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. When we spoke recently, Fein- to save people stein described moral injury as “a from drown- wound on the soul, an affront to ing, let alone your moral compass based on your alter the tragic own behavior and the things you conditions have failed to do.” In other words, chasing them rather than being triggered by exter- f rom t heir nal actions, moral injury comes from homes—­was the feeling that one has failed to live causing an- up to one’s own ethical standards. Of other kind of men- course, guilt and shame are common tal health crisis. responses to such failings, but moral He believed that injury occurs “only when symptoms these journalists get to a point of impeding a person’s were suffering from ability to function.” moral injury. One example of moral injury that Moral injury is Feinstein comes across frequently is not a new psycho- that of photographers feeling that logical concept. they benefited from the suffering of Jonathan Shay’s other people. He told me to picture a 1994 book Achilles lone photographer on a Greek beach in Vietnam: Combat focusing his lens on a boat full of ref- Trauma and the Un- ugees in the distance. Suddenly the doing of Character is boat capsizes. The photographer sees a classic study in the that most of the passengers cannot field. Shay began his swim and are beginning to drown. touchstone. People who don’t know career researching neuropathy, then “Do you wade in or do you call for the disorder’s actual symptoms confi- shifted to working with veterans who help?” He decides to do the latter. He dently state that they are suffering had ­PTSD, devoting his life to helping calls for help on his cell phone, and from PTSD­ after any number of un- them adjust to returning home. He continues to photograph the tragedy pleasant experiences. The widespread argued that PTSD­ was not an illness, in front of him. But his plea for help embrace of post-­traumatic stress as a but an injury: the “persistence of adap- is too late; many people die in the concept reflects its power not just as tive behavior needed to survive a stress- sea. Later he is lauded for his compas- a clinical tool but as a framework for ful environment.” He compared the sionate work. But guilt and shame how human beings process—­or fail to homecomings of soldiers in the Iliad gnaw at him for years. process—­trauma. with those of Vietnam vets, their dev- “The photographer who believes In 2015, Feinstein began interview- astated lives a result of fighting a war he built a successful career on the ing reporters who were covering the they did not believe in. back of others’ suffering is suffering

Top to bottom: A paratrooper hit by a mortar shell near Phnom Penh, Cambodia, in an attack that also injured Don McCullin, 1970 © Don McCullin/Contact Press Images. Migrants land on the island of Lesbos, Greece, after crossing from Turkey, 2016 © AP Photo/Santi Palacios REPORT 67

Di Giovanni Report Final 8.indd 67 6/17/20 4:11 PM misplaced guilt,” Feinstein told me. pressed . . . without “You can dissect the reasons you are phone . . . money there, but essentially you are there for rent . . . money bearing witness. In a sense, you are a for child support . . . contemporary historian.” money for debts . . . Over the years, I have come to money!!! . . . I am haunted by the vi­ know many war photographers, and I vid memories of have witnessed this phenomenon. killings & corpses The legendary British photojournalist & anger & pain . . . Don ­McCullin, now in his eighties, of starving or woun­ has told me repeatedly about his dis- ded children, of comfort with the times he chose to trigger-­ happy mad- continue taking photographs when men, often police, of he felt he should have been helping. killer executioners. In May 1999, I was in Kosovo with the photojournalist Alex Majoli re- “We are not social porting on the Kosovo Liberation workers,” the pho- Army when ­NATO accidentally tographer Corinne Dufka told me bombed the unit we were with. While during the siege of Sarajevo, when I pulled injured and dead bodies from I found myself emotionally drained the trench where we had been shelter- by the misery that confronted us ing, Majoli continued to photograph daily. “You are a reporter,” she said. the bombs falling from the sky and the “It is different.” But Dufka even- wounded soldiers. tually came to feel that the “You can always write about this moral responsibility that accom- later,” he shouted at me over the cries panied her war reporting was of pain and the roar of bombs. “I only too great. She walked away from have one chance to get the evidence.” her distinguished career at Re- Majoli’s work from that day is some uters to work for Human Rights of the finest war photography I have Watch, where she now runs the ever seen. And we’ve since talked West Africa division. about that question: Are we in the “It is a question of, How much field to bear witness to atrocities, to do you do?” Feinstein told me. document history, or to help people? “When you confront these ex- Schork was one of the few reporters I quisite dilemmas, you also ask knew who saw his role as a protector yourself: Why did I help this per- of civilians. When a shell landed in son and not that person?” Sarajevo, he would haul broken bodies Another aggravating factor of to his car and drive, through the ex- moral injury might be believing plosions, to the hospital. “It is what that your government—­one you human beings do,” he told me once. were brought up to trust—­is con- “Help each other stay alive.” tributing to the suffering you I often thought about Kevin Carter, witness. Many of the journalists a member of the Bang Bang Club, a reporting from the legendary group of four South African Mediterranean and photographers. One of Carter’s most the U.S.-­Mexico famous photographs depicts a starving border are working Sudanese child collapsed on the in their native coun- ground while a vulture hovers nearby. tries. An American Carter chased the vulture away, but he reporting on ICE­ of- was left shocked and full of sorrow. ficials separating The photo appeared in the New York desperate families at Times in March 1993. Carter won a the border may feel Pulitzer for the image. He killed him- doubly responsible— self four months after winning the and doubly helpless. prize, on July 27, 1994, at age thirty-­ three, leaving a note: f course, moral in- The pain of life overrides the joy to the O jury does point that joy does not exist. . . . de- not affect only war

Top to bottom: Kosovo Liberation Army soldiers, 1999 © Alex Majoli/Magnum Photos. Photographer Don McCullin in Hue, South Vietnam, during the Tet Offensive, 1968 © Nik Wheeler/Corbis/Getty Images. Kevin Carter 68 HARPER’S MAGAZINE / AUGUST 2020 photographing police firing on a protest in Soweto, Johannesburg, 1993 © Ken Oosterbroek. Courtesy Monica Zwolsman

Di Giovanni Report Final 8.indd 68 6/17/20 4:11 PM reporters. Soldiers who have wit- Feinstein believes that under- Another question is how we, as a nessed torture, including at Abu standing moral injury will be par- society, come to terms with Donald Ghraib, have written about their ticularly important in the aftermath Trump. What will be the long-­term moral injury. Doctors in Syria who of the pandemic, not just because of effect of feeling moral revulsion to- were unable to save the lives of thou- the number of people who are dying, ward our president’s behavior? sands of people while working under but because people are separated When I asked Feinstein this, he bombardment have also suffered from from their loved ones and unable to answered by first quoting ­FDR: “ ‘The presidency is not merely an administrative office . . . it is preemi- nently a place of moral leadership.’ This just highlights how far the presidency has fallen over the last eighty years.”

einstein’s moral-injury study is still in its early stages: he has F interviewed a new set of report- ers and that data is being analyzed. As in 1999, I am a participant. I recently completed my first questionnaire, and in doing so, thought back on my thirty-­year career in war zones. I thought of the people I helped, the ones I got out of cities under siege and burning villages, but also of the many I did not. I often felt like a vulture. But there are ways of protecting oneself. At Yale, where I teach a course about properly grieve. reporting on war and other catastro- “They can devel- phes (including pandemics), I begin op a whole host of by introducing my students to the mental difficul- concept of trauma. We simulate ties,” he said. He working in war zones, but I also speculated that teach them that those who spend medical person- hours looking at devastated cities nel might be es- through a viewfinder, or interview- pecially suscepti- ing victims of sexual violence during ble. “A position in wartime, or even those watching or which you can reading about it from a distance, are decide life-or- susceptible to the evil and darkness death issues like that surround conflict. this is an acutely Is it possible to repair a soul? uncomfortable Feinstein is looking at cognitive beha­ one to endure.” vioral therapy as one potential treat- And what ment for moral injury. In CBT,­ pa- it. Survivors of school shootings, pros- about the community at large? Will we tients seek to identify and alter ecutors trying cases that they know all suffer from moral injury given what irrational thought patterns. He be- will not see justice, and witnesses of we have witnessed during the pan- lieves it might be helpful for war re- police brutality can all experience demic? Feinstein thinks the predomi- porters who continue to agonize over moral injury. After the COVID-­ ­19 nant emotion will be anxiety, but that moments they can’t change. pandemic is brought under control, people will experience degrees of “I believe that we are a very resil- moral injury may be among the prob- moral injury. He told me to think of a ient species,” Feinstein told me. “We lems facing frontline health care hierarchy of suffering. Those who have have come through world wars and workers. These people have risked lost people they loved place at the top, previous pandemics, and we will of their lives to save others, but they and below them are those who lost a course endure here.” have been unable to save many oth- business or a chance to celebrate a life We have witnessed much tragedy ers. In some cases, they have had to milestone such as a wedding or a grad- over the past year. It has been historic, make decisions about who receives uation. “These too will leave their vast, overwhelming. Yes, we are resil- ventilators, who lives and who dies. mark,” he said. ient. But our souls are scarred. n

Top to bottom: João Silva, a member of the Bang Bang Club, photographing a car bombing in Baghdad, 2003 © Michael Kamber/New York Times/Redux. U.S. Border Patrol agents taking undocumented immigrants into custody in Texas, 2016 © John Moore/Getty Images REPORT 69

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