University of Southern California Dissertations and Theses

The family has a patient: A study of what a crippling illness in an adolescent means to five families

(USC Thesis Other)

The family has a patient: A study of what a crippling illness in an adolescent means to five families

PDF

Download

Open document

Flip pages

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content THE FAMILY HAS A PATIENT
A Study of What a Crippling Illness in an
Adolescent Means to Five Families
A Thesis
Presented to
the Faculty of the School of Social Work
University of Southern California
In Partial Fulfillment
of the Requirements for the Degree
Master of Social Work
by
lone Lane Wheeler
June 1935
UMt Number: EP66578
Ali rights reserved
INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.
In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.
OissMtatten PVMlsNftg
UMI EP66578
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
Microform Edition © ProQuest LLC.
All rights reserved. This work is protected against
unauthorized copying under Title 17, United States Code
ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, Ml 48106 - 1346
ê u>- '5b' W 5
This thesis, written under the direction of the
candidate's Faculty Committee and approved
by all its members, has been presented to and ^
accepted by the Faculty of the School of Social # 4 ^ . (
Work in partial fulfilment of the requirements
for the degree of
MASTER OF SOCIAL WORK
Dean
D ate.
TAffw 0/ .....
Faculty Cotnmittee
CWairman
TABLE OP CONTENTS
Chapter Page
I. INTRODUCTION....................... 1
The Problem
The Study Design
Limitations of the Study
II, THE FIVE FAMILIES................... l6
The Blair Family, (MaryAnn)
The Traeger Family, (Virginia)
The Larsen Family, (Lorna)
The Faust Family, (Burton)
The Roberts Family, (Thomas)
III. FAMILY RESPONSES TO CRIPPLING ILLNESS
IN AN ADOLESCENT..................... 65
Implications of the Study
BIBLIOGRAPHY................ . .............
APPENDIXES............... 78
Appendix I. Letter Sent to Parents
of the Adolescent
Appendix II. Letter Sent to the
Adolescent
CHAPTER I
I
I INTRODUCTION
The Problem
’ This is a study of what happened in the families of
five adolescent poliomyelitis patients with a residual dis- !
ability. It considers emotional, social, and economic ad- I
ljustments which were made because of the patient*s condition,
I :
by members of the family group including the patient himself.
!
It was done in the hope that even such a limited study, cen-
I
itering around adolescent and family relationships, might ;
help to suggest what a crippling illness in a teen-age child
I :
means in intra-family relationships and how it affects the
pattern of living of family members.
, I
The writer had an opportunity to work with a few ado
lescent poliomyelitis patients in the wards at the Orthopae-:
' - 1
die Hospital in Los Angeles.These adolescents attracted
particular attention because their adjustment seemed to be *
much slower than that of the younger children with the same
diagnosis, a fact which has been noted in literature on the
^Sometimes referred to hereafter as the Hospital.
jsubject.^ It has been shown in studies of poliomyelitis pa
tients that in infants and younger children the acceptance
of the resultant disability, when present, is achieved with
relatively little difficulty. On the other hand, the prob- I
I
lem of the adolescent has been aptly described by Dr. Seiden-
I
feld who wrote that "when the patient is an adolescent or a j
lyoung adult to whom life has just begun to reveal its mean- I
ing to a degree sufficient to make him eager to participate
fully and completely, poliomyelitis is much more meaningful
because of its sudden threat to terminate, temporarily, and I
sometimes permanently, such aspirations."^ A group of Cana-!
dian doctors also concur in this, concluding that in the ;
Lroup they studied, problems of the future gave younger chil-
! I
jdren no concern whatsoever, while the older children dis- =
I I
played much, anxiety and constantly sought information and I
^Reassurance as to the chances of a complete recovery.^
In all cultures the family is recognized as the basië
unit of society. In Western culture, the more complex
I ________________________
I ^J. D. Griffin, M.D., W. A. Hawke, M.D., and W. Wray
Barraclough, M.D., "Mental Hygiene in an Orthopedic Hospital,"
b'ournal of Pediatrics. 13(July, 1938), 84. j
; Herbert S. Ripley, M.D., Charles Bohnengel, M.D., and
Ade T. Milhorat, M.D., "Personality Factors in Patients with;
Muscular Disability," American Journal of Psychiatry. 99(May!,
1943) , 783. „ !
j Mortaon A. Seidenfeld, M.D., Psychological Considerr
ations in Poliomyelitis Care," American Journal of Nursing. |
turf June», lOlnr), j
^Seidenfeld, ibid., p. 370. j
---- ^Griffiny-HawkeT-and—Barracloughi -op— cit-ry-pv-83 ê — -
3
society becomes, the farther the pattern moves from the clasj-
j '
sic institutional family with its tradition of unquestioned i
I ' I
obedience to its head. In the United States with its ever- I
increasing industrialization and urbanization, this trend |
I :
from the institutional family to what is now called the com-:
I '
panionship family is particularly noticeable.^ In this type j
I ' '
jDf family the emphasis is on affection and consensus rather j
than on obedience to the acknowledged head. Although this is
the trend, families are found in all states along the con- |
tinuum from institutional to companionship type of organize-i
i I
tion. i
! Regardless of the structure, certain essential func
tions of the family are well identified, these being, namely,
the production and socialization of children. During the
first and most formative years of a child*s life the family’s
!
influence on his personality is greatest. As he grows and j
1
develops, passing gradually from one stage of maturation to |
I ■ i
another, he interacts with an ever-widening number of persons
while he continues to be dependent upon and to be a part of
I
the primary and intimate group which is his own family. At
the same time he develops two sets of standards by which he
Jjudges and is judged, or to which he tries to conform, the
standards of his family and those of his peers. Here there
is often basis for conflict which is felt by the child
^Ernest ¥. Burgess and Harvey J. Locke, The Family,
York American Book Company, -1950), p. 22.-------- -
4
especially as he becomes older.
In our culture, as the child enters the adolescent !
I
period he is faced with many adjustments based both on the !
jphysical changes to which he is subject at the onset of
puberty, and on the psychological changes which are involved
|as he works toward the integration of his personality as an ,
adult. In addition to this, society has certain fairly rigid
expectations about how the adolescent should behave during
this period when perhaps he is least inclined to conform.
The particulars of the development of the individual during
this period need not be reviewed here in any detail. It is •
i
•important, however, to state very briefly what the expecta
tions are for the adolescent so that in the interviews which;
I I
follow the families studied may be reflected against this '
picture of the adolescent in his family in our society. !
It is during the adolescent period that the individ-'
ual is expected to make a fairly definite decision as to his'
I
choice of vocation; he must prepare himself to enter what j
Erickson calls the state of industry, where his ego boundar-;
les are enlarged to include his skills and his tools.^ Dur-
I
ing this period the adolescent must establish relative inde
pendence from his parents, although during this time, too,
he still needs to be dependent. These life tasks can be the^
source of considerable conflict for the adolescent. His
^Erik H. Erikson, Childhood and Society (New York:
Wy-W— -Norton and Company, Inc-., 1950), P. 227. - ■ - --
choice of vocation may involve prolonged training”~during
which period he will have to continue to be, for the most
part, economically dependent on his parents.
Personality integration is further dependent on a
good heterosexual adjustment which must also be completed
during adolescence. This involves not only curbing strong
sexual impulses of which the individual becomes aware after
puberty, but the final resolution of the oedipal conflict
which during this period again becomes manifest and must be
dealt with.
Adolescence is often referred to as a stormy period
for both parents and children. It is a time when the ego
appears to be weak because it is unable to evolve adequate
adaptive mechanisms to deal with the many pressures placed
upon it. Despite this, it appears to be surprisingly resil
ient, so that the "ultimate solution of adulthood, with or
ganized, integrated defenses, can be achieved.During
this time, the adolescent leans strongly on his peers and
conforms more to their value standards than to those of his
parents whose standards he may consider to be narrow or out
moded. Conformity then becomes very important. This in
cludes conformity in modes of dress, speech, hair styles,
and patterns of action. At this period, too, when the ado
lescent is establishing his own identity as a potential
^Irene M. Josselyn, M.D., "The JEgo in Adolescence," ,
Amerlcan_Joumal__of__Orthopsy_ch.latr.y_. XXIVjApril, 1954)^ 2361.
worker, mate, and parent, his bodily image is of much im
portance and anything that may happen to change it must be
considered for the effect which it might have on the person
ality. !
I
As the individual approaches the end of adolescenceL^'j
he must literally "pull himself together." He must achieve -
an effective integration of his personality in order to
"find his identity" and to continue on into adulthood as a |
mature being who is prepared to establish a family and re- I
peat the cycle through which his parents have just come withj
him. I
The very fact of having poliomyelitis at this period'
i
Iwhen he is having a struggle to integrate his personality ,
I
jand thereby to gain a clear picture of himself as a socially;
I !
[acceptable, competent individual, would be an added stress ,
|to be dealt with by both the adolescent and his family. Thej
Ifact that statistically poliomyelitis is not high on the j
! I
ilist of diseases with a high mortality rate, and that those |
! '
who come through it with any appreciable amount of permanent!
j I
[crippling is also comparatively low, does not ease the situ-i
! t
ation for those who do have it. Such statistics are reassur
ing to very few people. Enotionally, the fear engendered by
the possibility of poliomyelitis is out of all proportion to
I
!the actual damage done or to the numbers of the population
who are stricken with it. There is no doubt, however, that |
i
such ..few _is. generally.wide-spread_among all .segments. pf_ the.j
7
'population, since it is known that the disease exercises no
I
jselectivity other than that of age, and that damage is done î
! '
|to some who have poliomyelitis, ‘
I A brief look at the statistics is interesting in
Ithis connection. There seems definite evidence that during :
Ithe last 20 years the trend in the annual case rate has been|
upward, particularly during the last decade during which a |
marked increase has occurred,^ The age group in which the ,
incidence of poliomyelitis occurs is also increasing, but it;
is still highest in children under ten years of age. A re- .
port of the distribution of new cases by age groups, compiled
|by the National Foundation for Infantile Paralysis indicates
Î
;that the incidence of the disease is lowest in the 15-19 year
'age group. There seems to have been, during the decade re- .
Iported, 1944 to 1954, a slow, but fairly constant decrease *
I *
;in the number of cases in this particular age group which |
may explain in some measure, the reason that specific studies
with this age group have not been undertaken. However, na
tionally, adolescents stricken with poliomyelitis would total
i i
up to a sizeable number. This however is now, hopefully, a j
decreasing one in view of the use of the Salk vaccine which *
has just been released for general use.
The literature on the psychosocial effects of polio-;
myelitis is very limited, amounting to less than two per cent
I
^Robert Serfling and Ida L. Sherman, "Poliomyelitis •
Distribution in the United .States, Public Health Reports,_ _
68 (May, 1953), 453-466.
8
of all published material on the various aspects of the dis--
1 I
ease. This dearth of material is especially apparent in |
seeking information on the psychosocial affects of polio- j
myelitis in adolescents. In general, if any mention is made
of this particular age group, it is only a word in passing. ;
I
There have been two comparatively small studies done, how- '
p '
ever, in which adolescents were studied along with adults, j
I
Neither of these investigations was conducted with adoles- ^
cents as the chief focus, the age limit of l4 years being se|t
as a means of delineating children from the older age groupsj.
In general, the literature reflects a definite con- ;
1 I
sensus that the manner in which a patient reacts psychologi-;
-cally to the disease, as well as the way in which he handles!
the resultant disability is determined by his pre-morbid per
sonality. In none of the studies reviewed was there evidence
to indicate that the patient’s reaction was determined by the
severity of the residual disability. It has been aptly j
I
stated that "being crippled does not automatically imply !
I __________________________________________________ I
' 1 I
i "^Morton Seidenfeld, Ph.D., "Psychosocial Aspects of j
poliomyelitis," Poliomyelitis (Philadelphia: J.B. Lippincott
■Company, 1952), 5B31 I
i p i
I ^Jacob H. Conn, M.D., "Relation between Personality i
Factors and Fatigue in Severe Poliomyelitis," Archives of j
Neurology and Psychiatry. 70(September, 1953), 3Ï0-Ï6. j
I Clarence S. Hoekstra, M.D., "The Psychiatric Re- j
action to Acute Anterior Poliomyelitis," Rocky Mountain |
Conference on Infantile Paralysis (Denver : University of ;
Colorado, School of Medicine and Hospitals, 1946), 69-74. ;
being handicapped."^ It seems to be the opinion of most in-
Ives tiga tors who have studied the psychosocial aspects of
■ ' j
poliomyelitis that many personality problems which come to !
; Î
I light after a child has had the disease were present prior ;
I I
:to the onset, but were not noticed by the parents. This is
' i
not peculiar only to those who have had poliomyelitis, but
is probably true in any case where there has been a fright-'
ening and prolonged illness, even where no physical residual
p
occurs
Motivation for this study was derived from several <
sources. It stemmed, as previously mentioned, from working
jwith adolescent poliomyelitis patients and noting problems ,
in their adjustment. It was also stimulated by the present
movement away from the earlier emphasis in medical social
work on the patient, with recognition of the family chiefly j
I
las a resource for helping the patient to make a complete re-:
Icovery from his illness or to reach his full potential within
jthe limits placed by his disease or disability. This empha-;
I ’
sis on the patient exists, perhaps more naturally in medicine,
!
Here, too, however, there is increasing awareness of the im-j
portance of understanding the patient not only as a disease '
^Leonard V. Wendland, "Some Psychosocial Aspects of ,
Poliomyelitis" (Unpublished Ph.D. Disertation, University of
Southern California, 1950), 2.
p
0. Spurgeon English, M.D., and Gerald H. J. Pearson,
M.D., Emotional Problems of Living (New York: W.W. Norton
and Company7TncT7^L943Tr~Fr3l3T~ !
10______________________________
entity, but also as he functions within his psychological
I I
and environmental milieu, if the best results are to be |
reaped from the rapid advances being made in medical science!,
j I
jThis trend was characterized very well by Dr. Richardson I
‘ about ten years ago in the book Patients Have Families.^ I
The fact that families also have patients and that the pa
tient’s condition and his emotional and social reactions to
his disease or disability are bound to be reflected in the |
I
various intra-family relationships has been recognized by |
medical social workers as they increased their own under- i
i ' !
standing of the dynamics of human behavior and also assimi- !
I
lated those teachings of psychiatry which are applicable in !
jthe practice of their profession. The individual’s person- i
I !
ality is largely formed by his early relationships within :
his own family. Once this individual became a patient, how
ever, the focus seemed to shift almost entirely to him, and
|consideration of the family as a group of individuals which
also will be affected by the situation was more or less de-
I
emphasized, while attention was focused on the patient and
how the family could best contribute to his convalescence or
rehabilitation* It was with the hope of making this a
family-focused study and contributing to the homeostatic
concept of the family that this inquiry was undertaken,
^Henry B. Richardson, M.D., Patients Have Families
(New York: The Commonwealth Fund, 1945)*
11
I As this shift in emphasis is emerging, a swing is |
[being made away from the patient-focused approach and toward
I j
I one which is oriented more to a recognition of the needs and
i I
Ibehavior of the family unit, with the patient seen as one l
i I
j member of the f amily, albeit one who at times may need more I
Iconsideration and more heIp.than the other members of the j
group. This trend is shown in the conference held at the j
i
end of 1953 under the sponsorship of the National Foundation
1 !
for Infantile Paralysis. The conference report gives much :
recognition to the needs of the family as well as to those :
of the patient in considering the advisability as well as j
the disadvantages of helping all concerned to plan for long-:
term care in the home, and it is pointed out several times ;
that one of the important factors in such planning is the
total family situation,^ i
i
The Study Design
Most cases of poliomyelitis in Los Angeles County
are hospitalized during the acute phase, in the Communicable
Disease Unit of the Los Angeles County General Hospital. i
I ' \
iWhen the patient has passed the communicable period of the. j
i
disease he may be transferred to a secondary hospital which ,
is equipped to give continuing care when this is needed. j
__________________________________________: _____ : _: ________ i
I
^National Foundation for Infantile Paralysis, Report
of a Conference on The Place of the Medical Social Worker in
the Home Care of the Long-Term Patient. New Yorkl Sie |
National Foundation for Infantile Paralysis, 1953. ;
^Ibid., pp. 8-13.
12
' — --- - - ■ - - - - - - I
'Orthopaedic Hospital is one of the hospitals to which such ,
[patients are transferred. It is a 75 bed hospital which al-|
: I
so serves a large number of out-patients through its clinics^.
; Since all the beds are not devoted to poliomyelitis patients:,
jthe actual number of such patients who had had poliomyelitis
! ■ I
during their adolescent periods and were still within the ad
olescent age group was found to be quite limited. In addi- i
I
tion, administrative policy of the Hospital permits members ;
of the attending staff to hospitalize their private patientsj
here also when beds are available. Because of this, a num- |
ber of patients who seemed to fit into the group for study
jwere private rather than clinic patients and it was felt I
that it was not advisable to try to involve these people in !
I
jthe study. ;
I The specific items which were used as a basis for I
I
selection of the cases to be used in the study were age,
I
presence of residual weakness from poliomyelitis, and avail
ability of the adolescent and his parents for interview.
I ' I
The writer wished to Interview adolescents who not only had j
I
had the disease during their adolescent years, but were still
within this period, since part of the interest was in the
I ;
adolescent’s adjustment to the disease as a new experience. |
i (
This placed an age limit of between 13 years and 19 years, ^
but as it happened, the cases available fell within a much j
smaller age bracket, with present ages ranging from l6 years'
13
I to iBlFëaM, R]ë6irthè
Hospital for the past four years, six eases were selected
in this way. One involved extensive correspondence which |
could not be effectively concluded in time for inclusion |
within the study. i
After selection ok* the cases, letters were sent both
to parents and adolescents signed by the Director of the j
I
Social Service Department, asking cooperation in the study. ;
It was indicated that the survey was being conducted as a |
i
means of learning more of how individual and family relation!-
ships were affected when a teen-age member of the family has:
poliomyelitis and is left with some residual.^ I
No formal schedule was used in the interviews. The I
writer had certain points in mind and tried to make sure i
I
that these were covered in each interview in order that feelj-
I
ings about poliomyelitis and its effects on the interpersonal
i
relationships of family members and family interaction could!
I
be discerned. Specifically, the writer tried to make sure |
that those interviewed talked about, or tried to talk about j
actual physical adjustment which had to be made by the family,
'the patient, or both as a result of the letter’s illness andj
residual disability. Both adolescents and parents were askeb
to discuss any changes in plans for the future which may
have been affected, such as plans for a career or marriage, ;
■ j I
■ ‘ •See Appendix for the letters sent. 1
14
and “ how "they felt about “ these. TheT subjecV6f changes which;
' i
,had come about in the family pattern of living was introduced
where not mentioned voluntarily, and the question raised of :
jdifferences in social activities both for the adolescent and
the family group. This included discussion of any shift in
j 1
Ithe kinds of activities, as well as in planning more around ,
( I
the patient’8 limitations. An effort was also made to bring!
out changes in relationships within the family group which
might seem to be associated with the adolescent having had aj
crippling illness. In every interview the writer sought par
ticularly to find out the meaning of this experience to the ;
person being interviewed and what he felt it meant to other
members of the family as they interacted within the family
unit.
!
I
Limitations of the Study ,
! There are several limitations which need to be taken
into consideration in reading this study. In the first '
I
place, the size itself, five cases, is a limiting factor. :
j
While it is believed that a study of even one case may help i
I i
to throw light on a given area under investigation, certainly
' I
the results of such research can be held valid only for the
cases studied. In this instance where five adolescents and '
their parents were interviewed, the conclusions are claimed '
as being valid only for these cases. Even such a limited i
study may serve to present some tentative hypotheses on the
15
[effects on â familÿ of â crippling illness in an adolescent.!
: ■ i
'It may be, too, that a much larger study would produce sim- |
I '
lilar findings. '
I ■
Another limitation, and one which occurred purely by!
I
jCOlncldence, is the homogeniety of the cases studied, a con
dition which is not at all typical of polion^elitis which is:
I I
generally accepted as being no respecter of persons on the
! j
basis of class, or color. The adolescents and their families
were all native-born, white Americans, Again, by coincidence,
I
jail the patients had a residual in the lower extremities. |
jThis is mentioned as a limitation because a residual in the I
lower extremities, even though it may be so severe as to con-
!
fine the patient to a wheelchair, could be much less trau- *
matic as far as the individual's ability to achieve independk
|ence, than one involving the upper extremities, partieularlyj
jthe hands, which would prevent the person from performing |
personal services for himself. I
I In the next chapter the five families are presented,
[through a brief profile of each followed by the interview
with the adolescent, that with the parent or parents, in
whichever order these took place, and an alaysis of each.
I Chapter III gives conclusions based on what happened |
I i
to the five families. Implications of the study and indica-j
Rions for further research are included in this final chap- ;
ter, ,
i CHAPTER II
I
i THE FIVE FAMILIES
f
I I
! The interviews with the five families conformed in
Several ways. Although no definite time limits were set, ,
there was uniformity in the time needed for the interviews.
phose with the parent or parents took between one hour and !
an hour and a quarter, while the interviews with the adoles-!
I
cents took no longer than 45 minutes. It is the writer's
I
Reeling that in general the interviews with the adolescents
bhemselves were more productive in giving a picture of fam- .
ily relationships as well as their own feelings about the |
situation. It is possible that the adults were less able to'
know and to show their feelings. They were, and probably
had been since the illness, attempting to align their feel- ,
I !
ings with what they felt they ought to be. The adolescents i
might have been more in touch with their own feelings, and
i
able to show them to an adult obviously not there for the ^
purpose of judging them.
' Most of the interviews with parents were with mothers
alone. In all oases where both parents were in the home, the
letter requesting the interview was addressed to both. Be- '
i
cause the interviews were scheduled during the business day,
16
17
rit was expected that some of the fathers would he lïhâbîe tcTj
participate. In each case, the mother was seen. One fathe^
took time from work to accompany his wife; he took an active
jpart in the discussion. In another case,a very revealing j
I :
: telephone conversation was held with the father. In a third
* ;
I
[instance, the patient's father was out of the home and the '
I ;
step-father was not contacted. With the exception previous-
ily mentioned, all those asked participated in the research. |
; !
i It will be obvious as the interviews are read that
; 1
I several of the parents were acutely aware of the need for
I he Ip in working with problems of individual and family ad
justment which had become acute subsequent to their child's
having poliomyelitis, and that they attempted to use the re
search interview for such purposes.
The interviews which follow have been shortened
I
somewhat; each is followed by the writer's analysis of the ;
meaning of their content in terms of this particular study. I
I
The Blair Family,(MaryAnn) j
MaryAnn is the l6f year old daughter of Mr. and Mrs.j
Blair, who have two younger children, Jerry, l4 years old, |
land Johnny who is four years of age. Socially the family |
> ■ I
lappears very stable. They have lived in their present home
jfor ten years, and Mr."Blair has been employed in various
jcapacities by the same firm for 20 years. He is now in an
i _______ ^All names of persons and places used_.in the case__
material are changed.
18
Iadministrative position. ;
The onset of MaryAnn*s poliomyelitis immediately |
followed a vacation in Yosemite National Park. She was hos
pitalized for one week in the Communicable Disease Unit at ■
Los Angeles County General Hospital and then transferred to '
Orthopaedic Hospital, remaining there one month. She was
I
just 15 years old at that time. j
While the patient apparently made a good adjustment
on the ward, she indicated some apprehension about returning
to school because of a fear that she might be rejected by ;
I
her fellow-students. After discharge it appeared that there
was a problem centering around the patient’s feeling that
Ithe whole family was catering to her. This she deeply re-
'sented. Both MaryAnn and her mother were seen by a medical ,
Locial worker who felt that Mrs. Blair was over-emphasizing |
the poliomyelitis and was trying to impose more limitations i
■than were medically indicated. At present, the girl is seen,
kn clinic only on an annual basis. She has returned to fullj
I
activity. It was noted medically that she has only a mild i
j I
residual weakness about the left hip with no impairment in |
walking.
j Interview with MaryAnn.— MaryAnn is a pleasant-faced
girl who is quite tall and large-boned. She is very heavy
through the hips and legs, and therefore walks with a heavy,i
floundering sort of gait. It was obvious that she had given j
thought to the stated purpose of the interview, and she
needed little prompting throughout. It seemed as though she ;
were glad to have an opportunity to talk about her problems.
_______MaryAnn. began the discussion by stating-vehemently—
19
}Whâir"ârdTffërën o 'hàvihg'"had polidiyeIitis'"haâ “ mëânt~lbo hër,
; explaining that she had always wanted to be a physical edu- j
j cation teacher and that "as long as I live I will never for-;
jget the day the doctor told me that I should change my !
Iplans." It seems that the basis for the recommendation was '
Ithe rather rigorous training required in order to prepare |
‘ for such a career rather than in the work itself, which the I
patient said could be governed by the individual teacher, '
once she had reached that status. She had then thought of
physical therapy as a possible vocation, but this too was
discouraged by the doctor because it involves so much stand-!
ing. She has found nothing else to her liking, j
! I
: The patient said that at the time she became ill she;
was not yet dating, and she isn’t doing much of it now. She
does not attribute this in any way to having had poliomyeli-l
tis. She said apropos of dates that she "can take them or |
leave them," and at this particular time she does not have a
"burning desire to get married." She indicated that she i
felt that such a desire might become all-encompassing and
might interfere with her plans for college. She not only
wants to go to college, but wants to get the most out of the’
experience. She thinks it is beneficial to go to college,
"especially if you can go to one away from home."
It is MaryAnn*s judgement that the past two years !
have been extremely difficult because of the suddenness as
well as the size of the adjustments which had to be made due;
to her illness. She described the onset of the disease and |
especially the shock she felt when, after a week at the Gen
eral Hospital, instead of being able to go home as she had ;
anticipated, some paralysis of the left leg was noted, and \
she had to be transferred to a secondary hospital. She de- I
scribed her first day or two at Orthopaedic Hospital, dur- |
ing which she "carried on" in a way in which she is quite
ashamed now. Thereafter, however, the stay was pleasant,
and although she looked forward to her discharge home, when
this occurred she had a much more prolonged and difficult
adjustment. She said that in the Hospital she got no more
attention than anyone else, but when she came home, the
iwhole family seemed to have geared itself to what were con
sidered to be her needs and wants. She implied that this
was quite different from their usual pattern of behavior
toward her, and she neither wanted nor liked it. , She said
it did, and still does annoy her to feel that special con-
Icessions are being made on her account. This situation
created constant conflict which she seemed unable to resolve
and she became extremely irritable which did not help her
relationships with other members of the family. She said
she knew that the weakness in her leg made it impossible for
her to do many things she-had previously-been accustomed toJ
20
doing. This in itself* was frustrating, but the constant c6h|-
cern of the family just made it worse and was one of the I
hardest things to take. During this period she developed a i
close relationship with her little brother who was only two,'
and was at home with her all the time.
When she had recovered to the point of being able to
return to school, she had another big adjustment to make, ‘
one which as she talked, seemed the most difficult of all. ;
She had previously been elected to a number of offices in
different school organizations, and had been a leader in
girls * athletic programs. When she returned to school she i
looked fine. Everyone commented on how wonderful and !
healthy she looked. She felt that they were unable to rec- I
’ oncile this with her physical limitations, and perhaps even ;
felt that she was just shirking. She found it difficult to j
jtry to explain the situation to them, and did not attempt toi
do so, nor did she discuss it with any of her teachers or |
her parents. She just became more and more bitter about thej
whole thing, and also guilty, because she felt that the i
other students were having to carry her load. As she put it,
i"l just rode along, and now that I’m back on full activity
I’m still trying to make Up for it." The need to rest and
restrict activity also limited her social life and she is !
sure that her friends just felt that she was being snobbish.'
This also contributed to the depression which she felt dur
ing this period, she said.
1
I Through the efforts of one of her physical éducation:
teachers who apparently had some awareness of the girl’s >
plight, MaryAnn said she was finally persuaded to take over ;
the job of manager of some of the girls* athletic teams, |
■since she could not be a player. She said she felt that
this was about the only good thing which had resulted from '
her having poliomyelitis because she learned that there is
jsatisfaction to be had from doing this sort of thing as well
as from actual physical participation. She said she was
'glad to find out that she had this capacity, and she feels
'that she did a good job with the managing. Here she also
pointed out another positive value, saying that she thought
the experience of being in the hospital had made her "grow
up a lot faster." She explained that she had never had to
make decisions for herself, had been away from the family
only rarely, and in general was pretty dependent on them.
When she was suddenly isolated from them, she had to make
decisions for herself, and finding that she was able to do
this seemed to be very gratifying.
In discussing her feelings about having had polio
myelitis she said that being in Orthopaedic Hospital and
seeing patients who had much worse.crippling.than she did__
21
jînadënüer~l?eâiïzë~that her own situation could hâve been much'
[worse. Still, she wondered why it had to happen to her, and'
[although she indicated that she had been given an answer, j
Iprobably by the minister of her church, there was a feeling |
jof not being satisfied with this, and of continuing resent- ,
ment over the fact that it had happened to her. !
! !
' MaryAnn indicated that she had always been a pretty |
happy-go-lucky person, living from day to day and never
thinking too deeply about things. After she was ill, she
had time on her hands, and had tried to analyze herself and j
iher family relationships. She said she had always consid- |
,ered that they were a pretty close-knit group although they |
{Certainly had their differences. She realized, however, ;
Ithat she didn’t know any of them very well, and felt that !
jbeing at home so much and the frequent trips to the hospital!
with her mother had enabled her to get to know the latter i
much better and had probably brought them closer together. |
She added that they really never had been too close before. |
As to the other family relationships, she said she '
jand her brother Jerry had never been very close; they are
quite different personalities. She is a spendthrift, while ;
•he is a miser, and the same kind of difference seems to run ;
(through other aspects of their personalities. The only
thing they had in common was an interest in athletics, and
she was always better than he. She believes that they are
farther apart now than they were before her illness. Her
relationship with her father has probably been the least |
affected, as things seemed to be about the same between i
them, she said * I
I
Interview with Mrs. Blair.— Mrs. Blair began the
interview by saying that she could see that they made a ,
number of mistakes in handling the situation with MaryAnn j
[when she returned from the hospital. She described how ex- |
jtremely upset they had been by the diagnosis, and their dis-!
{appointment when they learned that one leg had been affected
jand their daughter would have to spend some time in a secon-
jdary hospital. j
I j
I When MaryAnn came home they had some difficulty in |
knowing how to treat her. They tried not to pamper her. As
Mrs. Blair put it, "We tried not to let the bars down so, far
[that we would have a complete invalid on our hands." On the
[other hand, they did try to protect her as they were very
{Worried about her leg, and perhaps they did "anticipate j
things for her." She noted that MaryAnn seemed to feel that;
[they were over-protective of her and all the way through
I"she has resented everything we tried to do for her." Mrs. ;
Blair’s.manner.of. expression here gave _ the _impre s si on that !
she probably still harbors some resentment over what appeared
ito be MaryAnn * s ingratitude for the attention she was given, i
She added by way of explanation that she supposed that Mary-^
|Ann felt guilty about all the extra work she was causing, as'
she had always tried to be independent.
Mrs* Blair commented that the two older children had,
always preferred their father and that this has not changed :
although she feels that she did come to know MaryAnn much
better because of being with her so much for the few months
that she was not in school. Mrs. Blair described herself as:
being a person of little patience5 she angers quickly, but ,
also gets over it quickly, whereas Mr. Blair is much more :
even-tempered. 1
I Mrs. Blair indicated as her daughter had, that Mary-:
Ann had become quite close to the little boy and this rela- 1
jtionship continues to flourish. Jerry and MaryAnn have nev
er gotten along very well as he has always been jealous of 1
his sister's popularity as well as of her athletic prowess, ,
and has taken little pains to hide it. In this respect,
Mrs. Blair believes that the poliomyelitis, in slowing Mary-'
•Ann down, as she put it, gave Jerry a chance to catch up.
She said that she had never allowed actual fighting to go on'
between the children, and as a result of this they had de
veloped a pattern of verbal sniping at each other. She now
questions the wisdom of this. She described that they had
not realized that Jerry was very upset over his sister's i
illness until after she was transferred to Orthopaedic Hos- j
pital. He had an accident with a coaster he was riding, and
developed a brain concussion. While he was semi-conscious,
he kept talking about MaryAnn and expressing the fear that
she was going to die. |
I
I Mrs. Blair felt that the whole experience had re- j
suited in increased maturity for Mary-Ann, and commented also
Vhat "she almost lost her religion." She explained that i
MaryAnn had rarely been sick before. "To be sick was just ;
the end for her; her body had never betrayed her," Mrs. Blair
said. She feels that the girl has found no acceptable ex- '
pianation as to why she was stricken with poliomyelitis. Thé
mother feels that MaryAnn is still questioning this and I
sought advice from the interviewer as to how to help the girl
resolve this problem. |
' - I
Regarding family activities, Mrs. Blair said rather j
defensively that although MaryAnn thought they had given up *
a lot of things in trying to protect her after she was ill, j
they really had not. She mentioned one or two invitations j
which had been turned_down because.they.Involved a rather :
long ride and they felt that this, plus visiting might be j
tiring to the patient. They had not gone to Yosemite for
their vacation last summer as they usually do simply because
|MaryAnn*s illness was still so close that neither Mr. nor j
;Mrs. Blair felt they could enjoy themselves there. However,,
jthey do plan to go back this year. She indicated that most i
jOf their activities are within the community in which they 1
[live and they were never accustomed to doing a lot of "run
ning around" as she put it. ^
! ■ !
: As the interview drew to a close, MaryAnn came into ;
jthe adjoining room. She and her mother exchanged some light:
remarks about who was telling on whom. While these were I
Isaid in a facetious, joking way, there appeared to be a j
irather barbed edge or undertone, which gave the impression i
jthat the hostility between mother and daughter is not far |
below the surface. ;
Analysis of Interviews with MaryAnn and Mrs. Blair. - I -
phese interviews seemed to bring out clearly the fact that '
both mother and daughter were aware of the somewhat uninte- !
I ;
grated nature of the family relationships and of the lack of.
■understanding which exists among members of the group. Al- i
jthough both gave lip service to the fact that they thought |
jthey had in some way, grown closer together as a result of j
I ' {
MaryAnn's illness, this appeared to be more a verbalizing of:
what they felt should have resulted from their having spent ;
;So much time together, rather than from any real evidence
Ithat this had been the result.
I
I This lack of satisfying interpersonal relationships
k n the home may in some measure account for the patient's i
! j
expressed lack of interest in getting married as well as the
' . I
fact that she has not, up to this point been able to accept ;
I i
completely the fact of her own femininity. She is still ;
24
in te r e s te d c h ië^ fiÿ~in â th lë iic ^ 'p ü rs ü i^ ^ whic^" Toy' t ï ^ she
i
might be expected to have given up in favor of more feminine
i
interests. On the other hand, one might surmise that the |
jvery positive interest in and relationship to her small !
I
'brother has the quality of a maternal rather than of a true i
MaryAnn*s ambivalence and difficulty in making a
ipositive identification of herself is further indicated by
her inability to find a possible satisfactory vocation since
I
the doctor told her that she should not become a physical j
education teacher* She seemed to feel that this was one of !
I
’ the most painful results of having had poliomyelitis. On
the other hand, it seems rather inconsistent that one so im-;
bued with the desire to carry on in a chosen profession
should give this up without a more realistic consideration j
j
of the situation. The facts would seem to indicate that
where there is as little physical involvement as MaryAnn |
has, the decision as to her fitness to train for the job of I
teaching physical education might be a decision which would |
I
be effected by a number of other factors as well as her j
physical abilities. i
I It seems possible, too, that the sibling rivalry be-|
'tween MaryAnn and Jerry might be based in part on her mascu-;
line protest, and her need to excel in a field where he '
might normally be expected to do so. Jerry's reaction to j
!
his_sister!s .illness probably.was. an expression of the fear_J
25
jthat she was going to die. It also was an expression of his
own guilt over hostile feelings toward his sister, and per- |
haps had the connotation of magical thinking on his part |
jwhich made him feel responsible for her illness. This
i I
; proved a further barrier between MaryAnn and Jerry. I
Mrs* Blair's feelings of inadequacy in coping with ;
: family problems were apparent throughout the interview. She
indicated much guilt over this. Increased family tension
! , ' !
|as a result of this could hardly have been avoided, partieu-:
jlarly between mother and daughter, for, as a result of her
guilt feelings she was inclined to over-protect MaryAnn,
Ithereby raising more hostility between them. There is also
I :
jthe mother's feeling of being put upon by this illness which
had struck her daughter. Although she did not seem aware of
it, her attitude was definitely indicative of the fact that j
she resented her daughter's lack of gratitude for the fam- |
ily's and her own attempts to take what they considered to j
be good care of her. She gave vent to some of her hostility
in her expression that they felt they "should not let down
ithe bars" in regard to their treatment of the girl, but then
seemed almost deliberately to have punished her by over-
!
whelming her with unnecessary emphasis on her disability.
At no time during the interview did the mother give
any indication that she had been aware of the struggle which
I
her daughter had when she first returned to school; another
demonstration_of_her.lack _of understanding-of_MaryAnn. -She- =
26
failed to recognize that although the girl seemingly wanted :
I
to be independent, which was not unusual in a girl of this ■
age, she also had dependency needs which were unmet because i
I I
Ithe relationship between them was such that she was not freej
to give expression to these. !
! - I
MaryAnn*s need to continue to conform to the role |
I
she had previously established in the eyes of her peers is I
very apparent, and her inability to conform for awhile ere- |
ated frustration and guilt which is still unresolved. As !
she put it, she is "still trying to make up" for the time j
. I
jWhen she felt she was unable to live up to their expecta- !
jtions of her. In this light she considers poliomyelitis to I
I I
ihave been a punishment, but one for which she cannot find a
I ■
r
reason, and so her faith in her religion to which she turned;
I
for the answer, is shaken. This in itself is an upsetting |
thing, particularly to an adolescent who is subject to many |
conflicting feelings during this period of his development, j
I
The girl's statement that she was afraid that her }
friends would think she was a snob because she had to rest !
|and could not go to parties seems to be a projection of the
fact that she probably was not invited around as much as
jsome of the more attractive girls and that she considered |
Ithem to be snobs. In this way she could rationalize some of!
I !
I t h e i n c o n s i s t e n c y i n h e r p o p u l a r i t y a s a n a t h l e t e , b u t n o t
i !
as a girl. j
■ -------The. .apparently—accepting_ relationship which .existed. '
27
between Mr. Blair and his daughter seems to hâve continued:
I ■ !
more or less undisturbed by her illness, except as it is in-I
flueneed by increased tensions among other family members.
I i
It is of interest that while both Mrs. Blair and MaryAnn j
i i
mentioned a few positive aspects which they felt resulted
from the experience of the latter having had poliomyelitis,
these were far outshadowed by negative factors which seem to^
have been precipitated by it.
I
The Traeger Family, (Virginia) !
Virginia Crane, l6, and her eight year old half- '
I " ' I
brother. Tommy Dunn, are the children of Mrs. Traeger, who
is presently married to her third husband* She is contem- !
plating a divorce.
The onset of Virginia's disease was in September, I
11954. Poliomyelitis was not immediately diagnosed and she |
! " - ;
Was ill at home some four days before she was hospitalized j
I • *
i
at the Los Angeles County General Hospital. She remained inj
jthe Gorraaunicable Disease Unit there eight days before her *
I !
{transfer to Orthopaedic Hospital, where she was an in-patient
! I
for three months. While in the Hospital both Virginia and j
her mother were helped by one of the medical social workers. ;
! I
jVirginia at the time of her admission seemed much more im- |
i
mature than might be expected of a girl of her age* She was
!
'quite dependent and indecisive, and did not cooperate well
in the treatment program outlined for her. Mrs. Traeger
Gohsistëntlÿ refused re^ëï^î-W"a fâW.Iy"agëncÿ"despi
multiplicity of problems with which she was unsuccessfully j
trying to cope* i
I
Virginia has a severe residual in the right foot and
leg. She walks with a long leg brace and crutches. The foot
is flail, but some of the leg muscles are still gaining
strength.
Interview with ^s. Traeger.— The interview was con
ducted in an office at the Hospital. Mrs. Traeger had some |
difficulty in confining her conversation to the stated focus;
jOf the interview. She constantly turned to a discussion of •
her own marital and emotional problems which obviously were j
uppermost in her mind now that Virginia is in no danger, and
"could have been a lot worse off."
Mrs. Traeger said that Virginia had always been
rather touchy, and perhaps is a little more so now because
she is confined to home so much. She has not yet started to
use public transportation so that in order to get more than
'a few blocks from home she is dependent on her step-father.
'Although Mr. Traeger is still living in the home, the situ- j
htion between him and Mrs * Traeger has degenerated to the
'point where they are hardly on speaking terms, and he is not|
inclined to drive them around. Even when he is willing, j
Mrs* Traeger stated that his driving makes her so nervous
that she almost shrieks. When she married Mr. Traeger some
two years ago, he had tried to be nice to the children, but ,
he had never been around children and soon developed a re- !
sentment toward them because they got attention from her
jwhich he felt he should be getting. "While he never at
tempted to discipline them or interfere with my handling of
them, he has not developed any kind of a close relationship
with them," she said. When Virginia first got sick, Mr.
Traeger had seemed to make a special effort to be nice to
her. He came to take her home from the Hospital week-ends
when she had a pass, "but things soon reverted to their
former state,"
I
I - Mrs. Traeger recognized that her tension over her
marital situation was being reflected by an increasing num
ber of physical complaints for which her doctor had recom
mended psychiatric help. She has not followed through on
this recommendation.
29
I Mrs, Traeger separated from Virginia's father when
ithe girl was four years old. She went to work, so it was
{necessary for her to arrange for Virginia's care outside the
home. When she was about nine years old, Virginia developed;
.petit mal epilepsy, and this did not disappear until the be
ginning of menstruation at age l4. Because of the epilepsy,
Virginia had to be supervised very closely her mother said,
and could not be allowed to go anywhere alone. She thinks
this contributed to the girl's lack of independence.
!
! Mrs. Traeger believes that Virginia has resented not-
jonly her two husbands, but Tommy also. When he was born,
Virginia, then eight years old, was frankly disappointed, '
saying that she had wanted a sister. Virginia and Tommy seem
to quarrel even more now than they did before Virginia had
poliomyelitis. Tommy appears to be very jealous of his sis
ter, and shows this antagonism by shoving her or trying to !
trip her as she walks with the crutches.
j
The mother described Virginia as always having been
very shy. Her social life was quite limited so Mrs, Traeger
does not feel that this has been changed by the illness.
She said the girl did not go on dates. She has one or two
girl friends who visited her while she was in the hospital
and whom she still sees frequently. Commenting on "Vir
ginia's bashfulness," her mother said she is much more re
tiring than most girls of her age. She does not believe it
is because she wears a brace, although at first she thought .
this might have something to do with it. She feels that ;
many things bother Virginia which she is unable to bring out,
so she keeps them "bottled up," and the mother believes that ;
this has always been the cause of her irritableness. '
I The mother described how Virginia had always wanted I
to be a boy and insisted on wearing boy's"jeans. At first j
when Virginia came for out-patient care she always wore 1
8lacks. j
! I
I Mrs. Traeger said she did not think that Virginia !
had had any particular plans for the future when she got !
poliomyelitis, but now she seems quite interested in becom- ‘
ing a physical therapist. She has lost a year of school be-*
cause she can take only two subjects from the home teacher, I
but she works much harder on her school work than she used I
to. The mother said she had no plans for her daughter. She
stated, "I only hope that she has a happier life than I have |
I Despite the tension in the home, Mrs. Traeger de
scribed that when just she and Virginia are at home things
go .smoothly and they have a lot of fun together.— From her:
30
[manner of speaking about ~the~girl there" was" ïïttïë~do1îbt" of
her real affection for her daughter.
Interview with Virginia.— Virginia began the inter
view by complaining about her home teacher whom she felt was|
not giving her enough time. She indicated her increased in-|
tereSt in school work. This is motivated by her decision to!
become a physical therapist. In order to carry through on I
this, she will have to get good grades so that she can go to
college. ;
When she goes back to school she wants to go to the i
regular high school, not the crippled children's high school:.
She seems quite determined about this. She said she really
misses school and is anxious to go back. She liked "gym" j
and always got good grades in it; now she wonders if she will
even be able to take it. Virginia said there might be sev- j
;eral problems when she returned to school, centering around '
transportation and her need for additional time to get from î
jone class to another. She added that she "isn't so bad off,"
[and thinks she can make the necessary adjustments.
I
I Virginia remarked that she isn't particularly self- ,
iconsclous about the brace; she pointed out that it is dull
metal, and is not very noticeable. At first she hated it,
[she said, but she is used to it now and doesn't think it
will be too bad once she gets rid of the crutches which at- ;
(tract much more attention. When she returns to school, she i
[thinks she "will feel funny at first, going around with a j
brace." In response to a question about her clothes, she j
[said she wears jeans at home, but now that some of her I
skirts have been cleaned she wears a skirt when she goes |
lout. I
! Virginia does not feel that there has been any I
[change in the pattern of her social life since having been |
1111. She "never went around with a large group of kids;"
she has only two girl friends with whom: she has kept in
[close touch. She is looking forward to spending some time
|this summer with one who has moved to the beach. She also
'announced proudly that she had been on a bus a few days ago j
[for the first time since she had poliomyelitis, and managed |
quite well. j
I Regarding relationships within the family, Virginia i
{Commented that things between her mother and step-father arej
pretty strained, and it didn't make things any more pleasant:
'around the house, especially since it seemed to increase all
her mother's physical complaints, including migraine head- |
laches. She said her step-father never had had much to say, |
'and.„now,__not .only is he too quiet, but he ' s _always mad at_ j
31
Mom. They bicker and quarrel a lot but she ïs"used to it. ■
It only begins to bother her when the step-father begins to |
call her mother names. Virginia then becomes very angry at :
him, but does not enter into the arguments. She said. He I
is jealous and always says that the kids come first." !
Virginia said that as a result of her illness, she !
land her father had reestablished a good relationship. She j
[decided to leave her father and step-mother and return to |
‘ her mother after the latter*s third marriage several years
!ago. Her father and step-mother were quite angry, and did j
not even conmunlcate with her for over a year. She said ;
Ithey had been very nasty about it, and tried to make her I
ifeel guilty for leaving them. When she was hospitalized j
jher father immediately started to visit her, and after her |
■discharge, continued to come to the house to see her. He
[now has a regular visiting night, and Virginia said they I
both enjoy this. |
The patient said that her little brother had always I
[been pretty mean and nasty, but now he is much worse. She
{described incidents similar to those related by the mother,
and then explained, "he pesters me all the time, and when
■I yell at him. Mom gets mad at both of us." She said she
realizes that this is hard on her mother, because it goes
Ion all the time when her brother is at home. She explained
ithat her mother thinks she is "too touchy" and that if she ;
weren't so sensitive these little annoyances which her
brother perpetrates would not bother her. However, the |
patient feels that her mother is not aware of the extent to I
which this heckling goes on, especially if the mother is not;
at home. She said that at such times he defies her and |
dares her to hit him, knowing that she won't. She thinks hej
wants all the attention and doesn't care what he has to do I
to get it. j
In talking about her own reaction to the experience [
of having had poliomyelitis, she thought that being in the
General Hospital was the worst part of it. She was not par
ticularly frightened when she learned her diagnosis; she
! thought her mother was much more upset than she was. How- I
iever, after she learned that there was a residual paralysis ■
1 she was "mad" because she had been inhibited by having had j
[petit mal, and having been free of this only a couple of i
jyears, her ability to get around freely is again impaired by;
'another disease. !
I j
I Virginia does not feel that she has been getting any
imore than the normal amouht of attention from her mother,
;and described that they had always had a good relationship.
They_get_ along_ w©ll_when they are by themselves. The girl ^
spoke quite warmly of her mother, showing sympathy and ^
understanding. She said her mother helps her when she needs|
it because she can't get around as well as she used to, but I
her mother keeps telling her that she came out of it compar-'
atively well, and encourages her to do as much as she can
within the limits placed by the doctor.
In regard to future plans, Virginia said she just ,
wasn't sure she wanted to get married, but she supposed that
if the right man came along she would consider it. She re
lated the unfortunate experience of a cousin who had married'
an alcholic. She said that she plans to finish high school ’
before she starts to think seriously of marriage, anyway.
Analysis of Interviews with Mrs. Traeger and Vir
ginia.— While the background of this patient appears to be
relatively lacking in stability, and although she was left i
with an appreciable involvement, her adjustment seems not to
have been comparably difficult. She demonstrates certain
ego strengths which are surprising considering the rather
I
eratic pattern of her life. However, these strengths prob
ably are based on an early and continuing thread of love and ;
! :
acceptance by her mother which the patient has felt even dur
ing times when they were separated. That this kind of living
! I
has made her more dependent on her mother also seems apparent.
i ' !
This seeking to have her dependency needs met by her mother j
continues into the adolescent period where she normally would
: I
be feeling the need for more freedom and independence from
the parent. Virginia, however, does acknowledge feeling j
j'mad" that this, a second major illness in her life, is lim-j
I I
iting her independence, or at least her mobility, so there is
. i
indication of some maturing here. i
Mrs. Traeger herself seems to display many unmet de-i
pendency needs and immaturities. Although she has been mar-|
!
jried three times, she has not succeeded In establishing a I
j
ilastinig marital relationship. As indicated in the inter-
I I
[Views, there was an amicable relationship when the family as;
: I
[presently composed, came together several years ago. In- .
I I
stead of expecting and helping Mr. Traeger to assume the roie
! I
of parent as well as husband, she may have had a part in i
I
preventing this, standing, instead, as the connecting link |
[between the two children and their respective fathers. She |
was unable to mobilize herself to contribute to the unity of
the present family organization which had in it the elements
[necessary for a complete family. This has resulted in Mr.
[Traeger feeling excluded and withdrawing from responsibil- |
ities which, with help from her, he might have been willing I
I
and able to assume. Although the four of them live together-
I
and are supported by Mr. Traeger, there is in this situation
I I
I - I
I little of the feeling of a family. It is clear that Mr. [
Traeger is not in a parental role. There is no consensus j
j
and little companionship. It is a collection of individu- j
als, each striving to fill his own needs without help from I
j
jthe others. The relationship of Mrs. Traeger and Virginia
Ialone seems to have some complementary, mutually satisfying
{aspects.
I
: Mrs. Traeger finds it necessary constantly to mini- i
I ' i
!:mize_.the_ physical handicap. _ Because of Ji.er__own„tension andj
34
pr ëoG appear see s " VirgirnlsT' s"b ï t uat i oh
t
less clearly and probably is able to invest much less of .
t
herself in her relationship with the girl than she would
under less strained circumstances. This may also be a way ;
jof escaping from additional worry. If she can deemphasize !
‘ Virginia's disability, it is not so threatening to the girl's
jfuture. Virginia did not show that she felt this to be re-
IJection of herself. Mrs. Traeger’ hopes that Virginia will
!be happier" than she has been, but seems to disclaim respon-j
sibility for her daughter's future, as this also can be very,
' I
threatening, particularly if she is deeply concerned. <
I I
Information given by both Virginia and her mother
[implied that the sibling rivalry had been intensified since
jthe girl's illness. However, there may be only a more overt
[expression of the already-existing hostility between Virginia
!
and Johnny, It is also a reflection of Bh?s. Traeger*s in- ;
I
creasing inability to cope with family problems.
From the interviews it would seem that Virginia has |
jin recent months made certain gains in maturity such as can
|be expected during adolescence. She has come to a decision
las to where her vocational interest might be and has shown
I ’
jmovement by beginning to work hard on her studies. Even |
[though the work of a physical therapist may not be her final!
[choice and there may not even be opportunity for this be- |
I
jcause of her physical disability, at least she has made a
beginning in thinking q,bout herself as a worker. She seems
35
also to be coming to accept herself as a woman, which is |
: i
necessary before she can complete her personality integra- :
tion as an adult. The examples of family life which she has
had have not been encouraging, but she is not rejecting of
I
Ithe idea of marriage, although her ideas are still rather
nebulous on this. The fact that she is presently removed |
from close association with boys of her own age group is '
also a limitation in achieving a good heterosexual adjust
ment at this time. The fact of wearing a brace and being !
[thereby limited as to physical activity and sexual attrac- [
tiveness is a further limitation. It is by no means held
that Virginia's gains in maturity result from having had
poliomyelitis, but it does appear that this has not been a
determent to her development at this time. So it almost
I
seems in this case that the limitations of the patient's
!
life were a help in making an adjustment. The preoccupation;
of her mother with her own emotional difficulties prevented ;
any over-emphasis of Virginia's disability. Based on a real|
j
love of the girl, this may have helped* Virginia's social
activities were and are limited and these have not become
less* !
I I
l"be Larsen Family, ( Lorna ) {
I The Larsen family comprises only Mr. and Mrs. Larsen!
! :
and Lorna who is almost 18 years old; a brother and sister
j !
are out of the home.
36
Lofhâ was " admitt'ëd"'"tb~~tHe ~Goîimûhieâble t ,
I
of the Los Angeles County General Hospital on 12/11/52 when j
she was 15i years old. She was acutely ill, and after a
I j
[stormy course, was transferred to Orthopaedic Hospital on |
112/24/52, remaining on the ward until the end of June, 1953.:
i i
[Lorna had weakness of the abdominal muscles as well as in ;
i ;
{both legs, which remain practically flail* Subsequent to I
i ‘
[her first discharge, she was readmitted for surgery, a lower:
i !
jabdominal transplant which gave her increased stability* |
I :
IShe made an uneventful recovery from this surgery* She has |
I i
long leg braces, but has little ability to ambulate. She
uses a wheelchair most of the time.
I During Lorna's first period of hospitalization it
[was noted that her adjustment was poor. Both she and her
i I
imother had extensive contact with medical social service* ‘
I
!
{The family was very religious and their faith that Lorna |
: - I
jWould make a complete recovery inhibited her from making an [
[effort to help herself and to make maximum use pf the ser- j
vices offered by the Hospital* At the time of discharge |
both Lorna and her mother seemed to have a more realistic j
understanding of the situation and its limitations* ;
The family appears to be socially stable* Mr. Lar- [
sen, a truck driver, has been employed by the same firm for |
many years. The family has moved only once in more than 20 !
I I
years * They are all active in the church, which seems to I
i I
serve as one of their chief social outlets.
37
I Interview with Mrs. Larsen.— Mrs. Larsen was inter- I
viewed in the home. She is a rather glib person who spoke i
with an almost.forced cheerfulness. It was difficult to be j
sure how she really felt as she seemed to have a need to find
good in everything she talked about. ’
Larsen began the interview by saying how impor-:
tant she felt it was in cases where there was severe residual
paralysis, as with her daughter, to make the necessary physi
cal adjustments in a manner which was not too obvious to the i
patient. As she put it, "You have to be careful not to hurt :
or discourage the patients, as they don't want to be babied |
or pitied." She related some of the adjustments she had made,
such as placing things so that they are within Lorna's reach
from the wheelchair, and still not so obviously out of place
that the girl will feel that things are being disrupted by
rier own needs. |
Mrs. Larsen said that they had lived in the same i
house for 20 years, but after Lorna came home from the Hos- ;
pital, the house was sold and they had to look for another.
They had to be aware of many more things about the physical
set-up of the house than they would have had Lorna not been
in a whee1-chair. They had to make only a few minor adjust
ments in this place which they bought with the help of a 20
3 rear old son who is in the Army. It has the added advantage
of having a house in the rear which is occupied by their «
other daughter, her husband, and three year old daughter. |
Lorna often takes care of her niece who is a very active |
little child. ;
I ;
I I
I As to Lorna's adjustment, the mother said that she !
had always been a cheerful child, but that for two years she j
liad to have a home teacher, and she seemed to miss the com
panionship of young people her own age. Last September she |
Started to attend a high school for crippled children, and is
now having a wonderful time. Mrs. Larsen then commented that
perhaps Lorna is better off now than before she had poliomy
elitis. She went on to describe that the family had always
been religious and that they were very active in the church.
Lorna had gone all through a parochial school and was having !
her first experience in the public school when she became j
ill. Mrs. Larsen elaborated further on her statement by say-,
ing that seeing Lorna had helped a lot of the young people to
Realize that you can't just live for today, that you have to ;
be prepared to take what comes. She said she feels that Lor-j
ha believes this, too; she doesn't want pity from anyone. i
'{She realizes there is a purpose behind everything, even |
lihough _we__donlt_know..what_it_is ."__________ . . j
38
I Mrs* Larsen indicated that she did not feel that !
there had really been a change in family relationships* De
spite her statement, the information conveyed seemed to in- ;
[dieate that there was a very definite shift in emphasis in :
tamily relationships and that Lorna is now their first con- ;
[sidération, whereas before it had been more or less taken I
Ifor granted that she would go along with family decisions, I
Mrs, Larsen said that her husband always says now, "Lorna |
[comes first," '
! '
She noted a shift in the family's social activities !
since Lorna's illness. Although in general they continue toj
go to church, and visit the same people they always have,
they must now always consider if they can get the wheelchair
in or if Lorna's condition will be a complicating factor,
before they make any plans. Mrs. Larsen said that at the
time Lorna got poliomyelitis she herself was secretary of
the Church, and despite all the worry over Lorna, she did
finish out the year. She has not been so active in church
activities since, adding, "since Lorna had polio, her needs '
have come first." In addition to this she had always been
active in the FTA. There is one at the high school for the ;
handicapped, too, but she has attended only one meeting. In
trying to explain this she said "things always seem to come
up," and that she was a "home-body, anyway."
Mrs. Larsen believes that Lorna has matured faster
since her illness. She has always had initiative, and this
has stood her in good stead, enabling her to adapt herself i
more easily to her physical limitations. The mother related'
how Lorna does practically everything for herself, and that '
it has been rather hard for her and Mr. Larsen to learn to
;let her do things instead of constantly trying to help her.
i
In discussing her own relationship with her daughter!,
Bîrs. Larsen indicated that she felt that Lorna being in the
home all the time for two years after her illness gave them
a closer relationship. However, as she talked, there was
{little evidence of this. She said they didn't talk about
'Lorna's disability or how she felt about it. She helps
[Lorna with her exercises. She has always had a lot of pa- j
itience and she tries not to let Lorna see how disturbed she ;
is sometimes. Apropos of this she commented that "We know
[we are never expected to carry a bigger burden than we can.":
I As to future plans, Mrs. Larsen said Lorna had . j
planned to be a PBX operator as her sister had been, and
Seems to be adhering to this goal. She also believes that :
[Lorna does look forward to marriage, as she has remarked a |
■number of times, "I am going to walk down the church aisle |
when-I get married."- Mrs. Larsen related,-too,.-that Lorna . j
39
has added a new goal, that of being able to walk,"and is i
trying to achieve this before her brother comes home from j
Japan. j
Mrs. Larsen surmised that Lorna missed her old :
Ifriends, whom she does not see much any more, although she i
[does talk to them on the phone and occasionally has one over
jto stay over night with her. She now is going with a boy i
ifrom her high school, but the mother feels that she might be
going out more if she were able to walk.
!
Interview with Lorna.— Once Lorna understood the |
kind of information sought in the interview, she seemed to |
have little hesitancy in stating how she believed her life
and her relationships had been effected through having had i
poliomyelitis. She said that one of the things which both- j
ered her the most was the fact that her old friends are un- |
comfortable in her presence, that she is the one who has to !
Imake a constant effort to make them feel comfortable because!
'they are always saying something which they think may be ;
difficult for her to take. For instance, she said. We
might be sitting around talking and someone will say, 'Let's
go skating *, then they will all get looks of horror on their
faces because I can't skate and they feel that they have
said something terrible." She said she always acquisses and
that she enjoys watching them just as much. When this lat
ter statement was questioned further she said perhaps she
didn't enjoy it as much as she would have enjoyed partici- '
jpating, but it didn't bother her the way the others thought '
jit did. Again she said, "if they would only realize that I
don't feel any different." This is what made it difficult
for her, but within the past year there have been several
changes which have alleviated the situation. !
She said that having a home teacher and being lim- I
ited to only two subjects had not given her enough to do;
she could not keep up with her class, and therefore would ;
take longer before graduating. She had helped around the |
house, but despite this she had become quite depressed at ,
times. She said she realized that if she were busy she |
didn't get so depressed, so she would start to do her ex- |
ercises and sort of "work myself out of it," she said with ;
a giggle. I
Lorna is a very pretty girl with brown hair and I
jbright blue eyes. She spoke with much animation. She went I
I on to tell how happy she has been since she has been going |
to high school. She is quite busy and no longer gets de- :
[pressed. She said that before she started there she hadn't ;
gone out much except occasionally to drive-in movies. Since!
!gping..Ao.school,_however, she is haying_.quite„an_ active !
40
social life and"thbrôughïÿ"ën^ÿlng'iV." " She~~Eas a "boy-” ;
friend, a senior at the school. He has a severe cardiac |
condition for which he will have surgery this summer, "after
which we hope he will be all right," Lorna said. They not !
only go to drive-in movies, but to the regular theaters and :
;to parties, and do "practically everything every teen-ager ;
jdoes except dance." They plan to start bowling soon. She j
ifeeIs that her associations with the other handicapped stu- !
{dents are much more comfortable because the handicap is ac- *
{cepted, and she is not made to feel different. She added, i
"We go out on dates and we forget that we have handicaps." j
I She reiterated several times that when she came home from ;
Ithe Hospital she had not realized that she could ever be j
I this happy again. !
I :
I Although the record indicated that Lorna had felt
jthat having poliomyelitis was a punishment for having talked]
{back to her mother, there was no indication in her discus
sion that she had such feelings now. She said that she felt;
there had been a reason for her having had it, thereby echo
ing her mother's sentiment, and added, "but it shouldn't
happen to anybody." She could not clarify this expression
much, but said that she had been quite lazy before she be
came ill, and now she is much more ambitious, wants to do
everything for herself including many things which she had
previously resisted doing.
Lorna said that her goals in life are unchanged, but
she has added one, that of walking again. She had planned ;
to be a PBX operator and expects to attend a junior college ,
for training after she graduates from high school next year.;
While she has no immediate plans for marriage, she has al
ways thought She would like to marry when she is in her 20's ;
and sees no reason to change this expectation. |
I
i
Analysis of Interviews with Mrs. Larsen and Lorna.— |
i
It is obvious from the interviews that a number of changes |
took place within this family as a result of Lorna's having I
had poliomyelitis and having been left with a crippling con
dition. These changes involved not only some physical re
arrangement, but also changes in activity on the part of the
family group, and a shift in the parents* attitude toward
the .girl.___________________ . _________________
41
It could almost be said that facing her condition
has been harder on the parents, especially the mother, than j
on Lorna who seems to have achieved a certain emotional se- ;
curity before she had poliomyelitis. Although she undoubt- i
edly had some difficulty in adjustment, she now appears to
be accepting her limitations with relative equanimity* This]
is more than can be said for Mrs. Larsen who seems to have I
taken on a martyr-like role. While both mother and patient
expressed the feeling that there were positive aspects to
Lorna * s experience, the girl described these in terms of her
own increased maturity, while Mrs. Larsen seemed to need to I
go much farther in her search for the good side of the pic
ture, seeking a moral value in it.
Mrs. Larsen mentioned several changes in her activi
ties. The shift from intensive church work might indicate
some shaking of her own faith or an inability to explain
satisfactorily to herself why her daughter was stricken with
a crippling illness, since she seems to need to find the so-[
lution in an area over which she has no control. Her atten-^
dance at only one PTA meeting after Lorna started to high ;
i
^school also seems significant. Although this PTA would of- i
ifer the same opportunity for service and activity, working ;
; I
jwith the parents of other crippled children might be painfulj
I ' j
jto her and she may be more comfortable not being with this I
I *
[group. She rationalized her non-attendance by saying that i
she-had-"always-been a home=body,". but presumably she _was.„a_'
p'hôiaë-'bQdÿ" before "Lorna ' splines8, ¥oo.
Although one of the first things which Mrs. Larsen
mentioned in the interview was the fact that "they", refer
ring to crippled children, did not want pity, her own atti-
jtude seems pervaded by this element; pity for herself as
;
iwell as for Lorna. Actually, both parents now seem moti
vated by pity for their daughter and a need to try to make
i
up to her for what she has lost by no longer having the use |
of her legs*
i !
I Both Lorna and her mother indicated that they felt
I
that Lorna has become more mature. This they seemed to at- .
tribute to the fact of her having had poliomyelitis, but it !
must be remembered that Lorna was over 15 years of age when [
she became ill and that increasing maturity was to be ex- '
Ipected, particularly since she is now approaching the end of
the adolescent period. It can be said that, considering a
[direct cause and effect relationship, her illness and subse-|
I
quent disability does not seem to have deterred her progress
toward personality integration. There are, however, several
aspects which are unrealistic and untested, so to speak.
jLorna had already decided on the kind of work she would like!
|to do. Her choice seems sound, and since she had picked a
Isedentary kind of work, its accomplishment does not appear j
I I
unrealistic. Her goal of being able to walk again appears i
I !
less realistic, but not impossible if "walking down the |
I
bhurch...aisle" -or-some- other motivation is strong-enough, and.!
^3
iT”'ambïïlat'ing lÿ' wlthT b r a c e ôrutbhes meets hër coE-
(
ception of walking. j
As she approaches the end of her adolescence she
seems to have completed her sexual identification and seems i
to take pleasure in being a woman, looking forward to the i
[role of wife and mother within a few years. Again, this
I
iseems realistic. She has made a good school adjustment and '
la good social adjustment with her peers. A question can be
raised as to whether or not her adjustment would be as good i
I '
jif she were not with a group of people who also have physical
handicaps, a situation which she will have to face when she
enters junior college.
With regard to Lorna, it should be noted that her
situation cannot help but be a frustrating one. Regardless
of how many good things she may find about it, or the fact
that she considers herself to be no different from any other
jteen-ager, she cannot rationalize away the fact that she is
jdifferent, that her boy-friend and her school friends are
jdifferent. This is a defense which she needs in order to
jcope with her frustration. On the other hand, it has been
I
pointed out that in such cases frustration is not always a
I
[barrier to the achievement of a good adjustment, and some
times serves as a stimulons to the individual so that he
, I
channels his efforts and resources into the development of
44
otheF"assets ” ;
The Faust Family, (Burton) '
i Mr. and Mrs. Faust have four children, of whom
IBurton, 17, is the oldest. The family came to Los Angeles
I some three months ago following a period of unemployment for
Mr. Faust in Cleveland. When a friend in Los Angeles of-
jfered a job, he accepted it in order to relieve the finan-
I
cial strain, even though it meant leaving an area where they
I
had lived all their lives.
I I
' Burton became ill the day before the family was to ‘
leave for California so that the departure was postponed
about two months. He was hospitalized in a communicable
disease unit for about one week prior to transfer to a sec
ondary hospital in Cleveland. As nearly as could be ascer-
Itained, neither the patient nor the parents had contact with
[social service during this period.
Burton was seen in the Out-patient Clinic at Ortho- '
jpaedic Hospital in December, 1954. It was noted in the chart
I '
jthat he walked normally although the right leg appeared i
{somewhat smaller than the left. There was a mild weakness [
in several muscle groups on the right and his foot posture
jWas rather poor. Physical therapy was prescribed and he
I !
still comes regularly for this. No actual restrictions were*
^Wendland, op. cit., p. 4.
Ripley, Bohnengel, and Milhorat, op. cit. p. 782.
45
placed on Burton's phys 1 caT"acRvlty by thF~doctoF,~except j
that he should not become too fatigued, !
Interview with Burton.— The interview took place in |
the office, where Burton came following one of his regular !
jvisits for physical therapy. He was walking with a slight
I limp, but explained that this occurred only after his leg j
ihad been elevated for some time as in the treatment he had :
Ijust finished, !
' :
Burton told of his experiences in the hospital, I
these having occurred some six months ago, and related his J
fear of paralysis when he learned that the diagnosis of non-
parylitic type poliomyelitis had been changed to bulbo
spinal . He said that he used to get up and walk around the |
ward just to be sure he could still walk. When this was '
questioned, he explained that the staff was very busy, im- !
plying that he was not watched closely, and saying that it |
was just for a few minutes now and then, as "I was deter- . !
mined that I was going to walk." ' ,
In response to a question about how he felt he had ■
been most effected by polionQrelitis, he said, "Well, I was
the athletic type," and described his athletic interests and
activities, which were chiefly baseball and basketball, and
how he could no longer participate in these sports. As a
result of his physical limitations he had started to study
very hard, something which he had never done before. When
questioned on how he felt about this he readily admitted ^
jthat studying was not so enjoyable as athletics, but indi- '
icated that he felt he had no choice. He said he had already
decided to be an attorney and he supposed that it was good j
that he had had to start to study because he would have had '
to buckle down sooner or later, especially when he got to ;
college. In this aspect he could see that poliomyelitis, ]
■rather than having had an adverse effect on his career, had j
iprobably enhanced it by forcing him to prepare himself bet- j
Iter, but this was said with a rather resigned attitude, not !
one of real conviction. j
When asked if his social life had been changed any |
his response was quite spontaneous and he then seemed to be |
talking about what he considered to be the real root of his I
[trouble, the fact that the family had come to California and!
jthat he was finding it extremely difficult to make friends |
ihere. He described enthusiastically how things had been at |
["home", how he had grown up in the same neighborhood and has!
[always been part of a group. Even though he came from a j
I large city, he usually met someone he knew wherever he went,!
'and.„pe op le_ were.. ve ry friendly, _ where as.. out_here_he_ feels, !
46
jtbey” ~are~disintérFstèd'” anF . Hè has made no ;
Ifriends at school, and attributes this to the fact that he
{lacks status in the eyes of his school mates because he can-'
hot go out for any of the teams ; he has nothing to offer.
I ■ I
As to his social life, he said, "It's just with the ,
family." He then contrasted this with his former relation- j
iships with his age-mates mentioning their various social
and group activities including membership in a club. He hadI
not been dating much prior to having poliomyelitis and does i
not go out at all now except with the family. Reminiscing
about what fun he used to have he remarked that "Your teens
are supposed to be the years when you have the most fun be
cause later on you have a lot more responsibilities." When
asked if he felt that having poliomyelitis had cheated him
,out of this fun he replied that he did feel this way.
I !
' Burton said that he did not feel that his relation
ships with other family members had been changed any by his
having had poliomyelitis. He was not pampered nor made to
feel dependent during or immediately following his illness, '
although his parents have always been very willing to help
with his exercises or in any way he might need it.
As to relationships with his siblings, he mentioned
that he and his brother Michael who is less than a year his :
junior had always gone around in the same group because they
,were so nearly the same age, but that he did not feel as
, close to Michael as he did to David who is several years
younger. Even though David is only l4 years old. Burton *
stated that he felt much warmer toward him than he did
toward Michael toward whom he sometimes feels some rivalry. I
He could not see that his feelings toward the two brothers
are any different now; he still prefers David and feels
closer to him.
i
; The boy mentioned that he sees much improvement in
his leg and hopes that he will have no permanent residual.
He said that when he first started to drive the car again,
he noticed the weakness of his foot, but this has now great
ly improved. He has not attempted to participate in any
physical education activities at school, and did not even go
in swimming one week-end when the family went to the desert ,
[and there was a heated pool available. i
I
i Interview with Mr. and Mrs. Faust.— Mr. and Mrs, I
Faust were seen in the office. Mr. Faust had taken time off|
from work in order to participate in the interview. |
I Early in the interview it became very evident that I
the-parents were„ worried about Burton and had, come with__ the_j
47
ürcnilif-lkü» ï\G»]r1;tiG,3zïi:ry5 i.n tfiewii t() ,
îlnû a solution to the problem. They described the strain i
through which they had passed when they were apprised of the
diagnosis and later of the possibility that Burton might
'have to be put into a respirator. They felt that he made a
'good adjustment at the hospital and after his discharge, but
jsince their arrival in California he seems to have changed : ;
iHe feels rejected, his mother said, and all their efforts to
try to get him to associate with adolescents of his own age
have been futile. From the description given, these efforts!
have ranged from more or less subtle plans such as visiting ;
i friends who have children of the same age, to urging that hej
jgo with his brother to a teen-age social club sponsored by a!
{church group, and finally to rather hostile attempts on the ,
mother*s part to force him to seek companionship and social i
activity outside the family circle* She described this by j
saying that sometimes on Friday night Burton says, "Well,
jWhat are we going to do tonight?" She said this irritates
her and before she can control her words, she usually snaps :
back saying, "What do you mean, what are W going to do to- ;
night, what are you going to do?" She remarked that she
knows this is not the way to handle the situation, but she
gets so frustrated over it that she gets desperate. She al-'
so obviously felt very guilty over the entire situation, for
which she largely blames herself.
She described how she had always told her children
that "the friends you make in high school are the ones you
will keep all your life," and now, through her urging, they ;
had pulled up stakes and come out here where Burton seems
, unable to make a satisfactory adjustment.
I In discussing how Burton's difficulty seemed to ef- i
feet the other members of the family, both Mr. and Mrs. Faust
stressed the fact that they felt they had done a good job i
with their family, which they consider to be a well-integra-;
Ited, democratically operating group. They gave illustrations
of how any important decisions effecting the family were dis^
cussed with the children, although the interviewer's impres-j
Sion from this description was that the decisions were made I
first by the parents, and although they were subsequently !
discussed with the children, there was little idea that they;
would be changed even if the children did not favor them. I
I
I Mr. Faust described in some detail the difference
between their life in Cleveland and what it has been here.
He said their apartment had always been a gathering place
for their children's friends. The boys constantly had the j
house filled with their associates and carried on a social !
life which seemed entirely apart from that of the adults. I
fhe__parents_had__their„_own. interests in church and. charitablej
work and were out at some function almost every night. At
this point Mr. Faust remarked somewhat bitterly that since
they have been here, he and his wife have been out Just
twice without the children. The pattern of their living
seems to have changed, and they attribute this entirely to !
the change in Burton, because if he insists on going with !
them everywhere, naturally the younger children do too. i
Not only does the family all go out together, but, |
|Mr. Faust explained, where they go is even governed by dlf- i
jferent motivations. Whereas before they had selected activ-:
ities of interest to them alone, now they must take into |
jaccount the fact that the whole family will be participatingj.
|Nor is this the only consideration, for in their anxiety to I
get Burton to move without the family, they choose to visit !
friends who have teen-age children, hoping that he will be- <
come interested in them and find companions of his own. ;
Discussing relationships with the siblings, Mr. and ;
iMrs. Faust emphasized the fact that Burton had always been ;
the idolized older brother, even to Michael, who was only
about a year younger* They said there was occasional dis
agreement which could be expected between brothers, but that!
Michael and Burton had been inseparable* They had always
had the same friends and participated in the same activities.
Since coming to Galifornia, Michael has seemed to have made
a satisfactory adjustment and has had no difficulty in mak
ing friends* They wonder if part of Burton's moroseness
might not be based on Jealousy of Michael's ability to mix
easily with people, and commented that there never seems to :
be any rivalry between Burton and David. |
When asked how the other children reacted when told |
that Burton had poliomyelitis they described that all were i
worried about their brother, but Michael's reaction was so
[Violent that they were at a loss to account for it. His
mother said he became absolutely terrified, which to them |
[indicated again the closeness of feeling which he had for
his brother. They thought at first that he was extremely
[worried-about Burton, but later discovered that the basis
of his terror was chiefly the fear that he too would get
the disease.
The Fausts said that they had been rather proud of
the way they were raising their family and they are com
pletely at a loss to explain the change in Burton from a
fun-loving, happy adolescent to a somewhat withdrawn, and
[obviously uhhappy boy. They feel that his present inability
|to adjust is due to both his having had poliomyelitis which |
■resulted in his having to give up physical activity for a
while ,_and_to. .the...breaking up of old and happy, associations*
49
Mr. Faust noted very worriedly that "Burton just seems I
afraid to take a chance now," Although the doctor had told j
him to try to take physical education at school. Burton ar-|
ranged his program so that he would he unable to do so. In !
the past he was always very anxious to drive the car whethei^
his father was there or not. Now, although he drives the i
family when Mr. Faust is not available, when the latter is |
present, he does not even ask to drive. j
, The Fausts indicated that at the time of Burton's i
! illness they had hospital insurance which covered all the
hospital expenses. They said, however, that they had been j
! informed of the willingness of the National Foundation for
{Infantile Paralysis to assist financially if they needed it.i
I They were most appreciative of this and said it had been
[very reassuring to them.
Because of the anxiety of the parents over the situ
ation and their recognition of their need for help in this
matter, they were referred to the medical social worker who
services the clinic in which Burton was seen.
Analysis of the Interviews with Burton and Mr. and
Mrs. Faust.— Perhaps the outstanding thing about these inter
views was the demonstration of the lack of understanding .
which exists among family members. Here were parents who
felt that they had done a good job with their family, that
; ' i
ithey had given the children a warm and secure atmosphere in !
I i
jwhich to grow and develop, and suddenly they are faced with {
I !
l a withdrawn, hostile boy who obviously has not achieved the j
' j
jmeasure of security and maturity which they assumed he had. t
jln the face of crisis. Burton's defenses have crumbled, and ,
I i
he has regressed to an infantile level where his world is ;
I
pretty well bounded by his family alone. Although he does j
go out and is in contact with both adults and peers while at
school, having put in his time there, he again withdraws I
50
lïntG the family and has no life outside of it. While this ^
jneed to be with his parents and to try to gain their love
land attention is now quite overt, it certainly is not some- :
I
ithing which has been developed during adolescence, but as
I
previously noted, had probably been present year after
year,^ but had gone unnoticed because other activities en
abled him to sublimate it.
There is a definite possibility that Burton is using,
the present situation as a means of punishing his parents,
particularly his mother who had told him how important it
was to make friends in high school, and who then deprived
him of the opportunity to keep his friends. Mrs. Faust's
guilt around this situation is recognized by her, and in
turn makes her angry and frustrated because she seems unable
jto do anything to alleviate it.
^ From the interviews, the impression was that Burton
was making a satisfactory adjustment to limitations placed
I
pn him by recent poliomyelitis and that his difficulties ;
I I
became apparent only after the family moved and he was faced*
with the additional stress of having to adjust to a new com-|
j I
munity. Once having begun, however, the manifestations of j
I !
his personality inadequacies do indicate a rather serious
degree of disturbance, and one which demands help from out- '
j
side the family. Dr. Josselyn has said that "those problems'
J____________________________________________________________________________________________________________________________________________________________ ;
' ^English and Pearson, op. cit., p. 313.
51
wRiôhrârê hot éffëotivèlÿ-sôIvëtrd^ürW ad
the neurosis of the adult.Even though many of the neu
rotic conflicts originate from relationships in early
childhood, adolescence is a period during which they can be
resolved.
; Another point which seems apparent is that Burton's ■
I source of naricissistic supply had been seriously disrupted
I This does not come only from one source, but indications are
I that his needs for recognition and support were not ade-
I !
[quately met within the family group and that he therefore
I
derived more than usual satisfaction from his participation -
in sports. This activity not only gave him status within ;
and outside of the family, but it also provided a good
source for the dissipation of many of his frustrations and
hostilities. Burton now feels that his only source of gain-;
ing status has been taken from him. The strain of having to;
adjust to the limitations placed by the disease, plus the
additional stress of starting all over in a new community,
I i
have proved more than his defenses can handle at this time, :
I
and for the present, he has been unable to mobilize new ones'.
! I
j Several times during the interview Mrs. Faust men- =
i ' '
{tinned her feelings about dependence, indicating that she I
i I
had once gone to work because she felt that the children
were becoming too dependent on her. Again, she mentioned j
! ___________________________________________________: _______ I
, op. cit. p. 236. !
52
t hât Mïchâè 1 was**t oè' dependèht on Bürt oh, a 1 th ough~ there |
I
seemed nothing to substantiate this statement. This need
to be independent and to have her children independent of
her may be indicative of an unconscious rejection of them,
but more obviously would seem to stem from her own insecur
ity, There is little doubt that her emphasis on indepen
dence has resulted in many of the children's dependency :
needs being unmet* Although Burton verbalized the fact that
he did not want to be dependent on the family, he has become
increasingly and insistently dependent since they came to i
I
Los Angeles. This is a constant source of conflict to the
family because it is inhibiting to the parents as well as i
being contrary to Mrs. Faust's pattern while constantly ex-'
' !
tolls the virtues of independence.
The sibling rivalry of which Mr. and Mrs. Faust prof
fessed to be unaware is further evidence of lack of under- i
standing and integration within this family . Their charac- ;
!
terization of Burton as "the idolized older brother," hardly
I seemed borne out by the material presented. It was probably
, more indicative of the feeling that it should be this way in
' :
order to fit in with their idealized conception of "the
* j
* happy family," They reacted as though there might have been
; i
! some awareness of it which was not recognized because it was
j a threat. Their defensiveness in this matter was also shown
I in their rationalization of Michael's behavior when his I
■„brother„bccame_ ill... It would seem that Michael..feared that j
53
lîë'l^ôônâiïght be "stricken his "
hostile feelings toward Burton. He may have wished that
something terrible would happen to his brother, and when it
did, his first thought was that he would be punished by get
ting poliomyelitis too. There was no indication of a change
in the relationship between Burton and Michael. However, j
the fact that Michael is mixing with people, acquiring ]
friends, and participating in some social activities could
hardly be without meaning to Burton at this time when he |
feels so alone. j
It was not learned just what kind of a relationship ;
I i
{existed between Burton and his father. The latter seemed
somewhat more accepting of Burton, willing to work with him :
' ■ i
•on his problems. He made no attempt to hide his frustration
iover the fact that he and his wife now have no social life ■
• j
apart from the children, a fact which he attributes directly
to Burton having had poliomyelitis. He seemed to demon- ^
I
strate even less of an awareness than his wife of the pos- j
sibility that the problem was not within Burton alone; that |
family relationships were a contributing factor to the pres-;
ent situation.
I
I While there are many ramifications of this family's ;
I
: ;
jsituation which did not come out during the interviews, it i
i I
jcan be said unequivocally that there have been a number of |
{changes in the family's pattern of living and in their
[Apt_erp.ersonal.„relatlQ Burton had poliomyelitis. j
54
jOn the other hand, it cannot be claimed that all of these
j I
came about because he did have the disease, but only that '
this was a factor which effected the patient and the family.
The Roberts Family, (Thomas)
Mr. and Mrs. Roberts have four children. Thomas is
I :
;17 years old; his siblings, two boys and a girl, range in
t
age from loi years to six years.
Thomas was admitted to the Hospital about three ;
years ago after only one day in the Communicable Disease ;
Unit at the Los Angeles County General Hospital. His ad
justment on the ward, where he remained one month, was con-
Widered satisfactory, but after discharge his mother com
plained that the school work given him by the home teacher
was insufficient to keep him occupied, and he was "quite a
problem." At her insistence and assurance that both she and!
; t
the teachers would be alert to signs of fatigue in the boy, i
he was allowed to return to school. Shortly thereafter ‘
Thomas discontinued clinic attendance despite the fact that
k muscle check had been ordered as it was felt that some of
the muscles were still increasing in strength. He was still
wearing a short leg brace, and had some residual weakness in
, i
the lower left leg and foot.
i I
I Contact was reestablished with the family for pur- !
!
poses of this study. Mr. Roberts was contacted by telephone■
and indicated that the letters had been forwarded despite |
55
ithê fact that the family has moved some five times within {
jthe last three years* Mr. Roberts changed jobs once; he is
now a sales engineer, and one of the moves was necessitated
by a transfer in his territory. The Roberts have now pur
chased a house in a nearby county and Mr. Roberts has been
given a sales territory in the same area. After this ex- ;
plS-nation, he said that he and Mrs. Roberts would be glad to
!
participate in the study, the only thing being that his work;
;
|Often keeps him away from home and he was not sure he would !
be available. It was explained that an interview with his
wife would be satisfactory. He was then asked if Thomas had
indicated a willingness to participate, to which he replied,
"He will," As this sounded as though the boy might be given
ho choice in the matter, it was explained that if this would
make Thomas uncomfortable it might be better to omit it.
Mr. Roberts, however, insisted that Thomas would be avail
able, adding, "I don’t know how much you’ll get out of him, i
it may be nothing more than a series of grunts." When asked^
if this was because it was difficult for the boy to talk with
I
strangers he said, "No, he sometimes talks a lot, but at I
other times he won’t say much. He’s just a typical teen
ager, completely unpredictable." ;
I Interview with Mrs. Roberts.— Mrs. Roberts, after
listening to a clarification of the purpose of the study said
j/hey really didn’t think that Tom’s personality had been ef
fected by the experience of having poliomyelitis, nor that
family relationships had been at all changed by it. She said
they had just treated it like chicken pox or any other childf
hood_disease, although jthey were _vei*y upset„when they firs.t„j
56
Te àrnëd" thé 13 ïagnôs 1 ^ 83ïe^*ëxpTalhed* that * th "Imr 81 over
before they knew It was polio, so that perhaps it had been j
easier on them.
The family had just returned from a vacation in Se- !
Iquoia National Park when Tom became ill. Me was sick four î
or five days, running a high temperature, but since he did j
Inot have a stiff neck or other classic symptoms of polio
myelitis, the doctor had thought it was the flu. He seemed
to be getting along all right, and since he was to be a
freshman in high school and was most anxious to be there the
first day, they allowed him to go. When he returned from |
school he was dragging his left foot and could not seem to ■
control it. He was admitted to LACGH that day, but since '
the communicable phase was over, was transferred to Ortho- |
paedic Hospital the following day. ;
j
Mrs. Roberts said that she felt that the experience '
had really been good for him, as he was inclined to be self-,
centered and never seemed to have any concern for people who
were ill or in trouble. She thought this experience had
brought home to him the fact that this can happen to anyone,
■and had given him some understanding of what it means to be
[ill. She said that although he still has a slight limp,
they are happy that if he did have to have it, it turned out
!to be such a mild case, saying, "It’s too bad that anyone has
to have it, but I guess the Good Lord knows what he’s doing.."
I Mrs. Roberts indicated that before Thomas came home '
'from the hospital she and Mr. Roberts had decided that he :
would not be singled out for any special attention because
of having had polio, other than to carry out the medical
orders. She said that he had always resented the three
younger children, since he was over si3f when the second boy '
was born, and there has never been a close relationship be- ,
tween Tom and the others. Since they felt that he was a
rather spoiled child from having been the only one for so {
[long, they thought it would not help matters to pamper him j
when he came home. As a matter of fact, Mrs. Roberts said, '
{Tom’s illness really resulted in the other children getting ;
more attention and being watched much more closely for the
!next six months, for fear they might get it. From the way ;
Mrs. Roberts spoke, it was the interviewer’s impression that;
once the parents were over the initial fright occasioned by i
the diagnosis, and realized that Tom had a fairly slight j
residual, they did not feel any need to give him special I
attention.
The mother explained that Tom had never been inter- j
ested in sports, although he did like to swim. She commented
that ..since .his^.illness._he_ has refused., to go„swimming and she;
57
ithlnÎŒ because he* feels that perhaps he got polio- ^
myelitis from swimming in very cold water during their vaca
tion, She said his lower left leg is a little smaller than j
the right, but hardly enough to be noticeable. She seemed i
to think also that since his illness his resistance is much :
lower and he seems to have one cold after the other all
winter long. As to medical care, she takes him to the fam-
jily doctor for a check-up once in a while, but has never had
him seen by an orthopedist since he stopped coming to cliniC'
'She explained that at that time they were living some dis
tance from the hospital and had only one car, so that it was,
'difficult to continue coming* She said he had kept up his !
'exercises amazingly well for some time without any urging '
from her.
In discussing Tom’s personality Mrs. Roberts said
they used to think he was an introvert, but they have no
ticed that he does seem to enjoy talking with people. He
'does not go around with a gang, but usually has two or three
friends with whom he is close. He is particularly fond of i
reading, and doesn’t run around a lot. She noted that he
does not go on dates, because he doesn’t seem very interested
in girls yet. When asked if he danced, she replied, "He
won’t." She thinks he knows how, but finds it difficult to
discuss such things with him as he is stubborn and scornful.
For this reason she has never offered to teach him herself,
feeling sure she would be rejected, and once when she asked
him something about a dance, he replied, "How can I dance I
with my foot this way?" !
I
She said also that they rarely discuss plans which
concern his future, because if she or Mr. Roberts expresses
an opinion, Tom is sure to decide on just the opposite. He
has recently said that he plans to go on to junior college
after he finishes high school next year, and they are pleased
by this. I
' As the interview drew to a close Mrs. Roberts again :
said they could see no way in which Tom’s adjustment had been
affected by his illness. She did remark that it probably had
hot been fair for them to take him to Seattle as he had had a
difficult time in school up there and had been unhappy the
whole year they were there. Although they have been back
here only a short time, and he has gone to his present school
only one week, she believes that he is much happier now. :
! ' I
I Family activities, according to Mrs. Roberts are not
generally planned, and there was the impression of a group i
which is not particularly well integrated, although there |
appeared to be a close relationship between her and her hus-j
band_as__8he_described_ 8ome_of _ the. things which-they like ‘
58
jto do.
Apparently the family’s income is adequate now, hut
[at the time of Tom’s illness they had some help from the
{National Foundation for Infantile Paralysis in paying hos
pital expenses. They are very grateful for this, and Mrs.
.Roberts said that while ordinarily they don’t work for or
ganizations, they always go out and work for the March of
Dimes.
!
Interview with Thomas.— Tom came in after school
Just as the interview with his mother was concluded. He is
quite a tall, thin boy, good-looking, and with a pleasant
manner. From the way in which Mrs. Roberts made the intro
duction, and his response, it appeared that he was not awarei
of what was going on. When asked if he hadn’t expected this,
call, he said he didn’t know anything about it. His mother ;
immediately spoke up saying, "Daddy gave you that letter, j
didn’t he?" To this the boy again made a negative response. 1
After an explanation of what the visit was about, he indi- j
cated that he would participate, and his mother left the !
room. ;
Contrary to the impression given by Mr. Roberts,Tom ;
seemed quite at ease and spoke freely, although at times his!
thoughts did not seem too clear and he had a little diffi
culty trying to express just how he felt.
Î
In describing how he felt about having had polio
myelitis he said that he was so young that it really did not'
effect his future plans. He had had fun on the ward at the
Hospital, so that it wasn’t a particularly bad experience.
He explained that he never was athletic. He hates baseball
and football and never had any ability or interest in these -
kinds of activities. He does like to swim, he added. When |
asked if he did much swimming, he said that he had been only,
once since he had poliomyelitis, rationalizing that most of
the pools were too cold, and besides there had not been any :
near where they lived. He said the school doctor had ex
amined him this week when he started to a new school and hadj
said he thought it would be beneficial if Tom took swimming.
He said, "So I guess I’m going to take swimming as soon as i
my program is settled." He added that since being sick he
'notices that he gets colds much more frequently, putting it '
'this way: "In my : old age I seem to get colds all the time
jif I’m not warmly dressed." This seemed to be the only
.thing which he attributed directly to having had poliomyel
itis, other than some residual difficulty with his foot. He
[said the school which he is now attending has a large campus;
and he notices that his foot hurts him after he has done a {
lot-of walking-.-— He showed the. .foot which appeared to turn. J
59
under à ïit~t:le"7~ahd~ he seemed "l^mëwhat" worried 'about" T t j
I
Me then commented on how much he likes his present |
school, even though it is "sort of crumby," because the
buildings are old and remodeled. He likes his classes and i
his teachers. This led him to a discussion of the year, I
last year, when he went to high school in Seattle. This he
said was a terrible experience. The people up there were ;
snobs and he found it difficult to fit in* In trying to '
clarify why he did not fit in, he did not come up with much,
but it was obvious that he had thoroughly disliked almost j
everything about living in Seattle. The high school he at- ;
tended there had extremely high scholastic standards, and he
was not able to keep up with the standards. This made it |
all the more difficult since he did not like his classmates,!
his teachers, or anyone else he met up there. He explained I
that even though he had conformed to their ways of dress, j
language, haircuts, etc., he didn’t like doing it, and it
didn’t make him feel a part of things.
I
He went on to discuss some of his own philosophy, {
jsaying, "I don’t like to conform because I don’t want to be ;
like everyone else." He doesn’t feel that everyone is equal
;to him. He said history is his favorite subject and he :
•thought he would enjoy living in a country like England
which has a constitutional monarchy and recognizes differ- ,
ences in people.
; ■ i
I Thomas did not seem to feel that his having polio- j
{myelitis had affected any of his interpersonal relationships.
iHe said he had never been close to his brothers and sister I
because they are so much younger than he and they always !
make a lot of noise and annoy and embarrass him if they are
out somewhere together. In general he considers them to be
pretty much of a nuisance, and said he didn't really think
he would want to get married* He then added, "I know I will,
though, and probably will have some children." He indicated
that he has no immediate plans, but pointed out that most of
the students in the senior class were engaged to be married,;
and so are some of his own classmates who are juniors.
: His social life seemed mostly confined to going out
with a couple of friends, or playing chess and similar games!
which he enjoys. He said he knows how to dance, but doesn't;
{like to, and he did not feel that this was because his foot
■bothered him. He indicated that the family rarely goes out !
■together, saying the last time they went out to dinner to
gether was Thanksgiving. His parents go out, and are now |
[planning a trip to Las Vegas. He will remain at home to
'take care of the younger children. He did not seem bothered:
;by_„thisHe. . said regarding..his parents, _ that, he guessed !
60
tWéj-Wëre ""'alT right,” ‘ adding“tlïât "he really" "thought “his Dad
as a "pretty good guy," and that he liked him although he
does act quite emotional sometimes. He explained that when
he had poliomyelitis his father was editor of a small news
paper and had written a column which Tom felt was much too i
sentimental for publication. He made no specific comment |
regarding his mother.
I Tom several times expressed ambivalence about him- ]
jself. He said he had been told he was a snob. He isn't j
!sure if he is or not, but described himself as a "spoiled i
ibrat" when he was younger and told of the temper tantrums he;
used to have. He is also ambivalent about choice of a voca-!
tion, saying that he likes history, but doesn't know if he ;
has enough patience to be a teacher; he really does not like
children.
Analysis of Interviews with Mrs. Roberts and Thomas. |
--The strongest impression derived from the talks with Bt?s. !
! . ;
Roberts and Tom was that the latter really had never been
I
iintegrated into the family. It seemed almost as though he ;
Were an isolate within the family group. That this would
'create hostility on Tom's part seems natural. However, he
: i
“ appears to have found satisfactory means of channeling this i
hostility into socially acceptable behavior. His interest
in reading might be one way he had developed of sublimating |
this. Also, since he preferred sedentary pursuits to those ;
requiring more investment of physical energy, it might ap-
1 '
pear that Tom had not had an especially difficult adjustment*
|to make after his illness which occurred in early adoles- ;
cence. When there was superimposed the necessity for making!
I i
hew contacts outside the family and accommodating himself to|
;a different environment, he did have difficulty. This was |
I I
not alleviated until the family returned to a more familiar |
6 l
locale. .
1
The Roberts family did not seem to be a well- i
integrated group, but there was evident a certain acceptance;
of Thomas and his differences, as well as a willingness to '
allow him to follow his own wishes as long as they resulted |
in no trouble. It would be an exaggeration to characterize |
I
this as indifference on the part of the parents, but it does{
appear to be indicative of a certain shirking, or inability
to accept fully the responsibilities involved in raising a
I
family. This was typified by Mrs. Roberts* statement that ^
once the fright of the diagnosis was over, they "just {
! I
treated it like chicken pox." It was something which he hadi
had, was over, and could be forgotten. This was carried so
■far as to preclude continuing medical care which was defin- ;
|itely indicated. Whether this was rejection of the child ;
himself or just of a very painful experience, cannot be ;
definitely known, but for Tom the result was the same — he '
I
did not get the medical care he needed.
Although both Tom and his mother commented on his !
lowered resistence, nothing was done about it. The tendency]
to pass off Tom's frequent colds as resulting from his hav- '
ing had poliomyelitis may also be regarded as a manifesta
it ion of the parents* inability to accept fully the parental j
I 1
role. Instead of looking at their son's regime to try to |
\
{discover within it possible causes for his lowered resistence
I
to__infection,_. such as _ faulty__diet, . they, simply ..attribute _it__ !
jto a ÿsLsV iTlnèss" and seek neither medical opinion as to thej
[correctness of their thinking in this matter nor advice as '
jto how to overcome*it. After Tom was discharged from the
! ■
jHospital Mrs* Roberts exhibited an impatience to get him
jback to school, and thereby out of the home, at least part
■of the day. It is recognized that she had three younger !
phildren to care for, but on the other hand, sending Thomas
I
to school sooner than would ordinarily be recommended, re
lieved her of the responsibility for his constant care.
A clue to the kind of relationship which exists be- j
{tween Tom and his parents is found in the handling of the |
letter from the Hospital requesting the interview. The let-!
I
ter was addressed to the boy, but was not given to him. In j
the conversation with the interviewer, Mr. Roberts described;
i i
Tom as a "typical teen-ager." This phrase seemed, in the |
' i
hinds of the parents, to imply erratic or unpredictable be
havior and indicated a lack of understanding of the need and ^
the right of a 17 year old boy to make such decisions for i
himself, and their own obligation to give him an opportunity|
I
to do so. j
It seems, too, that the family pattern of passing !
things off as unimportant, plus the lack of freedom of dis- |
cussion between Tom and his parents are factors which inhibij
the working out of many problems. Although Tom seemed to be|
aware of the need for medical care for his foot, he appar- |
I !
ently__was,jipt free_ tp_ indicate . this. to his parents.. __.In_.the_|
63
pfhtërviëw*Ws'r R6bërtrs"^âld""that~whiîé"*thëyirséà
was an introvert, they now notice that he enjoys talking to i
people. This was apparent during the interview with Tom,
but while he may be willing to talk to other people there is,
little freedom of communication between him and his parents.
This, however, may not be entirely a matter of family rela-
I
tionships at this time. Adolescents, in their struggle for
independence often feel called upon to disparage their par- I
I
ents and to turn for advice and support to their own age- I
mates or to older people outside the family group, with whom
they do not have such intense and long-standing emotional
jties.
j As previously noted, Tom was the only child in the
family for over six years. There is not present here the
[overt sibling rivalry shown in some of the other families !
I !
interviewed, but this does not mean that it is not felt by ;
the adolescent. Tom projected his hostile feelings toward |
his younger siblings to all children, making the general ^
statement that they are a nuisance, and he does not like |
children, I
Thomas seems to have much ambivalence about himself
but this is not unexpected in the adolescent. He conforms |
to standards set by his peers, but he does not like this be-;
{cause he really does not want to be like everyone else. He |
i j
'does not go out with girls, but he "knows" he will get mar- j
i I
ried. These, conflieting_feelings are not out of line with i
64
the lïsüa 1* ^ ad o les cent s tïnïggïë” tdwàrd*^âh ihtë^âtëd* self 1...1
Torn has made progress toward this integration. He has not |
definitely decided upon a vocation, but he knows in which !
i
direction his interests lie. In other aspects of maturation
!
!he is slower, apparently not having as yet made a complete I
!
hetrosexual adjustment. How much of his continuing imraatur-'
(
ity results from the parents* laxity in being ready to help j
him with the solution of his conflicts can only be surmised,!
but it surely seems to be a factor in this.
CHAPTER III
FAMILY RESPONSES TO CRIPPLING
ILLNESS IN AN ADOLESCENT
The findings of the study with regard to the five “
patients, despite its limited size, seem in general to be
similar to those of previous investigations on the psycho- .
social effects of poliomyelitis. As other research with I
[poliomyelitis patients has indicated, there seems to be no
[correlation between the degree of physical crippling and the
individual's maladjustment following the disease; rather,
this seems to be directly related to his pre-morbid person-
jality development and the character of intra-family rela- '
tionships. Of the five adolescents interviewed, the two who
!
seemed to have the greatest difficulty in adjustment follow-.
!
ing their illness were those who had the least residual weak-
ness, with no actual paralysis. This statement is based on |
both subjective and objective factors as revealed in the j
interviews, and not on any kind of scale for measuring the
post-illness psychosocial adjustments of the five young
people. Therefore, socially acceptable ways of handling
feelings as well as physical limitations may have passed for
good adjustment in some, while those who more openly
65
66
expressed their distress over their situations were felt to|
have made a less satisfactory adjustment. '
All five adolescents studied seemed to have some
fear of competitive inadequacy with unhandicapped peers.
Of the two with the most severe residual, Lorna has seemingly
1
made a good adjustment among handicapped school-mates, while’
Virginia is still comparatively sheltered and has not yet i
had to face the school adjustment. How difficult and trau
matic this adjustment with peers is, seems dependent in
large measure on how much of an investment the adolescent
previously had in certain kinds of activity. With both
t ;
jMaryAnn and Burton, participation in sports seems to have :
'been their only basis of competition and means of maintain-
ling status with their peers. Therefore, even though the
I
[physical limitation was slight, it loomed large in terms of ,
the kind of adjustment which had to be made.
Lorna is the only one of the five adolescents inter-'
I ^ I
viewed who has dates with members of the opposite sex* The j
others limit their social activity either to a few friends
of their own sex or to their immediate family. It cannot be;
I
said that this is due to having had poliomyelitis, but only :
that with one exception they seem to be somewhat slower in j
i !
making a complete heterosexual adjustment than many individ-
I
iuals in their mid-adolescent years. Just how much of this !
! *
lis due to actual physical change brought about by the dis- ,
i
ease-,.-again, cannot be measured, .p a rtic u la rly -S in c e — th re e hadj
67
I such a slight residual and little noticeable physical
During adolescence when the individual is finding
i
that many of his defenses are not effective and there is j
difficulty in mobilizing new ones, adjustments to stressful |
situations are more difficult and the ego reaches the point :
I
I of exhaustion sooner than it might in a more stabilized per
sonality. This explains the finding that even though the
adolescent seemed to have made a satisfactory adjustment im
mediately following poliomyelitis, if there was an addition-
jal strain placed on him such as a move by the family, or even
the return to school with a restricted physical regime, the
;ego was unable to function adequately.
; No family-foeused study was found, so in this re-
1 i
jspect there is nothing with which to compare the conclusions'.
I I
There is no doubt that family relationships are bound to be !
effected by any meaningful experience of one of its members,
such as a crippling or threatening illness. As with the I
patient, the family's manner of handling feelings about the |
situation and the inter-personal adjustments which must be
made, is conditioned by previously established patterns of
dealing with anxiety-provoking situations. Some of the pre
viously used defenses here, too, may prove ineffective in
I
handling the situation.
I It was noted that inadequacies within the family
group_which had _ previously been _passed, over, came. to._ light__
68
under the additional stress placed by the adolescent's ill-J
ness, some being recognized by the individuals and some per-
jhaps discernible to an observer but not to those directly 1
{involved * That realignment in family relationships as well !
I
;as new adjustments did take place as the result of the ado- i
I ■ :
|lescent having had poliomyelitis was also seen. The adoles-j
[cents' physical limitations and emotional problems undoubt- |
edly placed an additional strain on the relationships of I
other family members, thereby bringing about a new focus, asj
in the case of Mr. and Mrs. Larsen, where Lorna now "always |
comes first." It would appear that the parents here have j
given up something of their own "first" relationships to |
each other in order to try to insure their daughter's happi-
I ;
ness. It is conceivable that the situation has brought them'
I ;
closer; neither of these possibilities was definitely learned
I I
from the interviews. In the case of Mr. and Mrs. Faust, Burj-
ton's retreat into the bosom of the family has disrupted the:
pattern of their social life, but they are facing together j
I
the problem of working toward a resolution of the difficul- |
ties. In the Traeger family, where there already existed a '
problem of Mr. Traeger*s not being assimilated as a member j
of the family, Virginia's illness perhaps added to the ten- ,
Sion, and raised a barrier against which he could not fight—
a crippled child. Tom Robert's parents seem to have main-
: 1
tained the pattern of their relationships almost unaltered. :
Whether this ..has been done without . emotional .cost, to. them, is !
69
not known/ mt certainly It was not without effect"on the ’ ,
i
boy in denying him physical care and emotional support which
he needed as well. ;
I
Problems between siblings seemed, for the most part ;
I
to have been affected adversely by the adolescent's illness.'
I In no case was there an improvement in sibling relationships!,
\ ' I
{and the evidence seems to show that natural rivalries be- ;
I
tween siblings had apparently resulted in guilt feelings on <
the part of the younger siblings with the attendant fear of ;
punishment when the adolescent got poliomyelitis. j
I Although there seemed to be a need on the part of
{the mothers, particularly, to indicate that the adolescents';
!
illness had resulted in a closer 'relationship between them, ■
i ■ ■ ;
there seemed little real evidence to bear this out. A clos-,
I :
:er relationship presumably would be based on a better mutual;
! I
iUnderstanding, but although this was mentioned by both Mrs. j
Larsen and Mes. Blair, it seemed to mean only that they had |
' ■ i
spent more time,with their daughters, not that they under- i
stood them better or enjoyed them more as individuals. Mrs.j
: i
Blair expressed resentment against the way MaryAnn had re- |
acted to the attention given her after her illness. Mrs.
Faust, too, showed hostility toward Burton for what she con-;
sidered to be a poor adjustment on his part. |
It appears from the cases studied that the adolescent
may have used the f a c t o f having had p o lio m y e litis and being,
i . '
l e f t w ith some re Sid uaT_ w e tn e s s as a peg on which to hang I
70
some”"of his natural hostile feelings toward" Ms "parents T *
Because of the guilt which the parents seemed to feel in
I
several cases, they probably were more vulnerable after the
[adolescent had poliomyelitis. This was then used by the
patient to punish them and to vent his feelings of hostility
i ■ ' .
which stemmed from previously unresolved conflicts created
I i
by the relationships and not from his having had a crippling!
illness. Thus the strain on intra-family relationships was !
^further increased. i
I I
I When the interviews had been completed and the writ-!
! I
ing of this study was almost finished, announcement was made,
of the efficacy of the Salk vaccine as an agent for the con-!
trol of poliomyelitis. It might appear, then, that the
findings of the study were almost outmoded before it was '
even finished. Unfortunately, however, it is not antici-
i
pated that poliomyelitis will be completely controlled im- ;
mediately, and there are and will be people who need the
help of social workers in handling the problems which may i
’ . I
arise in a family in which an adolescent gets the disease ;
and has a residual disability.' Furthermore, while this was
an inquiry into the effects of poliomyelitis in adolescents
as it effects their families most of the findings are appli
cable to any kind of crippling disease or accident in an
adolescent and the concomitant problems of patient and fam- ,
!
ily as they are revealed through such a situation.
71
Implications of the Study
The study demonstrates quite clearly that neither
the adolescents nor their parents were prepared nor fully
adequate to cope with the many emotional complications which
1
ifoilowed the patient's illness. It reemphasizes the need
for all staff and the medical social workers in particular |
to develop greater awareness of these concomitants of ill- j
ness. More attention needs to be given to ways in which to
[make services more effective to patients and parents, not
jonly as a means of preparing them for the possibility that
.problems not presently discernable may show up later, but |
{also, hopefully, as a way of preventing some of these prob-
I
lems from occurring.
I
I In addition, the study brings out the importance of •
family life education, which strives to help people to in- '
: i
crease their understanding of family relationships. Since i
I '
I
severe and sometimes crippling illnesses or accidents are |
i
a part of the life situations in many families, whatever I
preparation there can be for handling this by giving added [
understanding is well worth while. It would appear that
medical social workers have an important contribution to
make to this kind of education, which may be done through |
Parent-Teacher Associations, mental hygiene groups, and
other groups where people get together to try to gain a bet-;
I I
ter-understanding. of. .themselves and their children.__ ■
72
Because of the avâila/bilTtÿ' of fünâs from thé Nà- i
tional Foundation for Infantile Paralysis, there is no ap-
jpreciable financial problem imposed by poliomyelitis on the I
I . !
'family, even where prolonged In-patient care of expensive j
I !
jsurgery and appliances are required. Although, in general •
jthe findings of this study are applicable to situations |
iWhere crippling in adolescents arises from illness or acci- !
I
;dent, in this particular aspect there would be much differ
ence, for there would be the added factor of financial prob-;
lems which in themselves can have severe emotional repercus
sions as well as necessitate far-reaching environmental ad- i
'justments.
' There appear to be many possibilities in the area of'
family-focused studies which could profitably be done by
medical social workers, as well as studies based on adoles- |
cents as they react to the stress of severe illness or acci-|
dent. As previously pointed out, the literature on the prob
lems of adolescents as they react during or following such |
experiences is almost non-existent.
The material revealed in this study reassuringly |
confirmed the resilience and the capacity of human beings as
individuals and as members of a family group to meet and
I
handle stressful situations. However, it is also plain that,
as the result of a disabling illness in an adolescent member'
of the family, help was needed in order that the most satis- 1
i f ying adjustment could be achieved within the family as i
73
Imembers functioned individually and as a part of the primaryj
i ;
Igroup. For help in such adjustments, as they arise out of !
Ian illness, the family and the patient have a right to turn '
to medical social workers, who, in turn, must find more ways'
to make their help accessible to those who need it.
74
BIBLIOGRAPHY
Books
Barker, Roger G., Wright, Beatrice A., and Gonick, Mollie R.
Adjustment to Physical Handicap and Illness; A Survey
of theSocialPsychology of Physique and Disability! |
New York : Social Science Research Council, 194b .
i
Burgess, Ernest W. and Locke, Harvey J* The Family. !
New York: American Book Company, 19931
I
Cavan, Ruth Shonle. The American Family. New York: |
Thomas Y. Crowell Company, ' 1953• !
English, 0. Spurgeon, M.D. and Pearson, Gerald H. J., M.D. |
Anotional Problems of Living. New York; W. W. Norton ’
and Company, Inc., 1945.
Erikson, Erik H. Childhood and Society. New York:
i ¥. W. Norton and Company, Inc., 1950.
Flugel, J. C. The Psycho-Analytic Study of the Family. :
I London: The Hbgarth Press, 1939* ;
I 1
Groves, Ernest R., Skinner, Edna L., and Swenson, Sadie J.
; The Family and Its Relationships. Revised.
I Philadelphia: J. B. Lippineott Company, 1948. ■
Josselyn, Irene M., M.D. The Adolescent and His World.
New York; Family Service Association ofÀmérïcâ7 1953.
Richardson, Henry B., M.D. Patients Have Families.
New York: The Commonwealth Fund, 1945.
Simmons, Leo W. and Wolff, Harold G., M.D. Social Science
in Medicine. New York : The Russell Sage Foundation,
19541
Reports
California Youth Authority. Today^s Child in His Family
j and Community. Edited by Roy C. Votaw. Sacramento :
I California Youth Authority, 1950.
75
•National Foundation for Infantile Paralysis. Report of a
I Conference on The Place of the Medical Social Worker
in the Home Care of the Long-Term Patient. New^York:
National Foundation for Infantile Paralysis, 1953.
■ . Polioiryelitis, 1954. New York: National
foundation for Infantile Paralysis, 1955.
Articles
;American Orthopedic Association. "Infantile Paralysis or
Acute Poliomyelitis, A Brief Primer on the Disease
and Its Treatment," Journal"of the American Medical
Association, 131 (August 24, 1946], 1411-18.
Boyer, Robert, M.D. and Greenspan, Waldo, M.D. "Polio
myelitis, A Disease Process and a Community Problem,"
Archives of Pediatrics, 69(July, 1952), 296-309.
Conn, Jacob H., M.D. "Relation Between Personality Factors
and Fatigue in Severe Poliomyelitis," Archives of
Neurology and Psychiatry, 70(September, 1953)^ 310-16.
Coplleman, Fay S. "Follow-up of One Hundred Children with
Poliomyelitis," The Family, XXV(December, 1944),
' 1 -97.
Crothers, Bronsom, M.D. and Meyer, Edith, Ph.D. "The Psy
chologic and Psychiatric Implication of Poliomyelitis,"
Journal of Pediatrics, 28(March, 1946), 324-26.
Ebaugh, Franklin G., M.D. and Hoekstra, Clarence S., M.D.
"Psychosomatic Relationships in Acute Anterior Polio
myelitis," American Journal of the Medical Sciences,
213 ( January, 1947)/ H5-21.
Grant, Alice A. "Medical Social Work in an Epidemic of
! Poliomyelitis," Journal of Pediatrics, 24(June, 1944),
; 691-723.
Griffin, J. D., M.D., Hawke, W. A., M.D., and Barraclough,
I Wray, M.D. "Mental Hygiene in an Orthopedic Hospital,"
; Journal of Pediatrics, 13(July, 1938), 75-85.
I
Hoekstra, Clarence S. M.D. "The Psychiatric Reaction to
i Acute Anterior Poliomyelitis," Rocky Mountain Con
ference on Infantile Paralysis. Denver: University
i of Colorado, School of Medicine and Hospitals, 1946.
! Pp. 69— 74.
76
;Josselyn, Irene M., M.D. "The Ego in Adolescence,"
American Journal of Orthopsychiatry, XXIV(April, 1954),
; Z 5 7 :
iLowman, Charles LeHoy, M.D. "The Management of Poliomyel
itis," American Journal of Nursing, 47(June, 1947). i
367-69.
'Lowman, Charles LeRoy, M.D. and Seidenfeld, Morton A., Ph.D.I
"Preliminary Report of the Psychosocial Effects of *
Poliomyelitis," Journal of Consulting Psychology, ■
XI(January-February, 1947)/ 30-7.
Ivan. "Adolescent-Parent Adjustment," Marriage and
Family Living, XIV(November, 1952), 327:341
"Population Trends and Poliomyelitis, Los Angeles County, j
1948," Annals of Western Medicine and Surgery, j
3(February, 1949), 72-74. |
Rice, Elizabeth P. "The Families of Children with Polio- 1
' myelitis," Poliomyelitis. Philadelphia; J. B. Lippin-
cott Company, 1949^ Pp. 308-13.
!
Ripley, Herbert S., M.D., Bohnengel, Charles, M.D., and
Milhorat, Ade T., M.D. "Personality Factors in
Patients with Muscular Disability," American Journal
of Psychiatry, 99(May, 1943), 781-87.
I
Seidenfeld, Morton A., Ph.D. "The Psychological Sequelae
of Poliomyelitis," The Nervous Child, 7(January, 1948),
14-28.
I ________. "Psychological Aspects of Poliomyelitis," Poiio-
; myelitis. Philadelphia: J. B. Lippineott Company, !
I 19551 Pp. 283-91. j
Iserfling, Robert E., and Sherman, Ida L. "Poliomyelitis j
I Distribution in the United States," Public Health
I Reports, 68(May, 1953)> 453-66. ;
i ;
jStanfield, Clyde E., M.D. "Personality Repercussions of ;
I Anterior Poliomyelitis, A Review of the Literature," j
I American Journal of the Medical Sciences, 213(January,
I 1947), 109-15.
jVanRiper, Hart E., M.D. "Planning for the Poliomyelitis
I Patient * s Future," Medical Social Work, II(July, 1953)
I 8 1 -4 .
77
i Unpublished Material
ipayne, Elizabeth E. "Social Work in Medical Research -- A
I Specific Experience." Paper read before the meeting
of the Medical Social Work Section, California Con-
I ferenee of Social Work, Riverside, California,
Wendland, Leonard V. "Some Psychosocial Aspects of Polio
myelitis." Unpublished Ph.D. disertation. University
of Southern California, 1950.
78
Sample Letter to Family
ORTHOPAEDIC HOSPITAL
OFFICERS
K e n n e t h B . W i l s o n
P re sid e n t
J a r a e s S h e l d o n R i l e y
V ice-P re side n t
T h o m a s B . W i l l i a m s
V ice-P re sid en t
L e e S . S a n d e r s
E xe c, V ice-P re sid en t
C o r n e l i u s P . H i l l
T re a s u re r
L l e w e l l y n A . P a r k e r
S e cre ta ry
W a l t e r H . O d e m a r
A s s is ta n t S e creta ry
J o s e p h J . B u r r i s
A s s is ta n t S e creta ry
ORTHOPAEDIC
COUNCIL
F r a n k E . E c k h a r t
R i c h a r d W . K i r k l e y
L o u i s H . R o s e b e r r y
DIRECTORS
G e o r g e W . D r y e r
C h a irm a n o j th e B o a rd
W i l l i a m A . H o l t
V ic e -C h a irm a n o i the B o a rd
D o n a l d S . A l e x a n d e r
P a u l S . A r m s t r o n g
H o w a r d A . C a m p i o n
R i c h a r d C . C o l y e a r
J o h n L e w i s D r y e r
R o b e r t S . G r o v e r
J o h n T . H a s t i n g s
C o r n e l i u s P . H i l l
C h a r l e s L e R o y L o w m a n , M . D .
A l b e r t C . M a r t i n , J r .
W a l t e r H . O d e m a r
L e R o y D . O w e n
L l e w e l l y n A . P a r k e r
H o w a r d W . P o r t e r
J a m e s S h e l d o n R i l e y
G e o r g e D . R o b e r t s o n
V i c t o r H . R o s s e t t i
L u d w i g S c h i f f
W i l l i a m A . S i m p s o n , J r .
C a r l i s l e J . T h o r s o n
T h o m a s B . W i l l i a m s
K e n n e t h B . W i l s o n
2400 South Flower Street
Los Angeles 7, California
Dear Mr. and Mrs.
M a r y F . T h w e a t t
H o s p ita l D ire c to r
A l v i a B r o c k w a y , M . D .
C h ie i o i S ta ff
We are asking your cooperation in some research
which is being done at the Hospital to study
how the members of the family are affected when
a teen-age child has polion^elitis and is left
with some muscle weakness. This study will be
of value in showing us how better help can be
given to patients and their families when they
get such an illness.
The study, which is being done by Mrs. Wheeler
of our Social Service Department, includes a
personal interview with the parents and another
with the child. We are hoping that you and
______________ will help us with this study.
Your participation in this is, of course, vol
untary, and will in no way effect treatment àt
the Hospital.
We are writing to _____ , too, invit
ing him to participate in the study. Mrs.
Wheeler will telephone you within the next few
days to arrange the interview, which can take
place at your convenience either at the Hos
pital or in your home, as you prefer.
We would greatly appreciate your help, and we
thank you for your cooperation*
Yours very truly.
(Mrs.) Lois Blakey Johnson
Director
Social Service Department
ILW :w
79
Sample Letter of Adolescent
ORTHOPAEDIC HOSPITAL
OFFICERS
K e n n e t h B . W i l s o n
P re sid e n t
J a m e s S h e l d o n R i l e y
V ice-P re sid en t
T h o m a s B . W i l l i a m s
V ice -P re sid e n t
L e e S . S a n d e r s
E xe c. V ice-P re sid en t
C o r n e l i u s P . H i l l
T re a s u re r
L l e w e l l y n A . P a r k e r
S e cre ta ry
W a l t e r H . O d e m a r
A s s is ta n t S e creta ry
J o s e p h J . B u r r i s
A s s is ta n t S e creta ry
ORTHOPAEDIC
COUNCIL
F r a n k E . E c k h a r t
R i c h a r d W . K i r k l e y
L o u i s H . R o s e b e r r y
DIRECTORS
G e o r g e W . D r y e r
C h a irm a n o f the B o a rd
W i l l i a m A . H o l t
V ic e -C h a irm a n o f the B o a rd
D o n a l d S . A l e x a n d e r
P a u l S . A r m s t r o n g
H o w a r d A . C a m p i o n
R i c h a r d C . C o l y e a r
J o h n L e w i s D r y e r
R o b e r t S . G r o v e r
J o h n T . H a s t i n g s
C o r n e l i u s P . H i l l
C h a r l e s L e R o y L o w m a n , M . D .
A l b e r t C . M a r t i n , J r .
W a l t e r H . O d e m a r
L e R o y D . O w e n
L l e w e l l y n A . P a r k e r
H o w a r d W . P o r t e r
J a m e s S h e l d o n R i l e y
G e o r g e D . R o b e r t s o n
V i c t o r H . R o s s e t t i
L u d w i g S c h i f f
W i l l i a m A . S i m p s o n , J r .
C a r l i s l e J . T h o r s o n
T h o m a s B . W i l l i a m s
K e n n e t h B . W i l s o n
2400 South Flower Street
Los Angeles 7, California
M a r y F . T h w e a t t
H o s p ita l D ire c to r
A l v i a B r o c k w a y , M . D .
C h ie f o f S ta ff
Dear
I am writing both to’ you and your parents asking
your help in a study which is being done at the
Hospital. We want to learn what it means to the
family and the teen-ager when he has poliomyelitis
and is left with some muscle weakness.
Mrs* Wheeler of our Social Service Department,
who is doing this study would like to talk with
you, and also have a separate talk with your par
ents, or at least one of them. We hope you will
do this because by this type of study we hope to
gain a better understanding of how to help other
people in similar situations.
We would certainly appreciate your help in this
project. Mrs. Wheeler will telephone you within
the next few days to arrange an appointment, which
can be either at the Hospital or in your home,
whichever you prefer.
Thank you for your cooperation.
Yours very truly.
(Mrs.) Lois Blakey Johnson
Director
Social Service Department
ILW:w
Unfversity of Southern Californfa Llbreur

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

The impact of alcoholism on the family: A study of interaction within six families, their attitudes and feelings towards a father who is alcoholic

PDF

Impact on adolescents having hospitalized mentally ill fathers

PDF

The meaning of placement in a correctional institution to the adolescent boy

PDF

A study of semi-institutional and foster home placement in the social adjustment of adolescent girls: An evaluation of the social adjustment of twenty-six adolescent girls living in Amaranth Home...

PDF

The meaning of severe illness in childhood: A study of casework interviews with seven child patients

PDF

An analysis of resistance to a change in standards for day care services

PDF

What the Civilian Conservation Corps means to 115 Los Angeles boys who were honorably discharged on March, 1940

PDF

Social problems of the families of patients newly admitted to a state hospital

PDF

Impact of father's mental illness on children five to ten years of age

PDF

Studies in the use of professional time in family case work agencies

PDF

A study of the social worker's role in the admission and out-patient service at Wadsworth Hospital

PDF

Large families on relief: A comparative study of the dependency, occupational, social and economic factors relating to 173 large families receiving assistance in June, 1940, from the Harbor Distr...

PDF

Family care as seen by five discharged patients

PDF

Tracing the movement of six delinquency-prone adolescents in response to social group work

PDF

Study of the services needed and/or available to Negro newcomer families: A study of perceptions of eleven health and welfare agencies serving the community of Watts

PDF

Family care program: A descriptive study of the family care program at Patton State Hospital, San Bernardino

PDF

The return to a state hospital of mentally ill patients on indefinite leave of absence: Implications of the family situation

PDF

Adolescent delinquents: A case study of thirteen treatment referrals to The State Mental Hygiene Clinic by the Probation Department, Los Angeles

PDF

A study of the perception of Indian students in the United States of the modern middle-class family in India: Implications for social work practice and planning for family welfare

PDF

A study of adolescent participation in a family-centered approach to his problem

Asset Metadata

Creator Wheeler, Ione Lane (author)

Core Title The family has a patient: A study of what a crippling illness in an adolescent means to five families

Degree Master of Social Work

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Social Sciences

Format application/pdf (imt)

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c39-221382

Unique identifier UC11315073

Identifier EP66578.pdf (filename),usctheses-c39-221382 (legacy record id)

Legacy Identifier EP66578.pdf

Dmrecord 221382

Document Type Thesis

Format application/pdf (imt)

Rights Wheeler, Ione Lane

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA