A few years ago, before I became a therapist, I entered therapy for the first time. I had never taken psychiatric medication, never been diagnosed, and had never seen myself through a clinical lens. Although I had experienced a difficult and abusive childhood in Somalia, I came to understand that in my culture, trauma and childhood are not spoken about in the same psychological terms used in the West. Through lived experience and years of making better decisions, I began to make sense of what had happened to me. I did not see it as a mental health disorder, but rather as something I had survived and carried.
By the time I decided to train as a therapist, I was in a more stable and grounded place, and I wanted to experience therapy myself. I did not believe I was mentally unwell, but I wanted to better understand the therapeutic process, both personally and professionally.
One of the ways I had navigated trauma throughout my life, long before therapy, was through the expressive range of my mother tongue. In my first language, emotions like shame, hate, and envy are spoken directly and metaphorically. These feelings are not pathologized but voiced aloud in ways that are communal and symbolic. Where Western psychology often sees such emotions as internal wounds or traits of the self, my cultural language allows for projection and dialogue, making the emotional world a shared one.
In addition to this, I had the immense support of siblings and friends throughout the years. These relationships helped me reflect and understand myself more fully as I adapted to life in a new country.
Over time, I became conscious of how deeply my nervous system had been shaped not only by trauma and abuse but also by culture. These layers were often invisible or misunderstood in clinical settings. Because of these differences—and the way my embodied experience consistently diverged from clinical expectations—I have come to identify as neurodivergent. This identification did not come from diagnosis or disorder, but from recognizing that the system was not built to understand the way I think, feel, or process experience. It became a way for me to reclaim my way of being as valid, rather than as something needing to be corrected.
That cultural misreading, and the systemic pressure to conform to Western psychological language, would later reveal to me a subtler but very real form of systemic abuse, which I explore further below.
My first therapist was a psychiatrist who advertised herself as someone who worked with women with traumatic childhoods. I reached out, believing she might offer support that resonated with my experiences. During the intake, she asked about my life. I had no health issues, was in a stable marriage, had no children, and was in the midst of a career change after a recent job loss. I shared openly that my childhood had involved serious harm. Without much further inquiry, she told me I had PTSD.
I was surprised. I had never considered myself to have PTSD. In fact, I asked her, “Wouldn’t I know if I had that?” She replied that while my life looked good on the outside, I was carrying unacknowledged trauma underneath. After researching the diagnosis, I returned to therapy and asked if she might consider complex trauma instead. She firmly disagreed, explaining that complex PTSD was not recognized in the DSM and reiterated that my diagnosis was PTSD. The conversation was over. Her words were final. Her stance was immovable. I quickly realized that my own understanding, and even my language, had no place in the therapeutic room.
What followed was not healing. It was a quiet erasure. I was not explicitly forbidden from naming what happened to me as abuse, but I was expected to speak in the language of trauma. The expectation was clear. I should reframe, reinterpret, and empathize. The physical and sexual abuse I had survived, actions that would be considered morally and legally wrong in most cultures, were treated as internalized wounds to be processed. There was no room for moral clarity. No space for naming, witnessing, or telling the truth. That denial of language, of clarity, and of the right to name my own experience became its own form of harm.
That experience left a lasting impression. It showed me how therapy, when forced into rigid frameworks, can censor and silence the very people it claims to support. It can flatten the truth, reduce abuse to trauma, and treat resistance as pathology. It helped me understand how institutional systems, even when well-meaning, can enact a subtler form of systemic abuse. This is the kind that calls for healing but denies recognition.
When my clients speak, I listen differently. I do not assume that pain always needs reinterpretation. Some things are not misunderstandings. Some things are not trauma. Some things are abuse, and they deserve to be named, witnessed, and held as truth.
That experience, of being told what I was allowed to feel and how I was allowed to describe it, is what moved me to write this piece.
In recent years, mental health systems have increasingly embraced the language of lived experience and peer support. The idea sounds promising: that those who have been through distress, crisis, or marginalization can offer support, insight, and advocacy from the ground up. But something unsettling has happened in this process. Peer support has often become another extension of the system it was meant to challenge. Instead of centering embodied knowledge, it is frequently asked to conform to institutional expectations, clinical language, and flattened narratives. In doing so, it collapses vital distinctions, especially between trauma and abuse.
The collapse begins here: not everything painful is abuse, and not everything disorienting or wounding is trauma. These are different experiences, and they require different forms of support, accountability, and healing.
Trauma, as defined by Judith Herman in Trauma and Recovery, is a subjective experience. It overwhelms the nervous system, fragments the sense of self, and disrupts meaning. But, crucially, trauma can be re-integrated over time through supportive, boundaried, therapeutic relationships that allow for reflection, safety, and reframing. In many cases, what is initially felt as trauma may shift with perspective. The parent who felt neglectful may be understood as emotionally limited. The internal chaos may gradually soften through meaning-making and nervous system repair. The hallmark of trauma is that healing often comes from within, with the right conditions, including the freedom to make new meaning.
Abuse, however, is not about how it felt. It is about what happened. Abuse is a breach of boundaries, a violation of power, a morally wrong act. Whether personal or institutional, abuse is objective. It does not ask to be reframed. It demands to be witnessed. It requires truth, recognition, and justice, not reinterpretation. A person who was sexually assaulted or financially exploited does not need perspective-taking. They need their reality named, respected, and repaired. This is not therapeutic nuance. It is moral clarity.
Judith Herman’s more recent work, Truth and Repair, extends her framework. While her early writing focused on trauma and personal abuse, she later emphasized how healing is incomplete without public recognition. Yet even then, the full separation between systemic abuse and personal abuse remained blurry.
I want to go further. Systemic abuse is not just a broader form of personal harm. It blends trauma and abuse in a way that intentionally obscures reality. It gaslights. It blurs categories. It calls power imbalance a miscommunication. It redefines a survivor’s moral clarity as overreaction. In this way, institutional systems, including medical, psychiatric, and legal systems, often compound trauma by denying abuse. They confuse integration with silence and recovery with compliance.
This brings us to peer support, and why its promise has often become muted.
Many lived experience practitioners have endured both trauma and abuse, not just personally but also systematically. Yet when they enter the professional world, they are often encouraged to speak only in subjective terms. They are asked to process, not protest. To integrate, not indict.
The lived experience that challenges the system, the person who says, “I was traumatized and abused, and the system enabled it,” becomes inconvenient. Their embodied knowledge of harm, including moral injury, is pushed aside for professionalized storytelling. Safe trauma becomes the currency. Abuse, especially institutional abuse, is quietly erased.
This creates a false binary. The system elevates academic knowledge, which is abstracted, standardized, and disembodied, and devalues embodied knowledge that refuses to flatten or forget. The peer worker who remembers clearly and still holds outrage becomes too raw, too activated, or not integrated enough.
But in reality, this clarity is not a clinical risk. It is a form of authority.
To restore integrity to lived experience work, we must begin by reclaiming the distinctions:
- Trauma is subjective. It can shift with support, insight, and reframing. Its healing lies in meaning-making.
- Personal abuse is objective. It involves wrongdoing, moral breach, and requires truth-telling and repair.
- Systemic abuse blends the two. It distorts trauma to hide abuse and uses institutional power to deny both.
Each requires a different response. Trauma needs therapeutic holding. Personal abuse needs recognition and justice. Systemic abuse needs structural accountability, not just peer support that soothes, but social movements that demand.
The core question remains: Who gets to define reality? When peer workers speak from lived experience but are told that their experiences are merely subjective, they are being repositioned in the same hierarchy that harmed them. Systems continue to define what counts, not only as trauma but as truth.
We must flip that. Authority does not only belong to those with degrees or diagnostic frameworks. It belongs to those whose bodies remember, whose truths are inconvenient, and whose clarity is not ready to be softened. Lived experience should not mean scripted testimony. It should mean epistemic freedom, the freedom to define what happened, how it felt, and what healing requires.
And sometimes, healing does not begin with reframing. It begins with witnessing.
“Trauma is subjective. It can shift with support, insight, and reframing. Its healing lies in meaning-making.
“Personal abuse is objective. It involves wrongdoing, moral breach, and requires truth-telling and repair.
“Systemic abuse blends the two. It distorts trauma to hide abuse and uses institutional power to deny both.”
Beautiful synopsis of the “mental health” industries’ systemic abuse, Maram. And it’s all by DSM design, since no DSM “bible” biller today, may ever bill for ethically and truthfully helping any child abuse survivor ever.
https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1
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Thank you for parsing the definitions and needs of trauma and abuse. My excellent PTSD therapy helped me tremendously with the trauma of my childhood & marriage abuse. BUT I still need to hear the outrage of the abuse in responses from people I choose to share it with. Thank you for making this make sense for me! In doing so, you’ve helped me feel “seen” and not alone in a truly meaningful way.
Someone Else, the article you linked was a refreshing honesty. Thanks for sharing!
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Thank you for sharing. I agree that the promise of peer support is often watered down as people who share lived experience in the system are likely to be targetted in a system that can be oppressive. I also agree that it is really important to meet people where they are at and not where a therapy tells us to. It really doesn’t help to start out a relationship as a know-it-all or a judger. Western ways in mental health can be very oppressive as you point out.
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Wow! This really verbalized so much of how I’ve felt. How amazing it would be to receive validation from the heart instead of a text book. How I wish someone would say, “it happened. You were dismissed by the system built to protect.” It would be much more healing than the usual, “reframe your thinking,” as if experiencing the events and carrying the wounds can be cleaned up with happy thoughts. I’ve often felt like therapy was a punishment where, once again, I have to put in the work to fix the actions of perpetrators. It’s as if my survival and journey of healing enough to have a functional appearance weren’t good enough. The knife twists more when I’m told to put in more work so the abusers can be absolved of all accountability. Fantastic writing. I hope it makes a difference in the systems, but your patients are blessed to have you.
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I have felt this too in the realm of grief after my husband died in the hands of psychiatry. I was meant to “process the trauma” in order for me to learn and “make meaning” out of this event, to become a better person for it, and move on. But the reality is that there was repeated horrifying systemic abuse. And the reality is that my beautiful funny generous 38-year-old husband is gone. It reminds me of other terms, like toxic positivity and blaming the victim. It is deeply cultural. Thank you for this important piece.
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An absolutely captivating piece—such a great reminder that institutions may, in fact, perpetuate the very issues they exist to solve. I work in homeless services, and have implemented a peer mentor program. From this institutional perspective, and being a person with lived experience of homelessness myself, I absolutely had to check my intentions and train my staff to not use the peer mentors as our mouthpieces to push our agenda. We had to not expect certain outcomes or put the burden on the peer mentors to hold other people’s traumas. It was very intentional to not manage these relationships and allow the peer mentor space to show up as their authentic selves. But I’ll admit it was difficult to let go and give them that authority and autonomy. Your article highlights this issue beautifully—thank you for sharing your story so organizations like mine can be more mindful of not stifling or micromanaging the voices of those with lived experience.
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Dear Maram. I’m deeply affected by your story. First; I feel angry FOR you. You were abused, then abused again through the therapeutic process. But, I also feel a little angry AT you. Please accept my concern with compassion for us both. This harm was done by YOUR PSYCHIATRIST who is also your peer because You are a Psychotherapist. I read your piece expecting to hear of “harm done by non-professional peers.” A more accurate title would be: PEER PSYCHIATRIST compounds trauma, etc. This upsets me because I believe “good talk therapy” is sadly over. And, my experience informs me that free anonymous groups of non professionals with lived SHARED experience seem to be our best chance for growth.
The rest of your contribution here is so helpful. Abuse is the locus. Trauma is distinct. Witnessing essential. Resolution and health possible. Psychiatrists / even if they are peers / don’t listen / label and RX too quickly / and often cause enormous harm. And, I witness deeply embedded within your piece …… a quiet call to Mental Health Professionals to realize, they too, may be very sick, especially if they and the system in which they work are left unexamined. Thank you for writing. Don’t be afraid. Keep examining. Keep Witnessing. Use your Voice. Criticism is often meant to aid. Again, I’m so sorry you were harmed by a Psychiatrist. Welcome to the Club.
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Hello Maram, I am a retired trauma therapist. Your story reminded me of one of my favored clients. She was raised in Africa, by African parents who had only one tool as parents. Any misdeed was punished with a physical whipping. She was basically whipped nearly every day of her childhood. Yet, she emerged a resilient and intelligent person. She was a lawyer and married without children. Her issues were all in her personal relationships. She tended to view interactions inaccurately. This lead to much disfunction and disturbance, and she knew that the problem was with her.
She used my self-help program, Se-REM.com (Self effective – Rapid Eye Movement). It was an overwhelmingly emotional experience. She was fearful of doing it again, but with my encouragement she continued. She had so much buried pain, it was a serious process to rid herself of all the effects of her childhood. She is a happily married mother of 2 kids and is a great Mom.
You have obviously done personal work, but if you have pockets of pain in your brain, this program will help you find them, and process them out of your system. Please accept my gift. If you write to me at: [email protected], I will send you a link to a free download. Take care, David B.LCSW (retired trauma therapist).
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If you were to indict every person who’s abused someone living right now, abused as you define it, would that total so many people you would have to consider another means of addressing it because so many people would be in jail? I might also ask, are we sole individuals abusing or being abused by other sole individuals, or does crime come also from deeper founts? What part does community play, what part humanity?
Who gets to define reality? Hopefully people who see as much of it as can humanly be seen. I understand it sounds like moonbeams now, but we might not be alone on the inside in our own bubble of inviolate consciousness, and we might be moved upon by those around us, by humanity at large, on the inside, and our will takes on the flavor of that sharing, and we act upon it on the outside. Now that knowledge would revolutionize society.
But, still walking on them moonbeams as today would see it, the greatest knowledge of reality would be not only that we share consciousness but identity too, and it’s in this ballpark that we find another way to address being abused that does not involve the abuser being punished but healed, a healing where they not only have to face what they have done to you, but they also come to feel it and truly regret it, not only because they’ve hurt you, or even themselves, but because they’ve hurt us, and they have come to feel their humanity and their world deep enough they suffer for having hurt those wonderful things.
You can’t even approach there (have the abuser feel their humanity) with the ill will towards them I hear you feel between the lines of this article, the same the mass of humanity feels towards wrongdoers and always has. It might even be a large part of the problem of us. Subjective, objective, abuse, trauma, you’re drawing definite lines where things crisscross, and if there were a better way than the formula of crime and punishment to deal with being abused, would you take it?
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This is an important paper. For those of us concerned with the system of care and excited by the growing grassroots power and influence of people with expertise through personal experience, this is the sort of critical analysis that must occur for sustainable and healthy systemic transformation. Keep writing, Maram!
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Thank you. ❤️ A priest and psycologist helped me more than professionals, because he held space. Also finally at the abuse center, they put names on was i had been undergoing in my childhood and also as an adult, by my family. And thereafter in the system. Psychiatric hospitas treated my complex ptsd as personalty disorders, and my hyper sensitivity and “cleverness” ( I am also neurodivergent) was used against me. I was told to be manipulative, paranoid and needed to shape my personality out of cluster B. More trauma because I seeked help to try understand my dissociation and somatic reactions. After I got the cptsd diagnosis and better help 14 years into institutinalisation, the state declined my lawsuit because complex ptsd was not acknowledged in the diagnosis system. And I had not reported any big accidents or fysical injury, and certainly did not live in a war zone country, so my injuries didn’t fit the criteria for standard ptsd. My therapy was 13 years with having to face that what happened to me had been normal, but me myself needed to adjust to abuse. And whenever I was abused, my abuser was left in peace, while I was locked up. Because I was in fight. Then sent back to my abuser, trying to please. Waisted life – Norway, welfare nation they say
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I shall think about what you have written for a long time, and take your thinking into my understandings, use what you have written to consider differently.
Thankyou for writing this – a valuable perspective. And beautifully written.
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“Trauma is subjective” This is what I say before asking my patients in their intake (board certified psychiatric nurse practitioner) if they have experienced trauma. I tell them that we may both be involved in a minor fender bender. No one hurt. They go home and start making arrangements with their insurance company for repairs. I go home and I am so anxious I can’t remember the name of my insurance company and cannot get behind the wheel for months. Everyone is effected by things differently. And even if you have had trauma doesn’t mean you haven’t healed from it. However as far as diagnosis, it’s highly inappropriate to blame the DSM if she (the psychiatrist) didn’t even check for criteria. Did she experience nightmares, easily startled, flasbacks (which included seeing something that reminds you of what you experienced and feeling physically sick or anxious), purposedly avoid the place of occurance or thoughts of the occurance, constant instrustive and anxious thoughts of the traumatic event, and have these symptoms occured more than 6 months? If she did meet enough symptoms then yes the diagnosis fits, but I do understand that we cannot diagnosis complex trauma. We can’t diagnose something that we don’t have a diagnosis for because their is no agreed-upon criteria so not enough clinical data on successful treatment. America is horribly backwards and behind in psych. Which is ridiculous because we have more clinical staff. But the rest of the first world uses the ICD 11 to diagnosis. You can’t even get a copy in the United States! There are several things I would change. Like the BMI criteria for anorexia or the 4 day symptom criteria for mania/hypomania to meet bipolar disorder. But hey I just work with the actual patients while the people who meet the criteria, well, don’t
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I hate to disagree, but the ICD-10 would just be another set of subjective criteria that do not distinguish the causes or effective “treatments” of one case vs. another. What the heck is the difference if the person “meets the criteria” for “PTSD?” The question is, WHAT HAPPENED TO THEM that they are distressed about and WHAT CAN THEY DO to help find some perspective or justice or whatever it is that THEY need! I always told my clients that the “diagnosis” is just a code we have to give to the insurance company and that it means NOTHING about how I’ll treat them or what they need or want to change about their lives. Mostly, I never even mentioned diagnosis, I just wrote it on the report so the insurance would pay. I did fight to get some diagnoses CHANGED, when I felt the current diagnosis was creating harm. But mostly I would “diagnose” whatever would justify doing whatever it is I thought would be helpful.
The DSM and the ICD-10 are fantasies when it comes to “mental illnesses.” They literally VOTE on the criteria. There is nothing to indicate that all people having the same “diagnosis” have the same issues or will respond to the same approach. So what’s the point of a “diagnosis” that doesn’t tell you either what is the problem or what to do about it???
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Maram Khalif, thank you for sharing your truth! We know the truth when we hear it because it validates our experiences.
I’ve learned these truths you have expressed a while now and have been doing work to share my story while consciously unlearning and letting go of the oppression that was internalized. I do some work on Substack, Just Doing the Little Things
http://www.Substack.com/@mitzysky
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