Tag Archives: psychology

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:

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Why Kinksters are Awesome Clients

On April 24th 2014 I gave a lecture on BDSM in sexual care and health care to over a hundred doctors, psychologists, sexologists and psychiatrists. This lecture was part of a conference on practical aspects of sexual care and health care, a conference which I organised with the Sexology Practice in Tilburg, in collaboration with the Elisabeth Hospital in Tilburg. The conference was accredited by the NVVS (Nederlandse Wetenschappelijke Vereniging voor Seksuologie), the Dutch sexology organisation. This text is a rough summary of my lecture on BDSM.

As a psychologist I have specialised in working with sexual minorities, including SMers. Not only have I personally been involved in the BDSM scene for close to a decade, I’ve studied scientific research on the subject and worked with dozens of kinksters. When other professionals contact me with questions about BDSM they often seem a bit concerned or unsure of what to do. My message today is: BDSMers are great clients and it’s an advantage if your client turns out to be kinky!

We’re talking about a large group. It is estimated one in ten people have an interest in BDSM, and around 3 to 4 % identify as SMer. The BDSM population consists of about as many women as men. Of women, 65% prefer the submissive role and 30% identify as dominant. Men are usually dominant (60%) and 30% call themselves submissive. An interesting finding is that around 50% of both men and women enjoy both roles.

Kinksters might engage in bondage, sensory play, humiliation, roleplay (including Master/slave), painplay and many other activities. Note the use of the word ‘play’ – for many kinksters it is precisely that, a form of play. BDSM is fun, brings excitement and happiness into their lives and feels like a healthy part of who they are and what they do. For example, two friends of mine have a continuous D/s relationship. One of the rules in their relationship is that she cannot have any crisps without his permission. So there she is, holding her hand just above a bowl of crisps, not touching them and there’s a huge grin on her face. He tries to look stern “I said no, girl. You don’t want to get into trouble, trust me”. Her hand hovers there for a bit, then she grabs hold of one of the crisps, pushes it into her mouth and runs, laughing and protesting. BDSM can bring excitement and fun to everyday situations.

It appears to be impossible to distinguish kinksters from non-kinksters, except for the fact that kinksters are kinky. Contrary to what early psychologists believed, BDSM is not correlated with any Axis I classifications (depression/trauma/etc), any Axis II classification (personality disorders) or anything negative or pathological at all. Quite the opposite, actually. Some research has shown significantly higher levels of education and income than in the general population, show that kinksters are more involved in community service and a recent study in Tilburg show favourable psychological characteristics in BDSMers.bloopers_sept2014

So, if these kinksters are all so happy and healthy, why are they looking for help from psychologists, doctors and other professionals? Well, for the same reason non-kinky people need help… and a few other kink-specific problems. It’s important to remember that BDSM is not always part of the problem. A depression can just be a depression, no matter how perverted your client is. But kinksters can present some pretty kink-specific problems that can be puzzling to non-kinky professionals. For example, many couples experience that all the ‘workload’ is on the Dominant partner’s shoulders. The sub wants more D/s, the sub wants more play, but the Dominant has to do it, organise it. I discuss a couple where the sub is the active type, if she wants something done she’ll do it, and the Dom is more the laid-back type. Both partners want more BDSM in their lives, but after a long day of getting the kids to school, working all day, coming home, doing the housework, getting dinner ready, putting the kids to bed and finally landing their behinds on the couch in the evening, playing feels like “another item on my to-do list” for the Dominant, whereas the submissive would love to wind down with some kink. I ask the audience what they would advise, and we discuss the option of putting more of the ‘workload’ for play on the submissive. Subs can be ‘Rupsje Nooitgenoeg’ (The Very Hungry Caterpillar) so being realistic about the amount of time and energy that is available for kink seems important.

I was once contacted by a social work organisation that offered assisted-living housing. One of their clients came out as kinky and had started to attend BDSM parties and munches. They were quite alarmed and wondered if they would one day find their client dead in the gutter after one of these parties, they imagined the BDSM scene was a very violent place. They were also concerned their client was too obsessed with BDSM, as she had started wearing a BDSM symbol around her neck and had BDSM-themed art on her walls. I explained ‘BDSM puberty’. When people find out they’re kinky (or gay) they can go through a phase where it’s all they can think or talk about. Visit ALL the gay bars, be active in ALL the gay rights movements, wear ALL the rainbows! Or, in the case of a kinkster, visit ALL the events, wear ALL the outfits, have ALL the play! I was able to reassure the professionals in this organisation that there was no problem.

shibari_on_the_rocks_by_shibaridojo-d964jkcBut BDSM can be risky, although not in the way a non-kinkster might think. I showed the audience two pictures of BDSM, one with a quite serene and artsy bondage scene and one with a black and blue behind. Bruises and welts might seem scary but are in reality usually harmless, it’s actually the bondage scene that poses more risks. Heavy psychological play might seem intimidating. But kinksters do not display above average symptoms of PTSS (post-traumatic stress disorder), trauma or distress. Accidents, however, do happen. A worrying finding is that kinksters do not usually feel comfortable seeking medical or psychological help, as they are afraid of judgement and discrimination. Sadly, this fear is often justified. SM participants lose custody of children, security clearances, inheritances, jobs, are disowned, assaulted and are victims of persecution and prosecutions. In my own kinky social circle I know of three parents who were reported to Child Services exclusively because of their kink. BDSM can be risky because the non-kinky world makes it risky.

People who don’t deviate from sexual norms usually don’t really have to talk about what they do. There’s a script that can be followed: first kissing, touching breasts, stimulating genitals with hands or mouth and finally penetration. This script can be harmful and does cause sexual problems, but it alleviates you from the responsibility of talking about your desires. When you start to deviate from that heterosexual vanilla norm however, the scripts become useless and you have to communicate your wants and needs. Or else you might show up with diapers while your partner was getting ready for a suspension-scene! In practice this means your kinky clients are used to talking about sex, consent, boundaries and fantasies. They use things like safewords, activity-lists and soft and hard boundaries. Their experience in open communication is a great advantage in therapy sessions. I’ve noticed kinky clients are very willing to do their homework and are creative and playful. Kinky clients are fun clients. And honestly, they often have ‘fun’ problems. I recently saw a couple who wanted help because, when she was being cheeky, he didn’t give her a big smack across the face!

And with kinky clients, as a professional you can really make a difference, which makes working with this population all the more rewarding. I’ve spoken with numerous kinksters who have been told they were sick, they weren’t capable of intimacy, who have received treatment to get rid of the kink. By simply listening, helping them with their actual problems instead of making a problem out of BDSM, by offering some psycho-education on sexuality and diversity, you can make such a difference in a kinkster’s life.

Working with kinky clients can be a learning experience for professionals. Be aware of your own preconceptions, not everything you’ve heard or seen on tv is necessarily true. Be responsible for your own education, too often professionals bring their ignorance and curiosity into their working relationship and use their client’s time to ask questions when they should’ve done their own homework. There are many books and websites on BDSM, including my own (marijkespraktijken.nl). Learn to differentiate between your own emotional reaction and another person’s experience. When you’re a heterosexual man, imagining sex with another man might evoke some pretty negative emotions, but this doesn’t mean there’s anything wrong with homosexual sex. By the same token, some things in BDSM might repulse or frighten you, but this does not automatically mean there’s anything wrong. Be sensitive to the difference between your intuition as a professional, and your emotional ‘squick’ reaction to something that’s not for you.

Sex is intimacy, pleasure, connection, and in BDSM people try to be honest about their fantasies, they’re vulnerable, they bring their guards down, trusting that they will be accepted and loved. And whether we’re kinky or not, I think that’s something we’re all into.