Katerina, a Russian photojournalist covering the war in Ukraine, knew there might be a psychological price to pay for her years of documenting trauma, but she never imagined the toll it would take on her body. Blurred vision. Numbness in her extremities. Hand tremors. Years after fleeing conflict zones and the profession that resulted in beatings, Katerina, who requested anonymity fearing backlash from the Russian government, explains that her body remains locked in crisis, insomnia and unrelenting hypervigilance persisting, despite safety. “It’s like my body remembers," she says. “It still affects me.”
Every image takes something—and for many photojournalists, the cost is physical.
Bearing witness can trigger profound physiological transformations. Clinical research has shown that the body absorbs trauma—altering cardiovascular function, compromising immune defenses, dysregulating hormones, and rewiring neurological pathways. The science reflects what photojournalists have long suspected: prolonged exposure to suffering and atrocity can fundamentally restructure the body’s stress architecture.
Despite bodies keeping the score, the journalism industry looks away. Soldiers and EMTs are honored for their sacrifice, while photojournalists—who are also expected to run toward rather than away from devastation—are treated as outliers, any distress conflated with weakness. As Pulitzer-winning journalist Kate Woodsome observes, “When there are problems, it’s put on the individual. ‘They couldn't handle the stress.’” This dismissal reflects a toxic blind spot; the media industry praises resilience while pathologizing vulnerability. The camera, far from offering distance, often amplifies proximity to trauma.
Meanwhile, the threats facing journalists have compounded. Dr. Anthony Feinstein spent decades studying journalists' trauma. He observes, “You're no longer viewed as a neutral observer. You are a prize target." Ukrainian photojournalist Andriy Dubchak has lived this reality, saying, “When you have bulletproof vests with press signs, you become a target.”
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Despite the work growing increasingly perilous, institutional support has eroded. Shrinking newsroom budgets and fragmented freelance networks have created a perfect storm. Journalism is now more dangerous, more essential, and less protected than ever.
The danger for journalists doesn't come from a single event, but from sustained exposure to trauma. Medical research shows that when the body is under stress, it secretes the hormones adrenaline and cortisol which trigger our fight or flight response, helping you to focus and potentially saving your life. But with exposure to repeated stressors for sustained periods, this biological response can have the opposite effect. Chronic release of these hormones has been linked to disease across nearly every major body system, including but not limited to autoimmune, neurological, endocrine, cardiovascular, and gastrointestinal.
After decades of working with traumatized patients, psychiatrist Judith Herman recognized the missing diagnosis: prolonged, repeated trauma produces different physiological effects from single traumatic events. In 1992, she coined the term Complex PTSD (C-PTSD) for survivors of prolonged trauma under conditions of captivity, what she calls “coercive control." This occurs when victims cannot flee, by virtue of their relationship, citizenship, or occupation. “Patients with simple posttraumatic stress disorder (PTSD) fear they may be losing their minds,” she writes in her 1992 book, “Trauma and Recovery.” “But patients with C-PTSD often feel they have lost themselves.”
Two decades after Herman identified it, the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the handbook used by doctors and insurers—still refuses to recognize C-PTSD. Psychiatrist Dr. Bessel van der Kolk calls this omission “tragic,” noting that it leaves “large numbers of patients" without accurate diagnoses or effective treatment. “You cannot develop a treatment for a condition that does not exist,” he explains. “Even after twenty years and four subsequent revisions, the DSM and the entire system based on it fail victims.”
Journalists are among the most vulnerable to C-PTSD, yet they receive almost no institutional support. “Soldiers have intense traumatic experiences, but generally for a year, then they may not return.” Meanwhile, organizations send “journalists back to war year after year,” Feinstein explains. “There isn't another profession with such lengthy exposure to grave dangers.” The physical toll exacted by this unrelenting trauma exposure is exacerbated when leadership turns a blind eye to it. Journalist turned trauma advocate Dean Yates calls this willful ignorance “leadership malpractice,” and explains that when it occurs it “inflicts moral injury…[which] the body codes as a physical attack.”
Moral injury is core to what makes this chronic exposure so damaging.
It occures when someone witnesses or participates in acts that violate deep values, leaving, as Dean Yates wrote, “a wound not on the mind but on the soul.” For photojournalists, this arises from the expectation to observe without intervention.
"I came across some wounded civilians,” recounts former combat photographer Santiago Lyon. “I loaded them into my car, and took them to the hospital… I told my editors and they were horrified... [saying] 'You're not supposed to be involved.’ We're supposed to be these sterile, robotic creatures that are only interested in the facts.” The demand for neutrality in the face of horror asks people to go against not just morals but also biology. Mirror neurons wire us for connection—that means our brains naturally reflect the feelings and actions of those around us.
Trauma therapist Emily Sachs sees the physiological impact of moral injury in her clinical work, describing how newsroom reviewers of graphic footage wonder if something is wrong with them for feeling numb—until, later, insomnia sets in or displaced fury erupts. Where Sachs treats the aftermath, neuroendocrinologist Sue Carter exposes the biological mechanism. Carter has spent her career studying the neurobiology of social bonding. “Let’s say you’re a photojournalist,” she explains. “A bomb goes off. You see people injured…Your job title doesn’t override your biology. Your body doesn’t magically know it’s not supposed to respond.”
In the 19th-century, medical studies of “railway spine" were already tracing trauma’s physical toll on the body—yet centuries later, we still struggle to admit that psychic wounds can have physical consequences. Despite decades of documentation showing that trauma can manifest in physiological harm, the mechanisms by which psychological wounds become disease have received surprisingly little attention.
What we do know is alarming. Perhaps the most the direct impact of chronic cortisol secretion (the constant release of stress hormones) is increased inflammation, which causes long-term deterioration of body systems. Dr. George Slavich of UCLA’s Psychiatry and Biobehavioral Sciences Department explains, “Inflammation is involved in at least 8 of the top 10 leading causes of death in the United States.” This means trauma patients are far more likely to become sick and stay sick. A 2013 study found that Vietnam veterans were more than three times more likely to be diagnosed with autoimmune diseases including rheumatoid arthritis, diabetes, and inflammatory bowel disease.
The constant state of hyperarousal central to C-PTSD can also damage heart muscle tissue. People with a history of trauma face elevated risks of hypertension, inflammation, and coronary heart disease, with one study showing that Vietnam veterans experience a staggering 125% greater risk of death from heart disease. Chronic stress can cause the body’s metabolic systems to fail; rates of obesity and metabolic syndrome rise in direct proportion to trauma severity, while the odds of developing type 1 diabetes nearly triple. Even breathing becomes harder: those with PTSD are more than twice as likely to develop asthma. Because C-PTSD has long lacked clinical recognition, most research centers on PTSD. Yet if episodic trauma can lead to this level of systemic damage, it stands to reason that the biological toll of trauma that is prolonged, cumulative, and inescapable can only be far worse.
Trauma therapist Sachs has observed these physical manifestations. “I worked with a journalist who had a whole-body mess of symptoms—vertigo, rashes, cardiovascular problems. It was clear that when stress increased, these got worse… As things at work stabilized, so did her symptoms.”
For anyone who gets stomach aches before important meetings, the link between stress and digestion might not be news, but its depth might be. Carter explains that the gut lining is loaded with oxytocin and vasopressin receptors, hormones that regulate the stress response, making it “very common to have digestion issues for people who are under stress.” Under normal conditions, digestion relies on a delicate balance of biochemical interactions; when chronic stress takes over, those stop and the system breaks.
Our bodies remember, even when we wish they wouldn't. And that memory can be passed on to future generations. In “What My Bones Know,” Stephanie Foo presents studies showing that mice exposed to the smell of cherry blossoms paired with electric shocks developed enlarged scent receptors. Later, their offspring reacted fearfully when exposed to the same scent, despite never being shocked. Humans aren't exempt from this. Rachel Yehuda’s 2015 study found that Holocaust survivors and their children shared the same trauma-linked alteration on a gene that regulates stress hormones.
Dr. Philip Fisher has spent years examining how prolonged stress reshapes brain biology. “Our stress systems evolved for short-term crises, not chronic modern stressors like constant uncertainty,” says Fisher. “When you can't predict what’s coming, these systems fail to provide crucial homeostatic balance.” When the brain’s stress circuits are chronically active, they can misfire, psychological trauma hijacking the nervous system, as illustrated by research linking developmental trauma with seizures and movement disorders like tremors, dystonia, and parkinsonism.
Although the mechanisms are poorly understood, PTSD is also strongly associated with chronic pain, manifesting in everything from fibromyalgia to temporo-mandibular joint pain (TMJ) and chronic lower back pain. Katerina recalls her body's reaction when shooting an event in her new home country. “When I saw a policeman, I felt fear, even though the policemen here are almost all good guys, not like back home… My heart was pounding. I felt pain in my hand. It was as if my camera, and my hand, was somehow guilty.”
Ukrainian photojournalist Oksana Parafeniuk noticed a similar pattern among peers, saying, “During air raid alerts, they have pain in their muscles… They feel like their legs become numb.”
Sleep is critical for somatic recovery. During deep and REM sleep the endocrine, immune and cardiovascular systems repair, clearing waste more efficiently than while awake. Yet for the traumatized, sleep often offers no refuge thanks to hypervigilance—the chronic state of scanning for danger. This cornerstone of C-PTSD keeps the body locked in a state of arousal despite the absence of threat. As Parafeniuk explains, “You can never really relax... Even if there is no alert, I wake up multiple times, checking what’s happening. Even when I’m abroad, I react because of sounds. You hear something that reminds you of an explosion, and your body gets triggered. You realize you're not in a country where that’s possible, but your body still does.”
Psychotherapist Harry Key has spent his career treating trauma in the workplace. He calls insomnia “the great leveler" saying, "It crosses all generational and cultural boundaries…For photojournalists facing day after day of life-or-death decisions, it isn't just terrible for health—it’s a safety risk. Across studies, disrupted sleep is one of the clearest physiological characteristics differentiating the traumatized. For photojournalists, that means exhaustion from work becomes a barrier to recovering from work.
In chronic stress, the body remains in “high alert" mode. Over time, the stress response becomes dysregulated, meaning that individuals may lose the ability to perceive how stressed they actually are. This creates a damaging feedback loop: stress distorts bodily awareness, which prevents new regulating responses, exacerbating symptoms. Fisher describes this process as a kind of biological learned helplessness. “What we see in the context of these longer-term chronic situations is the systems begin to downregulate.” In other words, the very mechanisms designed to keep us alive begin to falter. “This downregulation isn't protective,” Fisher explains. “It’s adaptive, but harmful.”
"It’s like some permanent anxiety,” Katerina describes. “It starts at the airport on my way home. My body knows this is an unsafe space. When I come home, I feel tense, in a state of hypervigilance… this is when I start to have physical symptoms.” Even safely in her new home country, she says, “I scream at my loved ones when there’s a loud sound… my body says this is something dangerous.”
Journalism has long glorified risk, exalting war reporting as the pinnacle of the craft. This valorization of danger shapes the way trauma is treated or ignored. But the profession’s reward system is built on a contradiction. Reuters editor Rickey Rogers explains, “There’s a built-in system that rewards risk-seeking behavior.” Former Associated Press photo director Santiago Lyon elaborates: “In the news industry, people often get promoted into positions of leadership based on how successfully they have executed or behaved on dangerous stories. The assumption is that if you can function in a war, then you must be a leader. It’s a complete fallacy.” After a career of documenting trauma, photojournalist Lynn Johnson calls it out directly: “This idea that you are only impacted if you photograph a war is ridiculous.”
Money reinforces the myth. “It’s the old saying, if it bleeds, it leads,” notes trauma expert Dr. Judith Herman, who, in addition to her work, was married to a photojournalist. Freelancers like Oksana Parafeniuk face brutal economics: “If I start being too selective about assignments, I get less work.” Together, these cultural and financial pressures form what Herman defines as coercive control—the exact environment that breeds C-PTSD: isolation, intermittent reward, and an inability to escape.
The silence this creates is devastating. “Reporters aren't talking about this,” says journalist-turned-professor Natalee Seely. “They're scared they'll be branded as not able to do their jobs.” Dean Yates, once a top Reuters bureau chief, describes the fallout: “My identity began to disintegrate after I went on sick leave.” Now an advocate for trauma awareness, Yates hears the same refrain from colleagues: “I’m afraid I'll lose my job if I push back.”
The lack of institutional care is stark, especially given the minimal effort required to lessen the load on those suffering. Parafeniuk describes being assigned day after day to photograph parents who had lost children and echoes an appeal heard across the profession: when editors check in during emotionally difficult assignments, it can make a meaningful difference. Such gestures don’t require major resources, but remain rare. After assignments, she and colleagues often return home devastated, the physiological impact of the trauma lingering.
Dr. Herman witnessed this neglect firsthand. “The newsrooms were a very macho culture—like cops or firefighters—where the only way to deal with PTSD symptoms is with copious amounts of alcohol,” she said. That culture of “suck it up" isolates those suffering. And as Key points out, moral injury, on top of this, is often the breaking point. “Twelve months later the same photojournalist is asked to go take the same photos because nothing’s changed. That’s moral injury.” Andriy Dubchak echoes the futility: “We risked our lives, published the report, got 250 likes on Instagram, for what?"
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Much of what keeps journalists in this grim reality is the industry's failure to acknowledge it; leaders often believe that they are already providing ample support. Rogers argues that what Reuters does might be overkill: “We have an overly zealous security operation sometimes. They tend to pull people away from things when we're trying to go towards them.”
At the core of Reuters' preventative safety measures is something called HEAT (Hostile Environment Awareness Training). Yates discussed that training in “Line in the Sand" saying, “My five-day hostile environment course focused on first aid, spotting minefields, getting through fake checkpoints, physical safety.” There was no mention of the potential physiological toll exacted by prolonged trauma exposure and helplessness.
The persistent state of never knowing what moment will be your last is enough to push anyone to the brink. As Dubchak explained, “We made jokes because we understood the situation is not under our control... The next day, I got information that the guy who came 15 minutes behind us was hit. It’s luck—you are lucky, or not lucky.”
To cope, people often go numb. But this comes with a price. Yates describes the insidious consequences. After his son’s birth, he left the hospital early, later recognizing, “I’d shut down my capacity to feel, to touch, to love, to live.”
Dubchak observed his own transformation after years of covering conflict: “When I first saw a dead body—it was fear and emotion. But eventually I don't feel anything.” He calls this “professional deformation" and warns journalists, “Do not suppress your emotions. If you want to cry, cry. It’s your body protecting you.”
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According to Van Der Kolk’s research, Dubchak is right: numbing prevents appropriate protective responses. “Over time the body adjusts to chronic trauma," Van Der Kolk explains. “By numbing out she no longer reacts to distress the way she should, for example, by taking protective action.”
The journalism industry does not just need better wellness programs, it needs a paradigm shift to recognize trauma exposure as a workplace problem, not a personal weakness. As Kate Woodsome puts it, “When we tell journalists you're not the story, we need better language. You are not the story. And also, the story can affect you—and you can affect the story.”
But there may be hope. A new generation of journalists is breaking the silence around trauma and mental health. Key observes a pattern: “Once you get over the war story swapping and who’s been kidnapped for the longest, then you can get into the vulnerability of it.” This shift toward openness is most visible in younger professionals, though freelancers still face barriers that staff journalists don't when seeking support. This narrative shift is one that photojournalist Johnson had to live in order to continue work after decades of capturing complex trauma: “It’s not bravado to not take care of yourself. That’s not a badge of courage. That’s just not smart. If you're not healthy mentally, emotionally, then you really don't have the right to tell someone else’s story.”
Herman’s residency experience offers a model for adoption: “It was understood that medical training is stressful, so you got respect for going to therapy.” As evidenced from other industries, the culture in journalism won't change meaningfully until vulnerability is recharacterized as strength—something this new generation might finally be ready to embrace.
Key is blunt: newsrooms pay for Employee Assistance Programs but rarely ensure journalists actually use them. And when journalists do seek help, they're often met with therapists who don't understand the job. Feinstein warns this is worse than nothing: “It chases them away, and in many ways, it’s harmful.” Support has to come from someone who understands trauma and understands that journalists' work and personal lives will likely always be intertwined. The goal, as Key explains, isn't to separate work from life, but to show that caring for themselves is how they stay capable of working at all.
But even when the right resources exist, another barrier blocks the door: trust. When Santiago Lyon rolled out improved trauma support at AP, only 10 of 300 conflict journalists used it over two years. As Rogers noted at Reuters, “People don't trust that it is actually confidential. They think it'll affect their work reputation.”
As Van der Kolk writes, “Communicating fully is the opposite of being traumatized…study after study shows that having a good support network constitutes the single most powerful protection against becoming traumatized.” Yet, the detachment journalists' work demands often prevents this.
Lynn Johnson puts it plainly: “There is a cost to doing this work. We're not out here gathering fake news. We're putting our own bodies, psyche, and systems on the line because we believe in the truth. But there’s a cost—not just physical, but in your relationships that crash and burn regularly. It’s like concentric circles of damage in your life.”
Key puts it into perspective: we wouldn't send construction workers onto a skyscraper without training and PPE, saying, “if you fall, we’ve got great surgeons.” Yet we routinely send journalists to work with nothing. This is why, as Lisa Krantz argues, trauma education “has to start in universities.” Currently only about 10% of U.S. journalism programs offer trauma training, with gaps as wide as 53% between what educators say matters and what they teach when it comes to self-care.
Without trauma training, she warns, “you're just going to have a bunch of reporters who are unhappy, stressed out, guilt-ridden, and suffering a mental health crisis.”
We have long depended on journalists to write the first draft of history. What we have failed to acknowledge is the physiological toll this duty to bear witness might take. To take journalists' stories seriously is to take their bodies seriously. And if we believe that bearing witness is essential to a functioning society, then protecting the people doing it is not charity—it’s our responsibility.
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Produced by candidates for the MS degree in the Media Innovation & Data Communication program at the Northeastern University School of Journalism. © 2025
