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."

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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."

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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.

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"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.

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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."

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"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."

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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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Lance Cpl. William L. Miller volunteers himself for Medivac training before battle, choosing the part of a wounded marine at Camp Falluja, Iraq on November 5, 2004. Ten days later, Gilbertson saw Miller on a stretcher again; this time he wasn't acting. Miller was shot point blank by an insurgent hiding in a darkened minaret. He died en route to the medical facility. [Ashley Gilbertson / VII]

"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."

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Marines and Iraqi Intervention Forces take and return fire while they evacuate 5 Iraqi civilians who were wounded in fighting between the military and the Mujahadeen in Falluja, Iraq on November 12, 2004. [Ashley Gilbertson / VII]

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.

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"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.

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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.

PTSD5.jpg
Marines file back through a ravaged street from a mosque to their firm base at the southern end of Falluja on November 15, 2004. Lcpl William Miller was killed by an insurgent hiding in the mosque's minaret. The marines later leveled it with two 500 lb. bombs. [Ashley Gilbertson / VII]

"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."

PTSD1.jpg
Caption: Marine Cpl. Christopher G. Scherer, 21, was killed by a sniper on July 21, 2007, in Karmah, Iraq. His bedroom in East Northport, NY, was photographed in February, 2009. [Ashley Gilbertson / VII]

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.

I counted.

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."

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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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