State of Mind

“Dark Humor Is One of the Superpowers You Get With PTSD”

A conversation with Virginia Eubanks about her remarkable New York Times Magazine essay.

Railroad tracks head off into the distance against a light blue background.
Photo illustration by Slate. Photo by Getty Images Plus.

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In October 2015, Virginia Eubanks’ long-time partner, Jason, suffered a violent attack near their home in upstate New York. It took more than six hours of plastic surgery to rebuild his face and skull. A couple of months later, while his jaw was still wired shut, he suffered a second attack of verbal abuse on the street, including threats to kill him.

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Not all traumatic events result in PTSD, but Jason’s did—both for himself and, eventually, Eubanks. In addition to working as a writer and a political scientist, she was now responsible for navigating Jason’s illness as well as a health care and billing system that was at times a “hellish labyrinth.”  She described the attacks and their aftermath in an essay for the New York Times Magazine that ran this summer titled “His PTSD, and My Struggle to Live With It.” The essay spills over with love for Jason, from their early flirtations, to Eubanks blending him a Butterfinger smoothie while he recovered from surgery over Halloween.

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But it also doesn’t pull punches about how hard their life together became. Of a trip they took together in an Amtrak sleeper car—an attempt to rekindle a sense of adventure—she writes that they ended up simply trapped in a tiny space: “I seethed and withdrew, thinking how much fun I would be having if I were alone.”

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Eubanks joined me on a recent episode of The Waves, Slate’s podcast about gender and feminism, to talk about what people tend to get wrong about PTSD—and why women are more likely to suffer from the condition than men. Our conversation has been condensed and edited for clarity. You can listen to the full interview here.

Shannon Palus: How did you go about explaining what had happened to Jason to other people in your life—especially that this was not just a single point in time, but actually this ongoing thing that you live with now?

Virginia Eubanks: I was recently talking to this dear friend of ours who we hadn’t seen in a long time and he said, “You’ve actually done this great service to all of your friends because so many of us are out of touch, and the essay sort of explained what’s been happening since we last talked to you.”

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I told him, “Yeah, it’s like the most bummer Christmas card I’ve ever written.” It was kind of a dark joke, but dark humor is one of the superpowers you get with PTSD.

People often throw words like trauma, PTSD, and triggered around in casual conversation. But when it comes to talking about what those things really mean, when people are really suffering from an ongoing response to a terrible event—it’s hard!

One of the really interesting things about PTSD is that we both use the language of PTSD a lot and we also don’t really understand what it is. We both underestimate the prevalence of the kind of existential harm or trauma, the kinds of things that Jason experienced, and we overuse or misuse the language of PTSD. When people sort of flippantly say like, “Oh, this library book was late and it triggered me,” for example, it’s kind of the way that we can misuse the language of PTSD.

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I feel like both of those responses are different manifestations of denial. One of them is dismissal: “Just buck up, it can’t be that bad,” that kind of underestimation. The other side of that is false equivalence, which is saying like, “Oh, you have clinical depression? Everyone gets sad.” We get a lot of false equivalence around PTSD, too. You don’t need the absolute worst thing in the history of ever to happen to you in order to get PTSD. You don’t have to earn the diagnosis. If someone tells me they have PTSD, I believe them. Nobody wants PTSD, so if you tell me you have it, I’m going to believe you.

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But at the same time, we don’t want to say that all traumas are the same or that all trauma leads to symptoms of post-traumatic stress or to PTSD because it’s just simply untrue. Traumatic exposure and PTSD are different, separate things. Something like 80 plus percent of Americans will deal with a serious trauma at some point in their lives, but only 4 percent of men and 10 percent of women in the U.S. will develop PTSD.

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Why is the prevalence of PTSD so much higher in women than men?

There’s not a definitive answer to that in the research, but there are some really super persuasive theories. I get a lot of my understanding from three books. David Morris’ really fantastic memoir called The Evil Hours, Shaili Jain’s The Unspeakable Mind—she’s an MD—and a really early book by Judith Herman from the 1990s called Trauma and Recovery. I’ve cobbled together my understanding of the difference between men’s rates of PTSD and women’s from those three sources.

My understanding of the theory right now is that there’s three things that impact the likelihood of developing PTSD after a traumatic exposure. The first is prevalence—how often trauma happens. There are a lot more people, and mostly women, who experience sexual assault than there are people who experience being in combat service. In some ways it’s just kind of a numbers game, women experience more traumatic exposure than men do.

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But the nature of the trauma, what Morris calls the “trauma dose,” ends up really mattering as well, so the type and the intensity of trauma matters. For example, if you live through an earthquake and your bookcase in your living room falls on you, you’re injured and trapped under the bookcase for two days before anyone finds you, that’s a really serious trauma.
There’s a pretty good likelihood that you might develop PTSD without quick treatment and care.

Then the third thing that they think is related to whether you’re going to develop PTSD from a traumatic exposure is the response to the trauma. This comes from Herman who wrote all the way back in the early ’90sthat in order to resolve trauma, you have to restore human connection, so you need to be able to share your experience, and your experience needs to be acknowledged, and the community have to take some kind of action on it.

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This isn’t what happens for most people who try to share experiences with sexual trauma. The response there is often to belittle, to excuse, to dismiss, to blame the victim. The theory is that women have one, larger numbers of traumatic exposures; two, higher trauma dosage per exposure; and three, less recognition of the experience after it happens. So that there’s something like two and a half times more likely to develop PTSD after a traumatic exposure than men.

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You got a lot of unsolicited advice in response to the essay. What are some of the tips that people gave you?

There was a lot of unsolicited advice in two categories. One was medical advice, the other was relationship advice. Lots of people who live with chronic illness or other disabilities have written a lot about why you might want to reconsider giving people unsolicited medical advice—there’s some great stuff, for example, on the website the Mighty on this topic. But just speaking from my own experience, I found unsolicited medical advice frustrating at best and at worst, really quite patronizing.

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This is true even for folks who have had experience with PTSD themselves and have found something that they feel really evangelical about, that really worked for them. If you found the perfect treatment and your PTSD greatly improved or even vanished immediately, amazing, I’m so, so happy for you, but that’s not what most people experience. Most of us, at best, find some glued-together combination of therapies. For Jason, it was sensory motor and EMDR and talk therapy. For me, it was cognitive behavioral therapy and massage and hiking. We just put our heads down and we just grind through the years of healing because a lot of it is about patience and time.

I got a lot of relationship advice and most of it was people giving me permission to leave the relationship. I found this also fairly dismissive and a little patronizing. What’s interesting, I think, is a lot of it was framed as a kind of professional middle-class white “go get yours” feminism. “Don’t take care of that man. Go out and write your next book or whatever,” which doesn’t acknowledge that I was writing my next book while I was caring for Jason. I just don’t think that there’s anything emancipatory about rejecting the opportunity to care for people you love. To me, rejecting care is not feminism.

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I do think it’s feminist analysis to recognize that poor and working-class women, particularly migrants, particularly women of color, bear an unequal responsibility for care and that we’re neither respected nor remunerated sufficiently for the vast social and economic wealth that we create by doing that labor. One of the key feminist challenges of our age, particularly in the pandemic, is really grappling with the care infrastructure that supports everything else in our society. Whether it’s professional paid care or unpaid family, care workers deserve institutions that support them. They deserve resources for a providing adequate care to the folks that they love or their clients. You know what? We deserve money, too. Nothing happens without care. There’s no work without care. There’s no community without care. There’s no culture without care. We really do genuinely have to grapple with that.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

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