Trauma Discussion Proves Helpful

More than 60 journalists, educators and therapists met at the Guardian Newspaper's media centre in London on the eve of the Iraq war to hear just how important it now is to attend not only to the physical safety needs of journalists and media workers covering conflict, but also to their emotional well-being.

With nearly a dozen journalists dead in the first three weeks of the military campaign, and with many more witnessing serious violence and bloodshed, it was a message whose timing could not have been more relevant.

Jack Laurence, veteran CBS reporter from the Vietnam war and author of a powerful book about war journalism, appealed with passion for provision to be made after this war for journalists to talk to each other.

"In the absence of some kind of group work," said Laurence, "you're going to get what happened to so many of my colleagues from Vietnam: suicides; life long depression; broken marriages; attempted self-destructive behaviour; and in a very high proportion.

"It's all very anecdotal for me but so many of my friends are dead today from having covered too many wars. That is: taking risks again and again and again because whatever you want to call it, their values, their self-worth etc, have been so destroyed by the effects of the trauma they didn't care any more."

Stephen Jukes, chief news editor for Reuters, spoke of how the death of the news agency's most senior war reporter Kurt Schork in Sierra Leone in 2000 had been a turning point in understanding the needs of reporters in war zones.

"Seven or eight years ago," said Jukes, "there was a great reluctance to get into Hostile Environment training. But, after a while, people realised it saves lives. And, I suspect in a few years time, the same will be said of trauma training."

Britain's renowned military commander and later campaigner for humanitarian aid during the Bosnian civil war, Colonel Bob Stewart, spoke of the importance - well understood by the British army - of mutual support.

"Fundamentally," said Stewart, "it seems to me [that] the way people can actually help is by knowing, trusting and caring about one another in small teams. Yet journalism seems to think — because of the nature of journalism — that it can't be done; and I just wonder whether that could be one of the solutions to trying to help people who are subject to stress?"

Director of Dart Centre Europe Mark Brayne told how the BBC was focusing on precisely that kind of mutual support in its new trauma training programme — drawing on the experience of Britain's Royal Marines in seeking to de-stigmatise the experience of emotional distress.

It wasn't, said Brayne, about predicting that journalists would be traumatised. It was rather a question of saying 'Hey, we work in a profession that deals with trauma, it's core to our job; 75 percent or so of everything we report has got trauma in it somewhere. Either it's the preparation for trauma. It's the experience of trauma. It's the aftermath of trauma. Let's de-stigmatise it. Let's bring it into the mainstream'.

Dart Center Executive Committee Chair Dr Frank Ochberg told the gathering how some 15% of Vietnam war veterans went on to experience Post-Traumatic Stress Disorder, but how that figure could rise to 50% for those who'd experienced front-line combat.

It's a figure with particular relevance for journalists "embedded" as the jargon goes with coalition troops fighting in the Iraq war. Britain's respected psychiatrist and specialist in the psychological impact of the last Gulf War, Prof. Simon Wessely, has drawn attention to how closely these reporters will have identified with their units and how they will need to be especially aware after the war of the impact of losing those relationships and also processing what they have experienced.

Speaking at the Guardian event, CNN's Jim Bolden spoke of how journalists no longer had the luxury of saying 'I'm a business news journalist, or I'm a general news journalist, I only do this'.

"Last year I was sent to cover the Bradford riots," said Bolden. "The team consisted of a business reporter, a business producer, a business cameraman and a business editor. None of us had any hostile environment training, and none of us had ever been in anything like that before. It was an eye-opener to us, and an eye-opener to our desk.

"Those of us who are writing journalists may be using a camera; cameras have become a target. And, we can find ourselves in the field on our own. We won't have three people watching our back — that is something very new for us as well."

Since that Guardian discussion, the death and turmoil in the reality of the Iraq war has further emphasised just how important it is for news organisations to have emotional as well as physical safety support in place for their teams.

A Transcript of the Guardian Discussion

Mark Brayne: Thank you all very much indeed for coming. Most of you know, in principle, what today is about – Trauma and Journalism in an Iraq War.

Needless to say, we meet at a very sensitive and important time, with a campaign in Iraq starting possibly within days.

I think most of you know about the work of the Dart Centre Europe. It’s still embryonic , although we’re coming to a kind of cusp where Dart is going to need to develop in Europe in interesting and exciting new ways. We look forward to hearing your views and having your support for this.

To start this evening, I’d like to introduce Frank Ochberg, co-founder of the Dart Center US for Journalism and Trauma. Frank is one of the world’s leading specialists on PTSD [posttraumatic stress disorder] and was on the team that first defined this disorder, at the beginning of the 1980s, looking at the way that the American war veterans were experiencing the emotional impact of reporting trauma in the Vietnam War.

Frank Ochberg: I wish this wasn’t such an ominous time, but we really are an emerging community. For approximately a decade, several of us have realised how important it is to bring together those professionals who investigate from a background and discipline of skilled and dispassionate reporting, with those who investigate from the background of psychiatry, psychology, social work, nursing, to understand individual reactions.

Every year this becomes a richer, more rewarding and more compelling experience. And I think it was facilitated by the identification of PTSD as a concept.

First of all, PTSD is a medical diagnosis. We pooled some information, and saw three dimensions which affected or changed thinking and behaviour - and we would call these three dimensions Posttraumatic Stress Disorder.

The first of the changes is an alteration in memory. It is not that you cannot remember. It is that you remember what you do not want to remember when you do not want to remember it.

Think of this as a computer, or a television set, that decides to show you a scene when you have not tuned it in. It is a different memory pathway. It could be called a hot memory, and it is driven by an ancient part of the brain called the amygdala, which is part of the limbic system.

This can manifest as flashbacks or nightmares, and can be terribly intense, causing an individual who has it, [to think] that literally, they are crazy. They are not controlling what they want to think about.

This painful, intrusive and debilitating experience is one end of the spectrum.

At the other end of the spectrum is something very subtle. It could be a nuance, a sense, a feeling, but it’s connected clearly to some reminder of the traumatic event. And even though it’s subtle, if it happens enough it eventually gives the person a feeling that they aren’t the person that they once were.

This change from feeling like the person you were, to feeling like a victim, or a subject, or a diminished or a haunted person – even without the flashback, even without the nightmare - is a change. It’s a change in sense of self.

There’s a big debate going on now – is PTSD real? It is important? Does it require therapy?

Any therapist who has dealt with this and has listened and has learnt, knows that we are talking about the transformation, and in some ways with the dehumanisation, of a fellow human being.

And these people who have PTSD as we intended it to be understood and described are often tragic and living reminders of the cruelty of our species; of our failure to evolve in ways that honour one another – of the choices that we make. So that is the legacy.

The second part of PTSD is negative symptoms. They are not necessarily depression, but they consist of losing the full range of emotion. I sometimes think of this as a biologically adaptive way of reducing the impact of being episodically re-traumatised by your memory.

It is emotional anaesthesia. I interviewed half of the Vietnam veterans in the State of Michigan who were part of a national sample so that the US Congress could have, 20 years later, the impact of service, and of the reality of this disorder.

The most compelling and the most saddening and, in a way, the most indelible part of the legacy was the numbing and the avoidance that went with it.

These men, by this time, had got past their flashbacks and nightmares. But for many of them, they felt that they were shadows of their former selves. They had lost the capacity for love and for hope.

Often I would find some elements of love that still existed. ‘How do you feel about your children’? ‘Yes, I love them’. But then it would be, ‘But I don’t express it’.

Something is impaired in that capacity. And so the second of the three dimensions of PTSD is numbing, or avoiding certain places or interactions. In total it means that an individual has lost their tie to the human group.

This is the element that the spouses and the children complain about most. Where is this man? Where is this woman who used to be my spouse, my mother, my father? They’re not really available to me.

The third part is anxiety. It is a lowered threshold for anxious arousal that doesn’t have to have, necessarily, anything to do with a reminder of the traumatic event. The person has more active adrenaline. Or, at least, they have more activation of the sympathetic nervous system, so they are anxious.

This means you do not concentrate that well; you don’t sleep that well; you look over your shoulder; you jump at loud noises; and although we never put it in the DSM, the dictionary of psychological diseases, it means your sex life is impaired.

You cannot have a normal range of arousal and response with this amount of anxiety. The other parts of the syndrome impair usual sexual activity as well, so that element of intimacy, as well as attachment, desire, trust, is impaired.

We are not talking about trivial cases, or trivial situations.

Half way through the 1980s it became necessary to redefine what a traumatic event is. Back when I participated in writing the diagnosis, we said it was an event that was outside the usual range of human experience, and would be traumatic for almost anyone; such as rape, or witnessing a murder or hearing shocking news.For legal purposes, let me mention that you don’t have to actually see something, but you have to experience it.When we discovered that most of us are going to have a traumatic event in our lifetime that meets this threshold, we had to change the definition.

It is not outside the range of human experience; it’s inside the realm of what we’re going to encounter. So we changed the diagnosis to say, that at the time that the event happened, you had to experience terror or horror or a feeling of helplessness or incapacity.

A person who is affected in this way, more often than not, loses a sense of coherence; sometimes is scared speechless. But very frequently, they are unable to explain how they feel, what they saw, what they experienced.

And that’s where we come in; whether we’re journalists or therapists, to be able to help a person who is almost neurologically impaired in their ability to express - but has not been impaired in their ability to perceive - the story. For you to help them tell the story is therapeutic.

When somebody, voluntarily, comes forward and wants to be a subject because they have experienced the worst of humanity, far more often that not, your ability to help them put this into language, is redeeming, is re-humanising, is reconnecting them to community and to the human group. [This is] a very important task.

For that reason, those of us at the Dart Center, created an award of $10,000, for the best newspaper writing in America; and we have one in Australia.

The award is judged by a majority of journalists plus one therapist and one survivor of horrific events; and it is awarded for sensitivity and accuracy in the portrayal of the victim of violence.

It is to try to get that part of the story which competes with the more commonplace ways that we have of telling about events - trying to be sure that what one might call this second act makes it to Page One, and isn’t just simply a feature, or a puff piece, but a story that is told with compelling voice.

There are very sharp differences in the way that we are going to react to traumatic events. People are not the same, and the genders are remarkably different.

If you attend meetings of the parents of murdered children – it’s 90 cent female. The fathers do come in the beginning but they drop out. The mothers stay for the support and, I guess in a way, the welcoming of newcomers.

I don’t have research on this. I just have my sense as a clinician that, in many cases, fathers are a bit more angry and they want, in their minds, to follow the trail of the perpetrator. They do not really have the patience for the news stories that come in – and there may be other explanations.

It isn’t strictly a gender difference; I don’t want to imply that gender determines whether there is comfort in talking and listening to similar traumatic events.

There’s such an interesting debate going on in the British papers and in the US as well, about the ‘stiff upper lip’ and whether it is better to deny and to avoid rehashing and re-visiting trauma scenes. I believe for many people it is better to avoid.

I use a mechanism to help a person who is plagued with flashbacks to have the flashback in front of me and to develop a sense of mastery.

I remember working with parents of a murdered young man. It was appropriate for the wife to do this, and inappropriate for the husband. He didn’t have the flashback. He didn’t need to re-live in order to master a memory that was driving him crazy. He really wanted to be sure that his wife had that opportunity and both of them, now, are active in a victim alliance.

Certainly, there are ranges of remedies, of treatments, of information that are as different as we are different.

I would submit that Dart Centre Europe should pay attention to those differences, and should develop its approaches in a way that’s different from the Dart Center in America, or the Dart Centre in Australia, or those of us who are trying to start some programmes in South Africa.

There are regional, cultural, ethnic, gender and age differences. Let’s explore those differences and understand them.

A concept that Mark uses, that I really applaud and approve of is, emotional literacy. Recently Bruce and I both attended and participated in a fascinating conference of poets and journalists called The Languages of Emotional Injury.

How do we learn to be articulate and perceptive and communicate about emotion, and emotion in the extreme? It takes some doing. It takes some cultivating.

You don’t have to be a psychiatrist or a psychologist to speak the language, but it helps to have that ability - and I think that’s what Mark and Sue are trying to assure that their colleagues develop; emotional literacy and a language of emotional injury.

We’re on the brink of this war. Whatever happens, we can anticipate that trauma therapists are going to have a lot of business; that business will be booming.

Let’s think a little bit about how the business is going to come to us. They will be your colleagues, they will be the combatants; and while the statistics about trauma, emotional trauma after combat exposure, vary, I can tell you that good research of the Vietnam era showed fifteen per cent [developed] PTSD.

For those who were in the high war zone, it approached 50 per cent. But, it is 50 per cent. It is not everybody. If there were two soldiers in the same area and their friend, another combatant, is killed in front of their eyes, the odds are, one will get PTSD and one will not.

Does that mean that the one who does not get it is insensitive? Does it mean that the one who does has something morally or biologically wrong with them? I doubt it.

I think we have genetic differences, and how our brains are wired. Some of us will obsess in a way that we can’t control, and we keep horror alive.

Others of us do not have that pattern so we don’t get PTSD; but we’ll probably get something else. Those will be our clients, and those will be our concerns.

There also will be the non-combatant observers. These will be journalists, human rights workers, Red Cross workers and others in the theatre of action. They are just as exposed.

I believe they are more vulnerable to disability because their job doesn’t allow them to do something that they feel is effective. The human wiring is mammalian. Our arousal is so that we can do things that are physical and with our hands and with our teeth.

It is not a biological evolution that prepares us with adrenaline surges to operate equipment that requires meticulous control. The more you have an opportunity to do something that feels effective in the heat of battle, I think the better chance you have of coping with our biology as mammals. That biology is frustrated for many of us.

Reminders, colleagueship, that helps the journalist understand how important it is to have our eyes and our ears out there, to bring the stories home to the rest of us, to honour those who put their lives at risk – all this is terribly important.

So part of what we’re going to have to do is to receive our colleagues with honour, with respect for their courage and dignity, and for doing the job that needs to be done.

The families are very important. The kind of support that we give them matters, and makes a difference. When people come back, and are injured with PTSD, there is something called ‘the caretaker burden’.

This area is being researched, and needs to be remedied. It’s very similar to the burden that caretakers have when they’re dealing with loved ones with debilitating, physical illness.With PTSD, we do such a favour by explaining what it is, so that it becomes rational rather than mysterious. It helps somebody’s patience to increase - for the time it takes to overcome loss of intimacy, loss of sexuality.

What do we do when we do therapy? There are no formulas for therapy, but there are certainly principles. And the principles do include being collegial, as a therapist, with somebody who has been an observer of reality and brings back the imprint of that observation and that encounter.

• Being collegial – doing things to normalise the experience by explaining, demonstrating and showing why it is – and what it is.
• Offering an opportunity to re-live the experience in a controlled environment in order to develop mastery, and get over flashbacks. Not to confront the flashbacks is to not do effective therapy.
• Understanding what medication works, and when it is appropriate. Whether or not you are a physician, to know that there can be referral to a physician.
• Having an opportunity to move from feeling alienated to helping others to participating in the altruism and in the connection, and in the family that we are creating. All are very important parts of therapy.

We’re running some public service announcements in America about PTSD. You can answer a questionnaire in which you say what the trauma was and whether you’re getting help, and how the help is going.

A majority of the respondents have been abused. It is abuse usually in the marriage. It is also often sexual abuse - as the major trauma - that is bringing people to seek information in the US.

Most of them have had therapy. Two thirds of them are dissatisfied with the therapy that they’ve received. It’s bad therapy. That’s worse than no therapy.

So improving the quality of therapy, and assuring that our people - I’ll speak as a visiting professor of journalism, our people - get the best therapy, is up to us. That’s our job.

I’m now going to pass the baton to my colleague Bruce Shapiro (Field Director for Dart Center US and contributing editor, The Nation).

Bruce Shapiro: We are here at what is obviously a difficult moment right before a war; and it’s a uniquely difficult moment for a journalist.

War has always challenged journalism, and journalists, to tell the story of carnage and atrocity; to tell the story of heroism and cowardice; to tell the story of politics and tactics and to do it all at once.

This has never been an easy thing; it has always been full of risk for the journalist. The risk on the front lines; the risk, at times, of being discredited for telling the truth, which even one’s desk editors don’t always want to believe.

This happened to a lot of journalists during Vietnam; the risk of being censored by military authorities; it’s not an easy place to be. Nor has it ever been easy for the desk editors who have to make decisions about what reports from the front will run, and how they will be received by readers and so on. It’s always been hard.

But there are some new and important challenges to journalism in this war. Increasingly, we find ourselves telling as the news, the stories of civilian casualties in large numbers.

And this challenges the toolbox of the journalist. We know how to tell the stories of individuals; we do not always know how to tell stories of mass atrocity. We know how to tell the stories of generals and of warriors and we do not always know how to tell the stories of civilians.

We often, when refugees present themselves on our doorstep, do not know how to talk to them. These are practical challenges; new challenges that have never existed before.

Similarly, because of the advent of trauma science, we now know that stories can sometimes be distressing for those whose stories we tell. That too, is a new challenge. How to avoid re-traumatising. So there are new reporting challenges, new journalistic challenges involved in this Iraq war, and in other recent conflicts.

There are also some new risks to journalists. Reporters will be embedded directly in combat units. So reporters will be exposed in unprecedented numbers, at least, unprecedented since World War II, to the direct combat experiences, and direct combat risks, of soldiers.

There are new risks involving chemical warfare, and the other dangers that will face troops going to Iraq. There are new dangers, perhaps from low-intensity warfare in the aftermath of the major conflict; new dangers from occupation.

All of these things are new risks to journalists, as they are new risks to troops at the front. And for all these reasons, we need to be taking very seriously what it means to be a working journalist.

What is the toolbox that we need, to bring to the story of this war on the battlefield; to the story of this war as it plays out on the home front; to the story of this war in the lives of ourselves as we cover it, as we make news decisions about it; as we view the photos of it over and over and over again? We have to be asking these important questions.

The Dart Center for Journalism and Trauma in the US was founded to ask these kinds of questions. It was started with the initial idea that there ought to be a better, more effective way, a more respectful way, of covering victims of violence.

But, as we began to talk to reporters about what that means, some reporter in the room invariably would raise their hand and say, ‘What you say about PTSD is very interesting but you’re not talking about me!’

As reporters and journalists, people were coming away from their work, especially sometimes in mid-career, dealing with numbing, dealing with avoidance, dealing with depression; dealing with their domestic partnerships breaking up, for seemingly unfathomable reasons; dealing with substance abuse and knowing that somehow it was connected to the story, knowing that it was somehow connected to the work and yet not able to articulate it.

So at the Dart Center US, we have a dual focus. We work on the one hand to educate journalists, to give them a better toolbox for writing about victims of violence and making decisions about what counts as news when you’re telling the stories of people who are traumatised.

On the other, we provide information on how to support ourselves as journalists with these difficult stories, and what to do about trauma, traumatic exposure, traumatic stress and its aftermath in the journalism profession.

We as reporters, editors, news managers, are very pragmatic people. It’s fine to talk about sensitivity; it’s fine to talk about self-care, all these sort of things. But we know that our job is to get the story. Our job is to get the news. Our job is to get the paper out, and to get the news on air at night.

But, on the story-telling side, how can we interview people to avoid re-traumatising them? What does it mean when we go to interview a refugee, and this silent face or seemingly inarticulate person presents himself?

We want to get the story; we don’t know what to say to get it. How do we get through to open up instead of closing up? How do we gain people’s trust in order to get the stories?That is a very pragmatic set of decisions. How do you deal with the needs of the subject of our stories, if we have the time and inclination to deal with them? Is trauma news? How do you deal with the stories of people, whether it’s soldiers, whether it’s refugees, whether it’s people at home who are being distressed?

It is about doing good journalism. It is about giving ourselves the techniques, and the language, to keep doing good journalism.

Knowing about trauma helps us do that better. It helps us make better news decisions, and it helps us have better, more effective, careers that are integrated with our lives.

For the first time, reporters are going to war equipped not only with note pads and flak jackets, as part of their safety gear - but equipped as well with a language of emotional injury - the capacity to understand the impact of what they’re witnessing on their subjects, and on themselves.

MB: Thanks Bruce. I’d like to open this discussion up to the floor.

Ian Mayes (Guardian): What I’d like to ask is to what extent do you think - for a journalist who witnesses terrible events that may be able to induce trauma – is it important that the stuff is published at the other end of the chain?

BS: I think it’s absolutely essential. One of the many precipitating factors for emotional distress in the wake of a traumatic event is a sense that one was able to intervene, or not intervene. For many of us in journalism, reporting is a way of intervening in the cruelty of the world.

When we get the story we think it’s important; we want people to know. And in fact trauma survivors in general want to shout their stories to the stars but believe that no-one can possibly hear them or understand them.

When you write what you think is a good and important story and it does not appear, it can be crushing, because it ratifies that sense that you’ve witnessed something incomprehensible that no-one will ever believe.

FO: I don’t think that PTSD is effected by this. I know that there is no research evidence showing one way or another. But, I do think that the path to burnout, demoralisation and other problems, is effected.

The one set of research that I’m familiar with casts some light on a similar example; it was done by in Chile, of people who testified before tribunals about torture and it turned out that those who testified voluntarily - got their story out - had better mental health than those who didn’t.

BS: We don’t want to suggest that every reporter who covers war or difficult stories will get PTSD. In fact there’s some research in the States about news photographers who have covered stories which shows PTSD rates are comparable to, or lower than, other first responders.

Journalists are resilient, right? One of the reasons that we are resilient is, perhaps because of our training to tell stories, to frame narrative; and the ability to get it published and listened to.

Chris Elliot: I’m the Managing Editor of The Guardian. One of the difficulties of persuading colleagues to take PTSD seriously, is because you did only have the diagnosis in the 1980s. People inevitably think, ‘Well, what the hell happened to everyone before? What happened to the millions of soldiers who came back from the first and second world wars?’

All arguments that I’m sure you’ve all heard before. I’m interested to know what connections are there between shell shock, which is very well documented from the First World War, and PTSD? What are their similarities?

FO: Shell shock is part of PTSD. It depends on what you mean by shell shock because we never codified it. My image of shell shock is the person wandering around in a battlefield, disoriented, doing things by rote in a dissociated state. They’re in a trance.

Now we’ve come up with a new diagnosis –ASD – which is Acute Stress Disorder and that, has dissociation in it. Shell shock is happening at the time. PTSD is meant to mean a lingering effect that you can’t diagnose until a month later. But if you put together shell shock and battle fatigue, you have the full spectrum.

MB: I’d like to bring in Rob Cole, producer and veteran hack, with the BBC, and previously with WTN. Very briefly, Rob could you tell us about what happened to you?

Rob Cole: If you’d asked me before I got PTSD, would I get it, I would have been completely dismissive of it. I was very cynical about that kind of thing – ‘Oh well, you just need a good talking to and that’ll be fine.’

But, the war stories I worked on became accumulative, which resulted in me developing PTSD. For Rob’s story, click here…

MB: Rob, I’m really grateful to you and to other colleagues who have told us their personal stories. Since I started my project at the BBC five months ago I’ve heard lots of stories. There are a lot of our colleagues who have really gone through hell, and it is important for people to hear that, and to know that it is okay to talk about it. It is okay to own up to it, and recognise what is happening, so that this becomes part of the accepted culture.

FO: Rob, do you feel any change in management appreciation?

RC: Coming to the BBC has been a different world because they said to me, ‘Look, we know you’ve had that but we know you can do your job, and we’d like you to work for us.’

That helped me massively, because it means people have got confidence in you again. If someone says, ‘actually, you’re useless’, then you feel pretty terrible about it. So there’s no doubt now, especially at the BBC, there are so many mechanisms to help people.

MB: Sue, would you like to briefly talk about the Dart Europe website.

Sue Brayne: The heart of our web site really is about the personal stories. I felt that the personal stories were the most powerful way to provide a really authentic look at the life of journalists who have worked in hostile environments - and the effect that this lifestyle has on their families and on their partners.

Obviously, there is a ripple effect of what happens here, so these stories give Dart Europe a much better idea of the kind of help and support that we can give them.

But also, it is to make sure that Dart does not undermine journalists, implying they’re a bunch of emotional despots. As Bruce says, journalists have a sense of mission, they want to do this, so it’s not about saying journalists are weak and woolly because they are having these problems.

It is about raising awareness on the possible issues that journalists face. So the aim of the web site is to provide a really good, all-round idea of what news journalism is really about.

And it’s also to educate journalism students about what they’re getting themselves into. It is not just about writing column inches. It’s about the emotional effect it’s going to have on them and their life in the future.

I also wanted to do personal stories to add anecdotal evidence to existing research on related areas of traumatic stress on first line responders: police, aid workers and rescue workers. And, to build a bridge of understanding of how journalists can work better with these other organisations.

Another important part of our web site is to raise issues on things like newsroom bullying and the traumatic input that has on people who are already stressed out.

I also believe that making sense of a traumatic event is a really vital part of the whole healing process. So, the trauma and spirituality page provides comments on this area.

Another important part of this is families and support. Talking to the journalists, I realised that the families desperately need help too.

I’ve interviewed three journalists’ wives so far; and their stories are about what it’s like to live with somebody who has always got the suitcase packed underneath the bed, and is choosing to go and work in hostile environments, rather than staying at home; what the impact this is having on the kids.

So the web site is a virtual network, bringing together anyone interested in this area and that’s from journalists to editors to psychologists, therapists, etc.

Talking of therapists, one thing I feel really passionately about – and Frank mentioned this earlier – is about getting the right kind of therapeutic support for the journalists. To support this, we’re planning to create Dart Europe induction days for therapists who want to work with journalists.

The future of the website is to carry on building up this dossier of personal stories. But more immediately is, obviously, to start collecting stories from those in Iraq and what’s happened to them

Stephen Jukes: Seven or eight years ago there was a great reluctance to get into Hostile Environment training. But, after a while, people realised it saves lives. And, I suspect in a few years time, the same will be said of trauma training

For Reuters the watershed was the death in 2000 of Kurt Schork. Kurt was ambushed in Sierra Leone, with Mark Chisholm, a South African cameraman, and Yannis Behrakis. They were always together as a trio, and they were great friends.

Mark and Yannis survived. They are the first to say ‘We sought counselling , and we didn’t think it was a good idea at the time - but actually, afterwards, it was a great idea.’

And then we had 9-11 where the whole our New York newsroom was involved. A lot of staff did receive counselling, but this has only been available in the last few months.

We have now instituted formal briefings for any journalist who is sent abroad, and that includes not only ‘what’s the story, and what you’re going to write’, but also safety equipment. It also includes counselling and the fact that counselling will be made available. We’re trying to de-stigmatise it because there’s still this macho resistance to it. But, if it’s available to everybody, we found it helps.

We’re also training the news editors and management to recognise traumatic stress symptoms. And, when people come back from an assignment, we do a de-brief, which could, depending on the circumstances, lead to a referral handled through our employee assistance programme.

Anyone can ring our employee assistance phone line if they want help. They will then be referred to a specialised counsellor who is specialised in PTSD.

But, we also face a number of difficulties. The first is that not all our staff are based in the UK. We have 2500 journalists around the world. Only a small fraction of them are based here in London.

We’re quite capable of finding counsellors in America but it’s much more difficult for places like Zimbabwe, Ramallah, and Gaza.

Secondly, there are quite clearly two categories of journalists. One is those who are sent on short term assignments. The other is those who live and breathe it every day; those who are in Jerusalem, Tel-Aviv, Ramallah, Hebron, Gaza.

What can we do with those journalists, and their families, who live in war zones or hostile environments? This is causing us great concern.

What do we do about confidentiality? We want feedback from a management point of view, because we want to know how many people are using the support we make available.

But, we don’t want to know names unless, maybe, is there a point at which somebody could be a danger to themselves, or to other correspondents they are working with.

Is there then a point at which confidentiality becomes an issue of safety and moral responsibility? For instance, you are told about someone because of fears for their safety, and you have taken that person out of an active reporting environment.

We are also struggling with cultural issues. We’re not just an English organisation; we’re an international organisation. Many of our reporters are from the Middle East or from Asian, where there is a cultural reluctance to go into counselling.

MB: Steve, thanks very much indeed. Could we hear from Jim Bolden of CNN.

Jim Bolden (CNN): This is a very new thing for CNN too. We’ve implemented the Hostile Environments training, and now we’re moving into what we are going to do for people coming back.

This includes people on the newsdesk, the people who are talking to journalists on the phones. What are they listening to? What are people telling them about being on the road or in the field? And how are they responding to those challenges?

There are two challenges we’re seeing. One is that journalists are now targets. This is quite a new thing for us. We have to think of ourselves as not just sitting on the sidelines watching; we may very well be the people they’re going after. It’s something that’s quite different in the way we may respond to what’s happening out on the road.

The second thing is that journalists no longer have the luxury of saying ‘I’m a business news journalist, or I’m a general news journalist, I only do this’.

Last year I was sent to cover the Bradford riots. The team consisted of a business reporter, a business producer, a business cameraman and a business editor. None of us had any hostile environment training, and none of us had ever been in anything like that before.

It was an eye-opener to us, and an eye-opener to our desk. You can’t send guys out to cover a riot just because they are the ones to happen to be in the office that day.

It’s also about the merger of disciplines in certain circumstances. Those of us who are writing journalists may be using a camera; cameras have become a target. And, we can find ourselves in the field on our own. We won’t have three people watching our back - that is something very new for us as well.

MB: Jim, thanks. Steve Nicklin from Health and Safety, ITN.

Steve Nicklin (ITN): As Health and Safety Manager for ITN, I have been to various places to assess what’s going on. I’ve been walking up and down the Ardoyne Road (in Northern Ireland) as people have been stoned; I’ve been out to Ramallah and places like that just to see what people are doing and to make sure that people are working in the right way.

What we continue to do is to take as much care of our people as we possibly can.

We have an employee assistance programme to deal with bereavement, alcoholism, stress, and post-traumatic stress. All our staff are able contact our employee assistance programme 24 hours a day from anywhere they are in the world.

This has been extended to all the families as well. And we also extend this to free-lance staff who might be with us on contract. We also have basic guidance about what post-traumatic stress might be in our health and safety manual.

It’s mandatory for people to attend hostile environment courses before they go anywhere near a war zone - and in the last six months we’ve put quite a few people through chemical warfare training courses, and refresher courses.

In the last couple of years, since the May Day riots (in London) of 2000/2001, we have put a large number of people through riot training as well.

We’ve invested in management training for stress. Recently, we’ve had seminars for managers and news editors and those people likely to be talking to our people in the field, about PTSD.

We also always say to our staff that they do not have to take an assignment if they feel uneasy about it; they have the right to refuse an assignment.

We have sent letters to all those people, and their families, reminding them that they can back out; reminding them that there is this employee assistance programme and two cards have gone in with the letters.

One card to the family, which has the employee assistance number on it so the families can ring whenever they feel like it; and a card to be taken by the member of staff to the field so they can ring whenever they want.

There’s also a support system been set up by our Human Resources Department whereby the individual managers and the administrators of the individual departments have a list of names of families that they are going to look after.

Practically all of the families have been contacted by a person from ITN to ask how they are, to see if there’s any help they need, and to let them know they can call us at any time if they’re worried.

There’s also going to be a newsletter sent out to those families to let them know what’s going on because, obviously, the more information we can give them, hopefully the better it will be for them.

The one thing I would say is that I’m mindful of those who are ‘in the theatre’. There are a lot of highly experienced correspondents, but this time there are also going to be a few inexperienced people out there. I’m very aware of this.

But, it’s not necessarily those people out in the field that we’ve got to worry about. The amount of pictures coming in to the building is going to be enormous. That is going to have an effect on all of us. There are a lot of young people now who have joined the industry in the last few years; they could well be traumatised with the amount of things they will see.

And it’s not just the people working on the news desk - the journalists, the reporters, the writers of the packages. It’s going to be those people who are actually editing the pieces back at base, as well as archiving them.

MB: Thanks very much. I think that’s been a very useful and interesting summary of what some of the news organisations are doing. One of the things that struck us in the Dart process is just how far ahead the broadcasters are, on the whole, from the print industry. Getting through to the broadsheets have been difficult enough, let alone the tabloids.

The fact that the BBC now has a full-time trauma project is an indication of how seriously the BBC has now taken the need for trauma training and support.

One of the things I’m going to recommend is Trauma Awareness Training as soon as people come into the organisation, as well as for managers, and for everyone before deployment. It’s not about saying you’re going to be traumatised; it’s saying, ‘Hey, we work in a profession that deals with trauma, it’s core to our job; seventy-five per cent or so of everything we report has got trauma in it somewhere - either it’s the preparation for trauma; it’s the experience of trauma; it’s the aftermath of trauma; let’s de-stigmatise it; let’s bring it into the mainstream.’

I’ve now reached, in the last two months, with a series of brief and slightly longer training courses and briefings, over two hundred BBC staff. The Panorama team, the Correspondent team, and almost the whole of TV News have been through the training.

The stories that are coming back to me in this training is how important it is to see the experience of trauma in the field as part of a seamless web of experience and support that goes from the individuals on the coalface of the traumatic experience right through the picture editors, assignment editors, Monitors, etc.

At BBC Monitoring, one of our colleagues developed PTSD, which pole-axed him for nine months because he’d been reporting Sarajevo from the leafy suburbs of Reading. So it can strike in unexpected ways.

We’ve done good work in the BBC in the last couple of months in getting this awareness out there. We’re trailing a new approach to trauma support, which is not about sending people to counselling when they’ve got a problem – although that’s part of it - but before they have.

If they’ve been exposed to trauma or a traumatic assignment, we’re going to use a trauma risk assessment programme (based on the Royal Marines model) with the focus on creating a culture that allows for wobbliness after trauma.

This programme assumes, on the whole, that people are going to do pretty well, because we’re resilient. As Bruce was saying, we’re evolutionarily programmed to survive and cope with trauma. But, the programme allows time for any traumatic impact to surface, and be assessed again after 28 days. If there is a problem, then we can provide the right kind of support. I think it’s a model that could well work.

At which point I will hand over to Cameron March, who helped to devise the Royal Marine’s risk assessment model.

Cameron March (Royal Marines and MarchOnStress): Six years ago, we looked at what we needed to do with stress in the Royal Marines. We came up with a risk assessment plan, and we look at risk assessment to see how much stress people have taken on as a result of an incident.

We also look at education; we look at how to help people cope; we look at how to re-establish social contact; how to deal with the families. And the families are important. When our guys come back it’s the wives and partners who are the front line; they take the brunt of it. So we’ve incorporated them.

So, what we’ve tried to do in a very easy and simple way is produce a peer group-delivered system that helps people in the Royal Marines. It’s delivered by people who can speak the speak, talk the talk, and walk the walk; and it works very well for us.

Our guys are out there. And our risk assessors are out there with them. I got an e-mail from my warrant officer out there. He said we’re all ready, all the risk assessors are there, and we’re ready to go. And they are ready to go.

But the interesting point is what happens when they come back? In the following weeks, months and the years? And that’s when we’ll be there to help people. We will risk assess; we will get people into proper help. And it’s identifying these people which is so important.

I’m now going to hand you over to Neil Greenberg who works with me on this risk assessment project.

Neil Greenberg: We’ve been talking quite a lot tonight about PTSD. But trauma does not equal PTSD. For every person that gets PTSD, there will be another person who becomes depressed; there will be a whole host of people who aren’t functioning so well at work; and quite a lot of people who go out and do deep lager therapy - which we’re quite good at in the British Armed Forces.

So it’s really important to realise that we’re not just looking for these people who are hyper-aroused. We’re looking for people who aren’t functioning well.

We have, therefore, developed this peer-group programme. Which means that is we train Royal Marines how to talk to other Royal Marines.

And we’re able, pretty much, to train our Royal Marines and Royal Navy personnel to do this in a pretty short amount of time. It’s effective because it looks at what is going on three days after the event, and then it looks at it again about a month later.

We know that about three per cent of our people in the Gulf War got PTSD. That’s ninety seven per cent who didn’t. So if we go round trying to counsel all these people and make them all better, the evidence is that we can make them quite a lot worse.

What we want to do is find those three per cent who aren’t doing well - those who are depressed and those drinking too much - and give them help. And, we leave the rest of them alone to get on with their life.

So, this risk assessment schedule sees if people are getting better. If they’re getting better we’ll leave them alone. If they’re really bad we get them to medical help; and if they’re somewhere in the middle we feed that information back to the managers. We’ll say to the Commanding Officer, ‘Well sir, you’ve got four guys in that incident. These three – they are fine; this one is a bit wobbly.’

We then allow the CO to manage those people effectively. It may mean not sending them out to stressful experience or keeping them back in base camp, so they can help out with something important there.

We believe by making people strong in stress, rather than victims to it, people will do well.

And that really is what military psychiatry has shown over the years. The more people you send back (away from the front), the more casualties you get. The more you can keep people somewhere near the front line the better you’re going to keep those people functioning.

Some army units are now using this model; the Foreign Office have taken this on board; some of the police, the ambulance service, the BBC, and the American army. It’s simple and effective.

MB: Thanks Neil. Colonel Bob Stewart is with us, who famously worked with the British army in Bosnia in the early 1990s, and I’d very much like to hear your take on this.

Col Bob Stewart I think the first time I heard teamwork being used was by the Royal Marines. I find it rather sad that all four news organisations haven’t actually said, ‘We ask our guys to look after one another.

Of course it’s much more difficult because print journalists tend to operate alone, and television and radio do tend to have a small team.

But, how the hell do you actually organise it so that the same people work together, so they can look after one another - especially when they hate one another?

Bob Stewart: Fundamentally, it seems to me, the way that people can actually help is by knowing, trusting and caring about one another in small teams. Yet journalism seems to think – because of the nature of journalism – that it can’t be done; and I just wonder whether that could be one of the solutions to trying to help people who are subject to stress?

By the way, I also disagree with your figures. It seems to me that of the journalists I’ve met, ninety per cent have PTSD!

The nature of journalists is quite outward going and prepared to run risks. So with that kind of person I would think it would be three to four per cent, who might have a particular problem.

But, I think the biggest problem you’ve only just touched on is the families who have to live a dreadful existence while the journalist is away. I should think the partners often have PTSD.

How can you make these very dedicated, keen people, who are trying to do their very best, actually look after one another better? I have the deepest respect for journalists because I find, personally, as a soldier in Bosnia, they were the only people I could talk to.

They were the only people that gave me advice when I was the British Commander because I certainly couldn’t talk to the United Nations, and I certainly didn’t want to talk to the Headquarters United Kingdom Land Forces because the only instruction they gave me in seven months was, ‘Put a bloody helmet on!’

But the fact of the matter is journalists can also be terribly helpful outside their specific remit. I’m here tonight to honour the help they gave me and to say thank you; but more importantly than that, perhaps to help with any comments I’ve made.

So, I think you should work in better teams, get to know one another better, and work closer together. That would help reduce PTSD. It just seems sensible to me.

MB: Thank you. Milica Pesic.

Milica Pesic: I’m Milica Pesic from Media Diversity Institute. We are organising a workshop in Croatia for journalists from Southeast Europe who were working during the conflict. It’s for local media who didn’t have all these media organisations backing them and understanding them.

But, as an organisation working in this area, we are concerned we are actually going in the right direction with our work. We found research from Columbia University Research claiming that all the consolation given to the New York victims was actually useless; a waste of money.

More research from an Oxford-based institute claimed something similar. Counselling people to prevent PTSD is again, in the best case useless. In the worst, people are more likely to get PTSD.

So we decided to go for this awareness raising course workshop simply because journalists in Southeast Europe asked us to for this.

But if this new research has claimed that only three per cent of British soldiers in Bosnia have been suffering from PTSD, should we go in this direction? Are we emphasising something that doesn’t exist?

FO: There are so many different therapies and therapists - and the various studies that are done mix apples and oranges. The Columbia survey that you mentioned was written up in New York Times magazine section two weeks ago with a very interesting headline: ‘Repress yourself.’ For years therapy has been about discussing and re-living your trauma but now there’s an argument that it may be better, simply, to keep it to yourself.

And, there was a similar article in the Sunday Times making the point, ‘Stiff upper lip beats stress counselling.’ So I really think the burden of proof would be on these advocates who are saying that this attitude is better than therapy.

There are people for whom doctors would recommend, ‘Don’t get therapy!’ But seriously, you have to do a professional and informed assessment before you can reach that conclusion as a doctor.

PTSD is real. Brain scans will show differences. Controlled studies on medication and other mechanisms of help, show positive outcomes greater than placebo for those people who are diagnosed, suffering, and present themselves for care and treatment.

So Milica, you are not misleading your constituents and people who are listening to you when you go forward with a programme that suggests that information helps. Screening helps; and risk assessment, as the Royal Marines are doing, helps. Offering individual attention to those people at risk, and those people who have already begun suffering, helps.

MB: I’d like to bring in Jack Laurence who has written one of the best books about war reporting that I have ever read – The Cat from Hue – which goes inside the personal experience of one of the most dramatic wars that journalists have ever reported on.

Jack Laurence: Thank you Mark. Traditionally, in the press corps in my experience - and my experience goes back to the Vietnam War and 14 or 15 other wars since then, including the last Gulf War and Yugoslavia – the way that journalists recovered from the trauma of that day’s experience, or that week’s experience, was to gather in the bar of the hotel where they stayed, or share a bottle in the field with the troops and tell funny stories about it.

What journalists do is to sit down and make fun of themselves. They laugh about the experience. If you read the wonderful pioneering book by Judith Herman, the Harvard Psychiatrist, called Trauma and Recovery, the last stage of recovery is a group therapy session, in which the victims of trauma – not journalists, but women who’ve been raped; people who have suffered childhood trauma and abuse; war veterans; and many others who have similar symptoms – is to be in a group with others who recognise that you are not the only one to have had your world turned upside down. And then begin to finally see the humour in it; to see that you’re not alone.

And I just ask the question: Is Dart, are the Royal Marines, are the news organisations finding ways to bring journalists together after the Iraq war, to talk about it, maybe to have a drink about it?

Because in the absence of some kind of group work, you’re going to get what happened to so many of my colleagues from Vietnam: suicides; life long depression; broken marriages; attempted self-destructive behaviour; and in a very high proportion.

It’s all very anecdotal for me but so many of my friends are dead today from covering covered too many wars. That is: taking risks again and again and again because whatever you want to call it, their values, their self-worth etc, have been so destroyed by the effects of the trauma they didn’t care any more.

FO: The International Society for Traumatic Stress Studies is very cautious about the idea of group debriefing after exposure to trauma.

Telling your own story is usually felt to be satisfactory. But listening to everybody else’s, and then moving on, may give you the worst of all possible experiences.

BS: The Dart Center is not a provider of therapy. We are a provider of education, training, and network building work.

We are trying to create a network of journalists and professionals - others who are talking about the intersection of these issues. However, it’s not just about groups in the narrow sense of group therapy; it is about community and community response. Events like this are a way of building supportive communities that Judith Herman talks about in that book.

After September 11th, we set up Ground Zero, run jointly by journalists, psychotherapists and a group process expert who did, in fact, organise small group dinners.

They went to places where journalists gathered; bars, galleries, newsrooms, other places for informal discussions and a chance for people to talk; to do what you folks in the field did. So I do think there’s tremendous value in building solidarity and we stand for that.

It is essential because it is about restoring connection. But group therapy, narrowly, is not something that we do. We do believe in building community, and in people working together. For some people in therapy, group therapy is the right thing, and for some people it’s not.

MB: Dagmar Edwards.

Dagmar Edwards: I work in an organisation called Psychology Matters and I’m also a UKCP registered psychotherapist.

I was interested in the Times article that you referred to and the way that counselling was, basically, rubbished. One of the things that I’ve been extremely pleased about is the education element of this.

I really like the sound of the Marines model – people are given time so that there is assessment made as to what is the best form of treatment.

One of the problems I think has happened with recent traumas is people haven’t been given enough time to fully understand what has happened to them.

People need to understand the implications of biology, neuro-biology, on the impact on individuals and that can only happen through education.

Therefore, a lot of psychotherapists and counsellors now have to go through another learning curve so they understand these new implications that we now know about. I’m supporting the education.

Madeleine Beard: I’m from Marshmallow. A number of people have talked about the quality of listening. Cameron March, you said that peer groups were extremely valuable. It seems to me that by encouraging people, and a culture, to listen to each other, you give them permission to offload issues in a gentle, non-threatening and immediate manner so that it doesn’t build up in themselves.

Listening is damned hard work, but extremely valuable. It creates a humanity, and fosters humanity.

Duncan March: Three quick points. My name is Duncan March; I’m a director from Pilgrims Hostile Environment training.

First hostile environment training is merely a handrail for journalists to take into the field.

Online journalists who are very young - this is a new media that wasn’t around during the last Gulf War - who really want to get their name and their face on the map are particularly at risk. All hostile environment training can really do is provide a handrail for journalists in the field to avoid things like minefields and perhaps aid an injured peer or fellow journalist.

We’re trying to do that by having advisors in the field who are not seen as some ex-SAS steely-eyed dealer of death; they are someone who actually could be a front-line counsellor as well; someone that could be embedded in the media team. Everyone talks about embedding journalists into the military but what about trying to embed some of the military specialists into journalism?

Secondly, this war has been over the media in a massive way. It has been nasty in its expectation of chemical and biological weapons. Mark mentioned someone from BBC Monitoring being traumatised by the fact that they monitored the Sarajevo war from Reading. What media organisations have got to understand, when this war is over, is that this is not an example of a hostile environment; this is the extreme example of chemical warfare.

The truth is a hostile environment is also going to the Bradford riots as talked about earlier.

Thirdly. What we have found is that when those on our training courses come to the bar they relax and start talking about some of their experiences. They talk to the other consultants we have, and talk to us about our experiences; maybe the horrors we’ve seen, maybe the wars we’ve been in.

No-one does it in a way that’s brash bravado, but in a very subtle and humble way. It really is a way that people can relax.

MB: Time is almost up. I would just like Neil, Bruce and Frank to say a couple of words in conclusion.

NG: Whether you call it group therapy, or whether you call it getting round in a group and just having a drink or chatting, the ability to make sense of what has gone on in someone’s life, by reflecting off other people, is so important

That’s very different to debriefing, and making you express emotion you don’t want to. So certainly, in the Marines, part of what we teach is to make sure people do talk after the event to allow healthy ventilation. I would definitely go with that.

BS: All of you in this room, along with Mark and Sue, are now the seeds of a new network of working journalists, mental health providers, and others who are willing to support the idea of a culture of journalism in the 21st century that is in line with what we know about trauma.

This is the knowledge of what happens to people who witness and survive the worst things that people can do to one another. Keep talking to each other.

FO: I treat a lot of PTSD in extreme cases and I never see uncomplicated cases any more. It’s never pure PTSD, it’s always combined with other things.

What bothers me most when I’m dealing with journalists is those managers or publishers who don’t understand them, and who create, not a hostile environment but a work environment that belittles, demeans and ignores.

I think the antidote to that is to create the collegiality and the respect that we have among us in this room, and to hold up examples of good management.

The last thing we need are teams that don’t work as teams, and families that are dysfunctional families. So creating healthy work places is paramount.

Sometimes PTSD starts the discussion. It’s common ground, and all of us can relate to it. But the job is not one of treating PTSD, the job is one of becoming a civil society of peers – and when you work in teams that are functioning that way, it’s fulfilling.

MB: Thank you very much for coming. I’ve found this really stimulating and fulfilling. It has given me, Sue, and Frank and Bruce – and I hope all of you – a lot of ideas to take forward. This is the beginning of a very interesting period in journalism.

Dart is an umbrella, which I hope will bring in more and more of this kind of discussion. Thank you very much indeed.