Reply to Comment by D. L. Kay

We Are Grateful for Dr Kay's contribution to our paper, especially because he speaks not only as an analyst but also as a visually impaired person. We would like to elaborate on some of the points he raised.

We would agree that the stage of ego development in which the visual loss occurs is, indeed, a fundamental aspect of how the loss is responded to. Visual loss occurs mostly in the second half of life, and even people who give every outward appearance of a well-developed ego can be unexpectedly devastated by the loss of sight. We would extend Dr Kay's observation regarding the response of the family as a crucial factor, not only in childhood, but also of great significance at any stage of life. This fact is often overlooked in the treatment of the visually impaired.

Dr Kay's remarks about the shadow aspect of the wounded healer are very important. We also have found that negative attitudes toward the wound of blindness or the wounds of life never disappear, and that they are forever a recurrent aspect of one's inner life. We share his observation that the painful question of ‘Why me?’ is felt and heard by most who have lost their sight. However, we would point out that each visually impaired person takes a unique path, and not every blind person hears this inner cry. Likewise, not every blind person is envious or angry at those who can see. While many might hear the cry, ‘Why me?’ the blind co-author hears something different, which is equally painful. The question she hears is, ‘What did I do? What kind of neglect of my body or of my inner voices might have caused my loss of sight?’ She feels a guilt that years of severe emotional and physical stress and the habit of chronically over-extending herself may have contributed to the loss of her sight. The question has been, ‘What could I have done to avoid my visual impairment?’ Some of the differences between her experience and that which Dr Kay so clearly describes may be based on the fact that she grew up in a fami