A Roundtable on Coping with Chronic Illness and Disability. Presenters: Dr. Beatrice Wright and Dr. Hanoch Livneh >> We're ready to welcome you. I'm Chrisann Schiro-Geist. We are thrilled today to have both living in front of us a group of persons interested in our topics today which is coping with chronic illness and disability as well as everyone who is currently out there in -- connected to us through this web seminar. We really want to thank the Independent Living Rehabilitation Utilization center for partnering with us in this process of bringing together both the persons who can attend here at the University of Memphis and those who could not come to Memphis to have this wonderful round table that we're going to have but who are allowing us through the miracles of technology to webcast and to bring much of the rehabilitation world to a connectedness with us this afternoon. We also want to thank the Rehabilitation Research Institute for Underrepresented Populations for contributing to the webcast activities today. This is also an activity that has been promoted through our University of Memphis Institute on Disability, and I just wanted to say that we're all pulling together as a team as well as with the department. Dr. Strohmer will do an introduction to the department for you so that everybody really wants this to be a wonderful experience for all of you. All of the partners are thrilled and especially with the program in rehabilitation here at the University of Memphis for bringing our speakers to us today. Obviously you all are aware that we're going to have Dr. Beatrice Wright and Dr. Hanoch Livneh speak with us -- not to us -- because it's a roundtable on coping with chronic illness and disability. Before we have a discussion, Mr. Houston will come and tell those of us that are here how to use our technology. Thank you. >> Good afternoon, my name is Dan Houston. There is one button in the bottom of the console. You'll see a small face on top of it. The first person to press that will see a red light on the top of the unit on the microphone. I see (inaudible) and on top of the button as well. That means you are the active speaker. If the speaker is still active you'll see a flashing green light. (Inaudible). Are there any questions? Excellent. >> DR. STROHMER: Okay, good afternoon. My name is Doug Strohmer. I'm with the Department of Counseling, Educational Psychology and Research at the University of Memphis, and I have the honor and pleasure of introducing our panelists. It's a rare occasion where one gets to introduce someone who sort of spurred them to take the career direction that they took, and I have that opportunity this afternoon in Dr. Beatrice Wright. Her book, that I'll talk about in a minute, inspired me to take the career direction I took and so this is the first time I've met her and I want to thank her for all the good years I've had. Dr. Wright is a professor emeritus at the University of Kansas. In looking at her resume last night I noted that it's just incredibly impressive (inaudible) other than to say that she's one of the founders of the (inaudible). She holds fellow status in less than four divisions in APA. She's also an award winner in the American Rehabilitation Counseling Association I determined from looking at her resume. She's the author of a large number of articles and books. Two of her books that use psychological approaches to understanding disabilities were honored by APA by being included in a list of distinguished books in psychology. One of her books, Physical Disability -- A Psychosocial Approach probably inspired most of the rehabilitation counselors and rehabilitation psychologists working today. In fact, the student doing research with me currently who I think is in the audience somewhere is using that book as we speak. (inaudible) inspired many of us and impacted on many of us. One very short story about this impact years ago when I was attempting to become published and become a tenured professor, I sent an article to the Journal of Rehabilitation Psychology. It came back rejected but try again. And so I sent it in. It came back. I fixed it. I sent it back. It came back rejected. Try again. I sent it in again and the same result. So I called the editor, her name is Mary Janson and I said why aren't you publishing my article? I've done everything you've asked. And she said, well, Doug, the one reviewer that doesn't like your article is Beatrice Wright, and I said, oh, okay. I understand. And I went on and I did other things. However, I do have one last revision that I wonder if Dr. Wright would look at. In any case, welcome to Memphis. It's such a great honor and pleasure to meet you. Also another individual who's probably rejected my research many times before is Dr. Hanoch Livneh and someone who I consider to be a premier researcher and rehabilitation psychology and rehabilitation counseling. He's professor at the Portland State University, coordinator of the rehabilitation counseling program there. He's an award winner, American Rehabilitation Counseling Association award winner. He's won their career research award. He's a fellow in the Division of Rehabilitation Psychology for APA. He has extensive research background in coping with adaptation to chronic illness and disability, attitudes towards people with disability and measurement outcomes in rehabilitation. And he's someone who we've coveted for years that we want to bring to Memphis as an employee and this is the best we could do. We could get him here as a guest panelist. Hanoch, welcome to you as well. And I just want to acknowledge one other panelist, Dr. Erin Martz, who is busy trying to make the camera work. Erin is an assistant professor at Memphis. She's the coordinator of our rehab counseling program. Also an award-winning researcher, numerous publications, and she's the person who I'd like to acknowledge for setting all this up today. And my prediction is that she will be following in the footsteps of the other people on this panel and so I want to thank Erin for all of her work. And then I'll also be on the panel, but I'm just a guy that does the introductions and so welcome to you all. I'll turn it over to you, Erin. [ APPLAUSE ] >> DR. MARTZ: I'm designated as the moderator for this program. For you people in the audience, if you push the button, it will take turns in order, but we're also connected nationally and possibly internationally, we don't know who is logging on at this point. So they are going to be E-mailing questions during the program and I will read from my E-mail, but first of all, we're going to start with Dr. Wright and she would like to talk about her coping and succumbing framework. And I believe it's slide No. 9, and we also have it up on the screen and we're going to start out with that and Dr. Wright will take over from here. >> DR. WRIGHT: I, too, want to welcome you all. Those of you who are physically present and those of you who are webcasting near and far. (inaudible) something called coping versus succumbing framework and with the introduction when it was pointed out that I rejected his manuscript -- I was thinking. I wager -- I wish I knew why I rejected it, but I wager it had something to do with what I'm talking about today now in my presentation here -- and you can verify if that is the case. The reason why I'm going to be concentrating on something called the coping versus succumbing framework is that it is understood as being a black or white, either/or situation; and I hope by the time we get through that you will appreciate the complexity of the concepts. It's a conceptual formulation. It includes -- and I will elaborate this as we go along -- issues of value, issues of flawed human perception, issues of how we make corrections for flawed human perception that lead us astray. I would be very glad to have you interrupt me and ask questions. Though in this hall that we're in now, I'm not sure I'll be aware of when you want to ask a question, but Dr. Martz will keep me posted on that. In fact, I might even pose a question to the audience and to those webcasting it. I will ask Dr. Martz to read the first point under the coping side of the coping and succumbing framework, and under the succumbing side out loud so you can hear and listen attentively. >> DR. MARTZ: Point No. 1, the emphasis is what -- on what the person can do and that's the coping framework. The succumbing, the emphasis is on what a person cannot do. >> DR. WRIGHT: That may seem simple. The emphasis is on what the person can do. That's the coping framework versus the emphasis is on what the person can't do. Big deal. Seems so simple, but let me remind you of something: Why is it that so often the emphasis is on the deficits of the person, the shortcomings, what we call sometimes in a pejorative way the pathological? Why is it so hard to keep in focus on what the person can do, the assets of the person, the strengths of the person? Why is it so hard? It's so hard because after all a person comes in with a problem. The person doesn't come in with a strength. The client or with assets, he or she presents oneself with a problem. Our mind goes negative. Immediately our mind goes negative. And what we do as counselors, as clinical psychologists, might I add as psychiatrists -- anybody -- anybody in the helping profession, a stranger on the street, we zero in to what is presented to us, a disability, or if it's a chronic illness, if that's all we know about the persons that's what stands out. We call that (inaudible). It jumps out at us if it's a visible disability. Any person on the street can see it. That's all you know about the person. Your mind goes negative. Before I'm through, I want to be sure you ask me, if I don't think about it, but I'm sure I will, what do we do about flawed human perception? After all, I'm proposing it's hard wired in our brain. That's pretty rough stuff. That's hard to confront, yet we are able to control it; and I'll tell you how. Now I'll ask Dr. Martz to read point No. 2. It's a little long. >> DR. MARTZ: First may I ask -- I don't see any questions from the audience yet. Why is it do you think that our mind is wired to focus on the negative parts of human life? >> DR. WRIGHT: There are several explanations. Let me add a piece of research before I directly answer that. We know from research that more weight is given to negatives than to positives. Lots of research on that issue. The potency of negatives -- one idea is in terms of being hard wired is an evolutionary idea. One had to be alert to negatives in the environment to survive. That's why our attention gets focused on threats, on decadence -- that sounds like a very fundamental background causality piece of information that might account for it. But I tell you what -- let me jump in here. Once you're aware that your mind will go negative, you know, awareness is an amazing trait of the human being consciousness, awareness. It's simply amazing. Now, what I'm proposing even before we mig great down to No. 8 is once you becomes sensitized to what's hard wired in the brain, and there will be others as we go along, you can stop the action on the mind. What you need to do is stop the action of the mind and say, whoa, and then you shift to the strengths and assets of the person. And we can do that, and I propose that in our training courses, whether it's with disability, mental illness, any disadvantaged position that is categorized by society as a negative, that training in flawed human perception, I propose as hard wired, I propose that we can become sensitized to it through training, and I propose that we can stop the action and switch to what amounts to -- is a constructive view of (inaudible). So thank you for that question. Anybody else? >> DR. MARTZ: We have a question here. >> AUDIENCE MEMBER: I have a -- maybe I'm getting way ahead of this, but one of the things that came to me in the remarks that you've made already is that what we have currently in practice is an emphasis on quick things, quick therapy, brief therapy, getting to things real quickly. And when you're very time limited, it's probably an easy route to go to the negative are rather than the positive. So what do we do about that? Because it sounds like this understanding of what somebody can do may be a little bit more time-consuming than just the quick identification of what they can't do, but we do have is the realities of HMO's that are giving us four sessions or, you know, limits that are out there. How do we negotiate this needing to get to (inaudible). >> DR. WRIGHT: That is a big reality problem out there in society. We have to deal with reality problems. How do we deal with them? Well, it depends on what the reality problem is. I don't want to go too much into (inaudible) because I'm really eager to go through the remaining seven, but I will say advocacy, never give up on advocating. What does that mean? Working through your legislate tour, using the right to vote, societies change slowly, sometimes dramatically, just think of what happened in 1973 when the Americans with Disabilities Act with finally passed after many, many, many years, even decades I would say, of some kind of effort. That's a short answer, not in detail, but it just gives the outline. But if I could go on to No. 2 at this point and be sure we can have conversations afterward or follow it up if we have time. >> DR. MARTZ: Okay, No. 2: Areas of life in which the person can participate are seen as worthwhile. No. 2, little weight is given to the areas of life in which the person can participate. >> DR. WRIGHT: Think about that. It's really vital. Areas of life in which the person can participate is seen as worthwhile. What does all that mean? One can easily devaluate what the person can do and cause (inaudible) of a standard called the normal standard. We tend to idolize normality. I have here, by the way -- I brought it just in case I could refer to it and here is a good opportunity. An E-mail came to me just before I left Madison, Wisconsin. There's a presidential symposium called -- organized by the Association for Psychological Science, and it says how science produces stigma. Now, I wrote about how science produces stigma. I should say maybe four decades starting, and now it's getting a hearing. I will add, believe it or not, that McClain Hospital of the Harvard Medical School is shifting the Department of Psychiatry -- hear yee, hear yee -- is shifting its focus to what they call positive psychology and they are hiring a psychologist who is for positive psychology. So the point is take heart, there is change -- slow but sure sometimes. We're all impatient and I just remarked to a friend recently when I got stuck in Chicago coming here, I kept reminding myself, patience is a virtue. I must say it didn't -- (inaudible) I was very antsy. >> DR. MARTZ: I'll have to jump in at this point because she problem solved that day and advocated for herself and I was in communication with her all day and there was a three o'clock flight she got on and she was supposed to go out at 4:30 so that impressed me with her advocacy. >> DR. LIVNEH: I think some people may misinterpret the succumbing as being a very simple dichotomy. Some people would read it into some type of a continuum. So there is a gray area of coping under some conditions, under some conditions they may succumb. Do you feel it's more of a Draconian dichotomy or is it really more of a continuum with two end points and how you perceive that? I decided to ask that at this point rather than (inaudible). So we can really get some clarification before we get to No. 8. >> DR. WRIGHT: Right. Excellent. You know, the human being is not all one way and all the other way in anything. We speak about extroversion, introversion. The extrovert isn't always being an extrovert or the introvert isn't always being an introvert. There are circumstances and conditions -- now, this is a complex sentence -- factors both within the person and outside the person, meaning the environment, that makes for complexities and the individual response to those complexities. So, yes, I'm glad you did bring that up, Hanoch. Sometimes we're within the coping framework. Sometimes we're in the succumbing framework. And I'll tell you another thing, sometimes we want to wallow in self-pity. Sometimes we just get tired coping or dealing or problem-solving and we just want to mourn our loss and suffer our loss. It's very hard. I want to also say that what I am talking about is not only physical disability, not only chronic illness, I'm talking about loss of any deep source like bereavement or it applies to varying kind of mental illness. This has to do basically with issue involved in acceptance of loss, whatever the source, and it's not that you're always within a coping framework because sometimes you need a plateau, if not drifting into the succumbing framework just to reenergize yourself. And I'm throwing in a few other things that will come along the way, the role of your social environment, your support network is so very important. That requires in itself a great deal of sensitivity. Your friends, your family need to respect the person enough t one who is suffering enough, to take cues from that person as to when to proceed with shifting more to the coping fervor and that is certainly true of the rehabilitation counselor and anybody in the rehabilitation area as well, any of the helping professions. >> DR. MARTZ: Are you ready for No. 3? >> DR. WRIGHT: Okay, No. 3. >> DR. MARTZ: Coping -- the person is perceived as playing an act representative role in molding his or her life constructively. Succumbing -- the person is seen as a victim of misfortune. >> DR. WRIGHT: That brings us to several other principles. The person is seen as actively -- actively what was that -- dealing -- go ahead. >> DR. MARTZ: Is playing an active role in molding his or her life constructively. >> DR. WRIGHT: Yeah, as against being a passive recipient. Now, if you really, really respect the person, I'll use the generic term client, then you don't adopt that you know everything and the person has to follow your orders. It's so much easier for the -- I'll use the term therapeutic process -- if you consider the client as a co-expert and together you'll march along in solving the problem. That the client is an essential active participant. Sometimes you have to go slow and just respond to the client's feeling. This has to do a lot with the concept of the insider versus outsider position. The insider is the person who is suffering, whether because of a mental problem, physical illness, the person that we're talking about, that person has a whole world in consciousness and subconsciousness. The outsider, the rest of us, are not privy to that inside world at all. We think we are. We think we know what the person is thinking about, the is experiencing, we make inferences all the time. That's also understandable as to why we do that, but I won't go into that, but if you really give way to the difference in position between the insider and the outsider and respect the person and are convinced that that person needs to take an active role you can't talk for the person. It has to be a team effort. Then you sensitize yourself to what the person's needs are, what his thoughts are, and you elicit them whenever you can, as you can, as you go along. Are there any other -- >> AUDIENCE MEMBER: I have a question. Do you think that perhaps a student choosing to get off of his or her medication would be along these lines? >> DR. WRIGHT: You'll need to repeat that. >> AUDIENCE MEMBER: Do you think that a person choosing to get off of his or her medication would be something along these lines, coping, taking charge of their life? >> DR. WRIGHT: I'll repeat it to be sure I have your question. Do I think if a person chooses to get off medication, it's an indication that person is taking charge of his life? Is that the question? Oh, you're right there. Oh, Hi. >> AUDIENCE MEMBER: Hi. >> DR. WRIGHT: You know it's hard for me to see you. >> AUDIENCE MEMBER: I just see a lot of students, particularly some students with ADHD whenever they first get into college they choose to get off medication because their parents forced them to while they were in high school and after a semester or two they realize they needed it. I'm just curious your thoughts on that. >> DR. WRIGHT: by definition they are taking charge of their life. Is that choice a good thing always? Certainly not. That was a choice to take -- to get off medication. I'm not in a position in an individual case to say that was a good idea. Sometimes medication keeps the person who is psychotic, bipolar, as an example, on an even keel and they may choose to take charge of their life and get off (inaudible). In their mind it's probably for good reasons. They don't like the side effects, let us say, but it may not be a good choice. And should we respect that? Well, it depends. If we can interact with the person further and help the person understand getting back on medication, if it's an adult person who is independent for your supervision, you know, it depends on the case. All right. I think we can proceed to No. 3, is that right? >> DR. MARTZ: No. 4 now? >> DR. WRIGHT: Is it 4? Okay, moving right along. That's good. >> DR. MARTZ: and just a reminder for audience members, if you can ask your question a little more slowly because they are transcribing as we speak. No. 4, coping, the accomplishments of the person are appreciated in terms of their benefits to the person and others. This is asset evaluation. And not evaluated because they fall short of some irrelevant standard. And the succumbing framework, the person's accomplishments are minimized by highlighting their shortcomings and this is comparative status evaluation, usually measured in terms of normal standards. >> DR. WRIGHT: and that is really an important point, a complicated point. In the coping framework, the person's abilities are evaluated in terms of what they do for the person or someone else without comparing. We call that asset evaluation. It just respects a good thing for itself. If the person can move a finger, that's pretty remarkable. That's, in fact, amazing that you can move a finger. Isn't that amazing? We need to value that and make use of that as an ability, perhaps by being able to move the finger the person can learn to feed himself or many, many other things by that one ability. If you view whatever the person can do that is helpful to the self and helpful to the self may mean it gives that person pleasure. Or helpful to others -- recognize how wonderful that is and to make use of that asset whenever you can, you've gone a long way in working towards a constructive view of life with a disability. Now, disability not only physical -- remember you generalize beyond that. The problem is that we are so geared to what we call comparative status evaluation. I mentioned before idolizing normal standards. What's so good about a normal standard? Why do we idolize it? Why do we say if we fall short of a normal standard that's bad? If you fall short and that reflects an ability that's useful to the person, that's a good thing. It should be recognized as a positive. If it falls below standard, we stand to stigmatize that person. That's what that article is about -- that I referred to -- how science creates stigma because so much of our work in evaluation, in testing, has some kind of normal standard. We compare people one category of people with another kind of category t so-called mystical nondisabled, whoever they are, and we identify as normal in some way, and if you deviate from that, it's a bad thing. Let me make that concrete for you. Let's say in the intelligence testing field we have the concept of the 100IQ as being normal and then we categorize people as being borderline retarded and if you hit the IQ of 70 you're mentally retarded and is being retarded a good thing? No, it's a bad thing in our society. Why? Because it's below standard, and in terms of comparing the intellectual ability of that person with most of the people that we call normal, it falls short, but this (inaudible) holds a lot of ability in the person who has an IQ of 70, even if you have an IQ of 50, can you imagine a person with an IQ of 50 has the mentality of the average 8-year-old. Doesn't an 8-year-old have enormous abilities mentally? Enormous, but we are led astray because we idolize a normal standard. We emphasize instead of the assets of the person, the deficits of the person because the deficits stand out. Once you give a label, labels are fraught with a lot of danger because if the label turns to the negative, your mind -- my mind -- goes negative. It goes in the direction of what the person cannot do. I am as much a prey to it as the rest of the population. The only thing I can tell you, and remind myself, is be aware when your mind goes negative. Stop the action of the mind. That's not enough, because the mind can be empty unless you're meditating. Fill it with a direction to look for the strengths and assets of the person, what the person can do, how that can benefit the person, how you can utilize those assets in helping the person. It's factually an axiom in order for a person to improve the self, you have to make use of the strengths and assets of the person as well as -- I should quickly add -- the resources in the environment. We'll pretty soon come to the environmental side as we negotiate these things. If it's an axiom, how come we don't attend to it? An axiom is self-evident, isn't it? Isn't it self-evident that to help a person learn to walk you have to figure out what that person's strengths are that will enable him to progress in a rehabilitation/physical therapy regime? It's an axiom. But you know what, the obvious is not obvious until it's obvious. And you know something else, you have to be sensitized to the flawed human perception that leads us astray. In this case, when something stands out as negative for whatever reason, I mentioned one reason if it's below normal, idolizing normality. There are other reasons. For whatever reason, your mind, my mind, will go negative. It's incumbent upon us to be sensitized to that, interrupt the action of the mind, shift to looking for the positives and strengths. >> DR. MARTZ: I need to ask you, aren't there some things in the world that are simply negative? >> DR. WRIGHT: That's why I said for whatever reason. Now, I think we all here will agree that to suffer an injury that leaves you paralyzed, let's say. I'll take a physical example, is not a good thing. We wish it didn't happen, right? Okay, we could say isn't that intrinsically negative? Isn't it just obvious? That's why I say for whatever reason. Now, there are some people -- remember a man from England named Finkelstein? You were there at the conference. Do you remember him? He argued that it's all in the environment. Of course if everybody used a wheelchair, if we were born paralyzed from the waist down, then the human being, presumably, would have accommodated to that limitation and figured out how to make a wheelchair and we'd all be using wheelchairs we wouldn't even know what word stairs meant because we wouldn't have any stairs, et cetera, et cetera. It would all be in the environment. And we would not have even a concept that it's a bad thing. (inaudible) you look at a bird fly, haven't you often thought how nice it would be to soar above the earth and fly? We're not born that way, so we don't consider that lack of ability as a disability, as something negative. We just think how nice it would be to fly. Yes, that would be an asset. That's asset evaluation; and yet we don't devaluate ourselves because we can't fly. Any other question or should we proceed? >> AUDIENCE MEMBER: Is this turned on? Hi, Dr. Wright. I'm glad you brought up this point. It remind me of a discussion I had with my 11-year-old daughter yesterday. She has multiple medical problems. She's had early intervention and has overcome by far the majority of them. She's recovered so far that she now asks questions about the specific areas that she still has difficulty with, and as she moves into middle school, she'll go to regular education and she's beginning to notice that she doesn't make stellar grades in all her subjects. So she asks, mom, why is it okay that I make C.'s and D.'s and my brother makes A.'s and B.'s? Why can't I be like him? How do you help someone navigate the fact that our world functions on a comparative system between individuals of differing ability and help keep a child focused on what they can do instead of what they can't? >> DR. WRIGHT: That's a very important question and it's a (inaudible), but what can you do now on this trajectory of a lifetime of learning? I'm sure you said things to her like you have other kind of abilities that are just better -- now you're using a comparative -- as soon as you say better, you're comparing. Better than Joey across the street. I don't know what it would be, but you -- you can even do that without comparing. You can point out her strengths and assets. Isn't it wonderful that you have such a beautiful smile? I'm inventing. Maybe you can -- I'll turn it back to you. What could you say to her? >> AUDIENCE MEMBER: Well, we had this conversation that you're describing and, in fact, I asked her what her gifts were? >> DR. WRIGHT: What her what? >> AUDIENCE MEMBER: What her gifts were. And as it turned out, she performed in the opera this weekend. Now, so here is a child that wasn't supposed to walk, who is dancing and singing on stage at age 11. I said, you know, there are not very many children who might be able to do that. What are your other gifts? And then we talked about my gifts, and her father's gifts and they are all different. And I said, you know, everybody doesn't get the same gifts. And she said, yeah, but that doesn't solve my problem next year. (Laughter). >> DR. WRIGHT: at that point, you can stay with where she is at, remember I said positive to when a person is in the mode of focusing on the negatives, you can say yes, it's hard to feel that you can't make the grades of your brother like your brother. That's hard. You bring in effort as an asset value. Effort is a good thing without comparing and you can say, but I know you try and that is so good. And you know you can even elaborate, but not all in one breath. This is, you know, slowly over time. You can even say things like, you know, C. is not a bad grade at all. I got C.'s in blah, blah, blah, when I was in college. (inaudible). But you're not going to accomplish the shift from comparative evaluation to asset evaluation. That is a very maturity, life-long process. It does help as you have done when you remind the person or elicit from the person what things are very positive about her. In this case, she used the word gifts. What are some fun things you like to do? The wonderful thing about human functioning is -- now, this will apply especially to depression as an emotional disorder -- as long as you can find things that are satisfactory in life, whatever it is, and keep bringing to the fore those satisfactions in life, whatever is either interesting or tastes good, if you go the (inaudible) route, whatever you can do to bring out positives in living helps with the feeling of I'm not as good as on the negative side. >> AUDIENCE MEMBER: Thank you. >> DR. MARTZ: Shall we go to point No. 5? >> DR. WRIGHT: Yes. >> DR. MARTZ: the negative aspects of the person's life such as the pain that is suffered or difficulties that exist are felt to be manageable. They are limited because satisfactory aspects of the person's life are recognized. The negative aspects of the person's life such as the pain that is suffered or difficulties that exist are kept in the forefront of attention. They are emphasized and exaggerated and even seen to usurp all life. >> DR. WRIGHT: Partly our discussion bordered on this point when I said it's so good that you try bring out the positives in her life and then I went into depression. We know that you can limit the negative concerns of a person. You can help them live with it, shall I say. If you keep bringing out the positives and notice that we're talking about changes. I cannot emphasize enough the word values. We already talked about asset evaluation rather than comparative status evaluation. We talked about emphasizing what the person can do as a strength, as an asset. Now we'll use a technical term -- we're talking about containing disability effects. Your daughter, who is so disturbed and troubled by having C.'s and D.'s and not A.'s like her brother, we want to contain those negative thoughts and how do we contain them? In the disability language we call it the value change containing disability effects, if that's in the forefront, it will spread. What does that mean, it will spread? It will encompass the whole person, horror of horrors. Your daughter -- now, I'm not saying this is true of her, but it could be true that she begins to feel that she's not good at all, that she's a bad person, that she's slow in everything, that she's a misfit. I mean, on and on and on. You can stretch it out, and that does happen. We refer to that as the self concept where the succumbing side, No. 5, it was all encompassing. It encompassed the whole person. Now, a whole person is a highly different (no audio). (lost connection to video and sound). >> DR. MARTZ: (in progress) experiencing the spread of negative opinion. >> DR. WRIGHT: Good question. When it comes to flawed human perception such that -- I'm repeating myself -- when some things stand out as negative for whatever reason, and the context is very sparse meaning there is no positive to contain that negativity, your mind will go negative. Not only will it go negative in terms of the inferences you draw about the effects, in other words, disability will be exaggerated beyond the disability limitations itself, you'll make all kinds of inferences about personality, unhappiness, inferiority, but also inferences go the other way in terms of cause and that's where we get the phenomenon known as the just world phenomenon. The just world -- I'll come back to answer your question in a minute -- the just world phenomenon, it's an interesting one and there has been research on it. We have the idea that people should get what they deserve and do get what they deserve. In other words, rewards should be deserved, and punishment should be deserved. So if you are in a negative spot, somehow you deserve it. Where does sin come from? You have sinned? You have deserved it. You've brought upon it by yourself. You search for what kind of bad person you are to deserve it; but getting back to your question, applying all these ideas, does it apply to the outsiders as well as the insider, absolutely 100 percent. The outsider is thrown to flawed human perception. The insider is -- suppose I have a disability of whatever sort and my mind is going negative because of flawed human perceptions, suppose I'm concentrating on my disability and I'm feeling sorry for myself and I'm wondering am I an evil person, did I bring it upon myself? That's cause and et cetera. I can be trained, and counselors can help the person train. I can be trained to stop the action in my mind on the insider, on the human being. I can say, whoa, I know where you're going. I'm not going to go that way. That's not helpful. Stop the action of your mind, you insider, shift to something positive. Bring out -- think of the good things about yourself. Now, the next point, I think, No. 6 does deal with negatives further. >> DR. MARTZ: Okay. If I may interrupt before we go to No. 6. There is actually about 90 people online listening from across the nation. Thank you, everyone, for tuning in. There is a question from east Texas advocacy project in Tyler, Texas. She's been listening to what you have said about negatives and she was wondering if these negative attitudes are more of coming from fear of a person with a disability so the people are afraid of a person with a disability and they don't know how to interact and so she's wondering if you view fear as a negative response? >> DR. WRIGHT: Oh, if you are -- is the question if you have a disability, does it evoke fear in the onlooker? >> DR. MARTZ: Yes, I think so. >> DR. WRIGHT: It can. Yes, it can. Always -- no. Now, we have a concept of fear of the unknown. One big leap forward (inaudible) was both when we began to realize the problem of (inaudible) combinations on the outside, and the environment, eliminations of barriers of one sort or another and we had legislation to that, that helped the public become familiar with situations involving illness and disability. Educational programs, be it on television or otherwise, integrating children in regular classrooms brings about greater familiarity and we know it is the unfamiliar (inaudible) with the strange that evokes fear. A person with a visible disability can be expected to encounter people -- with strangers who are not familiar with their situation -- sort of be taken aback or even some sign of fear. Maybe that will happen with some frequency. And hopefully the frequency is reduced as our educational programs begin to reduce unfamiliarity. >> DR. MARTZ: Let's move on to No. 6. Managing difficulties mean reducing limitations -- I'm sorry -- means reducing limitations through changes in the social -- physical environment as well as in the person. And examples include eliminating barriers, environmental accommodations, medical procedures, prosthesis and other assistive devices and learning new skills and the succumbing framework includes prevention and cure are the only valid solutions to the problem of disability. >> DR. WRIGHT: Okay. So this just goes in to managing difficulties, as I said on the physical side. And it referred to on the environmental side. >> DR. MARTZ: As well as in the person. >> DR. WRIGHT: As well as in the person. >> DR. MARTZ: Shall we go -- >> DR. WRIGHT: Notice that (inaudible) on the person side and the environment side. Now, that's more complicated than you think. We'll start off with a simple thing first and then show the complexity. It's pretty clear that any behavior cannot take place in an environment of a vacuum. So we always need to include the environment an yet we very often neglect the environment. How come? That's an interesting question. Again, it's an axiom that you can't do anything in a vacuum. Behavior always includes something about the person, what they can do, the motivations, the intentions, whatever you a tribute to the person, and always something about the environment. So how come we neglect the environment? Okay, we neglect the environment because, after all, the person comes to us for help. The environment doesn't come to us for help. We focus on the person coming for help. That's concrete. The environment -- what's the environment anyway? It's amorphous. One has to, therefore, explore the strengths and assets of the environment as assiduously as you do in the person. What is the environment outside the person? Well, we think of the physical environment like barriers. If there are no ramps, you can't get into the building. Okay, that's a physical environment. There is the family environment, meaning the social environment. What takes place in the family? Is the family resources -- and I don't only mean financially -- I mean affective, cognitive, emotional resources, will those resources be helpful to the client? Harmful to the client? The complexities -- it's not simple. Then there is one other complexity. When this great psychologist named (inaudible), brought forth from Germany the idea that behavior is a function of the person and environment, what he was talking about was perception. How the person perceived the self and how the person perceived the environment such that if you perceived the environment as being flat and you didn't realize there was a hole there that you could stumble into, you would walk gayly along and that suddenly you'd have a disaster. You'd fall in the hole. In other words, it was a perception problem, something we call, to use a more technical term, a phenomenal logical problem. There is also an environment that you might refer to as an objective environment, meaning that there are events out there like the hole that we could call not phenomenological in the sense of the person's perception, but objective because all people will agree who see it that it's a hole, therefore, it's an objective environmental property outside the perception of the person. There may be an objective person attributes as well. Maybe I'm taking too much time. >> DR. MARTZ: Yes, 10 after 3. So you have No. 7 and No. 8 and then we'll turn it over the Hanoch. >> DR. WRIGHT: Let's go through that rather quickly. >> DR. MARTZ: the coping framework is managing difficulties also means living on satisfactory terms with one's limitations. Although the disability may be regarded as a nuisance and sometimes a burden, this involves an important value change. And the succumbing framework -- the only way to live with a disability is to resign oneself or to act as if the disability does not exist. >> DR. WRIGHT: Okay. The proposition is what I've elaborated in our discussion. We are working toward a constructive view of life with a disability. What does it mean to have a constructive view? It's the elaboration of these points which includes values and the other things that we mentioned. It is possible to live on satisfactory terms with (inaudible). Sometimes you may regard it as a burden. Maybe it is a burden. It is troublesome. It's a nuisance. So what. Life is not a bed of Roses anyway, there are a lot of snags along the way and we went through how you can pull yourself up out of it. But on the succumbing side the only way is to suffer your disability and to resign yourself to it. And No. 8. >> DR. MARTZ: No. 8, coping -- the fact that individuals with disabilities can live meaningful lives is indicated by their participation in valued activities and by their sharing of the satisfactions of living. And the succumbing is -- the person with the disability is pitied in his or her life essentially devaluated. >> DR. WRIGHT: That's actually the wind up. To live on satisfactory terms with a disability, it does mean accepting your disability as non-devaluating basically. So I thank you very much for your presence here, and you have a lot to think about as we all do. Thank you. [ APPLAUSE ] >> DR. LIVNEH: I'll take questions in just a minute. I just wanted to maybe address two or three of the questions that were directed at Beatrice before. Very briefly, of course, I think the first one had to do with the medication and if somebody chooses to get off. People think about it, usually they'll try to show what will be the impact of when person gets off. Will the behavior deteriorate? Will it affect their health? (inaudible) so really it's a combination of clinical and ethical issues when you get to that. so there is no simple answer but you definitely need to look at the whole situation. Over the years I met quite a few individuals, for example with schizophrenia or epilepsy, and the side effects of some of the medication were so severe, I would rather live with the disability itself and have the symptoms of any of these two conditions that actually go on medication. And these are very, very difficult decisions for both the person, family members of course and any other person involved in the person's life, but you really have to think about that. I also talked to over the years to quite a few individuals who were social security recipients, mainly because of pain issues, and again, some of them suffer the excruciating pain at the point where they elected to get off medication, we actually lost ourself, we were so knocked out with the medication, we would rather have the pain, but know who we are, the identity that we have as a person rather than have the pain gone, but lues ourself in the process. That's something you have to consider. It's more difficult to answer the questions with the A.'s and B.'s versus the C.'s and D.'s. I think in a way it's a reflection in our society on grades. We tend to grill our kids to think that grades are reflective of who we are and success in life. The point behind it is being in the situation where you ask the kid what are your life goals? What are your dreams? Are grades the way to get there? Many times it is no. Grades could be up to a point, but the royal way of getting to whatever it is you want to get to, again, probably if you played safely, the answer would be no, there are some other ways to get my goals and my dreams fulfilled without necessarily worrying about an A./B. versus a C./D. And the last comment had to do with I think the lady from east Texas maybe -- okay, really if you're looking at the literature, and I know that Doug is certainly one of the experts on attitudes in the field, are going back to around 1958 I think where they came with the first article about the roots or origins of attitudes, mainly (inaudible) attitudes towards people with disability and if you look at some of the development since then, there are probably about 20 theories or 20 models or 20 thoughts about why we possess or society has some of those negative attitudes, and obviously I'm not going to try to get to most of them here. But suddenly Beatrice talks about the unknown. That's very, very crucial. Some people bring in the issue of the fear of death, in other words, disability is symbolically being a death, in other words, the death of the eyesight, the death of movement or whatever it may be and somehow and on some level of consciousness or another, it may trigger some fears, some people, again, using psychodynamic tin term taigs thinks about self difficulties or some type of problem with image that may be threatened in the presence of a person with disability. (inaudible) meaning if it happened to him or her, it can happen to me. All the way from contagious diseases, even if they are not, you may think they may be, so you fear it and try to avoid it. Quite a few theories were advanced to explain that so there is really no way to use one specific theory or idea. There are quite a few that may explain the wide variance of reactions that we tend to see in society and their attitudes towards people with disabilities. So, yeah, in a way that's really one thing I wanted to address in terms of the question and if I can see what we have there. It's really not more than a confusing model to all of us and that's the reason we're doing it to confuse the audience. It always helps about halfway into it I guess. Really what you see here is what I think most people in the field of (inaudible) psychosocial adaptation and rehabilitation and people in our specific field tend to agree may be the way to comprehensively look at the role of coping as it relates to some earlier predictors as they often tend to call it and some outcomes. So if you really look at that, then again you'll see that really in a way it tends to verify much of -- or invalidate much of what Beatrice just said a few minutes ago. We are looking at some demographic variables, there is no doubt you have to look at the entire person and you'll see a list of some of the more specific basic elements of the variables on top. You also have to look at some of the specific variables that are related to the disability itself and you see these at the bottom square at age of onset, pain and so forth. (inaudible) and each of these individually, but again, you have to look at some of these issues since they are triggered by the disability or chronic illness. And then we have all the environmental factors, exactly as Beatrice just taught us, you have to look at both the subjective and objective environment as being part of the person's life space when you want to understand better how eventually they cope with and eventually adapt to the disability. So the three boxes on the left-hand side really are kind of the preliminaries. They really set the stage for the rest of the adaptation process. The middle one, which is the second from the right, you really see some of the personality or attributes that tend to interact with any of the first three variable boxes that we just talked about. Pain is one of them. I kind of look the liberty of somewhat enlarging the print on this one, but any of those be there more state specific or more trait, in other words, more kind of cross situational or trans-situational. All appear to be very important in terms of understanding the final outcome. In other words, the final adaptation to disability. And finally, on the right-hand side, what we try to put in here are some of the measures that over the years were used to tap psychosocial adaptation which means these outcomes we tend to measure of how well the person adapts or does not adapt to. I put some of the psychopathological ones as Beatrice mentioned. They are there, unfortunately, and have been there for many, many years. So that anxiety and depression and some of the negative sides of the person will be looked upon as some form of an outcome measure, but certainly moving into quality of life, some measure of adaptation which mean more successful I guess similar to the coping component of the coping/succumbing paradigm that Beatrice just discussed with us. Again, that's really the crucial thing. And again, the whole emphasis on quality of life and positive adaptation really grew exponentially in the last 10 or 15 years, but many times people forget that it's really 50 years or more ago that's what Beatrice and some of their colleagues back then really talked about. It's been there all these years. So when we hear in the work of sell I go man today about positive psychology and the work about posttraumatic growth, these are very fascinating terms, but really they are not (inaudible) of some of the work that was suggested 50 years ago. So terminology tends to change over the years. Different terms, different labels, but clearly in a way much of that work was really done by Beatrice and many of their colleagues 50 years ago. It's important I think to give credit to where it's due and at this point I thought it is important to really show that although we do look at some of the negatives, it's probably very, very crucial now to think more and more -- not just from the insider's point of view, both insiders and outsider's point of view, but look at the positive outcomes, the coping side of it, the successes that the person has, and similar factors that really would show us how to look at the person with disability in a much more positive, healthy way. >> DR. MARTZ: Thank you, Dr. Livneh. We have several questions coming from across the United States. If Dr. Livneh maybe you can address this as well. Can you distinguish between coping and adaptation or coping and adjustments? And let's see, we have a student locally, she's a University of Memphis student, and sorry, I did not mark her name down, but another lady listening on line asked the same question. >> DR. LIVNEH: I think that all the different ways of trying to understand the difference between coping and adaptation, if you're looking at the model over here, which again may be only reflects the majority which means it's not necessarily the right one, people would look at coping as being a precursor to adaptation, which means the type of coping that we use tends to eventually predict or somehow lead the way to adaptation; but it's not necessarily always and that's actually the reason we threw that arrow leading from right to left, which means possibly what we have here is a non-recursive model which means not necessarily just flowing from left to right where coping really predicts adaptation. Under some conditions, adaptation actually can later on enlighten or inform some types of coping. So I look at them as being interactive in nature, but if I were to be forced to choose a cause effect, if that is the right terminology, I would probably say that the literature would suggest that coping strategies or the use of coping strategies probably tend to somehow eventually lead to either more successful or less successful psychosocial adaptation. So basically the flow probably under most conditions is from really left to right in this particular model. >> DR. WRIGHT: the question really has to do with what we mean by adaptation. In the present coping/succumbing model, I'll notice that in the elaboration of the points there was reference to a lot of intrapsychic stuff called value changes. That's adaptation. What do you mean by adaptation -- you see, coping tends to mean that you're dealing behaviorally with reality things out there. So you learn how to walk, and you're motivated and you're persistent, let's say. So you're coping well with your paralysis, but it's all involved with intrapsychic stuff. That's the adaptation (inaudible), what goes on inside. I wanted -- now, this is really a leap from adaptation to coping, but I think the time has come when we can address the problem of prejudice among people with disabilities. That's a hard one because we're rightfully concerned with societal prejudice and attitudes that cut off opportunities of certain disadvantaged groups, right? So the prejudice has to do without there in the society. People with disabilities not only are a member of society, but they are, I tell you, they are human beings like everybody else and (inaudible) flawed in perception, flawed human perception that's hard wired to deal with, they can be very prejudiced against people with disabilities -- some other kind of disability, even their own, for the same reasons that those who don't have that disability have. And I think that sometimes that needs to be addressed in a rehabilitation counseling situation, not necessarily right off because the big problems are societal attitudes, but remember the big problems are -- include flawed human perception and we're all messed up with that and we can all learn tricks of the trade, how to control (inaudible) people with disabilities. >> DR. MARTZ: I guess I would like to ask -- I have many other questions coming in and by the way Steve from Michigan asked the same question on coping and adaptation. Okay, so if the individual human mind is hard wired to focus on the negative and that is also reflected with group thinking, how can we help shift those negative -- the negative focus on a societal level. You gave us advice earlier for how to do this -- stop thinking and just halt that negativity once you realize it. So that's what the person can do, the individual. What kind of steps do you think we can take other than the once you've already mentioned where we can help shift those -- that negative attitude about disability? >> DR. WRIGHT: You mean in society at large? Doing it from the societal point of view. Again, we've mentioned familiarity. Education means familiarity. Integrate leads to familiarity. Now, legal steps -- affirmative action means you take affirmative action to have diversity and the mission is not only to universities and colleges, but also in employment. All that leads to familiarity. Problems will remain. (inaudible) say in the workplace, a person with a disability may feel shunned, let us say. That can happen -- shunned -- but do you know you can feel shunned or discriminated against because of your sex, because of your religion, because of your color, race? I mean, the human being -- we can be saints but we can be sinners as well and I think it's helpful for a person with a disability to recognize that he or she is not alone. Everybody feels shunned, isolated, discriminated against, rightly or wrongly, it's a human perception some of the time. If they feel it as a persistent problem, that's not good if you feel that you're shunned, nobody will have lunch with you at work, you know, that's very difficult. Something that needs to change and what needs to change depends on, again, the individual, the circumstances on the job maybe, the job can be changed or who knows. >> DR. LIVNEH: Just to add to that, I think some studies show that about two or three types of efforts to try to work with negative attitudes are somewhat successful. The first one is really the exposure to people with disabilities, especially on a egalitarian level, working on similar projects, basically they are the same as we are, in other words, they think (inaudible) more with the effective component of the person and studies did show it truly has a lot of positive side to that. The other one is more working on the cognitive side, working on the information, trying to dispel some of the myths or the understandings about disability. Many people may hear MS, epilepsy, they think who knows what, but if you really understand what the person can do under these conditions, who the person behind the condition is, things were found to be quite successful. Cognitive element is very important. Media portrayal is crucial. We forget many of our kids and most of us grow up with media, T. V. or movies and it depends on how you portray people with disabilities in these types of areas. Some of you may remember the movies from the '30's and '40's. Usually if there was a person with a disability, there was a person who was usually the evil guy, the bad person either with the scar or with the limp, Captain Ahab. Some hype was associated with the negative side. These days they go over board the other way around. That's probably not too positive either. You have to find a positive portrayal of a person with a disability and what they can do or can't do. And some people suggest add to that legislative effort and that should add as well. Here you probably have to be careful because again if some people feel the government, you know, is shoving some legislation down our throats, it may actually create a negative impact rather than positive, but certainly the way the ADA and some other laws passed with that careful, gentle way, and that's another way of trying to deal with some of the negative attitudes. >> DR. MARTZ: Any questions from the audience? Please hit your button. We have a question. Where is the question? >> AUDIENCE MEMBER: We were talking about negative views being often facilitated or precipitated by people who fall outside the norms. And working especially with people who need rehabilitative services, we get people who fall outside the norms in the fact of cyclical natures of chronic illnesses or mental illnesses, and they are not always able to perform or be functional at a level that would keep them meeting just the basic needs. And often we're asked to help them to give up the ability to do those basic -- ability to function in order to qualify for services that would help meet their basic needs. So there is a conflict here in building somebody up and building up their assets, but at the same time they have an inability to continuously provide for their own needs, so until we can address this more legislatively, how do you suggest we work with people (inaudible) in that situation? >> DR. LIVNEH: I really don't know. That's a very good question. There is no doubt that disability in a way is a really relative term. In a situation, a person with no matter what type of disability you have, that it's an either/or situation. Even people with disabilities under many, many conditions really would function normally on conditions that are not affected functionally by them. If you know how to curtail some of those limitations, the better off you are, which means if you can really minimize the situation with the disability, certainly it will have an impact and only focus on those areas where it's really absolutely necessary to realize in these areas, yeah, there are some limitations. There are some functional limitations we need to deal with, but at the same time, if the person's strengths tend to over shadow the limitations which means there are many life contexts in where the person can function in a positive way, you want to focus on that obviously. I think as something we tend to forget, the idea that most people as was said before on more than one occasion tend to take even a small group of minimal negative situations or limitations and focus on that as being the entire person. That is the kind of thing that you really want to avoid from step 1. You want to make sure that they realize, yeah, there may be some cycles in your life, there may be some situations where you are going to be affected. But at the same time let's focus on the positive, let's focus on those areas and you really talking more about a time element in addition to being an environmental element. What are the times or the environment where the person can function normally? Can function successfully and let's see what you can do then? The others will take care of itself with time, but as long as you focus on the positive time and context wise, I think the bitter off you're going to do in the long run. What do you think, Beatrice? >> DR. WRIGHT: I'm going to answer -- I wasn't sure I got the entire question. Could you just quickly summarize what it was because somehow -- >> AUDIENCE MEMBER: Often it's one thing to say we can focus on somebody's assets. However, if the nature of their disability is cyclical enough that prevents them from consistently providing some of their own basic needs, and we're to get services for those needs to be met, sometimes we would have to encourage that person to not be as able as they can be. >> DR. WRIGHT: I see what you mean. You mean, you encourage them to -- oh, dear, that's a bad conflict. >> AUDIENCE MEMBER: It is. >> DR. WRIGHT: You encourage them to emphasize their disability, right, sometimes in order to get the eligibility for some kind of financial or (inaudible) something like that. It's a bad deal. That's not how -- what shall I say -- it's not helpful to the person's self-concept. It is helpful in getting that person the services that person needs. It's a good example of sometimes how you are in a bind. You know, with workman's compensation, you have a similar thing. You have an injury on the job, so how do you get workman's compensation? By showing how terrible that injury is. You emphasize anything you can, especially to get the lawyers on your side. They will exaggerate the nature of the disability. That's helpful to get the compensation. It's not helpful in terms of the person's self concept and feeling that he or she has abilities. So it's a big -- it's a big conflict and one is in a bind. The solution, I think, is not a real solution to be open and frank with the client, number one. Beyond that, maybe if we had a universal health care system, a better use of our tax money and that gets into legislation and advocacy and we're far from that. That is at least one direction of solution. Anybody who can benefit from services ought to be eligible for (inaudible) exaggerating their disability. Does that help you? >> DR. MARTZ: Good question. If I can continue along this line but in a different direction, I have an E-mail from Kristy. She's a systems change advocate in garden grove, California, and I will read part of her E-mail. It's rather lengthy, but I will try to summarize -- she transitioned back to Medicare and basically her question is -- well, first of all, she feels like she's not acknowledged as being a whole person who has immediate needs and she is classed and defined by one diagnosis and not the whole person or the need. And even though she is an advocate, she is wondering how to address the situation and change it (inaudible) I haven't read the whole E-mail, but basically she's in the medical system and they are viewing her by diagnosis and the acute problem. How can we get the medical system to look at the whole person I guess is the bottom line question? If we have universal health care some day, we still have the medical system, how do we get them to look at whole person? >> DR. LIVNEH: That's the million dollar question. I'm not actually going to answer. I'm staying away from that question. It's the same idea, can you change the entire medical system here. It requires probably I guess the interaction of consumers, employers, politicians, loved ones, you really need the whole group of individuals to work on that. it's not something that will have an easy solution. It's something without a quick solution. It is something that would require years of training, but unfortunately as we do know -- I worked a lot with the Social Security Administration, people eventually really are reduced to a label or to some type of a diagnosis. The entire, complex human being is lost. It has been painful to observe it for decades now. That is part of the deal. It needs to change, I don't know what it takes to change it, but I have a feeling that Beatrice has the answer for that. >> DR. WRIGHT: Not the answer, but an article. And the article I brought it because I thought it might be relevant and it's called, Labeling: The Need for Greater Person Environment Individuation. It's exactly what the question asked -- published in 1991. (inaudible) creates a problem. We can't exist in this world without categorizing. Can you imagine if we didn't have the capability up here to categorizing, we wouldn't be able to distinguish what's a dog from what's a cat, a tree from -- all that is categorizing. We group things according to a label. The only thing that isn't grouped is when you give an individual name -- Erin is an individual. There is no other Erin group. Or Hanoch -- I mean, there are other people named Beatrice, but my name is an individual name, but categorizing -- we have to categorize, but then again, fortunately as hard wired we could -- we could not get along without it, but it creates problems, some that we've discussed already. If the label is a negative one, what will you say -- the mind goes negative. Right? That's what this person is saying. I don't want to be categorized. I'm more than that label. I'm not just limited by that label. >> DR. MARTZ: I have an E-mail from Debra Fitzgerald who is a doctoral student at the University of Memphis. She wrote about a person with a substance abuse disorder. So I have to live the rest of my life labeled as an add Ict? (inaudible). What's the point of trying if I can not do anything? Can you comment from what you just said about this particular situation that Debra E-mailed about? >> DR. LIVNEH: Very briefly, that's one of the issues that you tend to see a lot in the field. Some types of -- almost by definition, many types of disabilities and chronic illnesses are permanent in nature, but at the same time many obviously are not. A person may overcome them or the conditions -- they may move on and the person may improve and no longer be categorized. I guess drug and alcohol is one of those iffy ones. I know AA says basically once alcoholic always alcoholic. So technically you carry the diagnosis with you no matter where you go, but if the symptoms are gone and the person is fully rehabilitated, would it be necessary to use that label diagnosis forever? You can say the same thing about many psychiatric conditions. If the person has a specific condition -- in other words, in the sense that thee behavior now is no longer affected to the point that they cannot be just a good, contributing member of society, would it be fair really to hold the person to some of the old diagnose ice and say that person was diagnosed in the 1960's with schizophrenia. Let's always carry the diagnosis with that person. Are we really talking about certain time elements that we have to decide, diagnoses are only good for three years or five years, and if the person at that time shows no sign of that condition, should we discard all the earlier evidence or documentation to that diagnosis and let that person open a new page in their life Ideally, that would be the thing to do. Practically, I don't know if it will ever happen. >> DR. WRIGHT: All that and now I'm following up on something. You know, when alcoholics anonymous started, and I think we will agree that it is a pretty successful, relatively speaking, program; but one of the precepts they have is that you have to say I am an alcoholic. You have to own that label, and if you abstain, you can say I am a recovering alcoholic, but not that I'm a nonalcoholic. They feel that you have to own the label, and that it's a life-long addiction because your physiology is vulnerable to that. And that set the stage for other kinds of help groups. The only recommendation that I have is a language one. To say I am an addict, that's too encompassing. I would substitute I have an addiction to alcohol or to -- what is it, some of the painkillers or something -- in other words, at least through language instead of using I am -- take diabetes. Instead of saying I am a diabetic, that encompasses who you are. >> DR. MARTZ: Isn't that representing spread just by your language usage? >> DR. WRIGHT: (inaudible). It encompasses the whole person. It's much better to say I have diabetes. I have an addiction to alcohol rather than I am an alcoholic. Limit the condition by having it not part of you as a central characteristic, make it more peripheral. Don't disown it. If you have an addiction to alcohol, don't deny it. We didn't even refer to denial. Denial is a very, very powerful motive in the human being. I think as hard wired as flawed human perception. So to admit something is really important to (inaudible), but don't make it a central characteristic by the language usage. >> DR. MARTZ: Okay, would either of you like to comment on the bio psychosocial model idea? And then we'll get to a question. Do you think that is one way that we can help the medical community recognize the whole person? Or if it's a bad question, let's move on. >> DR. LIVNEH: I don't think it's really like one of the solid models, but it's a variety of ideas where you look at the physical of the person and the social and again referring back to what Beatrice said earlier, we are really looking at the person in the context of the environment. At one point of time a month ago at a different conference I mentioned -- talking before about (inaudible) obviously one of the heros to many of us and certainly was a person who did a lot of training when Beatrice went through school in the '30's and '40's that here behind it was really -- you're looking as she mentioned earlier that the person's behavior is really a function of the environment and I guess the person himself. But at the same time I have a feeling or at least I would like to know -- I wish I could know if currently in the world today would he CT for time as a third factor in there which means the behavior is really a function of the person, the environment and the time of the person's life either subjective or objective time since obviously there are two sides to time. So the bio psychosocial model tries to encompass that the person is a very complex entity with a lot of areas and unless we look at the entire person as we learn I guess (inaudible) and really tend to do a lot of disservice to the person and to the real potential that that person may have. >> DR. WRIGHT: You know, I was a student of him so I could tell you about the issue of time. This gets a little bit though abstract. Do you want to spend the time on it? >> DR. MARTZ: We have seven minutes left and unfortunately we can't go over our time. Time is relative, but money is not. >> DR. WRIGHT: Are there other questions? >> DR. MARTZ: Yes, we have a lady in the audience. [ MULTIPLE SPEAKERS ]. >> AUDIENCE MEMBER: I'd be interested in your comments about models of disability as well as definition. You seem to be using a definition of disability as physical impairment or some sort of impairment. And one of the other models, the social political model of disability (inaudible) has a definition that goes something like disability is the attribution of corporeal deviation, about what bodies should be or do and I'd be interested in your comments about that. >> DR. WRIGHT: I think I heard her question. >> DR. MARTZ: Do you want to repeat it and also say your name. Please repeat it. >> DR. WRIGHT: Could you repeat it but the definition -- speak a little louder for me, please. >> AUDIENCE MEMBER: I'm sorry. You seem to be talking about disability as impairment. And so I was wondering -- asking for your comments about another definition of disability that grows out of the social political plod eel and the one I was referring to is one by rose Marie Garland Thompson and it goes something like -- as I remember -- (inaudible) not so much a property of bodies as a product of society's rules about what bodies should be or do. >> DR. WRIGHT: Yes, I referred to that before in response to one of the questions. It's good I think that you said the social/political or something. That is a viewpoint that everything is a construction of society and that the view that there is such a thing as a disability, a distortion of the body in some way, that is a construction imposed by society and is not something intrinsic to the person on the person side. It's all on the societal side and I refer to a time -- Victor Finkelstein -- who said if we were all born with whatever then our whole environment would be different and so the political advocates put everything in the environment. The trouble with that argument as I see it is we are not all born with that particular deformity or deviation from what we call normal and there are so many deviations from what we call normal, so we will always have differences among people, even if you take it in terms of disability. And then we will always then a tribute some characteristics (inaudible). We will describe a person as limited in locomotion for example. We a tribute the limitation in locomotion to the person and not to the construction of society. Just because of the deviation from some normative standard. We have to recognize that idolizing normal physical idea leads to problems. I could not go to that political stance by saying that everything is a societal construction because I do believe -- (technical difficulties). (loss of video and audio signals). This concludes the webcast.