Thursday, October 9, 2008

Character Psychology: PTSD

I write dark fantasy. Very, very dark fantasy. My characters go through hell and back on the page, and they genuinely suffer those events. Despite the most recent trend in fiction of the blase hero who shrugs off torture, maiming and psychological terror with a witty one-liner, my characters get to experience the full range of horror, grief, self-doubt, and pain as well as the relief, joy, and love that accompany their travails.

If yours do, too, this is the post for you.

Self-Defense

The human psyche is set up to defend us against long-term dysfunction associated with traumatic events. Factors that modern psychology label "defense mechanisms" - like denial and overcompensating - are meant to prevent us from being overwhelmed by all sorts of nastiness - warfare, muggings, rape, torture, natural disasters... you name it.


Most of the time, the defense mechanisms do their job - they defend the integrity of the person's mental state until the person has a chance to cope with the problem. But when defense mechanisms fail, or are carried on well beyond the period when acceptance and healing should have begun, mental health problems can set in.

Dysfunction

One of the best tools in the resource bag of an writer whose characters genuinely suffer their tragedies, is PTSD, or post-traumatic stress disorder. Originally used to describe the mental health problems of post-war combat veterans, this term has come to mean an anxiety disorder that comes about following significant traumatic exposure in any age group or population. Examples include folks who experience, have loved ones experience, or observe violent events like mugging, rape, murder, torture, kidnapping, terrorism, natural disaster, child abuse, or any form of significant physical or threatened harm.

So how do you know if your character has PTSD? Symptoms of PTSD include sleeping disturbances (especially nightmares), irritability, loss of pleasure in things once enjoyed, apathy or numbness toward people once close to, jumpiness or being easy to startle, and the potential to become aggressive or even violent.

The hallmark of PTSD are flashbacks - intense, uncontrollable memories of the traumatic event that have the power to remove the person from the here-and-now and take them right back to the moment of greatest trauma. Flashbacks are often triggered by everyday events, sounds, or smells. A backfiring car, the smell of a certain cologne, flashes of light, the sound of a balloon popping, certain phrases of dialogue - anything that triggers a memory can, in PTSD, trigger a flashback. Not every person with PTSD will have flashbacks, but all will suffer from vivid emotional or memory recurrences of the event. Fear, anxiety, and a sense of helplessness are very common.

People with the disorder often describe flashbacks as replaying the event in their minds, of forgetting where they really are and reliving the experience, of being in a bubble of terror. Unlike normal memories, flashbacks trigger not just an emotional response, but a physiological response as well. Release of adrenaline (the fight-or-flight reflex hormone) causes pounding heart, increased blood pressure, sweating palms, stomach upset (up to and including vomiting), a tendency toward aggression, dry mouth, an intense desire to flee...

All writers have some experience with adrenaline to draw from for painting their character's emotions. Just think of a time when you've been utterly terrified, or even nervous. The hormones that control your body's reaction to these emotions are the same. Maybe asking Susie Q to the spring formal got your heart pounding and your palms sweating. Maybe it was a traumatic event of your own that you have overcome or not yet faced. Draw on these experiences to let your characters experience emotions as real as those you felt when you stood there shaking, pupils dilated to take in more light, heart racing, mouth dry.

The purpose of adrenaline is to get your body ready to either flee from immediate danger, or to fight for your life. With PTSD, it's just a matter of that hormone being triggered strongly at inappropriate times, for memory rather than immediate threat.

Not every character needs to experience PTSD, but every character should have some reaction to horrible things that happen in their experience. If you think PTSD might be just what your character needs, read on.

The symptoms of PTSD usually occur within six months of a traumatic event, but can take years to show up. Symptoms must last longer than a month to qualify as a disorder under current psychological diagnosing guidelines.

Most individuals diagnosed with PTSD today get relief from a class of drugs known as selective seritonin-reuptake inhibitors (SSRI), which are also used to treat depression. Drugs in this class include Prozac, Lexapro, Zoloft, and Paxil. Individuals not treated medically can see symptoms resolve over time or by 'working through' their delayed reaction to the trauma. Psychotherapy and even virtual reality have been successfully employed in resolving PTSD. However, for some individuals, PTSD symptoms can become chronic, lasting years or throughout the remainder of life.

Women are more likely to develop PTSD than men, and individuals who experience traumatic events that were intentionally caused by another person, such as rape, kidnapping, or torture, are more likely to develop the disorder than survivors of natural disasters or events that are not directed specifically at the individual, like car accidents. People who suffer from severe PTSD may have difficulty keeping jobs. Some may attempt to avoid situations that trigger flashbacks or engage in "escape" behaviors like heavy drinking and drug use or attempt suicide.

PTSD, in fiction, can be a powerful tool to draw tension and internal conflict (and external if your PTSD sufferer gets violent). As in the real world, it can be devastating to the person's life and overall well-being. Combat soldiers, particularly from the Vietnam era, have been widely known to suffer PTSD to varying degrees. New therapies have been successful at helping many, but chronic PTSD remains a problem for many.

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4 Comments:

Blogger Xenith said...

I have a character who seems to be going through this but he's being uncooperative.

Does this work:

He had years of childhood abuse, then he spent the next 10 years studying in a "temple", where he was emotionally/physically withdrawn, and whatever else went on (this just backstory, so I don't know much about it).

Five years ago, he was dragged out into the real world and started to "recover" e.g. he's become close to a couple of people, found things he enjoys; although he still has some coping problems.

Now the tricky bit. He's started having ghost visions, as he calls them, more frequently and emotional outburst, as if he's going through some sort of relapse. Does this happen? On this sort of timeline?

My other difficulty is finding how it would be dealt with. Their society is roughly mid-19th century. I now have a large collection of e-books about Victorian mental health but as I don't know what they called it/classed it as, they're not a lot of use. Not that I expect you to be able to help with this bit, but I think if I grumble about it enough, someone will know :)

October 10, 2008 9:55 PM  
Blogger LJCohen said...

I have 2 book recommendations on the subjects of combat related PTSD:

Achilles in Vietnam: Combat trauma and the undoing of character, and

Odysseus in America: Combat Trauma and the trials of homecoming

Both are by Boston area psychiatrist, Jonathan Shay, who won a MacArthur 'genius' grant for this work in 2007.

These are both on my bookshelf--powerful reads and easy for the layman to understand, using the lens of The Iliad and the Odyssey as metaphors.

Excellent post and an excellent blog!

October 27, 2008 1:50 PM  
Blogger Arizela said...

Xenith -

Sorry for the long wait. I was on vacation for a while and my own muse mugged me.

The time-line is fine, if there is something that triggers this sudden relapse. I could be anything. Seeing an adult yell at a kid, seeing a kid who reminds him of the event. A noise. A smell. Anything, really. As for Victorian era mental health, I'm not the best expert at that and wouldn't even know where to begin to look, but I imagine they would have tried other Victorian remedies before jumping to putting him in an asylumn.

October 27, 2008 4:41 PM  
Blogger Xenith said...

Thanks. I'm not in a hurry :)

When I first wrote the comment, I thought the character in question was just starting to show signs of PTSD, then partway through it, I realised he had "been there, done that" years before. Interesting how focusing on the problem, brought this background information out :)

October 30, 2008 4:28 AM  

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