www.washingtonpost.com /magazine/2021/10/27/camp-fire-ptsd/

After a devastating wildfire, a California community faced another crisis: PTSD

Andrea Stanley 32-41 minutes 10/27/2021

Jess Mercer received a call from her stepmom, Annette, that morning, a little after 8 a.m. “We’re coming,” Annette said, her voice so unrecognizable it sounded foreign. Jess was at her apartment in Chico, Calif., a slightly overgrown university town that sits in a valley below the hilltop community of Paradise, about 20 minutes away. She was confused. It was early, on a weekday: Thursday, Nov. 8, 2018. She wasn’t expecting a visit from Annette, or her dad, Tommie.

But then Annette was saying it again: “We’re coming.”

Things got stranger: The sky turned dark. Ash fell like black snow, except it was warm, and carried the smell of smoke. Her family, Jess realized, was trying to escape a massive wildfire.

She heard her dad’s voice on the line. Everything he spoke was in short phrases: “Remember everything I’ve ever said to you. I don’t know. I’m trying.”

And then nothing.

The call left Jess panicked, and it got her thinking that “I don’t know” must mean that they didn’t know if they were going to get out in time. She jumped in her car, pointed it toward Paradise, and went almost nowhere before realizing that the roads had already been closed. So instead, Jess stood at the mouth of the scenic highway known as the Skyway, near the Walmart parking lot, and watched as cars streamed away from Paradise. She called her family back 60, 70, 80 times, but the cell towers were burning like pitchforks and service was unreliable.

For an hour, she scanned the panicked faces inside every car that went by, looking to see if she recognized them. A woman with six kids inside her vehicle, good. Sedans piled with so many people their heads hit the ceiling, deep breath. No sign of Tommie and Annette’s green truck, damn.

[Forced from Paradise: Leaving home after one of America’s deadliest wildfires]

Jess, now 36, had moved to Paradise from Wyoming when she was 16. For the first year, she lived at the Lantern Inn, with Tommie and Annette. Their small motel room had thin walls and one bed; Jess slept on the floor. Money was tight. In the evenings, the staff at the Cozy Diner across the street would give Jess leftover food from the salad bar, usually rolls and vegetables.

Eventually, her family moved to a three-bedroom, light-beige house off Dolores Drive in Paradise. Jess remembers how proud her dad was to move in. It was the first house he’d been able to buy since moving to California, some 20 years earlier.

When Jess turned 18, she moved to Chico so she could be closer to her job as a cashier at a big-box store. Even then, she still somehow spent all her time back up on the hill, an area known to locals as the Ridge. Over the next decade, she’d bounce back and forth between Chico and Paradise, until 2018 when she moved into a bright-blue house in Paradise with her partner, Ashley, and planned to stay for good. But in May of that year, they discovered that the house had foundational issues, and once again they found themselves in an apartment back in Chico.

That’s where Tommie and Annette showed up at the door, four hours after they’d called Jess. Tommie, then 70, was wearing burned sweatpants, tattered shoes and no dentures. He carried a cat crate but had forgotten to put the cat inside.

By the time the Camp Fire was done burning, it would level the town of Paradise, and a large portion of nearby communities: Magalia, Concow, Pulga and Butte Creek Canyon. Over 150,000 acres would be burned, 18,000 structures destroyed. At least 85 people would be killed. It was, and is, the deadliest and most destructive wildfire in California’s history.

Gone was the Lantern Inn off Skyway and the light-beige house on Dolores and seven other places that at one point Jess had called home. What remained, cruelly, was just enough to remind her that once upon a time she used to have a town: ash-faded advertisements at the Cozy Diner for $4.99 cheeseburgers, movie posters at the cinema for “A Star Is Born.” Three years later, the signs remain, which frustrates Jess. “To be vacant is one thing,” she says. “To be frozen in time is triggering.”

In May 2016, Jess had been formally diagnosed with post-traumatic stress disorder, largely due to living in a home with a schizophrenic brother. But after the fire, her trauma compounded. Now, she sees a therapist a few times a month and is on multiple medications. In the six months after the fire, her partner described her as “vacant.” The first time she had a panic attack was on the one-year anniversary of the fire. The second was last December. Both times she had to be hospitalized.

She always feels like she’s in fight-or-flight mode, she says. If she reaches down to pick something up, she never bends her knees. That way if she has to take off running, she’ll be ready to sprint. A split second can determine if you live or die. She knows this. Recently, a fire alarm went off during a work meeting and she ran out of the room.

An aerial view of a destroyed cul-de-sac in Paradise in 2018. (LiPo Ching/MediaNews Group/The Mercury News/Getty Images)

Sometimes she feels angry, like there’s a “beast” inside of her that could come out at any moment. Other times, she’s so numb, she can talk about painful memories like she’s ordering a sandwich.

She can feel the trauma in her body. Always being reminded of the fire has caused her to throw up and ache to the point where she has to soak in a tub; it has even led to seizures. When the seizures happen, it’s like her body is trying to release the PTSD, she explains.

To say that everyone in the area affected by the Camp Fire suffers from PTSD would be incorrect. But of the dozens and dozens of people I spoke with for this story, nearly everyone reported experiencing PTSD or PTSD-like symptoms. There were other things, of course: increased alcohol and drug use, anxiety, depression, anger, survivor’s guilt, grief. A select few were completely fine, telling me how the fire gave them a chance to rebuild their lives in a better way. But mostly, I heard about PTSD.

From Hippie, a 60-something war veteran who still has burn marks from the day he had to ride his motorcycle through flames. From Iris, a shop owner who lost her boyfriend in the fire. From Dawn, a mother of two who still has full-blown panic attacks. From Sean, who got so tired of fire sirens triggering his PTSD that he drove to a lake and thought of taking his own life. From Corinne, an artist who had a heart attack in her early 50s because of stress.

A more scientific gauge: A study conducted by scientists at the University of California San Diego that was published in February in the International Journal of Environmental Research and Public Health found that an overwhelming number of Camp Fire survivors were suffering from various mental health disorders, most prominently PTSD. “The amount of PTSD we saw in individuals was striking and very significant,” says Jyoti Mishra, senior author of the study and a professor in the department of psychiatry at UC San Diego School of Medicine. “It was on par with what we’d expect to see in war veterans, but now we’re seeing it in communities where individuals are exposed to wildfires. It really shows how climate change is a mental health stressor.”

What comes next, experts say, is a different kind of disaster. The mental health care system is not built to handle a world in which entire populations of people are routinely and consistently traumatized or living in a state of anxiety, and its outdated approaches mean most people will never get the help they need. “Therapists, counselors, the mental health community in general, is very late to the game,” says Susanne Moser, a leading expert on climate change adaptation. “They’re 20 years behind — at least.”

Lise Van Susteren, a general and forensic psychiatrist in D.C., says she “can’t think of anything more important than mental health and climate.” She adds, “In many cases, the physical damage from climate can be corrected. You can rebuild, you can restore, you can replant. But the profound impact on our mental health takes such a cumulative toll that it can determine how society functions. The problems of mental health are not invisible scars. They drip into our lives individually, politically, economically and socially, day after day.”

It’s impossible to ignore that climate change is a politicized topic. Not everyone acknowledges it as an existential threat. Maybe that’s why it’s even harder to admit, or easier to overlook, the slow strangle climate change will have on our mental health: that before the pollution from emissions engorges our lungs, it will likely drive many of us mad.

“Physical damage from climate can be corrected. ... But the profound impact on our mental health takes such a cumulative toll,” says psychiatrist Lise Van Susteren.

In 2014, Van Susteren flew to London. It felt like a last resort. For years, she and some of her colleagues had the sense that the mental health community was largely in denial about the impending wave of climate trauma. After Hurricane Katrina in 2005, various studies revealed a sharp rise in long-term mental health issues, even as the floodwaters receded. It was casually called “Katrina brain,” but the reality was alarming: One study in the American Journal of Orthopsychiatry found rates of serious mental illness doubled after the storm. A later report would show that 12 years post-disaster, 1 in 6 people were still struggling with PTSD.

For Van Susteren, and certainly others, it was a preview of what was to come, given that in a warming world, disasters like Katrina would only hit faster, harder, stronger and more often. The planet was changing, not only in a way we could see in crumbling, hurricane-battered houses along the coast, but feel in our crumbling, climate-battered minds.

[Here’s what you can do to cope with your anxiety about climate change]

Van Susteren’s meeting with the Climate Psychology Alliance in Britain would eventually lead to the creation of two groups back in the States: The Climate Psychiatry Alliance, formed in the fall of 2015, followed by the Climate Psychology Alliance North America in 2018.

Among other things, the groups work to influence policy and educate providers of mental health care. Earlier this year, they developed a climate-aware therapist directory. The network is currently made up of 97 psychiatrists, psychologists, counselors and social workers located across the country (to put it into perspective, there are roughly 150,000 psychologists and psychiatrists in the United States). Each signs a pledge, which in part reads: “A climate-aware therapist accepts that new forms of distress are arising as a result of global crisis, and believes that the professional training of the allied mental health therapy and counseling community can attend to this distress.”

This is important, says Ariella Cook-Shonkoff, a licensed psychotherapist in Berkeley, Calif., and a steering committee member of the North American psychology alliance. “Climate distress is on the rise, from eco-anxiety to PTSD to suicidality,” she says. “It is our responsibility as mental health practitioners to identify the evolving needs of our clients and respond accordingly, so that we can best serve and support them.”

California, a state of roughly 40 million people, has 19 mental health providers in the directory. The closest one to the Camp Fire area is an hour and a half away in Sacramento. States prone to climate disasters, like Florida, Texas, Louisiana or most states along the southern and lower-east coasts, have none. Nearly all of the providers are in urban areas, though membership continues to grow.

Yet the problem in Butte County isn’t just about finding a climate-aware therapist. It’s about finding any therapist. “There are very few counselors to help with the need,” Jess says. “It’s terribly sad. People bring it up in every town meeting.”

One woman, Pat Bryant, 66, tells me over coffee in a church auditorium in Magalia that she couldn’t find anyone to help her after the fire. Her home didn’t burn down, but her entire neighborhood did. Living in the debris and dust haunted her. For months she did nothing but sit in a chair in her living room, only getting up to go to the bathroom. She doesn’t remember eating, although she’s sure she did. As a breast cancer survivor, she eventually turned to her oncologist, who prescribed her medication. She ended up throwing the pills away and got involved as a volunteer at a church instead — a move that saved her life, she says.

In part, it’s nobody’s fault. The fire didn’t spare mental health providers. Their offices and homes burned down, too. In fact, the hospital was one of the first buildings to be destroyed. It still hasn’t reopened.

There were some services, like a program offered by the United Way that offered eight free therapy sessions to fire survivors. The program quickly ran out of money, though, and by the time many people had heard about it, it was gone. “The amount of people who needed aid was a little shocking to us,” says Melissa Jamison, a community service specialist with the United Way of Northern California. “We knew that people were struggling, but the need just kept growing. It’s a need that still exists. There is still so much work to be done. While the area is in the full swing of recovery, it still has many years ahead.”

The system isn’t necessarily broken; it’s working how it’s designed to. The mental health response set up after disasters is meant to be short-term. Yet as Katrina and the Camp Fire show, the mental health needs are not just acute and immediate, but chronic and long-term.

“The resources that organizations like [the Federal Emergency Management Agency] make available for mental health services post-disaster is time-limited,” Moser says. “After a year, the resources typically go away. And what they are providing is absolutely inadequate. You don’t heal trauma in 10 hours of therapy. That’s just ridiculous.” FEMA administrator Deanne Criswell responded through a spokesperson via email: “A survivor’s mental health is as much a part of their recovery from a disaster as shelter, employment and safety; they are all directly connected. FEMA will continue to leverage all of our capabilities, and those of our partners, to ensure survivors receive the support they need on the road to recovery.”

[Climate disasters will strain our mental health system. It’s time to adapt.]

Downed power lines during the Camp Fire in Paradise. (Scott Strazzante/San Francisco Chronicle/Getty Images)

On a Saturday morning in late June, in the midst of a heat wave in the dry season, I drive 25 miles from Paradise to Concow, passing by grasses the color of exhaustion and a red sign warning me that I’m entering a wildfire zone. There are trees, many of them still charred. A visible reminder that the destruction of a wildfire hurts — that here, it still hurts.

Before the Camp Fire got to Paradise, it burned down Concow, a rural town that sits off State Route 70, deep in the Sierra Nevada foothills, where most people live off single-lane dirt and gravel roads. It’s a community of off-the-grid hippies and pot growers and artists and retirees. To outsiders, it’s a poor, middle-of-nowhere place, but to those who call it home, it’s a pocket of close-knit people.

There, Jenny Lowrey, 61, and her partner, Bruce Matthews, 72, are part of a group that runs Lake Concow Campground. The 80-plus-acre property has traditionally been used as a recreational getaway, a place where families can spot bald eagles, snag a fish or sneak in a swim, for $15 a night.

More recently, they’ve opened up the campground for displaced fire survivors to stay for free. Many are from Concow, but others have pulled in from Paradise and Magalia. “It’s rough living out here,” Jenny says. Most people live in RVs, some without water, air conditioning, electricity or plumbing.

There is a battle over housing in Paradise. Of the 12,000 houses burned in the Camp Fire, just over 1,000 have been fully rebuilt. Many people were underinsured. Many more had no insurance at all. In 2020, Pacific Gas and Electric, whose aging power lines sparked the blaze, agreed to pay victims $13.5 billion. Most people are still waiting for settlement money.

It’s common to see parcels of burn-scarred land with RVs parked on them. But when the town began telling people they could no longer live out of RVs on their own lots if they didn’t have a building permit, many felt they were being forced off their properties with nowhere to go.

As Jenny and Bruce walk me around the property, Jenny often calls the fire survivors living there “their PTSD community.” We pass by a run-down RV, the size of a middle-class living room, and Jenny tells me there are five people living inside. “PTSD is one thing, but brokenness is different, and these people are broken,” she says. “They’re traumatized on unimaginable levels.”

She and Bruce are, too. They’ve buried friends who died in the Camp Fire. Bodies burned, right there on the road. Even scarier, they almost lost Bruce’s daughter after she got trapped on Granite Ridge Road. A burning telephone pole hit a truck with a trailer and turned it over, blocking the only exit off the mountain. The fire was moving quickly. With nowhere to go, she put the car in reverse and drove until she got to the last house on the road. She put a running water hose on top of her car, secured it in place with a rock, and texted her husband. “I love you. Here it comes.” Three days later, she was rescued.

“That will mess up your head,” Jenny says. “Sitting in your car, watching the flames come at you with your dog and 12 chickens — how do you even process that? We can’t.” Bruce’s big, friendly eyes well with tears.

The temperature hits 104 degrees and Jenny introduces me to Dinah Coffman, a Camp Fire survivor from Paradise. She lives on the property in a white RV, neat and tidy with an air fryer outside the front door. We sit in mismatching plastic lawn chairs in the shade, and two other women join us, Tami Donnelson and Tamatha Romer, 53, both fire survivors from Concow.

In the hour I spend talking to Dinah, she tells me of everything she lost in the fire. Her cats, the irreplaceable possessions she’d just inherited from her mother, her sense of home. She cries as she tells me about the nightmares that won’t stop and how uneasy she gets when the wind blows. She cries when she tells me she can’t stop scrolling Facebook, obsessively checking community groups for news of any potential fires.

Then it’s Tamatha in tears. “Since the fire, I can’t do math in my head,” she says. “I can’t remember anything. I can’t do a job interview without crying.”

Here, people talk about PTSD symptoms fluently and matter-of-factly. But it’s not just that they tell me about it; I see it. When a firetruck pulls into the campground and disappears into the pine woods, the women’s demeanor visibly changes. “I feel like I have the shakes,” Tami says, pacing. “My hair is standing up on the back of my neck. My heart’s pounding.”

Already she can’t sleep most nights, waking up multiple times so she can go outside and smell for smoke. She doesn’t really want to talk about what she saw the day of the fire, except that her 11-year-old daughter had to help burn victims dress their wounds.

None of the women have been to therapy, mostly because their time is consumed with physically rebuilding their lives. This prioritization is typical in most places post-disaster — but therapy also doesn’t seem like an option for them. A drive to Chico, the nearest large town, means traveling 80 miles round-trip and spending as much as $30 in gas. There are online and telehealth options, but cell and Internet services are spotty.

Down the hill from the women, in an RV parked in a clearing, lives Lucas Anderson, 34. His partner Pamela, their two young kids, ages 3 and 7, and Lucas’s 71-year-old mother live there, too. Like everyone, Lucas has an evacuation story, and it ends the way so many of them do: He lost everything.

Lucas works six or seven days a week doing plumbing, landscaping and general construction, but finding permanent housing has been hard. They didn’t have insurance on their home in Paradise. Over the past three years, they’ve bounced from motels to a temporary house to living in an RV, parking it in vacant lots, their friends’ properties and once a church lot. “I have plenty of trauma,” Lucas says. “I can tell when it starts getting to me because I’ll get into fights with my boss, my wife.” Nightmares keep him up at night. When there’s a fire, how will he get his family out safely if he’s sleeping?

He’s never gotten therapy because he has kidney stones to deal with and a family to provide for and his boss calls people with mental health issues “weak” and other family members have dealt with hard stuff without going to therapy and how much does something like that cost anyway? He doesn’t call what he’s suffering from PTSD. He interchangeably refers to it as stress and trauma and “something he’ll eventually need to deal with.”

Experts quibble over this, but some say he isn’t wrong, and that what we’re seeing is a different form of PTSD — or a new type of trauma entirely. There’s even a push among members of the Climate Psychiatry Alliance to get the American Psychiatric Association to change the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A formal diagnosis, using the DSM-5, could potentially open the door for insurance to cover different types of treatment and improve access to services. The process is slow, though, says David Pollack, a founding member of the Climate Psychiatry Alliance and professor emeritus for public policy at Oregon Health and Science University, because “of the very convoluted and complex process that the APA has for making changes to the DSM.”

“The DSM-5 has not adapted to this particular situation,” Van Susteren says. “We need to have a proper nomenclature for it so that we can validate what people are suffering from.”

Moser agrees: “There are researchers who think of this as a new category of trauma. This is an existential kind of trauma, and so I’m not certain it’s the same thing as PTSD in the way we think of it now. There are three different kinds of trauma: trauma associated with distinct, time-limited events; trauma due to ongoing but clearly defined perpetrators; and trauma that is chronic with more diffuse perpetrators but typically not a threat to all of humanity. Climate change has aspects of all of these.” However, she says, a study that would establish this as a novel kind of trauma is still years away from happening, and it will be difficult to prove.

A rescue worker looks for possible human remains in Paradise in 2018. (Marcus Yam/Los Angeles Times/Getty Images)

There were clear signs that the students were not all right. Jess could see it in the way they slugged around in baggy sweatshirts on 100-degree days, the way the smell of smoke would make them hyperventilate or completely freeze, the constant mention of “fire brain” — a way to describe loss of memory, feelings of fatigue and lethargy, and trouble performing everyday tasks.

Administrators at Achieve Charter School saw it, too. Their high school campus in Paradise burned in the Camp Fire and the elementary school was seriously damaged, forcing some students to travel to Chico to go to school at a pop-up site of portable buildings and porta-potties in a megachurch parking lot.

Mary Tickle, Achieve’s school psychologist, tells me that over the past few years the number of suicide risk assessments conducted within the school population has more than doubled compared with previous years. A survey done this year among fourth- through eighth-graders revealed that more than 40 percent of students were still experiencing PTSD symptoms.

What they were seeing wasn’t unique. According to Scott Kennelly, director of the Butte County Behavioral Health Department, the area saw an increased risk of suicide, especially in teens. It’s impossible to know what can be blamed on the Camp Fire, given the effects of the pandemic, and even before the fire, the area had some of the highest ACE (adverse childhood experiences) scores in California. Still, Kennelly says the rise in PTSD, along with depression, anxiety and substance abuse, is undeniable and significant.

[There’s a score (ACE) to quantify childhood trauma. Some health experts want you to know yours.]

Immediately after the fire, Jess knew she wanted to help. She had a background in social work and previously worked with kids in foster care and juvenile hall. “We needed a changed mind-set in addressing the PTSD within our youth,” Jess tells me as we eat sandwiches in a back booth at Nic’s, one of the first restaurants to reopen in Paradise. “I really wanted to use art to help kids heal, to help myself heal.”

She got her first grant, for $15,000, in February 2019, along with a donated white van, which she named Gertie. She used the money she’d been awarded to load Gertie with art supplies and began taking it to schools, youth programs and community events. Kids would draw their feelings on the exterior of the van. PTSD as seen in crayon-colored graffiti. In one drawing, there’s a picture of a boy, his head scribbled in red flames. Next to it, another stick figure, this one blue, and a thought bubble above his head that reads, “Thanks for letting me do art because it helps cool me down.”

Over the next year, Jess upgraded Gertie to Marge, a newer van that she didn’t have to sit on a phone book to drive, and began developing something more formal. The result was a 13-part, trauma-informed art curriculum called the Balanced Brain Project. This fall, she began teaching it to kids at Achieve’s after-school program in Paradise and Chico, as well as at a local homeless shelter. The topics include nightmares, body language and communication, to help kids work through their “trauma residue,” Jess explains.

Leading mental health experts say that this is exactly the kind of approach that will have a life-changing impact on communities. “The existing mental health system focuses on crisis and illness, one person at a time, only after they show symptoms of psychopathology,” says Bob Doppelt, coordinator of the International Transformational Resilience Coalition, a network of professionals working to address the mental health effects of climate change. “For decades, this has been shown to be extremely ineffective and inefficient. Even in the best of times, only 50 percent of those who need mental health assistance receive it. The crisis clinical treatment approach has zero chance of addressing the scale and scope of mental health problems, or the alcohol and drug abuse, adverse childhood experiences, violence, or other psychosocial problems generated by the climate emergency.”

“No part of the country is going to remain untouched” by climate trauma, says Gary Belkin, founder of the Billion Minds Institute.

Instead, we need more programs like Jess’s, says Gary Belkin, former deputy health commissioner of New York City and founder of the Billion Minds Institute, an organization working to modernize the country’s mental health infrastructure. “We need to think of mental health as a community-owned function and build up programs that will allow the community to respond,” he says. “Help should be so easy to find, you should trip over it.”

Alternative approaches are not just for kids, either. Thanks to the Ecological Reserves at California State University Chico, healing is happening through a forest therapy pilot program. “Other countries are sending their firefighters who have PTSD out into the forest as a way to receive trauma care, and it’s working,” says Eli Goodsell, director of the reserves. “In talking with my friends who were definitely suffering from significant PTSD after the Camp Fire, I wanted to change the outdoors from being a triggering environment to a healing environment.” Goodsell started the pilot program in late July, after years of grant writing and training and pandemic delays.

How forest therapy works is both woo-woo and grounded in science: It’s based on a Japanese practice called shinrin-yoku (also known as forest bathing), and the idea is that nature can be therapeutic. A trained guide walks a small group of people through the outdoors. The aim is to go slowly and take in things around you, mostly in silence. The process ends with a tea ceremony made of items foraged along the route. Sessions normally take one to two hours. The program is offered free to fire survivors and had over 200 participants within the first few weeks of operating.

Guides go through six months of training to become certified through the Association of Nature and Forest Therapy and can be from any background. The Chico State program has guides who are mental health practitioners, outdoor educators and Parks Department employees.

“Too many of our approaches to mental health are about staying in the frontal lobe,” says Kate Scowsmith, who became a trained ANFT guide through the pilot program. (The front lobe of the brain focuses on executive functioning.) “There needs to be a lot of ways to process trauma out of your body. Forest therapy is a beautifully simple approach where nature is the therapist. It’s very healing centered.”

After Scowsmith lost her home in Magalia to the Camp Fire, she too, experienced PTSD, causing her to have nightmares, difficulty sleeping and frequent visualizations of her home and belongings burning. “Forest therapy was part of my continued healing from the fire,” she says. “It has helped me find peace, calm and something dependable.”

Like anything, these programs take money. Before Jess got hired as a staffer at Achieve this summer to teach her art therapy program, she had to apply for 14 grants just to keep her work going.

[Climate disasters will strain our mental health system. It’s time to adapt.]

The hope is that funding from the federal government may help: In February, Democratic lawmakers put forth the Climate Emergency Act of 2021, which proposes that climate change be declared a national emergency, a designation that could help drum up money for myriad things, from more electric-vehicle charging stations to mental health services. But the bill hasn’t seen much movement.

A doll hangs from a string in the backyard of a home that burned in the Camp Fire in Paradise. (Marcus Yam/Los Angeles Times/Getty Images)

Since we choose to live in burn-prone zones, in houses made of wood, coveted for their nearness to trees and privacy, it would appear the easiest solution would be to move. Leave the street named for the generations of family that lived there before you and the land where you made a living raising cattle or growing apricots in the California sun. Leave your job, your school, your community.

After the Camp Fire, many residents did just that. The town of Paradise clocked in at just over 26,000 people before the fire. Three years later, about 6,000 remain. There were similar exoduses in other towns affected by the fire. People migrated to Washington and Tennessee and Idaho and anywhere but there. Abandoned lots sit where family barbecues used to be.

But the idea that we can just move, just outrun the threat, is an illusion. A place that won’t be affected by climate trauma? Experts like Belkin don’t know of one. “We used to think of disaster trauma as reactions to one-off events, where one could escape to recover, regroup and rebuild,” he says. “But no part of the country is going to remain untouched.”

Wildfires are becoming more destructive and frequent. More than 5 million acres have burned in the United States this season. The Bootleg Fire, which hit Oregon in early July, was a blaze so massive that it became capable of generating its own weather: fire whirls (spinning vortexes of air and flames), lightning and wind. In August, a fire swept through the Greek island of Evia, burning more than 100,000 acres. The country’s prime minister declared it one of Greece’s greatest ecological disasters. At the same time, historic droughts in Siberia, an area typically known for its exhaustingly harsh winters, led to fast-spreading wildfires that raged bigger than all of the other fires burning in the world combined. This is an incomplete list.

If it’s not a wildfire, then it’s something else. California is also experiencing devastating droughts, and there were recent floods in Miami and Houston as well as hurricanes battering cities like New Orleans and New York. This past July was the Earth’s hottest month on record, according to data from the National Oceanic and Atmospheric Administration. It’s a record that will likely be short-lived, given the dire findings in the latest report from the Intergovernmental Panel on Climate Change. Just this summer, nearly 1 in 3 Americans experienced a weather disaster.

[Five key excerpts from the United Nations’ climate change report]

Climate trauma isn’t unique to the Camp Fire area. The Northern California disaster is a microcosm of the problem, and a warning. It’s a reminder that there are questions we have been unwilling to prioritize: What should a mental health response look like in the wake of a climate disaster? How can we better prepare communities for the moment when they are forced to confront climate change? Do we need to prepare people for a climate dystopia, where climate trauma is ever-present and ambient? What do we call what we’re all feeling?

The second time I talk to Dinah, it’s via text in mid-July after she just evacuated the Lake Concow Campground: “My PTSD is going … Blood pressure up, heard racing, stomach churning, anger, helplessness … you name it I feel it lots of tears.”

Then two minutes later: “I’m a mess I can’t even spell.”

There’s another fire.

It would come to be known as the Dixie Fire, and, unbelievably, it started in the same spot (Camp Creek Road) and allegedly in the same way (a PG&E power line sparking) as the Camp Fire. At the time of publication, it had been burning for months and was still not fully contained. Already it had engulfed nearly 1 million acres, including the entire gold-rush community of Greenville, making it the second-largest blaze in California’s history.

Paradise was at risk of evacuation, too. Videos uploaded to Facebook by Camp Fire survivors of the smoke across Feather River Canyon came with PTSD warnings about how the content might be triggering.

Everyone was ready to run. Jess told me she was feeling angry but was trying to stay calm. “It’s eerie to relive flashbacks in real life,” she wrote in an email.

Days later, the smoke from the Dixie Fire made its way to New York, turning the sun into a hazy, gray pearl. On a midafternoon call while staring at the sky, I ask Moser: What does this kind of trauma feel like? “As if you lost your mother in a car accident four times,” she says. If we’re lucky, that’s all it will be.

Andrea Stanley is a writer and editor in New York.