“It isn’t in my past. It’s in my everyday.”

- Helen Wilson

First up, the textbook stuff.

Post-traumatic stress disorder, or PTSD, was previously known as ‘shellshock’ or ‘combat fatigue’. When it was first described, it was typically seen as specific to military veterans. Nowadays, we know it can occur in anyone who has directly experienced or witnessed a traumatic event, and can also be diagnosed in people who have been repeatedly exposed to stories of abuse, even if they themselves have not directly experienced the trauma.

PTSD can occur in anyone of any age, ethnicity, culture, and gender. An estimated one in eleven people will be diagnosed with PTSD in their lifetime; it’s also more likely to occur in young people, and is twice as likely to occur in women than in men.

Trauma affects everyone, at varying degrees of intensity. What makes PTSD different from ‘normal’ reactions to trauma is largely time — people with PTSD generally feel worse as time goes on, and become resistant to getting help, to the point where their quality of life is significantly affected and unlikely to stabilise without intervention.

—> Why should I listen to you about PTSD?

I personally struggled with PTSD back in school, and still occasionally experience relapses if I’m not careful. An unrelated traumatic event last year caused a particularly bad relapse. PTSD was also, unfortunately, one of the most common disorders I assessed and helped treat while practicing psychology.

—> Okay, so what is PTSD?

My suspicion is that most writers researching PTSD will already have a traumatic event in mind, and want to know how their character deals with the fallout. With that in mind, the very first point I want to make is that PTSD is not caused by the traumatic event; it’s caused by how the person processes the event. More often than not, the most significant contributing factor to the development of PTSD is a lack of effective social support in the aftermath of trauma. This means PTSD can result from a wide variety of situations; your character does not need to have experienced a traumatic event directly in order to be deeply affected by it. Maybe something traumatic happened to a friend or family member, or maybe they feel a connection to what happened in some other way. The important thing is that your character has been told, either by themselves or by someone else, that their feelings don’t matter. (‘It didn’t even happen to you’; ‘you’re overreacting’; ‘you’re not in danger anymore, you shouldn’t still be scared’; ‘why are you still upset’; ‘you should be stronger than this’; ‘you should be tougher than this’; etc.)

It’s more common than you might think to experience a traumatic event and not develop PTSD. People with unconditional social support provided by family, community, and friends may process the trauma effectively and beneficially. The problem occurs when the person is told to ‘get over it’, explicitly or implicitly. In this situation, you can think of the brain as a toddler throwing a tantrum. BUT THIS DID HAPPEN, the brain might scream. I REMEMBER IT. HERE, LET ME PROVE IT.

The brain learns it can’t rely on anyone else as an early warning sign of the danger, so it overcompensates. The annoying thing about this (apart from, you know, everything) is that PTSD might not manifest until months or even years after the trauma occurs.

Here are the most common symptoms of PTSD:

• Flashbacks and nightmares. These are easily the most well-known symptoms, thanks to Hollywood. Do not ever use Hollywood as a model for writing characters with PTSD. Nightmares are not picture-perfect video recordings of trauma, any more than normal dreams are perfect representations of the real world. Nightmares recreate the original feelings of fear, hopelessness, or helplessness. The subject matter is far less important than the feelings the nightmare evokes, which are usually similar if not identical to the original feelings sparked by the trauma. Likewise, flashbacks do not physically play out in some sort of violent break from reality; flashbacks are overwhelmingly internal. Picture intrusive daydreams. When flashbacks are vivid or crippling enough, the only outward sign you might see is paralysis, inattention, or someone withdrawing and isolating themselves from others.

• Emotional numbness, and avoidance of reminders. Characters with PTSD might begin avoiding people, places, and activities that remind them of their trauma. These reminders can be fairly obvious straight connections, such as the sound of a firework simulating the sound of a gunshot/grenade, but they can also be subconscious and completely unpredictable; characters might avoid certain smells or sounds without realising why. Characters might shut down when they perceive a certain smell, and be utterly confused about why when they recover. Characters might experience chronic pain, or sudden flare-ups of pain in response to traumatic reminders. Brains are extremely good at recognising patterns and making connections, even when those connections don’t make logical sense to anyone else, and this goes double for PTSD. Many people who suffer from it learn to avoid any situation that might result in a trigger. Emotional numbness can also result in a daily feeling of surrealism, like you’re detached from your life and nothing is properly real.

• Hypervigilance. In additon to the well-known paranoia, this can include difficulty sleeping and difficulty concentrating. If you’ve struggled with anxiety, you might have an idea of what this feels like. It’s prolonged distress that your character can’t escape or ignore; the constant certainty that they’re in danger; the constant need to find or create safety. If your character has a place where they feel safe, it will likely take impossibly high levels of activation energy for them to leave it. If there’s a person your character feels safe with, that person might have a hard time getting rid of them.

Your character might experience one or all of these symptoms, depending on the trauma, the level of support they have, and their usual coping mechanisms. Presentations of PTSD are as unique as the individuals who suffer from it.

—> Have you written any characters with PTSD? How did you do it?

I’m currently working on a sci-fi series centred around themes of trauma, recovery, and rediscovering purpose. Naturally, many of the characters are experiencing some level of PTSD, but my protagonist has it worst of all, and she experiences extra complications due to cybernetics regulating many of her brain functions. You’d think this would help. Instead, it robs her of many early warning signs of a trigger.

In the setting of my story, psychology is a commonly accepted science, and therapy is readily available to anyone who needs it. As a result, the protagonist knows exactly what she’s struggling with. And while therapy is still difficult for her (a common refrain with PTSD is resistance to accepting help), she has built effective coping mechanisms for herself. She starts the story in a dark and angry place; by the end, she has a strong social support network to help lift her to a place of health.

In the story, I write her experiencing flashbacks, avoidance, hypervigilance, and devaluing her own worth in favour of others. Her PTSD tends to manifest in overprotectiveness of people she cares about, which, in one situation, causes a panic attack when she feels utterly helpless to save a friend. She doesn’t have issues with sleep or appetite, due to those regulating cybernetics I mentioned, but on the flipside, this makes her biggest challenge emotional numbness. She usually doesn’t know how close she is to breaking down, until it happens; she either feels nothing, or she feels too much, and relies on others to develop a sense of emotional stability.

—> So what tips do you have for writing PTSD?

Does your character know what they’re struggling with? Do they have support? Are there systemic supports like therapy readily available? Knowledge of their difficulties may help moderate some of the symptoms your character experiences. If they’re especially stubborn and avoid help of any kind, it might not make any difference.

What was your character emotionally like before the trauma? How does that change, with a persistent feeling of danger in their everyday lives? Do they have supportive family, friends, relatives? Is there a cause for the trauma, either real or perceived, your character takes their anger out on? How does your character react to triggers when there’s no danger nearby? How does your character react when there’s a clear and present danger? I’ve talked before about how some mental illnesses persist because there’s a benefit of some kind for the brain; with PTSD, that double-edged benefit is being prepared and ready to act the moment danger rears its ugly head.

Often, someone may seem ‘strong’ and stalwart while experiencing the trauma, and then become ‘weak’, emotionally raw, and vulnerable once safe. A lot of people see this as getting worse, or as emotional or physical weakness. In reality, your brain doesn’t begin processing the trauma until it understands that it’s safe to do so. Keep this in mind when you’re writing your character; recovery is not a straight line. There is no single ‘cure’, only treatments that compound quietly in the background. Relapses, waves, and unexpected bad days will all be common occurrences. None of them mean recovery is out of reach.

—> Any other things I should keep in mind for my character?

Read first-hand accounts of PTSD. I linked one below that I found was a very good starting point.

Don’t try to hit every single note of PTSD at once; it won’t ring true, and puts an undue burden on your shoulders as the writer. If you’re not confident, my biggest suggestion is to write action rather than thought; show what your character is doing, instead of what ‘s going on in their head. In my experience, this makes writing more emotionally powerful, and it might help you identify your character’s specific emotional difficulties when you’re re-reading.

For further reading from people with PTSD, check out this first-hand story from the Anxiety and Depression Association of America (ADAA), or this second-hand story from the American Psychiatric Association.

If reading this was helpful to you, please consider supporting me on Patreon, or throwing a dollar or two my way on Ko-fi. If you have a question about a specific mental health topic I haven’t covered yet, let me know by emailing me at author@amariamson.com, or pinging me on twitter. Thanks for reading, and don’t forget to comment/share!