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By Stephanie O'Neill, Kaiser Health News
One of Carol Holcomb's last memories of her pine-covered neighborhood is the morning sun that reflected the red and gold on her trees on November 8th. That day, she promised to be beautiful in the town of Paradise, Butte County. .
She was therefore surprised to hear what looked like raindrops hitting her roof soon after. Holcomb, 56, went out to investigate and saw a piece of pine bark floating in the sky.
"It was about 3 inches by 2 inches," she said. "And it was smoking."
It was her first glimpse of the wildfire that would become the deadliest and most destructive in California's history – a dream she continues to relive in debilitating nightmares and flashbacks.
The campfire practically cremated Paradise, a city of 27,000 inhabitants. It killed 85 people in the area, many of them elderly. Most have died at home – others fleeing in their cars or trying to escape on foot.
For thousands of locals, the terror of sitting in traffic while the forest fire caused emotional scars on the left. "Everyone who has experienced this has been traumatized," said Linnea Duncan, a certified clinical social worker who escaped the fast-moving fire storm at Magalia, a community north of Paradise.
Dr. Sandro Galea, Dean of the School of Public Health at Boston University, said, "We expected PTSD and depression to be very heavy."
Galea, a leading researcher in the field of trauma and mass disasters, said the consequences for individuals may vary depending on factors such as the intensity of their experience, the type of support they receive. offered after the disaster and the fact that the community is gathering or not. recovery and reconstruction process.
For Holcomb, it took almost three hours to escape to Paradise. Smoke from burning houses, cars and brushwood turned day into night and reduced visibility to one foot. Barely able to see the road, she found herself behind a big truck whose tail lights her guide. While she watched the flames devour almost all around her, she could hear residential propane tanks exploding like steel-coated popcorn kernels.
"You could hear, boom, boom, boom," she said.
When she came out of the flames, her truck caught fire. Holcomb fired on the median of the highway and jumped in time to save himself and his cat. A man she did not know told her to get on her truck and they were safe. In the tumult, she left a backpack next to her truck on fire. It contained treasures: her mother's Bible, her grandfather's Purple Heart medal from the First World War and photographs of each of them.
Diagnosis: PTSD
Nightmares and flashbacks immediately after a disaster are normal, said Barbara Rothbaum, director of a recovery program for trauma and anxiety at the Emory University School of Medicine. It's the same for irritability, anger, hyper vigilance and problems with sleep and concentration. But when these symptoms persist for at least a month, the diagnosis can be made by post-traumatic stress disorder, or PTSD. Recognized for the first time by the American mental health community in 1980, it is the only mental health disorder related to exposure to traumatic events.
According to Rothbaum, for most people, psychological distress fades. But for others, especially those who avoid thinking, speaking, or writing about the event, the symptoms may persist for years, affecting their relationships, their work, and their ability. of healing.
"It's very similar to the grieving process," Rothbaum said. "We think there is no way to overcome the pain except through it."
According to Galea, in the general population, about 10% of those directly exposed to a disaster will experience PTSD. But studies show that among children, women and people who have already suffered from mental illness, the risk of PTSD caused by a disaster is much higher.
"It's the magnitude of a disaster that can often help us predict the severity of the mental distress of affected populations," said Lori Peek, professor of sociology, director of the Natural Hazards Center at the University of Colorado at Boulder.
And in heaven, the "magnitude of the disaster" was stunning.
Paradise officials reported that 9 out of 10 homes were set on fire in this low-income, middle-income city, which is very popular with retirees.
"It's quite traumatic," said Elissa Crane, who lost her rent to Paradise with her husband and disabled adult son. The family has been living in a hotel with confidence since November looking for an affordable apartment for themselves and their two cats. And now, with the temporary housing insurance on the brink of exhaustion, they are considering a permanent move to Idaho.
"We are animals and our nests are very important to us," Rothbaum said. "One of the most stressful things you can do to an animal is to ruin everything in its nest."
Martha Bryant's house was one of three people left in a ravaged neighborhood. On her first visit, she said, she failed to recognize her own home.
She continues to have nightmares; Traffic jams trigger panic attacks.
"What I remember most is just fear, panic and my heart racing," said Bryant, 60, resident of Paradise's third generation. "Nobody moved. And I cried, "Move! Move! Go for it! Move on! "
She says she knows she needs advice, but life has been too busy to make decisions.
In a study published in 2017 in the journal JAMA Psychiatry, Galea and his colleagues found that one of the ways to deal with the psychological consequences of a disaster is to use "phased care", which allows the victims to be during the recovery process, "so as to direct them to the care they need, when they need it," Galea said.
Regular treatment of mental health, including practical approaches such as cognitive-behavioral therapy, is one of two key stages of recovery. The other, Galea said, is to restore the social and economic functioning of a community.
The sociologist Peek, who studied PTSD after Hurricane Katrina, said that for those who want to return to paradise, participation in community-wide conversations is essential.
Virtual City Halls helped people displaced by the 2005 hurricane to participate in the recovery, Peek said. "It's these moments of connection and the feeling of cultural familiarity that have sometimes made a big difference in terms of the process of emotional healing," she said.
The Town of Paradise Facebook page seems to fill this role. In addition to providing advice on building regulations, safety issues and where to get clean water, it is a public forum where people can participate in live planning meetings and discussions on how to get clean water. the future of the city. Social worker Linnea Duncan is part of a group of therapists offering free treatment to Paradise residents.
For Carol Holcomb, however, it will not be possible to return home to heaven. She's cured – she's being treated for the symptoms of PTSD and, thanks to a thoughtful person who put the backpack she left in the truck, she found some of her family's treasures.
But Holcomb will not rebuild, she said. She is looking for a house in an agricultural community with trees in the orchards, which can withstand a forest fire. "I will never be able to live in the forest again," said Holcomb. "I just can not."
Kaiser Health News (KHN) is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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