Posts Tagged ‘post-traumatic stress’

Some years ago, the Vancouver Folk Festival included an activist for the disabled. When an announcer on one of the afternoon stages called him “differently abled,” he immediately took over the microphone.

“Differently abled?” he said. “Hell, I’m a bloody crip!”

I think of his reply sometimes when I see articles prefaced with a trigger warning that they discuss potentially disturbing topics. Then I wonder if the warnings really do anything for the people they are supposed to help.

To start with, isn’t a title supposed to make clear what you are talking about? With any halfway conscientious writer, most trigger warnings are redundant.

More importantly, I question whether the average traumatized person wants to be sheltered from potential upset. Possibly, just after their trauma they would prefer not to dwell on what happened. But, more than anything else, the people I know who suffer from long-term trauma have a tremendous desire to cope. They want to appear normal, even if that appearance is an illusion. They don’t want to stand out, or to talk about their problems, or to be given more special treatment than is absolutely necessary.

From this perspective, a trigger warning is not a kindness or a piece of politeness. It’s an implication that they can’t manage – that all their carefully constructed defenses aren’t enough, and that, although they are survivors, their survival tactics aren’t enough.

In their minds, I am told, such implications are, if not actually an insult, then a dismissal of their ability to survive. The truly traumatized (by which I mean the raped and assaulted, and the people with Post Traumatic Stress Disorder, not the upper middle class professional feeling thwarted at work) often take great pride in their ability to cope, so they are not going to appreciate any suggestion that they can’t.

In fact, their obsession with passing for normal is so great that a surprising number of those suffering from long-term trauma have said that, if a treatment could make them forget what happened or somehow remove its effects upon them, they would refuse it. A magic removal of their trauma would be a denial of the pride they take in having survived.

Yes, a trigger warning might spare them. But many of the traumatized don’t want to be spared. They want to prove, if only to themselves, that they can survive to some degree, even when faced with topics related to their conditions. This desire exists even when they encounter a trigger warning when browsing the Internet by themselves, and independent of how well they actually can rise above everything.

In effect, a trigger warning is an invitation for the traumatized to relax and spare themselves pain. Yet that is something that the traumatized cannot do with most people or in most situations. If they are lucky, they might be able to relax with a lover or a close friend, and resist the temptation to read past the trigger warning. But in most cases and with most people, the trigger is likely to be a challenge. If anything, some of the traumatized whom I know would be all the more tempted to click a link with a trigger warning, just to test themselves.

Those who provide trigger warnings mean well. The warnings are not just runaway political correctness, as conservatives have been known to suggest. But in their effort to pass for normal, few of the traumatized appreciate the effort to give them special consideration. From what I’ve seen, most of them would be more grateful if you let them face whatever happened along without any illusions and didn’t single them out for special treatment.

A trigger warning might seem to be a kindness. But from a traumatic perspective, it may be a subtler cruelty than a direct insult.

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In Sylvia Plath’s The Bell Jar, the main character gets hold of a diagnostic checklist of psychological conditions. In her downward spiral, she concludes that she is suffering from all of them. The episode is partly black humor, but many people today would probably miss the joke. They’re too busy diagnosing themselves with as suffering from all sorts of conditions, both dubious and real.

I first became aware of this modern tendency in the days after the 9-11 attacks. In the aftermath, people who lived on the other side of the continent from the attacks, people who had no friends or relatives killed or wounded in the attacks, and, in some cases, had never been to the sites of the attacks, were suddenly claiming that they were suffering from post-traumatic stress. Nor did they have any pre-existing trauma that the attacks might have triggered. Having heard of the condition, they were dignifying their alarm by elevating it to a psychological state. Very few (in fact, none, I would guess) had been officially diagnosed, or saw any need to be.

Soon after, I became aware that some computer programmers liked to claim that they were suffering from Asperger’s syndrome, a mild form of autism. The claim provided an excuse for any anti-social behavior, and, because Asperger’s is often associated with high intelligence, helped them to feel better about their shyness. Yet I never met one who had consulted a clinical psychologist to be properly diagnosed.

Since then, the habit has spread like a fire from an oil-soaked rag. I have heard people struggling to get by on four hours’ sleep each night allege that they were suffering from Chronic Fatigue Syndrome and people wired on eight or nine cups of coffee announce that they were suffering from Adult Attention Disorder Deficit. One person, starting to exercise after over a decade of inactivity and feeling a soreness and trembling in their arms and legs, claimed that they had Fibermyalgia; another, notoriously self-centered, states that they suffer from Prosopagnosia, or face-blindness. In one or two cases, I have heard people make one of these claims even after they had been diagnosed as not having the condition with which they identified so closely.

What makes these self-diagnoses particularly ludicrous is that some of these conditions are either not widely accepted as a physiological or psychological condition or else exist only under very specific conditions. However, such details are generally over-looked by the would-be sufferers.

Why people should make such unsubstantiated claims is not hard to understand. Saying that you have, for example, Chronic Fatigue Syndrome is more interesting, even to yourself, than admitting that you don’t take care of yourself. It also requires much less effort than changing your habits.

In the same way, to say you have face-blindness sounds far better than saying you are incompletely socialized, and need to learn to look beyond yourself and notice other people.

More importantly, if you have a psychiatric condition or a genetic predisposition, then your behavior isn’t your fault. You don’t have to do anything about it. You can excuse your behavior (at least to yourself) and go right on doing it. If anyone calls you to account, then they are the crass ones, not you. You are the victim of circumstance, and are not obliged to help yourself.

I make these statements with some confidence, because people who truly have these conditions generally act very differently. They do not announce their conditions to everyone they encounter – to the contrary, they often go to great lengths to conceal them, often changing their lifestyles or employment, or adding a battery of work-arounds to their arsenal of habits so that nobody will ever know. Far from being proud of their problems, they see them as handicaps or deficits for which they have to compensate and struggle against.

That is to say, people who really have problems don’t try to ennoble or publicize them. They’re too busy trying to do something about them.

In fact, what concerns me most about the self-diagnosing is that they can reduce the credibility of genuine sufferers. If employers encounter too many people using post-traumatic stress as an excuse for anti-social behavior, they may run out of patience and not give the necessary sympathy for the genuinely shell-shocked.

Similarly, anyone who encounters Adult Attention Deficit Disorder being used as an excuse for lack of concentration might very well be out of patience when they meet the real thing. After all, even reputable psychologists need time for a proper diagnosis, so how is anybody without training going to be able to separate the dubious condition from the true.?

I’m almost tempted to wish that the self-diagnosing could be inflicted for real with the conditions they already claim to have. But that would be cruel – many of these conditions are not ones that I would wish on anyone.

So instead, I’ll wish that the self-diagnosing would either grow up or keep quiet. What they are talking about is far too serious to tolerate their games. Unlike Esther Greenwood in The Bell Jar, many of them do not even have the excuse of adolescence or actual problems to justify their self-indulgence.

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A close acquaintance of mine has had post-traumatic stress syndrome (PTSD) for the better part of a decade. Recently, this person referred to their condition to a relative, only to receive the reply, “Aren’t you over that yet?”

The response highlights one of the many misunderstandings of this condition. In fact, from its origins to its symptoms, treatment, and long term prospects, probably no other mental condition is so misunderstood. Nor is understanding encouraged by the fact that the words “trauma” and “stress” are bandied about by people to refer to normal reactions to daily events or merely mild upsets.

So what is PTSD? Contrary to popular perceptions, it is almost never the anxiety caused by financial or romantic concerns, or by grief. All these circumstances can be stressful, but do not result in PTSD unless other factors are at play as well.

Nor is PTSD simply a reaction to physical trauma, such as combat or rape. Many people go through both and do not develop PTSD, while some people develop it because of psychological sufferings, such as interactions with unsympathetic authorities or the suicide or random deaths of people around them.

Just as importantly, there is no way of predicting what will cause PTSD. What triggers the condition in one person may seem trivial to another, and some cases of PTSD are caused by a single episode while others are caused by a continuing sequence of events. Contrary to the way that “shell-shock” was once regarded, it is not a matter of cowardice, but of being overwhelmed and rendered powerless by events.

Similarly, while some studies suggest a genetic predisposition to PTSD, what matters is whether a person ever encounters circumstances that will cause the condition in them.

Another reason to downplay any genetic tendency is that the cause of PTSD seems primarily psychological. What all cases of PTSD seem to have in common is a loss of world-view – in particular, an individuals’ ability to control their own life.

Faced with a loss of meaning and control, those with PTSD develop what psychologists refer to as “hypervigilance” — a more or less continual condition of extreme alertness. This condition generally includes permanent physiological changes to the body, including an exaggerated startle response, and permanently higher pulse rates, and higher blood pressure. A PTSD sufferer is always far closer to fight or flight than the average person, or than what they were when they were healthy.

These physiological changes explain the images of PTSD in popular culture, in which the crazed war veteran goes berserk, or the badly stressed resort to alcoholism or drug addiction. And, in fact, sometimes those with PTSD do act in this way. However, more common symptoms are depression, loss of purpose and direction, nightmares, and a distancing from social contacts. Perhaps the most common symptom is a sense of existential angst (in fact, it may not be a coincidence that existentialist philosophy emerged out of France around the end of World War 2).

All of these symptoms may be reinforced by a person’s reluctance to disclose their problem for fear of appearing vulnerable – after all, to the hypervigilant, to appear weak means that they are risking attack.

Contrary to the response my friend received, PTSD is not something you “get over.” It makes permanent changes to the body, and probably the mind as well. It can flare up at any time, even after many years. In this respect, PTSD is similar to malaria – it is something that you learn to live with, but never move beyond.

Treatment of PTSD is two-fold. In the short term, those who suffer from it can minimize its effects by reducing the stress in their lives. Eating a balanced diet, staying physically fit, and getting rest all help. Even more importantly, those with PTSD need to develop a routine that minimizes the stress in their lives. They may need to find less stressful work, or have more flexible hours, or even work from home.

For example, the poet and novelist Robert Graves, who suffered shell-shock in World War I, eventually fled to the quiet of Majorca after over a decade of unsettled life in England. When people congratulated him on his apparent recovery, he explained that all he had done was to organize his life to deal with his problems.

In the longer term, the most successful coping mechanism seems to be to find a way to reaffirm the world view and values that PTSD have shattered. A classic example is the Canadian general Romeo D’Allaire, who suffered PTSD from what he perceived as his failure to do his duty as a soldier and stop the genocide in Ruanda while he commanded United Nation forces there. After a period of adjustment in which he was often drunk, D’Allaire managed to re-assert his ethics by becoming a strong advocate for peacekeeping by both Canada and the United Nations. He has also spoken frequently about PTSD and become something of an advocate for Canadian soldiers who suffer from his condition.

This sort of compensation can mean that, despite their condition, many people with PTSD can lead highly purposeful and accomplished lives. The catch is that they generally have to continue their accomplishments in order to reassert their world view against the trauma that has physically and mentally transformed them.

Finally, perhaps the most important point to make is that PTSD is not a mental illness in the sense that schizophrenia is. Instead, it is more accurate to compare it to an injury such as breaking a leg that permanently changes regular functioning. A person with PTSD is sane by any legal or common sense definition, but, like someone in whom an injury has left one leg shorter than the other, they have some troubles with ordinary functioning.

The next time you see someone with PTSD, try to keep these points in mind. And remember – the only reason that you haven’t suffered from the same condition may be that you have been lucky.

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