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

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

DISCUSSION

A PARTICIPANT: I'd like to disagree in part with what you and Sherry said. I think a lot of the onus falls on the editors. I think you turn around, you come back from these places, and the editors say, “Listen. We need a background profile on a feature and can you get out next week for the next crap hole?” There's no understanding among editors of this issue. And, finally, I think that there is some growing understanding among journalists. This is where I disagree with the both of you. I remember some years ago going back for one of these “come back and talk with us all” and I was jet-lagged and I was very, very itchy and I did what men never do. I said, “My skin gets very dry and I have to put cream on it once in a while.” And suddenly this confessional happened with all the men in the room. “Oh, I do too. Yes, I do too.” I started to talk about acute stress, having lived it with other journalists. And when I started to talk about that, they started to talk about it too. So, I think the journalists are willing to talk about it, they just need a push.

SHERRY RICCHIARDI: Well, I think they're talking about it -- if I could respond for just a second. I think they're talking about it, but they're not doing much about it. I asked in a room full of journalists like some of you , you know -- Ron and Steven and Gary and Nancy. I've asked how many of you have ever had formal counseling. No one did. And I haven't and I don't think, Frank, you have. So --

GARY KNIGHT: I'd like to ask Frank and Anthony if it's plausible to or if there would be any merit in establishing some kind of course, similar to say the Centurion course, that journalists who expect to work in these areas could go to prior to going to them to help them get through these problems on their own? I say this because very often you're on the road for extended periods. It might, in some cases, be several months. Certainly, in the case of say, John Burns, who is in Sarajevo, I believe, for about a year. Many of us spend several weeks on the road at a very minimum. One of the ways the photographers get through this, is we generally, there's a very small number of us to start with, and we travel with each other, we're intimate friends, and you discuss these problems as you confront them. And I'm just wondering if that was plausible and if there was any merit in the notion?

FRANK OCHBERG: There are several things underway. Peter Hunter, who is Chris cramer's colleague -- and we're so glad that Chris supported his activity in developing the first briefing programs for physical vulnerability for the BBC in the field -- and he is beginning to put those elements into the briefings for the members of that industry. So one way to go about it is through a particular industry, but you're a freelancer. How would you do it as a freelancer? The vice president in America of the National Press Photographers Association, who like Frank Smyth was a Dart fellow, David Hanshoe is beginning to develop these kinds of packages and programs for the members of his profession. And they are cooperating in a different survey of PTSD and stress symptoms that they've gotten on the job. I think it makes all kinds of good sense. The State Department does it with some of its people going out in the field. One of the best units in preparing for deployment has always been the United States Peace Corps, where the rate of mental illness and emotional distress is below that of the general population on the job because of the kind of peer selection, peer counseling, and orientation to these sorts of distress that come up. Let me mention the society that bring together the experts internationally in traumatic stress. It's called ISTSS, International Society for Traumatic Stress Studies. And their website is istss.org -- I think that's it. We're developing ongoing relationships, we think it's very important for our colleagues in the media. So, I do want to hear your thoughts about what might go into such a briefing, but I think the interest is very much there and some things are already underway.

ANTHONY FEINSTEIN: I can just agree with that. And I think I'd like to highlight another potential difficulty, which is one that I've run into in the early stages of my study. And that's trying to get proposals through the Ethics Committee, because there are competing interests over here. Number one, the journalists want complete confidentiality with respect to their research, which is understandable. They don't want their results to be made known to people. They don't want their results to work their way back to their employers to show that, in fact, they may indeed have psycho-pathology. So you have to overcome that particular hurdle. But from the other side of the coin, the message I got from employers was that they don't want to leave themselves open to litigation. So, they are very, very careful about cooperating with any kind of study that increases the awareness of a problem or maybe even highlights a problem because this is the age of litigation and they don't want to
get sued.

So when you come to do your ethics form, and this gave me countless headaches, you've got to satisfy both parties. You've got to allow strict confidentiality, as you do with all research, but you have to put in a clause that says to the correspondent before they even take part in the study that this is entirely voluntary. If they agree or they don't agree, it won't make -- the news won't make its way back to their employer. Plus, they give a guarantee not to sue their employer if they end up with bad scores on their rating scales or whatever. So your idea is a good one, but I can see many roadblocks ahead from other people in terms of saying, “Well, hold on. We don't want a high profile for this.”

CHRIS CRAMER: Let me help you a little bit. Forgive me. I think we've got some considerable way to go before we get to your position. We have to make it okay to talk about it. It's not sufficient for any employer to say, “Oh, by the way, there's a kind of office round the back for basket cases when they come back from war zones. So, you know, if you want to nip in there, it's okay because we promise it's got darkened windows.” That's a copout. And, forgive me, I think the threat of litigation is a copout too because it occurs to me there's no difference in employers providing flap jackets and subjecting themselves to the risk of what happens to the people who don't wear them than providing counseling, voluntary counseling, for staff. Here's a practical suggestion. It becomes day seven of Centurion's course. Day six is safety, first aid, working in a hostile environment. Day seven is “Now listen. Some of you -- not all of you -- some of you may have some effects. Here are some of the effects you might have. If these happen to you, this is where you might go.” And that embraces freelancers instantly and immediately.

I started with BBC. I've been at CNN for four years now. BBC introduced safety and then, with some trepidation, introduced a voluntary scheme specifically not just for -- it went beyond what I call the “scheme for families of employees and employees.” In other words, it went beyond the type of counseling available for, if you like, troubles in the workplace. In other words, it was identified as more than that. CNN, at the moment, there is a scheme available for those who choose to ring. But the profile has got some way to go. But, I mean, BBC and CNN are light years ahead of the rest of the broadcast industry. Some of the print industry is doing quite well, thank you, if I'm marking them one to ten. Some of the print and broadcasting employers haven't even accepted the notion you should provide your staff with a flap jacket. So we have a hell of a long way to go.

TONY BORDEN: It's just at every one of these sessions somebody raises the point that I'll raise it then this time, which is local journalists. They have particular problems. They are part of the society, so they aren't coming and going, so they're there longer. But it also means that they haven't suffered differently. They've endured the same thing that everybody else has. Of course, they have many fewer, they have no resources whatsoever for dealing with it. I suppose everybody knows lots of Balkan journalist friends and I suppose most of them are actually, many of them are stopping journalism. As far as I can see are completely dropping out altogether. I've got some who are just absolutely just spacing out in all different havens. So I don't know whether that could be something, Dr. Feinstein, that could be an additional component to what you are looking at. I don't know how you'd do it and gather it, but if you needed any assistance, we would certainly collaborate. I know particularly some journalists, Russian journalists, covering Chechnya are absolutely knocked for six, that's for sure.

ANTHONY FEINSTEIN: I mean, what makes good research is to get a representative sample. So to ignore that would be a real negative mark on us. At the same time, it creates logistic difficulties, as well. And what intrigues me -- and this is not, God, forbid, a scientific point for me -- is Anthony Lloyd describes it eloquently as jumping off a speeding train. You come back from a war zone to where you live and you jump off that speeding train and you go to a bistro and do whatever you normally do. Now, there is a manifestly different issue of people who live there -- frightful, dreadful, and maybe their only recourse is to get out of the job. But the Anthony Lloyd “jumping off the speeding train” really brings it home to me. What it's like to conduct a conversation with your sister or brother and they say, “Well, how was it?” You say, “It was great, you know. Really fantastic. You know, all those corpses, they were really smart.” What do you say? Nothing. What do most people say? Nothing at all. Absolutely nothing

ROY GUTMAN: First of all, the Lloyd book is terrific. It goes through all of the aspects of stress, including substance abuse at great length. And I think it's a terrific confession, if you want, or just a self-examination. I wanted, though, to actually ask a question of another member of the audience. It seemed to me that among the other people who go through this stress or who go through it regularly as a professional obligation, it's the international community, the Red Cross people. Because they, literally, are in every conflict and that's their main job. And I wanted to ask Andre Pasquier if he could just give us some sense of how they deal with it because there might be some interesting carry over.

MR. PASQUIER: Oh, no. It's true that for ICRC delegates, we are exposed to this kind of problem almost permanently when we are on missions since we are posted in war torn countries, and usually for quite a long period of time. It could be -- we have had people, for instance, in Somalia for nearly three years without any break except for, what, maybe a few weeks of holidays every year. Or our situation, if I think of my colleagues who have stayed on in Rwanda during the genocide, where they were almost the only one left behind with a sense of, well, total outside -- being powerless to do much things. Doing little things and witnessing what was going on. All delegates go for that, for years the ICRC did just nothing. I personally have had a bad experience. For instance, I was in Cambodia during the fall of Nam Pan. It was a sort of a traumatic experience. And at that time, there was nothing. You had to cope with your own problems yourself. And usually we were sent to another mission right away, almost immediately, without break. Now we have introduced outside services and this problem is properly addressed in a systematic manner. And in the debriefings, this is part of the debriefing, so that people with problems could be identified and then advised.

FRANK OCHERG: And, Roy, if I might because I've been the debriefer. This was begun in the American Red Cross approximately six or seven years ago. So it's relatively recently. There is a mental health function. You have to be a licensed mental health professional to do this, but it's a whole range. It's not just psychiatrists. It's nurses, counselors who don't -- perhaps, they just have a two-year degree after college -- but all of us have been on assignments. The hardest assignment to do a debriefing on and to be on yourself in America is a plane crash. And that's just recently that the Red Cross does that. All of a sudden you're confronted with 200 people. You live in the hotel with them. They are suddenly bereaved. You go through imagining what it was like for that plane to go down and crash and everyone's decapitated. We go out with the morgue people, so we know what happens. It's a very, very hard scene.

The debriefing is very simple. And although I, as the mental health debriefer, have to put a check next to every Red Cross volunteer that comes out on that assignment, they're allowed to say that I don't want to do it. One in 20 or so says, “No. I know I don't have to do it. I'm not doing it.” You have them in a private room, although you can sometimes do three or four at a time. And you make it very, very user friendly. There's not a rigid set of things to go through, you just want to give them a chance to talk about what they've experienced. And if you get something flowing and something happened on the job, they will talk about it. You remind them, “I'm on the job with you. I've been there.” So it's not as though, as you wrote in your article, that we're people that have never seen the dead body or dealt with the issue. So very often our patients want to protect us against the images that they've seen. They don't think we can take it. So a little bit of reassurance on that score is good.

We get debriefed. And I want to tell you what happened the last time I got debriefed. The person who was debriefing me, didn't want to do it. I had been a mental health commissioner of the state, I think he had worked for me. Who was he to debrief me? I almost forced him to do it. And it was after a plane crash. I said, “Just ask me the questions.” And he asked a couple of questions. And before I knew it, I had tears running down my face. I don't know where this came from, but I was able to imagine my children dealing with my death. And it must have been something that happened from being at the plane crash. I have grown children. And, for whatever reason, this has never happened to me before or since. It was almost like pre-traumatic stress disorder. And I had quite a vivid identification with their feeling about me. And I, actually, I was grateful that I had forced myself through this debriefing because that was somewhere in me and had it not happened, I wouldn't have been aware of it.

I just want to point this out that it doesn't take very long. And if you have a certain amount of skill, you've been on these jobs, I think you can debrief reporters coming back. And it's not going through psychotherapy. If, in the course of this, what happens is you talk about a whole lot of other things and you have a whole lot of other symptoms, you know, between two adult people a bargain can be struck. Go see a specialist. But that sounds like something for your internist. And some kind of preventive work gets started.

STEVE LEHMAN: First, I have a comment and then a question. I think both in terms of what Dr. Frank Ochberg just said, I think that's real important and what Chris Cramer said about coming back and having a debriefing or counseling where it's like getting your laundry done, I think that's a really important issue to promote because, you know, if you look, if you analyze post-traumatic stress, the more someone talks about it, especially in those beginning periods just when they return, and the same way as a plane crash or, say, an Oklahoma City bombing, it's known that the people that get help originally, statistically do better in the long term. And so there is a definite stigma amongst journalists to go and seek counseling. But I think there's ways of institutionalizing that type of counseling. And even using the word “debriefing” versus counseling is one way of doing it. So I think, I really appreciate
what you're trying to do and I think you're on the right track.

The other question that I had, in referring to post-traumatic stress, there's the perception of there being dramatic symptoms. And I'm interested to hear what the two doctors have to say about the less dramatic symptoms. Symptoms that individuals might not be able to observe in themselves. And I think that's really important to look at. I mean, in the course of my work, I've been out in the field and I've seen people who have had post-traumatic stress. They shouldn't be there. And they're definitely in situations that have been beyond them and they need to get some type of help. But I've also seen a lot of people, and even in myself, where there's subtle changes. Maybe you're more impatient than you were before or you get angrier or you're attention span is less than it was before. And I was hoping that you might be able to talk about that because there are those subtle effects, not always these huge, dramatic things.

ANTHONY FEINSTEIN: I think that's right. I think there's a whole gamut of symptoms that people can present with from the pathomnemonic florid re-experiencing phenomena, the flashbacks, et cetera, that are immediately recognizable to the more subtle things, such as the withdrawal of social contact or not wanting to be with people or the irritability or the sense of, you know, life losing some of its pleasure. I think the avoident phenomena of PTSD can be harder to detect. Particularly amongst the person suffering from it. They're aware that something is different, but they may have difficulty articulating what the differences are. And that, of course, can lead them into a spurius conclusion that there's nothing major wrong, it's just minor. It's going to go away. So I think you do have to be sensitive to a whole gamut of changes.

FRANK OCHBERG: Let me mention a few minor symptoms. Just forgetting. The forgetting can take several different manifestations. One is, there's an important part of something that you just lived through and you can't recall it. A police woman killed a man in the line of duty, and she had to to save her partner. And she can't remember the gunshot going off. And that really -- it bothers her because she knows it happened and she's seeing me for a lot of other reasons and it's this concern she has about having a whole mind and being fit for something in the future. But because she can't remember it -- it shouldn't bother her that much -- yet, it troubles her in a small way. Difficulty with calculations. Someone has to go back to being the cashier at McDonalds and they can't add up the till. But she's past the horror and terror because she was raped there. But I have to work with her until that particular relatively small symptom is dealt with. Now, it may have other psychological meanings and it's what stops her from going back to the workplace, but that's a relatively small symptom.

I think we should distinguish between burnout, which seems to happen when you've been on the job a long time and when you don't feel supported on the job and you begin to get irritable and you lose your sense of humor, and PTSD. But they may go together. Particularly for the people in this occupation and in this room. But, you know, you don't have to make the same kind of research diagnoses that Anthony does. I think as long as you know the spectrum of symptoms out here that could get in your way, you could attack them in a proactive way and overcome them. That's the
lesson.

THOM SHANKER: Thanks. I have two comments since I've been on both sides of this question. Wearing my editor or management thug hat, I have to agree that these programs should be institutionalized because editors really are not in a position to say, “I think you should go speak to a counselor.” First of all because many of the misbehaviors you've described are so standard in our newsrooms, even among people who have never been in the combat zone then as opposed to alcoholism and substance abuse for which it's a much easier diagnosis to make by a layman or laywoman. This is much more difficult. So I think it has to be institutionalized to take that responsibility off the individual editor who really doesn't have the tools to do that.

As a correspondent, I have to echo what Mike and others have said that among ourselves of this generation, there's no shame in talking about this among ourselves, which I think really drives us to setting up some sort of working journalist group out of the editorial office. Funded, I don't know where, with complete anonymity, which I think you would have very terrific subscription to.

FRANK OCHBERG: Can I mention on that score, there is a group underway, and Chris and I are on the board of the group. It's called Coverage Unlimited. And a man up in Canada named Robert Frank is trying to put this together. To begin to refine the kind of outreach that could be available to people around the world and to vet those programs that would be better than others and perhaps to even have some teams that could go -- but it would be off, by, and for journalists with a few mental health people like myself as part of the development.

JOHN OWEN: I wanted to pick up on what Tony Borden said about local journalists and make you aware of a center, if you don't know about it, it deals with extreme cases of distress. But you should be aware of the medical foundation for torture victims in London. It's a remarkable center. And I met two Zimbabwe journalists there last year who had been tortured, you know, unbelievably by the Mugabe regime. And they have been helped enormously through the period of time they've spent there and it's run by a remarkable woman named Helen Van Berg. And they don't do only journalists, but they have done a lot work with local journalists and are very much worth a story or at least exploring. It's a tremendous resource in London.

A PARTICIPANT: I'm sorry. I said that we were talking those two days about death and life, about truth and lie, about crimes of war. And we heard a lot of stories from the journalists who covered the war all around the world. And this was what Chris just said, I almost got to have to duck because I was passing through everything what he was passing, you know. And I was thinking how our profession is really very hard and my question is considering not only PTSD, but all difficulties through which a journalist is passing through on his professional level, what is the average age of life of journalists on the international level and on this continent? Because I know that in some parts of Europe, it is 48. What is really -- have you ever talked about that? Have you ever researched something like that? And, also -- that is, one, my question -- and another question, also. If we are passing through all those trauma, you know -- Chris mentioned even paranoia, even a lot of the other things -- are we really able to conclude and to do our job in the proper way if you consider that our mental status and so on? I hope you got my point?

FRANK OCHBERG: I just now, I remembered a colleague at the London School of Printing, who had done a demographical analysis of journalists in the U.K., America, and Australia to look at age, gender. I don't remember the average age, but I do know that gender distribution is changing dramatically. Seventy years ago, every journalist in Britain was male and now, coming into the field is 50/50. So maybe there's hope.

CHRIS CRAMER: Well, let me try that one. Two things. I mean, first of all, do I believe that complete detachment from the story you're covering makes for fine journalism? Absolutely not. How could it? And, therefore, I think the notion that we are so detached, that we don't do that stuff, stress stuff, is absolutely dangerous. On the second question, which I think was the actuarial life span of an international journalists, well given the healthy state my Time Warner share options, I hope it's more than 52.

FRANK SMYTH: We have to wrap up. For anybody who didn't ask questions, I apologize. We won't be able to take questions again.

CHRIS CRAMER: If I could just make a quick reflection on the Centurion training side of things, one of the duties, which Paul has passed on to me in the last two and a half years, is the compulsory attendance as his chief instructor of attending the bar every evening between 6 o'clock and 11 o'clock. And it's noticeable when we have our PTSD presentation on Thursday evening, which at the end of the course, basically, is the clients have got used to us and we've got used to the clients. It's amazing how much attendance is actually at the bar that evening on Thursday evening. And what I actually find on Friday mornings quite often is because we've had the opportunity to speak to you all and likewise they've had the opportunity to really come forward having had the PTSD presentation, that a lot of the feedback we get from the clients is the fact that they actually enjoyed the PTSD presentation. But most of all what they got benefit from was the actual chance to speak about it and to present themselves in a way which, quite often, they hadn't been able to do on completion of an assignment or whatever the case is.

ROY GUTMAN: Thank you very much. I want to thank Frank and Sherry for organizing this. It was really their initiative that put this on the program and I am very grateful to them for it. I, of course, had to, like everybody else, I've been scraping my own mind and thinking, well, what are my symptoms. And I have to present one -- my wife is gone now -- which is that I found myself, if I was in a truly stressful situation, especially of my making or my own stupidity, that I wouldn't say a word about it when I got home. And I measured it once, how long it took me to start talking about it. And once I was in Mostar driving in an armored vehicle through the no-man's land and losing my way, just not having a good map. And this was something I might have done something about but I thought I could find my way. And driving around in it for an hour until I got arrested, thankfully, by the Croatians. And then they drew me a map and gave me the passes and, of course, everything worked out fine. But it took me a good six weeks before I could admit what had happened. And by that time, my wife didn't give a damn anyway. But definitely you wind up in situations that you wish you weren't in and they're very hard to cope with and you try to learn some lessons and one of the lessons is probably one should talk about it sooner.