Post Traumatic Stress Disorder (PTSD) is an unusual condition in that almost everyone has it to a greater or lesser degree, but few realise the impact that it has had on their lives. As the name implies, the condition describes when a person’s stress levels or reactions don’t go back to normal after a major traumatic experience. This article looks at how to write believable characters and situations involving PTSD.
PTSD is caused by exposure to a traumatic event, usually one in which a person thinks they are going to die. The classic examples are exposure to warfare, traffic accidents, sexual assault or physical assault. Experiences like these cause the brain to flood with fear, which can form long-term associations with the other stimuli present. This means that future exposure to those stimuli can trigger that deep fear again.
The classic symptom of PTSD is becoming full of adrenaline and going into combat mode when exposed to a loud noise or a touch to the head. In the former case, the loud noise might remind a character of the explosions of grenades and shellfire in combat; in the latter case, the touch to the head might remind of early childhood abuse at the hands of a parent. In either case, powerful memories of immense fear can quickly come flooding back.
The effects of PTSD are what could be expected from a close brush with gruesome physical death: adrenaline and cortisol prime the character for either combat or running. A character with the condition might easily become stirred into fight-or-flight mode as a response to the trauma. Here it can be seen that PTSD has considerable overlap with other psychiatric disorders, in particular Panic Disorder, Avoidant Personality Disorder and Generalised Anxiety Disorder.
Other effects are an increased propensity for self-harm. After all, one of the natural consequences of having a massively traumatic experience is that a person comes to realise that the world is much nastier or more dangerous than they thought it was. Some people with PTSD might decide that this world is actually pretty shit and not worth living in, given the horrors it contains.
In the case of violent crime or rape, a person might also come to lose all trust in a major societal demographic, which entails everyday difficulties. If a woman comes to distrust all men or a robbery victim comes to distrust all blacks, their life might become a lot harder and quickly, for no real fault of their own. Like children who have had bad experiences with dogs, a person with PTSD might come to dislike anything associated with their initial trauma.
Because PTSD is frequently portrayed in dramatic fiction, care must be taken not to write in cliches. The example of a nightmare leading to someone waking up in the middle of the night screaming, only to realise that the object of their terror is no longer present, is a striking one but also very heavily used. So too is the man staring into the distance, reliving a traumatic experience, not hearing someone calling to them.
A protagonist who suffers from PTSD might be aware of their condition or unaware.
If they are aware that they have PTSD, they might be a deep and sensitive character. They could be directly aware that a particular early life event has damaged them irreparably. This might be the reason for their unusual levels of compassion – the character knows what it feels like to be scared to death and commiserates with others who also do.
A story featuring such a character might be one about how they overcame their psychic damage and managed to find a way to engage joyfully with life. Often this involves healing oneself, the shamanic path. An extremely wise character may have attained their insight through having overcome an equally extreme trauma earlier in their life. Perhaps this experience caused them to understand what another character is going through.
It’s common to have PTSD and to be unaware of it. This is especially plausible on account of that people who incur severe psychological trauma might not show signs of it until many years later. A person might grow into early adulthood with a particularly surly or nasty character because of some heavy trauma incurred while a child. They might also show other signs of being strongly emotional, reckless or impulsive.
Just because a character with PTSD is not aware that they have PTSD, doesn’t mean that other characters will not be aware. In some cases it will be very obvious, because they will observe the first character go into kill mode for what seems like an insufficiently grave provocation. The character with PTSD might soon find that their condition is part of their reputation – they seem “damaged” in the eyes of others.
A combination of the two can also tell a story, such as the case of a protagonist who gradually becomes aware that they have PTSD or something like it. Perhaps they are perceptive enough to realise that a prior event has damaged their psyche – for example, they observe that they feel intense anxiety when presented with a stimulus that reminds them of a particular traumatic event.
If your protagonist encounters a character with PTSD, how that protagonist behaves might depend on their naivety and openness. A naive character might think that simply by being nice to someone with PTSD they can get them to behave normally. Although this is sometimes true up to a point, the reality is that PTSD often carries with it sinister undertones of bitterness and resentment.
It’s common for people who have PTSD for similar reasons to bond strongly over the fact. This is especially true in the case of soldiers, emergency personnel and survivors of abusive relationships. For one thing, misery loves company, but for another, severe trauma is often the kind of experience that deeply shapes a person and their conception of life and reality, so people who share the trauma often share an entire worldview that’s based on it.
C-PTSD (Complex Post Traumatic Stress Disorder) isn’t actually in the DSM-V, but it’s worth covering here for the sake of completeness. Essentially it’s a similar condition, only brought about by repeated exposure to a traumatic person or stimulus, as opposed to one single, horrifying event as is usually the case with regular PTSD.
The major difference with C-PTSD is the loss of a sense of self. One’s boundaries are violated with such consistency that it becomes hard to say where one ends and the outside world begins. This can be related to Depersonalisation Disorder and frequently coincides with a deep sense of distrust about other people.
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This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.