“You don’t come out perfect,” Eric Fessenden said, but you learn how to cope. A former Montgomery County firefighter, Fessenden attended the nation’s only in-patient facility designed to treat firefighters with PTSD. (Doug Kapustin/For The Washington Post)

After a 24-year career in the fire service, Eric Fessenden has a memory bank of the grisly calls he answered. He’s pulled bloated bodies out of rivers, treated victims of the D.C.-area Beltway Sniper attacks, and extracted the dead and the mangled from car wrecks.

Staying busy at work allowed the Montgomery County firefighter to put aside the emotional burdens of his job, but after an injury forced him to retire, he often found himself inexplicably anxious and angry. He woke up shaking in the middle of the night soaked in sweat. And the hikes he looked forward to each week with family members would end miserably when he inevitably snapped at them during the outings.

Fessenden, 48, thought that he suffered from post-traumatic stress. It wasn’t until recently he learned it was that — and more.

“I was in complicated grief over the loss of my career,” said Fessenden, the third generation of firefighters in his family. “They take away my career and take away my identity, and I feel completely useless in life.”

Fessenden recently discovered the root of his emotional outbursts after visiting the only residential facility in the country designed exclusively to treat firefighters with post-traumatic stress, depression, substance abuse and other disorders developed on the job.

Although it's widely known that military members are susceptible to PTSD and behavioral health issues from trauma they've witnessed, the IAFF Center of Excellence for Behavioral Health Treatment and Recovery in Maryland is part of a nationwide push to shed the stigma of mental health concerns and address increased rates of suicide in the fire service.

First responders witness trauma not only from everyday events such as car crashes and house fires, said Patrick Morrison, assistant general president for health, safety and medicine of the International Association of Fire ­Fighters. They’re also answering extraordinarily difficult mass-casualty calls, such as the Mandalay Bay shooting that killed 58 in Las Vegas, the Ghost Ship warehouse fire that killed 36 in Oakland, Calif., and devastating natural disasters such as Hurricanes Harvey, Irma and Maria.

“We’re showing up at everybody’s worst day, in a lot of cases,” Morrison said. “It’s not just part of our job — we want to do it. But how can we get to retirement and have a life after the fire service that’s not traumatized by what we did?”

Since the center’s opening in March, more than 200 firefighters have sought voluntary treatment at the 64-bed facility in Upper Marlboro, about an hour’s drive from the District. Its residents have flown in from across the country to attend the center.

Tim Craig, executive director of the center for firefighters. (Bill O'Leary/The Washington Post)

Tim Craig, the center’s executive director, said the licensed facility is not a 30-day program. Instead, doctors, psychologists, psychiatrists and nutritionists offer inpatient and outpatient services tailored to each person’s needs.

Firefighters come racked with guilt, thinking what they could have done differently on calls that ended tragically. Or they remain haunted by gruesome scenes that play over and over in their heads, absorbing the grief of the families they’ve helped.

Fessenden said one firefighter in his group at the center was overcome by the pressures of the job. He kept wondering whether some of his actions could have averted disaster.

“He thought he let the world down,” Fessenden said. “He said, ‘We’re supposed to be super­heroes.’ We have to remember that we’re allowed to always be humans.”

Not all insurance companies will cover the costs of going to the center, but the IAFF is working on improving coverage, Morrison said.

Fessenden spent more than $10,000 for his stay, a small price to pay, he said, to become a better man for his family and have a happier life after retirement.

“You spend all this time helping other people,” Fessenden said. “Why don’t you spend some time helping yourself?”

Carol Simmons, the clinical director at the center, said those who visit are taught what sights, sounds and smells set off panic attacks or anger in order to better cope in the future. Detox, individual therapy and group therapy are available, with firefighters getting help finding treatment closer to home to continue their progress after they leave.

Carol Simmons is clinical director of the center in Prince George’s County. (Bill O'Leary/The Washington Post)

“Once they get here, we peel back the layers and uncover the underlying trauma,” Simmons said. “To see the transformation is absolutely profound.”

The strength of the center lies in the ability for firefighters to seek help among their own in a familiar environment, according to those who’ve worked there or have been treated there. Living areas are designed like firehouses, and the cafeteria is outfitted with a long table along a brick-patterned wall to replicate the communal nature of meals in station houses.

The 15-acre wooded campus also has hiking trails, a pool, yoga instruction and a fitness room to help residents stay in good physical shape. Morrison said the idea is to create a place where firefighters feel comfortable opening up after years in a culture steeped in a “suck it up” mentality.

“In the ’80s, you definitely didn’t want to cry in front of anybody,” said Morrison, who worked as a Fairfax County firefighter. “You just stuffed it down and kept stuffing it. There’s only so much room for that before something happens and you have to deal with it.”

In some cases, the outcome of pushing aside emotions is alcoholism, substance abuse or suicide. A 2015 study published in the Journal of Emergency Medical Services found in a survey of more than 4,000 firefighters and paramedics that they reported contemplating suicide or attempted suicide 10 times more than the average American adult.

Richard Stack, a firefighter in North Attleboro, Mass., wound up at the center after he got into his car, turned on the engine in his closed garage and tried to quietly take his life — twice.

Stack said he was overcome by panic attacks, anxiety and flashbacks from his 26 years on the job. He would go by old scenes and replay in his mind gruesome incidents. Certain smells and songs that reminded him of traumatic calls would set him off. And after some calls, he’d get back to the firehouse, go to his office and have a complete breakdown.

The stress at work rippled into problems at home. “A combination of those calls took bits and pieces from me,” said Stack, 49.

With the support of his chief, union and family, Stack stayed at the center for 45 days. He found a place where he didn’t have to explain himself or be ashamed. The people there knew what it felt like to experience the heat of a burning building crumbling around them or the crunch of glass under fire boots as they pulled people from car wrecks.

“The peer support was tremendous,” said Stack, who left the center in October. “No one is judging you. We were dealing with the same suffering and emotional pain.”

“You don’t come out perfect,” Fessenden said, but you learn how to cope.

A bell for “ringing out” successfully treated clients. (Bill O’Leary/The Washington Post)

During a July 4 kickball game in a clearing in the woods with the other firefighters, Fessenden began getting the same anxious feeling he’d experience before snapping at his family during their hikes along the Chesapeake & Ohio Canal. With his guard down at the center, he realized a musty smell from a dead deer in the woods nearby reminded him of pulling dead, deteriorating bodies out of the Potomac River in Cabin John, Md., years ago.

Now when he is on hikes, he recognizes the smell and cracks a joke instead of flying into what before was inexplicable anger.