Goal instability and adjustment to physical disability.

Abstract

Few studies have examined psychoanalytic constructs in the adjustment of individuals with physical disability. According to H. Kohut (1977), optimal adjustment during life transitions is contingent on the individual's capacity for maintaining and pursuing meaningful goals, which reflects a stable sense of self. A series of studies was conducted to determine if goal instability would predict adjustment and health following disability. Goal instability was predictive of depressive behavior and acceptance of disability among individuals with recent-onset disability. Goal instability predicted subjective well-being 1 year later. Among community residents with a disability, goal instability was associated with life satisfaction; this relationship was not mediated by perceived stigma or community mobility. These findings indicate that a flexible yet durable goal orientation is associated with optimal psychological adjustment among individuals with a physical disability. Psychoanalytic thought has historically dominated clinical conceptualizations of adjustment following the onset of physical disability. Many early thinkers believed that individuals who incurred a disability should rationally accept the permanence and severity of their injury (Mueller, 1962; Nagler, 1950; Nemiah, 1957). This reality would take some time to digest, as the ego would be likely to feel a sense of castration at the loss of a limb or motor function. The losses accompanying the disability would deal a severe blow to the narcissism inherent to the individual (Cubbage & Thomas, 1989; Grzesiak & Hicock, 1994; Gunther, 1971). Most individuals would use denial to defend against the anxiety precipitated by the loss of limb or motor function (Knorr & Bull, 1970; Roberts, 1972; Stewart, 1977-1978). As the ego became able to permit experience of the loss, denial would be replaced by depression (Bracken & Shepard, 1980). In fact, the severity and immediacy of conditions like spinal cord injury (SCI) were considered such powerful blows to the ego that depression was often construed as a necessary prerequisite to optimal adjustment (Siller, 1969;