PTSD
Article
PTSD is a recurring concept in the Astral Codex Ten archive, appearing 3 times across 3 issues between July 15, 2021 and January 25, 2024. The archive places it in contexts such as “predicted a [insert some term other than “wave”] of post-traumatic stress disorder cases”; “mental health conditions including depression, PTSD”; “The best-known is PTSD”. It most often appears alongside Black Lives Matter, China, New York.
Metadata
- Category: Concepts
- Mention count: 3
- Issue count: 3
- First seen: July 15, 2021
- Last seen: January 25, 2024
Appears In
Related Pages
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- Black Lives Matter (2 shared issues)
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- China (2 shared issues)
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- New York (2 shared issues)
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- schizophrenia (2 shared issues)
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- Twitter (2 shared issues)
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- 1902 (1 shared issues)
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- 1903 (1 shared issues)
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- 1906 Japanese neurology journal (1 shared issues)
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- 1970s feminists (1 shared issues)
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- 1978 (1 shared issues)
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- 1979 study on capital punishment by psychologists (1 shared issues)
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- 2016 election (1 shared issues)
External Links
Source Context
Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.
Foreign aid agencies sprung into action to try to support the survivors. Joining in the general mobilization were Western mental health professionals, who predicted a [insert some term other than “wave”] of post-traumatic stress disorder cases.
III. PTSD In Sri Lanka
According to [insert some author name other than “Watters”], mostly things went like this: foreign counselors would go into a refugee camp and tell everyone that they had to speak openly about their trauma and emotions. The survivors would say that it sucked a lot that their families had just been killed, but wouldn’t seem very emotional about it, or really confess to having “trauma” as classically understood. The therapists would say this was very bad, and they were keeping all of their emotions “bottled up”, and they really had to “let it out” or else it would fester and they would end up with PTSD. The refugees, who were never exactly clear which sets of white people were giving out free food and which ones weren’t, figured they ought to do what these people wanted in case they were the free food ones. So they would say, fine, they all felt very emotional and had lots of trauma. The therapists would be delighted and move on to the next camp.
The San Francisco districts with the highest (left) and lowest (right) homelessness rates. I correlated homelessness rate and population-adjusted density in the same cities I looked at above, but it didn’t add much predictive value to housing prices. Maybe this is restriction of range (all big cities are dense enough to have homelessness, compared to suburbs), or maybe the key feature is relative rather than absolute density (ie the homeless will go to the densest place nearby). Conclusion: No social phenomenon is ever caused by just one thing, but San Francisco’s homelessness rate is around where a housing-cost-based model would predict. San Fransicko briefly touches on this, but overall tries to de-emphasize it in favor of talking about drugs and mental illness. Critiques of patterns of emphasis are necessarily subjective, but the book’s pattern feels misleading to me. Claim 2: Standard Accounts Underemphasize The Role Of Drugs And Mental Illness In Homelessness Having argued homelessness isn’t just about poverty, the book goes on to say we’re neglecting the central role of mental illness and substance abuse: Over the last decades there were many visible signs that homelessness was about much more than poverty and housing. Between 2010 and 2020, the number of calls made to San Francisco’s 311 line complaining of used hypodermic needles on sidewalks, in parks, and elsewhere rose from 224 to 6,275. In 2018, footage of dozens of people slumped over in an entrance to a Bay Area Rapid Transit (BART) station, many with needles in their arm, went viral. “We call it the heroin freeze,” said one local. “They can stay that way for hours.” Said another, “It’s like the land of the living dead.” For decades researchers have documented much higher levels of mental illness and substance abuse among the homeless than in the rest of the population. It’s true that just 8 and 18 percent of homeless people point to mental illness and substance abuse, respectively, as the primary cause of their homelessness, but researchers have long understood that such self-reports are unreliable due to the socially undesirable nature of substance abuse, and the lack of insight that often accompanies mental illness. Using other methods, San Francisco’s Health Department in 2019 estimated that 4,000 of the city’s 8,035 homeless, sheltered and unsheltered, are both mentally ill and suffering from substance abuse. Of those 4,000, about 1,600 frequently used emergency psychiatric services. Shellenberger’s source for 4000 homeless people having these issues is this SF Chronicle article, which seems to based off of this report. The report does estimate 4000 homeless people with mental illness and substance abuse, but it uses a yearly rather than point estimate of homelessness, and finds 18,000 rather than 8,000 people. That means it only finds a 22% rate of these problems, not a 50% rate. Thanks to commenter Sean for hunting down this report and helping explain this. I looked for other statistics to provide context on this number. This 2013 San Francisco Homeless Count found that 29% admitted chronic depression, 15% PTSD, and 22% some other mental illness. About 30% admitted to a substance use disorder, although as far as I can tell this is just the number who admitted it was a disorder, so maybe more used drugs. This article by the Los Angeles Times describes an LA study finding that 25% of homeless people had mental health issues and 14% had drug issues. The Times re-analyzes it in a way that ups the numbers to 34% and 46%, respectively. But they don’t say exactly what choices they made differently, and the few they do give don’t really inspire confidence. Although in some cases they count questions clearly about mental illness which the official definition inexplicably refused to count, in others they decide to count anyone who has ever had mental illness, reversing a government decision to require the mental illness to be long-term (does this mean that if I lost my house tomorrow, the LA Times use me as an example of a “mentally ill homeless person” because I saw a psychiatrist for OCD when I was a kid?) Studies like these don’t show causation. Sure, mental illness can make people homeless. But homelessness can also cause mental illness. One SF study found psych diagnoses among the homeless to be evenly divided among depression, PTSD, and everything else. Homelessness is a depressing and traumatic environment. Just because someone who’s been on the streets for a year has depression or trauma, doesn’t mean that we should attribute their homelessness to mental illness. This study by the California Policy Lab does better. It asks what factors played a role in homeless people losing their homes, and finds that 50% of unsheltered and 17% of sheltered homeless point to mental illness (given SF’s balance, that suggests 37% of SF homeless would point to that problem). But I can’t help but notice that when you add up the percent of people who lost their homes due to physical illness, psych illness, and drug use, it totals 147%. Based on numbers from other studies, it looks like if you added in job loss, eviction, etc, the numbers would total well above 400%. This makes me think people are saying “yes” if the factor played even a minor role in their eventual homelessness, and this shouldn’t be treated as 37% of homeless having mental health issues being their main problem. The same study finds that about 66% of the homeless “have” some mental health problem, but this time they don’t tell us what question they asked or what criteria they use. What about psychosis in particular? This meta-analysis claims that in developed countries (a category to which San Francisco still nominally belongs) about 19% of homeless people qualify for diagnosis with a psychotic disorder, including 9% with schizophrenia in particular. Not all people with psychotic disorders are completely crazy all the time, and some very much are not, but this is at least a specific condition with real criteria. Conclusion: Overall, I’m disappointed in most of the published research on this question, which seems more interested in producing glossy brochures about funding disparities than in informing anybody what any of their numbers mean. But putting it all together and squinting really hard, I think we can tell a story where 10-20% of the homeless are seriously psychotic, and another 20-30% have contributing mental health conditions including depression, PTSD, and others. Somewhere between 25% and 50% of the homeless have substance abuse problems, and this probably mostly overlaps with the 25% - 50% who have psych diagnoses. I think San Fransicko gets this mostly right. Claim 3: “Housing First” Isn’t As Great As People Think, And Might Be Harmful The National Myth About Homelessness is that The Bad People are refusing to give people houses until they’ve “proven” they “deserve” them, thus perpetuating homelessness when they inevitably fail to qualify. The Good People have united under an exciting new banner called “Housing First” to push the revolutionary idea that people should get houses regardless of whether they conform to normal standards of respectability or not. Wherever this is adopted, homelessness rates fall, and the formerly homeless becoming healthier, safer, and more likely to re-integrate into society. Best of all, the program pays for itself in decreased health care and policing costs. The only impediment to solving homelessness everywhere is the Bad People who still insist on not housing the homeless until they’ve “earned” it. In real life, everyone important has been united under Housing First since the Bush administration made it national policy fifteen years ago, and most of the cities with spiraling homelessness crises have been pursuing Housing First policies for decades (eg San Francisco has been trying Housing First since the 1990s). The Obama and Trump administrations both set funding policies that penalized any non-Housing-First welfare programs. Still, everyone is sure that the reason there are still homeless people must be that some Housing First opponent still exists somewhere, ruining everything with their purity-testing ways. But actually these people have already been relegated to the conservative think tanks where moribund ideas go to die. I have looked through a lot of studies and articles to try to see how well Housing First works. I am most sympathetic to the conclusions of Tsai (2020), who basically says that: Homeless people who are given houses are more housed than homeless people who are not given houses. Way, way more housed. You would not believe how strong of an effect giving someone housing has on them being housed. The same is true for other outcome measures like “time spent experiencing homelessness”, “number of days spent in a temporary homeless shelter”, etc. You might think this is obvious, but this is used as the primary outcome in a lot of studies, and “success” on this metric is behind a lot of claims that “studies show Housing First works great!”
Politics can become something between an addiction and an obsession. People can spend hours every day watching cable TV or scrolling through their Twitter feeds, trying to stay abreast of the latest outrage the other side is perpetrating. To be clear, they hate this. Each time they hear another outrage they’re somewhere between dejected and enraged. But they keep doing it. For hours a day. They will justify this with claims like “I need to stay informed so I can make a difference”. Then they will forget to vote because they were tired on Election Day. In any other situation, a condition with impaired cognition, psychotic symptoms, emotional instability that impaired normal functioning, and associated addictions/obsessions would qualify as a mental disorder. So again, which mental disorder is it? This post is about the possibility that it might be trauma. II. When Donald Trump was elected, some people described themselves as “traumatized”. Someone asked me for comment on the record, hoping I would say something like “as a real psychiatrist, trauma is a real disorder with strict criteria, and all you people are dumb”. I did not, in fact, make this comment. “Trauma” isn’t technically a mental disorder. The DSM contains seven “trauma and stressor related disorders”, of which the best-known is PTSD. An eighth disorder, “complex PTSD”, didn’t quite make it into the DSM but has been accepted by other classification systems, including the ICD-10 and WHO; other proposed trauma disorders are even less well-established. “Trauma” itself is a vague word encompassing all of these plus many less-well-defined situations. Although the vague concept “trauma” goes well beyond the DSM’s formal definition of PTSD, I think the latter makes a good reference point. Let’s look at the diagnostic criteria: [A trauma victim is someone who has] exposure to “actual or threatened death, injury, or sexual violence in one or more of the following ways: Directly experiencing the traumatic event(s).
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This is already quite broad! The victim doesn’t need to have anything bad happen to them - just be threatened with it. And they don’t need to personally be the victim of the threat. They can learn that it happened to someone close to them, or they can just hear about it happening to someone else. A police officer who hears about child abuse may be a trauma victim! The DSM’s job is to draw a medico-legal boundary - this counts, but that doesn’t. The real world has no obligation to obey the DSM, and often doesn’t. For example, can someone be traumatized by something happening to a distant family member? It would be insane to think this has never happened, and that some law of nature limits it to close family members. The DSM is just using the heuristic that probably it’s worse when it’s someone close to you. It goes on: [Part 4] does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related. Did someone prove it was a natural law that you can only be traumatized by seeing a story on TV if it’s for work? Or is this another unprincipled compromise? People not involved in the DSM, unbound by medicolegal considerations, have added all kinds of stuff to this basic definition. For example, even though it’s not in the strict DSM definition, psychologists almost universally agree that emotional abuse can be traumatizing. And in the current social climate, inevitably people have started talking about collective trauma, eg institutional racism may be traumatizing for some individual black person even if they personally have never been victimized in any dramatic way. The knowledge that people hate their whole group serves as an adequate proxy for anybody abusing them personally. Can you chain all of these exceptions together? Can witnessing a family member suffering emotional abuse be traumatizing? Can learning secondhand about someone encountering institutional racism be traumatizing? Can you be traumatized by hearing on TV that someone was emotionally abused on account of their race? Only if it’s part of your job? At this point the nice crisp distinctions of the DSM are starting to feel a little artificial. I think of all of this in a deflationist, spectrum-y type of way. Anything can be traumatizing if it gives you strong negative emotions and makes you feel helpless and victimized. The DSM points to some categories that are especially likely to cause this kind of reaction. Other people have added their own. But if something you hear on TV makes you feel victimized and helpless, then sure, go ahead and call it traumatizing. If Trump’s election made you feel victimized and helpless, then I’m prepared to say “trauma” is a potentially fruitful lens through which to investigate this response. (I’m not saying that Trump’s election was inherently traumatizing, or that trauma was the correct response. If you prefer, you can think of it as a condemnation of the media for irresponsibly fanning fear of Trump. I’m just saying, without trying to lay blame, that lots of people did experience feelings of fear and helplessness around Trump’s election.) III. I didn’t personally feel traumatized by Trump’s election. My own story, which I don’t claim is atypical or sympathetic in any way, is that in college a bunch of people tried to cancel me for something I’d intended to be an anti-racist joke, but which apparently didn’t come out that way. Former friends turned against me, I got a few death threats, and I was told to attend a criticism session at a local social justice meeting group (which I foolishly did; I thought people would realize I was cooperative and agreed with them, and so lay off - obviously this didn’t work). I briefly considered dropping out of college to avoid the hatred; instead I spent a month locked in my room, waiting for the storm to blow over. It was the worst experience of my life. Ever since then, when I read arguments promoting social justice and cancel culture, or saying that their victims are probably bad people and shouldn’t be allowed to defend themselves, I get all kinds of easily noticeable unpleasant bodily and emotional reactions. When I read good arguments against these positions, I get some kind of nice calm feeling, like that I’m suddenly safer and the world has brightened a little bit. I try as hard as I can to approach these kinds of issues fairly, but it wouldn’t surprise me if I make more of the “five Democrats and eight assault weapons” style reasoning errors there than I would on some boring topic like taxes. Of course, I hear similar stories from people on the other side of this particular culture war. A typical example (this is a pastiche of many people) would be a transgender person who sometimes gets harassed when they try to go into public restrooms. Even if it never gets beyond catcalling, they remember all the stories they read about trans people getting murdered, and even looks of disapproval feel like they carry the potential for physical violence. Then they hear about trans bathroom bills in North Carolina or wherever and absolutely see red; they feel like Society as an abstracted entity is trying to deny their right to exist. Then they invent entirely new kinds of social technology to prevent themselves from ever having to talk to or interact with the sort of people who would support such a thing. Most people haven’t personally been cancelled or discriminated against, and they might not have stories like these. But they might feel like society is “threatening” them with these kinds of experiences. Or they might have “close family” or “close friends” who qualify. Or they might have heard about them on TV. (In a work-related context? Sure, let’s say yes.) But also, there’s the collective trauma exemption! Everybody belongs to various groups - black people, white people, Jews, Christians, men, women, LGBTs, gun owners, socialists, cops. Parts of each of these groups have developed narratives about how they’re being singled out for special persecution by the people in power. You probably believe that some of these groups’ narratives are valid, and others are false and offensive. That doesn’t matter. The important thing is that (some of) the group members believe it. The DSM is quite clear that people react to threatened trauma, not actual trauma. If some very silly person works himself up into a frenzy believing he’s being abused and persecuted because he eats eggs for breakfast, that’s potentially traumatizing, even if his concerns have no basis. But also, everyday political debate crosses lines that would qualify as emotional abuse in any other sphere of life. People get told they’re disgusting or idiotic or deserve to die. They have to watch as powerful rivals plot openly how to ostracize them from polite society. Groups of their enemies get together to spread the rumor that they are Satanists, Nazis, or pedophiles. They have their views twisted into totally false claims that they want to murder children, which then “go viral” to people who otherwise know nothing about them. If you’re not famous, this might not happen to you personally - nobody says “John Smith is a Nazi pedophile”. But John Smith might be a socialist, and someone might say “All socialists are Nazi pedophiles”. If we believe that racism can traumatize minority individuals even if they’re not personally named in the stereotypes, we should believe that the discourse around socialism can traumatize socialists, even if they’re not personally involved. I’m probably not describing this well, so I can only beg you to supplement my inadequate words with your lived experience. All bullying sounds trivial when you’re not involved. “He called me a fatty on the playground!” Well, whatever, laugh it off. But somehow from the inside, iterated over many experiences, coming from people you perceive as more socially powerful than you, it creeps up on you, starts getting power you definitely don’t remember giving it. Think of some discourse you’re involved in, some issue you feel really invested in, and think about the people you find most unfair and enraging on the other side. I dunno, either you’ve had this experience or you haven’t. I think a lot of people feel persecuted and threatened by politics, a lot of people feel emotionally abused by politics, and a lot of people feel like they’ve had vicarious experiences of people they identify with being harmed by politics. This isn’t enough for a formal PTSD diagnosis - they probably didn’t watch the relevant TV news segments in a work-related context. But it might be enough to start doing some really unhealthy things to their brains. IV. Here’s what the DSM has to say about some symptoms of PTSD: B4: Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. The popular term for criterion B4 is “a trigger”. For example, if you were raped, you might be triggered by hearing someone describe rape. This is justification for so-called “trigger warnings” in books and movies. Triggers have long since jumped from the lexicon of PTSD to the lexicon of politics. Left-wingers describe exposure to right-wing ideas or symbols as “triggering”. Right-wingers try to avoid the terminology, because it sounds too leftie, but they have the experience so often that lefties asking right-wingers “oh, are you TRIGGERED?” has become a meme. Twitter searches for “triggered” are an interesting anthropological experience. A Google search brought up this lovely t-shirt. I think eBay’s policy of promoting inclusiveness by displaying shirts on ethnically diverse models may have failed them in this case. This is only the tip of the iceberg. Donald Trump Jr has a book called Triggered, and a biweekly TV show of the same name. Sheila Jeffreys’ biography is called Trigger Warning: My Radical Feminist Life. Jeffreys and Trump Jr may not have much else in common, but they are united by a shared appreciation for applying this technical psychiatric term to politics. I think this makes the most sense if political triggering and psychiatric triggering are literally the same thing because political toxicity is a subspecies of PTSD. D2: Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world. Do I even need to explain this one? D3: Persistent distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame himself or others. As stated, this doesn’t really apply to politics. But I claim this is an overly restrictive description of the true problem, which is a general distortion of cognition around traumatic stimuli. See for example Reasoning, trauma, and PTSD: insights into emotion–cognition interaction. Here the researchers make people solve math/logic puzzles with five apples and eight oranges or whatever; as usual, most people do fine. Then they change the content to traumatic stimuli, like five rapists and eight abusers. Nobody is particularly happy about this change, but traumatized people seem to do worse when the stimuli relate to their own trauma. This is an exact analog to the “five Democrats and eight assault weapons” task discussed above; I don’t know if one line of research inspired the others, but they show some similar results. Other people have even more general findings. You may remember the Stroop Effect, where people have to say the color of words without getting distracted by their content. One variant is the Emotional Stroop Effect, where instead of giving color words (“yellow”, “red”, etc), you use emotional words and traumatic stimuli. Traumatized people tend to do worse at Emotional Stroop tasks relating to their specific trauma. See Modification of cognitive biases related to posttraumatic stress: A systematic review and research agenda. See also The Precision Of Sensory Evidence for a discussion of how this effect might happen. E1: Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people and objects. As seen at your family Thanksgiving table. Politics makes otherwise kind people into angry jerks. E3: Hypervigilance This is defined as a heightened awareness of surroundings, constantly scanning for danger, and misinterpreting innocuous stimuli as threatening. Wikipedia describes it as “there is a perpetual scanning of the environment to search for sights, sounds, people, behaviors, smells, or anything else that is reminiscent of activity, threat or trauma”. Dog whistles. Microaggressions. The hallmark of the advanced political partisan is the ability to describe everything the other side (or neutral third parties) do as secretly a political offense, and to reduce every possible situation to their issue of choice. For the past ten years, I’ve been involved in the anti-AI-existential risk movement, and have gotten to know other people in this movement pretty well. I can say with high certainty that the number one motive of these people is that they do not want to be killed by robots. Still, over the years people have ascribed every possible motive to us except that one, for example: It’s a plot by Big Tech to distract from other harms they are committing.
Inline links: emotional abuse, institutional racism may be traumatizing, entirely new kinds of social technology, https://substackcdn.com/image/fetch/$s_!G65x!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F9be25ee8-5d77-4a57-a07d-efff5ff66b44_589x461.png, https://substackcdn.com/image/fetch/$s_!i3Mp!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F69cd8c8a-3f2b-4842-b8fd-1455aa1310bf_591x587.png, Triggered, Trigger Warning: My Radical Feminist Life, Reasoning, trauma, and PTSD: insights into emotion–cognition interaction, Modification of cognitive biases related to posttraumatic stress: A systematic review and research agenda., The Precision Of Sensory Evidence, Dog whistles
A Google search brought up this lovely t-shirt. I think eBay’s policy of promoting inclusiveness by displaying shirts on ethnically diverse models may have failed them in this case. This is only the tip of the iceberg. Donald Trump Jr has a book called Triggered, and a biweekly TV show of the same name. Sheila Jeffreys’ biography is called Trigger Warning: My Radical Feminist Life. Jeffreys and Trump Jr may not have much else in common, but they are united by a shared appreciation for applying this technical psychiatric term to politics. I think this makes the most sense if political triggering and psychiatric triggering are literally the same thing because political toxicity is a subspecies of PTSD. D2: Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world. Do I even need to explain this one? D3: Persistent distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame himself or others. As stated, this doesn’t really apply to politics. But I claim this is an overly restrictive description of the true problem, which is a general distortion of cognition around traumatic stimuli. See for example Reasoning, trauma, and PTSD: insights into emotion–cognition interaction. Here the researchers make people solve math/logic puzzles with five apples and eight oranges or whatever; as usual, most people do fine. Then they change the content to traumatic stimuli, like five rapists and eight abusers. Nobody is particularly happy about this change, but traumatized people seem to do worse when the stimuli relate to their own trauma. This is an exact analog to the “five Democrats and eight assault weapons” task discussed above; I don’t know if one line of research inspired the others, but they show some similar results. Other people have even more general findings. You may remember the Stroop Effect, where people have to say the color of words without getting distracted by their content. One variant is the Emotional Stroop Effect, where instead of giving color words (“yellow”, “red”, etc), you use emotional words and traumatic stimuli. Traumatized people tend to do worse at Emotional Stroop tasks relating to their specific trauma. See Modification of cognitive biases related to posttraumatic stress: A systematic review and research agenda. See also The Precision Of Sensory Evidence for a discussion of how this effect might happen. E1: Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people and objects. As seen at your family Thanksgiving table. Politics makes otherwise kind people into angry jerks. E3: Hypervigilance This is defined as a heightened awareness of surroundings, constantly scanning for danger, and misinterpreting innocuous stimuli as threatening. Wikipedia describes it as “there is a perpetual scanning of the environment to search for sights, sounds, people, behaviors, smells, or anything else that is reminiscent of activity, threat or trauma”. Dog whistles. Microaggressions. The hallmark of the advanced political partisan is the ability to describe everything the other side (or neutral third parties) do as secretly a political offense, and to reduce every possible situation to their issue of choice. For the past ten years, I’ve been involved in the anti-AI-existential risk movement, and have gotten to know other people in this movement pretty well. I can say with high certainty that the number one motive of these people is that they do not want to be killed by robots. Still, over the years people have ascribed every possible motive to us except that one, for example: It’s a plot by Big Tech to distract from other harms they are committing.