Notes on the Planning of Disability Intervention According to

the Psychoanalytic Approach

Psychoanalytic Perspectives of Disability: The Individual

Challenges of psychotherapy for the intellectually disabled
People with intellectual disability have been generally absent from most meaningful or large-
scale studies of psychotherapeutic treatment.

Much of the reason why is psychoanalysis’ reliance on language and capacity for self-awareness
and reflection

Need for language, communication skills, memory, abstract reasoning, possibly basic literacy, to
be at the right place at the right time.

Relating current emotions to life story and formative experience.

Challenges of psychotherapy for the physically disabled

Targets of psychoanalytic theory: interpersonal trauma, recognized in people with intellectual
disability. Connections appear similar to those in the general population, but is the principal of
sameness correct? Are disabled groups significantly enough different from the general
population that psychoanalysis will not work in the same way?

Psychoanalytic Perspectives of Disability: The society

Why to look at disability from a societal (social constructivist) perspective: Disability is not an
essential and identifiable reality, but rather a construct negotiated and ascribed through particular
political relationships.
1. The psyche is more than the conscious view of individuals, but is a complicated mix of
cultural, familial, and embodied elements. These unconscious structures underpin our
lives.
(We are not just individuals, we are impacted by our culture, family, and environment.)
2. Medicalisation should be rejected as it is an oversimplification, relying on catchall labels
and organic symptoms, and fails to address the socio-economic, cultural, and
psychosocial complexities of the individual
 (The Medical model is too simple: diseasecure. The individual is actually much more
complex.)
3. Unitary and fixed conceptions of the individual, and categories such as sane/insane,
healthy/unhealthy, able/disabled should be rejected as they are only cultural continua and
raise possibly harmful questions about human worth.
(Labelling people may reduce their worthiness as people. We should reject it.)
4. The study of disability should understand the self as fundamentally cultural and in
relationship to others. Example: One of the biggest fears of advocates of assisted suicide,
“You do not want to become so disabled that someone has to wipe your ass.”
(People are not disabled as individuals. When they are disabled, they affect their families
and friends. The fear of being a burden is often stronger than the fear of being disabled
itself.)

A word from the Author: “I want to suggest that our interest should lie not with the psyches of
disabled people (Priests, medics and psychiatrists have tried to own those for years) but with the
collective non-disabled psyche: the ways in which ‘non-disabled people and disablist culture
symbolise, characterise, construct, gaze at, project, split off, react, repress and direct images of
impairment and disability in ways that subjugate and, at times, terrorise disabled people whilst
upholding the precarious autonomy of non-disabled people’.”

Questions psychoanalysis may answer

1. What is the origin of the excessive emotional energy (be it sadistic, fearful or kind)
evoked by images of disability?
2. How do we account for patronising, hostile, or avoidant responses of nondisabled people?
3. What ‘emotional payoff’ is achieved by nondisabled persons’ involvement in ‘altruistic’
disability-related work?
4. What typically unacknowledged existential anxieties have disability come to symbolise?
5. Why are persons with disabilities repeatedly represented in popular media as dangerous,
helpless, disordered or infantile?

Society’s reaction to the disabled

Disability evokes contrasting and strong emotions: Fear, fascination, hostility, altruism,
avoidance, curiosity, etc. Why?
These reactions, whether positive or negative, are stigmatizing.

Psychoanalytic theories explore the intersection of private/public, or hidden/revealed, or

personal/shared responses to disability, and seek to take action at the level of social structures,
which they consider the real source of conflict.

Psychoanalytic model of reactions to disability

The familiar concepts of the Id, Ego, and Superego, give us a useful model to explain the
differing reactions of society to disabled people.

For example: the psychological investments and emotional pay-offs that non-disabled people
experience in their ‘altruistic’ or ‘caring’ work as professionals, volunteers or carers

The widespread un/conscious fantasies and fears around disability and impairment in cultural
responses to disability.

We may as a culture, use the same defence mechanisms which we use as individuals to develop a
distinction of self from other.

Psychoanalytic Concepts: Splitting the subject

Splitting offers one explanation, from the psychoanalytic perspective, for the development of
stigmatization and the strong mixed emotions we have towards the disabled.

Three Stories
You get that all the time people stare, people comment, or people … I would rather people said
to me, ‘What’s wrong?’ rather than just stare. Then you can hear them as soon as you walk past,
[whisper sounds]. (Jemma, mother of a disabled child reported in McLaughlin et al, 2008).

‘Don’t worry about paying love, we don’t charge for retards’ (comment from a fairground
assistant to the mother of a disabled child, from Goodley and Runswick Cole, 2010).

Kennedy (1996, p123) reports of a paediatrician who on examining a child with ‘hypnotonic
spastic quadriplegia’ (sic) found vaginal injuries, anal scars and a sexually transmitted disease.
He reported, ‘These symptoms could be due to an obscure syndrome’.

Development of splitting
As babies or very young children, we idealize our mother, who fulfils our needs and satisfies the
Id, making us the centre of the universe
As we grow and encounter situations where our mother is absent or does not meet our needs, we
being to develop a concept of the good and bad mother. This helps us to deal with the
contradiction that our mother is sometimes very present, helpful, and important, and sometimes
absent.

The good is nurturing and caring, and ensures that we remain the centre of the universe. The bad
is absent, and gives us the reality check that another cannot always be there for us, that we are
isolated and we will not be fused with another forever.

Growing ambivalence increases sense of own identity and creates guilt, mourning, and need fro
reparation. How can we hate someone we love so much?

As a culture we go through the same process. As pertaining to disabled people, this can be a
result of introjection (internalising desired aspects of the good life) and projection (externalizing
the bad, away from oneself, into another)

Nurture is valued and mourned, while at the same time, independence and mastery are both
valued and threatening (especially in a capitalist society): the dependence of the disabled creates
a split between desire and rejection.

This is stigmatizing as disabled people become the other the projection of our own fears and
vulnerability. “the fear and denial of our own vulnerability that causes us to hate and exploit the
vulnerability of others”

Psychoanalytic Concepts: Othering

Our identities are often created and maintained by distinctions we make between ourselves and
groups which we perceive as different from ourselves.

We identify an ‘other’ in society who we can devalue and attribute parts of our own experience
and selfhood which we wish to disown. Through this we reinforce ourselves as the opposite of
these unwanted characteristics.

Applicable to disability, racism, and any us vs. them situation.

Psychoanalytic Concepts: Interaction and projection

We often experience uncertainty in how to interact with a disabled person—vs. our experience of
a “normal” interaction—We must be assuming something about them.

Where do these assumptions come from?

Our own fears, struggles and vulnerabilities come to the surface, and we experience them as
belonging to the other, rather than ourselves. Now we are interacting, not with a stranger whom
we need to get to know, but rather with a living personification of our own fears and fantasies.

Psychoanalytic Concepts: The disavowal of disability

Quick Introduction to Lacan
1. The real phase: The child is one with primary care-giver and is a fragmented entity
2. The imaginary phase: The child begins seeing herself as a separate entity. Seeing herself
in the mirror, gives her an image of herself as fixed, and whole. She accepts this illusion,
giving herself an imaginary sense of mastery. However, she will never live up to this
illusion of wholeness.
3. The symbolic phase: The introduction of language brings the child into a disorientating
world of words, symbols and signs. The “I” a child speaks of is far alienated from the
true “I” of themselves, both by the illusion of wholeness and the inadequacy of symbolic
speech. The anxiety created by this is repressed into the unconscious.
4. Introduction of the phallus: Lacan (awkwardly) refers to the law, the authority which
promotes adherence to the symbolic and requires social law and good behaviour as the
phallus.

“The cultural actor depicted in the writings of Lacan, is one struggling with and inevitably failing
to match up to the ideals often associated with ableist culture… Ableist society upholds the
imaginary autonomous citizen, promotes signifiers of ableist achievement, mastery and
competence in symbolic culture and, crucially, denounces those who fail to match such ableist
images and signs as really uncivilised, dis-abled, fragmented, dis-coordinated shells of
humanity.”

Because we are all so lacking, our attention is drawn away from the able (which we are
conscious of lacking) and onto the disabled (who reminds us of the fragmentation within
ourselves, which we mourn.) Disabled people are disavowed: stared at/through, loved/hated,
feared/examined, in order to shift attention away from the myth of our own ableness.

The “big lie” of a society prejudiced towards the able is that there is where lack lies (in the
disabled person) not here in myself.
 (Hunt, 1966:151 - 156), “there are traces of a desire [my italics] to externalise evil, to
find a scapegoat, in attitudes to the sick … We are perhaps saying that society is sick if
we can’t face our sickness [Hunt’s italics], if it does not overcome its natural fear and
dislike of unpleasantness as manifested by disability.”

Psychoanalytic Concepts: Defining defence mechanisms

Defence Mechanisms are strategies which the psyche uses to deflect, disguise or re-order
feelings, memories and parts of self which we are not able to handle in their original form

Splitting: Already discussed

Idealization: We feel uncomfortable with the vulnerability we see in disabled people. The
part of us which wants to strive for mastery and independence might hate them. We
compensated for this anxiety-creating hate by idealizing disabled people.

Projection: Already discussed

Reaction formation: Similar to idealization, we run to the opposite emotion of that which
is causing anxiety. If we feel resentment or anger towards an “other group,” we may
overly identify with them.

Applications
Advice from Hunt to the disabled person who is mentally able enough to “escape” from
“disabledness”

“But if we deny our special relation to the dark in this way, we shall have ceased to
recognise our most important asset as disabled people in society – the uncomfortable,
subversive position from which we act as a living reproach to any scale of values that
puts attributes or possessions beyond the person (Hunt, 1966: 158-159).”

Hunt encourages us to question the ideal subject of society: The phallus (Really?) AKA
masterfulness, ability, wholeness, and urges disabled people to consider their exclusion from this
rat race (measuring contest?) not as a lack but as a place of resistance.

Practical Application of Social Psychoanalysis

To help individuals to be more aware of the conflicts within ourselves which are connected to
wider social conflicts of everyday life.
To disengage ourselves from the norms and directives of society: to recognise the “open door of
every consciousness.”

To demonstrate specifically how our reactions to disabled people highlight how our culture is
capable of promoting human suffering. For example, the culture may promote the pursuit of
impossible ideals and be narcissistic in character, focusing on gratification, which benefs some
members of society at the cost of others.

Flynn, Andrew G., (2012). Fact or Faith?: On the Evidence for Psychotherapy for Adults With
Intellectual Disability and Mental Health Needs. Current Opinion in Psychiatry, 25(5)
342-347. Retrieved from http://www.medscape.com/viewarticle/770314

Goodley, Dan, (2010) Disability Studies and Psychoanalysis: Time for the couch or culture?
Paper presented at The Space Between: Disability in and out of the counselling room
Conference, University of Toronto, Canada.

Watermeyer, Brian. Disability and psychoanalysis, Disability and Social Change: A South
African Agenda. Accessed from http://www.hsrcpress.ac.za/. Accessed on May 7, 2015.