Assessment of the depth axis (see also Appendix A) is often forgotten as it does not deal with immediate survival issues. However, depth axis components include what makes life meaningful and survival worthwhile. Thus disturbances to these components may actually cause more suffering than struggles for survival. Checking for these components and diagnosing them when they present themselves, is therefore very important. • Judgements Positive judgements include pride, worth, goodness and lovableness for actions in different disaster phases. Negative judgements include anger, guilt, shame, and a sense of injustice at one’s own and others’ actions. Assessment includes understanding the specific sources of both positive and negative judgements. • Beliefs Beliefs include basic assumptions about oneself and the world. They include values, ideals, principles, rights and codes of conduct. Assessment includes identifying both upheld values and ideals and beliefs which were shattered. Assessment also includes noting the source of false beliefs and basic assumptions which arose in the disaster. • Identity, self Assessment includes enhanced and compromised aspects of identity. Enhanced self-respect may stem from having acted altruistically or effectively according to expectations, or even beyond one’s prior self-estimation. Loss of self-esteem may arise from a sense of failed roles and having acted outside one’s ideals. Dignity may be maintained in adversity through maintenance of self-respect. It may be lost through loss of self- respect and its symbols and denigrating treatment by others.
20 • Spirituality, sacredness, beauty
Disasters may shatter assumptions about God, consequences of good and bad actions and connections with an ordered purposeful universe. Disasters may also be seen as having destroyed beauty and harmony. On the other hand, survival and its accompaniments may come to be seen as sacred and meaningful. As well, inventiveness may spring from necessity and creative impulses may flourish with regeneration.
• Existential meaning, purpose It is important to assess the balance of existential hope and despair and the meanings, fulfillment and purpose which have been derailed. The latter can be central motifs of distress. Hope of positive meanings and purpose provide energy for recovery. Disasters may reshape past meanings of life in the context of increased wisdom and maturity. When to Assess The aim and mode of assessments may vary and might need to be tailored according to the phase of the disaster (from initial “triage,” in the immediate aftermath of a disaster, through to detailed clinical assessment) and the impact of it on the individual. Each person’s response will be individual and may be complex, dynamic and variable over time. Reactions/responses to the event need to be assessed in terms of their appropriateness to particular disaster phases. Assessment is an ongoing process which is necessary to determine immediate, intermediate and long term community needs. It is also necessary to continually review and reassess the adequacy and appropriateness of service provision throughout the recovery process. Throughout all disaster phases assessments are directed to ascertaining needs for interventions and their specific types, e.g. psychological support, defusing and debriefing, crisis counselling, trauma therapy, longer term counselling.