"There is something about the visual memory that is even more ingrained, more difficult to process. And photographers are often forced to go back and look at the photograph, over and over again," said Dr. Jack Saul, Gilbertson's psychiatrist and trauma specialist. "I think photographers are more exposed, visually, than regular reporters."
Other clinicians seem to agree.
Some experts suggest that physical photographs, when compared to text of the same incident, exact a different cost. One reason: it can be difficult for photographers to place discrete photographs into a comprehensible narrative.
Santiago Lyon of the Associated Press explains that for a print journalists assigned to cover a traumatic event, their process involves asking questions of the witnesses, researching similar events, and observing the reactions of others. Then they get to control the story, choosing the words and descriptions that best capture the event.
Photographers often engage people in similar fashion, but unlike writers, photographers are left with flashes of the story without the opportunity to alter the content, or shape their material in the same way.
Some photographers have tried to construct their own narratives as a way to process the trauma they've seen. Dr. Newman, a trauma researcher at the University of Tulsa, remembers a photographer who personally arranged his photographs to music after filing them for publication. He told Newman that watching the arrangement over and over again allowed him to lower his level of anxiety.
Filmmaker and photojournalist Tim Hetherington seemed to replicate the same process by creating a video documentary in 2010, which knit together a series of scattered or otherwise random video clips and images. He called it "Diary." In May 2011, Hetherington and fellow photographer Chris Hondros were killed while photographing the conflict in Libya.
It took the war to teach...that you were as responsible for everything you saw as you were for everything you did.Michael Herr, Dispatches
While the mental health community had taken note of PTSD and its symptoms by 1980, it would be years before editors and newsroom executives caught up. In part, photographers were resistant to admit their own vulnerability.
"My view may sound harsh, but if you go to war because you want to, don't moan if it hurts you," said Gary Knight, an award-winning photographer and colleague of Gilbertson at VII Photo Agency.
Knight, who was a participant in Anthony Feinstein's study on war journalists, said that Feinstein found him to be "quite well-adjusted." While Knight admits that he's seen journalists stressed or ill at-ease in the field, he says it's nearly impossible to figure out the true cause.
In addition, Knight affirmed a popular claim made by most conflict photographers: being a war correspondent appeals to a particular type of person.
"I think many people who choose this profession have a disposition for outrageous behavior," said Knight, who has covered conflicts in over 90 countries throughout his career. "The mantra seems to be, 'If you are not living on the edge you are taking up too much space.' Journalists are the last people we should be worrying about."
Often, it is this mentality that has plagued photographers trying to cope with the trauma they've seen in conflict. For many sufferers, they looked for alternative coping strategies, whether through alcohol, substance abuse, or high-risk hobbies.
"If you had a hard time processing your experience, one's problems were solved at the bar," said Santiago Lyon, a career photographer-turned director of photography for The Associated Press. "Some people will tell you that the camera is a shield, but I don't subscribe to that view."
In 1994, Kevin Carter, winner of the Pulitzer Prize in photography, committed suicide by asphyxiating himself in the cabin of his car. Carter's award winning photograph -- taken of a malnourished Sudanese child squatting in the desert as a vulture lurked in the background -- graced the pages of untold international newspapers and magazines.
Carter was a member of the rambunctious, risk-taking group called the Bang-Bang Club, now immortalized by Hollywood in a 2010 film of the same name. The group garnered significant international attention for their documentary photography work on apartheid-era violence in their native South Africa. But the photograph that made Carter's career, also seemed to destroy his life.
In a 1994 Time Magazine article, fellow reporters and friends questioned the ethics of Carter, particularly when it came to his storied photograph: Why hadn't he helped the vulnerable girl he'd captured on film?, they asked. Many photographers pushed back and expressed support for Carter and his actions: it was not the photographer's responsibility to intervene; bearing witness and taking the photo, which The New York Times called "an icon of starvation," was a humanitarian act. Regardless of the moral or ethical debate surrounding Carter's decision to take the photograph, the trauma that he'd seen in his career began to overwhelm.
In his suicide note, Carter wrote: "I am haunted by the vivid memories of killings and corpses and anger and pain ... of starving or wounded children, of trigger-happy madmen, often police ... of killing executioners." He was 33 years old.
"What [Anthony Feinstein] did was make [journalists] aware of something that we all knew existed, but were all pretty ignorant about," said Santiago Lyon, director of photography for the Associated Press. "It sparked a change in the mindset of the newsroom."
The British Broadcasting Corporation and CNN led the charge by offering post-deployment debriefing sessions and self-diagnostic tools to individuals working in conflict zones or otherwise exposed to violence. Under the stewardship of former international correspondent Chris Cramer, CNN became an industry leader, eager to keep their reporters healthy -- physically and mentally.
As awareness grew, Dr. Feinstein was hired to consult and advise CNN and the BBC on strengthening their policies regarding mental health. The Associated Press hired Dr. Jack Saul, Gilbertson's psychiatrist, for the same purpose. In addition, the Dart Center for Journalism and Trauma, which began as a program at Michigan State University in 1991, expanded their scope and size, providing additional resources regarding the physical and mental risks for journalists in the field.
These support efforts for journalists and their mental health soon extended beyond the deployment period to their time at home.
"We are trying to capture any lessons learned from our deployments and maintain that contact with our correspondents when they get home," said Harris Silver, the high-risk deployment manager for the Canadian Broadcasting Corporation. "We want to ensure that our journalists aren't dropped as soon as they get back."
Santiago Lyon said it's most important to understand the sensitive nature of trauma. During his career, Lyon was kidnapped and wounded in the field. In his nine year tenure at the AP, Lyon has instituted a specialized program for any AP journalist who wants assistance with the trauma they've experienced.
"We seek out experts in the field to provide our colleagues with the support they need," Lyon said of the AP. "Trauma is a specialty in psychology and I don't think that your average employee assistance program is sufficient."
Dr. Feinstein has also made his self-diagnostic tool, a survey that can taken by any journalists in the field, available on request. The document charts a respondent's answers and measures the discomfort or symptoms of trauma. These results can then be shared with the company's psychologists -- at the journalist's request -- and can help monitor how the individual is coping with their assignment. In addition to the survey, most news organizations have created 24/7 confidential counseling lines for any journalist in need of further assistance.
But for all the advancements in company policies, stigma around mental health remains the most significant challenge in the war against PTSD.
Even in the fall of 2004, after Gilbertson returned, there persisted a professional mythology about a photographer's toughness, Gilbertson said. Advancement came, at times, merely from risking your life in the field.
"I remember the first time Ash got shot at [in Samara, Iraq]," said Joanna. "He used to be the last person in the [New York Times] bureau in Iraq, waiting around for assignments. After that close call, he broke into the established pecking order. At the newspaper, you have to earn your stripes."
Sometimes this mentality keeps photographers from sharing their concerns with editors.
After L.Cpl. Miller's death, Gilbertson was hesitant to tell The New York Times about the incident. Until an interview for this piece, Beth Flynn, Gilbertson's editor at the Times, didn't know Gilbertson was worried about getting fired in the aftermath of the Marine's death. Flynn says termination of his contract was never suggested, but Gilbertson's position as a freelancer made him feel vulnerable. After all, a photographer's ability to work is their only leverage. If Gilbertson couldn't do it because of the trauma he'd seen, he believed the newspaper would get someone else who could.
Over the last two decades, traditional news outlets have lost significant revenue, resulting in cutbacks in expensive departments. In most media houses, these budgetary changes meant foreign and international desks were often the first departments to lose funding.
As the number of full-time staffers shrunk, organizations looked to freelancers to plug the gaps. These freelancers often travel on their own dollar, or happen to live overseas, and usually lack sufficient medical insurance. As private contractors, freelancers market their consistency and quality in an effort to maintain relationships with editors in the industry. For these photojournalists to admit to suffering some form of mental illness, or that this suffering might impact their work, is risking unemployment, or so they believe.
"I work with a lot of freelancers, and they often come back without medical insurance and don't get any of the benefits," said Dr. Saul, who still counsels reporters in his office in Manhattan. "They can be on an assignment, get hurt, and their organization doesn't feel any sort of responsibility to take care of them."
"Outside major news organizations, support just doesn't exist," Gilbertson said. "You're expected to come back, take a week's holiday in the Bahamas and go back to work. Unfortunately, that is not how trauma works."
"Support, like medical insurance and disaster coverage, depends on your working relationship," said Robert Nickelsberg, a photographer who spent 25 years covering Asia and the Middle East for Time magazine. Nickelsberg now freelances from his home in New York, but is cautious about today's ill-defined and poorly regulated media industry. Freelance photojournalists are picked up and dropped as the demand for content dictates, he said, adding that just because a photographer is working, doesn't necessarily imply that they're going to be covered by the organization.
But even as media organizations grow cognizant of their responsibility for the physical risks on the job, sometimes these policies fail to include mental health coverage. As Gilbertson maintains, "PTSD is not a recognized wound of war."
Unfortunately, even if some journalists recognize war's effect on their mental health, they are often trapped in war zones. The story is simple: if the photographs that established a person's career were taken in conflict, covering war can quickly become their specialty.
"Freelancers often get stuck doing war coverage, and they don't feel like they have an alternative other than to go back out into the field," said Dr. Saul. "They may even want to stop, but because they haven't developed their freelance work domestically, that isn't an option."
For Gilbertson, this rang true. He'd grown up in Iraq, at least professionally. He'd received awards and developed credibility by taking dramatic and traumatic photographs where few people had ventured. His persona, the courageous photojournalist embedded at the "tip of the spear," had turned the war in Iraq into his calling card at The New York Times. But if Iraq made Gilbertson's career, it jeopardized everything else.
"Iraq had become my initiation, my rite of passage," wrote Gilbertson in a 2007 article coauthored by his wife Joanna, for the Virginia Quarterly Review. "Instead of granting me a new sense of myself and a new identity, Iraq had become my identity."
Gilbertson decided to return to Iraq in 2006, a decision that Joanna and his psychiatrist thought ill-advised. Dr. Saul warned, "If you go back to Iraq now, you'll probably keep going back." Joanna told him, "You're fucking crazy."
"I could easily rationalize my desire [to go back] to anyone who asked," Gilbertson wrote. "I told them I wanted to have one last look, that I needed to shoot the place differently, outside the constraints of daily coverage. I wanted to photograph Iraq emotionally, to react to my feelings on the spot instead of bottling them up as I'd done in the past." Ashley was persuasive, and The New York Times was interested. He flew to Baghdad in March of that year.
The now 27-year-old photographer began his rotation embedded with the U.S.Marines in the Iraqi capital of Baghdad. After two weeks with American forces, Gilbertson switched embeds to join the Kurdish Peshmerga, a military force that had just begun to patrol the capital and fill the security details left by departing American troops.
On the afternoon of March 27, Gilbertson, working with New York Times reporter Edward Wong, heard reports of Sunni Arab woman being forcibly evicted from a Shiite enclave in a suburb of Baghdad. The Peshmerga responded with Gilbertson and Wong in tow.
Gilbertson still remembers Suaana Saadoun's imposing figure and stubborn refusal to leave her home. A mother and grandmother who'd recently moved back to Iraq from Syria, Gilbertson photographed a triumphant Saadoun as she watched the Kurdish Peshmerga load her would-be evictors into the back of their military vehicle.
Joanna remembered receiving a call from Ashley that night. "He was so happy," she said, which was rare when he was on assignment in Iraq. He told her that the other Sunni families in the neighborhood had even applauded the Kurdish military that afternoon, a rare occurrence in the embattled city.
The next morning, however, Gilbertson awoke to the news that Saadoun was shot dead while walking to her local bakery. Allegedly, her murderers had been members of the same Shiite group that attempted to evict her the day before.
Gilbertson returned to Saadoun's house that afternoon. This time he captured the tears, wailing, and disbelief of her family. "I felt like a bastard taking photographs of them now, framing their pain," Gilbertson wrote of the event. "But I had to tell their story."
But Gilbertson had told this particular story too many times. Five years after Gilbertson first stepped foot in the country, he was still snapping photographs of death in Iraqi streets. The steady diet of violence had left Gilbertson swallowed by his own experiences; powerless -- he felt -- against the persistence of trauma.
"Covering the war used to make me feel like I was doing something important," Gilbertson wrote in the weeks following his embed with the Kurds. "I have grown to accept that people will not stop dying because I take their pictures."
Last January, I met Ashley midmorning, outside an apartment complex in lower Manhattan. Dressed in a black full-length coat, cameras and a tripod in hand, Gilbertson was leaning against a street sign, smoking his favorite: Marlboro cigarettes.
"How are you this morning?" he said, offering me a still-warm coffee as I arrived.
New York Magazine was writing a story about Private Danny Chen, an Asian-American Marine who committed suicide in Afghanistan after being bullied by fellow soldiers. The magazine called Gilbertson and asked if he'd be willing to take pictures of Danny's parents, the shrine they had erected in the family's East Village apartment, and, specifically, Pvt. Chen's bedroom.
Since returning from Iraq in 2006, Gilbertson had been photographing the bedrooms of men and women soldiers killed while serving in Iraq and Afghanistan. Captured in black and white on traditional film, the wide-angle images showed soldiers' rooms perfectly preserved by their families.
In 2007, his project, named Bedrooms of the Fallen and published in The New York Times Magazine, won a National Magazine Award. The accolade only pushed Gilbertson further, expanding overseas, capturing the bedrooms of NATO soldiers in their respective countries.
On this mild January morning, Gilbertson and I wandered through the apartment complex in search of the "D" wing, and the suite of Mr. and Mrs. Chen. After an awkward three-way conference call with the translator, who was running late, we were welcomed inside by Mrs. Chen. Instead of the three hours we expected, we were told that the Chen's had plans for 11 a.m., and they refused to be late. That left just 20 minutes to take all the photographs the magazine would need.
As Gilbertson set up his digital camera to photograph the living room, he engaged the parents in conversation through the translator. Gracious but focused, he sprinkled questions with apologies and took a moment to compliment the photo of their departed son. I stood. Quiet. Witness to a delicate cultural exchange: a photographer who spoke the language of loss and a family mourning the death of their only child.
"How many minutes do we have left?" Gilbertson asked me, attention trained on the eyepiece of his camera, lens pointed on Pvt. Chen's parents, both standing astride a portrait of their son captured in military dress.
"Eight minutes," I replied.
As we moved towards Danny Chen's bedroom, a room Mrs. Chen had avoided entering since news of her son's death, Ashley quickly exchanged his digital camera for the film-loaded Hasselblad, the same camera he's used to photograph 27 bedrooms around the world.
12... 13... 14... Off.
Ashley clicked the shutter closed.
Fifteen-second exposures; Ashley's camera was crammed so close to the bedroom's doorframe that he had to remove his glasses to focus each shot.
He clicked the shutter open again.
12... 13... 14... Off.
Those fifteen seconds burned into Gilbertson's film the Hentai poster -- a popular form of Chinese animation -- above Chen's bed, the calendar hanging slightly askew beside a light-filled window, the ruffled comforter left untouched, a stuffed monkey lying face down on his bedside table, the spotless desk and the neatly-stacked DVDs and video games. Looking at the stark black and white photograph, you'd think Danny Chen was expected home in moments. That is, until you saw the large wooden box on the floor. Closed, it contained all of Pvt. Chen's belongings, returned by the army in memoriam last October.
Bedrooms of the Fallen had originally been Joanna's idea. The project grew, in part, out of Ashley and Joanna's mutual frustration with The New York Times' production of' "Faces of the Dead," a database of headshots, names, and the hometowns of soldiers killed in battle.
"The military does this amazing job of creating warriors," said Joanna. "But in that process, something is lost."
For the Gilbertson's, these soldiers were "somebody" before they went to war, and their sacrifice deserved memorializing. Ashley, like many photographers at the time, had tried to photograph military funerals at Arlington National Cemetery, but even these images lacked something.
At the Look3 photography festival in 2006, Joanna was attracted to a particular photograph. This time it was a picture of a closet, empty, save a single hanging dress. "It captured the things people left behind," Joanna remembered. She thought it was powerful in its simplicity.
"Photographers need to create stories that are ... digestible," Gilbertson once told me, quickly adding that he hates that word. "But those stories have to remind this country that we're actually at war."
Photographing empty bedrooms, the living mausoleums of American men and women killed in a foreign war, was visually powerful without being graphic. The images were humble. But most importantly for Ashley, they were human.
"Photographs of a thousand more bloody soldiers won't change anything," he said. "I can't make [the public] care about the war by bashing them over the head with it."
But the Bedrooms project also provided Joanna, after years of waiting, an opportunity to be part of the profession that nearly tore the two of them apart.
"The first time he went was a disaster," said Joanna. She told Ashley that the project was important for his healing, and promised she would always be there for him, but would never accompany him on the shoots.
Gilbertson spent more than six months talking with the family of Thomas Gilbert, learning everything he could about him. More importantly, the time allowed him to gain the family's trust to photograph the bedroom; the last surviving memorial to their son. The result, Gilbertson said, was the most authentic war photography he'd every shot.
Today, sitting in his basement office with a half-finished beer on his desk, Gilbertson can still see three medium-sized, black and white prints of his most recent bedrooms shoots on his bookshelf.
The past few weeks had produced an initial draft of his upcoming photography book. Between the two covers, more than 40 separate bedrooms of soldiers from around the world would be displayed, with Ashley's own writing filling in the white spaces.
"I'm doing the best I can because someone paid for my life with theirs." Gilbertson said, before taking another swig of his beer. "Bedrooms of the Fallen is my apology."