Between discomfort and trauma

Emily J.M. Knox (ed.). Trigger Warnings: History, Theory, Context; London: Rowman & Littlefield, 2017; 298 pages; hardback £54.95; ISBN 978-1-4422-7371-9 .

by Sarah Chaney

In August 2016, the University of Chicago sent a letter to new students that received a great deal of academic and media interest. In the letter John “Jay” Ellison, Dean of Students, stated that the university was committed to “intellectual freedom”, indicating that other concepts referred to – “safe spaces” and “trigger warnings” among them – were antithetical to this notion. The connection between these concepts, as well as the letter itself, was much debated at the time, and the issues raised appear to be the starting point for many of the essays in this book. Are students’ minds really being coddled, or are there valuable things to be learnt from the use of trigger warnings and the debate surrounding them?

Trigger Warnings: History, Theory, Context does not take a clear-cut and dogmatic approach to the topic (as some others have done, most prominently those who object outright to the idea of trigger warnings like Greg Lukianoff and Jonathan Haidt). Most authors in this volume adopt a carefully critical view of trigger warnings that also seeks to understand and explore their implications and uses. The book focuses on higher education in North America; the location is only to be expected, perhaps, as this is where the bulk of debate has taken place. A few essays do look beyond higher education to the broader context from which trigger warnings emerged, including a rather Whiggish history of trigger warnings based on retrospective diagnosis of Post-Traumatic Stress Disorder (chapter 1) and a more incisive look at the use of trigger warnings in the treatment of eating disorders since the 1970s (chapter 3).

The volume claims to be interdisciplinary, although contributions largely stem from those working in the arts, humanities and social sciences. This is understandable: these fields have probably been the most affected by calls for trigger warnings, as well as being concerned with the practice of critical thinking and debate (which, according to their detractors, trigger warnings stifle). The inclusion of a number of authors with a background in library and information studies raises an interesting angle for historians about the way collections are labelled and configured. As Emily Knox indicates in the introduction, the American Library Association has long been opposed to the rating of texts, a practice which holds political connotations and has tended to be fairly arbitrary, usually based on the attitudes of a small group of people. Despite voicing this opposition, however, Knox goes on to raise the central tenet that runs throughout this book: while trigger warnings can and may be used as a form of censorship, teachers and lecturers also have an obligation to consider the welfare of their students.

These two potentially conflicting ideas are reflected in the division of the book into two parts. Starting with the context and theory around trigger warnings, the second half moves on to specific case studies, designed to try and offer some practical guidance for teachers. While Kari Storla does this excellently in her piece on handling traumatic topics in classroom discussion, other case studies are less satisfying and the first half of the book is ultimately of more interest to the historian, grappling as it does with the controversies raised by trigger warnings and placing them in wider context. Are warnings important for welfare, or damaging to students’ critical thinking? Do they protect or censor? Do they fulfil a genuine need for students or do universities use them to avoid confronting systemic issues around student welfare? Most authors do not resolve these questions – indeed, few come down squarely on one side or the other. This in itself reflects the complexity of the debate. It is, of course, possible in each case cited above for both things to be true, even in the same example.

Take Stephanie Houston Grey’s chapter on the history of warnings around eating disorders. This is one of the most thought-provoking and well-written articles in the book. Grey explores the public health response to eating disorders in the late 1970s, which she argues was one of the first instances in which widespread efforts were made to restrict speech on the grounds of preventing contagion. This “moral panic” resulted in crackdowns on eating-disordered individuals, most prominently online, which stripped basic civil rights from people but was nonetheless unsuccessful in reducing the prevalence of eating disorders. Grey’s thoughtful examination of one specific example that began nearly thirty years before trigger warnings became widespread online is an interesting opportunity for reflection on the emergence of triggers. In the case of eating disorders, labelling images and words as triggering might have begun from concerns about people’s welfare, but ultimately became repressive and silencing of people with eating disorders. Providing “critical thinking tools and skill sets”, Grey suggests, might instead assist people to engage in more productive conversations around eating disorders.

Although the context of public concern about contagion is very different from the modern emphasis on managing individual trauma, there are certain lines of similarity with other pieces in the book. Indeed, an emphasis on critical thinking tools to aid welfare is one of the most practical suggestions that emerges from the volume as a whole. As Storla notes, one of the biggest myths around the use of trigger warnings is the assumption that a blanket warning alone can somehow prevent students from experiencing trauma. Storla’s “trauma-informed pedagogy” instead provides a nuanced framework which incorporates student participation at every turn. Her classes develop their own guidelines, debate the use of warnings at the start of the course and consider the difference between discomfort and trauma. This provides a lesson to students in considering multiple viewpoints (in particular those of the rest of the class). Similarly, in their chapter Kristina Ruiz-Mesa, Julie Matos and Gregory Langner suggest that encouraging students to consider the differing backgrounds of their audiences can be a valuable lesson in public speaking. In both cases, trigger warnings become part of the educational content rather than being in opposition to it.

Trigger warnings can, then, be about opening up conversation as well as closing it down. Several authors, including Jane Gavin-Herbert and Bonnie Washick, suggest that student demands for trigger warnings may not even necessarily be about individual experiences of trauma but based in wider concerns about structural violence and inequality. Taking seriously and discussing these concerns may have more impact than a simplistic warning. Indeed, Storla argues that one of her techniques – the use of “safe words” by which students can bring an end to class discussion without having to give a personal reason for doing so – has never been used by a student in her classroom. However, its existence as part of a set of communal guidelines, she feels, means students are safe and supported and thus able to engage more fully in debates. Paradoxically, having the opportunity to censor discussion might actually promote it.

As a general guide, most of the authors in this volume agree that trigger warnings are an ethical and legal practice that can and should be put in place as part of increasing access to higher education. The people most likely to request trigger warnings are minority groups, who are also at greatest risk of experiencing trauma. The problem, however, comes when these issues are individualised, as neoliberal interpretations of trigger warnings have tended to do. Bonnie Washick’s sympathetic critique of the equal access argument for trigger warnings raises the way in which warnings have led to the expectation that individuals who might be “triggered” are viewed as responsible for managing their own reactions. While trigger warnings might have begun as a form of activism and social protest, they have since been medicalised (through the framework of Post-Traumatic Stress Disorder) and individualised. By taking a critical and contextual approach to trigger warnings, both teachers and students can gain from discussing them.

Trigger Warnings: History, Theory and Context is a valuable contribution to the debate around trigger warnings in higher education today, as well as an interesting exploration into some of the nuances around why and how such a concept has emerged. An edited volume particularly suits the topic, allowing for multiple and varied perspectives. No reader will agree with everything they read here, but then that’s precisely the point. If, collectively, the authors in this book achieve any one thing it is to persuade this reader at least that trigger warnings have the potential to generate more insightful debate and critical thought than they risk preventing.

Sarah Chaney is a Research Fellow at Queen Mary Centre for the History of the Emotions, on the Wellcome Trust funded ‘Living With Feeling’ project. Her current research focuses on the history of compassion in healthcare, from the late nineteenth century to the present day. Her previous research has been in the history of psychiatry, in particular the topic of self-inflicted injury. Her first monograph, Psyche on the Skin: A History of Self-Harm was published by Reaktion in February 2017.

Skin, muscle, bone, brain, fluid

Jennifer Wallis, Investigating the Body in the Victorian Asylum. Doctors, Patients, and Practices, (Cham, Switzerland: Palgrave Macmillan, 2017); xvi, 276 pages; 9 b/w illustrations; hardback £20.00; ISBN, 978-3-319-56713-6.

by Louise Hide

Skin, muscle, bone, brain, fluid – Jennifer Wallis has given each its own chapter in this exemplary mesh of medical, psychiatric and social history that spans work carried out in the latter decades of the nineteenth century in Yorkshire’s West Riding Pauper Lunatic Asylum. The body – usually the dead body – is at the centre of the book, playing an active role in the construction of knowledge and the evolution of practices and technologies in the physical space of the pathology lab, as well as in the emerging disciplines of the mental sciences, neurology and pathology. Wallis explores how, in the desperate quest to uncover aetiologies and treatments for mental disorders, there was a growing conviction that ‘the truth of any disease lay deep within the fabric of the body’ (Kindle: 3822). General paralysis of the insane (GPI) is central to the book. A manifestation of tertiary syphilis and a common cause of death in male asylum patients, it was one of the few conditions that produced identifiable lesions in the brain, raising hopes that the post-mortem examination could yield new discoveries around the organic origins of other mental diseases. Investigating the Body in the Victorian Asylum is, therefore, not only about how the body of the asylum patient was framed by changing socio-medical theories and practices, but about how it was productive of them too.

Whilst reading this lucidly written monograph, it soon becomes clear that West Riding was no asylum back-water. Its superintendent, James Crichton-Browne, was determined to forge a reputation in scientific research and West Riding became the first British asylum to appoint its own pathologist in 1872. Wallis has not only marshalled a vast amount of secondary literature, but made a deep and far-reaching foray into the West Riding archives, analysing some 2,000 case records of patients who died there between 1880 and 1900. Drawing on case books, post-mortem reports, administrative records and photographs, Wallis has created a refreshingly original way of conceptualising the asylum patient. Rather than exploring his – as it usually was in ‘cases’ of general paralysis – role within tangled networks of external social agencies and medical practices, she turns her focus to the inner unchartered terrain of unclaimed corpses. She shows how the autopsy provided different ways of ‘seeing’ as the interior of the body was ‘surfaced’ through a range of new and evolving practices and technologies, such as microscopy and clinical photography.  Processes for preserving human tissue and conducting post-mortem examinations were enhanced, as were methods for observing and testing tissue samples, and for recording findings. None of these practices was without an ethical dimension, such as a patient’s right to privacy and anonymity.

Doctors, perhaps, gleaned most from the living as they examined and observed patients on admission and in the wards; pathologists could venture into the deep tissues of the body, which were out of bounds for as long as a patient remained alive. Yet the two states could not be separated quite so neatly and Wallis turns her attention to the growing tensions between pathologists and asylum doctors as both scrambled to plant their disciplinary stake in the ground, navigating boundaries between the living and the dead body. How, I wondered, were practices mirrored at the London County Council pathology lab, which opened at Claybury in 1893 and also investigated various forms of tertiary syphilis, including GPI and tabes dorsalis, as well as alcoholism and tuberculosis? Wallis does touch on other laboratories, but it would be interesting to know a little more about how they associated with each other.

One of the many strengths of the book is the way in which Wallis makes connections between social and cultural mores and the impact of wider political and medical developments. Germ theory was, of course, highly influential. Wallis touches on the ‘pollution’ metaphor but might have expanded on the trope of the ‘syphilitic’ individual as a vector of moral depravity in the western context – an unexpected swerve of narrative into the belief systems of the Nuer jars slightly. Otherwise, Wallis provides a fascinating investigation of the social framing of the male body with GPI, explaining how atrophied muscle and degenerating organs might be interpreted as an assault on masculinity in a period of high industrialisation. Soft bones could be equated to a loss of virility and femininity; broken bones forced asylums to ask whether they might be due to the actions of brutal attendants, rough methods of restraint, or of physical degeneration in the patient.

Investigating the Body in the Victorian Asylum provides a meticulously researched and thoroughly readable – for all – social history of an important development in the mental sciences in the nineteenth century, centring it around the evolving practices of post-mortem examinations. I particularly like the way in which Wallis writes herself, her research process and her thinking into the book. Her respectful treatment not only of the asylum patients but of the medical and nursing staff who cared for and treated them is threaded through from beginning to end. One might not expect to be gripped by descriptions of ‘fatty muscles’, ‘boggy brains’ and ‘flabby livers’, but Wallis reveals a fascinating story that is full of originality and tells us as much about nineteenth century medical practice as about the patient himself.

Louise Hide is a Wellcome Trust Fellow in Medical Humanities and based in the Department of History, Classics and Archaeology at Birkbeck, University of London. Her research project is titled ‘Cultures of Harm in Residential Institutions for Long-term Adult Care, Britain 1945-1980s’. Her monograph Gender and Class in English Asylums, 1890-1914 was published in 2014.