**1. Introduction**

It was known that acquired visual impairment evoked several psychological reactions, including shock, depression, grief, resentment, shame, self-derogation, a resigned attitude, feelings of inadequacy, and feelings of excessive guilt (e.g., see [1, 2]). People's reactions to visual impairment were lack of understanding, misconceptions, and/or prejudice. In this chapter, we

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focused on the acquired visual impairment that occurs in adults. In this discussion, we provided an overview of the theories and empirical studies relating to the psychosocial problems that were commonly experienced by the visually impaired.

activities, and (d) had no recorded work history. They were also able to show that the welladjusted group demonstrated higher scores on intelligence, manual dexterity, emotional stability, and realistic acceptance of their visual impairment, and attained higher educational levels than the maladjusted group. However, no differences were found between these two groups on the degree of vision loss, health indices, or the level of social interaction. A followup study carried out 14 years later showed that these characteristics had been retained [11]. Joffe and Bast examined the relation of ego functioning and adaptation of 101 men with a visual impairment using the California Psychological Inventory (434 items' questionnaire that include 18 scales. Each scale measures interpersonal adequacy, character, intellectual efficiency, interests, etc.) and extensive structured interviews [12]. In this study, occupational status and mobility were used as the index of adaptation. No differences were found between the employed and the unemployed groups on measures such as educational level, age, degree of vision, and several psychological attributes such as defense and coping. However, by combining occupational status with mobility, the study examined the differences between accommodators (employed and high-mobility skills) and non-accommodators (unemployed and poor mobility skills). The researchers found that accommodators used extensive coping strategies, such as mature, adaptive, flexible, purposive, present-oriented, and reality-based behaviors. Accommodators also included objectivity, intellectualization, suppression, and tolerance of ambiguity as techniques to overcome visual impairment problems. By contrast, non-accommodators tended to rely on defensive strategies such as immature, non-adaptive, rigid, past-oriented, and irrational reactions, and used projection, regression, fantasy, dis-

Psychosocial Adaptation to Visual Impairment http://dx.doi.org/10.5772/intechopen.70269 95

**2.2. Individual factors of emotional and psychological reactions to visual impairment**

The individual variables that acted in specific situations to exacerbate or reduce the differences in each of these reactions, and determined the degree of further psychological adaptation, had been explained from the various viewpoints of different schools of thought. A sketch

One of the earliest theoretical approaches that emphasized the importance of vision in personality development and later adult life was developed by psychoanalysts. Blank maintained that reactions to visual impairment could often be traced to the unconscious significance of (1) the eye as a sexual organ, (2) the eye as a hostile, destructive organ, and (3) blindness as a

Traditional psychodynamic models emphasize the importance of concepts such as loss, mourning, and grief. In this context, Caroll maintained that the losses forced on the blinded person were many [3]. They interlocked; they overlapped one another. Any one of them was severe enough in itself. Together, they made up the multiple handicaps that were blindness. Each loss involved a painful farewell (a "death"), then, and Caroll identified 20 types of losses from blindness in his classic writing. These were (loss of) (1) physical

placement, rationalization, and doubt in their reactions.

of this material is discussed in the next section.

*2.2.1. Psychoanalytical and psychodynamic models*

punishment for sin (like castration) [13].

#### **1.1. Causes of visual impairment**

Visual impairment might result in serious difficulties, because human beings depended on visual perception to get most of their information from the world around them. It might also trigger a psychological crisis that could promote an intention to seek "death," as Carol described [3]. In Japan, an approximately 310,000 people suffered from visual impairment. However, this number was only those who had a certified disability; there were more people suffering from visual impairment than were on official lists. Visual impairment was brought about by various causes such as eye disease, systemic disease, encephalopathy, and traumatic injury. Eye diseases include glaucoma, retinitis pigmentosa, optic atrophy, macular degeneration, retinopathy of prematurity, and so on, while systemic diseases include diabetic retinopathy and Behcet disease. Encephalopathy includes visual impairment caused by brain injuries, and postoperative impairment from brain tumors.

The aspects of psychological distress resulting from these situations were different, depending on the time of onset and the type of visual impairment experienced.
