Secondary mental handicap and its relationship to trauma

SUMMARY Psychoanalytical psychotherapy is beginning to make important contributions to the field of mental handicap. Workers with the mentally handicapped, initiating policies to move their clients from long-stay hospitals into half-way houses and hostels, are very aware that the use individuals make of their handicap can be as damaging as the handicap itself. They are welcoming, therefore, the contribution of psychotherapists in addressing secondary handicap. This paper questions and examines the nature of secondary handicap and differentiates between mild secondary handicap or secondary gain and what the author terms “opportunist” handicap, where more extensive internal disturbance exacerbates the primary handicap. This paper also considers the possibility that some aspects of mental handicap can, in certain patients, represent a defence against trauma. This is discussed by means of clinical material from two severely mentally handicapped patients. The trauma of sexual abuse has played a part in the handicap of one, whilst cerebral palsy was the primary organic handicap of the other.