Blind Adaptation

Modalities of adaptation

2010-02-23T13:01:00.003-07:00

Travel – How do we get from point “A” to point “B?” Travel can entail a sometimes tedious variety of skills and factors. Here are a few:

Navigation/orientation – What are the senses, skills and attitudes that we bring into play when stepping out to the grocery store or to a movie (Yes, blind people do go to the movies.)
Planning/organization – Do your trips tend to be spur of the moment, once quick, hop in the car affairs that could be taken care of in half an hour? You may be finding now that travel is a much more involved affair, entailing bus passes, trip planning, knowledge of the environment that you intend to be in and preparation for long trips with water and an audio book. Include calculating how much grocery load that you can carry over “x” distance through “y” transfers with one hand on a cane and the other holding your Starbuck’s and you may find that you’re avoiding shopping altogether.
“That little kid is staring at me” – You could hear him ask his mother on the bus line that you feel a hostage to, “Why is that man carrying a cane?” He looks and looks and looks and you start to imagine (or detect) the furtive glances of others who assume that all blind people who use a cane are inevitably immersed in total darkness. The glances are furtive because they don’t want their travel companions to see them looking. You feel your face go hot as the kind but rough man grasps you less than gently by the arm to pull you into the seat next to him. Perhaps this is the daunting part for you that keeps you on as few buses as you can get away with without being a shut-in.
Driving as an integral part of independence – There is something distinctly practical in looking at aspects of our lives as sighted people that gave us meaning. Whether it was touring around the countryside all day visiting wineries or a simple hike at dusk, we are all more or less aware of our limitations but often unable to incorporate this awareness practically into our lives in a way that helps us maintain as much independence as possible without endangering ourselves or others.

Cooking and other “Activities of Daily Living” – How much is enough and how can I tell when my coffee cup is full? (aka: “Do you smell blood?” or “I bet you can’t guess how many times I’ve poured boiling water on my hand.”)

Measurement
Timing
Cutting and peeling
Cleaning
Hygiene

Reading and listening – This is probably the most potentially wrenching bit for me. There is something about reading printed material out of a book, magazine or newspaper that is inexplicably and intrinsically gratifying. The last printed book that I took in was Cold Mountain in 1999 – Every morning on the bus to work in the crappy fluorescent glow of the bus’ back seats and later on the train across town. All print now is for reference and nearly everything else is audio or a combination of computer generated text and speech. Though we’ll talk about the emotional implications of making such adjustments, this bit is about the practical, so let’s take a short look at it before diving in.

Why read? – Yes I said a “practical,” not “philosophical” look (at least for now). We’re not going to escape the need to read. Whether it’s a medication bottle or a movie description at the local Blockbuster, reading is a real and necessary part of everyday life. Besides, for many of us it’s simply gratifying.
Size, lighting, contrast and color – What can we do to place ourselves in the best possible position to read when we need or want to? Some of us need magnification, though in my case I need to use discretion in order not to unduly magnify the dozens of little blind spots scattered throughout the remaining fiver or so degrees of my visual field.
Reading position – Is it best to read on your back or upright in a chair? Lying on your stomach or on your side? Do you use a portable lap desk or pillows piled on your belly? Is it better to look ahead at your material or down at it? Basically, everything that can make you more comfortable while you read has the potential to extend your reading time, which brings us to the next…
What’s your stamina for printed or “displayed” material like? – Can you go longer reading from a monitor where the lighting and contrast on many web pages, for instance, are fairly consistent, or is strongly lit printed material more your preference for sheer endurance? Some of us have to read a lot and it pays to look at some of the minutia of physical environment as well as attention and reading technique in order to optimize our reading.
The technology of reading – Perhaps you’d be happy with one of the many CCTV’s on the market these days. You may be more oriented toward being able to look at and listen to your printed text at the same time, in which case any number of screen readers or “text-to-speech” engines might suit you.
Listening to your reading – I first discovered audio books for long commutes when I was still driving and since have hardly been able to stand being without one running in my ear from day-to-day. Depending on how you get your audio, and depending on what you prefer, selections may be limited or you may be stuck with abridgements. We’ll look at availability and the variety of ways that you can bring reading in audio into your life.

More subtle yet still important modalities of adaptation include communication and social adjustment. We’ll look at these on their own, along with the emotional component of vision loss.

A few words about adaptation

2010-02-23T12:46:00.003-07:00

I’ve found it useful to break adaptation down in a couple of different ways. More broadly we can say that adaptation to blindness can be categorized as follows:

Physical adaptation – What we do “in the world” to adapt to our environments
Cognitive adaptation – How we think and perceive around the idea of adaptation
Emotional adaptation – How we feel about blindness, adaptation and the circumstances that comprise them

Each of these types of adaptation will overlap in some way or another. For instance, the physical and cognitive aspects of adaptation intersect in navigation with a cane. The physical use of the can must be coupled with the learned skill in order for it to become an effective aid. Likewise, if there is great anxiety in leaving your home, using a cane becomes problematic. These three spheres of adaptation could be said to represent the will, the skill and the means to ,. There is an point to be made here. Those of us who are totally blind, or nearly so, serve as living examples of the idea of need as motivator by developing adaptive skills that often surpass our own. Or, as Fred Williamson’s character says in “From Dusk Till Dawn” when he’s talking about “Nam”: “You'll take it 'cause ya got no choice.” This is adaptation born of need.

For the blind, as well as those others of us who are sensory deprived, adaptation can also be broken down roughly according to our senses:

Sight – Let’s face it, for many of us sight is still our primary sense, if not in terms of everyday use and efficacy, in the way we think.
Hearing – Usually taken for granted and not naturally attended to in the same way that eyesight is. There is some exciting anecdotal evidence that suggest that some blind people use a form of echolocation in their day-to-day activities.
Touch – Not merely what you can feel with your fingers. What does the ground feel like under your feet?
Smell – How close am I standing to that dumpster?
Taste – Well, I’m at a loss here. I can only recommend that you refrain from putting very many things in your mouth that your sense of smell hasn’t already informed you are edible.
Vestibular – Technically, it’s about the orientation of the head based on information gained from the inner ear. More broadly and practically, it can tell you about your general orientation in space and how you are moving through space, i.e., which way is up, which way is down and accelleration. Vertigo which can occur with a constriction or fragmentation of visual field is the disruption of this sense. Along with other mechanisms (For instance, structures in the brain that direct movement of the eyes to targeted sounds), the vestibular sense automatically coordinates the movement of the eyes and the movement of the eyes can affect whether or not hearing is “turned on.”
Kinesthetic – Where is my right hand in relation to my nose? Put simply, the kinesthetic sense tells us, with surprising accuracy, where one part of the body is in relation to another.

Our examination of these aspects of adaptation will be, at least partly, anecdotal – my experience and, hopefully, yours as the site grows. There will also be a strong emphasis on the examination of research here. This research will include the psychophysical, computer models of human perception and cognition, case study and some looks at how the senses might interact, or even interfere, with one another. It’s my hope that this combination of experience and research will prove useful to those of you who have come looking for a reminder or a new spin on blind adaptation.

What does it mean to see? Part II

2010-02-23T08:42:00.003-07:00

I've spent most of my time in Phoenix, unlike Portland, with cane in hand. Depending on where we are we can be met with a whole range of responses to the cane, from complete indifference (Costco - you'd better also have a cart, if only for your own protection, because people don't seem to care if you can't see them coming), to complete deference (Finding that you gain attention and assistance that no one else would be getting). It can seem like a case of "He wants his cake, and to eat it too," when we throw the desire to be inconspicuous in. I sometimes like to think that I'm simply so attractive and radiate such happy goodwill that there isn't anyone who isn't attracted to me and, therefore, must help me, or worse, stare at me.

I'm not completely blind, though I must often look it. Standing alone on the train, with cane and sunglasses, it's usually not difficult to spot the unabashed stares. When I know that my admirer has seen me focus on an object or another person, perhaps them, the stare becomes a quizzical tilt of the head, a "Hey, he's blind but..." Occasionally, that tilt will become a question directed at me, which I'm generally happy to answer. It engages me and makes me feel a little less the freak. Indeed, I can show off a little with my usual "Only one in thirty legally blind people are totally blind," as well as stories of my clever little adjustments to my limitations - how I navigate, eat, converse, socialize, etc. But the problem is in the constant state of standing out. Most of us can blend, if only in our cars in traffic, when we don't care to engage or be engaged by those around us. Even a casual look, that glance down, then up, that many women catch men giving - that evaluative scan that asks; "Are you blind?" "Can you see at all?" "How did you know to step out of my way?" "Are you fit?" "Are you hot?" "Are you unattractive?"

To be able to see, when not exercising the option to blend, gives you the opportunity to decide to engage any question, any evaluation, any comment at least partly on your own terms, when you want to engage. Being sighted both protects me with the ability to discern who and when I want to engage. I don't always have that option with cane in hand or in situations where I have to be helped. Being sighted, in this context, means that we can be independent, not merely in the sense that we don't require assistance, but in the sense that, when we want to, we can remain apart - apart in our cars, on the bus or the train, in the store, movie theater or restaurant where we can find the restroom without assistance.

There are also the more obvious aspects of being sighted: to run without fear, whether for exercise or simply the joy of chasing your dog or a Frisbee; to read to yourself or another. In short, to be sighted means to appreciate all in the visual world. It is difficult to write this without counterbalancing immediately with what it means to lose that sense, but I'm going to try here in order to save that subject for a blog of its own.

The bottom line for this blog is that eyesight means independence. It practically becomes a metaphor for independence. It also represents consciousness, almost directly. Borrowing from Blakeslee and Blakeslee in The Body Has a Mind of Its Own, consciousness is predictive and embodied. From the most simple predictions, say a baseball arching toward a glove, to the most complex, this expression on my lover's face will lead to the next and a tone of voice and proclamation to follow, to the most subtle, my toes on this ledge sharpens the sense that I have in common with all that I might jump - and the terror that might accompany such a common shared perception - all represent a predictive consciousness that ties not merely to our own bodies, but to those of others - to their feelings and their predictions. So, the distinction becomes somewhat more clear between a desire for separateness born of independence to isolation or connection tied to the consciousness of ourselves and others. Eyesight connects us in this deeper sense, makes us who we are in a broader and deeper context.

I'll stop here in light of the temptation to treat paired opposites of eyesight and blindness. I really do want that later to have a blog of it's own.

What does it mean to see?

2010-02-12T07:42:00.004-07:00

This was the last post that I worked on a few years ago before simply quitting the blog. The end was abrubt, as I'd reached a kind of emotional cliff with it. Listing the physical, perceptual and cognitive aspects of eyesight was a fairly straightforward matter. Delineating limitations and the decisions that those limitations implied was more difficult.
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Most of us might think that this question is hardly worth asking as the answers must be terribly obvious. But for those of us who have lost or are facing the loss of our eyesight the question takes on special meaning.

We are primarily visual creatures. Of all the creatures of the earth, from the blind to the gifted, our eyesight falls somewhere in the middle in terms of acuity, field of vision, color sensitivity, contrast discrimination and phase or pattern discrimination (Simplified, how do we detect edges, borders and lines on often chaotic backgrounds? How is the “line” at the edge of a table discerned from the “line” that separates two tiles on the floor?). Taken in context with the other senses such as hearing, the vestibular, and the kinesthetic, vision is crucial in everyday life. We can hear lower pitched noises than most dogs. Combine that with an ability to visually locate sounds approximately twelve times faster than a horse and considering that this must all occur in the context of how the head is oriented in space and we have the makings of an incredibly refined and sensitive system. We can see in “frequencies” above that of those that either cats or dogs can sense (Though their superior ability to sense lower frequency movement makes them look insane as they track and pounce on shadows that we cannot see.). Nearly the entire back or “occipital” portion of our brains to a depth of about 3 millimeters is dedicated specifically to vision – far larger than the proportions found in most other animals.

Human eyesight can be effectively divided into 3 component parts: 1)The optical, or that which occurs inside the eye, as in a telescope – the mechanics of vision, if you like, 2) the perceptual, or that which occurs in vision systematically, from the retina, the retinal ganglion, through the optic nerve and the central visual pathways of the brain to the visual cortex itself and, lastly 3) cognition, which is an extremely broad term but for our purposes can be thought of as a subset of visual perception that includes how we think about what we see and how visual phenomena such as optical illusions and “figure/ground” effects are interpreted.

Vision is a sense that we so take for granted that we seldom consider the practical or emotional components to it. It simply “is what it is” until something goes wrong with it. When something goes seriously wrong with our eyesight what it means to see comes to include our physical safety and our emotional well-being. For those not suffering with a serious visual impairment this may be difficult to get a handle on.

Vision is very much about our ability to navigate and accumulate information. It is about being able to drive yourself to work, see the highlights in your lover’s hair, find your keys, see a movie, read a book and appreciate art. It’s about being able to see the stars. It can be about being able to take that discreet, appreciative sidelong glance at someone you find attractive. It can be about being able to see that appreciative sidelong glance, as well. [A1]

The first thing that comes to mind with regard to physical safety is mobility and navigation. Some of us have continued to drive well beyond the point that we should have stopped, for our own sakes as well as for the sake of those that we’ve shared the road with. I stopped driving nearly twelve years ago but only after several close calls with other cars as well as pedestrians. Navigation and orientation on foot may also become problematic. Still in that “in between” time of being sighted and being impaired but having already attended blind school I often exercised the option to navigate city streets and the insides of office buildings without my cane. Though I’m still here to tell the tale, I’ve not escaped the exercise of that option unscathed

To see, and be a male who exercises even a minimum of freedom, means to drive. In Portland, it meant the ability to independently plan for a hiking trip, alone or with a friend if my wife wasn't up to going, pack my shit up, set my alarm, wake and go - to just drive away, whenever and whereever I wanted. It's an even bigger deal here in Phoenix, where people don't seem to bat an eyelash at driving 20 miles for dinner our or a trip to Best Buy. So driving, for these purposes, is about the ability to move about freely and independently - to just go when it suits us. As a measure of both internal and external independence (degree of independence as perceived by others; i.e., "He's a rugged and independent man.) the ability to not simply move yourself from point A to point B, but the ability and inclination to drive yourself there, becomes and extremely important component with regard to how we fit in socially. Another way of looking at this independence might be in terms of what kind of help we can offer those who need it; our families, our friends, our co-workers. Who's turn is it to drive us to lunch? Who's going to help you move this weekend? I'll refer directly back to this in talking about what it might mean to be without eyesight, but we'll stick with this for now.

About these newly reposted blogs...

2010-02-10T10:20:00.003-07:00

In terms of writing, the last four years have been some of the least productive and least creative I've known. Following graduate school, the death of my parents, my separation from my wife and subsequent move to Phoenix, (all interspersed with bouts of severe depression) it was barely in me to acknowledge to myself, much less however many blog readers happen to trip across this site, that my eyesight has been ever worsening. In the midst of those circumstances and that realization, I had pretty much abandoned Blind Adaptation. But there is more to say. More practical stuff to be sure, but also more emotional stuff. There is more about how my own blindness affects not just me, but those around me, those who care about me.

I'm also pulling the old posts out, reviewing and revising where it seems prudent, and inserting new material that I feel may have been missing.

I may as well tell you, I'm still very well adapted for the amount of vision that I've lost. The term legal blindness, in my case, refers more to the amount of visual field that I've lost than it does my visual acuity, though each continue to diminish. I have less that five percent of a normal 200 or so degree visual field (Yeah, I know, the common wisdom is 180 degrees, but we have a slight capacity to see just behind that.). Most of that usable eyesight is concentrated in a little spot just over my right central field. The rest is...well, a sort of Impressionist miasma of light, color and movement sensitivities interspersed with just plain blank spots.

There are a couple of reasons that I've mentioned that I'm well adapted. The first, frankly, is that I may not always be - physically, mentally, emotionally - and I need a peg to hang what may one day become a former brag, a lost confidence. The second reason harkens back to advice given by a psychiatrist that my old mentor John Marks, Ph.D referred me to when I'd expressed a desire to help other blind people professionally - also blind, also well adapted and successful. He was, at the time, one of those increasingly rare psychiatrists who could afford to take the time to counsel his patients, not merely prescribe. When we first spoke, I was still filled with the exuberance of my abilities; from simple things like cooking to orienteering and dead reckoning abilities that rivaled those of most of the fully sighted people I knew. I, perhaps incorrectly after considering our exchange, attributed these mainly to an ability to be calm, steady and systematic in the judgment of my environment.

The psychiatrist, as much as he valued his own abilities and expressed delight in mine, suggested that I might instill a false hope and, eventually, frustration and resentment in others who might not be able to manage as effectively as he or I - no matter the quality of their training or counseling or support. That there are, and will be, limitations has been more and more clear over time. I'd first seen this many years ago as a sort of storm that overtakes one's ability to run, to drive, to twist and turn away; a flood that swamps a rowboat. I saw it as a nearly physical thing that overran physical things and abilities, realizing as it did that much of what was being pulled down under the wheels of this thing lumbering over me was a kind of quickness, or rather, I was reaching the limits of a quickness needed to move from the potential for disaster and adaptation. Pharmacists may refer to an overdose margin, that thick or thin line in which homeostasis may - or may not - pull us out of harms way. The thinner the line, the easier it was to jump from therapeutic dose to overdose, from high risk to certain failure or injury or death.

I'd always perceived that overtaking, that narrowing margin as a strictly physical problem and, ironically as a professional counselor, seldom considered the overrunning of cognitive abilities and almost never being swamped emotionally. Well, I was. Being first, if only in the way that I care to describe myself, a cognitive scientist, and only second a counselor, I saw my ability to learn slipping away. I saw the way my shift in dependence to my ears affected my spelling and the way that I saw and conceived of words in my own head. I began to sense the extra ticks from exposure to understanding when all I could rely on was hearing.

The counselor was the last in getting a shot at assessing this mess. I could go the rest of my life - which at times felt more than a little foreshortened - without seeing the Louvre. But to not read another book with my eyes and have to settle with that devastated me. I thought - sometimes still think - that I could feel a little of my mind slip away with every compromise to an audio book that I made, while still developing the skills to deal with them more effectively. I was changing, and I didn't like it. I was losing myself and didn't know how to go back. With this loss, vitality, exuberance and wonder, to say nothing of confidence, slipped away.

So there is more to add. This isn't a cookbook or a manual, or a way to say, "Look at me! I'm a well-adjusted mother-fucker!" In fact, by now, you should be getting something distinctly different from that. Whatever you do end up obtaining here, I hope it helps you to stay safe and sane.