When War Intruded into MS Research

Guest post by Anthony Feinstein

I am a clinician scientist and my primary research interest focuses on behavioral changes secondary to multiple sclerosis. Using structural and functional MRI, I search for brain changes that help explain cognitive dysfunction and depression, both commonly found in people with MS. So what has this to do with war? The answer relates to a patient who was referred my clinic at the turn of the millennium. She was a woman in her early forties who had presented in the ER with the sudden onset of signs and symptoms suggesting a stroke. She had difficulty speaking, was unresponsive to commands, and demonstrated limb weakness. Investigations, including detailed brain imaging, failed to reveal the lesion, and certain atypical clinical features that became apparent with time pointed to a different diagnosis, namely conversion disorder (formerly called hysteria). To cut to the chase, psychotherapy proved curative, the symptoms resolved, and the history that emerged after she had regained her speech revealed she was a war journalist who had experienced a rapid sequence of life threatening, traumatic events while covering a civil war-related famine in East Africa. She had never spoken of her distress while out in the field. It was only on her return to Canada and her subsequent emotional collapse that the degree of her sadness and despair became apparent.

She proved to be a fascinating patient whose profession had given her a ringside seat as history unfolded. Much as she loved her work, however, it was clear that it came with a considerable psychological cost. This observation sparked my curiosity and got me thinking about how frontline journalists as a profession coped with the grave dangers that came with war reporting. A quick search of the trauma literature revealed something surprising: not a single publication on the topic. To be sure, there was an extensive literature on veterans, police, firefighters, and victims of rape and physical assault, but nothing on war journalists. To come across a void like this in the psychological literature is, to put it mildly, unusual. Data abhors a vacuum, so I wrote a grant application and received funding from the Washington-based Freedom Forum. Eighteen months later, I was able to answer my question: war journalists were a resilient group, but resilience did not always confer immunity to psychological illness. Rates of PTSD and depression were significantly elevated relative to the general population and to colleagues who confined themselves to local reportage.

My findings were published in the American Journal of Psychiatry. The New York Times ran a story on the study, and I went back to my MS work. In reality, I had never really left it; fascinating as the war journalism study was, it had always been an addendum to my MS research. But, as any researcher knows, new data always ask new questions. No sooner had the war journalism data been filed way than the attacks of 9/11 occurred. How did domestic journalists, those who had made a decision to stay away from war and the bang-bang, cope when terror paid a home visit? A second study was needed and duly completed. And then came the invasion of Iraq and the question of how journalists embedded with the military fared compared to those who remained independent. A third study answered this question, which in turn begged another, this time focusing on those journalists who both lived and worked in zones of conflict. In this case, I completed a study of Mexican journalists, which revealed how their psychological health was being undermined by the drug cartels targeting their families. No sooner was this study completed than Lara Logan, the CBS journalist covering the Arab Spring, was sexually assaulted in Tahrir Square in Cairo, raising concerns about the vulnerability of women frontline journalists. Mining my burgeoning database, I was able to address the gender question, too.

And so it has gone on, for a world that is perpetually in conflict continues to present new and ever more serious threats to the physical and emotional well being of the men and women who keep us informed. For me, this has introduced a parallel stream to my research. The MS work continues, thankfully well-funded, taking advantage of new developments in technology to gain better insights into brain-behavior relationships that can translate into improved patient care. But now, running in parallel (and far less well-funded, unfortunately), is another avenue of inquiry, one that also has great relevance for the times we live in: namely, I am researching how we can ensure that the well being of the journalists who risk their lives to give voice to those dispossessed by war and revolution is not lost sight of. It is work that resonates globally, to judge by the volume of correspondence I receive from journalists, relatives of journalists, news organizations, masters and PhD students, novelists, playwrights, documentary film makers, and actors, all people who are taken with the importance and salience of an issue that will be with us for a long time to come.


feinsteinAnthony Feinstein is a professor of psychiatry at the University of Toronto and a Guggenheim Fellow. He is the author of Journalists Under Fire:  The Psychological Hazards of Covering War.