WP3: Identity’s Impact on Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is “a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury” (Pyschiatry.org). People with PTSD will be affected by symptoms that disturb their daily lives. The four main groups of symptoms are intrusion, avoidance, alterations in cognition and mood, and alterations in arousal and reactivity. Intrusion manifests through nightmares or uncontrollable thoughts or memories associated with a traumatic event. Avoidance usually occurs when someone with PTSD recognizes an object, place, or person associated with their traumatic event, so the association prevents the survivor from viewing associated events/objects as objectively inoffensive. Avoidance can also be refusing to talk about the event. Alterations in cognition generally means that a survivor cannot recall certain details of trauma or their lives, and their emotional state changes after the event with thoughts that align with negative emotions like shame. Alterations in arousal and reactivity can be seen as outbursts, self-destructive behavior, or staying overly alert in safe situations.

All these symptoms can manifest internally, so a person with PTSD contends with them silently or they occur unnoticed by those around a survivor. Or, these symptoms can express themselves in ways that a society takes notice of because these behaviors can be surprising or seemingly without cause. Throughout the history of the United States, gender and race both dictate the perception of PTSD within an individual, affecting the amount of time it takes to diagnose someone with PTSD, and the quality of treatment they could receive. Exploring the differences in diagnosis and treatment equity is of vital importance both from the perspective of the medical world and broader societal acceptance.

A common mistake people make when discussing PTSD is using it to describe Post Traumatic Stress (PTS). While the two have similar symptoms, PTSD is a mental disorder and PTS is a temporary reaction to traumatic events. For example, my sexual trauma caused me to be diagnosed with complex PTSD that affects my brain chemistry and leaves me with lifelong repercussions. I experienced PTS after a car accident I was in at the end of my senior year in high school. The difference lies in how my body and mind recover after the traumatic event and whether I can recover without medical and psychiatric assistance. With the car accident, I experienced discomfort in cars for a while afterward and had instances of panic at the notion of repeating the incident or seeing others experience a car accident. But all of those symptoms cease to preoccupy my mind less than a year later, and I don’t experience any remnants of trauma when I ride or drive in a car now. However, my sexual trauma continues to affect me in the present, and five years later I know that it is not going to be something that fades with time. I am receiving treatment because it altered my brain chemistry. That is the difference between PTS and PTSD.

Because PTS is an immediate short-term response to something traumatic, the repercussions are manageable by those around the survivor because they understand the correlation between the event and the reaction. PTSD is deceptive, and symptoms can set in months or years later and continue for an entire lifetime. Survivors do not always know that what they are experiencing are symptoms related to a traumatic event. When I started therapy for the first time since my traumatic event, I went in to manage my angry outbursts and mood swings because they were causing me emotional distress. After my diagnosis of PTSD, many other behavioral patterns of my life started to elucidate underlying medical conditions. Other symptoms that I did not even realize were symptoms of PTSD could be traced back to my traumatic event. The issue with this type of diagnosis years later is that those who see me or any survivor experiencing mental disorder symptoms only see someone behaving badly because the timing does not directly suggest PTSD.

Because men and women are not seen or treated equally in society, their PTSD diagnoses and quality of treatment are too often extremely different. Author and researcher of psychiatric treatment for PTSD, Miranda Olff, says, “Women have a two to three times higher risk of developing [PTSD] compared to men.” Within the medical community, symptoms typically associated with women’s experiences with PTSD are more likely to get a woman diagnosed faster. However, a popular misconception of PTSD is that it exclusively afflicts people who have contended with physical suffering like military service members. PTSD has been a psychological response to trauma for, theoretically, all of human existence. But the diagnosis was only added to the psychological zeitgeist after the World Wars and subsequent mass tragedies. During WWI, soldiers suffered what was called “shell shock” and “acute mania”, both of which were considered mental failings of soldiers in the war.

This era of poor psychological resources and toxic masculinity meant that soldiers were expected to willfully neglect any emotions based around the trauma of their experiences in war. The remnants of these patriarchal misconceptions are still infused in our ideas around trauma today. “Gas hysteria” was a term used to diagnose soldiers fearing poison gas attacks in the midst of WWII. Those that went “mad” after war were pitied because they weren’t strong enough to withstand the demands of combat. In reality, these men experienced trauma without access to any healthy coping mechanisms and their emotions were further invalidated by the need for masculinity and lack of appropriate medical treatment (Horwitz). While the most recognized cause for PTSD is military trauma, the most common cause for PTSD in women is rape. However, because PTSD was popularized by war’s effect on soldiers (a man’s territory), it wasn’t seen as a disorder that could affect women. In reality, from 2001 to 2003 the National Institute of Mental Health reported 1.8% of US male adults had PTSD as opposed to 5.2% of US female adults.

Women also experience PTSD in a much different way than men simply based on the way they are perceived. Those experiencing PTSD are more prone to frustration which is more widely accepted in men. Dr. Amber Hayden from Women’s Health Network articulates, “There is still a well-established double standard when it comes to anger, and it splits directly along traditional gender lines. Men get more leeway when it comes to anger, perhaps because they have traditionally been viewed as world protectors, controllers and enforcers.” Because women deal with the stereotype that they are emotional and overdramatic, their anger is taken less seriously.​ They are expected to model an unreasonably inhuman composure, masking their anger to be accepted by others, but active PTSD exacerbates the management of anger.

Anger can take many forms, but I’ve found in my research that uncontrollable outbursts are the most common expression of anger seen in those with PTSD and a symptom I’ve experienced myself. When men exhibit hostile outbursts, people living in a patriarchal society tend to make excuses for them. For example, Will Smith’s outburst at the 2022 Oscars was hailed by some as a man defending his wife or excused as a man in a moment of vulnerability, when it was actually an unprompted act of violence. Flagrant displays of emotion from men, especially anger, are considered brave or vulnerable. These same allowances are rarely made for women. Instead, women are categorically dismissed as moody and/or uncontrollable. Society applauds men for exhibitions in which women face admonishment.

My own experience with PTSD shows that, as a woman, certain actions are not acceptable for me to display. When I become unreasonably agitated, my anger cannot result in any connotation of hostility because many will assess that I am in a socially unacceptable state, sometimes classified as “unladylike.” Acting on my anger can even put me in a dangerous situation, especially in confrontations with men. There is no telling how a man will react when I respond aggressively instead of de-escalating the situation by not expressing myself.

Those who suffer from PTSD due to sexual assault also face a wide range of judgement based on their race or gender. Women are typically seen as dramatic or “overreacting” which only serves to discredit the true trauma they have experienced and undermine their ability to process that trauma. On the other hand, men who suffer PTSD from sexual violence face emasculation, accusations based on the idea that because men are hyper-sexual, if they have any sexual encounter, they must have enjoyed it. The mistake in this assumption falls under what is deemed sexual. Rape is about power and violence. The sexual assault a man experiences equals what a woman experiences, violence exercised by someone with more power. Trauma is a constant regardless of gender, but toxic masculinity influences the afflicted and others to believe that men are not allowed to feel emotions that are perceived as weak. It is more acceptable for a man to experience PTSD as a veteran from war than it is for a man to experience PTSD from sexual violence. Also, women have higher rates of PTSD, so it is more commonly seen in women than men even if the most famous examples come from male centered activities (like combat for soldiers).

As a college student, my academic life takes up a good deal of time and my high school academic life did the same. Both existed after my traumatic event, and it’s important to see that people react differently to traumatic stimulants. Sometimes, a survivor of a traumatic event can become listless, disassociative, and isolated or unmotivated. While people could perceive someone experiencing these as lazy or unambitious, it is important to consider that someone who reacts to a traumatic event with hyperactivity is not inherently better than someone who shuts down. Both are equally PTSD symptoms and can have life-altering consequences. For me, I shifted into perfectionism based on the intense feelings of shame and low self esteem I felt. I overcompensate for my lack of confidence with as close to perfection as possible performing in school and extracurriculars. This proved to be self-destructive behavior but those around me simply viewed it as “overachieving” and becoming successful. In reality, I worked myself to the bone trying to please everyone around me and achieve the level of perfection I had insisted upon for myself. Being a young overachieving woman seemingly full of potential gave those around me the illusion that I was an incredibly awesome candidate for life. But those closest to me, like my parents, showed discomfort at the lengths I was going through to be perfect and the standards to which I aspired to achieve.

Similarly to how stereotypes about gender influence the perception of someone with PTSD, race influences how others handle PTSD or even view their trauma symptoms. Also, because PTSD expresses itself with such a wide range of symptoms that can each manifest differently based one one’s race or gender or both, a PTSD sufferer may be judged differently by others. For example, while I can testify to the life -altering implications of this disorder, being an elite college-educated white woman from a middle class family with PTSD, my race and gender allow me to be assumed innocent and non-aggressive. Other races do not have that privilege. L. Song Richardson assesses that based on implicit racial bias, “Officers will be more likely to evaluate the ambiguous behaviors of Black civilians as aggressive, violent, or suspicious.”

Stephon Watts was a 15-year-old Black child with Asperger’s Syndrome. During a mental health crisis, two white officers shot him to death while holding a butter knife in his own home (Access Living). This case, and many others, show the dangers of how law enforcement view those with mental differences. Because Watts was Black and a boy, he was considered a large enough threat to kill when in reality he was an angry child with a butter knife. Gender and race play a role in how we view a person with PTSD or simply how we view someone experiencing symptoms of a mental health crisis. Based on his identity, Watts was viewed as a threat, whereas if I had been in that situation, it is highly unlikely that I would have been killed. A white person having a mental health crisis is less likely to experience brutality or murder at the hands of the police. And, as a young white woman, I’m the least likely to experience brutality at the hands of police during a mental health crisis because preconceived notions about my skin color and gender cause authorities to deem me hysterical but non-threatening.

The demonization of Black men stems from prejudices formed during the enslavement of peoples during the first century of the United States. Furthermore, the stereotype of criminality that has been pushed onto Black men based on their history of low socio-economic status in the United States creates a dangerous situation for Black men suffering from PTSD. Because PTSD can manifest into angry outbursts (I know it does for me) and this can commonly lead to expressions of emotions that are unmanageable for the person experiencing them, a white woman like me can lash out in public and experience only judgment, but a Black man could be faced with dangerous consequences, including brutality or even death at the hands of the police.

Racist and sexist stereotypes overlap for black women or other women of color suffering from PTSD with often devastating results. The stereotype of the “angry black woman” makes the expression of anger without repercussion almost impossible for Black women. They are not allowed to express their anger in ways that men or white women do because they are labeled dangerous or dramatic or both. There is nothing Black women can do about this perception either, because sometimes even their calmest ways of dealing with issues can be labeled aggressive or inappropriate. The National Black Women’s Justice Institute, in their recent post Black Women, Sexual Assault, and Criminalization wrote, “Sexual trauma is frequently associated with PTSD, depression, substance misuse, suicide ideation and attempts, and other adverse health effects. For black women, the added effects of sexism and racism can heighten depressive and PTSD symptoms. When trauma is unaddressed, it leaves us more at risk of interaction with law enforcement and the legal system because often how we express our trauma does not conform to traditional clinical symptoms. As a result, we are criminalized instead of receiving the treatment and care we need and deserve.”

PTSD can affect anyone across the gender spectrum and across racial and ethnic lines. Because of this, stereotypes regarding race and gender affect how those with PTSD have to function in society. Racial and gender identities affect the impact of a mental disorder on a person, the way they must conduct themselves, and the consequences of uncontrollable symptoms.

WORKS CITED:

Hayden, Dr. Amber. “Anger in Women.” Women’s Health Network, 19 Jan. 2022, https://www.womenshealthnetwork.com/emotions-anxiety-and-mood/anger-in-women/.

Horwitz AV. PTSD: A Short History. Johns Hopkins University Press; 2018.

Nbwji. “Black Women, Sexual Assault, and Criminalization.” NBWJI.org, NBWJI.org, 20 Apr. 2022, https://www.nbwji.org/post/black-women-sexual-assault-criminalization.

“Post-Traumatic Stress Disorder (PTSD).” National Institute of Mental Health, U.S. Department of Health and Human Services, https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd.

Olff, Miranda. “Sex and Gender Differences in Post-Traumatic Stress Disorder: An Update.” European Journal of Psychotraumatology, Taylor & Francis, 29 Sept. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632782/.

Richardson, L. Song. Implicit Racial Bias and Racial Anxiety: Implications for Stops and Frisks. NYU Law, https://www.law.nyu.edu/sites/default/files/upload_documents/Richardson%20Terry%20Draft.pdf.

“The Story of Stephon Watts.” Access Living, 13 Apr. 2022, https://www.accessliving.org/defending-our-rights/racial-justice/community-emergency-services-and-support-act-cessa/the-story-of-stephon-watts/.

“What Is Posttraumatic Stress Disorder (PTSD)?” Psychiatry.org — What Is Posttraumatic Stress Disorder (PTSD)?, https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd.