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Treatment, Not Trigger Warnings

As an assistant professor of German literature at Princeton University, I once taught a class about how Germans understood World War II and the Holocaust in the postwar period. Several weeks into the course, an Orthodox Jewish student came to my office hours to tell me how troubled she was by the material, which she had not realized would be included in the course. She felt that the Holocaust should only be discussed in a sacred context and had avoided taking classes on the topic taught by secular academics. As a theological question, I cannot say whether she made the right choice, but she decided to stay and became one of the most thoughtful participants in the class. Her perspective added greatly to the education of the other students.

Recently, students on campuses across the country have begun asking for “trigger warnings” to be placed on course material that might cause distress or provoke symptoms of post-traumatic stress disorder (PTSD). The student government at the University of California at Santa Barbara formally called for such warnings to be placed on potentially offensive materials. Oberlin College students drafted a guide for professors that was, for a time, posted on the college’s website (after being criticized by faculty and outsiders alike, the policy is “under revision,” as the site says now). As a psychiatrist and former professor, I am opposed to such proposals.

One of my areas of specialization as a psychiatrist has been the psychiatric consequences of trauma, which can range from nightmares and flashbacks to panic attacks. On my child-psychiatry rotations, I have seen children with severe behavioral problems resulting from abuse and neglect. I have worked with adults who have gone on to become chronically suicidal or self-harming as a result of early abuse. At the VA, I have treated veterans haunted by horrifying acts of war that they experienced or in some cases even took part in.

I have enormous sympathy for students who arrive on college campuses suffering from the aftereffects of childhood trauma as well as for returning veterans trying to go back to school burdened by symptoms of PTSD. These students have often been living with their symptoms for a long time and have come to accept them as normal. They may not be fully aware of the impact symptoms are having on their daily lives, and many of them are certainly not aware that help is available. The late teens and early 20s can be a critical window in the development of symptoms that can impair people for the rest of their lives.

As a psychiatrist, I nonetheless have to question whether trigger warnings are in such students’ best interests. One of the cardinal symptoms of PTSD is avoidance, which can become the most impairing symptom of all. If someone has been so affected by an event in her life that reading a description of a rape in Ovid’s Metamorphoses can trigger nightmares, flashbacks, and panic attacks, she is likely to be functionally impaired in areas of her life well beyond the classroom. The solution is not to help these students dig themselves further into a life of fear and avoidance by allowing them to keep away from upsetting material.

I am also skeptical that labeling sensitive material with trigger warnings will prevent distress. The scientific literature about trauma teaches us that it seeps into people’s lives by networks of association. Someone who has been raped by a man in a yellow shirt at a bus stop may start avoiding not only men, but bus stops and perhaps even anyone wearing yellow. A soldier who has seen a comrade killed by a roadside explosive device may come to avoid not just parked vehicles, but also civilians who look like the people he or she saw right before the device exploded. Since triggers are a contagious phenomenon, there will never be enough trigger warnings to keep up with them. It should not be the job of college educators to foster this process.

It would be much more useful for faculty members and students to be trained how to respond if they are concerned that a student or peer has suffered trauma. Giving members of the college community the tools to guide them to the help they need would be more valuable than trying to insulate them from triggers. Students with unusually intense responses to academic cues should be referred to student-health services, where they can be evaluated and receive evidence-based treatments so that they can participate fully in the life of the university.

One of the most important treatments for PTSD is exposure therapy, which helps patients unlearn the associations between traumatic events and triggers so that they can start functioning again. Narrative therapies also provide exposure by encouraging patients to tell their stories over and over again, allowing them to find a less central place for the event in their personal history so that they can start to rebuild their lives.

One of my biggest concerns about trigger warnings is that they will apply not just to those who have experienced trauma, but to all students, creating an atmosphere in which they are encouraged to believe that there is something dangerous or damaging about discussing difficult aspects of our history. The current DSM specifically excludes exposure to media depicting traumatic events as a cause for PTSD. During my training as a psychiatrist, I have seen how the aftereffects of trauma can destroy lives, but I remain convinced that discussion and debate are among the most important things a college education has to offer.

Sarah Roff is a fourth-year resident in psychiatry and behavioral sciences at the University of Washington Medical Center. She holds a Ph.D. in comparative literature from the Johns Hopkins University and worked as an assistant professor of Germanic languages and literatures at Princeton University. After graduation, she will be working on an inpatient psychiatric unit treating patients with borderline personality disorder involved with the criminal-justice system.

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