Abstract
Acquired visual impairment exhibits distinctive characteristics, which may include progressive impairment, along with the fundamental feature of a low incidence of visual impairment. In Japan, many with acquired visual impairment seek reintegration into society through schools for the blind. This qualitative study examined the relationship between enrolment in schools for the blind and experiences of posttraumatic growth (PTG) in people with acquired visual impairment, focusing on the role of segregated placements. Participants with acquired visual impairment (n = 21) were selected by sampling target schools for the blind across Japan and participated in qualitative interviews that were analysed using theoretical thematic analysis, with both inductive and deductive approaches. To understand PTG in participants and the specific factors and mechanisms that produce it, PTG theory, which describes growth in five different domains, was used as a framework. The results showed that PTG in these participants was apparent in terms of ‘personal strength’, ‘new possibilities’, ‘relating to others’, and ‘appreciation of life’. The school for the blind, designated as a ‘school’ for this minor population with special provisions catering to their unique needs, appeared to play a key role in PTG. In addition, other factors such as ‘acupuncture/moxibustion/massage therapy’ introduced during enrolment, and the progressive nature of their visual impairment, also seemed to influence PTG. In essence, schools for the blind allowed respondents to meet others facing similar challenges, who provided mutual support, leading to increased PTG. These schools also serve as places to instil confidence in individuals experiencing vision loss and expand their limitations. This study suggests that schools for the blind may facilitate positive psychological changes in people with acquired visual impairment, underscoring the need for a nuanced understanding of the significance of segregated placement in fostering positive outcomes.
Keywords
Introduction
Living in the community is a fundamental right of all, including those with impairments (Council of Europe Commissioner for Human Rights, 2012), and is related to the principle of social inclusion, which affords people with impairments the opportunity to be independent and participate in ‘mainstream’ society (Bredewold & van der Weele, 2023). It is entirely contrary to these principles for people with impairments to live in institutions, environments, and cultures defined by ‘strict routines and rules’ (European Expert Group on the Transition from Institutional to Community-based Care, 2012, p. 122; e.g., specialised shelters), and facilities and environments exclusively catering to them and isolating them from mainstream society have been criticised as ‘segregated placements’ which hinder their participation in the local community (Mansell, 2006; Wiesel & Bigby, 2015). Thus, the de-institutionalisation of care and rehabilitation facilities where people with impairments congregate have been promoted, leading to the integration of places for people with and without impairments.
However, because of inattentive integration in which the needs of individuals with impairments and their families are overlooked, individuals with impairments find themselves living in a society that does not fully accept them. For instance, Martinsson et al. (2012) and Bredewold et al. (2018) reported that the negative effects of deinstitutionalisation on individuals with intellectual and psychiatric disabilities include physical illnesses due to inadequate support, social isolation, increased suicide rates, and a significant rise in care provided by family members, which can be perceived as a burden.
In addition, Hall (2010) and Woelders et al. (2018) reported that places where a homogeneous group gathers allow them to feel a sense of friendship and belonging, potential recognition by others, and a positive reassessment that can help them set new goals. Thus, reports have challenged the idea that the segregated placement of individuals with impairments is universally unfavourable.
Visual impairment (VI) is a loss of visual function that cannot be resolved by corrective measures like spectacles or contact lenses (Hallahan et al., 2014). It is considered a low-incidence disability (Lieberman et al., 2019) that rarely occurs or manifests in only a few cases. Therefore, individuals with VI find it difficult to meet others in the same situation. VI is classified as congenital or acquired (Hupp, 2003). Acquired VI includes VI that develops in adulthood (Bajaj, 2019) and is often progressive in nature (Parmeggiani et al., 2011). Thus, people with acquired VI experience frequent and daily instances of being unable to do things or go to places that they once could as the impairment progresses. They also struggle to be understood by those around them as their vision deteriorates (S. Wang & Boerner, 2008). Furthermore, because of the sensitive nature of their disability, these individuals are often selective in their relationships, resigning themselves to abandoning some (Sztonyk & Formella, 2020). These combined factors can cause people with acquired VI to feel isolated and become housebound (Bassey et al., 2019).
In Japan, rehabilitation centres and schools for the blind serve as places where many people with acquired VI opt to acquire social reintegration skills. A quantitative study by Matsuda and Miyauchi (2023) shed light on the posttraumatic growth (PTG) of people with acquired VI who were enrolled in a vocational course called ‘Riryoka’ at schools for the blind. This large-scale national survey highlighted the strong correlation between connections built with others in schools for the blind and a positive perception of the self, indicating a significant influence on PTG. In essence, this study suggests that enrolment in schools for the blind, that is, segregated placements, strongly facilitates PTG. However, the specific elements and mechanisms of segregated placement underlying this increase are unknown, and further research is needed to determine the relationship between positive psychological changes and segregated placement in individuals with acquired VI.
This study aimed to clarify the meaning of segregated placements from the perspective of PTG in those with acquired VI enrolled in schools for the blind. The research questions are as follows:
Why did the PTG of people with acquired VI increase following their enrolment in schools for the blind?
Which factors promoted the rise of PTG?
Posttraumatic growth
Posttraumatic growth (PTG) is defined as ‘positive psychological changes experienced because of struggle with traumatic or highly challenging life circumstances’ (Tedeschi et al., 2018, p. 3). The PTG theory divides these changes into five primary domains: greater personal strength, new life possibilities, improved ways of relating to others, greater appreciation of life, and greater spirituality (Tedeschi et al., 2018). This five-domain theoretical framework is useful for understanding and identifying the factors associated with PTG (Z. H. Wang et al., 2023).
Japanese schools for the blind and
Riryoka
Currently, there are 67 schools for the blind in Japan, 80% of which offer vocational courses that are integrated into their high school departments. All these schools also have kindergarten, elementary, and junior high departments (Association of the Principals of Schools for the Blind [APSB], 2021). In 2020, enrolment in these schools was 2,366, with approximately 30% of students having multiple disabilities (APSB, 2021).
Riryoka, a vocational course, is offered in 58 schools (one national and 57 prefectural), which currently serve approximately 550 individuals with VI. Nationwide, Riryoka adheres to a uniform national curriculum. It welcomes individuals with a high school diploma and imposes no upper age limit for enrolment. Although it requires a high school diploma, Riryoka is integrated into the high school departments of schools for the blind. Consequently, approximately 40% of individuals with acquired VI currently enrolled in Riryoka are in their 40s, with some of the oldest in their 70s (APSB, 2021). Furthermore, as Riryoka is part of the high school department, these older students are eligible to acquire the status of a ‘high school student’, enabling them to access student discounts and other benefits in the country. Riryoka offers 3-year education for national qualifications in acupuncture, moxibustion, Anma massage, and shiatsu (riryo), and more than 80% of teachers in Riryoka are individuals with VI holding a national riryo certification (Association of the Teachers of Acupuncture and Massage in the Schools for the Blind, 2020).
Method
Study design
This qualitative study was part of a sequential, explanatory mixed-methods study investigating the relationship between schools for the blind and PTG among people with acquired VI enrolled there (Creswell & Plano Clark, 2018). This study was conducted to understand the results of an earlier quantitative study (Matsuda & Miyauchi, 2023).
Participants and sampling
Participants were people with acquired VI who had been enrolled in Riryoka at a Japanese school for the blind for at least one year and whose PTG increased following enrolment. Participants with acquired VI were identified as those who did not have VI or did not have severe VI until the age of 18 years and entered a school for the blind after the age of 18 years because of VI. The PTG was determined in individuals scoring at a moderate or higher level on the Japanese Posttraumatic Growth Inventory (PTGI-J) scale, which assesses PTG (Cohen & Numa, 2012; Sztonyk & Formella, 2020).
To select the schools, a cluster analysis was conducted using five items: total number of students, geographical location, number of students with VI enrolled in Riryoka, number of students living in dormitories, and number of teachers with VI (Long, 2020). A dendrogram was created using Ward’s method and one school from each cluster was selected based on the results of the analysis when the number of clusters was set to five. In addition, the national school was added for a total of six target schools. Finally, 21 individuals with acquired VI were included in this study. Demographic data of the schools had been collected in a previous quantitative study (Matsuda & Miyauchi, 2023).
Data collection
Participants chose face-to-face or online interviews. One participant chose a face-to-face interview, which was conducted in a classroom at the interviewee’s school. The remaining 20 were conducted online.
Interviews were conducted between July and November 2022 by two researchers trained in interviewing and lasted approximately 60 min per person. Furthermore, none of the interviewers were directly acquainted with the participants nor had they any prior contact.
The interview content was based on the results of the preceding quantitative study (Matsuda & Miyauchi, 2023). The quantitative study clarified that people with acquired VI who had strong connections and trust with others, such as peers, teachers, and locals through Life at a School for the Blind exhibited higher levels of PTG. In addition, it was suggested that those who frequently participated in extracurricular activities that deepened connections with others also exhibited higher levels of PTG. Therefore, this qualitative study investigated PTG that increased following their enrolment in schools for the blind, specifically examining the elements of these schools that supported the increase in PTG and why these elements facilitated the rise in PTG. A flexible, semi-structured interview guide (Miles et al., 2020) to encourage participants to speak freely included the following key questions: ‘How did you get enrolled at a school for the blind?’, ‘Did anything change due to going to this school?’ and ‘What prompted this change?’ This study was approved by the Research Ethics Committee of the Faculty of Human Sciences, University of Tsukuba, in 2021 (authorised registered number Tsuku 2021-185A).
Data analysis
With participants’ consent, all interviews were recorded and transcribed verbatim. Using thematic analysis with reference to PTG theory (Ohlsen et al., 2021), this study investigated how PTG-like changes occurred and what prompted them. Two researchers independently analysed the interview content to ensure the validity of data interpretation by minimising subjective aspects. Drawing on Hower et al. (2018), the coding framework for PTG-like changes and the factors that prompted them were developed using both inductive and deductive approaches. First, the data were analysed thematically according to standard qualitative methods (Braun & Clarke, 2022), and codes related to the themes were constructed using descriptive coding/sub-coding and provisional coding/sub-coding. The main themes were identified using a five-domain framework from Tedeschi et al.’s (2018) PTG theory, which has been used in previous studies (i.e., Z. H. Wang et al., 2023). The definition of each domain is explained in detail below in reference to Tedeschi et al. (2018).
[Personal Strength] is a psychological change that would not have occurred in the absence of a difficult event (VI in this case). It refers to the restoration of trust and the image of oneself, which had been diminished by suffering the impairment. Specifically, the person becomes aware through new experiences and successes that they are strong and gains confidence, as well as an enhanced ability to cope with further difficulties.
[New Possibilities] refers to the discovery of new roles and goals, including discovering and building new pathways and interests in new activities and hobbies that would not have been possible without the difficult event.
[Relating to Others] refers to new relationships with others that would not have been possible without the difficult event. It also includes psychological and behavioural changes, such as persons with VI disclosing their impairment to others, accepting reliance on others, and becoming more intimate with others. It also includes psychological changes such as efforts to build and maintain good relationships with others.
[Appreciation of Life] refers to a feeling of gratitude towards life and each day that would not have been possible without the difficult event. For example, people may feel more appreciative of the things they used to take for granted (e.g.: being alive). It also includes changes in life priorities such as developing new values and philosophical views.
[Spiritual Changes] refers to an increase in religious beliefs and appreciation of the mystical and supernatural that would not have been encountered without the difficult event.
The coding framework was repeatedly discussed among the researchers and recoded to ensure consistency and validity.
Results
Participant characteristics
This study included 21 individuals with acquired VI (14 male and 7 female) aged 21–62 years. Table 1 presents the basic characteristics of the participants. Of the participants, 18 lived with a family member or partner and 3 lived alone (Nos. 8, 16, 18). All participants had progressive eye diseases (retinitis pigmentosa, glaucoma, and optic atrophy), except for one who lost his sight due to an occupational accident (No. 16). The time when they were first diagnosed with VI was, on average, 7.6 ± 8.0 years before they enrolled in schools for the blind (27 years for the longest, No. 3). During that period, 17 of 20 participants (all except Nos. 10, 13, 14) had continued to work while having difficulty seeing but had retired ‘when it finally got bad’ (No. 19). Two participants (Nos. 10 and 13) had been unemployed, avoided going out, and stayed indoors for 5–10 years.
Characteristics of participants.
Regarding their feelings prior to enrolment in schools for the blind, all 21 participants indicated that their poor eyesight had significantly reduced their self-value, such as feeling that they ‘could not do anything’ (Nos. 6 and 14) and that they ‘would not be able to do it anyway’ (No. 21); one even contemplated suicide (No. 18). The tendency to use impairment as a crutch in their lives (i.e., ‘I have been using my vision condition as an excuse for everything’ [No. 9] and ‘I am always going back to my VI as a reason for things not going well’ [No. 8]), was observed in four participants (Nos. 8, 9, 17, and 21), and some had no goals and lived their lives aimlessly (Nos. 10, 13, and 17). Moreover, they felt that, as persons with impairment, they were a ‘nuisance’ (Nos. 7, 13, 14) to others. Seven respondents avoided engaging with others, as they worried that others would not be considerate or accepting (Nos. 10, 13, 14, 15, 17, 19, and 21), and four stopped communicating about their sight difficulties, as they were not understood (Nos. 1, 4, 9, and 10). Some participants deliberately ended their previous close relationships with friends and became more selective (Nos. 19 and 21). In addition, four participants felt isolated and unable to tell anyone about their impairment (Nos. 8, 13, 15, and 19), including two who were unable to talk even with family members (Nos. 9 and 10).
Ten respondents had a negative impression of schools for the blind before enrolment (Nos. 1, 4, 6, 8, 12, 13, 17, 19, 20, 21); they considered them ‘dark’ (Nos. 1, 19, 21), ‘where people with impairments go’ (Nos. 13, 17), and described ‘an image of going backwards by defeat’ (No. 8).
Changes in PTGs resulting from enrolment in schools for the blind
The changes resulting from enrolment in schools for the blind were organised using a five-domain framework based on PTG theory and categorised into four themes (Table 2). No corresponding theme was found for [Spiritual Changes], in line with research that observed little change in this domain among Japanese people (Taku et al., 2007).
Results interpreted using PTG framework.
Theme: personal strength
Individuals often experience a decline in self-esteem and feelings of helplessness after acquiring VI (Stevelink et al., 2015). All participants in the current study initially harboured pessimistic thoughts about their impairment upon enrolment. However, within the environment of the school for the blind, they encountered ‘much younger children’ (No. 18), such as students in kindergarten, junior, and senior high school departments, and ‘children with more severe disabilities’ who were ‘optimistic, strong and positive in everything they do’ (No. 10). This encounter seemed to open doors for psychological change. That is, many of the participants felt that they had been making excuses for not being able to see and that they had a pessimistic view of the impairment, whereas others felt that ‘even those little children are doing their best, what am I complaining about?’ (No. 15) and ‘I spoilt myself’ (No. 3), experiencing embarrassment about their own state (Nos. 1, 3, 5, 7, 10, 13, 15, 17, 18, 20).
Moreover, the ‘outstanding despite not being able to see’ (No. 20) teachers in Riryoka were a trigger for them to undergo a restoration of their image of themselves. Specifically, they were surprised by and respected the Riryoka teachers, who had acquired knowledge and skills while using assistive devices and living independently, even though they had severe vision impairment. Through intimate interactions with Riryoka teachers, who were individuals with VI themselves, and with other VI students, participants seemed to become aware of their own strengths and gained confidence, which became the fuel to try new things (Nos. 1, 3, 4, 5, 6, 7, 8, 11, 13, 14, 17, 19, 20).
Finally, the participants’ classes were small, with an average of three students (maximum of seven people, minimum of one person), and were taught by teachers with expertise in VI education. This caring environment allowed the enrolees to gain the experience of learning ‘for the first time on an equal footing’ (No. 9) and a solid sense that they could ‘successfully participate in activities’ (Nos. 1, 5, 6, 7, 9, 13, 15, 21). Furthermore, many participants acquired not only riryo techniques but also information on assistive devices and welfare services which are crucial for living independently (Nos. 2, 4, 5, 6, 8, 9, 10, 11, 14, 16). These components inherent in schools for the blind seemed to help participants restore their self-trust and the image of themselves which had been diminished by their impairment.
Theme: new possibilities
Many participants opted to pursue riryo due to the challenges of continuing in other occupations after acquiring VI, often thinking fatalistically, ‘this will be my only option if my eyes get worse’ (No. 17). However, upon learning actual riryo techniques in schools for the blind, those who harboured such thoughts took immense pride in reintegrating into society as riryo practitioners (Nos. 2, 3, 7, 11, 12, 14, 16, 17, and 18). They found pride in effectively utilising senses other than vision and securing long-term employment as riryo was tied to a national licence. Therefore, attending a school for the blind opened new pathways for economic and social independence, providing them with fresh goals for the future.
Moreover, while people with VI often struggle to engage in leisure activities (Jessup et al., 2010), enrolment in schools for the blind has prompted many people to explore new hobbies. Sports and humanities clubs in these schools were tailored to accommodate their VI under the guidance of specialist teachers. Numerous participants with acquired VI discovered new ways to enjoy leisure activities, such as athletics, tea ceremonies, music, and other pursuits they had previously abandoned (Nos. 6, 10, 11, 13, 15, 16, 20, and 21).
Finally, many participants assumed new roles, such as supporting others with similar VI, and were valued in their classrooms and schools for their contributions. Furthermore, middle-aged participants enrolled in schools took on leadership roles in school events and club activities, responsibilities they had never been entrusted with before. They became role models for younger students with VI, sharing their firsthand experiences of society and relationships, which the students in junior and high school departments, whose experiences were limited, appreciated (Nos. 2, 3, 9, 15, 17, 20).
Theme: relating to others
Many of the participants had no contact with people with VI prior to enrolling in schools for the blind, and in a situation where ‘no one understands’ (No. 1) their pain, they felt alone, ‘unable to talk to anyone’ (No. 8) about their impairment. Through enrolment, they met other people with acquired VI for the first time, and all participants felt a sense of closeness to those in the same situation. They also shared the pain of being misunderstood by those around them, talked to others about the difficulties specific to their impairments, and expressed their feelings. They learned to become more intimate with others, which at times led to spontaneous conversations that would not have been possible without a certain degree of trust, such as making fun of each other about their impairment or laughing about their eyes with humour, thus providing them with a natural setting where they could self-disclose their impairment.
Many of the participants felt relieved that they were ‘accepted’ (No. 8) for the first time for being blind. They also felt secure that they could ‘be themselves’ (No. 21) without having to hide, as others ‘acknowledged’ (No. 17) and ‘respected’ (No. 20) them. Schools for the blind were described by the participants as a place ‘where one can share their true feelings’ (No. 4) and provide ‘comfort’ (No. 1).
Their self-disclosure extended outside school, including to their family members (Nos. 1, 2, 9, and 20), old friends (Nos. 5, 6, 7, and 12), and local people (Nos. 9, 12, and 13). This tendency seemed to be further fuelled by their identification as ‘high school students’. For instance, one male participant (Participant 5), in his late 50s, informed his long-estranged high school friends about his return to ‘high school’ due to deteriorating eyesight, albeit for vocational training purposes. His friends responded humorously, with one remarking, ‘Oh, I’m jealous’, reflecting their nostalgic view of high school as a time of exploration and opportunity.
Behavioural and psychological changes were also observed among the participants. For instance, some participants with mild VI, who had previously relied on others to adapt to their situation because they were the only ones with impairment, experienced a shift when they met other individuals with impairments, in addition to those who had more severe vision impairments than themselves, for the first time. This encounter led them to reconsider and recognise the importance of mutual adaptation, not just one-way dependency. This realisation also motivated participants to make efforts to cultivate better relationships with others.
Furthermore, the acceptance of relying on others was evident among participants, particularly those with milder VI. This acceptance was triggered by observing peers and teachers with more severe VI behaving freely and cheerfully while actively seeking and receiving help from others (Nos. 5, 13, 20, and 21).
Theme: appreciation of life
Most participants (20 of 21), as well as many of their teachers and classmates, had progressive VI, such as retinitis pigmentosa, glaucoma, and optic atrophy. By being in a learning environment with other people with progressive VI, participants seem to have gained a sense of appreciation for the limited time they had left to see and cherish the present (Nos. 1, 2, 4, 6, 8, and 19), reinforcing their feelings of valuing what they could see in the current moment. For instance, Participant 2 stated how he or she became ‘painfully aware of how hard it is to become unable to see’ (No. 2) by meeting other members, and Participant 4 mentioned, ‘I want to cherish what I can see now’.
Furthermore, not only other classmates and teachers who had progressive VI but also children with multiple disabilities who attended these schools seemed to further encourage these participants to become aware of the preciousness of life and the importance of every day.
For instance, 19 of the 21 participants (excluding Nos. 2 and 21) had encountered students with multiple disabilities. This encounter was such a shock that one participant recounted, ‘When I first saw them, I didn’t know what to say’ (No. 1). Among other participants, one felt that ‘we should appreciate life itself’ (No. 11), and others thought they should appreciate the life they had taken for granted (No. 1, 9, 11, and 18), such as being able to walk on their own, enjoy meals, talk to people, and be with their family, even if they had poor eyesight.
Finally, some participants experienced a change in their life priorities and developed new values and philosophical views following their enrolment. For instance, many participants who had to leave their jobs due to their impairment prior to enrolment in school for the blind tended to place great value on being able to see (Nos. 8, 9, 17, and 21). Hence, having to leave the job because of impairment was devastating. Yet, through enrolment in schools for the blind, their mind-set changed, as described by Participant 8: ‘being able to see is not so meaningful’. Furthermore, participants seemed to place greater value on the things in life which are not visible, such as bonds and connections with others and human relationships (Nos. 6 and 8).
Discussion
The results of applying a framework based on PTG theory showed that the psychological transformation prompted by enrolment in schools for the blind among students with acquired VI was observed in four domains.
Schools for the blind provide opportunities for people with VI, which is a low-incidence disability, making it difficult for them to encounter each other, meet, and create supportive environments through school events, extracurricular activities, and classes. The desire of individuals who have experienced illness or impairment to help and contribute to others has often been reported to be more prevalent among those with similar experiences (Kampman et al., 2015). Therefore, places, where people with similar experiences or impairments can gather, are likely to foster mutually supportive relationships, allowing people with acquired VI to play a role in supporting others and gain the experience of helping others.
Furthermore, schools for the blind served as places where individuals encountered riryo and assistive devices, providing confidence, setting new future goals, and offering a means of independent living to individuals with progressive vision loss. It is uncommon for people with acquired VI to experience positive changes following an impairment (Boerner et al., 2006). Considering this, schools for the blind have emerged as places that provide strength and confidence and promote growth for individuals with progressive vision loss, who are otherwise likely to face numerous negative experiences.
As highlighted earlier, schools for the blind play a significant role in fostering PTG and are recognised as educational institutions tailored to the needs of this minority population. However, our findings suggest that while schools for the blind are influential, other factors, such as the characteristics of the profession of riryo and the progressive nature of individuals’ VI, might also have contributed.
For instance, in terms of riryo, 15 of the 21 respondents felt that returning to society as riryo practitioners made it possible for them to build new careers. Riryo, which has become an occupation for people with VI, has generally been criticised on the grounds that it limits free occupational choice and hinders social inclusion (Li et al., 2022). However, the aspects highlighted by the participants in this study, such as the improvement in skills through training of the non-visual senses and the potential for economic independence regardless of age, are less commonly observed in traditional professions for people with acquired VI (i.e., selling lottery tickets in European countries; Spungin & Huebner, 2017). Therefore, the abovementioned aspects of riryo that allow people with VI to engage with pride should be acknowledged in their pursuit of economic independence.
Finally, the gradual progression of acquired VI, leading to irreversible blindness, is a significant factor that cannot be ignored. The heightened respect for time felt by participants with acquired VI might have occurred because of the progressive nature of the condition, which is consistent with the work of Z. H. Wang et al. (2023) on PTG results in cancer patients.
Limitations
This study has several limitations. The results indicated that school events and club activities also served to enhance PTG. However, the impact on PTG may have differed in schools, where the spread of COVID-19 resulted in restrictions on certain activities. In addition, apart from their high PTGI-J scores, the participants in this study came from various backgrounds, and the male and female participants showed differences in their enthusiasm for financial independence and in their career experiences before enrolling in schools for the blind. Moreover, family support appeared to play a role for some participants who lived with their families. Therefore, future research should consider these individual characteristics and variables related to pre-disability life when sampling. This could afford us a deeper understanding of the meaning of segregated placement from the perspective of individuals with acquired VI. Finally, in this study, we focused on people with acquired VI who scored high on the PTGI-J, examining the meaning of segregated placements. In the future, by focusing on people with acquired VI who score low on the PTGI-J, we may be able to derive beneficial suggestions for schools for blind in Japan.
Implications and conclusion
Acquired VI possesses distinctive characteristics not only of being fundamentally low in incidence but also of being a progressive impairment in most cases. Understanding the visual experiences of individuals with acquired VI can be challenging, leading to frequent misunderstandings about their surroundings. The study’s result highlight that schools for the blind, designated as ‘schools’ for this minor population with special provisions catering to their unique needs, can provide people with acquired VI with mutual support by meeting peers facing similar challenges and instil their confidence. This facilitated an increase in PTG. Therefore, when considering the dynamics of a community of people with impairments, it is crucial to carefully deliberate on the role of segregated placements and advance discussions accordingly.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the JSPS Research Fellowships for Young Scientists, grant number 22J10451.
