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Harper's Magazine | Di Giovanni Report Final 8.indd 64 6/17/20 4:11 PM REPORT ON MORAL INJURY Can a new diagnosis help heal our souls? By Janine di Giovanni n May 1999, Anthony Feinstein, a multiple sclerosis, studying how they “They told me there was nothing quiet South African psychiatrist respond to the disease. “I look at behav- published on the topic,” Feinstein re- Iworking in Toronto, received a dis- ioral changes,” he told me. “Their de- called. “I didn’t believe them. Because traught patient at his office. The pression, their anxiety, how a change in medicine, there is always something woman— Patient X— was a war reporter in patterns occurs. Basically I’m trying that comes before you.” who worked exclusively in conflict to understand their brains.” But the University of Toronto’s zones. She had just returned from a But the journalist with clear symp- medical library did not have a single particularly gruesome assignment, toms of post- traumatic stress disorder study on the subject. Feinstein was which had left her depressed and lethar- weighed heavily on Feinstein. He won- baffled: there was extensive scientific gic. Feinstein noted at the time that she dered whether her suffering might have data on firefighters, police officers, sol- appeared to be suffering from deep and been prevented if she’d had the right diers, and victims of sexual assault, sustained trauma. training before her assignment or if but a void when it came to reporters. During one session, after Patient X she’d been treated immediately after described her state of mind, Fein- returning. Could early intervention hough sometimes remembered stein asked whether she’d spoken to alleviate stress-induced depression? as a more peaceful time, the her employers about her condition. This was the late Nineties, and TNineties were full of blood- She recoiled. PTSD was not as widely researched as shed and misery. The decade was “If I told my bosses I was emotion- it is now. Most reporters and humani- marked by wars in Africa, the Bal- ally distressed, I would never get back tarian workers had not heard of it. kans, and the Middle East, often in- in the field again,” she explained in Feinstein’s knowledge of the affliction volving extreme violence carried out tears. She’d lose her job. Whatever she came partly from his background: he’d by paramilitary groups with little re- felt had to stay hidden. grown up during apartheid and wit- gard for international law. In the days Feinstein is a research psychiatrist nessed extreme violence. He knew before journalists started embedding who primarily focuses on patients with that soldiers returning from active with troops, those of us who reported combat suffered from PTSD, but he’d on these conflicts were free agents. Janine di Giovanni is a senior fellow at Yale’s never heard of a conflict reporter suf- There were no precautions in place to Jackson Institute for Global Affairs. Her new fering similar symptoms. He asked his protect us. Few reporters wore flak book, based on a report in the December 2018 issue of Harper’s Magazine, about the research team to compile studies that jackets or helmets; fewer had insur- persecution of Christians in the Middle East, might provide precedents, but they ance or security guards. When we will be published next year. came back empty- handed. heard news of a war, we jumped on a Opposite page: A police station in Freetown, Sierra Leone, destroyed by the Revolutionary United Front, 1999 © Riccardo Venturi/Contrasto/Redux REPORT 65 Di Giovanni Report Final 8.indd 65 6/17/20 4:11 PM plane and arrived cold, notebooks or especially dangerous, the group went cameras in hand. ahead. Schork and Moreno never Most of my colleagues were freelanc- came back. ers with no conflict training, and the violence in Bosnia, Chechnya, Soma- heir murder sent an earth- lia, Rwanda, Liberia, Sudan, the Congo, quake through our small tribe and other places was harrowing. Many T of reporters. The event also reporters were killed, many others per- motivated Feinstein to pursue his study manently injured. Several of my friends of war reporters and PTSD. He got the took their own lives. I was in Somalia names of one hundred and seventy war in 2002 when I got a call on my satellite reporters, one hundred and forty of phone and was told that Juan Carlos whom agreed to be interviewed, in- Gumucio, a much- loved Bolivian re- cluding me. Our responses to Fein- porter for El País, had killed himself stein’s questionnaires were compared with a shotgun. Years later, Gumucio’s with those of a control group. third wife, Marie Colvin, my colleague Feinstein was alarmed by the results. and friend, died during a rocket attack “I do not believe there is another profes- in Homs, Syria. sion that has more exposure to war than In 2000, I was working in Sierra your group,” he told me. While soldiers Leone during a particularly bloody often served one or two tours, he said, conflict. In mid- May, as Freetown was “You go back year after year after year about to fall to the Revolutionary to war.” Feinstein compiled a database United Front— a brutal paramilitary of more than a thousand frontline group whose signature was to cut civil- journalists and ians’ arms off at the wrist or elbow— I concluded that ran into my old friend Kurt Schork, the mean time who was on assignment for Reuters. It’s spent in war hard, even now, for me to explain how zones for career iconic Schork was to his colleagues. He war reporters was often described as the greatest war was nearly fifteen reporter of our time. years. “You and Schork came late to journalism— your colleagues he had been the chief of staff of New created a bubble York’s Metropolitan Transportation around your- Authority and a Rhodes scholar selves,” Feinstein alongside Bill Clinton— and he was in told me at the his forties when he made his name time. “You be- photographing Kurdish atrocities dur- lieved you were ing the first Gulf War. He was later neutral observ- sent to Bosnia, where I met him dur- ers, and you ing the siege of Sarajevo; he remained were immune in the city for five years. to harm. Even On Wednesday, May 23, I had din- though you knew more than one— ner with Schork in Freetown, and I often many— who had been killed. handed him a VHS tape that showed You created this bubble by saying, RUF members committing atrocities ‘We are okay. We are fine.’ ” against United Nations peacekeepers. I was relieved to find out that I He told me that the next morning he did not have PTSD; but it turned planned to drive to Rogberi Junction, out that most of my colleagues did. a rebel- held crossroads town northeast It showed: alcoholism, depression, of the capital, along with two other an inability to commit to partner- reporters and Miguel Gil Moreno de ships, and suicide were all symp- Mora, an Associated Press cameraman toms of untreated PTSD. and producer who was also among the Feinstein’s study was published finest in his field. to much acclaim in the September I had breakfast with Moreno before 2002 issue of the American Journal they left. We joked about frogs mating of Psychiatry. Aided by former in the abandoned hotel where we were CNN London bureau chief John staying. Though there were reports Owen, Feinstein shared his results that the road to Rogberi Junction was with newsrooms around the world Top to bottom: Kurt Schork helps a boy after a mortar attack in Sarajevo, 1992 © Reuters. Photographer James Nachtwey offers water to a man in Rwanda, 1994 © Scott Peterson/Liaison/ Getty Images. Kummu and Abu Bakarr Kargbo, who were attacked by the Revolutionary 66 HARPER’S MAGAZINE / AUGUST 2020 United Front, in Freetown, Sierra Leone, 2005 © Yannis Kontos/Polaris/Panos Pictures Di Giovanni Report Final 8.indd 66 6/17/20 4:11 PM to persuade editors to pay attention to refugee crisis. The flow of people es- Feinstein built on Shay’s work, their war correspondents’ trauma. Most caping wars in the Middle East, in studying moral injury among conflict of them did. His work became a refer- particular the civil war in Syria, was reporters. In 2016, he began an initial ence point for CNN, the Associated the largest such displacement ever report with the journalist Hannah Press, the New York Times, the BBC, documented. More than one million Storm for the Reuters Institute, inter- and many other news organizations to women, men, and children attempted viewing eighty reporters on the mi- develop conflict- reporting protocols. to cross the Mediterranean to get to gration beat. He found that Europe— and more than 3,700 are n the two decades since Feinstein estimated to have died in the effort— moral injury rather than PTSD or began studying trauma, PTSD in that year alone. depression emerged as the biggest has transformed from a relatively Unlike Feinstein’s earlier subjects, psychological challenge confronted I by journalists covering the migration obscure diagnosis into a cultural the reporters covering this humanitar- crisis. Good journalists will of ian catastro- course feel moved by the migration phe were not crisis, but they cannot fix it and themselves at should not attempt to do so. Guilt, risk; they were which is often misplaced, can be a not getting faulty motivator of behaviour. So too shot on the can moral injury. front lines. But he found Moral injury and PTSD can occur that a sense of together— this is not infrequent— helplessness— but they are two separate phenom- the inability ena.
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