Fri
Aug 28 2009 1:06pm

Post-Traumatic Stress Disorder in Fiction, Part 1

Moonlight and dew-drenched blossom, and the scent
Of summer gardens; these can bring you all
Those dreams that in the starlit silence fall:
Sweet songs are full of odours.
– Siegfried Sassoon, “The Dream”

I have Post-Traumatic Stress Disorder. Which is difficult to admit, because fiction—the medium through which people most often learn about the experiences of others—tends to imply that those who suffer from PTSD are non-existent at best, broken as par of course, and dangerous lunatics at worst. And sometimes the only depiction available in a story or series is the “worst” scenario.

It’s a little upsetting, not least because people fall back on the stereotypes presented in fiction when they know you have PTSD.

But, like anything else, occasionally fiction gets it right.

In this post I’ll discuss the caricature of PTSD in fiction; in a second post, I’ll talk more in depth about some specific examples that mostly get it right (and, in one case, pretty much all of it right).

Before I cover either, however, I ought to describe how PTSD is actually experienced. This goes rather beyond the Merriam-Webster definition or, to be frank, the times when fiction would like to show off PTSD.

Parasites of the Mind

PTSD is the intrusion of traumatic memories in life. It’s important to note that these memories intrude upon life, like an unwanted relative intrudes upon the peace and order of your household; they aren’t simply a remembrance. This effect is due to the way these particular kinds of memories are stored.

They say that memory is not digital, by which they mean that the storing of memories is an imperfect process compared to, say, videos or pictures. Information is lost as memories are integrated into long-term storage, often removing much of their vividness and immediacy, putting them at a distance.

Traumatic memories in PTSD aren’t integrated this way. Your brain says DO NOT WANT, and as a result, they remain unprocessed—vivid and, unfortunately, so immediately accessible that they slip into consciousness at the drop of even tiny triggers.

But because you need to deal with everyday life, you need to put these memories somewhere other than your immediate attention, and so a compromise is reached: you toss the equivalent of a tarp over them.

And then, for the most part, you’re functional. Just like unwanted aunts or uncles, the traumatic memories aren’t around most of your life.

But just like tarps, sometimes the winds of real life blow across your memories. Maybe it’s a gentle but persistent zephyr that blows up a corner or side of the tarp, letting loose merely a potent aspect of terror or fear or hopelessness. Maybe a stronger storm wind blows off full corners, and you get something more immersive, shall we say.

And sometimes a hurricane whips up out of nowhere and tears off the whole thing. You can guess what happens then.

I called these episodes “waking nightmares” before I knew what they were.

The tarp comparison means that, in other words, a trigger can result in anything from

  • a slight change in behaviour, which can be so subtle that neither you nor those around you are aware of it until you completely lose composure, i.e. sudden expressions of anger or fear. The most common occurrence of PTSD intrusion.

  • partial reliving of one or more senses that occurred during the original trauma. Examples include abject fear, physically shivering, senses of gut-churning disgust, strangling sensations. This doesn’t occur anywhere near as often as the first type.

  • the stereotypical full flashback, where you entirely relive the full memory. You disassociate entirely with the present, and you probably will have an extremely vague recollection later, or even none at all. This is actually pretty rare, and many afflicted with PTSD may never experience it.

When I said the tarp was a compromise, I didn’t say it was a good compromise. And obviously the way towards healing is actually integrating these memories properly.

But do you really want to permanently integrate memories of rape camps, war, or child abuse?

I didn’t think so. The cost of waking nightmares seems surprisingly cheap next to full integration, although it isn’t, really.

Some people are more vulnerable to PTSD than others, some situations are more prone to produce PTSD than others, and severity can vary. The people who aren’t vulnerable are the ones you want to turn into Navy SEALs. Fictional characters, on the other hand, tend to be rather binary about this....

There Are No Therapists

“One must wonder why Jack Bauer isn’t Ax Crazy by now.”
– TVTropes.org

Let’s face it. It’s annoying for a writer to deal with characters and trauma that’s not actively forwarding a plot point or other. And let’s also remember that in many societies, one of the easiest ways to lose audience sympathy is for a character to be mentally ill. You’d have to work that much harder in characterizing your protagonist and that much harder in plot synthesis.

And yet, trauma is undoubtedly an interesting part of saying who your character is. And, well, forwarding plot points. Indeed, some of the most memorable parts of fiction occur when a character “loses it”.

That is why There Are No Therapists in much of fiction, even where they’re badly needed.

And because trauma seems... easy, like feeling sad, surely everyone knows about that!... this also leads to a certain amount of Did Not Do The Research with respect to more complex disorders like PTSD. Don’t even get me started on some of the Armchair Psychology that can also show up.

Thus results two main branches of PTSD portrayals in fiction:

A. What PTSD?
B. Set Piece PTSD

In What PTSD?, a character may witness horrible things, experience horrible things, be forced to do horrible things. During these events and perhaps a few days, even only hours later, the character is conveniently recovered enough to move to the next plot point or to the denouement. Butchered human carcasses, murder, torture—it doesn’t matter. Actual PTSD is never a possibility for the main character.

This is the purview of military science fiction. Actually, any military fiction. And actually, a lot of fiction across all genres and mainstream. I can count on the fingers of one hand fiction I’ve run into that doesn’t invoke this pattern, including works that I very much enjoy.

Despite the name, What PTSD? may feature PTSD in a marginalized way. For instance, something like PTSD may be referred to, but its actual treatment is short (which is odd, since the average minimum for recovery of “mild” PTSD is around three months1) and offscreen. Or PTSD symptoms are used as a simple flag to mark other characters as weak, broken, and just not as good a person as the protagonist. Fiction that uses What PTSD? in this way will drop the matter into a dark hole after it has expired its usefulness to forwarding plot.

On the other end of the scale is Set Piece PTSD. It bears a surface similarity to the intrusiveness of PTSD, but without all the subtleties that would have allowed PTSD symptoms to be more than the instigator of plot points, a convenient plot barrier, or a crippling affliction of secondary characters.

In Set Piece PTSD, PTSD only occurs as flashbacks—full and frontal, leading to actual unconscious physical attacks, gunfire, and other extreme drama involving the endangerment of others and self. At all other times, the character often lives in What PTSD? Land. There is no in between.

Set Piece PTSD is wonderful to give to villains, either proving that they’ve passed beyond a moral event horizon or are imperfect in karmalicious ways. “Out, out, damned spot!”, wrote Shakespeare, making the use of this very old indeed.

It’s also wonderful to give a kind of neutered Set Piece PTSD to protaganists as well, because it helps block plot and gives them a just-debilitating-enough weakness while keeping them mentally pure and sympahetic. Any number of stoic characters who happen to be war veterans are like this.

Oh, and you can use it to get characters to see Thestrals.

(Yes, I do love Harry Potter, for other traumalicious reasons, so to speak.)

Set Piece PTSD is often not mentioned outside of forwarding plot points or creating Very Special Episodes, but it’s kept in the toolbox for later use.

Yeargh.

And this is all fine and well for writers, who don’t need to waste time researching trauma or fiddling with its depths, and for the readers who are blissfully unaware of what the actual follow-through of seeing Thestrals means.

It is not at all fine for those of us with PTSD, who wonder what the hell the rest of the world is on, because we want some. Also, the whole “you are pathetic and weak, because you allowed yourself to break like this. If you want to matter, you must be fixed instantly. Chop chop!” message is a bit, well, depressing. PTSD doesn’t just happen to “weak” people, it happens to most people when presented with the appropriate circumstances, including school shootings, bombing terrorism, and the aftermath of severe natural disasters.

There’s some work here to be done by writers.

Next time: Living With PTSD While Solving Mysteries, Battling Aliens, Questing—You Know, the Little Things in Life.

1 Source: The Post-Traumatic Stress Disorder Sourcebook, by Glenn Shiraldi. And yes, it is available for the Kindle.


Arachne Jericho writes about science fiction and fantasy, and other topics determined by 1d20, at Spontaneous ∂erivation. She also thinks waaay too much about Sherlock Holmes. She reviews at Tor.com on a semi-biweekly basis, and is not at all a scary person in real life.

26 comments
Daniel Abraham
1. DanielAbraham
As you know, Arachne . . . (puts on 60's scientist coat, takes it off again) I've gotten to be around some PTSD with all the levels you mentioned, up to the full flashback. I have great sympathy for the project you're on here, and I'm looking forward to hearing what you think.

I would just like to put in a plug for Peter Wimsey. If you've read Dorothy Sayer's mysteries, I'd be interested in your take on his episodes of shell shock.
Tess Laird
2. thewindrose
My husband was a medic in Bosnia. I have seen him go through your first two 'tarp comparisions'. we will sit and try to talk through it, try to integrate the memories. But they are so horrific. Many books and movies leave me cold when they are so flippent about PTSD. If only it were that easy to go through an episode and be all better. But some get it right, and that is good - for people who never have experienced it and for those who have either 1st or 2nd hand real experiences. I look forward to your next post and to any thoughtful recomendations.
Dru O'Higgins
3. bellman
A very interesting and personal subject for me.

There are many books where part of my mind was marveling and envious at the ease of the protagonist shrugging off some serious abuse. The first Harry Potter was one of them. I'm very curious to read the next posts.

And DanielAbraham, I'm embarrassed to admit this, but I didn't know that about Peter Wimsey. They've been in my must read list for thirty years, maybe I should finally get around to it.
Evan Leatherwood
4. ELeatherwood
Wow. Thanks for illuminating something I will admit I never noticed before, both about the structure of fiction and a certain mental health issue.

Also, there is such a thing as mild PSTD?! And it can only last a few months. That's amazing. How often does that go undiagnosed?
OtterB
5. OtterB
Very interesting. Looking forward to your post about works that pretty much get it right.
Arachne Jericho
6. arachnejericho
@DanielAbraham,

Lord Peter Wimsey was---is, I'm still reading up the series something seriously quickly---one of the first PTSD characters I ever read who felt real. I'm, in fact, debating whether to devote an entire post to Sayers' Wimsey series, because so much was gotten right.

@thewindrose,

I hear you. I used to think something was wrong with me.

Seeing flippancy in the news media as well, ugh. They are always happy to eat up stories where some solider has lost it and shot his/her family, and almost never go any farther than that.

@bellman,

I agree about Harry Potter. The first Harry Potter book was more significant to me with respect to child abuse rather than a realistic portrayal of PTSD. Although maybe wizards are also mentally more resilient, just as they are physically more resilient. It would explain why there are not therapists at Hogwarts.

With respect to Lord Peter Wimsey, the three books that stand out to me with respect to PTSD in particular are Whose Body? (the only Wimsey book in the public domain in the U.S. and Canada, available free via Feedbooks and Project Gutenberg), The Nine Tailors, and---perhaps unusually---The Unpleasantness at the Bellona Club. But just about all the books delve at least a little into Wimsey's psychological profile, which is unusual for a mystery series.

@ELeatherwood,

You're welcome. One of first pieces of fiction advice I ever got was, "Don't make your characters mentally ill unless you really know what you're doing." And it is very true; research is important.

"Mild" PTSD has a heavy emphasis on the quote-mild-unquote, of course. Part of the indicators of how severe PTSD will be in a person, apart from individual factors---environmental and, perhaps, genetic---is (a) duration of exposure to the trauma, and (b) whether the trauma was inflicted by other human beings.

Long and inflicted by people (rather than nature) results in worse PTSD, generally.

@OtterB,

Thank you. I may spread them out among a couple more posts.
OtterB
7. BritMandelo
I'm having trouble with this in my current revisions. I have mild PTSD, but I have mostly emotional and not physical triggers. One of my protagonists has a more physically triggered, more intense level of PTSD. It feels strange and a little sickly personal to try and write about it, and I always feel that I've overdone it and made his trauma campy when to me, it's anything but. It feels deeply personal.

He does have one major freak-out during the book, but it's justified, and he tries to "put it away" afterwards, but it's difficult. No real super-flashbacks, mostly sensations and minor visuals (because that's how it works for me). I feel like I've represented it well, but I've never studied psychology, and I'm pulling only from my own experience. I'm always worried it won't work for somebody who has suffered physical abuse, because I'm trying to translate my emotional issues to physical.

Bah. I don't know. I'm just paranoid about the revisions.
Liza .
8. aedifica
Arachne, I'm re-reading Robin McKinley's Sunshine right now and now that I think of it, the main character probably has some form of PTSD through most of the book. Have you read it? If you have, how true-to-life did you think it was? (Or should I wait for the posts on books that do it right, to see if it turns up there?)
Arachne Jericho
9. arachnejericho
@BritMandelo,

I think your PTSD protagonist sounds right. And interesting. Your protagonist struggles with it, rather than it going away, and it's not simply something he can turn on and off.

Hopefully the next couple of posts may help you feel less paranoid. Or not. Writing about something deeply personal as this is difficult and ironically fraught with way more "but did I do it right?" feelings than if it was more remote. I understand.

I kind of worry about that all the time with this little series of posts and keep going back over them repeatedly, and have to self-set deadlines or I will never get them done. And that's just analyzing other people's work.

@aedifica,

I haven't read Sunshine, but now I'm curious.
Marc Houle
10. MightyMarc
There are a few novels where characters suffer from PTSD. The one that immediately comes to my mind is "In Country" by Bobbie Ann Wilson.

I loved this column, by the way. PTSD falls in the grey area between being "normal" and being "crazy". And as far as disorders go, PTSD sure isn't "sexy" enough to use as a character flaw or weakness for most protagonists.
Arachne Jericho
11. arachnejericho
@MightyMarc,

Thanks!

And I think you put the matter very well.
Chris Meadows
12. Robotech_Master
Although I don't have PTSD, nor do I know anyone personally (that I know of) who is suffering from it, one of the best fictional depictions I've seen of it is in a story in an on-line shared writing universe, called "Hands Across the Sky". The story is unfinished (alas), but what has been written of it is very gripping. (The author doesn't have it, either, but he told me he had done a lot of research.)
Allyn Edgar Hughes
13. allynh
My Dad was in WWII, in the Philippines, near the end of the war. He would only mention a handful of what I call snapshots; never talking about them in a group, they were always one snapshot here, one snapshot there. It took me decades to realize that they were describing a series of linked events that happened when they were getting "short", when there was a chance that the war might actually end and they could get out of there alive; and they were caught in an ambush.

One snapshot he would describe was trying to push a guy's intestines back in. He would compare it to the long party balloons that clowns use to make balloon animals. They just kept spilling out, and there was no way to pack them back in.

And each time he talked about the events, he was still there.

The question I have is, I can never remember the term used to describe what happens when someone looks at their own hand or arm and can't recognize what it is, or that it is attached to them. It's just a "thing" they can't identify. I think it's called "disassociation", but I'm not sure.

If you get the chance in your essays, you might put a bibliography in the last essay of not just the fiction examples you are using, but the fact books as well. In effect, list the books/stories with a star rating as to how effective they are as sources for writers to build on.

Thanks...
Arachne Jericho
14. arachnejericho
@Robotech_Master,

Thanks for the recommendation! A lot of research is a good sign. Plenty of writers take a certain amount of trauma for granted.

@allynh,

That is definitely disassociation. Trauma brings a lot of that along, even when it doesn't turn into PTSD---and with PTSD, disassociation can come again and again long after the original trauma has physically ceased to exist.

As I understand it, disassociation can be brought on by things other than trauma, but all my personal experience with it is related to trauma.
OtterB
15. eltimbalino
You bring up an interesting point about the role of writers. How much are we responsible for telling a good tale and how much should we let social responsibility effect the telling?

Understanding and integrating realistic PTSD into a story can certainly add depth and interest but as you have said, this is not as easy as picking the low hanging fruit of throw away plot devices.

My children were in a car accident and I had heard a bit about PTSD, but your post is the first time it has really made sense to me. I had only heard about it symptomatically, your experience view made all the difference.

p.s. Wow, my first animated Kaptcha!
I am grateful for your post and will write with greater empathy and awareness as a result.
Jason Lyman
16. jlyman
This is a very interesting subject to me. My wife came from an abusive marriage before I met her. While we were dating, and for a time after being married she would experience flashbacks. Sometimes there seemed to be a trigger and sometimes not. It could have been the sound of rain that triggered some memory associated with a shower, or something like that.

It was very new to me as I had never seen it happen before. She told me that I needed to talk to her whenever it happened as that kept her grounded in the here and now, even though she was experiencing the past again.

The interesting thing that helped her turn it around was a suggestion that her therapist said. She was told to take control of the memory and instead of her ex beating her, she could beat her ex. She was able to remember that during a few episodes and changed the ending to something more to her liking, so to speak. In her case this pretty much broke her out of the episodes. After about five years she has not had another recurrence.

I don't know how unique that case is or if that works in more complex or severe bouts with PTSD, but I am glad that it worked for her.
OtterB
17. Karin Low
This was very interesting. All 3 of my novels (beginning with 'Warchild') were my attempt to examine in a realistic way the effects of trauma on 3 different people from 3 different backgrounds, and to explicitly show that nobody reacts to their trauma in a standardized way (their experience would not be identical to someone else's, even if the event was the same or similar.) I agree that many stories give this examination short shrift.
OtterB
19. jackdaw
I recommend Pat Barker's non-SF novel Regeneration which contains a fictionalised account of Sassoon's stay in a war hospital while suffering from "shell shock".

I volunteered for many years on a sexual assault help line, doing crisis phone work and in-person short-term counselling. There is a form of PTSD called Sexual Assault Trauma which we often saw. Most victims recovered from SAT within 6 months; although the effects of the assault persisted, the acute intrusion effects you describe subsided.

Karin - I loved your books because of their accounts of people coping with trauma. Warchild has a special place in my heart. Thank you.
OtterB
20. Karin Low
Jack, thank you so much.

I also agree that 'Regeneration' is fantastic ... it was a great film too.
OtterB
21. TheAngryLawnmowerInTheSky
Honestly, I wonder if anyone will ever study a possible cause of PTSD that few have even considered before. Is it really all just about the trauma? It's not due to weakness exactly, we know that beyond a doubt. But isn't it possible that societal or religious norms might be part of the cause?

If you had been taught your whole life that killing is bad and if you do kill someone, you will burn in hell for eternity, and you knew you'd be ostresized by society in general (It's the lunatic psycho serial killer! Stay away from him!), what do you think it would do to you if you had to kill, even in self defense? You'd have a hard time wrapping your mind around what you had done, no doubt about it. And that what PTSD is for the most part.

Now, what would the same situation do to a person that had raised outside society without so much as a Bible to read? What if that person had been told that our own animal instincts were perfectly nature? Killing someone might not be such a terrible thing to that person. Him or me-I chose him-someone had to die... Where is the PTSD?

Is PTSD more prevalent among Christians? Muslims? Atheists? Satanists? I'd love it if we could see the statistics broken down. From what I've seen, it seems Satanists and Atheists have faired better with the aftermath of war. Chistians did not seem to do as well when it came to coping, though they prayed for God's help often enough. I could be wrong, but I still say it'd be a worthy bit of research.
Arachne Jericho
22. arachnejericho
@eltimbalino,

Thank you.

@jlyman,

My current psychologist is telling me something similar; to try to hang onto the present instead of getting swept up in the past. We're working on other small steps, but they're all geared towards integrating the memories come hell or high water.

("Extinction", where you expose someone repeatedly to the stimulus without pain following, until it stops freaking them out, is a brute-force approach that's not terribly practical.)

@Karin Low,

Yup, trauma affects people in very different ways. That subtlety alone can be missed in a lot of works.

Your books sound interesting. :)

@matociquala,

You're welcome, and I hope you enjoy the next installments.

@jackdaw,

I definitely have to check out Regeneration now. Sassoon is near & dear to my heart as far as poets go.

And thank you for the information on SAT.
OtterB
23. SteveC
I have to wonder if the "What PTSD" scenario is really that unrealistic. Does nobody integrate their traumas? I would expect this to happen, especially in successful military organizations - and most especially with elite military organizations whose members are there by choice - such as the stereotypical mercenary outfit featured in much military SF. Not to sat PTSD doesn't occur, and even occur a lot - especially among soldiers fresh from civilian life. But the absence of PTSD in a traumatized character shouldn't be an automatic red flag, IMO.

IN one of his early books on adult children of alcoholics (The ACOA Syndrome?) D. Wayne Dyer describes what he calls "chronic shock", which may or may not be identical to PTSD, or perhaps a sub-element of it. I don't know. But they seem a lot alike.

In Dyer's discussion, it seems that one thing which determines whether a trauma gives rise to "chronic shock" is whether the trauma victim can express their emotions to s supportive figure. (After the initial numbness of shock wears off and the pain begins to be experienced.) This seems to help the process of integration. Absent the opportunity to do this, the shock cycles back into numbness, which would seem to be like your "tarp".

The relevance here, is that many of the merc outfits depicted in military have rituals for newly blooded soldiers, letting them know that they are now part of the group, bound by the bonds of shared experience. This would seem to function to prevent or at least alleviate PTSD.

So again, I don't think the absence of PTSD in military SF is always unrealistic.

-Steve
Arachne Jericho
24. arachnejericho
SteveC,

There are people who do integrate their trauma, and some people who aren't susceptible to PTSD at all---that's where you get Navy SEALs and similar special units. Situations and personality play an important role in whether PTSD occurs or not. And definitely being able to talk about it early on to someone who can help you organize your thoughts properly cuts down on the need to create the tarp.

What I am saying, however, is that trauma integration is much more difficult than a lot of fiction makes it seem to be.

Nor am I saying that trauma must always lead to PTSD, even in fiction---just pointing out that some trauma in some military fiction is, well, rather excessive in nature, and exposes some characters whose personalities that don't seem geared to easily integrate it, in settings that have no therapists. Convenient, yes; realistic, no. Always happens, no; happens a lot, yes.

Also, as I point out in part 4 of this series, even chronic PTSD does not mean constant weakness. We with PTSD cope a lot better than fiction often makes us out to be---and that's another failing of some military fiction, and fiction in general, to make it seem that in order to be functional you have to be PTSD-free.
OtterB
25. Sikaal
PTSD is a very seriouse mental health issues, but can be dealt with. One technqiue that Gary Craig has found is EFT, Emotional Freedom Techniques. He has worked with many dealing with PTSD and been very successful. EFT works by tapping on stress release points of the body with the fingers.
OtterB
28. michael robinson99
A very moving book I have recently read involves a doctor who spent 25 months on the front line in Angola's liberation war against Portugal in the 1960s. On his return home, he is unable to sustain relationships or a proper job, but hides in his large, empty, barely furnished apartment in Lisbon, alienating the love from women that he craves, by endlessly reciting the horrors he experienced in Africa: The Land at the End of the World by Antonio Lobo Antunes.

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