He is quick to point out that not all journalists who cover conflict are suffering; some return from the battlefield largely unscathed. That 29 per cent of war journalists develop PTSD, Dr. Feinstein notes, leaves more than 70 per cent who don’t. Likewise, 76 per cent of journalists do not develop depression. Many do not develop drinking problems. But the rates are still significantly higher than those in the general population and higher, for example, than rates for police officers, fire fighters and veterans who have not seen active combat.
It is truly a dangerous time for journalists: 900 have been killed covering combat in the past two decades compared to just two killed covering the First World War. “Iraq has been by far the most lethal conflict for journalists, with close to 200 members of the press killed so far. This number exceeds the mortality rate for journalists from World Wars I and II and the Vietnam War combined,” says Dr. Feinstein.
Whether steered by confidential help lines established by news outlets, or encouraged by Dr. Feinstein’s books, his documentary or his reputation, journalists are turning to him in increasing numbers. He responds, depending on the severity of their symptoms, with an array of treatment options including cognitive behavioural therapy, cautious use of medication and counselling. For those with full-blown PTSD or depression, taking a break is often his first recommendation. “If someone is acutely traumatized and in a war zone, my advice to them is, ‘You need to take a break from this and look after yourself,’” he explains. “That’s common sense; if you’re a long-distance runner and you’ve developed a fractured leg, you’re going to take a break from running.”
For those in remote areas, he will set aside an hour a week to counsel them remotely, over the phone; he has treated journalists this way for several months at a stretch. (The opening scene in Under Fire, for example, shows Reuters photographer Finbarr O’Reilly preparing for an assignment in West Africa by packing his flak jacket and calling Dr. Feinstein in Toronto.) For those whose problems turn out to be more acute, he recommends returning home – wherever home might be – to seek local expertise.
Graeme Smith, who covered the war in Afghanistan for The Globe and Mail from 2005 to 2009, visited Dr. Feinstein at his Sunnybrook offices as a precaution. “I wanted to get my head checked, to put it bluntly, and he assured me I’m not suffering from PTSD or depression,” says Graeme, adding that the session gave him a clear picture of what he should be watching for: changes in sleeping habits, relationships or appetites for food or sex. “He also told me to watch for any irrational avoidance behaviour, a tip-off that somebody can be scarred by a particular experience and unwilling to repeat it.”
But much of Dr. Feinstein’s work is more proactive than reactive, working with news outlets and journalists before problems arise.
In 2007, Dr. Feinstein designed and helped launch a confidential online self-help resource (conflict-study.com) that allows journalists to complete self-assessments of PTSD symptoms, depression, general psychological well-being and alcohol and substance use. Users receive immediate feedback that can be used to facilitate access to a family doctor or an employee assistance program for therapy, if needed.
And Dr. Feinstein spreads the word through in-depth educational seminars, such as the one he led at the New York offices of CNN in December. There, he offered a series of two-hour sessions in which he presented data from his research; explained PTSD, depression and substance abuse; and facilitated a Q&A. The format benefits journalists who cover conflict far from home, he says, but also those who cover domestic events such as 9/11 and Hurricane Katrina.
Perhaps the most unusual seminar he led was in Boston, by invitation from National Public Radio, which involved Israeli and Palestinian journalists across from one another at one table. “Interestingly, the issue of PTSD was very familiar to the Israelis, but it was a completely new issue among the Palestinians; they were fascinated by it,” recalls Dr. Feinstein.
He was a keynote speaker at the 2008 Journalism in a Violent World conference, part of the Canadian Journalism Forum on Violence and Trauma, of which he is director.
His message is sinking in, and Under Fire should help spread that message with screenings in New York, Los Angeles, England and Toronto. Canadian media are behind the curve, Dr. Feinstein admits, while organizations such as CNN are leading the way. “It’s people’s personal responsibility whether they want to look after themselves or not. The way you break through the barrier and convince people to take the issues seriously is through education,” he says. “And the culture is changing – and that’s been very rewarding.”
Changing, but still with far to go, as one journalist points out. “I'm stunned to hear that media professionals who have seen the film are shocked,” says the Toronto Star’s Watson.“Which tells me that even people in the business, who I assumed knew what we were going through, largely didn’t.”