Secondary handicap in LD

Here are references relating to different types of therapeutic interventions we can offer and different types of mental health issues, developmental disorders and other presenting problems.
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Dr.Dot
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Secondary handicap in LD

Post by Dr.Dot »

This is an edited essay I wrote. It is rather psychoanalytical in its approach, but that is where the term secondary handicap is primarily placed. Anyone interested in this area I would encourage to read further around the 'death wish', which there is lots about in Valeire Sinason's book. I think it is a really important area of psychological thinking.


Handicap is defined as the disadvantage people experience because of their disability. Disability and handicap are complex phenomena; which reflect the interaction between peoples idiosyncratic attributes and societal characteristics. This alludes to the fact that disability, and its impact on people (the handicap) can be influenced by both personal and external factors.

It is difficult to separate out primary disability and secondary handicap, as the determinants of learning are constitutional, environmental and psychological, and these entities overlap and masquerade as each other. There can be a blocking of intelligence and/or functioning by psychosocial and environmental background as well as difficult to manage emotions, such as, anger and loss. There is an increased susceptibility to psychological difficulties in the LD population, which cannot be fully explained by a primary LD.

Valerie Sinason (1992) proposed three forms of Secondary Handicap, form a psychodynamic perspective: mild secondary handicap; opportunistic secondary handidcap and secondary handicap as a defence against trauma. However, there are other forms of secondary handicap, such as, low self-esteem, low self-efficacy, minimising skills and being excluded.

The experience of secondary handicap in relation to other peoples reactions
People with an LD form a marginalised, devalued, disadvantaged and often abused sector of western society. The reactions of other people toward people with LD are informed by several layers of knowledge and emotion and can provide some understanding of how Secondary Handicap may emerge.

Cultural and social aspects
The attitudes of society are shaped by several factors that reinforce ideas about people with LD as 'different'. Social representations (constructions) aid the formation of attitudes at societal, cultural and individual levels. As such, prejudice towards the LD population has unfolded, implicitly creating disadvantage and, therefore, handicap. Sinason (1992) suggests that when people encounter others with an LD they can: stare without shame; giggle; become sentimental; turn away; show fear or hostility and sometimes assert that people with a LD should be kept hidden, delivering exclusion and disadvantage. People with disability are often prescribed roles’ within society such as: object of dread or pity; holy innocent; menace and/or forever childlike. These roles fit the social construction of LD and are prejudicial.

The role of the family
Parents often feel intense pain when a child with a LD is born. There is often a sense of guilt that it is the parent’s fault their child has an LD, which can be accompanied with shame. One of the most common defence mechanisms is denial. Denial may be in the form of blatant resistance to reality, but it is more likely to emerge as a subtle disavowal of the nature and extent of the problem, accompanied by an underlying depression. This can lead to inadequate attachment, inevitably producing an insecure attachment template potentially placing people with LD at a disadvantage when forming relationships. Parents can also ward off the reality of their child’s difficulties by keeping them safe, as a perpetual child. The disavowal of the true extent of their child’s difficulties is eliminated by not allowing them to grow up. This allows the parent to develop a defensive system whereby the loss of a ‘whole’ and able human cannot be realised.

The siblings of people with a LD are aware of the ‘difference’ between them from a young age. As children become socially aware, they can become embarrassed about having a sibling with LD. There is evidence to suggest that many siblings keep the fact that they have a disabled sibling a secret in social circumstances; and whilst they do not necessarily wish that their sibling did not have a disability, there is a preference for them to be more able. The impact on the family as a whole can lead to the social exclusion of all members, but more so for those with LD.

The role of the professional
There are often a wide range of professionals involved in the care of people with LD. It is not uncommon for people with LD’s primary relationships to be with health and social care professionals. Accordingly, they provide a large input into the day-to-day life of people and their responses to their ‘clients’ can lead to secondary handicap. For example, responding to client need, professionally, but underpinned by social representations, may lead a clinician to keep people safe, but childlike. The systemic ‘protection’ of people with LD can lead to secondary handicap. There can be a curtailment of an individual’s liberty because of a potential for them not being able to read social situations, or because they have not been provided with the learning opportunities to know how to behave in society. This can lead to an underestimation of an individual’s abilities and the disallowing of access to the community, in order to keep them safe. Health care workers often only ‘know’ people in a professional capacity not coming across people with LD in social circumstances; their focus is often in relation to an individual’s disability and how to alleviate or manage any difficulties for their client and the system around them. This perpetuates the pathologising of the LD population and denies people within the group the status of being human. Labelling people with LD can be self-fulfilling, adding to the potential of secondary handicap. Health professionals often have a top-down, medicalised approach that can lead to a ‘fire-fighting’ approach to care rather than a holistic approach that facilitates a service user to reach their full potential or ensure that all of their needs are met. Accordingly, there can be subtle and unintentional emergence of SH in the hands of professionals, who are often trying to work in the best interests of their clients.

The maltreatment of people with a learning disability
The lifetime estimated prevalence of all forms of maltreatment in the LD population ranges from 11.5 to 28%. The lifetime prevalence of sexual abuse has been reported to be as high as 53%. It has been found that people with LD are 7.7 times more likely to be maltreated than their peers in the ‘normal population’. Emotional and physical neglect can occur in a wide range of environments. Within the family, in health/social services and within society at large.

The response to trauma, abuse, neglect and insecure attachments

Sinason (1992) asserted that secondary handicap can emerge as an exaggeration of the primary disability as a defence mechanism to protect against traumatic memories. She asserts that this can occur in two ways. Firstly, it can be a defence against any traumatic life experiences, which people may have been exposed to, such as, physical or sexual abuse. Secondly, as a defence against the trauma of living with the psychological and emotional pain of the original handicap. Secondary handicap maybe because of, both, the pain of living with LD and any abuse people may have been subjected to.

The exaggeration of the Primary Disability can occur in a variety of ways. Sinason (1992) cites: guttural and reduced speech which is markedly poorer in content and articulation than the speech the person is able to produce; twisted postures or jerky movements; violence that is directed towards the self or others; as well as not making eye contact. The defence can serve multiple protective functions that allow for the active turning away from reality. For example: other people are less likely to talk with you, if you do not ‘talk properly’; people are less likely to make demands on you if you appear physically disabled, unpredictable and violent; being less intelligent than you [organically] reduces thinking. Thus reducing the likelihood of ‘knowing’ about, and acknowledging the meaning of the trauma that has been suffered, as this can only occur through interacting with others. Accordingly, cutting oneself off from others disavows the trauma as well as the ‘self.’ The defence may also serve to protect people from rejection because they are damaged people, that others cannot bear to know.

Insecure attachments have been found to be damaging in the normal population, increasing the likelihood of a wide range of emotional and psychological difficulties such as anxiety, depression and personality disorders. The attachment process can be disrupted when the expectation of a healthy baby is not realised. From a psychoanalytical perspective, the capacity to learn is dependant upon our ability to tolerate frustration. The ability to tolerate frustration develops through emotional attunement and containment. If a child’s attachment figure is psychologically unavailable, there is an additional loss of not developing the ability to tolerate frustration over and above the organic difficulty in doing so. From infancy, people are attuned to the emotions of others, including to those to which we are insecurely attached. There develops a reciprocity to the desires of important others, in order to please them and remain physically and emotionally safe. The child with LD, who has a parent that is depressed due to mourning or who uses the defensive system of keeping the person younger than they chronologically are, learns to reciprocate. Remaining a handicapped child or exaggerating the primary disability allows their parent’s defensive system to remain intact. Pleasing the parent allows a secondary handicap to emerge, but without pleasing rejection from the parent comes to the fore. Accordingly, it is easier, and in some ways, more functional for people to remain in their prescribed role of ‘childlike’ than to develop and become more age appropriate, as that may lead to punishment or risk being alienated from the parent.

Challenging Behaviour

Challenging behaviour is the most common reason for a referral for clinical intervention in the LD population and is associated with ‘psychiatric’ problems such as anxiety and depression. The prevalence estimates for challenging behaviour in the adult LD population range from 3 to 36%, and is a major source of social exclusion, a secondary handicap in itself.

Sinason (1992) suggests that self-injury/violence towards the self raises psychodynamic questions about the nature of the self-attack. Challenging behaviour serves to exaggerate the primary disability by reducing the levels of functional communication and by being perceived as unpredictable. Further, depending upon the nature of the injury challenging behaviour can cause additional physical disability through further brain damage if the violence is directed towards the head. Other sensory or physical disabilities may occur depending on the site of the injury, for example eye gouging can lead to the loss of sight.

Responding to cultural reactions
Living as people with LD is an emotionally demanding task. Knowing you are ‘different’ from others and that there are prejudices against you is difficult to bear. People with LD respond to this by employing a multitude of coping strategies. Mild secondary handicap refers to a compliant, defensive exacerbation of the primary disability to keep the rest of the world happy with them. The concealment of the small discrepancy between what is ‘normal’ and ‘abnormal’ on the human continuum protects the self and others from the unbearable reality for both but delivers secondary handicap to people with LD.

People with LD often show a ‘handicapped smile’ accompanied with an outward friendliness. This defence mechanism is thought to serve two purposes: as a defence against the societal death wish and as a quiet deception by people with LD in order for them to gain some sense of superiority by the concealment of their true potential.

Responses to the knowledge of difference

Several sources of information allude to the fact that people with LD are, or are perceived to be different from others. The social comparison made by people with LD may lead them to either employ the ‘handicapped smile’ or a ‘cloak of competence’. The cloak of competence is thought to be a coping strategy that defends against the level of ‘difference’ by minimising the discrepancy in the functioning of the person, whilst this may reduce the outward appearance of disability it may deliver a secondary handicap through the denial of the need for support. It also serves to defend against being a person with LD, an unremovable stigma.

The knowledge that you are different to others, and are perceived negatively in society evokes a wide range of emotions and difficulties for people. Some of these emotions may be projections from others, such as, shame and guilt. However, emotions also come from the core pain that comes from being different and discriminated against. The rage that someone may feel in relation to their life experience and their primary difficulties, may lead to a secondary handicap. Sinason (1992) asserts that this intense anger, if not dealt with, will find a home in an ‘opportunistic secondary handicap’ such as challenging behaviour.


Key References

Jones, R. Harrison, C. & Ball, M. (2008). Secondary handicap & learning disability: a component analysis. Mental Health and Learning Disabilities Research and Practice, 5, 300-311.

Klotz, J. (2004). Sociocultural study of intellectual disability: moving beyond labelling and social constructionist perspectives. British Journal of Learning Disabilities, 32, 93-104.

D & Miller, L. (2004). Unexpected Gains. Karnac: London

Sinason, V. (1992). Mental Handicap and the Human Condition. Free Association Books: London.


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Content checked by qualified Clinical Psychologist (BlueCat) on 23/05/2016
Last modified on DATE
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Felicity75
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Joined: Wed Jul 24, 2013 12:49 pm
Location: Dudley

Re: Secondary handicap in LD

Post by Felicity75 »

I have just came across with this and thank you so much for sharing it. I felt very emotional by reading this as I have two siblings with disabilities and I cannot agree more with the 'siblings feelings embarrassed to share with other that they have a brother/sister with a disability'. I think the first time I have really shared that I had a brother and sister with disability without feeling embarrassed was at University, which I feel very guilty about now and there are times I feel that I am a bad person for hiding it.

Thank you again for sharing this, I would like to see a section in the form for individuals who chose Psychology (clinical/counselling etc) path because of their personal experiences and the impact this had on the person. Of course thats if they want to share it, I also want to know if peoples personal experiences are being valued as much compare to paid experience. When I have read sections such as 'A week in the life of healthcare A/SW etc' I feel like this is what I have been doing for whole of my life and I come home to this. However I never mention my personal experience of supporting my my sis/brother in my application. How does anybody else feel who in similar place feel about this?

Sorry if i have shared this in the wrong place
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