Five years ago, Lady Gaga co-founded the Born This Way Foundation, a non-profit with a general goal of creating safe spaces and fostering tolerance. And today, on the foundation’s website, she’s written an open letter about her ongoing issues with post-traumatic stress disorder.

Gaga’s piece never gets into why she’s suffering from PTSD in the first place, but she does describe, in some detail, the effect that the disorder has on her and how it can sometimes make her appear detached: “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.” She writes about shutting down when she doesn’t know how to deal with a situation, and she even includes a note from her doctor. You can read her piece here.