Browsing by Subject "Disability"

This dissertation takes up questions of how theologies and practices of baptism shape visions of what it means to be a disciple of Jesus and a participant in Christian ecclesial communities. In particular, the dissertation investigates how baptism as the paradigmatic initiatory practice of the Church might transform communities to cultivate radical belonging for people with intellectual and developmental disabilities.

In order to address these questions, the dissertation engages a variety of methods, including historical and thematic analysis of theological texts (particularly in the field of disability theology), theological engagement of New Testament texts and biblical scholarship on the Pauline epistles, as well as an analysis of qualitative research conducted by the dissertation’s author (in-depth, semi-structured interviews) among adults with intellectual and developmental disabilities, their families and key support persons, as well as clergy and lay leaders in Christian denominations across the ecumenical spectrum. An integrative analysis of theological texts, biblical texts, and narratives arising from the qualitative research analysis provides a foundation for constructive theological suggestions, in a practical and pastoral register, at the conclusion of the dissertation.

This dissertation concludes that a baptismal hermeneutic provides a critical lens to faithfully reflect on disability, as well as transformative practices to support the flourishing, belonging, and witness of people with intellectual and developmental disabilities in Christian faith communities. Baptismal theologies and practices suggest the centrality of communal, Jesus-centered, and participatory accounts of Christian identity in the Church – the community this dissertation names as the baptized Body. In particular, the dissertation commends practices of baptismal preparation, testimony, and reaffirmation as key avenues for participation of all people in ecclesial spaces (robustly inclusive of people with intellectual and developmental disabilities). These practices constitute transformative pathways to affirm the centrality of baptismal identity and baptismal vocation to discipleship for an ongoing, radical transformation of ecclesial life, empowered and sustained by the Holy Spirit. In addition, the baptismal hermeneutic and baptismal practices explored throughout the dissertation critically expand discourse on intellectual and developmental disabilities in the field of Christian theology.

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Background: While nationwide health surveys commonly assess the prevalence of mental health conditions and disability status at the population level, they often fail to elucidate the relationship between mental health and disability. The aim of this study is to estimate the association between past-month poor mental health days and two indicators of disability (difficulty doing errands alone and difficulty making decisions) among sexual and gender minority (SGM) respondents to the 2021 BRFSS survey. Methods: A secondary analysis was conducted on the publicly accessible 2021 BRFSS data to estimate the association between past-month poor mental health days and indicators of disability among SGM. Logistic regression models were used to report odds ratios and 95% confidence intervals. We then examined potential effect modification by gender, sexual orientation, race, and SES factors, and present stratified estimates as indicated. Results: We observed increasing difficulty of completing errands alone with increasing past-month poor mental health days (OR 2.64, 95% CI 2.194, 3.178 at moderately poor mental health; OR 5.025, 95% CI 4.289, 5.889 at severely poor mental health). This association is modified by gender and SES. We also observed increasing difficulty of making decisions alone with increasing past-month poor mental health days (OR 3.298, 95% CI 2.871, 3.787 at moderately poor mental health; OR 6.792, 95% CI 5.979, 7.716 at severely poor mental health). This association is modified by sexual orientation, gender and race. Conclusions: There are clear dose response relationships between mental health and the two disability outcomes that are modified by socioeconomic status, gender and sexual identity.

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Background: A growing number of female passengers of a newly-introduced battery powered taxi, referred to as the `Easy Bike´, sustained Spinal Cord Injuries and anterior neck lacerations. This severe injury occurs, as their traditional scarves entangle in the taxi´s engine drive shaft. Injuries sustained by entanglements of scarves in machinery has been known in the literature as Scarf Injuries. This study aimed to conduct key informant interviews to explore Scarf injury survivors challenges in receiving adequate care and maintaining a high Quality of Life (QoL). Methods: We conducted semi-structured in-depth interviews with 12 Scarf Injury survivors and their caregivers after discharge from a rehabilitation center in Bangladesh. Results: The main themes that emerged from the qualitative data were 1) perceived level of health, function and possible participation, 2) access to emergency and acute care and quality of care, 3) challenges in community reintegration. Participants often perceived their ability to perform activities and tasks to be lower than their bodily functions allowed, leading to a self-limitation in their daily social life. Commonly reported health concerns were urinary and bladder control, infections and breathlessness. None of the participants perceived that they received appropriate emergency care at the injury site, and transportation to a medical facility usually occurred in unsafe vehicles due to limitations in general awareness and knowledge of the injury sustained. At the facilities there was a reported gap in knowledge and competencies regarding the etiology of this type of SCI, leading to multiple referrals for diagnosis and delayed management. Community and social reintegration was mainly impacted by lack of financial resources, lack of realistic goals, poor mental health including suicidal thoughts and previously mentioned secondary complications.

Conclusions: Increasing awareness and knowledge about SCI emergency and acute care might contribute to improved long-term clinical outcomes and survival rates among Scarf Injury survivors. Moreover, greater competencies and awareness among providers to manage this unique mechanism of injury would increase the patient´s and caregiver´s level of understanding of their condition, and would result in earlier adoption of a coping process.

Implications: Early rehabilitation that focuses on physical and mental health, alongside empowerment and integration, appears to be lacking in this setting Further studies are needed to identify effective and culturally sensitive intervention programs for females living with Scarf Injuries in LMICs.

St. Thomas Aquinas on Disability & Profound Cognitive Impairment

Abstract

This dissertation raises a question regarding the relationship between the condition of the body, moral virtue, and human flourishing. Our main objective is to reconstruct Aquinas's theological understanding of corporeal infirmity in order to depict, in broad outline, a Thomistic theology of disability and cognitive impairment. A prominent concern in this investigation is to understand, according to Aquinas, the significance of the body in the perfection of human activity towards the realization of our natural and supernatural end, as well as the implications of Aquinas's view with respect to persons who have a profound and utterly debilitating cognitive impairment.

Remarks on disability and impairment are found throughout Aquinas's Summa Theologica and his treatise De Malo. Although Aquinas did not compose an ex professo theological tract on `disability,' the integral and systematic character of what he says about these matters implicates the whole of his thought and, in particular, his moral theology. In his Summa, Aquinas brings together careful scriptural exegesis, patristic and medieval sources, as well as the best philosophy of his day. The result, with respect to our theological understanding of corporeal infirmity, is an innovative and far-reaching depiction of a properly Christian understanding of these matters.

In the experience of corporeal infirmity, we are confronted with a question that pertains directly to the proper object of moral theology. [1] Regrettably, there remains a notable lacuna in contemporary Aquinas studies and Thomistic moral theology on the topics of disability and cognitive impairment. In particular, the vulnerability of human beings to the evil (malum poenae) of corporeal infirmity and the moral significance of profound affliction has received very little attention. We intend that the interpretive work of this investigation in the theology and philosophy of Aquinas will help address that lacuna.

We can describe the relevance of this project to the work of Thomistic moral theology in stronger terms. Aristotle's great insight was to understand that any description of the good life and the happy life of the human being cannot be separated from an account of how that life is possible for the kind of beings that we are, i.e., the biological constitution of the rational animal. Aquinas appropriated that Aristotelian thesis and revised it in the light of the Christian doctrine of creation. So conceived, integral to moral reasoning in the Thomistic theological tradition is the ability to account for how faithful discipleship, Christoformic virtue, and cruciform love are possible for the kind of beings that we are, i.e., our creaturely constitution: mortal rational animals made in the image of God.

Moreover--and here are the stronger terms mentioned above--no moral theology can pretend to any measure of seriousness if it does not account for how discipleship, Christoformic virtue, and cruciform love is possible for the created rational animal while contingently and unequally bearing the corporeal wounds of original sin. Specifically, grace restores and heals what was lost at the fall (original justice), but baptism does not immediately heal the wounds of original sin in our bodies (our trust in Christ entails the hope of bodily resurrection). Yet, Christ calls us to discipleship, virtue, and love as we await the restoration and healing of our wounded bodies in the consummation of glory. On this understanding of the human predicament, our present concern is to provide a theological account of what it means for the created rational animal to flourish with respect to its natural and supernatural ends, even as it continues to bear the corporeal wounds of original sin.

The four chapters of this dissertation are divided into two parts. Part 1 (chapters 2 and 3) is concerned with Aquinas's understanding of the first perfection or creaturely integrity of the human being. The objective is to depict Aquinas's account of the human being by showing how he made use of Aristotle and Augustine. Towards that end, chapter 2 focuses on Aristotle's metaphysical biology and his account of human defect; Aquinas's Augustinian doctrine of creation; and Aquinas's appropriation and subversion of Aristotle's account of `defective human beings.' Of particular importance in chapter 2 is Aquinas's engagement with the forms of irrational human behavior described in Aristotle's Nicomachean Ethics and Aristotle's theory of natural slavery outlined in Book 1 of the Politics (i.e., despotic rule over an essentially defective human being who is incapable of discursive reasoning).

Special attention is given to the precise metaphysical defect of the `slave by nature,' as distinct from other forms of human defect on Aristotle's terms. We show how Aquinas subverts Aristotle's notion of natural slavery (by rejecting the possibility of essential defect), while revising Aristotle's phenomenological description of the natural slave's dispositional dependency under the moral logic of merciful care for vulnerable and dependent persons. Specifically, Aquinas stipulates the moral imperative to counsel and protect human beings who variously and unequally `lack the use of reason' due to an extraordinary injury of the cognitive faculties.

In chapter 3 we focus on Augustine's account of the image of God and the mind (mens); Aquinas's appropriation and development of Augustine on the activity of the imago trinitatis; Aquinas's understanding of the rational soul as the substantial form of the body; and the incorruptible aptitude of the rational soul to image God by knowledge and by love.

Part 2 (chapters 4 and 5) treats Aquinas's understanding of the second perfection or orderly operation of the human being, and the effects of original sin upon that activity. The objective is to depict Aquinas's account of the purpose and perfection of the human being and to do so by showing how he went beyond Aristotle and Augustine. Chapter 4 describes Aquinas's understanding of the operational limitations unequally experienced by particular human beings as a consequence of original sin. We address, according to Aquinas, how the second perfection of the human being in operation came to be wounded, and we formulate a metaphysical account of evil suffered (or affliction). From that basis, a typological sketch of corporeal infirmity and cognitive impairment on Aquinas's terms is provided. The purpose of this systematic overview is to reconstruct Aquinas's theology of disability and cognitive impairment, to show its internal coherence, and to indicate points of significance from the aspect of our creaturely dignity and creaturely destiny.

Chapter 5 describes how those who `lack the use of reason' participate in the sacramental life of the Church (principally through Baptism and Eucharist). In particular, we treat Aquinas's understanding of the condition amentia (`mindlessness'), where a person `lacks the use of reason' due to a profound and utterly debilitating impairment of particular corporeal and cognitive faculties. We provide an account, on Aquinas's terms, of the moral implications of a profound cognitive impairment on the order of amentia. Our interest is the way Christians afflicted with amentia can, on Aquinas's view, participate in the life of the Church and live the virtues.

Specifically, just as the acquired virtues dispose and enable a person to act in accordance with the light of natural reason, which is proportionate to human nature; in the light of grace and consequent of baptism, the infused virtues dispose and enable a person to act in a `higher manner' and toward `higher ends,' in relation to a `higher nature'--which is our progress toward the perfect participation of the blessed in the divine nature. On Aquinas's terms, the consummation of grace and infusion of supernatural virtue at baptism can be understood to capacitate someone who completely `lacks the use of reason' with supernatural knowledge and a supernatural principle of self-movement. So capacitated, there is no reason to deny that a person afflicted with an amentia-like condition could be graced to realize a meritorious magnanimity in knowledge and love of God.

Likewise, on Aquinas's terms, there is good reason to believe that in baptism persons with profound and utterly debilitating cognitive impairments are capacitated for Christian friendship--even as they remain incapable of performing the acts ordinarily associated with Christian friendship. That is to say, although profoundly impaired, through baptism a person with an amentia-like condition is capable of the kind of friendship that is only possible for creatures endowed with an immortal and incorruptible rational soul. It is a friendship based on the fellowship of our deepest happiness, which is the consummation of grace; where our creaturely likeness to God according to image (by knowledge and by love) precedes and causes a supernatural likeness that we share as members of the Body of Christ.

Beginning with a thorough description of the human being and corporeal infirmity, on Aquinas's terms, and in light of his main influences, it is possible to reconstruct his account of cognitive impairment as such, its moral implications, and the moral significance of profound bodily affliction in the Christian understanding of the good life. The goal is to bring to light the doctrinal and moral integrity of what Aquinas says about physical disability and cognitive impairment--he says quite a lot--and, subsequently, to make reasonable inferences on those matters where he is silent.

Fate is not destiny. Saint Thomas Aquinas helps us recognize our fate--we who are or who will soon become weak, disabled, and cognitively impaired--in the light and the hope of the Divine consummation of nature, grace, and glory. He helps us not only to see but also to recognize that the existence of the mortal rational animal, the image of God, is beautiful. It is the beauty that belongs to the One called Beautiful, the exemplar after whom our likeness is for now but an imperfect shadow. Our infirmities, the evil we suffer, and the afflictions of our mortal wretchedness is our fate; but our fate will be redeemed and made perfect in the light of His glory, through the Beauty of the Cross.

[1] For Aquinas, the question of happiness is the principle concern of all morality. To be happy is to live a good life, which is the life of moral virtue. Affirming that basic judgment, Servais Pinckaers, O.P., remarks that "if the idea of happiness is the initial consideration in moral theology, the place of suffering will be obvious, for it is precisely the reverse of happiness. Suffering will then be an element of moral theology from the very start...[the] banishment of the consideration of suffering from ethics is an outgrowth of a rationalistic conception of the human person." Servais Pinckaers, The Sources of Christian Ethics (Washington, D.C.: Catholic University of America Press, 1995), 25.

For decades, life course and stress process scholars have documented that negative, stressful experiences have consequences for health across the life course. However, less attention has been paid to hearing impairment, a highly prevalent functional limitation that has significant implications for the quality of life of older adults. Hearing impairment is common at older ages (reported by 27.3% of those aged 65-74 and 45.1% of those aged 75 and older) and has negative consequences for the quality of life not only of the focal individual but also for those close to them (CDC 2017, Ciorba et al. 2012, Dalton et al. 2003, Wallhagen et al. 2004). The aim of this dissertation is to apply a life course and stress process framework to the experience of hearing impairment via two studies that each use nationally representative, longitudinal data from the Health and Retirement Study (HRS). My findings contribute to our understanding of marriage, family, gender, and health by moving beyond the traditional approach that focuses on individuals with disabilities to explore the impacts of disability on spouses.

In Chapter 2, I build on the stress process framework by conceptualizing hearing impairment as a chronic stressor that impacts mental health and examining the role of social support in this relationship. Using fixed-effects regression models applied to three waves of HRS data (2006, 2010, 2014), I found that worse self-rated hearing is associated with a significant increase in depressive symptoms, and that social support interacted with hearing impairment: low levels of social support were associated with more depressive symptoms but only among people with poor self-rated hearing. Moreover, high levels of social support reduced depressive symptoms for those with poor hearing. These findings suggest that hearing impairment is a chronic stressor in individuals' lives, and that responses to this stressor vary by the availability of social resources.

Chapter 3 examines stress proliferation among married couples. While decades of research show the health benefits of marriage, stress proliferation suggests that chronic stressors such as disability may undermine social relations, thus limiting their role as a coping resource. For this study, I matched couples by household identification number over ten waves of the HRS (1998-2016). Fixed-effects regression models revealed that wives’ hearing impairment is associated with an increase in husbands’ depressive symptoms, but that husbands’ hearing impairment is not associated with wives’ depressive symptoms. This could be because women in heterosexual marriages have traditionally been expected to monitor their husbands’ health, but not vice versa. Since men are less used to serving as caregivers, they may find their wives’ hearing impairment distressing. Also, wives usually find social support outside of the marriage, while husbands traditionally rely on their wives for companionship. This would provide wives, but not husbands, with external resources to cope with their spouses’ hearing impairment. These findings reveal that the stress of hearing impairment does spill over from one spouse to another, depending on gender.

Overall, this dissertation demonstrates that hearing impairment is a chronic stressor that has major implications for individuals’ mental health. Moreover, the mental health consequences of hearing impairment are not only limited to individuals but can also spill over to impact spouses. Further research is needed to extend our understanding of how disability, in general, and hearing impairment, specifically, shapes health across the life course for individuals and those close to them.

This dissertation analyzes the development of legal strategies to restrict “wastefulness” or “prodigality” during the economic crises of the long sixteenth century in Southwest Germany, as the state, community and small town families struggled to preserve family and household resources. Using local, state, and imperial court trials of “spendthrifts” from early modern Württemberg, the thesis shows that prodigality laws provided litigants with a flexible, multifaceted tool to prevent reckless financial mismanagement. Once laws began to criminalize wastefulness in the mid-sixteenth century, lawmakers, litigants, and judges used this concept to intervene in family affairs and brand heads of households as legally incompetent. Although litigants largely applied spendthrift laws against male heads of households, family members and the authorities also challenged women with property, accusing them of squandering precious family resources and transgressing gender- and class specific standards of proper household management. The new legal and social culture of thrift and wastefulness not only had profound consequences for gender- and class-based norms of economic behavior but also transformed those economic norms into prerequisites for legal personhood. Finally, the thesis suggests ways in which early modern guardianship and spendthrift laws shaped wider concepts of citizenship, rationality, disability, and deviance, pointing to long-lasting influences that shaped state policies in Germany into the twentieth century.