Mark Ralston / AFP / Getty

A Mental-Health Crisis Is Burning Across the American West

Each fire season can compound the trauma of the one before it.

There’s a fire up north, the woman says, the Kincade Fire. It flickered into existence on the nighttime horizon, a shapeless brightness billowing into the sky. Now the wind’s whipping it south toward Santa Rosa. Evacuations are under way, and she worries her home will burn. Allison Chapman listens in silence. She’s modeling for a makeup demo when the woman walks into the studio, where Allison studied after moving south a couple of years ago, at 18. She knows this woman from back home in Northern California, knows how close this woman lives to her grandparents, knows that if the fire is threatening this woman’s home, it’s threatening theirs, too. She feels the panic coming on.

It begins, usually, with a quickening of the heart and a tightening of the chest. Then comes a rush of cold, which is ironic, in a way, because her fear is fire. Her mind jumps backwards first—to the flames tearing across the mountainside on a late-summer evening in 2015, to the dark smoke rising from the woods around her house, to the toy wagon wheels discovered weeks later amid the wreckage—then springs forward and explodes like a shotgun shell into a million imagined tragedies. She shivers.

Only this time she doesn’t. In the four years since the Valley Fire destroyed her home, Allison has learned to suppress that feeling before it overwhelms her. She tells herself that she is okay, that her grandparents are okay, that everything is okay.

Allison had occasional panic attacks even before the Valley Fire. Afterward, though, the attacks seized her daily and lasted as long as a couple of hours. Often something would trigger them—a word, a smell, a sound—but other times they came without cause. Her panic would catch her like a riptide, sudden and irresistible. When it did, her mother, Ellie, would find her curled up on the floor of her room, hyperventilating, and hold her until her breathing slowed.

The next day, it would happen again. Or if not the next day, then the day after. She felt she’d lost control. She started to cut herself. She wore long sleeves to hide the scars.

When the woman leaves, Allison calls her mother. (The Atlantic agreed to use pseudonyms for all family members to protect their privacy.) Allison’s grandmother is lying in a hospital bed with her lungs full of smoke, Ellie says, but she’ll recover. Her house is safe for now, though you can never be sure with fire; you’re always at the mercy of the wind. And, what’s more, this will happen again.

California has long had a propensity to burn. Its record of fire begins underwater, at the bottom of forest-fringed lakes, where ancient blazes left their stories in charcoal deposits. Tens of thousands of years later, the record continues in the logbooks of the Spanish, who saw “many smokes” rising above the coastal treetops when they sailed into San Pedro Bay on a Sunday morning in October 1542. Baya de los Fumos, they christened the waters. “The Bay of Smoke.”

Even by California’s standards, though, recent years have been extraordinary. Nine of the 10 most destructive fires in the state’s recorded history have occurred in the 21st century—six of them in the past four years alone. In October 2017, the Tubbs Fire destroyed more than 5,600 buildings in Napa and Sonoma Counties, making it the state’s most destructive fire on record. About a year later, the Camp Fire supplanted it, razing the town of Paradise and killing 86 people. Just last fall, the Kincade Fire torched nearly 80,000 acres.

Wildfires tend to leave a common signature—the black earth and white ash, the jagged trees and bleak chimneys. Americans have come to know these well. But the physical ruin is only a part of the aftermath.

According to Patricia Watson, a psychologist at the National Center for Post-Traumatic Stress Disorder, 10 to 30 percent of wildfire survivors develop diagnosable mental-health conditions, including PTSD and depression. Another 50 percent may suffer from serious subclinical effects that fade with time. Studies have found that substance abuse and domestic violence rise after natural disasters. And while most fire survivors make a full recovery, many require formal treatment.

In more than 50 interviews over the past two years, I’ve heard from survivors, researchers, clinicians, and government officials about the ways in which this long-lasting psychological damage can transform lives. Many survivors described feeling fragile and less capable of managing stress for years after a fire. Some recalled looking for incinerated possessions and breaking down when they realized they would never find them. One man recounted taking his granddaughter to see the 2018 Mary Poppins movie—about a family on the brink of eviction—and crying through much of its two-hour running time. That was more than three years after he lost his home.

When a whole neighborhood or town feels these effects at the same time, the result is what one psychologist and fire survivor calls “community-wide trauma.” “It’s hard not to have a little PTSD,” says Jessyca Lytle, whose home burned down in the Valley Fire. “A lot of people just see it as ‘Well, it’s the new normal. I’ve just got to learn how to deal with it.’”

The trauma is sustained and amplified by a distinctive characteristic of California’s wildfires: They recur, often in quick succession. A number of the survivors I spoke with described feeling “haunted” and “disturbed” by subsequent fires. As irrational as they knew it was, they felt as though the fires were stalking them.

Now there is the coronavirus pandemic, a new disaster layered atop an already many-layered mental-health crisis. And while the virus will subside with time, the fires will not. According to the most reliable predictions, they will only worsen in the coming years. A 2016 study published in the Proceedings of the National Academy of Sciences concluded that as long as there remains fuel to burn, “anthropogenic climate change will continue to chronically enhance the potential for western U.S. forest fire activity.”

All the while, Watson says, it will grow harder for survivors in vulnerable areas to maintain a sense of hope. And much of California is a vulnerable area.

Aftermath of the wildfires in the Coffey Park Neighborhood in Santa Rosa, CA. October 11, 2017. (Jim Goldberg / Magnum)

Allison Chapman had always been an artistic child, but not until after the Valley Fire did she turn her talents toward special-effects makeup. Before, she’d painted fantasy worlds and nature scenes—“sweet stuff,” her mother said. After the fire, she fixated on simulating blood and gore. She would paint bullet wounds on her neck, lacerations on her arms, the sickle-shaped scars of a Glasgow smile on her face. Once, she did herself up like the disemboweled Black Dahlia.

Ellie began to notice Allison shaking and sweating even when she wasn’t having panic attacks. And she’d grown so pale. At first, Ellie suspected the flu, but the symptoms did not abate. Only later did she see her daughter slipping into the bathroom after meals.

At the same time, Allison’s makeup art was starting to look more realistic. Ellie could swear that  some of the wounds seemed to be reappearing in the same places. One day, she saw Allison cleaning makeup off her arms in the sink. As the water streamed over her skin, most of the red streaks washed away—but not all of them.

The effect, Ellie said, was “mind-bending.” It can’t have helped that she was struggling with her own mental-health problems—the whole family was. Her husband, Liam, had suffered from depression for years, but after the fire, Ellie said, it was “a whole new level, almost a different creature.” Mia, who was 8 at the time of the fire, had been the fearless child; ever since, she has been nervous and jittery. Now, when Ellie makes Mia’s bed, she often finds objects hoarded beneath the mattress, everything from candy to pocketknives. In the months after the fire, 6-year-old Zoe seemed afraid that if she left the house, she might never come back. The fear was not entirely unfounded: The Chapmans spent nights in more than half a dozen homes and shelters that year. For a while, they rented a place near a mountaintop helipad in Cobb, the remote, working-class community where they used to live. When Zoe heard the drone of a helicopter overhead, she would drop to the floor and spiral into hysterics, her mother recalled, like “someone who had been in a war zone.”

Ellie herself knows something of trauma: She has long suffered from PTSD and anxiety caused by physical and sexual abuse in her childhood, she told me; since the fire, her symptoms have worsened exponentially. She quit her job at a winery because being there brought her back to the day the fire started. She quit her job at a plant nursery because being around other people was too much for her. There are just so many triggers, she said. She feels “like a semiautomatic weapon.”

In the year after the fire, many days were hard, but one stands out. Allison and Ellie don’t remember the exact date. Allison’s sisters were playing in the yard when she walked into the family’s galley-style kitchen and drew a knife from the knife drawer. Leaning against the sink, staring at the white cabinets and yellow walls, she pointed the blade at the floor and contemplated what she was about to do. She’d considered suicide before, but never this seriously. She’d never felt the weight of the knife in her hands. “I was basically ready to end it all and be done with it right there,” she told me.

Then Ellie walked into the kitchen and saw her daughter slumped against the counter. Ellie took the knife, and they both began to cry.

Allison’s teenage years had always been difficult. She’d struggled with bullies, with friends, with anxiety. But she’d managed. After the fire, Ellie said, “her coping mechanism was gone.”

Psychologists sometimes say that trauma gets burned into the mind, like the imprint of a branding iron, and in a way it does. In truth, though, trauma is not so much a scorch mark as a flame, flaring up and dying down, inconstant. It burns in the mind. And just as some materials burn more readily than others, so too do some minds.

Part of this is genetic. Another part is cognitive. But a growing body of research has also linked vulnerability with prior exposure. “When traumas accumulate over time,” says the Alaska Network on Domestic Violence and Sexual Assault, “they may be associated with more severe and complex psychological reactions.” For an alcoholic or a battered partner or a victim of sexual abuse, this means a heightened risk of serious mental-health problems. And if another disaster strikes—say, a pandemic—the risk rises higher still.

After a wildfire, the particular nature of the resulting trauma depends on the particular experience of the affected survivor. For some, trauma derives from the panic of a narrow escape. Studies have repeatedly linked fear for one’s life with PTSD, which is part of the reason firefighting takes such a heavy psychological toll. A 2016 International Association of Fire Fighters report found that firefighters experience PTSD at rates comparable to those of combat veterans. They are also about 40 percent more likely to take their own life than the general population. In 2017 alone, 103 firefighters died by suicide—10 more than did in the line of duty. Even for fire survivors who have been spared the imminent danger and acute fear, the weight of the loss—of homes, of communities, of memories—can be enough to induce trauma. It was for the Chapman family.

The Rivas family was not spared the imminent danger and acute fear. On a windy night in October 2017, Erika Rivas’s 13-year-old son roused her from a fitful sleep about half an hour before their home burst into flames. He was whispering something about a fire. His cousins, who lived just a few houses down, were already evacuating, he said.

Coffey Park, where the Rivases live, is a quiet Santa Rosa suburb whose tree-lined lanes and cul-de-sacs do not attract much traffic. But when Erika and her son looked out their front window, they saw utter gridlock. The time was 1:30 a.m. “Something’s wrong,” she told her husband. Moments later, through a back window, he saw “a meteorite-size ball of fire” crash down in the backyard. “We need to get out now!” he yelled. “Everybody, get out now!” They had no time to grab anything—not clothes, not money, not photographs. Erika didn’t even have time to put shoes on. As she rushed to the car, she heard solar panels shattering overhead, like a thousand china plates dropping all at once. Giant tumbleweeds bounded across the smoky street. By the time Erika pulled out of the driveway, the garage was on fire.

In the end, the Tubbs Fire consumed 36,000 acres, 2,800 homes, and 22 human beings. One of the 2,800 homes was Erika’s. One of the 22 human beings was her neighbor. A firefighter who’d been in the area that night saw Erika’s house burn down just 15 minutes after she fled with her family. When she was allowed to return, she sifted a few relics from the rubble—her grandfather’s wedding ring; a safe full of papers torched by the sheer heat of the blaze; her grandmother’s coffee cup, which looked all right but fell apart when she tried to pick it up.

Looked all right but fell apart—that was how Erika felt after the fire. “You think one day you’re fine, and then something happens,” she told me. “You see something that you remember, and you just cry.” Or you recall something that you’ve lost—she kept reaching for her spatula, she said—and you also cry. Or you cry for no reason at all.

But even then—perhaps especially then—the ambient stress of the recovery process hangs in the air, and that is reason enough. After a wildfire, obstacles abound: the scramble for shelter, the competition for builders, the toil of the insurance process. Studies have shown that these ongoing personal, logistical, and financial difficulties often lead to depression. “Somebody goes through a trauma—if they’re going to then face a whole lot of continuing obstacles, then that maintains the stress,” says Joe Ruzek, a PTSD researcher at Stanford and Palo Alto Universities. “It becomes more difficult to put the trauma behind.”

These long-term challenges can even elicit PTSD symptoms in survivors who do not initially manifest them. A year after Hurricane Katrina, researchers found that more than 40 percent of survivors with PTSD had not developed symptoms until after the six-month anniversary.

“People have that experience of revictimization because there’s an adrenaline after the fire of, like, Okay, we’re going to get through this,” Ronit Rubinoff, the executive director of Legal Aid of Sonoma County, told me. “Then that adrenaline fades and people realize … Jesus, I am no closer to even just putting a stick in the ground.”

Two years and two builders after the Tubbs Fire, the Rivases have only just moved into their new home. The process added one more stressor to what Erika says was already the worst time of her life. For years, she told me, she has regularly seen a therapist for PTSD and depression resulting from childhood trauma. But within a few weeks of the evacuation, her symptoms had grown much worse. Today, the smell of smoke can still trigger panic attacks. She cannot light a candle. And her memory has suffered. Usually it’s little things: where she left her keys or phone, for instance. But sometimes, she’ll forget long stretches of time. Once, she couldn’t remember who had taken her children to school in the months after the fire. With time, the lapses have grown only more frequent. Her therapist always says, “Maybe it will come to you,” but it never does.

On a windy night this past October, while still living in a rental house, Erika sat by the TV with her family, watching the news about the Kincade Fire and thinking to herself, This is just like last time. Only this time the drama was unfolding in slow motion. She’d helped her children gather their things in case of an emergency evacuation, but she couldn’t bring herself to pack her own bags, because what are material possessions worth in a state that combusts on an annual schedule?

When the evacuation order arrived a few days later, the Rivas family drove to the same restaurant where they’d eaten after the Tubbs Fire: Habit Burger. And just like that, cataclysm became custom. When it snows, we stay home and drink hot cocoa. When it burns, we evacuate and eat at Habit Burger.

“I feel like this is normal right now,” Erika told me after the Kincade Fire, once she and her family had returned to their temporary home. “I don’t want this to become a normal thing in my life.”

For many Californians, it already has. On Cobb Mountain, people call firefighting planes the state bird. Across the state, schools have smoke days instead of snow days.

At Legal Aid of Sonoma County, which has represented many survivors of the 2017 Wine Country Fires, prospective clients were, for a time, asked to fill out a mental-health intake survey. A score of 15 or higher indicated that the client needed mental-health support. Of the 50 assessments the office reviewed in the year and a half after the fires, just one scored below a 15.

Aftermath of the Tubbs Fire at the Journey's End Mobile Home Park in Santa Rosa in 2017. (Alessandra Sanguinetti / Magnum)

For a moment, not long after the Valley Fire, Ellie Chapman felt a kind of freedom. No more chores, no more dishes, no more laundry: She had no household responsibilities, because she had no household to be responsible for. The shock, she says, was “absolute.”

This is how it goes for many fire survivors. The panic of disaster resolves into the numbness of shock; the numbness of shock, into the pain of trauma. Cobb Mountain had not yet reopened when a family friend called to tell the Chapmans that their house was gone. They were living out of their Ford Explorer at the time—a big car but a small home—so that is where they cried.

Two weeks later, when the National Guard escorted Ellie back to the property in a Humvee, to look for the pets she’d left behind, she hardly recognized what she saw. The meadow out front where the yellow-flowered mullein used to grow was stone-smooth and black, and all that remained of their home was a scorched chimney. The animals were gone. Amid the wreckage, she spotted the metal handles of her great-grandfather’s handmade rolltop desk, which she had treasured above all other possessions. Don’t take anything that doesn’t have a heartbeat, the officers told her. She left the handles in the dust.

At around that time—before Allison was bingeing and purging, before she was cutting herself, before she drew the knife from the knife drawer—Ellie began in earnest to seek mental-health treatment for her family. In a nearby town, FEMA and the California Governor’s Office of Emergency Services had set up a disaster-recovery center. Ellie went from one folding table to the next, asking representatives from federal, state, and local organizations where she could find help. Over the next three years, she says, she tried more than half a dozen organizations and government agencies. At the plant nursery where she worked, she asked almost every customer for advice about where to go.

Some people referred Ellie to crisis hotlines, but Liam and the girls wouldn’t talk to a stranger on the phone. What little in-person care she found came mostly in the form of group sessions, and she wasn’t going to talk about her marital problems—she had caught Liam cheating—or her daughter’s self-harming in that kind of setting. “This is a small community,” she told me. “We all kind of know each other … I didn’t want to do that.”

And yet she didn’t know what to do. On the morning of May 16, 2018, she texted a friend:

I tried to contact lake family services recently, to inquire about counseling, as my husband and I just separated mothers day weekend. But they rather callously offer nothing..... I can’t stop wondering if I had any luck these last two years finding ANY accessible mental health support at all, this may have been avoided. It has really just all been too much to sort out myself.
We so desperately are in need of help......
I am completely lost at this point.......

When you picture Northern California’s wine country, Lake County is not what comes to mind. It is among the poorest counties in California, with a median household income of just over $40,000 a year and a poverty rate just under 20 percent. It ranks among the top counties statewide in annual opioid deaths. It lags in internet and computer accessibility. And nearly 14 percent of its residents have a disability—more than twice the state average.

Fire, of course, does not discriminate on the basis of race or class or ability, but that does not mean survivors bear an equal burden. A 2018 study by researchers at the University of Washington and the Nature Conservancy found that wildfires hit low-income communities harder than they do their wealthier counterparts, and it’s easy to see why. Some wealthy Californians have hired private firefighting brigades to defend their estates; many poorer families lack the financial resources to take even basic preventive measures, such as trimming trees and clearing brush. When their homes burn, their insurance is less likely to cover the costs—if they have insurance at all. In the words of Rubinoff, from Legal Aid: “Recovery is not equal.”

Nor is its impact on mental health. A 2017 report by the Substance Abuse and Mental Health Services Administration concluded that less wealthy, less educated survivors are more likely to suffer from depression or post-traumatic stress in the aftermath of disasters. In communities that already lack resources, the psychological fallout can be devastating. California as a whole faces a shortage of mental-health professionals, which the governor’s office has predicted will worsen in the coming years—and that was before the pandemic. In rural areas, it is especially pronounced. Janet Coffman, a health-policy professor at UC San Francisco, says wildfires are putting “additional strain on the behavioral-health system in places that were already struggling to meet needs.”

Such is the case in Lake County. According to a 2015 Medical Board of California survey, the county does not have a single psychiatrist who provides patient care for at least 20 hours a week. And while it does have psychologists, it does not have enough. In a remote community like Cobb, accessible—and escapable—only by steep mountain roads with nauseatingly sharp switchbacks, finding mental-health professionals can be especially hard.

Four and a half years after the Valley Fire, Ellie has given up looking for mental-health treatment. She and Liam saw a couple’s therapist for a while, but after 10 sessions they couldn’t afford to continue. On a cold, bright morning in February, as she drove down the road she’d used to evacuate years earlier, panic seized her, and everything went dark. She woke up in a parking lot with the sun in her eyes and an oxygen tube in her nose and paramedics all around her.

Allison, too, still has panic attacks, but not as often as she once did. She lives with her boyfriend near Los Angeles, where she freelances as a makeup artist, mostly for student productions and commercials. Her dream is to do makeup for major horror movies. She still wears long pants and hoodies to hide her scars.

A burn scar, in fire science, is the land a wildfire claims. For a long time, this was something of a misnomer. A scar recalls the wound that made it; it is a matter of memory. But fire was just the opposite: In the same way that the mind lets go of the extraneous to make way for the essential, flames erased excess foliage to make space for new growth. The forest burned, but in time it healed.

Now it really does scar. The most fearsome modern wildfires don’t just burn overgrowth and excess; they incinerate entire ecosystems, and sometimes those ecosystems don’t regenerate on their own. Fire, once a natural mechanism of forgetting, has become an unnatural mechanism of remembering.

Someday not long from now—maybe this summer, maybe next year, maybe the year after—a new fire will ignite near Allison or her family. She’ll smell the smoke or hear the news. And when she does, her heart will quicken, and her chest will tighten, and her mind will jump back once more to that late-summer evening in 2015, to the fire on the mountain and the smoke in the sky, and it will all begin again.