Trauma vs. Drama

Before continuing, I need to make it very clear that the intent of this post is not to minimize anyone’s experiences. The sole purpose of this post is to present a brief look at an academic discussion that began a couple decades ago and is still taking place today in academic journals and publications.

The idea is conceptual bracket creep in the context of PTSD.

Before looking at bracket creep, we must look at the uniqueness of PTSD. There are two things about PTSD that make the disorder very different from other mental health disorders.

The first difference is that with PTSD, there is a clearly delineated victim and perpetrator. In other words, it is the only mental health diagnosis in which there is a particular someone (or something) to blame for inciting the disorder. For example, a patient who developed PTSD as a result of sexual assault has a clearly identified assailant to blame. A soldier who developed PTSD after serving in active duty in a warzone has that particular combat experience to blame. A child who developed C-PTSD (complex post-traumatic stress disorder) from repeated abuse and neglect has a particular abuser to blame.

The second difference is that a PTSD diagnosis requires exposure to a traumatic event as one of its defining criteria. Without the identification of a horrific event, there can be no PTSD diagnosis.

This is where the debate lies when it comes to conceptual bracket creep.

Richard McNally, a psychologist, researcher, and clinical training director for Harvard University’s psychology department, first discussed this idea of bracket creep in one of his publications twenty years ago. He explained that bracket creep refers to the idea that more and more types of horrible events creep within the brackets of what is defined as “traumatic.” Traumatic events now include experiences that were previously considered minor or trivial, such as watching a character’s serious injury or death on a television show. Researchers Byron Good and Devon Hinton stated that this bracket creep also includes other “experiences that are uncommon but not necessarily extraordinary, and are successfully managed by most people.” Over the past two decades, studies have identified patients with PTSD symptoms as a result of such stressors as getting their wisdom teeth removed or being on the receiving end of offensive sexual jokes in the workplace. There was even a study published in 2001 by Breslau and Kessler showing that this expanded trauma criteria was responsible for 89% of residents in a Michigan community to be identified as trauma survivors.

While offensive jokes and teeth extractions can be very problematic, they were not historically the type of inciting events that led to PTSD diagnoses. That is, until now. Some of this could be attributed to the comforts of modern life. Our modern life conveniences, our support systems, our infrastructures, and our technology have all contributed to us living in the safest time in human history. For this reason, what constitutes as dangerous has now expanded a bit to include previously ordinary experiences.

Some of this bracket creep can also be attributed to the ease in which mental health vocabulary enters into our everyday conversations. It is no coincidence (at least for me) that McNally’s original academic publications on PTSD bracket creep coincide exactly with the launch of social media platforms. Our social media platforms allow us to share what we think we know about mental health. And so, words like trauma, gaslighting, triggers, narcissism, and other psychology terms become overused and oversimplified. There is now an increasing number of teenagers turning to TikTok for mental health information.

Why Is Bracket Creep a Problem?

There are two major concerns with PTSD bracket creep. The first issue is that broadening the concept of a traumatic event can lead to an over-diagnosis of PTSD in people whose symptoms are not severe enough to warrant the diagnosis. This can lead to unnecessary labeling and unnecessary psychological treatment.

The second issue is that bracket creep can trivialize serious trauma. When relatively minor setbacks are considered “traumatic events,” it can invalidate the struggles of those who have experienced serious life-threatening adversity.

Becoming hypersensitive to non-life-threatening stressors leads to a blurring of the lines between trauma and drama.

When people mistakenly define trauma as any event that has a lasting negative effect, they begin to conflate the word “trauma” with the word “adversity.” This trivializes the potency of trauma. It can also damage our development of personal resilience because we will never learn how to recognize our normal stress responses to adversity. For example, it is perfectly natural and expected to feel anger and sadness and frustration and anxiety and depression in a racially or sexually hostile work environment. Those are perfectly appropriate stress responses to negative experiences. But labeling those events as “traumatic” can weaken our resiliency and remove our agency to effectively handle the situation.

Conclusion

So what’s the solution? How do we resolve these concerns about bracket creep? The only way that I can envision a resolution is to narrowly define our criteria for “traumatic event.” Here in the United States, our therapists use the DSM (Diagnostic and Statistical Manual of Mental Disorders) in order to diagnose patients, and we really should follow the criteria of the ICD (International Classification of Diseases) maintained by the World Health Organization. In the ICD, a diagnosis of PTSD is based only on the patient being either a direct recipient of the traumatic event or a personal witness to another person’s traumatic event. (Indirect exposure such as through the media does not qualify someone to be labeled a trauma survivor.) This does not mean we dismiss people who are mentally distressed after tooth extractions or who are mentally distressed because of hostile work environments. We most definitely have to help these patients heal from their mental distress. We just name these types of mental distress something else other than trauma.