On May 12, 2007, Karachi’s residents stayed indoors. Public transport was closed and so were schools, but Asif* was heading towards the very danger that most people were avoiding.

As a television reporter for a major news channel, he did not have the option to stay away. Word had gotten to him that a cameraman was hiding under a car to protect himself from the hired thugs of a local political party who were on a killing rampage nearby.

The violence was prompted by the arrival of the recently suspended Chief Justice of Pakistan Iftikhar Muhammad Chaudhry. Gunfights and riots erupted across the city as Pakistan Peoples Party (PPP) and Awami National Party (ANP) activists, who supported Chaudhry, clashed with workers of the pro-government Muttahida Qaumi Movement (MQM).

Asif and a colleague of his made their way to Malir Halt area where the cameraman was trapped. When they arrived, they saw bodies strewn around the vicinity. Some were still alive, but there was no one around to help them. A rangers’ office nearby had its shutters down too.

A man was lying on the ground with a bullet in his stomach. When Asif noticed he was still alive, a gunman prevented him from helping the bleeding man. He was to be left for the dead.

What happened in the following moments still haunts the 45-year-old journalist to this day. While Asif was trying to negotiate a safe passage for as many people as he could, the gunmen suddenly opened fire at a group of people they believed to be supporters of the rival political party. Asif had never seen anything like it. "The way these people were shot in cold blood remains etched in my memory," he says.

When Asif noticed he was still alive, a gunman prevented him from helping the bleeding man. He was to be left for the dead.

Reporting on violence was not new to Asif, who now has 15 years of experience in the field. Being around dead bodies was part of the job. But this was different. He could not sleep for three days and it took him years to shake off the effect the incident had on his daily life. Taking a shower was particularly traumatic, as he could not keep his head under running water for more than a few moments. For a while, he could not sleep without all the lights on.

"It broke me," says Asif. Even in the absence of any medical evaluation of what he went through, it is obvious that he suffered. He wouldn’t be the first, or the last.

As much as journalists like to believe that they are immune to the impact of violence and tragedy, the reality is sometimes different. While some journalists build a robust coping mechanism to deal with the emotional effects of their line of work over time, there are others who are more vulnerable and suffer in silence. Afraid of being judged by their peers and superiors, they try and process the feelings on their own.

Speaking to journalists from diverse backgrounds and mediums, there seems to be a dismissive – almost flippant – attitude towards trauma or stress-related psychological disorders. At least at first.

"It’s a natural part of the job," says Wusatullah Khan, a senior journalist associated with the BBC and Dawn News, as he sips a cup of tea in the lawns of the Karachi Press Club. The subject of mental health is a hard one to broach in Pakistani society to begin with—least of all, among a group of seasoned male journalists. For there is the idea that journalists are observers, reporting on the suffering of others is their job -- which somehow renders their own suffering irrelevant. Yet, even the senior professionals acknowledge tremendous amount of pressure that comes with working in the field.

"I still remember those golden curls sticking out from under the rubble. They most likely belonged to a dead girl whose body was still trapped underneath," says Khan, recalling his experience of covering the 2005 Kashmir earthquake that claimed more than 80,000 lives. He believes he is immune to the hard realities of the job, but admits that perhaps this is his way of rationalizing his experiences. "Maybe there is a dormant virus inside us; one never knows when it will surface," he says.

Most journalists don’t even know the problem exists. "I feel fine. I like adventure and danger," says Wasay*, a crime reporter. In his 14 years on the job, Wasay claims to have covered “thousands of violent incidents”. Apart from the more dramatic ones – bomb blasts and riots – he estimates reporting on two or three killings on a typical day.

“One time, I caught an SHO taking bribes. He threw me in the lock up and beat me. The video is online. On another occasion, I was also beaten by the Rangers,” he says. That, though, is not the worst of it. While covering the funeral of a local cleric, Wasay was caught in the crossfire and sustained four bullets in his arm. He was trying to cover his face.

"My family says I’m no longer a human being. I don’t get extremely happy on happy occasions and I don’t get too upset when someone close to me dies. I just don’t feel anything," says Wasay. But without professional psychiatric evaluation, Wasay’s statements remain just that—statements.

In an environment where senior journalists and newsroom managers pay little heed to the emotional well-being of reporters, it is no wonder that so few come forward with their problems. For journalists all over the world, especially Pakistan, witnessing a cold-blooded murder – as was the case with Asif – or being exposed to killings regularly – as was Wasay – is not uncommon. If not through first-hand contact, many experience these events second-hand. Reporters, assignment editors, desk editors, photojournalists, cameramen and other members of the newsroom are involved in the coverage of many tragedies and traumatic events, including natural disasters. All these events create lasting memories, some more crippling than others.

Researchers in the field of traumatic stress in the West are only beginning to examine the toll this profession may have on the mental health of journalists. It was not until 15 years ago that Post-Traumatic Stress Disorder (PTSD) was acknowledged in the field of journalism—one of the last professions to recognise the serious disorder. In 2013, the American Psychiatric Association (APA) specifically included to its definition of PTSD work-related, repeated and indirect exposure to distressing material.

The Dart Center at Columbia University in New York is a resource hub on the topic of journalism and trauma. It provides guidance on how to report ethically on tragic and/or traumatic incidents as well as to protect oneself from their harmful effects.

The center recently published an analysis of over two dozen studies conducted between 2001 and 2014, which included journalists from all over the world and across mediums. The research collectively showed that 80 per cent to 100 per cent of journalists have been exposed to work-related traumatic events. These include fires, murders, disasters, war and mass casualties. "A significant minority of those exposed are at risk for long-term psychological problems, including PTSD, depression, and substance abuse."

Dr Anthony Feinstein at the University of Toronto is a pioneer in this research and has dedicated his career to studying journalists and PTSD since he first discovered this connection 15 years ago. Currently a professor of psychiatry, he has conducted numerous studies on journalists who have reported on the genocide in Rwanda, the civil wars in the Balkans, 9/11, the wars in Iraq and Afghanistan and drug-related violence in Mexico.

Regarding the inability of many journalists in Pakistan to recognise psychological symptoms or the dismissive attitude of seniors in this profession, Feinstein was not surprised. "These responses are similar to those that I received 15 years ago, when I first began my research," he says. "There is a universality to trauma and people react in similar ways," he adds.

In Pakistan, little to no research has been done on the impact of prolonged reporting on violent and traumatic events as well as the extreme stress of newsrooms have on journalists. Pressure comes from various sources, including intelligence agencies and political parties, as well as criminal/terrorist networks. These factors exclude daily workplace stressors, such as deadlines and long work hours.

Exposure to violence in Pakistan is far more frequent compared to most other countries, and many journalists fear for their jobs as well as their lives. Pakistan was ranked the fourth deadliest for journalists in the world in a report published by the International Federation of Journalists this year.

In the absence of quantifiable evidence to shed light on journalists and their mental health, along with the reluctance of most media houses to invest in the emotional – and physical – well-being of their daily reporters, there are still some who are working to break the silence on the issue and help journalists cope.

In 2013, the American Psychiatric Association (APA) specifically included to its definition of PTSD work-related, repeated and indirect exposure to distressing material.

Recognising the needs of hundreds of journalists in the embattled region of Khyber Pakhtunkhwa and the tribal belt, the journalism and psychology departments at the University of Peshawar established a Competence and Trauma Center for Journalists in November 2014 in collaboration with DW Akademie, a German media company. The centre receives referrals for journalists who seek counselling through the Peshawar Press Club and the Khyber Union of Journalists. Therapy is free for journalists.

"We were not expecting more than four or five people in the first month of operation," says Professor Altafullah Khan, chairman of the department of journalism and mass communication at the University of Peshawar . So when 40 journalists came through the doors in 2015, those involved with the centre knew they were making a difference. "We were pleased to see some senior journalists breaking the stigma and coming forward," says Altafullah Khan. In the initial stages of introducing counselling at the local press club, Khan recalled what he feels is a normal first response from journalists: “You are making this place sound like a mental asylum."

"The main issue is how quickly these journalists get burnt out due to stress," says Farhat Naz, a psychotherapist who worked at the centre during its first year of operation. She has been involved in therapy treatment of over 20 journalists; in her opinion, many of those who seek help suffer from the psychological impact of working 24/7 and receiving poor compensation.

The symptoms, she says, include anxiety, sleep deprivation, depression and, in some cases, PTSD. After experiencing traumatic events through their work, some journalists get flashbacks and suffer nightmares regularly. "Family members are affected in many cases, as journalists return home appearing irritable and aggressive, losing their temper more frequently."

"There is a serious need to build a vocabulary around trauma in Pakistani newsrooms," says Sehrish Shaban, who has worked in newsrooms in the United States, Pakistan and India. She is now a media consultant and is also studying to be a counsellor herself. To gather material on how pervasive the problem is, Shaban recently conducted an online survey of 500 journalists across Pakistan. Her findings speak of the occupational stress that is inherent across newsrooms all over the country, especially in television news.

Also read: The price of a life: Compensating victims of terrorism

The survey shows that 66 per cent of respondents had faced both a security threat and knew a colleague who was attacked. Almost 60 per cent of respondents reported routinely working overtime; 65 per cent feared job security; and almost all of them struggled with poor compensation and ethical dilemmas. "Pakistan’s relatively young, privately-owned television and online news industry lacks regulatory standards that safeguard professionals," says Shaban.

She did not include direct questions related to mental health as she feels that many journalists still don’t know how to talk about the subject. One can’t simply ask, ‘Do you feel you suffer from depression?’ and hope to get any kind of truthful response. Shaban is now in the process of approaching newsrooms with training programmes to help journalists understand trauma and deal with stress.

There is a macho culture and deeply-rooted stigma surrounding matters of the mind which permeate through newsrooms and reporting fields all over the country. In a male-dominated profession like journalism, people hesitate to talk about their emotions—especially related to the job. Most reporters are probably happy just to have jobs. They are acutely aware if they show any ‘weakness’ or vulnerability, somebody else will be more than willing to step up.

"I spoke about it [trauma] with my inner circle of close friends and colleagues, but never publicly— not like this," says Asif. He feared his superiors would stop giving him “hard core” assignments.

There are still some, though, who have spoken about their experience publicly in order to raise awareness about the issue. "The well-being of a reporter is more important than news," says Farzana Ali, who has 19 years of experience in journalism. As the bureau chief for Aaj TV in Peshawar, where militancy is a major security threat, Ali and her 23-member team have seen a fair share of violent incidents.

Beginning 2007, when there was a massive spike in violence across the region, Ali says they had no idea what was happening to them at the time. They were given an assignment and that was that. There was no training on how to cover militancy or bomb blasts. Over the years, Ali desensitised herself to headless corpses and the smell of blood, something which made her gag previously.

"I spoke about it [trauma] with my inner circle of close friends and colleagues, but never publicly—not like this," says Asif.

The Army Public School (APS) massacre in Peshawar on December 16, 2014 was a turning point for Ali and many of her colleagues. On that day, 144 people, most of them children, were brutally gunned down by the Taliban. "It was the first time we realised that we are human beings, and not above having an emotional reaction," she says. The APS attack struck a deep chord with journalists. It was the first time, says Ali, that many of them cried during live coverage—both men and women.

Ali speaks out on the issue often and has even been involved with trainings at the trauma centre at Peshawar University. "The main problem is the misconception that people who struggle with the psychological effects of reporting on violence are crazy."

While it’s important to have external resources such as the trauma centre at University of Peshawar and a group of peers to turn to, the support of media organisations is instrumental in bringing about real change. The facility of having an in-house counsellor may be a long way coming, but journalists should at least feel safe enough to approach their supervisor and request a different assignment in times of distress. "It is important to raise awareness and support at all levels of the newsroom," stresses Shaban.

"After I was shot, my organisation sent a psychologist to see me. Not to give me counselling, but to assess if I was still capable of working," says Wasay. After three days, the psychologist gave Wasay a clean bill of mental health. He never saw him again. During those sessions, Wasay says the psychologist repeatedly asked him questions related to his competency at work: “Don’t you want to leave your job? Can you still do reporting? Is it not too dangerous?”

“I felt like a stray dog. After almost paying the ultimate price in the name of my profession, I felt my employers had disowned me."

Wasay was back at work within a month.

**The names of some journalists have been changed to protect their identity*

The writer is a staffer at the Herald.