Today on Freudian Script, we are exploring Post Traumatic Stress Disorder – aka PTSD.
Unlike other topics I’ve detailed, PTSD has a lot of Hollywood exposure – it’s dramatic, it’s visual, and it can throw your sober sensible “normal” character into a hellish irrational out-of-character orgy of chaos. With this post, I want to highlight the areas that Hollywood often glosses over and which can serve the writer interested in authenticity.
DISCLAIMER: This blog post is designed for writers of fiction. If you are concerned that you or someone you know has symptoms of mental health problems, please see your doctor.
What is PTSD?
PTSD is a stress condition arising after a trauma – a definition which surprises precisely no one. Historically, it was first noted after the First World War, when it was termed “shell shock” or “war neuroses”. During the Vietnam War, interest in the condition increased due to the frequency of its occurrence and it was more openly acknowledged and studied. However, there is still a lot of stigma around PTSD, especially among veterans.
However, PTSD is not a condition limited to soldiers. The trauma is defined as “a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature” – i.e. a threat to life or bodily integrity (rape, torture, etc.); getting caught up in a natural disaster; or witnessing the death or severe injury of someone in close proximity.
As a rule, symptoms start within six months of the trauma – however, if they don’t, that’s simply termed Atypical PTSD (medicine does this a lot, particularly psychiatry). There are three main symptom groups:
> Re-experiencing – flashbacks (reliving the event as if you were there again); intrusive memories (e.g. hearing the voice of your attacker); nightmares (reliving the event in dreams).
> Hypervigilance – increased sensory arousal and looking out for any possible danger, with exaggerated reactions (e.g. diving under the table when a waitress drops a plate).
> Avoidance – limiting exposure to situations which may be triggering, to reduce re-experiencing and hypervigilance. This can also involve emotional detachment and a sense of unreality.
As the example of typical portrayal of a PTSD sufferer, I will use Bennet Drake from BBC One’s fantastic Ripper Street. Fantastic except for the PTSD bits.
Drake is a war veteran. He had one dark night in the desert where he killed a lot of people, among many other dark days where he killed a lot of people. As a result of this, he developed Hollywood PTSD.
Of course, he had nightmares. Nightmares and insomnia are very common PTSD symptoms – so far, so real. To cure his nightmares, he went through some Egyptian goddess ritual and got a tattoo. As PTSD treatments go, this isn’t exactly gold standard but it’s 1889, so we’ll let him off.
Fast forward several years and Drake is a policeman. Canonically, he doesn’t get the best sleep but this is attributed to his lack of bedmate (another unusual PTSD remedy). The only time his “PTSD” symptoms arise is in one convenient episode where his old war buddies turn up.
As triggers go, this makes sense – events that recall the traumatic event can lead to a resurgence of symptoms. However, Drake’s only symptom is flashbacks. And these flashbacks only distract him when his boss is trying to get his attention and resurface when he’s on the attack – doesn’t even break his concentration as he’s kicking arse and taking names. In fact, the only purpose those “flashbacks” serve is giving the director some nice cuts for the fight scene.
That is not PTSD. That is PTSD For The Plot.
My favourite example of PTSD on screen is Josh Lyman in The West Wing (a performance which bagged Bradley Whitford an Emmy).
In the Season 2 episode “Noel”, Josh descends into PTSD Hell. I recommend watching the whole episode, as the use of music as a trigger is very well portrayed (see Arachne Jericho’s excellent post here for further analysis). Josh also sees similarities between himself and a suicidal pilot. The irritability – secondary to hypersensitively – takes over every inch of his life.
The climax occurs at a Yo-Yo Ma concert, where Josh relives his trauma to the prelude of Bach Cello Suite No. 1. And the flashbacks don’t stop there. To escape the cycle, Josh puts his hand through a window.
The fatal flaw in this portrayal of PTSD (which I’m otherwise enamoured of) is recovery. A common theme with mental health problems in fiction is that the drama is in the crisis and not in the treatment and episode resolution (if that can be achieved). At least Josh went to therapy and didn’t recover through an off-screen magic wand aka The End Credits. However, ongoing evidence of PTSD is nowhere to be seen.
While full resolution is possible with appropriate therapy and can sometimes be achieved with intensive residential therapy programmes, that is not the norm. Residual symptoms and common and sufferers can relapse when reminded of the trauma. As The West Wing went on for seven seasons, it wouldn’t be unreasonable to expect a relapse or two – it’s not like nothing ever happens at that White House.
As seen in the examples above, the most common portrayals of PTSD involve the re-experiencing – nightmares and flashbacks. Few dwell on avoidance and hypervigilance, tending to gloss over these aspects. Most ignore recovery and treatment entirely.
The key to a sensitive and accurate portrayal of PTSD is showing the consequences of the illness. This is not a one-episode wonder, though it’s often trotted out as one. The wider impact on work, family and social life can flesh out the character’s despair – and magnify his isolation.
Consider how hypervigilance may make the sound of a child’s laughter unbearable. And how avoidance of alleyways at night may generalise to the streets by day, the world outdoors, until the sufferer is housebound, unable to watch TV or read a book for fear of a trigger.
But there is also hope. PTSD is very amenable to therapy and our portrayals should reflect the completion of a journey with PTSD, and not just the “sensational” lowlights.
If you need advice or guidance on writing a character with a mental illness, please contact me by e-mail or in the comments below – I am always happy to help out!