The soldier suddenly stripped of sight by an enemy bullet might have been the most dramatic example, but the exacting challenges he had to overcome were essentially no different than any other newly blinded adult's. Understandably, therefore, the military rehabilitation programs were watched with close attention by the agencies concerned with the welfare of all blind people. Even though newly blinded adults constituted a relatively small part of their caseloads, it seemed reasonable to suppose that the techniques that succeeded with men blinded in battle might well be adapted for those whose blindness was of years-long, even lifelong, duration.
Although, thanks to the Barden-LaFollette Act, the federal government was prepared from 1943 onward to become a partner of the states in the vocational training and placement of employable blind adults, no realistic leader in work for the blind was under the delusion that rehabilitation programs for civilians could be mounted on a scale comparable to what took place at Valley Forge or Old Farms. The military centers commanded unlimited resources of funds, personnel and authority. There were no quantitative ceilings on manpower to staff the centers or to create and maintain the necessary facilities.
Of equal importance were the psychological differences. The war-blinded constituted a largely homogeneous group of youthful and vigorous men whose hopes for the future were not vitiated by memories of failures in the past. In a state-operated rehabilitation center for blind civilians a few years after the war conditions were very different:
Our students are a most heterogeneous group. What they have in common is that they are all legally blind. … Their ages vary from 16 to 65; their I.Q.'s from 65 to 145; their visual handicaps, from congenital blindness to partial sight with travel vision. Their heterogeneity is accentuated by wide differences in ethnic, social, educational, and cultural backgrounds.
Our present group of eight, for example, consists of the following clients: a 25-year-old congenitally blind college graduate; a 44-year-old divorcee who has been blind only a few months; a 42-year-old congenitally blind borderline mental defective who was recently released from 15 years in a state hospital for epileptics; a 40-year-old mechanic who retains vision sufficient for travel—his visual handicap is the result of a self-inflicted gunshot wound eight years ago; a 32-year-old congenitally blind male who, until recently, was spoonfed by his mother; a 30-year-old man with travel vision who is a borderline schizophrenic; a 20-year-old man with practically no vision but who likes to drive cars and whose I.Q. is 80.
Agencies for the blind were not lacking in experience in working with persons so diverse in background, need and potential. What was new, in the rehabilitation center movement that began just after World War II, was bringing them together under a single roof for a concentrated period of adjustment services. It was the exact opposite of the traditional home teaching method which delivered such services to blinded adults one by one.
As was the case with many other forms of social service, the movement for home teaching of the blind stemmed to a great extent from religious motivation. In 1855 Dr. William Moon, the well-to-do Englishman blinded in young manhood who devised the linear type system named for him, founded a charitable organization, the Moon Society, to promote and distribute the devotional works he was publishing. The society's emissaries toured the British countryside, seeking out blind persons who could be instructed in the reading of the books and benefit by the religious consolation they offered.
Twenty-five years later Dr. Moon, accompanied by his daughter, crossed the Atlantic to introduce his type and the program of his society to the United States. He did not make much headway in New England, where Howe's Boston Line Type was flourishing. Philadelphia, however, proved more receptive. It was there, in 1882, with the active help of John P. Rhoads, who headed the local branch of the American Bible Society, that there came into existence the Pennsylvania Home Teaching Society and Free Circulating Library for the Blind, which pioneered home teaching of the blind in the United States.
William Moon died in 1894. Soon after his death, his son, Robert, an ophthalmologist, came to the United States, married a girl from a prominent Philadelphia family, and settled in that city to become secretary of the home teaching society his father had founded. Supported by private philanthropy, the society remained in existence until 1945. Although Moon type lasted longer and in 1972 was still being produced in England, it was home teaching that proved to be Dr. Moon's most enduring legacy.
A few years after the program's successful start in Philadelphia, the Perkins school began a similar effort in Massachusetts, partly as a way of providing useful employment for its intellectually gifted graduates. There was no question in anyone's mind, then and for many years thereafter, but that home teaching of blind adults could and should be performed by other blind persons. In 1900 the Massachusetts legislature was induced to appropriate public funds in support of the home teaching service, which Perkins had financed up to that point and which it continued to administer until 1916, when the program was taken over by the state commission for the blind. As established by Michael Anagnos, the first criteria for selection of home teachers were graduation from Perkins, followed by graduation from a normal school and some experience in teaching.
Connecticut preceded Massachusetts in financing home teaching through public funds; its first appropriation was made in 1893. Other states launched similar services soon after the turn of the century; by 1926, home teaching programs existed in 25 states under such varying auspices as state commissions, voluntary agencies and libraries for the blind. It was hardly an expensive service, which may partially account for the fact that although two of the first four home teachers appointed by Anagnos were men, the field evolved as one almost exclusively staffed by women. The early home teacher was paid as little as $1 a day, out of which she had to defray her expenses as well as some of the expenses of the sighted guide who accompanied her (few were capable of traveling alone, nor was it the custom, in those days, for respectable women to go about unescorted).
The duties of the pioneer home teacher were far more extensive than the title implied. She instructed homebound blind adults in one or more finger-reading systems, in handicrafts whose sale might yield a small income, and in methods of coping with the demands of daily living. But before she could fulfill these basic tasks, she had to turn to local officials, clergymen, educators, even newspaper advertising, to locate an area's blind residents. If, as often happened, her case-finding efforts turned up a blind child, she became the referral link between the child's parents and an educational resource. Some other essential parts of the job, as described in 1919 by Kate M. Foley, California's first home teacher, were
to conduct a campaign for the prevention of blindness and conservation of vision in adults and children; and … to set forth the need of the blind, convince the public that its attitude toward them is often an added affliction, and correct a few of the many mistaken ideas concerning those deprived of eyesight, and, when possible, to find employment for them.
To fulfill these added responsibilities the home teacher had to have a sound working knowledge of eye diseases, their causes, prognoses, and possible cures. She had to be familiar with existing resources for help to blind persons. She had to be an accomplished speaker and a persuasive advocate. Above all, at no time could she forget that she herself was exemplar and symbol.
It was a tall order, one that could hardly be filled by the average young woman newly graduated from a school for the blind, which was all the prerequisite needed in some states for appointment as a home teacher. Recognition of the unrealistic nature of such assignments was what motivated Olin Burritt of Overbrook to initiate, in 1922, a two-year course in cooperation with the Pennsylvania School of Social Work and Health. His choice of a social work school as partner in this area of vocational preparation reflected his and others' growing awareness that the home teacher's job had at least as much to do with social service as it did with instruction.
During the Twenties and Thirties social work was emerging as a profession with rapidly evolving standards of advanced education and training. The dilemma thereby created in work for the blind was a painful one. If home teaching was a social service, and social service could only be properly administered by the educationally qualified, should blind people be content with less than the best? Should they not have the benefit of service from professionally equipped social workers even though such persons were apt to be sighted and thus lacking in empathetic understanding of the special problems of blindness? This was one side of the coin. On the other was the question of how blind home teachers could attain recognition and status in the burgeoning social work profession.
"Home Teachers—Sightless or Seeing?" was the title of a symposium organized by the Outlook and published in its issue of March 1932. The three participants—Burritt, Murray B. Allen, executive secretary of the Utah Commission for the Blind, and A. Siddall, chairman of the Northern Counties Association for the Blind in England—were unanimous in their conclusions that any handicaps imposed by blindness on the efficient execution of the home teacher's job could be largely overcome by adequate training and preparation. All three deplored the fact that such preparation was not universally demanded in the employment of home teachers. But, as Burritt blandly observed, the identical problem existed among those engaged in general welfare work: "Some have less than a grammar school education; some are high school graduates; a few have college degrees, and a very small number of these have done graduate work." Not only were most welfare workers unequipped to meet professional standards of social work but, knowing little or nothing about the problems of blindness, they were doubly incapable of serving as home teachers of the blind. Given equal qualifications of training and experience, Burritt maintained, the blind home teacher would invariably outperform her sighted counterpart.
Most of the arguments he advanced in support of his position centered on the confidence a capable blind person inspired in the client, the client's family, and in the community. There was also a practical consideration: "Under present conditions the blind home teacher can be secured for lower compensation than a seeing welfare worker of equal ability." The dollar-a-day era was past, but an agency's outlay for salaries and traveling expenses for two persons—home teacher and sighted guide—was only some $50 a week, "which would not be considered excessive for a thoroughly trained and experienced [sighted] welfare worker."
Burritt's tone was dispassionate. Not so Allen's, whose article dwelt on the emotional impact of the blind home teacher: "There is a freemasonry set up when blind and blind stand face to face. When one is teacher and the other pupil, the pupil's resistance is already half gone. … " The first blind graduate of the University of Utah, Allen was a dedicated champion of home teaching, credited with initiating work for the adult blind in his own state and also in neighboring Arizona, Nevada and Wyoming.
The British contributor to the symposium added still another facet. How could agencies for the blind expect to persuade industry and commerce to employ blind workers if they themselves did not set the example by hiring the capable blind?
Clearly, blind home teachers would have to be instructed in the principles and methods of social work, and sighted social workers whose jobs brought them into contact with blind clients (which became more and more the case as the nation's public assistance network grew) would have to be taught about blindness.
In 1932 the Eastern Conference of Home Teachers appointed a committee to develop minimum standards of practice. The committee's report, presented two years later, analyzed the responses to questionnaires it had sent out to home teachers and employing agencies across the country and concluded that the needs in the field varied so widely that "it is to be doubted if any one code of standards would meet them all, but it is to be hoped that the time is not far distant that such a code can be formulated."
The time came five years later. The 1939 amendments to the Social Security Act stipulated that all persons employed in administering welfare programs financed by federal funds be placed under a merit system. Since, in many states, the commission for the blind was part of the state welfare department, home teachers would have to meet the same civil service standards as the sighted social workers employed in other facets of welfare assistance.
The worrisome element here was not only that a great many blind people were in danger of being ruled ineligible for jobs they had long held, but that they might be replaced in the home teaching posts by sighted workers who, while possessing the required education and training, lacked knowledge of how to deal with blind people.
In 1937 a number of short-term training programs in the special problems of blindness were conducted for state and county social workers in Colorado, Maryland, Florida, South Carolina, and New York City. Kansas, Michigan, Arizona and South Dakota were added to the list in 1938. In addition to assigning staff members to participate in these training sessions, the Foundation produced a book, What of the Blind?, which was a collection of papers by specialists on various aspects of blindness and services to blind people. A supplementary volume, More of the Blind, was issued three years later. Both became standard reading resources in graduate schools of social work.
Throughout this period, promising young blind people were urged to prepare for a career in social work. The Foundation's 1942 annual report noted that of the 19 scholarship recipients that year, five were full-time students at graduate schools of social work and three others were enrolled in the home teacher training course at Overbrook. The next sentence was printed in italics for emphasis: "At present all of the former Foundation students who have completed training in social work are employed."
Provisions for professional education and training might solve the problems of the next generation of home teachers, but what was to be done about the three hundred or so persons already employed in the field? In 1938, following a conference of specialists convened by the Foundation to work out the philosophy and principles of home teaching, the AAWB established a committee on professional standards, which in turn appointed a board of certification for home teachers. The recommendations of these groups were presented to and adopted by the 1941 AAWB convention. The certification system had two levels. The Class I requirements called for two years of college work, including courses in social work and teaching, plus proficiency in braille, typing and six handicraft skills. Four years of experience could be substituted for the two years of college attendance. Class II was reserved for those who, in addition to meeting the Class I academic, experience, and skills requirements, were college graduates with at least one year of postgraduate study in a school of social work.
When the certification board's chairman, Murray B. Allen, reported to the AAWB convention in 1947, he stated that 60 Class I certificates and three Class II's had been granted; that, under a one-time "grandfather clause" arrangement, 52 home teachers with 20 years or more of experience had been certified in a separate classification; and that 73 new applications were pending.
All but a few of the first certificate holders were women. But in 1956 a partial survey of home teachers employed by 60 agencies found 64 men among the total group of 241. The same survey also made it clear that home teaching continued to be dominated by blind workers; 204 of the 241 were legally blind, with the remainder about equally divided between the sighted and the partially sighted.
A key factor in the certification of home teachers was the establishment, in 1942, of a six-week summer training program, cooperatively conducted by the Foundation and a graduate school of social work, that enabled practicing teachers to earn the academic credits they needed to qualify for Class I. Initiated at AAWB request, the program was conducted in 1942 and 1943 at Western Reserve University in Cleveland, and then transferred to the University of Michigan at Ypsilanti where it continued under Foundation sponsorship for the next ten years until federal funds became available for training grants.
Another important source of aid for those seeking certification came through the college-level correspondence courses offered by the Hadley School for the Blind in Winnetka, Illinois. This unique organization was founded in 1920 by Dr. William A. Hadley as an avocational pursuit when he lost his own sight in middle age. A former high school teacher, he worked out a series of correspondence lessons to teach braille to a newly blinded woman in another state. The success of the experiment led him to devise courses in various other subjects. When word of the one-man enterprise reached local citizens, a group of Winnetka businessmen and educators raised funds to supply the professor with an office, secretarial help and a braille press. The school, originally known as the Hadley Correspondence School for the Blind, was incorporated as a non-profit organization in 1922.
From a handful of courses in such subjects as reading and writing braille, English grammar, business correspondence, and biblical literature, the Hadley program grew over the years to embrace more than a hundred subjects on grammar school, high school, and college levels, as well as vocational and avocational subjects. Its tuition-free courses served 4,700 blind youths and adults all over the world in 1972.
AAWB certification requirements and classifications were substantively revised in 1959, with the former Class II being retitled Home Teacher Specialist. Two years earlier, the number of certificate holders had reached an overall total of 261. The statement of philosophy issued by A.N. Magill, chairman of the board of certification, in connection with the revisions, underscored what was already accepted reality: "that professional home teaching embraces counseling and casework as well as instruction" and that it "should be the basic field service for the blind which begins the process of rehabilitation."
It was in these words that the link was finally forged between the century-old home teaching function and the newly emerged rehabilitation center idea. The connection was more tightly drawn a few years later when, after a lengthy semantic wrangle, home teachers were renamed rehabilitation teachers. Official status was given to the new job title at the point when the Commission on Standards and Accreditation of Services for the Blind (COMSTAC) adopted its standards in late 1965. Three years later the AAWB accepted this change in terminology for certification purposes.
As with the other rehabilitation disciplines, the trend toward professionalization of home teaching was greatly accelerated when the 1954 amendments to the Vocational Rehabilitation Act provided a separate grant program for personnel training. The discipline took a further step into professional status in 1963 when Western Michigan University used a federal training grant to inaugurate a two-year master's program for home teachers. A major impetus for the establishment of this graduate program was the Cosgrove report, Home Teachers of the Adult Blind: What They Do, What They Could Do, What Will Enable Them to Do It. This report, published by the AAWB in 1961, was the product of a year-long federally financed study to evaluate the role of the home teacher and provide guidelines for improved services.
Elizabeth Cosgrove, who directed the study with the help of a 22-member advisory committee, disclosed its findings with unsparing candor. Because of caseload pressures, ill-defined intake policies, lack of clarity as to the place of home teaching in an agency's overall service structure, administrative indifference or unawareness, many home teachers were being left with "a diffusion of activities," some of which they were not qualified to execute. In too many instances home teachers were treated as appendages who were not functionally integrated into the agency's program. Two out of five teachers interviewed in the course of the study did not even have desk space in the agency office but operated out of their homes. Even fewer had adequate access to clerical help. Personnel practices and salary scales tended to reflect this nebulous, not to say inferior, status.
Boldest of all, Miss Cosgrove said out loud what for years had only been whispered: that many pursued home teaching not because it was their choice but because it had been presented to them as the only type of position available to educated blind persons. This was a note that had seldom been struck in the published literature. One of the few exceptions had been in 1951 when Sophy L. Forward, home teaching consultant for the Pennsylvania Department of Public Welfare's Office of the Blind, told the AAWB that vocational counselors had "misdirected many blind young people into the home teaching profession. Home teaching has been too ready a solution to a placement problem."
The recommendations made by the Cosgrove study flowed from its criticisms: agency policies to be clarified, intake procedures to be placed in the hands of those professionally qualified to make competent decisions, personnel practices to be standardized, home teaching functions to be clearly delineated and educational curricula to be developed in relation to those functions. Most of the recommendations were subsequently embodied in the COMSTAC standards.
No longer a jack-of-all-trades, the rehabilitation teacher came to operate on a level that was deeper but narrower than that of his nineteenth-century forebears. No longer invariably referred to as "she," any more than was the modern classroom teacher, the rehabilitation teacher employed up-to-date tools and techniques of both education and social casework in his operations, some of which began to take place in such group settings as convalescent care and geriatric institutions. Even electronic technology was seen to have a potential role. In 1968 an experimental effort was made in "teleteaching" homebound blind adults in California. Using a telephone console unit hooked up to the phones of nine clients of the Braille Institute of America, a rehabilitation teacher gave simultaneous lessons on braille reading to the nine, switching to recorded tapes with part of the group while working individually with other members.
While the auxiliary duties once discharged by the old-time home teacher—case-finding, public education, etc.—were transferred to others, his core responsibility remained essentially unchanged. As one teacher put it: "The newly blind adult will always need someone to search him out at his home, sit down by his rocking chair, allay his fears and show him how to live a fuller life." The home teacher himself also remained essentially unchanged, continuing to command those unique personal qualities that started generations of blind adults on the road to rehabilitation.
There were two members of the civilian advisory committee on the war-blinded who followed the developments at Valley Forge, Dibble and Old Farms with particular interest. They were the heads of their respective state agencies for the blind—Dr. Roma S. Cheek of North Carolina and R. Henry P. Johnson of Florida. Both enjoyed sound political connections in their states, with the result that within a few months after the war ended, both managed to secure legislative authorization to establish state rehabilitation centers for blind civilians.
North Carolina was first off the mark. With a $15,000 appropriation, matched by an equal sum from the Lions Clubs of North Carolina, the State Commission for the Blind opened what it called a Pre-Conditioning Center for the Blind in November 1945. Using as its initial quarters a handful of vacant buildings that had formerly housed a National Youth Administration facility in Greenville, it was developed into a substantial establishment under the leadership of the energetic Henry A. "Pete" Wood, who eventually succeeded Roma Cheek as state commissioner. The Florida operation, named Holly Hill Diagnostic and Pre-Vocational Training Center, was opened in Daytona Beach in April 1946 as a unit of the state agency then known as the Florida Council for the Blind.
The first center to open under non-governmental auspices was in Little Rock, where the Adjustment Center for the Blind began operations in March 1947 as a project of Arkansas Enterprises for the Blind. The project had been initiated the preceding year when Roy Kumpe, founder and executive director of Arkansas Enterprises, persuaded a statewide convention of Lions Clubs to sponsor a civilian rehabilitation center and to raise $10,000 for its first quarters.
By 1950, when about thirty units of one kind or another were in existence and calling themselves "rehabilitation" or "adjustment" centers, it became apparent that these terms meant different things in different places. The length of training in some was six weeks, in others, four months, and in one, nine months. Costs varied correspondingly: from as little as $102 in one center, which conducted a six-week summer program on the premises of a state school for the blind, to sums ranging up to $650 for three-month programs in residential centers operated by voluntary agencies.
In the great majority of cases, costs were borne by the state vocational rehabilitation unit, financed by a combination of federal and state funds under the Vocational Rehabilitation Act. There were also some trainees whose tuition and maintenance were paid by the Veterans Administration, and rare occasional instances in which the needed funds came from private sources.
A 1950 Foundation survey of 11 centers highlighted the diversity of services, techniques and philosophy that then existed under the rubric of "adjustment." Definitions ranged from Dr. Howard Rusk's aphoristic statement that rehabilitation meant "to help the disabled to live within the limits of his disability but to the hilt of his capabilities" to the detailed tripartite formula evolved by the Baruch Committee on Physical Medicine, which analyzed a center's services in three separate categories: physical medicine, psycho-social treatment and adjustment, and vocational-educational programs.
Apart from differences in sponsorship among the 11 centers (5 were newly established by state agencies, 6 were units of long-established voluntary agencies which also operated sheltered workshops), there were also important variations in program, emphasis and execution. All 11, for example, made use of psychological testing, but the tests were administered and interpreted by personnel with such differing degrees of professional competence that some of the results were viewed with doubt. Craft training was given in all, but for different purposes and under different types of supervision, ranging from occupational therapists in some centers to self-taught instructors in others. Mobility lessons of one sort or another were also given in all, but here the differences were even sharper. The report noted:
The greatest variation in travel training lies in the use of the cane. All concede that the cane is the extension of the hand and is a tool with more uses than to show the sighted public that the blind have a visual disability. Two centers use the long metal cane but of varying lengths. Some insist upon the length of the cane being measured from the waist, others from the middle of the forearm, and again, others recommend no specific length but consider the comfort of the student. All centers use some variation of the Valley Forge training technique. Two of them follow it almost to the letter. … Much needs to be done to develop more uniform techniques based on past experience.
Since the ability of a blind person to travel independently depended on more than the use of a mobility device, whether cane or dog guide, all 11 centers offered help in the development of the auditory, olfactory, and kinesthetic senses. Here, too, they used different techniques. In one center, the only formal practice in using the sense of smell was through not telling trainees what was on their dinner plates. Kitchen odors plus sensations in the palate were considered sufficient clues to olfactory training. In others, practice in distinguishing odors took the form of a game in which trainees tried to guess the identity of vegetables, spices, and various woods by smelling them without touching them. All the centers emphasized olfactory alertness in teaching outdoor travel orientation, calling attention to the environmental clues offered by distinctive odors emanating from bakeries, shoe repair shops, restaurants, or laundries.
Makeshift techniques and trial-and-error methods were a feature of most programs, but this was to be expected in what was essentially a new form of service. But there were also some genuine positives, particularly in the training for daily living which every center offered. More concrete teaching techniques might be needed, but the real key was something both more intangible and more important than technique: the atmosphere built by staff attitudes and relationships. The survey report devoted a pregnant paragraph to this aspect:
The student usually comes from a protected environment where he has absorbed the fears of his family and friends and has never had an opportunity to develop independence and self-confidence. The casual attitude of the entire staff toward blindness, observed at all centers, is perhaps the thing that makes the training click. … There is no one there who says "Don't do this" or "Be careful." He can try and adventure as far as he feels he is capable.
It was awareness that "the best and only authorities with practical experience were the people who were doing the job" that led to the convening of a unique six-day meeting in early 1951. The Spring Mill Conference, co-sponsored by OVR and the Foundation, took the form of a workshop featuring no speeches, no outside "experts" and no participants other than 29 persons actually engaged in full-time work at 12 different rehabilitation centers for the blind. The location—a small hotel in a state park in southern Indiana—was chosen for its isolation; here the participants could concentrate on just what they did that "made the training click."
They succeeded in getting the heart of it down on paper. Fortified with a good deal of background material (including a 136-page document giving detailed profiles of nine different center programs, along with a set of case records from each of the nine, selected to show failures as well as successes), the workshop members produced the first organized body of basic methods and techniques for rehabilitation center programs. The product of their combined thinking was incorporated in a report, Adjustment Centers for the Blind, which became what amounted to a comprehensive operating manual.
In the next five years enough changes took place to warrant a second look at the national picture. Good programs had been made better, marginal efforts had been strengthened, and some of the weakest had either closed down or had stopped claiming to be rehabilitation centers. The number of centers had grown and would probably continue to expand under the incentives offered by the Vocational Rehabilitation Act amendments of 1954 and another bill enacted the same year, the amended Medical Facilities Survey and Construction Act, which enlarged the Hill-Burton hospital building program to make funds available for construction of rehabilitation facilities that did not have to be part of a hospital complex.
The New Orleans Seminar of February 1956 was convened, again under joint OVR-Foundation sponsorship, to develop principles and standards that could guide the proliferating growth along constructive lines. It, too, was attended by a small and carefully selected group, some of whom had been at Spring Mill. Their assignment this time was not to deal with specific operating methods or procedures, but to think along broader conceptual lines. Out of the work of the 17 persons who spent five days in subcommittee and general sessions came a set of precepts that largely foreshadowed the standards later adopted by COMSTAC.
In addition to evolving criteria for assessing the need for a center in any given community, state or region, the conferees dealt with staffing patterns and personnel qualifications, with physical plant requirements and essential elements of finance and budget. Their conclusions, published by OVR in Rehabilitation Centers for Blind Persons, propelled work for blind adults a considerable distance toward professionalization by putting new stress on the psycho-social aspects of rehabilitation and differentiating more sharply than ever before between the needs of center clients as persons and their needs as potential jobholders. A basic concept was that a rehabilitation center existed "for the specific purpose of assisting blind persons to meet their individual reorganization needs" and that eligibility for its services "need not be limited to those with remunerative employment potential."
The standards and principles evolved at New Orleans proved too lofty to be realized in a few years' time. That vital differences continued to exist in policies, procedures and philosophy became evident in 1960 when a third national conference in Washington brought together the administrators of 25 centers. Their major conclusion was that an accreditation procedure was needed for ongoing evaluation and review of the centers and their performance. At a fourth national session in Chicago in April 1965 the standards for rehabilitation centers proposed by COMSTAC were critically examined and approved. These leaned heavily on principles developed at a 1961 conference, whose findings had been published as The Grove Park Report. That report broke down into discrete categories the many services lumped under the general heading of rehabilitation, presenting differential definitions and criteria for personal adjustment services, prevocational diagnostic evaluation, and actual vocational training.
Although some rehabilitation centers continued to be much more vocationally-oriented than others, this form of service became a permanent feature of work on behalf of blind adults. Many centers expanded their physical facilities with the help of federal funds. Arkansas Enterprises for the Blind estimated the 1969 value of its five-building rehabilitation complex at more than $1,500,000. Constructed in 1970 by the Texas Commission for the Blind, the Criss Cole Rehabilitation Center in Austin, Texas, incorporated architectural features specifically tailored to training needs: corridors in three contrasting floor surfaces to help develop the kinesthetic and aural awareness required for orientation and mobility exercises, various types of doors and stairs, different kinds of walls in outdoor courtyards to help in differentiating echoes.
By 1972 the rehabilitation center for the blind had come a long way since the early days of hasty improvisation in North Carolina, when Henry A. Wood scrounged trucks from the State Highway Commission, equipment from Army surplus stocks, money from the state legislature, and free labor from volunteers to transform the nation's first civilian rehabilitation center from a makeshift affair in an abandoned NYA camp into a landscaped complex with housing for eighty clients at a time and a headquarters building named for Wood after his 1965 retirement as executive director of the state commission for the blind.
One of the principles enunciated at the New Orleans Seminar and reaffirmed by the Washington administrator's conference was that rehabilitation centers for the blind should also serve persons with additional handicaps, provided these handicaps did not pose insuperable obstacles to the rehabilitation of the trainee or to the progress of others simultaneously undergoing training. Perhaps the most venturesome effort in this regard was made by the Industrial Home for the Blind in Brooklyn which, in 1962, undertook an extended regional project in rehabilitation of deaf-blind adults. Noteworthy rehabilitation programs serving other types of multihandicapped blind persons also came into existence in many parts of the country, making use of group therapy and individual psychotherapy to cope with emotional and personality maladjustments.
Even with the most expertly refined techniques, no rehabilitation process can hope to achieve its goals without sufficient motivation on the client's part. The ophthalmologist has a crucial role to play in imbuing the visually impaired person with the will to go on despite blindness, and it has been a source of deep concern to workers for the blind that many eye specialists are slow to reach out beyond purely medical concerns. Writing in the Archives of Ophthalmology in November 1967, Dr. Richard E. Hoover noted: "It is difficult to tell a person he is irrevocably blind. It is easier to insinuate or hold out a hope that the person may some day see again through a miracle of medical or surgical triumph. Hope for recovery, so important therapeutically in most aspects of medicine, is a cruelty to the permanently blind. … "
A similar point had been made a decade earlier by the psychiatrist Louis Cholden who wrote that maintaining hope for the return of vision was "the wrong kind of hope." Cholden, who for three years served as psychiatric consultant to the Kansas Rehabilitation Center for the Blind, drew his insights from work with the trainees at that center, for whom he conducted a group therapy program. A lucid speaker and writer, he had begun to attain a nationwide reputation in the field of work for the blind when a 1956 automobile accident cut his life short at the age of thirty-seven. A posthumous collection of his papers, A Psychiatrist Works with Blindness, published by the Foundation in 1958, became a standard reference work in illuminating the emotional impact of blindness.
How much did the practicing ophthalmologist actually know about rehabilitation possibilities for persons who lost the use of their eyes, and to what extent was this knowledge being employed to start blind patients on the road to rehabilitation? A study seeking the facts was jointly sponsored by the Foundation and the Seeing Eye, Inc., and conducted by Professor Samuel Finestone and Dr. Sonia Gold of the Research Center of the New York School of Social Work, Columbia University. The study, whose findings were published in 1959 in The Role of the Ophthalmologist in the Rehabilitation of Blind Patients, analyzed the responses of 180 randomly selected eye specialists to a questionnaire probing their attitudes and practices. It found that relatively few were doing as much as they could in referring blind patients to sources of rehabilitation service: that a large number, particularly those in private practice, admitted to inadequate knowledge of community resources that could give such services and therefore made few referrals, and that among the latter were a significant percentage who did not themselves feel optimistic about a blind person's chances for a useful life.
Blind people themselves had long been vocal on the question of the eye doctor's role. Addressing a conference of ophthalmologists in 1950, M. Robert Barnett said bluntly that a patient's adjustment to blindness would be much easier if the process began "in the doctor's office and at the hospital bed."
No matter how skillful and supportive the ophthalmologist, what Barnett called "the will to carry on" does not come easily to the person confronted with blindness. The extent to which emotional reorganization is involved in adjusting to a new kind of life situation is generally acknowledged, but the form that this adjustment takes has long been a subject of controversy.
At one end of the spectrum were psychiatrically oriented authorities such as Dr. Cholden, who wrote in 1953 that a patient's initial reaction to blindness was apt to fall into a pattern in which a stage of shock is followed by a reactive depression, "a period of mourning for his dead eyes." It was Cholden who, in the same paper, first voiced the belief that "the patient must die as a sighted person in order to be reborn as a blind man"—a theme put into practice the following year by Father Thomas J. Carroll when he founded the 16-week program for newly blinded adults at St. Paul's Rehabilitation Center. As elaborated by Father Carroll, the death-and-rebirth rehabilitation theory involved acceptance and resynthesis of 20 separate losses of function ranging from the tangible—vocation, financial security, freedom of movement, activities of daily living—to the psycho-social: sense of physical integrity, social adequacy, self-esteem, etc.
This dire view was vastly different from the equally extreme denial mechanism of intrepid blind people who dismissed loss of sight as a mere inconvenience, easily overcome by "learning to use the other gateways to the mind." One of the most extraordinary statements along these lines was made by Helen Keller who, lacking both sight and hearing, wrote that "the language of the senses is full of contradictions, and my fellows who have five doors to their house are not more surely at home in themselves than I."
It remains a moot question whether there is, in fact, a specific personality pattern that enables some blind persons to overcome their handicap more readily than others. Efforts continue to be made to explain the mechanism of adjustment. The death-and-rebirth theory was set forth during a period when Freudian psychoanalytic concepts dominated much of professional thinking. Two decades later, computer-age thinking found expression in a concept that compared the human organism with an information system in which the sensory organs were the source of input while the brain acted as a processing and storing mechanism that determined behavioral response to various physical and social situations. The author of this viewpoint was the psychologist Emerson Foulke, director of the Perceptual Alternatives Laboratory at the University of Louisville (Kentucky), according to whom there was no "personality of the blind" and the Cholden-Carroll interpretations were "a non-valid concept."
From the earliest efforts of home teachers to coax people out of rocking chairs, to the contemporary social service, recreational, and vocational programs for young and old, rehabilitation principles and techniques were always inherent in services for blind persons. Although practiced in their most structured form in the rehabilitation centers, these principles guided the work of all organizations that strove to equip blind persons with skills that lessened dependency on others.
A multidisciplinary national task force on independent living, appointed by the Foundation in 1971 to work out guidelines for service agencies, recommended a number of areas of further investigation and action, including study of the delivery of health services to the visually handicapped and development of a university curriculum for homemaker education.
Earlier the same year the Foundation issued a comprehensive manual, A Step-by-Step Guide to Personal Management for Blind Persons, that drew on the large body of practical experience accumulated by rehabilitation teachers, therapists and blind persons themselves to spell out in sequential form the easiest and most effective methods of self-care and homemaking without sight. The manual covered techniques of personal hygiene, grooming, cooking, and household management, shaving for men and application of cosmetics for women, tying shoelaces, coding and identifying clothing by color and style, vacuuming floors, pairing socks, sewing buttons, defrosting refrigerators, separating eggs, cutting pie, frosting cake, bathing and diapering babies, handling money, dialing a telephone, and dozens of other tasks that sighted persons perform without a second thought. Supplementary manuals of the same type dealing with home mechanics and repair were scheduled for the future.
Taking the manual one step further, a series of public demonstrations of how blind women could use the same cosmetic techniques as others was begun in 1969 in a cooperative endeavor with the Helena Rubinstein Foundation. In two years, 20 "cosmetology workshops" were conducted across the country.
Another Foundation project in partnership with a commercial firm, Thomas J. Lipton, Inc., was organized in 1972. This, it was announced, would consist of a series of short-term training workshops in food preparation and nutrition at which teachers, rehabilitation personnel, public health nurses, county agricultural demonstration agents and others could learn the techniques that would enable them to instruct blind people in modern home economics. Those attending the workshops would also be introduced to some of the specially adapted aids and appliances developed to enable blind persons to function efficiently as homemakers.
Rehabilitation is a complex process. But its basic theory is simple and perhaps best expressed by the analogy of the four-wheeled cart that loses one of its wheels. Is the vehicle permanently out of commission? Not at all. Move the wheel that has lost its partner to the middle, and you have a three-wheeled cart perfectly capable of moving forward.
