To Trigger…

Yes, I’m a liberal. Yes, I don’t unconditionally believe in trigger warnings. Yes, we exist.

The argument in favor of trigger warnings stems from the fact that there are some emotions people don’t want to feel. No one likes to be depressed, or anxious, furiously angry, lonely, or uncomfortable, unless maybe there’s a new horror movie or it’s a fetish. However, when we label these emotions as “bad” or “negative” and do everything we can to avoid them, we’re giving our emotions more power than they deserve. When our emotions hold power over us, we become increasingly anxious and avoidant.

My first experience with anxiety was eerily similar to Bridget’s. I was sitting in a fuzzy, lime-green saucer chair from Target re-reading a book I was probably too young to read. After my anxiety attack, I threw the book in the trash and would’ve burned it if it weren’t for my fear of fire. I don’t remember its title now, but I do remember it was about a mess of children suffering from a variety of psychoses, living in poverty in the Deep South. The children murdered some people, evaded some murders, and did something with a poisonous snake imported from Africa. It was more unsettling than it was scary, but it triggered something I didn’t have a name for at the time. I suddenly imagined myself harming myself and killing my loved ones, and I couldn’t stop. The thoughts distressed me so much I shook until I vomited so hard the blood vessels in my face burst. I vomited into my hot pink trash can to the tune of E.T. by Katy Perry. The thoughts grew more frequent and more horrifying over the following months. I didn’t understand what was happening to me, and I was terrified to find out what was wrong. I started to see a therapist, but I worried if I told her the violent details of my inexplicable thoughts, she would ship me off to an insane asylum. I felt like I didn’t have any control over my body. I was convinced that my hands were going to disobey my brain, and grab the steak knife from the drawer in my kitchen and ruin my life. I was only able to enter the kitchen if my hands were tightly clasped behind my back and if someone was already in there. Soon, I was no longer able to enter the kitchen at all. It was great for my weight. I’m not sure why scaring yourself sick never caught on as a dieting trend. But unfortunately, my dietary habits weren’t the only thing affected. I avoided movies, TV shows, books, and radio stations that might mention violence, jail, or Katy Perry’s E.T. It was hard. We live in a violent world. The more I worked to avoid things I thought were triggers, the worse my anxiety attacks became when I was inevitably set off. I became convinced that something was seriously wrong with me. How could I still be considered sane if I was scared of my own thoughts? How could I have such dangerous and harmful thoughts if I didn’t secretly want to do these dangerous and harmful things?

I was so convinced I was losing my mind I had to prove to myself I still had control over my body. When I was alone in the house, I would tip-toe and slide and stumble into the kitchen, just so that I could touch and hold and play with the objects that could be weapons of mass destruction. I regained my power over the knobs of the oven and the thin steel of the steak knife. I learned how to be comfortable with my discomfort. My emotions were just emotions as long as I didn’t let them control my actions.

I was later diagnosed with a form of OCD called harm OCD. I learned that the thoughts I had were ego-dystonic, inconsistent with my beliefs and sense of self. They are very common in people who suffer from OCD. I learned that what I was doing with my kitchen appliances was a type of exposure therapy. It took me until my sophomore year in college to find a therapist I trusted enough to talk to about my thoughts, thoughts I’d been experiencing since seventh grade.

My current therapist has a PhD in psychology. He works at CHOP and practices CBT, cognitive behavioral therapy. My opinions on trigger warnings come from my experiences with CBT.

Cognitive behavioral therapy de-emphasizes the patient’s relationship with their past, and focuses on helping the patient deal with the uncertainty of the future, “retraining” the brain with worksheets to challenge maladaptive thinking patterns and controlled exposure therapies. Cognitive behavioral therapy for people struggling with phobias consists of slowly introducing the patient to the object they fear the most. For example, if the patient has arachnophobia, the therapist will start by having the patient talk about spiders, then looking at pictures of spiders, then existing in the same room as spiders, touching a spider, and finally letting the spider crawl on them. CBT is more effective than other forms of more traditional talk therapy with 80-90% of people showing complete remission by the tenth session and a lower relapse rate than that of traditional talk therapy.

Right now I am doing emotional exposures with my therapist for OCD and anxiety. I try not to ask people what they think or how they feel about me. I avoid reassurance seeking. I read books and articles about suicide. I imagine myself in horrible scenarios, causing harm, hurting my family members. It’s hard, but it’s helping. I know that if I get anxious unexpectedly or if I have a flare up of my OCD, I am still in control of myself. My errant thoughts will just be errant thoughts, and then they’ll pass.

Before I started the module on emotional exposures with my therapist, we did interoceptive conditioning. This is another form of exposure therapy where the patient engages in physical activities designed to produce the physical sensations mirroring those which they encounter when having an anxiety or panic attack. I breathed through a coffee straw then downed two glasses of water and spun around in a chair for a minute. This made my chest feel tight and my stomach queasy. When I took a plane to London and felt these same symptoms while trying to eat some dry chicken over the Atlantic, I was able to think through them. I did not escalate my anxiety by assuming my body was out of my control, or that I was going to become seriously ill. Uncomfortable physical sensations no longer trigger my anxiety.

Therapy is a controlled environment where the patient should feel comfortable enough to allow the therapist to lead them through guided exposures. In real life we are exposed to the things we fear without warning, and often times without sympathy or compassion.  CBT is a specialized form of therapy. An Article published by The Atlantic entitled “The Only Cure for CBT is Expensive, Elusive, and Scary” details the complexities and limitations of CBT.  It’s hard to find good mental health care in America. I’m very privileged to be able to receive CBT from a professional who specializes in it. I am very privileged to not know what is like to be “triggered” in an academic setting. My argument is not that trigger warnings should be completely eradicated from institutions of higher learning, but that their use should be limited.

The argument for the standardization of trigger warnings focuses on reducing trauma exposure in the classroom. In countries with “high income levels,” First World countries, the rate of exposure to trauma is 72.4%, but usually only about 5% of the population suffer from PTSD. PTSD is different from anxiety and depression. The DSM, the diagnostic statistic manual, is written and maintained by a team of researchers and psychologists from the American Psychological Association. The DSM-5 distinguishes trauma and stressor related disorders from anxiety disorders by requiring that “the onset of symptoms is precipitated by a specific, serious, adverse life event” and that “stress is necessary, even if not sufficient, for the outbreak of the disorder.” People who have a “specific, serious” fear should not be forced to be exposed to stimuli that could trigger adverse, stressful reactions. However, this seems to be the minority of students.

The Association for University and College Counseling Center Directors reports that 41.6% students experience anxiety. A study published by the National Institute of health claims that only 11.9% of college students suffer from the disorder, and another study published by the American Journal of Orthopsychiatry states that the number is closer to 13.9%. The most prevalent of the recorded anxiety disorders is Generalized Anxiety Disorder. Various studies have sought to define the number of college students coping with trauma and stress induced disorders, but these numbers are even more inconclusive than the ones listed for anxiety. The discrepancy in the reported numbers can be attributed to a variety of things including, but not limited to, the sizes of the study, whether the data was based on students reporting that they had anxiety or based only on an official diagnosis, and the inclusion of “non-traditional” college students. What we can extract from the data is that a significant number of college students struggles with a loosely defined fear they may be exposed to in the classroom. The unconditional use of trigger warnings in these settings may actually be harmful, not helpful.

Bridget and I were both triggered by the vague genre of “horror” when we were younger. Then, when Bridget was in college she was triggered by a book which included details of dissociation. Bridget attempted to read the book, but found it impossible to finish and had her therapist write a note to her professor, who was reasonably accommodating and excused Bridget from finishing the novel. When Bridget elected not to continue reading, she engaged in a form of self-censorship based on a specific fear. If the book had a trigger warning for something as vague as horror, Bridget, and probably a significant amount of other students, would not have elected to read the book at all. When our fears are not concrete, either because we do not fully understand them or because we are easily triggered, we limit our exposure to all kinds of stimuli. When we limit our exposure, we increase the amount and type of things we are scared of. There’s an entire universe of things which could scare us. In Bridget’s piece she references 13 Reasons Why, specifically the suicide scene that was triggering to her. She states that it didn’t trigger another student in her class who had also struggled with depression. We can’t always predict what will disturb us, and if we continue to try to predict it, we’ll become increasingly bothered by the world.

Michelle Craske, a prominent psychologist at the UCLA, published extensive research on this subject in an article entitled “Maximizing Exposure Therapy: An Inhibitory Learning Approach.” This article explores the pitfalls of exposure therapy as it is currently utilized by CBT. The biggest pitfall is the way which people are slowly exposed to to their fears. Isolated exposure therapy tends to work for a short period of time, but when the patient is exposed to their fear in an uncontrolled environment, the paranoia returns. I understand the argument that an academic classroom is not a therapist’s office and your professor isn’t a licensed mental health professional, but the classroom, especially in institutions of higher learning, is a relatively safe space. The arguments posed by such institutions against trigger warnings, such as the University of Chicago, do not cite “making students uncomfortable” as a reason for refusing to implement trigger warnings. Instead, they talk about academic freedom. They want professors to be able to speak openly about the fields they’ve spent their entire lives studying without feeling censored. They want students to feel comfortable voicing their opinions. They are afraid that if they implement trigger warnings, students will use them as an excuse to close their minds off to the world views they disagree with, limiting debates. NPR did a story in response to a letter sent by the University of Chicago in the Fall of 2016, welcoming the class of 2020 and declaring that there would be no trigger warnings or designated “safe spaces” on campus. One of the girls quoted in the article, 16 year old Ellie Carter, believes that this is a good development. She is quoted as saying, “I can’t understand why a college campus would be the kind of place where people would police uncomfortable topics or topics that should be. This is the place that they should be having that discussion at.” An environment of your peers is the best place to learn and to grow.

I understand the benefit of trigger warnings. I was scared of my own thoughts for years. I couldn’t eat. It would be hypocritical of me to oppose trigger warnings. However, there is a danger in trigger warnings. If we expect ourselves to be scared of something, we will be scared of that thing. If we are convinced something will hurt us, it will hurt us. If you try not to think about a white bear for 30 seconds, you will think about a white bear. If we let our emotions of fear overcome us, then we will always be scared. I’m not advocating that everyone needs to get over their fears immediately, but a large part of exposure therapy is letting yourself be scared. Healing comes from thinking differently about not only the thing that scares you, but also the emotion of fear, and other “bad” emotions. Fear isn’t bad. Fear, from an evolutionary perspective, is great. We don’t get eaten by bears anymore because our ancestors learned to fear them. If we learn how to let ourselves feel all of our emotions, we’ll be more adaptable creatures, and we won’t need trigger warnings.