In 2016, the renowned psychiatrist Anthony Feinstein was approached by Hannah Storm, director of the International News Safety Institute. She was concerned at some of the personal accounts she was hearing from journalists working on what was then known as Europe’s refugee crisis.
Feinstein pioneered the study of the effects of conflict reporting on the psychological well-being of journalists. Storm wanted him to conduct a new study looking at the impact of the refugee crisis on those covering it.
A professor at the University of Toronto, Feinstein’s previous work with reporters was turned into the documentary “Journalists Under Fire” which was short-listed for an Academy Award and won a 2012 Peabody Award.
The South African-born professor helped to broaden the understanding of the relationship between post-traumatic stress disorder (PTSD) and front-line reporting. But in the case of the refugee crisis, he was curious about the role that a less well-understood condition, “moral injury,” might be playing.
A concept familiar to the U.S. and other militaries involved in Iraq, the condition would prove to be prevalent among the journalists working on refugee stories who took part in the survey.
The resulting study, co-authored by Hannah Storm and Bennis Pavisian, was published by the Journal of the Royal Society of Medicine. Here, Feinstein discusses his findings and their wider relevance.
Refugees Deeply: Your study identifies moral injury as the chief risk for journalists covering forced migration crises. Could you explain what moral injury is and how it differs from terms more familiarly associated with stressful reporting, such as PTSD?
Anthony Feinstein: The straightforward definition is that moral injury is the injury done to a person’s conscience or their moral compass when that person perpetrates, witnesses or fails to prevent acts that transgress their own moral and ethical values or codes or conduct. It can come about in a number of ways.
You do something that you consider morally wrong. You witness something that you see as morally wrong, or most importantly, you fail to prevent something that you view as morally wrong. You see here acts of commission, things that you might do, but also acts of omission, things that you don’t do, but which you feel you should’ve done in retrospect.
This has particular relevance to the refugee crisis in Europe because many of these journalists were reporting on a very difficult story, very close to home. Often, these stories are covered far away from home, in countries far away from where you live, but now this is on your doorstep, whether it’s in Greece or Italy or Germany. In fact, this might be very close to your actual home itself, not just your country, but close to where you live.
How does your country respond? How do your fellow citizens respond? How might your neighbors respond or your friends respond to this huge influx of migrants? It’s asking different questions compared to previous work in which you fly off to a faraway country and witness things at a distance. Journalists saw things that they felt were morally reprehensible, and this upset them because it was sometimes their friends or their countrymen or the government who they faulted for this moral lapse.
It’s asking different questions compared to previous work in which you fly off to a faraway country and witness things at a distance. Journalists saw things that they felt were morally reprehensible, and this upset them because it was sometimes their friends or their countrymen, or the government, who they faulted for this moral lapse.
There was also the issue of how involved you personally get in what’s going on. I don’t think it was unique to the refugee crisis, but once again, I think it was given, perhaps, additional impetus because these were stories that were unfolding right on your doorstep, often within your society. Are you just a journalist? The journalists found themselves in very awkward situations.
There’s even one instance in which a journalist arrived in a situation in which there were all these dead bodies on the beach. The local authority, in the form of one man, had to move these bodies, and he asked the journalist, “Can you help?” Journalists aren’t there to become undertakers and move bodies, and yet there’s a moral obligation that perhaps they do something, and if they don’t do it, if they don’t follow through with it, it can lead to feelings of guilt.
The press, volunteers from Europe and locals who collect the equipment of the boats meet people arriving on Lesbos island in 2015 (NurPhoto/NurPhoto via Getty Images)
Refugees Deeply: Your paper is based on a survey of journalists working on the refugee crisis in Europe. Could you tell us briefly about the methodology behind the study?
Feinstein: I’ve used the same methodology over the last almost 20 years to try and reach a widely dispersed group of people, which the journalists are. I collect my data over a secure dedicated password access website with encrypted data. I establish a website for the study, the news organizations give me the email address of the journalist. I don’t collect any identifying data, so I don’t collect names.
The journalists are sent an email. They’re given a unique identification number to enter the site, and then they fill out questionnaires that relate to demographics, in this case moral injury, and also other potential psychological difficulties that might arise, such as post-traumatic stress disorder, depression, substance abuse.
I’m a quantitative researcher, in other words, I use numbers to assess behavior, and by that I mean the rate and scales for PTSD or moral injury, for example, are all number based. Individuals rate their responses according to a code, and then I go and analyze the numbers.
Refugees Deeply: What were the common complaints that journalists observed and what conclusions did you draw from these?
Feinstein: I think it’s important to emphasize a couple positives in that we didn’t see high rates of PTSD symptoms or depression, or substance abuse, which is obviously very good. And moral injury, which I think can be a significant problem, is not a mental illness. It’s very important to emphasize that. It’s not a mental illness.
It just speaks to, as the definition mentions, people feeling that somehow they’ve let themselves down morally, that they’ve transgressed their moral code, and the risk for that is that your emotions can change as a consequence, your behavior can change, and your thoughts can change, so we know this from the military.
In the case of journalists, they can become angry at their profession and walk away from their profession; in theory, they can view their organization in a very cynical light, they can view their news managers in a negative light. There are numerous potential consequences for moral injury.
Refugees Deeply: Many people will be familiar with your past work with conflict reporters. Could you comment on the main differences between forced migration reporting and conflict reporting in terms of its impact on those doing the work?
Feinstein: I think the big difference is – with the migration crisis, difficult as it was for journalists to witness – it really wasn’t a significant element of personal threat or danger, which really sets it apart from war reporting in a very substantial way. I think that’s probably the main reason why we didn’t find high rates of PTSD symptoms in this group.
Now, of course, witnessing people in distress can be a stressor for PTSD. Certainly, journalists, from time to time, were exposed to dead bodies or refugees who had died, and that can certainly count as a stressor for PTSD, but overall, you’re not seeing the level of death and terrible destruction that you witness in war zones, and most importantly, the element of personal threat is not there.
Refugees Deeply: Do you have recommendations for people managing journalists who are reporting on stories like this or for organizations approaching this topic?
Feinstein: The main purpose behind all this research is, “What can be done to help journalists?” Before you can start addressing that, you have to define what the problem is. This is just one study that indicates that moral injury might well be a problem for journalists. It would be good if others can replicate this.
The next question is, “Well, if you’ve now identified moral injury as a challenge for the profession, what can be done to address it?” I think there needs to be a discussion about this. I don’t think psychiatry can step into journalism and say, “Hold on. This is what you guys need to do.” I think where psychiatry can be helpful is to start and maybe facilitate a discussion and hear what news organizations have to say about this.
These issues need to be addressed and discussed in depth by journalists, by the news organizations, by managers before journalists go out in the field to do this very difficult work.
My personal view is that moral injury can be addressed proactively through education, that journalists need to have a very clear understanding of what their role is when they go and cover a story. They need to understand what’s expected of them, and news organizations should be able to define that. Similarly, they should be clear about what is not expected of them.
I think there’s a challenge that needs to be addressed with moral injury, which is often misplaced guilt. These issues need to be addressed and discussed in depth by journalists, by the news organizations, by managers before journalists go out in the field to do this very difficult work. I do think there are a number of things that can be done to mitigate against this. I think journalists understand what the issues are. Now there needs to be a discussion amongst them, hopefully with some input from people like myself.
The point that I keep on stressing about it is that this is not a mental illness. This doesn’t carry the stigma of a mental illness. I think in many ways that makes it easier for people to speak about it, come out and give their own personal experiences. These are issues that are not unique to journalists. These are issues that citizens are being confronted with now on so many levels, one just has to look at the moral vacuum in politics to become acutely aware of this.
This interview has been edited for length and clarity.