Post Traumatic Stress Disorder – PTSD – is a popular device for fiction authors. PTSD forces your characters to overcome insurmountable obstacles emotionally and mentally. Characters who are at war with themselves in addition to any external conflict just makes good fiction.
The problem is writers research symptoms and run with it. There’s so much more to PTSD than flashbacks that can add emotional layers, depth, and connection for readers.
**UPDATE** So, this is one of my more popular posts and it’s personal for me because even though I haven’t been officially diagnosed with PTSD, I’m very close to the line. One therapist called what I struggle with mild-PTSD (which, I know isn’t a clinical term, but sometimes having a label helps).
As this has been a personal struggle for me especially over the last few months, I wanted to go back and add some details and nuance that hopefully you’ll find helpful.**
What Do Writers Get Wrong About PTSD?
Post Traumatic Stress Disorder (PTSD) has been called shell shock and historically was lumped in with ‘hysteria’ for women. You can research this mental illness, the causes, and the symptoms, (here’s a great link), but I’m more interested in helping you write it with accuracy.
Giving characters a traumatic past and an ongoing condition that hinders their ability to move on is great for character arc if you can pull it off. Otherwise it can come off sounding trite or melodramatic. The character struggling with PTSD is facing overwhelming odds, and any character who stands up to a bully of any kind (even when it’s a mental illness) is someone readers will cheer for.
Do more research than just symptoms. Flashbacks seem to be the most appealing aspect of writing a character with PTSD, but actual recurring flashbacks are a symptom of very severe PTSD which is absolutely debilitating in every way. Try talking to someone who struggles with this. Read blogs written by those who live with or struggle with this, or have a loved one who struggle with this. Know that the symptoms don’t encompass the whole struggle but are simply the tip of the iceberg.
What Else Is There To PTSD Other Than Flashbacks?
Yes, flashbacks can happen with PTSD, but here’s the truth about flashbacks – not everyone has them frequently or even at all. Most writers love the idea of using flashbacks, I’ll admit they’re fun to play with, but where writers often miss the mark with PTSD are all the OTHER symptoms that are debilitating and soul-crushing. Far more common are triggers which require more subtlety and art to really convey how devastating they can be.
PTSD is a filing problem – basically. Where most brains are able to process and appropriate file away a traumatic memory, for whatever reason – a particular memory or file gets left out and never gets filed away (processed). It’s kept front and center for easy access essentially rewiring the brain.
When triggered, (a smell, a place, a feeling, a person, etc.), the inner-most part of the brain (the amygdala – stay with me) sounds off like a fire alarm. When that fire alarm goes off, the rest of your brain diverts all power/energy to that alarm centre. So, once the fire alarm goes off, you’re incapable of “thinking” your way out of a situation. Instead, you’ll instinctually react in the way that’s most likely to “save you” whether it’s fight, flight, or freeze.
When PTSD rewires the brain, that fire alarm (which is useful, which is necessary) is now super super sensitive. It’s like placing a fire alarm over your toaster. You’re going to get a lot of false alarms. So, in real life we might take the battery out of the alarm, move the alarm or move the toaster. But with PTSD, because the brain can’t figure out where to file that memory, you’re kind of stuck with these constant false alarms. So most or at least a lot of energy goes into avoiding setting off that fire alarm.
This creates a near-constant hyper-vigilance that is exhausting. Utter, soul-draining, bone-weary exhaustion. To the point where you can’t think clearly – you struggle to order your thoughts or prioritize things correctly (Learn more about the mental fog here.) It’s debilitating and can very thoroughly undermine your self-confidence. Every small task or outing gets weighed against the emotional and physical and mental toll it could exact. And let me tell you, this foggy thinking makes life seem pretty f—ing hopeless pretty fast.
And while only the most severe cases have persistant flashbacks, that hyper-vigilance and exhaustion is pretty common. The mental fog caused by the hyper-vigilance or a trigger is common. The frustration and internalized shame of not being able to sort your thoughts, or trust your own thinking is intense.
Give Your PTSD Character A Coping Mechanism
Most people learn coping mechanisms to manage the symptoms of PTSD simply to function, but those mechanisms wear out, their effectiveness wanes over time, our tolerance of them grows thin. If a trigger is the fire alarm, the coping mechanims are essentially the broom being used the fan the fire alarm to prevent it from going off.
If that “broom” is the only way you can manage life at all, you’ll go to some pretty extreme lengths to prevent having it ripped from your hands. Now, that “broom” can be expressed in a wide variety or combination of ways: anger or violence, self-medicating with drugs or alcohol, workaholism, eating disorders, becoming a hermit, suicidal, etc.
At the same time, someone with PTSD is going to cover up their pain at all costs. People stare. They avoid you. They whisper. And all of that gets internalized over time. They’ll be fine in a social situation until they aren’t and they react in (what might appear to be) an irrational or erratic way, but internally they’ll have clamped down and “soldiered up” as long as possible.
Show the consequences of how ineffective that bloody broom strategy is! Show what happens when the broom is taken away (alcohol, a person, a schedule, etc.).
Show Don’t Tell A Trigger With PTSD
You want to show and not tell, right. The person struggling with these kinds of anxiety or PTSD is going to go to great lengths NOT to think about the original traumatic event. Who consciously relives traumatic events? Nobody.
More likely, the traumatic memories are shoved to the very back of the mind and actively avoided, and numbed when avoidance isn’t possible. They’ll be ruled by emotions, and unless they dig down into the WHY of their strong emotion, the PTSD may go untreated for a very long time.
Instead, show the coping mechanisms (the broom) used to control the symptoms or turn their mind off (escapism, fantasy, porn, drugs, alcohol). For me there’s a predictable progression that happens that tips me off to that fire alarm detecting smoke. I feel it in my gut first, a clamping down, a tension, a tightness, and a feeling like I don’t want to be in that place. Then I start to blush, my face feels like it’s on fire. Then I start to tremble. I’ll look down and notice my hands trembling, but at times it won’t feel like I’m looking at my own hands at all. Then my last warning is profuse sweating – regardless of the environmental conditions.
Now keep in mind, that through all of these symptoms, I’ll be waving my damn broom at the fire alarm with the ferocity of a kid trying to put out a fire with their breath. I’ll be using all the grounding techniques I can think of because I’ve decided I can’t or won’t let myself leave the situation.
When PTSD is triggered you’re at war with yourself quite literally. It will seem to come out of nowhere or can build up slowly to a crashing crescendo. A moment ago you were rationally able to recognize there wasn’t any danger, but then the switch is flipped and your body is absolutely convinced you’re in mortal danger.
Know what your character’s primal goal is when they’re triggered. Is it safety? Is it survival? Is it escaping? Have them seek that out at all costs.
They could have a mantra they recite to control their thoughts. They might have a safe person, someone they trust to watch their backs in new or upsetting situations. The slow removal of their dependence on their grounding techniques or coping mechanisms is a great way to show growth.
Those who know what their triggers are will actively avoid situations that might set them off. This is a potential for conflict – force them into a situation where they’re uncomfortable, where they feel threatened or unsafe. Spring it on them. Put them in new situations. I wasn’t aware that exercise fatigue mimicked my PTSD symptoms, so I was triggered by a jerk at the gym and couldn’t feel it coming on because I was in the middle of a workout. The times when you’re triggered without warning are the worst. Being blindsided sets you back days, weeks, even months.
A Blindsided Character Could Be An All-Is-Lost Moment
Being blindsided by a trigger at any point. A situation that’s been fine a thousand other times can trigger you that one day because someone new is there, because you can’t get your usual seat by the door, because someone’s wearing the cologne that your attacker wore. This is a great device to save for a pivotal conflict.
It’s like a two-by-four to the head. Show their emotional wounds bleeding all over the floor and have them keep going anyway. Show them growing stronger, trusting people again against their instincts, forgiving themselves because they couldn’t get a hold of themselves again, etc. Let the whole process be messy, two steps forward and one step back. The stories that end in a pretty bow and leaves everyone “cured” simply aren’t authentic.
Have a question you’d like to ask about writing PTSD in fiction with realism? What’s the most compelling portrayal of PTSD in fiction you’ve seen so far?
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