Third Thoughts About Trigger Warnings

As you may have noticed, the world is an upsetting place.  At least on college campuses, one popular way to mute the pain of the world is to make an announcement before you say anything upsetting.  These announcements are called trigger warnings.  Though widely mocked, they’re spreading widely.

Casual critics usually reject trigger warnings on puritanical grounds: We have the duty to face the ugliness of the world, even if we don’t like it.  But psychologically literate critics have a more powerful critique: People must face their fears to overcome them.  Greg Lukianoff and Jonathan Haidt provide a primer on exposure therapy:

However, there is a deeper problem with trigger warnings. According to the most-basic tenets of psychology, the very idea of helping people with anxiety disorders avoid the things they fear is misguided. A person who is trapped in an elevator during a power outage may panic and think she is going to die… If you want this woman to retain her fear for life, you should help her avoid elevators.

But if you want to help her return to normalcy, you should take your cues from Ivan Pavlov and guide her through a process known as exposure therapy. You might start by asking the woman to merely look at an elevator from a distance—standing in a building lobby, perhaps—until her apprehension begins to subside. If nothing bad happens while she’s standing in the lobby—if the fear is not “reinforced”—then she will begin to learn a new association: elevators are not dangerous. (This reduction in fear during exposure is called habituation.) Then, on subsequent days, you might ask her to get closer, and on later days to push the call button, and eventually to step in and go up one floor…

Students who call for trigger warnings may be correct that some of their peers are harboring memories of trauma that could be reactivated by course readings. But they are wrong to try to prevent such reactivations. Students with PTSD should of course get treatment, but they should not try to avoid normal life, with its many opportunities for habituation… And they’d better get their habituation done in college, because the world beyond college will be far less willing to accommodate requests for trigger warnings and opt-outs.

Interestingly, however, Scott Alexander vehemently objects to this critique of trigger warnings:

You know, I love science as much as anyone, maybe more, but I have grown to dread the phrase “…according to the research”.

They say that “Confronting triggers, not avoiding them, is the best way to overcome PTSD”. They point out that “exposure therapy” is the best treatment for trauma survivors, including rape victims. And that this involves reliving the trauma and exposing yourself to traumatic stimuli, exactly what trigger warnings are intended to prevent. All this is true. But I feel like they are missing a very important point.

YOU DO NOT GIVE PSYCHOTHERAPY TO PEOPLE WITHOUT THEIR CONSENT.

[…]If a person with post-traumatic stress disorder or some other trigger-related problem doesn’t want psychotherapy, then even as a trained psychiatrist I am forbidden to override that decision unless they become an immediate danger to themselves or others.

I freely admit that Scott’s objection initially seems quite strong.  But there’s one little problem: Rhetoric aside, psychotherapy is just a particular kind of conversation.  And to borrow Scott’s punctuation…

FREE SPEECH MEANS YOU DON’T NEED GOVERNMENT-APPROVED TRAINING TO HAVE A CONVERSATION.

“Administering exposure therapy without patient consent” isn’t like forcibly injecting someone with morphine.  Instead, it’s like something almost all of us do every day: Sharing our unsolicited opinions.  Current law largely avoids this tension by turning a blind eye to conversation unless you call it “therapy.”  (Colorado even has official procedures for registering as an “unlicensed psychotherapist.”)

I’m one of Scott Alexander’s biggest fans.  But if we took his medical ethics literally, every conversation would have to be preceded by paperwork.  If this seems overstated, remember that some people have severe social anxiety.  For them, hearing the statement, “Nice weather we’re having,” could be construed as treatment.  Indeed, we couldn’t meet Scott’s standard even if we did require paperwork for any conversation.  After all, some people – like me – are terrified of paperwork.  When you ask me for my signature, you are ipso facto administering medical treatment without my consent.

As you might know, I’m against medical licensing.  But you don’t have to agree with me to see that current law and medical ethics create an enormous loophole for conversation-that-looks-just-like-psychotherapy-as-long-as-you-don’t-call-it-psychotherapy.  And what a lovely loophole is it.  The loophole doesn’t just permit people to speak without fear of accidentally practicing medicine without a license.  It also permits people to listen without fear of accidentally receiving medical treatment.  That’s the glory of free speech!

None of this means, of course, that you should use your free speech to be rude or insensitive.  But once you accept the science of exposure therapy, you’re likely to change your mind about what counts as “rude” or “insensitive.”  If casually discussing sensitive topics ultimately makes traumatized people feel better, why should there be a norm against it?  At minimum, the science is a good reason to switch the default rule.  Instead of expecting controversial speakers to say, “May I discuss X?,” the burden should be on sensitive listeners to ask, “Can we please change the subject?”

In sum, trigger warnings are indeed a bad idea.  Psychologists are correct to worry that trigger warnings make trauma worse.  Yes, on second thought you could accuse these critics of advocating forced medical treatment.  But on third thought they’re not, because calling psychotherapy “medical treatment” is a metaphor.  Current law all but admits this.  And thank the stars that it does, because a society where we took the medical metaphor literally would be dystopian enough to trigger us all.

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