holistic and integrative therapy help disabled people

Can holistic and integrative therapy help disabled people?

What is a disability, can we leisurely define it; disability as a “phenomenon”?

Unfortunately, disability either acquired or hereditary is the leading health and social problem in many countries including well-developed countries. It represents the significant health-social challenges of this era. As of now, as is, the healthcare system and social system is very oppressive, inadequate and inappropriate to meet the needs and challenges of the people living with disabilities. What is desperately needed is a fundamental shift in prospective approach with the application of complementary, alternative, holistic, integrative and functional treatments where the subjective experience of the disabled person is of central concern. Yes, subjective and personal experience!

Life, wellness and health coaching for the disabled people are necessary and of urgent need. Some disabled people are with vocational rehabilitation services for years, not months as it should be. Actually, the primary goal of their existence, primary function and mission are to prepare and find employment for the disabled people (funded for their operation predominantly from federal resources about 75%).

It looks like each disabled person is getting stuck in one of the phases, either in “the very beginning”, “hitting the wall”, “turning around”, “letting go”, “opening up”, “letting in”, and “the end of “healing” process” (1). The phase “hitting the wall” is the phase where most of the disabled people are giving up all malfunction services and so-called “independent living” where they realize that they are actually in reality heavily dependent on their family or primary caregiver for the rest of their life. All care and everyday living are on the primary caregiver’s shoulder, family and friends…

Finally, we reached the point that life, wellness, and health coaching specifically designed for disabled people are “a must.” Most of the disabled people (if they can afford) are chronically placed in psychotherapeutic sessions with CBT (cognitive behavioral therapy), yes, chronically for years, instead of as CBT standards proposed 6 -16 sessions and that’s it. No achievements, no improvements, then a psychotherapist should take another way of therapy. CBT strictly focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Well, it sounds good, but after a short period, another challenge is coming. Severe depression is a common co-morbidity of the disabled people which is “coming” silently but persistently, stay as a shadow following the disabled person who desperately wants to find a new way of life, meaning, and purpose of life as a disabled person, employment, lost dignity…a coming poverty, a new monster. Not a problem, here are antidepressant therapeutics widely available and readily prescribed even from primary care physicians. After changing six or more different forms of antidepressant therapeutics, no expected improvements or so little with frequent relapses. Some disabled people also do not know they have treatment-resistant depression; social factors are not improved, home-bound lifestyle is still in existence and persistent, and the disabled person is falling into a severe episode of depression.

Definitely, integrative, functional approach in the treatment of the disabled people is promising including holistic, alternative or complementary therapy in the form of applied intensive life, wellness, and health coaching; finding a new way of life, meaning, and purpose of life, objectively approaching a job search, employment, getting back lost dignity, fighting depression and anxiety and symptoms of post-traumatic stress disorder getting disabled. Certainly, disabled people also deserve to find and feel the greatest love of all in their lives as all other people do.

What is a disability?

Millions of people live with a visible or invisible disability, acquired or hereditary disability, physical, mental, intellectual, cognitive, developmental or sensory disability, disability with comorbidity and without comorbidity, nearly one in five people, currently almost 49 million people have a disability in the U.S.A. According to the data from the World Bank “one billion people or 15% of the world’s population experience, some form of disability and disability prevalence is higher for developing countries. One-fifth of the estimated global total, or between 110 million and 190 million people, experience significant disabilities” (2).

Disability is not a category of disease; it is a condition caused by physical, sensory, cognitive and mental disorders that cause significant limitation in one or more major life activities. According to the Americans with Disability Act “major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working (Americans with Disability Act).” Probably, much better statement about disability we can find in the World Report on Disability, World Health Organization (WHO) stated: “Many people with disabilities do not have equal access to health care, education, and employment opportunities, do not receive the disability-related services that they require, and experience exclusion from everyday life activities. Following the entry into force of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), disability increasingly understood as a human rights issue. Disability is also an important development issue with an increasing body of evidence showing that persons with disabilities experience worse socioeconomic outcomes and poverty than persons without disabilities.” (3).

It is imperative to understand disability as a phenomenon, fully. Yes, I would say the phenomenon. Defining disability is exceptionally complicated. A long time, I was searching for one good definition of disability. Probably, one of the best descriptions of disability is from the World Health Organization; it stated: “Disability is complex, dynamic, multidimensional, and contested. Over recent decades, the disabled people’s movement together with numerous researchers from the social and health sciences have identified the role of social and physical barriers in disability. The transition from an individual, medical perspective to a structural, social perspective has described as the shift from a “medical model” to a “social model” in which people viewed as being disabled by society rather than by their bodies” (3 – 8). Indeed, this statement provides a much better description of what disability is and how disability is transforming from a medical model into a social model. However, I did not stop searching for a better explanation and a better definition of disability.

Leonardi M. and colleagues in 2006 in their article published in the Lancet stated: “Disability promoted as a “bio-psycho-social model,” it represents a workable compromise between medical and social models. Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (9). Generalization about “disability” or “people with disabilities” can mislead and any form of generalization should be avoided seriously. Persons with disabilities have diverse personal factors with differences in gender, age, socioeconomic status, sexuality, ethnicity, or cultural heritage; a unique culture. Each has his or her preferences and subjective responses to disability (10). A broad range of international documents has highlighted that limitation is a human rights issue, including the World Program of Action Concerning Disabled People (1982), the Convention on the Rights of the Child (1989), and the Standard Rules on the Equalization of Opportunities for People with Disabilities (1993). More than 40 nations adopted disability discrimination legislation during the 1990s (11). According to Harris J. and the article published in 2015 the Americans with Disability Act as it is stated the marquee civil rights legislation for people with disabilities expresses a national approach to disability that recognizes the role of society in its construction, maintenance, and potential remedy. But its mission is incomplete, and it has not generated the types of interactions between people with disabilities and nondisabled people empirically shown to deconstruct deeply entrenched social stigma (12).

Disability as a phenomenon is very complicated, from a biological, medical, social, psychological point of view. As Sen A. in 2009 stated in his book: “Disability is a development issue, because of its bi-directional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” (13). It looks like the definition of disability is not entirely reached, and still, the question of how disability supposed to be defined is fraught with political, ethical and philosophical complexities (14).

How disabled people get even more impaired than actually, they are?

Predominantly, disability is associated with some co-morbidities, and one of them is severe depression. Depression by itself, a separate entity is a form of disability. So, people with a disability who developed depression as co-morbidity are more disabled. Some previous research exhibited that co-morbid depression and chronic physical conditions associated with disability (15). Unfortunately, there is a substantial lack of data on disability and suicide in the U.S.A. There is a small number of national data on studies related to this topic. Some studies reaffirmed that disability is the risk factor of depression by using longitudinal data (16). Certainly, home-bound lifestyle, lack of employment, lack of transportation, malfunctioning or not provided services by vocational rehabilitation and social services, heavy dependence on a primary caregiver, the majority of disabled people will over a specified period develop the first signs and symptoms of depression and even suicidal ideation. Overall, significant indicators for increased suicidal risk in the population of disabled people are unemployed for an extended period, profound social isolation due to the homebound lifestyle and lack of transportation, significant change in health status because the majority of the disabled people require frequent medical attention and treatments.

Progressively, due to lack of proper access to healthcare providers (even some primary care physicians do not want to accept Medicare and Medicaid insurance). Lack of mental health support and help either because they cannot afford due to overly expensive treatments and office visits or lack of mental health care providers locally, severe depression will be accompanied by suicidal thoughts or ideation in disability. Unproperly treated or untreated depression eventually in combination with the unbearable social status and life under the limit of poverty of the disabled people will convert into devastation condition of major depressive disorder with frequent suicidal thoughts. Majority disabled people are oppressed by ableism too, living as disabled people in a society that hates disability, or a society, the community, suffers from great stigma and taboo regarding disability. Overall, disability and its functional limitation in daily living activities have associated with suicide in the population of the disabled people (17). Still, there is a substantial lack of research data regarding what category of disabled people are more prone to develop severe depression, people with acquired disability or hereditary, and people with visible or invisible disability. Disabled people who suffer from suicidal ideation deserve to be seen by a therapist who “speaks” their language and understand their experience, thus cultural competency related to disability is a “must” for all healthcare professionals including pharmacists in the retail setting, social workers, psychologist and psychotherapists, rehabilitation counselors and our primary caregivers. There is a lack of research data what is the response of primary caregiver on a disabled person with developed depression as comorbidity and vice versa.

Unfortunately, despite a substantial lack of national data on suicide and disability in the U.S. some studies have been shown that there is a substantially higher suicide rate in the population of disabled people with certain disabilities such as multiple sclerosis, spinal cord injuries and intellectual disability (18). As Giannini M. and colleagues in 2010 stated: “It is imperative that U.S. researchers and policymakers address the substantial gaps in knowledge that remain to help create a clear understanding of suicide in the disability population, especially targeting children and youth ages 10 to 24 and other at-risk age cohorts”. It sounds like a “wake up call” but still, since 2010 we do not have some significant contribution regarding research in this field. One of the possible reasons for such a condition is the fact that suicidologists are not able to find the data regarding the suicide rate in the population of disabled people, the data are hidden, or there is a lack of proper evidence regarding this particular issue.

As one disabled person said: “Happy spring, I am “celebrating.” What? Six years of unsuccessful services with vocational rehabilitation services, still no job for me, with master’s and two doctoral degrees and numerous national and international certifications in the vocational evaluation process they made me an office clerk that even GED would be challenging for me, a home-bound lifestyle, severe disability, and heavy dependence on a primary caregiver…for them, I am “a low expectation and high liability.” I am “celebrating” a full five years in CBT (cognitive behavioral therapy) paying out of pocket. My potentially successful suicide was prevented by my primary caregiver, not a psychiatrist, not a psychotherapist, not a rehabilitation counselor…but holistic therapy helped me to make a balance in my body-mind-soul and found a “healthier” myself.”

This blog is the first blog in the series of three blogs dedicated to disability, disabled people and how holistic therapy, life, wellness, and health coaching can help disabled people to live productive life finding “the greatest love of all.”

Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center

References:

1. Lindsey E. The gift of healing in chronic illness/disability. J Holist Nurs. 1995 Dec;13(4):287-305.

2. http://www.worldbank.org/en/topic/disability

3. WHO Library Cataloguing-in-Publication Data World report on disability 2011.

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5. Driedger D. The last civil rights movement. London, Hurst, 1989.

6. Barnes C. Disabled people in Britain and discrimination. London, Hurst, 1991.

7. McConachie H et al. Participation of disabled children: how should it be characterized and measured? Disability and Rehabilitation, 2006,28:1157-1164.

8. Oliver M. The politics of disablement. Basingstoke, Macmillan and St Martin’s Press, 1990.

9. Leonardi M et al. MHADIE Consortium. The definition of disability: what is in a name? Lancet, 2006,368:1219-1221.

10. Learning lessons: defining, representing and measuring disability. London, Disability Rights Commission, 2007.

11. Quinn G et al. The current use and future potential of United Nations human rights instruments in the context of disability. New York and Geneva, United Nations, 2002b (http://www.icrpd.net/ratification/documents/en/Extras/Quinn%20 Degener%20study%20for%20OHCHR.pdf, accessed 21 Sept 2010).

12. Harris J. Processing disability. Am Univ Law Rev, 2015; 64 (3), 457-533.

13. Sen A. The idea of justice. Cambridge, The Belknap Press of Harvard University Press, 2009.

14. Sisti D.A. Naturalism and the social model of disability: allied or antithetical? J Med Ethics 2015, 41 (7): 553-556.

https://www.dol.gov/ofccp/regs/compliance/faqs/ADAfaqs.htm

15. Deschenes SS, Burns RJ, Schmitz N. Associations between depression, chronic physical conditions and disability in a community sample: a focus on the persistence of depression. J Affect Disord. 2015; 179: 6-13.

16. Noh JW, Kwon Y.D, Park J, Oh IH, Kim J. Relationship between physical disability and depression by gender: A panel regression model. PLoS ONE 11 (11): e0166238.

17. Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: A population-based study. Am J Orthopsychiatry. 2007; 77 (1): 56-60.

18. Giannini MJ, Kreshover S, Elias E, Bergmark BA, Plummer C, O’Keefe E. Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disabil Health J. 2010 Apr;3(2):74-8.