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OFFSETTING THE HANDICAP OF BLINDNESS

By Lucy Wright, Associate Director, Boston School of Social Work.

The present stringency of the labor market has opened up opportunities for the present, at least, for use of handicapped labor, as never before. Among returned disabled soldiers it is so probable that there will be a certain number of blind men, that the government has already prepared a plan for their reception and special training. It is especially worth while, then, at this time, to try to formulate some fundamental principles of social case work in readjusting industrially men handicapped by blindness.

Foremost among these is the principle that all the work must be work with and not for the blind. If the "give and take" relation is the essential working basis of all good case work, it is doubly so in work for the physically handicapped. It is quite usual for blind men to ask: "Will you see what you think of my case?" A man of rare ability with oncoming blindness may put this to you: "I have a year, they say, before I shall be totally blind. I expect you people to tell me how to use that year to the best advantage." Another may say: "I am willing to do my part, but I cannot manage alone against such heavy odds. What will society do about my case?"

If we are to work intelligently with the blind we must first find the man behind the handicap. That is, I believe, the only hopeful basis on which it is possible to equalize his chances in such a way that he may make the contribution he has to make to society, be it small or great. To find the man behind the handicap is not, however, so simple a program as it may seem.

There are, first of all, certain obstacles in the minds of the rest of us. Blindness is a very obvious handicap. We who are relatively whole cannot help dwelling on what is gone rather than on what is left in others. It takes a blind person to say, as one cheerful, successful blind woman said to me, "Why, it's not the fact that you're blind that counts, but only how you take it!" We sighted ones even "speak up loud" to people who wear smoked glasses, so vague is our concept of what may be going on behind those glasses in the mind of the person who simply cannot see with his eyes. We do not trust and understand the intellectual life without sight or the use of other senses as well as that of sight, and so we class together men who cannot be classed together in any other respect than that of the physical handicap they suffer in common.

The very existence of organized work with the blind from nursery to special work shop, encourages the tendency to lump the blind in a class. The best efforts of the best workers, blind and sighted, have not been able to offset the danger, and will not be unless, at this moment, when a share of the world's attention is turned to the physically handicapped, we succeed in "putting over" some such idea as I have suggested.

This idea will not be particularly pleasing to those among the blind and their sighted champions who believe that blindness is in itself a qualification for special consideration for it cuts right through the whole exploiting design. It removes the basis for either emotional or exclusively political handling of the industrial affairs of the blind. Without doubt the most serious obstacles to the development of a plan of work with the blind, on what a blind man has called "the something for something" basis, as against the "something for nothing" basis, lie in tendencies of both blind and sighted supporters of this cause to exploit the situation of the blind for emotional and political values rather than to develop it on the basis of a reasonable efficiency. This is regrettable, not only on economic grounds, but because it puts the blind and work with the blind on a false, unstable and temporary basis, and cannot, in the long run, bring them happiness and usefulness. Emotional exploitation is usually the fault of the sighted. Political exploitation is more often the fault of the blind, and the measure of success or failure of work with adults depends very largely upon the leadership in this respect within these two groups.

The great advance made in every department of social work in the direction of tests and estimates of individuals has greatly improved the quality of social case work with the blind. This is illustrated in the department of education of blind children, by the work of Robert W. Irwin in the public schools of Cleveland, Ohio. Here we see the prospect of equalizing chances in life for physically handicapped children, not only by giving them equal opportunities with sighted children, but by sifting within the group the sub-normal from the sound and training them appropriately. These are first steps. The principle needs only to be carried further in work with adults, and made to cover character as well as mental and physical tests, until we acquire a basis for and skill in estimating the possibilities of individuals, in time to be of service to them and to the community. One example of a move in the direction of this testing-out principle is illustrated in work for adults, under the Massachusetts Commission for the Blind, by the effort to use home-teaching of the blind as a preliminary try-out before shop training. This plan makes occupation therapy a test, if not a step, in pre-vocational training of blinded adults.

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The need for securing a real basis for social case treatment of employment problems of blind men by coordinating the various lines of effort in adult work through some such central agency as state commissions or federal boards has been forcibly illustrated in the plans worked out for disabled soldiers in various countries since the war. The program includes orderly use of curative occupations, vocational reeducation if necessary, and placement in accordance with ability, whether in competitive industry, home occupation, or subsidized shop. Such an orderly technique presupposes coordination of forces in the industrial service of the blind, not on a basis of philanthropy, but of public educational and vocational service.

It must never be imagined that the principle of "finding the man behind the handicap" will minimize the amount or expense of work to be done. It is only a means of finding out what are a person's potentialities for the sake of reasonable economy, efficiency and, most important of all, for the happiness of the handicapped. This plan for individualizing may, on the one hand, be regarded as a protest against the unnecessary and harmful expedient of "trying to make a silk purse out of a sow's ear." A thinker with a scientific mind points out that this attempt, too common among social workers in what are still pioneer days, not only taxes the worker and defeats its own purpose, but too often destroys the possibility of a perfectly good pig-skin purse. It may, on the other hand, be regarded as a protest against the waste and unhappiness resulting from misuse of fine minds and natures in inappropriate work. This is felt most keenly in observing the lives of well-trained, intellectual blind people, for whose good energies society with its prejudices furnishes no outlet in effective work.

Individualization of the handicapped involves continuous recognition of the difference between those who are and those who are not capable of industrial aid. It involves distinctions among the forms of industrial aid, but requires always the same underlying principle. Society says to the handicapped man, "You keep up your end in proportion as you can, -- we will keep up ours in proportion as is necessary, in order that you may make the contribution that is in you, be it little or much." This is the "something for something proposition" which must lie behind every form of industrial aid for the blind. To carry it out we need (1) to work out an orderly technique of social case work that is as acceptable and understandable to a handicapped man as to the sighted worker with the blind; (2) to provide by way of background a campaign of education reaching family, neighbors and employers in every community to which disabled men return, whether they are the victims of disease, industrial accident or war.

The difficulties of finding the man behind the handicap are many and various. It may be that he can be discovered early by some very simple touch. On the other hand it may take years to find the man behind the handicap, and then his contribution may be so slight that the subsidized shop may be obliged to meet him not only half-way, but more, if he is to "do his bit."

The fact that a physically handicapped man finds himself in the almshouse is no proof that he lacks skill and character. But it is well to try by actual test whether he has skill with his hands, as well as to make sure whether he has the force of character to stand up in the community. Raising of false hopes is one of the unkindnesses to be guarded against in all work with the handicapped. The temptation is great. For the almshouse population, the visiting home teacher who by actual try-out can test the mind and skill of hand of the individual, and form a just estimate of his character, is an essential part of a safeguarding plan. Through such a worker we make occupation therapy and pre-vocational testing a reality in work with adults. Massachusetts has been especially fortunate in her state home teachers (blind), and one among them has an especial gift for finding the good human qualities that lie behind the handicap of blindness, as well as the ability to read with the fingers and learn simple manual processes such as netting and basketry. The following is her own account of such an instance:

Another man, formerly at the State Farm, was there because while trying to earn a living at canvassing, after losing his sight, he had been robbed of his wares by a dishonest guide. He placed himself in the poorhouse, and had been transferred to the State Farm, where I found him. In the four months of instruction he learned to read and write Braille, to cane-seat and pith-seat chairs, and make rake knit bags. He was sent to a workshop in April to learn broom making, and before his vacation in August, had also learned to weave coarse rugs. He is now completing his apprenticeship, and will shortly find a place among the blind wage-earners. He has made since July first about fifty rake net bags and sold them, receiving between forty and fifty dollars for his work. (1)

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Then there is the man who meets you more than half-way. You are being tested rather than he. How can you help him contribute all that is in him to give? This kind of man is healthy, in mind, body and spirit. He simply lacks the use of one sense-organ. He requires no long period of readjustment. He masters one hand process after another. He had trade-training behind him before he lost his sight, and is confident that he can, with backing and special equipment, follow his old vocation of florist, in which he has had twenty years experience. Your job as a social case worker is with possible employers and backers, and not with the blind man. It is not a question if he will "keep up his end," but whether society will keep up its end. You must prove by actual experiment, and you can do it only with the aid of some florist of standing, that this man can actually do without sight the processes he did with sight, and that there will be a market for his labor, if he is provided with the necessary capital and tools with which to work. The story of how this particular man developed a greenhouse, with crops of chrysanthemums, tomatoes, mushrooms, etc., and of how, when the fuel shortage compelled him to close down, he turned successfully to competitive factory work cleaning bobbins in a worsted mill, is full of interest, -- but what I have told is perhaps enough to suggest the variation in peace problems of employment of blind men.

The variation among disabled soldiers promises to be in some ways greater, in others less, -- less, because the men are already sifted by certain mental and physical tests before they go to the front; greater, because of the chances of other physical handicaps in combination, perhaps quite different from those appearing in problems of civilian life. Greater, too, because among officers and men, this disability may cut across we know not what range of men of talent. The plans so excellently carried out at St. Dunstan's, England, for soldiers disabled by blindness, and the carefully laid plans for American soldiers who may be so disabled, all provide for curative occupation early. Visitors from St. Dunstan's go to the blinded in hospital wards early "for good comradeship." All of the nurses, including the superintendent, in some of our base hospital units have voluntarily equipped themselves with knowledge of principles and practice of occupation therapy, and the government has laid careful plans for each succeeding step to the point where the handicapped individual comes back to live out his life in the community.

Canadian experience tells us that the principle of helping a man back to his former vocation holds in 90 per cent of cases of all disabled soldiers in Canada. Only 10 per cent need complete re-education. Placement takes on a new aspect when the country cannot afford to lose the labor of a fraction of a man. Work for the handicapped is transformed, and it is for us to see that the basis of transformation is brought over permanently into our community programs. Only ignorance of the true possibilities for individuals, and the dangers of emotional and political exploitation stand in the way.

In the meantime, for the worker with individual cases, there are suggestions out of past experience that may be helpful. The informal use of some simple classification, in arranging all the facts about the man and the situation may help both the man and the social case worker to face things together. Dr. Southard's discussion of classification in his course on Social Psychiatry at the Boston School of Social Work this winter has stimulated many of us to put in more orderly shape half-crystallized ideas and methods in social case work. The plan outlined in the footnote for rearrangement of all the facts in the situation is one we are in process of trying out at the School both as a help towards making a plan and getting at larger implications. (2)

It presupposes that all the necessary facts have been gathered and recognized, and that only questions of actual diagnosis and treatment remain. It seems to be most helpful in the matter of proportions and emphasis. The individual as unit, and the offsetting of defects by powers are perhaps the most important points about it in relation to the blind.

In speaking to various groups this winter, students and others, it has seemed to me that it was more important to direct them to acquaintance with the life stories of handicapped individuals -- in fiction (when truly interpretative), in biography, autobiography and in fact -- than it was to dwell on points of special technique, in the education and employment of the blind. Nothing will replace this knowledge. The part of the blind in work with the blind has been its characterizing feature from the start. Often the best thing you can do for a newly blind man is to put him in touch with some other man who has been through similar experiences, and worked out for himself a recognized place of usefulness and a philosophy of life. For suggested reading, to prepare the mind for "what blindness is like from the inside out," a short list is given below. (3) Many more might be given. These are selected because they seem to me to help towards imagining what life in the dark may be like. The titles, even here, often stress what is gone, like "Closed Doors" and "Hitting the Dark Trail." Two suggest both sides of the case in quite a remarkable way, -- "A Beacon for the Blind" and "The Outlook for the Blind." The two most genuine and helpful titles to me are "The Best of a Bad Job" and "The World I Live In." "Closed Doors" and "The World I Live In" do not relate to employment problems of men, but they, perhaps, set you right, at the start, better than any others.

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To summarize briefly, there are seven suggestions towards helping to find the man behind the handicap that seem most important to "put over" at this time. They are the following:

1. Acquire confidence in other senses than those of sight.

2. Try to understand the real possibilities of intellectual life without sight.

3. Consider character as well as economic values. Professor Amar has made this point very clear in saying, "The mutile possesses always a perfectly utilizable capacity for some kind of work.. . . He may actually compensate for his physical defect by an active good will, which increases his social value. This is a psychologic fact which must be turned to advantage."

4. Help the handicapped to measure themselves, not only against the handicapped, but against all those with whom they must compete.

5. Make plans for offsetting handicap on the basis not of "something for nothing" but of "something for something."

6. Test the facts to be faced with some simple classification that can be talked over by you and the blind man together.

7. Look for your inspiration to the lives of the blind themselves.