Print version from original audio tape transcript of talk.

Edited to make more readable but maintaining original ideas of the time about ‘disability’.
THE PSYCHOLOGY OF DISABILITY
March 1972 – V. Finkelstein
My presentation today is titled ‘The Psychology of Disability’ although this is really about
‘psychological aspects of disability’. I will be looking at this from two angles.
• First of all a recent development in psychology which has attracted some attention and
which I feel has some merit for the subject of this talk.
• Then I’ll go on to present some changes in the way ‘disability’ can be interpreted.
So, this talk focuses on theoretical issues; trying to rethink some long-standing basic
concepts. I will be reading some rather longish quotes.
Recent Development in Psychology
I will start by presenting a new theoretical approach in clinical psychology and begin with a
quote from a Professor of Psychology who has been lecturing for quite a long time:
“I was myself taught at Oxford in the 1950’s that psychology was a science. In
retrospect, my education there now seems to have something of the character of a genial
inculcation: ‘Psychology is the science of behaviour.’ Definition. Anything that lay
beyond this, any dabbling in matters continental was deemed by the formidable men who
taught us to be bogus, that word again, or worse still confused. From them, I myself
assimilated the tacit assumptions of Anglo-Saxon empiricism. The distrust of any but
local full scale theory, the atomistic belief that knowledge is built up from fact, one piled
upon another, the quasi-religious faith in the primacy of stimulus-and-response, contempt
for social science and disregard for any social or cultural processes. The taste for
explanations in term of mechanical or electronic analogy, the avoidance of complex or
ambiguous aspects of personal experience or, what is the same thing, satisfaction in
reducing these to simple, preferably, biological facts.”
He goes on to talk about his students and says that psychology students in universities today
are no longer willing to accept the same assumptions without questioning them:
“They assume that the empirical tradition in the human sciences is only one of several
alternatives open to them – the structural, the phenomenological, the anthropological,
and so on”
The first thing that I would like to get across, is that psychology has reached another one of
its turning points. We are beginning to evaluate some of the developments of the fifties,
particularly the great advances in behaviour therapy; and there is no doubt that there were
advances. However, the naïve assumption that at last we have made the major break-through
is being questioned. It is in fact in the area of general psychiatry, where one is looking at
complicated problems and not simple phobic behaviour, that straightforward ideas from
stimulus-and-response psychology, seem to provide inadequate global explanations. This has
provoked a great debate: I would add once again in psychology.
One of the schools of psychology that has developed, critical of both ‘psycho-analytic’ and
‘behaviour therapy’ assumptions, was developed by an American, George Kelly, and has
been called the ‘psychology of personal constructs’. This, I think, offers another way of
interpreting human behaviour. For our purposes today we do not need to examine the
approach in detail, but need only to note some of the basic tenets.
Kelly’s point of departure is to criticise mainstream schools of psychology for being
applicable to patients but not to the therapist or researcher who interprets the psychological
behaviour of others. In other words, interpretations offered by ‘stimulus-response’ and
‘learning’ theories are not self-reflexive – the theories do not apply equally to the behaviour
of patient and therapist or researcher. He dealt with this problem by proposing a
philosophical scheme which he called ‘constructive alternativism’.
You will have noticed, in the quote above, the students do not say the ‘empirical approach’ is
wrong. They only assert that this is but one approach amongst many. In some circumstances
the empirical approach may be effective, but it is not always appropriate. This criticism has
been aimed at ‘stimulus-response’ based therapies. In phobic behaviour, for example when
somebody is afraid of snakes, behaviour therapy with ‘desensitisation’ techniques may be
appropriate and effective. But learning theory techniques directed at undifferentiated
behaviour resulting in an inability to cope with everyday life, simply does not work. In these
circumstances alternative therapies are needed.
Kelley’s starting point is ‘the person’. He says that when an individual anticipates events,
such as the behaviour of another, they are acting as lay psychologists. He maintains that this
process is an essential character of human beings. What people do when they relate to others,
is try to form (construct) an idea or a picture of what that person is likely to do, behave and
think. We are mentally constructing a set of expectations about people or events. He says
this is what psychology, too, is all about – about-prediction, about comprehending situations
in a manner which enables correct expectation of people’s behaviour and events. Human
beings, he maintains, behave in relation to their anticipation of events, such as the expected
behaviour of others.
He builds his approach on a set of assumptions: The world is real and not an image created
by the mind (this deals with philosophical criticism of his approach). We can only
understand the world in the terms of time and place (events are fixed in reality and in space).
We assume all events are linked, things are integral (the notion of ‘cause and effect’ is given
recognition here).
From this base he put forward a “Fundamental Postulate”:
“a persons processes are psychologically channelled by the ways in which he anticipates
events.”
This, in a nut-shell, is what ‘personal construct theory’ is about.
He says that a person’s mental and physical behaviour is a continuous process; it is a constant
changing sequence of events. In this respect there is no need to account for ‘motivation’ – a
persons processes are self motivating from life to death.
He maintains the processes are psychologically channelised; they are placed in a channel by
the anticipations people make about events that are going to happen. It is a predictive
psychology. The focus is on ‘anticipation’.
From the ‘fundamental postulate’ he derives eleven corollaries as the basis of his
psychological theory. I shan’t discuss this here but emphasise that the psychology of
personal construct theory brings the person with a problem in, say, psychiatry or disability, to
the forefront. This shifts the concern of the helping professional from interpreting symptoms
or diagnosing a problem onto identifying ways in which the particular individual, facing the
problem, construes or anticipates events.
In Kelly’s view when people construe events or situations with mistaken anticipations this
can lead to psychological stress and anxiety. He says that each individual has certain basic
constructs of the world essential to their well-being. When anticipations based on these
constructs are unfulfilled then they may begin to break down psychologically.
For example, put simply, we all have a basic need to be loved and liked. A child may expect
that particular behaviour towards their parents will be rewarded with their love. In the course
of life, however, parents facing their own conflicts in a marriage, may find that the marriage
breaks down and one of partner leaves. The child may approach this parent in the usual way
expecting that if he said, “I love you, I like you, won’t you stay home”, he can anticipate that
they will not leave. Part of his ‘construction’ of this parent (part of the way that he maintains
his expectations for this parent) may not indeed then happen. The consequence of his
expectations not happening (the fact that what he anticipated did not happen) may mean that
his ‘basic’ constructs have to be reformulated. When this becomes a major challenge then the
established personality may start to crumble. Suffering these stresses and strains may result
in a complete break down, perhaps resulting in something serious like schizophrenia. Seen
this way, this is how schizophrenia might be understood – as the breakdown in a person’s
basic constructs.
As an aside, some of the techniques
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used to assess personality employ grids which plot the way a person construes his world.
These have also been turned into tests for conditions like thought-disorder where you get a
breakdown in the relationship between a person’s basic constructs.
Personal Construct Theory can be rather complicated – a matter not really appropriate for
discussion here – but what I wanted to emphasise is that this school of psychology interprets
a person’s behaviour in terms of that person’s construction of anticipating events in life rather
than from the point of view of I the therapist, or I the specialist. Our concentration is on the
person with the problem. I may construe the patient’s break-down in a certain way, but this
may be totally irrelevant to the way the patient construes his world. What we have to do is to
find out how the patient construes the problem. How he sees it. What is going wrong with
his anticipations. So the emphasis is on the patient’s viewpoint. There are major
consequences flowing from this approach: the professional cannot say he know better than
the patient. Because the emphasis is on the dynamics of his anticipation of the world we
cannot then be sure what his anticipations really were without taking the patient’s viewpoint
seriously.
So, in this approach to psychology there is a certain equality between patient and therapist
that is deliberately cultivated for use in the therapeutic situation. Therapy then become a way
of saying “Here is my example of a different way that I could construe your world. Perhaps
you could try looking at the problem my way and see if this might be useful to you. Perhaps
my way
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of construing your world may not result in anticipations you normally would expect.”
Interpreting ‘Disability’
Now, we can move on to looking at different constructions of ‘disability’ and the
expectations that might follow different viewpoints. We will start with looking at some
definitions of ‘disability’. Here, is a fairly typical definition – “Physical defects that affect
his movements or physical action to a greater or lesser extent and prevents him from
functioning normally in the physical sense”. They go on to say “we should, therefore, regard
cripplehood rather as a yardstick for determining how greatly a particular individual’s
performance of his role in society is influenced by physical factors.” This sounds a fairly
reasonable definition. But what I want to put forward is the possibility that there is
something fundamentally wrong with this concept of disability.
What they are in effect saying is that when something happens to a person, something
physical, this results in some functional disorder which causes a person to become ‘disabled’.
Now, an alternative way of looking at this is to say that the cause of disability has got nothing
to do with the physical defect of the person at all but it is related to the way that society is
organised in relation to that particular physical condition. For example: I can’t use my legs,
and when I come to a building which has some steps than I can’t climb the steps – I can’t go
into the building because I am disabled. This is the usual way that such a situation might be
interpreted; but this is not at all
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how I might interpret the situation: as the disabled person, the person with the problem, might
look at it. The way that I see it is that there are some steps which ‘prevent’ me from entering
the building: it is the steps that cause my disability! It is the barrier in the environment that is
making things go wrong.
Now, let me talk about the psychology of ‘normal’ functioning – the normal way of
interpreting situations where social functioning is impaired. Let us say that you want to go
from A to B and your motor car breaks down. How do we look at this? Does the person say
“I have now become ‘disabled’, I am disabled now that I am unable to move from one place
to another”? Hardly. We see the broken-down car as preventing movement through the
environment. Man is constantly overcoming impairments, or situations, outside of
themselves which prevents them from reaching personal objectives. Another example: since
man can’t fly when he flaps his arms, he doesn’t conceive of himself as ‘disabled’ because he
doesn’t fly. What he does is he designs an aeroplane, which overcomes this inadequacy, if
you like.
What a person wants to do – his anticipations, his expectations, where he wants to go – may
be frustrated by any amount of problems, or specific conditions, and we need to look at the
individual’s ‘anticipation’ within these situations in order to identify what needs to be
overcome. In this respect we need to understand the person’s physical condition and then
start to see what we can do to overcome the particular problems ‘ out there’, in social events
or society, in the buildings, equipment design, machinery. This is the ‘normal’ way of
approaching problems faced by non-disabled people: this is the way we overcome the
environmental conditions which ‘disable’ people.
Now you will see that I am not saying that disabled people don’t have physical impairments;
but I am saying that society is organised in a way which enables,
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say, people who walk so that when they come to a building they can correctly anticipate they
will be able to enter the building. However, architects don’t design buildings so that people
who use wheelchairs are similarly enabled and they too can anticipate they will not be
‘disabled’ by that building’s entry steps. What I, as a disabled person, want to see is that
there are ramps, that the kerbs in the streets, etc., are designed in a way that I can anticipate
that wherever I go, move in society, I will not be faced with ‘disabling’ barriers. As I see it
there is no theoretical reason for us to say that we cannot overcome all such problems –
particularly at a time when we just put a man on the moon – in the same way that we don’t
say the limitations of man’s physical nature prevents space travel.
What I want to emphasise is that until recently we have been saying that it is a physical
character of a disabled person that causes his disability. This is really putting the emphasis in
the wrong place. I want to add, that historically it may have been useful to do this, but that
this has had certain negative consequences. Nowadays we can construct an alternative way
of looking at disability, which may be more useful. This will enable us to build on what has
gone before. Now, the point I am trying to make is fundamental to the reinterpretation of the
problems that disabled people face.
Despite progress in understanding the situation of disabled people even progressive people
who have begun to think differently about disability issues, still make the same error. I’ll
read a longish quote again from somebody who has been involved in the field of disability for
a very long time. The paper is headed:
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“The Changing; Character of Disability” illustrates how this person’s view. The first point
concerns a semantic change:
“The words disability, disabled and disablement are themselves showing changes in use
and being replaced at the present time. 50 years ago, the word cripple and incurable
were in respectful use. They were perpetuated in the names of several well known
institutions but no one would use these names in an institutional christening today.
Disabled persons and chronic sick took their place and have, in their turn, been
perpetuated this time in an Act of Parliament, The Chronic Sick and Disabled Persons
Act 1970. It is significant that no attempt was made in this Act to define either term.
Probably few people realise that the sub-group, the young chronic sick officially
describes all those who are over 16 and below a pensionable age. Now we are
beginning to use the terms impairment and handicapped to indicate the abnormality and
disadvantage of being disabled.”
She goes on to say that in a recent survey there was a fresh attempt to define ‘disability’:
“Reference to the disabled is more likely to conjure up a picture of someone in a
wheelchair, a spastic, or someone crippled with arthritis, than someone with T.B. or who
is totally deaf or a bronchitic. In general, we have used the term impaired to identify
those lacking part or all of a limb, organ or mechanism of the body, whether or not it
causes handicap and handicapped. Whether the person is at a disadvantage due to the
lose or reduction of functional ability.”
The author
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goes on to say:
“Thus we now have impairment and impaired to indicate a disorder or abnormality which
may or may not cause a handicap or disadvantage to the person concerned and
handicap or handicapped when they do so disadvantage.”
Now this seems to be advanced, but there is still no reference to the ‘out there’, where I say
the cause of ‘handicap’ is to be located. One starts to see, it seems to me, that the
differentiation between impairment and handicap merge once again when the impairment is
said to cause the handicap. I think this is incorrect. I don’t think a physical condition can
cause a particular kind of relationship between a person and the environment. Disability, I
believe, has with the relationship itself. That is basically my position on disability.
Let me go on a bit further. Because I put the disabled person in the forefront this is the
person who, whether he knows it or not, is in a position to say to you what disability is really
about. I think that it is for the expert or professional person to start looking at any problems
from the disabled person’s point of view and, thereby, making sense of what is really going
on. The author of this particular article does in fact say, for example, that disabled people
themselves are now increasingly setting up their own organisations and saying we must have
a re-think about the meaning of ‘disability’. She adds that the Disabled Income Group,
which is an organisation of the disabled, “has undoubtedly by campaigning as handicapped
people, for handicapped people, altered the conception of the handicapped as passive,
accepting group quite different from the non-handicapped people.”
So the fact that we have
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reached a new understanding in the field of disability, has encouraged some disabled people
to say that ‘disability’ should be recognised as a social phenomena. We are not saying that
the experts were wrong before. We are saying that there is an alternative way which may be
more useful now. The author of my quote goes on to say one important hurdle does seem to
be being overcome – the idea that handicap is a medical problem and its management belongs
to the Health Service:
“The vast majority of handicapped problems are mainly social, educational, employment,
architectural and care character. Doctors and the remedial professions contribute
constructively when they abandon the doctor/patient, therapist/patient relationship and
simply offer a rehabilitation service.”
I want to support this progressive view of how the experts can help most at this time. This, I
feel is an alternative way to what we’ve been doing before. I would like to go on to give
some examples of what I mean by using a few press cuttings. First of all, I shall quote a
surgeon, talking about spine bifida. He has criticised the fact that spine bifida children were
just being kept alive. I will not go into that. What I want to go into is the concept of disabled
people as seen through is eyes. He says:
“The severely paralysed spina bifida child is usually in a wheelchair by the age of 13
‘obese, odiferous and impotent’ contemplating a sorry future with justifiable melancholy.”
Now to me, this is a
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concept of disability to which I don’t subscribe. Here, the surgeon is putting forward his own
anticipation of what is going to happen to spina bifida children. What we really have to ask
is why should this be so? Why should his views be important? There are, in fact,
innumerable questions one can ask about his viewpoint. What are the ‘constructs’, the
conception of the disabled, used by the surgeon? His view is not necessarily correct – there
are alternative ways of anticipating the life of children with spina bifida.
To my mind what we need to go and look at is how disabled people see themselves. Do they
see themselves in this way? What do they think is the problem? Do they see, for example,
impotence as a problem or not? How do they anticipate their sexual lives? How do they
anticipate the fact of being in a wheelchair? What anticipations and expectations of life do
they have? Now, I don’t think that the surgeon’s approach is really helpful at all. To my
mind, the reason that this occurs is because the person involved is seeing disability as caused
by the physical nature of spina bifida.
In this case, this is really what he is looking at. He is not looking at ‘disability’ as something
that we can overcome with gadgetry and technology that we certainly have available now.
Myself, for example, wouldn’t be here 50 years ago, I wouldn’t have been alive, I wouldn’t
have survived as a human being if we didn’t have these solutions. The life of paraplegics was
regarded exactly as he described spina bifida, even when I first became paralysed. This was
the expectation of life that my parents had for me and I had when I first became paralysed. It
is palpably wrong and incorrect to have these kind of expectations.
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It leads you to a very rigid, and fixed, expectation of what you can do with people. The
example shows how a conception of disability as something caused by a physical conditions
restricts your thinking. Your concept of disability becomes fixed and then you don’t think
that things can be changed. Now, I want to go on to the question of access and show a
contradictory story. Disability is a very topical subject, and I’ll refer to another example:
There is a story current that one of the major television companies wanted to do its bit for the
disabled in the course of a soap opera and invited real, live, disabled people along to its
massive new multi-million pound studio complex to take part. They found there was no way
of getting the wheelchairs in. The architect had not planned for good deeds. As money was
apparently no problem – to judge by some of the new building’s refinement – you could say
this mistake was due to ‘ignorance’. What I want to get at here is that a television company,
in its nice new building, can see that the approach to disability is changing so it wants to
respond positively and they invite disabled people along. However, what happens is that the
underlying view of disabled people is manifested, comes out into the open – their needs have
been ignored. It was only when disabled people couldn’t get into the building that the true
nature of the disability is revealed. This is not merely a question of re-thinking what we think
disability is. The example shows where ‘disability’ resides – in the fact that they couldn’t get
into the building because of its design.
I think the story has a nice twist. It shows how a television company, thinking they were
being progressive, that they had overcome the exclusion of disabled people, that were looking
at it from a changed viewpoint, were
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looking at the wrong thing. What people need to do is to look at what is causing the
disability. I think this brings it out. Now, some other example from a ‘disabled person herself
who wrote a letter to the newspaper and I want to read a few extracts from this. She is
writing to complain about her life, or what she says is “the lack of a social life”.
She says
“I think my subsequent neurosis can be traced to the mixture of bafflement and barely
concealed distaste which my comparatively slight disability (a touch of the Toulouse-
Lautrec’s) seemed to evoke in other members.”
This when she joined a social club to overcome her loneliness. She goes on to say that she
lost her childhood friendships:
“When they, moved out of my orbit via the normal round of marriage and family,
childhood friends, and most of them were imaginary, were left behind in my country of
origin”
as she changed her country where she lost these friendships. She goes on to complain about
how her timid attempt to come to terms with the world hadn’t got anywhere and then she
goes on to say,
“please understand that it is not the loneliness or the solitariness that hurts, it is the
isolation, the sense of being marooned on a desert island, though within speaking and
touching distance of the whole human race.”
Now, as I wanted to say, nowhere in this letter does the person complain about her physical
condition. Nowhere does she say that this is the cause of her misery. What she is
complaining about is that
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she is unable to integrate. While it is true that in her passive condition she comes back to
saying – well I’m trying to accept the world – she also says that she is not complaining about
her loneliness, solitariness and isolation (which I think is really tautological). But she sees no
further than the problem in itself and, therefore, is trapped in it. She cannot move out of the
problem condition because her anticipation is that if only somehow I can escape my isolation
then everything will be alright. But how can she? There is no way that in this way of
construing her ‘disability’ she will see a solution to her problems. The way that I think that
the experts, professional people can help, is to start to help such a person see that the cause of
disability lies out there. When we start to build ramps, and so on, such a person would be
able to get out and escape the isolation.
There were a whole lot of letters in reply to that. I’ll read one or two:
“I wonder if my experience with the physically imperfect would help. I’ve noticed my first
sensation of bafflement and distaste completely disappears on further acquaintance. I
once worked with a man with...”
What this person is getting at is ‘look you haven’t anything to worry about, actually, because
when people do get to know you then they wont reject you’; and all the letters are in fact in
this vein. They only deal with her problem, her isolation, as if it were sort of encapsulated,
psychologically – ‘well you haven’t really got anything to worry about, you are a nice person,
and we do accept you’. None of letters comes back to the question of the cause of the
disability. None of the letters in fact can help us see how we can help overcome the very
thing that the person complains about. They simply say ‘people do like other people after
they get to know them’.
Now that is really basically my concept of disability, my challenge, my alternative approach,
my conception of psychology. There are, of course, a whole lot of psychological
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reactions which are well-known in disability, and I want to add that the approach I support in
no way contradicts the fact that people do experience withdrawal, aggressiveness, that are
seen with disability. These are normal psychological reactions to expect under these
conditions. But there are, to my knowledge, no known associated personality types with
disability and, nor in all the literature I have read, have I found the idea that the disabled
people themselves really complained about the physical thing. Ultimately, it always comes
down to the fact that there is something ‘out there’ that is the barrier causing their difficulty.
THE END.
[References used in quotes are missing]