Out of the 30 younger ex-Service men, 27 were below 45 years of age; 15 were employed at the time of the interview; four were still serving but were waiting to be medically discharged. Of those who had left the Armed Forces, 13 out of 30 had left over 10 years ago and just over half (17 out of 30) were married or in a long term relationship. The great majority (26 out of 30) had served in the Army.
Twelve men had a combat-related visual impairment, of which 10 sustained the impairment during deployment to Iraq or Afghanistan. 12 out of the 30 sustained their impairment less than 5 years ago. Genetic causes of visual impairment were the most common causes of visual impairment (
n = 7) among those with a non-combat-related visual impairment followed by ocular medical conditions (e.g. age-related macular degeneration, glaucoma) (
n = 4) and environmental causes (
n = 4) (e.g. toxic or injury related). The overwhelming majority of ex-Service personnel used low vision aids (28 out of 30); four had a guide dog, 17 used talking books and 19 used a white stick. Approximately one in three participants screened positive for probable depression, probable anxiety or probable Post-Traumatic Stress Disorder (Stevelink et al., (2015)
http://bjo.bmj.com/content/early/2015/04/23/bjophthalmol-2014-305986.full.
In the next section the findings of the two themes identified for the current paper, specifically ‘coping (strategies)’ and ‘impact of vision loss on daily life’, are combined to describe how vision loss affected the person from the time directly after becoming visually impaired and how this changed subsequently.
Coping with a visual impairment and impact on daily life
Directly after becoming visually impaired, younger male ex-Service personnel thought
“life is over” and they “
[didn’t] want to carry on”. Their confidence was undermined, they felt sorry for themselves and had the feeling there was no way out.
Phil (non-combat-related visual impairment, age 35–44 years): “Well initially straightaway it [loss of vision] stopped me from going out straightaway. I went in for the first two years, first year and a half at least, I was very depressed. Very sorry for myself and thought that was it (…). (…) I didn’t think there was anything I could do so yeah, dread, full of dread and fear and all that lot did come into it.”
These feelings and experiences were reinforced by other losses that were experienced as a result of their loss of vision such as losing their job, experiencing relationship difficulties and an increased dependence on others.
In most cases, if personnel suffered a deterioration of their sight whilst in Service, they were medically discharged and as a result had to confront the issue of changing their career. This was similar amongst those who had left the Service and had started a civilian job. This forced change of career was generally experienced as a
“regression” leading into a cascade of accompanying consequences such as experiencing financial hardship if living on benefits, different family dynamics due to for example family members taking on the role of carer and, above all, impaired self-esteem. Ex-Service men felt that by no longer being the breadwinner in the household and a highly trained professional, they were set back to square one as said by Alan (combat-related visual impairment, age 25–34 years):
“(…) it’s like all that experience, all that knowledge… shoved right back in your face (…). (…) You’re a broken toy now. What happens to broken toys… goes to the tip doesn’t it? (…). You know you’re a broken toy they don’t want to know you.”
Denial of the consequences of vision loss resulted in ex-Service men trying to do the things they were used to do; this resulted in feelings of frustration and irritation as illustrated by Richard (non-combat-related visual impairment, age 45–54 years):
“(…) at first it [loss of vision] made me really down and depressed and … . Because I’d known for quite a while before that there was something wrong. And I went through not accepting it. So at first I wouldn’t accept it and then when I first finished work obviously I had to walk everywhere. I got quite narky with people. If I was out with my stick and they’d bump into me. I’d get quite angry with them… because it was everybody else’s fault for getting in my way. So I went through like a stage of denial, I suppose and then being angry.”
The emotional turmoil personnel went through whilst adjusting, adversely affected their relationship with their partner. Those who were in a relationship at the time of becoming visually impaired suggested that their impairment put a strain on that relationship. Personnel experienced increased dependence on their partner resulting in changing relationship dynamics. Both the partner and the person affected needed time to adapt to this new situation. In a few cases, participants divorced or ended their relationship with their partner, but the dominant view was that the impairment was a contributing factor but not the main reason for breaking up.
Charlie (non-combat-related visual impairment, age 35–44 years): “But it [loss of vision] very nearly I think cost us my wife and I our marriage, because I was quite unpleasant on more than one occasion. But thankfully we’re coming through the other side so yeah it’s been a difficult journey.”
Members who became visually impaired in combat were proud about the circumstances that led to their loss of vision (
“serving Queen and Country”), whereas those with a non-combat-related visual impairment struggled with the question ‘why me?’ and even felt guilty, ashamed or embarrassed. Some personnel expressed the hope that their vision would improve over time or were looking into potential treatment options. Personnel were mourning about what they had lost and what they could have done if they had not sustained a visual impairment.
Harry (combat-related visual impairment, 35–44 years):“You know the doctors are going to say to you at some point you don’t need to come and see us anymore, and that’s when it will sink in and that’s what you’ve got for the rest of your life, that’s what you’re stuck with. And at that point you need to just accept it, just get on with it because the longer you kid yourself it’s going to get better, or there’s going to be some miracle surgery, the longer it ‘ll take you to adapt.”
The visual impairment not only affected the domain of work and interpersonal relationships but also other areas as illustrated by Nick (non-combat related, age 25–34 years):
“(…) you do have a bad impact on your day to day life especially from washing up to having food or to prepare a meal. Then taking medication and also you know dress yourself, and also you can’t actually go out on your own all the time. So your movement is quite restricted although it can be done with some training outside, but there is the danger off (…) colliding with something or someone or some obstruction.”
As time passed, ex-Service personnel were able to “change [their] head around” and tried to adjust to their visual impairment and its consequences, by applying various coping strategies. The ‘military ethos’ of “crack on” and “adapt and overcome the situation” helped them to overcome any problems they experienced. However, for some personnel it acted as a barrier because they were reluctant to ask for help and struggled through with their visual impairment (defined by the researchers as coping at a cost).
Other reasons for coping at a cost were that younger ex-Service personnel felt ashamed, lacked confidence or were too proud to ask for help. They did not want to be seen as a burden on others. Coping at a cost was enforced by reactions from the public. For example, Max (non-combat-related visual impairment, 35–44 years) was assaulted when using his cane on public transport after accidently bumping into someone; they did not believe he was visually impaired so from that moment on he decided not to use a cane anymore.
The unavailability of support and resources influenced how younger members coped with their loss. Ex-Service personnel tried ‘to escape’ by, for example, substance abuse or made a non-fatal suicide attempt.
Tom (non-combat-related visual impairment, 25–34 years): “When I first lost my eyesight I never had that emotional support. I never had it and I dealt with it on my own. My way was hitting the drinks and hitting the drugs and going crazy.”
Other examples of maladaptive behaviour included isolation and social withdrawal from family and friends, acting aggressively or in an unfriendly manner.
Besides the use of maladaptive coping strategies, several adaptive coping strategies were applied. One of these was termed by the researchers as ‘downward comparison’. Younger ex-Service personnel pointed out that they were aware of other people being worse off than themselves such as soldiers with serious brain injury, cancer patients or if they still had some vision left those who were completely blind. Others made a comparison with vision impaired members who managed to carry on successfully. By making a downward comparison or by comparing themselves with people who had faced the same problems, coping was facilitated as members got inspired and motivated to
“crack on with life”.
Oliver (non-combat-related visual impairment, 35–44 years): “They [members of Blind Veterans UK] proved that there are other people in the same situation as me and even not worse, and that you know you can still do day to day tasks and you can still do a lot of varied things if you put your mind to it. You know and it’s just challenging your mind to being able to do these things.”
People’s favourite leisure activities and interests changed substantially because they were no longer able to undertake them due to their loss of vision. Driving a car was missed tremendously, followed by sporting activities and reading. Personnel tried to get around these barriers by adopting a problem-focused approach (e.g. use of low vision aids, retrain, find other activities they were able to do). Also accepting or asking for (social) support from family, friends, charities or seeking professional support, helped ex-Service personnel to adjust and carry on.
Just after becoming visually impaired, personnel needed a lot of help and relied heavily on others. Once they started to adapt, people learned new skills and strategies, resulting in increased confidence and less reliance on others. This had a positive impact on the mental well-being of the person with the visual impairment and facilitated the process of accepting their loss of vision and its consequences. Further personnel learned what they are still able to do and what not, thereby reflecting on and adapting to the restrictions their visual impairment imposed. However, the dependence on others played a limiting role and new activities such as taking up different hobbies like disability sports were not always experienced as that satisfying.
Andrew (combat-related visual impairment, 25–34 years): “You have to accept that sort of thing as part of the hard bit in the beginning. (…) once you’ve accepted it [loss of vision] you get used to it and just move on from then. Then obviously you have achievement from there and then you put yourself to whatever you need to achieve.”
Achievement was often mentioned as a next step. Younger ex-Service personnel decided to set a particular goal such as starting a new course or degree, or signed up for a sporting challenge. By working towards a particular goal, personnel got back in a daily routine, their confidence increased as well as their self-worth. This impacted positively on their mental well-being. Reflecting on the different experiences of the participants it becomes apparent that coping with loss of vision is a dynamic long-term process. Even after years, people may struggle as new situations, challenges or life events come by.
Jack (combat-related visual impairment, 25–34 years): “It’s been [amount of years] now and there was a time I thought I’d accepted what had happened to me, but you know that was temporary. And yeah I don’t think I’ve fully accepted what’s happened to me. There [are] good periods and bad periods and you know they come and go quite randomly and yeah they affect me for different amounts of time and I can get quite negative sometimes and quite self-deprecating.”