Conditioned to Grieve or Dead Inside: Line of Duty Deaths and Mental Resilience

– Executive Summary

Between January 1, 2021, and December 31, 2021, 141 firefighters have died in the line of duty in the United States.[1] Given the nature of their chosen profession, firefighters can expect to attend about as many funerals every year. These line-of-duty funerals have anywhere from several hundred to several thousand uniformed members in attendance on the day of the service. Culturally, attending line-of-duty funerals is considered a requirement of the job. When the death of a member occurs, firefighters show up to validate the sacrifice. So ingrained is funeral attendance in the firefighting culture that both the Uniformed Firefighters Association  and the Uniformed Fire Officers Association  established a line-of-duty fund for members to attend line-of-duty funerals in other cities.

There are ancient and historical precedents for death rituals that are consistently observed by only a few groups in modern societies, firefighters being one of the foremost.[2] However, despite all the funerals, firefighters do not seem to be especially traumatized by so much death, contradictory to research on critical incident stress management or post-traumatic stress disorder, particularly as it relates to cumulative effects.[3] This thesis seeks to understand what factors, if any, can be found that contribute to the mental resilience of firefighters.

Chapter I includes the literature review and analyzes the critical role death rituals have played in the development of communities and passed down from generation to generation as a tradition. These traditions are meaningful for the survivors and community’s health, according to Renfrew, Boyd, and Morley,[4] who suggested a recurring theme in burial traditions throughout history: remembrance.[5] The authors defined these rituals accordingly: “Deathways include actions and social performances attending to the death, mourning, disposal, and remembrance of deceased individuals.”[6] This definition is applicable today and provides the basis for continued adherence to a basic condition of community development and sustainment. Adherence to death rituals is contradictory to the modern phenomenon of death denial and avoidance behavior.

Chapter II examines the role of death rituals from ancient civilizations through modern times and across a variety of cultures and communities. It discusses cultural norms, religious and spiritual beliefs, Eastern and Western perspectives, and secular and atheist views on death and death rituals. In addition, it examines death denial, a relatively modern phenomenon primarily caused by advances in modern medicine and the “inconvenience” of death in advanced societies.

Chapter III discusses modern death anxiety before discussing death among professionals, broadly categorized as non–death-related (NDR) occupations and death-related (DR) occupations. Those in DR occupations experience more exposure to death than NDR occupations and the general population.[7] Despite the prevalence of death anxiety in modern society, DR occupations in general demonstrate at least the same or better resilience to death than the general population and those in NDR occupations.[8] 

Among DR occupations, there are cultural, educational, and social identity variables that either facilitate or inhibit community and individual mental resilience when death occurs.[9] Understanding how each DR occupation encounters, copes, and assimilates death and death anxiety is significant in understanding the foundational elements that support individual mental resilience when a death occurs. Those foundational elements: culture, community, and social identity, have a long history of supporting community and individual resilience when encountering death. Each DR occupation, however, save the fire service, is either missing one of these foundational elements or is unable to support the individual and community need for death rituals from a structural or practical perspective. The fire service demonstrates both structural and social variables that further delineate a distinction which facilitates better community and individual mental resilience when encountering death and the death of a co-worker in the line of duty.

Overall, the research indicates the traditions of grief and mourning in the fire service contribute to mental resilience. When a line-of-duty death occurs, the fire service demonstrates the positive attributes of death rituals as they relate to culture, community, and social identity. The fire communal response can only be explained in terms of culture, community, and social identity, which according to the research supports resilience.[10]

The basic “purpose” of a funeral in society allows the family and friends to say a goodbye to the loved one. Death is a social event and so is the death ritual, be it in the form of a funeral or other ceremony.[11] The purpose of a line-of-duty funeral is much more elaborate and symbolic. It is intended to conjure, maintain, and even extend the in-group narrative. It publicly declares the deceased was a valued member and, by extension, that in-group association and protection is extended to the immediate family.

[1] Rita F. Fahy and Jay T. Petrillo, Firefighter Fatalities in the U.S. – 2019 (Quincy, MA: National Fire Protection Association, 2021),​Files/​News-and-Research/​Fire-statistics-and-reports/​Emergency-responders/​osFFF.pdf.

[2] Colin Renfrew, Michael J. Boyd, and Lain Morley, eds., Death Rituals, Social Order and the Archaeology of Immortality in the Ancient World: “Death Shall Have No Dominion” (New York: Cambridge University Press, 2016), Kindle.; Tony Walter, “Modern Death: Taboo or Not Taboo?,” Sociology 25, no. 2 (May 1991): 293–310,​stable/​42857623; Sam Kedem, “My Failures and Successes in Treating 9/​11 Firefighters,” American Academy of Experts in Traumatic Stress, 2020,​traumatic-stress-library/​my-failures-and-successes-in-treating-9-11-firefighters.

[3] Daniel S. Weiss et al., “Frequency and Severity Approaches to Indexing Exposure to Trauma: The Critical Incident History Questionnaire for Police Officers,” Journal of Traumatic Stress 23, no. 6 (2010): 734–43,​10.1002/​jts.20576.

[4]Renfrew, Boyd, and Morley, Death Rituals and Social Order in the Ancient World.

[5] Renfrew, Boyd, and Morley.

[6] Renfrew, Boyd, and Morley, chap. 21

[7] Laura K. Harrawood, Lyle J. White, and John J. Benshoff, “Death Anxiety in a National Sample of United States Funeral Directors and Its Relationship with Death Exposure, Age, and Sex,” OMEGA – Journal of Death and Dying 58, no. 2 (March 2009): 129–46,; Betsy Lattanner and Bert Hayslip, “Occupation-Related Differences in Levels of Death Anxiety,” OMEGA – Journal of Death and Dying 15, no. 1 (August 1, 1985): 53–66,; Janet R. Serwint, Lorene E. Rutherford, and Nancy Hutton, “Personal and Professional Experiences of Pediatric Residents Concerning Death,” Journal of Palliative Medicine 9, no. 1 (2006): 70–82,

[8] Lattanner and Hayslip, “Occupation-Related Differences in Levels of Death Anxiety.”

[9] Linda Jean Fraser, “Death and Grief in the Military: An Attitudinal Focus” (master’s thesis, Naval Postgraduate School, 1983),; Substance Abuse and Mental Health Services Administration, “First Responders: Behavioral Health Concerns, Emergency Response, and Trauma,” Disaster Technical Assistance Center Supplemental Research Bulletin, May 2018, 1–15,; Serwint, Rutherford, and Hutton, “Personal and Professional Experiences of Pediatric Residents Concerning Death.”

[10] Renfrew, Boyd, and Morley, Death Rituals, Social Order and the Archaeology of Immortality; Kate Torgovnick May, “Death Is Not the End: Fascinating Funeral Traditions from around the Globe,” We Humans (blog), October 1, 2013,; Peter L. Berger and Thomas Luckmann, The Social Construction of Reality (London: Penguin Books, 1991); David Brannan, A Practitioner’s Way Forward: Terrorism Analysis (Salinas, CA: Agile Press, 2014).

[11] Bob Simpson, “Death,” ed. Felix Stein et al., Cambridge Encyclopedia of Anthropology, July 23, 2018, 4,

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