PTSD Cognitive Formulation: Harry Potter, The Boy Who Lived

After an intermission of a few months, Psy Fiction is back with another psychological formulation blog post! Sorry for the radio silence… things got a bit hectic in this ol’ pandemic! But some unexpectedly altered Christmas plans and subsequent low-key lockdown annual leave, has allowed time for some blog writing… and naturally the traditional festive Harry Potter movie marathon sparked some inspo…

So this time, we’re heading over to the Wizarding World for a formulation “case study” of the boy who lived, the chosen one… Harry Potter. This famous wizard will illustrate the PTSD Cognitive Formulation… with his response to a very traumatic experience at Hogwarts…


So… which of Harry’s many traumatic experiences are we referring to…?

Re-watching all the movies was a stark reminder that Hogwarts is a death trap, Dumbledore’s management as headmaster is more than questionable, and a visit from the magical equivalent of OFSTED (and child protection services) is long overdue…

And parents still send their kids to this school?! Anyway… I digress… but seriously there was not a shortage of traumatic experiences to chose from which poor old Harry has had to endure in conjunction with his studies. For the purpose of this blog we are going to be focusing on the absolutely horrifying end to the 4th book/movie, the Goblet of Fire. After unexpectedly being transported to an unknown location via the Triwizard Cup which was secretly a port key (an enchanted object which transports whoever touches it to a specific location), Harry is faced with the return of Voldemort, being captured, threatened, physically assaulted, tortured, and witnessing the murder of his school friend, Cedric Diggery…

I’M NOT CRYING, YOU’RE CRYING.

For those of you who are not Potterheads and are just in it for the hard-core psychology biz-ness (who could blame you), or if you simply need your memory refreshing – no problemo! Here’s two short videos of the events which will be the focus of Harry’s PTSD formulation:

Following these events, the story continues in the fifth book/film, The Order of the Phoenix. There were some mixed responses to Harry’s character in this book, with comments on Harry’s changed demeanour, seeming like an ‘angry hormonal adolescent’ who seemed increasingly irritable towards others, often shouting and dismissing his friends. In this blog we want to take a different perspective… could we in fact instead consider Harry’s behaviour as a response to the extremely traumatic events he experienced, rather than just being a moody self-centred teenager…?


What is PTSD?

Someone can experience Post-Traumatic Stress Disorder (PTSD) as a response to being exposed to a traumatic event.

There are two types of traumatic events:

  • Type 1 Trauma: aka ‘Simple’ Trauma – this involves a single-event traumatic event, e.g. a one-off random attack by a death eater at a Quidditch World Cup, or crashing your flying car into the Whomping Willow.
  • Type 2 Trauma: aka ‘Complex’ Trauma – this involves chronic and repeated trauma/abuse, often of an interpersonal nature, which can occur early in a person’s development, e.g. being forced to sleep in a cupboard under the stairs as a young child, or being tortured using the Cruciatus curse.

For this post, we will focus on a formulation for PTSD in response to Type 1/single-event trauma (although Harry has experienced plenty of both types across his life…).

Many people experience trauma and recover without any long-term consequences. There is often a period up to a month after a single-event trauma where an individual experiences an acute stress response. In this time, they may exhibit characteristics of PTSD, which are natural responses to traumatic events, but these often reduce within the month timeframe. If a person’s difficulties persist for longer, they may be be experiencing a post-traumatic stress response which could benefit from treatment.

Characteristics of PTSD, defined by the American Psychiatric Association:

  • Intrusion: Intrusive thoughts such as repeated, involuntary memories, distressing dreams, or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
  • Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
  • Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; reduced interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).
  • Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.

Reference: Above symptom list taken from American Psychiatric Association’s page – What is PTSD?

As already described in the ‘About Psy Fiction‘ page, the purpose of psychological formulation is to go beyond a specific diagnosis or list of symptoms, to develop a more detailed understanding of someone’s difficulties. This is particularly important with PTSD as we know everyone responds to trauma in different ways. Using a formulation allows us to go beyond the list of characteristics above, to identify maintenance cycles for these difficult post-traumatic experiences. This aims to help someone understand their individual experience and trauma response, in turn helping them to make changes and overcome their difficulties.


What is the Cognitive Model for PTSD?

There are a few different psychological models of trauma and PTSD, however for this post we are focusing on learning about Ehlers and Clark’s (2000) cognitive model of PTSD. Below is the model lifted from their paper.

Ehlers and Clark (2000)

For the Hermione Granger’s out there, the above model may be self-explanatory, in which case feel free to head straight down to Harry’s formulation below. For others, you may find at first glance the diagram looks like a complicated route to a hidden room at Hogwarts on the Marauder’s Map… if so, do not fear – we’ll walk through it step by step!

Characteristics of Trauma / Prior Experiences

The first part of this formulation could be separated into two parts: 1) Prior experience – this considers what may have predisposed the person to have a post-traumatic response to this incident, e.g. if they had similar experiences in the past; what were their prior core beliefs about self/world/others. 2) Context/characteristics of trauma – such as whether this was a life threatening event, do they know the perpetrator, did they feel overwhelmed/certain they would die.

Cognitive processing during trauma

Activation of the brain’s fight or flight threat response in a traumatic event can have an impact on how the brain remembers and processes the experience. Dissociation as well as phenomena such as weapon focus can also negatively impact on attention and information processing, e.g. being ‘zoned out’, or focusing on the weapon but not other factors.

Nature of trauma memory

Due to the changes in cognitive processing during a traumatic event, the brain stores trauma memories differently to normal memories. They can be fragmented, as well as some parts be very vivid, with strong sensory memories. This can lead to intrusive memories, flashbacks, and nightmares, which can feel like the traumatic event is happening again in real time, as the the memory has not been stored properly and ‘time stamped’ in our brain. (The ‘filing cabinet’ or ‘linen cupboard’ metaphors can be a helpful way of understanding these)

Appraisals of trauma and its effects

These appraisals are the person’s negative beliefs about what the traumatic experiences (and the effects of these) mean about themselves, others and the world. For example, the event could mean ‘I am weak’, ‘others are dangerous’, or ‘the world is unsafe’. This can be influenced about how others respond afterwards e.g. ‘others do not care’, ‘I deserved it’, ‘It’s my fault’. Appraisals of the effects (‘sequelae’) of the trauma, can include beliefs such as ‘I am going mad’, ‘I am damaged’, ‘I have no future’.

Current threat

The brain’s threat system continues to be activated in the present and on high alert to potential threats (‘hypervigilence’). We can think of the brain’s threat system like an ‘over-sensitive’ fire alarm. When ‘matching triggers’ are experienced, this causes a full fight or flight response. These triggers could be things closely related to the trauma (e.g. seeing the perpetrator), however more often they are safe everyday experiences which have a small resemblance to the trauma e.g. a smell , a specific colour, or a tone of voice. This hypervigilence can cause a constant feeling of fear, irritability, as well frequently trigger flashbacks, making the danger seem real and in the present, despite the person being safe.

Strategies intended to control threat/symptoms

i.e. ‘safety behaviours‘ or ‘coping strategies’, which often have unintended negative consequences. The most common is avoidance, such as avoiding trauma reminders. Individuals can also avoid thinking about the trauma, due to fear of not being able to cope with these memories. For some it may feel safer avoid other people and isolate themselves. People can feel ‘numb’, detached or dissociated from difficult memories or emotions. People can also use other means such as substances to try to numb or cut off from memories or threat response.

Maintenance cycles (arrows)

The arrows in the model demonstrate how the coping strategies such as avoidance, unintentionally maintain the individual’s difficulties and level of current threat. Avoiding memories and triggers, mean that appraisals are not challenged and memory isn’t processed. As the memory continues to be unprocessed, it continues to come back intrusively as flashbacks. This maintains ‘scariness’ of memory, as well as negative assumptions about the world being a scary and unsafe place. Additionally, avoidance means that people have reduced access to things that may help in their recovery, such as social support, which maintains a feeling of isolation. Heightened emotions and irritability can further cause interpersonal difficulties, which adds to feeling alone and that there is something ‘wrong’ with them.


Harry Potter’s PTSD Formulation

So is there evidence that Harry is experiencing characteristics of PTSD? Lets take a look at the initial symptom list…

  • Intrusion: at the start of the Order of the Phoenix which takes place after the traumatic events in the graveyard, there is evidence that Harry is experiencing instrusive flashbacks of the events in the form of nightmares.

“Don’t think about that, Harry told himself sternly for the hundredth time that summer. It was bad enough that he kept revisiting the graveyard in his nightmares, without dwelling on it in his waking moments too.”

J.K. Rowling, Harry Potter and the Order of the Phoenix

  • Avoidance: the book further describes Harry wanting to avoid thinking or talking about what has happened at all costs, due to it being too painful. He also described a feeling of emotional numbness and disconnect from reality, which could be seen as a form of dissociation.

“Harry nodded. A kind of numbness and a sense of complete unreality were upon him, but he did not care; he was even glad of it. He didn’t want to have to think about anything that had happened since he had first touched the Triwizard Cup. He didn’t want to have to examine the memories fresh and sharp as photographs, which kept flashing across his mind. Mad-Eye Moody, inside the trunk. Wormtail, slumped on the ground, cradling his stump of an arm. Voldemort, rising from the steaming cauldron. Cedric … dead … Cedric, asking to be returned to his parents …”

J.K. Rowling, Harry Potter and the Order of the Phoenix

  • Alterations in cognition and mood: there appears to be a lot of shifts in Harry’s thoughts, belief system and mood after this traumatic event. Most notable is Harry seeming to have a more negative view of life, as well as frequent angry outbursts.

“I DON’T CARE!” Harry yelled at them, snatching up a lunascope and throwing it into the fireplace. “I’VE HAD ENOUGH, I’VE SEEN ENOUGH, I WANT OUT, I WANT IT TO END, I DON’T CARE ANYMORE!”

J.K. Rowling, Harry Potter and the Order of the Phoenix

  • Alterations in arousal and reactivity: In addition to Harry’s increased irritability, it also appears he was experiencing heightened arousal, being on high alert and over-reactive to potential threat. An example of this is his response to a noise he hears at the Dursleys’:

“A loud, echoing crack broke the sleepy silence like a gunshot; a cat streaked out from under a parked car and flew out of sight; a shriek, a bellowed oath, and the sound of breaking china came from the Dursleys’ living room, and as though Harry had been waiting for this signal, he jumped to his feet, at the same time pulling from the waistband of his jeans a thin wooden wand as if he were unsheathing a sword.”

J.K. Rowling, Harry Potter and the Order of the Phoenix

So we’ve got evidence of Harry displaying characteristics of PTSD for several months after the traumatic incidents. But we want to really understand what is going on for Harry… why is he suffering with these difficult experiences? What is maintaining these challenging thoughts and emotions? You guessed it… it’s formulation time…


We’ll now apply Ehlers and Clark’s PTSD model to Harry’s experiences at the end of Goblet of Fire…

So this formulation allows us to consider the impact of Harry’s past experiences and the personal connections to this traumatic experience (e.g. his past link with the perpetrator, Voldemort) which helps to understand how this event is much more complex than, for example, a one-off attack from a stranger. It also demonstrates how the way in which other people respond to Harry after the events also has such a huge impact on his ability to process and cope with this experience.

In terms of maintenance cycles, Harry’s avoidance and emotional numbing means he does not have opportunities to process what has happened to him. This means these memories stay vivid and painful, and a strong emotional response is triggered at any reminder of the event. Dumbeldore eloquently describes this vicious cycle of avoidance/emotional numbing in his quote:

Numbing the pain for a while will make it worse when you finally feel it.

J.K. Rowling, Harry Potter and the Order of the Phoenix

This avoidance of the trauma means the memory remains intolerably painful. Harry is therefore constantly in ‘fight or flight’ to be on high alert to potential triggers he needs to avoid, to protect himself from this memory becoming activated. This leads to him being on edge, often feeling irritable or having angry outbursts in response to trauma reminders (e.g. the argument with Seamus in the common room when he questions if Voldemort is actually back).

This further entrenches the belief that the world is unsafe and others are not to be trusted, not allowing these appraisals to be challenged. These interpersonal outbursts can also lead to others distancing themselves from him, causing further feelings of isolation and beliefs that others do not understand. This maintains the constant state of high alertness, in the context of a diminished social support network.


So… does harry have post-traumatic stress forever then?

So there we go… using formulation we can understand why Harry’s acts how he does in Order of the Phoenix, giving a more compassionate understanding of where his irritability and anger may be stemming from… (rather than just being a moody teenager or it being down to questionable acting…)

Although this is a heart-breaking account of a young person striving to manage multiple traumatic experiences… we see that Harry’s nightmares and intrusive traumatic memories, as well as his angry outbursts, do in fact reduce over the films. This is the case even with Harry facing new traumatic experiences on the regular. The tale of Harry Potter therefore also sheds light on factors which can help people overcome traumatic events and subsequent post-traumatic symptoms. The two main things which stood out to me were:

  1. Empowerment: As a response to Harry’s trauma, he felt like he was out of control and helpless as to whether Voldemort would come back and attack again. However, the establishment of ‘Dumbledore’s Army’ enabled Harry and others to act on fears of being helpless, by training in magic which would equip them for future battles. Harry takes a key role in this due to his past experiences, giving him purpose and ownership to changing his and others’ futures. This could be linked to the idea of ‘post-traumatic growth‘ where individuals feel able use their experience of trauma to positively benefit themselves/others. Harry is also encouraged to feel ownership of his emotions and behaviours, trying to shift the narrative from “I can’t control my feelings/memories” to feeling more empowered that he has some control in the choices he makes and how he behaves. This is evident in his conversation with his godfather Sirius Black:

 

2. Connection/Relationships: Despite Harry’s attempts to push others away or outward irritability towards others, his close friends stuck by him with unconditional positive regard, coming back to offer support at all times. Harry also had adults he could turn to for support such as Sirius. Other adults, such as Dumbledore, encouraged Harry to face his difficult memories and talk through his traumatic experience, to break the avoidance cycle, which may have helped Harry to process this experience. The creation of ‘Dumbledore’s Army’ was also a very clear message that people did believe what Harry had been through, which challenged the narrative that he was lying about his traumatic experience.


That’s all folks!

Thanks for reading! I’ll be back with another famous formation soon… but until then I would love for you to stay in touch!

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Which star of the silver screen would you like to see a formulation for in the future?

Let me know in the comments!


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Check out a previous post!

Longitudinal CBT Formulation: The “Mad” Queen

29th June 2020


LOOKING AFTER OURSELVES

The aim of this blog is for informal educational purposes only. However, some of the things discussed may resonate with your own experiences, so please do what you need to keep yourselves safe and well. If you are affected by any of the issues discussed in the blog and feel you need further support, please do seek help and advice from appropriate services, such as your GP or local mental health services. Other reputable mental health support helplines can be found on the NHS website: https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/


Disclaimer: All Harry Potter film images and video rights belong to Warner Bros. Pictures Game of Thrones image rights belong to HBO. Images and reference to the original movies are used in this blog post in the understanding that it falls under ‘fair use’. This is due to the images and reference to the films being used in the context of a commentary/critique of the original material for educational purposes. To my knowledge, the use of images in this post do not deny the owner of income and they are not being used in this context for monetary gain of the user.


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