Living with PTSD: Persevilience and the Art of Carrying On

By Matthew Parish

Tuesday 27 October 2026

There is an unfortunate temptation, when writing about mental illness, to begin with a confession. The language of confession implies shame: that there is something one has concealed and must now admit. I do not think that is the right way to talk about mental health, and it is particularly inappropriate when talking about post-traumatic stress disorder. PTSD is an injury to the mind caused by experiences that the mind was never designed comfortably to absorb. So I am not confessing that I have PTSD. I am explaining what it is like to live with it.

I was diagnosed with PTSD after multiple meetings with several psychiatrists, following events several years ago in my life that were truly harrowing. I do not propose to recount those events in detail here. It is enough to say that they involved attempts to kill me and to destroy me, and that they left consequences that proved much more durable than the events themselves. One of the strange things about trauma is that the danger may disappear while the mind continues behaving as though it has not. The external world moves on, while something inside you does not.

It took several years even to arrive at the correct diagnosis. That is one of the frustrations of psychiatric medicine. If you break your leg, an X-ray generally reveals what has happened. There is no equivalent X-ray for a damaged mind. The psychiatrist has to listen, observe, compare symptoms, exclude alternatives and, above all, understand the history. The patient has to learn how to describe experiences that may themselves be extraordinarily difficult to articulate. Sometimes both sides get it wrong, and sometimes it takes years before the pieces finally fit together.

Then, after finding the diagnosis, it took several more years to find the right treatment. Curiously enough, I ultimately found the treatment that worked best for me in Ukraine. There is a grim logic to this because Ukraine is a country in which psychiatric injuries have become part of the national landscape.

Soldiers return from positions where they have lived beneath artillery, drones and the possibility of sudden death. Civilians have endured missile attacks, displacement, occupation, bereavement and the destruction of their homes. Families have been divided by war. People have lost limbs, relatives, livelihoods and the ordinary assumptions about tomorrow upon which psychologically comfortable lives are constructed. Ukraine has therefore acquired an enormous and tragic familiarity with trauma, even if the country’s systems for treating it remain under tremendous pressure.

I discovered something important in Ukraine that no prescription could provide: I talked to people. I talked to a great many people who had suffered psychiatric injuries arising out of experiences very different from mine but producing symptoms that I recognised. There is an extraordinary relief in discovering that some peculiarity of one’s own behaviour is not peculiar at all. Someone describes waking at a particular hour, an inexplicable collapse of energy, a nightmare or a sudden desire to withdraw from company, and you think: yes, I know that. You begin to understand that these things are symptoms rather than moral failures.

That recognition has created in me a particular sympathy for Ukrainian veterans and civilians suffering from the psychological consequences of war. It is not an abstract sympathy. I do not merely think that PTSD is regrettable or that governments ought to devote more resources to mental health. I sometimes see behaviours in other people that I recognise because I have experienced them myself. There is an intimacy to that recognition which statistics cannot convey, and it is one reason why my attachment to Ukraine has become intensely personal.

PTSD is not a constant condition, at least in my experience. Some mornings I find it extraordinarily difficult to get up. There may be no rational explanation for this. Nothing terrible is scheduled for that day. There may be work I actually want to do, people I want to see and places I want to go. Nevertheless, the act of getting out of bed can seem like an absurdly formidable undertaking. On other days I wake up and I am completely fine, ready to work and wondering what yesterday’s problem was all about.

This variability is one of the things outsiders may find hardest to understand. We tend to imagine illness as something relatively constant: you either have influenza or you do not. Psychiatric injuries are often more capricious. A person can be energetic, productive and cheerful one day and find the most elementary routines exhausting the next. This does not necessarily mean that anything has happened in between, and searching obsessively for an external explanation can sometimes be pointless.

I take a cocktail of psychiatric medications. Some days they seem to work extremely well, while on other days I wonder whether they work at all. Sometimes I notice what I believe to be side-effects and sometimes I notice none. I have learned not to treat every fluctuation as an occasion for dramatic conclusions. Human beings fluctuate anyway, and people with PTSD may fluctuate more than most.

Sleep is another battlefield. Sometimes I have trouble sleeping and sometimes I have nightmares. At other times I suffer from somnolence and could apparently sleep indefinitely. The relationship between trauma and sleep is particularly cruel because sleep is supposed to be the period in which consciousness releases us from the day’s anxieties. Yet the traumatised mind can continue its work after consciousness has retired for the night, and the result can be that neither sleeping nor waking feels quite as straightforward as it once did.

My personality has changed as well. I have become substantially more introverted than I used to be. There was a time when I drew considerable energy from constant social interaction. Now I value solitude much more. I read, write and think, and I am more selective about company. I am also less troubled by being alone than I once was, because solitude has become a place in which I can restore some order to my thoughts.

Yet something else happened at the same time: I became braver. This sounds paradoxical because one might imagine that a person who has developed PTSD after terrifying experiences would become more frightened of the world. In some respects that happens. In another respect, however, once genuinely dreadful things have happened to you and you have survived them, many of life’s ordinary difficulties lose some of their menace.

A bureaucratic problem, an unpleasant encounter, a professional disappointment or a hostile personality can increasingly be met with a hearty shrug. Life has already shown me some of its more unpleasant cards, and therefore many everyday adversities no longer seem quite so intimidating. That does not mean recklessness, nor does it mean that fear disappears. It means that fear acquires perspective.

I have become better at coping with what life throws at me on an individual daily basis because I have learned that tomorrow is another day. Today’s apparently overwhelming problem may look considerably smaller after sleep, coffee and a few pages of a good book. There is something liberating about discovering that one does not have to solve every problem immediately and that sometimes endurance is itself a perfectly respectable response.

Reading and writing have become enormously important to me. Writing imposes order upon experience. An event that exists inside one’s head can be shapeless, intrusive and frightening. Put it into sentences and it acquires a beginning and an end. You can examine it, move the clauses around and decide what it means. The writer exercises a modest sovereignty over experiences that once exercised sovereignty over him, and for me this has become one of the most valuable consequences of writing regularly.

I used to think alcohol made a significant difference to my condition. I no longer believe that it does, at least in my case. I drink less heavily than I once did, but I have discovered that whether I have a drink seems to bear remarkably little relationship to my mood or my functionality. I can have a bad day without drinking and a perfectly good day after having a drink, or vice versa. That is an observation about me, not medical advice for anybody else. People respond differently, and alcohol can plainly be dangerous for some people with psychiatric conditions or in combination with particular medications.

The more important lesson has been that there is no simple chemical switch that turns my condition on and off. PTSD has become something I live alongside. It is neither my identity nor an occasional visitor. It is more like an unpredictable travelling companion: sometimes silent, sometimes tiresome and occasionally overwhelming. Nevertheless, it does not get to decide where we are going.

That distinction matters enormously because one of the most damaging stereotypes surrounding mental illness is the assumption that illness and competence are opposites. They are not. A person can be ill and successful, suffer nightmares and conduct a meeting the following afternoon, have difficulty getting out of bed on Tuesday and perform extremely effectively on Wednesday. A person can take psychiatric medication and pursue several careers. A person can suffer periods of psychological incapacity without being generally incapable. Human beings are more complicated than the administrative boxes into which medicine, employers and sometimes society attempt to place us.

I have managed, notwithstanding PTSD, to navigate a reasonably normal life and to operate fairly effectively. I work, travel, read, write, meet people and pursue projects. There are days on which all of these things are more difficult than they ought to be, and there are other days on which they are effortless. Over time I have learned to exploit the good days and to accept the bad ones without allowing either to define my expectations of tomorrow.

This is one reason I have become interested in Alastair Campbell’s idea of “persevilience”, his fusion of perseverance and resilience. The distinction is useful because resilience by itself can sound rather passive: something strikes you and you bounce back. Trauma does not always work like that. Sometimes you do not bounce back, at least not to precisely the place from which you started. Sometimes you are changed permanently, and the challenge is to decide what you are going to do with the person you have become.

Perseverance supplies the missing element because it is about continuing even when recovery is incomplete. Persevilience, as I understand and admire the idea, does not require pretending to be invulnerable. It means accepting vulnerability while refusing to surrender one’s purposes to it. You acknowledge that today may be difficult and nevertheless do what you can. If you cannot do everything, you do something, and then you try again tomorrow.

Looking back, I realise that I had been applying something like this principle to myself before I had a word for it. I did not recover in the sense of returning to precisely the person I had been before the events that caused my PTSD. I am not that person anymore. I am more introverted, more cautious about certain things and occasionally more tired. Yet I am also braver, more reflective, more independent and perhaps more capable of recognising suffering in other people.

Ukraine has reinforced that lesson because this country is full of people discovering their own versions of persevilience. Some carry injuries that can be seen immediately, while others carry injuries invisible to everyone except themselves and perhaps those closest to them. Many continue working, parenting, volunteering, fighting, studying, loving, arguing, laughing and planning for the future while carrying psychological burdens that would once have been discussed only in whispers. The fact that they continue does not mean that they are uninjured, and the fact that they are injured does not mean that they are incapable.

That is why Ukraine must talk about mental health, as must Britain and everywhere else. We should stop imagining psychiatric illness as a dividing line between the functional and the dysfunctional, the strong and the weak, or the successful and the unsuccessful. Mental health is not arranged into such convenient categories. Some extraordinarily capable people are mentally ill. Some people who appear perfectly well are barely surviving. Some people receiving substantial psychiatric treatment are simultaneously running organisations, writing books, raising children, fighting wars or otherwise living lives of remarkable accomplishment.

There should be nothing embarrassing about saying that one’s mind has been injured. Nobody is ashamed of having physiotherapy after a serious physical wound, and nobody imagines that taking antibiotics constitutes a failure of character. The brain is part of the human body, albeit an unimaginably complicated part, and it can be injured as surely as a knee or a lung. Treating such an injury should no more be regarded as a source of shame than treating any other consequence of violence, accident or disease.

I am writing about my own PTSD for precisely this reason. I do not want sympathy and I certainly do not want to be defined by a diagnosis. I want the subject to become ordinary enough that people can discuss it without embarrassment. I want a Ukrainian veteran, a displaced civilian, a journalist, a volunteer or anybody else who has experienced something terrible to be able to say, “I am having a bad day”, without believing that this admission diminishes them. A society that permits people to speak openly about psychiatric injury is likely to be stronger, not weaker, for doing so.

There are still mornings when getting up is difficult. There are still nights when sleep does not come, or when sleep brings dreams I would rather not have. There are days when the medications seem miraculous and days when they seem useless. There are periods when I want company and periods when I want everybody to leave me alone with a book. Then there are perfectly ordinary days, when none of these things occupies much of my attention at all.

Those ordinary days are perhaps the greatest victory because mental illness does not require every moment of life to become a heroic struggle. The objective is not to spend one’s existence dramatically overcoming PTSD. The objective is to live: to work, travel, make friends, write, laugh, make mistakes, pursue ambitions and occasionally waste an afternoon doing absolutely nothing useful. I have PTSD, but I also have a life. Of those two facts, the second is considerably more important than the first.