After the Wildfires: Reflections on Positive Psychiatry and Posttraumatic Growth

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Psychiatrists are accustomed to listening to and supporting patients who present as a result of traumatic experiences, but how do we respond when faced with disaster? Like many others, I experienced firsthand the devastation of the recent California wildfires. Although I lost my home of 14 years, I gained a new understanding of the role of positive psychiatry’s role in fostering resilience in the face of a traumatic experience.

From Normalcy to a Different State

January 7, 2025, started like an ordinary day. I had various work calls, and my adult son stopped by to fix a few things around the house. In the afternoon, I joined a call with colleagues from an American Psychiatric Association work group, leading a discussion on the role of exercise and lifestyle psychiatry in clinical practice. At 3:58 PM, as we were wrapping up our chat, my home lost power.

My wife, son, and I needed to run an errand, so with no power in the house, we decided to head out, pick up what my son needed to finish his project for us, and enjoy a dinner out. Our meal was interrupted by a phone call from my older son asking if we were OK.

It is funny how our brains work: We thought the smoky aroma was a misstep in the kitchen when it had been much more ominous—the fires burning nearby. My older son, who lived nearby, explained that a fire was raging up Eaton Canyon, just to the east of our home by a few hundred yards.

Photo provided by Dave Baron, DO, MSEd

Reports claimed the fire was traveling 100 yd/s up the canyon, so we rushed home to prepare for evacuation. The visibility was already near zero, but we made it. The strong winds were blowing east when we arrived, which we figured gave us approximately 10 minutes to grab what we could, all in the dark. We did not get much: our passports, a laptop, and a tennis racket sitting by the door. With the electric garage opener stuck closed, we left our cars behind and departed in my son’s car. We hoped the winds would keep blowing east and our home would be spared. Looking back, we were very fortunate: Had the winds shifted to the west while we were evacuating, as they did later in the evening, I would not be here writing this.

The drive to safety was surreal—it felt like we were watching a movie. We watched the flames grow, whipped by the ferocious gusts of wind.

Evacuating during a California wildfire was not new to us. We had evacuated a few years prior in a similar situation: high Santa Ana winds, very low humidity, no measurable rain for months, and increased vegetation (kindling for the fire) from heavy rains earlier that year. However, it felt different this time because the flames were so close, and we could not get much out of the house before leaving.

Again, I reflect on good fortune. We had our son with us; he calmly found the way to safety with his car’s navigation system. (While evacuating, we could not even see streets.) Perhaps his presence also reminded us that we left with what is most important: our lives.

We did what I have told patients in the past: keep perspective. We knew this would not be good, but we had a safe place to go, and our family was safe. We were fortunate to have help from our son.

The next morning, our older son again phoned, tearfully informing us that everything—our home, our cars, our belongings left behind—was gone, reduced to ash. We drove back hoping to find something, but we could not get to the house, as fires continued to be dangerous.

Photo provided by Dave Baron, DO, MSEd

When we finally got to the spot where our house used to be, we could see the total devastation—not just our home but so many others with nothing left. It looked like a war zone; likely, there was damage and explosions from gas lines that had not been shut off. From that vantage point we also noticed how randomly the flames unleashed their fury. The house below ours was OK, but others nearby were not. In some places, trees still stood, and in others, they were burned to nothingness. It was reminiscent of how a tornado leaves a wake of destruction.

Not much was left of our home; it had become a deep pile of rubble. (An insurance agent later found a presidential medal and brought it to me.)

It took almost a month before the Eaton fire was declared fully contained on January 31, not before inflicting massive destruction. In all, 14,021 acres were scorched, and more than 9000 structures were destroyed. Sadly, 29 people died. As workers continue the clean-up, more families are learning that their homes are unhabitable due to the toxic remnants.

Professional vs Personal Perspectives

Understanding trauma is not new for me. I coauthored work with Carol S. North, MD, adjunct professor of psychiatry at UT Southwestern Medical Center in Dallas, Texas, looking at postdisaster major depression. Although we were unable to identify symptoms to guide construction and validation of screeners for postdisaster major depression, we learned a lot from the data. The work looked at 1181 total survivors of 11 different disasters: natural disasters (eg, floods, tornado, earthquakes), technological accidents (eg, plane crash into a hotel, firestorm), and intentional disasters (eg, mass murder episodes, terrorist bombing), and included survivors of the September 11, 2001, World Trade Center attacks. We found employment and current marital status to be associated with remission of postdisaster major depression, possibly highlighting the protective role of social supports and schedules. Interestingly, 9/11 survivors were more than twice as likely to have postdisaster major depression than survivors of other disasters, perhaps related to the greater psychosocial and interpersonal loss associated with that event.^1-3

Over the years, I have worked with refugees and 9/11 survivors, and in doing so, I have often wondered how I would react when confronted with loss following a disaster. I practice and preach positive psychiatry, which became important in this journey. Its premise is simple: It encourages individuals to live meaningfully despite their illness or circumstances and offers tools that go beyond curing symptoms.

Looking back over the past 3 weeks, one thing is clear to me: I am a very lucky guy. I escaped with my health and that of my family. Everything I lost from my 45-year career as an academic and sports psychiatrist, photographer, and collector of coins and sports memorabilia is a reminder of how lucky I was to acquire all that stuff in the first place. The material things were amassed via wonderful adventures and experiences that yielded glorious memories. And memories are fireproof.

Additionally, I was reminded of how lucky I was to have so many friends and colleagues. Because the Eaton and Palisades fires were monumental in their devastation, the story caught the attention of the international media. Within days, I received concerned calls from friends, previous students, and colleagues around the world, some of whom I had not heard from in years. They offered support and even invited me and my family to come live with them. My best friend from residency gave me shoes, a dress shirt, and a cashmere topcoat to attend a family wedding in Philadelphia, Pennsylvania, allowing me to participate in a bit of normalcy, even happiness. Organizations like the Chabad House of Pasadena have similarly been generous, offering food, gift cards, essentials, and most importantly, support and a genuine sense of caring for everyone who needed it.

It was inspiring to see all of this, and it confirmed the relevance of positive psychiatry, as described by my friend and colleague, former president of the American Psychiatric Association, Dilip V. Jeste, MD. It affirms the importance of being thankful for all we have (not on what we lost), the critical role of social connectedness and having purpose in life, and not taking anything for granted. We focus on enjoying what life gives us with those we love and care about. Life can throw some wicked curveballs, but we are still in the game, which is something special worthy of celebration.

Emotional Resilience

One of the colleagues who has regularly reached out to check on us is longtime friend Michelle B. Riba, MD, MS, Psychiatric Times deputy editor in chief emeritus. She suggested I share my thoughts on resilience following a disaster and the lessons learned.

Emotional resilience is broadly defined as an individual’s ability to adapt to stress, adversity, or trauma in a healthy way. It involves the capacity to bounce back from challenging experiences and maintaining emotional balance and mental well-being. The literature notes key aspects of emotional resilience include adaptability, emotional regulation, perspective (seeing challenges as opportunities for growth rather than insurmountable obstacles), self-awareness, self-efficacy, social support, and a sense of purpose.

Emotional resilience is an ongoing process that involves learning and practice. It can be fostered through mindfulness, stress management techniques, supportive relationships, and positive thinking. Ironically, evidence has supported the potential positive impact of experiencing a disaster (ie, posttraumatic growth). Posttraumatic growth can result in a greater appreciation of life, purpose, and relationships.

Current evidence-based literature⁴ reports most individuals maintain resilience in response to climate disasters, whereas few exhibit chronic distress or delayed response. This has been my personal experience and is consistent with what I have observed in working with those affected by the Eaton fire.

Personally, the stress of navigating the federal assistance agency has been tempered by the caring demeanor of our insurance agent, who drove 30 miles to give me that presidential medal he found in the rubble, and the ongoing support and generosity of Chabad of Pasadena. These positive interactions have contributed to my posttraumatic growth.

I have seen similar signs of positivism and resiliency among other survivors of the wildfires in counseling them. We are in the acute phase of dealing with this disaster and related trauma. The first step is dealing with the now: feeling safe. I have used this approach before and continue to leverage it for myself and those I have supported. Then, we look at what we need to get through to tomorrow and to keep getting through each tomorrow. Many of the principles of cognitive behavioral therapy and lifestyle psychiatry come in handy, and we ask open-ended questions to find each individual’s strengths.

From positive psychiatry, we know that social supports are crucial, so it is important to encourage individuals to find and engage in those social supports—families, friends, and organizations. For me, having the Chabad House has been incredibly helpful as a place to talk to positive people, feel supported, and have a safe place just to be.

After disasters, people feel a loss of control, so we need a bit of cognitive restructuring and rebuilding foundations. Check to make sure they are sleeping, eating, and exercising. Mindfulness and meditation can be extremely helpful, especially when there is disrupted sleep. There was one patient of mine who was a survivor of the 9/11 World Trade Center attacks who had trouble sleeping because of the sounds of that day. We discussed how we could rethink what those sounds signified and put them in a more positive light, which helped.

It is also important to find a sense of normalcy. My work with child refugees showed me how simple soccer play could help them focus on the positive and the play instead of dire circumstances. Although the California wildfires destroyed schools and displaced families, it is important to get those kids back into school so they can play with friends and enjoy their sports activities.

Concluding Thoughts

Where my house stood, there remains a burnt rose bush. On my last visit to the site, I looked a bit closer and found a slightly damaged yellow rose, a symbol of resiliency and a reminder that life goes on. I make time to watch the sunsets, as I always have, which brings me joy. I am reminded of the blessing it is to be able to help others and to contribute to society, and I have made that a focus. As I am involved in sports psychiatry, I take a lesson from athletes when they lose a match or game but get back up and keep going.

FIGURE. The 6 Pillars of Lifestyle Psychiatry

Poignantly, this year’s American Psychiatric Association annual meeting will take in Los Angeles, California, a mere 12 miles from the total devastated areas of Eaton and Pasadena; the theme is lifestyle psychiatry. Lifestyle and positive psychiatry play an important role in resilience and recovery, and it is important we understand and leverage their core tenets in providing optimal care to patients experiencing emotional distress resulting from exposure to traumatic events. Attention to the 6 pillars of lifestyle psychiatry (Figure) and a positive psychiatry approach are key components of enhancing resilience postdisaster exposure and increasing the opportunity for posttraumatic growth and improved quality of life.

For those of us who lost our homes, it may take time to rebuild. Yet, resilience and posttraumatic growth will allow us to move forward.

For Further feading, please see: psychiatrictimes.com/view/ resources-for-resilience-after-disaster

Dr Baron is a professor of psychiatry Western University of Health Sciences, an adjunct clinical professor in psychiatry and behavioral sciences at Stanford University in California, and research professor at Claremont Graduate University in California.

References

1. North CS, Baron D. The symptom structure of postdisaster major depression: convergence of evidence from 11 disaster studies using consistent methods. Behav Sci (Basel). 2021;11(1):8.

2. North CS, Baron D. Outcomes and correlates of major depression in 11 disaster studies using consistent methods. Behav Sci (Basel). 2021;11(1):4.

3. North CS, Baron D, Chen AF. Prevalence and predictors of postdisaster major depression: convergence of evidence from 11 disaster studies using consistent methods. J Psychiatr Res. 2018;102:96-101.

4. Chen S, Bagrodia R, Pfeffer CC, Meli L, Bonanno GA. Anxiety and resilience in the face of natural disasters associated with climate change: a review and methodological critique. J Anxiety Disord. 2020;76:102297.