War journalism can be a hazardous occupation. The current conflict in Iraq has left 33 journalists dead and many more wounded. Measuring danger by mortality is, however, only one way, albeit the most visible, of assessing the toll war takes on reporters, photographers and cameramen. What can follow in danger’s wake is often more difficult to discern and quantify for it lies within the realm of the abstract. Fear, sadness, guilt, nightmares, agitation, are just some of the symptoms of psychological distress that are a consequence of experiencing or witnessing life-threatening events.
It is important to emphasize that the majority of individuals exposed to a traumatic event will not develop any formal psychiatric disorder. However, what distinguishes war journalism from other professions is repeated exposure to danger. And because journalists are not schooled in how to react to violence, as policemen and soldiers are, for example, theoretically they are more likely to be vulnerable to danger’s troubled aftermath.
Journalists’ Response to Danger
Over the past four years I have undertaken a series of studies that have assessed how journalists respond to the dangers inherent in their work. Funded initially by the Freedom Forum and later by news organizations such as CNN and the BBC, I have collected behavioral data on hundreds of journalists who define their careers by work they do in conflict zones. My first observation, which predated any data collected, was surprising. When I did a thorough computer search of all the medical and psychological literature, I failed to find a single article devoted to this subject. In an era that has seen a dramatic increase in research devoted to the psychological effects of trauma, the subject of war and journalism had largely escaped attention. Anthropologists had explored the world of the combat journalist, but the questions they asked were fundamentally different from those I proposed to answer. Before giving the findings from my studies, some basic clinical descriptions are needed. There are a number of well-defined syndromes that can arise as a consequence of exposure to a traumatic event. Posttraumatic stress disorder (PTSD) is the most common. PTSD consists of three symptom clusters—re-experiencing, avoidance and arousal.
Re-experiencing: This refers to unwanted intrusive recollections of the traumatic event that may occur during waking hours as flashbacks or recurrent thoughts and during sleep as nightmares.
Avoidance: Its symptoms reflect a reluctance to return to the scene of the trauma, but may also encompass a numbing of emotions or a damping down of emotional responsiveness to people and events.
Arousal: This refers to the heightened responses of the body’s nervous system that may manifest as a startle response, an expectation of further violence even in situations deemed safe (e.g. after a return to civil society), problems falling asleep, irritability and poor concentration.
PTSD frequently occurs with other conditions such as major depression and substance abuse. Major depression denotes a syndrome of sadness that is accompanied by combinations of other symptoms including sleep and appetite disturbance, loss of enjoyment of life, lack of sex drive, feelings of worthlessness and guilt, poor concentration, low energy, and suicidal thoughts.
In my first study, 140 war journalists were assessed for the presence of these disorders. Results were compared with data obtained from 107 domestic journalists who had never seen combat. Significant differences between the groups were found. This was not surprising, with the war journalists endorsing many more symptoms across all domains. Notable, however, was the high lifetime rates of PTSD and major depression in the war journalists’ group: They were four to five times those found in the general population and more than double those in traumatized policemen. These lifetime rates among these journalists approached those recorded in combat veterans. Alcohol consumption, but not illicit drug use, was also markedly increased in the war journalists. An important observation was that journalists who had PTSD and major depression were not receiving the necessary treatment.
After September 11th
My second study took place after the terrorist attacks of September 11th. Data were collected on a group of 46 journalists working for a New York-based news organization. Of particular interest was the fact that these journalists had never been exposed to war; many of them had deliberately decided not to report from zones of conflict. Then suddenly destruction and mayhem were thrust upon them. Among the 46 journalists I studied, 30 percent of them lost a friend in the attacks, and about 12 percent lost a colleague. In the months after the collapse of the World Trade Center, symptoms of PTSD were common amongst these journalists. And their profile resembled that of the war group I’d collected earlier. However, as time passed their symptoms dissipated; one year later, their scores had returned to baseline. Here it is germane to emphasize that such a pattern of spontaneous symptom resolution is unlikely to be found in war journalists given their ongoing exposure to the conflict.
A third study looked at whether embedded journalists are at greater or lesser risk for developing PTSD and major depression when compared with their unilateral colleagues. Data from the war in Iraq reveal no differences between the groups: Their psychological scores are virtually identical. What is the reason for this? The answer lies in the frequency with which the two groups are exposed to danger. This, too, is virtually identical. Within the first month of the war, journalists in both groups reported an average of three life-threatening incidents, underscoring once again the hazards that accompany this type of work.
Why Journalists Return to Cover War
Given the dangers confronted, the high mortality, and increased risk of developing PTSD and depression, what motivates journalists to return repeatedly to war zones?
The journalists in my study spent, on average, 15 years covering war. Those I interviewed spoke of factors such as the importance of bearing witness, keeping the public informed of important events, having a ringside seat as history unfolded, and personal ambition. Yet there seems to be another pivotal factor that may override all of these. There is evidence that individuals who are attracted to risky and dangerous professions are to a high degree biologically primed for this type of activity. The biochemistry underpinning all human behavior steers particular journalists in this direction. These are individuals who eschew the nine-to-five routine and comfort of a predictable office job for the drama and excitement of the battlefield.
Preliminary data from a recently completed study in my laboratory demonstrate that final year Canadian journalism students who propose following a career in foreign lands not only have a fundamentally different personality profile from their peers who wish to remain at home, but also possess different cognitive attributes. This last point refers to a certain pattern of thinking and approach to problem solving that correlates with well-defined neural networks. To use a computer analogy, the behavior and decision-making processes of journalists who chose a hazardous work environment might be, to a considerable extent, hard-wired. This does not, of course, remove personal choice from the equation. Rather it should be seen as tilting the probability in a certain direction—towards a favoring of novelty, risk and uncertainty, even as it encompasses compassion and the promise of giving voice to the victims of war.
These theories are applicable in varying degrees and permutations to other professions as well. When it comes to making a career choice, those who become journalists are no more susceptible to biological determinants than those who become stockbrokers, librarians and mountaineers. Or psychiatrists, for that matter!
Responding to the Findings
From the moment I first began researching journalists and war I have been at pains to stress that this work was never meant to pathologize a profession. And the data bear this out. For the most part, journalists who spend a decade or two in conflict zones are a resilient group, physically and psychologically. It is, however, inevitable that when faced with intermittent danger of life-threatening magnitude, year in and year out, some will develop psychological problems. PTSD and depression are not uncommon to find in such journalists. Indeed it would be naive to think otherwise.
Now that the problems have been defined and placed in context, responsibility rests with news organizations to decide what should be done about it. PTSD and depression are treatable. If left untended they can cause enormous misery, both to the individual and his or her loved ones. I therefore find it reassuring that the management in some of the big news organizations such as CNN and the BBC are at last waking up to this fact and providing the necessary help to journalists. Good journalism requires healthy journalists, not those who might filter the news through their own emotional problems.
Anthony Feinstein, author of “Dangerous Lives: War and the Men and Women Who Report It,” is a professor in the department of psychiatry at the University of Toronto and a neuropsychiatrist at Sunnybrook and Women’s College Health Sciences Centre in Toronto, Canada.