In case you haven’t noticed, the fires of the Great Trigger Warning Debate are burning high again, this time in the halls of academia. Students at UCSB have called for trigger warnings in course syllabi, prompting the New York Times to equate dissociative spells, nightmares, and anxiety attacks with “squirming”. Now, along comes Pacific Standard with an article that tells us science says we shouldn’t give sexually assaulted students with PTSD even the same consideration we give television viewers who don’t like nudity on their screens.
As the article was written by Dr. Richard J. McNally, who directs clinical training for Harvard, I didn’t expect to find fault with the science he cited. This turned out to be mostly true. I found the argument presented in the article pretty appalling, however.
On a side note before I get to the arguments: You may well have the impression that “trigger” is a concept unique to post-traumatic stress disorder. If you do, you’re not alone. I saw someone on Twitter just a few days ago suggest that a broad view of trigger warnings was somehow appropriating the experience of PTSD sufferers. Reading the article won’t disabuse you of this notion–it’s entirely a discussion of PTSD–but this isn’t true.
Think of a trigger the way you’d think of a stimulus in classical behavioral psychology. It is an event that provokes a response over which someone has very little control. Pavlov’s bell was a salivation trigger in his dogs.
Of course, we’ve moved on a good bit from strict behavioral psychology, and people aren’t dogs. “Trigger” these days describes an event to which we react in a way that is significantly but not entirely automatic or beyond our conscious control. Suppressing a reaction to a trigger requires cognitive and emotional resources, executive function, but it can be done. “Trigger” now applies to events that provoke a wider variety of maladaptive responses as well, such as bingeing in someone with eating disorders or self-hatred in someone with depression.
But on with the article.
There are five studies presented to support points of argument in the article. The first three essentially constitute a prevalence argument. Stringing the numbers given by McNally together, we’re left with a statement that about 3% of women and about 0.2% of men experience long-term (greater than three months) PTSD associated with sexual assault. Applying that number to college students doesn’t account for greater rates of sexual victimization in populations that are also less likely to attend college, but it also doesn’t account for the fact that college campuses themselves pack a lot of sexual assault into a short period of time, making only long-term incidence measures less appropriate.
At a college like Harvard, with 7,200 undergraduates, that gives us a minimum of 110 students at any given time for whom trigger warnings solely about sexual assault could be useful on a long-term basis. Do those 110 students not deserve that accommodation? Because let’s face facts: PTSD is a disability that educational institutions have a duty to accommodate. Or is McNally arguing that they should have to individually identify themselves as having a history of sexual assault and mental illness to each of their professors in order to receive that accommodation? Do they need to face each professors idiosyncratic thoughts on the legitimacy of both sexual assault and PTSD in order to be accommodated?
Frankly, I don’t think McNally has thought this through. It is far, far easier to get faculty to print simple content notices about the subject matter they’ll be covering, particularly in a syllabus, where they’re already discussing the subject matter they’ll be covering, than it is to ensure that all your faculty will respond appropriately in one-on-one situations with students talking about sexual assault and mental health. These are not subjects and situations where colleges and universities really want tenured faculty applying their “academic freedom” at will, at least not if they have the best interests of their students in mind. There are too many misconceptions and outright prejudices common to our society that don’t magically dry up when someone receives an advanced degree.
I’m going to skip to McNally’s fifth argument here, because it’s almost as simply dealt with by thinking it through.
Many women who have experienced sexual assault reject the label victim in favor of survivor. But although the latter term connotes empowering agency, having trauma become central to one’s identity bodes poorly for one’s mental health. The psychologists Dorthe Berntsen and David C. Rubin developed a short questionnaire called the Centrality of Event Scale (CES) that assesses how important a specific event is to one’s personal identity. The CES captures how integrated the event is in one’s autobiographical memory, the extent to which it marks a turning point in one’s life story, and the degree to which it shapes one’s expectations for the future. My Ph.D. student, Donald J. Robinaugh, and I found that among 102 women who reported histories of childhood sexual abuse, the more central their abuse was to their identity—as measured by the CES—the worse their PTSD symptoms. In particular, seeing one’s future through the lens of one’s abuse was especially associated with the severity of PTSD symptoms. These data suggest that acknowledging one’s abuse but not allowing it to dominate one’s sense of self may foster resilience against the long-term psychologically toxic effects of childhood sexual molestation.
This is an very simple correlation vs. causation issue. Do people whose trauma is central to their identity suffer worse PTSD? Do those people who suffer the worst, longest-term PTSD feel that the trauma that won’t leave them has come to dominate and define their lives? Or does ongoing, severe PTSD perhaps limit people’s lives in such a way as to make continued PTSD more likely?
The study McNally cites, on which he was also an author, (available as a pdf) cannot address the question. The study occurred decades after the abuse and the onset of PTSD, and getting a chicken or egg answer could only be done in the immediate aftermath of the trauma (if at all). This should have been mentioned in the paper as an obvious limitation, but it wasn’t.
It should certainly be mentioned when any policy recommendations are made based on its conclusions. If the severe PTSD comes first rather than as a result of how trauma is viewed, this provides even stronger incentives for dealing with it compassionately and effectively up front.
This brings us back to McNally’s fourth point, which is that PTSD is not cured by avoidance. This is true, as far as it goes. It is also irrelevant to the argument at hand.
While PTSD is not cured by avoidance, it is also not cured by dumping people back into the soup. If it were, it would have taken us longer to discover PTSD as a disorder. If sending “shell shocked” soldiers back to the front had worked in WWI to do anything other than get people killed, we wouldn’t have spent so much time and effort figuring the problem out. Abrupt reimmersion into trauma isn’t helpful and may make someone’s PTSD worse.
PTSD is actually treated through a very controlled desensitization process. Triggering stimuli are introduced on a gradually escalating basis, and drugs and techniques for coping with stress. One level of stimuli is conquered before the next is introduced. The person with PTSD has a hand in planning the treatment and assessing its effects.
Most importantly, the person with PTSD does not have triggers thrown at them without warning. This, however, is what McNally is advocating for in his article. In suggesting we eliminate avoidance, because it doesn’t cure PTSD, he is advocating for surprise triggers, which also don’t cure PTSD. Neither avoidance nor surprise will cure PTSD.
The argument over trigger warnings is not about curing a mental illness. It is about accommodating it so that people who have that mental illness don’t have another barrier to full participation in society.
McNally’s avoidance argument misses another important point about trigger warnings on campus. This misunderstanding is common to many if not most of the people I see arguing against them, however, especially those who argue against trigger warnings as a way of championing literature. (I follow a lot of writers.) If you’re one of these people, please stop and take a moment to let this sink in: Trigger warnings are not about avoiding triggers.
I know that seems counterintuitive, but it’s true. Maybe this post from a college instructor will help:
My position is influenced by having spent some years in the feminist blogosphere audience, and my reading of trigger warnings has always been that they are simply warnings so that readers know what they’re about to get into. Perhaps someone who knows that reading about sexual assault will set of a strong emotional reaction will put off reading that story on their lunch break at work, and instead pick it up again at home. Someone else may not care at all, and can click through to read right away. Posts on difficult subjects have not disappeared from feminist blogs since the advent of trigger warnings, and a skim through comments sections on some such pieces will often show readers who were viscerally reminded of their own experiences.
From an instructor’s point of view, I consider that students may be doing their homework at home–or in downtime at a workplace, in a public area like a library or cafeteria, side by side with friends or teammates in a group study session, or any number of other environments. They might be planning to go to work, or sleep, or a high-stakes exam after studying. If the reading I assigned might prompt a student to be overcome by a memory of being assaulted, to be taken with rage or sadness (whether from personal experience or not) at reading in depth about genocide, then would it be such a bad thing for the student to know that in advance and be able to plan their reading schedule accordingly?
People with disabilities choose to do things that hurt all the time. If you have disabled friends, chances are good you’ve heard the phrase, “Oh, I’m going to pay for this tomorrow.” People with disabilities choose to do things that take energy they don’t really have to spare. They choose to walk when they could, and maybe should, sit. They choose to eat and drink things they know may cause problems.
They choose to engage with triggering material. People with PTSD are no different than people with any other disability in that respect. Read the comments on those blog posts with sexual assault trigger warnings. You’ll find people who have PTSD from sexual assault. You’ll find people whose PTSD was triggered. They saw the warning. They still read the post.
Why do people with disabilities do all these things? Because they don’t want to be shut out of worthwhile things by their disability. Because they want to have what everyone else has. Because choosing a small amount of pain beats the alternative. Because having a disability doesn’t suddenly stop someone from that very human impulse to live beyond their limits. Because they know the right amount of ambition can bring improvement.
Trigger warnings on syllabi won’t make people stop reading literature or taking classes on racism or war or genocide. What they will do is help people decide when and where to deal with the material, to take a propranolol first or make sure there’s someone around to talk to afterward. Trigger warnings will help people deal successfully with material that is traumatic for them without being retraumatized, which is the goal for PTSD treatment.
McNally knows this, or he should. This isn’t a good argument against trigger warnings any more than his other four, which just goes to show that you need more than science to make a compelling argument. McNally didn’t.