Did Daenerys Targaryen have PTSD?

The penultimate episode of Game of Thrones, “The Bells”, featured a neat victory — thrown completely awry when Queen Daenerys incinerated huge swaths of already-surrendered King’s Landing. This led to heartbreaking choices viewers saw in the finale, when those who loved the queen most had to act in the best interests of those she had not already killed.

Many viewers dismissed the episode as a pretty piece of art with lazy-to-no storytelling. GOT’s audience wanted the kind and just woman from the beginning of the series to conquer and rule as peacefully as possible, though she had been committing acts of increasing violence as a means of self-protection and dominance.

No less than the Washington Post crowed, “…3,500 parents may be having second thoughts after last night’s ‘Game of Thrones’”. The reporter was referring to newborns named Khaleesi, her honorific title, or Daenerys.

But the bizarre reaction she had when she should have been celebrating a victory, the cockamamie emotional processing and the tragic use of her once-cute dragon, seem more plausible in light of the repeated traumas doled out to her by Messrs. Benioff and Weiss. Indeed, Daenerys likely had PTSD, and we can learn quite a bit about PTSD with the show as an illustrative example.

PTSD is a disorder occurring in people who have experienced a traumatic life event. The symptoms include anxiety, difficulty sleeping, hypervigilance, nightmares, and avoidance of situations that remind one of the event, as when veterans avoid crowded, noisy malls. Other manifestations include increased irritability and anger, reckless behavior, and emotional detachment. We saw a lot of these within Dany in just one episode. Her shocking execution of Varys may have stemmed from paranoia

The Unburnt also suffered a lot of trauma. Any of these injustices would be likely to trigger PTSD: the decapitation of her best friend; abuse by her brother; the murder of her father and other relatives; being sold to a violent, nomadic horde. She also lived through the death of a spouse, rape, the death of her only human child, the death of her protector, and the death of two dragon “children”.

PTSD and genetics

Genetics were not on Dany’s side. PTSD has been shown to be heritable, meaning that genetic variations passed on from parents to child can make a person more likely to respond to trauma with symptoms of PTSD. What’s more the heritability is two to three times higher for women. So, while the Mad King grew to be an erratic and dangerous leader who may have been suffering due to the loss of his father and friend in a fire, Dany was highly likely to be born with a tendency toward his reactivity and rage, compared to her brother.

Childhood trauma is worse.

Dany’s experience of the murder of her father by a trusted servant, plus being sold at the age of 13 as a bride, increased her odds of having PTSD. When trauma happens at a young age, people are more likely to develop signs and symptoms of PTSD.

A lack of oxytocin could make PTSD patients more reactive.

Jon Snow’s rejection of her consanguineous advances could have heightened Dany’s emotional reactivity, making her act unstable and full of rage. Oxytocin, also known as the “love hormone” is something humans need. Experiences from cuddling to breastfeeding produce oxytocin, a sort of chemical incentive to reach out and touch someone. A small study showed the administration of oxytocin to be helpful in calming down people with PTSD. But the queen was romantically rejected; she was not getting the oxytocin boost she needed.

Acute depression can worsen underlying PTSD.

The queen was clearly in an acute depressive episode when she waged war, which made her more vulnerable to heightened PTSD symptoms and consequences. In the beginning of “The Bells”, the audience learned Khaleesi had not been eating, drinking, or sleeping. These are all symptoms of acute depression. Her best friend was killed in front of her, publicly cementing her ineffectiveness as a diplomat. It was a dual personal and professional blow.

Changes in eating and sleeping are not only symptoms of depression, but the longer they go on, the more they can worsen the depression itself. The brain needs good nutrition and adequate rest to function properly. Soldiers and medical residents, deprived of food and sleep, often report higher levels of depression than other people their age in different jobs. And in that final scene before all was alight, Emilia Clarke’s face contorted with so much unchecked pain, one could see any last hope of reason fleeing her mind.

So, suppose Ms. Targaryen set fire to King’s Landing not because she suddenly turned into a bad person, not because she made a fully deliberate choice, but because her brain in was in the grips of tremendous stress, trauma, isolation (as even the showrunners explained), and fatigue. Reactive. Unpredictable. Vengeful. Going low when they finally went high.

But it is wrong to extrapolate to “PTSD always means violence”, dragon-mediated or otherwise. Some patients experience their PTSD as fear, crying, feeling “out of one’s body”, or agoraphobia. Nor should people with PTSD be ostracized or removed from consideration as romantic partners or friends. Game of Thrones, being a fantasy show in its final season, had to take the specter of a woman gone temporarily amoral and illogical to its logical extreme. A grieving widow might slap her toddler for the first time in her life; the Breaker of Chains transmogrified into the Mad Queen.

But neither woman was beyond repair. Both were deserving of help and support to get back to how they felt before the trauma happened. Because of Dany’s position of power, and addiction to power, though, her loved ones could not take the risk of trying to rehabilitate her. In medieval times, murdering people gone violent in the throes of PTSD must certainly have occurred when authorities or townspeople felt the danger to society was too great.

In modern times, criminal or violent activity that occurs when the perpetrator has PTSD sometimes results in a lighter sentence or acquittal of intentional wrongdoing. The accused often regret what they have done and attest they did not plan to harm people or property. In order to prevent violence and tragedy in the first place, high-risk situations for PTSD should be identified and psychiatric care mobilized. That is why the U.S. Veterans Administration invests so much in PTSD care-so veterans can live productive, harmonious lives in society and not get in trouble with the law.

Patients who have been diagnosed with PTSD can benefit from regular therapy, medication, supportive friends, and even newer technologies like virtual reality. And as for those girls named Daenerys? They can know they were named after an inspiring, alluring, loving, fearsome female character who suffered, but still tried to do some good in the world.

Words @stat @abcnews @economist @latimes Interests: #meded, integrative med, health policy, tech, environment. Internal medicine MD based in LA. Go @stanford

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