Some psychosocial aspects of poliomyelitis

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SOME PSYCHOSOCIAL ASPECTS OF POLIOMYELITIS

A Dissertation Presented to the Faculty of the Graduate School University of Southern California

In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy

Leonard Virgil Wendland June 1950

UMI-.Number: DP31431

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fZLju

Pk.D &'s< vtnl T h is dissertation, w ritten by __3^©0jnyar

..............

lQij.

The relation of educational level reached and weekly Income

. . . . . . .

The role of prosthesis and employability •

110 115

Opportunities for advancement in 121

present employment Security in present employment..........

125

Job stability

125

• • • • « . » • • • • • • .

Subjects who have been employed in "war work" • • • • « • • • • • • • • • •

V.

133

Summary of employment

................

137

PSYCHOSOCIAL ADJUSTMENT

* ..................

li|2

Marital status

.........

1J4.3

iii CHAPTER

PAGE Subjects who are married, single, and divorced

...............

Married subjects who have children • • . , Personality ratings

......................

1I4.3 1I4.9

157 158

Male ratings ..................... Female rati ng s..........................

158

Personality ratings in terms of age of onset

I6I4.

Some indications of adjustment.............

168

The social life of the post-poliomyelitic . . . . . . .

168

Religious activity » * • • » « • • • • » •

190

subjects

Illness as punishment from God » • • • •

197

Belief in religious faith healing

• • •

202

active in religion......... ♦ . . . .

206

Social adjustment of those subjects

The sports-mind edne ss of male and female subjects

. . • ........ *

Subjects having at least one hobby • Subjects who are interested in movies Subjects who have television sets •

. . .

211

» • •

215

• •

215

. ♦ •

218

The reading habits of 151 postpoliomyelitic subjects • • • • « • • » » The use of alcoholic beverages

222

229

iv CHAPTER

PAGE The use of tobacco by males and females • •

231

Subjects who are self-conscious of their physical deformity

• • • • • • • •

233

Parents who fear their children might contract poliomyelitis

• « » • • • • « «

239

Attitudes toward the future • « • • • • • «

2lj.2

Responses to projective questions • • » • • •

2I4.5

What more Orthopaedic Hospital might have done • « « « • • » « * » « « . * • •

2 I4-5

Most perplexing problem • • • • • » • • • •

2i|-7

What more parents might have done ♦ * » • ♦

2l$-7

Suggestions which might help other poliomyelitis patients VI.

* • • • • • • • •

2i|.8 25 I*.

SUMMARY AND CONCLUSIONS . V • • • * • • •

25 U

Conclusions of this study • • • • • • • • • •

237

Problems for future research

263

Summary of the study

• • •

• • • • • • • •

BIBLIOGRAPHY............................... . . . .

265

APPENDIX A.

Interview Materials

.............

267

APPENDIX B.

Sorting Device

• • » • • • • • • • • •

271

APPENDIX C*

Table of Magazines Read • • « • • • « •

273

LIST OF TABLES TABLE I*

PAGE Response to Letters Sent to k37 Poliomyelitis Subjects • . • .

. ♦ . . * •

li}.

IX*

Male-Female Distribution * * * * * .........

31

III*

Tabulation of Age Distribution • * • • * * • •

33

IV.

Cumulative Frequencies and Percentages for Age Distribution of Subjects . . . * • • • •

V.

Distribution of Male and Female Subjects with Percentages of Degrees of Apparency

VI.

* . • •

VIII. IX.

36

Cumulative Percentages for Apparency 37

Distribution............. VII*

3k

• « • • * • • •

I4.I

. * • * • • •

)\Z

• • • • • • • • * • *

k3

Age of Onset of Male Subjects Age of Onset of Female Subjects Summary of Age of Onset

X.

Surgery (Male) * • * * • • • • • • • • • • • •

I4J4-

XI*

Surgery (Female) • * . • • • • * * * * • * • » .

lj-5

XII •

Summary of Surgery • • • • • • • • • • * • * •

I4.6

XIII.

Male Subjects1 Expression on Effectiveness of Surgery « * • • • • • «

XIV.

U8

Female Subjects1 Expression on Effectiveness of Surgery • • * • • • • • *

XV.

•*.

.........

50

Summary on Sub jects1 Expres3 ion on Effectiveness of Surgery

......... . . . *

51

Vi TABLE XVI. XVII* XVIII.

PAGE Physical Involvement . . . . . . . .......

52

Summary of Need for Orthopaedic Appliances • Comparis on of Male-Female High School G r a d u a t e s .......... * ........... » • . •

XIX.

. • • • • • • • • •

.............

62

. . . . . . .

..............

63

Female Subjects Who Received Training 6I4.

Beyond High School . . • • • • • . . • • • XXIII.

61

Male Subjects Who Received Training Beyond High School

XXII.

..........

Female Subjects Who are High School Graduates

XXI.

58

Male Subjects Who are High School Graduates

XX.

5^

Percentage of Male and Female Subjects Who Completed College in Terms of Degree of ♦

66

XXIV.

Comparison of Male-Female College Graduates.

67

XXV.

Cumulative Percentages of College Graduates

Apparency

• • • . • • • • . .

with Reference to. Apparency

........

XXVI.

Summary of Education............... • • • •

XXVII.

Subjects Who Liked S c h o o l ...............

XXVIII.

73

Summary and Comparison of Grade Estimates by Male-Female Subjects

XXIX.

69

• « • • • • •

........

75

Subjects Who Feel that Education was Useful for Employment

• s 77

vii TABLE XXX.

PAGE Subjects Who Received State Bureau of Rehabilitation Educational Assistance . .

XXXI.

78

A Comparison of Employed and Unemployed Groups on the Basis of Apparency of 87

Deformity • XXXII. XXXIII. XXXIV. XXXV.

Employment Status of Female Subjects Summary of Occupations

• • • • • « • • . •

Type of Employer of Employed

• • • • • • •

. • • •

. ♦ . • • • • • •

100

102

. • .

103

. . . • •

105

Male Income Distribution for Those Employed in Terms of Apparency

XXXXII.

98

Nature of Investment of Females in Terms of Degree of A p p a r e n c y .........

XXXXI.

97

Nature of Investment of Males in Terms of Degree of Apparency

XXXX.

95

Frequency Distribution for Amount of Investment by Female Subjects • • • • • •

XXXIX.

93

Frequency Distribution for Amount of Investment by Male Subjects • • • • • • •

XXXVIII.

91

Summary of Subjects Who are Business Owners In Terms of Degree of Apparency • . ♦ . •

XXXVII.

88

Summary of Subjects Who are Business Owners in Terms of Amount of Investment

XXXVI.

• • •

Female Income Distribution for Those Employed Outside of Home in Terms of

viil TABLE

PAGE Apparency * • • • * . ♦ ............. *

XXXXIII.

Mean Income of Employed in Terms of Apparency

XXXXIV.

........................

111

Female Weekly Income Distribution as Related to Education Received • » • « •

XXXXVI*

107

Male Weekly Income Distribution as Related to Education Received • • « . •

XXXXV.

106

112

Comparison of Mean Income of Male Subjects Employed in Relation to Educational Level Reached . * • ........... * * . *

113

XXXXVI I . Comparison of Mean Income of Female Subjects Employed Outside of Home in Relation to Educational Level Reached * XXXXVIII.

111).

Percentage Dis tribut ion of Apparency of Disability Gompared with Prosthesis Used by Males in the Employed Group « .

XXXXIX*

116

Percentage Distribution of Apparency of Disability Compared with Prosthesis Used by Females in the Employed Group •

L.

Heed for Orthopaedic Appliances by Subjects not Employed • • • • * • • • •

LI*

LII*

118

120

Opportunity fbr Advancement in Present Employment• • • • • • • • • • • • • • •

122

Security in Present E m p l o y m e n t ........

12i|.

lx PAGE Male Employment Stability •

12?

Female Employment Stability . . . . . . . . .

128

Male-Female Employment Stability

130

. . . . . .

Comparison of Subjects in Terms of Physical Involvement and Percentage of Subjects in Same Employment During Last 10 Years

• . .

131

Occupational Stability over Ten-Year Period

. . . . . .

........

. . . . . . .

132

Job Stability for Subjects Employed over Last 10-Year Period . • • • • • • • * . . • Did War Work

• • • • . *

. . . . . . . . . .

Active Service in Armed Forces

. . . . ♦ . •

13& 156 138

Male^Marital Status

ii*4

Female Marital Status ♦

146

Marital Summary • • « • • • • • • • . • • * »

3^8

Number of Children of 53 Married Male Subjects



150

Number of Children of 53 Married Female Subjects

151

Mean Number of Children of Married Males and Females in Terms of Apparency • « » • •

153

Summary of Children of 53 Male and 53 Female Subjects • • • • . • • . . . . . . .

15^

X

TABLE LXVIII* LXIX* IXX*

PAGE Percentage Distribution for Children • • •

156

Male Personality Ratings « • •

159

Male Personality Ratings Compared with Degree of Apparency

LXXI. LXXH.

• • • • • • • • • •

160

Female Personality Ratings • • • • • • • •

161

Female Personality Ratings Compared with Degree of Apparency

LXXIII* LXXIV*

• • • • • • * • • •

162

Summary of Personality Ratings « • » • • •

163

Personality Rating of Males in Terms of Age of Onset

XXXV*

• • • • • • • • • • • •

# • «

Percentage Distribution of Personality *

169

• •

170

Percentage Distribution of Personality Ratings in Relation to Age of Onset

LXXVIII. LXXIX# LXXX* LXXXI*

Extent of Social Life of Males • • • • • ■ •

172

Extent of Social Life of Females • . • • •

173

Social Life Summary

175



« • • ♦ * • • •

Social Life of Males in Terms of Age of Onset • • • • * • • • .........

LXXXII*

I76

Social Life of Females in Terms of Age of Onset

LXXXIII#

167

.............

Rating with Reference to Age of Onset LXXVII«

165

Personality Rating of Females in Terms of Age of Onset

LXXVI*

........

Male Social Preference • « • • • • « • • •

178

179

xi TABLE LXXXIV* LXXXV* LXXXVI*

page

Female Social Preference • • • • • • « •

l80

Male-Female Social Preference

182

Male Participation in Orthopaedic Hospital Social Program

LXXXVTI*

• • • • • • •

• • • • • • •

LXXXX#

186

Summary ofMale-Female Orthopaedic « « • •

187

in Some Social Club •♦♦ ♦ •

189

Hospital Social Participation LXXXIX#

lStj.

Female Participation in Orthopaedic Hospital Social Program

LXXXVIII*

• • • • •

Membership

Protestant Religious Affiliation

• • • •

192

LXXXXI#

Catholic Religious Affiliation ........

195

LXXXXII*

Jewish Religious Affiliation . . . • • •

I 9J4.

LXXXX1II*

Comparison of Religious Affiliation In Terms of Apparency

LXXXXIV#

Comparison of Subjects by Religious Preference • • • • « *

IXXXXV•

? •

*

• • • • • « • • • • • • •

199

Subjects who Believe Illness is Punishment from God

LXXXXVTII*

198

Comparison of Subject Participation in Religion in Terms of Apparency • • • «

LXXXXVTI.

196

Summary of Total Subject Participation In Religion

LXXXXVX•

195

• • • • • • • •

• « • • • • • • «

200

Subjects who Believe in Religious Faith Healing in Relation to Apparency • • •

20J

xil TABLE

PAGE

LXXXXIX*

A Comparison of Subjects Active and Inactive in Religion on the Basis of Belief in Faith Healing * • • • • * •

C* Cl* CII*

, 20lj.

Social Life Rating of M a l e s ......... * •

207

Social Life Rating of Females

208

• • • • • *

Comparison of Percentage Distribution of Males and Females for Social Life of Subjects Active in Religion, and all Subjects * « * • • • • • « • • , • • *

210

GUI*

Interest of 68 Male Subjects in Sports • •

212

CIV*

Interest of 83 Female Subjects in Sports «

21J

CV*

CVI* CVII* CVIII* CIX*

A Comparison of the Male-Female Subjects1 Interest in Sports • » • • * • • * • • •

2llj.

Subjects Having at Least One Hobby * • • •

216

Male Interest in Movies

• • • * • • • • •

217

• • • • • • * •

219

Female Interest In Movies

Comparison of Male and Female Interest in Movies

CX* CXI* CXII* CXIII* CXIV.

• * • • • * • • • • • » • • •

220

Subjects Who Have Television in Home * •



221

Reading Habits of Male Subjects

* ** *

*

22J

• . .

*

225

Reading Habits of Female Subjects

Reading Habits of Male and Female Subjects

227

Subjects Who Use Alcoholic Beverages in Relation to Apparency * • • • • • • *

230

xlll TABLE CXV*

PAGE Total Subjects Who Use Alcoholic Beverages Compared with Total Subjects According to Apparency

CXVI*

Subjects Who Smoke in Relation to Apparency

CXVII*

........

* • • * • • * • • • •

2^k

Subjects Who are Self-Conscious of Physical Deformity

CXVIII*

• • • • • 232

• • * • • • • • * • • • • * * •

236

Subjects Who are Self-Conscious of Deformity Compared with Total Subjects in Terms of Apparency

CXIX*

• • • • « * , • •

Parental Concern About Poliomyelitis ........

2 I4.I

• • • • • • • •

2i|-3

in Relation to Their Children CXX* CXXI*

237

Attitudes Toward the Future

Comparison of Male-Female Attitudes Toward the Future # * . * * * * • • • • • • • • •

CHAPTER I

THE PROBLEM IN RELATION TO PREVIOUS RESEARCH Our society presents a variety of problems and difficulties to each of its members which makes integra­ tion of the self and adjustment to one*s social fellows difficult.

Discovering satisfactory ways of adjustment to

the demands of our culture is one of manfs perennial problems#

In the hope of eventually discovering a satis­

factory means of integration and acculturation man is constantly seeking new ways of meeting the-cultural and social hurdles which confront him. This adjustment, in terms of self and society, may be facilitated or impaired by numerous variables#

In this

study we are concerned with one variable, namely, the aftereffects of poliomyelitis, as it impairs or facili­ tates adjustment in some psychosocial areas. I#

SOME THEORETICAL ASSUMPTIONS

The crippled or deformed person has long been an object of special pity and attention.

Sometimes the

malformed individual arouses only rude curiosity, some­ times pity, and sometimes only disparagement. A handicap is usually thought of as something which places a person at a disadvantage - that is, something with

which the majority of people do not have to contend*

In

this sense the individual who has been left deformed or crippled by poliomyelitis is, from the objective point of view, considered to be handicapped*, However, from the subject point of view,., being crippled does not automatic­ ally imply being handicapped.

The handicapped individual

is not necessarily a maladjusted person but it is possible that such a person is forced to face problem situations which make so-called "normal11 adjustments very difficult* Just how important health,., wealth and success are for a given individual is difficult to determine*

How

important a given traumatic or other experience may be in explaining overt behavior is equally difficult to ascer­ tain.

It may be assumed that the presence of illness,

crippling,, or deformity are responsible directly or in­ directly for certain changes in behavior as well as the general philosophy of life of that individual*

Since

life, from the dynamic point of view,., is striving for self-realization, then anything that hinders or retards that process'may be considered frustrating*

It may be

assumed, therefore, that whenever factors impinge on the nonnal advance and development of the personality In the direction of self-realization that changes in behavior do take place.

This assumption is based on 'the belief

that Illnesses often are frustrating experiences calling

for some form of adaptive or non-adaptive behavior. It is likewise assumed that handicaps which are likely to be of a short duration are less likely to be pronouncedly frustrating than those handicaps whose prog­ nosis is of an indefinite time limit.

The residual

crippling o.f the pbliomyelitic-, it is assumed,.within varying degrees, is to remain with the individual for his life span.

Since the poliomyelitic is confronted with

the possibility of facing an] entire life with his handi­ cap it may be assumed that such a possibility may loom as a very frustrating experience. The degree of frustration that a crippled subject is apt to experience as the result of poliomyelitis is probably dependent to some extent upon the following four factorss

(1) The nature and extent of the handicap,

and the possibility of its elimination or alleviation, (2) The attitude of the parents toward the individual and his handicap, and the extent to which the immediate environment can be changed so that it accepts the child *

and is in turn acceptable to the child,

(3) The attitude

of*the social group in general toward the child and his handicap,, inasmuch as social approval and acceptance is one of the basic psychological needs of every personality, (4) The individual^ attitude toward his handicap and flexibility in adaptation to change,.

4

It is possible tbat a physical deformity may be thought of as a frustrating barrier to psychosocial adjust­ ment*

However, it may be that a handicap may act as a

spur to endeavor and thus instead of retarding acceptable adjustment in some areas it may actually channel the re­ sources and efforts of the person in the direction of so-called wsucaess.M Frustration as a psychological fact is such a fundamental part of our everyday life, as we know it, that it would be difficult to imagine a world without it.

Frus­

trations,, in one form or another, are basic experiences in life for most people.

From the subject point of reference

most persons experience some form of frustration.

From

the objective point of reference some handicaps are not readily apparent.

It may be assumed that most people have

some handicap or hindrance, not necessarily physical, to the fullest realization of their personalities. The psychosocial reaction to poliomyelitis, whether it is of a severe physical nature or not, might well be related to other personality needs which can utilize the ppst-poliomyelitic handicap as a convenient vehicle to express more basic personality needs.

Since it is im­

possible to do more than hypothesize as to the meaning back of behavior, we can do little more than reaffirm that* though we may be unable to explain behavior, it neverthe-

less does have meaning for the psychological self* A handicap may produce a variety of types of be­ havior*

The type of reaction to a frustrating situation

is probably dependent upon the dominant needs within the individual’s hierarchy of needs at the time*

A handicap,

interpreted as frustrating, is often met by increased effort on the part of the individual in order to over­ come the frustrating agent or minimize its effects*

Frus­

tration may likewise be met by changing desired goals* In a follow-up study of one hundred post-poliomyelitic children Copelhnan1 found that it is extremely difficult to isolate whether a child’s overt behavior after having had poliomyelitis was significantly differ­ ent from his behavior patterns previous to the onset of the illness.

When parents uponrthe return of post-poliomye-

litic children to their home could not discover any obvious deformity, they frequently "needed* some focal point for their attention and consequently isolated some insignifi­ cant personality change which they could blame upon this frightening disease*

Such personality changes frequently

took place in the subject after sufficient parental attention concentrated at this point seemed to impress 1 Fay S. Copellman, r,Follow-Up of One Hundred Children with Poliomyelitis,*’ Family, 25:289-297, December, 1944.

6

the child with the desirability of utilizing this unusual attention#

Cbpellman also noticed that some parents tend

to blame poliomyelitis for overt behavioral problems following the illness, which previously existed but which the parents could not previously emotionally accept#

It

is entirely possible that some behavior following polio­ myelitis may be directly due to the illness, while other behavior has been indirectly precipitated by the illness^ Rosenzweig2 classifies reactions to frustration as to whether only the segmental need or the whole person*ality is involved#

When the reaction is primarily con­

cerned with the fate of the frustrated segmental need it is designated as ”need-persistive.” When the personality in and of itself is threatened, then the reaction is thought of as ”ego-defensive.”

This does not mean that

the ego is not involved in the need-persistive type of reaction, but it means that the reaction is not primarily ego-defensive in character. Aggression is an objective reaction to frustration. One hypothesis of aggressive behavior is that whenever i t . is manifest it is due to some form of frustration#

When­

ever there is interference by persons, groups,, or things 2 S. Rosenzweig, ”An Outline of Frustration Theory,” Ini Hunt, J. Me V., Personality and Behavior Disorders» Vol. I, (Hew Yorks Ronald Press, 1945), P 382.

7

* with the wishes of the individual, one may expect aggress­ ive reactive behavior.

The opposite of the aggressive

reaction^ is the withdrawing, regressive reaction.

The

latter reaction seems to be a learned response due to social conditioning, previous?experience, and the fear of pain or punishment.

According to Cbpellman^,, those who

contract poliomyelitis when young are apt to become withdrawn and bewildered while older children react in a more aggressive manner.

Whereas aggression almost always

presupposes a frustrating experience,, it is not necessarily true that every frustrating experience should therefore produce overt aggressive behavior*. The feelings that may be overtly expressed in aggressive behavior patterns may be internalized producing behavior that may indicate displaced aggression. According to Rosenzweig^ there are two types of reactions to frustration in general.

(1 )} Though the

desired response is not possible, a response is neverthe­ less made and in spite of the frustration the need is metJ (2 ) The response is one which tends to protect the integration of the personality ifT it is threatened by the 3 Oopellman, loc.. clt..

4 S. Rosenzweig, frIII. Need-Persistive and EgoDefensive Reactions To Frustration As Demonstrated by an Experiment On Repression,MPsjc* Rev. 48s347, July, 1941.

8

frustrating experience.

The former type of responseris

the °need-persistive” response and the latter the ^godefensive0 response*

The latter reaction takes priority

over the former in that a more basic need is stimulated by a less basic: need* Against this general theoretical background the nature of the psychosocial adjustment accomplished by the subjects in this study will have added significance.* With the exception of this theoretical framework this study was begum with an absence of hypothetical assump­ tions as to the nature of the expected findings. II. HISTORICAL STATEMENT The plan and nature of this study was structured somewhat by one done previously at Orthopaedic Hospital, Los Angeles, California,, under the direction of Dr. C. L* Lowman*-*

Since the present study made use of some of the

same subjects previously used and since the form used in this study was somewhat patterned after the previous study,. It seems that a historical statement is necessary*

When

reference is hereafter made to a ^previous s t u d y i t will refer to the one made by Dr. Lowman and the Orthopaedic 5 C. L. Lowman, °A Survey of the Vocational, Edu­ cational and Social Status of Poliomyelitis Patients,” Cbnducted for the National Foundation for Infantile Paralys is, (unpubli shed, 1942) *

9

Hospital Staff, unless otherwise specified* The Orthopaedic Hospital*s records as of January 1,, 1939 showed that 1836 poliomyelitis patients had been treated in the Hospital Clinic*.^ Dr* R. L* Carroll^ contacted 1732 of those infantile paralysis patients who had gone through Orthopaedic Hospital with the intent of making a physical aftereffects checkup*

Of these patients,-

794 were eventually examined by a member of the Orthopaedic Hospital Staff* In conjunction with the physical aftereffects of poliomyelitis survey carried on by Dr. Carroll at Ortho­ paedic Hospital in 1939 and 1940, the Research Staff of the Hospital carried on a survey on the vocational, educational,, and social status of poliomyelitis patients. This study was under the direction of Dr. C;. L. Lowman aided by a grant from the National Foundation for Infan­ tile Paralysis.

Of the 794 patients examined by Dr.

Carroll, those patients 16 years of age and older were contacted in the Interest of the survey studying the vocational, educational, and social status of poliomyelitic patients.

Of the 794 patients a total of 437.- 203 males

6 Robert L. Carroll, “After Effects Survey of Infantile Paralysis at Orthopaedic Hospital,, Los Angeles, 11 (unpublished, Orthopaedic Hospital, Los Angeles, California, 1941), p. ii. 7 Loc. cit.

10

and 234 females, were interviewed by the Research Staffi, The majority of the data collected on the vocation­ al, educational, and social status of the 437 patients has not been published*. A copy of. the manuscript containing the data may be found in the Medical Library of Ortho­ paedic Hospital, Los Angeles, California#®

A number of

excerpts from this manuscript have been published *,9 - 10 The basic purpose of the original survey by Dr* bowman and Staff was fourfold:

(1) To study the problem

of employment as related to the degree of physical handi­ cap*. (2) To study the educational background of subjects in an attempt to determine the adequacy of the educational opportunities for handicapped children*

(3) To study the

personality adjustment, including marriage*

(4) To find

the amount and cost of physical care in the program for rehabilitation of poliomyelitic patients. Ill*

SOME SELECTIVE FACTORS

Selective factors in present subject sample* The 8 bowman * loc* cit*.

9 Charles beRoy bowman and Mortan A* Seidenfeld, f,A Preliminary Report of the Psychosocial Effects of Poliomyelitis,*1 J. Consulting Psychology, 11:30-37. January-February, 1947♦ 10 Mi A* Seidenfeld, ,fPsychological Elements In Work Interference from Physical Disability, 11 J* Consulting Psychology. 11:326-333, November-Deeember, 1947.

11

present sample of subjects may, within limits, be thought of as a representative sample of poliomyelitis patients* Because of the selective factors involved we may say that the present sample is representative of the clinic patients who have been patients at Orthopaedic Hospital, Los Angeles, California.

However, there are certain selective factors

of which we need to be aware. In the historical statement mention has already been made to a study begun in 1939 by Dr* Carroll.^

Some

factors that are brought to light in the present study reflect the fact that the majority of the subjects origin­ ally examined by Dr. Carroll had been charity patients at Orthopaedic Hospital, Los Angeles,, California.

The age

limit for charity patients in the Orthopaedic Hospital is 21 years and thus all patients treated in the clinic were below that age.

This age limit becomes a definite

factor in the statistics related to the age of onset.

This

selective factor is also important in that the majority of subjects are now in their prime, as far as employment is concerned, and the mean income will therefore possibly be affected. The fact that the majority of the patients Included in the 437 cases used in the psychological survey conducted by the Hospital Research Staff in 1939-1940 came from 11 See page 9.

12

the Orthopaedic Hospital Olinic files is a selective factor affecting the present study.

Since all the subjects for

the present study were subjects in the previous study, it means that the selective factors present at that time are likewise important in this study.

(1) Perhaps the most

important selective factor is that only patients under 21 years of age were included.

(2 ) Such factors as sex, race„

nationality, religion, and environmental background were accidental rather than selective.

Perhaps It is well to

note that, since a majority of the hospital clinic patients are charity patients, it may mean that children of clinic age from wealthy homes are more frequently given private medical care; and were it possible to include such subjects in a sample, it would give significantly different results. The means of locating present subjects, as will be noted below, is another selective factor.

Inasmuch as

some people are not registered voters, It means that con­ tacting those subjects who are registered voters represents a selective factor.

Furthermore, the use of the Tele­

phone Directory as a means of locating some individuals represents a highly selective factor in several ways. During the war years it was extremely difficult for any­ one to get a telephone unless it was considred vital to the war effort.

If a subject changed place of residency,

it became exceedingly difficult to get a telephone.

The

13

fact that the cost of having the service of a telephone is prohibitive for some people likewise is a selective factor# In a like manner, the use of the files of the State Bureau of Rehabilitation as a means of locating subjects was selective in that not all subjects have applied for assist­ ance from this Bureau.

Thus only those who had applied or

received aid had addresses on file.

Even in the cases of

those who had made contact with the State Bureau of Rehab­ ilitation, only those who had received aid in the more recent years had addresses that were more up to date than those on file at Orthopaedic Hospital.

Thus a subject who

had received aid from the State in more recent years was more easily located than those subjects who had never received aid or had done so ten or more years ago. Table I reveals that 20.8 per cent of the letters sent Initially to 437 subjects remain without any reply. Since all letters carried a return address it may be assumed that the 91 letters were received but the subjects were not desirous of cooperating in the proposed study. This would seem to propose another selective factor in this study.

Why 91 former patients should refuse to coop­

erate in this study can only be surmised.

Though it is

impossible to generalize as to the real reasons back of this lack of cooperation, certain possible reasons may be suggested.

These reasons are suggested because some of

TABLE I

RESPONSE TO LETTERS SENT TO 107 POLIOMYELITIS SUjBJECTS

N

$

Cards returned 151

8 5 .8

Subjects not interviewed

15

8 .5

Subjects deceased

10

5 .7

176

1 0 0 .0

Subjects interviewed

Letters returned unclaimed

'

H

%

176

40.5

170

3 8 .9

91

2 0 .8

k37

10 0 .0

these feelings were expressed in cases who were inter­ viewed.

(l)

It may represent hostility toward the

Hospital or its Staff., Since the initial letter was sent out to prospective subjects on the Orthopaedic Hospital stationery and under the name of Dr. Lowman, this refusal to reply may indicate certain disgruntled feelings toward this Institution and its Staff.

Some of the subjects who

were interviewed expressed definite feelings against the previous survey done by Dr. Lowman and members of the Staff It may be noted that though some subjects expressed such feelings of hostility they nevertheless desired to coop­ erate with this study which may mean several things. A strong emotional tie to the hospital.,

(a)

(b) Ambivalent

feelings of appreciation and hostility,, with resultant guilt feelings, finding a degree of guilt reduction by doing something for the hospital.-

(2) Refusal to answer:

the request to participate in this study may reflect a desire to ”get lost.”

Some subjects interviewed tended to

live in an exclusive private world and seemed somewhat to resent being disturbed even for the period of the inter­ view.

(3) Perhaps a rather important reason might be

found in the desire of many former poliomyelitis patients to want to forget that they ever had this dread disease. A certain amount of resentment was frequently in evidence during the interview since the individual once more became

16

a'"subject" and was the focus of attention*. Some subjects expressed the desire to forget that they ever had polio­ myelitis and that they were handicapped* be like other people*

They wanted to

Subjects thus expressed the desire

to "forget it all* 11 To such a person a letter reminding him that he had had poliomyelitis and that he is handi­ capped and the object of stares and pity comes as a start­ ling jolt*

The prospect of being interviewed by someone

to some extent identified with the institution of which he once was a patient is unthinkable since it symbolizes that which he has sought to escape*

As has been mentioned,

several of the subjects who had been contacted and who had Indicated their willingness to cooperate, when contacted by telephone,, indicated that they would be glad to answer any questions over the telephone but did not wish to be interviewed in person*. The dynamics back of such a request again is open to conjecture.

However, it might mean a

desire to keep this interview from becoming too personal* Over the telephone the subject would be hidden from the scrutiny of the interviewer and, perhaps even more import­ ant, the subject would be in command of the situation and might terminate the interview at any moment*

(4) Some of

the subjects undoubtedly are deceased and the next of kin did not see the need to return the self-addressed card* (5) Personality regression may have resulted from the

poliomyelitis directly or indirectly.

Poliomyelitis

subjects, like any other group of people, show a prefer­ ence either for or against social contacts: with strange people.

It may be assumed that some of the subjects who

did not reply to the initial letter felt that they could not face the social situation that an interview would imply (6 ) Though all of the subjects contacted are adults from the standpoint of years, some are relatively immature. Some of the subjects interviewed continued to live with parents and to some extent responded to the domination of their parents.

In some cases when subjects were inter­

viewed in homes, parents attempted to dominate the inter­ view and insisted on sitting in and answering the questions relative to the interview.

Then again, some subjects when

interviewed requested that the mother answer certain ques­ tions for them, since they felt the mother could do so much better.' It is quite possible that some subjects would have cooperated with the study but a parent or parents, or hus­ band or wife, may have decided against participation be­ cause they are ashamed of them.

In the case of one male

subject the mother returned the card for her 28-year-old unmarried son.

He has continued to live with his pre­

maturely widowed mother,, whose husband had been killed in a: car accident . The mother returned the card with instruc­ tions that she wished to see the interviewer before her son

18

was interviewed*

Since this was possible, the interviewer

complied with the request*

The mother then proceeded to

tell how her" soni acted and in general **prepared” the inter­ viewer for the meeting

It was rather obvious that the

mother felt that the interviewer needed to be prepared to meet her son.

Since the interview took place at the home

in the evening,, ife was impossible to speak to the son with­ out the mother1^ constant interruptions.

These interrup­

tions did not only deter the progress of the interview but likewise emotionally upset the son to the extent that he quite freely expressed his feelings toward her.

Upon

leaving, ,the mother exclaimed, "You see what I mean.”

In

this case,, however, as may be inferred from this short case summary, the mother is expressing a need to dominate the son, who in turn rebels against such intrusions. Another subject when contacted by telephone several times to determine a satisfactory time and place of meeting and after a number of explanations why it was not convenient at various times, requested the interviewer to come on a certain evening,, in that her husband was home that evening, and that she would prefer being interviewed at that tlmev A multigraphed letter-^2 signed by Dr. C. L. lowman, 12 See Appendix A.

was sent to each of the 437 subjects.

Enclosed in each

letter was a government postal card mimeographed so that the patient could check his willingness or unwillingness to cooperate in the proposed study.-^ It; is interesting to note that of the cards returned,, with the exception of the cards returned by next of kin of those subjects deceased, all indicated their willingness to cooperate#* Examination of Table I will reveal that 437 letters were sent to 437 potential subjects in the present study# Since records were available in Orthopaedic Hospital with the names of the previously used subjects, a card file was made of these names for the present study.

Because the

addresses on the previous records were to a large extent out-of-date,, it frequently meant sending a letter1to a number of subsequent addresses before the subject was successfully contacted. In this study every effort was made to contact patients whose present address: was unknown.

The present

whereabouts of some subjects was traced through friends. Others were traced through addresses in the Hospital's patient file as well as from the file of the Boys.* and Girls1 Alumni Clubs.of the Hospital and other organizations Reference to Table I indicates that 170 letters remained 13 See Appendix A.

unclaimed, though many more were returned unclaimed from the initial mailing.

In some cases three and four letters

were sent to different addresses before the subject was located.

When letters were returned unclaimed because of

invalid addresses, further search for the correct address was made in the Los Angeles Registry of Voters, the Files of the State Bureau of Rehabilitation, and the Telephone Directory.

Since all the female subjects are now of

marriageable age, it means that a good percentage of females single in the previous study are now married.

The

marriage of female subjects brought about the complication of a different name which made it difficult and sometimes impossible to trace some successfully.

Nevertheless the

present study has a slightly higher ratio of female sub­ jects compared with male subjects than did the previous study.

The previous study had 203 male subjects and 234

female subjects.

In the present study the N for males is

68 or 33*5 per cent of the male N in the previous study. The N for females in the present study is 83 or 35*5 per cent of the female N in the previous study.

Though the

male-female ratio remains very much the same as in the previous study there is a slight skewing in the direction of the female.

Thus, while it was difficult tracing the

movements of female subjects during the past ten years, the present N for females would seem to be adequately

21 balanced with tbe Male N. All subjects who had remained actively associated with the Boys1 and Girls1 Alumni Clubs of the Orthopaedic Hospital were easily located.

Table LXXXVIII^ indicates

that 1 9 *8 per cent of the subjects studied are still associated with some of die Orthopaedic Hospital social activities*

However, since 80*2 per cent do not partici­

pate in any of ihe Orthopaedic Hospital social activitiesf the use of the files of these groups as a means of locat­ ing subjects does not pose as a determining selective factor, for some of these subjects would undoubtedly have been located in some other manner had they not been locat­ ed through the files of these social groups* Reference to Table I reveals that 176 subjects returned the card enclosed in the initial letter indicat­ ing that they would be willing to cooperate in the present study.

This means that 1^0*3

were located. deceased*

cent of the I4.37 subjects

Of the 176 subjects located 5*7 per cent were

Though some subjects were located and indicated

that they would be willing to cooperate, they were not interviewed because they failed to keep their appointments or in other ways failed to follow through in a coopera­ tive manner* ”

Only one subject definitely refused

34 See page

187#

22

to give the desired information., indicating that her per­ sonal history was not for publication and that her time was too valuable to be used in answering questions.

Sever­

al of the subjects who had been contacted desired to answer any questions over the telephone but did not wish to be personally contacted.

Of the subjects contacted,

8 5 *8 per cent were interviewed.

In the previous study by Dr. Lowman,3-5 subjects were interviewed as they came to the hospital for other purposes.

It was felt that since only a small percentage

of the subjects used previously had continued to keep in close contact with the hospital, it would be exceedingly difficult to request all those willing to cooperate in the present study to come to the hospital for their interview. A few subjects requested that they be interviewed at the hospital and it was possible to accomodate those who so requested.

It was felt, however, to ask all to come to

the hospital would become a significant selective factor in that means of transportation, taking time off from work, and in general the time and effort that it would require, would mean that a subject might be willing to cooperate in the study but would nevertheless be unable to do so. 15 Lowman, loc. cit.

23

In the present study it was felt desirable and worth the time and cost, in the interest of getting the most possible realistic picture of what has taken place in the psychosocial adjustment of the post-poliomyelitis patients in the last ten years, for the interviewer to go directly to the subject.

By so doing, the selective

factor, otherwise imposed by requiring subjects to come to the hospital, was eliminated.

Most of the subjects resid­

ing in the State of California were personally interviewed over a period of 6 months.

Thirteen subjects were con­

tacted who now reside outside the limits of the State of California or in a remote section of the State, or could not, for other reasons, be personally interviewed.

How­

ever, it may be noted that 133 subjects, or 91.4 per cent of the total subjects here reported were personally inter­ viewed.

Basic data were acquired from the other 8 . 6 per

cent by means of correspondence. Every effort was made to accomodate the subjects as to time and place of interview so that all conditions favored the completion of the interview.

Most of the

subjects were interviewed in their homes with a good share of the interviews taking place in the evening. Some subjects were interviewed at their place of business or work; others were seen during the lunch period.

When

subjects preferred to be interviewed at the hospital or

24

at some other convenient place, every effort was made to comply with the request* The interview was structured by means of a mimeo­ graphed

q u e s t i o n n a i r e .

6

^he questionnaire is a conveni­

ent work sheet so arranged that information pertinent to the study could be filled into appropriate areas without needing to turn pages.

Rapport with the subjects was

readily established, the basis for rapport having already been established in the initial letter sent to all po­ tential subjects under the name of Dr. C. L. Lowman.3-7 Since most of the subjects know Dr. Lowman, and the letter indicated his interest in the study, rapport with the subject was far less difficult than might otherwise have been expected.

However, as might be expected, certain

subjects who were contacted were hostile toward the inter­ viewer.

This hostility could in most cases be explained

as displaced hostility toward the hospital or its staff. Some examples of this hostility will be cited at a more appropriate place in connection with an expression by the subjects of what more might have been done by the hospital that would have improved their opportunity for rehabili16 See Appendix A . 17 Charles L. Lowman, M. D., Director of Education and Rehabilitation, Orthopaedic Hospital, Los Angeles, California.

25 nation.

A sorting device was constructed to facilitate the isolation of specific variables.

One hundred and fifteen

variables were coded on the edges of 7,lx9§n cards.

Blue

cards were used for all male subjects and pink cards for all female subjects.

Data were codified for each subject

on the edges of a single card.

Variables representative

of a subject were indicated on the card by means of the removal of that numbered section of the margin correlat­ ing with a predetermined code sheet.

One half of a sample

card is included in the Appendix.1^ IV.

PURPOSE OF THE STUDY

Purpose of this research. The last ten-year period has been a significant decade for our country. A decade that has witnessed the mobilization of a nation at peace to one at war has likewise had untold effect on the lives of many people.

Whereas research data had been

collected and analyzed ten years ago on the vocational, educational and social adjustment of 437 poliomyelitic patients, it appeared desirable to make another survey study of essentially the same areas of adjustment. 18 See Appendix B.

In

26 the interest of and for the furtherance of data relative to the eventual psychosocial rehabilitation of the postpoliomyelitic patient, it was deemed desirable to make a study of a sizable group of subjects who had been studied previously ten years ago. Whereas the subjects used in the present study were subjects of the previous study ten years ago, data are available, as mentioned above, relative to their psycho­ social status as of that time.

In the present study we

are attempting to bring up-to-date data relative to the psychosobial effects of poliomyelitis as they pertain to a group of 151 subjects.

Some of the data collected in

this study relate specifically to the last ten-year period while other information duplicates that which was collected ten years ago. No effort will be made to draw definite conclus­ ions from the data collected.

An attempt will be made to

present the statistics in such a way that they may speak for themselves.

The present study represents a sizable

sample of subjects, many of them now in their most pro­ ductive years. Specific areas of research. More specifically this study attempts to do the following: 1.

Make a follow-up study of as many of the

27 previously studied poliomyelitis patients as possible, thus making it possible to more adequately interpret the psychosocial adjustment or poliomyelitis patients, 2.

Present data which will reveal the occupational

history of poliomyelitic subjects, bringing to our attention the manner in which they were affected by the recent war, 3.

Indicate the relationship of educational level

reached to employment status. Ij., Bring to light some factors relating to the psychosocial adjustment of the post-poliomyelitic patient, V.

ORGANIZATION OF REMAINDER OF THE RESEARCH

Chapter I has dealt with the theoretical background for a research study on the psychosocial effects of polio­ myelitis.

A historical statement was made relative to

previously conducted research on this subject.

Certain

selective factors in this study were noted. Chapter II will deal with the descriptive factors of the 151 post-poliomyelitic subjects used in this study.

Such factors as:

distribution of sex, age,

degree of residual paralysis, and use of prosthesis by the subjects will be discussed. Chapter III will deal with the educational back­ ground of the subjects In this study.

The amount of

28 schooling received and the type of degrees earned will be of specific interest.

The educational level reached by

the studied subjects will be compared with the educational level reached by the general population. Chapter IV will deal with the employment history of the subjects.

The employment history will be con­

fined to the past ten-year period.

Weekly incomes,

employment stability, type of employment and employer, use of prosthesis, private investments, nature of in­ vestments, and active service in the armed forces of the United States Government will be studied in relation to the degree of residual paralysis• Chapter V will deal with some of the factors re­ flecting the psychosocial adjustment of the l^l subjects in this study.

The marital status of each subject and

the number of children born to married subjects will be discussed.

Data relative to a personality rating for

each subject will be included.

Some factors which reflect

psychosocial adjustment will be discussed. factors to be analyzed are:

Some of the

social life, religious life,-

interest in sports, hobbles, movies, television, and reading habits.

The responses to several projective

questions will illustrate some of the unrecognized feel­ ings of the subjects. Chapter VI will summarize some of the findings of

the study.

Conclusions to each of the research problems

will be made.

The nature and findings of this research

pose other interesting research problems.

Several

specific areas of research, based on what has been done in the present research, will be suggested.

CHAPTER II

DESCRIPTIVE DATA The group of subjects used in this study we assume, taking into account the selective factors isolated, are a random and representative sample of post-poliomyelitic patients who have at some time been patients of Ortho­ paedic Hospital, Los Angeles, California. Certain descriptive data were accumulated and analyzed statistically for several reasons:

(1) Descrip­

tive data were considered to be important in the fuller understanding of the subject as an individual.

(2) It was

thought important to have descriptive data in that they reflect the psychosocial adjustment of the individual. Distribution of sex of subjects. Reference to Table II Indicates that the total N for this study Is 151*

The ratio of males and females is i|-5*0 per cent and

55*0 Per* cent respectively.

As has been noted above,

the previous study conducted at Orthopaedic Hospital had an N of I4.37 with the male N being 203 being 23if«

female N

Both the previous and present study Indicate

a somewhat higher percentage of females.

However, in the

interest of making the present study comparable to the 1 See page 9*

31

TABLE II MALE-FEMALE DISTRIBUTION

Sex

N

%

Male

68

45.0

Female

85

55.0

151

100.0

original study as far as the subject group is concerned, it is interesting to note that in the former study I4.8 .7 per cent of the group were males while in the present sex distribution ij-5*0 per cent are males.

Likewise in the

former group 51 «3 Pe** cent were females and in this study there are 55

P©** cent females.

Thus the male-female

ratio has shifted slightly in the direction of a larger proportion of females than males• The total N in this study is 15.I and thus it means that the present study represents a follow-up study of 3I4..8 per cent of the previously studied group.

Age of subjects studied. Table III represents the age-distribution for the subjects in this study.

Table

IV gives a more complete picture of age-distribution in terms of cumulative percentages.

Statistically we may

determine that the median age for males is 5 2 *2 , for females the median age is 5^4-*1» group the median age is 53*9*

terms of the total An age-distribution such

as we have would lead one to postulate that this group, of subjects is at the present approximately in what may be thought of as the prime of life. Apparency of residual physical involvement. How apparent a residual physical involvement is, is of vital importance in considering the psychosocial effects of

TABLE III TABULATION OF AGE DISTRIBUTION

Male N

i

Female -N %

Total N %

22

32 .3

2k

2 8 .9

46

3 0 .5

30 - 34

15

2 2 .1

18

21.7

33

2 1 .9

35 - 39

17

2 5 .0

26

31.3

43

2 8 .5

14

2 0 .6

10

12.1

24

1 5 .9

1

25 - 29

4=~ 0

Age of subjects

45 - 49

k

M

4

2 .6

50 - over

1

1 .2

1

0 .6

83

10 0 .0

151

10 0 .0

68

10 0.0

v>i

VJ4

TABLE IV CUMULATIVE FREQUENCIES AND PERCENTAGES FOR AGE DISTRIBUTION OF SUBJECTS

Female Cumulative of % f

Totals Cumulative f of %

50 - over

1

83

10 0 .0

1

151

k5 - 1+9

k

82

9 8 .8

k

150

99 .Ij-

Age of subjects

‘Male

0 1

f

cf

Cumulative i

1 0 0 .0

68

10 0.0

10

78

9U-.0

2k

ll).6

9 6 .8

35 - 39

17

5**-

7 9 -k

26

68

8 1 .9

kl

122

8 0 .9

30 - 3k

15

37

5 k 'k

18

1)2

5 0 .6

33

79

52.1j-

25 - 29

22

22

32.3

2^

2k

2 8 .9

if-6

k6

3 0 .5

P

ll*.

poliomyelitis.

In this study an attempt was made to grade

the degrees of deformity on a five-point scale.

The

definition of what each degree means is doubtlessly of a subjective nature.

Likewise it is recognized that other

observers would doubtlessly have graded the degrees of apparency differently.

However, since all grading was

done by the same individual and as impartially as possible, the over-all significance of any errors made may be lost in the general consistency of the grading.

Table V gives

a frequency and percentage distribution of the group in terms of degree of apparency.

Table VI gives cumulative

percentages for males and females as well as for the total group.

The median degree of apparency may be statistically

arrived at as 1 .2 . The following is a brief descriptive title for each degree of apparency:

Number 0 apparency represents

an Individual who has no deformity; or if there is de­ formity, it is so slight that the casual observer will not notice the deformity should he meet the individual on the street.

Number 1 apparency implies that it is noticeable

that this individual has some type of deformity, yet the manner in v/hich the deformity is expressed by the subject, or interpreted by the observer, is of such a nature that the observer assumes something is wrong but cannot detect what it is• Number 2 apparency means that what handicap

TABLE V DISTRIBUTION OF MALE Sc FEMALE SUBJECTS IN TERMS OF DEGREE OF APPARENCY

Degree of Apparency

N

Male %

Female N %

Total Subjects N %

lj-

1

1.1|

5

6.0

6

3.?

3

11

16.2

12

lit-.5

23

1 5 .3

2

16

2 3 .6

12

11+.5

28

18.5

1



l*.l

36

14-3*3

66

14-3.7

0

10

14.7

18

2 1 .7

28

1 8 .6

68

100.0

83

1 0 0 .0

151

100.0

Vjsl On

37 TABLE VI CUMULATIVE PERCENTAGES FOR APPARENCY DISTRIBUTION

Degree of Apparency

Male

Female

4

1 0 0 .0

1 0 0 .0

1 0 0 .0

5

9 8 .6

94.0

96.1

2

82.4

79.5

8 0 .8

1

5 8 .8

6 5 .0

62.3

0

14.7

21.7

18.6

N a 68

N - 83

Male and Female

N s 151

38 the subject has is apparent to the casual observer. Humber 5 apparency implies that the deformity is very apparent so that even the most casual observer will be able to detect the extent of residual paralysis.

Humber

Ij. apparency means that the subject is so badly crippled that he or she is incapable of movements with the aid of crutches or braces and spends all the time in a wheelchair or in bed. Some deformities are of the kind which can be easily concealed, at least for men and, likewise, for those women who rather consistently wear slacks.

Several

female subjects indicated that they do not go anywhere where the wearing of slacks is not appropriate, since slacks conceal their underdeveloped leg or the brace on the leg.

Two of the female subjects have been wearing a

prosthetic stocking made of some form of plastic foam. These are worn over the deformed leg and when worn give the appearance of a leg similar to the normal one.

The

need to wear this type of prosthetic appliance indicates marked Sensitivity concerning the appearance of the de­ formed leg.

However, if a subject is sensitive to this

factor, it doubtlessly is more desirable to wear such an appliance than to remain extremely self-conscious of oners appearance.

Self-consciousness of the apparency of de­

formity may mean that such an individual will lead less

39 than a normal social life.

It is possible to make the

general observation that the female subjects seemed to be more sensitive to their cosmetic appearance than did the males.

This may mean that physical appeal and appearance

may be considered a greater asset by women than by men. nevertheless we need to recognize that physical appearance is one of the tangible components of personality.

Most

individuals tend to react to their first impressions of others.

If first impressions are not favorable because

of physical deformity, it means that the physical condition represents a very real personality handicap. Age of onset.

Psychosocial adjustment to the

disabling aftereffects of poliomyelitis may be directly or indirectly related to the age at which the subject contracted the disease.

The age of onset is correlated

with psychosocial adjustment in Chapter V.

Since subjects

in this group were to a large extent patientscbf the Orthopaedic Hospital Clinic and were thus at the time of admittance below the age of 21, it means that the age of onset In this group of 151 subjects will exclude all those above that age at the time of onset.

Consequently,

the age of onset in this group is undoubtedly lower than might be expected in a random sample of poliomyelitis subjects not excluding those contracting the disease

above the 2 1 -year age limit. Table VII gives the data relative to the age of onset for male subjects* onset for female subjects*

Table VIII gives the age of Tables VII and VIII give data

relative to age of onset in terms of degree of deformity at the present time*

Table IX gives a summary of the age

of onset for both males and females*

It will be noticed

that a larger percentage of males contracted poliomyelitis during the adolescent years, ages 12 to 1 8 , than did females*

In the female group a larger percentage of the

subjects contracted poliomyelitis during the first three years of life. Tables X and XI give information relative to the amount of surgery undergone by males and females res­ pectively*

Table XII, which summarizes the amount of

surgery undergone by males and females, indicates that no male subject has undergone surgery more than 10 times, while 6*0 per cent of the females have*

Likewise, 19*1

per cent of the male subjects have had no surgery, while only 1 0 .8 per cent of the female subjects have undergone no surgery.

However, the percentage of male and female

subjects who have undergone surgery at least once but not more than four times is almost identical.

It must be

recognized that the amount of surgery which subjects believe they have undergone may differ somewhat from the

TABLE VII AGE OF ONSET OF MALE SUBJECTS

Degree of Apparency

0 - 3 years N *

If. - 6 years N %

7 - 11 years N %

k

12 - 18 years N $ 1

6.3

3

2

6.9

3

2 5 .0

3

27.3

3

1 8 .7

2

10

3^-5

2

1 6 .7

3

27-3

1

6.3

1

15

51,7

1+

33.3

k

36.3

7

10.7

0

2

6 .9

3

2 5 .0

1

9-1

ll-

2 5 .0

29

100.0

12

100.0

11

100.0

16

1 0 0 .0

•HF-

TABLE VIII AGE OF ONSET OF FEMALE SUBJECTS

N

years %

k - i N

h

3

8.7

2

8 .1;

3

2

5-7

6

2

2

5:7

1

20

0

7 -1 1

12 - 18 years

2 5 .O

1

8 .3

3

2 5 .0

6

2 5 .O

2

16.7

2

1 6 .7

57-1

5

2 0*8

8

6 6 .7

3

2 5 .0

8

2 2 .8

5

2 0 .8

1

8 .3

Ij-

33.3

35

1 0 0 .0

2k

1 0 0 .0

12

1 0 0 .0

to

N

years %

0 -3

ro ON

ro

ro M

VO

vn VM M rv> I-1 M • •• .• ro ro

M VM

vn

& i -h ot> oa tsj o

ro

vm

ro

w3

ON

5 - io

£■ • V>1

V

&*

#

-P"

VM

VO



g o *Tj f 1 03

w gj 05 Q o

»-3

feS 11

CO -

20

!s!

Over 20

SaS ii On CD

J-3

TABLE XI

H

1

LT\

H

%

H

1+

1

2 .0

3

1 5 .0

3

5

1 0 .2

6

3 0 .0

1

2 5 .0

2

8

164

3

1 5 .0

1

2 5 .0

8

l+o.o

2

5 0 .0

20

1 0 0 .0

k

1 0 0 .0

1

3

33-3

23

46.9

0

6

6 6 .7

12

21+.5

9

10 0 .0

1+9

10 0 .0

20 Over

- 20

0H r

-d■ H

11

Degree of Apparency

No surgery

AMOUNT OF SURGERY UNDERGONE BY FEMALE SUBJECTS

%

K

N

1

1 0 0 .0

1

1 0 0 .0

H = 83

-f=“ vn

l).6 TABLE XII SUMMARY OH SURGERY

Male N %

Female N %

Over 20

1

1.2

H y i ro o

Amount of Surgery

4

4.8

5-10

14

20.6

20

24.1

1-4

41

60.3

49

59.1

No Surgery

13

19.1

9

10.8

68

100.0

83

100.0

.If7 However, it is assumed, in spite .

actual amount of surgery*

of these possible errors, that the over-all picture of surgery undergone by the 151 subjects will essentially be correct* It was felt desirable to allow the subjects to express any feelings vhich they had related to the surgi­ cal program which they had undergone.

The factual value

of these subjective expressions may be dubious5 however, it did have projective values*

It is interesting to note

in Table XIII that 15 subjects, representing 22*1 per cent of the total male group, expressed the feeling that some surgery was useless.

Of these 15 male subjects exactly

33*3 Per cent have either a

or Nl1* degree of apparency*

Table XIV indicates that 22 or 26.1 per cent of the total female group expressed the feeling that some surgery had been useless*

Similar to the male group

mentioned in Table XIII, 1^1*0 per cent of the females expressing the feeling that some surgery had been useless have a physical deformity rating of W0M or ^l"*

These

percentages are isolated Inasmuch as it may indicate that the less deformed subjects are more critical of the surgery undergone*

This may be a projection of feelings

of disappointment In that a subject is so near to being so-called wnormalw but not entirely*

A comparison of

Tables X and XIII indicates that of the 10 male subjects

TABLE XIII MALE SUBJECTS* EXPRESSION ON EFFECTIVENESS OF SURGERY

Degree of Apparency

Some surgery was useless N %

More surgery was thought necessary B %

Surgery has .No expression of stood up well .opinion K % .N $

k

1

6.7

3

4

2 6 .7

1

7- 1

k

23.3

2

9.5

2

5

53-5

k

2 8 .6

5

27.7

2

9.5

1

5

2 0 .0

7

5 0 .0

8

i9 with a wOn degree of apparency 6 had no surgery* males of

Thus J4.

apparency did undergo some surgery and 2 of o r 5 0 *0 P®** cent, felt that some surgery was

these useless•

Another comparison of Tables XI and XIV indicates that of the

36

female subjects adjudged as having a ^l11

apparency of physical deformity, 33 of these subjects underwent some surgery.

Seven subjects, or 21.2 per cent,

felt that some surgery was useless.

Of the 12 females

that were adjudged as having a W3W degree of apparency, 5, or J4-I.7 Pe** cent of the subjects, felt that some surgery was useless. Table XV summarizes feelings of male and female subjects as to the effectiveness of surgery.

This Table

likewise reveals that 20.6 per cent of the male subjects and 1 8 .1 per cent of the female subjects needed more surgery but for various reasons did not complete their surgical program. Physical involvement. The locale of physical involvement is important in at least two ways.

(1)

Involvement in some areas is less disabling for the individual.

(2) Certain types of involvements can be

much more easily concealed than others.

Table XVI indicates

in a gross way the areas which are most frequently involved*

TABLE XIV FEMALE SUBJECTS* EXPRESSION ON EFFECTIVENESS OF SURGERY

Degree of Apparency

Some surgery was useless N %

More surgery was thought necessary N %

Surgery has No expression of stood up well opinion N % N %

b

3

1 3 .6

3

3

2 2 .7

3

2 0 .0

1*

1 2 .9

2

5

2 2 .7

2

13.3

5

1 6 .1

1

7

31.9

6

1*0 .0

13

1*1.9

10

6 6 .7

0

2

9.1

1*

2 6 .7

7

2 2 .7

.5

33-3

22

1 0 0 .0

15

1 0 0 .0

31

1 0 0 .0

15

1 0 0 .0

2

6 .1*

N = 83

VsJI O

51 TAB IE XV SUMMARY ON SUBJECTS' EXPRESSION ON EFFECTIVENESS.OF SURGERY

Subjects 1 expression

Male N

%

Female N %

Some surgery was useless

15

22.1

22

26*5

More surgery was thought necessary by Orthopaedic Hospital

14

20.6

15

18.1

Surgery has stood up well

18

26.5

31

37*3

No expression of opinion

21

3 0 ;8

15

18.1

68

100.0

83

100.0

52

TABLE XVI PHYSICAL INVOLVEMENT

Hocale of involvement

n

One or both lower extremities &/or 55 trunk

Male i>

Female N. %

Total N $

80.9

68

81*9

123

81*5

One or both hands and arms

3

4.4

2

2.4

5

3.3

Combination of upper and lower extremities &/or trunk

5

7.3

10

12*1

15

9.9

Ho residual paralysis

5

7.4

3

3*6

8

5.3

68

100.0

83

100.0

151

100.0

in the group being studied.

It may be noted that 7*^1- P©**

cent of the males have no residual paralysis.

A rather

conclusive evidence as to the absence cf any residual paralysis for these 5 male subjects is that they were members of the armed forces during the recent war.

The

percentages for male and female subjects having one or both lower extremities and/or trunk involvements is almost the same.

Approximately 80 per cent of the males and

females have residual paralysis of one or both lower extremities which may mean that the involvement is local­ ized in the area which makes it most difficult to make a good adjustmenfc. The most severe localization is an over­ all combination of upper and lower extremities which means a general over-all involvement• Orthopaedic appliances♦ Sensitivity of physical involvement is frequently intensified by the need to wear some form of orthopaedic appliance.

Table 3CVII indicates

the type of appliance worn by male and female subjects. The Table discloses that 5 5 Pe r ©©nt of the subjects interviewed wear no appliance .ViThough some subjects are able to get along without an appliance, it does not necessarily mean that their efficiency might not be improved did they wear some form of appliance.

Some

subjects indicated that they had decided without the

5k TABLE XVII SUMMARY OF NEED FOR ORTHOPAEDIC APPLIANCES

Type of appliance

Male N

*■

Female N1. %

Total • N. %

35

51.5

49

59*0

84

Orthopaedic shoe

6

8;9

'6

' 7*2

12 - 7.9

One leg brace

5

7.4

9

10.9

14

9.4

Braces &; crutches 8

11.7

10

12;i

18

11.9

2

2.4

7

4.6

2

1.3

None required

55.8

Orutches

5

7 .4

Brace and cane

2

2.9

Cane

3

4.4

1

1.2

4

2.6

Shoe extension, crutches & cane

3

4,4

1

1.2

4

2.6

Wheel chair and braces

1

1.4

3.6

4

2.6

2

2.4

2

1.3

83

ioo;o

151

100.0

Other68

100.0

55 opinion of a doctor to take their brace off and get along without it#

The data on Tables XVI and XVII make an

interesting comparison#

Table XVI Indicates that approxi­

mately 80 per cent of the total number of subjects have lower extremity involvements; nevertheless in Table XVII we see that 5 ^ *5 Per cent of the men and 5 9 * 0 per cent of the women wear no appliances#

This necessarily means that

a good percentage of subjects having lower extremity In­ volvements get along without the assistance of appliances# In this chapter we have dealt with some of the descriptive factors of the I5 I poliomyelitis subjects in this study#

Forty-five per cent of this group are males

and 55*0 per cent are females#

The median age for males

Is 5 2*2 years, while the median age for females is 5^*7 years#

The method of grading the degree of physical

deformity or apparency was discussed.

For the purposes

of this study "degree of apparency," "degree of physical Involvement," and "degree of residual paralysis" mean one and the same thing#

Sixty per cent of the males and

71 #2 per cent of the females in this study contracted

poliomyelitis prior to the age of 6 years*

Approximately

80 per cent of the subjects have physical involvement

localized in one or both lower extremities.

Fifty-five

and eight tenths per cent of the subjects wear no ortho­ paedic appliance*

CHAPTER III

EDUCATIONAL.BACKGROUND In the light of physical disability the need for education and training becomes intensified.

Schools

undoubtedly find added problems in the meeting of the educational needs of the post-poliomyelitic child.

In

this chapter we wish to describe the educational back­ ground of 151 polioxnyelitie subjects.

We likewise wish

to compare the general educational level of this group of subjects with that of the general population in this area of the State of California to see if there are*any significant differences between the two groups. Due to the physical disability certain courses may not be adaptable to the needs of a handicapped individual Certain vocational fields are limited to those without any physical handicap*

A number of the subjects inter­

viewed expressed the fact that at one time they had hoped to become a public school teacher, only to be informed that they would not be accepted in some school systems and that if they did complete their training, they would frequently find that their physical handicap would stand between them and a teaching position*

Some of the diffi­

culties incurred by some of the subjects interviewed, as far as inability to go up and down stairs in school

57 buildings, have been eliminated in some systems♦ At the present time schools are available in the larger public school systems where physical difficulties for the physi­ cally handicapped are maintained at a minimum* I.

EDUCATIONAL LEVEL REACHED

A survey was made as to the educational level reached by all subjects*

Table XVIII gives a comparison

of both males and females who finished grade school only, those #10 entered but did not finish high school, and those who did complete high school training*

This Table

indicates that there is no significant difference in the number of males and females who completed high school education.

Nor is there any significant difference in

the number that completed grade school only and the number that entered but did not complete high school. Median years of school completed* The median years of school completed for males is 11*9 and that for females 11*8.

This compares very favorably with the

median years of school completed for the general popu­ lation in the State of California.

According to statis­

tics from the United States Bureau of Census**- the median years of school completed for the general population 1 U. S. Bureau of Census, Statistical Abstracts of the United States: 19^9* (Seventh edition.) Washington, CT'C. / 1”959> P 112

.

TABLE XVIII

COMPARISON OF MALE-FEMALE HIGH SCHOOL GRADUATES

Male

. School level .

Female %

Total N *

N

%

55

8 0 .9

65

7 8 .3

120

7 9 .5

High School but not graduate 12

1 7 .6

16

19-3

28

1 8 .5

1

1*5

2

z .k

3

2 .0

68

100.0

83

1 0 0 .0

151

1 0 0 .0

High School graduate

Grade School only

vji

co

59 of the State of California, 25 years of age and over in I9I4.7 , was 9 .0 years.

These same statistics indicate that

the median years of school completed for males and females was 8 . 9 and 9 .5 years respectively.

This indicates that

there is a significant difference in the years of school completed far this group of 151 poliomyelitic patients when compared with the general population of a like geographic area. According to Table III,^ 50*5 Per cent of the present group of subjects is at present in the 25 to 2 9 year age interval.

Since the United States Bureau of

Census statistics were compiled from data accumulated in 19 i4-7 > it means that at that time the oldest subject in

the present 25 to 29 age interval were at least 25 years of age, whereas the youngest in this interval might have been as young as 22 years of age.

When these statistics

were compiled the youngest subjects used in the present study had already completed most of their education.

In

I9I4-O the total median years of school completed in the State of California, for those 25 years of age and over, was 9.9.5

Inasmuch as there is a significant difference

in the median years of school completed, 9 *9 yeaz*s complet2 See page 5 5 . 3 U. S. Bureau of Census, ££• cit., p. Ill*

60

ed as of 19 ij.O and 9*0 years completed in 19 ^4*7 * it *&ay mean that the war years interrupted the educational program of the general population while it did not so seriously affect the educational program of the subjects under con­ sideration* Tables XIX and XX further analyze male and female subjects #10 completed high school or less in terms of physical involvement*

It may be noted in the case of

both males and females that approximately I4.5 per cent of the total subjects completing high school had a physical involvement rated as a W1TI apparency* Tables XXI and XXII are tabulations of the 151 male and female subjects who took some training beyond what was received in high school.

Some of the subjects

who took training in addition to what was received in high school were not high school graduates*

A number of

the subjects expressed the feeling that they were not getting the rigit kind of training in the standard high school curriculum and therefore did not complete high school.

Some of these sub ject3,then went to some special­

ized school to get specific job training.

About 22 per

cent of the male subjects took a maximum of one yearTs training in addition to what was received in high school. However, 5^*2 Per cent of the women felt the need of training beyond what was received in high school*

ro

H1

vm

-p-

Grade School education only

H* O O •

o o

Degree of Apparency

o

CO

03

»-»

ro

H o 4o o

vn

CO

vm

ro ■P" vn H

ro

M on

.GO •

High School but not a graduate

V>l

VN

i-3

> W PI t 1 trd bd

!» W H

X

Pd

tt

a

CO

o

Pd

O 0 t-» Q 1

^r» V jl

H* O o o

a

II On OO

19

VO

ro

VJl

s ro

»-3 M

vo

M M V 4J =l" ro ON ON M -P- -P~ 03 -P“

High School graduate

CO

ro v>i

Degree of Apparency

{2* Grade School education only

ro

o o

VJI O

V JI

o

hi tr* hi CO

M

ON

3 CO vjj

on

VM M GO • ~0 CD

ro

>04

M

ro

GO

V JI

00

■•

ro

H *. ro

!2S

High School hut not a graduate

vji

o i*> W hi

W M sw CO

o W o o

Q hEi J > ON VJI

I—*

O O

11 CD

V>l

m

V JI

IO

VM

ro

CO

‘ v£>

M

-p "

V JI

On

pr

VJ4

Id 4=v>|

ON

'tej High School graduate

»-3 hi c o

►3 > t■ u Ed

15

o

m

ro

ro

CO

4=- M

100.0

M • ro

VM

21

vm

VJI VM •

.

ON

o

vm

ro

ON

m



ON

■ 4 = r

-F"

Sz5

0 - 1 year additional atudy

ON



Degree of Apparency

.

ON

vm

m

100.0

1 - 5 years additional study • VM

,. ON

.. O

■. VM

.. GO

P s C/3 $

td M 3 9 O W 17

ro

100.0

H* M » CO

4=ro

VM -. vn

ON

VJI

VM VJI -. VM

ro

College graduate

W o

Q td o

fcrj td

vo . .

•-PT"

03 td g H

W United States Government Printing Office, Washington D. C., 191+9 .

91

TABLE XXXIII SUMMARY OP OCCUPATIONS

Occupational Description!

NT

Male %

Female N. %

20

29.4

6

7^2

Semi-Professional

3

4.5

3

3.6

Sales

8

11.8

2

2.4

Clerical

8

11.8

16

19.4

Service

1,

1.5

Vi tt

53.0

Agricultural Services

2

2.8

16

23.5

3

3.6

3

4; 5

1

1.2

2

2.4

Professional

Skilled Semi-Skilled Unskilled Unemployed

7

10 «2

6

7.2

68

100.0

83

100.0

92

of males and females In terms of this standard description of occupations.

It is worthy of note that 29*4 per cent

of the male subjects are employed In what is rated as professional work.

When the number of male subjects en­

gaged in work classed as professional Is compared with the number of males in the general population who are in professional work, we see a significant difference in percentages.

Of the 68 male subjects, we have 2$.k- per

cent engaged in professional work, as compared with the ij..5 per cent of the general population.^ distribution,

subjects, or 53

under service occupations.

In the female

Per cent, are listed

Service here refers to those

primarily engaged in domestic employment.

Four of this

group of i|l|- females carry on a part-time business within the confines of their domicile. Type of employer of physically handicapped. In Table XXXIV we will note that 26.lj- per cent of the male subjects are in business for themselves.

The next largest

percentage in this group is absorbed by those males in the small business concern, while I9 .I per cent of the group work for some large public corporation.

A like

percentage-work for public service, usually civil service. It is interesting to observe that a very small percentage 2 U. 3. Bureau of Census, op. cit., p. 1 9 0 .

93

TABLE XXXIV TYPE OP EMPLOYER OF EMPLOYED

Type of Employer

m

Male %

Female N. %

Large Public Corp.,

13

19.1

8

9.6

Public- ServiceOivil Service

13

19.1

15

18.2

Small business Concern

15

22*2

6

7.2

Business for self

18

26*4

8

9 .6

Working for family or friends

■2

2.9 40

48.2

Working in Home as domestic Unemployed

7

10*3

6

7.2

68

10 0;o

83

100 ..0

9k of the group have depended upon the family or friends for employment * Next to domestic work as housewives, the females in this study are primarily attracted to public service posi­ tions-

Table XXXIV indicates that approximately the same

number of women are employed by large public corporations, small business concerns, and business enterprises of their own. Those subjects who are business owners- It has been noted in Table XXXIV that 26.14. per cent of the males and 9 .6 per cent of the females are in business for them­ selves.

Being in business for oneself might mean the

inability of the individual to find and keep a desirable position-

It might also mean a dissatisfaction with the

security offered by working for someone else.

It like­

wise needs to be noted that 3 *[email protected] subjects are business owners, or part owners, but continue to spend the major part of their time in some other employment.

This ex­

plains the difference of the male N In Table XXXIV and Table XXXV. In Table XXXV we have a distribution of the amount of investment each business owner has in his businessOmitting the males and females who made no estimate of the business investment, we see that about 50 Per cent of the

95

TABLE XXXV

SUMMARY OF SUBJECTS WHO) ARE BUSINESS OWNERS IN TERMS OF AMOUNT OF INVESTMENT

Male

Amount of Investment

N

%

$30,000 and over

1

4 .8

#20,000 - $25,000

1

4 .8

#155000 - #20,000

l1

4 .8

Female w. %

$25,000 - $30,000

1

12,5r

#1 0 ,0 0 0 - #1 5 ,0 0 0 O O O•k O •H

t O O O* in *

5

2 3 .8

#1 ,0 0 0 - #5 ,0 0 0

9

42.8

1

12#5

#0.00 - #1,000

1

4.8

4

50.0

Ho: Estimate- of Investment

3

1452

2

25.0

21

100.0

8

ioo;o

96 males have a maximum of a $5>000,00 investment#

Only 2 of

the female subjects have investments which are at all significant#

These investments, as shown in Table XXXV,

indicate the size of the business or the individual^ interest in a larger business• Table XXXVI gives a distribution of those subjects who are in business for themselves, in terms of degree of physical involvement.

Among the males, about 5^ per cent

have physical involvement of a relatively insignificant nature.

The female distribution indicates that those most

severely handicapped are endeavoring to make a business for themselves.

Tables XXXVII and XXXVIII indicate the

amount subjects have invested in their business in terms of physical involvement#

Table XXXVII shows that the bulk

of male investors, about 66 per cent, have investments in the neighborhood of $1,000.00 to $10,000.00.

Table

XXXVIII emphasizes the fact that the bulk of female invest­ ors have small businesses which might be thought of as self-employment.

One female subject, however, has an

investment of from $15,000.00 to $20,000.00.

This subject

is in the medical profession. Tables XXXIX and XXXX give more detailed informa­ tion concerning the amounts and the nature of the investments made by male and female subjects.

A large

majority of the investments are in the nature of a business

97 TABLE XXXVI SUMMARY OP SUBJECTS WHO ARE BUSINESS OWNERS IN TERMS OF DEGREE OF APPARENCY

Degree of Apparency

Male

m

%

4

Female %

r. l

12:5

3

5

23.9

2

25.0

2

6

28.5

2

25.0

1

6

28.5

3

37.5

0

4

19.1

21

100.0

8

100 ..0

TABLE XXXVII FREQUENCY DISTRIBUTION FOR AMOUNT OF INVESTMENT BY MALE SUBJECTS

o o P © P

H O *

H

NM

IO

ro

on

nm

Qollege graduate NN

1 - 5 years additional study

XXXXV

H

Graduate study T&BLE

H

fo H* CD P5*

H

Professional degree

ro

0 - 1 year additional study

CO p

p* ct O

H NJl

m

H*

Apparency

II

Degree of

159

TABLE LXX

MALE PERSONALITY RATINGS COMPARED WITH DEGREES OF APPARENCY

*p

•H t r~i tiiO gj*H C -P

O C$ 03W U © N Pk

Degree of apparency 1

0 %

N

2 %

N

3 %

N

Total

k %

ft

%

ft

%

1 5

5

50.0

Ib

1*6.7

8

50.0

7

6 3 .6

2

2

20.0

10

33-3

7

1*3r7

2

1

3

50.0

6

20.0

1

6 .3

10

100.0

30

100.0

16

100.0

1

100.0

35

5!-5

18.2

21

3 0 .9

2

18.2

12

17.6

11

100.0

68

100.0

0 1

100.0

'

160

TABLE LXXI FEMALE PERSONALITY RATINGS

Personality rating

k

1

0

N

fo

1

100.0

N

2

$

3

N

%

2

7*7

2

ll

M • o

CO

CO

'

ro

• o



6a! Go out more than the average person

-P"

CO

ro •

ro CO •

ON

On

•• ro

ro

\J1

M

ro

ro

M

4="

CO • -

M ON •

M ON •

o> .

H • . ON

ro CD •• ON



o o

w > t MH

• o

-F7*



is!

Go out like the average person

ON ■

ro

-F7*

M

o o • o

-po • o

.

CO

ro

■p“

is!.

Constantly going somewhere

Oxj ► *3 td t* t?d C/3

17k is comparable to a similar tendency noted in the males cited above.

Those females who are most severely involved

physically tend to have an active, rather than inactive, social life.

In general, however, there does not seem to

be a noticeable relationship between degree of residual paralysis and extent of social life. The social life of the male and female subjects is compared in Table LXXX.

Compared to the males, a slightly

higher percentage of females never go anywhere, and an even higher percentage are constantly going somewhere. Approximately an equal number of males are either socially Inactive or socially hyperactive.

In terms of

the social rating scale used, males have a median social life of 1 . 8 and females a median social life of 1 «9 » This suggests that this group of subjects has, as a whole, a rather adequate social life. Table LXXXI makes a comparison of the social life ratings of the male subjects in terms of age of onset. Among the 29 males who contracted poliomyelitis during the first 5 years of life, I4IJ. .8 per cent of them are rated as having an average social life.

In those males

who contracted poliomyelitis during the I4. to 6 age-range, 3 3 *3 Per cent were rated as going out occasionally to

friends, but less than the average person.

Forty-five

and five tenths per cent of those who contracted polio-

175

TABLE LXXX SOCIAL LIFE SUMMARY

Male

Female N %

Extent of Social Activity

N

%

4 Constantly going somewhere

5

7.3

12

14.5

3 Oo out more than average person

9

13.3

14

16.8

2 G-o out like the average person

28

41.2

25

30.2

1 G-6 out ocassionaily to friends

22

32.3

23

27.7

4

5.9

9

10 ;8

68

100.0

83

1 00;o

0 Never go out socially

TABLE LXXXI SOCIAL LIFE OP MALES IN TERMS OP AGE OF ONSET

Social Life

Age of onset 0

H

- 5*

u

%

33.3

2

1 8 .2

8

5 0 .0

2i

1 6 .7

5

1^5 .5

7

14-3.8

1

6 .2

16

100.0

"

2

6 .9

1

9

5 1 .0

2

13

1 ^ .8

3

2

6 .9

3

2 5 .0

3

2 7 .2

k

3

10 .l^.

1

8 .3

1

9 .1

12

1 00.0

11

10 0.0

1 0 0 .0

2

**

0

29

12 - 18

7 - 11 N i

■k

N

1 6 .7

H

177

myelitis during the 7

11 age-range were rated as having

an average social life* The relationship between age of onset and extent of social life for the female subjects is presented in Table LXXXII.

Among those female subjects who contracted polio­

myelitis during the 0 to 3 age-range we may note a pyra­ miding of percentages at the average social life level. In those who contracted poliomyelitis during the 7 to 11 age-range we have ^ 0 * 0 per cent rated as having an average social life.

The other percentages on this Table seem­

ingly are quite evenly distributed and thus are possibly of a lesser significance* Each subject was asked whether he prefers to associate with another handicapped person, whether it makes no difference to him, or whether he would rather not associate with another handicapped person.

Table

EXXXIII presents data for the males concerning this question of social preference, in terms of degree of apparency.

By inspection we may see that only one subject

said he preferred to associate with other handicapped individuals.

Those subjects who definitely would rather

not associate with other handicapped individuals are subjects who have the less serious degree of residual paralysis. Table LXXXIV tabulates the social preferences ex-

TABLE LXXXII SOCIAL LIFE OF FEMALES IN TERMS OF AGE OF ONSET

Social Life

Age of onset 0 N

14- - 6

'

N

i

7 - 11 N %

12 - 18 N %

0

k

ll.k

5

12.5

1

8.3

1

8.3

1

9

25.8

7

29.1

3

25.0

If

33-3

2

10

28.6

6

25.0

6

50.0

3

25.0

3

8

22.8

k

16.7

2

I6.7

if

Ij-

11.U

i*

16.7

2

16.7

2

16.7

100.0

12

100.0

12

100.0

55

100.0



2k

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O

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• NO

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h

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VN

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Degree of Apparency

Would rather associate with handicapped

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It makes no difference

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ON

H ro

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Would rather not associate with handicapped

2

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II ON CO

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1

0

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ro

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vx vx vx A X • • 4=“ vx

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♦ o

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Degree of Apparency

& Would rather associate with ^handicapped

vx vx • vx

vx

It makes no difference

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w o Q H

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M W t?d •si

vji H

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VO

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181 pressed by the females#

We may note a large percentage

of female subjects with no or a minimum of physical ^in­ volvement expressed the feeling that they definitely would rather not associate with other physically handicapped individuals.

The severely handicapped females,

likewise, expressed the feeling that they would prefer not to associate with other handicapped individuals. Some severely handicapped persons stated that they know only nnormaln people and no other handicapped individuals* It seems a bit doubtful that a handicapped individual should not have opportunities to meet and associate with other handicapped individuals.

It might seem more plaus­

ible that handicapped persons prefer not to associate with the handicapped because it is a constant reminder of their own physical condition.

The individual who finds himself

becoming reflective concerning his own physical condition whenever associating with another physically handicapped person probably has not fully accepted his deformed body as a part of his ego.

If this assumption is true, then

it might seem to indicate that a relatively large percent­ age of the subjects studied have as yet not successfully or wholly integrated the real physical structure into the conceptualized self. Table LXXXV summarizes the social preferences ex­ pressed by all males and females.

Here we note that 67*5

TABLE LXXXV ,MALE-FEMALE SOCIAL PREFERENCE

Male

Social Preference

Female N %

Total N %

N

i

1

1.5

6

7.2

7

U .7

It makes no difference

17

25.0

25

30.1

1^2

27.8

Would rather not associate with other handicapped

50

75-5

52

62.7

102

67.5

68

100.0

Would rather associate with other handicapped

83 100.0

151 100.0

182

183

per cent of the subjects expressed a definite dislike for associations with other handicapped persons*

This prefer­

ence is reflected in the fact that only i|. males and 2 females in the group studied, married spouses who were handicapped.

Subjects frequently mentioned that they had

never courted a handicapped person*

Twenty-seven and

eight tenths per cent of the subjects indicated that it is immaterial whether they associate with handicapped or non-handicapped persons*

These percentages might indi­

cate that 67*5 per cent of these subjects have not made an adequate psychological adjustment*

The assumption is

that avoidance of physically handicapped on a social level reflects difficulty in objective self-acceptance* Other subjects, expressed a definite preference to associate only with other handicapped individuals.

A

survey was made of those subjects who have at some time been active in the Orthopaedic Hospital social program and those who are at the present time active.

Table

LXXXVI is a distribution of those male subjects who have been and are associated with the social program sponsored by the Orthopaedic Hospital.

Twenty-six males, or 38*3

per cent, have at some time participated in the social program*

Of those #10 have at some time been active in

this program, 69*9 P©r cent have ceased being active. Prom this Table we may ascertain that 71*7 Per cent of

o

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VM

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Degree of Apparency

\

a Have participated in Orthopaedic Hospital social program

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po

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ON o H Q O • O

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ro H* • ~vl

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H

O

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hj H

Do not participate in Orthopaedic Hospi­ tal social program

i»-3 O

J» H ■ > 03 1-3

O H O O

£ h Pd O O O 00 H O O • o

f\> ro • o

ro

VM

ro

VM —J

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^ Do participate in Orthopaedic Hospital social program ^ at present H ■F" CD

185

the males have never participated in the Orthopaedic Hospital social activities.

A number of factors are

undoubtedly responsible for this inactivity.

However,

one major reason expressed by some of the subjects is that they do not wish to associate with handicapped persons, but prefer to associate with nnormal11 people. This is in keeping with the indications found in Table LXXXIII. Table LXXXVII is a distribution of the females who have participated in the social program at Orthopaedic.. Hospital.

Thirty-four, or 1+0*9 Per cent of the females,

have at some time been active in these social activities* By subtracting the BT of subjects who have at some time participated in these social activities, we may discover that 1+9 females, or 59*0 per cent, have never participated in the Orthopaedic Hospital social program. Tables LXXXVI and LXXXVII do not seem to indicate that present active participation in social activities especially for handicapped is particularly related to the degree of involvement.

Table LXXXVIII makes a comparison

of males and females with respect to relationship to the social program at the Orthopaedic Hospital.

Prom this

Table we may discover that 59*7 P®r cent of the subjects have at some time been active in the social activities of the Orthopaedic Hospital*

Several of the subjects express-

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Have participated in Orthopaedic Hospital social program

Do not participate in Orthopaedic Hospital social program

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Degree of Apparency

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& Do participate in Orthopaedic Hospital social program ^at present H

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ON

TABLE LXXXVTII NUMMARY OP MALE-FEMALE * ORTHOPAEDIC HOSPITAL SOCIAL PARTICIPATION

%

1 —I

Male N

1

Relation to Orthopaedic Hospital Social Program

Total _N %

Have participated in Orthopaedic Hospital social program

26

38.2

3k

1*0.9

60

39-7

Do not participate in Ortho­ paedic Hospital social program

60

88.2

61

73.5

121

80.1

8

11.8

22

26.5

30

19.8

Participate in Orthopaedic Hospital social program at * present time

H 0 3 •s j

188

©d their feelings that they feel extremely uncomfortable attending social activities vtiere there are only physically handicapped persons present#

However, according to Table

LXXXVTII, 19*8 per cent of the subjects who have had little, if any, contact with the Orthopaedic Hospital as patients, nevertheless, remain active in its social program* An attempt was made to determine how many subjects have expressed their social adjustment by belonging to some social club#

Table LXXXIX shows a distribution of

those males and females who are active members of at least one social organization, in terms of degree of physical Involvement#

A larger percentage of those males and

females active in some social organization seems to fall In the group having physical involvement rated as *1 * than any other apparency group#

Prom this Table we may

determine that 60*5 per cent of the males and 50.6 per cent of the females belong to some type of social organi­ zation# Some subjects expressed definite feelings against belonging to social elubs specifically for handicapped people#

One subject said she felt handicapped people do

not like to be treated as if they are different#

She

suggests that: wIndoor Sports Clubs11 etc# may be fine in one re­ spect, but I think they tend to make the handicapped feel as if they don’t quite belong to this world# I

189

TABLE LXXXIX MEMBERSHIP IN SOME SOCIAL CLUB

Male

Total %

Female N. %

N

2.4

4

9.5

5

6.1

8

19.5

8

19.1

16

19.3

2

10

24.5

10

23.8

20

24.1

1

18

43.9

16

38.1

34

40.9

0

4

9.7

4

9.5

8

9.6

41

100.0

42

100.0

83

100.0

Degree of Apparency

N.

%

4

1

3

190

think all handicapped people are realists. They know their deficiencies, but why put them in a group by themselves? I know I have never really wanted to be­ long to any of these clubs, for fear people would get the idea I was different from them. I have friends who are handicapped, but certainly I wouldn’t want all my friends to be handicapped. I walk on crutches, have a ^figure that looks out of this world,” no doubt about that. However, I often go to Night Clubs with friends, and although I can’t dance, I can thoroughly enjoy others dancing. To get in a wheel chair and pretend to dance, just wouldn’t do for me. Perhaps some derive satisfaction from this so-called ”sport,” but I know a great many do not. It appears that the larger proportion of subjects in this study have made a rather acceptable social adjust­ ment.

In general, it is rather common for those who have

a physical handicap to prefer to associate socially with the non-handicapped.

The majority of subjects lead a

rather average social life.

More than one half of the

males and about one half of the females belong to some social organization, thus indicating the desire and ability to be social. Religious activity. The nature of a desirable religious interest will not be discussed in this study; nor will the exact relationship between religious activity, or inactivity, and personality adjustment be discussed. Religion may be thought of as a unifying philosophy of life and is thus an indication of personality adjustment.? 7 Gordon Allport, Personality, a Psychological Interpretation. (New Yorkt Henry Holt & Company, 1937)> p • 22o•

191

Therefore, the affiliation with and the participation in some religious group was surveyed.

Table LXXXX indicates

the apparency distribution of 107 subjects affiliated with some Protestant religious group.

Table LXXXXI represents

the apparency distribution of 23 Catholic subjects.

Table

LXXXXII tabulates the apparency distribution for 15 Jewish subjects. Table LXXXXIII gives a frequency distribution of physical involvement for each of the religious groups. Table LXXXXIV makes a comparison of males and females in terms of religious preference.

We note that 70*9 Per

cent of the subjects are identified with the Protestant religion, 15*3 P®** cent with the Catholic religion, 9 .9 per cent with the Jewish religion, and 3*9 P®** cent with no religious preference.

Subjects were asked what, in

their opinion, religion does for them.

Many were unable

to express themselves in any definite way.

Some of the

more common comments weie % wIt is something to hang onto.w

11It frees the mind from troubles, gives one a new

start and clearer perspective . phy to live by.”

?,It gives one a philoso­

Other subjects felt that they had not

been accepted in churches and thus had ceased to go to church.

Some subjects expressed the feeling that religion

is an escapism which they do not need.

A few subjects

indicated that they are agnostics or atheists.

192

TABLE LXXXX PROTESTANT RELIGIOUS AFFILIATION

Degree of Apparency

Male N

%

4

Female N %

Total N. %

4

6*5

4

3.7

3

7

15.2

7

11.5

14

13.1

2

11

23.9.

11

18.0

22

20.6

1

20

43.5

27

44.3

47

43.9

0

8

17.4

12

19.7

20

18.7

46

100.0

61

100.0

107

100.0

195

TABLE LXXXXI CATHOLIC RELIGIOUS.AFFILIATION

Female N%

Total N. %

9.1

1

8.3

2

8.7

2

18.2

2

16.7

4

17.4

2

3

27.3

3

13.0

1

5

45.4

Degree of Apparency

W

4

1

3

Male %

0 11

100.0

6

50 ;o

11

47.9

3

25.0

3

13.0

12

100.0

23

100.0

TABLE LXXXXIX JEWISH KELIGTOUS AFFILIATION

Degree of Apparency

Male N

%

Female N %

Total N. %

2

37*5

2

13.3

4 3 2

2

22.2

1

12.5

3

20,0

1

5

55.6

3

50.0

8

53.4

0

2

22.2

2

13.3

9

100.0

15

100.0

6

100.0

TABLE LXXXXIII .COMPARISON OP RELIGIOUS AFFILIATION IN TERMS OF APPARENCY

Degree of Apparency

Protestant H %

Catholic N %

Jewish %

No Preference H $

r

k

k

2.7

2

1*3

3

llj-

9-3

k

2.7

2

1-3

2

22

111.7

3

1-9

3

1-9

1

kj

31.0

11

74

8

5

0

20

13.4

3

1.9

2

107

71.1

23

15.2

15

3

1.9

1.3

3

1-9

9-9

6

3.8

W

tr> £ W 00 o H

H VJI

H

VJI

£

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Go to movies two times a month, or less

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