Components of the parameter axis describe what happened, when to whom. The following are assessed: • The details of the particular stressor and the extent and nature of devastation. • Details of when it happened and over what period.
17 • The details of the affected community - demographics, social system groupings and networks, special groups which may be of help or are vulnerable, those secondarily affected. • Ages of those affected - children, adults, and elderly. Process Axis The process axis assesses the nature of the ripple effects, including the what how and why of disaster consequences. Each of the components which follows has biological, psychological and social (functionally biopsychosocial) aspects. • Stressors. Assessment of the noxiousness of stressors includes the number dead and injured, degree of mutilation, presence of human motivation in the causation of the disaster, youth of victims, closeness to the epicentre of the event, extensive destruction, suddenness of the event and unpreparedness. The more of these factors that are present the more stressors are likely to lead to trauma, and be traumatic stressors . Lesser stressors which may be resolved and even lead to better adjustments are called crises . Lesser stressors again may be “daily hassles”. Disaster stressors usually have a cascade of a mixture of stressors. • Stress responses Assessment and making sense of stress responses relies on assessing which survival strategies (fight, flight, rescue,
attachment, goal achievement, goal surrender, competition,
cooperation) were evoked to deal with stressors. Stress responses may be adaptive, in which case they provide satisfaction. If insufficient or maladaptive, they may lead to stress and trauma. The wide range of fluctuating and often opposite (e.g. altruistic and selfish) manifestations is due to the multiplicity of survival strategies used in disasters and their adaptive and maladaptive, biological, psychological and social aspects. The presence of even intense stress responses in the initial stages may not indicate bad prognosis, as they may lead to adaptive dealing with stressors.
18 • Stresses and Traumas It is important to assess and distinguish adaptive, maladaptive/stress and trauma responses. While adaptive responses lead to satisfaction, unsuccessful/maladaptive ones are associated with a sense of strain stress or distress which are nevertheless still reversible. On the other hand, trauma responses are associated with a sense of overwhelming threat of death and irretrievable disruption. Severe stress and trauma responses (often called traumatic stress or critical incident stress responses) need to be assessed and monitored for their potential long term entrenchment and evolution of symptoms and illnesses. Stress and trauma responses are biological, psychological and social. Psychological stress responses include a variety of intense emotions and cognitive difficulties experienced as difficulties in concentration, poor memory, sense of mental overload and fatigue with decreased mental functioning. Psychological trauma responses include intense helplessness, powerlessness, aloneness, abandonment, engulfment, constant danger and disintegration. Cognitive responses include shock,
dissociation, inability to sequence and have insight and perspective. (For classification and specific diagnosis of biological, psychological and social adaptive, stress, and trauma responses see table in Appendix B.)
• Strengths and Vulnerabilities Strengths are assessed in terms of training and successful past disaster experience, relevant coping skills, supportive networks and ability to use them, personal and financial resources and resilience. Vulnerabilities to be assessed include past traumatic events and illnesses, past fragility and lack of resilience, current noxious stressors, losses of people and resources (see Stressors above), lack of coping skills and supportive networks, and having young or elderly dependents. • Defences Defences mitigate stresses and traumas by diminishing awareness of them. Assessment involves identifying particular defences and the benefits and costs of the tense coping equilibrium of which they are part. Dissociation may manifest as a sense of unreality, out of body experiences or numbing. Fragmentation of responses may emphasise only one of biological, psychological or social responses. Disconnections (such as suppression or repression of awareness and memories) distortions of memories (such as projection, displacement) avoidance of anxieties (such as denial, withdrawal, overwork and substance abuse) all have benefits and costs in particular circumstances.
19 • Symptoms and Illnesses Though both affected people and workers naturally reject illness models while they are trying to reconstitute normality and in fact to prevent pathology from occurring, it must be recognized that traumas and defences do lead to a wide variety of biological,
psychological (including PTSD) and social symptoms and illnesses, which account for well known increases in morbidity and mortality after disasters. Assessments include diagnosis of these dysfunctions,and assessments of past and present vulnerabilities and strengths which compound with current stress and trauma consequences.