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Normative and Diagnostic Reactions to Disaster 223

with clergy during treatment. Finally, COPE advises clinicians on how to
return patients to their communities to receive the social support that
could ameliorate, resolve, or at least delay the relapse of traumatic symp-
toms or posttraumatic stress disorder.
For clergy, COPE recognizes the clinical utility of their normative func-
tions and guides them on when and how to make a referral to clinicians, as
well as how to protectively welcome back congregants who have suffered
from trauma and have received necessary clinical care. This continuum
of collaboration will encourage vigilance in religious communities in the
care of persons traumatized by disaster and to allow for early intervention
in the case of relapse.
With Figure 16.1, you see the schematic design of the COPE model. This
single sheet allows us to visually and conceptually describe a hierarchy of
mental health needs of persons in their own communities.
The diagram begins with a large unshaded hexagon, which recognizes
the mental health support provided by the clergy and their congregations
before disaster. These normative relationships do not require the presence
of clinicians. It is this Community Context that we seek to restore after
disaster. This stage recognizes that healthy adults may further their psy-
chological well-being by taking part in what Erik Erikson called activities
of generativity. Generativity is the work we do in our homes, our commu-
nities, and our religious congregations to improve the well-being of future
generations.
The increased shading of the hexagons represents increasing severity of
psychological distress. During the Early Postimpact stage of disaster, all per-
sons may question the meaning of what has occurred and why it occurred
to them. Clergy are frequently called on to answer such vexing questions
and strive to provide people with Spiritual Coherence and to restore a sense
of meaning sufficient to move forward. In this second stage, when there are
emotional difficulties (e.g., a person bereaved by the sudden loss of a spouse
in a disaster), the clergy and religious community provide social support
that can help the individual to cope. Depending on the wisdom traditions
and theological orientation of an individual’s religion, at this stage the con-
gregation may provide faith-based rituals of support. These first two stages
describe normative parts of the multifaceted duties of clergy, which would
not require professional clinical consultation or care.
The switch from statements to questions, as well as the switch from
black to white lettering in the third hexagon, represents situations that
would involve contact with mental health clinicians by the clergy. Clergy,
as persons who regularly comfort grieving families, could be the first to