On Trigger Warnings

triggerwarningsI’ve felt a bit apprehensive criticising trigger warnings. The thing is, I believe the requests for trigger warnings come from a genuine desire to make the world a safer, more welcoming place for people with post-traumatic stress disorder (PTSD). I don’t believe for a second that those in favour of trigger warnings want to be protected from negative feelings or wish to censor what we can freely discuss, as some writers have argued. I don’t agree that it’s just a way of avoiding discomfort. Instead, I think it’s genuine kindness and a commitment to changing our world to be more inclusive to everyone that’s motivating trigger warning requests. I think trigger warnings are a bad idea, and I’ll explain why later, but I don’t believe they come from anything other than kind, helpful intentions. I’d recommend reading the above articles if you think trigger warnings are just content indications for the sensitive, or all about avoiding feeling the feels. I will not be arguing against that straw man.

The reasoning behind trigger warnings is that people who have experienced certain types of trauma (specifically assault and sexual violence, although trigger warnings for racism and sexism are becoming more common) can be ‘triggered‘ by mentions of that violence. When a person is triggered they can experience flashbacks, intrusive memories, severe anxiety and self-destructive behaviour. So it follows that person would benefit from a warning about the content of a text, movie, etc. if it includes discussions of violence. This makes it easier for the person with that trauma to navigate what they want to be confronted with, for example by not reading a text that discusses rape. Trigger warnings can even be understood as a way of navigating consent, I let that person know beforehand what I intend to do (discuss rape) so they can make an informed decision whether they want to read my text or not.

As a therapist who has worked with people suffering from PTSD I really understand where this is coming from. Being confronted with a ‘trigger’ can send a sufferer into flashbacks, which can disrupt their life for hours, days, sometimes weeks. In severe cases, being triggered can cause the person with PTSD to harm themselves or become suicidal. It’s heartbreaking and honestly I completely understand why, as a society and inside our communities, we want to do what we can to support people who are going through this. A trigger warning, in that context, just seems like such a small and effortless thing to do, right? A small bit of kindness that can prevent so much misery.

And I am so in favour of changing our world to become more inclusive and welcoming, and sometimes it’s seemingly small or effortless things that can make all the difference. For example, I make a conscious effort to use inclusive language when it comes to gender. Not everyone identifies as male or female, not everyone has gender-norms confirming bodies, and reflecting that in our language costs us literally nothing. It has no negative effects at all, while at the same time making the world a kinder place for everyone. I think we should do more things like this, and I think trigger warnings come from a desire to do exactly that: a small, harmless thing that makes the world a bit kinder.

The thing is though, I don’t believe trigger warnings are harmless. Let me start with a related example. Some people with an eating disorder become deeply triggered when they are confronted with a situation that includes public eating. They report panic and self-harming behaviour, not unlike what some sufferers of PTSD report when they are confronted with triggers. Still, it would be a truly bad idea to give a ‘content warning’ for each event that would include public eating. Yes, it would prevent a lot of pain for those few people with eating disorders who are triggered by public eating. But it reinforces an unhealthy idea that eating is a dangerous thing. If we start giving content warnings when an event will include a meal, if we start behaving in an eating disordered manner as a society, unhealthy attitudes towards food will only flourish.

Now I want to stress that if someone is suffering from a mental illness, they should do what they have to do to get through whatever they are going through. I don’t believe in policing how people deal with what life has handed them, and good or healthy coping with psychological problems is an individual thing. If you’re dealing with an eating disorder and you need to avoid public eating, then you go and do that. It is completely fine to ask people around you to give you a warning so you can avoid things that trigger you, so you can take care of yourself. But it would not be a good idea for all of us, as a habit, to start warning each other when we intend to eat food.

One of the more common triggers is, actually, depictions of ‘normal’ sex. Because sexual violence so often doesn’t ‘look violent’, watching a scene where two people have tender sex can be the worst trigger in the world. Still, I think we all intuitively feel that ‘trigger warning: vanilla sex between two consenting adults’ would not be a good idea. And that’s not because we don’t take people who are triggered by depictions of sex seriously, of course we do. And it’s not because nobody it triggered by regular sex: many people are, and it might even be a more common trigger than depictions of rape. So why is nobody arguing for trigger warnings for ‘normal’ sex? I think it’s because we all feel that sex is not dangerous. But it’s gotten in our heads that depictions of violence are.

Some people who oppose trigger warnings argue that trigger warnings discourage exposure, and therefore are bad for people with PTSD. This is nonsense. Simple exposure to triggers does not do anyone any good, and it shows a great misunderstanding of exposure therapy to think unwanted exposure to things that scare or deeply upset us has anything to do with effective exposure in PTSD-treatment. It’s belittling and incorrect to think refusing the use of trigger warnings would be better for their mental health, that we’re just triggering them ‘for their own good’. This is not how exposure therapy works.

People who oppose trigger warnings have argued that people just want to avoid negative feelings, that we’re becoming too sensitive, that we can’t even handle being confronted with views different from our own. I could not disagree more. If anything, we should become more sensitive. Sensitive of our own emotions, our own needs. We should become more accommodating, more empathic, more willing to change. Our society needs changing. We need to become more aware of the ways we can make our spaces more safe and welcoming to people of colour, people with non-normative gender identities, people with disabilities, women. I’m constantly figuring out how to stop the subtle ways we hinder and harm each other, the ways we make each other invisible, and finding opportunities to make this world a kinder place. Opposing trigger warnings might be one way to do that.

In an individual’s case, trigger warnings may simply be a way of coping. I don’t care if it reinforces or violates dysfunctional associations, the world is not a therapy setting. People need to do what they need to do to kind of deal with everything, and I think we should be supporting each other instead of policing how each of us copes.

So I do not claim that people who suffer from certain experiences do not know best what they need in order to manage that. I’d actually argue the complete opposite: people know best, we should not police how people cope, we are not each other’s therapists, we should not demand ‘perfect’ coping, we need to be each other’s support and respect people’s own insights into what works for them. Avoiding certain triggers and asking people around you to give you a trigger warning for things that are particularly triggering to you is fine.

But I have big reservations about using trigger warnings in a general sense, not because it’s bad for individual people with PTSD, but because of the modelling effect it has. For example, if my mom is afraid of spiders and I see her become afraid, this models the fearful expectancy and increases my chances of becoming phobic myself.

Say trigger warnings become customary. Before scenes including sexual violence on Netflix they show a trigger warning. Before discussing sexual violence in class there’s a trigger warning. When there’s a rape scene in a book, they put a trigger warning on the back. A sort of cultural understanding develops that depictions of sexual violence is not the sort of thing that a person should be exposed to without a warning. Because those depictions can be so triggering to a person who has experienced trauma that it becomes harmful.

This models an expectancy that depictions of violence could trigger to such an extent that it should be avoided.

And say I then got raped.

The groundwork for the dysfunctional expectancy has been planted, there’s this sort of half-truth that people who have experienced rape will often be triggered by depictions of violence (even though that wasn’t really the case, it’s usually other stuff). Will this increase my chances of experiencing that dysfunctional expectancy myself? Have my chances of being triggered by such depictions increased? Have we modeled a harmful association?

We don’t know. But considering how anxiety disorders work, we are sure environmental factors have effects. And we know anxiety symptoms and disorders feed of modelling, quite strongly.

So if you use trigger warnings, I don’t think you’re an over-sensitive PC-policing free-speech hater. I really don’t. I think you’re wrong, and I think we should be having a conversation about this, but I thank you for being kind.

Some comments to further clarify my point:

One of the underlying mechanisms of PTSD are dysfunctional associations between certain stimuli and incorrect, negative, excitatory expectancies. We used to think exposure worked through habituation, something causes a lot of distress but when we’re confronted with that stimulus a certain number of times our emotional response reduces. However, we now know that exposure therapy works through inhibitory learning. The original association between the conditioned stimulus and the unconditioned negative stimulus (the Bad Thing that might happen) doesn’t go away, but instead a new association is created that competes with the older association, an inhibitory expectancy. We now design exposure in such a way that the experience maximally violates the negative expectancy about the adverse outcome. Reduction of fear is no longer a goal during the therapy. In fact, strong fear reduction during exposure is associated with higher relapse after therapy.

We don’t develop mental illnesses in a vacuum, we’re influenced by our environment. A simple example is how fear of spiders often runs in families: parents model the behaviour and kids ‘catch’ the phobia from them, we learn through observation. One of the common dysfunctional expectancies in PTSD is the belief that the memory of the trauma will lead to Disaster with a capital D. Patients believe they will not be able to handle it, that they’ll go crazy, and when they are confronted with a trigger it sets off that whole chain reaction, I’ll think of my rape, I can’t think of my rape, I’ll go nuts, I can not handle this, I’ll literally die. This reaction can be so overwhelming the patient can resort to self-destructive coping mechanisms, and everyone around them gets caught into the same fears, they can’t be triggered, they’ll hurt themselves, they’ll overdose, they’ll cut their arms up, they’ll attempt suicide.

We see the same thing in eating disorders sometimes. Although the symptoms of PTSD can be terrifying and heartbreaking, anorexia literally kills. So parents and partners and friends are in total distress and want to do everything to avoid the Bad Thing (death, definitely an ‘unconditioned stimulus’). No butter in the house, no eating when she’s in the same room, knives used for cheese cannot be used for her fruit because calories and she’ll refuse to eat her one apple then and if she does not eat she will die. When you have an anorexic in your house you sometimes need to do all these things, the whole family starts to behave in an eating disordered manner because sometimes you just don’t have a choice.

What I’m saying is, we shouldn’t all start acting eating disordered simply because some people need to the people around them to act eating disordered for a while to help them cope. It’s okay to do this if someone in your life needs it, but we shouldn’t all start doing this because it’s just not healthy.

Trigger warnings model the incorrect and dysfunctional expectancy that depictions of violence will lead to memories of the trauma, and that remembering the trauma will lead to a Bad Thing (unconditioned stimulus/US). It’s like we’re almost literally presenting the PTSD schema (CS – US/UR – CR), activating a dysfunctional association. It would go to far to say that this would directly cause or create a disordered association, but I can’t think of any theory under which such modelling would have no effect at all. Given what we know about learning and the role of expectancies in anxiety disorders I find it hard to believe it has no influence.

9 thoughts on “On Trigger Warnings

  1. Daan

    Triggers can be futile little things, the smallest detail you encounter reflects deep inside a memory awakening a flashaback. You cannot foresee these let alone put a warning on everything. If you know you are easily triggered or know someone who is, you can try to avoid and guide it as good as possible, but it is walking on eggs and no matter how hard you try, one will eventualy break. It is a fragile thing, makes living a living hell sometimes, you can try, but you cannot cushion the whole world.

    Does a trigger warning itself not trigger itself by emphasizing on the trigger it warns about, just like saying “Do not think of a pink elephant”?

  2. Anonymous

    I really like the respect this piece has for people who have had overwhelming experiences. I have big respect for these people and I dont feel invunerable myself, but do we need to use the word ilness to have respect for these people?

    I do think having conflicts within yourself is quite different than having a sickness by a bacteria. I think being clear without hocus pocus is very important. If trauma is an ilness than were is the pill to heal this? You cant say there isnt been put enough money in that search…

    The whole complicated word PTSD is also very hocuspocusery stuff. Trauma and overwelming experiences is much better. Keep it simple please! Not the psychiatrist should feel great but the person!!!

    Then the word patient. That is really not sensitive! How does feeling dependant help? The person is already suffering. A patient is somebody who has had a sickness by for example a bacteria, not an overwhelming experience.

    Using al these terms is a nice example of reducing human experience into ilnesses. The reductionalism of psychiatrists has failed, the damage done is already big enough, we are more than a bag of molecules.

  3. Anonymous

    This makes me sad, if even you can’t see through this anymore. You had to many biological psychology classes I think.

    I understand the deception is very advanced. I gave you the clip of top researcher and psychiatrist in the nederlands , who step for step shows how the research community works.

    Well show me any data which proofs that any pill like(antipsychotics, anti depressant, anti anxiety or ritalin) that any pill helps in the long term. Like 10-30 years.. Or that it doesnt do damage in that time..

    Show me any data of an individual objective biological test of ilness. Even the dsm now says shizophrenia is not a ilness.

  4. Anonymous

    My writing has implecations so I should als inform what to do if suffer mentally.

    If you have schizophrenia and you are dutch. Inform yourself about damage of antipychotics and watch this:

    If you have a depression, look at the side-effects and dangers and long term effects. Also there are big research flaws in these studies.

    If you have a child with ADHD. The big MTA study found zero better effect of ritalin after 3 years. What did help? social relationships. Long term effects of medication is not researched good enough. Be careful please.

  5. Anonymous

    This is wat psychiatrists do to traumatized soldiers. Thank you brave survivors of psychiatrists who dare to speak up! You are no sick patients, you are heros and survivors!

  6. Anonymous

    When I read people talking about ilnesses I take some time to give them a chance to understand this stuff. Now I am going on to the next forum. But I wil speak up ofcourse against this, because it is not ok

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