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The dozens of journalists killed while covering the current war in Iraq gives currency to the dangers encountered by those who bring us the news from the world's conflict zones. Despite the risks inherent in their profession, it is only recently that the psychological health of war reporters has been captured in a systematic and empirical manner.
War journalism can be a hazardous profession. The current conflict in Iraq has seen over 40 journalists lose their lives, while others have gone missing (International News Safety Institute, 2004). There is nothing new in this. Phillip P. Knightley (1975), in his history of war correspondents, noted that danger is ubiquitous and that many of the profession's finest have died in zones of conflict. Reporters Without Borders (<www.rsf.org>), an organization that keeps an eye on journalism safety, has a monthly bulletin in which a list is published recording the number of journalists killed, wounded or under arrest.
Given these facts, it is surprising that until recently, no research was directed at exploring the psychological health of war journalists. This dearth of information contrasts with a plethora of studies investigating how combat veterans (e.g., Lee et al., 1995), police officers (e.g., Robinson et al., 1997), firefighters (e.g., Turner et al., 1995) or accident survivors (Epstein et al., 1998)--among many others--have dealt psychologically with trauma.
Evidence that journalists are indeed affected by work in war zones can be found in the rich genre of the war memoir. Tim Page, who made his mark as a photographer in Vietnam has written of his suicide attempt (Page, 1988); Anthony Loyd has documented in painful detail his battle with substance abuse (Loyd, 1999); Greg Marinovich has written of his considerable psychological distress in the early 1990s as he photographed township violence in the run-up to South Africa's first multiracial elections (Marinovich and Silva, 2000). These are but three examples illustrating how war and danger may adversely affect the emotional lives of those who record conflict in word and picture.
Nature of Distress
Over the past four years, we have undertaken a series of studies to address the deficiencies in this literature. Our first study was an attempt to elicit the prevalence and nature of psychological distress in journalists who define their career by work in war zones (Feinstein et al., 2002). A list of 170 journalists from organizations such as CNN, the British Broadcasting Corp., Reuters, the Associated Press and the Canadian Broadcasting Corporation was obtained. Of this group, 140 (80%) agreed to participate. To control for the generic stressors of journalism, such as pressures attendant on timelines and obtaining the "scoop," a group of domestic journalists who had never been to war zones were also studied. Whereas the war group listed Bosnia, Rwanda, Chechnya, Iraq, Israel, Congo, Sierra Leone, Indonesia, Somalia, Ethiopia and Afghanistan as their work environments, the domestic journalists had confined themselves to local reporting in areas unscathed by war. Both groups of journalists had been in the profession for approximately 15 years.
There were, however, some significant demographic differences between them. The war journalists were predominantly male, and the majority were single or divorced. The domestic group had a more even gender distribution, and most were married. The mean age of both groups was similar, late 30s, and there were no differences in education.
Our psychological assessment was divided into two phases. In the first, journalists completed a series of questionnaires that looked at symptoms of posttraumatic stress disorder (Impact of Events Scale-Revised [IES-R]), depression (Beck Depression Inventory-Revised [BDI-R]) and psychological distress (28-Item General Health Questionnaire [GHQ-28]). Information was also collected on alcohol consumption and illicit drug use. Significant (p<0.01) differences between the war and domestic groups were noted across all these variables. Not surprisingly, war journalists endorsed significantly more symptoms of PTSD and depression (Figure). Their weekly alcohol consumption, for both males and females, was above the recommended medical guidelines (Bondy et al., 1999). Approximately one-quarter of both journalist groups used cannabis on a regular basis. Hard drug use was uncommon across all journalists, although the minority that used cocaine tended to come from those who covered war.
The second phase of the study involved a detailed, structured clinical interview with one in five journalists from each group. Using the structured clinical interview for DSM-IV, 28 war journalists were interviewed. Of these, all had been shot at numerous times, three had been wounded (one had been shot on four separate occasions), and three had had close colleagues killed while working together on assignment. Two journalists had been subject to mock executions, two had had bounties placed on their heads, one had survived a plane crash and then been robbed by soldiers who looted the wreckage, and two had had close colleagues commit suicide.
Seen within this context, the prevalence rates for PTSD were understandably high: 29% lifetime, 11% current and 4% prewar exposure. No control journalists were diagnosed with PTSD. Since PTSD, in all but one case, developed after journalists began working in war zones, this suggests a strong connection between the dangers confronted and the development of psychopathology. In this group, the high PTSD figure was matched by rates for major depression. Here, the lifetime rate of 21% was well above that of the 5% documented in the control group. This comorbidity between major depression and PTSD is in keeping with trauma studies from other populations (e.g., Bleich et al., 1997). Finally, substance abuse was higher in the war journalists, with over 50% of the group drinking to excess as defined by accepted weekly intake levels.
While war journalists show higher rates of PTSD and major depression and drink more heavily, our data revealed that they were not more likely to have received psychological help for these conditions.
Our data also allowed us to explore certain questions of interest to the profession. The first was to investigate whether a particular type of journalist was most at risk for psychological problems. Here, results illustrated that photojournalists had more symptoms of PTSD and a greater frequency of medical problems such as high blood pressure and peptic ulcer (Feinstein et al., 2002). Given that this group of journalists is exposed to the greatest dangers, these findings make intuitive sense. As a celebrated war photographer noted, "If your pictures are not good enough, you're not close enough" (Capa, 1999).
A second interesting observation was that freelance journalists who worked for large organizations on contract--without the benefit of medical insurance and pension plans--were more likely to show greater levels of depression and social dysfunction, as measured on the GHQ. This may be attributed to the relative isolation in which they worked, without support afforded their colleagues.
Covering Domestic Terrorism
This study took place in the immediate aftermath of the terrorist attacks of Sept. 11, 2001. A group of journalists based in New York who focused on domestic news were forced by circumstances to cover the aftermath of the attacks on the World Trade Center (Feinstein et al., unpublished data). What was notable about these findings is that three months post-Sept. 11, their PTSD profile was identical to that obtained from war journalists. However, one year following the terrorist attacks, these scores had returned to a baseline identical to that obtained from domestic journalists' pre-Sept. 11 PTSD levels.
This transient elevation in symptoms of intrusive thoughts, avoidant behavior and autonomic hyperarousal was not matched by an increase in depression symptomatology. Similarly, there was no transient increase in substance abuse. What we can conclude from these findings is that the profile of domestic journalists covering the Sept. 11 attacks bore superficial similarities to that noted in war journalists, but the range of psychopathology was significantly less and the distress documented was transient.
The Iraq Experience
A third, recently completed study has investigated how journalists have faired psychologically in the current war in Iraq (Feinstein and Nicholson, in press). One hundred journalists from a U.S. and a British television news organization were approached to take part, and 85 journalists agreed. They were equally divided into those who were embedded with military units and those who functioned unilaterally. This allowed us to explore whether embedded journalism (i.e., the process whereby journalists work under the protection of military units) is associated with an increased risk for psychological distress. Our data were collected within the first four weeks of the Iraqi conflict.
These data revealed that the exposure to violence and danger did not differ between the two groups of journalists. On average, each group had been exposed to three life-threatening events (with a range of 0 to 10). Consequently, the psychometric profiles of the embedded and unilateral journalists were virtually identical with respect to PTSD, depression and psychological distress. Of note was that PTSD scores on the IES-R were similar to those obtained in our first study, which predated the current Iraq war by four years.
These data illustrate that there is a consistency to journalists' responses across conflicts. Whether working in Bosnia in the early 1990s or the current conflagration in Iraq, journalists' emotional responses are consistent. They frequently endorse, in a consistent manner, symptoms of PTSD and, to a less extent, depression. What our data cannot tell us is how journalists are currently faring in Iraq. Anecdotal evidence suggests that the levels of danger have never been higher. With the constant threat of kidnap and execution, it would appear as though the profession has entered an even more hazardous phase.
Although some of the journalists did seek mental health care, there was no statistically significant difference between traumatized and nontraumatized journalists in the frequency with which they sought psychological help (Feinstein et al., 2002). Additionally, there are no data available to compare journalists to residents in the war zone.
In summary, our studies have provided empirical data for what might have been inferred intuitively. Journalists brave considerable danger in bringing us news of war. The data dent a longstanding myth that the profession has embraced, that one can enter a war conflict and emerge both physically and psychologically unscathed. This myth has perhaps been a necessary prerequisite to allow journalists to confront extreme danger. While it is germane to point out that the majority of journalists cope well with adversity, it is equally important to note a significant minority who do not. It is therefore imperative for news organizations to address the psychological health of their employees.
Good journalism depends on healthy journalists. For the general public to be kept abreast of important world events, it is essential that the news not be filtered through the emotional distress of the men and women recording history.
This work was supported by grants to Dr. Feinstein from the Freedom Forum and CNN.
Dr. Ghaffar is a resident physician in the department of psychiatry at the University of Toronto.
Dr. Feinstein is professor of psychiatry at the University of Toronto and a clinical and academic neuropsychiatrist at Sunnybrook and Women's College Health Sciences Centre.
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