Losses and Restorations to Psychological Security
Part 1 in a series of articles by Margaret E. Cleary, M.S., R.N., CVRT, based on principles from Thomas J. Carroll’s book Blindness.
Loss of Physical Integrity
Carroll’s Concept: Physical integrity involves being whole as a person, belonging to the in-group and feeling okay with one’s body image. Life is under one’s control and privacy is possible. People with visual impairment experience being different, now feel no longer part of the in-group, develop unconscious fears and symptoms, and realize their past (mis)conceptions about “the blind person.” They connect the damage to their “eyes” to the destruction of their “I”s.
Cleary’s Observation: Individuals with diabetes may intensify loss of physical integrity due to the real effects of diabetes and other complications that may impact physical wholeness; develop confusion about whether or not they can, or want to, self-manage the whole new life schedule; or hate the new “I.”
Restoring Physical Integrity
Carroll’s Concept: As this loss is due mainly to psychological factors, individuals must learn that although they have lost their sight, they still remain basically whole and healthy. Thus, the rehabilitation process of regaining techniques of everyday living and mobility restores their functioning as a “regular” person.
Cleary’s Observation: People with diabetes and visual impairment benefit from learning as much as possible about diabetes and its possible complications. It is important to develop habits that prevent further loss of physical integrity and to utilize the availability and expertise of health and vision rehabilitation personnel to return to “normal.”
My Reflections: Throughout the years, hundreds of students with whom I worked related that they welcomed the opportunity to have a new lease on life. They were ready to relearn principles of diabetes self-management; assume prevention strategies to fend off related complications; and participate in recommended rehabilitation programs.
Loss of Confidence in the Remaining Senses
Carroll’s Concept: Misconceptions arise and confusion sets in because of the belief by many that the remaining senses automatically improve. These senses include hearing, touch, taste, smell, balance, and motor or muscle memory. They can be made more efficient. The loss of confidence results because sight can no longer be used as the tester or validator of the other senses. To obtain trustworthy information, people with visual impairment must either rely on what was learned before sight was lost or what people say – memory or human trust. This may result in the development of severe dependency.
Cleary’s Observation: People with diabetes may be uncertain whether or not they are passing a restaurant or a candy store; be confused about the identity of coins and bills; be reluctant to exercise due to balance insecurities; be disinterested in food as it may not taste the same; and be distrustful of muscle and motor memories, therefore be susceptible to falling.
Restoring Confidence in the Remaining Senses
Carroll’s Concept: Confidence is restored in people with visual impairment as the work of testing is taken over by other senses. Other senses are tuned in through such skills training as reading braille, using shop equipment, learning keyboard skills, and adapting personal self-care techniques.
Cleary’s Observations: People with diabetes and visual impairment may find value in using a recording device to keep a record of daily food plans; making braille records of food intake with a slate and stylus or a braillewriter; keeping insulin administration records with a digital recorder; performing blood glucose self-monitoring, and self-administering medications.
My Reflections: Mrs. T. learned to give herself eye drops by storing her medications in the refrigerator and feeling the cold drop as it landed.
Loss of Reality Contact with Environment
Carroll’s Concept: Carroll described that sight alone fixes us in relationship to things around us. Motion and balance sensitivity both play a part in orientation to the environment. Sight not only identifies those factors, it centers us among them. Sight reaches out to touch and hold the environment stable. Stability of orientation to the environment is of great importance to security. People with visual impairment loses that sense of security. Hearing helps, but it is disembodied; taste and smell are pervasive and confusing; and touch is more tangible, but not dependable, because its ability to move may set one adrift.
Cleary’s Observation: People with diabetes may want to take better care of their diabetes but dislike the atmosphere of a hospital or medical office; dread stepping onto a scale and losing balance; resist choosing desirable foods; feel boredom riding an exercise bicycle; and fear managing new oral medications or injections.
Restoration of Reality Contact with Environment
Carroll’s Concept: The problem here is to restore strong, sure, direct contact with the real environment. People with visual impairment learn to keep questioning, “How did I know that?” or “What sense cues entered in?” “What was different about the experience?” They begin consciously to receive and interpret information.
Cleary’s Observation: Individuals with diabetes and visual impairment benefit greatly when learning safe mobility training; becoming proficient at “anchoring” when drawing insulin; practicing the principles of thorough foot examination and care; as well as applying new techniques for self-managing in an unfamiliar place.
My Reflections: Anchoring, in rehabilitation, refers to the process of securing or connecting to somebody or something. Of the skills taught to me by my vision professional colleagues, I find the art of anchoring the most beneficial. When working with students who have health challenges in addition to their vision deficits, safety issues surface. Creating a safe and anxiety-free environment ensures both dependable and skillful activities. Anchoring both the student and the surroundings becomes key. Anchoring in this context refers to the process of securing or connecting to somebody or something. It provides stability and safety, keeping the individual and environment in place.
Students taught me that anchoring provides stability and keeps the individual and environment in place. Examples of this include trailing a wall with a hand; using a long cane for mobility; and placing elbows on the table when performing blood glucose monitoring.
Loss of Visual Background
Carroll’s Concept: Carroll described that this loss is of the background in which an object exists. Visual background plays a great part in our daily lives as a background of peaceful or kaleidoscopic change. When walking down the street, we are busy observing the many sites and sights around us. We use it to orient ourselves to where we are and where we are going.
A person with visual impairment does not see the changes in the room as the day progresses or the seasonal environment differences. The lack of diversity, distraction, and change prevents the refreshing of spirit and strength. What is left is an individual in a visual vacuum, a void in which there is no change, color or moving forms.
Cleary’s Observation: People with visual impairment and diabetes experience a change of lifestyle that turns daytime into nighttime, and vice versa. Visual background can no longer be used to perform self-managing duties, randomly moving about, and accomplishing several tasks at a time. These tasks may involve doing blood glucose management, drawing up insulin, or sorting multiple medications.
Restoring Visual Background
Carroll’s Concept: All the senses benefit from direct training to recognize the input and make sense of it. Somewhere below the level of consciousness, sounds, smells, tastes, and tactile sensations coming in can be taught to appropriate a visual image, thus forming a visualized background to daily life.
Cleary’s Observation: For people with diabetes and visual impairment, functions are restored by developing awareness of the whole environment when walking, so as not to get injured; being aware of changes in the body that suggest the development of a complication (e.g. increased swelling or warmth); and exploring the mechanics of a new monitor with speech.
My Reflections: Jack, a retired banker from Oklahoma, complained “I can’t sleep and I don’t know whether it’s night or day.” With the help of a team approach, he turned that around. Adopted suggestions included using talking timepieces, setting alarms to notify him of the time when monitoring, medication, or food were due; staying awake during daytime hours; and taking on home maintenance tasks.
Loss of Light Security
Carroll’s Concept: Society promotes false perceptions equating blindness and darkness. Common views hold: Light indicates truth, beauty, knowledge, and love. Darkness denotes ignorance, evil, despair, and hate. Blindness does not cause an absence of light, but there is a loss of light security or lightlessness. A person with visual impairment may develop misperceptions. These misperceptions produce fears, in varying degrees, of constant lightlessness. While not all individuals lose all light perception, the loss may mean lovelessness and loneliness to some degree.
Cleary’s Observation: People with diabetes may also feel lightlessness, lovelessness, and loneliness when coping with the multiplicity of self-managing tasks and may struggle with issues of dependency versus independence.
Restoring Light Security
Carroll’s Concept: Rehabilitation strives to dispel the concept of living in darkness through helping people with visual impairment have positive achievements, eliminate the negative concepts of lightlessness, and benefit from public education.
Cleary’s Observation: People with diabetes and visual impairment may dispel the loss of light security with positive reinforcement that they remain lovable despite body changes, limitations, and fears associated with diabetes; by acquiring skills to prevent hypo- and hyperglycemic reactions that might limit the ability to function safely; and by using low vision devices.
My Reflections: Hearing stories of neighbors who had to flee in the middle of the night due to fire or flood caused John T. in Colorado to have an emotional setback. With the assistance of an online personal disaster program he organized his environment and acquired confidence in his preparedness and safety.