Death, destruction — and trauma — of L.A. wildfires

Lives have been lost and disrupted, and thousands of homes and businesses have been destroyed as wind-whipped wildfires continue to burn around Los Angeles a week after they began. Mental health professionals expect emotional and psychological wounds will endure long after the blazes have been extinguished.

The Gazette spoke with Karestan Koenen, an expert in psychological trauma at the Harvard T.H. Chan School of Public Health, who investigated the mental health impacts of the 2018 Paradise fire, which destroyed the town of Paradise, California, killed 85, and became the deadliest and costliest fire in state history. Koenen, a professor of psychiatric epidemiology, talked about what to expect in the days and weeks ahead.

In the Los Angeles fires, we have at least two dozen dead, more than 100,000 have been evacuated, more than 12,000 structures burned. That’s a lot of loss and upheaval. Are you expecting mental health impacts right away or more likely later?

We would expect mental health concerns to manifest right away, but the first thing is that everyone needs to be safe. Their basic needs have to be addressed. People lost homes but also places of employment, schools, churches, community structures, support systems, and different aspects of life. There’s a lot of research that shows that one of the things that predicts poor mental health outcomes after disasters is the disruptions in things like employment, housing, etc. So, one of the best things to prevent long-term mental health consequences is to address people’s basic needs for a safe place to live, for food, for work.

How much variability do you see in such a situation? I imagine there’s a different impact if you just had to evacuate versus your home burning down or you know a neighbor who died.

There’s a lot of variation in experience. One of the reasons the Paradise fire was so traumatic was because people had little warning. It is particularly traumatic when your life is threatened, and they were evacuating while fire was burning around them.

I’ve done a lot of interviews on trauma over the years and the person I did the Paradise interviews with, Dr. Roger Pitman, an expert on PTSD, said the only interviews where he saw as much trauma were in war, in combat veterans and civilian war survivors. It’s because of all the losses. When people lose their homes, it’s the loss of the home itself, but they also lose their clothing, stuffed animals, family photos, heirlooms, boxes of their kids’ newborn stuff. And pets. Losing a pet can have a really big impact. Pets often run away when there’s a fire, and their owners experience guilt that they were not able to save them.

Is it different for firefighters versus people who are victims and being evacuated?

Yes. Firefighters and first responders are trained in how to deal with the situation. Being prepared, having rehearsed what to do will reduce the chance of having negative outcomes.

Firefighters and first responders can still experience trauma, especially if their lives are threatened, but they have a purpose. They’re doing something to help. One of the hardest things to handle in a disaster is the feeling of helplessness, that loss of control. If you’re evacuated, you don’t know where you’re going — maybe to temporary housing — and you don’t control when you can go back to your house. So, when we talk about trauma, we talk about losses and things that are out of your control, that are threatening and unpredictable. Fires are all of those things.

Are there some people who, under the same circumstances, are unaffected, and can we predict who that will be?

We can’t predict that very well, but there are things that make people more or less vulnerable. People with a history of mental disorders, depression, or physical health problems might be more vulnerable. People who don’t have good supports, don’t have stable employment, don’t have insurance, they would be more vulnerable, under more stress after the fires.

Then there’s the exposure itself, whether you saw your home burn or someone die versus being safely evacuated. Maybe bad things happened, but you didn’t witness them. There’s a lot of evidence that how kids feel will be influenced a lot by how their parents respond to what’s going on. Kids are vulnerable but can be buffered by their parents and other supports, like the school still being open, so they can still go even though they’ve been evacuated. That’s a better situation, because then they at least still have a normal school day.

So, if you’re a parent, you should try to kind of act as if things are under control, even if that’s not what you feel?

No, I’m not saying that. Rather, it’s an argument for parents to make sure they’re attending to the things they need, like when you’re on an airplane: Put on your own oxygen mask first, before you put on your kid’s oxygen mask. If parents can do things that help them feel better, it will trickle down. Supporting parents and caretakers is one of the best ways to support kids.

Is there an ideal time frame after we take care of basic needs that mental health assessments and care interventions should start?

After fires like this, a lot of people will show distress. That might look like being hypervigilant, on guard, being tense, feeling anxious, worrying, being reactive to things in the news about a fire, for example. They could be depressed, sad, have trouble sleeping, or trouble concentrating. It’d be normal to experience those things after what happened.

But many people heal on their own, even with pretty extreme trauma. A lot of people go through a natural recovery process, talking to friends, speaking with people in the community. In a few weeks to a month — after the fires are out and things are stable — people should be feeling better, their anxiety should be going down.

If it’s persisting or getting worse, that might be a time to get some help. Another thing to watch for is avoidance, isolating, or using substances to cope. Keep in mind too that the things you used to like to do, like exercising and going outside to enjoy nature — activities interrupted by the fires — there’s evidence that they help people’s mental health. So as soon as possible, take some time to do things you enjoyed.

How do you know when it’s time to seek professional help?

When the things I mentioned — anxiety, feeling sad most of the time, problems sleeping, problems concentrating — start interfering with things like work: You are back, but you can’t get your work done; you can’t concentrate. Also, if they’re interfering with relationships: You find yourself avoiding people you normally like spending time with or you’re losing your temper a lot more, in an extreme way. If you’re feeling bad, it’s not getting better, and it’s interfering with your life, that’s definitely time to get help.

Is there anything you learned from the Paradise experience that might be helpful in the aftermath of the fires in L.A.?

 We already talked about the importance of attending to people’s basic needs — a safe place to live, food, etc. But there’s also the importance of rebuilding the community. In Paradise, the loss of a community as well as individual homes was what made it even worse for people because they lost their way of connecting with people. So, if there are ways to connect people, provide places to gather and connect, that’s important. We often focus on the basic needs, like food, shelter, clothing — which totally makes sense — but we also need to focus on the community connection.

So, if you belong to a church that burned down, maybe get people together somehow?

It should probably be others, leaders or relief organizations, who facilitate that. If people are overwhelmed, dealing with their own basic needs, they’re not going to have a lot of extra energy to organize things.

One thing with the L.A. fire is it seemed to affect people with different socioeconomic statuses, including superstars. My hope is that those with more resources will be able to help those with fewer. Negative mental health consequences of disasters, like the L.A. fires, are common but they can be mitigated and even prevented if the right supports are in place and the community comes together.