Yesterday, Dan linked to several posts that claimed PTSD is rare, that avoiding triggers actually makes the condition worse, and that millennials in college abuse the term. I don't agree with all of those conclusions, and I don't agree with his assessment of trigger warnings.
In 2014, I spent 10 months fact-checking a book on PTSD from human rights reporter Mac McClelland. It was a memoir, but it was also loaded with research. I was hired to fact-check the parts of the book that covered the most up-to-date clinical research on PTSD, specifically rape-related PTSD.
It was a pretty shitty year. Here's what I learned:
• No one knows for certain whether PTSD is over-diagnosed, or under-diagnosed.
What we do know is that the experts on PTSD—many more than the ones Dan cited—disagree. The estimates for the prevalence of PTSD in Iraq and Afghanistan vets alone ranges from 100,000 to more than 300,000. That's a pretty big difference.
• Rape is underreported, often results in PTSD, and is common.
One of the facts that took me weeks on end to check dealt with whether most of the people suffering from PTSD in our country were survivors of rape. Here's the best answer I could come up with, based on the best studies I could get my hands on.
The rate of PTSD for Vietnam combat veterans is 31 percent for men, and 27 percent for women. The rate of PTSD for rape survivors is 65 percent for men and 46 percent for women. Domestic violence is also another driver of PTSD diagnoses.
There are 21.8 million veterans in the United States. There are 157 million women in the United States. According to the National Intimate Partner and Sexual Violence Survey, 19.3 percent of women have been raped in their lifetimes, and so have 1.7 percent of men.
If those prevalence rates hold true, that means rape survivors make up a bigger portion of the PTSD population in the United States than combat veterans.
When you think of PTSD, do you think of a rape survivor? I didn't until fact-checking this book.
• It's also common in college.
One of the experts Dan cites says that many rape victims get over their symptoms in the first few months after their sexual assault.
Even if half of survivors of sexual assault move past their symptoms in the first few months (let's remember that the other half does not), an estimated one in five women are raped while in college.
PTSD is defined in the DSM-V as a disorder with symptoms that persist longer than one month. If one in five women are raped in college, 46 percent develop PTSD (with symptoms lasting longer than a month), and then half see those symptoms go away after several months, that means that 4.6 percent of women in college experience PTSD symptoms that last longer than several months.
Several months is more than enough time to make the decision to drop out.
• Our understanding of PTSD has changed over centuries, and will continue to change.
It used to be known to the Greeks as being "out of heart." Or as "nostalgia" during the American Civil War. Hysteria, even. Our current understanding of PTSD mostly comes from observations of Western combat veterans. But if the calculations above are even close to right, most of the people suffering from PTSD in this country are not combat veterans. They're civilian women.
• Exposure therapy is not the right way to treat PTSD for everyone.
Another expert cited by Dan says that avoidance is a symptom of PTSD. And that "systematic exposure to triggers is the most effective means of overcoming the disorder."
The Department of Veterans Affairs endorses exposure therapy and cognitive behavioral therapy (CBT) as treatment for PTSD. But CBT and exposure therapy don't work for everyone, and some new ways of treating PTSD—including trauma-centered yoga, even—have shown some pretty dazzling clinical results. "As I dug into it, I was learning that there were nearly as many treatments for PTSD as there were causes," McClelland wrote in her book. "We'd come a long way from the World War I-era method of trying to electrically shock and emotionally abuse PTSD out of soldiers."
The VA is currently investigating dozens of these treatments in clinical trials, because we still haven't figured out how to treat PTSD for everyone. Assuming that exposure therapy works for everybody—or that it's therapeutic or even helpful for PTSD-havers to experience triggers in a classroom—is fundamentally unproven.
• Denying trauma often denies the existence of structural violence in our society.
"When trauma studies don't find that the fault lies with the victim, and when they create space for those victims' realities to be validated, an entire society becomes responsible," McClelland wrote.
I don't know what she thinks about trigger warnings—I'm not speaking for her here—but I do know that based on the research I did for her book, trauma (and by extension, violence) is way more common in our world than anyone would like to admit.
"Denial, repression and dissociation operate on a social, as well as an individual level," Dr. Judith Lewis Herman, renowned psychiatrist and researcher, wrote in her book Trauma and Recovery.
Taking that much into account, I err on the side of being sensitive to people who say they're triggered by specific reminders of rape or war. I think that they have enough shit to deal with, that society hasn't caught up to understanding what they're going through, and that it's better to treat a mental health and physiological condition with compassion than it is to assume that person is being hypersensitive.
Trigger warnings are ways for PTSD-havers to choose whether they are able to engage with certain material that could trigger them. Like George S. Bridges wrote in his Seattle Times op-ed, I think that's a good thing. I have yet to see someone demonstrate that trigger warnings are actually being widely abused by PTSD malingerers. Instead, most of what I read on trigger warnings seem to be attempts to invalidate or ignore the people who need them the most.