Why I don’t agree with trigger warnings

When I was suffering from PTSD, I didn't want to be wrapped in cotton wool.

Twitter is no longer a "safe space". It has become a vehicle for outrage, to the point where many no longer choose to express themselves at all, or do so skittishly through a network of private messages. Following the furores of the last couple of weeks, Suzanne Moore has put a trigger warning on her Twitter bio, a disclaimer as if to say "will cause offence". That, and her joking about the terminology with Julie Bindel, caused yet more disapproval from some corners of the social network. A trigger warning is not something to joke about. Trauma is not something to joke about. Trigger warning: this next tweet contains a flippant remark about trigger warnings.

For those not au fait with the terminology of the small corner of the internet that makes up feminist websites and message boards, a "trigger warning" initially existed to warn survivors of violence and rape, or those suffering from eating disorders, that an article or blog post may contain language that might "trigger" traumatic memories, thus causing flashbacks, panic attacks, or distress. A worthy goal, although also of limited use, as I’ll go on to explain. However, in recent years the phrase seems to have become shorthand for "anything you may not like", and to many has taken on the unpleasant connotation of providing a means for the oversensitive internet language police to vet content – some would argue.

As Moore was. I have PTSD, but I did not find her or Bindel’s jokes particularly upsetting. I would rather inhabit a Twitter where people feel able to have a laugh, thereby taking the risk that it may upset me, than a strangely sanitised social network where people check their "privilege" at the door like a fur coat (no knickers), with no dance floor, no booze and no fun awaiting them- just a vast, pompous expanse of skittish hacks dealing in whispered platitudes. No, thanks, that’s not for me. In the aftermath of the traumatic experience I suffered, I avoided internet feminism completely. Not because of "triggering" content, but because I wanted to go it alone. I did not want their "safe spaces" and their trigger warnings and their "calling out" of sexism. I did not want any of them as an "ally". It seemed, to me, so very American. I’d take the NHS. Good old Nye Bevan and an hour a week in a room with a stranger and a box of tissues. Reliving it all. Over and over, again and again.

Before I continue; a disclaimer. In explaining my choices, I am not condemning those of others. This is important. I have no doubt that internet support groups and feminist websites have helped many women suffering from PTSD, that the ability to share stories and testimonies and to weep has helped many to heal. But, in the aftermath, it is not what I wanted. Trauma is a strange beast. It binds people together, like twine. And especially women. You see it online all the time. The lifelong friendships formed across the ether, the complicity, the shared lingo, and yes: the anger at men. I felt it too, which is partly why I didn’t want their anger. My own was toxic enough.

It is rarely said, but post-traumatic stress disorder can turn you into a horrible person. I found its old name "shell shock", strangely fitting. Not because I had ever seen action – the poems of Wilfred Owen do not count – but because that was how I felt. Like a soft, gelatinous, wobbly little thing surrounded by a hard shell of fury. And instead of seeking out others in the same position, I stayed crouched inside, pink and seething.

I’ll admit something else that will perhaps be unpopular: those message-boards, those websites, smacked to me of victimhood. I didn’t want to be a delicate little flower who could be brought to tears by a paragraph. I already felt a keen sense of injustice, not helped by the terminology: "Camden & Islington Victim Support", "if you have been a victim of crime…" and so I never heeded trigger warnings on the internet. Not once. The contrary: I forced potentially upsetting scenarios down my throat.

Triggers can spring from anywhere. Revisiting a place, or even getting a sense of it. The odd gait of a stranger in the street; a passing resemblance; a certain time of night. For me it was depictions of hanging or strangulation. You never realise how common they are until they become so laden with horror. The frequency that they appear in works of literature (at one point it felt like every novel I read had a hanging in it), in films, in television programmes. Should they have had a trigger warning? Impossible. I had to - must - inhabit the real world. There was only so many times that I could take the long way round, that I could not go out at night. My therapist used the analogy of a factory conveyor belt to describe traumatic memory. There I was, pushing all the boxes off- toppling them one by one, before they could even hope to be processed. I blinkered myself from the reality of events. I ran from them.

All of us, at one point or another, make a choice regarding what we will and will not expose ourselves to. For that reason, while studying Primo Levi and the literature of the Second World War at university, I chose not to google "medical experiments of Dr Josef Mengele". It’s the same reason for which television news broadcasts are often preceded with the words "this contains scenes some viewers may find upsetting" – so that you can make the choice to switch off. Equally, one makes the choice to be outraged. Some viewers may find this offensive. Some. Not all. Most will be unfazed. But not all.

With triggers, one does not make the choice to have a flashback, or a panic attack, or to collapse in tears at work and have your day ruined by a random reference in an internet post. Equally, as Suzanne Moore pointed out, a soldier can have a flashback because of a curtain moving in the breeze. To have text alerting you to the possibility of a trigger is a privilege unknown to most PTSD sufferers. The world is full of triggers. You could, I suppose, try to liken a trigger warning to informing epileptics that there is some strobe lighting coming up. Except it’s not that simple. I remember my grandfather telling me how one man’s seizure had been set off by the light flickering between the trees as he drove. Similarly, that specific depiction of violence on the internet might be your light between the trees, but it isn’t mine.

Of course no one is suggesting that we stop reporting the news. I don’t think, like some, that trigger warnings hinder freedom of speech. But they do display an increasingly nannying approach to language that is being used to shut down discourse and to silence. Often, it is coupled with a sense of passive aggressive glee ("um. You should have put a trigger warning on that"). I do not doubt that they are of enormous service to survivors with specific triggers likely to reoccur on feminist websites, but it has got to a point now where I feel women I have never met are trying to wrap me in cotton wool, and I detest that. PTSD can make you hypersensitive and hyper-aware – not qualities I see as desirable in a writer or an editor whose job is to produce words for the general population. Whether a survivor personally feels ready to stop toppling the boxes is their choice and only their choice. Some never will; the trauma is too profound to ever process. But there are some survivors who are trying to open their boxes, and a trigger warning can serve as an admonition to stay in our shells. I wanted out of mine.

A trigger can be anything - one man’s seizure was set off by the light flickering between the trees as he drove. Photograph: Getty Images

Rhiannon Lucy Cosslett is a writer for the New Statesman and the Guardian. She co-founded The Vagenda blog and is co-author of The Vagenda: A Zero Tolerance Guide to the Media.

Davide Restivo at Wikimedia Commons
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Scientists have finally said it: alcohol causes cancer

Enough of "linked" and "attributable": a new paper concludes that alcohol directly causes seven types of cancer.

I don't blame you if you switch off completely at the words "causes cancer". If you pay attention to certain publications, everything from sunbeds, to fish, to not getting enough sun, can all cause cancer. But this time, it's worth listening.

The journal Addiction has published a paper that makes a simple, yet startling, claim: 

"Evidence can support the judgement that alcohol causes cancer of the oropharynx [part of the throat], larynx, oesophagus, liver, colon, rectum and [female] breast"

So what's especially significant about this? 

First, scientists, unlike journalists, are very wary of the word "causes". It's hard to ever prove that one action directly led to another, rather than that both happened to occur within the same scenario. And yet Jennie Connor, author of the paper and professor in the Preventive and Social Medicine department at the University of Otago, New Zealand, has taken the leap.

Second, alcohol not only causes cancer of one kind – the evidence supports the claim that it causes cancer at seven different sites in our bodies. There was weaker evidence that it may also cause skin, prostate and pancreatic cancer, while the link between mouth cancers and alcohol consumption was the strongest. 

What did we know about alcohol and cancer before?

Many, many studies have "linked" cancer to alcohol, or argued that some cases may be "attributable" to alcohol consumption. 

This paper loooks back over a decade's worth of research into alcohol and cancer, and Connor concludes that all this evidence, taken together, proves that alcohol "increases the incidence of [cancer] in the population".

However, as Connor notes in her paper, "alcohol’s causal role is perceived to be more complex than tobacco's", partly because we still don't know exactly how alcohol causes cancer at these sites. Yet she argues that the evidence alone is enough to prove the cause, even if we don't know exactly how the "biologial mechanisms" work. 

Does this mean that drinking = cancer, then?

No. A causal link doesn't mean one thing always leads to the other. Also, cancer in these seven sites was shown to have what's called a "dose-response" relationship, which means the more you drink, the more you increase your chances of cancer.

On the bright side, scientists have also found that if you stop drinking altogether, you can reduce your chances back down again.

Are moderate drinkers off the hook?

Nope. Rather devastatingly, Connor notes that moderate drinkers bear a "considerable" portion of the cancer risk, and that targeting only heavy drinkers with alcohol risk reduction campaigns would have "limited" impact. 

What does this mean for public health? 

This is the tricky bit. In the paper, Connor points out that, given what we know about lung cancer and tobacco, the general advice is simply not to smoke. Now, a strong link proven over years of research may suggest the same about drinking, an activity society views as a bit risky but generally harmless.

Yet in 2012, it's estimated that alcohol-attributable cancers killed half a million people, which made up 5.8 per cent of cancer deaths worldwide. As we better understand the links between the two, it's possible that this proportion may turn out to be a lot higher. 

As she was doing the research, Connor commented:

"We've grown up with thinking cancer is very mysterious, we don't know what causes it and it's frightening, so to think that something as ordinary as drinking is associated with cancer I think is quite difficult."

What do we do now?

Drink less. The one semi-silver lining in the study is that the quantity of alcohol you consume has a real bearing on your risk of developing these cancers. 

On a wider scale, it looks like we need to recalibrate society's perspective on drinking. Drug campaigners have long pointed out that alcohol, while legal, is one of the most toxic and harmful drugs available  an argument that this study will bolster.

In January, England's chief medical officer Sally Davies introduced some of the strictest guidelines on alcohol consumption in the world, and later shocked a parliamentary hearing by saying that drinking could cause breast cancer.

"I would like people to take their choice knowing the issues," she told the hearing, "And do as I do when I reach for my glass of wine and think... do I want to raise my risk of breast cancer?"

Now, it's beginning to look like she was ahead of the curve. 

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.