Skip to main content

Verified by Psychology Today

Alison Bonds Shapiro M.B.A.

Hidden Disabilities

What about the things that are invisible to us?

Very often our perception and judgment of a person is based on what is visible or apparent to us - what we can readily notice. But what about the things that are invisible to us? How do we access information, or even remember that there is information about a person that we don't notice?


Hidden Disabilities

I recently met Grace, a woman who had a traumatic brain injury when she was sixteen years old. She was in a car accident, an all too common occurrence. An accident occurs, the head hits a part of the car and internal damage to the brain results, ranging from mild to severe. Grace shows no outside cues of brain damage. There are no visible cues of her head injury. Grace's walking, vision and physical reflexes look "normal."

In the course of our conversation, Grace told me of the years of difficulty she has encountered attending school and college. Through the expenditure of a lot of effort and diligence Grace has managed to graduate from college and even graduate school, but it has been very difficult for her. She has required a lot of assistance to organize and work with information. Grace's brain was damaged in the car accident. Her ability to hold information was altered by the impact.

The biggest difficulty that Grace has faced is not the effort it takes to organize information, however. It has been in convincing people that she had a problem at all. People look at Grace and assume she is fine and then react to her difficulty as if she is being lazy or choosing to be obstinate. Teachers' judgments of Grace have been based on assumptions made from Grace's physical appearance. A few stopped to enquire what was true for Grace. Many did not. It was frustrating enough to have to struggle with the school work. Imagine having to struggle with negative judgments at the same time.

A few weeks ago I had my own, somewhat unexpected, encounter with a hidden disability. I attended a large meeting in a very noisy restaurant. I had no idea until I arrived just how noisy the atmosphere would be. Post stroke I cannot manage that much noise and try to concentrate at the same time. As a result of my own brain injury my shields for noise and over stimulation were damaged. Whatever protective barrier I might have had no longer works. For a couple of weeks after that meeting my brain was so over stimulated that I could not manage loud noises of any kind. My brain hurt and I could not concentrate.

A friend of mine, Dr. Lyn Freeman, who is doing brilliant work helping women heal from breast cancer at tells me that chemotherapy can cause damage to brain function, what's called "chemo-brain". Woman who are undergoing treatment may have many of the same cognitive effects or sensitivity to over-stimulation that are seen from a stroke or a traumatic brain injury. These effects usually resolve when the treatment is over and the women have time to heal, but that process can take years.

Brain injuries are only some of the causes of hidden disabilities, of course. Someone with an orthopedic injury may not be able to lift heavy objects or move fast. Some people have visual acuity problems and lose peripheral vision. The list goes on and on. What is important is that we remember that someone we know may have a hidden disability.

What can we do about our tendency to assume that what we perceive from the appearance of a person is what is "true" about them? We can first realize that there may be more to know. We can stop a minute and ask ourselves - is this all there is about this person? Then, if we see someone we work with, live with or care about having difficulty, we can take a breath, slow down and enquire what is happening. We don't need to make a judgment one way or another based on what we think we see. Perhaps the person is simply tired that day but perhaps there is a deeper, more longer lasting problem, a hidden disability. We cannot know unless we ask.

We can use open-ended questions without assumptions embedded in them. Rather than saying, "Why are you being lazy or obstinate or refusing to do what I asked you to do (you get the idea)?" we can ask, "What do you need to accomplish this task?" We might learn a lot more than we think.


About the Author

Alison Bonds Shapiro, M.B.A., works with stroke survivors and their families, and is the author of Healing into Possibility: the Transformational Lessons of a Stroke.