In a sketch on Euphemisms, George Carlin mocks the way that language has changed, “squeezing all the humanity” out of a term that needs to describe a state of extreme pain and distress. “Shell shock” became “battle fatigue” became “Operational exhaustion” became Post-Traumatic Stress Disorder (PTSD).
Join me below the fold for a discourse on vernacular, euphemisms and triggers.
Editor's Note: Operational Exhaustion is an excerpt adapted from Vernacular and Euphemisms - Get Out! Trigger warning? STFU! by LilithGardener, published with the Courtesy Kos group on May 31, 2014. It has been lightly edited for this series.
Shell shock referred to an altered state of being in people who were exposed to violence. They were exhausted beyond their capacity to resolve their conditioned fear response and their nervous systems were stuck in a state of alarm long after real danger had passed. The conditioned fear response occurs in all animals and is an essential mechanism within our survival-based evolutionary learning system. A simple example of conditioned fear is teaching children not to touch the stove by bringing their hand close enough to feel pain.
When we are calm and rational our nervous system is in balance. The parasympathetic nervous system (restorative brain chemistry) is balanced with our sympathetic nervous system (threat response and survival brain chemistry). PTSD occurs when a person's normal resilience to violence or threat of violence is disrupted and their nervous system is unable to resolve their survival response, (Freeze, Fight, or Flight), and return their body/mind to a state of calm readiness. This is important and bears repeating. We are calm and alert, and able to think clearly, when the parasympathetic branch of our nervous system is in balance with the sympathetic branch.
WTF is a trigger?
Many triggers help us all to stay alive. They are part of our evolutionary response to survival threats. They activate our sympathetic nervous system and flood our bodies with stress hormones. That's why they work. They compel us to focus and change our immediate behavior in ways that increase the survival or our species.
Effective triggers are impossible to ignore. The horn of a fire engine alerts us to an emergency. In traffic the fire engine horn is so repulsive it motivates people to change their behavior, to stand back or get out of the way. It is essential communication that helps first responders go quickly through crowded streets to the persons in distress.
After danger has passed and the triggering stimuli turns off our parasympathetic nervous system can bring us back into balance. Studies of breath and breathing have shown that when we inhale our sympathetic system is dominant, and when we exhale our parasympathetic nervous system is dominant. When you take long slow breaths and consciously slow down your breathing rate your brain gets the message that danger has passed. That's the neurochemistry behind the phrase, "Take a deep breath." That is why meditation works. It's why coherent breathing works. With training, it is possible to interrupt an anxiety attack in 3-5 breaths simply by lengthening your exhale.
Any stimulus associated with a traumatic event can become a trigger.
In PTSD a trigger is like a loose switch that can initiate a freeze, fight, or flight response associated with a prior traumatic or terrifying event. Some people have disturbed sleep after watching a violent movie. During sleep our brains can't distinguish images of the movie from actual threats in real life and in real time. Loose triggers are why people have nightmares. Those memories and images can activate a biochemical response, releasing adrenaline and other stress hormones, even during REM sleep. When awake, a loose trigger activates a neurochemical switch that can take someone's awareness out of the present moment, and refocus their attention back to an earlier event in their life. In that sense being triggered is like having one foot in the present and one foot in the past. Being easily startled, or being triggered by trauma-related cues, is one symptom of PTSD. The resulting disorientation in the time dimension interferes with focus on the task at hand and can be debilitating.
WTF is a trigger warning?
In her beautiful diary, Green Mother sorted through some common misperceptions about PTSD. She explained what triggers are and why trigger warnings matter.
Putting that trigger warning out is a mindful step, that tells the world we are intelligent enough to comprehend the depths of trauma, and strong enough to care for those who have been affected by it.Trigger warnings help vulnerable people get on with their lives. An ace bandage on a sprained elbow prevents further injury during the time a vulnerable joint needs to heal. In the same way, trigger warnings help people avoid further injury while they heal from prior exposure to violence. They help vulnerable people navigate their way around content that can reinforce past trauma. It's the reason the Nickel Mines and Sandy Hook Elementary Schools were torn down. Forcing young children to go to school where there classmates had been murdered could trigger them and interfere with their recovery.
Take A Breath
Trigger Warning: Concert Video, Flashing Strobe Light
Trigger warnings might not be possible
People learn to cope ahead. If a trigger is truly unavoidable they learn to manage what happens afterward. I have an unavoidable trigger associated with fire engines. It maps to September 11, 2001, when I lived across the street from a hospital emergency room. Living there for many years, I was accustomed to the ordinary sounds of traffic and the comings and goings of that ER department. My earliest awareness that morning, that something was terribly wrong, was the sound of multiple emergency vehicles arriving one after the other, in rapid succession.
The horn of a fire truck became a trigger. It's a very specific trigger. Not an ambulance. Not a police car. Not any other kind of horn or siren. A firetruck. It is my only remaining trigger to that horrible day. If I'm on the street and a fire horn blares nearby behind me, I usually get triggered. My heart will race, my breathing will become rapid and shallow, I'll burst into tears or feel an overwhelming urge to run. Sometimes, even 12 years later, I lose awareness of my surroundings. It can take me an hour or more to calm down and focus on anything else. Being triggered means awareness and experience of the immediate present is overwhelmed because some stimuli has activated a compelling internal focus on the past.
But if a fire truck blares their horn anywhere in front of me, within my visual field, there is no neurochemical trigger to disturbing memories of that day, there are no tears, and there is no urge to immediately run away.
Why does my visual field matter?
First and foremost, triggers are a neurochemical survival response. The information flooding in through my eyes is more important than what I hear, and it anchors my awareness in the present moment. My eyes automatically map the emergency signal as external distress. My brain learns from the visual cortex that there is no immediate threat to my own life. My mind quickly understands that an attack like 9/11 is not beginning again.
But wait. I wasn't in the buildings that fell and I didn't have to run anywhere that day.
A skeptic might think I'm making this up, that I'm just adding drama to enhance a story, that I just over-react. They would be wrong. So where does the urge to flee come from? Triggers can be subtle and complex and mapping their origins can take a long time. This is one trigger that is straight foward and easy to understand. The urge to flee is one form of conditioned fear response. It's real human biology doing what has kept us all alive long enough to reproduce. Bursting into tears is autonomic nervous system overload, signaling a need for help. It's so primal it's the same biochemical cascade that causes an infant to cry in response to the sound of other babies crying. It's a mechanism that amplifies a survival signal. It helps to ensure that babies in distress receive necessary attention from adults nearby.
In this example, the urge to run is a neurochemically-triggered behavioral response to an internal perception of imminent danger. The trigger flips a switch in my brain that activates my freeze, fight, or flight survival mechanism, even in the absence of an imminent threat to my own life. The medical term is dysregulation of a fear response. The danger is in my imagination, but the biochemistry has very real effects.
Listening to the silence between the words
George Carlin made an important point about the way euphemisms dilute and diminish our ability to describe a state of extreme pain and distress. In recent weeks, I’ve read posts by Kossacks I respect that show they have little or no comprehension of trauma. There was a diary about trigger warnings in which some Kossacks said they think people who talk about triggers are ginning up faux outrage. The ignorance on display was alarming.
I felt embarrassed for them and very disappointed. How could my progressive brethren be so clueless? I suppressed an urge to post some snarky reply.
As disappointing as it was to read those comments, they weren’t hijacking the diary. They weren’t posting the same assertions again and again across multiple diaries with no respect for the topic of the diary. They were participating in a discussion and they honestly didn’t know that their flat rejection of the entire concept could be hurtful to those who cope with PTSD every fucking day. Their honesty exposed a vulnerability and their courage. They were willing to expose their internal dialogue to public scrutiny.
They were earnest enough to say, “Looks like BS to me. I don’t get it.” I cherish and respect that willingness to engage the topic.
This is why I read Daily Kos. It's why I blog about gun law here. And it's why we'll listen to your story even when you don't R-T-F-D.
The way to peace is through more of this, not less.
Thanks for reading.