How does seeing and experiencing extreme situations on a regular basis such as rapes, murders, etc., impact a FireFighter's civilian daily life?

by Dr. Stephen Johnson, Ph.D., LMFT
Clinical Program Director,
FireFighters Down

Firefighters who are constantly in the line of duty often feel like they are on the front lines without a foxhole, so to speak. They can face acute traumatic events on a day-to-day basis.

They may feel like they’re used to it. However, when the trauma that they are dealing with causes trauma in their own lives and when it doesn't go away, it’s called Post Traumatic Stress Disorder or PTSD. According to the Department of Veterans Affairs, the four main types of PTSD symptoms are the following:

1. Reliving the event. Memories of the traumatic event can come back at any time. The Firefighter may feel the same fear and horror that he did when the event took place. For example, he may have nightmares. Or he may feel like he is going through the event again; this is called a flashback. He may see, hear, or smell something that causes him to relive the event, called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers. He may think the world is completely dangerous, and no one can be trusted.

2. Avoiding situations that remind him of the event. He may try to avoid situations or people that trigger memories of the traumatic event. He may even avoid talking or thinking about the event. He may come home and plop himself down in front of the TV to just turn off the events of the day. He may turn to alcohol, pain medications and other drugs to numb himself.

3. Negative changes in beliefs and feelings. The way he thinks about himself and others changes because of the trauma. This symptom has many aspects, including the fact that he may not have positive or loving feelings toward other people and may stay away from relationships.

It can lead to a change in the bedroom --either there’s no interest in sexual intimacy, or the demand is constant and unrelenting. Spouses are cautioned that if your lover has morphed into a non-verbal teenager, it’s time to make an appointment with the marriage counselor before you can’t remember why you ever fell in love.

Watch out for the “Usta” syndrome. Examples of the Usta Syndrome: I usta hunt; I usta fish; I usta work out; I usta read to my kids… This can lead to “I usta be married,” or worse, “I usta have a life and now it’s time to end what’s left of my life.”

4. Feeling keyed up (called “hyperarousal”). He may be jittery or always alert and on the lookout for danger. He might suddenly become angry or irritable. For example, He may have a hard time sleeping or concentrating. He may be startled by a loud noise or surprise. Being overwhelmed can appear as tantrums, loss of temper, storming out, tears, etc.

What are the common symptoms that injured Firefighters suffer from mentally?

Sleep deprivation, black/white thinking, doomsday predictions, a sense of injustice and betrayal, the need to exact vengeance, reliving an event, bad dreams, loss of short-term memory and sexual dysfunction are but a few of the symptoms and all are treatable.

Do Injured Firefighters differ in anyway?

Post-Traumatic Stress Disorder (PTSD) is most often associated with soldiers coming home from war zones. For many of these men and women, living with PTSD means revisiting the pain and negative emotions they felt in a moment of crisis, very much as they experienced them the first time around, despite attempts to move on. It can quite literally feel like being trapped in the past.

Firefighters often face similarly traumatic events in their line of work. As first responders, they continually put their own lives on the line to aid others. The physical risk is present and unambiguous, and the resulting wounds are more easily treated. Unfortunately, the signs and extent of emotional damage are obscure and frequently missed or ignored.

How are members of the Injured Firefighters Crew affected?

Members of the crew can experience PTSD through being impacted by the trauma sustained by another Firefighter. This is similar to a “contact high” but, in this case, is considered a “contact low.” Witnessing another crew member’s injury or death while on the lines of duty causes a peripheral PTSD taking the form of collateral damage. Having awareness of the circumstances that can take a crew member down, out of his marriage or even out of his life via suicide, can cause wounds to the crew that resist healing. Survivor guilt, either because one is doing better or the belief that one didn't do enough to prevent the other’s injury, can persist for years.


Which Firefighters are at greater risk for PTSD?

According to research by Dr. Matthew Tull in “Rates of PTSD in Firefighters,” you are at greater risk for PTSD if you:

1. Begin your fire service career at a young age.

2. Have underlying mental health issues.

3. Were in close proximity to death.

4. Hold a supervisory position.

5. Experience multiple traumatic events in close proximity.

6. Are unmarried.

7. Were previously in treatment for another disorder.

8. You do not need to fulfill any or all of these factors to suffer from PTSD.


How can a Firefighter assess whether he’s experiencing PTSD or not?

For those who are experiencing persistent stress after about a month, the Trauma Screening Questionnaire may be administered as a screening component. A “Yes” answer to six of the 10 following questions necessitates a referral to a mental health care professional. It does not, however, constitute a diagnosis.

1. Do upsetting thoughts or memories about the event come into your mind against your will?

2. Having upsetting dreams about the event?

3. Acting or feeling as though the event was happening again?

4. Feeling upset by reminders of the event?

5. Do you have bodily reactions (such as fast heartbeat, sweating, dizziness, stomach

pains) when reminded of the event?

6. Difficulty sleeping?

7. Irritability or outbursts of anger?

8. Difficulty concentrating?

9. Heightened awareness of potential dangers to yourself and others


How can the spouse of an injured Firefighter support his getting into treatment for his PTSD?

When you suspect that your husband may be suffering from PTSD follow your intuition and take the lead on getting him evaluated. Chances are he won’t take the point on initiating counseling himself. That’s called the “Sturdy Oak Syndrome” or “John Wayne Syndrome.” Firefighters, by their very nature, customarily fall into this category. He doesn't want to appear weak. You may need to be the one to set up the appointment and drag him in, even if he’s kicking and screaming.

The most important rule of all when seeking treatment for your spouse is to include yourself in the healing process. The majority of those being treated for PTSD admit to lying to their mental health team; you are the one that knows what is really going on, even if you don’t know why, so insist on being part of the team.

Don’t underestimate the impact of PTSD on you and your family. It is a treatable injury, not a life sentence. There is no need to live a life of quiet desperation or find yourself divorced from the love of your life.




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Dr. Stephen Johnson is founder and executive director
of Men's Center Los Angeles and leader/wayshower
of the Sacred Path men's retreats for the past 30 years.
He is also clinical program director of FireFighters Down, a non-profit organization of therapeutic service providers united to help injured Firefighters and their families.



The Men's Center Los Angeles is proud to support and endorse our very own Captain Mike Henry and this excellent wounded warriors program designed to assist Firefighters and the people who love and care about them. Your support of this important work is greatly appreciated.

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