Cambriangirl

I’ve taken a less conventional approach towards Blogging Against Disablism Day. Hooray! It’s about trigger warnings, so naturally there’s some mention of traumatic stuffs, but not in too much detail. Please stick with it, there is some science at the end.

A guest article by the one and only Hetty Garbagegurgler. Hetty is a satirical caricature from an alternate version of reality which shows some strange opposites yet some scary parallels to our own. To be read in an accent of as much faux-outrage as possible:

With PTSD, we know that exposure to certain triggers can lead to breakdowns and loss of an entire afternoon, or maybe even days of work. This is a serious thing but luckily in the world we live in, this is always taken into consideration in the media.

However, does this concept of triggers really stand up to scrutiny when we think about, say, food allergies? I mean, sure there have been studies done on it and such, but this is an opinion piece and I can’t be bothered to go and hunt for them. And without any studies to point to, at least this humble blogger can’t be accused of confirmation bias, right?

Let’s look at this in more detail. What is a trigger? According to the Collins English Dictionary, when not talking about the obvious firearms, a trigger is any event that sets a course of action in motion. When we’re talking about illness or disability it usually has negative connotations.

People with allergies often claim that they are affected by triggers as much as those with mental disabilities. I know, it sounds weird, right? We all know that specific, intense depictions of a traumatic event (such as a sexual assault) can affect PTSD sufferers severely, causing symptoms such as dissociative fugue states where they end up halfway across the country with no memory of how they got there, self-destructive behaviour such as excessive drinking or self-harming, or maybe even loss of memory. And these things are serious enough that they can make people lose their jobs. That’s like, common knowledge. That’s why we have the usual media warnings around such depictions.

But apparently certain types of food can cause people to feel ill, or go into something called anaphylactic shock. This is not as widely known as the intricate workings of the mind, and quite frankly, it is hard to believe. Some people claim that having an allergic episode, especially anaphylactic shock, affects their ability to work.

Hang on just one second. In the world we live in, mental health conditions are obvious and we must make people aware of unexpected triggers that can severely debilitate their daily functioning, but the idea that we should extend this to the less obvious and, frankly, overreactionary, physical health conditions is just ridiculous. I mean, I know we get a lot of people with such allergies tell us personally what kind of things are likely to trigger an episode, but how are we to really ever know? Does it mean we have to get trigger-happy with food packaging? Just think how terrible it would be if every food item’s packaging design had to be interrupted with annoying messages about how it contains egg or nuts!

We don’t want to end up in a world where people care more about their physical health than other peoples’ enjoyment, do we?

Or at least, all of this is what I would say if I wasn’t willing to consider the real complexities behind any kind of health condition. Luckily this has all been satire up until this point, so I actually think that both physical and mental health conditions should be taken into consideration whenever someone’s interacting in the media in a meaningful way. It’s a concept called accessibility, and it is a good idea to pay it some more attention.

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It’s Blogging Against Disablism Day today, and my contribution came about from the recognition that certain mental conditions and disabilities (for example PTSD) are often treated as an afterthought, and in many cases even more so than other forms of disability. I deal with a lot of accessibility work in my day job, and it’s hard enough convincing people just of the need to make something accessible for a blind person, let alone people with mental health conditions. I don’t like the idea that an active choice I make to not include accessibility information could needlessly make life more difficult for someone. If given the choice between mildly irritating someone who doesn’t like the fact I’ve included a warning, and causing a full mental breakdown/substance abuse relapse of a person recovering from a serious assault or time spent in a war zone, I’d rather mildly irritate someone.

You never know exactly who your audience will be, and saying ‘well blind people will probably not visit my website so I won’t bother making it screen reader friendly’ is as useful as setting up a restaurant and saying ‘Well it’s incredibly unlikely that someone with a nut allergy is going to come here, so I’m not going to even mention if something’s been prepared near nuts.’

And also it was fun to imagine a world in which people with mental conditions were treated with respect, but the downside being that a physical condition was given the current status that many mental conditions have. I’m kinda hoping for a world where both are treated seriously and with respect owing to the varying natures to which different people experience their disabilities.

Here’s some links and useful articles which talk a bit more about PTSD, if you want to know more:

•  http://forums.xkcd.com/viewtopic.php?f=22&t=30688 
  An XKCD forum thread which has kind of turned into a database on triggers. Very useful if you need it!
•  http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1999-13972-002 
  Paper: Substance abuse in PTSD patients more likely to recur after exposure to specific situations of unpleasant emotions relating to their trauma, and interestings, physical discomfort too.
•  http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(08)00085-8/abstract 
  Paper: More on substance abuse as coping mechanisms for young people with PTSD when exposed to triggers.
•  http://connection.ebscohost.com/c/articles/66425805/what-services-supports-are-needed-enable-trauma-survivors-rebuild-their-lives-implications-systematic-case-study-cognitive-therapy-township-adolescent-girl-ptsd-following-rape 
  An interesting account of a rape survivor’s PTSD worsening as she was left to both identify and avoid triggering cues on her own in a community which constantly alienated her and expected her to ‘get on with it’. When exposed to cognitive therapy which recognised and worked through her specific triggers, she improved greatly. Noted: failure to establish a safe environment for revisiting triggers interferes with recovery time.
•  http://www.ncbi.nlm.nih.gov/pubmed/21090878 
  Interesting paper on perceptual priming in PTSD and identifying trigger words. This has a bigger effect on the brain than you might think – heightened blood flow to the left prefrontal cortex, which controls semantic memory among other things.
•  http://nimbusuncensored.tumblr.com/post/33661019600/lets-be-real-for-a-second-about-trigger-warnings-and 
  Blog post about good and useful instances of when trigger warnings could be used. This one is genius for making the distinction between effective uses of trigger warnings and the more obscure type which is liable to send people into fits of ‘This is PC madness gone wrong!’, and so on…

 A bit more about the science side of it:

You’ll note I’ve linked to a lot of psychology articles. This is mostly to help make people aware that psychological trauma triggers are very real, and vary from person to person. There is some evidence in these papers that suggest trigger avoidance is not a good thing overall, which I accept, but there was also plenty to suggest that exposing people to triggers has a less detrimental effect if steps have been taken to make an environment feel safe.

I found little evidence of how best to approach the subject of trigger warnings in such a newly born environment as online social networking (which is what I am really interested in). The conventional trigger warning notices for major identified trigger topics such as sexual abuse or suicide seemed to do pretty well for the many mental health forums and communities that have persisted throughout the past couple of decades, but with increasing exposure of the wider online community to this terminology it’s probably a good area to research a bit more in future. My foremost concern is in how to provide effective accessibility measures, so I’ll certainly be keeping track of any developments in the area.