Inciting events
Stuff that seems to set off illness
In fiction writing, an inciting incident “sets the main character on the journey that will occupy them throughout the narrative”—or, otherwise put, it is a “ball of chaos that spins into the story and knocks the protagonist’s life out of balance.”
They say life imitates art, and in my work, I have seen inciting incidents play out in many people’s health stories. With my startup Pictal Health, I’ve helped 80 people create visual timelines of their health history — first by hand, and now with our health history timeline software. (Sign up for updates as we continue our invite-only beta.)
Along the way, I’ve noticed trends in what types of events appear to kick off people’s health problems and “knock their life out of balance.” I’ll call them “inciting events,” for brevity.
Let’s look at the types of inciting events I have seen, and then let us discuss implications.
Disclaimers: what follows is an unscientific review, based on my own observations. In some cases, correlation may not mean causation — just because an event happens at the start of someone’s health journey, doesn’t always mean it is necessarily a ‘cause’ of that health journey. For the visual examples shared below, I have permission to share and/or have removed all identifying info.
Infection or virus
For many of my clients, some kind of infection or virus appeared to kick off their serious health issues. Here are a few I have seen:
- Covid-19
- Mono (and multiple clients have had both psychological and physical symptoms appear after severe Mono)
- Lyme
- Shingles
- Food poisoning
- Tropical diseases, picked up while traveling or working abroad
- Or just an unknown virus (my own autoimmune symptoms started way back in 1988, after being out of school for a week with a virus)
For the below client, Shingles badly worsened existing symptoms and brought on new ones.
For someone with Long Covid, the initial Covid infection was the clear symptom trigger.
Exposures
Working with Veterans through a project with the VA, I frequently saw exposure to fumes or pollution in the history of people who now have memory problems. One had worked as a pilot and was exposed to jet exhaust; the person below was exposed to chemical and fume exposure while working on oil rigs, and later developed memory loss and Parkinson’s-like symptoms.
Another client struggling with chronic fatigue lived for years near a polluting factory.
Others have lived in moldy houses.
And some have been subjected to secondhand cigarette smoke.
Pregnancy or childbirth
“Everything started after my pregnancy.” I’ve heard some version of that statement many times. The person below saw a clear worsening of symptoms after her child was born.
As you can see, she also had a smattering of stressors (in yellow) and infections (in red) in her history. As it turns out, she has just recently gotten a diagnosis of narcolepsy, which has likely been present for decades and had worsened in the stressful time after her child was born.
Here’s another client who saw her symptoms start after the birth of her son:
Women’s health issues are notoriously misunderstood and minimized. But it should not be surprising that the intensive, full-body experience of pregnancy, childbirth and caring for a newborn may result in changes to our health.
Trauma
By “trauma” I mean significant episodes or phases that may result in Post-Traumatic Stress Disorder (PTSD). In our visual timelines, trauma usually takes the form of a life event, and we make it larger to emphasize its importance. See the larger yellow shape below; we’ve called this trauma an ‘Adverse childhood experience.’ This gives the person the ability to disclose that there was a trauma, without having to immediately share what happened.
Trauma has been a factor for many of my clients, whether experienced in childhood, in military combat, or elsewhere in life. PTSD causes psychological symptoms, and it can lead to physical illnesses such as chronic pain, hypertension, obesity, cardiovascular disease, and autoimmune disease. The excellent book The Body Keeps the Score explains the science behind this.
I have seen that PTSD symptoms may take a long time to appear after the inciting traumatic event. The person below wasn’t diagnosed with PTSD until almost 25 years after the original traumatic events. There is a semi-quiet phase of 10 years or so, and then symptoms gradually intensify; diagnoses slowly layer in as blue dots, Emergency Room visits appear in red, and finally the PTSD diagnoses appears.
This paper discusses the physical effects of PTSD and the challenges in understanding and treating delayed-onset PTSD. Seeing the story visually helps us keep the big picture in mind, showing us how events that happened long ago may still affect us today.
Stress
Trauma and stress are often interwoven. Here I’m thinking of everyday stressors that impact health: I’ve often seen job stress (especially a bad boss), the death of a loved one, fights or conflicts, the stress of being a caregiver, etc. We know stress is bad for our health, but it can be hard to remember this and see the effect stress is having on us, especially when we’re in the middle of it. In the below example, a stressful phase in yellow precedes the onset of various symptoms.
Concussions / TBIs
Obviously an accident can be a life-changing event. Concussions and Traumatic Brain Injuries (TBIs) stand out because they come with psychological and physical symptoms, and the more concussions people have, the easier they are to acquire. In the case below, a TBI was followed by decades of cyclical depression.
((( Signals )))
Perhaps not the same as an ‘inciting event,’ there are certain patterns that occur in people who later become more seriously ill.
Allergies / Asthma / Eczema
A naturopath once mentioned to me that they see allergies and asthma frequently in people who later acquire more serious autoimmune conditions. It’s something I have noticed as well, and there is evidence behind this. In the visually ‘quiet’ phase before a serious illness, I’ve often seen scattered references to allergies, asthma or eczema.
(Not to mention, GI issues or Irritable Bowel Syndrome, as seen in the example above.)
Chronic infections
Infection is also thought to have a link to autoimmunity, and many of my clients have years of chronic infections such as sinus, yeast, ear infections, pneumonia or bronchitis that show up as repeating red dots on their timeline.
Chronic infections are often accompanied by chronic antibiotic use, the negative effects of which are becoming more clearly-understood. We represent antibiotic use on people’s timelines as well.
A complex mix of the above
As you have likely noticed, people often have many of these inciting events. They build up over time, creating complex arrays of symptoms and syndromes. The person below experienced stress and trauma, mold and chemical exposures, chronic infections, and a head injury.
For the people I have worked with, this level of complexity is not exceptional. It is the norm. But our healthcare culture makes it difficult to tell complicated stories verbally, in too-short appointments, and it’s practically impossible for clinicians to absorb and make sense of these stories. This is exactly the problem we have set out to solve.
Why is it helpful to identify inciting events?
A skeptic may say, “Does it matter what the inciting event was? Should we avoid dwelling in the past, and instead focus on getting better now?”
While there is certainly value in focusing on healing, I believe there are also benefits to identifying inciting events, and seeing them visually.
- Increased self-understanding. When people can see their whole story, it helps them process and make sense of it. They can see not only what happened, but potentially why. Even if this doesn’t change the outcome, I believe there’s a certain feeling of peace in being able to put the pieces together, and say “of course this is where I am, look at what happened to me.” Many of my clients have said this, almost word for word. As one recently said, seeing her timeline and everything she’s been through helped her “give herself grace.”
- Better-informed treatment decisions. I’m not a clinician, but it seems to me that pinpointing inciting events could be useful when deciding on treatment. Post-infection syndromes, past trauma, environmental exposure — these may each have a specific approach. I’m sure many clinicians are interested in hearing about these root causes, and I have seen that holistically-oriented clinicians already spend lots of time digging for these types of events in their intake.
- Be heard, seen, believed. Seeing the story visually may help patients be truly heard and seen — and it may help avoid medical gaslighting. Mapping everything out helps inciting events jump out visually; it’s often apparent how, after a certain slice of time in someone’s history, everything changed. The types of inciting events I listed above are fairly well-known and considered legitimate, especially now, as Long Covid has shined a spotlight on post-infection syndromes. Yet those with invisible illness continue to be told their symptoms are psychological. I hope that visualizing inciting events can help reduce the epidemic of medical gaslighting.
What if there’s no obvious inciting event?
That’s ok. Often our bodies do things for reasons science doesn’t understand (yet). We should still believe and listen to patients, who can help us discover causes and cures for mysterious illnesses.
What did I miss?
Is there a type of inciting event you think should have been included? Let me know in the comments or drop me a note at hello@pictalhealth.com.
Interested in seeing inciting events in your story?
Learn about Pictal membership and how you can make your own visual health history with the Pictal App.
Let’s hope for a better, more connected and supportive future
Seeing these patterns across stories can be upsetting, but it is also exciting. It helps reinforce that however “weird” or “unusual” our story may seem, we are not alone; many, many others have been through something similar. And as research and clinical practice start to catch up, there’s more hope than ever before for patients with complex histories.
Related, from the Pictal files:
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