“Not just PTSD. Complex PTSD. The difference between regular PTSD and complex PTSD is that traditional PTSD is often associated with a moment of trauma. Sufferers of complex PTSD have undergone continual abuse–trauma that has occurred over a long period of time, over the course of years. Child abuse is a common cause of complex PTSD,” she says. Then her eyes drift to the corner of the screen. “Oh–we’re out of time! Let’s continue this next week.”What My Bones Know, p xi
* C-/PTSD trigger warning for Part I of What My Bones Know:
Child abuse, child neglect, thoughts of suicide, self-harm (cutting, disordered eating). The descriptions are direct and honest but not terribly graphic. If you have C-/PTSD, please be sure to read Foo’s author’s note at the beginning of the book.
Thanks for your patience as I continue figuring out how to talk about this complex, beautiful memoir. It has both touched and challenged me deeply. As a result, my writing has come later than I planned, and this blog is more impressionistic and less finished than I would have preferred.
I think one source of my discomfort is how Foo’s descriptions of her childhood resonated with my own experience of living with a partner with PTSD. Let me be very clear here: my partner has never been abusive. Even in the worst times, when the house was full of dissociation and mice and knives under the furniture. And unlike Foo’s parents, Jason has always insisted on taking responsibility for the harm he caused others when he was very unwell. As he said to me recently, “I’m accountable for everything I did. Even the things I don’t remember.”
And yet, there are two ideas that young Stephanie Foo leaned on to survive the intense abuse and neglect of her childhood that feel very, very familiar. There’s a third response her therapist Dr. Jacob Ham described in an Instagram live the two did together that also powerfully aligned with my experience. I think many of us who have cared for traumatized loved ones will relate.
1. Your feelings are more important than mine because they have higher stakes.
Foo survived relentless abuse from her mother, and she describes in her memoir how she learned to suppress and regulate her emotions for her own safety:
“After the beating was over and the berating stopped, though, it was easy. I just turned off the flow of tears and stared out of the window. Or went back to reading a Baby-Sitters Club book. I put it all behind me and moved on. … [W]hat was I supposed to do with those feelings? Catalog them? Sit there thinking about them all day long? Tell them to my mommy and expect sympathy? Please. My feelings didn’t matter. They were pointless. If I felt all those soft, mushy feelings, if I really thought about how messed up it was that my mother threatened to kill me on a regular basis, could I wake up and eat breakfast with her every day? … If I took up all that space with my feelings, what space could I maintain for hers? Hers were more important. Because hers had greater stakes” (p 14).
Jason is not my parent, and during the Catastrophe, I understood that it would be unfair to expect emotional support from him, because it was simply beyond his capacity. I was not a child in the wake of the attacks — I am a fully grown, emotionally developed adult. I did have friends and therapists and a community that provided safe and supportive places to have and process strong emotions. So my experience of Jason’s PTSD was very different than Foo’s experience of childhood abuse.
And yet…for the first five or six years, I trained myself to not respond emotionally to the constant waves of anxiety and panic and depression and rage and ice-cold withdrawal. I was the keel that our boat required in the seas of PTSD. Keels don’t bend. Keels convert the sideways force of the wind into forward motion. That felt like my purpose as a caregiver. Turn the force of punishing psychic blows into healing. Provide ballast, even if that meant that I was always underwater.
2. I can get through this by working harder.
Foo describes enormous successes achieved at a very young age: Editor of her high school newspaper. Writing stories professionally in her teens. Finishing college in two and a half years. Working on the immensely successful and influential podcast, Snap Judgement. Getting her dream job at This American Life in her 20s.
“Like a good Protestant American,” she writes, “I continued to save myself through work” (p 48). How could I possibly still be suffering, she reflects, if I am so successful?
I’ve written about my own reliance on this strategy elsewhere, and won’t belabor the point here. But I collapsed into nervous laughter reading this section. Work has certainly been my go-to coping mechanism.
As a teenager, the fictional character I most identified with was Jurgis in The Jungle. Upton Sinclair clearly wanted us to view him as a patsy, killing himself for capitalism. But Jurgis’ refrain — “I will work harder” — always spoke to me.
At times, PTSD caregiving made me feel like a drone, a worker bee. There were benefits: I did more than 100 events to support my last book. I taught classes! I wrote grants! I started new projects! But the strategy also had real costs: to my physical health, to my other relationships, and to my own mental health.
3. I’m the audience of a play I didn’t even buy tickets for.
In their enormously moving conversation on Instagram Live, Foo and her therapist Dr. Jacob Ham are discussing dissociation and their strategy of “Google Doc therapy,” where the two of them would record, transcribe, and comment on Foo’s sessions.
Foo says, “When you’re triggered, you don’t have this perception, but when I [read] the transcripts [of our therapy sessions] … I could see [where] I stopped in the middle of a sentence and went 180 [degrees] away from the scary thing. In our first session, I went on for a page and a half, rambling about my husband Joey’s job. … I asked, ‘What is happening here?’ and you said, ‘Ah! Classic case of dissociation.’ I scrolled up, and right before then, I was talking about my childhood history and saying, ‘Oh, my mom used to hold knives to my throat.’ I turned off my brain in some way to say that, and then I got lost.”
In a move that I deeply appreciate, Dr. Ham then describes his own response to Foo’s dissociation during therapy.
“For me as a therapist, I either get lost in the story because I don’t know what it’s about, or I get really bored and annoyed,” he says. “To me it’s a signal. You just disappeared on me! I’m not part of this conversation anymore. I’m the audience of a play I didn’t even buy tickets for. I become an object instead of a subject.”
Most therapists have this vital flaw of being too polite. They don’t want to interrupt, shame you, or tell you that this is bad. They want to collude with this avoidance. I can’t collude with this; I can’t abide with your dissociation taking over your authenticity. That’s why it feels rough to work with me.
I identify with feeling like the inert audience for dissociative ranting. Dr. Ham helped me name why being in that role has always bothered me so much. Dissociative talk is not human communication; it is broadcast. Like PTSD caregiving at its worst, dissociative talking turned me, the ostensible listener, into an object rather than a subject. The keel. The drone. The untiring ear.
I aspire to his tricky and powerful refusal to collaborate with C-/PTSD. Ham left me thinking. How do we approach the suffering of our loved ones with compassion and deep affection, but still refuse to collaborate with it? With dissociation? With addiction? With withdrawal? With whatever supplants their authenticity?
* A note on the content/trigger warning language here. One of the things I talk about a lot on this blog is how muddled our language about C-/PTSD is. I struggle with the use of “trigger,” for example, to talk about emotional or somatic responses of discomfort that aren’t related to C-/PTSD. Recently, Amadi Lovelace posted a thread on Mastodon that helped me clarify my discomfort and I’m trying some provisional new language as a result.
Lovelace’s argument is that the way content warnings (CW) get used on the social media platform — to hide conversations a poster thinks might be emotionally difficult or annoying for others — is an appropriation of an accessibility tool intended for those with C-/PTSD. She notes that the CW function is often used to identify pet peeves, preferences, and potential sources of discomfort: self-promotion, conversations about race, spoilers for movies, reflections on Twitter. She argues that the practice produces three problems:
1) Monopolizing and mis-using accessibility tools. Content warnings are intended as an accessibility tool for people with C-/PTSD and other trauma-related conditions. Lovelace writes that CWs “provide guidance to vulnerable people that material might trigger serious emotional disturbance, panic attacks and/or PTSD symptoms.” To use it for other purposes is, she writes, akin to people using building entry ramps as bike jumps, making it more difficult for people with disabilities to access public space.
2) Chilling crucial dialogue. Non-specific warnings (i.e. “racism”) can have a chilling effect on dialogue about crucial (and uncomfortable, for some) topics. Lovelace writes, “CW means ‘this could impact your health’ not ‘you might not want to see this.'”
The purpose of content warnings, she concludes, “was never about allowing people to avoid things that bother them or that they want respite from, but to allow people with PTSD and other, similar significant issues rooted in trauma experiences to engage with material or on platforms without having their health condition worsened abruptly and unnecessarily.”
3) Diluting the effectiveness of CWs and thus directly harming people with C-/PTSD. Proliferations of content warnings about preferences and pet peeves effectively dilutes the power of CWs, making it more likely that someone with C-/PTSD will get blindsided by graphic material that can cause them immediate damage.
Lovelace writes that CWs are intended for “things known and recognized to be harmful because they encompass almost all triggers…depictions or descriptions – esp. detailed descriptions – of abuse, violence, gore, medical procedures and death.” That doesn’t mean that there aren’t other, more individual, triggers out there — one of Jason’s big ones is the vibration of a bus passing near our house — but, Lovelace writes, “Individual triggers are separate from the kinds of things that are routinely given warnings as an access tool because they’re not something that can be known. … Individual issues can only be addressed within close community, and people know that.”
I love that the CW function is built right into Mastodon. But a primer on the social media platform’s culture explains that users should content warn when topics might cause discomfort or offense. The example provided of a discussion that should carry warnings is “mental health.” Putting a CW on a conversation that merely acknowledges the existence of mental illness risks reproducing stigma and protecting the privilege and ignorance of the neurotypical rather than helping people with C-/PTSD manage their condition.
Lovelace’s analysis helped me clarify my own thinking and so I’m trying something new: I will continue to reliably provide content warnings for the kinds of material that Lovelace identifies: “depictions or descriptions – esp. detailed descriptions – of abuse, violence, gore, medical procedures and death.” I will call those warnings “C-/PTSD trigger warnings” instead of content warnings. I’m not warning readers of difficult content. I’m warning readers with C-/PTSD about content that reliably triggers flashbacks, dissociation, and other trauma responses.