Content note: PTSD, anaphylaxis
I have an old friend who I’ll call Sarah. Sarah has a rare, fatal allergy to chicken. If she eats chicken she can literally go into anaphylactic shock and die in a matter of minutes. Her allergy is so severe it can even be triggered by the smell of chicken being cooked. She’s never had a full-on anaphylactic episode from inhalation alone, but she does have a powerful and deeply unpleasant reaction to it, and she doesn’t want to take any chances.
When Sarah was in graduate school she lived in a student apartment on campus. Because of her allergy, she was given the one apartment in the building that had its own kitchen. The other students shared a kitchen on the floor. Unfortunately, the shared kitchen was between her apartment and the way out of the building, so she couldn’t help but walk by past it. And if she was coming or going when someone was cooking chicken, she couldn’t avoid the smell. And the reaction.
Sarah knows her allergy is inconvenient for the people around her. She feels bad about this, although she really shouldn’t. When she moved into the apartment, she went and spoke to every other student on her floor, individually. She explained her chicken allergy to them and asked that if they planned to cook chicken, could they please just let her know in advance so that she could make sure she did not have to walk past the kitchen until they were finished. She didn’t ask them not to cook it at all, just to give her a bit of notice when they were planning to.
Most of the students did. One refused to. She didn’t refuse to Sarah’s face; she simply went ahead and cooked her chicken when she wanted without giving Sarah any warning. At least once that Sarah knows of, one of the other students reminded her of Sarah’s request; her response was something along the lines of that she couldn’t be bothered, and Sarah would just have to deal with it.
Just have to deal with an extreme allergic reaction that may not actually kill her, but could trigger symptoms that make her feel like she is going to die. Just deal with it. Because this neighbour couldn’t be bothered to give Sarah a heads-up so she could do what she needed to protect herself. Too much trouble.
You can see where I’m going with this. Sarah’s neighbour was behaving very much like the people who simply refuse to use trigger warnings before sharing material that might adversely affect others. In fact, they are worse because in many cases they are actively trying to dissuade anyone from using them. As obnoxious as her behaviour was, Sarah’s neighbour wasn’t, as far as she knows, going around telling the other students they shouldn’t be letting her know about the danger their chicken cooking might pose to her.
And that’s exactly what we are talking about – danger. Not offence. Not discomfort. Real, genuine harm. The word “trigger” is in there for a reason. It reflects the language used by clinicians and researchers when talking about conditions that make the people who have them susceptible to sudden, acute reactions, set off by things that would be more or less benign to others. Anaphylaxis is one such condition. PTSD is another. In fact, the two conditions often share symptoms – hyperventilation, dizziness, a feeling of being suffocated. The suffocation may more readily lead to actual death in an anaphylactic, but when you’re suffering repeated spells of really feeling like you are going to die, I’m pretty confident in saying that’s going to have a negative effect on your health. And psychiatric conditions do kill people, sometimes, at least indirectly. It’s not the same risk as eating something you have a fatal allergy to, but it’s not incidental or negligible, either.
Anaphylaxis and PTSD have something else in common, too, and that’s that they’re both unpredictable: the triggers aren’t necessarily only where you expect to find them. Sarah once nearly died after eating a “vegetarian” pizza, probably due to cross-contamination in the restaurant kitchen. Other allergic people’s triggers may be even harder to avoid, like peanuts. And not every allergic reaction is an anaphylactic reaction, either, just as not every read of potentially triggering material will actually set off the symptoms in someone with PTSD. But just because you don’t know whether or how someone is going to react to something isn’t a reason not to warn them when you know it’s something they might react quite severely to. Letting them know allows them to decide for themselves whether the risk is one they feel able to take. Not letting them know gives them no real choice in the matter – even if it’s a day when they’re feeling exceptionally vulnerable, or left their epi-pen at home.
Ultimately, where you stand on trigger warnings says a lot about where you stand on mental health. If you think Sarah’s request for a heads-up was reasonable, if “may contain nuts” doesn’t provoke you into writing awful New Statesmen columns about the threat to culinary freedom, but you think PTSD sufferers should just grow a thicker skin and certainly should not expect other people to have any regard to their condition, then what you’re basically saying is that mental health doesn’t matter in the way that physical health does. Not an uncommon view, of course, but one I suspect many of those in the “anti-trigger warning” camp would be loath to admit they hold. Either they do hold it, or they’ve entirely missed the point of what trigger warnings are about. There really is no third option.
I used a content warning for the first time on a recent post – didn’t hurt me a bit and hope it kept safe anyone who would have reacted to it. 100% support from me for this.
We live in a world of warnings for things great and small. We read reviews before we go to seem a movie so we’re not disappointed. We check menus to see what’s gluten-free, vegan, or more spicy than we’d probably like. We always take care of our friends by saying “that was fun for me, but if you don’t like X maybe you want to skip it” and no one makes fun of us for it. Unless it is something that doesn’t affect privileged jerks, in which case they feel triggered and trigger warnings must be eliminated?
Trigger warnings and content notes have saved me a lot of painful anxiety over the years I’ve been reading blogs that use them. Getting to mentally prepare, and then read at my own pace (today or a week from now) is invaluable. It sometimes means the difference between three days of flashbacks and insomnia, or just having momentary discomfort.
Tw: Mention of rape
I suspect some of the resistance to trigger warnings is due to the fact that they know it would be cruel to serve exclusively peanut-contaminated dishes at a cafeteria (not that there aren’t people in denial about allergies, too), but if mental health is equal to physical health, it follows that it might also be cruel to make books with rape required reading in school. Yes, it is cruel, but it’s not like it will suddenly be less cruel if people refuse to acknowledge what they’re asking. Basically, people are saying “don’t make us admit it!”
It’s like expecting people who need glasses to “deal with it” if their glasses are damaged, and then expect them to see properly. Makes no sense once you really think about it.
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I’m not sure about this. I entirely support the use of trigger warnings – or rather, nasty content warnings – because it’s simply polite. But I worry that the way it’s presented here misrepresents how PTSD works. The food allergy is when one specific, known thing causes a reaction. With PTSD, any number of random things can cause a reaction. It is simply not the case that someone who has been assaulted and suffers PTSD will be triggered by references to assault; they may be triggered by certain surroundings, or clothing, or sounds, or…
Also, I don’t think tying warnings to a specific mental health condition is helpful. Warnings are a matter of good manners for everyone.
The reduction of trigger warnings to “nasty content warnings” and PTSD-trigger prevention to “good manners” is precisely why this is a controversial issue. It’s the effect of specific triggers on people with a specific mental health condition that trigger warnings are intended to address. It’s not about politeness but literal necessity.
Thank you for the reply. OK, I think I understand your point. In general usage, the term “trigger warnings” seems to be used in a broader sense than the specific triggers you are referring to. Perhaps it’s being misused. It might be useful to develop more terms to distinguish between good manners warnings, and public health necessity warnings.
So, for example, at the top of this post you have a content note, which references two things that are presumably not mental health trigger warnings. Is it correct that you called that a “content note” deliberately, and that it is to be distinguished from a trigger warning?
Well spotted, yes, exactly.