MALCOLM RITTER
Associated Press Science Writer
NEW YORK (AP) -- For many New York City firefighters, Sept. 11 is still taking a toll in nightmares, sleepless nights, anxiety and other psychological stresses, say mental health professionals who are helping them deal with their reactions.
Social workers, psychiatrists and psychologists have rushed to help the fire department handle the counseling workload, and the International Association of Fire Fighters aims to raise about $3.5 million to pay for more help.
Firefighters are not required to get counseling, but many have done it anyway, said Tom Manley, health and safety officer for the city's 9,000-member Uniformed Firefighters Association.
``Everybody is getting drained psychologically,'' Manley said. ``It's taking its toll.''
Some firefighters can't bring themselves to go to ground zero any more, he said, because ``mentally they can't deal with it.''
In an interview, one fireman recalled being curled in a fetal position Sept. 11 in the collapsing lobby of the Marriott World Trade Center Hotel. Cement dust and smoke choked the room.
``You had to throw up to clear your throat,'' he said.
Eventually he was able to pick his way out of the remains of the collapsed hotel, leading some others to safety. But even now, the experience isn't over.
``I don't sleep at all at night without medication,'' said the 20-year veteran, who asked not to be identified because he doesn't want his colleagues to know what he's going through.
He suffers nightmares about being caught in another collapse. For a while he had bizarre out-of-body experiences when he was with his family, feeling like he was dead and viewing the scene from above.
He'd known about 70 firefighters who died, including two he'd spoken to just minutes before their deaths. One morning, the day after going to the funeral of one and the wake of another, ``I found myself sitting in the crotch of a tree outside my house. I was out of it. I knew I needed help.''
He found the names of a psychiatrist and another counselor in a directory, and now he's seeing them a couple times a week.
At the midtown Manhattan firehouse of Battalion 9, a couple firefighters sat around the kitchen table in the firehouse Friday, talking to counselors who show up a few times a week from a local hospital.
The firehouse lost 15 men -- an entire shift -- on Sept. 11. The final funeral for them will be Saturday.
Joseph Nardone, commander of Battalion 9, said some of his men need counseling while others are resisting. ``But I think that after the last funeral the guys might need it more,'' he said.
The city's firefighters ``have been through a terrible ordeal and we want to support them,'' said psychiatrist Dr. Spencer Eth, medical director of behavioral health services at St. Vincent's Catholic Medical Center in New York. St. Vincent's is lending manpower to the department's counseling effort.
After all, they have been attending funeral after funeral, and given their close-knit culture, it's like losing family members, Eth said. In the firehouse, ``your buddies aren't there anymore, and these are deaths of young people who should not have died,'' he said.
The World Trade Center disaster claimed 343 city firefighters; before this, the largest department loss was 12 in a 1966 fire.
Apart from the grief and the trauma at the site, there is also guilt over having survived when friends died. And because so many died, the surviving firefighters have not been able to fully carry out their traditional roles as surrogate parents for the families of the dead, Eth said.
So ``on top of everything else, there is an understandable feeling of having let down their buddies,'' he said.
The goal of counseling is to keep normal reactions to all this -- like nightmares and anxiety -- from growing into worse problems like drinking, accidents and heart attacks, Eth said.
The psychological support must continue long-term, said Therese Rando, a psychologist and clinical director of the Institute for the Study and Treatment of Loss in Warwick, R.I. As a specialist in traumatic loss, she has been consulted by some mental health professionals who are working with the firefighters.
For many in the fire department, she said, the shock of Sept. 11 won't really wear off until next spring and summer. Then, when reality fully sets in, the firefighters -- used to taking action to solve problems -- will be unable to do anything to change the terrible reality of their losses.
They will need to take some positive steps, like memorializing their friends or even just embarking on a new exercise program, Rando said.
Eth said St. Vincent's plans to continue helping the department conduct counseling for at least a year.
``The memories don't go away when the headlines do,'' he said. ``So we are going to be there for the long run.''
Mental health counseling will be offered for the 55,000 members of the New York Police Department, to help them cope with post-Sept. 11 trauma, police officials said.
``Ultimately, our goal is to do everything we can to help the members of the NYPD and their families make it through these difficult times,'' Police Commissioner Bernard Kerik said in a statement.
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