Overexposed: A Photographer's War With PTSD

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"One of the truly great things about war ... is that all you have to do is survive."

PTSD6.jpg
Marines run for cover after white phosphorus was accidentally fired at them by another company in Falluja, Iraq on November 9, 2004. 
[Ashley Gilbertson / VII]

As Ashley Gilbertson crept up the dark staircase of a minaret in Fallujah, he hovered closely behind advance troops of the United States Marines. Stepping around and over the rubble created by an earlier shelling of the mosque, Gilbertson could hardly see the two soldiers in lead.

Moments before starting their climb, Gilbertson argued to be the first person in the room. He wanted to take first shot at the insurgent who used this holy perch to prey on advancing U.S. forces. However, Lance Corporal William Miller and his partner, Lance Corporal Christian Dominguez, would not back down, and they took the lead that November afternoon. As Gilbertson took to the stairs, his partner Dexter Filkins mounted the steps behind him.

Guns at the ready, the convoy had just crested the first flight of crumbling stairs when gunfire erupted. Gilbertson was pushed backwards, tumbling down the steps. His face felt wet.

It was the blood of Lance Corporal Miller.

As the scene became chaotic, Gilbertson's immediate reaction was to shoot back.

He didn't.

He couldn't.

And it wouldn't matter.

The only weapon Gilbertson carries is a camera.

You don't have time to start examining your emotions when you are in the middle of this kind of situation. You kind of push them to a deeper place in your mind and examine them later.

Tim Hetherington, on filming the documentary Restrepo

Photojournalists strap bulletproof vests to their chests, steady 60-pound packs on their backs, and hang camera equipment from their shoulders before trekking into the world's most dangerous environments. They follow marine units, rebel militias, and protesters -- stride-for-stride -- into the field, through crumbling neighborhoods and down crowded streets. There, unarmed and exposed, they take pictures of combatants and the afflicted: civilians suffering in battle, hospitals straining to cope with the wounded, and the communities within which conflict lives.

Their industry rewards intimacy, often driving photographers closer to the sharp edge of conflict. But after capturing those last breaths and cities laid waste by violence, these photographers are left to scroll through the day's shots before wiring the most gripping images to newsrooms around the world.

Some photographers try to lose themselves in the technical elements of their images: the exposures and f-stops, saturation and white balance. These aspects allow a modicum of control. The most successful are praised and rewarded for their work. The events that shock their humanity, serve as fuel for their professional career. But sometimes, when trauma weighs too heavily -- when those recorded moments become too 'decisive' -- photographers internalize what they've seen. Like soldiers, photographers can carry these wars home

"I don't think you can go into the most traumatic situations that arise on earth, voluntarily, and come back unchanged," said Ashley Gilbertson, who admits that his experience in Iraq is never far from thought.

Eight years after Gilbertson and Filkins climbed those steps, those perilous moments on the step have followed Gilbertson.

"A 22-year-old kid was killed because Ashley needed a photograph," Filkins said. "He's tormented by that."

---

Growing up in Melbourne, Australia, Ashley Gilbertson took his first photograph at age 13. An avid skateboarder in his youth, Gilbertson's spent his first rolls of film capturing his friends in the skatepark. Before long, he traded his boards and buddies for a passport and a camera bag. At some point, the lens took over.

By age 24, Gilbertson had photographed refugees in Indonesia, drug runners in Papua New Guinea, and displaced people in Eastern Europe. In 2002, as tensions escalated in the Middle East, he made his way to Iraq.

Between 2001 and the United States invasion of Iraq in March of 2003, Gilbertson worked sporadically as a freelance photographer documenting the struggles of the Kurdish population in northern Iraq. Abused by Saddam Hussein's regime for decades, the Kurds had become a symbol of Iraq's broken and violent government. Gilbertson had a front row seat as America's next war flowed over Iraqi borders. During this period, Gilbertson met Ruth Fremson, a photographer at The New York Times, who passed his name on to her editor at the paper.

He came recommended, remembers Beth Flynn, the head photo editor at paper's foreign desk. Flynn thought Gilbertson was intelligent, calm under pressure, and had a healthy assessment of risks in the field -- qualities she believed critical for photographers working in high-risk areas. With the newspaper covering the war in Iraq in real time, they put Gilbertson on contract as a freelance photographer.

PTSD4.jpgRunning by a minaret of a mosque that was later bombed to the ground after Lcpl. William Miller was killed by an insurgent in the staircase, Marines push through the last part of southern Falluja as they encounter enemy who fought in what is seen by commanders as their last stand, on November 15, 2004. The hole in the minaret is from a tank round. They are marines from the Bravo company, 1st Battalion, 8th Regiment 1st Marine Division fight to take control of the insurgent stronghold of Falluja. They have moved into an industrial area in the southern part of the city after fighting their way through the north where insurgents have been regrouping during the battle.

By fall 2004, Gilbertson, who was then holed up in the Times' Baghdad Bureau waiting on assignments, caught word that the U.S. military was preparing a massive operation in Fallujah -- a city carved up by local insurgent groups. That November, just as Gilbertson was packing up to leave Iraq for vacation in France, The New York Times offered him and their senior writer, Dexter Filkins, an embed with the 1/8 Marines. The military was calling the operation Phantom Fury.

The 1/8 Bravo of the United States Marine Corps was a 160-man battalion leading the sweep of Fallujah. The military hadn't pushed into the city until that November 9, and the Marines were slowed to a trudge through Fallujah's narrow streets, U.S. forces engaged in near-constant firefights. The risks for American forces, and the journalists covering them, were exceedingly high.

""It reminded me a lot of the Black Hawk Down movie because every turn they made was potentially deadly," said Flynn, who was monitoring Gilbertson from the Times' headquarters in New York. "I kept telling Ashley that no picture is worth your life."

Death seemed to be around every corner for the 1/8 marines. Gilbertson remembers that the operation suffered 6 fatalities and another 40 injuries in the week and both Gilbertson and Filkins, known by colleagues to be a risk taker, had narrowly escaped tragedy.

Together, the Times men sprinted across Fallujah's highways amidst the whizzing of enemy bullets. They had slunk down narrow streets while incoming fire ricocheted off smoldering cars and into pock-marked buildings. They accompanied midnight reconnaissance missions through unknown city blocks, their night-vision goggles guiding the way. Under threat at all times, they only paused to eat their plastic-wrapped, pre-packaged meals, called M.R.E.s, and sleep -- in full gear -- in shifts as the Marines stood guard.

"I didn't realize it was going to be that bad," said Dexter Filkins, who had served as the New Delhi Bureau Chief for the Los Angeles Times before joining the Times. "What happened in Fallujah was unpredictable."

Conditions were so dangerous that Gilbertson and Filkins had to worry that the light of their laptops would alert insurgents of the military's position. As a result, both men would file stories and photographs each day either zipped completely inside their sleeping bags or from rooftop port-o-potties.

"War is usually seven parts boredom, one part terror," said Dexter Filkins, reciting a common refrain for soldiers of war. "But in Fallujah that ratio was reversed."

Being on the front lines means photographers are consistently exposed to threats -- the direct and the unseen. This level of risk is required, in part, because powerful photography demands intimacy: intimacy with the subject and the story. Photojournalist Robert Capa famously avowed, "If your photographs aren't good enough, you aren't close enough." That maxim remains central to the industry today.

Despite a lengthy and distinguished career, Capa is often remembered for his historic photographs of the Allied Forces landing on Omaha Beach in World War II. His proximity to the fight -- riding shoulder-to-shoulder with soldiers as their boats breached enemy lines -- showed the grittiness of the war and the documentary power of the photograph.

In 1955, the Foreign Overseas Press Club inaugurated the Robert Capa Gold Medal, awarded to the photographer whose work demonstrated exceptional quality, respect for the traditions of photography, and "exceptional courage and enterprise." Capa had been killed by a land mine in 1954 while photographing an American war in Indochina. Sixty years later, Ashley Gilbertson received the Capa Gold Medal for his coverage of an American war in Fallujah.

Gilbertson crudely remembers sitting in a bar that January night in 2005, Robert Capa Medal in hand. Across from Dexter Filkins, also awarded that night, Joanna Gilbertson, Ashley's wife of six years, recalls the highs and desperate lows of that moment.

"The worse off journalists are, the more rewarded they tend to be," Joanna said. "Ashley felt like he traded Miller for his award." And it's that juxtaposition -- career success built on a foundation of trauma and suffering -- that lingers with journalists.

Sure, the bullets and bombs are still indiscriminate in battle, putting the life of the soldier or photographer in the balance. But today, participating in, or capturing, "history" in war may be more than it was in generations past.

Unlike the "Great Wars" of military lore, today's conflicts are fought outside traditional battlefield. They're fought amongst civilians, amidst neighborhoods, and against opponents without uniform. Instead of marching troops down the hillside with bugler and drummer in tow, modern militaries engage in battles tagged as "urban" or "kinetic." In these new battles, the enemy is potentially everywhere, and the participants are almost constantly under duress. As a result, mental health experts now worry about the long-term consequences of wars like Iraq and Afghanistan.

"These are the first conflicts in the history of modern warfare where combatants were sent back to the combat zone again and again," said Dr. Harry Croft, a distinguished life fellow with the American Psychiatric Association. United States troops can spend nearly a year in battle with only a few months' rest, or "dwell time," at home before returning to the field. Dr. Croft, who has worked with veterans since the war in Vietnam said, "A great human experiment is going on as we speak, and we don't understand the impact of long deployment times and short dwell times."

Alongside these troops are cadres of conflict photojournalists who trade in and out of conflict just as frequently. But while soldiers return home, traumatized by their own experiences, the experience for journalists, who are often just as vulnerable, is usually overlooked.

"There are two kinds of war correspondents," said Joanna. "There are the ambulance chasers who go where the action is, take the pictures and throw them up as if to say, 'This is what's going on.' Then there is the kind that gets emotionally invested in the story."

"[The latter] are the ones that are more effective," she said. "But they're also the ones that are most affected." She believes that Ashley is a member of the second group.

---

"Many of these journalists are very well educated, but quite psychologically naïve," said Dr. Anthony Feinstein, from the dimly lit interior of his office at Stonybrook Hospital just outside of Toronto, Canada.

Dr. Feinstein completed his medical degree and served as an army field medic in his native South Africa before training in psychiatry at the University of London, in the United Kingdom. While interested in the issue of trauma and conflict, Dr. Feinstein worked extensively on mental health issues associated with multiple sclerosis, traumatic brain injury, and conversion disorder, until a Canadian journalist walked into his office in the late 1990s. The woman presented with a strange array of symptoms and then appeared to recover before relapsing a week later.

While Dr. Feinstein couldn't find anything physically wrong with the woman, he wondered whether her symptoms were the product of stress associated with her work. Soon after, he asked his staff to dig into the available research on stress, trauma, mental illness, and journalists. His staff couldn't find a single study. In 2002, Feinstein, who also teaches on the University of Toronto's faculty of psychiatry, decided to conduct a study of his own.

PTSD2.jpg
Marines rest in a mosque after a heavy night of house-to-house fighting and an ambush that killed one marine and wounded seven more on November 11, 2004. To the far right, Lcpl. William Miller sleeps by his friend, Lcpl. Demarkus Brown. Miller died two days later escorting journalists inside a minaret, and Brown died one week later. [Ashley Gilbertson / VII]

According to Feinstein's groundbreaking findings, subsequently published as a book-turned-documentary, Journalists Under Fire, nearly a third of "war journalists" are at risk of developing PTSD during their careers. In other words, journalists are roughly six times more likely to suffer PTSD than non-journalists -- an incidence rate almost identical to that of soldiers.

"Journalists, in general, are pretty resilient given their diet of all this traumatic exposure all the time, but the exception is war correspondents," said Dr. Elana Newman, a trauma psychologist at the University of Tulsa and member of the Dart Center for Journalism and Trauma.

Discussing Feinstein's initial findings, Dr. Newman said, "Amongst these elite [war journalists] you see high levels of PTSD, depression and alcohol abuse when you compare it to the other studies. Nearly 28 or 29 percent of these journalists suffer from PTSD, and 21 percent suffer depression."

---

"I killed someone. It's my fault," Gilbertson said, sobbing amidst the static of his satellite phone.

Those were the first words Joanna Bernstein, Gilbertson's girlfriend at the time, remembers hearing on the evening of Nov 14, 2004. Gilbertson was on a rooftop at Camp Fallujah in Iraq as he recounted the death of L.Cpl. Miller to Joanna.

"It wasn't your fault," she repeated into the receiver, trying to console him.

Gilbertson then called Beth Flynn, his editor at the New York Times, who arranged his speedy removal from Fallujah. No one in the New York office knew the specifics of the event, but they agreed that Ashley had to get out.

The next morning, November 15, Gilbertson flew on a military aircraft from Fallujah to Baghdad, where he stayed overnight before boarding a flight to Amman, Jordan. Three days after he had watched as L. Cpl Miller's body was removed from the minaret in Fallujah, Ashley met Joanna in Paris.

On their flight to New York, Joanna tried to break some of the tension with a trick she'd learned from her grandfather. After being served dessert on the plane, she asked Ashley if her dish smelled funny. When he leaned in to investigate, she rubbed it in his face. Instead of laughing, Ashley, who had always been easygoing with Joanna, got angry.

In the first weeks at home, Gilbertson got angry often. He got angry at the subways, and at the lines in the grocery store. He got angry with businessmen who complained about the puddles outside Manhattan subway stations. Most of all, he got angry with people he called "armchair philosophers": individuals who opined about the war without ever having emptied Iraqi sand from their boots.

Through photographs, Ashley wanted to bring the war home to the millions of Americans. But after he returned, Ashley didn't see an America at war, and he had little patience for anyone who hadn't walked the sharp edge of conflict.

"One of the truly great things about war that people don't understand is that all you have to do is survive." Gilbertson said. "You don't have to make small talk with some shit-bag on the subway about how busy the day is."

War simplifies and sharpens life, he said. Often, it made "regular life" unbearable.

This frustration with day-to-day life stemmed from an addiction to what Gilbertson calls the "survival mode." In Iraq, or more generally in war, everything was in focus. He was always alert.

"You don't emotionally process what you're going through," Gilbertson said. "You just keep going."

But that level of focus can become unsettling when walking the streets of Manhattan. His frenzied conversations, combined with an even shorter fuse, signaled to many friends and family that something was wrong.

Most significant was Ashley's reactions to the people closest to him. Often blowing up into fits of anger without significant provocation, Ashley -- also a heavy drinker -- began to binge the point of "stupification," as Joanna called it.

"Ash hated everyone at this time," Joanna said, remembering countless bar fights Gilbertson would have with strangers. "If you hadn't been to Iraq, he thought you wouldn't understand."

---

PTSD has an interesting, if confused, history in the landscape of mental illness. While it was only added to the DSM, or Diagnostic and Statistical Manual of Mental Disorders, in 1980, PTSD's symptoms can usually be traced back to the earliest experiences of war.

Recorded in ancient Roman texts, and mentioned throughout the western canon of military history, PTSD has had a number of labels: "battle rattle," "war fatigue," "shell shock," or "soldier's heart." In WWI, infantrymen from Britain and France, hobbled by what they'd seen in combat, would be carted off the battlefield to front-line hospitals where doctors, who at the time knew little about how the brain processed trauma, would prescribe bed rest and proper meals in the hopes that the soldiers would recover.

As the field of medicine advanced and the monitoring of soldiers' symptoms improved, a formal diagnosis started to coalesce. However, it was the fallout after the war in Vietnam that prompted health professionals to re-think the relationship between war and mental illness.

Soldiers would return claiming myriad issues: some might suffer fatigue, due to poor sleep, recurring nightmares, or general jumpiness. Others would suffer heart palpitations, chronic chest pain, tremors, various joint and muscle pains, or even loss of voice or hearing. In some cases, like the woman that caught Dr. Feinstein's attention in the late 1990s, individuals could even suffer functional paralysis, a condition in which the body suffers stroke-like symptoms that can render the individual immovable.

However, the primary case studies for PTSD were still soldiers, and it would take more than two decades before experts would extend the diagnosis beyond those who pulled triggers.

Today, photojournalists like Ashley Gilbertson can develop PTSD while snapping a shutter.

"Some photojournalists fall apart after the first assignment, while others handle it for decades.," said Corrine Dufka, a retired photographer, who is now a senior researcher on West Africa for Human Rights Watch in Washington, D.C.. "[Photographers] are in the death and danger business, and you never know how they will react."

Unfortunately, despite access to modern brain scans, advanced clinical trials, and even long-term studies of the disorder, the mental health community has been unable to identify indicators to determine when, or whether, an individual exposed to trauma will in fact experience PTSD. For most frontline journalists, each assignment becomes a game of Russian roulette.

"The only certain way to prevent PTSD is not to send men, and now women, to war," write Edgar Jones and Simon Wessely, in their 2006 book Shell Shock to PTSD. "None of pre-deployment screening, forward psychiatry during combat or debriefing after combat prevents PTSD."

Iraq had become my initiation, my rite of passage, but instead of granting me a new sense of myself, or a new identity, Iraq had become my identity. Without Iraq, I was nothing.

Ashley and Joanna Gilbertson in "Last Photographs," Virginia Quarterly Review, 2007

Most mornings I found Ashley Gilbertson in his signature white, button-down shirt and black jeans, sitting at his large black-brown wooden desk in his basement office, laptop computer open in front of him.

Gilbertson has soft features, and long, tightly curled dirty-blond hair -- cartoonish and free-wandering. His greetings were always cheery -- a quick "Hey man" and a generous, wry smile. In the months we had spent together, Ashley could be blunt, and even impatient, but he was always courteous to newcomers, acquaintances, and just about every barista in New York's West Village.

Some days, when the smile seemed a little forced, and the jokes less frequent, I could tell that Ashley was distracted, bothered, or both. I could never be sure what was on his mind, but some moments the reasons seemed clear.

PTSD3.jpgMarines from Bravo company, 1st Battalion, 8th Marine Regiment detain an insurgent after they shot him and his two comrades in the neighborhood nicknamed "Queens" during the battle for Falluja, Iraq on November 13, 2004. [Ashley Gilbertson / VII]

In late October 2011, Gilbertson was asked by his staff at VII Photo Agency to review and re-draft his professional archive. In part, this meant working through the thousands of frames from his time in Iraq. Gilbertson filtered through most of the photo sets in his collection, but left Iraq for last.

One morning that month, Gilbertson's eyes were hard, and his facial expression flat. With the slightest hesitation, Gilbertson started clicking through the photographs that defined his career, only seven years prior.

He stopped on his first front-page feature photograph for The New York Times. The picture, taken from the open door of a U.S. military helicopter in flight, captured a machine gunner manning an imposing 50-caliber weapon bolted to the floor of the aircraft, as the chopper buzzed at low altitude through waning afternoon sun.

A few frames later, Ashley paused on a picture of Dexter Filkins, the New York Times reporter he'd worked with in Fallujah. Filkins is caught mid-stride, eyes focused on something left of the frame, wearing a flak jacket and helmet. Ash broke the silence with a chuckle, noting the plastic spoons stuffed into the left chest pocket of Filkin's bulletproof vest.

Filkins didn't go anywhere without his spoons, said Gilbertson, with a smile. Filkins had told him that he could never rely on the army to provide cutlery.

But Gilbertson grew quiet as he pressed his laptop's right arrow, flipping to the next frame. In the photographs, soldiers are frozen in high action -- alive -- by the Nikon D100 digital camera Gilbertson now keeps in a small, red, plastic container, stacked in the closet adjacent his desk. He mentioned Marines by name, and discussed how some of them died. Gilbertson could still remember down to the minute, how long after each photograph was taken that the soldier was killed.

"I think [photographers] get a lot closer to this stuff than writers do. It's not that writers aren't also looking for the human drama," Filkins said, "but some photographers are better at doing that than others. Ashley saw things that I didn't."

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Adam McCauley is a Canadian freelance writer and photographer currently based in New York City. His work has appeared in The New York TimesTime, and online in The New Yorker.

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