PTSD and Medical Trauma Reference¶

Post-Traumatic Stress Disorder and Medical Trauma
Abbreviation	PTSD, C-PTSD
Type	Trauma disorder / Mental health condition
Affected Characters	Amber Makani, Ben Keller, Cassidy Harris, Cody Matsuda, Connor Martinez, Jacob Keller, Jeremy Wallace, Marcus Henderson, Michael Bell, Nina Cruz
First Mention	Multiple timelines (1990s-2050s)
Severity Range	Mild to severe; can be chronic or resolved with treatment
Management	Trauma-focused therapy (CPT, PE, EMDR), medication (SSRIs), safety planning, support systems

Overview¶

Post-Traumatic Stress Disorder is a mental health condition triggered by experiencing or witnessing a terrifying event. It is characterized by intrusive memories, avoidance, negative changes in thinking and mood, and changes in arousal and reactivity. PTSD is not weakness or character flaw—it is a highly treatable condition that develops after trauma exposure.

Historical Context and Medical Evolution¶

Ancient Recognition of Trauma¶

Earliest Documentation: - Symptoms resembling PTSD documented on Mesopotamian cuneiform tablets over 3,000 years ago - Ancient Greek literature describes combat-related psychological symptoms - Trauma responses observed throughout recorded history - However, no formal medical framework existed

Historical Names: - Various terms used across centuries: "nostalgia," "soldier's heart," "railway spine" - Symptoms recognized but understood differently in each era - Often attributed to moral weakness, cowardice, or malingering

Civil War Era: "Soldier's Heart"¶

Da Costa's Syndrome (1860s): - Dr. Jacob Mendes Da Costa studied Union soldiers with unexplained symptoms - Rapid heartbeat, anxiety, shortness of breath, fatigue - Called "soldier's heart" or "irritable heart" - Attributed to physical strain rather than psychological trauma - Estimated 5,000+ Civil War soldiers affected - Treatment focused on physical heart, missed psychological component

World War I: "Shell Shock"¶

Recognition and Initial Response (1914-1918): - Term "shell shock" coined by Charles Myers in 1915 - Initially believed caused by physical damage from artillery blasts - Symptoms: tremors, nightmares, paralysis, mutism, blindness (with no physical cause) - 80,000 British soldiers diagnosed by war's end

Shifting Understanding: - By war's end, recognized that soldiers not exposed to shelling also had symptoms - Debate shifted between organic (physical) and psychological explanations - Many soldiers court-martialed for "cowardice" when they had shell shock - Some executed for desertion while experiencing trauma symptoms

Treatment (Often Harmful): - Electrotherapy (painful shocks to "cure" paralysis) - Isolation, discipline, shaming - "Talking cures" (early psychotherapy) used by some clinicians - Rest cures for officers; harsh treatment for enlisted

Post-War Suppression: - British government banned the term "shell shock" after WWI - Research into organic causes discontinued - Veterans left without support, labeled as weak

World War II: "Combat Fatigue" / "Battle Neurosis"¶

Terminology Shift: - "Shell shock" abandoned; "combat fatigue," "battle neurosis," "war neurosis" used - Recognized that any soldier could break down given enough combat exposure - "Every man has his breaking point"

Treatment Evolution: - Forward psychiatry: treating soldiers near front lines - Rest, food, reassurance, return to unit quickly - Recognized importance of unit cohesion - Still significant stigma; diagnosis could end military career

DSM-I (1952): - American Psychiatric Association published first DSM - Included "gross stress reaction" for trauma from disaster or combat - However, condition considered temporary, expected to resolve

Post-Vietnam Era: Creation of PTSD¶

Vietnam War Context: - 2.7 million Americans served in Vietnam - 700,000+ needed psychological treatment - Unlike previous wars, veterans returned individually (not with units) - Faced hostile reception from anti-war public - Delayed-onset symptoms common

Veteran Activism: - Vietnam veterans began organizing and advocating - "Rap groups" (peer support) formed by veterans - Veterans described experiences medical establishment didn't recognize - Psychiatrists working with veterans pushed for formal diagnosis

DSM-III (1980): - Post-Traumatic Stress Disorder formally recognized - First appearance of PTSD as diagnosis - Validated that trauma could cause lasting psychological damage - Criteria established: trauma exposure, re-experiencing, avoidance, hyperarousal - Major victory for veteran advocates

Expansion Beyond Combat: - Recognition that PTSD applies to non-combat trauma - Rape survivors, accident survivors, disaster victims - Childhood abuse survivors - Medical trauma (later recognized)

Complex PTSD Recognition¶

Judith Herman's Work (1992): - Psychiatrist Judith Herman proposed "Complex PTSD" in book "Trauma and Recovery" - Argued standard PTSD criteria didn't capture prolonged, repeated trauma - Focused on domestic violence, child abuse, captivity situations - Proposed additional symptoms: affect dysregulation, negative self-concept, relationship difficulties

Diagnostic Journey: - C-PTSD proposed for DSM-IV but not included - "Disorders of Extreme Stress Not Otherwise Specified" (DESNOS) used in research - DSM-5 (2013) still did not include C-PTSD as separate diagnosis - ICD-11 (2018): Finally included Complex PTSD as formal diagnosis - Recognition that prolonged trauma creates distinct symptom pattern

Medical Trauma Recognition¶

Historical Invisibility: - Medical trauma not recognized as legitimate for most of PTSD history - "You should be grateful you survived" dismissed trauma responses - Avoidance of medical care seen as "non-compliance," not trauma - Healthcare providers caused trauma but didn't recognize it

Emerging Recognition (2000s-Present): - ICU-acquired PTSD studied (25% of ICU survivors develop PTSD) - Medical procedures recognized as potentially traumatic - Loss of bodily autonomy, painful procedures, life-threatening events - Medical gaslighting identified as trauma source - Still underrecognized by many healthcare providers

Specific Medical Trauma Sources: - ICU stays, especially with delirium - Cancer diagnosis and treatment - Childbirth trauma - Chronic illness misdiagnosis and dismissal - Medical racism and ableism - Institutional medical abuse

DSM Evolution and Current Understanding¶

DSM-III (1980): PTSD established as diagnosis

DSM-III-R (1987): Criteria refined

DSM-IV (1994): Required trauma involve "intense fear, helplessness, or horror"

DSM-5 (2013): - Moved PTSD from Anxiety Disorders to new category: Trauma- and Stressor-Related Disorders - Removed requirement for specific emotional response during trauma - Added negative cognitions and mood as symptom cluster - Recognized anhedonic/dysphoric presentations - Added dissociative subtype

ICD-11 (2018): - Included Complex PTSD as distinct diagnosis - Requires PTSD symptoms PLUS disturbances in self-organization - Affect dysregulation, negative self-concept, relationship disturbances

Race, Gender, and Class Disparities¶

Gender: - Women twice as likely to develop PTSD as men - Sexual trauma more common for women - Women's trauma historically dismissed as "hysteria" - Combat PTSD research focused on men; women veterans understudied

Race: - Black and Hispanic individuals have higher PTSD rates - Racial trauma (experiencing racism) recognized as trauma source - Historical trauma (intergenerational) affects Indigenous and Black communities - Minority veterans face compounded discrimination - Less access to culturally competent trauma treatment

Socioeconomic Factors: - Poverty increases trauma exposure - Less access to treatment - Job loss, housing instability from PTSD symptoms - Downward spiral of untreated PTSD

Healthcare Access: - Trauma-focused therapy not available everywhere - Long waitlists for VA and community mental health - Insurance may limit therapy sessions - Medication without therapy is insufficient for many

Era-Specific Implications for Series Characters¶

Jacob Keller (Complex PTSD): - Prolonged childhood trauma creating C-PTSD pattern - Diagnosed in era when C-PTSD increasingly recognized - Affects dysregulation, relationships, self-concept - Intersects with autism, bipolar disorder, epilepsy - Lifetime of managing trauma alongside other conditions

Cody Matsuda (PTSD from suicide attempt/ICU): - Medical trauma from 1995 overdose and ICU stay - Diagnosed in era before medical PTSD widely recognized - Avoidance of medical care as trauma response - Loss of speech compounds isolation - Trauma at 16 shaped entire adult life

Ben Keller (Complex PTSD, untreated): - Childhood abuse creating C-PTSD - Undiagnosed, untreated—represents those who fall through cracks - Violent instability from unprocessed trauma - Without treatment, trauma perpetuates harm

Nina Cruz (PTSD): - Trauma survivor with hypervigilance - Anxiety in crowded/loud environments - Represents trauma affecting daily functioning

Marcus Henderson (PTSD from 2019 crisis): - Acute PTSD from psychiatric crisis - Diagnosed in modern era with better recognition - Trauma from manic episode and its aftermath - Intersects with FASD, autism, bipolar disorder

Connor Martinez (Medical PTSD): - Specifically medical trauma from septic shock - Modern recognition of ICU/medical trauma - Post-septic complications plus psychological impact

Jeremy Wallace (Medical trauma): - Trauma from 1998 cardiac arrest and aftermath - Diagnosed in era before medical trauma well-recognized - Seizures as reminder of traumatic event - Learning to live with both epilepsy and trauma

Amber Makani (Trauma/PTSD from abuse): - Childhood abuse and witnessing brother's TBI - Complex trauma from multiple sources - In recovery—represents healing is possible

Michael Bell (Institutional trauma): - 19 years of institutional abuse - Trauma from documentation and witnessing abuse - Gifted intellect meant he understood what was happening - Institutional trauma survivors rarely recognized

Cassidy Harris (Health anxiety/trauma): - Trauma response from witnessing medical emergency - Developed health anxiety from vicarious trauma - Shows trauma can develop from witnessing, not just experiencing

WHAT IS PTSD?¶

Definition: Post-Traumatic Stress Disorder - mental health condition triggered by experiencing or witnessing a terrifying event. Characterized by intrusive memories, avoidance, negative changes in thinking/mood, and changes in arousal/reactivity.

Key Points: - Develops after trauma exposure - Symptoms persist 1+ months - Causes significant impairment - NOT weakness or character flaw - Highly treatable

Trauma Types: - Acute trauma: Single traumatic event - Chronic trauma: Repeated/prolonged trauma - Complex trauma (C-PTSD): Prolonged trauma, often in captivity or abuse (Michael's experience)

WHAT IS MEDICAL TRAUMA/MEDICAL PTSD?¶

Definition: PTSD specifically from medical experiences—procedures, diagnoses, hospitalizations, medical emergencies, or medical gaslighting/neglect.

Common Triggers: - Life-threatening medical events - Painful procedures - Loss of bodily autonomy - Medical gaslighting (not believed) - Medical racism/ableism - Loss of function/abilities - ICU experiences - Chronic illness diagnosis

Why Often Missed: - Medical professionals don't recognize it - "You should be grateful you survived" (invalidating) - Blamed for "non-compliance" (actually trauma response) - Avoidance of medical care seen as "difficult patient"

Prevalence: - 25% of ICU survivors develop PTSD - Higher in chronic illness populations - Very high in marginalized communities (medical racism) - Almost universal in institutional abuse survivors

PTSD SYMPTOMS (DSM-5 Criteria)¶

Criterion A: Trauma Exposure¶

Must have experienced/witnessed/learned about: - Actual or threatened death - Serious injury - Sexual violence - OR repeated exposure to aversive details (Michael documenting abuse)

Medical Trauma Examples: - Cody: Near-death from overdose, ICU, loss of speech - Andy: Medical emergencies, seizures, police threat - Michael: Institutional abuse for 19 years - Lizzie: Medical neglect, preventable suffering

Criterion B: Intrusive Symptoms (Need 1+)¶

Intrusive Memories: - Unwanted, distressing memories - Can't stop thinking about trauma - Feels like happening again - For Cody: ICU memories, feeling unable to speak - For Andy: Pain being dismissed, ER experiences - For Michael: Punishment, isolation, Sharon's voice

Nightmares: - Trauma-related dreams - Night terrors - Sleep disruption - Waking in panic

Flashbacks: - Feeling like trauma is happening now - Dissociation (disconnection from present) - Can be triggered by reminders - For Cody: Medical settings trigger ICU flashback - For Andy: White coats, hospital smells - For Michael: Authoritative voices, institutional settings

Physiological Reactivity: - Physical response to reminders - Heart racing, sweating, panic - Body remembers even if mind doesn't - For Andy: Elevated heart rate entering hospital (POTS + PTSD)

Criterion C: Avoidance (Need 1+)¶

Avoiding Trauma Reminders: - Places, people, activities associated with trauma - Avoiding medical care (even when needed) - Refusing certain procedures - Not talking about trauma

Medical Avoidance Examples: - Cody: Avoiding doctors, delayed care - Andy: Skipping appointments, not reporting symptoms - Michael: Avoiding anywhere that feels institutional - Result: Worsening health, delayed treatment

Avoiding Thoughts/Feelings: - Not thinking about trauma - Suppressing memories - Emotional numbing - Substance use to avoid

Criterion D: Negative Changes in Thinking/Mood (Need 2+)¶

Negative Beliefs: - "I'm broken" - "The world is completely dangerous" - "No one can be trusted" - "It's all my fault" - For Cody: "My body betrayed me" - For Andy: "Doctors will never believe me" - For Michael: "I deserved it" (internalized)

Persistent Negative Emotions: - Fear, horror, anger, guilt, shame - Can't feel positive emotions - Detachment from others - Inability to experience joy

Distorted Blame: - Blaming self for trauma - Ellen: "I should have known about Cody" - Survivors often blame themselves - Perpetuates trauma cycle

Loss of Interest: - Anhedonia (can't feel pleasure) - Withdrawal from activities - Isolation from loved ones

Feeling Detached: - Disconnection from others - Emotional numbing - "Going through motions" - Depersonalization/derealization

Inability to Remember: - Dissociative amnesia - Gaps in trauma memory - Brain's protection mechanism

Criterion E: Arousal/Reactivity Changes (Need 2+)¶

Irritability/Aggression: - Anger outbursts - Little provocation - Lashing out at loved ones - Destroying property

Reckless/Self-Destructive Behavior: - Risky activities - Substance abuse - Self-harm - Medical non-adherence

Hypervigilance: - Constantly on guard - Scanning for danger - Can't relax - Ellen: Hypervigilance about kids' medical care - Jon: Constant monitoring of Chrissie - Andy: Hyperaware of police, medical settings

Exaggerated Startle Response: - Jumping at sounds - Intense reaction to surprises - Always on edge

Concentration Problems: - Can't focus - Mind goes blank - Easily distracted - Memory difficulties

Sleep Disturbance: - Insomnia - Nightmares - Hypervigilance preventing sleep - Exhaustion worsening other symptoms

COMPLEX PTSD (C-PTSD)¶

What Is C-PTSD?¶

Definition: PTSD from prolonged, repeated trauma, often involving captivity, abuse, or inability to escape. Includes PTSD symptoms PLUS disturbances in self-organization.

Who Gets C-PTSD: - Childhood abuse survivors - Domestic violence survivors - POWs, captives - Institutional abuse survivors (Michael, Lizzie) - Chronic medical abuse/neglect

Additional C-PTSD Features¶

Emotion Dysregulation: - Difficulty controlling emotions - Intense anger, sadness, shame - Emotional numbness alternating with overwhelm - Self-harm or suicidal behavior

Negative Self-Concept: - Profound shame - Feeling permanently damaged - Worthlessness - "I am fundamentally broken" - Michael: Internalized "I'm difficult, I deserve punishment"

Relationship Difficulties: - Difficulty trusting - Avoiding relationships OR clinging desperately - Fear of abandonment - Difficulty with intimacy - Michael: Learning trust with Lizzie, Jon, Chrissie

Michael's C-PTSD¶

Trauma Source: - 19 years institutionalized (ages 6-25) - Formative years in captivity - Repetitive abuse (punishment for autistic traits) - No escape, no advocates (until Ellen/Jon) - Sensory torture (denied rest, overstimulation)

C-PTSD Symptoms: - Profound distrust of authority - Hypervigilance about institutional settings - Emotion dysregulation (meltdowns from overwhelm, not autism alone) - Negative self-concept ("I'm difficult") - Relationship difficulties (learning to trust) - Flashbacks to punishment - Avoidance of anything institutional

Recovery: - Safety first (living with Jon, Chrissie, Lizzie) - Building trust slowly - Lizzie's love helping heal - Documentation as trauma processing - Never fully "over it" but learning to live

MEDICAL PTSD SPECIFIC PATTERNS¶

Triggers in Medical Settings¶

Sights: - White coats - Hospital corridors - Medical equipment - Needles, IVs - Fluorescent lighting

Sounds: - Beeping monitors - Alarms - Intercom announcements - Medical jargon - Authoritative voices

Smells: - Antiseptic - Alcohol wipes - Hospital food - Latex

Situations: - Waiting rooms - Exam tables - Being horizontal (ICU memory) - Loss of autonomy - Being restrained

Medical Avoidance¶

Behaviors: - Skipping appointments - Not reporting symptoms - Refusing procedures - Leaving AMA (against medical advice) - Not adhering to treatment

Why This Happens: - Trauma response (brain protecting) - Associating medical care with harm - Loss of control unbearable - Retraumatization risk too high - Rational response to past harm

Consequences: - Delayed diagnosis - Worsening conditions - Medical professionals labeling "non-compliant" - Cycle of trauma perpetuates

For Cody: - Avoiding doctors after suicide attempt - Medical settings trigger ICU flashback - Delaying care even when needed - Eventually: trauma-informed doctor helps - Still difficult, still triggering

For Andy: - Medical racism = repeated trauma - Each ER visit potential retraumatization - Avoiding care = survival strategy - Sarah advocating, but Andy still traumatized - Hypervigilance in medical settings

Medical Gaslighting as Trauma¶

What It Is: - Having symptoms dismissed - Being told "it's in your head" - Being called "difficult" for advocating - Being disbelieved about pain, experiences - Being blamed for illness

Why It's Traumatic: - Invalidation of reality - Loss of bodily autonomy - Helplessness (can't make them believe) - Betrayal (should be help, is harm) - Repeated trauma with each encounter

Cody's Experience: - CFS dismissed as depression - Suicidal ideation dismissed as "melodrama" - Not believed until nearly died - Lost speech as consequence - Decades of trauma from not being believed

Andy's Experience: - Pain dismissed as "exaggerated" - Symptoms attributed to "just being Black" - Medical racism = repeated gaslighting - Each appointment potential trauma - Never knowing if will be believed

TREATMENT FOR PTSD¶

Trauma-Focused Therapy¶

Trauma-Focused CBT: - Processing traumatic memories - Reducing avoidance - Challenging negative beliefs - Gradual exposure to reminders

EMDR (Eye Movement Desensitization and Reprocessing): - Bilateral stimulation while processing memories - Reduces emotional charge of memories - Highly effective for PTSD - Can be done without talking extensively (good for Cody)

Prolonged Exposure: - Gradually confronting trauma reminders - In safe, controlled way - Reduces fear response - Teaches: can survive remembering

Cognitive Processing Therapy: - Examining trauma-related beliefs - Challenging distortions - Building adaptive beliefs

Medications¶

SSRIs (First Line): - Sertraline (Zoloft) - Paroxetine (Paxil) - Only FDA-approved for PTSD

SNRIs: - Venlafaxine (Effexor)

Others: - Prazosin (nightmares) - Mood stabilizers - Anxiety medications (short-term)

Trauma-Informed Medical Care¶

What It Looks Like: - Asking about trauma history - Explaining procedures beforehand - Giving control when possible - Believing patients - Recognizing avoidance as trauma response - Accommodating triggers - Never restraining unless life-threatening

What Cody Needs: - Communication about procedures (AAC accessible) - Understanding of trauma history - No surprise touch/procedures - Time to process and consent - Presume competence despite nonspeaking

What Andy Needs: - Belief when reports pain - No accusations of drug-seeking - Acknowledging medical racism - Sarah present as advocate - Trauma-informed Black providers if possible

What Michael Needs: - No institutional settings - Choice and autonomy - Understanding of institutional trauma - Time to build trust - Never using authority/force

VICARIOUS/SECONDARY TRAUMA¶

What Is It?¶

Definition: Trauma experienced by those who witness/hear about trauma happening to others. Common in caregivers, family members, professionals.

Who Experiences: - Ellen: Cody's suicide attempt, professional exposure to abuse - Sarah and Marcus: Witnessing Andy's medical racism - Jon: Hypervigilance about Chrissie's safety - Healthcare workers, advocates, family members

Ellen's Vicarious Trauma¶

From Cody: - Finding him after overdose - ICU vigil - Watching him lose speech - Guilt ("I brought him home") - Changed her forever

From Professional Work: - Documenting abuse (Michael's 307 incidents) - Seeing Lizzie's neglect - Hearing residents' stories - Witnessing preventable suffering - Carrying others' trauma

Symptoms: - Hypervigilance about all her children - Difficulty trusting medical system - Exhaustion - Emotional numbing (protection) - Work becoming more personal, less "objective" - Guilt when can't save everyone

Coping: - Moore family support - Greg's practical care - Work giving meaning (transforming trauma) - Eventually: therapy, boundaries - Collaborative work with Cody (meaning-making)

Caregiver PTSD¶

Jon's Experience: - Watching Chrissie seize - Flu incident (seizure while he driving home) - Monitor shrieking, her convulsing - Getting there too late (already with paramedics) - Holding her while she slept, sobbing

Symptoms: - Hypervigilance (cameras, monitors, protocols) - Intrusive images (what if she seizes while cooking?) - Avoidance (difficulty leaving her) - Startle response (any alarm sound) - Nightmares - Guilt (never doing enough)

Not Diagnosed But Real: - Caregivers often don't recognize own PTSD - Minimized ("she's the one suffering") - But trauma is real - Needs treatment too

Logan's Professional Trauma (Treating Evan M.)¶

The Case: During Logan's PGY-1 residency at Johns Hopkins (2030-2031), he treated Evan M., a fifteen-year-old with traumatic brain injury from a car accident. The parallel to Logan's own accident at seventeen was immediate and unavoidable: same catastrophic injury, same desperate questions ("Will I be normal again?"), same fear visible in the patient and his family.

Triggers: - Seeing Evan in the hospital bed = seeing himself at seventeen - Evan's question "Will I be normal again?" = the question Logan had asked - Watching Evan's struggle with acceptance = reliving Logan's own journey - Evan's progress (regaining speech, improving motor function) = hope that felt almost painful in its intensity - Evan's setbacks (seizures, behavioral changes from frontal lobe damage) = triggering Logan's unprocessed trauma

Professional Boundary Challenges: Logan had to navigate an impossible balance: - Providing care that required clinical objectivity - While being triggered by a patient whose experience mirrored his own catastrophic injury - Managing his own emotional response without compromising Evan's care - Recognizing when empathy crossed into projection

The Crisis Point: When Evan's family decided to withdraw from aggressive rehabilitation and focus on quality of life, Logan experienced this as giving up rather than acceptance. He called Julia from his car in the hospital parking lot, voice breaking: "They're stopping his intensive therapies. He could improve more. I know he could."

Julia had to deliver difficult truth: "Baby, you are not treating yourself. You are treating Evan. Your job is to provide him the best possible care based on his goals and his family's values, not to save yourself through him."

What This Taught Logan: - That his fierce determination to see Evan improve was partly about proving that catastrophic injury didn't have to mean permanent limitation—a narrative Logan needed to believe about his own life - That accepting limitation wasn't the same as giving up - That survival could take many forms and all of them deserved respect - That good medicine meant serving patients' actual needs rather than the outcomes he hoped for - That his lived experience as a disabled person would be both gift and burden in his medical career

Long-Term Impact: - Logan developed better professional boundaries around trauma cases - Learned to recognize when his own trauma interfered with patient care - Understood that his job was to meet patients where they were, not where he wished they'd be - Integrated the lesson that excellent patient care sometimes means supporting choices that differ from what the doctor would choose

Symptoms Logan Experienced: - Intrusive thoughts about his own accident triggered by treating Evan - Hypervigilance during Evan's sessions (monitoring for setbacks, catastrophizing) - Emotional dysregulation (hope and despair in rapid cycles) - Difficulty disengaging after clinical hours (researching Evan's prognosis obsessively) - Physical manifestations (pain flares, exhaustion beyond what rotation demands warranted) - Calling Julia repeatedly for support when parallel became too sharp

Not Diagnosed But Real: Logan didn't recognize this as trauma response at the time—he thought it was just the difficulty of being a resident, of caring too much, of being invested in patient outcomes. Julia recognized it for what it was: his unprocessed trauma from his own accident surfacing through treating a patient whose experience mirrored his.

DISSOCIATION¶

What Is Dissociation?¶

Definition: Disconnection from thoughts, feelings, memories, or sense of identity. Brain's protection during overwhelming experiences.

Types:

Depersonalization: - Feeling detached from self - "Watching myself from outside" - Feeling robotic, going through motions - Body feels unreal

Derealization: - World feels unreal, dreamlike - People seem fake or distant - Colors muted, sounds distorted - "Is this really happening?"

Dissociative Amnesia: - Can't remember trauma - Gaps in memory - Brain protecting by forgetting

Dissociative Identity Disorder (DID): - Separate identity states - Result of severe childhood trauma - Not common but real - Not depicted in series

Dissociation in Medical Trauma¶

During Trauma: - Brain disconnecting to survive - Common during procedures - "I wasn't there, I was floating" - Protective mechanism

After Trauma: - Flashbacks with dissociation - Triggered by reminders - Functional impairment - Scary, disorienting

For Cody: - Possibly dissociated during ICU - Flashbacks with derealization - Medical settings trigger dissociation - Feels disconnected from body (already lost speech)

For Michael: - Dissociated during punishment - "Went away in my head" - Survival strategy during institutional abuse - Still happens when triggered

TRAUMA RESPONSES (The 4 Fs)¶

Fight¶

Anger, aggression, confrontation: - Lashing out when triggered - Arguing with medical staff - Anger as protection - Michael: Meltdowns during abuse (fight response punished) - Ellen: Controlled fury at systems (channeled fight)

Flight¶

Avoidance, running away: - Medical avoidance - Leaving situations - Canceling appointments - Escaping triggers - Cody: Avoiding doctors - Andy: Wanting to leave ER

Freeze¶

Shutdown, inability to move/speak: - Immobilized during procedures - Can't advocate for self - Compliance from fear - Dissociation - Can look like "cooperation" but is trauma - Chrissie: Freezing when scared

Fawn¶

People-pleasing, appeasing: - Agreeing to avoid conflict - Not advocating for needs - Trying to be "good patient" - Apologizing excessively - Michael: Initially trying to be "good" (didn't work, punished anyway) - Many disabled people: Fawning to survive medical system

Important: - All are involuntary - Brain's survival responses - Not conscious choices - Not character flaws - Require compassion, not judgment

WRITING TRAUMA IN SCENES¶

Showing Flashbacks¶

What to Show: - Trigger (sight, sound, smell, situation) - Sudden shift in awareness - Past and present blurring - Physical response (heart racing, sweating) - Disconnection from current reality - Others noticing something wrong

Example - Cody in Hospital: - Smell of antiseptic - Beeping monitors - Suddenly back in ICU - Can't breathe, can't speak (already can't) - Vision tunneling - Ava's voice bringing him back

Recovery: - Grounding (5 senses) - Safe person's voice - Slow return to present - Exhaustion after - Embarrassment, shame

Showing Hypervigilance¶

What to Show: - Scanning environment constantly - Startling at sounds - Can't relax - Noticing everything - Preparing for danger

Jon Example: - Checking cameras compulsively - Hearing every sound Chrissie makes - Can't focus on work (mind on her) - Jumping when phone rings - Constant "what if" thinking

Showing Avoidance¶

What to Show: - Canceling appointments - Making excuses - Physical discomfort approaching trigger - Panic when can't avoid - Relief when escapes

Andy Example: - Delaying doctor appointment - "It's not that bad" (pain clearly severe) - Sarah pushing, Andy resisting - Finally going, heart racing whole time - Wanting to leave immediately

Showing Medical Trauma Response¶

During Medical Appointment: - Elevated vital signs (trauma response) - Difficulty communicating (freeze response) - Compliance that looks like consent (fawn) - Dissociation during procedure - Advocate needed (Sarah for Andy, Ava for Cody)

After: - Exhaustion - Needing to process - Nightmares that night - Avoiding next appointment - Cycle continues

RECOVERY AND HEALING¶

What Recovery Looks Like¶

NOT: - "Getting over it" - Forgetting trauma happened - Never being triggered - Going back to who you were before

IS: - Learning to live with trauma - Reducing symptom intensity - Expanding life despite PTSD - Building safety and trust - Finding meaning - Post-traumatic growth possible

Stages of Recovery (Not Linear)¶

1. Safety and Stabilization: - Physical safety (out of danger) - Emotional safety (support system) - Basic functioning (eating, sleeping, working) - Coping skills - Michael: Living with Jon, Chrissie, Lizzie = safety

2. Processing Trauma: - Therapy - Facing memories - Reducing emotional charge - Integration - Cody: EMDR, processing ICU trauma

3. Reconnection: - Rebuilding life - Relationships - Meaning and purpose - Identity beyond trauma - All survivors: Building life after

Post-Traumatic Growth¶

Can Include: - Deeper relationships - Greater appreciation for life - Increased personal strength - New possibilities - Spiritual development

Examples: - Cody: Becoming advocate, helping others - Ellen: Work transformed by Cody's experience - Michael: Love with Lizzie after years alone - Andy: Disability rights advocacy

Important: - Growth doesn't mean trauma was "worth it" - Trauma still harm - Growth is what survivors built DESPITE trauma - Not required to find meaning

WHAT NOT TO DO¶

Avoid These Tropes:¶

❌ "Weak" for having PTSD - PTSD is injury, not weakness - Trauma changes brain - Survival, not failure

❌ Cure through love/relationship - Love helps but doesn't cure - Professional treatment needed - Unfair burden on partner

❌ Instant recovery - PTSD treatment takes time - Healing not linear - Setbacks normal

❌ Violent PTSD stereotype - Most people with PTSD not violent - More danger to self than others - Perpetuates stigma

❌ "Should be over it by now" - No timeline for healing - Complex trauma especially long - Everyone's pace different

❌ Triggering for drama - Don't use triggers lightly - Show respect for trauma - Purpose beyond shock value

❌ Trauma defining character - Person exists beyond trauma - Joy, love, life still present - Not only "trauma survivor"

RESOURCES CONSULTED¶

National Center for PTSD
International Society for Traumatic Stress Studies
Research on medical PTSD
Studies on institutional trauma
Literature on complex PTSD
Trauma-informed care guidelines

WRITING CHECKLIST¶

When writing trauma/PTSD scenes: - [ ] Trauma type clear (acute, chronic, complex) - [ ] Symptoms accurate (intrusion, avoidance, hyperarousal) - [ ] Triggers realistic and consistent - [ ] Trauma responses shown (fight/flight/freeze/fawn) - [ ] Avoidance has consequences (health, relationships) - [ ] Treatment realistic (therapy, meds, time) - [ ] Recovery non-linear (setbacks normal) - [ ] For Cody: Medical PTSD, ICU trauma, loss of speech - [ ] For Andy: Medical racism trauma, ongoing retraumatization - [ ] For Michael: Institutional C-PTSD, 19 years of abuse - [ ] For Ellen: Vicarious trauma, professional exposure - [ ] Avoid "cure through love" trope - [ ] Show both struggle and resilience - [ ] Trauma-informed care when available - [ ] Resources provided when showing crisis

This is a living document. Update as you research further or develop trauma storylines.

Last Updated: October 10, 2025

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