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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.

Operational Exhaustion



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

by David Gilmour

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.

Why?

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.

This diary is part of series Walking on Eggshells? How it Happens and How to Stop.


Originally posted to Walking on Eggshells on Thu Jun 12, 2014 at 01:34 PM PDT.

Also republished by Personal Storytellers, House of LIGHTS, KosAbility, and Military Community Members of Daily Kos.

Poll

Have you ever deliberately modulated your state of anxiety or distress simply by slowing down your breathing? By deliberately lengthening your exhale?

7%2 votes
3%1 votes
46%12 votes
11%3 votes
0%0 votes
11%3 votes
3%1 votes
7%2 votes
0%0 votes
0%0 votes
3%1 votes

| 26 votes | Vote | Results

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Comment Preferences

  •  Tips for talking about triggers (17+ / 0-)

    "The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” — William Arthur Ward

    by LilithGardener on Thu Jun 12, 2014 at 12:38:43 PM PDT

  •  Funny you mention the breathing (9+ / 0-)

    we teach that to autistic kids all the time when they are having trouble with anxiety.

    It's starts when they're little and we tell them, "Smell the flowers, blow out the candles."

    It's neat to see it in action with the little ones, because it can have a real effect for such a small action.

    I blog about my daughter with autism at her website

    by coquiero on Thu Jun 12, 2014 at 01:48:04 PM PDT

  •  Very good diary - very good explanation. (9+ / 0-)

    I've got fairly loose triggers myself - don't read, watch movies/shows, etc that deal with graphic violence or I get nightmares.  Periodically something will trigger one from stuff I read or watched when I was a kid.  I can read history about the overall concept without triggering anything - history of WWII or slavery or sexual abuse or whatever - but the moment I get a description of a specific activity, I'm in trouble.  So yes, breathing is good and helps - as long as I'm awake.  Nothing helps if it's still with me when I go to sleep.

    Thank you for the diary.

    •  Thank you, bfitzinAR (6+ / 0-)

      For stopping by and for sharing what it's like for you.

      "The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” — William Arthur Ward

      by LilithGardener on Thu Jun 12, 2014 at 02:22:37 PM PDT

      [ Parent ]

      •  So there's an old trick (5+ / 0-)

        that, I guess, works 'cause it's old.

        when everything is in pieces around you stop.

        Breathe in until you feel your belly button move.
        Hold it one-two-three.
        Breathe out until you feel your belly button move inward.
        Repeat twice more.

        Weirdly, though this usually takes @ 10 seconds, it's remarkably good for all sorts of things. Panic, stress, rage, not remembering how to tie the tie or whether the tourniquet should be loosened for 30 seconds every 10 minutes or 10 seconds every 3 minutes ... you get the idea.

        Don't exceed three repetitions, though. It disrupts your train of thought too much.

        LBJ, Van Cliburn, Ike, Wendy Davis, Lady Bird, Ann Richards, Barbara Jordan, Molly Ivins, Sully Sullenburger, Drew Brees: Texas is NO Bush League!

        by BlackSheep1 on Thu Jun 12, 2014 at 03:27:41 PM PDT

        [ Parent ]

      •  I appreciate you for writing this - (0+ / 0-)

        apparently series since I was in another one this morning - got a phone call and had to leave w/o commenting - while willful ignorance (also known as stupidity) can be a problem at times, most issues in communication come down to understanding what the other person is saying.  There was a time in my life when I got into every conversation with "define your terms".  Sometimes it's still a good idea.

    •  can sure empathize about the nightmares. (2+ / 0-)
      Recommended by:
      LilithGardener, bfitzinAR

      as a person who had a lot of nightmares (for unfortunate 'good' reasons) as a kid until suddenly becoming a lucid dreamer, age about 12, around 1960. (I didn't know it was unusual, nor that there was even a word for it, until a couple of decades later). Lucid dreaming helped me hang on as my life went to pieces under one smallish hammer after another - just a cumulative effect. At a peculiar point in which an overexposure to pesticides co-occurred with "euthyroid" medical "care" around '05, i lost lucid dreaming and it hasn't come back. and disabilities accellerated downward. So again i have nightmares every. damn. night.

      eh well, in case of the possibility you might be able to acquire lucid dreaming and de-fuse nightmares, I highly recommend Patricia Garfield's

      Creative Dreaming: Plan And Control Your Dreams to Develop Creativity, Overcome Fears, Solve Problems, and Create a Better Self, Simon & Schuster, first printed in 1974, reprinted with 19 domestic printings and nine foreign editions in 1976. Revised and reprinted in 1995.
      I've only read the '74 edition. There are a lot of used copies here, probably various editions. BetterWorldBooks has a free-ship option, besides supporting literacy internationally. they're reliable.

      for a lot of years i read everything i could find about dreaming.  at some point after becoming disabled, a fellow research librarian who specialized in medical lit got me hooked up with those online databases and that's mostly what i've been reading since then. the limited medical literature on dreaming and nightmares and other sleep disorders is ...um ... unimpressive. i've got about 50% of all the sleep disorders wikipedia lists as dysomnias at that article and others, but few of them actually carry negative emotional impact in my case, they mostly just make me really irritated over my sleep being wrecked, and some of them years ago i found very interesting to experience.  i don't think i can possibly be all that unique, so if i'm not then the medical understandings/research in these things might be, well, inadequate.  still, i hope you'll find ways to have less terrible dreams... and fewer.  good luck.

      •  Sorry you are having them again - (2+ / 0-)
        Recommended by:
        mettle fatigue, Wee Mama

        and I have found ways to derail them.  As in I can usually avoid them as long as I avoid the triggering event in the first place or at least don't take the "triggering" image to sleep with me.  I have no idea if this is an official technique but basically I've spent a whole lot of "in bed but not asleep yet" time creating in as great a detail as possible a fantasy world that I go to each night as I start to drift off.  I'm still creating and adding details to it.  As long as I do that, well, there are no monsters in my fantasy world and the what are (at least to me) ordinary things one deals with in life are planned for and successfully dealt with.  I don't usually dream of that fantasy world, but as long as I'm in it when I go to sleep, there are no nightmares.

        I hope you find something that can help you since the lucid dreaming went away.  (I didn't know the name of lucid dreaming, but I sometimes do it.  It's random for me.)

  •  My sense is that what the word "trigger" means (1+ / 0-)
    Recommended by:
    LilithGardener

    from one reader to the next is extremely varied without most of them realizing it, far less any useful consensus about how to use it for consistent understanding/meaning.

    A minority may understand it in a physiological sense as a stimulus (not necessarily noxious) and have no psychology or neuropsychology background for understanding it any other way. A few have that background. Most seem to have vague notions and little grounding. It's kind of an unfortunate word for the phenomenon this diary and its parent diary (and the related ones) discuss, but i suppose we're stuck with it, at least until neuropsychology comes up with a more precise term that doesn't have other meanings in other contexts.  Based on the diaries I've read here, I'm interested (another unsatisfactory word) to find that a wide range of reactions I've got can be termed as 'triggered', yet somehow i find the word inadequate.  and slightly sideways.

    the word "feels" to me like a stimulus of intention, i suppose because of the basic meaning of "trigger" as an intentional mechanism by which to ignite, release, or cause something specific to happen.  i guess we don't have a word for stimuli that ignite, release, or cause physiological, psychological &/or neuroendocrine reactions/responses in us that arise in the environment through which we move and which 99.99% of the time arise without having a thing to do with us personally.

    various people in my life have literally said that i took this or that ambient causal stimuli "too personally" as if i have a choice in the matter.  others said I was too "sensitive" and that it was a selfish sensitivity because in their view it lacked equal perception of other people's reactivities. Possibly it's pure coincidence that over time i've developed a pretty self-destructive level of empathy with the pain of others...

    hopefully the ongoing discussion among people who do understand and have to live with or work professionally with the phenomenon will gradually instill a better understanding in others.  hopefully in association with coming up with a better by being unique word for it.

    •  Thank you mettle fatigue (0+ / 0-)

      Even for just one person the word "trigger" can mean  different things depending on context. Any stimulus can become a trigger, and that includes internal cues as well as external cues.

      E.g. a recurring nightmare (an internal cue in the mind) can trigger the whole physiological cascade of stress hormones that happen when someone is triggered during the day.

      "The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” — William Arthur Ward

      by LilithGardener on Fri Jun 20, 2014 at 04:49:04 PM PDT

      [ Parent ]

  •  Everything is a trigger (0+ / 0-)

    But a conscious person chooses their response

    Happy just to be alive

    by exlrrp on Fri Jun 13, 2014 at 06:47:54 AM PDT

    •  Sorry I'm too late to tip, exlrrp (0+ / 0-)

      Thank you for dropping by.

      I think you're probably correct, except the conscious part is a big challenge for some of us. Becoming conscious of the stimuli that serve as triggers and what past events they map too can be slow and frustrating, especially when a trigger induces dissociation, which can be thought of as dysregulation of a "freeze state."  

      Most people now know about flight or fight response, but few know that there is also a third survival response, "Freeze, fight, or flight."

      When the trigger causes disorientation, and techniques that rely on consciousness are thus unavailable, sometimes working directly with the body can really help.

      "The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” — William Arthur Ward

      by LilithGardener on Fri Jun 20, 2014 at 04:56:47 PM PDT

      [ Parent ]

  •  Rainfall became a trigger for me in 1993, when (0+ / 0-)

    Iowa had horrible flooding (we were the sixth Great Lake in satellite pictures). Hearing rainfall made me tense and uncomfortable for five or six years until the effects of that flooding summer had enough time to fade away. It was rather sad, as before I had always enjoyed rain and during that several year period rain was emotionally draining instead of restorative.

    Sorry I missed this when posted - we were off on a thirty mile training ride.



    Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

    by Wee Mama on Sat Jun 14, 2014 at 10:05:10 AM PDT

    •  Thanks for commenting, Wee Mama (1+ / 0-)
      Recommended by:
      Wee Mama

      Yes, any stimuli can become a trigger. The time when you were triggered by the sound of rain sounds like a similar mechanism to my fire engine horn trigger. The stimulus flips a switch that activates a circuit associated with the earliest stimulus associated with the life threatening event.... which the mind interprets as "It's starting again..."  

      I'm glad the memories eventually faded for you.

      "The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” — William Arthur Ward

      by LilithGardener on Fri Jun 20, 2014 at 05:05:50 PM PDT

      [ Parent ]

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