From shock to awwww

"PTSD" softened the blow of "shell shock." Words should tell the story, not protect the listener.

As I went deep into this phenomenon in the first year, I started to look for a better word than “canceled,” something that better described what these people went through and where their lives are, however many years later. “Canceled” seemed too online, overused, too close to “cancel culture,” a term I despised even then because it hides both the traumatic elements and the consequences for the targeted individuals. I wanted something that sounded more official and serious, a word or phrase that would make people purse their lips with knowing concern and say “Yes, this is a serious problem.”

George Carlin exposed my mistake.

“American English is loaded with euphemism, because Americans have a lot of trouble dealing with reality. Americans have trouble facing the truth. So they invent a kind of soft language to protect themselves from it.”

He talks about a well-known condition among soldiers, “when a fighting person’s nervous system has been stressed to its absolute peak and maximum. The nervous system has either snapped or is about to snap.”

“In the first world war, that condition was called ‘shell shock.’ Simple, honest, direct language. Two syllables. Shell shock. Almost sounds like the guns itself.”

In World War II, he tells us, it was battle fatigue. “Four syllables. Takes a little longer to say, doesn’t seem to hurt as much. Fatigue is a nicer word than ‘shock.’”

Korea: “The very same combat condition was called ‘operational exhaustion.’ We’re up to eight syllables now and the humanity has been squeezed completely out of the phrase. It’s totally sterile now—it sounds like something that might happen to your car!”

Finally, a term that has held on for 50 years. “Thanks to the lies and deceit surrounding [Vietnam], I guess it’s no surprise that the very same condition was called post-traumatic stress disorder,” Carlin says, making each word as ponderous as possible. “Still eight syllables—but we added a hyphen! And the pain is completely buried under jargon.”

Finishing with a twist of the knife, he says “I betcha if we had still been calling it ‘shell shock,’ some of those veterans would have gotten the help they needed at the time.”

Canceled.

Two syllables. Like a judge’s gavel, the first syllable hits hard and crisp. The second hangs briefly in the air before shutting the door. When we hear it, we can see it stamped in red, bold, capitalized letters diagonally over an event poster. You may have seen the poster so many times that it’s faded into the background, but now there’s no overlooking it. It grabs your attention anew—not because of the headline act, but because it was canceled.

The articles that cancel people work the same way.

Maybe it’s a section of the news you don’t normally read, or an industry or organization you don’t care about, and it’s a person you’ve never heard of. But you know that those words alongside that name and maybe a photo put you on notice: this person is now canceled. The articles don’t use that word and nothing is in red, bold, all caps. But the meaning is unequivocal, and because our evolutionary psychology is easily hacked and hijacked, every reader knows what to do.

Many canceled people have all the symptoms of post-traumatic stress disorder, but they don’t have the official diagnosis. Under the DSM-V, being canceled is not one of the approved causes of PTSD (what would Carlin say about further diminishing the experience by reducing the words to an acronym?).

PTSD works as a diagnosis, but it fails as a description. My partner once met a well-known combat veteran. The first thing she said about him when she got home was, “He’s tense as a piano wire.”

I wrote recently about how we need a culture of the presumption of innocence, akin to a culture of the First Amendment, and that we cannot rely on the law to protect those values for us in the last resort. PTSD vs. shell shock is similar. Psychiatrists and mental health practitioners can use PTSD as a diagnosis, billing code, and starting point for their treatment. But in our culture and society, we need to think in terms of shell shock and canceled.

“At what point are we going to know how to treat this?” Michael Capiraso recently asked.

Three years after being canceled, Capiraso “had such severe depression for so long that we couldn’t even peel back to the PTSD. I didn’t want to be on the earth. No job, identity ruined, depressed, physical health and mental health just deteriorating. The depression was so severe that we couldn’t get at the initial hit job that caused it all because the collateral damage was happening every day in real time.”

Anti-depressants, cognitive behavioral therapy, exposure therapy, neurofeedback, and other traditional modalities delivered spurts of partial relief, but nothing sustained—and certainly nothing approaching a way out.

Looking back at the parade of SSRIs he was on, he says, “You’re only supposed to be on these for two years, not for your life. But no one goes by that.” The pharmaceutical industry is notorious for providing relief, not cures, for treating symptoms and not causes. The upshot for the industry is that few prescriptions come with an exit strategy. But people with severe depression and PTSD often are contemplating a different kind of exit strategy.

When I first contacted Capiraso in 2023, he was around to receive my email because about two months earlier he had decided that however he got himself out of the abyss, he would take the “alive” option to do it. And he was barely willing to speak with me because he had recently completed a course of ketamine-assisted therapy.

Ketamine “lifted the lid just enough to let something else in,” he says. He regularly borrows a metaphor from the psychiatrist who oversaw the ketamine treatment: “It’s like you’re skiing and there’s only one rut in the snow. You’re stuck in there and you can only go where it’s going to take you. The ketamine is like fresh powder: you can see in every direction, you can decide to go in any direction, and then you can go that way.”

The ketamine treatment loosened up the depression enough for his practitioners to finally approach the root cause of the depression and the PTSD: the cancelation. His psychologist recalls: “Michael did not ever fully benefit from [psychiatric] medication alone until he started the ketamine. But then, as his mood started to lift somewhat, you could get in there a little bit and start thinking about the world in different ways.”

Sometimes you don’t fully appreciate how hard a problem is until you try to solve it, or you hear about the lengths that someone at the top of their field took to solve it.

The consequences of being canceled, the day-to-day experience and the symptoms that clinicians log in their notes can give you the scale and scope. But they don’t convey a sense of the hardness. Think of it this way: if you’re drilling a well, are you shoveling through sand and dirt, or do you need a motorized diamond drill bit to cut through granite? Capiraso’s mental health after being canceled was the latter. Three years of every conventional treatment produced a barely tolerable steady state and the occasional blip of light.

Run out of town

It took ketamine just to get him to where he “was not willing to settle” for how things had been for the last three years. From there, he could explore the boundaries of medicine and healing to find an actual answer. Another year later, four years post-cancelation, he could start a counter-offensive to reclaim his identity and his future.

He sometimes wonders how things might have been different if someone had recommended ketamine to him a year earlier. How much would he and his family have been spared? How much good could he have done in that year?

He is full of appreciation and respect for the practitioners that did their best to help him—and did help him—through those years. But the limitations that run through our medical system as a whole are even more constraining when it comes to mental health. And when professionals and laypeople don’t even know what they are dealing with, that the person in front of them has been canceled and everything is downstream of that, treatment barely gets off the ground.

Capiraso was very close to not being there to answer my email. Many canceled people I’ve spoken to came just as close. And I know the stories of a few canceled people with whom I will not be talking. Delays in recognition, understanding, and treatment weigh heavily.

No mess, no fuss, no muss

Seventy years passed between troops coming home with shell shock and Carlin mocking society’s retreat behind post-traumatic stress disorder.

Everything is faster in the digital era. Twenty years into cancelation, and a wall of cancel culture think-pieces protects most people from having to think much or at all about actual canceled people.

Cancelation is the contemporary version of public humiliation and banishment. Maybe we were able to fast-track our way into soft unknowing because being canceled doesn’t leave an obvious physical mark or disfigurement.

Canceled people don’t have a letter branded somewhere on their body, although many feel like they do every time they go out in public. Nor does one’s banishment from their social and professional circles start with them cutting off part of their finger. The people in the digital town square don’t throw physical stones, light physical pyres, nor line the street leading out of town into a wilderness, where everyone knows that a solitary individual has little chance of survival.

Cancelations are much gentler on the mob: minimal barriers to entry, no messy violence, no icky manifestations and reminders of what they did. Worst case scenario: a passing mention in someone’s abstract musing about cancel culture. If you see a canceled person out in public a few years later, that’s just proof that it wasn’t all that bad.

“I don’t like words that hide the truth. I don’t like words that conceal reality,” Carlin said.

If “canceled” had the meaning it deserves, if we hadn’t allowed ourselves to be tranquilized by the extra lilting syllables of “cancel culture,” if “canceled” could punch the listener right in the attention span the way “shell shock” did, I betcha some canceled people would have gotten the help they needed at the time—and some would still be alive today.

Photo credit: Eric Huybrechts via Flickr, under CC BY-ND 2.0.