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Omwake, E.B. Solnit, A.J. (1961). "It isn't Fair"—The Treatment of a Blind Child. Psychoanal. St. Child, 16:352-404.

(1961). Psychoanalytic Study of the Child, 16:352-404

"It isn't Fair"—The Treatment of a Blind Child

Eveline B. Omwake and Albert J. Solnit, M.D.

SUMMARY

Ann's treatment enabled her to develop ego capacities necessary for repression, but this could not be fully accomplished until she was helped to establish better object relations and to be aware of her absence of vision. The awareness of her blindness was a painful and arduous achievement that required years of painstaking work. The treatment promoted the availability of neutralized energies through the therapist becoming a needed love object who was an ally of the child's ego. In this manner the treatment also enabled Ann to develop oedipal longings. Initially, the therapist made contact through an auditory and tactile pathway that established the therapist as an object associated with safety and with libidinal gratifications. Through this attachment the therapist was gradually permitted to provide leadership in organizing the perceptual experiences, especially those dependent upon a visual component. In blind children there is more anxiety because of a lack of visual warning involved in accidents. This danger factor disturbs ego consolidation. Such children need a protecting mother in order that hearing and touching can become useful as a protection.

Following the ideas set down by Freud (1915a), (1915b) in regard to the adaptive function of repression, especially the infantile repression, it occurred to us that Ann's painful memory represented a deficit of two of the ego capacities that are forerunners to the establishment of selective repression. These two forerunners are: (1) a

stimulus barrier that permits a protective sensory filtering to prevent the child's exposure to an overwhelming amount of stimuli; and (2) the visual component of mental imagery. The eruption of fragmentary sensorimotor memories under the influence of the primary process occurred when deficits in the stimulus barrier and in the capacity to form a visual psychic image were combined with the understimulation and lack of protective guidance Ann received in the first three years of her life. This formulation could explain Ann's inability to erect repressive barriers as an adaptive mechanism available to her ego.

Through verbalization and interpretation Ann was helped to bind and transform instinctual energy and to contain the anxiety associated with the threatening outer world. As neutralized energies became available in this way the child could erect the anticathexes (Freud, 1915b) necessary for the establishment and maintenance of repression. The anticathexes facilitated the establishment of ego repressive activities, which in turn operated like the construction of a dam with transformers, valves, and spillways. These structural elaborations promoted a differentiated release of Ann's dammed-up impulses, permitting the mental energies to flow into the development of speech and logical thought, and the recognition of body boundaries.

The blind child is handicapped in his development, but this can be overcome by educational and therapeutic measures. Education of blind children tends to overexploit the speech development and the richness of the fantasy life. This may lead further to deficits in reality testing. Dorothy Burlingham (1941) has suggested that speech remains a foreign body, rather than an expression of inner life, for the blind since they lack visual images. Other sensory modalities should be invested, practiced, and elaborated in order to help with reality testing (Anna Freud, 1960).

In her autobiography written while she was a student at Radcliffe (1905), Helen Keller described the transformation from primary- to secondary-process functioning as she experienced it when language became available to her:

Ann's rebirth involved this acquisition of a "strange, new sight."

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