“The most powerful weapon in the world is a photograph,” according to Associated Press photographer Eddie Adams, who took the incredibly-timed picture in 1968 of a South Vietnamese general shooting a suspected Viet Cong guerrilla in the head on the streets of Saigon – the victim grimacing from the bullet’s deadly path.

Adams wasn’t kidding: there are many examples, but witness the international upheaval following the photo of three-year-old Syrian refugee Alan Kurdi’s lifeless body washed ashore in 2015.

We’ve all seen photographs of war and natural disasters. The conflicts vary, but the pictures depict death, despair and destruction. But what of the people who captured these shocking images? As flesh-and-blood humans, how do photojournalists cope with work that is dangerous and tears at the heart? We might think of them as unblinking and hard as their cameras, but as Anthony Feinstein shows, that’s a myth.

A Toronto neuropsychiatrist and member of Toronto’s First Narayever Congregation, Feinstein has assembled a hefty, attractive book whose glossy pages stand in stark contrast to their contents. Inside, disturbing images and words convey the stuff of nightmares.

Feinstein’s Shooting War is a remarkable book that combines 18 essays, one each for some of the world’s pre-eminent conflict photographers, alongside a single, jarring photograph around which the text is built. The essays result from face-to-face interviews with the photojournalists, their relatives and close friends, and shine a light on not only what motivates photographers to enter conflict zones, but the human cost of bearing witness to wars, natural disasters, and other crises.

The book grew out of a series Feinstein wrote for the Globe and Mail that examined a dozen photographers. He added six more for this volume.

Feinstein isn’t a photographer by profession, but he was a soldier. In 1982, the newly minted doctor was “unwillingly” conscripted into the South African army and shipped off to a distant war in Namibia and southern Angola. Among the items soldiers were not permitted to bring was a camera.

Of course, somebody did, and the resulting grainy, amateurish, four-by-six-inch colour photos, which Feinstein still has, served to kindle his interest and passion in war photography, he writes in the book’s introduction.

His main medical interest is multiple sclerosis, but for the past 20 years, he’s had what he calls an “enduring passion” for the intersection between war and journalism. It began in 1999, when he counselled “an interesting patient who came my way,” as he put it in a recent CJN interview (one media outlet identified the patient as a reporter who had developed “significant psychological issues” in the course of her work).

Since then, Feinstein has published a series of studies exploring the psychological effects of warfare on journalists who have covered conflicts in Syria, Afghanistan and Kenya. He’s been a Guggenheim fellow and won a Peabody Award for his documentary Under Fire: Journalists in Combat.

The Daily Beast pronounced him “perhaps the pre-eminent expert on the effects of conflict on the journalists who document it.”

Feinstein said he’s concerned about two things: how journalists are affected psychologically by working in conflict zones, and why they do it in the first place.

“One area of war journalism that I find particularly fascinating is photography,” Feinstein said. “The photographers have to get really close to what’s going on. You can’t hold back. (There’s) a heightened risk of injury, death and psychological trauma.”

There’s a tendency on the part of media consumers, he noted, to gloss over the impact of hard-to-see pictures on those who take them.

“We look at the photographs and we admire them, and they’re remarkable. We might be appalled by what we see. We can never stay neutral in the face of these images. But I think people don’t give enough attention to what effect this kind of work had on the photographer,” Feinstein said.

For the most part, the journalists he interviewed were resilient, even after working for 30 years, but some developed anxiety, depression and post-traumatic stress disorder, or PTSD. “They’re not immune from what they see and confront.”

The story of Australian photographer Ashley Gilbertson is especially compelling. Embedded with the U.S. Marines during the Iraq War in 2004 and in the thick of the battle for Fallujah, Gilbertson had heard that an insurgent had taken cover in a minaret. He wanted a picture.

Shots rang out when he was taken to the scene by a military escort, and a marine in front of him was killed. Gilbertson blamed himself and developed what Feinstein called “incapacitating guilt and PTSD.”

The photographer’s way of coping was to produce an antiwar book, Bedrooms of the Fallen, depicting the empty bedrooms of young men and women who had been killed in war. “His photos are powerful testimony to the futility and pain of war,” Feinstein said. “These bedrooms are frozen in time.”

Feinstein calls the story of Sir Don McCullin “moral injury writ large.” The British photographer, who was knighted by the Queen, continues to beat up on himself and express guilt for intruding into the lives of people who are suffering.

“He blames himself for building a career on the backs of others’ suffering,” Feinstein said. “He really shows all the features of profound moral injury, even while continuing to work.”

On the other hand, South African lensman João Silva offers “a remarkable tale of resilience.” Following a long career covering war, and celebrated as one of the great war photographers, he lost both legs after stepping on a landmine in Afghanistan. But he rebuilt his life and developed no emotional problems.

Story by story, “you see these remarkable anecdotes from journalists, how this work has had the most profound effect on them, and yet they’re driven to keep doing it, notwithstanding the dangers and the challenges,” Feinstein noted.

He added that he doesn’t believe the photographers are motivated by the old romantic notion of the swashbuckling war correspondent.

“My sense is that this group is not driven by this anymore,” said Feinstein. “After a long period of time doing this kind of work, what becomes most compelling for them is the need to bear witness and tell stories. And that’s one of the most refreshing things being around this group, because I don’t come across ego or people trying to protect a persona or convey a certain image. They’re very much a down-to-earth group. I find that so refreshing. There’s no artifice, no hubris. They’re upfront. They speak openly and truthfully about what they witnessed and what they personally experienced. And that makes for fascinating interviews.”