know that even though each day is technically a new day, it isn’t with you, despite the fact that I wish it were… I thank you for shaping me into the person I am today despite what others think. That’s one thing I can say with full honesty.
Female, Age 18
Borderline Personality Disorder, PTSD, ADHD, General/Social Anxiety, Major Depression

A downward spiraling staircase used to capture the tone of the associated letter written to Depression for Dear Diagnosis

Dear Depression

I hate you. I hate you for what you’ve done & continue to do. I hate you for who you’ve hurt & continue to hurt. I hate you because you are you – an invisible weighted cloak; an off-radar, black storm cloud; a high-frequency cry for help that most humans cannot hear; a mythical diagnosis… Your elusive essence is what upsets me the most! Why me? Why them?? Why only a select few???

You first appeared in early adolescence – I was only in middle school and in the throws of puberty. My developmental state & the particular life events that forced me to face my own mortality at too early an age caused the lot of us to believe that you were ‘circumstantial’.

If only I… improved my physical state of health; changed schools; made the ‘right’ friends; built a stellar college resume; had a boyfriend; got rid of my acne; got reconstructive surgery; was happier with my appearance; got into the ‘right’ sorority; partied harder; took more risks; did more traveling; went to a ‘better’ college; had ‘better’ friends; put my attention elsewhere; was more selfless; was able to help more people; was able to save more money; had a ‘better’ job; moved someplace else; was closer to the one I loved; was dating someone else all together; invested in counseling; found the ‘right’ counselor; invested in self-help; worked harder at self-help; invested in supplemental healthcare; admitted my mistakes; figured out how to be a ‘better’ person… If only I changed                             , my life would feel better; & you would be gone! Or, so I thought… and, at times, still like to believe.

The sad truth is that most folks that know me don’t really know me, because they don’t know you. If they did, they might run the other way! You’re wrought with stigma. You’re often seen as the result of a weak will or character deficit. Those of us that claim you are made to defend your very existence, so as not to be branded by our inability to independently manage you – to simply ‘get over it’; ‘look on the bright side’; ‘stop the melodrama’; ‘suck it up!’

​Good thing I know how to keep you hidden or (at least) how to disguise you. You live behind the masks that I wear & the anger I have come to wield. I’ve worked hard to prevent you from ruining my reputation, yet, your very nature oftentimes prevents me from being seen & heard. You encourage isolation & withdrawal, self-doubt & self-harm. You feed a vicious cycle that, in turn, feeds you:

(FEELING) You cause me to feel sad & (ultimately) hopeless. (THOUGHT) You fill my mind with doubtful thoughts – ‘What’s wrong with me? My life is horrible. I can’t stand feeling this way!’ (ACTION) You encourage me to stay in bed, distract, numb, & avoid all that requires effort. Under the spell of this cognitive-behavioral catch 22, my brain chemistry worsens; I’ve got even fewer endorphins in my court. So, this downward spiral perpetuates: (FEELING) I am genuinely fatigued – feeling run down & lacking the energy necessary to invest in self-care. I’m irritable, confused & ashamed. (THOUGHT) I reason, ‘Will I ever feel any better?? This is hopeless…’ (ACTION) I keep to myself. I skip meals or binge on unhealthy foods. I’m largely sedentary. I discontinue efforts toward a wholehearted life & aim to stay numb… Work performance suffers; relationships suffer; self-image suffers; biochemistry suffers yet, you thrive!

The worst part about life with you is that despite all of this insight – all of the logical solutions to minimizing your effects, not to mention the degree in psychology I went in search of – you have literally infiltrated my mind & my body. You have reinforced unhelpful schemas & harmful behaviors for years on end. You’ve been a part of my life for so long, in fact, I fear that you truly have influenced my character & my will. You’ve certainly seized my idealism & rose-colored glasses…

Depression, hear me when I profess that I will never give-up the only life I’m certain to have as a result of the garbage you put in my mind’s eye, nor will I allow your physical weight to keep me down & out. I would never give you an excuse to take host inside of those that my suicide might harm, because I hate you. I hate you for all that you’ve done & all that you do; and I refuse to let evil prevail.

Female, Age 35
Clinical Depression, among other things

A sign sitting atop stone steps that reads, "Stop the Stigma on Mental Illness"; which was selected to accompany a letter written to PTSD for the Dear Diagnosis literary project.

Dear Posttraumatic Stress Disorder (PTSD)

NOTE (from the Author): I wrote this letter to bring awareness to not just PTSD but to all mental health disorders. These aren’t games that we play – this is a life or death situation for those of us who suffer. I’m also writing because we need to stick together to break the stigma around psychiatric medications. I tried getting through my depression the first time without them, and I only dug myself into a deeper hole. Another thing I wish to convey is that PTSD should not be seen as a label. I know many people who cringe when they find out someone has it – they think that we’re out of control but we’re not… To those that suffer, please don’t do it in silence because you don’t have to. It’s okay to not be okay. If you ask for help, I like to think that there will be people to catch you when you fall. We just need to trust the process and take our medications like we’re supposed to – so that we can be the best that we can be. Thank you for taking the time to read this in an effort to really understand the battles we go through daily. 

Yes – I have you; but no – you’re not a result of time spent in the armed services, as there are many experiences that birth you. You can result from any trauma throughout your life – trapping your victims into dark boxes… Little did I know you were the main reason I had so many problems. When I was diagnosed with ‘Bipolar, Manic 1 with Anxiety’; I hadn’t a clue that it was really a small part, playing a big role as the devil’s advocate in my mind.

For almost 20 years I searched for an answer to my angry outbursts and sensitivity – becoming overly emotional over the smallest of things. I couldn’t understand why I let myself get so attached to certain people, knowing that they might not be in my life forever. This detachment issue I had – led me to lots of pain and lots of heartache. Before treatment, I was at a complete loss as to why I couldn’t remember much of my childhood… But then, you were named and thanks to the help of therapists, all of the puzzle pieces have fallen into place.

My car accident had only added fuel to the fire that raged out of control. I had no idea how to stop it! I spiraled downward so fast we almost didn’t catch you before it was too late. I’ve almost lost my life on several different occasions because the path that brought me to you was never clear. It was a dark path of self-destruction. From self-harm, to alcohol, to drugs – the light at the end of the tunnel became dim with time. If it weren’t for my family, the friends that have become family as they were on this journey with me since day one, and the wonderful staff at my treatment facility – I wouldn’t have made it through the fog.

I used to regret my past – having been a part of all of these things – but since coming out of treatment and being six months clean, I am no longer ashamed! Someone once told me to ‘stop beating myself up about my addictive behaviors because I did what I had to in order to survive’. I understand that now and see the strength many people said I had. Life really is greener on the other side, now that I understand that you were there all along. With all of it fresh in my mind, I am thankful everyday I get to wake-up with a chance to become a better person than I was the day before. I am now grateful for my past because it’s shaped my character and who I am today. Now that I have knowledge of what the root problem is, I know who I truly am; and the peace of mind that comes with that is priceless.

Another Survivor

Female, Age 25
PTSD; Bipolar I Disorder with Clinical Depression & Generalized Anxiety; Alcohol Use Disorder, Substance Use Disorder

A disassembled Russian tea doll set symbolic of what it is like to manage the 'parts' of Dissociative Identity Disorder (DID) at Dear Diagnosis: a literary project.

Dear Dissociative Identity Disorder (D.I.D.)

NOTE (from the Project Director): According to the DSM-5, Dissociative Identity Disorder is when two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self. The disorder develops after severe developmental trauma that interrupts the child’s ability to integrate all parts of self. 

​You are hard to describe. It’s hard to put into words just how life saving – yet destructive – you really are. Allow me to describe a day with you:

I wake up in the morning to start the day. I get dressed, start the coffee and jump in the shower.  I step in, but you do too causing something else entirely to take place. Someone else takes over – someone inside decides to step forward and pilot the body for a few hours. One of my ‘parts’ comes to life, yet I, the host, am completely out of the loop – completely blacked out, like a person whose drank too much and can’t remember anything they did the next day. Accept, not the same at all, because this isn’t chemically induced – it is all me and extremely scary.

During these episodes I act completely unlike my adult self. I switch into one of 3 alters: (1) A timid 5 year old girl; (2) An outgoing and vibrant 8 year old; and, lastly, (3) An angsty 13 year old who thinks she is a full grown adult.

I remember when my therapist first told me about you – ‘Dissociative Identity Disorder’, formerly known as ‘Multiple Personality Disorder’.  My entire body initially cringed, because I didn’t want to be the “crazy one”; but then I calmed down and thought about what this diagnosis really meant. It meant that I wasn’t crazy! It meant that I wasn’t blacking out for hours at a time for no reason. It meant that years of lost time and actions that were allegedly performed by me (but felt so foreign to me) came from someplace real!

I am getting to know you, now, and my respective parts, but we’re not exactly friends – frankly we want to kill each other at times (NOT an overstatement).  But, I’m learning to respect you and each of the parts that you enact within me – because each part has a story and each story comes from someplace very real in my life. Places that will forever affect me because they took place in early childhood. I wish I were stronger – strong enough to hold onto each piece separately, so as not to slip in and out of your dark holes. I’m grateful, however – grateful that you saved me during times in my life that I needed those parts of myself to survive my past.

My 5 year-old part is small. I see her in the sad eyes of other little girls who clutch onto the arm of their favorite teddy bears. She has short brown curly ringlets that bounce when she walks. She talks, but is hardly heard because she whispers. She is scared, scared she will be seen by men who have hurt her; scared she will talk too loud and be punished; scared she will blink her eyes too long and the people she thought loved her will disappear forever. She has deep brown eyes and big bold pupils that look around at everything. She doesn’t just see the world as it appears, though; she sees what she can sense – fear, happiness, joy, and excitement.  She is quiet, but she loves to be noticed. She loves when someone safe wraps their arms around her and holds her tight.  She loves when you look at her artwork and adore it. Unfortunately, when I picture her in my mind I see her as exceptionally tiny – a minuscule little girl in the corner of a big dark room. She is curled up with her head bent down. She is wailing, cries echoing through her chest.

My 8 year-old part is the protector. She is who kept me calm and happy in times of extreme panic and sadness during my upbringing. She is one big ball of energy, a classic bouncing pre-adolescent girl. She loves music and dancing and can play the piano better than anyone in our system.  She is a pudgy little thing, with a gap in her two front teeth and cheeks big enough to fit in an entire handful. She is adorable, nonetheless. She has a zest for life and loves everyone she meets. She will play with anyone, introduce herself to anyone and put herself out there in, sometimes, not so safe of ways… She has wavy brown hair, not as curly as her 5 y/o counterpart, and brown eyes. She loves to talk and to be talked to. She doesn’t hold as many bad memories as either of the other parts I seek to understand.  Unlike both of them, that isn’t her primary purpose. Her purpose is to help me function in everyday life, like in school, work, and social situations – you, DID, have made it clear to me that her primary position is to help me survive in the present…

The oldest part of the bunch knows and claims her age. She is 13 going on 30 (pardon the pun). She has been an integral part of the system for the longest amount of time. She was present for the majority of the trauma that occurred – she is the manufacturer of resentments, anger, and the hard shell that wards off any forms of love, affection, and care from foreign sources. Her primary job is to keep everyone safe – every part of me looks to her for safety… But, in doing so, she has learned to push everyone in the real world away. She isolates, self-harms, over drinks, and acts out sexually in order to fill internal voids that she wont let anyone else help her heal because she is too scared to be vulnerable…

Each of my parts have played vital roles in my survival up until this point. Without them, I don’t know that I would have been able to handle the trauma, pain, and heartache that my past has created for me. Of course there are plenty of things to complain about as a result of your existence, DID; you haven’t been all good. Switching in to a terrified 5-year-old personality in the middle of a job interview (for example) is not ideal. The ways you show up, in fact, have caused me to lose any hope at being hired; any hope in holding down a job when I really needed it most.  But, I’m learning every day how to appreciate each of the parts that you keep me in touch with – each of which has helped me get to where I am today. I am learning how to create boundaries with each part of me that remains intact. For example, I now understand the importance of making time for myself – the adult; as well as how to facilitate appropriate playtime for the others – ‘the littles’.

So, DID, thank you for your service. Thank you for being there when I was just a little girl, just a vulnerable tiny little child who had no one to help her. Thank you for giving me my soldiers – all 3 of them – to fight my battles for me when I couldn’t fight for myself. Thank you for quite literally giving me the superpower to survive the unthinkable. But please hear me when I say, I am stronger now. I am safe. I can do this on my own.

Female, Age 23
Dissociative Identity Disorder, Complex-Post Traumatic Stress Disorder, Clinical Depression

A boy stands at the baseball mound ready to swing, while his mother - who suffers from Anxiety - watches from behind a chain-link fence.

Dear Anxiety

I don’t care what type of specific diagnosis you want to manifest as: Generalized Anxiety Disorder, Social Anxiety Disorder, Selective Mutism, Panic Disorder, Agoraphobia, and others. You are so creative in the ways you cripple our lives.

Of all the horrible things I have to say to you… I want to tell you I hate you most because you hurt my children. I want to go to sporting events, volunteer with groups at school, plan big birthday parties, and do all those things moms get to do. The joy on their faces warm my heart on the days I make those things happen. It takes everything I have to do it.

The tragedy is that you, Anxiety, hold me hostage and keep me from being who I want to be. You have killed the mom I wanted to be… still want to be. You must relish in the moments I hear my youngest say, “Why isn’t Mommy coming to church again?” And do you contort your beastly face into a demonic smile when you hear, “I wish you could come with us today. It’s not as much fun at the game when you’re not there.” You break their hearts. But they are still too young to understand… so you make it look like I am the one breaking their hearts. They don’t understand it’s not me. I take the blame for you and your evil ways! I HATE YOU!!! You break my baby’s hearts…

Anxiety, you will not win. Just as you have been relentless in my life, I, too, will persist beyond your ability to hold your grasp on my life. It’s MY LIFE. It is not yours. I will continue finding the right balance of medications, holistic approaches, and therapy to finally beat you some day. Then I’ll plan a big party for myself and invite everyone I know! Well… almost everyone. You, Anxiety, will not be invited. You will be burning in Hell where you belong.

Female, Age 37
Clinical Depression, Generalized Anxiety Disorder, PTSD