Anthony Feinstein Wins Ochberg Award

Dart Center: You note that the connection between war reporting and symptoms of trauma is intuitive, but has not been adequately studied. Why haven't researchers paid more attention to the psychological hazards of combat reporting?

Anthony Feinstein: Studying symptoms of psychological distress in war journalists is indeed new. I believe that journalists in this field have, in the past, worked under the misguided assumption that they were somehow immune from psychological distress. This ties in with a macho image that has attached itself to the profession but matters have changed over the past few years and prominent journalists, who have been traumatized by their work, are now speaking out about the psychological risks involved. They are removing a culture of silence that has been in place and it is through the lead of journalists themselves that their profession is now taking a closer, harder look not only at their physical well being but also at their emotional health too.

DC: What led to your own interest in war reporting and trauma?

AF: I have always had an interest in psychological trauma, although it has never been at the forefront of my research endeavors. More recently, I had a patient who is a war journalist and, she was the catalyst for making me undertake research in this area.

DC: Do the psychological stresses differ between different wars or combat situations? Has the Iraq War presented unique pressures for journalists?

AF: Iraq has presented unique stressors because it is such a violent environment. The threat of kidnapping and beheading has meant that many journalists will not travel to Iraq. So there is now a reduced pool of journalists to call upon. This is unprecedented.

DC: How generalizable are your findings?

AF: My findings are applicable to war journalists only.

DC: Do gender or demographic factors seem to affect a combat journalist's resilience to stress and trauma?

AF: I have no data suggesting that demographic or gender variables impact directly on a journalists resilience to psychological distress. Having said that, there is some indirect evidence from my data in relation to women journalists. Historically, women in the general population have always reported higher levels of PTSD and depression than men but in my sample of war journalists, there are no gender differences. This is not to say that women journalists do not develop psychological distress, but when they do, their rates are comparable to their male counterparts. This is an unusual finding and may suggest, indirectly that women who go into this profession are a highly select group who may have a higher threshold when it comes to showing signs of psychological distress.

DC: In other populations, such as military personnel, social support has been shown to be important in determining post-trauma outcomes. Have you seen evidence of this among journalists?

AF: I do believe social support is an important variable when it comes to mitigating the effects of stress. It is not something that I have looked at in great detail in my research, but I am struck by the high percentage of war journalists who are either single or divorced. At the same time, I have to shy away from arriving at definitive conclusions with respect to marriage as a protective variable given that there may be journalists who are currently married but whose marriage is a source of ongoing stress. I have certainly come across this situation clinically. Thus, to better answer this question, further research is required.

DC: You've studied the neuropsychiatry of PTSD. How can this discipline be used to tell us more about the effects of combat reporting on journalists?

AF: There is nothing to suggest that the biological underpinnings of PTSD in journalists differ from that found in other research groups. The basic biochemical variables are surely the same. And so it is fair to extrapolate from what has been learned from other disorders both with respect to therapy and the short and long-term consequences of PTSD.

DC: What's the next step in studying the effects of combat reporting on journalists, and effective responses to journalists suffering from stress or trauma?

AF: The next steps in studying psychological distress amongst war journalists should include the following: defining effective treatment strategies for those traumatized; working with the spouses and partners of war journalists to mitigate the effects of distress on relationships and family life; and finally, I believe it is important for a study to be undertaken demonstrating how trauma may effect the way journalists report the news.

DC: You write that it isn't your intent to "pathologize a profession". Could you elaborate?

AF: When I wrote about being careful not to "pathologize a profession" I was being sensitive to the concerns of journalists and their news bosses. I understand that it is not easy to have a psychiatrist coming into a profession and exploring potential psychopathology. As such, it is important for me to stress over and over again that traumatized journalists are a minority. The great majority of journalists who do war work do not develop PTSD or clinically significant depression. What is however, notable about my findings is that the minority who do become traumatized is not insignificant. If I combine the PTSD and depression data, it would appear as though one in three journalists over the course of long careers in war zones are at risk for some form of psychological distress. It is here that the therapeutic efforts need to be focused.

DC: What are the most important points war reporters or news editors should take from your research?

AF: There are a number of important messages for the profession to take away from my work. First, and to stress what I have stated earlier, this profession is resilient when it comes to dealing with the horrors and dangers of war. At the same time, there is a significant minority who will develop distressing emotional sequelae as a result of their work. This does not in any way diminish these individuals as journalists. It is important for this group to receive the appropriate help. It is my firm conviction that with therapy, the majority of these journalists will recover and get back to doing what they do so effectively. However, without receiving help or should the diagnosis be missed, these journalists suffer in silence. This affects not only their ability to work effectively but also spills over into their relationships and family life. We know that if left untreated, disorders such as PTSD and depression carry a high morbidity. This is likely to apply to journalists as well!

For all these reasons, quick and effective treatment needs to be instituted for those who need it.

DC: You mentioned that we know some important things about morbidity in connection with trauma and stress ...

AF: To have research data in isolation and to not act on it is a huge waste. That's the whole importance behind translational research, so you can translate what you've done in the field or in the laboratory into clinical practice. I think the important thing is to be able to translate the gist of your research findings into good clinical practice. And this, I think, is starting to be done very effectively by the Dart group which has to approach news organizations and say "Here are the facts" and "What can we do about addressing this?" Otherwise, I think, research becomes stagnant and disembodied. It really has to have a clinical correlate. And a correlate is better health care for journalists who are at risk. Because if they don't get it, then I think the potential for many things unraveling is actually very high.

I have to be very careful about, you know, concluding that PTSD is going to affect someone's ability to work as a journalist, the quality of their journalism. But certainly there is good data—and we have it—that if you have got PTSD, or depression, or you're drinking to excess, the quality of your social relationships is terrible. And that doesn't get better spontaneously, it only gets worse. And I think there's a real risk that if the diagnosis of a particular condition is missed, or if important clinical symptoms are missed, the potential for that journalist to get into difficulty with respect to relationships, colleagues, work habits, the use of alcohol—all those factors can be adversely affected by these symptoms. And like all medicine, the longer you delay treatment the more difficult it is to reverse.

DC: Do we know much about what treatment is effective for this particular population [war journalists]? Is it different from the general population?

AF: I don't think there is a literature out there as to effective treatment for journalists. But I think the basic principals that apply to the general population also apply to journalists.

My anecdotal sense is that a little bit of treatment goes a very long way with this group. You have individuals that are highly motivated to do this work, that want to get back to doing it, and I think that's a very powerful predictor of good response. There's no culture of Compensation Neurosis in this group. They're generally smart. They're articulate. I think they can grasp psychological concepts very quickly, which makes them ideal patients in a sense. So I have found that the limited interventions that I've put into place with journalists, which have ranged from a one-off educational session to ongoing support therapy to some CBT work even done over the telephone has been very effective in reducing symptoms and getting people back to feeling better. So I think this is a rewarding group to treat. It would be nice to have empirical data to prove that. That might be quite hard to get. Maybe its not even essential. I think if the journalists themselves are endorsing the treatment that they receive as being effective then that in itself is a very powerful thing.

One of the interesting observations is—and I don't know if this is on the record or not—but from the current Iraq War there are at least two journalists, that I know of, whose deaths were suicide. So the link between major depression and suicide is very strong, and so that's the worst possible outcome of someone whose treatment needs aren't getting met.

Depression is the single biggest factor that promotes suicide, so it's fair to extrapolate that death by suicide is related to depression.

[It's a well-replicated finding that a high percentage of patients with major depression commit suicide. Of all the mental disorders, it's the one with the highest rates of suicide. Some people would dispute the actual number, but the conventional figure is 15 percent. And so if there are significant rates of major depression in journalists, then by extension there has to be a high risk of potential self-harm in this group.]

DC: Can anecdotal evidence be useful? I'm thinking of stories like the Kevin Carter story. [Carter won the 1994 Pulitzer Prize for Feature Photography for a picture of a starving Sudanese girl. He committed suicide at age 33, two months after receiving the award.]

AF: Absolutely. I think you always want to be careful with anecdotal evidence, but I think it can be very powerful. If journalists are giving stories of their close colleagues who are committing suicide, they want us to sit up and listen. But I think, even moving beyond that, just the pure statistics, there has to be an increased risk in this group if their rates of depression are high. There just has to be. You can't divorce the two.

DC: Could you talk more about the difference in the stress caused by the Iraq War?

AF: It's clear that Iraq has become enormously more dangerous for journalists, to the point that the majority of the Western journalists have left. They've gone. In fact, they don't want to go back. And I think it's quite unprecedented that you've got the majority of journalists now saying I do not want to go to Iraq. So number one, it speaks to how dangerous the situation is there because they're all fearful of kidnappings and beheadings. That's the worst scenario. And so the group that has remained behind and is prepared to go I think is an unusual group. They're skewed. They're not the norm in terms of the average war journalist. That also raises all sorts of interesting questions if you want to research them. You really cannot extrapolate from that group to the broader group because, I think, they're a biased group by virtue of the fact that they're in Iraq. You've got to be really careful then, if you take a group of journalists like that and you look at their behavioral responses.

I have found this paradox, which is: enormous stress, severe stress, and yet their emotional difficulties are not as high as they were in the study that I did three years earlier. And that's the paradox. And I think the paradox is just sample selection. What you've done is you've skimmed off this particular group that is quite comfortable going into Iraq, who have a stomach for this intense violence and danger and as a result aren't as emotionally discombobulated by what's occurring. So that is a really interesting paradox.

DC: Could you talk more about the differences between covering wars or natural disasters?

AF: I might be completely wrong, but I think war reporting is fundamentally different from disaster reporting because there is the absence of personal threat. I think personal threat is a very powerful variable in this. As horrible as tsunamis are, and Katrinas, and all the rest, and as devastating as they are to look at, there is largely the absence of personal threat. Journalists [covering disasters] aren’t dying in large numbers; they’re not getting shot at; they’re not getting abducted; they don’t have the threat of all the other horrors that come with the war zone. And I think that that has to make a difference in terms of their emotional response. So I think that while journalists can be very upset by what they witness in a disaster situation, I just wonder if it has the same connotation as being in a war zone, having your close friend killed, or you being kidnapped and threatened with mock execution.

DC: I have not seen studies that look at covering different types of disaster and trauma and the effects on reporters.

AF: Neither have I. It would be very difficult to do I think.

DC: What would be the primary difficulties in doing that type of comparison?

AF: Well, I think you have journalists who have been to everything. The ones who go to Katrina are the ones who’ve gone off to combat. So you’ll have a dilution of the data. You don’t have a disaster specialist and a war specialist who don’t cross over.

You may want to survey 500 experienced journalists and ask them a very simple question: what do you find more difficult: war or disaster?