In the days since fires ravaged towns here, people have pulled together. Strangers at coffee shops share their trauma, talking of homes destroyed and loved ones lost.
Almost everyone seems to know a neighbor who knocked on a door or lifted someone into a car, and saved a life.
The phrase "The love in the air is thicker than the smoke" is on signs in shop windows, in Facebook posts and on people's lips.
The community solidarity has buoyed people's spirits, experts say. But when it fades, the trauma will stay.
"That's when the cracks start to show," said Jennifer MacLeamy, a therapist in Petaluma, which neighbors Santa Rosa, the city hardest hit by the fires. "People's lives are still devastated."
The wildfires that ripped through the region killed more than 40 people and displaced tens of thousands from their homes. Those who evacuated had only minutes to do so, leaving them with few, if any, possessions.
Other natural disasters, including previous wildfires in California, have left scars in the minds of survivors, studies have shown. Already, therapists in the Bay Area report hearing from patients who say they're having trouble sleeping or feel scared when they hear heavy winds or sirens.
Health workers say North Bay residents require psychological attention to head off serious problems. Those mental health needs, however, are often neglected after disasters as communities focus on repairing the damage that can be seen.
Anxiety, flashbacks and tantrums
Talking to therapists at the Petaluma Health Center recently, a woman described her 4-year-old son as extra needy and energetic since they evacuated their home.
"I told my mom he's a Stage 5 clinger right now," the woman told MacLeamy, who is the center's director of behavioral health.
Children might have separation anxiety, be unusually irritable or complain of headaches or stomachaches after traumatic events, MacLeamy said. Some might regress and begin sucking their thumbs, throwing tantrums and wetting the bed even though they had grown out of those behaviors.
MacLeamy created a Parenting Through Crisis class last week after co-workers told her they were struggling to talk to their children about the fire. She said the cashier at the grocery store started crying when MacLeamy asked how she was doing.
"People are just barely stitched together," she said.
Julayne Smithson, 55, was working as a nurse at Kaiser Santa Rosa hospital while her mobile home burned across the street. She had purchased the home and moved to Santa Rosa just three weeks before.
Smithson and her Chihuahua, Tiki, found a place to live temporarily, but are still searching for permanent housing.
"It's just amazing how stressful this all is. You don't realize it, you don't realize you're in stress, but you're just exhausted," said Smithson, 55.
Anxiety, flashbacks, sleep disruptions, and hypervigilance are normal, and what therapists call an acute stress reaction. The strain may reopen old emotional wounds, or lead alcoholics to begin drinking again. Not everyone experiences these problems immediately.
"We're really anticipating the reality of this to hit people in the next couple of weeks — the reality of what they lost," said Maryellen Curran, who oversees behavioral health services for the Santa Rosa Community Health centers.
PTSD after natural disasters
The feelings could develop into post-traumatic stress disorder if they continue for more than a month and interfere with relationships or work, experts say.
A study of Californians evacuated from their homes during the 2003 wildfires showed that 33% were depressed and 24% were experiencing PTSD three months later. People whose property was damaged and who were injured or had a loved one injured were the most likely to be affected.
Lawrence Palinkas, USC professor of social policy and health, said people trained in mental health should be triaging survivors of the fires and referring those who are particularly stressed or not coping well into treatment.
Some experts say there's a 30-day window after a traumatic event, a "golden month," in which even small interventions can make a difference.
"It should be happening right now," Palinkas said. "Simply because you've provided food and shelter, it doesn't mean the job is completed."
Sonoma County health workers have been administering psychological first aid to evacuated people for days, county health department spokesman Scott Alonso said.
"As long as those shelters are open and there's a need, our folks will be out there," Alonso said.
Some questioned whether the region has the capacity to provide more mental health care. The healthcare system took a major hit in the fires, with hospitals and clinics damaged and hundreds of medical professionals losing their homes.
When community solidarity fades
Even for those who didn't lose homes or loved ones, seeing a hometown dotted with trucks from the Federal Emergency Management Agency and people wearing masks can be painful. The air still smells of smoke.
Cyndi Evans, 49, couldn't sleep through the night for days last week because the winds were changing so quickly that a new neighborhood could be at risk within minutes.
"I felt very vulnerable, very raw," said Evans, who lives south of downtown Santa Rosa.
Evans said she's grateful her home was spared and her family is safe. She began volunteering at a shelter last week.
"I still feel weepy for our town," she said. "This isn't over yet."
Many people, some of whom are experiencing survivor's guilt, welcomed those displaced into their homes. Shelters in the region reported having too many volunteers and donations.
The sense of unity and support that swells after a crisis is one of the best ways to ward off PTSD and depression, but it often wanes when rebuilding starts, Palinkas said.
Some groups will feel slighted because they won't get as many resources as others, he said. Social networks also fray after disasters because loved ones have died, people scatter to find new housing, and survivors tend to withdraw because they feel isolated, he said.
"The disruption of the social fabric of the community is as much a victim of a disaster like this as the disruption of individual health and well-being," Palinkas said.
Andrea Williams-Epting, 30, started a Facebook group to share mental health resources for people affected by the fire. She said she's heard people in Guerneville — about 20 miles west of Santa Rosa and close to a redwood park — say they've become sensitive to certain triggers: the sound of the wind, helicopters, people smoking or candles.
"Even just out here in Guerneville, people are on edge because you strike a match and the redwoods can just go up in flames," she said. "It's going to take a while for people to heal."
Mental health resources
- The National Child Traumatic Stress Network has a guide to help patients talk to their children about wildfires, as well as tips based on the kids’ age — pre-school age children, school-age children or adolescents.
- For adults and children, there are some relaxation tips.
- The Redwood Empire Chapter of the California Assn. of Marriage and Family Therapists compiled a list of licensed therapists offering free counseling to people affected by the fires.
- The federal Substance Abuse and Mental Health Services Administration runs a disaster distress hotline at (800) 985-5990.