DOCUMENT RESUME

ED 085 934 EC 060 716

AUTHOR Laity, G. C.; Harrison-Covello, A.TITLE The Blind Child and His Parents: Congenital Visual

Defect and the Repercussion of Family Attitudes onthe Early Development of the Child.

PUB DATE 73NpTE 24p.; Reprinted from the American Fo/undation for the

Blind Research Bulletin, n25, January 1973

EDRp PRICE MF-$0.65 HC-$3.29DESCRIPTORS *Blind; *Child Development; *Child Rearing; Early

Childhood; *Emotional Adjustment; Exceptional ChildEducation; *Exceptional Child Research; Infancy;Mothers; Parent Influence; Personal Adjustment;Rating Scales; Visually Handicapped

ABSTRACTDiscussed are the effects of parental attitudes on

the early development of..the congenitally blind child. Thedispropo9tion between n-fWmily reactions and the limitations of thehandicap are attributed to symbolic aspects of blindness andpreviously existing pathological elements in the parents. Comparedare developmental milestones (such as the year's delay inestablishing J. Piaget's concept of object permanence) of young blindand seeing children. Stressed is the import/once for emotional healthof the 4- or 5-year-old blind child's recognizing and verbalizing hisblindness. The author reports on his examination of over 500 blindchildren under 6 years of age which involved a scale of developmentand an interview with the parents (usually the mother). It isconcluded that one third of the children are relatively normal andcome from accepting homes (more than half of these children have someuseful vision); that another group of children with high verbalskills but low autonomy, sensory-motor, and sociability skills havemothers who are nonrejecting but overprotective due to lack ofinformation; that a third group with high autonomy but lowsociability, language and sensory-motor,scores typically have motherswho were never able to overcome initial depression and rejecition; andthat a final group with very low overall development appear -to havesuffered severe affective deprivation. It is stressed that al blindchild's upbringing requires greater virtues in the mother thOn doesthe normal child's upbringing. Appended are two scales of developmentfor preschool blind children. (DB)

FILMED FROM BEST AVAILABLE COPY

Frinted from the iiirvrican Foundation for the Blind Research Bulletin

NorILPr 25, January 1'173

THE I3I.,IND AND HIS PARENTSCONGENITAL VISUAL DEFECT AND THE REPERCUSSION OF FAMILY ATTITUDES

ON THE EARLY DEVELOPMENT OF THE CHILD*

G. C. Lairy, M.D.**A. Harrison-Covello, M.D.***

Centre National Ophtaimologique des Quinze-Vingtsand Hopital Henri-Rouselle,

Paris, France

INTRODUCTION

It is evident that the mere ex-istence of a handicapped child in-variably alters the balance of thefamily. While this situation is heldby many writers to be responsible for-any evident upsetting of the bal-ance, from the separation of theparents to severe psychiatric path-ology of one of its members, an al-ternative view is that the familyreaction depends rather on "pre-egisting psychological conditions,"inasmuch as the_handicap would seemto permit the expression of feelingswhich, in the normal course of events,would have been less intense or bet-ter controlled (Coughlin, 1941).Furthermore, for many of those incharge of guidance or educationalservices, it is always the inadequateattitude of-the family which isblamed as the origin of vicissitudesin the child's development and his.failure to adapt to his handicap.

*This is an English languageversion of the paper "AttitudesFamiliales et Deficit Visuel Con-gental," originally published inthe journal Interpretation, Vol. 5,No. 2-3 (April7September 1971),pp. 157-186.

**Maitre de Recherches,I,N.S.E.R.M.

***Attachee de Recherches,I.N.S.E.R.M.

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U.S. DEPARTMENT OF HEALTH,EDUCATION A WELFARENATIONAL INSTITUTE OF

EDUCATIONTHIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIGINATiNG IT POINTS OF VIEW OR OPINIONSSTATED DO NOT NECESSARILY REPRESENT OFFICIAL NATIONAL INSTITUTE OFEDUCATION POSITION OR POLICY

On looking into the literatureconcerning family reactions t.O thehandicap of a child, one constantlymeets a number ofstereotypes, ir-respective of the handicap in ques-tion: parental depression, especiallyin the mother; wounded narcissism;anxiety and guilt at the time of dis-covery of the handicap; later, com-pensatorys attitudes of rejection orof overprotection, etc. In practice,going beyond these similarities, oneis struck by the disparity of, thesefamily reactions and by the frequentdisproportion between their possibleintensity and the real limitationswhich the handicap implies. It isfrom this dual viewpoint that onemay grasp, on the one hand, the sym-bolic value of the handicap and, on ,

the other, the possible role of path-ological elements in the parentalstructure which already existed priorto the new situation created by thehandicapped child.

It is not our intention to at-tempt a comparative study of the re-spective parts played by blindnessand by other handicaps in originat-ing an early disturbance of the child-family relationship. In fact, itseems clear to us that the early orcongenital visual defect of the childis indisputably specific:

on the level of reaity, blind-ness is not equivalent to anyother handicap; even granted anideal mother-child relationshipand the best possible education,the earliest development of theblind child will follow a verydifferent evolution from that of

the sighted child, and all hislatei adaptation, both educa-tional and socioprofessional,will run up against great diffi-culties;

on the symbolic level, blindnessis in a special position owingto the fact that in every indi-vidual it evokes very primitivefantasies .relating immediatelyto sexuality and castration.It is enough to recall the po-sition of blindness in mythologyas being a condign divine pun-ishment for incest, reservedstrictly for men. The.well-known ambivalence of these fan-tasies, which bestow simultane-ously on the blind person bothtotal impotence and a magic om-nipotence, could not be better,illustrated than by the imageof the adolescent albino inFellini's Satyricon, blind andimpotent, but hermaphrodite andA god. In the parents of achild born with a visual defect,thiA often provokes phobic re-actions, which in turn influ-ence the child's developmentthrough his object relationsand his learning processes. Infact, the absence of sight rulesout any possible grasp of theworld at a di-stance. This graspcan come about only through themediation of "tactile seeing"and will thus depend on "whatis given to touch," with all theimaginable limitations due toprohibitions against eroticizedtouch.

This immediate phobic reactioncan be overcome, either spontane-ously, or more especially with theaid of guidance. However, when aphobic structure exists in one ofthe parents, and particularly in themother, prior to the birth of theblind child, an almost inevitablearrest of development or the psy-chosis of the child is to be ex-pected.

That a blind person can reacha normal or even a superior level ofdevelopment and integration is atruth underlined by many writers,and on this is based the claim thatblindness as such is not a suffi-.cient fondition for the hindranceof:.intelligence in the widest sense

(Hatwell, 1966). However, the pro-portion of backwardness or of psy-chosis is distinctly .higher amongchildren horn blind than among sight-ed children, which frequently givesrise to the diagnosis of "multihan-dicap" even in ,the absence of anyother associated physical defectThis not ion, which is very widelyturned to account in couhries wherethe appropriate educational andtherapeutic possibilities remain'unreliable, certainly deserves tobe very widely criticized.

On the other hand, in countrieswhere more systematic studies havebeen carried out, the notion hasgradually evolved that the retardedor deviant development of blind chil-dren depends more on early educationthan on their blindness as such.Thus, from a survey carried out overa period of five years on a group ofnearly 300 children born blind (Nor-ris, 1956). arrived at the conclusionthat the development of the blindchild who has no other major physi-Cal handicap may show a regular pat-tern of progress, at the end ofwhich he will'reach, at school age,the same level as that of sightedchildren of hiS'. age, provided thatthe educational situation has been"favorable."

This writer emphasizes the ex-treme diversity of the levels ofachievement of blind children, theimportance of fluctuations in thescores gained by a child in thecourse of studies over a period oftime -- fluctuations which are alwayslinked to variation in the factorsof the child's environment and con-cludes that what creates problemsis not so much blindness as theadult's incapacity to know what hemay expect from a blind child andhow to encourage his optimal devel-opment.

We owe the most remarkablestudies of the congenitally blindchild to psychoanalysts. The de-scriptions and interpretations towhich we shall refer are the out-come of their direct observation ofchildren carried out within theframework of guidance begun as earlyas possible after the discovery ofblindness, and of the treatment ofcertain cases, referred to them at

idler stoge t.itil records suggestirur,Aardation or psychosis (Burlinqhar,1961, 1964, 1965; Fralbery -and Freed-ihan, 1964; Fralberg et al., 1966;Fraibery, 1968; Omwakc and Solnit,1961; Burlingham and Goldberger,1968) .

These studies allot a p,-,sitionof primary importance to the environ-ment in general and to the family inparticular. First, guidance as con-ceived by these writers represents atherapy for the parents, to the ex-tent to which it is not confined tooutlining suitable behavior towardsthe child and to giving educationaladvice concerning his training, butinasmuch as it enables the initialshock of the discovery of the handi-cap to be toned down and permits themto understand the meaning of thephases of regression which will in-evitably mark the child's path of de-velopment, even if this is'a favor-able one. Second, the'therapy ofvery disturbed children also consistsof taking in hand the whole family, I

even in psychoanalytic treatment ofone of its members.

In France there is no systematicguidance service or any possibilityof early specialized education forthe visually handicapped, and it isoften from the age of five or six on-wards, and sometimes very late, thatwe are asked td assess these childrenwith a view to their schooling or in-stitutional care. However, at ourinstigation we have for several yearsbeen able to see younger children,chiefly in an ophthalmological ca-pacity, and to trace the developmentof a number of them. Our observa-tions, compared with those of writerswho have been able to study blindchildren from birth or during thefirst months of life in the frameworkof intensive guidance. enable us toconsider the disturbances in thechild's*development and their rela-tion to the family attitude not onlyphenomenologically, but also dynamic-ally; and to specify what in thesedisturbances and attitudes can be in-fluenced toward "normality."

SELECTED DATA FROMTHE LITERATURE

We shall attempt to summarizethe views of the writers concerning,first, the optimal development of the

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blind child under guidance, by makincan artificial division into various"sectors" which we shall again makeuse of in the analysis of our owndata, followed by the picture of de-lay or "deviation" in this develop-ment.

During the first year, and espe-cially the first eight months, theremay be no quantitative retardation(by the Gesell tests, for example)of the postural development of theblind baby the bolding up of thehead, the movements of the body turn-ing over in the cradle, the seatedposition, the position standing withsuppqrt--all these may be observed-at-the same ages as in the rightedchild. This cwitinues to be true ofthe selective smile at sound or con-tact (the mother's voice, or contactwith the mother), the first vocaliza-tions, and the acquisition of thefirst words.

Clear differences become appar-ent beginning in the last quarter ofthe first year and during the wholeof the second year: no crawling onall fours; considerable backwardnessin walking; a halt in acquiring newwords; continuation of a great selec-tivity of affects, with extreme de-pendence on the mother or on a smallnumber of special members of thehousehold. These difficulties maybe overcome later, chiefly from thethird year onwards, when the childis able to acquire normal autonmy ofmovement and speech.

It is in the sensorimotor field,the field of exploring and manipulat-ing objects, that distinct differ-ences are observed very early. Dur-ing the greater part of the firstyear, the blind child has no spon-

' taneous tendency to move his handsand arms. He does not hold out hisarms to be picked up. Burlingham(1961) correctly observes .that theblind child in the cradle moves hisfeet and legs much more than hishands and arms, which for a long,time retain the newborn position,with arms bent and hands at shoulderlevel. The hands are rarely broughtto the midline and the child doesnot play with his fingers.

The reactions of otientation tonoise, which appear about the secondmonth in the sighted child, are

observed only towards the seventhmonth in the blind child.

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The voluntary grasping of an ob-ject (which appears spontaneously atapproximately five to six months ofage in the sighted child) begins inthe blind child at about seven months,for an object which has just beenhandled and then taken away from thechild, and at about one year for anobject located by purely' auditoryclues. The concept of object perma-nence, in Piaget's sense, takes rootonly very late and remains weak fora long time. In this area the blindchild shows a developmental delay ofat least a year, which bears witnessto the primary role of vision in theconstitution of,mental representa-tion. This notion can be acquiredby the blind child only after a pro-longed phase of training in whichtactile manipulation plays an essen-tial part, as purely auditory informa-tion is not enough to give substanceto the object unless it has beenhandled simultaneously, or very re-cently. Thus, for a long time thereis no active seeking for the objectlost, as if it existed only while indirect contact with the child.

The development of speech under-goes a very special course of devel-opment starting from actual verbaliza-tion during the second year. Whereasthe sighted child rapidly enlarges hisvocabulary, the blind child does notincrease his stock of words and mayeven forget words already learned.Only in the third year, and especiallywhen he is able to move about autono-mously and enter into contact withmore and more objects, does his lan-guage really become richer (Freiberg,1968). But one may also note theacquisition and use of a great numberof words which are devoid of meaningfor the child and are a mere imita-tion of the speech of sighted persons.

Burlingham (1961) considers thatthe oral pleasure derived from thefirst babbling plays a greater roleand lasts longer in the blind babythan in the sighted one. Before be-ing used for communication, words aretoys, and talking is an activity whichis an end in itself. The excessiveprolongatibn of this mechanism maylead to the echoed speech, or verbal-ism of the blind. Here, too, one mayexpect the adequacy of the child's

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speech as a means of communicationto depend on the adequacy of hi!; en-vironment.

In the fovegoing.outline we haveas much as possible, limited the con-sideration to motor and cognitive de-velopment. indeed, a fundamental no--tion which is much stressed by theseauthors is that this development de-mands a much more intensive trainingthan in the case of the sighted child;that this training is not spontaneousbut must be induced by the adult and,above all, that it can be meaningfulonly in a context of satisfactorylibidinal object relations. Herelies all the importance of the familyattitude (which for the sake of sim-plicity is often limited to the moth-er's attitude) and of the quality ofthe mother-child relationship.

For the first few weeks ormonths of his life the blind childis in fact very quiet and may remainpassively, for a dangerously longperiod, in what S. Freiberg (1968) calls"a void" which can be filled only bywhat is given from outside. It ismost important that from birth thechild should be held in the arms,played with, and placed at the centerof family activities during his wak-ing hours; but it is still more im-portant that the stimuli given to'himshould be a source of pleasure totheir originators as well as to him.Only through shared pleasure can a"dialogue," in Spitz' sense, be setup between the baby.and his humanenvironment.

This is indeed not peculiar tothe blind child and is valid for allchildren, but--and this is the firststumbling block--the blind child whoneeds more stimulation than .a sightedbaby, both quantitatively and quali-tatively, is likely to be to a greatextent deprived of this, as on theone hand he asks for less, which isthe first expression of his passi-vity, and on the other the mother.may remain withdrawn from the childowing to her depression. It is atthis peintthat early guidance findsits full justification and usefulnessif it succeeds in'diminishing thisinitial maternal reaction and in en-couraging mutual pleasure throughinteraction.

1.1bidlnal object relations ray,tneretole, be established norallynurinu tno 11 rst year and the childway show selective attachwent toIris mother or to the people around

hiw, whom he distinguishes fromstranyets by the sounds of theirvoices, by the way they hold, himand, later, by exploring thC,r faces.Differences are noticed very early,however. The smile is less frequentin the case of the blind child andis less.distinct, as if deadened;it arises only from interaction with'another person and is not evoked byinanimate objecti. During the sec-ond year open displays of affectionremain induced responses and thechild behaves as if he cannot himselfbe the initiator of a relationship.

This lack of initiative is linkedwith a defect in the gradual gain inindependence from the mother. Therole of sight is here again a deter-mining fabtor in the process of men-tal representation and internaliza-tion of the libidinal object. Thesame delay is seen in the realizationof the concept of the libidinal ob-ject constancy as for the object'permanence. Hence, the separationanxiety shows particular intensityand continues well beyond the end ofthe second year. The blind childseems to bo reduced to a state ofhelplessness and panic as soon as heloses contact with his mother, andmay react to this loss by a globalregression in all histacquisitions.The reaction to anxiety and frustra-tion is very characteristic in theblind child. All writers havebeenstruck by the fact that he reacts bywithdrawal, regression, immobility,and autoaggression; that energy isdischarged through his axial ratherthan his peripheral musculature; andthat there is no spontaneous tendencytowards a motor discharge directedagainst an external object. The pro-longed dependence on the mother,which entails on her part an in-creased dependence on the child, andthe weak nature of acquisitions for-ever challenged by unforeseeable emo-tional shocks, make the child's sec-ond year a difficult and trying peri-od. Concrete circumstances (thechild's being put into hospital,ophthalmic treatment, the illness ordeath of a parent, etc.) may giverise to real crises which are diffi-cult to overcome (Colonna, 1968).

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'tarty yriters, in particular.Parmeleeet al. (1958), have observed thateven in the best conditions of guid-ance wothers who have quite got overthe initial shock Of the discovery ofthe child's blindness may later de-.compensate, not knowing how to con-trol and master this regressive anx-iety.

The service of guidance and earlyspecial education (such as some "Sun-shine Houses") can help considerablyin coping with this critical periodby widening the child's fieldofcathexes, by developing his motorinitiative and his mastery of an en-vironment which offers both richnessand security, and especially by help-ing the mother to understand herchild's needs and to meet them with-out excessive anxiety or guilt.

It is between the ages of threeand five that the child is able toacquire progressively greater self-control and improved emotional sta-bility. AtIthe age of five or sixhe may attain qualities of autonomy,control; and curiosity which renderhim fit to begin schooling, as such,with the appropriate technical fa-cilities.

Inasmuch as this result isstrongly dependent on previous train-ing which Involves the active inter-vention of the mother at every stage,the difficulties and hazards of thislearning process must be stressed.Winnicott defines the good potheras one who "must be capable of adapt-ing actively to the child's needs."In the case of the blind child, theseneeds are at once unexpressed (ini-tial passivity) and very complex; thenecessity to compensate for the ab-sence of sight by awakening all theother channels of sensation, tactile,auditory, kinaesthetic, etc. (but thechild has no spontaneous tendency to-wards such compensation), and thenecessity of,existing in the.other'sfantasy in spite of the difficultiesof identification created by blind-ness.

Learning by itself, or "over-stimulation," might suggest that theblind child should in every way andat the same ages behave "like" asighted child. In fact, what isnecessary is to create and maintaingratifying conditions of exploration

(both for the mother and for thechild) which may in turn facilitatemotility, intentionality cf movement,dialogue and so on, not by a simpleimitation or 'veneer" of the sightedchild's behavior, but by means suitedto the blind child who is accepted asbeing different and as having a spe-cial pattern of development.

Burlingham (1965) rightly insiststhat learning and play should mergeand that this is one of the thingswhich should be taught to mothers.She attaches a high value to bodilygames: the mother's playing with thechild's body and the blind child'sexploring his own body and his moth-er's body, which is still more neces-sary to him than to the sighted child.

In tie opinion of this authorthe mother's body retains its functionof a "toy" well beyond early infancyand certainly until the age of three.She attributes to a scarcity or ab-sence of these early bodily games notonly the lack of libidinal cathexisin the child's own body (which could,we believe, be the source of disturb-ances in the body scheme so often ob-served later) but also the blindisms(rhythmic rocking movements and repe-titive movements of the body or thehands) so common among blind peoplethat this name has been given tothem, even though they may also beseen in autistic sighted children.

These blindisms are also attri-buted by the same writer to the re-striction of movement caused by blind-ness to the extent to which it de-prives the child of any possibilityof controlling the consequences ofhis actions, and which is maintainedby the household because of the realor supposed dangers which they wishto spare him in the external world.In her view they have the doublefunction of autoerotic activity andof discharging energy which cannotbe otherwise discharged.

The choice of "toys," vehiclesof the learning process, should bedecided upon in accordance with theblind child's own needs (Burlingham,1965); many traditional toys (smallscale models, for example) have nomeaning for him, although handlingthe real adult objects may interesthim (saucepans, car, light switch,etc.); certain children's games hold

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no interest unless theyltiredifferently ifcr example,tower with blocks becomes a naveif the child :s first allowed toknock down the tower built by some-body else) and certain activities '

take on a special importance (gameswith deOrs,.for example). The in-genuity and tolerance of the familymay be measured by the diversity andadequacy of the play activities sup-plied er at least not forbidden tohim in his'family environment.

It seems that the-completion ofthe blind.child's early developmentrequires the recognition and.verbal-ization of blindness by the child, -and the most favorable time is atabout four or five years of age(Burlingham, 1961; Cratty et al.,1968), but often later (Deutsch,1940). The cther's ability to seeis experienced by the child as amagic power: the sighted person can"feel" and "know" without touching;one cannot hide from him, whereas hecan disappear or reappear as hepleases, etc. The magic omnipotenceof the sighted adult for the blindchild finds support in reality whichexperiencetends to strengthen in-stead of progressively controlling.It is clear that the recognition ofthe blind/s:Lghted difference issuperimposed on that of the differ-ence between the sexes. The lattermay be hidden or distorted to anequally great extent by the absenceof sight, and especially by the at-titude of sighted adults, the motherin particular and then the teachers.They very often

atthat learning

or information at this level is use-less, or impossible, even forbidden,as the blind person can be conceivedonly as castrated or hermaphrodite,but not as a sexually differentiatedbeing. Here we must stress the ab-sence of reported data, the rarity ofexperiments on sexual information oreducation of the blind, and the verybelated nature of thiS educationwhen it is finally planned (Van'tHooft and Heslinga, 1968 Wright,1968).

On the other hand, we do findin,the available literature cases ofcongenitally blind children whosedevelopment, far from being optimal,is very delayed or "deviant," butwhose disturbances can be totallyor partly reversible at the cost

of intensive care of the child andof his family.

Fraiberg (1968) points out theuniformity of the clinical pictures,and the descriptions of other au-thors (Keeler,. 1958; Parmelee, 1955;Parmelee et al., 1958) correspond tohers. The children she has studiedshow the same symptoms irrespectiveof age, and their behavior at tenyears old may be identical to thatat three years old, with the excep-tiOn of progress made in the fieldof locomotion. This would seem tobe an arrest of the ego developmentoccurring in the second year, whichresembles psychosis but differs fromthe cases of autism observed in thesighted child and coincides ratherwith the classic case of Spitz' aban-donism where the child spends most ofhis time lying in bed, in an arm-chair, or on the floor, chewing anobject with an absent-minded air.Objects or toys hold no other inter-est than to be put into the mouth,which remains the primary organ ofperception. The hand has no autonomyof its own and is not used for ex-ploration or manipulation. -It is theblind hand, incapable of a voluntarycoordinated movement, which seems tobe solely at the service of the mouthyet unable to be used for voluntaryfeeding.

-Contact with human beings iS ofa very primitive kind, symbiotic fu-sion, or clinging and biting. Themother may be the preferred object,but sometimes the mother is in no waydistinguished from the environmentand this behavior is generalized.Also to be noticed in these childrenare the ceaseless rocking movementsof the head or body, or rhythmic flap7ping of the hands and arms. Speechis essentially echoed, with repeti-tive use of.words, sounds, or phraseswhich the child has heard. He refersto himself in the third person andspeech is not used for communication.

Most of the authors who haveanalyzed these cases emphasize theconsiderable disturbances in thefamily which the blindness has broughtabout; severe and long-lasting depres-sion and guilt in the mother and herfailure to establish "emotional con-tact" with the child in the course ofthe first few months (Keeler, 1958).

\'. Fraiberg (1968), Burlingham and

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Goldberger (1968) stress the factthat these patterns can be reversedif they are treated (both ,mother andchild) early enough. The later theeducative therapy begins, the moreincomplete and hazardous will be theimprovement.

But here, too, one may wonderwhether the limits of this improve-Tent are not those of the environ-ment, therapeutist included. In thecase of "Peter,1! described at lengthby Fraiberg and Freedman (1964), thetreatment was abandoned at the ad-vent of puberty, it being consideredthat the results attained could notbe'surpassed. This is oddly remi-niscent of the case of Itard's wildchild.

SUMMARY OF THE AUTHOR'S OWN DATA

Over the last eight years wehave examined about fifty children,either completely blind or with verypoor sight (legal blindness), undersix years old, and chiefly at theNational Ophthalmological Centre ofthe Quinze-Vingts. We have been ableto follow the progress of a number ofthem insofar as their iparents askedto see us again or accepted our sug-gestion to follow the development oftheir child.

In the case of multiple examina-tions long and repeated interviewswith the parents enabled them to be-come conscious to some extent oftheir attitude towards the child, andeven to alter

During these examinations wevery frequently came across some ofthe kinds of behavior just described,but if we were impressed by the mag-nitude of the disturbances both ofthe child and of the parents, thediversity of the pictures seemed tous as striking as their gravity.This brought home to us the needfor a method of examination wherebythe quantified evaluation of a level'of development would take on meaningonly in the context of observationof the child and the parents in theirreciprocal relationship. For everycase and at each consultation theexamination lasted for several hoursand was carried out by two differentpeople. It consisted on the onehand of the application of a scale

of development, and on the other ofan interview with the parents (mostoften the mother) and observation ofthe child in their presence.

The test used was the scale ofsocial development of. Maxfield-Bucholz (1957), (Leger and 'hairy,1965), which is the only test stand-ardized on a population of youngblind children. Its internal or-ganization has been rearranged andcomplemented with items, from Brunet-Lezine for children less than oneyear old, and from Hayes-Binet forolder children.*

The Maxfield-Bucholz scale ofsocial.matur,ty is a questionnaire,which asks of theperson questioned- -usually the mother -a detailed de-scription of the child. Its chiefinterest lies in the fact that,thisdescription rapidly transcends theboundaries of the questions askedand devellops into a free discussion,in which ignorance, errors of judg-ment, feelings expressed, and emo-tional coloring permit an understand-ing of the way the mother sees herchild; the mother-child relationshipinfluences the protocol in two ways.This relationship determines thechild.'s level of social flinctioningand conditions its presentation inthe mother's account; but comparedto reality the mother's account con-stitutes a distortion which must becircumvented and assessed if the in-quiry is not to be meaningless.Observation remains the only meansof finding out the way in which thechild does or does not do certainthings, his attitudes toward objectsand the environment, and his inter-actions with adults.

The criticisms which may justlybe made of these tests spring fromthe fact that they are adaptationsof tests for sighted children; andthat they assess the behavior of

'blind children from the point of viewof those with sight and in relationto them. The disguising of certainitems, adaptation of performancescalling-upon sight, to performances

*These modifications have beenelaborated upon by E. M. Leger, towhom we also owe a great many setsof psychological reports serving asa basis for this work.

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eallino upon the sense of tou,eh orhoarinq, should not obscure thispoint , Oven if standardization en apopulation of blind children speIcific8YIT involves blindness in theclassification.

The original Maxfield-Ducholzscale is comprised of 85 itemsdivided into six age groups, fromone to six years, and these itemsare again divided into seven cate-gories: general autonomy, 'abilityto dress without help, communica-tion, socialization, locomotion,activity. The distribution of,--the different categories in eachage group is rather uneven.

The reorganization of thisscale results in the groupingtogether of the scale's originalitems under five headings com-pleted by items taken from theBrunet-Lezine or the Hayes-Binettests. The five sectors of be- ,

havior are thus distinguished:posture, sensory-motor, soci-ability, speech, and autonomy.

Under the heading Posture(whose items only cover the firstthree years), only the postural .

abilities of the child are test-ed (ability to master the seatedand standing positions, and la-ter walking) but not their effi-ciency, which depends on learn-ing and on what is allowed bythe mother. These are assembledunder the heading "Autonomy."

The Sensory-Motor sector testsin turn the motor aspect of grasp-ing; interest in sounds, objects,and the environment; activitydirected toward objects; thecapacity of attention and offixation on a given action; playactivities with sounds and wordsand later with objects and peo-ple.

The sector entitled Sociabilityconsists of items testing, firstof all, sensitivity to human con-tacts, reaction to the voice, af-fective displays expressing theneed for contact, exploration bythe child of his own body andthe beginning of object relations,and the distinguishing of familiar

and unfamiliar voices; later, themodalities of exchange and the in-ternalization of prohibitions;later still, verbal knowledge .ofthe parts of the body, the abilityto cooperate and to adapt to day-to-day surroundings; finally adap-tation to a wider collective ex-istence, consciousness of,-selfand cooperation with other chil-dren, adaptation to the group andthe ability to respect its rules.Under this heading we have addeda further item ifor the second year,measuring the ability to surpassthe first oral stage by accepting

. solid food, and'another for thethird year testing the faculty ofsphindter control; these two ac-tivities seem to us to assess aXype of relational modality ratherthan the acquisition of autonomy.

Under the heading Speech wehave ,grouped items testing solelycommunication with the help ofordered. sounds. Verbal games,songs learned by heart, and count-ing rhymes have been placed under.the'heading Sensory-Motor.

Finally, the Autonomy sectorcomprises items expressing thechild's ability to do things "byhimself." This sector assemblesthe things which stand out mostclearly in what is allowed, en-couraged, or forbidden by themother. This becomes evidentfirst of all with regard to loco-motion: moving about indoors andoutdoors, awareness of obstaclesand ability to avoid them, assess-ment of uistances, etc.; but itis relevant to all daily activi-ties, such as feeding, dressing,care of the body, cleanliness,etc. As for sphincter control,we have considered it importantto dissociate the ability to ex-ercise this control (measured inthe Sociability sector) from theputting into practice of thisability, as the latter dependson the attitude of the mother.It may appear arbitrary that wehave compiled this sector sepa-rately from that of Sociability.In fact, they test two fieldswhich are distinct and which oftenare not parallel.

The results obtained from thisscale lead us to the schematic

9

description of four groups accordingto the overall level, but especiallyaccording to the elective nature ofthe disturbances in one or anotherof the sectcrs of development, andthe qualitative differences betweenthese disturbances which cannot beadequately, rendered.by quantitativeassessment.

Gr_ouup I. This group is charac-terize y an overall quotient nearor equal to normal, with relativelyhomogeneous scatter in the five sec-tors of behavio.. studied. It com-prises about one-third of our popu-lation and can be considered as the"normal" group. Study of the familyenvironment shows that after a de-pressive phase, usually short, thechild has.been satisfactorily ac-cepted and that the educational at-titude has been on the whole neitherlimiting nor rejecting. Much morefrequently than for children in thefollowing groups, one sees siblingsborn after the blind child. Thefact that the parents have been ableto plan or to accept to have anotherchild in itself bears witness to thefamily attitude.. The younger childby his very existence will have anormalizing role on various counts.Being the child to "heal" the par-ents' narcissistic wound, he makespossible the positive cathexis ofthe blind child's progress, and bymeans of the games he shares withhim he also has a favorable influenceon his learning and the developmentof his relationships.

It shoUld be noted that less thanhalf the children in this'group arewholly blind, and that the remainderhave some useful remaining vision(legal blindness). It is certainthat this weak residual sight, whenit exists, can facilitate the child'searly development; it allows the par-ents to ignore the blindness for a.

longer time or to valorize the re-maining sight, and in this case itleads them toencourage hiM to useexisting sight to best advantage andto develop visual-manual coordina-tion. Later one sees in these chil-dren a good use of remaining sight inexploration or orientation.

Schooling for children in thisgroup is taken for granted by theirparents, and its variety depends onconcrete factors: the degree of

sensory deficit, the geographicalsituation of the parents, etc. Thechild is even sometimes put into akindergarten with sighted children,either spontaneously or at our sug-gestion.

Other types of profiles, to befound in nearly 40 percent of ourpopulation, are distinguished not somuch by a mediocre overall socialquotient (the average being around75) as by the extremely wide scatterof performances, with certain sectorsshowing normal or superior scores,whereas others show extremely lowscores. Several forms of dissimi-larity may be.observed, but two ex-tremes seem to stand out in relation

. to the parental attitude, accordingto whether the failuresreflectsdefective learning only or a dis-turbance of the object relations.

Group II. The second group ischaracterized by normal posturalabilities, and especially by a normalor superior level of speech for thechild's age. By contrast, perform-ances in the Autonomy, Sensory-Motor,and Sociability sectors are mediocreand the scores under these threeheadings barely reach the level ofapproximately half the child's realage.

What is most striking. in thefield of behavior is the child's ex-treme passivity--a passivity main-tained or even encouraged by the over-protective attitude of the mother,,who does not encourage him to dothings by himself, but takes overall daily activities from him. Thisstate of infantile dependence alsofinds expression in other spheres:delay in accepting solid food, delayin acquiring habits of cleanliness(sometimes very late bed-wetting),etc. However, apart from blindismsand,the usual manifestations ofseparation anxiety, we are dealinghere with genuine delay--behaviorwhich would be normal for a youngerchild--rather than with really patho-logical behavior..

The quality of speech should beemphasized. Indeed, the children inthis group display considerableverbal richness, using language-bothas a means of communication and as agame. It is with these children thatone often finds long periods, just

10

before falling asleep, when they Lalkto themselves or to a favorite objectin a way which reproduces in. itsterms or its rhythms dialogue withan adult. These episodes, duringwhich the child usually seems veryhappy, may even precede true verbal-ization and testify that gerfiline pre-Verbal dialogue has already been es-tablished between the child and hismother.. And indeed, after the firstdepression, the mother waits for and.experiences her child's learning totalk as.a reassurance that shewillbe able to understand'his needs andcommunicate with him. But thesemotherd very.much underestimate thechild's real capabilities in every-thing concerning his activity; theyare very limiting, ,and'spare himexperiences which they fear may betraumatic. When there is some re-maining vision, the child is notencouraged to make use of it for ex-ploration, and later he behaves likethose who are wholly blind with re-gard,to orientation, locomotion,location of obstacles, etc.

It is interesting to note thatthere are a number of premature ba-bies in this group. It seems thatprematurity as such may play a de-cisive role in determining the moth-er's attitude. On the one hand, avery small and delicate baby handedover to the mother at a late stageand requiring special precautions inrearing during the first few monthsinduces and justifies her anxietyand overprotection; at the same time,the real danger of the possibilityof the baby's dying may annul un-conscious wishes for the child'sdeath so often observed in the moth-ers of full-term blind children,especially those of the followinggroup.

These nonrejecting, "too good"mothers often become aware of theirattitude in the course of the inter-view, and of their wish for thechild to remain a small baby, easierto protect. They are quick to ex-press their regret at being totallylacking in information hitherto,and respond readily to guidance.Usually they greet with delightedastonishment the demonstration thattheir child's capabilities exceedtheir own assessment. They willinglyaccept educational advice and theperiodic interviews;they sometimes

even ask.fur them. During successiveexaminations of these childrenhave been able to measure the conse-quences of the change in the mother'sattitude. Spectacular progress maybe observed very swiftly in a fewweeks or months, which has a bearingin particular on everything relatedto the Autonomy sector, but which canalso raise the overall quotient by 15to 20 points. This giving of autono-my to the blind child who has a goodspeech level will facilitate and has-ten his starting school, which the.mother would inStinctively. tend topostpone to a dangerous extent. Wethink in fact that disorders due tothis type of parental overprotectionare the most easily reversible in thepreschool period. If we refer backto our earlier studies of the visu-ally, deficient child of school age,brought up without guidance (Lairyet al., 1962), we see that disordersof motor and emotional control, cog-nitive disharmony, and lack of eager-ness to learn are frequent; the laterthat schooling begins the more seri-ous they are and which then necessi-tate intensive education, reeduca-tion, or even psychotherapy.

Grout/ III. The other extremeform of disharmonious scatter ismarked by normal postural develop-ment (always taking into account thecharacteristics of our test) and bya high score in the field of autono-my, sometimes above the normal. Yet,in the Sociability and Language sec-tors -the scores obtained do not reachhalf the child'.s real age; the great-est failure is found in the sensory-motor field, where, in general, suc-cesses do not exceed nine monthsaccording to Brunet-Lezine and thefirst year on the Maxfield-Bucholzscale. Observation of the childmakes it abundantly clear that thesefailures do not indicate a mere de-lay in development, but are the ex-pression of very pathological be-havior as much in exploration andlearning as in relationships. Withregard to grasping and manipulationof objects one may note that, incertain cases, the object is usedonly for aggressive outbursts, throw-ing, hittinig, etc.; or with certainfamiliar otdects, for delicate andcomplicated manipulations, stereo-typed and repeated indefinitely. Inother cases there is a definite re-fusal to hold and manipulate, or even

11

a withdrawal by the child as soon ashe comes into contact with the ob-ject, as if this contact were pain-ful. Where food is concerned, themother reports not only refusal ofsolid food but vomiting at contactwith such food. Here one may.justi-fiably talk of touching and feedingphobias. To these phobic symptomsmay be added displays of terror atany unfamiliar noise.

On observation one is oftenstruck by the child's appearance;the sartorial affectation of. whichhe is the object, and sometimes theclash between the perfection of hisclothes and the socioeconomic levelof the parents immediately give theimpression of a doll-child, a child-object. This child may remain cling-ing to his mother, huddled up againsther in a symbiotic attitude, his im-mobility broken only by.blindisms orthe ceaseless movements of pressingagainst the eyeballs with a fingeror the whole hand, and showing ter"ror if he is touched or spoken to.He remains silent or tirelessly re-peats phrases overheard, which haveno connection with the immediatesituation except that they seem tobe intended to distract the mother'sattention.

Study of their speech sometimesreveals complete mutism in the young-est children and, later, echoedspeech as classically described: thevocabulary seems to be rich, and cer-tain children are able to reproducewhole sentences which have just beenspoken to them in the same tone andsometimes even in a similar voice;they may answer a question by repeat-ing the question asked; they referto themselves by their first name orin the third person, and they do notdistinguish themselves from the per-son who is speaking to them or'whomthey are addressing. While theydisplay an astonishing memory forwords and occasionally a great inter-est in musicei speech is not used oris used very defectively to expressneeds or to communicate.

The mothers of these childrenare very typical: they have all gonethrough a long depressive period ondiscovery of the child's sensory de-fect, compensated.by an apparentlystrong attitude of attempt to over-come this. They have "decided" to

forget the'sentory:defect and to bringup the child "like any:other,"end inthis way have encouraged' certain:number of activities; walking, climb-ing,. riding a bicycle, etc. Inact,during, the interyiewit becomes:clearthat this depressive phase hat notbeen left behind, that th with'forthe child's death-contipuesand thatthe motheris restructuring herselfat theprice of a negation.of the:de-feet-, or of the child himtelf: 57;c'iMe:

mothers 'find it an unendprable,ordeal -rrto .occupy themselves in a seriesdaily tasks for the child (feeding,'bathing,'ete.) and :leave these to thecareof other people-grandmether,domestic help,-ete. They do-not_playwith the child, who is often. left for:hourt.at:a:time with tjte: d-adio.orrecords ; they pride-themselvep- on hitmusical knowledge without:seeming to'be'affected-by the total absence ofany..possibility:ef dialogue,HTlierationalization of this attitude maybe'compulsive professional or hotlse7wifely aetivity, indispehseble totheir own balance. Semetimes'refugeis taken in magical beliefs and thechild is taken to healers.:or on year-ly pilgrimages. All cathexis in 'thechild is suspended while a miracleis awaited.

One is faced.with a phobicstructure fairly well compensatedbefore'the birth of the handicappedchild, even if certain symOtOms hadappeared (feeding phobias, dirt pho-bias-,',etc.), and forwhich the up-brinqing,:of elder children would haveposed!hoMajotproblem, .1lowever,- thepoSsibility'.oaving another childis -always rejected in this.conteXt,even if there is no ,geneticto justify the fear of a repetitionof the handicap-.

These motherd are not very re-sponsive to guidance. Interviews;are difficult and are felt to be aItrial.and judgment to the extent thatIbey...prousetheir-guilt,and questiontheir defense system. They show anin mediate need forilindividual treat-.mentbat.this treatment is alwaysrefused if the problem is raisedduring the:interview. They, ask fornothing, nei.ther help for ,themtelvesnor educational advice for the child;if.theyask for anything it is of theorder-of a miracle, or to -place thechild in an institution. In a, fewcases of repeated examinations we

12

. .

.found, that when new aoclui s.Olons hadbeen made by the child they rcMai-ned:incomplete; or were :even Col.maj'ned. atth6 prioe:of,reoression'A an'hothr

osector. So our i te rventi on. Itllu.

mother :cou h 1 remove a prohihi t ion: inone spheie,.1mW to all appearances.left intact or eyens1-Tengtheped themechanisms responsible,

Thut the child seems to hetrapped'in the maternal falsehoodwhich ConsistSof her apprent-wish,that he should. be :,"like a .sightechird'!.and her prohihitionof. hisexistencexistence as a-plind child, in hisstate :of total dependence he:appearste express by his-phobic behaviorhoth a response to his mother'.s pho-:bia and the fear of losing"-his with-er if he transgresses her prohibi-tion.

These cases' come close to those.described byjraiberg as ego,:defqt:,&n:a. doubtless- possible tocarry out therapy for the motheronly from the Moment of totally taking over the child - -as in the caseof Peteri-to which, we have alreadyreferred: We should recall, ih-thisfamout example, that Peter's Motherembarked :upon her own analysis-'onlymany months after the beginning ofhis reeducation in.a psychoanalyticcontextreeducation in whicn shehad to participate and in the courseof. which she,was able gradually tobecome aware of her own problems.

. In our experience, in the ab-sence of such possibilities most ofthese children are condemned to be-ing- placed sooner or later in a.mental.-liespital. If they reach aspecial schobli. their level of'acgui-sititon reMains- very low andtheir,.noncathected learning remaint,'asitwere, ,external". to theM.and alwaysfragmentary.,

Group IV. The last type, has avery lowoverall:level of develop-,ment,,thespcial quotient a-debt-dingto our scald-not' exceeding 40, anda fairly hombgeneoUSscatte.r for theScores.obtained under all headings.

-,.Itis-certain that among these chil-Aren are found genuine multlhandi-

_caps due to the associatieheflAind-

- nes with an early;encephalopathy.It may also be noted that certainchildren showing signs of deafness

associated with their blindness maycome into this groilp; at least for aslong .is thedeafness is not disc).(Iscd,theieLy,,demonsl.ratingjho;importanceof combined sensory deprivations.Rut if thoSe cases 'are excluded-, acertain number are f0und 'for whomonly:a severe affettimedepationcan -exrlain the picture', identical inall, respects, to that of,marasmusdescribed.by Spitz. In this pictureof 'Ory widespread disturba.nce,blindness figurcsas an .epiphendme-non. T ihe markdd delay in the pOs-,

,..tural sector should Ire cMphasized.This has xarelyTheeninoted*in theli(eratire relatingto blind children'and in our population itJias onlybeen obServed in this tontext:: Itmay become ,apparent:from the earliestmonths: general hyOotonia,especiallyof the axial musculature; consider-able delaY:in-holdingup the head andin the acguisition of the seated andthestap4nT positions, even withsupport: These children also,shOw(jrcat.frailty and an extreme suscep-tibility to even trivial infeOtions(rhinopharyngitis, otitis, etc.);.

These cases of severe retarda-tion through affective deprivationare relatiVely scarce incur pOpula-tion.* It is customary forthem tobe considered by-pediatricians as"neurological" and ranked as multiplyhandicapped with associated braindamage. The prognosis is all themore serious in that this label de-prives the parents of all hope atthe same time as it soothes guiltand blocks any attempt at adaptatededucation.

*We are speaking here only.ofchildren seen with their mothers.While severe affective depKivatiOn isexceptional when the child Temains inhis family, it must be mentioned thatin prance abandonment at birth isquite frequent for babies born blind.According to an estimate in 1947, theproportion of blind children left tothe care of Public Assistance (com-pared with the total number of blindchildren) was more than four timesgr'eater than that of children with-

, out any,sensory deficiency.,

13

DISCUSSION

It is oi,vious that many fieldsexpldrod:within

tic' limits of this account.-.mong these; the spccifiC roleof t_he father, his own. reactionto th0 Child's visual" handicap,and. the` impact of his attitudeon futuredentificatiOris wouldall merit special study.

2. lanytheoreical:gue'stions arisewith:regard to the affectiyeadaptation of the congenitallyblind: child. With referenCe toFreud one may recall the'primaiyimportance attached to the"visual" (the eye; seeing, see7ing-drive) in theestablishmentof :object relations amd the enstire structuring.of the psychicapparatus (Bourdier, 1971); itwoulcLseeM that the study ofthose born blind could eitherconfirm or-radically:junderminethese theories. Quite-obViouslythe problem-could be posed onlyby enhancing the "sensory" Iack(a lack which at this stage isexperience&as such.,only by'others) to the detriment ofthat which relates,to "drive,",as no equivalent of the seeins-

. drive seems.to play such aprevalent organizational role

, in the human being.

'Ambiguity arises from the factthat not-to see does not implynot to perceive, but that theObject perceived is ,differentfrom theobjeCt seen. Congeni-tal blindness-must, therefore,be studied as a differeht or-ganization in which we do notkhow what the ways and means ofsubstitution for the seeing -.drive are. ,We only know thatWithout external assistancespontaneous'development,occursin,a way which, compared with

.

that of sighted children, evokespSychosis. But even in'casesof nonpsy,chotic development theimplieations Of these considera-tions with regard to key mo-ments in affective development,such as the internalization oftheobject, the primal scene,and the-discovery of the dif-ference-between the sexes stillhave to be. defined.

r.

We have seen how theinternaliza-tion of the object may be achieveddespite the delays and the set-backs .of this achievement, whosemodalities are linked to the dom-inance of the sense of touch.The "optical of theobject's Gestalt, which is globalandinstantaneous, is-replaced bythe fragmented representation,'successively built up by degrees,of -the haptf-c field of percep-tion (Revescz, 1932). The aboH-lition of distance immediatelyinvolves the dependence of per7-ception on the object given totopch,-and.the'difficulty of dis-tance judgment.

Concerning the other two points;.however, information-is very in-adequate: In the 'literature, we:have found no psychoanalysis tf-a congenitally blind adult. --

Psychoanalyses of children re-late to aUtistitchildren, anddirect Observation ofnonautis7tic blind children is invariablymodified by: the presence of the,analyst. and his active influenceon the mother.' We haVe person7ally .been able 'to follow thecases of two blind:adolescentgirls during :psydhotherapy. Thefantasies-of- primal Stenesevoked_ in the course of treat-.ment were striking for their-Aerrifying and, ,especially, un-limited natureLthe whole body.:was in imminent danger of beingbroken into by acmetl:!):(: equallylimitless.: In additton,it_becamp obViouS that:thelack for-them amounted to theabsence of thissomcthing whichthey were. unableeven to connectwith the penis as a _real object.

This7:-experiente:isplainly toofragmentary for. us tobe:able,todraw any::conclusions, but it does,enable us to consider the tor-rective.-rtletf aightA.n :therepresentation of donscidus-fan-y.tasi0,.and.its links with un-constiodslantasies,

Another problem notattempted isthat.of:the solution of -the Oedi-pui:.Gomplex in-theAplind,boy,owing tothe.fact that he hasidentification' difficUlties ifhe cannot live otherwise thancastrated in the fantasy of'others.,

14

In practiCe a complexprobJeM Lo define to what extentthis affcctiVefdevelopment undpr-lies .the integration of theblind in the society of thesighted. If the high qualityof early deVelopment is a neces-sary condition of that ofe4aterdevelopment, it is certainly notsufficient, and we know how fewpeople born opr.tountryaehieveproper S6tioprofessionaland affectiVe integration.

Lukoff and Whiteman (1970),studying the means of adapta-tion and their determining so-.cial :factors in 500: blind Adults,conclude that the degree andlevel Of'independence which theyattain answers-the expectations,of the environment. :This en-vironment obviously-covers thefamily, which is of coursecranted a dominant role, butit is widened to include thewhole of society, and this posesagain, on a different level theproblem of the.attitude of thesighted towards the blind. Itmust be remembered-that the, con-tradictory fantasies.cif.theimpotent - omnipotent b lidd per7eon are universal, and that theydetermineequaIly, contradictorystereetypes-(from the patheticbeggar to'the blind genids). Itis-thus conceivable that-certaineducational end :social structuresintended for the blind reflectthe ambivalences described forthe microcosm of the family and'in some way give them the forceof law. ,

Hence, the "normal" blind child-brought up to school age withoutparticular overprotection mostfrequently finds7himSelf segre'gated in an institution amongblind-:children :only,..wherelearning Clearly Will take.precedenceover the blossomingof the personality. Despite theveryJavorable-resulteoftempts at early integratiOn ofthe:blindothild into schoolsfOrsighted ohildren.carriedOut in.:other Obuntries,.Atehouldbe notedhere that'in.:France.no':edutationalintegration.of.blindchildren:is'proVidecl..forbY law_before the enclofeecondary.schooling. This:means that a

very small number of them benefit(the "blind geniuses") and thatthe great majority remain de-pendent on protected surround-ings of assistance or attainprofessional autonomy only .at. a

mediocre level (traditionaltrades). Hence, one of the es-sential functionsof theseclosed and protected circlesdesigned by the sighted appearsto be that of protecting thelatter from the photogenic ob-ject,-blindness, by freeing/themselves from guilt throughthe rationalization of technicalobligations.

4. In conclusion, we think it im-portant.to qualify the very gen-eral claim put forth in our in-troduction, that accordingly itis the inadequate attitude ofthe environment, and primarilyof the family, which is respon-sible for the failure to adaptto blindness. Whereas one maygive the family credit for thegood adaptation of a blindchild, one cannot invert theproposition without underesti-mating the complex elementswhich come into play. The ab-sence of sight makes the child'supbringing genuinely difficult;it demands much greater virtuesin the mother than those re-quired for.bringing up a sightedchild. The necessity to adaptto the special needs of theblind child should not overlookthe fact that these needs re-main unknawn. The quality of-performanCe which some blind

children achieve bears witnessto very remarkable ingenuity ontheir part, but leaves untouchedthe profound lack of comprehen-sion of the compensatory mecha-nisms which they brin4 into play.To our knowledge, only W. Brodey(1969) has attempted A compre-hensive study of these mecha-nisms by placing himself in agroup of blind students as anethnologist faced with an un-known world, the blind studentsacting as informers. By livingblindfolded for long periods hewas able to experience at firsthand to what extent the'hyper-cathexis of sight in everysighted person suppressed (inthe physiological sense of theterm) the relevant informationconveyed by the other sensorychannels, and to measure thequality of this information.This writer reached the con-clusion that while the sensoryworld of well-adapted blindpeople is different, it is infact infinitely more rich andvaried than the, world of thosewith sight. Hcniever deservingof criticism the methodologymay be, this path of studyamong others seems to be likelyto lead to a more positiveunderstanding of blindness,and to a demystification ofthat which, in familial edu-cational, and social atti-tudes, is merely a projectionof this lack which is in our-selves.

ACKNOWLEDGMENTS

We are deeply indebted to D. Burlingham for her constant support and toW. A. Cobb for his help in translation.

15

BIBLIOGRAPHY

Bourdier, P. "Essai Psychanalytiquesur le 'Regard," in A. Dubois-Poulsen, G. C. Lairy, A. ReMoud

Oeds.) La V.--,nction du iegard,Colloque de 1Inserm, Paris1971.

Brodey, W. M. ."Human Enhancement:Its Applications, to Percep-tion," Proceedings of the Partional Seminar on Se-rvices toYoung Children with Visualpairment. New York: AmericanFoundation for the Blind,June 1969, pp. 11-51,

Burlingham, D. "Some Notes on theDevelopment of the Blind,"Psychoanalytic Study of _,theChild, 1961, Vol. 16; pp. 121-45.

Burlingham, D. "Rearing and itsRole, the Development of theBlind," Psychoanalytic Studyof the Child, 1964, Vol. 19,pp. 95-112,

Burlingham, D. "Some Problems ofEgo.DeVelOpment in Blind Chil-.dren," PsyChoanalytic Studyof the Child, 1965, Vol. 20,pp. 194-208.

Burlingham, D. and A, Goldberger."The Reeducationa Retarded'Blind Child," PsychoanalyticStudy of the Child, 1968, Vol23, ppo 369-85.

Colonna, A. "A Blind_ Goes toHospital," Psychoanalytic Studyof the Child, .1968, Vol, 23,pp. 391-422.

Coughlin, E. W. "Parental AttittidesToward Handicapped Children,"Children, 1941, Vol. 6,-pp.41-5.

Cratty-, C. Peterson, J. Harris,and R.' Schoner. "The'Develop-.ment of Perbeptual-Motor Abili-ties in Blind Children andAdolescents," The few,) Outlookfor the Blind, 1968, Vol. 62,pp. 111-17.

Deutsch, P. "The sense of Realityin Persons Born Blind," The

Pr:,A,,iogy, 1940,vol. 10,.pp. 121-40.

Fraiberg, S. "Parallel and DivergentPatterns'in Blind and SightedInfants," Psychoanalytic Studyof.the Child, 1968, Vol. 23,pp. 264-300.

Fraiberg, S. and D. A. Freedman."Studies in the Ego Developmentof the Congenitally'BlindChild," Psychoanalytic Studyof the Child, 1964;- Vol. 19,pp. 113-69.

Fraiberg, S., B. L. Siegel, andR. Gibson. "The Role of Soundin the Search Behavior of a

'Blind Infant," PsychoanalyticStudy of the Child, 1966,Vol. 21,.pp.'327757.

Hatwell, Y. Privation Sensorielle'et Intelligence: Effete .do.laCecite Precoice,sur la Gen.eiedes Structves Logiques del'intelligence. Paris:1,.U.F.,-1966, 232 pp.

Keeler,' W. R. "Autistic Patternsand Defective Communication inBlind Children with RetrolentalFibroplasEa," in P.:H. Hoch,

,J. Zukin (eds.), Psychopathologyof qommunication, New York:Grune & Stratton, 1958.

Lairy, 3. C., S. Netchine, andM. T. -Neyraut. "L'EnfantDeficient Visuel," Lachiatrie de l'Enfant, 1962,Vol. 5, 2, pp. 357 -439.

'Leger, E. M. and G. C. Lairy."Exploration Psycholoqique duJeune Enfant Aveugle--Methode,Critiques et ObserVationsPersonnelles," La Psychiatricde l'E:faAt, 1965, Vol. 8, 1::pp. 275-302.

Lukoff, I. F. and M. Whiteman. "TheSocial Sources of Adjustmentto Blindness," New york:

American Foundation for theBlind, Inc., Research Series21, 1970, 291 pp.

Norris, M. "What Affects BlindChildren's Development," NewOutlook ror the Blind, 1956,Vol. 50, Sept., pp. 258-67.

Omwake, E. B. and A. J. Solnit."'It Isn't Fair.' The Treat-ment of a.Blina Child," Psy-choanalytic:Study,of the Child,1961, Vol. 16, pp. 352-404.

Parmelee, A. H. "The DevelopmentalEvaluation of the Blind Pre-mature Infant," AmericanJournal of Diseases of Children,:1955, Vol..90, pp. 135-40.

..Parmelee, A. H., M. G. Cutsforthand C. L. Jackson. "MentalDevelopment of Children withBlindness Due to P.etrolental

17

Fibroplasia," American .'curnaZ::scases. of rhildrenf_1958,

Vol. 96, pp. 641.r54.

Revescz, G. Psychology and Art ofthe Blind. London: Longman's,1952.

Van't Hooft, F. and K. Heslinga."Sex Education of Blind-BornChildren," The New Outlookfor the Blind, 1968, Vol. 62,pp. 15-21.

Wright, R. "A Self-DiscoveryVenture for Visually Handi-capped Children," The Inter-national Journal for theEducation of the Blind,1968, Vol. 18, April,pp. 124-26.

APPENDIX

SCALE OFDEVELOPMENT FOR PRESCHOOL BLIND CHILDREN

The numbers alone refer to cor-responding items of the Social Ma-turity Scale of Maxfield-Bucholz.

Maxfield, K. and S. Bucholz.A Social Maturity Scale forBlind Preschool Children.New York: American Foundationfor the Blind, 1957.

The letters P, S, C, or L fol-lowed by a number and the age inmonths refer to the correspondingitems of the Brunet-Lezine test.

Brunet, 0. et I. Lezine. LeDeveloppement Psychologique dela Premiere F;nfance. Paris:PUF, 1951,,129 pp.

The numbers preceded by JIB re-fer to the corresponding items ofthe Hayes-Binet test.

Hayes, S. P. "AlternativeScales for the Mental Measure-ment of the Visually

Postural

Handicapped," Outlook for theBlind, 1942

4Vol. 36, .pp.

225-30.

Hayes, S. P. "A Second TestScale for the Mental Measure-ment of the Visually Handi-capped," Outlook for the Blind,'1943, Vol. 37, pp. 37-41.

In the scale, First, Second...year refers to the real age of thechild to be tested.

The number of months indicatedafter the items of Brunet-Lezinerefer to the age at which therewas successful performance bysighted children. (This explainswhy the second year of real agein the blind child may correspondto performance during the firstyear by sighted children.)

/ First Year

Sensory-Motor Sociability Language Autonomy_

1 2 S9 1 month L8 1 month

S10 7 months

P3 2 months C4 1 month S10 1 month C8 2 months

1

S10 10 months

P7 2 months 4 - 3 L8, 3 months

P1 4 months C3 4 months S9 2 months L8 4 months

P7 9 months

P2 4 months C6 4 months S10,2 months L8 4 months

P1 5 months C3 5 months S9 3 months L8 5 months

P1 6 months 6 - S9 4 months LB 6 months

P1 7 months 7 - S9 5 months L8 7 months

1 18

Postural Sonsory-Motor

First Year (Continued)

Scolability Language Autonomy

P1 8 nonths C3 7 nonths :S 10 6 months 15 -

5 C6 9 months 12 LB 10 months

PI 9 months 8 S9 9 months 16 -

11 9 LB 12 months

19 - 10

P7 9 months 13

14

17 -

20 -

Second Year

25 29 S9 10 months 22 21

P1 10 months C2 10 months S9 12 months 32 PL 12 months

26 C2 10 months S10 12 months 37 31

P1 12 months C5 10 months 34 LB 15 months 33

P7 12 months C6 10 months 24 i L8 18. months 35

P1 18 months C2 12 months S9 6 months L9 21 months P1 15 months

P1 21 months C5 12 months S9 7 months L8 24 months P7 15 months

C2 15 monthsi P7 18 months

C3 15 months P7 21 monthsC4 15 months

23

C5 15 months

28

30

38

C2 18 months

S9 18 months36

39

21

40

19

1

Third Year

Postural Sensory - Motor, Sociability Lanquage Autonomy

P1 24 montns

P1 30 montn.:

42

46

45

HB3

44

51

50

41

47 1184 L9 24 months

43

48 'S10 24 months 1,8 20 months

49 I

54 SIO HB6

55

1182

P7 24 months

C2 24 months

P7 30 months

C2 24 months

52

53

S9 30 months

1Fourth Year

69 62 6]

57

HBG 69 64

56

66

i I65

)1B6 70

67

HB5 1184

60

68

58

Postural

Fifth Year

Sensory-Motor Sociability Language Autonomy

79 71 8l

-74

80 72 83

78

85 77 HB1

82 HB2 75

76

84

73

Sbdh Year

86 I-1B1

93

94

90

95

87 I

89

88

91

92

,

21

4

Brunet I.ez ine

First '1%.ar

Postural

P3 - 2 months Lying on back, holdshead erect when pulled by theforearms to a seated position

P7 - 2 months Turns self from sideto back

P1 - 4 months When lying on stomach,keeps legs extended

P2 - 4 months Lying on back, liftshead and shoulders when gentlypulled by the forearms

P1 - 5 months' Stays seated withslight support

P1 - 6 months Held vertically, sup-ports part of own weight on feet

P7 - 7 months Passes toys from onehand to the other

P1 - 8 months Lifts self to a seatedposition when slightly pulled bythe forearms

P1 - 9 months Can remain standingwith support

P7 - 9 months ° When held under thearms, males walking movements

Sensory-Motor

C4 - 1 month Reacts to bell

C4 - 3 months Holds a rattle firmlyand shakes it with sudden, in-voluntary movements

C3 - 4 months When seated at thetable, fingers the edge of thetable

C6 - 4 months While lying on back,shakes the rattle placed in handand listens to it

C3 - 5 months Grasps a block whenit is placed in contact with hand

22

C3 - 7 months Grasps two blocks,one in each hand

C6 - 9 months Rings the bell

Sociability

S9 - I month Ceases crying whenapproached or spoken to

S10 - 1 month Begins sucking reac-tion in anticipation of feeding

59 2 months StOps moving or turnshis head when spoken to

S10,- 2 months Smiles at familiarvoices

S9 - 3 months Becomes animated atthe perception of feeding prepara-tions

S9 - 4 months Laughs out loud

S9 - 5 months Uncovers self byarticulated kicking; .grasps ownthigh or knee

S10 - 6 months Distinguishes betweenfamiliar and strange voices

S9 - 9 months Reacts to certainfamiliar words

Language

L8 - 1 month Emits small gutturalnoises

L8 - 2 months Emits several vo-calizations

L8 - 3 months Babbling: prolongedvocalization

L8 - 4 months Vocalizes when spokento

L8 - 5 months Utters cries ofjoy

L8 - 6 months Makes trills

L8 - 7 months Vocalizes several well-defined syllables

L8 - 10 months Repeats a sound thathas been heard

L8 - 12 months Can say three words

Autonomy

S10 - 7 months Can eat a thickcerea2_ with a spoon

S10 10 months Drinks from a cupor a glass

P7 9 months When held under thearms, makes walking movements

Second Year

Postural

P1 - 10 months When standing withsupport, lifts one foot and putsit down

P1 - 12 months Walks with help whensomeone holds hand

P7 - 12 months When standing, bendsto pick up a toy

PI - 18 months Pushes a ball withfoot

P1 - 21 months Kicks the ball, afterdemonstration

Sensory-Motor

C2 10 months Finds a toy hiddenunder a napkin

C3 - 10 months After demonstration,puts a block in a cup without re-leasing it (or takes it out ofthe cup)

C5 - 10 months Takes the round formfrom the board

C6 - 10 months Looks for the clapperof the bell

23

C2 - 12 months Picks up a thirdblock while keeping the two al-ready in possession

C5 - 12 months Puts the round formback into the hole on the board

C2 - 15 months Constructs a towerwith two blocks

C3 - 15 months Fills a cup withblOicks

C4 - 15 months Introduces a tinyobject into a bottle

C5 - 15 months Puts the round forminto the hole on the board whenrequested

C2 - 18 months Constructs a towerWith three blocks

-Sociability

S9 - 10 months Understands an inter -_diction, stops doing somethingwhen requested

S9 - 12 months Gives an object byrequest.

S10 - 12 months 'Repeats.actionswhich have provoked laughter

S9 - 6 months Takes own feet inhands

S9 - 7 months Puts feet in mouth

Language

L8 - 15 months Can say five words

L8 - 18 months Says at least eightwords

L9 - 21 months Asks for food anddrink

L8 - 24 months Makes sentences ofseveral words

Autonomy

P1 - 12 months Walks with help whensomeone holds hand

P1 15 months Walks alone Sociability_

P7 - 15 months Climbs stairs on allfours

24 months Helps to set ownthings in order

P7 - 18 months Climbs stairs stand- 510 30 months Does not wet beding when someone holds hand at night

P7 - 21 months Descends stairs whensomeone holds hand

S9 18 months Feeds self with a Languagespoon

Third Year

Postural

P1 - 24 months Kicks a ball on re-quest

P1 30 months Tries to stand onone foot

L9 - 24 months Calls self by ownname

L8 30 months Says "I"

Autonomy

P7 - 24 months Climbs and descendsstairs alone

P7 30 months Can carry a glassof water without spilling

S9 - 30 months Puts on ownSensory-Motor slippers

C2 - 24 months Constructs a towerwith at least six blocks

C5 - 24 months Puts all three formsin the board

24