Early one morning in April 2003 Stuart Hughes, along with a cameraman and a producer, set off for Kifri, a town about 18 miles from Baghdad, as part of an assignment for BBC News.
The former frontline town had been bombed a few days earlier by American planes which had forced Saddam Hussein's men out of their trenches towards Baghdad. Escorting the world affairs correspondent and his team, was a young Kurdish soldier who assured them that the area was safe.
Within seconds of arriving at Kifri, Hughes stepped out of the car and set off a landmine that had been hidden in the grass. Their Iranian cameraman, Kaveh Golestan, thinking they were under fire from above, ran away from the vehicle to what he thought was safety.
Instead he ran further into the field stepping on one landmine and falling onto another. He was killed instantly.
Scared and confused, Hughes was unaware of how bad his injuries were. As he lay on the ground all he could smell were explosives and burnt flesh. He tried not to look down in case the sight of his injuries made him faint. His colleague, Jim Muir, managed to reverse back along the path they had taken by following the tracks in the grass so that Hughes could receive emergency treatment. The landmine had blown off his right heel. Five days after the incident, he had his right leg amputated below the knee.
Six months later, Hughes was back at work. "I never cut myself any slack," he says. "I wasn't going to compromise at all, because going back was my way of coping."
But eventually things would catch up with him. In 2007 he began having severe anxiety, panic attacks, insomnia, difficulty concentrating and depression. He was diagnosed with post-traumatic stress disorder (PSTD), which lasted for two years. "I think with any kind of mental health issue it's never just one thing that causes the problem, it's a combination of factors. It wasn't as though suddenly I had problem, it just crept up on me over a number of years."
As a journalist suffering from trauma as a consequence of his work, Hughes is not alone. The coverage of extreme human distress is a fundamental part of a journalist's job. Whether it is a war zone, a child murder, a domestic terror attack, a grisly trial, or collating graphic images from the web, journalists are often confronted by traumatising experiences and images that few, outside the emergency services, experience.
Yet despite being exposed to human suffering, sometimes on a daily basis, the psychological impact is often overlooked by the public, editors and journalists themselves.
Gavin Rees, director of the Dart Centre Europe for Journalism and Trauma, says that journalists are like tight rope walkers. "[They] stay on target, stay on mission and do wonderful, wonderful work and stay balanced for a long time. But you can't carry on walking a tightrope forever. You need to take some rest and you need to get away from the job."
Rees says there is an old fashioned view that journalists are "Teflon-coated" and unaffected by their work. "There is this idea that if you're a kind of rough, tough journalist and you rush out into the world, reporting on human destruction and misery, you expect the people in your stories to be affected by what happens to them but you don't necessarily expect to be affected yourself."
Cat Hepple was affected more than she anticipated when she was working as the north of England correspondent for the BBC. In 2004 she was sent to Liverpool to interview the family of Ken Bigley, a British businessman who was kidnapped in Iraq by Islamist militants.
Despite a high profile campaign to save him, Bigley was beheaded after three weeks. During that time Hepple was the only journalist the family agreed to speak to. She interviewed them several times in private, including immediately after they had watched the video of the beheading.
Afterwards Hepple began having nightmares. One night she dreamt that Bigley was alive and had seen where he was held captive. "I was convinced that I had rung the family to tell them this. It sounds crazy but I had to check my phone. That was when I realised that maybe that was a form of post-traumatic stress. I was having nightmares that were so vivid they genuinely felt true."I was having nightmares that were so vivid they genuinely felt trueCat Hepple
Friends and colleagues told Hepple that she was getting too close to the story, seen as a weakness. She says this attitude was one of the reasons she quit her job in 2009 to become a wedding photographer. "If you allow emotion to come into your work it was thought that you are not able to cope and that you are not strong enough. That frustrated me."
The idea that an emotional journalist is not an effective one or that showing vulnerability is a professional weakness means that many journalists don't talk about their reactions to traumatic events, sometimes to their detriment. Hepple says that internalising her emotions for her 17-year career took its toll: "If you haven't been allowed to display any emotion, you take that emotion away with you and you bury it. That is not good in the long run."
Far from burying his emotions, BBC security correspondent, Frank Gardner, "got it all out" in a book. Gardner was shot six times by al-Qaeda sympathisers in Saudi Arabia. The attack in 2004 left him partially paralysed. His colleague, cameraman Simon Chambers, was killed.
Yet nine years later, Gardner has never suffered from PTSD. He says his book, Blood and Sand, is one of the main reasons. "As soon as the bullet wound in my right shoulder had healed enough, I asked for a laptop in hospital and wrote down everything that had happened." He says he then "bored everyone who came to visit me telling them what happened. I didn't hold things back."
By not holding back, it was easier for Gardner to come to terms with what happened to him. Unlike him, BBC presenter Sian Williams regretted bottling up her emotions after she spent a week covering the 2004 Pakistani earthquake.
When she, her producer and a camera operator arrived in the earthquake zone in Muzzaffrabad, they only had nuts and raisins to eat before their supplies arrived. Williams was humbled when families who had lost everything and were sleeping rough offered them rice from their charity shipments. With no running water and thousands of people living in makeshift camps, Williams says, "conditions got pretty nasty, very quickly".
The experience had a lasting effect on Williams. "Afterwards, I didn't want to talk about any of it. I felt guilty that I had been able to leave after a week, leaving everyone behind." She went back to work in London and didn't tell anyone how she felt. It wasn't until the death of her mother that the images of the earthquake came flooding back. "I started thinking about death and realised I should have talked to others about what had happened."
Williams and Heppel are examples of how trauma is not limited to the term PTSD. If PTSD is the most extreme consequence of trauma, there are many more reactions that are not talked about but are just as important to acknowledge. They can include flashbacks, avoidance of anything that might trigger memories of the event such or heightened irritation.I felt guilty that I had been able to leave after a week, leaving everyone behindSian Williams
These reactions are also not restricted to journalists covering war, high profile kidnapping or natural disasters. Sandra Laville is the crime correspondent for the Guardian and has witnessed some particularly harrowing things in court.
Last summer she was reporting on the murder of Tia Sharp, a 12-year-old girl who went missing for seven days. Stuart Hazell was sentenced to 38 years in prison for her murder.
Laville found it particularly hard because she has young children. "It was awful... I felt really dark for quite a long time."
The fact that the case was so close to home made it all the more upsetting for Laville. But reporters like her often have to sit through detailed and horrific court cases for weeks at a time. "People don't realise that when you go to a court case about paedophilia or a child murder it is horrible. You get everything, but the public doesn't get that because we don't put all the detail in."
One of the reasons that home news, however distressing, is overlooked when it comes to journalist's mental health is that it usually lacks the obvious horrors of war and foreign reporting. Laville thinks there is a double standard when it comes to people's perceptions. "[War correspondents] drink, they get traumatised and have lots of relationships but it is not accepted if you do it in the UK.People don't realise that when you go to a court case about paedophilia or a child murder it is horribleSandra Laville
"I don't want someone to say it is glamorous to sit in a court room but there is something closer to home that is deeply traumatic. To sit and watch and investigate stories about children being murdered is deeply traumatic."
This lack of attention on UK-based reporters is a big concern according to Professor Neil Greenberg, a psychiatrist who has worked with the military to develop ways of preventing traumatic stress. While war reporters are particularly susceptible to trauma, they are often more aware of the dangers. Greenberg says he is more concerned about trauma happening to journalists who are completely unprepared and whose management departments are unprepared. This could be the fresh young reporter on a local paper or, more recently, a journalist monitoring user-generated content to report on conflict and disaster.
Markham Nolan works for Storyful, a company that helps newsrooms verify the best content from the social web. During the Arab Spring that meant trawling through hundreds of hours of horrific footage uploaded by civilians and soldiers in the centre of the action. Nolan has seen pictures of torsos cut in half by gunfire, skulls blown open and children dying. He says that some images have lived with him: "The most graphic ones remain in your memory until something comes along to topple it." A recent example is a video from Syria where he saw corpses being mutilated with iron rods. "That was one of the most gruesome things I've seen in a few months."
Storyful realised they needed to do something and brought in a psychiatrist for staff feeling overwhelmed. But not every news organisation is so forward-thinking. Stuart Hughes fears that many more journalists are slipping under the radar.
Since suffering from PSTD, Hughes now raises awareness about the psychological welfare of journalists. When he began speaking out, he was taken aback by how many colleagues and friends confided in him. "I think there is a lot of trauma out there, not just among war correspondents, but also people who cover traumatic court cases or interview victims of violence or rape. There is a lot of untreated trauma that hasn't, and maybe never will, come to the surface. It just lingers."
But if Hughes is right and there are so many undisclosed cases of trauma, what is being done by news organisations to help their staff? Not enough, according to Mark Brayne, former foreign correspondent at Reuters and the BBC and now a practising psychotherapist.
Brayne worked as a foreign correspondent during the Cold War. However, the pressures of his job led to the breakdown of his marriage and took him into psychotherapy at the end of the 1990s. He recalls: "A light went on and I thought, 'wait a minute, there's more to life than chasing news conferences and ambulances'".If the trauma is buried, denied, hidden, it will fester and eat you up from withinPatrick Howse
He left the front line to become a producer for the BBC World Service and started training as a psychotherapist in his spare time. "I started jumping up and down at the BBC, making myself very unpopular at one point. I really irritated people by banging on about the need for emotional psychological support for journalists."
When the UK went to war in Iraq in 2002, the corporation took note and organised an urgent series of workshops on coping with traumatic situations.
Things have come a long way since then and both the BBC and Reuters now offer Trauma Risk Management (TRiM). First developed for the military, TRiM is a peer support system, which teaches non-medical people how to spot the signs of distress in others. Sian Williams took the two-day course after Pakistan and said it was one of the most important things she has done in her 28-year career. "Things are changing within the industry and I'm honoured to be in a position to help anyone who has had a traumatic experience."
The BBC may be heading in the right direction but 11 years after the first trauma workshops, Brayne says there remains "a breath-taking unwillingness or reluctance on the part of the journalism profession to put trauma awareness right at the heart of journalism practice."
Part of the responsibility lies with bosses and editors. Evidence shows that the biggest factor determining whether a person develops PTSD is how they are treated after the event. This could be as little as a simple recognition of a reporter's hard work.
Patrick Howse found the lack of recognition from his bosses particularly harmful to his mental health. When he was reporting for the BBC in Iraq in 2009, a rocket came through the ceiling of his office. No one was injured but he and the crew had been recording on the roof only 15 minutes earlier and would have certainly been killed. Three days later, he walked into the television centre to drop off his flak jacket. "Not one of my bosses said a single word to me. Not a single word. Except one of them who asked if I wanted to go to Burma." Howse, who was feeling tired and traumatised from having to work 16-hour days under the constant threat of attack, said he went away "thinking that no one cared if I lived or died – that is fantastically psychologically damaging."
Howse was diagnosed with PTSD in 2010 and has set up a website where he publishes poems about his experiences. He says that "dozens and dozens" of other journalists have contact him with similar problems.
Unlike so many other journalists who have been affected by trauma, Howse broke the taboo by speaking about it. He believes that, until other journalists do the same, very little will change. He says: "The feeling that you should be ashamed of being traumatised is outmoded and frankly ridiculous." Howse says that trauma is a "natural" and, at times, inevitable consequence of the job, "But it's what happens next that counts. If the trauma is buried, denied, hidden, it will fester and eat you up from within. Let's get it out into the daylight - let's all take responsibility for each other, be open to the experiences of others and be honest about our own."