Vivienne Purcell - Understanding Visible Differences: Working Therapeutically With Individuals Who Look Different

This series introduces readers to the theory and practice of counselling and psychotherapy across a wide range of topical issues. Ideal for both trainees and practitioners, the books will appeal to anyone wishing to use counselling and psychotherapeutic skills and will be particularly relevant to workers in health, education, social work and related settings. The books in this series emphasise an integrative orientation weaving together a variety of models including, psychodynamic, attachment, trauma, narrative and systemic ideas. The books are written in an accessible and readable style with a focus on practice. Each text offers theoretical background and guidance for practice, with creative use of clinical examples.

Arlene Vetere, Professor of Family Therapy and Systemic Practice at VID Specialized University, Oslo, Norway.

Rudi Dallos, Emeritus Professor, Dept. of Clinical Psychology, University of Plymouth, UK.

More information about this series at http://www.palgrave.com/gp/series/16540

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I have written this book as a resource for supervisors, therapists, their clients and those caring others who wish to understand more. It is intended to be a brief and wide-ranging work to complement those specialist reference books which are excellent clinical resources. It is the one I often wished for in busy supervision sessions.

The generous contributions of interviewees who were willing to share their own experiences of caring for, adjusting to and living with difference have been invaluable. Id like to thank Jo Williams, Kenny Ardouin, Beth Angella, Sasha Lynne, Kay Kay, Paul McSharry and Beth Shaw in particular, for their time and openness. Their approval was sought for all interview comments used prior to publication.

Finally, huge thanks to Arlene Vetere, Rudi Dallos, Mike and Kit Neill whose help, belief and encouragement I have been able to rely on.

Even in a multicultural society most people have little difficulty in recognising others whose physical appearance is outside the norm. Historically human social groups are formed by blood ties which amplify and assign value to recognised similarities and geographic interests, and appearance is an important signifier of people like us, often reinforced by marriage/partnership patterns (Berry ). Favoured and disfavoured characteristics within social groups are to some extent historically/socially formed, and as such are mediated by status and variable over time, but also impacted by the resources and survival needs of the group. Tradition matters, and normalises beliefs and behaviours. Mary Douglas , in her early anthropological work Purity and Danger (1966), studied how these patterned beliefs maintain symbolic boundaries in ritual, religion and lifestyle.

It does not take much imagination to realise that a person with physical differences outside the normal range and/or limitations may frequently confer fewer advantages on a small isolated human group. Such differences may be tolerated more easily in an adult (say) who is injured in battle but has knowledge and/or wisdom to share, than a dependent child. Female, and to a lesser extent male, children whose marriageability is affected by physical defects are also more likely to be regarded as liabilities or sources of shame in honour-based cultures.

Historically in many traditional societies infants or adults that looked different at birth would be ostracised or killed, with superstitious beliefs associated to them, such as fearing they would bring bad luck, and there are examples today of communities which regard having a different or disabled child as shaming. The African Child Policy Forum (ACPF) (). The prospects for such children and their mothers can be very bleak, particularly in groups with limited resources. More hopefully in Nigeria there has been a public education campaign and dissemination of disability-related information with the intention of overcoming persistent false beliefs about disability. These previously included a curse from God, ancestral violations of social norms, offences against the local Gods, witches and wizard actions, adultery and more.

These beliefs may at first seem outlandish, but in the UK the discovery of disability during pregnancy frequently results in a termination where there are no strong counter beliefs. For example, 63% of foetuses identified with spina bifida and 83% of those with anencephaly were aborted (Johnson et al. ). Few loving parents would choose a disability for their child, and they are encouraged to try again by doctors, hoping for one that is able-bodied, clever and beautiful, or at least average.