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Anthony Feinstein is a professor of psychiatry at the University of Toronto and on staff at Sunnybrook Health Sciences Centre.

This year alone, five journalists have been killed in Syria, four in Ukraine and three in Gaza. Journalists working in countries that have historically been risky places for them, such as Mexico, Somalia and Iraq continue to be killed, kidnapped and intimidated.

These disturbing statistics, swamped as they are by greater societal suffering, prompt the question: How do journalists who cover war, revolution and disasters cope emotionally with what they witness and experience personally?

In trying to answer this question, the first point to make is that until recently, there were little empirical data to go by. Despite a considerable literature devoted to emotional trauma in veterans, firefighters, police and victims of assault and rape (to give but a few examples of groups studied), front-line journalists had received almost no attention.

The reasons for this oversight are many and complex, ranging from a belief that as objective, non-combatant observers, the profession was somehow protected from the violence that came with the job, to the carefully constructed derring-do persona of the foreign correspondent, an image that does not sit well with emotional breakdown.

News organizations also played a prominent part in fostering a culture of silence surrounding the psychological well-being of the men and women who they dispatched to conflict zones. There has never been a shortage of young journalists wanting to cover war, which meant that there were always ready replacements for those who were thought to lack the "right stuff." Front-line journalists knew this, and preferred to keep quiet about their suffering rather than making their distress known.

In a post 9/11 world, this has begun to change. In 2002, a study published in the American Journal of Psychiatry revealed that journalists who devoted their careers to covering war had rates of post-traumatic stress disorder and major depression that well exceeded those of colleagues who confined themselves to other subjects. The findings, a seminal shift from anecdotal to empirical data, were a wake-up call for the profession. A number of news organizations reacted positively to the results, setting up confidential counselling services for staff. But a decade on, many others remain far behind, sending their journalists into harm's way without any system for dealing with the emotional fallout.

To be sure, a sensible balance must be struck. While subsequent studies have confirmed elevated levels of psychopathology, most war journalists are highly resilient and do not suffer from PTSD or depression. Exposure to war can cause distress, but this is not necessarily synonymous with psychiatric illness.

Indeed, the finest war journalists, the ones who have done this work for decades, usually understand that war leaves its mark on them. The eloquent voice of BBC journalist Allan Little sums it up well: "Do not delude yourself into thinking you can swan in and out of other people's wars year after year and not be affected in some way," he tells colleagues.

The challenge for news organizations is to recognize when the effects of exposure reach a magnitude that warrants therapy. Having a skilled psychiatrist or psychologist on call is one solution.

Looking away, however, is no longer an option. Such neglect does the journalist a major disservice. Disorders such as depression, PTSD and substance abuse exact a telling toll on the journalists and their families.

Apart from the ethical issue of ignoring, minimizing or dismissing these treatable conditions, organizations do themselves and the public a disservice, too. Good journalism depends on healthy journalists. Having the news of war pass through the filter of a journalist's distress may distort the story.

"The reporter is the last bastion of truth," British foreign correspondent Jon Swain noted on the eve of the 2003 invasion of Iraq. If proper credence is to be given to these words, the time has come for laggard news organizations to address the possibility that some of their journalists carry emotional wounds from what they've seen and experienced.

Anthony Feinstein is the author of Journalists Under Fire: The Psychological Hazards of Covering War.

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