Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The controversy that surrounds trigger warnings

Maria Yang, MD
Conditions
May 24, 2016
208 Shares
Share
Tweet
Share

A reader I respect asked me for my thoughts on trigger warnings.

Per Wikipedia, trigger warnings are “warnings that the ensuing content contains strong writing or images which could unsettle those with mental health difficulties.”

Let’s put aside the last part of that definition, “those with mental health difficulties”, as some articles suggest that trigger warnings are not limited to those with mental health difficulties. Part of me wonders why that fragment is in there.

First, some relevant clinical information, as trigger warnings as described in popular press are commonly paired with post-traumatic stress disorder (PTSD):

DSM-5 has loosened the definition for trauma. Affected individuals do not have to directly experience the trauma (“exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways”). Parameters to describe reactions to the trauma, however, still exist. In a previous post I reviewed the other DSM-5 criteria for PTSD.

The vast majority of people who experience trauma as described in DSM-5 do not go on to develop PTSD. Yes, people may experience symptoms in the days to weeks following the event. Most people, though, incorporate the events into their lives and move on. This is a testament to human resilience.

One of the most effective treatments for PTSD and other conditions related to anxiety and fear is “exposure,” delivered in a gradual process called “systemic desensitization.” For example, if a woman was a victim of rape and has symptoms of PTSD, the therapist and woman build a hierarchy of anxiety-inducing experiences related to the rape. The least anxiety-inducing experience may be her thinking about the facts of trauma. The most anxiety-inducing experience may be her wearing the exact same clothes she wore that day, going to the location where the rape occurred, and describing, out loud, what happened. Something in the middle may be her walking past the location where the rape occurred.

The therapist helps the patient learn coping skills to recognize, acknowledge, and manage anxiety and other uncomfortable reactions. They then work through the hierarchy, from least anxiety-provoking to most anxiety-provoking, until the patient is able to meet and overcome the anxiety associated with the traumatic event.

Do note that avoiding cues associated with the trauma is not included in the descriptions above.

So, back to trigger warnings:

Different people respond to cues in different ways. Some victims of rape don’t have any visceral reactions when they hear or talk about rape. Some do. Some people only have visceral reactions if they smell something from or see certain objects associated with the traumatic event.

Who decides which triggers are worth mentioning and which are not? Does anyone have the right to tell someone else what is a trigger and what isn’t?

People have different capabilities to cope with stress. I mean no disrespect in the following sentence: Some people have never learned how to deal with themselves. They don’t know what to do when they feel angry or sad or frustrated. No one ever taught them what to do with those emotional energies. They have a skills deficit.

Thus, for some people, the best way they’ve learned to take care of themselves is to ask for trigger warnings. That strategy has worked for them and, as a consequence, they continue to use it. The feeling of empowerment is much preferable to feelings of discomfort.

For all of us: You feel the way you feel. It’s neither right nor wrong. People may tell you that you’re overreacting or “too sensitive,” but that’s about them, not about you. You feel the way that you feel.

Emotions aren’t simply reactions. Emotions give us information about the situations we’re in. They help us decide on next steps. We certainly prefer some emotions to others. All emotions, though, serve a function. Avoiding them often causes more problems.

The request for trigger warnings may not represent a need for coddling. It may reflect a need for greater validation. When we feel like no one understands where we’re coming from or what we’ve experienced, sometimes we try harder to make others listen to us with hopes that they will then understand us.

As social creatures, we build our identities in relation to others. Context matters. Perhaps the request for trigger warnings is a reaction to the limited support and acknowledgment we received when we experienced trauma. This is an opportunity to not only advocate for ourselves, but also to advocate for others who may still feel uncomfortable expressing their own distress. Feeling empowered is much preferable to feeling uncomfortable.

Do people want trigger warnings because we, as a society, are unwilling or unable to talk about the horror, helplessness, and terror that accompanies trauma?

If people can ask for trigger warnings, that means that they have voices that others can acknowledge, hear, and respond to. What about all the people in the world who don’t have a voice? And are yet unable to escape trauma? The request for trigger warnings can be noble, but does little for others who are currently experiencing and recovering from their own traumas. Not talking about something doesn’t mean it will go away.

Furthermore, the underlying assumption of trigger warnings is that people who have experienced trauma can’t handle life. Not only is this assumption wrong, it is also dangerous.

As I noted above, most people who experience trauma do not develop PTSD. For those who do develop PTSD, they can and do recover. That doesn’t mean that recovery is easy, quick, or painless. Like anything important, it takes time and energy.

Because we build our identities in relation to others, requests for trigger warnings could send the message that people who have experienced trauma will never recover. It can also suggest that people who have experienced trauma are “defective” or, as in the Wikipedia definition, have “mental health difficulties.”

To be clear, there is a role in alerting people to potentially disturbing experiences. Movie ratings do this: That “R” rated movie has violence, nudity, and drug use. This information serves a purpose for parents and viewers of films. If you find the film disturbing, you can use the energy from your own emotional reaction to write a letter of umbrage to the filmmaker, avoid similar films in the future, or tell your friends not to see the movie. However, how you react to the film doesn’t mean that everyone else will react in the same way. It also does not mean that film makers must heed your requests to provide warnings about its content.

Given that people respond to cues and deal with stress in different ways, people have unique emotional reactions to events, and avoidance is not an effective treatment for anxiety and trauma-related disorders, requests for trigger warnings are ultimately short-sighted and will not help people learn about themselves, grow, and recover.

Maria Yang is a psychiatrist who blogs at her self-titled site, Maria Yang, MD.

Prev

The enemy is not death. The enemy is needless suffering.

May 24, 2016 Kevin 4
…
Next

What it takes to be a great doctor: Master the fundamentals

May 24, 2016 Kevin 5
…

Tagged as: Psychiatry

Post navigation

< Previous Post
The enemy is not death. The enemy is needless suffering.
Next Post >
What it takes to be a great doctor: Master the fundamentals

More by Maria Yang, MD

  • A doctor’s COVID-19 advice to physician leaders

    Maria Yang, MD
  • When a patient in jail lacks impulse control

    Maria Yang, MD
  • Does medical school train students to become managers or leaders?

    Maria Yang, MD

Related Posts

  • New CDC warnings underscore how vaping is smoking 2.0

    Daryl Pearlstein, MD
  • The burden of the badge: an MD student’s response to the FIGS controversy

    Palak Patel
  • Advocating for people with disabilities: People First Language

    Leonard Wang
  • Qualifying conditions for medical marijuana

    Patricia Frye
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN
  • What does Kelly Loeffler’s health plan do to coverage for preexisting conditions?

    Robert Laszewski

More in Conditions

  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • The teacher who changed my life through reading

    Raymond Abbott
  • Revaluating mental health assessments: It’s not just the patient you should consider

    Tomi Mitchell, MD
  • Breaking down barriers: How technology is improving diabetes management in underserved communities

    Anonymous
  • Yoga and self-care won’t cure my Crohn’s disease

    Kristen L. Cole
  • What causes fainting and how to prevent it during needle procedures

    Jean Paul Brutus, MD
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • Lifestyle change: the forgotten solution in health care

      Tyler Petersen | Conditions
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • How medical student loan forgiveness can advance health equity [PODCAST]

      The Podcast by KevinMD | Podcast
    • The rise of generative AI in health care: Here’s what you need to know

      Anil Saldanha | Tech
    • Finding peace through surrender: a personal exploration

      Dympna Weil, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Unlocking the secret to successful weight loss: Curiosity is the key

      Franchell Hamilton, MD | Conditions
    • The teacher who changed my life through reading

      Raymond Abbott | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Heart Failure's Obesity Paradox Falls Apart on Further Inspection
  • Nobody Wants This Job. Should Physicians Stick Around?
  • Early Postpartum IUD Placement Yields Low Complete Expulsion Rate
  • Hydrocortisone Reduced Mortality in Patients With Severe Pneumonia
  • Obesity Tied to Density of Food Stores Carrying Less Healthy Options, Report Finds

Meeting Coverage

  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • High Rates of Psoriasis Clearance With Investigational TYK2 Inhibitor
  • Rapid Improvement in Atopic Dermatitis With Topical PDE4 Inhibitor
  • New Approaches in the Bladder-Sparing Paradigm
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • Lifestyle change: the forgotten solution in health care

      Tyler Petersen | Conditions
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • How medical student loan forgiveness can advance health equity [PODCAST]

      The Podcast by KevinMD | Podcast
    • The rise of generative AI in health care: Here’s what you need to know

      Anil Saldanha | Tech
    • Finding peace through surrender: a personal exploration

      Dympna Weil, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Unlocking the secret to successful weight loss: Curiosity is the key

      Franchell Hamilton, MD | Conditions
    • The teacher who changed my life through reading

      Raymond Abbott | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The controversy that surrounds trigger warnings
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...