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Most New York City firefighters have bounced back strongly from the trauma of Sept. 11, but many have left their jobs, and some are still plagued by anxiety and flashbacks, therapists say.
''For those who stayed, recovery has been excellent. We've seen a surprising resilience,'' says New York psychiatrist Kevin Kelly, who works half-time treating city firefighters. He spoke recently at the American Psychiatric Association meeting in San Francisco.
About 500 firefighters rushed to the World Trade Center on Sept. 11, 2001; 343 were killed there. But what survivors saw that day was only the beginning, Kelly says. The nine months of recovery and cleanup work at Ground Zero has induced some of the worst trauma.
''This has been horrific and lasting. We've got guys having nightmares about body parts,'' Kelly says.
He organized psychiatrists of Irish heritage from the Celtic Medical Society in New York to voluntarily treat firefighters. The department is heavily Irish, ''and it became clear these guys were reluctant to talk to outsiders, but they might be willing to talk to people with names like Kelly,'' he says.
Out of 11,000 firefighters and 3,000 emergency workers, more than 5,000 have come in for counseling related to Sept. 11, says Malachy Corrigan, fire department director of counseling services.
He says 125 members of the force have been diagnosed with post-traumatic stress disorder (PTSD) related to the terrorism, and about 60 still can't fight fires because their symptoms are so severe. Most have been reassigned to other jobs, but a few are out on disability.
Retirements have skyrocketed since the terrorist attacks. Based on past years, 450 would have been expected to retire in the 20 months since Sept. 11, but more than 2,000 have taken retirement, Corrigan says.
Some built up overtime rapidly in the Ground Zero work, making earlier retirement possible; others retired at the urging of worried families; about 350 left mostly because of medical problems, often lung ailments sustained in Ground Zero work. ''Undoubtedly, some of the retirement is due to 9/11 stress, but we can't say how much,'' Corrigan says.
The department's treatment programs for alcohol problems typically have about 200 participants, ''but about twice that many are in treatment since 9/11,'' he adds. Surveys suggest that smoking is up, too, he says.
Relatively few are so stressed that they have PTSD, but a lot are experiencing flashbacks and anxiety, says psychologist Ellen McGrath, who counsels firefighters in the Brooklyn area.
''Some say they still feel the spirits of the guys they lost. They'll say, 'I heard Leon's voice here the other day.' . . . These guys are like brothers, so it's like they lost brothers, but many were closer to the guys in their station house than they are to their own brothers,'' McGrath says. Still, she says, ''we've seen a lot less PTSD than we expected.''
Firefighters are classic risk takers, the ''Type T'' personality type, says Temple University psychologist Frank Farley, whose research has found distinctive traits in physically bold daredevils. He's not surprised by the low PTSD rate.
''For Type Ts, it's like that old Frank Sinatra song: 'Pick yourself up, dust yourself off and start all over again,' '' Farley says.
''They're usually robust people who can take the hard knocks and keep ticking.''
Type Ts hesitate to open up about personal traumas, he adds, ''because it just doesn't fit with their self-reliant image. . . . But they do want to get back in the game. They're confident, forward-looking people who recover well from the stresses of life.''
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