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Members and friends of ISTSS have a treat in store. Dangerous Lives, by Canadian psychiatrist Anthony Feinstein, informs and inspires. The book examines seasoned journalists who cover war, particularly those most affected by the work they do. You meet this remarkable breed of professional witness; you are transported to memorable and forgotten zones of conflict; and you inhabit the personal space of those who document human cruelty. But more than that, you travel with a pioneer—an unusually gifted and motivated clinician/scientist. This book is Feinstein’s odyssey.

Dangerous Lives begins with an unusual case that piqued the doctor’s curiosity and caused him to curtail his clinical practice specializing in psychiatric care for people with neurological conditions.

“The woman had suddenly taken ill in a restaurant while dining with family and friends. Her husband had noticed her ashen appearance and the beads of sweat on her brow and nose. When asked what the matter was, she had been unable to reply coherently. Alarmed by his wife’s garbled speech, he had called for an ambulance. En route to hospital, the woman lapsed in and out of consciousness, and by the time she arrived in the emergency room it was feared she had had a stroke” (p. 1).

But she did not have a stroke, nor any other brain damaging condition. She was a mature, experienced foreign correspondent, and her assignments had been harrowing. Eventually, her armor cracked and her nervous system responded with an unusual posttraumatic consequence: a conversion disorder, rather than PTSD.

Feinstein was not a PTSD expert at this stage of his career, nor was he acquainted with the lifestyle of the battlefield journalist. But he did what any good clinician should do: He perused the scientific literature. Surely there would be some studies of journalists, trauma and posttraumatic consequences. Remarkably there was none. (There are several now—see www.dartcenter.org for details.) Finding none, Feinstein then did what few have the gumption and tenacity to do. He designed and conducted his own research to fill that void.

His carefully controlled study was released at conferences in London and Washington in 2001, published in the American Journal of Psychiatry in September 2002, and reprinted in its entirety as an appendix in this book. Using a relatively large sample (140) of the relatively small cohort of English-speaking war reporters and photographers with more than 15 years on the job, Feinstein discovered and documented this finding: War reporters have significantly higher rates of PTSD, depression and alcohol intake than media counterparts who are not battlefield correspondents (107 well-matched controls). The fact that the prevalence of PTSD among Feinstein’s cohort (28.6 percent) resembles rates for combat soldiers rather than civilians is not a trivial conclusion. It is neither an artifact nor a sampling error. It has profound implications for the media organizations that send reporters and photographers into emotionally hazardous duty, and for the men and women who choose to document the breaking of human lives.

In Dangerous Lives, Feinstein goes further, adding flesh to the bones of academic analysis. Following is his description of Anthony Loyd of The London Times: “[He] was estranged from his father, but wears a locket containing some of Kurt Schork’s ashes (a slain colleague)” (p. 93). “Loyd...reported in Bosnia, Croatia, Albania, Kosovo, Afghanistan, Nigeria, Ethiopia and Syria. But the conflict that stands out for him as the most dangerous was Chechenia” (p. 11). It was there that Loyd encountered a Russian woman carrying the leg of a dead relative. “Days later I could see that woman. Literally for several days after it, there was this serum of an imprint,” Loyd says. “I still think of the image very often. I certainly have not forgotten it” (p. 13).

Greg Marinovich, a free-lance photographer whose extreme experiences in South Africa are chronicled in the book, The Bang Bang Club, explained the dignity of working for Time magazine and the discomfort of working for Newsweek (p. 121). Feinstein uses Marinovich and other free-lancer’s stories to explore and explain the physical, emotional and existential dangers of this unaffiliated cohort’s work.

In a chapter titled, “War, Women, Wives and Widows,” Feinstein notes how in two instances, childbirth precipitated PTSD symptoms in veteran war journalists with no prior history of PTSD. One, unnamed, explained, “I started having, and still have to a lesser degree, intrusive memories of very violent events...They just flash into my consciousness. People getting killed...Having a child promotes a higher degree of empathy with the things that we have been covering” (p. 160).

A trauma scholar will appreciate the quality of PTSD evidence in Feinstein’s sample. Where his original study was quantitative (or “nomathetic”) his book is qualitative (or “idiographic”). He takes pains to explain his respect for his willing subjects—and the fact that most war journalists do not have PTSD, depression or alcoholism. Nevertheless, a few media critics have called him misguided for implying that their colleagues are less than sane and sound.

In sum, this is a well-written, interesting, important book for members of our field. It gives us good science, with humanistic and accurate appraisal of fellow investigators of trauma. It should inspire young colleagues to undertake similar investigations of people in professions at high risk for PTSD.

Frank Ochberg, MD, is a Michigan psychiatrist, Chairman Emeritus of the Dart Center for Journalism and Trauma, and the 2003 recipient of the ISTSS Lifetime Achievement Award.