Paulie Hawthorne is used to fire. She grew up in southeastern Oregon, long a hotbed for wildfires.
“I can remember, even as a kid, there were fires. I mean, it was just kind of a thing that happened,” Hawthorne, 47, said. Hawthorne and her husband had to evacuate in 2017 from their old home in Brookings, Oregon, during the 2017 Chetco Bar wildfire, which burned through more than 190,000 acres, including about 80,000 acres in the Kalmiopsis Wilderness. Today she lives in Klamath Falls, Oregon, a small city about 280 miles south of Portland that has seen frequent, low-intensity fires over the years. While her current exposure has been mild, when she smells smoke in the air or simply sees ashy skies, it pulls her back.
“The hardest part about evacuating is you just think it's gonna be like a couple days, and we were out for almost a month,” she explained.
The lingering dread associated with fires isn’t unique to Hawthorne, and the wildfires that have devastated large chunks of Oregon and California aren’t just decimating towns and driving residents away. Mental health experts say the fear and uncertainty that comes with wildfires can cause long-term psychological impact on residents. Worse yet, just as the region is seeing a growing increase in people seeking therapy, there is a deficit in available therapeutic resources.
Darla Gale, a licensed marriage and family therapist specializing in trauma and founder of Heartstrings Counseling in Loomis, California, said it is the unknown that is causing an abundance of stress and anxiety.
“We have had a tremendous increase in calls just in the last few months. It’s been overwhelming. I’ve had to hire seven more therapists to handle the load,” she said.
Many of her clients were previously victims of the 2018 Camp Fire, a deadly and damaging California fire that took nearly 90 lives.
“For the fire survivors, it's the PTSD because of the smoke,” she said, using the acronym for post-traumatic stress disorder. But she also noted that some who survived the Camp Fire have now had to re-evacuate. It’s trauma on top of trauma.
Even residents who did not lose their homes say these wildfires have a lasting impact on their ability to manage daily life, even outside the direct path of destruction.
During the Two Four Two wildfire — which ravaged Klamath County, Oregon, in September — Hawthorne said she and her husband had trouble sleeping and were obsessively checking the sky and internet for information. Though they live some 15 miles away from the path of the fire, they simply didn’t feel safe.
“We both almost felt a compulsion to start getting our stuff together,” she said.
Hawthorne, who is a social worker and mental health therapist, said she is very familiar with the symptoms of trauma and PTSD. But that knowledge has not made dealing with wildfire anxiety any easier.
There are triggers, she notes, “every time you smell smoke, every time somebody says there's a fire close by or close by somebody's house,” Hawthorne said. She explained that the hardest part is the worry she feels in coming across these indicators and how her awareness of wildfires has made her hypervigilant. The fear that odor evokes, and even the word "fire" engenders, she explained, are a part of “the long-term mental health effects that we're not really equipped to handle,” referring to this extreme awareness.
Lisa Lovelace, a therapist and owner of Synergy eTherapy, an online group practice that offers mental health counseling to residents in 17 states, said over the past few months her practice has gone from 13 to 15 clinicians to handle the stress burden and influx of new clients. Lovelace has been a licensed clinician since 2007 and running this practice for about four years.
“People are just feeling it in an intense way that I don’t think maybe they’ve ever felt, and then people that are already predisposed for anxiety or depression or history of trauma already are being exacerbated,” Lovelace said.
Nikki Phillips, 27, of Portland, Oregon, said she is no stranger to evacuations having grown up in southern Louisiana, a hurricane zone. But that doesn’t make it easier.
“No matter how many times you do it, it still hurts when you have to leave your home,” she said.
She experienced Oregon’s Eagle Creek Fire in 2017 which burned through over 48,000 acres of land in the Columbia River Gorge over a span of three months.
"But now it’s 2020, and we still don’t have proper tools to handle these disasters," she said. "It’s kind of hard to have good mental health days when your world is, literally, on fire."
Lovelace said it’s not just the clients: Even the therapists in her practice are feeling the impact.
“What’s interesting is our therapists are rarely in a traumatic environment with our patients, but now therapists are holding it for themselves, their families and their clients,” she said, adding, “We are really feeling the brunt of what others in the nation are feeling.”
Lovelace’s colleagues aren’t the only mental health experts who have been experiencing this wildfire anxiety firsthand.
The pandemic, wildfires and heat waves are affecting the mental well-being of Ali Mattu, a clinical psychologist and resident of Santa Clara, California. Though Mattu isn’t in a spot where he needs to evacuate, he said the mix has made him feel limited.
As someone who works in the mental health field, Mattu intellectually knows the tools needed to cope. “But, you know, deep breathing is not something that's going to get you through multiple crises that are compounding each other, and real limitations on what you can do,” he said.
The combination of the wildfires with the strain of the coronavirus pandemic has increased the need for mental health treatment while also revealing the inequalities in the rate of infection.
Hawthorne has seen this firsthand in her work in a tribal behavioral health clinic.
“Now we're also thinking in the back of our mind, 'Do I get too close? Do I touch them? How many people have they been exposed to?'” she explained.
Over the past few months, the coronavirus pandemic has had a disproportionate impact on Native Americans, according to the Centers for Disease Control and Prevention. The CDC found confirmed coronavirus cases for American Indians and Alaskan Natives in 23 states to be 3 1/2 times greater than that of non-Hispanic white people.
But ensuring safe coronavirus practices — including social distancing, wearing masks and resisting touch — have posed additional hurdles in treating mental health. It’s hard to comfort people who’ve experienced loss when you cannot come close.
Gale, the California-based trauma therapist, advocates for “plenty of rest, exercising, eating [and] taking care of your body.” Further, she added, “We like to teach a lot of mindfulness and being in the present.”
To take charge of a situation that seems out of control, Gale teaches her clients to move away from identities that don’t serve them.
“You can be a victim, or a survivor, or you're a thriver. While it may be difficult to come out of unhealthy patterns, people have to stop thinking in ‘victim mode,’" she said. “We have a few people that have lost everything, yet they’re rebuilding their life and they’re thriving from that. They’re not getting stuck in that path.”
In working in the community space, Hawthorne said, “Once the fire is out, that's just the beginning.”
Oct. 5, 9:32 am: An earlier version of this article misspelled in a caption the name of the town in California where Darla Gale's office is. It Loomis, not Lumos. The caption has been updated.