crazy

On trauma aftermaths that don't advance the plot

The way TV shows trauma can lead people to expect every reference to trauma to be a plot point. This can be isolating to people coping with the aftermaths of trauma. Sometimes people treat us as stories rather than as people. Sometimes, instead of listening to us, they put a lot of pressure on us to advance the plot they’re expecting.

On TV, triggers tend to be full audiovisual flashbacks that add something to the story. You see a vivid window into the character’s past, and something changes. On TV, trauma aftermaths are usually fascinating. Real life trauma aftermaths are sometimes interesting, but also tend to be very boring to live with.

On TV, triggers tend to create insight. In real life, they’re often boring intrusions interfering with the things you’d rather be thinking about. Sometimes knowing darn well where they come from doesn’t make them go away. Sometimes it’s more like: Seriously? This again?

On TV, when trauma is mentioned, it’s usually a dramatic plot point that happens in a moment. In real life, trauma aftermaths are a mundane day-to-day reality that people live with. They’re a fact of life — and not necessarily the most important one at all times. People who have experienced trauma do other things too. They’re important, but not the one and only defining characteristic of who someone is. And things that happened stay important even when you’re ok. Recovery is not a reset. Mentioning the past doesn’t necessarily mean you’re in crisis.

On TV, when a character mentions trauma, or gets triggered in front of someone, it’s usually a dramatic moment. It changes their life, or their relationship with another character, or explains their backstory, or something. In real life, being triggered isn’t always a story, and telling isn’t always a turning point. Sometimes it’s just mentioning something that happened to be relevant. Sometimes it’s just a mundane instance of something that happens from time to time.

Most people can’t have a dramatic transformative experience every time it turns out that their trauma matters. Transformative experiences and moments of revelation exist, but they’re not the end all and be all of trauma aftermaths. Life goes on, and other things matter too. And understanding what a reaction means and where it came from doesn’t always make it go away. Sometimes, it takes longer and has more to do with skill-building than introspection. Sometimes it doesn’t go away.

On a day to day level, it’s often better to be matter-of-fact about aftermaths. It can be exhausting when people see you as a story and expect you to advance the plot whenever they notice some effect of trauma. Pressure to perform narratives about healing doesn’t often help people to make their lives better. Effect support involves respecting someone as a complex human, including the boring parts.

The aftermath of trauma is a day-to-day reality. It affects a lot of things, large and small. It can be things like being too tired to focus well in class because nightmares kept waking you up every night this week. TV wants that to be a dramatic moment where the character faces their past and gets better. In real life, it’s often a day where you just do your best to try and learn algebra anyway. Because survivors do things besides be traumatized and think about trauma. Sometimes it’s not a story. Sometimes it’s just getting through another day as well as possible.

A lot of triggers are things like being unable to concentrate on anything interesting because some kinds of background noises make you feel too unsafe to pay attention to anything else. For the zillionth time.  Even though you know rationally that they’re not dangerous. Even though you know where they come from, and have processed it over and over. Even if you’ve made a lot of progress in dealing with them, even if they’re no longer bothersome all the time. For most people, recovery involves a lot more than insight. The backstory might be interesting, but being tired and unable to concentrate is boring.

Triggers can also mean having to leave an event and walk home by yourself while other people are having fun, because it turns out that it hurts too much to be around pies and cakes. Or having trouble finding anything interesting to read that isn’t intolerably triggering. Or having trouble interacting with new people because you’re too scared or there are too many minefields. Or being so hypervigilant that it’s hard to focus on anything. No matter how interesting the backstory is, feeling disconnected and missing out on things you wanted to enjoy is usually boring.

When others want to see your trauma as a story, their expectations sometimes expand to fill all available space. Sometimes they seem to want everything to be therapy, or want everything to be about trauma and recovery.

When others want every reference to trauma to be the opening to a transformative experience, it can be really hard to talk about accommodations. For instance, it gets hard to say things like:

  • “I’m really tired because of nightmares” or 
  • “I would love to go to that event, but I might need to leave because of the ways in which that kind of thing can be triggering” or 
  • “I’m glad I came, but I can’t handle this right now” or
  • “I’m freaking out now, but I’ll be ok in a few minutes” or 
  • “I need to step out — can you text me when they stop playing this movie?”

It can also be hard to mention relevant experiences. There are a lot of reasons to mention experiences other than wanting to process, eg:

  • “Actually, I have experience dealing with that agency”
  • “That’s not what happens when people go to the police, in my experience, what happens when you need to make a police report is…”
  • “Please keep in mind that this isn’t hypothetical for me, and may not be for others in the room as well.”

Or any number of other things.

When people are expecting a certain kind of story, they sometimes look past the actual person. And when everyone is looking past you in search of a story, it can be very hard to make connections.

It helps to realize that no matter what others think, your story belongs to you. You don’t have to play out other people’s narrative expectations. It’s ok if your story isn’t what others want it to be. It’s ok not to be interesting. It’s ok to have trauma reactions that don’t advance the plot. And there are people who understand that, and even more people who can learn to understand that.

It’s possible to live a good life in the aftermath of trauma. It’s possible to relearn how to be interested in things. It’s possible to build space you can function in, and to build up your ability to function in more spaces. It’s often possible to get over triggers. All of this can take a lot of time and work, and can be a slow process. It doesn’t always make for a good story, and it doesn’t always play out the way others would like it to. And, it’s your own personal private business. Other people’s concern or curiosity does not obligate you to share details.

Survivors and victims have the right to be boring. We have the right to deal with trauma aftermaths in a matter-of-fact way, without indulging other people’s desires for plot twists. We have the right to own our own stories, and to keep things private. We have the right to have things in our lives that are not therapy; we have the right to needed accommodations without detailing what happened and what recovery looks like. Neither traumatic experiences nor trauma aftermaths erase our humanity.

We are not stories, and we have no obligation to advance an expected plot. We are people, and we have the right to be treated as people. Our lives, and our stories, are our own.

An example of both types of mental health stigma

Content note: This post contains both criticism of and respect for the mental health system. If you find either upsetting, it’s likely that this post will bother you.

I wrote recently about two distinct kinds of mental illness stigma. There’s dismissiveness, where people aggressively deny that someone’s mental illness is real. There’s dehumanization, where people believe that someone’s mental illness is real, and treat them as though their condition makes them less than fully human. Both are common, and people who have experienced one more than the other tend to have very different perceptions of the mental health system.

One example of difference in perception: Mental health advocates often say things like “Medication for mental illness is just like insulin for a diabetic”. People who have mostly faced dismissiveness often see this as validation; people who have mostly faced dehumanization often see it as a threat.

From the perspective of someone who has mostly experienced dismissiveness, it might sound like this:

  • I’m really glad that someone understands how serious my medical condition is
  • People have told me over and over that I don’t have a real problem
  • Or that medication is just a crutch I’m using to avoid dealing with things
  • Or that it’s whiny to want medication
  • Or they might say things like “You’re not sick. People with cancer are sick.”
  • My medication is really, really necessary
  • Or even: my medication saved my life, and I think I’d die if I stopped taking it.
  • I’ve had to fight my doctor, my family, or my insurance company to get access to the medication I need.
  • It messes up my life when people don’t take my need for medication seriously.
  • I’m glad someone gets it about how real my medical condition is, and how important it is for me to have access to medication.

For someone who has mostly faced dehumanization, a statement like that might sound more like this:

  • People have treated me like I’m not a person, and use analogies to physical conditions to justify it.
  • People have made me take medication I didn’t want to take, that did things to my brain and body that I didn’t like.
  • They’ve done this to me in order to change how I felt, thought, or behaved.
  • They’ve told me that what they were doing to me was just like giving insulin to a diabetic.
  • And that this meant I could not possibly have any valid reason to object to the treatment they wanted me to have.
  • But diabetes and mental illness aren’t actually all that similar.
  • Insulin-dependent diabetics who refuse treatment die. When I refused treatment, I didn’t die. It’s not the same. I’m not sick in that way.
  • The way I am is not the same as having a life-threatening physical condition with an obvious straightforward life-sustaining treatment.
  • It’s important that people understand the difference.
  • When they don’t understand the difference, they treat me as though I’m not a real person unless I am on the medication they want me to be on.
  • People say “unmedicated” like it means violent, dangerous, or incapable of understanding something. It doesn’t. It just means that someone isn’t taking medication. That doesn’t tell you anything in itself.
  • I need people to respect me as a person, and respect my right to make treatment decisions. When they don’t, things can get really bad really fast.

There are numerous other examples of things like this. Most things people say about mental health look very different to people who have primarily experienced dismissiveness than they do to people who have primarily experienced dehumanization. Neither perspective is right or wrong exactly; both are important and incomplete.

Access to psychiatric medication is important; respect for the humanity and human rights of people who have been diagnosed with mental health conditions is also important. Things aren’t great for anyone, and they could be a lot better for everyone.

tl;dr Mental health discourse often looks very different depending on perspective. People who have mostly faced dismissiveness tend to see things one way; people who have mostly faced dehumanization tend to see things a different way. Scroll up for a concrete example.

Two kinds of mental health stigma

Content note: This post contains both criticism of and respect for the mental health system. If you find one or the other upsetting, this post will likely bother you.

There are two basic kinds of mental health stigma: dismissiveness, and dehumanization. Mental health conversations tend to have trouble acknowledging both at the same time — usually it’s at most one.

Dismissiveness stigma is when people deny the reality of mental illnesses. This plays out in a number of ways. One classic example of dismissiveness is “antidepressants are just a tool of capitalism to stop people from noticing that things are wrong”, or “Stop complaining. There are people with real problems”. There are many other examples.

Dehumanization stigma is when people deny the humanity of people with mental illnesses. A classic example of this is people who believe that the purpose of mental health treatment is to reveal the real person underneath — and that therefore, any objections they might make to the treatment “aren’t the real them talking”. There are many other examples of this as well.

Dismissiveness and dehumanization are both major problems. They’re both real, and they both do a lot of damage, even up to the point of costing people their lives.

People tend to perceive the mental health system very differently based on which kind of stigma looms largest for them. For a lot of people, it’s much easier to see one type than the other.

People who mostly experience dismissiveness often see the psych system this way:

  • No one took my problem seriously
  • I was scared to turn anywhere for help
  • Once I finally took the leap and went to therapy, things got so much better
  • Or, once I finally stared medication, things got so much better
  • (Or even: medication and therapy saved my life).
  • (Or even: I’m so glad people finally pushed me to get treatment; they were right.)
  • I wish people wouldn’t be so afraid. I wish everyone had access to this.
  • We need to fight stigma so that people can get the help they need.
  • (And to reform laws so that everyone has access).

People who mostly experience dehumanization often see it more like this:

  • When I entered the psych system, people treated me like I wasn’t a person
  • They forced me to take medication I didn’t want to take
  • The drugs didn’t work, and had harmful side effects
  • When I complained, they treated it as a symptom and raised the dose
  • They forced me to be in therapy I didn’t want to be in, and that made me worse
  • When I tried to advocate for myself, people treated it as a symptom, and no one took me seriously
  • Things only got better for me when I stopped therapy and/or medication and started a different approach
  • (Or even: stopping therapy and/or medication saved my life)
  • I wish people wouldn’t be so uncritical of a system that hurt me
  • I wish “unmedicated” wasn’t used as a slur implying that people who make the choices I make are all terrible people
  • We need to warn people, and reform the laws and systems that allow people to be treated this way

Some people’s experiences in the mental health system are positive in ways that nothing else is; some people’s experiences are horrifying. (And for a lot of people, things are more mixed). Neither type of experience is universally representative; both are real and common. Both matter, and need to be part of the conversation.

When most of someone’s experiences are with dehumanization, it can be hard to understand that dismissiveness is also a problem. Or why anyone would regard mental health care as positive, or lack of access to it as a problem. They may also find the terminology of “mental illness” repugnant, and have a strong preference for “crazy”. But it really is the case that for some people, mental healthcare including therapy and medication is a really good thing. And that for some people, the biggest problem with the system is difficulty accessing it (either because others discourage it, or because it’s too expensive.)

When most of someone’s experiences are with dismissiveness, it can be hard to understand that the dehumanization experiences are also real. (Particularly for people who were really afraid of mental health care and then had a transformative good experience with it.) It can be hard to understand why someone would prefer an apparently pejorative term like “crazy” over an apparently-netural term like “mental illness”. It can seem like people must be exaggerating, or that these things only happened in the past, or something like that. But dehumanization is still a problem now, and fighting treatment stigma will not address that problem.

Both dehumanization and dismissiveness are important barriers to people being treated as they ought to be. Because of both types of stigma, people lack access to help they vitally need. For some people, that help is treatment. For others, it’s access to resources like housing, respite, and assistance with food. For a lot of people, it’s both. People’s very real mental health struggles should not be dismissed; neither should the humanity and human rights of people with mental illnesses be denied.

tl;dr There are two types of mental health stigma: dismissiveness, and dehumanization. Dismissiveness is when people deny the reality of your condition; dehumanization is when people think that your condition makes you less than human. Dismissiveness is often made better by the mental health system; dehumanization is often made worse. People whose experience is primarily in one category often don’t understand that the other category exists. Both matter, and both need to be part of the conversation.