Editor's Note: The following article is reprinted from the RT News, the quarterly publication of the Rehabilitation Teaching Division of the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER), December 2006.
"My diagnosis still hadn't sunk in. I didn't want to tell my mother that we'd learned I'd be blind within a matter of years" (Ryan Knighton 2006).
Knighton, in Cockeyed (2006), like most individuals that are newly blind or those that have a vision impairment, is showing some signs of denial to his vision loss. According to the American Foundation for the Blind, "ten million people in the United States are blind or visually impaired." The major eye conditions are Cataracts, Macular Degeneration, Glaucoma and Diabetic Retinopathy. This article will discuss the adjustment stages and how having a positive attitude will impact people that are blind or visually impaired.
The seven phases of adjustment to blindness according to Tuttle and Tuttle (1996) are: (1) Trauma, Physical or Social, (2) Shock and Denial, (3) Mourning and Withdrawal, (4) Succumbing and Depression, (5) Reassessment and Reaffirmation, (6) Coping and Mobilization, and (7) Self-Acceptance and Self-Esteem. As one goes through each phase/stage, there is no set timeframe in terms of how long a client/consumer will stay in one particular phase/stage. Also, one cannot over look the importance of supportive family members and friends.
Now lets look at each of the seven phases. In the trauma stage, the client may become overwhelmed on hearing the news for the first time that they are losing sight or may become blind. Clients become disbelieving in the Shock and Denial stage; for example, a client may say, "I can see fine and I'm not going blind." Tuttle and Tuttle (1996) stated, "three factors that. influence the intensity and severity of the shock: 1) the significance of the loss to the individual, 2) the suddenness or unexpectedness of the event, and 3) the degree of visual loss" (p. 144).
Self-pity is the main characteristic in the mourning and withdrawal phase. Clients might become very isolated during this phase and stop doing activities that they once loved to participate in.
Clients begin to think negative in the succumbing and depression phase/stage. Tuttle and Tuttle (1996) stated Dobson's work on the "D's" of depression as despair, discouragement, disinterest, distress, despondency and disenchantment. Vision professionals have to be on the lookout for clients that show signs of major league depression and be able to make a referral to a professional counsellor.
The next stage in the adjustment process is reassessment and reaffirmation. In this phase/stage the client self-examines their life and finds meaning (purpose for living).
In the next to the last stage (coping and mobilization), the client will go out and find information and or new skills so that they can move on with their life. As the client moves from the coping/mobilization phase/stage to the final phase of self-acceptance, the client will gain in self-confidence, self-worth and begin to have closure with his/her vision loss.
Father Carroll's Losses
Carroll (1961) stated the following about adjustment: "Total adjustment might be defined as the attitude which enables the blinded person. to face the fact of his/her blindness, admitting its severity without minimizing or exaggerating it. to return as a whole personality to the society from which he/she came" (p. 232).
Here we see that clients have to face their vision loss, or becoming blind, but not spend too much time on negative thoughts, so that the person can re-enter society and become a productive member of the society.
Father Carroll also came up with twenty losses that a blind person goes through, and organizes these twenty losses into six major areas of loss. The six major areas of loss are: (1) Basic Losses to Psychological Security, (2) Losses in Basic Skills, (3) Losses in Communication, (4) Losses in Appreciation, (5) Losses Concerning Occupational and Financial Status, and (6) Resulting Losses to the Whole Personality.
Table 1.1 Carroll's Losses
Area 1: Basic Losses to Psychological Security
Area 2: Losses in Basic Skills
a) Loss of Financial Security
b) Loss of Mobility
c) Loss of Techniques of Daily Living
Area 3: Losses in Communication
a) Loss of Social Adequacy
b) Loss of Ease of Written Communication
d) Loss of Ease of Spoken Communication
e) Loss of Self-Esteem
f) Loss of Information Progress
g) Loss of Total Personality Organization
Area 4: Losses in Appreciation
a) Loss of Physical Integrity
b) Loss of the Visual Perception of
c) Loss of Confidence in the Remaining Senses
d) Loss of the Visual Perception of the Beautiful
e) Loss of Reality Contact with Environment
f) Loss of Visual Background
Area 5: Losses Concerning Occupation & Financial Status
a) Loss of Light Security
b) Loss of Recreation
c) Loss of Career, Vocational Goal, Job Opportunity
Area 6: Resulting Losses to the Whole Personality
a) Loss of Personal Independence
In looking at the table above, a client could have two of the losses in one area and one loss from another area or areas. It really depends on the client in terms of what losses that they are going through and when they are going to experience that particular loss. These losses are different from Tuttle and Tuttle's (1996) seven adjustment phases/stages.
Do you see the glass half empty or half full? Those that go through life with a negative attitude will find it difficult to find happiness. On the other hand, those that have a positive attitude will find some happiness in living every day. Losing vision or becoming blind is a hard thing to go through but with the right attitude clients can go through this challenge. According to Harrell (2003), "The next time you are faced with a difficult challenge, focus on staying positive. Remember that you're setbacks can be setups for even greater opportunities" (p. 9). Harrell is stating that having a positive attitude in a time of need can lead to advancement. Remember it took Edison 3000 attempts before he had the light bulb.
The million dollar question is how does one have or create a positive attitude. The answer to this question is quite simple; Harrell suggests that people have to have a positive inner dialogue. Harrell (2003) stated, "The key to ridding yourself of this attitude of helplessness is to clear your mind of negative inner conversations and replace them with more hopeful messages" (p. 42). When training clients to deal with their adjustment to blindness, it is important that the clients realize that they are having a negative thought/attitude and disregard the negative thought and come up with a positive thought/attitude.
In terms of adjusting to blindness and vision impairment, the two major theories that were discussed in this article were Tuttle and Tuttle's seven phases of adjustment and Father Carroll's six areas of loss. When clients go through the seven adjustment phases or any of the six areas of loss, it is very important that the client stays positive and not negative. Realizing that negative thoughts/attitudes are coming on is important, so that the client can get rid of the negative and create a positive inner dialogue.
Timing is also important. If clients spend too much time on negative thoughts of their disability or not enough time grieving the loss of sight, then major problems can arise. This author cannot instill the importance of positive thinking and the effects that it has on the client and the vision professional.
"Strangely enough, losing my sight wasn't quite as bad as you'd think, because my mom conditioned me for the day that I would be totally blind."--Ray Charles
American Psychological Association, 750 First Street NE, Washington, DC 20002-4242, 1-800-374-2721, http://www.apa.org (opens in a new window)
Association for Education and Rehabilitation of the Blind & Visually Impaired, 1702 North Beauregard Street, Suite 440, Alexandria, VA 22311, 1-877-492-2708, http://aeerbvi.org (opens in a new window)
Carroll Center for the Blind, 770 Center Street, Newton, MA 02458, 1-800-852-3131, http://www.carroll.org (opens in a new window)
Hadley School for the Blind, 700 Elm Street, Winnetka, IL 60093-2554, 1-800-323-4238, http://www.hadley-school.org (opens in a new window)
Mr. Harrell (Dr. Attitude), 8374 Market Street #504, Lakewood Ranch, FL 34202, 1-800-451-3190, http://www.keithharrell.com (opens in a new window)
Power Optimism, 2464 Lafayette Ave. Abington, PA 19001, (215) 855-2127, http://www.poweroptimism.com (opens in a new window)
American Foundation for the Blind. Statistics and Sources for Professionals. Retrieved On July 7, 2006, From World Wide Web at www.afb.org/Section.asp?SectionID=15&DocumentID=1367 (opens in a new window)
Carroll, T. (1961). Blindness: what it is, what it does and how to live with it. Boston, MA: Little, Brown and Company.
Harrell, K. (2003). Attitude Is Everything. New York, NY: Harper Collins Publishers.
Knighton, R. (2006). Cockeyed. New York, NY: Public Affairs.
Tuttle, D. and Tuttle, N. (1996). Self-esteem and Adjusting With Blindness; The Process of Responding to Life's Demands. Springfield, IL: Charles C. Thomas.