I've posted this on behalf of an awesome friend of mine at their request. Ideas derive from direct and indirect input from various survivors and folks with PTSD. (For the record, it's the same awesome friend who gave permission to share "A Guide to Sighted Allyhood" and "How to be an Ally to Sick People.")
How to be an Ally for People with PTSD
All of us experience anxiety in some situations. Whether it's having to present in front of a huge audience, perform in front of a panel of judges, undergo surgery, or whatever, we all have moments in our life where we face (sometimes extreme) anxiety. However, Post-Traumatic Stress Disorder, or PTSD, is what happens when someone's lived trauma (including but not limited to: combat exposure, natural disasters, abuse, rape, violence, medical treatments, torture, a near-death experience or other life-threatening event) leads to a chronic level of high anxiety, hyper-vigilance, being in a constant survival mode, and re-experiencing the traumatic event or emotions surrounding it (often called "triggers" and "flashbacks").
Complex PTSD or C-PTSD is frequent in people who have survived ongoing trauma where they could not escape, especially during childhood, such as childhood sexual abuse survivors, survivors of abusive cult rituals, or ongoing painful medical treatments. It includes a sense of broken trust, a loss of self, dissociation, and attachment issues. Many people with PTSD also have other anxiety disorders, depression, and chronic illnesses, because trauma tends to throw off the entire mind-body system. Since many people do not disclose having PTSD, and many people living with PTSD don't have an official diagnosis, you can't always rely on people telling you they have PTSD. Some ways to tell if someone MIGHT have PTSD is if they are often easily startled, jumpy, or on edge. If reading this seems to describe someone you know, it may be good to give them the benefit of the doubt and follow this advice, even if they don't have PTSD/ don't know if they have PTSD.
First & Foremost
It is not a matter of will.
It is not a matter of being weak-minded.
PTSD is what happens when you've had to be strong in a time of intense suffering.
PTSD can happen to anyone who has lived through trauma. Life-threatening or soul-crushing trauma. Not small traumas where you fall, get up, and return to your sense of safety--Big Trauma, the kind of Trauma where you fall, and when you try to get up, there is no ground beneath you to even sit on. The kind of Trauma that shatters your entire perception of the world and the people in it.
Some research shows a genetic disposition, anatomical and physiological changes in the brain and brain chemistry, and points to other predicting factors that a trauma survivor will develop PTSD. If you are a Trauma survivor but don't have PTSD, consider other factors. You may have had a support system whereas another survivor didn't. You might have lucked out genetically. The point is, some people get PTSD and some don't. It's a common (but not universal) human response. It's not about seeking attention, being a drama queen, being hypersensitive, being stuck in the past. Something awful, or something in addition to what you've already survived could happen to you tonight and you could develop PTSD as a result.
First I will outline some practical tips, and then I will launch into explanations that give background context to why these tips are useful. It might be helpful to come back to these tips to understand them in their full context.
You can include a trigger warning for topics that are likely to cause distress. This is useful on Facebook, Tumblr, in a book or e-book, in an article, or any other text format. Here's what it looks like:
Trigger warning: rape culture
[start talking about rape culture here]
The spacing and punctuation is intentional and is meant to off-set the triggering content from the warning. It gives survivors a chance to decide whether they want to face distressing content. If the content of a post seems to be borderline between potentially distressing and neutral, you can use "Content note" instead of "Trigger warning" so that you don't have to judge the level of potential distress. For example:
Content note: food and dieting
In in-person events, you can preface any stories or comments by saying "this might be triggering for some people" or "I plan on discussing torture at the Judge Rotenberg Center. If anyone wants to step out now feel free."
A specification of detail can be helpful too. For example:
Trigger warning: brief mention of rape
Trigger warning: discussion of rape culture
Trigger warning: detailed account of rape
Are all the same content, but to varying degrees.
Touch & Personal Space
Always ask for consent before touching someone or getting in their personal space. Establish which parts of someone's body they are okay to have touched, and what kind of touch is okay, and what amount of personal distance is okay. Ask every time. For example:
"Do you want a hug?"
"Is it okay if I lay down next to you?"
"May I touch your hand?"
"Can I play with your hair?"
If the person says no, or is very hesitant or unconvincing with their "yes", let it go.
Needless to say, all of this translates to the bedroom. In sexual intimacy, it is important to be VERY explicit about consent. Consent should be established for every new kind of sexual activity every time. This is especially crucial for sexual abuse survivors.
In long-lasting relationships you can establish norms.
Leave it up to the survivor to reveal their story, how much, and in what way. For example, if you are sitting at a table with friends and the topic of Hurricane Katrina or Applied Behavioral Analysis (ABA) Therapy comes up, don't say "Oh yeah, Dave, didn't you go through ABA?" or "Oh yeah my friend here is a Katrina survivor." Respect a survivor's choice to tell their story on their own terms.
If someone asks for a topic change, respect that request. No questions.
As an Ally if you suspect someone is triggered, you can use these moments to check in in a discreet way. For example you can use a non-verbal cue or send a text message. If they indicate they are not okay, you can try to change the subject naturally: "Did anyone see that movie that just came out?" Making it into a big deal--"Let's not talk about Katrina; some people at this table have been through it"--can be embarrassing and awkward for the survivor. Try to keep it subtle.
Sometimes a survivor is triggered but wants to face it in the moment and use coping skills. Respect that choice too.
Triggers & Flashbacks
You might have noticed a trigger warning at the top of this article. Triggers are sights, sounds, smells, feelings, words, ideas, thoughts, and situations that remind someone strongly of their trauma. Triggers are named so because they often trigger flashbacks, which is an intense re-experiencing of trauma or feelings around it. A flashback can range in intensity. A person having a flashback can experience anything from a tinge of fear to being fully convinced they are back in the traumatic situation. So, for example, reading the word "rape" in an online article might remind a rape survivor of when they were raped. The smell of beer might trigger flashbacks for a survivor if their attacker had beer breath during the attack. A loud sound or vibration might remind a combat or earthquake survivor of their trauma. Being belittled or dismissed in a conversation might trigger a survivor whose abusers belittled and dismissed them for years.
If someone's level of anger or fear seems disproportionate to the situation at hand, there is a good chance they are being triggered. As an Ally, you can remind yourself that this person is not only processing their present feelings, but also past feelings that they were never given the chance to acknowledge. When we are surviving trauma, we do not have the safe and nurturing environment to confront our feelings. Therefore, a survivor may have years of buried anger, fear, shame, and other intense emotions. Present-day situations may bring up these emotions. For example, if someone calls your friend a retard and your friend reacts by flying on the handle, it may be because they were called a retard for years growing up by the people who abused and hurt them.
If you suspect someone is triggered, telling them "oh you're just triggered" will not necessarily be received well. Sometimes when people trigger, they don't realize they are triggered. Some people recognize they are in the moment; some recognize it in retrospect; some never do. Each survivor is in a different place of healing and self-awareness.
Meet the person where they are in terms of their healing. If they acknowledge being triggered, you can too. If they deny it, recognize that they have not gotten to the point in their own healing yet to recognize it. It's easy to recognize from the outside looking in, but as the survivor, it requires stepping outside oneself, which is a pretty advanced stage in the healing process. Respect where they are at and do not place a value judgement on their healing process.
As an Ally you can validate this person's feelings. Recognize that it is the part of themselves that was hurt and traumatized speaking. Realize that it is about more than just Here and Now. It's not just about this small incident that happened--it's about much more. Recognize that even displaced anger can still be valid anger. Comfort the hurt part of that person. Do not belittle the person, argue technicalities, or try to push along their healing process. They will heal on their own timeframe, on their own terms. Support them at their pace, on their terms.
Note: This does not mean allowing or excusing abusive behavior. If a triggered person is being abusive, you are allowed to hold them accountable for their behavior. You should take measures to establish your own emotional boundaries and seek safety from abuse. That said, if you acknowledge the survivor inside them and comfort that survivor, oftentimes that dismantles the abusive behavior. It is their Inner Survivor begging to be heard and once heard, the need for self-defense often subsides.
Boundaries & Consent
When someone is in distress, our immediate reaction is to give that person a hug, or some kind of physical affection. So a lot of non-PTSD folks may be inclined to be physically affectionate when someone is triggered or having a flashback.
Establish consent before carrying out any sort of physical or emotional intimacy.
Many Survivors have had their personal boundaries, both physical and emotional, violated. Therefore, it is common for someone having a flashback or being triggered to NOT want physical contact.
It is also a common reaction for people with PTSD either to have non-existent boundaries or to set down concrete-wall boundaries. Many people with PTSD are still learning how to establish healthy boundaries and may set boundaries at both extremes before the pendulum swings towards the center.
Physical Boundaries--it is really important to ask a survivor if they want a hug or want to be touched. If they say "no", respect that request.
How much, where and the kind of touch can make a difference. Some people are triggered by forceful touch but not light touch, some people are just the reverse. Some people can handle touch in a quiet area, but in a busy or noisy area may not want to be touched. The presence of other triggers in the environment may affect someone's level of touch-aversion. It's also a good idea to be more explicit about respecting personal space in general. For example it might be considered nice but not necessary to excuse yourself if you have to reach over someone, but these small courtesies can have a whole other depth of meaning for people with PTSD.
If the person in question is in such distress they cannot express themselves clearly, check for signs. Does their body tense up when you touch them? Do they try to break physical contact after you've established it? Do they back up or look threatened when you approach them? These are signs they don't want to be touched.
Do they relax and seem calmer when you touch them? Do they reach out to initiate physical contact? Do they look comforted when you reach to hug them? These are signs they want to be touched.
Emotional boundaries--when a person is having a flashback, it is important to ask the person if they want to talk about it first. If they want to be left alone, respect that space. If they want to talk to someone else that is not you, respect that too. Many survivors have had their trust in people or situations severely tampered with and may be working on building up trust again. It's important not to force trust. If that person needs to turn to another person they trust more right now, or if that person feels they cannot trust anyone right now, give them that space. Do not take it personally. If a survivor does not trust you enough to talk to you about it, it has nothing to do with how trustworthy you are and has everything to do with them learning to build up trust again. As they heal, they will start to trust more.
Situational boundaries--it is a good idea to give survivors flexibility with getting out of a situation. For example, if you host a party and it turns out you've invited a survivor's perpetrator, find a way to either get rid of the perpetrator or at least minimize their interaction as much as possible. If a party has drugs and alcohol and your friend is triggered by drugs and alcohol, offer to leave with the survivor. If you want to go see a movie, and you know your friend is a veteran, mention if the movie contains lots of combat scenes. Give them a heads up and offer an out. If they express a strong aversion to something, don't pressure them into doing it. Respect their aversion and move onto something else.
It can be painful to be on the outside of a PTSD survivor who is going back and forth between being overly trusting and overly distrusting, setting no boundaries and then concrete-wall boundaries. This may bring up your own emotional history. In this situation, as an Ally, it is extremely important to take care of yourself too. Reach out to people OUTSIDE your relationship with the survivor to talk to. Seek your own support system as well. Respect your own boundaries and limits as well.
"So, what happened?"
Do not ask a survivor about their trauma. They will come to you about it if and when they are ready. If they never do, don't take it personally. Some survivors find it easier to express their trauma through other channels such as poetry, art, music, dance, etc. Confiding in loved ones is only one channel.
When a survivor comes to you about their trauma, this is an honor and a privilege. It means they trust you enough to be vulnerable. This is not the time to judge whether their trauma really happened, if it was really that bad, if they are exaggerating. This is not the time to fact-check or cross-examine them. Trauma can be hard to remember. Memories are can be confusing, fragmented, and hard to fully understand. Emotion distorts memory and the human mind is not perfect. A survivor might also be mixing up memories from two separate traumatic events or may be missing some pieces of the puzzle. Childhood memories may also be through the lens of a child's mind and therefore may make it hard not only for you, but for the survivor themselves to understand through their adult mind. Often memories are just as confusing for the survivor as they are for you.
This is not the time for unsolicited advice. Do not tell them "well you're the one who enlisted" or "your shirt was low-cut and you were drunk" or whatever other "explanation" you have. The trauma is not the survivor's fault. Do not victim-blame. It is either the result of bad circumstances (such as in the case of natural disaster) or the the fault of the perpetrator (the person who hurt them).
This is not the time to tell them about how you or someone you know lived through something worse. This is not the time to remind them of the starving children. The pain and suffering of other people does not lessen a survivor's pain. Playing Trauma Olympics serves no one and is an undercut way to dismiss or brush off the survivor's trauma.
Instead, take the survivor's story at face value. Trust the process. In listening to their story without judgment and with compassion, you help them in their healing process. You are not obligated to offer some golden nugget of wisdom. Just your presence, a lending ear, eye, or hand can work wonders. It is a privilege to be in this role and have the opportunity to show allyship in this way.
Keep in mind that PTSD is related to the person's own perception of what happened and their survival response during the trauma. In other words, even if, for example, a doctor told a cancer survivor they would die from the cancer, and they ended up surviving, they still need to process the emotions of having believed they were going to die.
This also means that two people could have survived the same traumatic event (maybe even together) but still have responded differently. Different survivors will be affected in different ways and to different degrees. That is because trauma does not exist in isolation--the person's life before the event, how they were able to respond to the event, and their neurology all factor into how their PTSD manifests now. Everyone is different. No two survivors are the same.
This is a live document and open to change. If you have PTSD or are a survivor, feel free to comment! I know I didn't cover everything there is to say on this topic, so please, please feel free to add whatever comes to mind.