What is to give light must endure burning.
—Victor Frankl

I had this plan, I was going to spend each issue clarifying an overused, misunderstood and generally obnoxious term or diagnosis. Remember last time when I went on a tirade about ‘triggering’. I planned to do the same with narcissist, borderline, attachment styles, and so forth. Of course, I may still get there but I had to regroup. The fires. They fucked me up. And I do not even live in LA. I went through this—fires—twice before. We lost everything. Every structure, every memory, every photograph of my parents’ wedding. All of it – gone. And then, during the pandemic, after the house had been rebuilt and I, a grown person with allegedly marketable skills, had to leave the life I was building and stay with my mother, isolated and frustrated, the fires came again. Forced evacuation but only I left, probably because I was a nightmare to be around and they made me leave. I drove through smoke and falling ash and embers to my girlfriend’s house, crying most of the way, terrified and sad and completely unravelling. But I got there, and she immediately told me I was being dramatic, and it was not really that bad, and why did I have to make everything about me? We broke up. And then I blew her boyfriend, basically on principle, and I take great joy that she is ageing wretchedly

So, fire scares the hell out of me. And I am heartbroken by the devastation wrought upon a city I truly love. Los Angeles is home to my closest friends—family really—and hundreds (thousands maybe) of perfect nights and days spent drinking. Bad choices and so, so much fun. I almost died in LA, more than once. I fell in love there, or so I thought. I met my heroes and my nemeses. I got lost in someone’s (James Caan maybe?) backyard in high school, at a party I barely remember except how much I liked kissing this guy Nathan, who took me home so we could fuck while listening to Too Short—which is the opposite of romantic but still irretrievably awesome. I will not, ever, say that the recent fires were triggering. I refuse. But they probably were. What I will say, however, is that now all the Coachella girls in their dumb hats and the hipster dudes whose pants are always a little bit too short, now when they say they have experienced trauma it will—likely for the first time—be true.

Because trauma and Post-Traumatic Stress Disorder (PTSD) are real. They happen. People become the walking wounded, with something shattered in their eyes. I have seen it too many times to count, clinically, socially, in my family and in the mirror. Which is why I cannot stand to hear some 20-year-old who has never experienced anything, ever, say she has PTSD from that time a bouncer refused her entrance to a club, or some such nonsense. It devalues and undermines the severity and impact PTSD and trauma have on the world.

Now, here is a quick and dirty cheat sheet for what PTSD is. Really. According to any doctor, psychiatrist, psychologist, clinical social worker or nurse worth their salt:

A diagnosis of PTSD requires at least one item from the following 6 categories:

1. One must have been exposed to death, threatened death, actual or perceived serious injury or be the victim of actual or threatened sexual violence. Either through direct exposure, witnessing the event, learning that a loved one has been harmed, or what is known as indirect exposure, which relates most commonly to first responders, medics, therapists, and others who hear about or engage with trauma on a professional basis, which is often referred to as ‘vicarious traumatization’.

2. The individual continuously re-experiences the trauma through one or more of the following symptoms: unwanted memories, flashbacks, nightmares, physical reactivity (i.e., freezing, elevated heart rate, panic attacks, narrowed vision, catatonia, and other adrenal fear responses), and emotional distress after being exposed to traumatic reminders.

3. A person suffering from PTSD will assiduously avoid trauma-related stimuli by eschewing trauma-related thoughts or feelings and/or trauma-related reminders.

4. Two or more of the following elements must be present, and they must have begun or become more severe after the trauma: Inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect, decreased interest in activities, feeling isolated, and problems with experiencing positive mood or affect.

5. Two or more of these arousal symptoms must have begun or increased in severity after the trauma: difficulty sleeping, irritability or aggression, risky or destructive (included self-harming) behavior, hypervigilance, increased startle response, and poor concentration. 

The above symptoms must persist for more than one month, cannot be attributed to medication, substance use, or other illness. Finally, the expression of PTSD must cause the individual impairment, either socially, occupationally, interpersonally or otherwise, and distress. In therapist parlance it must be ‘an area of clinical concern’.

Got it? Now, I know that was boring but there is just no way to make PTSD sexy or fun. There just isn’t. And it slithers its way into every place, every life, every story. Like a many-tentacled monster, the symptoms and damage reach far beyond the individual, reducing people, costing us both emotionally and financially. PTSD shortens life expectancy, increases the likelihood of substance abuse, contributes to domestic violence and destroys families. It costs the nation billions of dollars a year, and we in the US basically do the bare minimum to address it.  Suffering from PTSD is like living with cancer, only nobody feels bad for you. Stigmatization and flat-out denial of treatment run rampant, while bullshit ‘cures’ make people rich. Ketamine, ayahuasca, and MDMA (basically any psychedelic trip that costs 20 grand and is led by a white dude – usually handsome and wearing a lot of linen) have become disturbingly prevalent, and are lauded as a ‘miracle treatment’. Unfortunately, the obnoxious white guy in many scarves guiding you on your journey of healing is not licenced, not trained, and probably knows fuck-all about the chemicals he is messing about with. These trips are unregulated and absolutely not a good idea to get into without actual guidance, and integrative therapeutic treatment. And then, of course, we have our EMDR, a treatment lauded for its evidence base but complete nonsense if and when one actually examines said research. All of it becomes overwhelming, disheartening and infuriating. Well, fuck that. Yes, the world happens to us, and there is no predicting what it might do tomorrow. Which is why, in the aftermath of this devastation, I want us all to draw our loved ones to us and celebrate the time we have, to be existentialists, if only for a moment, and remember that Victor Frankl survived the camps of WWII and emerged with his humour, brilliance and joy, still intact. You know how he did it? Neither do I.

In all seriousness, if you want help, or want to know more about PTSD, for the love of George Michael do not seek answers on the internet. Please just email me. I am happy to provide a succinct list of reliable articles and can offer some guidance regarding treatment options and referrals.