Day Two, Panel Four: The Psychological Impact of Covering War Crimes

Moderator/Discussant: Frank Smyth, Washington Representative, Committee to Protect Journalists

Dr. Anthony Feinstein, University of Toronto, Sunnybrook Medical Center

DR. FEINSTEIN: Time does not heal. It doesn't go away by itself. It's also associated with other mental disorders as you've heard from Frank. And you have to be careful that you don't miss picking up clinically significant depression, other anxiety disorders, substance abuse. Bearing those things in mind, there's a very large literature devoted to PTSD, secondary to war or to man-made disasters or to natural disasters. But when you do an in-depth research on the behavioral science literature, and that in talking about med-line searchers and psych literature research going back to the second World War, there is no empirical data devoted to your profession. There is no data showing how journalists respond to war or to stressful situations. It's something about your profession. At the same time, as a researcher you have to be conscious of not over-diagnosing because it's bad to miss a diagnosis, but you don't want to mis-attribute a diagnosis as well because people can get labeled.

And when you are undertaking a research project you start becoming aware of the many issues involved. I just want to briefly share with you an anecdote. In the early 1980s when I was freshly out of medical school, I got conscripted against my will and got sent as a medical officer to the war in Angola, northern Namibia. And I was with a group of 18 men. I was the medical officer who had to not attend to the psychiatric needs, but to put the pieces together. And I had the foresight to realize that this was a unique chance to document in-depth the way people responded to stress. And each night before the blackness of an African night descended on one -- and there's not much dusk in Africa -- I would go around and just document the phenomenology of what the men were experiencing. And of the 18 men, all but one had the intrusive and the avoident phenomena that Frank has spoken about, and at times the autonomic arousal. But -- this is the important point -- the men were functioning quite well. The exception was the commanding officer, who during the day functioned extremely well, but at night, when the blackness of night came on us and we were trying to sleep, he would have these most appalling nightmares and yell out commands in his sleep and cry like a child. And the men would come to me and say, “Doctor, do something.” Well, what can you do in the middle of the African bush? And I would go and wake him up and he would say to me, “Well, why are you waking me up?” And sunlight would come and he would function extremely well. And I would say to myself, “Does this man have PTSD? He's got the intrusive recollections, certainly at night, and yet during the day he's functioning quite well.” And the point that I'm trying to make is that you might have some of the symptoms of PTSD, but you might not necessarily have the disorder. And you have to be very careful from a research perspective to be accurate about making your diagnoses.

So, briefly, the research project which I'm undertaking with John Owen -- and I want to acknowledge John's invaluable support and his sense of nurturing this project because it could not happen without him -- we want to try and document empirically what you as reporters experience when you go off to war. And there are now a number of valid and reliable rating scales that can capture the phenomenology of post-traumatic stress disorder, plus, let's not forget, whether there's associated depression or anxiety and the extent to which substance abuse may be complicating the clinical picture. That can all be done fairly well through self-report questionnaires, but we want to take the study to another level and also have a look at face-to-face interviews with reporters because that makes your data connection more valid. And the idea would be to try and survey a wide variety of correspondents and then follow that up with face-to-face interviews with a subsection of those correspondents. And in that way we can also probe aspects of pre-morbid personality. What kind of person is this reporter and does that predispose him towards a particular stress reaction?

Then to put those findings into a proper context, we want to get a control group. And we have access to what I think is a very good control group in Toronto, which is a group of reporters who have never done combat or foreign reports. These are domestic reporters, people who report the local scene. And they will get the same list of questionnaires and the same kind of interviews and then we'll be able to run comparisons between the cases who are you as reporters and the control group who have not been exposed to the horrors of war.

A PARTICIPANT: Are the photographers included as well?

DR. FEINSTEIN: Absolutely. Yeah. Thank you for that reminder because we want to start with you. I think off of what I saw yesterday -- I think after that it's downhill. The study can answer a number of important questions. Number one, it will give you a baseline as to what's going on in your profession. To what extent are you stressed by your profession? You might not be. We can't make any assumptions. If you want to adopt the empirical approach to research, you started with a null hypothesis that says your not going to differ from the control group. And then you try and disrove the
null hypothesis to show that, in fact, you do differ. You're also able to answer a number of ancillary questions, such as what the effects of gender on people who go off and report war? Do females respond differently from males? What about the duration of time you've spent as a war correspondent? Does that protect you against stress disorders? Does it leave you more vulnerable with time? What about the effects of marriage? We know that marital status is often a good protector factor when it comes to other mental illness. For example, schizophrenia. But does marriage protect you from a stress reaction or does it in some way sensitize you to the possibilities of added loss, separation from your children and your wife? These are questions that haven't been looked at all in your profession and our study, if we get your cooperation as correspondents, has the ability to answer it.

Dr. Anthony Feinstein, Bio.
Associate Professor of Psychiatry at the University of Toronto and Director of the Neuropsychiatry Programme at Sunnybrook and Women’s College Health Science Centre.

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