Although reporters, and war correspondents in particular, are a hardy bunch, Shapiro added, some do break down, and often start self-medicating with drugs or alcohol.

“I have talked to many journalists who’ve gotten derailed by psychological injuries,” he said. “I have seen people who are no longer able to meet deadlines, who are haunted and wake up every night, and people who go the opposite direction and race toward danger.”

THE PRICE OF SHUTTING DOWN

Research shows, unsurprisingly, that the greater the exposure to violence, suffering and death, in particular involving children, the more likely people are to break down.

And those situations are exactly what many journalists - along with aid workers, firefighters, policemen and soldiers - have to deal with as part of their job.

“To go to a place like Haiti after the earthquake and see the kids digging for their parents… it’s going to affect you,” said Dr. Matthew J. Friedman, who directs the National Center for PTSD at the U.S. Department of Veterans Affairs.

“It’s human nature to basically soldier on,” he added. “On the one hand it is adaptive to shut down emotionally, but that comes at a very high price.”

Not everybody who witnesses a traumatic event up close - a fatal car crash, a murder - develops PTSD; according to the VA, about eight percent of men and 20 percent of women do so. Exposure to war, high-intensity assignments or longer time in the field will up the risk further.

Replacing quaint terms like shell shock and battle fatigue, the American Psychiatric Association first defined PTSD in 1980 in its Diagnostic and Statistical Manual of Mental Disorders, often called the bible of mental illness.

The diagnosis includes a trio of distressing symptoms that must remain for at least a month. The first part is re-living the traumatic event, for instance as frequent flashbacks or nightmares, or as extreme physiological reactions to everyday things like reading a book. The second is avoidance - such as going out of your way not to get near the local playground or, say, eschewing the smell of charred meat on a barbecue - and a “numbing” toward other people and positive emotions. And the third is being revved up all the time, looking for potential signs of danger.

A person with PTSD often experiences depression, too. On his website http://www.conflict-study.com, Feinstein, supported by CNN and Chris Cramer, has created a confidential self-assessment tool that journalists can use to probe their mental health.

Sometimes the symptoms will dissolve by themselves, as they did for Cramer, though only after shattering his dreams of overseas reporting. Today he is a manager with Reuters and the president of the International News Safety Institute, an organization that promotes safety for people in the media.

“If I had known then what I know now,” he said, “I would have taken myself off to the shrink and probably had several of them.”

NOT NECESSARILY A CAREER ENDER

David Loyn, a long-time international development correspondent with the BBC in London, is one of the journalists who chose to get help. On a tumultuous trip to Afghanistan in 1996, Loyn saw a man get executed on the street for the crime of stealing his television camera.

“I was on my knees begging for his life and telling this police officer that he shouldn’t shoot him on my account,” Loyn told Reuters Health. “It was not a good day. For that, I sought professional counseling. I wasn’t badly affected, but I was pretty shaken up.”