World Health Organization has defined disability as “… an umbrella term, covering impairments, activity limitations, and participation restrictions.” Actually disabilities come from the limitations and restrictions of the environment. It is a gap between a person’s capabilities and the demands of the environment. Therefore, the severity of one’s disability largely depends on the quality of the surrounding environment that one lives. For example, a person with hearing impairment would not be that “disabled” any more if he got an audiphones. The recovery and rehabilitation of disabilities not only need capability improvement of disabled individuals, but also calls for the efforts of the environment.
Definition of Health and Health to the Disabled
In 1948, the WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. In 1986, the WHO redefines health as “a resource or everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”
For people with disabilities, the former definition of health seemed unreachable because they cannot achieve such a complete physical, mental and social well-being state and disease or infirmity is unavoidable in their lives. So, can disabled people live healthily? The second definition gave us a positive answer. We can build well being for people with disabilities by building resources. Quality of life includes both objective and subjective dimensions, subjective one is proved to be more forceful in enabling disabilities. As a social worker, when we work on rehabilitation of this special social group, we should not use our standard of “Health” to demand them, which is unfair and infeasible.
Rehabilitation of Psychological Rehabilitation
Rehabilitation
In dictionaries, rehabilitation is described as the restoration to a disabled individual of maximum independence commensurate with his limitations by developing his residual capacity. When talking about rehabilitation, people always focus on many practical aspects such as medical, education, vocation, housing, transportation, etc and many efforts have been made on these aspects. However, the psychological part remains to be a problem which affects lives of disabled people and their families all the time.
Objectives of Rehabilitation and Psychological Rehabilitation
The vision of World Health Organization Six-year Plan on Disability and Rehabilitation¼ˆ2006-2011¼‰is “All persons with disabilities live in dignity, with equal rights and opportunities”. Similarly, purpose of UN Convention on the Rights of Persons with Disabilities is “To promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.” The Social Welfare Department of Hong Kong SAR Government described the objective of Rehabilitation Services as to acknowledge the equal rights of people with disabilities to be full members of the community by assisting them in developing their physical, mental and social capabilities to the fullest possible extent and by promoting their integration into the community.
Under achieve these goals, the objectives of psychological rehabilitation is to help the disabled people reconcile with their trauma and loss, rebuild confidence, reenter the community, and live with positive attitudes and dignity.
Needs and Characteristics of Disabled People
Need of Compensation
Just like an ordinary person, most needs of disabled people are quite common such as family, education, occupation, marriage, friendship and so on. Besides, there is a distinct need existing in people with disabilities—-the compensation need, both physiologically and psychologically.
Dr. Alfred Adler studied “The psychic compensation of inferior organs” and pointed out that when there is a disease or defect in a particular organ of the body, the functions of some other organs will be enhanced to compensate for the lacking functionality. Accordingly, when a person realizes his physical disability, he needs such compensation otherwise to make him a “normal” individual. This compensation psychology can be either positive or negative.
Psychosocial Adjustment Trajectory
There are four stages in the process of psychosocial adjustment. During each stage relapse could happen from time to time because of environmental or individual factors.
Gradually increasing in complexity of behavior. The process of identity reconstruction and self reorganization unfolds.
Stable periodic attractors in pre-disability life gradually shift to periodic or strange attractors. Chaotic, unpredictable life experiences emerge, which follow highly irregular patterns.
Chaotic and complex conditions gradually give way to self reorganization under circumstances of a series of new life experiences. More intricately adaptive cognitive and behavioral patterns begin to form.
New and adaptive patterns of self-organization and behavior gradually emerge, resulting in restoration of psychic balance and increased acceptance to life reconstruction.
Different Psychosocial Adaption and its Negative Characteristics
Livneh and Antonak stated that people with congenital and acquired disabilities differed psychologically in a significant way.
The psychosocial adaptation of people with congenital disabilities involves a)growing up with an impaired body, b)building body image, ego, and self-identity and c)parental and social issues of dealing permanently with a disability.
On the other hand, despite all the issues mentioned above, acquired disabilities are, a)finding their sense of self suddenly and dramatically challenged or altered, b)facing significant changes in social and familial relationships and life roles, while, c)dealing concurrently with psychological distress, physical pain, prolonged medical treatment, d)gradually increasing interference in or restriction of the performance of daily activities.
In those processes mentioned above, possible negative psychosocial characteristics are produced and most common ones among them are low self-esteem, low self-efficacy/confidence, depression, anxiety, introversion, neuroticism, and chronic pain.
Some Techniques for Psychological Rehabilitation of People with Disabilities
There are many intervention techniques for social, medical and vocational rehabilitation for the disabled such as family therapy, community-based counseling and so on. People with disabilities are often in want of assessing their past, being aware of and involved in the present, and seeking new ways to actualize their desire and wishes, so group and individual therapies are needed to promote self awareness, confidence, expression, communication and understanding of one’s life.
Expressive Art Therapy
Expressive art therapy uses a variety of verbal and nonverbal techniques for therapeutic intervention and self growth. Through art process, individuals can gradually get aware of his conscious and unconscious thoughts, conflicts, feelings and passions. People can heal through use of imagination and the various forms of creative expression like painting, dancing, singing and so on. Expressive art therapy is extremely suitable for disability rehabilitation because it is flexible in time, place, and population. Some disabled people are unable to speak, some cannot express their feelings. This therapy gives them a chance to share, discover and develop their understanding of their lives. In addition, living with disability required creativity. Learning to work with limitations was inherent in the creative process as well as learning to live with disability. They can realize their full potential by creating art works, which also enhance self esteem and self efficacy.
Cognitive Behavioral Therapy
Cognitive behavioral theory suggests that thoughts and emotions are best understood in the context of behaviors associated with cognition or cognitive processes as well as the extent to which individuals adaption and respond to different stimuli and make self-judgements. Cognition, behavior and emotion are interrelated to each other and cognition plays a vital role in emotional outcomes.
To assist disabled clients to gain self awareness and self acceptance and to replace their beliefs and behaviors, we can help them identify their dysfunctional beliefs and thought patterns. For instance, people with disabilities often thought themselves as useless, isolated and troublesome. If we replace those dysfunctional cognitions with functional self-statements and reconstruct some positive cognitions, emotions and behaviors will be greatly improved.
Body-Mind-Sprit Technique
Body-mind-spirit technique is an indigenous psychological rehabilitation technique which brings together Western body-mind technique and insights from Eastern schools of thoughts (Especially Buddhism, Daoism, Confucianism and Traditional Chinese Medicine). “Body” stands for physical fitness; “Mind” means emotion management; “Spirit” refers to spiritual exercise. It emphasizes interconnections and interactions between body, mind and spirit, not only stressing cultivation of strength and resilient character, but also paying attention to life education and spirituality. Eastern elements like meditation, mindfulness, yoga and massage, plus good living habits such has close to nature, proper sports, healthy diet, disabled clients are expected a)to discover the potential ability and quality inside oneself and to cultivate self-confidence; b) to review and reconstruct important relations; c)to seek more opportunities and alternatives; d) to accept and sublimate impairment and trauma; e) to clarify correct life meaning and to build a positive life attitude, and f)to learn to admire and care about themselves.
Limitations
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After a disabled person talking with a therapist or a social worker, he may feel much better. But when he gets out of the room, when he encounters any restrictions in environment the next second, the progress they made just now crumbles to dust. That means the psychological rehabilitation may take a long time and involve a great amount of repeated work. So we should prepare ourselves for long-term strategies and frustrations.
Lack of professionals
Since the number of people with disabilities is huge and keeps growing every year in Hong Kong, professionals for psychological rehabilitation of disabilities are in great need. Although medical, vocational, housing and transportation cares are being given by the government, organizations, communities, corporations and schools, we are expecting more policies, institutions and professionals, to enable these disabled.