Disability, Identity & Invisible Grief

Maren, 34, graphic designer

Presentation

Born with spina bifida (myelomeningocele, L4-L5). Uses a wheelchair full-time since age 14 after progressive loss of ambulation. Works remotely as a freelance designer but wants to transition into UX research — recently passed over for an in-house position she suspects was due to accessibility concerns. Divorced two years ago, now in a new relationship where her partner's family keeps calling her 'inspiring.' Says: 'I spent my whole life being the girl who didn't let it stop her. I'm tired of being a story about overcoming.'

History

Raised by a single father after mother left when Maren was 3 (mother cited inability to handle the medical demands). Father was devoted but anxious — managed every medical appointment, surgery, and accommodation with military precision, leaving no room for Maren to grieve or struggle. Spina bifida required 11 surgeries by age 16, including shunt revisions and orthopedic procedures. Father's refrain: 'We don't feel sorry for ourselves in this family.' No space for anger or sadness about disability. Older brother was the 'easy child' — healthy, athletic, low-maintenance. Maren became hyper-competent and emotionally self-sufficient by necessity. No substance use. Previous therapy at 22 was CBT for depression, helpful for acute symptoms but never addressed disability identity or the medical trauma of childhood surgeries.

Clinical note: Maren's case illustrates a clinical population that therapy training almost never addresses: disability as a dimension of identity, not just a presenting problem or medical history. Her father's compulsory resilience ('we don't feel sorry for ourselves') is a specific form of emotional invalidation that Olkin (1999) identifies as common in disability families — well-intentioned but deeply harmful, because it forecloses grief and forces the child to organize around performance rather than experience. The mother's departure explicitly linked to disability creates a specific abandonment wound: 'my body makes me too much for people.' The emerging exhaustion with 'inspiration' is a developmental achievement, not ingratitude. Disability identity development models (Gill, 1997; Gibson, 2006) describe a trajectory from internalized ableism through rejection of dominant narratives to integrated identity — Maren is in the critical middle stage. The job discrimination adds a structural dimension that individual therapy alone cannot resolve — connecting Maren to disability community and legal resources is clinically appropriate. The accumulated medical trauma of 11 childhood surgeries is often unaddressed in therapy because it was 'necessary' — but the body doesn't distinguish between necessary and unnecessary intrusion. Previous therapy addressed depression symptoms without touching disability identity — a common clinical error that treats the downstream effects while ignoring the river.

Where Approaches Genuinely Disagree

Is this grief or oppression?

Psychoanalysis

The invisible grief of disability — mourning a body or capacity that was expected — needs processing.

vs.

Narrative Therapy

Locating the problem inside the person pathologizes a social failure. The suffering is political, not intrapsychic.

Philosophical Lenses

These are not treatment plans. They are ways of seeing — philosophical perspectives that illuminate aspects of this case that clinical modalities may not address directly.

Sara Ahmed

Maren's experience is what Ahmed calls a 'misfit' — the friction between a body and a world not built for it. The wheelchair is not the disability. The stairs are. The inaccessible venue is. The interviewer's unconscious flinch is. Ahmed's phenomenology of orientation reveals that the world is arranged for certain bodies and not others, and that this arrangement is experienced by the well-fitted as neutral, natural, simply 'the way things are.' Maren wants to transition into UX research — a field that talks constantly about accessibility while conducting its own hiring processes in spaces that exclude her. The invisible grief is not about spina bifida. It is about the daily labor of navigating a world that was not designed with her in mind and then being expected to be grateful for the accommodations that partially correct this failure.

Maurice Merleau-Ponty

Maren has used a wheelchair full-time since age 14 after progressive loss of ambulation. Merleau-Ponty's concept of the habitual body is crucial here: the body retains the schema of its former capacities even as the actual body changes. The phantom limb is his most famous example — the amputee's body 'remembers' the arm. Maren's situation is more complex: she did walk, and her body schema still carries that history, layered beneath the current schema organized around the chair. She is not a person who cannot walk. She is a person whose body holds two histories — one ambulatory, one not — and whose daily experience is the negotiation between them. The grief is 'invisible' partly because it has no single origin. It is distributed across every encounter with a world built for the body she no longer has.

Gilles Deleuze & Félix Guattari

Deleuze and Guattari's concept of the Body without Organs challenges the medical model that organizes Maren's life. Medicine has mapped her body — L4-L5, myelomeningocele, progressive loss — through a schema of deficit: what is missing, what doesn't work, what deviates from the normative body. But Maren's body is not a broken version of a normal body. It is a body with its own capacities, its own ways of moving, sensing, and inhabiting space. The BwO is not about having no organs but about refusing the organization imposed from outside — the medical gaze that sees only pathology, the social gaze that sees only limitation. Maren's desire to move into UX research is itself a Deleuzian gesture: she wants to redesign the interfaces between bodies and worlds, which is precisely the work of someone who has lived the failure of existing interfaces.

7 Formulations

Select 2–3 modalities to compare side by side:

Sources & Method

This is a composite fictional case — no real client is depicted. Formulations represent how each modality would typically conceptualize and approach a case with this presentation, based on published clinical literature and training materials. Each formulation draws on the modality's own theoretical framework, key texts, and clinical principles as documented on its modality page. Full source citations for every modality are available on the Sources page.