Stoic Firefighters Wrestle With Post-Disaster Emotions

After several months of what on the surface might seem like small talk between mental health professionals from St. Vincent’s Catholic Medical Centers and some of the firefighters in New York City, the details of horror and devastation that became an unwelcome part of their lives on September 11 are beginning to surface at last.

Some firefighters talk about their harrowing escape from the World Trade Center after the attacks, while others talk about the gruesome recovery efforts. Others won’t talk about their experiences at all.

Many speak about the loss of brotherhood—the firefighters think of themselves as family. Rescue 5, a firehouse on Staten Island, lost almost half of its firefighters. In all, 343 firefighters who worked in firehouses in New York City were lost in the terrorist attacks. Many are still attending memorials for their dead comrades.

“Firefighters are an incredibly caring and hard-working group,” said Roy Lubit, M.D., who is a child and adult psychiatrist at St. Vincent’s and has counseled the firefighters. “In addition to their regular work, they are often involved in community activities. If a fellow firefighter dies, it is not uncommon for the whole firehouse to care for the children of the fallen firefighter.”

As part of an agreement between St. Vincent’s and the Fire Department of New York (FDNY), psychiatrists (including residents), psychiatric nurses, and social workers have been counseling the firefighters individually and in groups since mid-October, according to Donald Thoms, M.S., director of World Trade Center Services at St. Vincent’s. The counseling is supported by a large grant from Pfizer Inc.

“The fire department has always had a counseling center for the firefighters,” commented Spencer Eth, M.D., who is medical director of behavioral health services at St. Vincent’s and helped to facilitate the agreement between St. Vincent’s and the FDNY. “Given the enormity of the tragedy of 9/11, however, the FDNY staff members were overwhelmed. We are augmenting the staff but doing it at their location, which is more convenient for the firefighters.”

Former APA President Joseph T. English, M.D., who is chair of psychiatry and behavioral health sciences at St. Vincent’s and professor and chair of the department of psychiatry and associate dean of New York Medical College, said, “We feel our job is to be totally responsive to what [the fire department] needs. . . .The fire department clues us in as to where we can be of help, so we take their lead and go where they wish us to, and this involves the families of the firefighters in addition to the firefighters.”

The details of a similar contract between Columbia University and the New York Police Department were unavailable due to the confidential nature of the contract.

Staff from St. Vincent’s counsel the firefighters at firehouses in Manhattan and Staten Island and at the FDNY Counseling Center in Manhattan.

In addition, counselors from St. Vincent’s, the FDNY, and the community operate a weekly support group for families of the firefighters at the FDNY Family Counseling Center in Staten Island.

Each session is well attended—25 to 35 family members including the children, parents, and siblings of the firefighters come together each week to express their feelings and support one another, Thoms said.

According to Lubit, many firefighters—as do many people in New York City who were affected by the September 11 attacks—show signs of posttraumatic stress disorder (PTSD) or traumatic grief.

“For those who lost loved ones,” said Lubit, “the normal bereavement process is greatly complicated by the absence of a body to bury and by their images of gruesome ways in which their loved ones died.”

He added that traumatic bereavement often requires special treatment similar to that provided to people with PTSD.

Increased alcohol use, strained relationships, irritability, and difficulty concentrating and sleeping are also common problems in the firefighters, he said.

Finding Common Ground

A major feature of PTSD is the avoidance of reminders of the event or events that caused the trauma, Lubit pointed out. According to DSM-IV-TR, this is characterized in part by “efforts to avoid thoughts, feelings, or conversations associated with the trauma.”

Asking direct questions about how the firefighters are dealing with traumatic issues would likely be met by an avoidance response, said Lubit. Thus, counseling staff must be careful about how they approach the firefighters.

“The best way to connect is to just hang around and slowly build a relationship,” said Lubit. “The firefighters have literally invited us into their houses—we are their guests and never forget that.”

The firefighters often joke with the mental health staff and enjoy showing staff the tools of their trade—fire engines, hoses, and other equipment, said Lubit.

The firefighters also talk more about their families and fellow firefighters than themselves, Lubit observed. Sometimes this leads firefighters into discussions about their thoughts and feelings.

This avoidance had been the norm rather than the exception in interactions between St. Vincent’s staff and the firefighters—until recently. “Trust is beginning to build, and more firefighters and family members are beginning to come into the fire department counseling centers for help,” he noted.

Call to Duty

“Bringing up painful details of the trauma is particularly difficult for the firefighters because they are still on the job,” said Lubit, “and need to be on top of their game given the difficulty and dangerousness of their work.”

During funerals and memorial services, firehouses are closed so members of the force will not have to spring into action suddenly when they are grieving, he added. Another problem is that help seeking is not part of the firefighters’ culture, which is rescue oriented.

“Seeking mental health services or talking about feelings may be perceived as weak,” said Lubit. “Rescue workers such as firefighters and police also have significant concerns about confidentiality and worry about whether going for counseling could negatively impact their careers.”

In addition to his work with the firefighters, Lubit has been conducting educational sessions for businesses located in Manhattan and providing counseling to employees affected by the attacks. He said that some employees who worked in buildings or lived in apartments that were evacuated on September 11 are showing signs of PTSD. “People are complaining of intrusive memories, emotional numbness, and hyperarousal.”

Some schoolchildren are faring no better. Lubit has worked with school children who were forced to evacuate their schools on September 11. He met with them while they were at their temporary schools and more recently since their return to their home schools. “Many have been drawing endless pictures of the towers on fire, planes flying toward the towers, and the smoke cloud that hit them,” he said.

Lubit noted that, for the most part, the children who are experiencing the most emotional difficulty have parents who are traumatized. He said that research points to the fact that “one of the most important things in terms of a child doing well after a trauma-causing event is that the parents are calm and emotionally available.”

A number of parents have chosen to transfer their children to schools outside of lower Manhattan rather than send them to the once-evacuated schools because they have concerns about environmental hazards such as asbestos and other unknown air contaminants.

“In one public school that had been evacuated after September 11 and since reopened, half the children have left,” he noted. “This causes additional anxiety in the children left behind,” said Lubit. ▪