Wednesday, March 19, 2014

Triggers—A Question for Rape Survivors

Trigger warnings—does anyone remember approximately when those things started showing up on Web pages and in bulletin boards? As far as I can recall, I only started seeing them about a decade ago, when I subscribed to a mental health forum for reasons unrelated to this topic. The general rule of them there was, before you initiate a discussion that might cause any sort of traumatic reliving of an experience, you had to add a trigger warning (also called a trigger, TW, spoiler, or spoiler warning) to the subject line of your message. Common trigger warnings there included:








In recent years, even outside of mental health, addiction, and survivors-support sites, trigger warnings started showing up more and more frequently. The three that I can recall seeing most often are trigger warnings for rape, for domestic violence, and for battlefield trauma. This makes sense. Aside from rape and domestic violence, the most common source of PTSD is combat, and the USA is just ending twelve years of war in two separate countries on the other side of the world.

I understand the purported purpose of the trigger warnings. They're supposedly helping PTSD sufferers to avoid any descriptive material that could trigger a painful recollection and, worst case, reliving of the source stressor. In fact, I've employed trigger warnings myself. If you go to the Amazon page for my recently published Urban Fantasy, Gifts, and scroll down to the Book Description, you'll see that the first line reads:

[Trigger Warning - drug-facilitated, forcible, and violent rape.]

Generally, I have two qualms about this whole "trigger warning" concept. First and foremost, if all you're doing in your message is referring to yourself as a "rape survivor," what's the point of the TW? I mean, if we're really afraid of the mere word, you've already stated the nasty trigger word in the subject line. This, in my experience, describes a good 66% or more of the documents I've seen with a TW in the subject line.  Seriously, if you're only going to mention the word once in your letter, haven't you already done just as much harm by naming the trigger in the warning? How, then, does your warning help anyone?

My second qualm will take a little background. Bear with me for a few more lines.

Recently, I was speaking with a therapist friend of mine, and she told me the most successful PTSD treatment available today—providing the greatest notable relief and the longest-standing successes—is a new form of Cognitive Behavioral Therapy (CBT) called "Prolonged Exposure" (PE) therapy. PE isn't really a new idea, just a revamped and more carefully modulated version of immersion therapy. Like all immersion therapy, the goal of PE is to get patients to a point where they can see, hear, read details of events similar to their own PTSD source without suffering any of the usual ill consequences (dissociation, hallucination, loss of sleep, loss of appetite, depression). Or, to put it more bluntly, the survivor of violence should be able to hear, see, or read about violence similar to what they suffered without reliving the experience.

Looking around on the Internet, the best lay-description I could find for PE is the one on the VA's National Center for PTSD. You can follow the link for more details, but the bare bones of PE is the following four steps:
  1. Education - they teach you about the next three bullets.
  2. Breathing - relaxation through breath control—something like Qi-Gong for beginners.
  3. Immersion - in dribs and drabs, they start feeding you images like what you experienced to cause your PTSD. This might include stories, videos, newscasts, or even play-acting traumatic experiences.
  4. Talking through it - this includes talking about your own experience and about those immersion exercises. This is where the actual therapy takes place.
My first reaction to PE was: Awesome sauce! I know some people who could really benefit from something like PE. Some of them have been suffering for over a decade. Sadly, like most psychotherapy, I quickly learned that PE comes with no guarantees. Although their success rates have been dramatic (I've heard and seen reports of upwards of 80%, which is phenomenal considering the variables involved), PE does not work for everyone.
My second reaction was to begin wondering about Trigger Warnings—in particular, my own trigger warning. If the most successful treatment for PTSD involves controlled immersion, is the widespread use of trigger warnings—the systematic conditioning of survivors to avoid reading about violence—is this doing PTSD sufferers a disservice? Now, I'm not so naïve as to think stumbling upon vivid descriptions of a violent sexual assault could ever be at all therapeutic for a rape survivor, but I have to wonder: when I provide that trigger warning—that little note saying "rape survivors should go no further"—am I perhaps circumventing a survivor's autonomous development of coping mechanisms? Am I protecting people or being overly-protective?

Understand, I'm not arguing for the elimination of all trigger warnings. I would just like to see a little healthy debate on the topic. So, whether you're a survivor or not, I'd like to hear from you. Where do you stand on the use of trigger warnings? Who should employ them? When? Where?


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