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THE PSYCHOLOGICAL IMPACT OF VISION

LOSS

MARGO SIEGEL, MSW

THANK YOU BACKGROUND SUMMARY OF TOPICS

INTRODUCTION

ALL PRESENTATIONS ARE SUBJECT TO BIAS AND/OR SELECTIVE PROCESS…THIS PRESENTATION INCLUDED.

NO MATTER HOW MUCH I THINK I KNOW, SOMEONE ALWAYS KNOWS MORE!

THIS PRESENTATION IS DESIGNED TO APPEAL TO VARIOUS LEVELS OF EXPERIENCE AND EXPERTISE.

THIS PRESENTATION WAS DERIVED FROM YEARS OF WORK EXPERIENCE, RESEARCH FINDINGS AND ACADEMIC COURSEWORK AND PERSONAL OBSERVATIONS.

(RICHARD HARRIS, LICSW; NASW: RHODE ISLAND)

PRESENTATION ASSUMPTIONS, BIASES, AND LIMITS

PARTIALLY-SIGHTED (STABLE)

PARTIALLY-SIGHTED (UNSTABLE)

CONGENITALLY BLIND

TYPES OF VISION LOSS

FROM YOUR EXPERIENCES WORKING WITH STUDENTS, WHICH TYPE OF VISION LOSS WOULD YOU BELIEVE TO BE MOST CHALLENGING PSYCHOLOGICALLY?

EXAMPLES

“A STRONG DISCREPANCY EMERGED BETWEEN THOSE PATIENTS WITH DIFFERENT CLINICAL PROGNOSES, THAT IS, BETWEEN THOSE BLIND AND THOSE AFFECTED BY PARTIAL SIGHT LOSS. THE PSYCHOPATHOLOGY PICTURE WAS WORSE FOR THOSE WITH PARTIAL SIGHT LOSS WHO DISPLAYED A MORE MARKED PRESENCE OF DEPRESSED MOOD, ANGER, AND HOSTILITY. CORRECTION OF GRADUALLY DETERIORATING SIGHT SEEMED TO POSE GREATER PROBLEMS THAN ADAPTATION TO TOTAL, DEFINITIVE LOSS”(LEO ET.AL., 1999).

RESEARCH STATES:

REASONS: FEAR OF THE UNKNOWN

VISION FLUCTUATES EMOTIONAL ROLLER-COASTER

PARTIALLY-SIGHTED (UNSTABLE)

“RESEARCHERS HAVE LINKED THE RESPONSE TO BLINDNESS TO A GRIEF REACTION, IN WHICH PATIENTS MOURN THE LOSS OF THE SIGHTED SELF” (LEO ET. AL., 1999).

RESEARCH STATES:

ELISABETH KUBLER-ROSS 5 STAGES: DENIAL AND ISOLATION ANGER BARGAINING DEPRESSION ACCEPTANCE

GRIEF AND LOSS

MENTAL HEALTH DISORDERS: ANXIETY DEPRESSION ASD SLEEP DISORDER (CIRCADIAN DYSCHRONOSIS)

DSM-IV-TR

“PEOPLE WITH VISUAL IMPAIRMENT MAY BE ANXIOUS ABOUT THE ATTITUDES OF OTHERS, WHETHER NEGATIVE OR PATRONIZING, OR AFRAID OF APPEARING CONFUSED, ARROGANT OR UNINTERESTED IF THEY DO NOT RESPOND APPROPRIATELY” (FEU, 2003).

RESEARCH STATES:

EXCESSIVE WORRY PANIC ATTACKS OCD BEHAVIOR IRRITABILITY DIFFICULTY FOCUSING SLEEP DISTURBANCE

SYMPTOMS: ANXIETY

“IT IS WELL ESTABLISHED THAT A GREATER PROPORTION OF INDIVIDUALS WITH VISION IMPAIRMENT EXPERIENCE DEPRESSION THAN THOSE WITHOUT. STUDIES CONDUCTED LARGELY IN THE U.S. HAVE FOUND THAT UP TO A THIRD OF PEOPLE WITH VISION IMPAIRMENT REPORT CLINICALLY SIGNIFICANT DEPRESSIVE SYMPTOMS” (REES ET.AL., 2010).

RESEARCH STATES:

EXTREME SADNESS FEELINGS OF

HOPELESSNESS LACK OF INTEREST DECLINE IN GRADES ISOLATION SUICIDAL IDEATION

SYMPTOMS: DEPRESSION

DIFFICULTY WITH SOCIAL INTERACTIONS/RECIPROCITY

FAILURE TO DEVELOP PEER RELATIONSHIPS

REPETITIVE PATTERNS OF BEHAVIOR LANGUAGE/COMMUNICATION DELAYS

(ONSET PRIOR TO AGE 3) BEHAVIORAL ISSUES/AGGRESSION

SYMPTOMS: ASD

SEVERE MALADJUSTMENT OF THE SLEEP/WAKE SCHEDULE

BRIGHT LIGHT/BIOLOGICAL CLOCK LONGER THAN 24 HRS. SLEEP CYCLE INTERNAL TEMPERATURE/HORMONAL

SECRETIONS INSOMNIA/DAYTIME SLEEPINESS

SYMPTOMS: CIRCADIAN DYSCHRONOSIS

DIFFICULT Y IN DEVELOPING SOCIAL SKILLS: ATTACHMENT THEORY (JOHN

BOWLBY); INTERPERSONAL ENVIRONMENT (SELMA FRAIBERG)

LACK OF MIRRORING CHRONIC MISATTUNEMENT PREMATURE ISOLATION

POSSIBLE REASONS FOR MENTAL HEALTH ISSUES IN CHILDREN WITH VISUAL

IMPAIRMENTS

LACK OF ENVIRONMENTAL EXPERIENCES

PARENTAL ATTITUDE SOCIETAL VIEW/STIGMA

OTHER REASONS

EARLY INTERVENTION ADVOCATE AND EDUCATE ALLY FOR

STUDENTS/FAMILIES FOCUS ON STRENTHS REALISTIC GOALS FOR

FUTURE PROMOTE SOCIAL SKILLS

HOW CAN YOU ASSIST STUDENTS IN YOUR SCHOOL/CLASSROOM?

A YOUNGSTER SHOULD BE REFERRED FOR PRIVATE THERAPY/COUNSELING WHEN SYMPTOMS CONSISTENTLY INTERFERE WITH DAILY FUNCTIONING.

WHEN TO REFER?

CLINICAL THERAPISTS: SOCIAL WORKERS (MSW)

PSYCHOLOGISTS (PhD) PSYCHIATRISTS

WHO CAN PROVIDE MENTAL HEALTH SERVICES?

COGNITIVE BEHAVIORAL THERAPY (CBT)

SOLUTION FOCUSED THERAPY (FAMILY)

PSYCHODYNAMIC PSYCHOTHERAPY

THERAPEUTIC APPROACHES

INDIVIDUAL (ONE ON ONE)

FAMILY SUPPORT GROUPS (STUDENTS, PARENTS)

TYPES OF THERAPY

“I AM VERY CONFUSED BECAUSE SOMETIMES I WILL BE TALKING WITH SOMEONE ABOUT SOMETHING I AM VERY INTERESTED IN AND THEY’LL GET THE IDEA THAT I AM TOTALLY BORED. IN FACT, ONCE, WHEN I WAS TAKING A CLASS, MY TEACHER THOUGHT I FELL ASLEEP WHEN I WAS REALLY AWAKE AND LISTENING RATHER CAREFULLY…I DON’T HAVE MANY FRIENDS AND SOMETIMES I WONDER ABOUT THIS AND WHY I AM ALWAYS SO MISUNDERSTOOD. I WOULD LIKE TO LEARN IN THERAPY HOW TO EXPRESS MYSELF BETTER SO PEOPLE DON’T CONTINUE TO MISUNDERSTAND ME” (JEPSON, 2004).

RESEARCH QUOTE:

QUESTIONS AND

DISCUSSION

IT’S YOUR TURN!

AMERICAN PSYCHIATRIC ASSOCIATION . (2000). DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FOURTH ED., TEXT REVISION WASHINGTON D.C.: APA.

CARVIL, S. (2001). SENSORY IMPAIRMENTS, INTELLECTUAL DISABILITY AND PSYCHIATRY. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, 45 (6), 467-483.

REFERENCES

CARVILL, S. (2001). SENSORY IMPAIRMENTS, INTELLECTUAL DISABILITY AND PSYCHIATRY. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, 45(6), 467-483.

COOPER M., & LESSER, J. (2011). CLINICAL SOCIAL WORK PRACTICE: AN INTEGRATED APPROACH. BOSTON, MA: PEARSON.

FEU, M. & FERGUSSON, K. (2003). SENSORY IMPAIRMENT AND MENTAL HEALTH. ADVANCES IN PSYCHIATRIC TREATMENT, 9, 95-103

GREENSPAN, S. & WIEDER, S. (1998). THE CHILD WITH SPECIAL NEEDS. DECAPO PRESS.

HARRIS, R. (2013). PRESENTATION: WORKING WITH FAMILIES WHO HAVE A CHILD OR PARENT WITH A DISABILITY. RHODE ISLAND: NASW.

JEPSON, L. (2004). FINDING THE PAPER CLIP: MAINTAINING CONNECTION WITH CONGENITALLY BLIND CHILDREN. JOURNAL OF INFANT, CHILD & ADOLESCENT PSYCHOTHERAPY, 3, 509-528.

KUBLER-ROSS, E. (1969). ON DEATH AND DYING. NEW YORK: NY, COLLIER-MACMILLAN.

LANGDELL, C., & LANGDELL, T. (2011). COPING WITH VISION LOSS: UNDERSTANDING THE PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL EFFECT SANTA BARBARA, CA: PRAEGER

LEGER, D., GUILLEMINAULT, C., DEFRANCE, R., DOMONTS, A., PAILLARD, M. (1999). PREVALENCE OF SLEEP/WAKE DISORDERS IN PERSONS WITH BLINDNESS. CLINICAL SCIENCE, 97, 193-199.

LEO, D., HICKEY, P., MENEGHEL,G., CANTOR, C., FRANZP. (1999). BLINDNESS, FEAR OF SIGHT LOSS, AND SUICIDE. PSYCHOSOMOTICS, 40(4), 339-344.

MEFSON, L. , DORTA, K., MOREAU, D., WEISSMAN, M (2004). INTERPERSONAL PSYCHOTHERAPY FOR DEPRESSED ADOLESCENTS. NEW YORK, NY: GUILFORD PRESS.

NOVICK, K. & NOVICK, J. (2005). WORKING WITH PARENTS MAKE THERAPY WORK. LANHAM, MD: ARONSON, ROWMAN & LITTLEFIELD.

REES, G., TEE, H., MARELLA, M., FENWICK, E., DIRANI, M., LAMOUREUX, E. (2010). VISION-SPECIFIC DISTRESS AND DEPRESSIVE SYMPTOMS IN PEOPLE WITH VISION IMPAIRMENT. INVESTIGATIVE OPHTHALMOLOGY AND VISUAL SCIENCE, 51(6), 2891-2895.

SACKS, S., WOLFFE, K. (2006). TEACHING SOCIAL SKILLS TO STUDENTS WITH VISUAL IMPAIRMENTS. NEW YORK, NY: AFB PRESS.

SPENCER, E., DUPONT, R., DUPONT, C. (2003) THE ANXIETY CURE FOR KIDS. HOBOKEN, NJ: WILEY & SONS, INC.

TUTTLE, D., TUTTLE, N. (2004). SELF-ESTEEM AND ADJUSTING WITH BLINDNESS, THIRD ED., SPRINGFIELD, IL: CHARLES C. THOMAS.

EIGHTY PERCENT OF WHAT CHILDREN LEARN IS FROM VISUAL SOURCES.

IT IS IMPORTANT TO PRE-TEACH CONCEPTS AND ROLE-PLAY FOR COMPREHENSION; OBSERVE DEVELOPMENTAL BEHAVIORS OF SIGHTED CHILDREN AND THEN ASSESS SKILLS OF CHILD WITH BLINDNESS.

ALWAYS PROVIDE DESCRIPTIONS OF NON-VERBAL CUES; TEACH CHILD WITH BLINDNESS TO ADVOCATE AND ASK QUESITONS FOR CLARIFICATION; TEACH SIGHTED PEERS/ADULTS THE CORRECT WAY TO PROVIDE INFORMATION (E.G., ALLOW THE BLIND CHILD TO HOLD THE DOLL; NOT JUST DESCRIBE IT).

ADDENDUM: TEACHING SOCIAL SKILLS TO CHILDREN WITH VISUAL IMPAIRMENTS (WWW.PERKINS.ORG, 2011).

INDEPENDENCE WILL ONLY OCCUR BY PROVIDING THE BLIND CHILD WITH MANY SOCIAL OPPORTUNITIES; DON’T ISOLATE WITHIN THE CLASSROOM OR HOME ENVIRONMENTS; GO OUT INTO TH E COMMUNITY AND TALK TO PEOPLE TO INSTILL CONFIDENCE.

THE VISUALLY IMPAIRED CHILD NEEDS TO TAKE RISKS; INTERACT WITH MANY TEACHERS AND PEERS; NOT JUST ONE PARAPROFESSIONAL; MANY NEIGHBORS AND FAMILY MEMBERS.

THERE IS ACCESS TO SOCIAL LEARNING IN DAILY LIFE; TAKE ADVANTAGE OF ALL ACTIVITIES.

“HANDS BECOME EYE.” PERMIT HANDS-ON EXPLORATION OF NEW SURROUNDINGS/INCLUDING FACES TO MATCH VOICES.

SOCIAL SKILLS PRACTICE PROMOTES SELF-CONFIDENCE AND SELF-RESPECT. BEING ACTIVE IN LIFE AND TAKING RISKS PREPARES THE CHILD FOR HER FUTURE LIFE.

IT IS CRUCIAL THAT BLIND CHILDREN HAVE AVAILABILITY TO POSITIVE ADULT ROLE MODELS WHO ARE ALSO BLIND OR VISUALLY IMPAIRED WHENEVER POSSIBLE.

HOLBROOK, M. (2006). CHILDREN WITH VISUAL IMPAIRMENTS: A PARENTS’ GUIDE. BETHESDA, MD: WOODBINE HOUSE, INC.

LENNOX, T. (2012). LIVING FULLY WITH LOW VISION AND BLINDNESS. TRAFFORD PUBLISHING.

ADDITIONAL READING

MAGEE, B., & MILLIGAN, M. (1995). ON BLINDNESS. NEW YORK, NY: OXFORD PRESS.

MARTIN, H. (1996). WHAT BLIND PEOPLE WISH SIGHTED PEOPLE KNEW ABOUT BLINDNESS! ORLANDO, FL: MARTIN PUBLISHING.

RUBIN, L. (2012). DO YOU DREAM IN COLOR? INSIGHTS FROM A GIRL WITHOUT SIGHT. NEW YORK, NY: SEVEN STORIES PRESS.

RUBIN, L. (2003). THE MAN WITH THE BEAUTIFUL VOICE. BOSTON, MA: BEACON PRESS.

SACKS, S., KEKELIS, L., GAYLORD-ROSS, R. (1997). THE DEVELOPMENT OF SOCIAL SKILLS BY BLIND AND VISUALLY IMPAIRED STUDENTS. NEW YORK, NY: AFB PRESS.

SPUNGIN, S. (2002). WHEN YOU HAVE A VISUALLY IMPAIRED STUDENT IN YOUR CLASSROOM. NEW YORK, NY: AFB PRESS.