ARI SHAPIRO, HOST:
In Northern California, many survivors of the wildfire that destroyed the town of Paradise are now struggling with the psychological scars from everything they endured. Stephanie O'Neill has more.
STEPHANIE O'NEILL, BYLINE: For Carol Holcomb, last November 8 started as just another beautiful fall day in Paradise, Calif. And then she heard what sounded like raindrops hitting her roof, so she stepped outside to investigate.
CAROL HOLCOMB: And something floated down in front of me. And I looked at it, and it was a piece of pine bark that was about 3 inches by 2 inches, and it was smoking.
O'NEILL: As the deadliest wildfire in California history bore down on Paradise, it took Holcomb nearly three hours to inch her way out through traffic-clogged streets, all the while watching in disbelief as the firestorm devoured businesses, homes and even steel propane tanks that exploded like kernels of popcorn.
HOLCOMB: You could hear the boom, boom, boom.
O'NEILL: Then, just as she made it to safety, the cab of her truck caught fire. A fellow evacuee picked up Holcomb, who continues to relive it all in nightmares and flashbacks. Dr. Sandro Galea is dean of Boston University's School of Public Health. He researches mass trauma borne from disaster.
SANDRO GALEA: People who lived through the event - the large number of them will go on to have mental health problems, which includes, typically, things like post-traumatic stress disorder - PTSD - and depression.
O'NEILL: Linnea Duncan, a licensed clinical social worker who herself fled the fire, is part of a network of certified trauma therapists offering free treatment to Paradise fire victims.
LINNEA DUNCAN: This was horrendous. I tell you that most of the people that I've been working with - it's full-blown PTSD.
O'NEILL: Just how many will struggle in the long term will depend in part on the intensity of their experience, whether mental health support is available to them and how well the community comes together as it rebuilds. That's according to Lori Peek, director of the Natural Hazards Center at the University of Colorado at Boulder.
LORI PEEK: It's the magnitude of the disaster that oftentimes can help us to predict how severe the mental health distress is going to be among affected populations.
O'NEILL: And in Paradise, the magnitude of destruction was huge. The Camp Fire, as it was named, virtually incinerated the town of 27,000, killing 85 people, many of them elderly.
Barbara Rothbaum is a pioneer in PTSD research who works at Emory University in Atlanta. She says it's normal for those who lived through disasters to initially experience a host of psychological symptoms, from severe nightmares and flashbacks to irritability, hypervigilance and problems with concentration.
BARBARA ROTHBAUM: For the majority of people, they do decrease over time.
O'NEILL: Studies suggest children, women and those with prior mental illness are most at risk of getting PTSD. Rothbaum says stress runs especially high when the familiar's lost.
ROTHBAUM: We are animals. And our nests are very important to us. And one of the most stressful things you can do to an animal is mess up its nest.
O'NEILL: Martha Bryant gets that. Her home's among 1 in 10 left standing in Paradise, where nothing looks familiar anymore.
MARTHA BRYANT: I have absolutely no bearing on where I am. I passed my own driveway.
O'NEILL: Bryant has ongoing nightmares of her escape. Driving in traffic triggers panic attacks. And as the town starts to rebuild, there will be new layers of stress. Again, Linnea Duncan.
DUNCAN: It's not just the fire. It's being displaced. It's going through dealing with the insurance companies. It's going through your rubble.
O'NEILL: Mass trauma expert Galea authored a study suggesting the best way to treat the psychological fallout of disaster is by routinely screening survivors and directing them to the treatment they need as they need it.
It's the kind of care Carol Holcomb is now getting. But for her, the healing will happen somewhere other than the town of Paradise because she says she can never again live in a forest with the threat of wildfire.
For NPR News, I'm Stephanie O'Neill.
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SHAPIRO: This story is part of a reporting partnership with NPR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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