Detail from a wall mural in San Francisco

Mental Health: An Autobiography in Five Short Chapters for People with PTSD and CPTSD.

The “Autobiography in Five Short Chapters,” by Portia Nelson is a mainstay of 12 Step Programs.
It is primarily used as an allegory to describe the addictive process. i.e. the insanity of repeatedly and consciously making the same mistake with the hope of getting different results.
The “Autobiography” goes like this:
“I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am helpless.
It isn’t my fault.
It takes forever to find a way out.
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
I walk down another street.”
Portia Nelson, There’s a Hole in My Sidewalk: The Romance of Self-Discovery

I received my copy of “Autobiography in Five Short Chapters” in a clinical setting, as part of a treatment group for people with C-PTSD.

For me, that’s a problem. Here’s why:

In my experience, people with primary substance abuse disorders know they are in a hole, even in their denial. They not only know where the hole is, they know how they fell in, and they know the way out.

Our for profit medical system sees “behavioral” health and 12-Step Programs as a cheap alternative to providing the more expensive services required by people with mental illnesses.

Some people with severe mental illnesses have substance abuse disorders, but they are secondary to our illness, and to the artificially induced poverty, that forces us into slum housing and into the arms of aggressive drug dealers.

I did not fall into a hole.

I was placed in a hole as an infant.

Any attempt to crawl out that hole was met with violent beatings.

After she solemnly read the ‘Autobiography in Five Short Chapters’ to us, the therapist who was running the group asked us what we thought.

I raised my hand:

“What if we were stuffed into a hole before we knew we were alive?”

She had no answer.

Behaviorism has few answers for people who need intensive psychotherapy.


For those of us with mental illnesses related to childhood sexual assault and trauma, I offer this Autobiography in Five Short Chapters for People with PTSD and CPTSD.”

Chapter One
“I wake up and I am in a hole. I don’t know that I am in a hole. The hole forms the circumference of my world. I base my options in life on its width and depth. It is uncomfortable but the hole is all I know.
I feel constrained and helpless.
One day I look up and see that light enters the hole through an opening at the top.
My eyes are so dazzled I cover them.
Chapter Two:
I live in a hole in the sidewalk but I am not certain of this.
I try to pretend that It isn’t true but I see that there are edges at the top of the hole through which the Sun shines.
I decide to climb toward the light to look beyond the edge.
I climb to the top.
It takes a long time.
I see that beyond the hole is a vista that is more rich with possibility than anything I have ever imagined.
My fear is so profound I fall back into the hole where I know I am safe.
Chapter Three:
I live in a whole in the sidewalk, which is where I was placed as an infant.
I try to forget what I saw when I climbed toward the light and looked over the edge.  The hole feels small and cramped but the thought of leaving fills me with dread.
I try to pretend that I don’t know that I am stuck but pretending doesn’t work anymore.
I am furious.
Why am I in this hole?
 It isn’t my fault.
I contemplate climbing out
Chapter Four:
I live in a hole in the sidewalk. My world is in this hole yet I feel I must leave this tiny world for the larger one above: the real world.
I slowly climb to the top of the hole and slowly pull myself out.
I stand at the edge of the hole, terrified and uncertain of what to do next.
Chapter Five:
There is a hole in the sidewalk. I’ve spent my life in this hole and once believed  it was the entire World. I am terrified and want to throw myself back into the hole, but enter psychotherapy instead.
Rob Goldstein 2014 – 2019

24 thoughts on “Mental Health: An Autobiography in Five Short Chapters for People with PTSD and CPTSD.

  1. Hello! I started a new blog! I look forward to catching up on yours. Took some time off for photography. Bethany

    Liked by 1 person

    1. Thank you Jacquie, I am healthier now than when I first wrote this post, but there are people out there who are just entering treatment. I want them to know that it is right to question treatment providers who want to send abuse survivors to Alcoholics Anonymous. There is nothing wrong with attending A.A. Meetings and other 12 Step groups, but A.A. is NOT the first line treatment for PTSD and C-PTSD. The first line of treatment is psychotherapy.

      Liked by 1 person

      1. I believe people want to help, but unless you’ve lived with the disease you can’t possibly know what is needed.
        My daughter often gets advice on my grandson’s Type 1 Diabetes even though they have no real idea of what he needs. It can be frustrating.

        Liked by 1 person

      2. I don’t expect everyday people to understand Dissociative Identity Disorder. I get the sense that some readers think I’m in pain, but I’m not. The whole point of DID is not feeling. When it comes to chronic conditions, whether DID, diabetes or chronic fatigue syndrome or even a sudden disability brought on by an accident, most people want to help but that impulse is often followed by feelings of powerlessness, which sometimes results in pity and avoidance. If I could say one thing to people it is I have learned to take care of myself and I’m imperfect at it but given the odds, the fact that I’m here at all is a triumph. Thank you for your thought provoking comment, Jacquie.

        Liked by 1 person

    1. Thanks Paula. The image is a detail of a wall mural. There are days when it feels like PTSD is endless suffering and there are days when the struggle to achieve ‘normal’ seems just not worth it. Those days are becoming less frequent.


  2. I have read and retread this post. Where does a person get the resources to deal with the situation you describe, I am overwhelmed with your struggle. When I was a kid by biggest problems were the ones I got led myself into. Despite having a nurturing mother. You are a amazing to have survived.

    Liked by 1 person

    1. You know,,,the brain is an amazing thing and for every deficit there is a compensating force….The defense of DID
      works very well until it stops working…

      and my survival tells me that some force wants this story told…I have to believe that or there would be no reason to continue…


  3. Reblogged this on Loving Me, Too and commented:
    The expansion of this poem teaches us not to beat ourselves (or others) up for feeling trapped and frightened. It takes a lot of courage to climb out of some holes no matter how we got there. Some days, it takes a lot of courage to stay above ground, above the covers. Remember to love yourself.


  4. I’ve used the Autobiography poem for years in my work and never heard this question you asked. Thank you for asking the question. Your expansion of the poem is amazing! I’m glad you’ve had the courage to ask such questions and share a richer, broader perspective. You do an excellent job of clarifying that the challenge of climbing out the hole is not to be taken lightly. I hope your journey goes well.

    Liked by 1 person

    1. Thank you for saying this. Many people misunderstand my stance. regardless of how one enters the hole the struggle to emerge can be painful and frightening. What I wanted to do was point out that some of us wake up in the hole without knowing where we are. Thank you for affirming my intention. 🙂

      Liked by 1 person

  5. Hmmm, this is very meaty. I have to contemplate this for a while. I think there’s a whole other story for In (and out of) therapy. I’ve been with the same therapist for 14 years….the illness does not go away…and at this point I’m kneeling on the sidewalk looking down the hole thinking please G-d I don’t want to go back in there!!!!

    Liked by 1 person

    1. I know exactly what you mean. I cannot believe that I’ve spent most of my life seeing psychiatrists who never really saw me.

      I started a CPTSD class at Kaiser. It’s once a week and very triggering and I desperately need to trust that Kaiser wants to do the right thing because
      if my health care providers are willing to passively let me die from this thing then the World of people is a World of savages. And as the child of an Orthodox Jewish family I define evil as choosing to do what is beastly when one knows how to do what is Godly.

      Evil is refusing to gather the light.

      When I believe that people are fundamentally beastly I feel hopeless and that is when the hole looks safe and warm.

      For me the hole can be the illusion of Second Life.

      I can easily let the alters that enjoy VR spend the rest of their days playing in SL.

      Liked by 1 person

      1. Well….myself, I think it is all the work of the Sitra Achera, the Other Side, that plants these seeds of evil in what should otherwise be Godly people in order to contain, constrain, and twist them in the direction of serving the side of evil. I look at people like my mother, who has no concept of “other,” she is that self-absorbed…she can’t see anything. When I explain to her that when she drove me out of her house I had to prostitute myself in order to have food and shelter, she stares at me blankly, unhearing. It’s depressing to hear that your parents are/were Orthodox. That is one of my sources of grief: that people who put on T&T and pray three times a day and fast on fast days, can be so hideously abusive nonetheless, completely without scruple or insight. I think I must be a little bit triggered….I’m triggered anyway, tonight. People are writing very deep, dark stuff tonight. I wonder what the planets are up to? I might have to call my favorite astrologer later, when Shabbat is over on the West Coast.

        Liked by 2 people

      2. I shall not add to your triggers. I will say that my moments of despair are few. I would not have chosen the ordeal of my parents but I have been given all the tools I need to understand it and to craft it into something that can do good in the world. My task is stay alive to give witness to the creative power of the human mind….

        Thank you for being such a splendid member of
        the Word Press community. 🙂

        Liked by 2 people

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