Lady Gaga has posted on open letter about her battle with post-traumatic stress disorder (PTSD).
It's after she revealed in an American interview that she's been suffering with the psychological condition since she was raped at the age of 19.
In her online post she calls her battle a "daily effort" and describes her experience as having "chronic pain" in her brain.
PTSD can be triggered after a traumatic event and can include flashbacks.
Head Stuck in a Cycle I Look Off and I Stare, by Lady Gaga
I have wrestled for some time about when, how and if I should reveal my diagnosis of PTSD.
After five years of searching for the answers to my chronic pain and the change I have felt in my brain, I am finally well enough to tell you. There is a lot of shame attached to mental illness, but it's important that you know that there is hope and a chance for recovery.
It is a daily effort for me, even during this album cycle, to regulate my nervous system so that I don't panic over circumstances that to many would seem like normal life situations. Examples are leaving the house or being touched by strangers who simply want to share their enthusiasm for my music.
I also struggle with triggers from the memories I carry from my feelings of past years on tour when my needs and requests for balance were being ignored.
I was overworked and not taken seriously when I shared my pain and concern that something was wrong. I ultimately ended up injured on the Born This Way Ball. That moment and the memory of it has changed my life forever. The experience of performing night after night in mental and physical pain ingrained in me a trauma that I relive when I see or hear things that remind me of those days.
I also experience something called dissociation which means that my mind doesn't want to relive the pain so "I look off and I stare" in a glazed over state. As my doctors have taught me, I cannot express my feelings because my pre-frontal cortex (the part of the brain that controls logical, orderly thought) is overridden by the amygdala (which stores emotional memory) and sends me into a fight or flight response. My body is in one place and my mind in another. It's like the panic accelerator in my mind gets stuck and I am paralyzed with fear.
When this happens I can't talk. When this happens repeatedly, it makes me have a common PTSD reaction which is that I feel depressed and unable to function like I used to. It's harder to do my job. It's harder to do simple things like take a shower.
Everything has become harder. Additionally, when I am unable to regulate my anxiety, it can result in somatisation, which is pain in the body caused by an inability to express my emotional pain in words.
But I am a strong and powerful woman who is aware of the love I have around me from my team, my family and friends, my doctors and from my incredible fans who I know will never give up on me. I will never give up on my dreams of art and music. I am continuing to learn how to transcend this because I know I can. If you relate to what I am sharing, please know that you can too.
Traditionally, many associate PTSD as a condition faced by brave men and women that serve countries all over the world. While this is true, I seek to raise awareness that this mental illness affects all kinds of people, including our youth. I pledge not only to help our youth not feel ashamed of their own conditions, but also to lend support to those servicemen and women who suffer from PTSD. No one's invisible pain should go unnoticed.
I am doing various modalities of psychotherapy and am on medicine prescribed by my psychiatrist. However, I believe that the most inexpensive and perhaps the best medicine in the world is words. Kind words… positive words… words that help people who feel ashamed of an invisible illness to overcome their shame and feel free. This is how I and we can begin to heal. I am starting today, because secrets keep you sick. And I don't want to keep this secret anymore.
For help and information on mental health visit BBC Advice.
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