Few journalists, even veteran ones, know about psychological injury, a strange, invisible condition that is as widespread as it is taboo. But psychological trauma can pose a serious danger to a reporter’s health or even life, just as it can for combat troops, humanitarian aid workers and any other men or women working in the field in a major armed conflict or disaster.
The after-effects of a trauma that caused no apparent injury can, on return from the field, often be the source of disturbed behaviour, depression, insomnia, alcohol or drug abuse and health problems, as well as work, family or conjugal difficulties. Without treatment, a mental injury can lead to social exclusion, accidental death or suicide.
It is vital to respond to this danger by providing prior information, describing the symptoms, and distributing lists of specialists and institutions that know about this phenomenon. There is no protection, no mental equivalent of the bullet-proof vest, no real preventive measure. Journalists are alone when they are in the field, facing death. But good information can enable a journalist to envisage this form of injury, know its effects and be better aware of the condition and its solutions.
Good psychological preparation can help journalists to better manage their professional lives before and after working in a war zone. And psychological injury has every chance of being cured if it is detected and treated in time.Peu de journalistes, même confirmés, connaissent la « blessure psychique », ce mal étrange, invisible, aussi répandu que tabou. Pourtant, à l’instar des combattants, des humanitaires ou de tous ceux, hommes et femmes, qui travaillent sur les terrains de conflit ou de catastrophe majeure, le traumatisme psychique peut mettre gravement en danger la santé, voire la vie du reporter.
Post-Traumatic Stress Disorder (PTSD) is a combination of reactions or symptoms that can occur in someone after experiencing, witnessing or confronting a traumatic event causing death or serious injury or involving the threat of death or serious injury, which has given rise to an intense fear, feeling of powerlessness or feeling of horror.
Such an event may be an accident, violent assault, rape, hold-up, abduction, earthquake or flood. They are particularly common in war zones.
Anyone exposed to an event of this kind of intensity can develop the characteristic symptoms, which include :
- repeatedly reliving the event in one’s thoughts
- avoidance of situations that recall the event and dulling of general reactions (emotional numbness and anaesthesia)
- hyperactivity. Although individual variables may increase the likelihood of developing post-traumatic neurosis, the most decisive factor seems to the seriousness of the event experienced. If the trauma is sufficiently significant, it can develop in people with no predisposition.
We should explain that the term post-traumatic syndrome, neurosis or stress is used if the disorder has lasted for more than a month. In the first month, we talk rather of traumatic shock or acute stress.
2. How do you detect it ?
The person has been exposed to a traumatic event. The symptoms may appear in the first three months after the trauma but there may be a delay of several months or even several years before the symptoms appear.
The traumatic event is constantly relived in one or several of the following ways:
- Recurring invasive memories of the event including images, thoughts and perceptions that give rise to a feeling of distress.
- Recurring nightmares about the event that cause distress.
- Reexperiencing, the sudden impression that the traumatic event is going to recur or behaviour suggesting this, the feeling of reliving the event, illusions, hallucinations, dissociative episodes and flashbacks.
- An intense feeling of mental distress when exposed to internal or external content that evokes or resembles an aspect of the traumatic event (such as TV footage, noises, smells, sensations or anniversaries). Physiological reactions when exposed to internal or external content that evokes or resembles an aspect of the traumatic event.
- Persistent avoidance of stimuli associated with the trauma. Efforts to avoid thoughts, feelings or conversations associated with the trauma, efforts to avoid activities, places or people that arouse memories of the trauma, inability to recall an important aspect of the trauma.
- A marked decline in interest in important activities or decline in participation in these activities.
- A feeling of detachment or alienation from others.
- A blocking of feelings and emotions (including an inability to feel love, affection). The impression that one’s future is blocked (that, for example, one cannot pursue a career, get married, have children or lead a normal life).
- Presence of persistent symptoms: difficulty sleeping or disturbed sleep, irritability or anger attacks, difficulty concentrating, hypervigilance, exaggerated reaction when startled.
Recall of the traumatic event is often extraordinarily precise. People say they relive the scene as if they were there. The images, the memories of the screams and the smells seem more real than ordinary memories. These symptoms may be accompanied by physical or psychological symptoms of anxiety or panic, such as palpitations, accelerated heart beat, sweating, trembling or muscle tremor, shortness of breath, a feeling of choking of smothering, chest pain or discomfort, nausea or abdominal discomfort, dizziness, vertigo, light-headedness or the impression of fainting, fear of losing self-control or of going mad, fear of dying, sensations of numbness of tingling, shivers or hot flushes (from Diagnostic and Statistical Manual of Mental Disorders IV, Criteria of a panic attack).
“The trauma is a limpet stuck to the brain…At the start, its presence is silent and painless. But one day, a few weeks or even a few years later, the person is suddenly gripped by panic. Each night, the same nightmare makes him relive an identical scene that leaves him at the foot of the bed, horrified and sweating, a lost soul. He is aware of it, he fears it, he tries to escape it by drinking coffee or alcohol but nothing works. As soon as he closes his eyes, he is condemned to see this horror. It is a film loop, a computer bug, a mental prison cell in a high insecurity neighbourhood.”Jean-Paul Mari, Sans blessures apparentes, Robert Laffont, 2008 (in french), p. 113.
“He feels dead and yet he lives. It does not make sense. The person moves, talks and breathes although he has just confronted the moment of his death. His friends still treat him as someone like them but he is convinced he is elsewhere. He is no longer part of this world but is not yet in the other one. He is sure he is mad. His life no longer has any meaning as it is leading inexorably to the moment of his death… which he has already lived through.”Idem, p. 111.
“What with nightmares and flashbacks, the trauma is like a well-conducted guerrilla campaign that allows no respite. The patients remain on their guard between attacks, still trembling from the last one and fearing the next one. With their minds constantly at melting point, occupied by many scenarios, constantly brooding and distrusting everything, they jump at the least alert and panic when they feel threatened.”Idem, p. 115.
The illness resulting from a trauma can lead to seriously disturbed behaviour, the inability to continue working, psychiatric hospitalisation, massive abuse of drugs, medicine and alcohol, social isolation and even suicide. In most cases when the symptoms and problems persist more several months after the trauma, the passage of time does not result in recovery unless there is treatment.
3. How is it treated?
Breaking through the silence
- The Ancients said: “Death is like the sun, it cannot be looked at directly.”
- The trauma, or the traumatic image, is a vision of horror, an encounter with death, one’s own death. “I saw death, I saw myself dead, I died…”
The trauma is an “image” (sight, smell, sound, sensation) and by definition unspeakable. The trauma victim therefore lacks the words to describe this horror. And it is inaudible to others, who cannot bear to hear the unbearable.
The cure therefore above all involves breaking through the silence that encloses the trauma victim.
“The way out for survivors is to say nothing. The encounter with death cannot be told. It is unspeakable simply because the words for expressing it do not exist. All they have to do is let slip a few fragments to see the incomprehension in the eyes of the people they love. The trauma sullies the person who endured it. Drugs, alcohol and mutilation are just the start of the arsenal of self-rejection and search for oblivion.”Jean-Paul Mari, Sans blessures apparents, Robert Laffont, 2008, p. 116.
To achieve a cure, one has to be able to detect the symptoms of Post-Traumatic Stress Disorder quickly. There can be no denial. The taboo surrounding this illness must be broken. The silence and incomprehension that encloses trauma victims in their recurring nightmare must be broken. They must be pushed into seeing a specialist.
Rule: After exposure to psychological trauma, journalists must lose no time in consulting a psychiatrist aware of PTSD. If they do so, they have every chance of being cured and being able to resume working, with no lasting consequences and with their experience enhanced.
While actual prevention is not possible, it is vital to see a psychiatrist once or twice a year, depending on the intensity of the stories covered and the events experienced.
“There are no universal remedies, just individual cases. Everyone has their hidden story, their random events, and their forbidden memories. If the trauma victim is listened to, guided, encouraged and sometimes calmed with anxiolytics, he becomes fascinated by the troubles endured by this other self, an unknown treasure much more interesting than the obscene perception that torments him so much. The nightmare scenario that had until then been fixed and unchanging like a computer bug finally starts to evolve, transform and dilute its horrible image amid other scenes (…) With a bit more effort, the psychotherapy achieves its goal. The trauma victim is no longer wild and distraught like one possessed. Instead, he works like the little child who seeks to rejoin his brothers on the Planet Earth, to reenter the world of language. Words, magic words, have replaced the trauma. Words, magnificent words, have replaced the image.”Jean-Paul Mari, Sans blessures apparents, Robert Laffont, 2008, p. 283.