As we grow and age, various sets of expectations change and evolve. The nature or direction of these changes depends on our species-specific and individual, genetically inherited developmental capacities, as well as the proscribed roles and the ethnic and social status we are born into. Other aspects, such as the prevailing political-ideological climate and religious beliefs, the historic period with its economic and technologic systems, and family idiosyncrasies and structure, are among the contributing factors to the individual’s adaptive and adjusting style. They are part and parcel of the mold from which the unique individual emerges and creates an idiosyncratic style of adaptive (or maladaptive) perceptual and conceptual functioning, a response repertoire, and a personality structure, through which the individual negotiates the surrounding environment.
For the purpose of differentiation between objective loss of function and the ensuing subjective state, I choose to call the objective and actual loss a disablement. Thus the loss of a leg is, within this context, a disablement (impairment). An individual’s reaction to injury, illness, or loss of function can be a psychologic impairment, which contributes towards the ensuing physical disability. Reaction to disability can therefore be considered an adjustment process to a disruptive event that impinged on and interrupted the “normal mode” of functioning of that individual. This implies that when an individual is confronted with a disablement, various adjustments are attempted in order to cope with the newly created situation. The elicited response to the disablement may encompass most, if not all, levels of the individual’s functioning. This would include, among others, the vegetative process, the autonomous nervous system and cortical responses, the hormonal and autoimmune response, as well as the intra- and interpersonal reactions. Above all, the response to disablement and rehabilitation would depend on what the disabling condition means to its victim.
The response thus triggered by the various aspects of one’s functioning and coping style might optimize or, conversely, minimize the rehabilitative efforts. Acceptance of the resultant objective limitations, the development of compensatory functioning, and adjusting to a different mode of life and different societal roles that are called for by the newly created conditions, will usually be adaptive. Unwarranted retreats to lower level functioning, isolation, rejection of oneself, loss of self-appreciation, or ultimately an escape into nihilism or death would obviously be considered maladaptive. For some individuals who have experienced coping difficulties prior to a disablement, disability may be utilized as an escape from responsibility or a tool for manipulations. In others, it may bring about further deterioration, or it may have just the opposite effect and become an opportunity to turn a stagnant life around. Some reports reveal that in some instances of emotionally dysfunctional individuals, disability may contribute positively to their overall adjustment.
Subjectivity of Disability
The aim of Milwaukee orthopedic specialists and other clinicians in general is to prevent maladaptive adjustment in patients. They will usually consider the acceptance of a life spent in a wheelchair for a patient who has the capacity to learn to ambulate on his or her own as maladaptive adjustment, yet have to understand that the patient’s choice is an adjustment that may nevertheless be the best choice from that person’s vantage point.
When a maladaptive response is the result of faulty reality testing, value judgments, misinformation, or defective neuronal brain activity, it becomes the duty of “responsible others” to enable that individual to shift to a more appropriate and adaptive one. Parents, spouses, teachers, clinicians, and at times society, will take on the role of the “responsible other.” Yet who really knows best? The individual’s right to make his or her own life decisions has to be respected unless there is objective evidence that judgmental faculties are diminished.
Adjustment to Disablement
Among the factors contributing to adjustment are the extent of the injury or illness, the onset mode, the prognosis, cortical involvement, the social, medical, psychologic, and economic support systems, and the subjective perception of the situation, as well as the premorbid coping capacity of the individual. Also of significance is the realistic degree of interference the disability may have in the vocational and personal mode of life of a given individual. A loss of one finger should objectively have little effect on a professional singer but will most likely bring an end to much more than just the career of a concert pianist. Good psychologic adjustment may drive the latter into becoming a successful conductor, whereas a bad adjustment might cripple the same individual for life. Adjustment is more dramatic during a major disabling condition. It must be remembered that what makes a condition major or minor is subjective, and therefore even minor physical conditions are major to most of their owners. Also, pain and reaction to injury are subjective and not in direct proportion to the actual extent of injury. The difference in the need for adjustment is ultimately due to personal perception.
Cedric Loiselle is an experienced writer who enjoys imparting useful information to many readers. The topics he usually writes about include business and finance, health, and home improvement.
