The good news is that chronic stress is treatable, both with therapy and medication. "People do improve. They do get better, but it can be a chronic recurring condition," says John Fairbank, an associate professor of behavioral medicine at Duke University."
For firefighters, police officers, medical workers and others, the roots of future mental problems is in the present, experts say. "Right now, because they're still in the phase of working and recovery and rescue, they're taking their feelings and they're stuffing them. That way you can continue to work, and you are not allowing yourself time to feel the emotions or to grieve," says Jerry Brakeman, president of the Association of Traumatic Stress Specialists and director of employees assistance with the United Firefighters of Los Angeles, an employees' union.By not reacting on an emotional level, emergency workers handle things differently than other victims and witnesses. "Normally you at least have the freedom to respond and be overwhelmed," says Dr. Harold Kudler, a psychiatrist at Duke University. "When you're an emergency worker, you don't have that. You have to be so attuned to your job and focused on your job that you overlook the messages you're getting that the whole world is not what you thought it would be."
The stress of keeping a lid on emotions can lead to a variety of symptoms, including sleeplessness, anxiety, irritability, physical and emotional withdrawal and numbness, Kudler says. Though those symptoms may appear in the weeks after a tragedy, they don't necessarily lead to post-traumatic stress disorder, experts say.
The key is to give breaks to emergency workers and watch them closely, Kudler says. "They have to have somebody they can go to and talk to, someone who's keeping an eye on their efficiency and health."
Dealing with stress, of course, is nothing new for emergency workers. Many fire and police agencies have counselors and psychiatrists on staff, and post-traumatic stress disorder has been an official medical diagnosis for two decades.
But even with emotional support, the stress of trauma can stick with people for weeks, months, even years, and post-traumatic stress disorder can kick in after a month, Kudler says.
"They may get repeated visual images coming into their minds even though they're trying not to think about them," he says. "The next major set of symptoms is avoidance as they go out of their way to avoid [the tragedy] in thoughts or feelings or conversations. They begin to feel cold or numb inside, and finally they develop persistent arousal so they're always jumpy, constantly scanning their environment for signs of danger."
Cognitive behavior therapy, in which patients work to change the patterns of their thinking, often is successful, Fairbank says. Antidepressants also may help.
For now, though, concerns about post-traumatic stress disorder should be far from the minds of emergency workers and those who care for them, Fairbank says. "It's too early," especially since it's not clear if the traumatic events themselves are over, he says.
The focus should be on "listening to people and giving people permission to talk about their fears," he says.
What To Do
If you know emergency or rescue workers involved in the aftermath of Tuesday's terrorist attacks, lend an ear to them. If they appear to be having trouble, urge them to see counselors. If mental illness is looming, "your best chance of getting on top of the situation is to get help early," Kudler says.
Post-traumatic stress disorder doesn't affect just war veterans. Learn about that and other myths about the disease from the Post-Traumatic Stress Disorder Alliance.
Learn more about the disorder in this fact sheet from the Sidran Traumatic Stress Foundation.