“We’ve got a very high bottom as a culture. Which is why we’re so traumatized the whole time. Anything’s traumatic. Your phone doesn’t work. How traumatic could that be?”– Will Self, on the Our Struggle podcast
Apologies for the long delay since my last post. Life intruded — a bomb cyclone of work, relationship stuff, a death in the family — and I took some time off.
Yesterday, I was preparing to pick up our discussion of The Evil Hours with a post on David Morris’ potent genealogy of PTSD. I was comparing it to Will Self’s frustrating “A Posthumous Shock,” a strangely ahistoric 2021 Harper’s essay that claims to historicize trauma culture. In it, Self explains that trauma as a concept/experience/phenomena began with the advent of the railroad. “Trauma is so widespread precisely because of the ubiquity of traumatogenic technologies in our societies: those of specularity and acceleration, which render us simultaneously unreflective and frenetic,” he writes. “On this analysis, the symptoms deemed evidence of PTSD are in fact only an extreme version of a distinctively modern consciousness.”
That is to say, shedding some of Self’s razzle-dazzle language, trauma/PTSD as we know it only exists because our technologies of self-reflection (magazines, film, TV, social media) and speed (trains, planes, and automobiles) have created a shallow, entitled sense of suffering among mostly white, mostly western, mostly rich people of privilege. Our coddled minds project anxiety and panic into our flaccid bodies, he argues, as a means of defense against real pain, and as a rationalization for the pain we cause others. Claiming trauma, he argues, is a way of making ourselves feel both special and morally inconsequential.
I’m not convinced by his argument. He gets important parts of the history of PTSD wrong, suggesting that the struggle to include PTSD in the DSM-III by Vietnam Veterans Against the War (VVAW) was primarily about compensation, for example. The essay feels ugly-spirited: snark is not a useful orientation when trying to unravel or understand the pain of others.
THE TYRANNY OF SYNECDOCHE
But most tellingly, Self conflates trauma and PTSD. “By ‘trauma,'” he writes, “I mean in part the cluster of symptoms defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as post-traumatic stress disorder (PTSD).”
As I’ve written elsewhere, trauma and PTSD aren’t the same. The DSM-V actually defines trauma as “an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about an unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.” It requires that the survivor of the event experienced “intense fear, helplessness, or horror.” (For more on the controversy about the changes in the diagnostic criteria for PTSD, see “Trauma Redefined in the DSM-5,” by Jones and Cureton.)
As the DSM also makes clear, trauma doesn’t automatically produce PTSD. While more than half of us experience trauma during our lifetime, only about 7% of people go on to develop PTSD, which has symptoms that are separate from the event that incited it: intrusion (nightmares, flashbacks); avoidance (numbing, withdrawal); negative alterations in cognition (persistent and unreasonable fear, guilt, and shame); and arousal (hypervigilance, exaggerated startle reflex, sleep disturbance). You only get diagnosed with PTSD if these symptoms significantly impair or disrupt your life for more than 30 days.
Conflating trauma and PTSD is a slippery rhetorical trick, synecdoche on steroids. The part (PTSD) comes to stand in not only for the whole (trauma) but for everything the author thinks is wrong with the world (this putative thing critics call “trauma culture.”) This linguistic slippage allows Self to diminish, erase, and delegitimize a real, specific thing by expanding it to include a universe of things it is not. Metaphors gone wild.*
WORKED UP IS NOT TRIGGERED: THE REACTIVITY PYRAMID
Something deeply ironic happened as I initially sat to write my critique of Self’s essay. I got really worked up. So much so that I began to tip into activation — I got light-headed, my breath became rapid and shallow. I stood and paced the room, letting my body work out its desire for flight. One of the key things that activates me, I have learned through my own journey partnering PTSD, is having my experience or humanity erased and dismissed.
I laughed to myself. Self would probably argue I had proved his point.
The stigma of mental illness allows this kind of nonchalant smudging of important distinctions. If “upset” is the same as “triggered” is the same as “PTSD” is the same as “trauma,” then yes, we live in a trauma culture. People are pretty upset right now. There’s good reason. But that’s like saying that having your foot fall asleep is the same as neuropathy is the same as diabetes.
Of course, emotional upset, being triggered, having PTSD, and experiencing trauma are not the same, and no one is arguing that they are, except, perhaps, a few too-credulous cultural critics.
So I thought I’d shed some light by sharing the specifics of my own experience. I am a person who has always gotten worked up by things I feel passionately. I have always thought it was a superpower, not a pathology. But in the six years I’ve been partnering PTSD, and since my own diagnosis, I’ve developed a much more nuanced view of the top three tiers of what I’m calling the Reactivity Pyramid.
As I wrote in an earlier blog, I’m much more likely to move from upset to activated these days. Being activated means I am pushed to the edges of my window of tolerance (more on that here) into a symptomatic reaction — panic attack, emotional shut down, hypervigilance. Because I’ve had access to great therapists, both cognitive and somatic, I’ve learned to pick up my body’s cues that I’m moving from upset (a normal condition) to activation (still normal, but things are starting to get dicey). So I’m usually able to use my resources — breath, movement, identifying and unraveling cognitive distortions — to keep from becoming triggered.
Being triggered means that you are having a bodily response to a sensory input (sound, smell, image, etc.) that brings you back to a trauma as if you are living through it again. It is a reflexive response that arises from the survival brain, the amygdala, not the hyperrational neocortex. It doesn’t feel like an uncomfortable thought or an out-of-control emotion. It feels like non-consensual time-travel, and it is terrifying.
During the roughly four years that Jason was suffering so badly that I feared going near him, I got triggered a fair amount: by medical paperwork, debt, the stresses and strains of caregiving, being failed by institutions that should have helped us, and by Jason himself. I’ve described what that was like elsewhere. But because my PTSD was mild, I could usually recover by attending to myself extra carefully over the ensuing hours or days.
I almost never dissociated. I think it happened twice, in the early years, during fights with Jason that were so bad that I couldn’t recall any details in the days after. I had a feeling that something terrible had happened, but I couldn’t for the life of me remember just what. There were these smeary holes in my memory.
I want to be clear that my ability to consciously control my reactions — to stop myself from rocketing to the top tier of the reactivity pyramid — was because my case of PTSD was so very mild. I had the seasonal allergies version: annoying, but not really threatening to my health. Most people with PTSD struggle for years to expand their window of tolerance enough that they can recognize triggers before they happen and minimize their impacts.
Jason, for example, lost most of TWO YEARS to dissociation. This is a guy with a legendary memory. We used to play a game, a party trick really. I’d say, for example, “October 27, 1984,” and he’d tell me what he had been doing on that day. Sometimes he couldn’t dredge up the actual day, but he always had details of the week: what song he was learning to play on the guitar, a funny thing his sister said, a conflict with a middle school teacher. Today, while he can still produce pristine pictures of his days prior to the attacks, he retains only a handful of memories from 2016 and 2017.
I had a very minor, mild case of PTSD. My symptoms lasted about 18 months. About a year in, after I started journaling about our journey, I started to recognize in my suffering — the panic attacks, nightmares, withdrawal — symptoms of PTSD. I asked a clinical psychologist to test me, I was diagnosed, and I got more targeted help. I got better. Today, I’d say I no longer have PTSD. I’m cured, or maybe the disease is in remission.
The complexity of my actual experience is impossible to understand through the lens of “trauma culture.” Just as Self conflates PTSD and trauma, most of us turn the severity of every case of PTSD up to eleven. All PTSD is the worst PTSD ever. That’s the atrocity hierarchy at work, and its slippery (cynical?) synecdoche threatens our survival.
* Metaphors about non-mental health problems rarely function this way. Sontag convincingly argued that attributing human emotions and motives to cancer interferes with patients’ actual experience of having cancer and hampers their healing. But no one ever argued that our over-reliance on cancer as metaphor means that cancer doesn’t actually exist.