Monday, June 10, 2013

Traumatizing Your Characters, Part 8: Avoidance and Numbing, the most misunderstood of symptoms ...

This series is getting comically long, but I promise--only a few more posts! If you need a recap, here you go:

And congratulations to Marcy, who won the copy of Nobody But Us by Kristin Halbrook!

Now ... back to our discussion of symptoms of PTSD. We've discussed the most well-known symptom cluster--intrusive recollection, which includes things like flashbacks, nightmares, and other sorts of re-experiencing of the trauma. That's the one you'll see portrayed in the movies and in books most often.

Today, we discuss a symptom cluster that is equally prominent in PTSD, but much less understood by lay-people, in my experience: Avoidance and general numbing of responsiveness.

Here are the symptoms from the DSM-IV-TR:

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
  1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma
  2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
  3. Inability to recall an important aspect of the trauma
  4. Markedly diminished interest or participation in significant activities
  5. Feeling of detachment or estrangement from others
  6. Restricted range of affect (e.g., unable to have loving feelings)
  7. Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Some examples from fiction (these next two aren't YA, but are so appropriate that I couldn't not offer them):
It was in the nature of their love that Kathy did not insist that he see a psychiatrist, and that John did not feel the need to seek help.  By and large he was able to avoid the sickness down below.  He moved with determination across the surface of his life, attending to a marriage and a career.  He performed the necessary tricks, dreamed the necessary dreams.  On occasion, though, he'd yell in his sleep -- loud, desperate, obscene things -- and Kathy would reach out and ask what was wrong.  Her eyes would betray visible fear.  "It wasn't even your voice," she'd say.  "It wasn't even you." ~In the Lake of the Woods by Tim O’Brien (emphasis my own)
He is here. And I can see as he looks at me that he does not know whether to laugh or cry. I feel the same. My eyes see him but they do not register his being. Nothing runs out of my eyes to greet him. It is as if my self is hiding behind an iron door.” ~ Possessing the Secret of Joy by Alice Walker (emphasis my own)
If you were experiencing intrusive memories of the worst moments of your life, you probably wouldn't embrace that experience, right? Instead, you'd want to control and suppress those memories as much as you could, just so you could go on with your life. So as you think about humans' reactions to life-threatening, heinous events, remember this: Our responses to trauma are about survival. Most symptoms of PTSD are the brain's attempts to keep the organism alive and safe and functional ... gone a bit haywire. But the impulse for health and survival is there. Avoidance and numbing is no different--the brain is trying to protect the person by keeping him buffered from incapacitating and threatening stimuli.

People who have PTSD do not say, "Hey, let me tell you about what happened to me." In fact, the most effective treatments for PTSD involve repeated (and carefully controlled) exposure to that trauma narrative and those memories, and it's extremely daunting for people with PTSD to do. It works, but it requires a lot of courage and determination. If you're writing a character with PTSD, remember that. They duck reminders of the trauma, conversations about the trauma, and emotionally withdraw, but it's a matter of emotional survival and self-protection.

Dissociation is not exactly a codified symptom of PTSD, but it is widely acknowledged as something that goes along with it. Dissociation is exactly what it sounds like--it's what happens when a person detaches from reality. And ... it's completely normal. Daydreaming and fantasy are forms of dissociation, a typical response to being trapped in an inescapable situation. Like a boring class, for example. But like so many other things, it's a continuum, and some forms of dissociation impair functioning and are actual disorders (Dissociative Identity Disorder, for example). Dissociation can essentially be considered extreme avoidance. If you're writing a traumatized character, you might want to look into it and make sure you understand it.

A brief example of dissociation from Nobody But Us by Kristin Halbrook:
He’s little, dark eyes and sharp smell drifting under my nose. It’s him. He’s here, he’s found me. I do what I always do. There’s this room, four walls painted pale sunshine but no windows. That’s where I hide. I’m stiff as a canoe, a vessel gliding effortlessly over still water in a sunshine room. His face is talking to me again, but there is no Zoe here to hear his words. ~Zoe, who was beaten by her father, upon getting caught shoplifting by a store owner.
In all three examples, plus the example from Speak that I used last week, the authors smoothly convey the avoidance, numbness, and dissociation not just by telling us, but by showing us through the prose. Something as subtle as saying "his face is talking" instead of "he is talking" shows a level of detachment the reader instantly and instinctively absorbs. In good examples, this kind of dual communication is nearly always present--the author shows images and moves the story along, but word choice, sentence organization and length, and cadence boost the impact tremendously.

Do you guys have any other examples of good passages or books that convey this particular symptom cluster of PTSD?

On Wednesday, we'll be talking about the third and final symptom cluster--Hyper-arousal. Then, on Friday, we'll discuss writing accurate treatment. And ... that's it! We'll have covered everything except perhaps a few of your questions--feel free to ask for additional information in comments, and I may do a final post to answer them.


  1. I like how that last passage has those short sentences, like she can barely talk, or is holding her breath, and then, when she reaches to her special room, the words glide like her canoe into the open.

  2. This is brilliant. Damaged characters are the best characters, so it's really great to see you break this all down, especially the examples.

  3. Taking notes here...I have some serious catching up to do of your blog.
    This is really helping me with Penny!
    Hope you're good!

  4. I'm so excited to have won Nobody But Us - I've been wanting to read it. And I'm really enjoying your posts; they are very informative.

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  6. This is really helpful! Thanks so much!
    After reading this and some other things online, I was wondering if you had any examples of depersonalisation and/or derealisation in writing.