Resilience and post-trauma growth

Research in recent years has begun to examine why some are able to remain resilient in the aftermath of psychological trauma—and why some seem to emerge healthier than before—rather than focusing only on the negative psychological effects of trauma.

In the Washington Post, Michael E. Ruane reports:

Although the shattering psychological impact of war is well known, experts have become increasingly interested in those who emerge from combat feeling enhanced. Some psychiatrists and psychologists believe that those soldiers have experienced a phenomenon known as "post-traumatic growth," or "adversarial" growth.

Ruane spoke with National Center for Post-Traumatic Stress Disorder director Matthew J. Friedman (a member of the Dart Center advisory council), who cited fragmentary evidence of a growth phenomenon but said (in Ruane's paraphrase) that "research on the issue has not been that extensive."

Ruane also spoke with University of North Carolina psychologists Lawrence G. Calhoun and Richard G. Tedeschi, both leading proponents of the post-traumatic growth theory. Ruane writes:

Both men stressed that growth is not necessarily a goal, nor is trauma "good." Calhoun said: "Post-traumatic growth occurs in the context of . . . suffering. We hope everybody who goes to Iraq comes back safe and sound and doesn't have any traumas to grow from."

The increasing attention being given to post-traumatic growth and resilience is reflective, Ruane writes, of recent research showing that "most people exposed to combat and other traumatic events do not develop chronic mental health problems."

"It used to be thought that virtually everybody who experienced these kinds of catastrophic events would go on to develop" PTSD symptoms, said Lt. Col. Charles C. Engel Jr., a psychiatrist at Walter Reed Army Medical Center in Washington. "That was kind of a post-Vietnam War assumption. What we've learned over time is that probably, on average, really about two-thirds to three-fourths don't develop PTSD."

Of course, a corollary of Engel's statement is that one-quarter to one-third of people who experience these kinds of events do develop PTSD.

An officer's suicide

Army investigators believe Col. Ted Westhusing, age 44, committed suicide in June 2005 near Baghdad. In Sunday's L.A. Times, T. Christian Miller tells Westhusing's story. Relying on "a copy of the Army investigation of his death that was obtained by The Times"—Westhusing's family declined to be interviewed for the article—Miller gives a detailed account of Westhusing's time in Iraq.

A professor of philosophy and English at West Point, Westhusing volunteered for duty in Iraq in 2004. He wound up overseeing a private security company that was contracted to train Iraqi police corps.

Miller writes:

His friends and family struggle with the idea that Westhusing could have killed himself. He was a loving father and husband and a devout Catholic. He was an extraordinary intellect and had mastered ancient Greek and Italian. He had less than a month before his return home. It seemed impossible that anything could crush the spirit of a man with such a powerful sense of right and wrong.

The Army's investigation suggests that Westhusing began to encounter emotional difficulties after allegations against the company he was overseeing.

By June, some of Westhusing's colleagues had begun to worry about his health. They later told investigators that he had lost weight and begun fidgeting, sometimes staring off into space. He seemed withdrawn, they said.

His family was also becoming worried. He described feeling alone and abandoned. He sent home brief, cryptic e-mails, including one that said, "[I] didn't think I'd make it last night." He talked of resigning his command.

Related: A report from the Army Surgeon General's Mental Health Advisory Team-II (MHAT-II), released in July, found the suicide rate for Operation Iraqi Freedom soldiers during 2004 to be 8.5 per 100,000 soldiers, down from 18 per 100,000 in 2003.

The MHAT-II appears to have used a strict definition of suicide, however. The report notes that "Firearms were the only confirmed method of suicide for OIF soldiers in 2003 and 2004 with the exception of one drug overdose case in 2003." Some mental health experts believe that many friendly-fire incidents can be considered suicide, although it can be difficult for investigators to confirm such cases.

Also: The Dart Center has a tipsheet on covering suicide.

The case against torture

Several former CIA officers explain to reporter Jason Vest that they oppose the use of torture in interrogations not only because it is ineffective, but also because it is morally wrong. (Read the whole story in National Journal.)

One officer, Burton L. Gerber, "who retired in 1995 after 39 years with the CIA," tells Vest:

"The reason I believe that torture corrupts the torturers and society," Gerber says, "is that a standard is changed, and that new standard that's acceptable is less than what our nation should stand for. I think the standards in something like this are crucial to the identity of America as a free and just society."

Another officer, Merle L. Pribbenow, "a 27-year veteran of the agency's clandestine Directorate of Operations," worries about the effects of torture on the torturers:

"If you talk to people who have been tortured, that gives you a pretty good idea not only as to what it does to them, but what it does to the people who do it," he said. "One of my main objections to torture is what it does to the guys who actually inflict the torture. It does bad things. I have talked to a bunch of people who had been tortured who, when they talked to me, would tell me things they had not told their torturers, and I would ask, 'Why didn't you tell that to the guys who were torturing you?' They said that their torturers got so involved that they didn't even bother to ask questions." Ultimately, he said -- echoing Gerber's comments -- "torture becomes an end unto itself."

Pribbenow also said he was moved to write down his thoughts out of concern for the current generation of intelligence officers. "I don't personally know of any cases where an agency officer ever [tortured] anyone; that was always taboo, something we just didn't do," he said. "But I had been seeing stuff in the news, on TV, TV commentators, that sort of thing, in favor of torture, and I thought, 'I know there are a lot of new intelligence officers, new guys who don't have a lot of experience,' and thought maybe something like this will help them make their own decisions as to how to handle themselves in these situations, especially when people in authority are saying things that are unclear."

Another officer, Frank Snepp, who was the CIA's top interrogator in Saigon from 1972 to 1975, tells Vest that despite the power of moral arguments, many people in the community seem to find pragmatic arguments more persuasive:

"One of the big lessons for the agency was that the South Vietnamese torturing people got in the way of getting information," he says. "One day, without my knowledge, the South Vietnamese forces beat one of my subjects to a pulp, and when he staggered into the interrogation room, I was furious. And I went to the station chief and he said, 'What do you want me to do about it?' I told him to tell the Vietnamese to lay off, and he said, 'What do you want me to tell them in terms of why?' I said, 'Because it's wrong, it's just wrong.' He laughed and said, 'Look, we've got 180,000 North Vietnamese troops within a half hour of here -- I can't tell them, don't beat the enemy. Give me a pragmatic reason.' I said, 'He can't talk. He's a wreck. I can't interrogate him.' He said, 'That, I can use with them.'

"The important lesson for me was that moral arguments don't work," Snepp says. "But if you have pragmatic reasons, that will work. But the most important thing is that the only time you can be sure that what you're getting from someone is valid is through discourse. In Tai's case, the idea was to develop absolute trust, which you do not do by alienating and humiliating someone. He liked poetry; I brought him books of poetry, and in many sessions we sat and discussed poetry, nothing else. The most extreme thing I did was a disorientation technique, where I would keep jumping from one subject to another so rapidly that he might not remember what he'd told me the day before, or not remember that he had not, in fact, told me what I was saying he'd told me. Little by little, I drew him into revelations. And I was highly commended for this work."

Related: "Does Torture Work?"

U.N. resolution on journalist safety

A draft resolution that would help force governments to investigate killings of journalists was presented to U.N. Secretary General Kofi Annan at the World Electronic Media Forum in Tunis. Annan told the WEMF meeting, "The United Nations ... defends your right, as journalists, to be free from physical intimidation and harm."

The resolution was presented at the Forum by International Federation of Journalists (IFJ) General Secretary Aidan White, acting on behalf of the IFJ and the International News Safety Institute (INSI). The two organizations are trying to gather governmental support for the resolution to be put before the UN Security Council.

In his speech (read the full text here), Annan noted that:

the vast majority of journalists killed since 1995 did not die in cross fire, but were deliberately hunted down and murdered, often in direct reprisal for their reporting. I will continue to press Governments to uphold their responsibility both to create conditions in which journalists can do their job safely, and to bring to justice those who commit crimes against them.

Many governments allow such killings of journalists to go univestigated and unpunished. According to an INSI statement, "If adopted the resolution would give the Secretary General for the first time an opportunity to monitor how governments are chasing down the killers of journalists and to put before the Security Council proposals for further action." The resolution would also allow "governments who persistently refuse to track down the killers of journalists to be reported to the International Criminal Court."

Annan also urged journalists around the world "to find the words and images that will draw attention to the silent, daily tsunami of poverty, hunger, disease and environmental degradation."

More about Baghdad hotel bombing

Fort Worth Star-Telegram reporter Leila Fadel (see below) has written another first-person story about the bombing of the hotel where she and other journalists were staying. She writes:

We all lived, except for the man who made the cookies and pastries in the bakery.

Ali Abdul Salam walked to work as he always did that morning. But on Friday the white van, which breezed down a road that typically has an Iraqi police checkpoint, backed up to the blast wall as Ali walked up to an opening in the concrete. The blast took Ali and put smoke, fire and rubble in his place.

Maybe some of the burnt flesh that landed by the pool is his, or the foot in front of the hotel entrance or the arm found in the gym on the fifth floor. Or maybe they're the remnants of the bomber, who took his own life, Ali's and the lives of a little girl and her mother.

...

My employer, Knight Ridder, provides security for me as a Western journalist in Iraq. But Iraqis live each day on the dangerous roads of this capital city without the blast walls, guards and coiled concertina wire that protected me today.

NewsXchange conference roundup

Followthemedia.com has posted a summary of the recent TV NewsXchange conference in Amsterdam, including reports on sessions about "Trauma Support for Journalists" and "Journalist Safety in Conflict Zones."

Click here to read the report [registration required].

Baghdad bombers target media hotel

Fort Worth Star-Telegram reporter Leila Fadel describes the bombing of the Hamra Hotel in a memo to her newsroom posted today on the Star-Telegram website (reg. req.). Fadel writes:

Our hotel was apparently targeted and attacked today, according to military officials. One car bomb was meant to make a hole in our blast walls; the other was supposed to enter the complex and blow up.

Thank God the hole was not large enough to pass through and the second bomb detonated in the same spot.

At first, I thought they were targeting the Ministry of Interior after Sunni prisoners were beaten and starved in a secret jail behind our hotel. But American troops said there was no question that we were the target.

Journalists in Iraq killed, imprisoned

Journalists in Iraq continue to face threats of imminent death, imprisonment or kidnapping. Statistics show the Iraq War to be far more deadly for media workers than the Vietnam War or World War II.

Boston Globe reporter Farah Stockman summarizes statements made yesterday by Reporters Without Borders and the Committee to Protect Journalists. Stockman writes [registration required]:

The Committee to Protect Journalists says 58 journalists and 22 media workers -- which includes support staff such as translators and drivers -- have been killed in Iraq since the beginning of the war in March 2003. An estimated 66 journalists were killed covering the Vietnam conflict over two decades, and an estimated 68 during World War II.

In Iraq, insurgents are believed to be responsible for the deaths of at least 34 journalists, including five Iraqi reporters killed in the city of Mosul by unknown gunmen.

The circumstances of many deaths are unknown. But 13 deaths came at the hands of the US military, according to an analysis by the Committee to Protect Journalists, which filed Freedom of Information Act petitions on the military investigations of the deaths.

Reporters Without Borders has counted at least 10 journalists killed by US forces.

Most of those killed were Iraqis, who are playing an increasing role for Western news outlets because of the security risks.

Stockman notes that five journalists are currently in US military custody. She cites the killing of Reuters cameraman Mazen Dana as an example of the perils faced by Middle Eastern journalists in Iraq:

Several military investigations have found the soldiers' actions justified. For instance, in August 2003, US troops shot Mazen Dana, an award-winning Palestinian cameraman for the Reuters news agency, after he had received US permission to film outside Abu Ghraib prison near Baghdad. A military investigation said the soldier who shot him acted reasonably, noting that the soldier saw a man with "dark skin and dark hair" and mistook his camera for a grenade launcher.

VA Cancels PTSD-Claim Audit

The Department of Veterans Affairs announced last week that it won't audit 72,000 PTSD-compensation claims. The VA had suspected some of the claims to be fraudulent, but after a review of a random sample of PTSD-claim files, the VA announced:

"We have now just completed our own careful review of those 2,100 files cited in the IG's report," said the Honorable R. James Nicholson, Secretary of Veterans Affairs. "The problems with these files appear to be administrative in nature, such as missing documents, and not fraud."

"In the absence of evidence of fraud, we're not going to put our veterans through the anxiety of a widespread review of their disability claims," Nicholson said. "Instead, we're going to improve our training for VA personnel who handle disability claims and toughen administrative oversight."

The VA had earlier drawn protest from veterans groups and lawmakers with its announcement in August of its plan for an across-the-board review of PTSD disability claims. AP reporter David Hammer writes:

Sens. Dick Durbin and Barack Obama, both D-Ill., called for the initial inspector general's review when they learned Illinois veterans were receiving fewer benefits than veterans in any other state. The senators said there appeared to be a higher threshold for accepting PTSD claims in Illinois.

Obama said they were disturbed that the VA, rather than looking at why some veterans' claims weren't accepted, sought cause to nullify existing benefits.

"We thought it was wrongheaded and the amount of anxiety caused by this review was significant," said Obama, although he is still concerned about the PTSD benefits discrepancy in Illinois. "We stopped the VA from going backward, but we still need to move forward."

The notion that a large number of veterans are fraudulently collecting PTSD disability benefits is one that is easily called into question with publicly available statistics. For example, as of September 2004, according to a VA fact sheet, 161,028 Vietnam veterans were receiving PTSD-related disability payments—a number that represents about 5.1 percent of the 3.14 million soldiers who served in Vietnam. If fraudulent claims of PTSD were a significant problem, one would expect the percentage of veterans actually receiving benefits to be much higher. If one assumes that the estimate given in the 1990 National Vietnam Veterans Readjustment Study is still accurate, and 15 percent of Vietnam veterans currently have PTSD, then that would suggest that there are more Vietnam Veterans with PTSD who are not receiving benefits (9.9 percent) than those who are (5.1 percent). In 2002, 65,154 Vietnam veterans (about 2.1 percent of the 3.14 million soldiers who served in Vietnam) claimed 100 percent disability for "Psychiatric and Neurological Diseases"—a broad category that includes physical brain injury as well as psychological ailments such as depression and PTSD.

Understanding Depression

Common preconceptions about depression are becoming outdated. Mental health researchers in recent years have found that depression can manifest itself strikingly different ways. Also, the disorder's symptoms seem to differ among men and women.

L.A. Times reporter Melissa Healy looks at new discoveries about how depression is experienced by men. Many men have suffered undiagnosed depression because their symptoms did not correlate with stereotypical notions of the disorder. Healy writes:

But today the diagnosis of depression is in the midst of a long-overdue makeover, as medical and mental-health professionals have come to recognize that in at least half of depressed men, the recognizable litany of symptoms don't really fit.

Some depressed men may be plagued by impotence and loss of sexual interest, but others may become wildly promiscuous. Many complain of depression's physical symptoms — sleep troubles, fatigue, headaches or stomach distress — without ever discerning their psychological source. Compared to women suffering depression, depressed men are more likely to behave recklessly, drink heavily or take drugs, drive fast or seek out confrontation.

Instead of acting like they are filled with self-doubt, depressed men may bully and bluster and accuse those around them of failing them. For many men, anger is a mask for deep mental anguish.

Tennessee School Shooting

Local coverage of yesterday's shooting in Jacksboro, Tenn., which left one school administrator dead and two more injured ...

Prosecutors seek to try shooter as adult—Knoxville News Sentinel [free registration required]

"School shooting 911 tapes released"—WBIR-TV, Knoxville, Tenn. [Follow video link to hear 9-1-1 tape excerpts ...]

"Campbell County schools closed, counseling offered"—WBIR-TV, Knoxville, Tenn.

Related:

"Covering Children and Trauma"—a Dart Center tipsheet for journalists.

Also: The National Child Traumatic Stress Network is a good resource for journalists who wish to learn more about the possible effects tragedy can have on children ... The School Violence Resource Center has a map of school shootings since 1996.

"Intimately acquainted with death"

It is well-known that reporters and photographers in conflict zones are often exposed to psychological trauma. It is often forgotten, however, that people back home in the newsroom face similar exposure.

After 18 months working with photos of death and destruction in Iraq, Chicago Tribune picture editor Jonathan Elderfield recently moved to the features department. "I needed a break from looking at dead bodies," he wrote Sunday in a first-person story. Elderfield describes the daily routine looking at images that, he says, "have left their mark on me emotionally":

My job for the last year and a half has been to look at every hard news photograph from across the world and nation that comes into the Tribune's photo system. I have become intimately acquainted with death in Iraq, mostly with the death of the Iraqi people. While there are more than 2,000 dead servicemen and women, there are many times more dead Iraqis.

Every weekday I have seen images of Iraqi dead or of grieving family members. I have seen exploded cars, pools of blood, terrified children, dismembered bodies, bodies in mass graves. My job is to sort through these images of the dead, dying and grieving and to decide what is a good picture, what is acceptable to publish in the newspaper--or what is too gruesome.

I have to make aesthetic judgments about images of death. I am not the final arbiter of what goes on the front page or in the main news section (that is generally a group decision, or ultimately decided by the paper's editor) but I am on the front line. I see every news image from Iraq that enters the newsroom.

So, although I haven't been to Iraq and have never served in a war zone, I feel that I very well may have seen more images of death in Iraq than most soldiers who have served there. I would never equate my looking at photographs of the dead with witnessing acts of violence in person; however, I know that Iraqi children die there almost every day.

Related: Last fall, the Dart Center held a discussion about the emotional and psychological effects of repeatedly viewing violent images at the Frontline Club in London. Several top journalists and news managers participated. (Click here to read a report on the discussion.)

Does Torture Work?

Erroneous information connecting Iraq and Al Qaeda—and used to bolster support for military action against Iraq—was likely the result of torture.

Newly declassified portions of a Defense Intelligence Agency report—released last Friday by Michigan Senator Carl Levin—show that DIA analysts had doubts about the evidence provided by an Al Qaeda member held prisoner by U.S. personnel. The New York Times' Douglas Jehl writes:

The document, an intelligence report from February 2002, said it was probable that the prisoner, Ibn al-Shaykh al-Libi, "was intentionally misleading the debriefers" in making claims about Iraqi support for Al Qaeda’s work with illicit weapons.

The story of al-Libi's capture and interrogation has been in the news before (as noted by Laura Rozen and Atrios). In June, Newsweek described al-Libi as "the subject of a bitter feud between the FBI and the CIA over how to interrogate terror suspects." The FBI favored "a carrots-and-no-sticks approach," the Newsweek report explained, while some in the CIA favored "bolder methods." After initially being questioned by FBI officers, al-Libi was handed over to the CIA and taken to Cairo, where he was apparently subjected to "bolder methods" and subsequently produced his false testimony about ties between Al Qaeda and Iraq.

In July's American Prospect, reporter Jason Vest (a 2003 Dart Ochberg Fellow) took an in-depth look at the FBI's approach, interviewing retired veteran FBI agent Jack Cloonan. Vest writes:

Based on his experiences interviewing Islamist radicals everywhere from New York City to Khartoum, Cloonan believes that interrogations can gather intelligence that’s both operationally actionable and court admissible (“nothing that shocks the conscience of the court,” as he puts it), and holds that torture -- by hands American or foreign -- is rarely ever useful or necessary. Cloonan and a New York Police Department detective secured actionable intelligence from a suspect in the foiled millennium-bombing plot in just six hours on December 30, 1999 -- by following FBI procedure, and by encouraging a suspect to pray during his Ramadan fast. The suspect even agreed to place calls to his confederates, which led to their speedy arrests.

Cloonan cited al-Libi's case as an example of "how uninformed and counterproductive notions have come to dominate the post–9-11 environment." Cloonan told Vest that FBI agents were getting good results using non-coercive methods—"... they start building rapport. And he starts talking about Reid and Moussaoui. They’re getting good stuff ..."—but then the CIA took over:

What Cloonan’s agents told him happened next blew his mind. “My guys told me that a Toyota Tundra with a box in the back pulls up to the building,” he recalls. “CIA officers come in, start shackling al-Libi up. Right before they duct tape his mouth, he tells our guys, ‘I know this isn’t your fault.’ And as he’s standing there, chained and gagged, this CIA guy gets up in his face and tells al-Libi he’s going to fuck his mother. And then off he apparently goes to Cairo, in a box.”

Cloonan says CIA officials he later spoke with furiously denied al-Libi was actually put in the box. But he seems to consider this at best a matter of hairsplitting, as there was no question as to what kind of situation al-Libi was being delivered to in Egypt.

Related: From May 2004, a Dart Center article, "Bad Apples, Bad Command, or Both?" looks at the psychological roots of atrocities. Experts on war crimes and war psychology discount the notion that abuse and torture of detainees at Abu Ghraib was the work of a few "bad apples."

Anthony Feinstein Wins Ochberg Award

Canadian psychiatrist Anthony Feinstein, author of Dangerous Lives: War and the Men and Women who Report It, has won the 2005 Ochberg Award for Media and Trauma Study.

The award, administered by the International Society for Traumatic Stress Studies (ISTSS), is named for Dart Center founder and executive committee chairman emeritus Frank Ochberg. Feinstein received the award November 5, at the ISTSS annual conference in Toronto.

An extended interview with Feinstein will be posted at dartcenter.org later this week.

Times-Pic staffers back in New Orleans newsroom

Two months after Hurricane Katrina, New Orleans Times-Picayune journalists are busy covering their city's recovery—and personally dealing with insurance adjusters and roofers and contractors.

Times-Picayune Editor Jim Amoss recently spoke with Editor and Publisher's Mark Fitzgerald, who writes:

But three weeks after the paper's return to New Orleans, Amoss added, the stress "is every bit as great as it ever was" during the storm, including the staff's now-famous evacuation to Baton Rouge in circulation trucks as floodwaters rose around the newspaper building.

"In the beginning, it was the stress of not knowing what ever happened to your house or your car," he said. "Now, it's the stress of, what am I going to do? Should I demolish my house? And if I do, is it going to have to be raised on 10-foot piling?"

Related: In the October/November issue of American Journalism Review, Times-Pic reporter Brian Thevenot describes the post-Katrina "Apocalypse in New Orleans."

"Killing the Messengers"

Last week, journalist Mark Danner appeared on On the Media and spoke with co-host Brooke Gladstone about the recent bombing by insurgents of the Palestine and Sheraton Hotels in Baghdad. The hotels are the well-known home to many foreign correspondents in Iraq. Danner, who recently stayed at the compound that houses the two hotels, told Gladstone:

It is probably, with the exception of the Green Zone itself, the most highly guarded site in Baghdad. And there's no way you can attack the Palestine and the Sheraton without knowing that you're attacking a key point of the foreign press. So it seems to me that one of the things they were probably trying to do is get maximum amount of attention by bombing this particular target. And, of course, it did get enormous coverage.

Danner also commented on the difficulty of reporting in Iraq and journalists' increasing reliance on the internet for gathering information:

Well, that is true that various groups in the insurgency do have direct access to the Internet. And the press itself, as the direct access that they have on the ground has become increasingly constrained, has relied on the Internet to get news of what's happening, to see the announcements that Zarqawi and other groups make claiming responsibility, and also, in some cases, to use videotapes of attacks, which are very frequently put up on the Internet by these groups. So it's true that the monopoly on information that the traditional press has had has now been broken.

Threats against press in Columbia, Iraq, Russia

In the latest edition of Dangerous Assignments, Chip Mitchell reports on the state of journalism in Columbia. Mitchell writes:

Interviews with three dozen news professionals show that media outlets and journalists across the country routinely censor themselves in fear of physical retaliation from all sides in the nation’s conflict.

At least 30 Colombian journalists have been murdered over the past decade for their work. “We love our profession, but we’re human,” says Carmen Rosa Pabón, news director of Voz de Cinaruco, the Caracol Radio affiliate in the northeastern city of Arauca. “Threats and killings make us afraid. To survive, we have to limit ourselves.”

On some occasions, verified news is suppressed shortly before broadcast or publication. In other cases, probing journalists are killed, detained, or forced to flee. More often, investigations never even get started. The issues shortchanged are human rights abuses, armed conflict, political corruption, drug trafficking, and links from officials to illegal armed groups. Journalists end up focusing instead on “pleasant topics like fauna and flora,” says Angel María León, news chief of Arauca’s RCN Radio affiliate.

Elsewhere in Dangerous Assignments (a publication of the Committee to Protect Journalists), CPJ executive director Ann Cooper protests the U.S. military's imprisonment of local, frontline journalists in Iraq. Another report, by Nina Ognianova, examines a dozen contract-style murders of journalists in Russia.

Click here to download the PDF version of Dangerous Assignments.