If You Want a Messy, Perfect Example of PTSD, Watch 'The Handmaid's Tale'

“The Handmaid’s Tale,” a dystopian story based upon the 1985 book by the same name by author Margaret Atwood, depicts a post second civil war totalitarian theocracy where fertile women are relegated into a form of child bearing slavery. In its fourth and final season, the lead character, June Osborne, brilliantly portrayed by actress Elizabeth Moss, finally escapes the confines of Gilead and reunites with her husband and infant daughter in Canada. In the most recent episode, June finds herself struggling to settle into her new life of freedom and exhibits classic characteristics of post traumatic stress disorder (PTSD). In fact, it’s one of the most deliberately concrete depictions of PTSD I’ve ever witnessed and I found myself very moved by how I recognized my own struggles through her experience. 

• What is PTSD?

A word of caution…while I happen to know that many of my female friends including those with significant trauma histories watch the show, it is very triggering. June, the Handmaid’s and all the women in the story endure extremely graphic and violent physical, emotional and sexual abuse including death. If you are easily triggered, I do not recommend watching this show. After six years of trauma therapy, I still often find myself struggling to get through some of the more visually explicit episodes. The strength exhibited by the women, solidarity of their relationships and hope for some kind of justice keep me coming back.

Episode seven of season four is entitled “Home,” and is where the extraordinary depiction of PTSD is most evident. For reference I’d like to include a link to the diagnostic criteria for PTSD as per the DSM-5. While only a licensed mental health practitioner can actually diagnose someone with PTSD, I’m using this criteria simply as a reference tool to indicate the ways in which my own experience is markedly similar to June’s in this episode.

 Under criterion one, she must have endured a stressor including but not limited to death, threats of death, threats of injury (physical and emotional), sexual violence to oneself or others that she was witness to. June experienced all of these, on numerous occasions to varying degrees of severity. The threat of continued violence toward her grants her asylum into Canada at the beginning of the episode. I myself experienced child sexual abuse, emotional abuse, covert incest and neglect starting in early childhood.

 Criterion two includes experiencing intrusive symptoms. June has constant intrusive memories, flashbacks, and physical reactivity. She seems to walk around in a trance, still in freeze mode. While in the grocery store she mistakes women in red Djellabas for Handmaid’s on the other side of the display counter and she is triggered into flashbacks by the design on a water bottle. When I was first diagnosed, certain smells, images, sounds and physical sensations would cause me to freeze, instantly have a panic attack or have flashbacks. These have lessened over time, but certain ones may last forever.

 Criterion C involves avoiding reminders of the trauma. She has to stave off anxiety to spend any amount of time with those who remind her of Gilead, even her close friends. She has trouble with being alone with her husband and in particular with sex. She avoids intimacy until she can do so in an aggressive, seemingly violent way where she is in control. At one point all the women are talking and one of them says “We are all f****ed up about sex.” I can tell you that sex is still something I struggle feeling comfortable with. It’s taken a ton of work to get to the point where I don’t dissociate and get too triggered to engage.

 Negative cognitions and changes in mood are Criterion D. 

Her self loathing at having failed to bring her older daughter with her causes her to apologize constantly. She feels like a failure as a mother, wife and friend and questions why she deserves to have gotten out. The intense shame is overwhelming and something that guides her difficulty interacting with those around her. I’m a master at apologizing for things. Shame is such an undercurrent that I often feel compelled to take responsibility for everything around me just to take some control over my feelings of helplessness. My husband has made it a habit to point out when I say “sorry” just to show me how frequently I do it and how mindlessly it occurs.

 Concurrently, and consistent with Criterion E, June startles easily, is hyper vigilant, has tremendous rage, is impulsive and seems even vindictive. She is intent upon getting justice for the atrocities she and others endured at the hands of those in charge of Gilead. Her reactivity to everyone and everything is overwhelming and she appears easily flooded by feelings, particularly those involving anger. While I struggle with anger, I too can be hyper vigilant, always at the ready to deal with disaster. If catastrophizing was an Olympic sport, I’d win the gold medal with ease.

 Criterion F (Duration), G (Functional Impairment) and H (Excludes cause of symptoms due to prescriptions, substance abuse or illness) are also all positive in both June and myself. While it’s harder to assess duration in June because the show has gone on for years, my trauma goes back to childhood. I’m now 45 years old and I can pinpoint examples of symptoms fitting the various criterion for PTSD back to childhood.

 Additionally June appears to experience persistent Dissociation and the inability to remain present, often seeming to drift off into her own world, as if her soul has somehow fled her body, eyes vacant and distant. I occasionally deal with Dissociation, but not as pervasively. I have also had occasional bouts with Depersonalization but they have been infrequent. When they have happened, however, it’s extremely disconcerting. It’s like I’m not in my body at all, moving through the motions while watching myself do so from above my body. A true “out of body” experience.

 It would be disingenuous to compare the fictional traumas endured by the character of June to those I experienced in real life. Frankly that’s not even the point. It’s not a competition. But her manifestation of the traumas she endured are resonant to my own. Often it’s difficult to express what it feels like to live with the symptoms of PTSD. You can explain it, but those who haven’t experienced it can’t really grasp how debilitating it can be. I feel like just showing this one episode of “The Handmaid’s Tale,” even out of context from the rest of the show, would give people a brilliant physical representation of it. It’s truly beautifully written, powerfully acted and amazingly edited to give substance and texture to the lack of control, terror and speed with which being triggered can lead to flashbacks and other PTSD symptoms.