PERSONALITY AND ADJUSTMENT PROBLEMS
5. Unrelated anxieties transferred
to bodily handicap (Meng, Stafford).5
6. Blame of parents (Meng, Allen andPearson).
7. Feeling of guilt for hostility towards
parents (Meng, Winkler).
8. Body-image at variance with reality (Schilder, Bender).
9. Eftorts to achieve social acceptance
(Meng, Lowrnan3&, Allen and Pearson).
10. Dependent, demanding, apathetic behaviour deriving from over- solicitous protective situation (Meng, Allen and Pearson).
11. Variable, conflicting behaviour in response to variable, inconsistent attitudes of others (Allen and
Pearson).
12. Goals beyond achievementpossibilities due to pressure from parents, and to physical, social and economicrestriction (Lord, Landis and Bolles).
13. Conflict between withdrawal and
compensato,y tendencies (von Baeyer).37
14. Acceptance of disability as apunishment for sin (Winkler).
15. Retaliatory behaviour for "unjust" treatment by nature (Meng) 16. Self-concept (Fishman)38.
17. Degree of acceptance of
disability by disabled person (Fieldin)3.
18. Value systems of disabled person and his associates (Dembo).
19. Cultural role of disabled
person (Schneider4°, Fitzgerald 41) 20. Intergroup dynamics (Schneider).
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Studies in Psycho-Social Adjustment
No satisfactory information regarding the adjustment of disabled children in comparison with that of non-disabled children is available.
There are numerous studies which bring out the differences in the adjustment of the two groups. Their findings are in many instances offset by others which in general show the converse of the situation.
According to the latter the adjustment of the disabled and the non- disabled can be favourably compared. We may consider this problem in detail. In order to study the emotional needs of crippled and non- crippled children, Cruickshank and Dolphin administered the Raths Sen-Portrait N. Test to two groups of children. Group I consisted of 87 crippled children; and Group II of 193 non-crippled chiIcren. The group of crippled children included 42 boys and 45 girls; the group of non-disabled children, 97 boys and 96 girls. In the former there were children handicapped by cardiac conditions, cerebral palsy, poliomyelitis, Perthe's disease, progressive muscular distrophy, spina bifida, and other orthopaedic or neurological imparirments. The following Table shows the mean scores achieved by both groups of children in eight areas of emotional need as included in the test. It may be noted that there are no statistically significant differences to be observed between the two groups of children.
Table Vifi
SIGNIFICANCE OF THE DIFFERENCES IN MEANS OBTAINED BY CRIPPLED AND NON-CRIPPLED CHILDREN.
Need Means
Crippled 1 Non-crippled Per cent group n 871 Group n 193 t-Scores level of signi
ficance of t
Part A: Presenceof Needs
t
Belonging 3.46 2.88 1.4367 10-20
Achievement 4.45 3.81 1.4286 10-20
Economic Security 3.90 3.97 0.0147 90
Freedom from fear 6.37 6.07 0.4517 60-70
Love and affection 2.56 2.28 0.8505 30-40
Freedom from guilt 5.63 7.12 1.9487 5-10
Decision making 4.57 3.77 1.7010 5-10
Understanding world 4.99 5.99 1.5242 10-20
I
Belonging
Part B: Fulfilment of Needs
5.92 5.82 .1558 80-90
Achievement 5.05 5.02 .0532 90
Economic Security 4.24 3.83 .8888 30-40
Freedom from fear 4.09 4.43 .6730 50-60
Love and affection 5.34 6.19 1.2513 20-30
Freedom from guilt 3.49 3.47 .0488 90
Decision making 4.24 4.35 .2171 80-90
Understanding world 3.41 3.02 .9934 30-40
The same authors had earlier felt that the need to be free from feelings of fear and guilt would be characteristic of the crippled children. Later when they compared the adjustment of crippled and non-crippled children the same results were obtained.
The Use of Project/ye Test Materials
Utilising children from the same population as included in the Cruickshank and Dolphin group, Broida and his associates madea more detailed study of the need to be free from intense feeling of fear, which was typical of both groups of children to a degree not noted in other areas of emotional need42. Broida administereda selected group of cards taken from the Symonds Picture Story Test, a thematic apperception-type test, to three groups of crippled children:
(A) a group where the need to be free from feelings of fear was over- met, (B) a group normal with respect to this need, and (C) a group where the need was not being met. The authors state:
"It is interesting that the children in Group C produce the greatest number of social themes. Frequently these children expressed the desire in their stories for social acceptance and social participation.
On the other hand the children in Group A whose need to be free from fears was grossly over-met also produce a large number of social themes. The significance of this is undoubtedly the same for
Group A as for Group C. The earlier study of these children
(Cruickshank and Dolphin) showed that the children of Group A were also those whose need for love and protection was, as was the fear factor, over-met. These crippled children who are overprotected to an extreme show in their themes hesitancy and insecurity about entering
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into social activities. The wish for social participation is nevertheless present. Conversely, children in Group C whose fears were not alleviated also expressed caution concerning social situations. The children of Group C produced almost four times as many social themes as did the children of Group B.43
A second area in which significant differences were observed between the three groups of children pertained to themes containing guilt. "Children of Group B, whose need to be free from feelings of fear is within normal limits, produce five times as many guilt themes as Group A and more than twice as many as the children of Group C" . The authors speculate that "morality is developed, at least in part, through social interaction both in and out of the family". The children of Group B (who were not impeded either through the presence of intense feelings of fear or through oversolicitation) were apparently emotionally free to move into social situations and have greater social participation. This greater social participation and the lack of maturity to cope with the problems encountered in the social situations, may
have resulted in the production of guilt feelings. Since the children of Group A and C were restrained from participation in social situations because of the factor of fear, no guilt was experienced and little, if
any, was apparent in their themes.
Since Broida's study indicated that with proper testing materials differences are observable within a group of crippled children, Smock and Cruickshank, utilizing another projective-type test, studied differences between handicapped and normal populations of children45.
The Rosensweig Picture Frustration Study (Children's Form) was administered to matched groups of 30 handicapped children and 30 non-handicapped children. The groups were matched on the basis of age, sex, and intelligence. The handicapped children had a mean chronological age of 157.8 months (S.D. 12.12) and a mean intelligence quotient of 93.73 (S.D.1 1.02); the normal children, a mean chronological age of 157.3 (S.D.11.39), a mean intelligence quotient of 95.57 (S.D.
11.49). No statistically significant differences were obtained between the two groups on the matching criteria. Fourteen boys and 16 girls were included in each group. The handicapped group consisted of 15 orthopaedically handicapped children, 10 cardiac children, two partially sighted children, and two hard-of hearing children.
"One consistent difference between the groups is that the handicapped group responds to frustration in terms of its ego-threat
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value, whereas the normal children's responses were more in terms of reaction to frustration of a specific need or interference with immediate goal activity. The level of frustration tolerance of the handicapped child is apparently much lower than that of the normal child. Consequently, frustrating situations are likely to be perceived by handicapped children as a threat to the total personality structure.
This is not only true where the frustrating circumstances elicit a characteristic ego-defensive response from both groups, but is also
• the only area wherein a differential reaction is noted in theoverall comprison of the two groups. Thus the handicapped child is likely to ignore the barrier to need-satisfaction and/or project blame and hostility upon the agent of frustration. The normal child is able to concentrate more of his attention upon the resolution of the problem with which he is immediately confronted." Broida and his co-worker had suggested that a desire for and fear of social participation constituted one source of anxiety and fear reactions in the handicapped child.
One of the objectives of Smock and Cruickshank was to observe whether social relations did constitute an area of frustration in greater degree for the handicapped child than for the non-handicapped child.
"Data from the present study confirm the findings of Broida et al; and, furthermore, indicate,that the handicapped child simply cannot tolerate any situation wherein personal inadequacy is... implied in the relationship. The lack of any difference between the groups' reactions to ego-blocking situations indicated that interference with goal activity is not significant enough to elicit characteristic group reactions. It is when an individual is accused of some offense by another person that the greatest differences between the groups are noted. In such situations the handicapped child manifests significantly more ego- defensive-extrapunitive responses. There seems to be no question but that the handicapped child is basically insecure in his relationship with others and that he feels quite inadequate in dealing
realistically with external appraisal or criticism by other. The result seems to be that in these situations the handicapped child uses a characteristic defense mechanism, i.e., the projection of blame and hostilityupon the interpersonal environment." Herein one sees partial verification of the retaliatory behaviour commented upon by Meng which he says grows out of a feeling on the part of the handicapped that nature has been "unjust".
It should be stressed that in use of non-threatening projective techniques basic differences in the adjustive mechanism, in the
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emotional development, and in personality problems between crippled and non-crippled children become more apparent.
An investigation conducted by Vivian Harway in the line of the studies just reported, throws more light on the problem. The purpose of her study was to compare the behaviour of orthopaedically handicapped and physically normal children with regard to the extent to which the children were able to evaluate their capacities in a situation and were able to set goals for themselves which were consistent with their capacities. She studied two groups, one consisting of 80 orthopaedically handicapped children and the other of 40 physically normal children, matched for age, sex, and mental age. She employed two experimental situations: One, an intellectual task involving letter- symbol substitutions, the other, the Rotter Aspiration Board.
The hypothesis that handicapped children would manifest behaviour that was vascillating and inconsistent due to uncertainty in goal setting situations was supported by the data. The low degree of association between the aspirations in the intellectual and motor tasks suggested, however, that both this variability and the tendency toward overestimation observed in the handicapped group were specific to particular situations or constellations of related situations and were not generalized behavioural approaches to the problem of self- evaluation... The second hypothesis, that the handicapped child would be more likely to manifest unrealistic patterns of approach to the problem of self-evaluation was supported in part by the experimental results. There was a tendency for more handicapped than normal children to utilize an unrealistically over ambitious approach on both tasks. In addition, a greater proportion of handicapped than normal children use a confused and inconsistent approach on the intellectual tasks. However, the degree of similarity between the two groups in approach is so great that it cannot be said that this hypothesis was fully borne out by the data."
According to William M. Cruickshank characteristic differences obtain in the adjustment of physically handicapped and normal children when considered as groups. It does not mean that the adjustive problems of the two groups of children are not basically the same.
The problems to which both groups of children must adjust are in large measure identical. The techniques of adjustment and learning are comparable to both groups. The developmental processes of crippled children are considered to be no different than of normal
children. The fact, however, that a physical and visible defect is inserted into the life space of the handicapped child constitutes a factor of adjustment that is not in any degree present in the physically normal individual. The manner in which the crippled child integrates the disability into his life space will, of course, vary widely, just as people demonstrate
individual differences and uniqueness in most other human
characteristics.
Areas of MaI-adjustment
Dr. Usha Bhatt observes that in every physically handicapped person there are two conflicting personalities: (1) the basic personality, and (2) the personality developed after disablement. In order that he may attain normalcy, it is essential that integration of these two personalities takes place. In most cases, the physically handicapped person is faced with conflict in various areas. The areas of conflict are mainly as follows:
(1) Body image
One of the fascinating paradoxes of the human condition is that the human body, which unites us as a biological species gives rise in each of us, on a psychological level, to a body image that is one of the subtly unique features of the individual personality48. We have already seen that the exponent of the theory of body image was Dr. Paul Schilder.49 The body image is defined as the concept or picture each person has of himself and of his physical structure. It is an integral part of the psycho-biological constitution of any individual.
The very early, basic body image is incorporated into the psychic make up of an individual during the first few years of life. It depends upon inner impulses from muscles, organs, and skeletal structure in the body. It depends upon the perception one has of one's external body. Further, it is also moulded by the view others have of one's body, and how the person feels others view his body. It is, therefore, a very basic and profound psychic force within the psychological framework of the individual.50 It plays a significant role in the development of personality as it determines to a large extent, an individual's idea of himself and the ideas of others about himself. The image of our body includes not only the body as a whole but also of different parts of it. When a disease occurs, particularly the one that results in crippling, the body image gets modified. It has to be reorganized in such a way that the disabled person's deformed or
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missing limb can somehow fit into his original image. It is not surprising to find that the integration of a physical disability into this body image takes considerable time and psychic energy. In the initial stages, it is difficult for a disabled individual to find any place for the deformity or defect in his old body image. Because of this difficulty, many a disabled person resorts to defence mechanisms such as denial of disability or escape into fantasy. This sort of symptomatology is essentially a defence which the ego unconsciously sets up to maintain its integrity in the face of the new distorted body image. This point is illustrated by Katherine Hathway. When she looked at herself in a mirror after her recovery, she felt that the strange, pitiable, hideous figure she saw therein could not be her own reflection, because inside she felt like a healthy, ordinary, lucky person.51
(2) Seff-Evaluation
As has already been mentioned, society places certain value on the physical structure of an individual or on any part of the body.
This makes it necessary for a disabled person to adjust himself to certain generally prevalent social psychological facts. His social status is perhaps the most important of them. Very often he is considered inferior by himself and his fellow men, not only with respect to his specific limitations, but as a total person. Feelings of shame, inferiority
and worthlessness as well as insecurity and frustration may overwhelm him. Inability to cope with the social standards and emotional needs normally creates a sense of inadequacy leading to self devaluation.
The devaluation that he encounters in his social contacts reflects upon his idea of 'himself'. Constitutional defects of any sort give rise to a sense of being different from others. In the case of a crippled individual, this sense comes rather easily and quickly. Howard Rusk and Eugene Tayler state: "Physical defect has a unique, personal, and often deep, unconscious significance for the disabled persons, 'for physique is one of the principal raw ingredients of personality.' It also has social significance, for physique is one of the grounds upon which class and caste distinctions are made." 52
Roger Barker and others believe that "The Physically
handicapped person being a member of a minority group and subject to the same economic and social pressures as other minority groups, is likely to develop the same emotional outlook as those who are discriminated against, because of age, sex, religion or race." Katherine Hathaway expresses quite vividly the influence of social attitudes on
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the personality of the handicapped individual, when he says: "Yet when I found that the only social success I could possibly hope for among the girls and boys of my own age consisted in my being thought cute and funny and childish, in my thirst and hunger to mingle with them and to be accepted I began to cultivate in myself for meeting these social needs the character of the appealing little clown.
I slipped into the ancient role that is always expected, it seems, of the imperfect ones of the world. I was Punch, the queer little human toy, the jester at court, respected and beloved in a way in which no other kind of person is respected and beloved."
(3) Insecurity
In addition to self devaluation a physically handicapped person suffers from yet another psychological situation, namely, insecurity.
Disablement causes a sort of indefiniteness and uncertainty in many areas of his life. A person handicapped by birth feels that the world is not made for him and the one who experiences the impairment later in life finds it extremely difficult to adjust to a new environment and even the familiar situations become embarrassing. The following are the three areas in which insecurity manifests itself.
(a) Physical Insecurity
A physically handicapped person suffers from relatively greater feeling of insecurity about the world around him. The cultural world of houses, jobs, automobiles and cities is devised with the requirements of a broad group of relatively "normal" people in view. The special needs of a crippled or a blind person are not taken into account in planning a town or building. Obstacles on the pavements or roads and architectural barriers make the movements of the physically handicapped rather dangerous. A disabled person who is aware of the possibility of such impediments is filled with anxiety and fear. As
Usha Bhatt points out, a disabled person before planning his
movement has to make sure whether he can climb up the steps, or whether the house to which he is invited has a lift, or whether he can make use of bus, train or any other ordinary mode of transport to find his destination. If he cannot get up or go down, he cannot get out of his dwelling; he cannot get into a bus, tram or taxi; he cannot walk into the milling crowd, and he cannot attend to his job if he has one, he at once feels that he has been cut off from the rest of the world.Inability to cope with an ordinary situation is rather frustrating. The 151