When Calgary Herald reporter Michelle Lang was killed by an explosive along with four Canadian soldiers during a routine patrol south of Kandahar City at the end of December, it was a stark reminder of the risks taken by journalists in a war zone like Afghanistan.
Less well known are the considerable psychological hazards to which journalists and other civilians who go to war zones, such as doctors and aid workers, are exposed. Like soldiers, they frequently suffer from depression and post-traumatic stress as a result of bearing witness.
Anthony Feinstein, a psychiatry professor at the University of Toronto and the director of the neuropsychiatry program at the Sunnybrook Health Sciences Centre, is one of the world's leading experts on this kind of post-traumatic stress. It was an almost accidental outgrowth of his work on disorders associated with conditions such as multiple sclerosis or traumatic brain injury.
"I got sent a journalist to my clinic who looked like she had a neurological disorder," says Dr. Feinstein, who has a humble, scholarly air, in tweed coat and horn-rimmed glasses, speaking in a soft, authoritative lilt.
"She seemed as though she had had a stroke - she had aphasia and couldn't speak and looked comatose, but the tests and brain scans came back normal.
"It turned out she was a front-line journalist who had worked in the Sudan and elsewhere in Africa and had a conversion disorder - where emotional problems manifest themselves in physical symptoms."
At that time, in 1999, post-traumatic stress had been a recognized disorder for two decades and there was already substantial research on it in soldiers, firefighters, police officers and rape victims - but not journalists.
There were, Dr. Feinstein noted, plenty of memorials to journalists killed in the line of duty. But no one seemed to have asked how journalists and other non-combatants who work in conflict zones function emotionally.
He applied for a grant from Freedom Forum, a Washington-based foundation that promotes freedom of the press. With the help of a former CBC news editor there named John Owen, Dr. Feinstein recruited 140 journalists, each of whom had at least 15 years of experience in the field.
"I then got hold of journalists who did not do wars or disasters, to use as a control group," he says. They all filled out questionnaires, but with a smaller subset, "I conducted detailed interviews where I could tease out every sign of psychological difficulty."
The results were striking: At least a third of the war journalists had, at some point in their career, exhibited symptoms of depression, post-traumatic stress or both. And yet they were no more likely to seek psychological help than those who hadn't had symptoms.
"What surprised me," Dr. Feinstein says, "is that I didn't really know how dangerous this was - they had been shot at, had seen friends killed, had been subjected to mock executions. ... They weren't covering the war from hotel rooms, they were right there, and they were subject to high levels of danger and a remarkable amount of stress."
The fact that traumatized reporters, like traumatized soldiers, remain leery of seeking help has everything to do with the culture of journalism.
"There is this idea that you can just swan off to war, because you're a journalist, and everything will be fine," BBC correspondent Allan Little told Dr. Feinstein.
"But while soldiers are schooled in violence, and expect it, journalists go from ivy-covered liberal-arts programs and suddenly find themselves in Grozny."
The reckless, macho attitude is gradually changing: Both the BBC and CNN, for example, have taken Dr. Feinstein's studies seriously, and an increasing number of news organizations are taking steps to encourage journalists to get help.
He now frequently conducts "telephone therapy" sessions with journalists in the field, focusing on simple but helpful things such as sleep, hygiene, nutrition and maintaining relationships and a sense of balance.
The most important thing, according to Dr. Feinstein, is for people in these fields to be educated about the signs of trauma and for there to be a process in place to deal with it.
"You can't make things easier," he says. " But you can contain the damage - and being pre-emptive benefits everyone, from the journalists to their colleagues and families."
Three years ago, Dr. Feinstein attended the opening of an exhibition at the Canadian War Museum titled Canada At War. "When I saw the Afghan ambassador stand up and thank Canadians for all the sacrifices they were making," he says, "it suddenly struck me that the war had finally come home, and that you couldn't help but have a clear picture of its price.
"But even now, no one really talks about it in their everyday lives, and we don't really talk about it as a country."
Daniel Baird is a Toronto-based writer.