Understanding Trauma in The Last of Us : A Look at the Effects of Traumatic Events
Disclaimer: The assessment and diagnosis of any mental health disorder should be done by a licensed mental health professional and should be treated with evidence based treatments. This is for information and entertainment purposes only.
Joel Black is a Licensed Clinical Social Worker and Psychotherapist in private practice. He is trained in the assessment and treatment of trauma related disorders.
In my therapy practice, I educate my clients on what effects experiencing trauma can have on the individual. It is important to understand how it alters emotional regulation, the ability to maintain healthy relationships, physical symptoms, sleep, ability to manage intrusive thinking, and, most notably, the role avoidance plays in managing the symptoms. Most people have experiences during their lifetime that are intensely stressful, upsetting, or even dangerous. It is natural to have changes in perception and behaviors after experiencing such events. When these effects persist for a significant period of time after the trauma the individual may require an assessment to determine if they meet the criteria for a mental health disorder such as PTSD.
The Last of Us is a video game series developed by Naughty Dog and published by Sony Computer Entertainment. The series follows the story of Joel and Ellie, two survivors in a post-apocalyptic world infested with a deadly fungal infection. Throughout the series, both characters face various traumatic experiences and are forced to confront their emotions and personal demons.
HBO has adapted the video game into a television series. With its growing popularity, I want to take this opportunity to discuss how traumatic events are experienced and processed by the characters. This show illustrates how the effects of traumatic events change the way the characters interact with their environment. The symptoms cause interference and avoidance that affect their ability to be effective in certain situations. It motivates their behaviors and is present in how they manage their relationships with others.
These are fictional characters and I do not intend to conduct mental health evaluations on them or provide a formal diagnosis. My goal is to point out scenes that qualify as traumatic events (there are plenty), and point out how the writers portray their symptoms and responses to the trauma. I hope that this increases the understanding of trauma and its effects. If you suspect that you or someone you care about has experienced a trauma and are struggling managing the symptoms of this trauma, my encouragement is to schedule an appointment with a mental health professional qualified to assess and deliver evidence based treatments for PTSD or other trauma related disorders.
This is not intended to be an episode recap, summary, critique, or discussion about the plot, storyline, acting or anything like that. I simply will note scenes in the show that illustrate experiencing trauma and its effects. I am proceeding with the assumption that the reader has familiarity with the game or the show. As I warned at the beginning there will be spoilers.
Summary of Common Responses to Trauma – Use this link to read about the common responses to trauma that I’m looking for in the characters. At the end of the article is the American Psychiatric Association (APA) criteria for traumatic events.
S1E1: When You’re Lost in the Darkness
From the beginning – The show introduces the characters of Joel – the father, Sarah – the daughter, and Tommy – Joel’s brother, Sarah’s Uncle. There is no mention of Sarah’s mother. The fact that even when it’s time to flee they do not discuss contacting her or finding her suggest that she is not part of their lives. Without further explanation, what caused this is just speculation. It is very possible that she passed away, which could result in trauma for both Joel and Sarah, depending on the circumstances.
Avoidance is the most common response to trauma. It is very possible that the pain connected with the events that resulted in the mother not being around is so unbearable that the characters suppress it so it doesn’t interfere directly with their attempts to move on with their lives. This is only if the circumstance were traumatic.
Of course, without further details, we just don’t know for sure. It is very much possible that they have all worked through their emotions and have come to peace with whatever happened to Sarah’s mother. Or, maybe she has not had a significant enough role in their lives for them to have formed a strong emotional attachment. Until we know more this is just speculation.
9:55 – The bumper sticker on the truck Tommy is driving says “Desert Storm War Veteran.” Prolonged Exposure Therapy is an evidence based treatment for trauma that was developed within the military for combat veterans struggling with PTSD. For obvious reasons, military veterans are highly vulnerable to developing trauma related mental health disorders. This early in the show there is no indication that this is the case for any of our characters, but it is worth noting.
22:30 – Up until this point into the show there were indicators that something was going wrong, but nothing has been directly explained, and the main characters are unaware of any danger. There are news reports of violent attacks and emergency personnel, with sirens blaring, are present in many scenes. Sarah even mentions this to her neighbor, which is dismissed as people simply not being right with Jesus. Still, this whole time something seems off.
Later on that night Joel has to leave to bail Tommy out of jail because he got into an altercation when he intervened while one person began violently attacking a third person. After Joel leaves Sarah notices the neighbor’s dog at her door, which is unusual, so she goes to check on them. Then Sarah witnesses her neighbors being eaten by granny. Then she is chased by granny, who clearly has something very wrong with her, as evidenced by the moving fungus coming from her mouth (and the fact that she was eating her family, I guess) forcing Joel to kill her with a pipe wrench, which she also witnesses. Joel is frantic and doesn’t have time to explain, but urges Sarah to get in the truck to flee. While fleeing Joel is forced to run over the other neighbors with their truck, as they attack another neighbor.
So this certainly qualifies as exposure to actual and threatened death. The characters experienced for themselves and witnessed it happening to others including people they care about, the neighbors. The confusion, chaos, and the level of gruesomeness of the violence adds to the intensity of the fear and overall distress the characters are feeling. Also, they have no clear understanding of where safety is available or how to pursue it.
During fleeing scenes – The scenes that follow provide more of the same. Death, threatening situations, chaos, uncertainty, repeated ineffectiveness in escaping the situation. The pressure and stress just keeps intensifying.
32:35 – Now we come to the primary trauma that contributes to Joel’s story and his character development. Most of his observed symptoms going forward are the result of his adaptation to what happens here.
The chaos of the previous scenes culminate with the three of them being chased by an increasing number of infected, and then witnessing a passenger aircraft plunge to the earth in a fiery explosion. The force and debris flying from the crash wrecks their vehicle and injures Sarah to where she can no longer walk and needs to be carried by Joel. They also still are not quite certain what is happening or how to be effective in managing or escaping the danger.
Tommy becomes temporarily separated from Sarah and Joel. Joel is doing his best to avoid attacks from the infected while carrying Sarah. He encounters a soldier from the army and attempts to assure him that they are not infected. But the soldier receives a message over his radio that apparently said something along the lines of, “Kill everyone you see, infected or not.” Because then he apologizes to Joel and Sarah and opens fire on them. The initial impression is that Joel was able to toss Sarah, who he was still carrying, fall to the ground and avoid the initial gunfire except for a graze. As the soldier approaches to finish him off, Joel pleads with him to stop, but the soldier just keeps apologizing and advancing on Joel, gun raised.
Just before he shoots Joel, Tommy arrives and kills the soldier with his rifle. Their relief is short lived, though, as they both realize that Sarah was struck by the soldier’s initial gunfire. Joel, frantic, makes attempts to revive Sarah and begs Tommy for assistance. Tommy, observing that the situation is hopeless, is frozen and all he can say is “Joel” in a helpless tone. Joel watches as Sarah reaches out to him with fear and panic in her eyes and is holding her as she takes her last breath.
Yup, definitely Trauma.
39:00 – After Sarah’s death the show fast forwards twenty years to 2023. It shows how people have survived and adapted to the new world. Quarantine zones, or QZ’s were established for safety from the infected. The governing body is a group called FEDRA. They appear to be corrupt, draconian, fascist, and violent. This, predictably, has resulted in a rebellion or resistance group forming called the Fireflies.
Joel, who was a general contractor before the infections, now seems to make a living doing whichever job is available, no matter how unbecoming. A young boy is seen approaching the QZ, but appears to not be infected. In the QZ he is given an examination which includes being scanned with a device that detects infection. It confirms that he is in fact infected, but just hasn’t “turned” yet. The boy is executed by FEDRA, telling him that they are giving him some “medicine.”
Joel’s job today is to burn the bodies of the infected that have been executed. When the young child’s body is delivered for burning Joel’s co-worker could not bring herself to do it and asks Joel to. This suggests that she has some sort of sensitivity that allows her to come to acceptance with her role, adapt, and be effective at burning dead bodies, but she is still vulnerable when it is a child. It is also notable that she turns to Joel for help when the last time we saw him his daughter was dying in his arms.
Adaptations to trauma can be nuanced and complex. Sometimes they may seem confusing. This is avoidance, the most common response to trauma. This suggests that there were factors around this lady’s trauma that allowed her to accept burning dead bodies, unless it was a child. Or, maybe just the thought of a child dying was significantly more distressing than an adult, who knows?
41:20 – Other evidence that FEDRA is a brutal, totalitarian, regime is that there are public lynchings. This is using trauma as a weapon, just like public lynchings do in real life, btw. The hope is that the fear and distress of witnessing the execution and the suffering the victim endures as they struggle for breath will result in avoidance, again, the most common response to trauma. The crimes include sneaking into or out of the QZ’s. FEDRA hopes that they can traumatize the residents into avoiding even thinking about escaping. Who voted for these guys?
42:09 – “The more you shoot people the harder it is to sleep I guess.” Apparently another one of Joel’s hustles is drug dealing. He sells some pills from a factory in Atlanta to a FEDRA soldier. The quote refers to the fact that the factory makes 2 things: bullets and pills, supposedly to help FEDRA soldiers sleep.
Nightmares are one of the common responses to trauma. Traumatic events are so intense and so far out of the realm of normal events, the brain has a difficult time processing it. Ruminations, or repeatedly replaying the event over and over again is the brain’s attempt to make sense of what happened. The problem is, the person is forced to feel that fear and other intense emotions every time the brain brings it back up. And when that happens during sleep, it results in nightmares and difficulty staying asleep. This is one of the reasons drug and alcohol abuse is another common response to trauma. It appears that FEDRA soldiers are so traumatized that there is a need for a factory to produce the amount of Oxy needed for them to deal with it. And it’s not even enough because this soldier has to buy them from Joel.
43:50 – Here we meet Tess, who we find out in a bit is Joel’s wife, girlfriend, partner or whatever. She is in the midst of a traumatizing situation because, well, why wouldn’t she be. She was scammed by a group of guys while trying to buy a truck battery from them. The leader now has Tess captive. His underlings seemed to have roughed her up more than he planned, and now his worry is that Joel is going to retaliate (he wasn’t worried about that when he decided to steal from them?).
Tess, however, seems ready to move on and forget about it. Her attitude is like, “Hey, you got me” and she just wants them to let her go so she can move on with her life, or so she says. We find out later that she very much intends on teaching them a lesson. Their discussion is interrupted when a Firefly bomb detonates right outside the room they are in, killing one of the assailants and sending the leader to flee. So Tess has been assaulted, threatened, and witnessed death. And on top of that, while trying to get away she is mistaken for a Firefly and arrested.
46:58 – Now we meet Ellie, the other main character besides Joel. Long story short, something’s up with her where she can get bitten but not turn. When we meet her it appears she is being held prisoner by the Fireflies and they are running tests on her to confirm that she is in fact a miracle child with an immunity to the fungus.
Later she meets the leader of the local Firefly group, Marlene. In the conversation between the two we learn that Ellie grew up in a FEDRA military school, but escaped and that’s how the Fireflies found her. We also learn that Ellie is an orphan and Marlene is the one who originally sent her to FEDRA school to keep her safe. Yup, a military school run by an evil dictatorship counts as a “safe space” in this world.
So being held prisoner is something many of us would most likely find traumatizing. Ellie shows some of the symptoms listed in the common responses to trauma. She recoils in fear when Marlene reaches to unlock her cuffs, showing an exaggerated startle response. She is also showing a high level of anger and irritability. I guess that could just be her personality. Or maybe being shackled and held captive is legitimately irritating.
49:11 – Come to find out all this stress and strain over getting a car battery was because Joel and Tess plan to go meet up with Tommy. We learn that he is somewhere in Wyoming and Joel has been able to keep communication with him through CB radio up until now. But it’s been 3 weeks since he’s heard from him. So this motivates Joel to speed up his efforts to get going. He gathers his hidden supplies and maps out how he will get there.
That night, as he’s falling asleep, there’s audio playing from the night 20 years ago when Sarah was killed, suggesting that night still haunts his sleep, a common response to trauma we discussed earlier. To qualify for PTSD symptoms need to persist for more than a month after the trauma. Twenty years is more than a month.
1:12:14 – So Joel and Tess work to find out where Robert, the leader of the gang who robbed them will be. When they catch up to him, well, he’s dead. He tried the same move he tried on them with the Fireflies. It didn’t go well. Him and the rest of his gang were gunned down. Marlene is shot in the exchange and in bad need of medical attention. Also, her partner is missing an ear. The icing on the cake is that the battery all this mess was over never worked in the first place. Autozone doesn’t seem so bad anymore, does it? Oh, and it turns out Marlene and the Fireflies know Joel and Tess.
So now both sides are stuck. The Fireflies needed the battery to smuggle Ellie to a medical facility with doctors that supposedly can create a cure from her blood or something. So they promise Joel and Tess that if they deliver Ellie they will be given a reliable vehicle to reach Tommy. Joel doesn’t like the idea of smuggling people, but they don’t have many other options.
Joel and Ellie go back to his place to wait for night time when they can sneak out. When he wakes up from a nap Ellie tells him that he mumbles in his sleep. So it seems that Joel cannot go to sleep at all without dreaming of that night. No wonder he’s so grumpy all the time.
1:18:09 – Joel, Ellie, and Tess finally get going and sneak out behind the wall. They barely get anywhere before the soldier from before who was buying the pills catches them. Ellie, knowing she will be detected as infected, attacks him. The soldier pointing the gun at Ellie to kill her sparks a flashback to when Sarah was killed. Joel attacks and kills the soldier.
So… I don’t think there can be a more clear example of re-experiencing than this. It’s almost a 1:1 recreation of what happened, except Ellie isn’t really his daughter, of course. There is also increased arousal, but they were already doing something dangerous anyway. But clearly anger was present, I mean, he beat the guy to death with his bare hands. Even Ellie looked shocked at how intense Joel got in that moment.
Reference
APA Definition of Trauma (https://www.apa.org/topics/trauma) – Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.
Specific criteria:
- Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
(American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders)
Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences – Therapist Guide, Edition 2 (Edna Foa · Elizabeth A. Hembree · Barbara Olasov Rothbaum · Sheila Rauch) Aug 2019 · Oxford University Press . I encourage reading the excerpt, here is a link to it: Common Responses to Trauma