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When an adult loses his sight, he must become adapted to being a different person, with altered body image, capacities, hopes, and social position. Until he accepts these changes, rehabilitation cannot proceed. If the loss of sight is sudden, there is a period of shock, in which the patient is unable to think or feel—a kind of protective emotional anesthesia or constriction of the ego. The individual's way of coping with other major problems will largely determine the capacity of his ego for recovery after loss of sight. The longer the state of shock lasts, the more difficult the subsequent rehabilitation seems to be. No effort at readjustment is effective during the period of shock, and the shock can be reinduced by raising and then dashing hopes for the return of vision.
As the patient begins to experience emotions again, he goes through a kind of reactive depression. He recognizes the loss of his vision and begins a period of mourning for his dead eyes. It seems to be necessary that he experience this depression before he can accept the reality of his blindness. The depression, therefore, is not a sign of poor prognosis and efforts should not be made to prevent or abort it. Acquisition of a new body image is the major problem of rehabilitation.
Many obstacles work against this process, including a peculiar concerted effort of society to prevent the patient from accepting his blindness. Friends and relatives try to cheer up the patient with news of miraculous cures, new drugs, and wonderful doctors; rarely is hope offered to the patient that he may yet have a full though different life, which he must learn to live. Curiously enough, ophthalmologists themselves often do much to withhold the fact of blindness from their patients, probably because of the emotional factors that led to their choice of ophthalmology as a profession, and because they unconsciously equate blindness with castration.