Sep 29 2009 5:39pm

Post-Traumatic Stress Disorder in Fiction, Part 3

“It doesn’t sound like something they let you have when you work in the White House….”

“As long as I’ve got a job, you’ve got a job.”

— Josh Lyman and Leo McGarry, his boss, in The West Wing

In part 1, I talked about how Post-Traumatic Stress Disorder is actually experienced in real life, and the general ways in which fiction often gets it wrong.

In part 2, I covered in detail two specific examples of PTSD portrayals in Babylon 5 and The Lord of the Rings.

Part 3 is going to cover two more portrayals in detail, both more realistic, sometimes even more positive, than induced Set Piece PTSD or the “destroyed forever” implications when PTSD is used as a bitter(sweet) closure to a story.

Post-Apocalyptic PTSD
World War Z: An Oral History of the Zombie War (by Max Brooks)

“I’ve heard it said that the Holocaust has no survivors, that even those who managed to remain technically alive were so irreparably damaged, that their spirit, their soul, the person that they were supposed to be, was gone forever. I’d like to think that’s not true. But if it is, then no one on Earth survived this war.”

— Jurgen Warmbrunn, several years after WWZ

Out of the current plague of zombie narratives out there, World War Z is not only one of the first, but the most innovative, realistic, comprehensive, and nuanced book about a post-apocalyptic zombie event. Contrary to many of its sub-genre successors, World War Z’s pseudo-documentary format allowed it to cover different aspects world-wide across international boundaries, exploring the ramifications—ecological, commercial, political, cultural, societal—that a terrible zombie infestation, one that nearly brings the entire world to its knees, would wreak.

Naturally, the book also looks at the lingering psychological effects of this post-apocalyptic “war.”

One of the factors—though by no means the only factor—of the severity of a PTSD case depends on the root cause of the traumatic events involved. PTSD brought on by non-intentional means—natural disasters and accidents are the primary examples—tends to be less severe than PTSD that results from trauma caused by human hands. The more intimate, prolonged, and intentional the involvement of other people, the worse the trauma.

A zombie invasion raises an interesting question: is such an event a force of nature, since zombies are without sentience (in most literature at least, including World War Z)? Or, because zombies used to be living people, still look like people, and in the worst cases are actually loved ones, is this perceived by the human mind as being violence with human intent, even betrayal? Whatever the answer, PTSD is as guaranteed to be involved with a not insignificant portion of the human population, just as hundreds of WWI veterans suffered from PTSD.

A really good writer can have a trauma blast with this sort of scenario. I’m rather surprised that they don’t take advantage of this more often. Indeed, trauma pops up in just about every “interview” covered in World War Z. PTSD ranges from a man who discovers that he can no longer walk down a street without thinking about how to kill people; to shell-shock-like symptoms that affect the soldiers who eventually curtail the zombie invasion after months, even years, of combat; to people who lose their minds and try to act like zombies; and more. In fact, the shell-shock (I like to think of it as Z-shock) is regarded as normal by the psychologists involved with the troops at the end, and anyone who didn’t “break,” even a little, under such pressure is more than a bit concerning.

In fact, an entirely new kind of trauma, arguably a severe variant of PTSD, is brought up by Brooks in World War Z: Apocalyptic Demise (or Despair) Syndrome (ADS). In a manner like PTSD, this disorder showed up in populations even after they reached safety points, while the entire world was known to be under siege, and that the human race might not survive. So great was the stress and hopelessness that people would “go to sleep one night and not wake up the next morning,” even if they were perfectly healthy. One interview is devoted to a man’s attempt to combat ADS—and though his success rate is unrealistic, the fact that this kind of wide-ranging psychological disorder was speculated upon at all is something that most post-apocalyptic books don’t even contemplate.

Is ADS realistic? Perhaps, and perhaps not. We haven’t really had an extended apocalyptic mass-PTSD generating scenario for the human race. But then again, there are a lot of people who still don’t believe that PTSD is real or anything other than “not wanting to let go.”

The Strange World of Triggers
“Noël,” The West Wing

“Well, I know it’s going to sound like I’m telling you that two plus two equals a bushel of potatoes, but at this moment, in your head, music is the same thing as—”

“—as sirens….”

– Dr. Stanley Keyworth talks about triggers with Josh Lyman

Much as I love The West Wing, and much as it kept an awful lot of its plot lines going through multiple episodes, ultimately as a series it tended more than most (save for Lost) to drop a fair amount of threads, even main characters, randomly. But for all that, the program covered many issues rarely touched upon by other dramatic series, even today, and that included areas outside of politics.

“Noël” was done as a Very Special Episode, and it’s only in “Noël” that we see any of Josh Lyman’s symptoms show up after being shot in “In the Shadow of Two Gun Men.” And yet “Noël” was executed so well, including the creators Showing Their Work when it came to portraying Josh’s PTSD, that I forgive them this flippancy.

There were many ways, both big and small, that carried the day through for “Noël”; I mean, even the secondary thread of the episode featured PTSD in a holocaust survivor visiting the White House and seeing a picture of her father's (killed in the camps) there.

Camera shots. Lighting, setup, and framing being a director’s prerogative, The West Wing had some of the best camera work around for “realistic” dramas, unequaled in that genre since. “Noël” was no exception, and indeed, had special camera work, particularly the transitions, giving viewers the shifting sense of present and past that immersive episodes of PTSD can present. Drifting between the psychological session, the recollection of events real and disguised, and the triggered episode of music, the filming and cutting was fleet of foot and achieved, as close as is possible, an actual PTSD episode. Contrary to stereotypical presentations, PTSD most often does not present as a clear-cut, sequentially cohesive flashback.

Subtle expression. As I mentioned before in the tarp explanation of PTSD symptoms, it’s not often the case that the entire tarp on traumatic, live memories is entirely exposed, but more often that corners and edges lift, allowing the subconsciousness a glimpse of the horror beneath. This affects behavior in often subtle ways, not immediately transitioning into Set Piece PTSD, and not suppressing entirely as What PTSD?. As we watch the episode, Josh begins and stays at “stage 1” for most of the time, including the point where he begins to scream at the president. As Leo McGarry comments after the disastrous meeting: “I don’t think you were fully conscious in there.” Leo knows what he’s talking about, even as Josh is horribly mortified at his own actions.

Subtle triggering. In many stories featuring some poor bastard with PTSD, triggers are often simple: like a car backfiring or fireworks going off. These are indeed real triggers for war veterans or people who have been involved in intercity shootings, but for others suffering from PTSD—and even veterans—triggers can be more insidious.

For Josh, it began with researching a pilot who committed suicide the day of the episode, with a simple comment: “It wasn’t the plane.” What haunts Josh even more is that the pilot shared his birthday—and in anyone’s mind, sharing a birthday is a strange tie in the subconscious. Here the trigger is difficult to state, because it darts in and out of the net of mental associations that the brain makes all the time—useful for everyday living, learning, and survival; but also produces strange triggers from everyday events. This trigger is mostly emotional.

Josh’s second trigger turns out to be music, probably because the high brass holiday music that Toby selects has the same harmonics in some senses as the sirens that sounded when they took Josh away from the site of his near-deadly shooting. After that initial linking, Josh’s brain quickly, and without his awareness, starts to associate all music with sirens, to the point where Yo-Yo Ma’s wonderful cello concert is not quite so wonderful for Josh. This is one of the worst thing about triggers; they can quickly bring along friends, and it’s not always under your control.

Gradual build-up. As I mentioned previously, Josh doesn’t repeatedly segue into full-blown PTSD during the episode; instead, he stays at stage 1, and works his way through the stages into stage 4, when he has that violent episode in his own apartment. This progression also isn’t linear, but follows a more exponential curve—which is very realistic. A slower linear progression is likely also experienced by some PTSD sufferers, but in my experience progression either levels out or accelerates in this manner.

On television, this is often as close to a portray to “everyday” PTSD as one is likely to get.

Throughout this, I have to mention my love for Leo McGarry, which was cemented after this. Not only does he recognize from the reports of his staff that Josh is having problems, he also realizes that Josh’s outburst wasn’t intentional and was influenced by his trauma. Not many people have the background, the sensitivity, or the guts to make that leap of understanding—and not many would get Josh the help he needed, much less stay around afterward and be supportive. Too often those who suffer from PTSD are left to fend for themselves.

“Noël” breaks my heart afterward with its final realistic touch: Josh isn’t healed instantly by his session with the awesome psychologist that Leo brings along to the White House. When Donna leads Josh home, they stop at a caroling group singing “Carol of the Bells.” Josh stands there and stares and stares and tries not to react, but the carol slips into the sound of sirens, and Donna leads a shell-shocked Josh away.

Next time, I’ll talk about one body of work: Dorothy L. Sayers’ Lord Peter Wimsey mystery series. Among intrepid amateur detectives, Wimsey suffers a severe setback that few other mystery writers have bestowed upon their main characters: he’s a veteran of World War I with PTSD. When it comes to investigating violent crime, this is kind of a handicap.

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 normally reviews at Tor.com on a semi-biweekly basis, but it’s been a few... interesting... weeks.

Lena Vogelmann
1. kalafudra
Did you happen to catch the pilot of NBC's new show "Mercy"? The main character, Veronica, suffers from PTSD after working as a nurse in Iraq. I'd love to hear your take on it.
Rikka Cordin
2. Rikka
Ahh, that episode always made me cry... D: I just wanted to hug poor Josh. Mind you, I was about 12 the first time I saw it. >.
Natalie Ingram
3. Raethe
Thanks for doing this series of posts. Not only are they fascinating in their own right, but I can also say that you've convinced at least one writer to try and portray PTSD realistically (or at all). And if even those hopeless amateurs can listen, hey, who knows, right? ;)
4. Maetrix
I've always been a big fan of the M*A*S*H series and how they've explored all the difference aspects of Trauma and in all it's various forms.

What also impressed me was they made active use of the Psychiatrist through the character of Dr. Sidney Freedman (Alan Arbus) with ever the tagline:

"Ladies and Gentlemen, take my advice. Pull down your pants and slide down the ice."

But the material they dealt with, and also for the time period in which the show aired, was pretty edgy stuff.

Even though most episodes are a reboot, the show maintains enough continuity that some episodes focus on the hardships of their life.
Joseph Blaidd
5. SteelBlaidd
As an interesting exploration. WMy wife and I just watched episode 134 of ST:Voyager - Memorial which involves the crew experinacing induced PTSD from a memorial erected about a masacre.

I also found in reaserching this a book, The Two Space War which is a sf novel written by LT COL(ret.) Dave Grossman, author of a lot of reasearch on this topc including the book On Killing

Also love M*A*S*H, just thinking about the last episode can bring tears to my eys.
Daniel Cole
6. zaldar
There really are not any episodes of the west wing that are bad. Amazing how that works out. This episode probably taught me more about ptsd than anything else did (until I read your posts).
Arachne Jericho
7. arachnejericho

I'll have to check that out! I've a friend who's a nurse who'll probably appreciate the show, too. :)


Yeah, I always did want to hug Josh too. Poor guy.

On a side note, Donna, I believe, got PTSD later after being blown up in a car in the Middle East, in a series of stellar episodes, I believe 5th season. Hers was covered in far less detail though.


:) Glad I can help.


Hmmm, I'll have to check out M*A*S*H. High recommendations from just about everyone I've talked to online or IRL.


Thank you for the extra recommendations!


I'm inclined to agree with you re:West Wing. I can think of West Wing episodes that were sub-par, but technically that's sub-par by West Wing standards, and still way more interesting than most television out there.
8. Jebus
One of the top 10 episodes in the greatest TV show of all time. The calibre of acting, writing, direction and producing on that show has never been seen before and not seen again (although Sorkin's Sunset Strip show came close).

My favourite ep ever was the final episode of season 2, brilliant TV making.
9. Fred Lerner
I work at the National Center for PTSD, and I would like to invite readers of this series to visit our website at http://www.ptsd.va.gov. Here you will find a wide range of reliable information resources, including my own project, the PILOTS Database -- an online index to 38,000 publications on PTSD and related disorders.
Phil Mandryk
10. pmandryk
Thanks for writing these articles. Someone close to me has PTSD and you have helped me bridge a gap that I would have been unable to.

The "Alan Alda" years with him directing MASH got quite dark and strikingly un-funny. "Dreams" is probably the most morbid SitCom episode I have ever seen. Laughing at the morose reminds me of that "Cop Humour" which allows police officers to make jokes after witnessing horrific events day after day after day. What a coping mechanism. I wonder if it ever catches up with them?

Thank God for giving the human brain the "tarp" which you reference. Cheesecloth really would not have been effective...
Arachne Jericho
11. arachnejericho

“Two Cathedrals” is indeed an excellent piece of work.


Thank you for the link!


You're welcome.

On black humor: I don't know if it ever catches up with them. I know that back in the days when I was still under the thumb of my abusive parents, especially in college, I committed dark humor all the time. If anything catches up with us, I think, it's all the psychology stuff building up inside, of which dark humor is merely a day tripper.

Over at Not Exactly Rocket Science (one of my favorite science-for-the-everyman blogs), there was a post about molecular bodyguards of memory that appear to be this very tarp I talked about.

The comments to that science article are rather clueless, by the way, but I think that's because the article doesn't explain PTSD well enough in addition to the discovery of the guardian molecules. Without the tarp analogy, the function of the molecules is indeed backwards to many people.

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