A Life Story of a Nurse Who Lost Her Sight Mid-Life: The Miracle of Finding the Resolve to Live as My Authentic Self

You often see advice saying that on note, you should pin the article you most want people to read.

I've seen that information a lot.

Now that it's been a little over a month since I started on NOTE, I thought about it again.

What was it that I wanted to convey on note?

I pondered that question.

When I thought about what I most want to convey through note, I remembered that the initial reason I wanted to start Note was, "I want to deliver what I wrote in my master's thesis to as many peers as possible."

So, I've decided to pin my master's thesis, which had been buried because I've been posting so many articles lately!

And, until now, I had been posting it in several parts because it was too long, but you can only have one pinned article 😿

It will be a quite long article, but I've decided to post it as a single piece.

As for why I decided to post my master's thesis on NOTE,

"The Reason I, Who Cannot See, Started Note"

I wrote about it in that article, so please read that as well if you'd like.

Now, please read this, which is closer to an essay than a thesis I wrote with all my heart, if you'd like.

I hope that my thoughts will reach someone's heart, even if just a little ♡
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A Life Story of a Nurse Who Lost Her Sight Mid-Life
—The Path to Finding the Resolve to Live as My Authentic Self—


※This manuscript is an excerpt from a paper written by the author as a master's degree thesis at X University, with some additions and corrections. Due to being an excerpt, some parts of the structure, such as chapters and sections, are missing. Also, although a small number of figures and tables were used in the original thesis, they have been omitted.

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〈Table of Contents〉
◇Chapter 1 Introduction
□Section 1 Research Motivation
□Section 2 Research Purpose and Significance

◇Chapter 2 Previous Research
□Section 1 Definition and Explanation of Terms 〇Item 1 Visually Impaired Person
〇Item 2 Mid-life Visual Impairment
〇Item 3 Low Vision
〇Item 4 White Cane
〇Item 5 Visual Rehabilitation and Low Vision Care
〇Item 6 Accompanied Travel Support
〇Item 7 VISIONGRAM
□□Section 2 Current Status of Visual Impairment 〇Item 1 Current Status of Visually Impaired Persons
〇Item 2 Characteristics of Visually Impaired Persons

◇Chapter 4 Results and Discussion
□Section 1 Introduction of Person A
〇Item 1 Profile of Person A
〇Item 2 Relationship between Person A and Me
□Section 2 The reality of "not being able to see," which I had turned away from, became familiar, and I could no longer escape.
〇Item 1 "I didn't worry about it seriously"
〇Item 2 "If it doesn't interfere with daily life, you can manage somehow"
〇Item 3 "The fact that I couldn't see became familiar for the first time"
□Section 3 To protect myself from the reality of not being able to see, I decided to discard my former self and live as a new, incapable self
〇Item 1 "I was at a loss"
〇Item 2 "Determined to stay smiling for my child"
〇Item 3 "Discard my former self and live as an incapable self!"
□Section 4 Living as my authentic self, including the fact that I cannot see, rather than a false self
〇Item 1 "The real me isn't like this! But..."
〇Item 2 "I am working as a nurse!"
〇Item 3 "I hadn't changed at all"
〇Item 4 Living as my authentic self, including the fact that I cannot see
□Section 5 What "not being able to see" means to Person A
〇Item 1 Not being able to see is one of the conditions of my life
〇Item 2 I don't like being a visually impaired person

◇Chapter 5 Comprehensive Discussion
□Section 1 The identity of a self that cannot see
〇Item 1 Person A who has faced the self that cannot see
〇Item 2 I who have faced the self that cannot see
〇Item 3 Thoughts on looking back at the process of facing the self that cannot see
□Section 2 What it means to "see" and what it means to "not see"
□Section 3 Limitations of this research and future tasks

◇Chapter 6 Conclusion
◇References

◇Appendix Tables
□1 Self-introduction
□2 My own answers to the interview guide
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◇Chapter 1 Introduction

In this chapter, I will describe the motivation and background for conducting this research, as well as the purpose and significance of the research. I will also introduce the structure of this thesis.

□Section 1 Motivation for Research
Going blind or becoming a visually impaired person does not simply mean losing the function of seeing or losing a life where one could see; it means losing one's very existence up to that point and signifies the death of a normal life (Carrol, 1961, translated by Higuchi, 1977). Becoming a visually impaired person is a highly shocking event that can drastically change one's life up to that point, so accepting the disability is by no means easy.
I lost my eyesight due to illness in my 30s and became a mid-life visually impaired person. I could no longer see anything that I had taken for granted, I couldn't do a single thing I used to be able to do, and I lost confidence in myself more and more as I became a person who could do nothing. Left behind by the world that could see, I was filled with fear and loneliness, thinking that I would have to live in this world alone from now on.
Visual impairment took away the important things I had gained until then: my job, human relationships, connections to society, a stable life, self-confidence, dreams, and hope. In particular, losing my job as a nurse, which was my hope for living, was a more painful experience than losing my sight. I lost my only hope and was on the verge of being crushed by the reality of not being able to see. And I despaired of my life. Losing my eyesight mid-life was a major turning point and a deeply painful experience for me.
I couldn't easily face myself like that, and I felt that I was a weak and useless existence who could only think negatively, so I began to deny myself even more. "I had lived my life working hard as a nurse facing patients, so what was wrong with me? Why me? Why did this happen to me?" I spent desperate days thinking only about such things. Not being able to see was everything about me, and I couldn't acknowledge the self that couldn't see. This suffering has not disappeared even now.
However, 8 years have passed since then, and I have come to think that not being able to see is not everything about me, but just a state of not being able to see, and that I should just live my life as a person who can no longer see in my own way. This is only because I met many people and was supported by them. In particular, it was a big deal that I met the person I aimed to be relatively early on.
Among mid-life visually impaired people, there are many who cannot easily meet such supportive people and suffer alone. Among the peers I met at the functional training facility, there were many who said they had been shut in at home for more than 10 years after losing their sight, not knowing what to do and unable to ask anyone for help. Among them, there were many who thought about taking their own lives or developed mental illnesses. Many people spent years or even over a decade before connecting to support organizations or functional training. I feel that the thought, "If I had known sooner, if I had gathered the courage to come to functional training sooner, I wouldn't have had to suffer so much alone," was common.
Of course, I was the same. This is because even if a mid-life visually impaired person wants to hear the stories of people in the same position as themselves or wants to know their thoughts, the support system to fulfill that is not in place. The reality that I, as a person concerned, realized is that there are still many people who are worrying and suffering alone. That is precisely why I felt that it was necessary to convey the thoughts and experiences of myself and my peers as people concerned with mid-life visual impairment.
My experience over the 8 years since I lost my sight was a steep path like climbing Mount Everest, and at the same time, it was a path like a treasure filled with rich encounters and experiences. Of course, there were many painful, difficult, and frustrating things, but on the other hand, I also experienced many events where I could feel happiness, such as happy things, fun things, and feeling the warmth of people. I want to face my own experience sincerely and give meaning to this important experience. And I want to leave it in the form of words and convey it to many people.

□Section 2 Purpose and Significance of Research
The purpose of this research is to clarify the movement of the heart in the process of how a person concerned who has experienced losing their sight mid-life has faced the "invisible" self, while thinking and feeling what. Through that exploration, I will also consider the thoughts held by people who have to lose their eyesight mid-life and the support they need in that process. At the same time, I hope to look back on my own life and be able to give meaning to that experience.
The significance of this research is that by shedding light on the thoughts of people who have become mid-life visually impaired, it can lead to emotional support for people who have had similar experiences and contribute to the enhancement of mid-life visual impairment support in the future. By delivering the raw voices that can only be conveyed because I am a person concerned, I aim to make society more aware of life without sight.

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◇Chapter 2 Previous Research

In this chapter, I will define the terms used in this research and explain the terms used in visual impairment support. Also, based on various literature and materials, I will describe the current status of visual impairment and an overview of previous research on mid-life visual impairment.

□Section 1 Definition and Explanation of Terms
〇Item 1 Visually Impaired Person
Visual impairment is defined differently in fields such as medicine, education, and welfare, but in this research, I will consider it based on the definition in welfare, which is used in more laws and systems. The definition of visual impairment in the welfare field is stipulated by the Act on Welfare of Physically Disabled Persons. In the Act on Welfare of Physically Disabled Persons, Article 4 states that "In this Act, 'physically disabled person' refers to a person 18 years of age or older who has a physical disability listed in the appended table and who has been issued a physical disability certificate by a prefectural governor," and visual impairment is stipulated in Article 15 (Ministry of Health, Labour and Welfare, 1951). Also, as shown in Table 1, the judgment criteria are finely stipulated by the physical disability degree grading table.
Visual impairment is divided into visual acuity impairment and visual field impairment. Visual acuity indicates the ease of seeing objects, and impairment is recognized when corrected visual acuity is 0.6 or less, and it is divided into grades 1 to 6 depending on the degree. The visual field indicates the range in which objects can be seen, and it is measured using either a Goldmann perimeter or an automated perimeter, and the remaining visual field is calculated from the results and classified into grades 2 to 6.
From April 2022, part of the certification criteria for visual impairment was revised. For visual acuity impairment, the previous method of judging by the sum of the visual acuity of both eyes was changed to judging by the visual acuity of the better eye, and for visual field impairment, judgment criteria using an automated perimeter were added. This is a revision that brought it closer to the WHO judgment criteria, and before this revision, because it was judged by the sum of the visual acuity of both eyes, there was a difference between life visual acuity and certificate judgment visual acuity, but with this revision, judgment based on the difficulty of daily life is now performed.

Table 1 Physical Disability Degree Grading Table (Appended Table No. 5 of the Enforcement Regulations of the Act on Welfare of Physically Disabled Persons) (Excerpt of visual impairment only)
Grade 1 The sum of the visual acuity of both eyes (measured by the international visual acuity chart, and for those with refractive errors, measured by corrected visual acuity. The same applies hereinafter) is 0.01 or less
Grade 2
1 The sum of the visual acuity of both eyes is 0.02 or more and 0.04 or less
2 The visual field of both eyes is within 10 degrees each, and the loss rate due to visual efficiency for the visual field of both eyes is 95 percent or more
Grade 3
1 The sum of the visual acuity of both eyes is 0.05 or more and 0.08 or less
2 The visual field of both eyes is within 10 degrees each, and the loss rate due to visual efficiency for the visual field of both eyes is 90 percent or more
Grade 4
1 The sum of the visual acuity of both eyes is 0.09 or more and 0.12 or less
2 The visual field of both eyes is within 10 degrees each
Grade 5
1 The sum of the visual acuity of both eyes is 0.13 or more and 0.2 or less
2 Half or more of the visual field of both eyes is missing
Grade 6 Visual acuity of one eye is 0.02 or less, visual acuity of the other eye is 0.6 or less, and the sum of the visual acuity of both eyes exceeds 0.2


1) Regarding visual acuity of 0.01 or less
Regarding visual acuity of 0.01 or less, in addition to finger counting, hand motion, and light perception shown in Figure 1, it is classified into four categories, including no light perception, which means not feeling light at all. Among these, visual acuity of hand motion or less is called blindness, and among them, no light perception is called total blindness. People with visual acuity of finger counting or more are sometimes called low vision or visually impaired, but there is no clear definition for the terms, and even among visually impaired people and supporters, there are many cases where the recognition of each term does not match. For example, many people perceive total blindness as hand motion or less or light perception or less, and there are also people who think that low vision is congenital and low vision is visual impairment due to mid-life visual impairment. As described, there is no clear definition of terms, and the current situation is that it is not widely known.
Figure 1 How visual acuity of 0.01 or less looks

〇Item 2 Mid-life Visual Impairment
Mid-life visual impairment is a state in which a person who was originally a sighted person has developed an impairment in visual acuity or visual field due to some factor such as illness or accident in the middle of life and has become visually impaired. Igarashi (2003) states that mid-life visual impairment is a person who has developed a visual impairment after experiencing a normal visual life for a long period of time, but the age standard for the time of developing the impairment is ambiguous, and even within laws and systems, I could not find one that showed a clear definition. In this research, I define mid-life visual impairment as a state in which a person develops a visual impairment due to some reason such as illness or accident after adolescence, and as a result, receives various hindrances in life.
It is said that humans obtain more than 80% of information from the outside world through vision, so developing a visual impairment in the middle of life is a major event that completely changes one's life up to that point. Becoming mid-life visually impaired limits activities, causes changes in life due to social, economic, and occupational constraints, and has an impact on the psychological aspect, which has a very serious effect (Takada, 2012). It is said that when one becomes mid-life visually impaired after adolescence, one experiences a strong sense of despair and helplessness (Japan Blind Welfare Committee, 2012). Mid-life visual impairment is a major shocking event that makes it impossible to use vision as a means of obtaining information, temporarily falls into a state of being unable to do anything, and completely changes one's life up to that point, giving deep despair and suffering. To recover from this despair, various support is required. However, the current situation is that it is hard to say that such support is being carried out sufficiently.

〇Item 3 Low Vision
This refers to the degree of visual function that causes some hindrance in daily life and social life, and the Japan Ophthalmologists Association defines a state of having inconvenience in daily life due to visual impairment as low vision.
Generally, when imagining visual impairment, I think many people imagine "totally blind people who cannot see at all," but in reality, there are far more people with low vision than those who are totally blind, and they have a certain degree of visual function and live while utilizing their remaining visual function. People with low vision have the characteristic that "it is difficult to tell that they are visually impaired by appearance" (Sakamoto, 2007), and because of that, they are sometimes misunderstood in various ways. For example, there are people who have visual field constriction and have difficulty grasping their feet or surrounding conditions and have difficulty walking, but their central visual acuity remains relatively intact, and they can see characters and images. In such cases, they can read books and play games. On social media, etc., I often see posts such as "They are holding a white cane but reading a book or playing a game. They can actually see, so isn't the visual impairment a lie?", and there are cases where they are spoken to directly. This arises from misunderstanding and can sometimes hurt the visually impaired person. Since not everyone holding a white cane is totally blind, it is a situation that can naturally occur.
For people with low vision, the parts they can see, the parts they have difficulty seeing, and the parts they cannot see differ from person to person, and what they can and cannot do differs accordingly. How they see also changes depending on their physical condition that day, the weather, and the surrounding environment. Therefore, accurately conveying how one sees is a very difficult task. Because there are people who see in various ways, what each person can do and what they have difficulty with differ.

〇Item 4 White Cane
The white cane is called a "visually impaired person's safety cane" and is one of the prosthetic devices for visually impaired persons stipulated by the Ministry of Health, Labour and Welfare. It is a tool used by visually impaired persons to walk safely, and under Article 14 of the Road Traffic Act, visually impaired persons are obligated to carry a white cane. As shown in Table 2, white canes are divided into three types: support canes, symbol canes, and long canes, and long canes are divided into two types: folding and straight.

Table 2 Types of White Canes
Support cane Also called a body support cane, it is a white cane for supporting the body. Its characteristics are that it is made of sturdy and flexible material, and the grip is T-shaped. A white cane mainly used by people with weak legs and hips or elderly people.
Symbol cane A white cane mainly used to inform people around that one is visually impaired.
Often used by people with low vision who do not have difficulty walking compared to totally blind people. Also used when walking with a guide. The form is shorter and thinner compared to a long cane.
Long cane A white cane for grasping obstacles one step ahead when walking.
A generally known white cane, there are two types: straight and folding, and the shape is long, suitable for exploring obstacles and steps.

White canes can be broadly divided into two functions: "symbol" and "exploration".
The first "symbol" is a function to convey to people and vehicles around that one is visually impaired, and it has effects such as danger avoidance, such as having people around move out of the way, and making it easier to receive assistance.
The second "exploration" function is a function to collect information while checking the road surface condition by sliding the white cane on the ground or walking while tapping, and also to find obstacles, etc., and by this, it becomes possible to grasp steps, obstacles, slopes, etc., and walk safely. Walking while tapping the white cane leads to checking the road surface and the situation ahead from one and a half to two steps ahead of oneself at all times, and it is possible to avoid dangers such as falling or bumping. As described, in order to walk safely in a state of not being able to see, it is very important to use the white cane correctly and walk. However, there are many people who do not have a white cane, or even if they have one, they are not able to use it correctly.
In a survey on white cane carrying by mid-life visually impaired persons conducted by Takada in 2003, 40.8% of severely disabled persons with a physical disability certificate of grade 1 or 2, and 33.3% of those judged by walking training specialists to need it, were not carrying one (Takada, 2003). I think two factors are largely involved in this.
The first is that correct knowledge about white canes and necessary training are not being provided sufficiently. The result was that 5.4% of people received information about the functions of white canes and walking training at the welfare counter when they were provided with a white cane, and most people had not received an explanation (Takada, 2003). This is a survey from about 20 years ago, and it may have improved little by little, but even among those who applied recently, many people have not received an explanation. It is presumed that the state where information is not provided sufficiently still continues.
Compared to other prosthetic devices such as electric wheelchairs, hearing aids, artificial arms, and artificial legs, white canes are inexpensive and have a simple structure. Therefore, there is a tendency to think that no particularly detailed explanation is necessary. However, a white cane that has not been explained about its correct usage and functions and has not been selected according to the person's condition is the same as just a white stick, and while it may fulfill its function as a symbol, it does not fulfill its original function of utilizing the exploration function to avoid dangers such as steps and obstacles. This cannot be called a white cane as a substitute for visual function, and safe walking cannot be performed. A white cane can fulfill its original function only when provided together with walking training to know the correct usage.
Also, even if one has received an explanation about walking training, there are many regions where one has to wait for a long period of time before receiving walking training due to the lack of a system for providing walking training. There are people who have been walking dangerously while feeling anxious for many years without knowing the correct way to use a white cane or whether the white cane suits them. In the San-in Chuo Shimpo on May 18, 2024, the current situation of visually impaired persons who are walking in an anxious state without knowing the correct way to use a white cane because the waiting period is long even if they apply for walking training or Braille training regarding the state where waiting for visual rehabilitation continues in Shimane Prefecture is reported (San-in Chuo Shimpo, 2024). This is considered a problem occurring not only in Shimane Prefecture but also in other regions. In order to be able to use a white cane correctly and walk safely, it is important to provide information about white canes and walking training when applying for a physical disability certificate or a white cane, and to develop a provision system so that people who need it can receive walking training at the time they need it.
The second factor is that the psychological resistance to having a white cane is large, and even if one understands the necessity, one cannot have it due to psychological resistance. A white cane has a function as a symbol to convey to people around that one is visually impaired. This function has a great merit of ensuring safety and receiving assistance by letting people around know that one is visually impaired, but it is also about disclosing one's disability. There are many people who have a great conflict about this. When you have a white cane, you attract the attention of many people in both good and bad ways. When the resistance to the fact that one cannot see is strong and one is not facing reality, the experience of being made aware by people around that one cannot see and is visually impaired is a great mental burden. Therefore, I often hear stories of people concerned who choose not to have a white cane, especially when walking in areas where they have many acquaintances.
For visually impaired people, a white cane is an important symbol for having people around understand oneself, and at the same time, it is a symbol that is thrust upon oneself that one is visually impaired. I want you to know that great courage is required to have a white cane. And I want people who will be involved with people concerned who will have a white cane from now on to inform them of the merits and necessity of having a white cane, and to provide psychological support to alleviate the conflict about having a white cane.

〇Item 5 Visual Rehabilitation and Low Vision Care
In rehabilitation for visually impaired persons, two terms, visual rehabilitation (hereinafter referred to as visual rehab) and low vision care, are often used. Visual rehab is used in the welfare field, and low vision care is used in the medical field. Although expressed by two different words, the contents often overlap, and they are often used without clear distinction.

1) Visual Rehab
The Japan Blind Welfare Association (2017) defines visual rehab as "activities carried out by medical, welfare, education, etc., in cooperation with the aim of enabling people to live lively lives with roles in society independently in their own way even if they have a visual impairment." In order to live independently and in one's own way even after becoming visually impaired, it is necessary to increase what one can do and stabilize the foundation of life. Therefore, in visual rehab, support is provided to build the strength to lead a stable life through walking training, daily life training, etc. Also, visual rehab includes vocational training, and support is provided to acquire the strength to be active in society even in a state of not being able to see.
Speaking of vocational training for visual impairment, training in "massage, acupuncture, moxibustion" conducted in the therapy department of visual support schools is generally imagined, but in recent years, computer operation training using software that reads characters on the screen called a screen reader is also being conducted.
Visual rehab is sometimes conducted at functional training offices as functional training, which is one of the welfare services based on the Comprehensive Support for Persons with Disabilities Act, but there are very few functional training offices, and even if one wants to use them, one has to go to a distant place, and there are many cases where long-term waiting is required. It is far from a state where anyone can use it immediately when needed.
On the other hand, in projects provided as unique services of local governments based on regional support projects, emergency life training projects for mid-life blind people, etc., the project name, project content, usage method, user's self-burden, project budget, etc., are also different for each. There are local governments that do not conduct such projects at all or sufficiently, and the current situation is that there is a large difference in the services that can be received depending on the region. Also, such unique projects have various budget scales, and many offices are forced to operate on tight budgets.
On the website of the certified NPO Kobe Eye Light Association, the current situation where the association is forced to operate the project in the red due to a significant decrease in the commission fee from Kobe City for the visual rehab project, making it difficult to continue the project, is reported (Certified NPO Kobe Eye Light Association, 2024). This is not a problem limited to Kobe City, and the current situation where sufficient budget cannot be secured and sufficient activities cannot be performed within a tight budget is seen in various regions.
Projects conducted uniquely by regions are conducted close to the users, and there are many visiting projects, making them in a form that is easy for users to use, but it is not a situation where anyone can receive them anywhere, and it is also in a state where there are issues with the continuity of the project.
For visually impaired people, being able to move safely and do things around oneself by oneself is a great joy and plays an important role in living in one's own way. In mid-life visual impairment, one experiences many times that one cannot do what one took for granted, and loses confidence in oneself. There are many people who are caught up only in what they cannot do. However, by changing what one thought one could not do to what one can do one by one through visual rehab, one can regain confidence in oneself. For example, "I thought I couldn't withdraw money at an ATM in a state of not being able to see, but I learned of the existence of an ATM with a receiver that can be operated with voice and push buttons, and I became able to withdraw money by myself," "I thought I couldn't cook rice because I couldn't put water up to the line, but I was taught that I could easily measure with a rice measuring cup, and I became able to cook rice by myself," etc., visual rehab is where one can realize that one can still do various things if one devises. Even if each one is a trivial thing, the joy of being able to do what one could not do is great, and one can regain confidence. Visual rehab is indispensable for visually impaired people, and it is necessary to create a future where visual rehab can be delivered to everyone who needs visual rehab.


2) Low Vision Care
This is a general term for support provided to people with low vision, and it is a comprehensive expression of medical, educational, vocational, social, welfare, and psychological support. The Japan Ophthalmologists Association states that the role of ophthalmology in low vision care is the "window to low vision care," and fulfills the role of checking the patient's way of seeing and bridging to necessary services and support organizations according to each person's condition (Public Interest Incorporated Association Japan Ophthalmologists Association, 2023). Also, prescription of low-vision glasses, light-shielding glasses, etc., as prosthetic devices, and creation of medical certificates for application for physical disability certificates, disability pensions, etc., are also the roles of ophthalmology. Low vision care at ophthalmology is centered on consultation and information provision, and there are few organizations that actually conduct training. For low vision care, a low vision examination judgment fee of 250 points/month can be calculated as medical remuneration, but this is remuneration for selecting auxiliary tools based on the results of the examination and cooperating with other visual impairment support organizations, and medical remuneration for subsequent training is not stipulated.
The Japan Federation of the Visually Impaired submitted a request to the Ministry of Health, Labour and Welfare in 2019 seeking a revision of medical remuneration for low vision care, but this request has not yet been accepted (Social Welfare Corporation Japan Federation of the Visually Impaired, 2019). The current situation is that medical remuneration for rehabilitation for visual impairment in ophthalmology is very small compared to medical remuneration for rehabilitation for other diseases and disabilities. Therefore, the role of ophthalmology in low vision care is limited to "window" and "bridging," and regarding actual training and support, it relies on visual rehab conducted in the welfare field and support at educational institutions.

3) Functional Training
This is a welfare service based on the Comprehensive Support for Persons with Disabilities Act and is a type of self-reliance training. The target of use is a person who possesses a physical disability certificate for visual impairment. It is conducted at functional training facilities such as the National Rehabilitation Center for Persons with Disabilities and the Social Welfare Corporation Japan Lighthouse, and there are 18 functional training facilities nationwide (Social Welfare Corporation Japan Lighthouse Training Department, 2023).
According to the website of the National Rehabilitation Center for Persons with Disabilities, regarding functional training, it is introduced as "mainly for people with visual impairment, we support through training, etc., so that they can make the most of their existing strength and lead a more fulfilling life in the community, home, workplace, school, etc.," and as main training contents, walking training, computer training, Braille training, recording/playback machine training, daily life training, and low vision training are introduced.
Functional training is broadly divided into walking training, communication training, and daily life training, and aims to acquire the basic strength to live in a state of not being able to see through training and to be able to lead a stable life.

4) Walking Training
Using a white cane, one trains in methods to be able to walk safely even in a state of not being able to see. It is conducted by walking training instructors, etc., who are experts in visual rehab. It is training to acquire techniques and ingenuity necessary to do white cane walking by oneself, such as methods to explore information at one's feet and information ahead, methods to check the surrounding environment and safety from information obtained from senses other than vision such as surrounding sounds, smells, and wind direction, and methods to create a map to the destination in one's head. In addition, training is also conducted on walking techniques necessary for each person, such as how to walk when being guided by a person, safe walking methods without using a white cane indoors, etc., and how to utilize remaining visual acuity when walking. Regarding walking with a guide dog, it is conducted not by a walking training instructor but by a guide dog training instructor.

5) Communication Training
This is training to acquire methods to utilize characters such as ICT equipment operation methods using voice and magnification, Braille, and ink print (characters written on paper). In ICT equipment training, one masters methods to use computers, smartphones, tablet terminals, etc., according to each person's remaining visual acuity using magnification functions, color vision adjustment functions, and screen reader functions (functions that read characters drawn on the screen as voice). Training is conducted so that one can use Word, Excel, PowerPoint, Outlook, the Internet, etc., using various functions such as screen readers and magnification. Recently, cases aiming to acquire such skills and return to one's original workplace are also increasing.
In Braille training, training to touch and read Braille, which represents characters with 6 dots, and training to write by hitting dots by oneself are conducted.
In ink print training, one trains in methods to write characters even in a state of not being able to see, and also learns so as not to forget kanji.
Also, as training for people with low vision, training to see characters, etc., using magnifying reading machines, monoculars, and low-vision glasses is also conducted.

6) Daily Life Training
This is training for visually impaired persons to acquire techniques and ingenuity regarding movements around oneself necessary for living. Because necessary techniques differ depending on each person's lifestyle, etc., the training content is tailored to each person's life. For example, housework movements such as cooking, cleaning, laundry, ironing, sewing, how to apply makeup, how to choose clothes, how to distinguish money, ATM voice operation, and passbook management methods using Internet banking, etc., one thinks of and acquires methods to be able to do various movements necessary for life so as not to have trouble in life even in a state of not being able to see.

7) Walking Training Instructor
This is a rehabilitation professional who provides guidance on walking using a white cane, daily life movements, etc., to visually impaired persons. Unlike other rehabilitation professionals such as occupational therapists and speech-language-hearing therapists, it is not a public qualification, but it is a qualification certified by the Ministry of Health, Labour and Welfare. They are often placed in functional training facilities for visually impaired persons, visual support schools, information provision facilities such as Braille libraries, and local governments. The training of walking training instructors is conducted by two places, the Social Welfare Corporation Japan Lighthouse Training Department and the National Rehabilitation Center for Persons with Disabilities College Visual Impairment Department, commissioned by the Ministry of Health, Labour and Welfare, and the number of walking training instructors trained per year is about 30. This is extremely small compared to other rehabilitation professionals.
A walking training instructor is not a national qualification, and medical remuneration for rehabilitation for visual impairment is very low, so the placement of walking training instructors in hospitals has hardly progressed. Therefore, compared to other rehabilitation professionals, their status is often not stable, and their salary level is also low. Because it is not a national qualification, there are many people who do not know that there is a rehabilitation professional called a walking training instructor, and because their status is unstable, there are few people aiming to become walking training instructors. The fact that there are not many facilities where placement standards for walking training instructors are stipulated is also considered to lead to the fact that walking training instructors do not increase. I think it is necessary to stipulate clear placement standards and guarantee their status, like other rehabilitation professionals.

Item 6 Accompanied Travel Support
This is one of the disability welfare services based on the Comprehensive Support for Persons with Disabilities Act, and provides support for going out to visually impaired persons who have difficulty going out alone. Specifically, it provides support such as movement such as guidance and safety assurance, and provision of visual information while going out, reading aloud, and writing on behalf. For example, when accompanying for shopping, it provides not only guidance to the destination and guidance in the store but also product explanation and provision of information desired by the user. Accompanied travel support supports not only daily going out but also leisure and social participation, and is one of the important services that support the lives of visually impaired persons.

〇Item 7 VISIONGRAM
This is a visual filter developed by Dentsu to visualize visual impairment. It was announced at the World Championships for visually impaired judo held in Tokyo in December 2023, and the Japanese national team adopted it. Based on examination data, it expresses each athlete's visual acuity and sensitivity by changing the size and density of dots (Dentsu, 2024).
How visual impairment looks is influenced by various factors such as visual acuity, visual field, and color vision, and even with the same disease and the same disability grade, the way of seeing is various. Having people around correctly understand one's way of seeing is important for receiving appropriate support, but it is very difficult. However, if you use this VISIONGRAM, you can easily let people around know your way of seeing.
On the official website of VISIONGRAM, the philosophy of "aiming for a world where understanding of visual impairment deepens and both disabled and non-disabled people can live together easily" is posted, and it is expected that new communication will be born through VISIONGRAM. I think VISIONGRAM can not only become a new communication tool but also lead to enriching the lives of visually impaired persons.
By utilizing VISIONGRAM and easily and accurately conveying your way of seeing, you can have people correctly understand your disability condition, issues, necessary support, etc., which leads to creating an environment where you can be active in your own way.

VISIONGRAM can be created by inputting your own examination data, and anyone can use it. I felt that VISIONGRAM could become an important tool that supports the lives of visually impaired people.
□Section 2 Current Status of Visual Impairment
〇Item 1 Current Status of Visually Impaired Persons
According to the "2022 Survey on Difficulty in Daily Life, etc. (National Survey on Actual Conditions of Disabled Children/Persons at Home)" conducted by the Ministry of Health, Labour and Welfare (2022) in December 2022, the number of visually impaired persons in Japan is 273,000, and it is estimated that about 90% of them are mid-life visually impaired. The number of visually impaired persons is 6.54% of physically disabled persons and 2.34% of all disabled persons. This is the smallest number among physical disabilities. Also, in the previous survey in fiscal 2016, it was 312,000, and it is decreasing.
In the breakdown of physical disability certificate grades for visual impairment, 113,000 are grade 1 and 93,000 are grade 2, and severely disabled persons of grades 1 and 2 account for 75.45% of the total. Compared to hearing impairment and physical disability, the ratio of severely disabled persons is overwhelmingly high, and the number of certificate holders of grade 3 or lower is an extremely small result (Ministry of Health, Labour and Welfare, 2022). Looking only at these results, the number of visually impaired persons looks small and is decreasing. However, the number of visually impaired persons in Japan estimated by the Japan Ophthalmologists Association in 2007 by analyzing census data and various epidemiological research data, etc., as original data is about 1.64 million, and it is considered that there are far more visually impaired persons than the results of the "Survey on Difficulty in Daily Life" and the number of physical disability certificate holders (Japan Ophthalmologists Association Research Team Report, 2006; 2007; 2008).
Chairman Takeshita of the Japan Federation of the Visually Impaired points out that in the method of estimating the number of disabled persons based on the results of the current "Survey on Difficulty in Daily Life," the number of valid responses from visually impaired persons is small, and the number of visually impaired persons may be estimated to be small (CB Holdings, 2024). For visually impaired persons, it is difficult to respond to a survey with many questionnaire items written in ink print, and there is a possibility that there are many visually impaired persons who have not responded.

Also, visual impairment has a deep relationship with aging, and in cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy, etc., the number of patients increases with aging. Considering this, in Japan where aging is progressing, it is highly likely that the ratio of people who become visually impaired mid-life will increase in the future, and in particular, it is estimated that the number of elderly mid-life visually impaired persons will increase. It is considered important to consider support for people who bear the double difficulty of visual impairment and the decline in physical function due to aging.
〇Item 2 Characteristics of Visually Impaired Persons
It is said that visual impairment generally causes information impairment and movement impairment due to not being able to see. Information impairment is that one cannot collect character information because one cannot see, and one cannot operate ICT equipment such as smartphones and computers, making it difficult to access information, making it difficult to obtain necessary information.
It is said that humans obtain more than 80% of information collection from the outside world through vision. Therefore, developing a visual impairment leads to losing many of the means of information collection. When one cannot see, not only does information collection by characters become difficult, but it also causes various difficulties in life. Information obtained from vision is large and is indispensable to our lives. Therefore, there are many people who cannot easily connect to information on support for visual impairment and worry alone.
Movement impairment is that walking or going out alone becomes difficult because one cannot see. One cannot go to various places freely, and it also becomes difficult to go to government offices and support organizations to obtain support. One loses many opportunities for social participation and often becomes socially isolated.
Among people who have become visually impaired, it is said that there are many people who experience "shut-in" because it becomes difficult to go out of the house. In a survey on the going-out situation of visually impaired persons conducted by Takada et al. (2012), 42.4% of visually impaired persons were in a shut-in state where going-out opportunities were less than 3 times a month, and 59.5% of them had decreased mental health. Shut-in makes connections with society thin, and furthermore, makes connections with information thin.
Information impairment and movement impairment affect the difficulty of connecting to people and information, and this creates a situation where it is difficult to connect to support. I think this difficulty in connecting to support is the first major characteristic of visual impairment.
Another major characteristic of visual impairment is the rehabilitation (hereinafter referred to as rehab) system. Rehab has its etymology in Latin, and is a word made from "Re" meaning again and "habilis" meaning adaptation. Translated literally, it becomes "making it in a suitable state again," and when a disability occurs in body or mind function due to some cause and one becomes unable to adapt to life, it is to recover the lost function through training, acquire alternative means, and make it a state where one can adapt to life again. For example, in lower limb paralysis due to spinal cord injury, it is difficult to recover the lost function of both lower limbs as it was, but through rehab, one aims to acquire the technique to live in a wheelchair and acquire the strength to live in one's own way as oneself in the current state.
Even in visual impairment, it is difficult to recover the lost visual function, but through rehab, one aims to acquire the technique to see objects by effectively using remaining visual acuity, and the technique to walk or lead a daily life even in a state of not being able to see, and acquire the strength to live in one's own way. "Visual rehab," which is rehab for visual impairment, plays a very important role just like rehab for exercise, language, swallowing, etc.
Losing the function of seeing is losing many of the means of obtaining information, and the impact on life is very large. That is by no means small compared to the impact that spinal cord injury has on life. That is precisely why it is important to receive visual rehab early and acquire the strength to adapt to life in a state of not being able to see. However, among these rehabs, only visual rehab is not being worked on within the medical positioning, and the current situation is that almost all training including walking training is being conducted only within the framework of welfare.
If it were a spinal cord injury, rehab training at a hospital or facility would be conducted, and one could return to the community in a state of having a prospect of life in a wheelchair. On the other hand, in visual impairment, in most cases, one has no choice but to return to the community in a state of not knowing how to live because one cannot see. Stories of people who feel as if they were abandoned by the hospital because they had to be discharged while still having great confusion are often heard among people concerned.
Even if one is hospitalized for an eye disease and becomes visually impaired, one cannot receive visual rehab such as walking training or daily life training at the hospital. This is because professionals who can conduct visual rehab are not placed in hospitals. There are facilities where orthoptists conduct low vision training, but many are outpatient only, and it is not a system where one can receive sufficient training.
The Japan Ophthalmologists Association sets the role of ophthalmology in low vision care as "window" and "bridging," and has created a smart site to connect from medical care to support for welfare and education, and has realized introduction in 47 prefectures. The smart site was proposed by the American Academy of Ophthalmology in 2005, and in Japan, the Hyogo Prefecture Ophthalmologists Association created it for the first time as the smart site "Tsubasa." Currently, the Japan Ophthalmologists Association supports it, creates it for each prefecture, and distributes it to ophthalmology medical institutions. The leaflet is designed so that contact information, etc., of visual impairment support organizations in the nearest region can be written, and it is distributed to people judged necessary at medical institutions, helping to bridge from medical care to other support organizations (Public Interest Incorporated Association NEXT VISION, 2021). I think that if this smart site permeates medical institutions nationwide, it might be possible to reduce the number of people who feel abandoned by the hospital.

However, there are many problems such as support being interrupted between medical care and welfare, and the welfare system on the receiving side not being sufficiently in place, and the current situation is that the smart site itself is not functioning firmly. Therefore, I think it is necessary to consider not only the function as a "window" but also a system where one can receive firm rehab within medical care just like other disabilities.
I think that the environment where it is harder to access rehab compared to other disabilities is a characteristic of visual impairment and a problem that has a major impact on the subsequent life of visually impaired persons.

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◇Chapter 4 Results and Discussion

In this chapter, I will introduce Person A in Section 1. From Section 2 onwards, I will introduce the main narratives in the following order, and by analyzing their meaning, I will consider how Person A has faced the self that cannot see.
"I didn't worry about it seriously," "If it doesn't interfere with daily life, you can manage somehow," "The fact that I couldn't see became familiar for the first time," "I was at a loss," "Determined to stay smiling for my child," "Discard my former self and live as an incapable self!," "The real me isn't like this! But..."," "I am working as a nurse!," "I hadn't changed at all," "Living as my authentic self, including the fact that I cannot see," "Not being able to see is one of the conditions of my life," "I don't like being a visually impaired person"
□Section 1 Introduction of Person A
〇Item 1 Profile of Person A

Person A is a woman in her 50s and a mother of one child. Her husband is a person with a steady and caring personality. My impression of Person A is that she is calm at first glance but has a very strong core. Her hobbies are walking with her beloved dog, watching YouTube, and home gardening. Before her visual impairment progressed, she said she preferred to spend time actively, such as going out to cafes and bookstores alone and moving her body, rather than spending time quietly at home.

Table 3 is a chronology showing the transition of Person A's main life events and changes in life due to visual impairment. She was diagnosed with a chronic progressive eye disease in her 20s, and from around her mid-30s, she began to realize visual impairment due to visual field constriction. She has been working as a counselor at an organization that provides visual impairment support since her 40s, receiving various consultations from visually impaired persons and their families, and providing support for living in one's own way together with illness and disability. Visual impairment continues to progress even now, and difficulties in life due to difficulty in seeing are gradually increasing. Person A calmly accepts such a current situation as reality and values living as her authentic self.
Figure 2 is a VISIONGRAM showing Person A's current way of seeing. Her right eye visual acuity is hand motion (to the extent that she can distinguish that something is moving when moving her hand in front of her eyes), and her left eye visual acuity is 0.3, and she has lost more than 90% of her visual field. She has become a severely visually impaired person with a physical disability certificate of grade 2, and grade 2 is the most severe grade for visual field impairment. Her left eye visual acuity remains relatively intact, but her visual field is extremely narrow, and it is difficult to identify people's faces and surrounding conditions. Since the characters she can see at once are about 2 to 3 characters, reading and writing using visual acuity have become difficult. Reading sentences requires considerable effort, and it is changing from reading using a magnifying reading machine to information collection by voice. Because her visual field is narrow, many difficulties occur in movement and daily life, and she said that she has increased using accompanied travel support to move because walking alone has become difficult now.
〇Item 2 Relationship between Person A and Me
Person A and I met right around the time my left eye visual acuity dropped significantly and I became a visually impaired person who obtained a grade 1 physical disability certificate. It was triggered by being introduced to Person A at a visual impairment support organization I visited by chance seeking a white cane, saying, "There is a staff member who is also a visually impaired person and a nurse like you, so why don't you talk to her?" Person A worried, suffered, and stayed close to me during the period when my visual impairment progressed and I had to lose even my job as a nurse, which I considered my calling. If it weren't for Person A, I might not have been able to overcome this period.

Meeting Person A gave me new hope and goals when I had completely lost confidence and goals as a nurse and as a person. The figure of Person A, who supported me with all her might, taught me that "there are still things I can do even if I can't see," "I can be a support for someone," and "I can work splendidly as an interpersonal support professional." And I began to think, "I want to find a job again where I can be a support for someone as an interpersonal support professional." Since that time, Person A has been the existence I have aimed for.
For me, Person A is as big and important an existence as my family and best friend, and that has not changed even now. Even now, nearly 8 years after we met, Person A is my goal. And while being a good senior and a good understanding person, she has also become a good peer as a person who cannot see and as a professional in visual impairment support. I feel that now, little by little, we have become a relationship where we can not only be supported but also support each other.
□Section 2 The reality of "not being able to see," which I had turned away from, became familiar, and I could no longer escape.

〇Item 1 "I didn't worry about it seriously"

In her mid-20s, Person A underwent an examination at the hospital where she worked and was told that she had a chronic progressive eye disease and would become visually impaired in the future. The subjective symptoms at this time were only night blindness, and she did not feel inconvenience in her nursing job or daily life.
"I was young in my 20s, and because there was no hindrance to daily life that much, I didn't feel like consulting someone or getting depressed, but I remember being shocked alone. It was shocking after all. It was shocking, it was shocking. Yeah, I think it was shocking. But I don't think I worried about it seriously"
In an examination she took with a light heart as a bridal check, she learned of the existence of a disease she hadn't thought of and received an unexpected shock. Person A used the word "shock" many times to express her feelings at this time. Regarding chronic progressive eye disease, she said, "It's like a disaster that fell from the sky. It was something I never wanted to receive," and perceived the disease as a disaster. Because she was a nurse, just by being told the disease name, she could vaguely picture her future self, such as what kind of progress this disease would follow and what kind of life visual impairment would be. However, regarding this shock, she states, "I didn't worry about it seriously."
Person A, who had no hindrance in life, says about her subjective symptoms at this time, "It's true that when I went to a dark place or a suddenly bright place, I couldn't see, and I wondered why, but that was all..." She says she had no realization at all of "not being able to see" or "not being able to see in the future." Yamakawa (2020) states that even if one receives notification about the possibility of blindness in the future while one can see, it often does not accompany a sense of reality. Person A was the same, and even if she was told "you will not be able to see in the future," she could not grasp it as her own reality, and I wonder if she felt that not being able to see was an event in a distant world far from herself. Being able to distance oneself from the reality of not being able to see might be one of the characteristics of chronic progressive eye disease. Person A actually chose the action of not thinking deeply.
The suffering of chronic progressive eye disease is often expressed as "suffering like strangling with silk wadding." It can be said that it is suffering that slowly corners you, and attacks you slowly and surely, even if it is slowly. The degree of symptoms, the time of appearance, and the speed of progression differ for each person, but many patients follow a course where symptoms appear little by little and progress. It takes decades for symptoms to progress, and one slowly becomes unable to see. Therefore, at the time of diagnosis, despite having few subjective symptoms and not feeling hindrance in life, one must receive a serious declaration that "you will not be able to see in the future." This is a major characteristic of this disease. Patients with chronic progressive eye disease must face the reality that "you will not be able to see" from the moment they receive the notification.


In Person A's case as well, symptoms have progressed gradually over nearly 30 years. Nearly 10 years have passed from receiving the diagnosis to feeling the hindrance in life due to subjective symptoms. While there is no cure and one will not be able to see in the future, when looking at the present, not being able to see has not yet appeared in front of one's eyes. Especially in a state where there are no subjective symptoms that cause hindrance in life, it is presumed that the declaration that one will not be able to see does not feel real and one cannot grasp it as one's own matter. However, I think that this reality that one will not be able to see is just something one can turn away from, and it is always in one's consciousness. Every time one feels a trivial change, the reality that one will not be able to see appears in front of one's eyes, giving anxiety and agitation. One is forced to live such a life.
Also, the disease name notification was an event that occurred in her 20s when her nursing job was very busy and fulfilling, and because she thought "illness is something you get after getting older," I think it made the sense that the illness was a reality that happened to her thin. Even if there were peers who faced the intractable disease of patients as work, there were almost no peers who faced the intractable disease as her own problem around Person A. And if she looked at the days of working as a nurse, there were many things she had to think about and many things she had to do right in front of her eyes. The reality she could see in front of her eyes might have made the reality of the distant future that she would not be able to see invisible.

〇Item 2 "If it doesn't interfere with daily life, you can manage somehow"

Person A realized a rapid decline in visual acuity in her left eye during pregnancy, but because she thought there was no point in rushing during pregnancy for a disease with no cure, she did not go to the hospital immediately. After childbirth, she went to the hospital at a time when things had calmed down a little, and there she was declared again that she had a chronic progressive eye disease, that there was no cure, and that she would become visually impaired in the future.
"I was told the disease name again, you will go blind, it won't be cured, there is no treatment policy, and when I was told that, it was shocking. More than the first time, I think this was the most shocking. Because it makes me re-recognize it. But at that time, I didn't have time to be depressed, my child was small, and, you know, I still had to do various things... I have a memory of going home shocked on the way back from being told. Hmm, but, if I was dragging it to the next day, I don't have that memory, so being chased by daily life might have worked positively in a sense. I think there was a place to escape into. Hmm, escape into, or rather, after all, I think it didn't interfere with daily life that much. Because one side could see. In the end, if it doesn't interfere with daily life, you can manage somehow, right"
Even after receiving the diagnosis of chronic progressive eye disease for the first time, by looking at the life in front of her eyes, she was leading a daily life that was no different from before. She continued her nursing job, got married, and was blessed with a child. However, due to the decline in visual acuity during pregnancy, the reality that she would not be able to see appeared little by little in her daily life. And she was told again at the hospital that she had a chronic progressive eye disease and would become visually impaired in the future. She was forced to face again the reality that she would not be able to see, which she had turned away from until then, and was shocked. She said that the shock at this time was greater than the first time.

Why was the shock at this time greater for Person A? In the first diagnosis, there were almost no subjective symptoms, but this time, she experienced an episode of decline in visual acuity in her left eye, and the realization that she would not be able to see had increased. Therefore, I think she accepted her subjective symptoms as something more concrete, not something vague without a sense of reality like before. Imamura et al. (1997) state that in chronic progressive diseases like Parkinson's disease, acceptance of the disease is not only progressing with the passage of time, but is also greatly influenced by symptoms at that time, etc., so one experiences swaying back and forth many times along with the progression of symptoms, and is shocked. Chronic progressive eye disease is also a chronic progressive disease like Parkinson's disease, where symptoms gradually progress and subjective symptoms appear little by little. I think that every time she felt a change in how she saw, she experienced a swaying back and forth to the reality that she would not be able to see, and while accumulating that shock, the fact that she could not see became realistic.
However, even this time, Person A was able to continue a daily life that was no different, saying "you can manage somehow." Although symptoms appeared in a visible form of a large decline in visual acuity in her left eye, in reality, if one has visual acuity in one eye, one is not affected much in most daily lives. Also, because she was in the middle of child-rearing and her daily life was very busy, it might not have given Person A time to think. Therefore, by doing daily life, I wonder if she was able to turn away again from the reality that had appeared a little that she would not be able to see.

〇Item 3 "The fact that I couldn't see became familiar for the first time"

Person A's difficulty in seeing had been progressing little by little, but without feeling a major hindrance to life, she was leading a daily life that was no different as a mother and as a housewife, and was raising her child with love in her own way. However, from around her mid-30s, subjective symptoms due to the progression of visual field constriction gradually appeared, and bumping into things, dropping things, and falling increased.
"After all, every time I bumped into things, I was shocked why I would do such a thing... shocked... yeah, it's shocking, shocking. At that time, I still thought of it as a small, yeah, failure. After all, every time I failed, my feelings would get depressed, and I think it might have led to sad thoughts. (Omitted) When failures gradually increased, I felt, ah, is this it? The words that I would go blind, that I would lose my sight, appeared on the surface. After all, in daily life, after all, that, failure, or rather, a situation where I couldn't do things the same way as before was born, and I think it became familiar for the first time that I couldn't see"
In this narrative, two words were particularly impressive. One is "shock." Person A changed the way she said it while repeating the word shock twice, three times, four times, as if she were talking to herself, "That was it, wasn't it." It was not a strong tone at all, but as if she were reconfirming the painful feelings of that time deeply while having a dialogue with herself. And the other is "failure." This word failure also came out many times, but Person A always inserted words like "that" or "this" before the word failure, as if making time to think. I felt that feelings like "why," "how come," "it shouldn't be like this," "actually it's not a failure at all" were expressed quietly in this time.

Person A felt confusion, "Why does such a thing happen?" at her own actions that she had never done before, and perceived this change as a failure. While repeating that failure many times, she noticed that "this is happening due to not being able to see," and felt the hindrance in life due to not being able to see for the first time. And the words "you will go blind" appeared in front of her eyes as reality, and she realized that it had changed from "you will not be able to see" to "you cannot see." Until then, she had thought of not being able to see as a problem in a distant world, but at this time, she came to perceive for the first time that not being able to see was a familiar problem happening to herself.
She could finally no longer escape from the reality that she would not be able to see, which she had desperately tried to escape from until then, and the reality that she could not see came to be thrust upon her at all times. I wonder if the shock that she could not escape from this reality that she could not see was not a shock with strong energy that would lead to anger, for example, but rather a shock that would lead to deep disappointment that would suck up all of her own energy. And I think that that was what made Person A speak quietly.
□Section 3 To protect myself from the reality of not being able to see, I decided to discard my former self and live as a new, incapable self

〇Item 1 "I was at a loss"

Person A was forced to face the reality that she could not see. The shock this reality gave was something she had never experienced in her life up to that point, and it was not something she could easily face. Her head and heart were filled with the reality that she could not see, and she fell into a situation where she could think of nothing and could do nothing. She lay in bed and could not even do housework, and it had a major impact on her daily life. She said she realized, "When I'm really shocked, I become unable to do anything like this."
"In my life up to now, I was generally the type who could overcome things even if something happened, but honestly, this was an experience where I was like, this is it. Yeah, I was so, ah, what should I do, I was really at a loss, everyone is the same, but I was at a loss, I had no strength in my body, and I felt like I couldn't even shed tears. I couldn't even put this situation into words"

Fukasawa (2012) states that losing one's sight in the middle of life is so painful that it cannot be expressed in words, and there are many people who harbor suicidal desires due to anxiety about future life due to blindness. 56.2% of mid-life visually impaired persons have thought about suicide, and the reasons include social, psychological, economic, and family blows caused by visual impairment (Yamada et al., 2012). The shock given by losing one's sight in the middle of life is so great that one thinks about taking one's own life. It is not difficult to imagine that various emotions such as confusion, chaos, fear, anxiety, and disappointment arise, and one is dominated by them and loses mental leeway.
Person A was originally a type of person who was relied on rather than relying on others, and she was aware of it herself. And she had the pride that she had overcome most things by her own strength. For Person A, who had been a reliable existence as an older sister, a nurse, and a mother until then, the reality that she could not see was a major setback she experienced for the first time that she could not overcome by herself, and she was at a loss not knowing how to deal with it. The self that repeated failures of bumping into things, dropping things, and falling was a self completely different from the self until then. I think that realizing failure was being made to realize the self that had changed, and being thrust upon the reality that she could not see. I think that acknowledging the self that had changed was acknowledging the reality of the self that could not see. Because the figure of the self that could not see and repeated failures was far from the figure of the original self, I speculate that facing reality was something that required even greater energy for Person A.

〇Item 2 "Determined to stay smiling for my child"

Person A loved children and valued herself as a mother and child-rearing very much. Child-rearing while holding difficulty in seeing was difficult, but she said she raised them with plenty of love with a stance of waiting, emphasizing the child's "growing by themselves." Around the time the child went to nursery school, she would lose sight of the child due to the narrowness of her visual field, so she would hold the child's backpack and go out to various places together. When they became elementary school students, she tried to call many friends to the house, play together, and spend time eating snacks. And the child who received plenty of such mother's love was also a bright child with a constant smile. However, Person A faced the reality that she could not see, and became unable to fulfill her role as a mother. And she lost the smile as a mother that she had valued.
"When I was having a hard time at that time, after all, I didn't have a smile. Even myself at that time. When I looked suddenly, I noticed that the child's smile had decreased. Ah, this, I thought, it's because I'm not smiling, at that time. And there... ha... it's no good... I thought, yeah, I, what should I say..., I thought I shouldn't make my child feel like this, and, I decided to stay smiling"
Person A let out a deep sigh with "...ha..." and quietly muttered "it's no good..." in a low voice. Until then, she had been talking relatively calmly without stumbling much, but there was a silence of several seconds before and after this part. It was as if she were squeezing out words while accepting the self-reproach and pain that came up, remembering that time.

Person A noticed that the smile had disappeared from her child, and thought that the child's figure was a mirror reflecting herself, and that by not being able to smile, she was taking away the child's smile. By becoming unable to manage daily life and losing mental leeway, she might have lost the smile she valued as a mother.
Omae (2009) states that the sense of crisis that one must support the family has a major impact on both acceptance and stress regarding facing disability, and I think that for Person A as well, the existence of the child was a major pressure and also a major support. And she decided, "I cannot go on like this. I must regain my child's smile," and came to think that she would somehow fulfill her role as a mother. For Person A at this time, the reality that she was not fulfilling her role as a mother might have been a greater shock than the shock of facing the reality that she could not see. Therefore, I wonder if she was able to change her focus from the self that could not see to the self as a mother. I think that what supported Person A, who was on the verge of being crushed by the reality that she could not see, at the limit was the existence of her important child and herself as a mother.

〇Item 3 "Discard my former self and live as an incapable self!"

Person A, who had a strong determination that "I must fulfill my role as a mother to protect my child's smile," noticed that if she continued to face the reality that she could not see as it was, she would not be able to maintain herself, and would become unable to fulfill her role as a mother or continue daily life. She came to think that the thing she should prioritize most now was fulfilling her role as a mother, and for that, she had to change the current situation. And she changed from a state of facing the reality that she could not see head-on to a stance of how she could escape from facing this reality directly.
"I really hated that too, this isn't me. So I, if I go on like this, I will be crushed, mentally, I know my bottom, so, I thought, I don't want to become depressed if I go on like this, so to not lower it any further, I thought what should I do for that, and I decided to discard my former self! I discarded it! I discarded it perfectly. I decided to live from this incapable self"
Person A thought of the failure due to not being able to see not as "because I cannot see," but "I fail because I am clumsy and originally slow," and tried to change her consciousness so that she would perceive "I fail because I am an incapable self" instead of "because I am a self that cannot see." I wonder if she was desperately trying to protect herself by forcibly convincing herself that "I didn't change, I was originally this kind of person," and escaping from facing the reality of "the self that cannot see" and "the self that has changed."

Person A repeated the word "discard" many times. Also, the word "perfectly" was very impressive. I felt that Person A's thought, "I don't really want to discard my former self, my original self, and I don't want to give up, but it can't be helped," was contained there. I think she used the expression "discarded perfectly" daringly to express her strong determination, "I don't really want to discard it, but I discard it because I can't maintain myself if I don't!" I think that facing "the self that has changed" was a painful work that required great energy, to the extent that she had to discard the "self" she had valued until then.
Person A made the choice, "If I face reality and break myself, I will escape without facing reality." This choice of "escaping" is also something that can never be done easily. What made it possible was the existence of her child who was more important than herself, and I wonder if her strong determination as a mother to protect her child's smile supported her courageous decision to escape. I think Person A's choice, "Discard my former self and live as a new self," was a figure of "escaping from facing reality" to protect herself as a mother.
□Section 4 Living as my authentic self, including the fact that I cannot see, rather than a false self

〇Item 1 "The real me isn't like this! But..."

Person A created a self called "a clumsy and incapable self" that was far from her original figure, and every time she faced failure or things she couldn't do, she told people around her, "I fail because I am clumsy," and told herself the same. By doing so, she forcibly turned her eyes away from the reality that she could not see and protected herself. On the other hand, every time she played the clumsy self, she also harbored a major conflict, "The real me is not clumsy... this is not my figure."
"Going out for child's events, going out, going shopping, greeting mothers, etc., when those became impossible, or when there was failure among everyone, when I couldn't say I couldn't see and was hiding it, I played a clumsy self, and said, 'I'm sorry for such a failure, I'm clumsy, I'm clumsy,' or something, yeah, I didn't cover up the situation, yeah... At that time, while doing that..., yeah... the real me is not clumsy, not clumsy... I had times when I thought, ha... yeah... I had times when I thought, and playing an incapable self... yeah... I had times when I had the thought that the real me is not like this... yeah... yeah. After I stopped playing, that disappeared... But, but, if I was told it's hard, conversely I was also painful, and I probably didn't want to touch myself there that much. Yeah. Because it's a self I can't accept... Because it's a sad part... If I touch there any further, my feelings will get depressed, so I didn't want people around to touch it, and I think I didn't want to touch it myself either... Yeah... yeah..."

Just as she used the words "The real me is not clumsy..." repeatedly, for Person A, the clumsy incapable self is an unintended self she created. While nodding "yeah" many times as if confirming something, she made a little pause each time, and was trying to convey the pain of the situation where she had to play a self different from the real self. I wonder if she harbored various feelings, such as regret for creating such a self, guilt for interacting with people around her as a false self, and anger and sadness for the situation where she could not behave as her original self.
She was desperately trying to hide it so that people around her and she herself would not notice the reality of the self that could not see. She might have thought that if she touched that reality even a little, she would not be able to maintain herself and would easily break. I wonder if Person A at this time was maintaining herself at the limit. Beyond Person A's words, who hesitated saying "But... but..." and repeated "yeah" many times confirming to herself, I felt that a message to herself, "This was necessary to protect myself," "So it couldn't be helped..." "It's okay. This was good..." was contained.

〇Item 2 "I am working as a nurse!"

By living as a false self, Person A became able to fulfill her role as a mother and her role as a housewife. Even if she lay in bed when she was alone during the day, she became able to smile and say greetings like "See you later" and "Welcome back" in front of her child. She regained her smile as a mother and gradually regained her mental peace. And she became able to have a little mental leeway, and became able to turn her eyes to the thought she had been harboring all along, "I want to work as a nurse again." At such a time, she met the chairman of Facility P and received a request, "I want to hire you as a nurse at our place (visual impairment support organization). I want you to do consultation support," and she started working as a nurse again. However, when she actually went to work, she felt major confusion at being seen and treated by people around her not as Nurse A, but as Person A who is a visually impaired person.
"When I went to Facility P, I strongly felt that I was being seen as Person A who is a visually impaired person, and there, no, that's not it! I was already rebelling there, and I had in my heart that I am not like that (Omitted) I myself like nursing work, and wanting to return to being a nurse was also something that supported my life that became difficult to see, so it was also a big pillar that supported me, so, I will hire you as a nurse, and please also do consultation support work, you can interact with patients, right, then for me, the form is different, but I had the consciousness that I was working as a nurse, all along, even now. So there, it's nothing more or nothing less (Omitted) Everyone thinks of me as a counselor who is a visually impaired person, but I am always consulting as a nurse, so my stance might not have wavered."
Person A started working with great joy and expectation that she could work as a nurse again and interact with "patients" as a nurse. However, even though she was facing "patients" as a professional called a nurse, she was not seen by the staff around her as anything other than facing a person concerned, as a visually impaired person herself. In an environment where behavior as a visually impaired person needing support was expected, she says she was able to have a heart that strongly rebelled, "That's not it." Even if people around her looked at her as if being a visually impaired person was her title or business card, she alone strongly held onto herself as a nurse. In an environment where she was not recognized as a nurse, why was she able to continue holding onto herself as a nurse with such strong feelings?

Person A likes interacting with people and being useful to people, and becoming a nurse was her dream since she was a child. She worked with pride and fulfillment in her nursing job. She felt great charm in the nursing job where she could face illness together with "patients," face various difficulties, and always stay close to "patients." And even after leaving work for child-rearing, she had been harboring the feeling, "I want to return to nursing work again." The thought, "I want to work as a nurse again," was one important support for living while maintaining herself in the reality of the self that could not see.
On the other hand, Person A states that she had a feeling of giving up, "It's impossible," about working as a nurse in a state of not being able to see. She says, "With a self that bumps into things and fails all the time like this, I can't stand in front of patients as a nurse, right? So I thought it was impossible," and she harbored the feeling, "It's impossible in the current state," at the same time as the strong feeling, "I want to return." However, she had not lost hope, and she had the wish, "If a cure is found someday and I can see again, at that time I will definitely work as a nurse again." I wonder if being a "nurse" was "important self" the same as, or more than, being a "mother." Because it was a self she had wished to return to all along, no matter how much she was not recognized by people around her, I wonder if she alone was trying to be a nurse. I think that for Person A, the self as a nurse was her original figure that was not false, so it was something she wanted to protect even if she had to be stubborn.

〇Item 3 "I hadn't changed at all"

Person A was facing "patients" every day as a nurse. In the welfare consultation field, it is often expressed as user or consultant, but Person A consistently expresses it as "patient." I wonder if Person A's strong thought, "I am a nurse," is expressed there as well. While facing "patients," she experienced moments many times when she suddenly felt, "Even when I could see and now that I cannot see, haven't I changed?"
"Even while working at Facility P, my professionalism as a nurse who was working, or my consciousness when doing work, or my consciousness when facing patients, or the state of how I grasp things, I noticed that it hadn't changed at all, me, while doing it. So, ah, once, I, my, that current situation, the situation where I couldn't see, I thought it was impossible to live with that, so I discarded it once, but in the end, when I was doing something, it's the same, right, so I thought, I hadn't changed. So in the end, the result was that"

Completely different from her usual slow and calm tone, Person A spoke all at once in a fast pace. I think the tone with a resonant voice, energetic, as if words were running through, expressed Person A's joy and happiness. I felt that Person A was conveying to me the joy that was coming up, "Listen, listen," as if a child were telling a parent about the happy thing of the day. I think this joy of Person A was a feeling of relief, "I hadn't changed at all." The attitude of facing "patients" and work, the way of grasping and thinking about things, the things she values, whether she can see or cannot see, they hadn't changed at all. And when I looked at myself from the perspective of "the self that hasn't changed," the things she values as a mother, the attitude of facing her child, the feeling of valuing her family, the strength of independence that she wants to do what she can by herself as much as possible, the personality with a strong sense of justice that she hates crooked things, the self that hadn't changed appeared more and more. She was made to notice that the true self she had intended to give up and discard once actually existed within herself.
Person A decided to live with a "false self" to escape from facing "the self that has changed," and lived while playing a false self. However, she harbored feelings such as unintendedness, guilt, frustration, and sadness for having to live as a false self. Therefore, the notice, "It wasn't a false self, it was the true self," led to the thought, "I hadn't been living as a false self," and I wonder if it brought a sense of relief and removed feelings such as guilt and frustration until then. And by reaching the thought, "I should continue to live as my true self from now on," I think she came to be able to think that the self that cannot see now is the same self as when she could see, and that she should just live as her authentic self, including the fact that she cannot see.

〇Item 4 Living as my authentic self, including the fact that I cannot see
Person A noticed that the self that can see and the self that cannot see are the same self, and came to think that she should just live as her authentic self. And she acknowledges that the self that cannot see is also herself, and is living while facing the self that cannot see. I felt strength in such a figure of Person A, and re-recognized that Person A is the figure I should aim for. The following is a part of the dialogue between me and Person A.
Me: Person A, have you stopped thinking "ah" so much? Thinking "ah" in daily life.
A: That's right. It has decreased quite a bit now. It's not that it's gone, but, that's right, I don't feel like "ah" anymore. Because I stopped comparing with before. I sometimes think about what I was doing before, but I stopped thinking about comparing with the self before, or which was better, or things like that, yeah, I don't think about things that make me think "ah" anymore...
Me: There are still many things that make me think "ah." When something doesn't go well, or things don't go as I thought, I still think "ah" after all. Feelings like why... or how come... or it shouldn't have been like this... come out... I still have many things that make me think "ah," and there are many times when I become painful. And, I end up thinking that such a self is a weak self and no good. I know in my head that it's not like that, it's not no good, it's okay to be weak, but my heart doesn't follow (Omitted)

A: That's fine. That's normal. I have been facing it for at least 20 years longer than B (author), and there is age, etc., right. What kind of period it became like that, etc. So it's not strange at all to think that way, it's not no good, yeah, I have been thinking that way all along too. It's not that you have to be strong, or you shouldn't think about things like that, there's no such thing. I also thought at first, feelings like I have to be like this, I have to be a strong self, or I have to be able to do everything by myself... I thought that way, but it's not like that. If you think you have to be like this, you have to lie to yourself and force yourself. If you force yourself like that, it puts a burden on your heart more and more and you become painful.
But, there's no such thing as you have to be like this. There's no need to force yourself. It's okay to be your authentic self, your authentic life-sized self. It's fine if you are honest with your heart. Thinking "ah" is not a bad thing either. Sad, frustrated, angry, anxious, of course happy, fun, every feeling is your honest feeling, so it's not that you shouldn't feel that way, or weak or strong, it's fine either way.
Person A at this time was talking to a peer as my supporter and as a senior who has walked a life that cannot see. With a very warm voice, she was talking as if talking word by word, confirming the reaction. Person A also quoted my abstract word "becoming ah" as it is. I contained many meanings in this word "becoming ah." For example, a scene where I felt depressed facing the moment I felt I couldn't do what I could do until then, a scene where I felt frustrated because I couldn't do what I wanted to do because I have a visual impairment, anxiety and confusion I feel in daily life because I cannot see, anger, indignation, sadness, and various negative feelings, and hatred for myself who thinks about such things, etc. I used it containing various thoughts, but I felt that I was sufficiently communicating with Person A just by this auditory expression "becoming ah." Rather, I obtained a sense that I was able to convey to each other precisely because it was this onomatopoeia "ah."
While talking, I remembered the time I first met Person A. When I had just become unable to see, Person A was the one who taught me, "You are not alone," when I was anxious about everything and felt as if I were left behind in a world where only I could not see. She stayed close to me all along, "You don't have to worry alone. You can rely on me anytime," when I thought I was all alone and had lost everything. Person A's existence was a gentle and warm light that appeared in the darkness for the first time. As a senior walking one step ahead of me, she was a light that illuminated the path I should go, and became a guidepost. And even now, she is showing the direction I should go, "You should just be honest with your heart and acknowledge your authentic self and live." "Whether you can see or cannot see, you are you, and you haven't changed at all. There is no need to force yourself to change," "It is also you who feels anxiety, despair, anger, sadness about the fact that you cannot see, and it is natural that there are various selves, and since every self is you, it is not good or bad." I learned these thoughts from Person A. She saved me who was suffering.

Person A could not face the self that had changed and become unable to see, and once decided to discard the self she had built up until then and made the resolve to live as another self. In the end, she was made to notice that she could not discard herself, and came to think, "The self that can see and the self that cannot see are one and the same self connected, and I hadn't changed at all, and I don't have to change." I think Person A now has the resolve to live as her authentic self, including the reality that she cannot see. Even so, as she says, "It's not that there aren't times when I think ah I see sometimes," when she bumps into something she cannot do, something unreasonable, or difficulty, she is thrust upon the reality of the self that cannot see and has changed, and says there are times when she is confused.
However, unlike before, she does not compare her past self with her current self and feel pessimistic, "The self that cannot see is a clumsy, incapable, no-good self that only fails." Person A has become able to accept what she cannot do as reality, as it is. I think this heart that can "accept as it is and it is fine as the current self" and acknowledge herself was a resolve acquired after spending a long time and experiencing many hardships to live while facing the self that cannot see. And I thought that this is what I am wishing for now.
□Section 5 What "not being able to see" means to Person A

〇Item 1 Not being able to see is one of the conditions of my life

In this interview, I heard many of Person A's thoughts about "losing one's sight in the middle of life." And as a conclusion to the interview, I asked again, "What is not being able to see to Person A?"
"At first, there was a process where I was sad or why me... It was shocking. After all, it was shocking. Why me... what did I do... why did this happen... I had a period where I worried about such things. There was a period where I couldn't turn my eyes. Illness, not being able to see, is like a disaster that suddenly fell from the sky. So, of course, I didn't want to receive it, and I was filled with feelings like I wanted to discard it or escape. But now, it's not a disaster but a condition. At first, it was a disaster, so I wanted to shake it off, and I was struggling to see if I could do something about it. Now, as one condition, as one condition for me to live, I live within that. Including that, it's me. Just like I live in Japan, or I am how old, it's one condition. It's something I cannot escape from, and the idea of escaping or something like that has disappeared, and I feel like I have accepted it as one condition and am thinking of living within that. Since I cannot escape no matter what, then it is better to live happily with a calm heart even a little in that environment. I think it is better to think about how to live better. I feel like this is my current feeling. But, it took time until I could think this way, and there were various things"

When the reality that she could not see first came in front of her eyes, Person A perceived it as a disaster that suddenly fell from the sky, and was desperately trying to escape from that disaster. However, she noticed that the past self that could see and the current self that cannot see are the same self, and came to think that the reality that she cannot see is not something she wants to escape from anyway, but something that is always with her, something she can never escape from. She came to think that not being able to see is one condition always attached to her life, and that living within that condition is her life. And I wonder if she came to think that she wants to pursue "living better" as much as possible within the condition of not being able to see.
Ueda (1980) states that disability acceptance is overcoming inferiority and transforming into a positive life attitude by coming to perceive that disability is not everything about oneself and does not lower one's value as a whole. I think Person A also re-perceived that not being able to see does not determine her value, but is just one of the conditions of life, and experienced a change in values so that she could pursue "living better" within the condition of the self that cannot see. That is the figure of growth and development that humans originally possess, and I wonder if it is the essence as a person. Recovering this essence, accepting one's disability as one of the conditions of life, and becoming able to think about "living better" within that condition might be what is expressed by the word "disability acceptance." To Person A, not being able to see has become just one of the conditions of life, and it is by no means special. I felt that Person A wants to convey to many people, "Not being able to see is by no means a special thing."

〇Item 2 I don't like being a visually impaired person
In the interview, Person A used the expression "I don't like it" together with the word visually impaired person many times. She is not the type who usually expresses emotions in words straight. Therefore, this straight word "I don't like it" that appeared many times in the interview was very conspicuous.
"Ah, I, I don't think I am a visually impaired person. I think I became ill in my eyes and my eyes became bad, but depending on how you call it, I am a visually impaired person (Omitted)"
"Disability certificate, disability certification, don't you not need disability or something like that? I have always thought, so, just like 'you have this disease,' I am just receiving disability certification, and there is no need to put it out, and I think, don't I not need the word visually impaired person itself. (Omitted)"

"I think why do I have to be fitted into a new category, framework, called visually impaired person and think."
"........."
"Because I didn't like it...."
"When I heard the word disability certificate or the word visually impaired person..."

"Because I didn't like it...."
"So, I think that's why I'm thinking this way"
The word "Because I didn't like it..." came out in a quiet and slow tone, as if muttering, at the timing when I was about to move to the next question after a silence of 8 seconds. At that time, because the silence continued, I was thinking of moving to the next question, but I felt an atmosphere as if the story was continuing somehow, as if Person A was about to say something, and I stopped moving to the next question. What came out at that moment was the word "Because I didn't like it..." The narrative until then was spoken in a resonant voice, at a slightly fast pace, rather energetically, but "Because I didn't like it..." created a completely different air. And after that one word, a silence of several seconds visited again, and it leads to the next word. The silence between each word sounded to me as if it was telling Person A's thoughts more than the expressed words. During this silence, Person A seemed to be remembering her various experiences until now and ruminating on the emotions of each time. I think "Because I didn't like it..." which seemed to have welled up from the bottom of her heart was Person A's true heart and represented the trajectory she had fought until now.
Thinking about what Person A has been fighting against until now, I think it is not against the fact that she became unable to see itself, but against being treated as Person A who is a visually impaired person. Her current state of not being able to see is the result of the worsening of chronic progressive eye disease, and because it causes hindrance to life, it is a situation of disability. I thought that disability is just something that expresses the situation the person is placed in, and by no means expresses everything about the person. She perceived herself not as a visually impaired person, but as one patient in a situation of visual impairment, and harbored discomfort and resistance to being seen as a visually impaired person.

However, in reality, in her work, she was forced to behave as Person A who is a visually impaired person, and experienced many scenes where she was seen and treated by people around her as Person A who is a visually impaired person. "(Even though you are a visually impaired person) it's amazing that you can do this," "(Because you are a visually impaired person) you don't have to do it," etc., she continued to receive treatment as if the thought "(Even though you are a visually impaired person)..." was visible on their heads as a matter of course.
Hoshika (2002) states that disabled persons experience many scenes where they are forced to be conscious of their attitude toward "disability" by receiving social pressure that gives special meaning to "disability" and defines "disabled person," and I thought that by receiving what is required in society and the actions from people around them, they experience many scenes where they have to create "self" as a disabled person required by people around them, not the figure of the original "self." This thought of Hoshika is the same as Person A's experience. "I am a normal person the same as everyone, and I am just in a situation where I cannot see, so why do I have to be treated as if only I am some other living thing called a disabled person?" I think Person A's confusion and indignation were very large, and she had been fighting against this thought all along. I think that each of those thoughts led to Person A's difficulty in living, and this difficulty in living was contained in the one word "Because I didn't like it..."

ーーー
◇Chapter 5 Comprehensive Discussion

It is said that humans obtain more than 80% of information from the outside world through vision, and developing a visual impairment is something that completely changes one's life up to that point. The reality that "I cannot see" changes everything: the life I have built up until then, my life, and my reason for existence. Facing reality is something that can never be done easily. Despite that, it cannot be said that the support system for people who have become mid-life visually impaired is in a sufficient state. The current situation where there are many people who are worrying and suffering alone about the reality that is hard to accept still continues even now. In order to improve such a situation even a little, I thought I wanted you to know about our lives, lives, and thoughts, so I conducted this research.
In this research, by thinking about how Person A, who bore the fate of becoming unable to see in the middle of life, has faced the self that cannot see, I have shed light on the lives, lives, and thoughts of people concerned with mid-life visual impairment. The process of consideration was also a process of asking the meaning that "can see" and "cannot see" have, and I felt and was made to think about many things through this research activity. In this chapter, I will comprehensively consider the identity of the self that cannot see that appeared from Person A's narrative, together with my experience. And I will describe what it means to "see," what it means to "not see," the life that cannot see, and the world that cannot see.
□Section 1 The identity of a self that cannot see
〇Item 1 Person A who has faced the self that cannot see
In Chapter 4, from Person A's narrative, I thought about how she has faced the self that cannot see and the process Person A has followed. I thought that this process could be divided into four: (1) a period of escaping from facing the reality that I cannot see, (2) a period of becoming unable to escape from facing reality and being on the verge of being crushed by reality, (3) a period of deciding to live as a new self to stop facing reality, and (4) a period of noticing that I hadn't changed at all and deciding to live as my authentic self, including the fact that I cannot see. Person A followed this process over nearly 20 years.
Person A's chronic progressive eye disease continues to progress even now, and the difficulty in seeing and the hindrance to life are also increasing. People's faces become invisible, reading characters becomes difficult, walking alone becomes difficult, and things she cannot do or things that are difficult are increasing one by one. Every time she faces such changes and is made to realize what she cannot do, the reality that she cannot see weighs heavily on her heart. Person A, who has the resolve to live as her authentic self, accepts reality, including the fact that she cannot see, as it is. Although she has sad feelings, "ah I see," she has stopped being strongly pessimistic, "why... how come..." Although there is anxiety due to what she cannot do, she turns her eyes to small joys, fun, and happiness in daily life, and is living honestly with her heart in the figure of her authentic self, including the fact that she cannot see. I wonder if this "resolve to live as my authentic self, including the fact that I cannot see" is the "identity of the self that cannot see."
Identity is a concept proposed by psychoanalyst Erikson (Erikson, E.H 1902-1994), and it has come to be used as a general term now. In Japanese, it is often expressed as ego identity. It is used as a word expressing who one is, that one is oneself, what one's self-likeness is, one's attributes, what kind of existence the self recognized by others is, etc. (Erikson, 1959, translated by Okonogi, 1973). And identity crisis is a state where swaying occurs in "who one is," and it is an event that collapses from the foundation the "self" that one has built up in one's life up to that point. Identity crisis is exactly a crisis.
Due to the disaster that suddenly fell from the sky called chronic progressive eye disease, Person A's identity received a major shock. And the identity of the self that was supposed to walk a life that can see without illness collapsed. I think the shock Person A felt when thrust upon the reality that "you will not be able to see in the future" was a shock due to identity crisis. I think the days from there were days of facing identity crisis. I think the process Person A followed over 20 years was a process of identity reconstruction. That process is also the trajectory of Person A's life who has faced the crisis called identity crisis.
Funayama (2011) states that many patients who have contracted cancer perceive the self before becoming cancer as the past self and are forced to reconstruct a new self-identity called "cancer patient." I think this is the same for people who have become mid-life visually impaired. Contracting cancer or chronic progressive eye disease is losing the self from when one was healthy until then, and cancer patients must live while always harboring fear of recurrence and death, and chronic progressive eye disease patients must live while always harboring fear of blindness. The situation of living while facing such illness is not something that can be accepted easily, but it is something that must be accepted. To face that, I think patients need to reconstruct a new self-identity.

Person A desperately protected herself by escaping from the reality that she cannot see. And she tries to accept it little by little and regain herself, but she was greatly agitated again by the next change. In progressive diseases like chronic progressive eye disease, one must experience swaying back and forth due to changes many times along with the progression of symptoms. While repeating days without rest for the heart, I think she reconstructed the identity of the self that cannot see little by little.
Person A now, whose identity of the self that cannot see is established, has become able to accept the reality that she cannot see as it is and face it calmly. Of course, there is a mental burden brought by the reality that she cannot see, but the major agitation like before has disappeared, and I wonder if she has been able to spend daily life with a calm heart. The fact that I felt strength in Person A and thought I wanted to become like Person A might have been an expression of the feeling that I wanted to reconstruct this identity of the self that cannot see.
〇Item 2 I who have faced the self that cannot see
My visual acuity dropped rapidly in about 1 year. Therefore, I could not think that becoming unable to see like Person A was a matter of the distant future. It started from a state where I had no choice but to face it as a clear problem that I would not be able to lead the life I had until then. Before I had time to think about what it means to not be able to see, I was thrust upon many problems as changes in life. Rather than realizing symptoms by falling or bumping into things, it was a start from where I didn't know how to walk. I was not given any time leeway, such as getting used to changes gradually. I was in a state where everything I could do naturally when I could see became impossible, and I didn't know how to live or how to live. I had no leeway to face my feelings at all, and I was just desperate about how to manage the life in front of my eyes.
At this time, I don't even remember well whether I felt painful or suffering. I wasn't even able to feel anything. Emotions didn't well up at all, and I might have been trying to live calmly and as it is. I think the shock that I became unable to see gave me was so great, and my head and heart were completely frozen by the event that was too shocking. Freud (Freud, A, 1895-1982) explains that through defense mechanisms, which are the work of the ego, humans, when facing emotions that are unacceptable to the self, make it so that they don't have to be conscious of those emotions and protect the ego (Freud, 1936, translated by Sotobayashi, 1985). I think my state at this time was suppressing unacceptable emotions unconsciously through repression, which is one of the defense mechanisms, and trying not to notice. I think I was desperately trying to protect myself by creating a situation where I feel nothing and think nothing. This was the first stage of facing the self that cannot see that I experienced.
The next stage is the period when various emotions welled up. After some time passed, I feel that the expression "I met my feelings" fits better. Confusion and bewilderment about the reality that I cannot see and the reality that I had completely changed from the self until then continued, but I became able to look down on the situation I was placed in little by little. And I despaired that it was truly the bottom of life. Only negative emotions welled up toward the self that cannot see, such as "Don't I have any value to live anymore?" "Am I just a hindrance to society?" and I even thought, "I don't care what happens to my life anymore, I wish I could just disappear as it is."
However, I had the belief, "I will absolutely not take my own life by myself." That is because as a pediatric nurse, I met many children who couldn't live even if they wanted to live. I saw up close how much the children wished to live and how much the families wished for them to live. And I was taught how important and precious life is. That is precisely why I couldn't think about ending my own life by myself. Every time I was on the verge of being crushed by suffering, thoughts to encourage myself came up, "Since the children were also doing their best, I must also do my best. Weren't those children trying to live desperately even in a more painful situation? I must not lose to something like this. Since everyone is watching, I must do my best." Also, every time I faced painful things, just as I thought, "That child must have had such feelings at that time, too," there were many patients I had met until then in my heart. Not only myself, but the patients I met in the past who shared that suffering with me supported me. I think it was because I had this support that I was able to go on facing the reality that I cannot see, even if little by little.
Person A also felt the same way that when facing difficulties, the patients I met in the past as a nurse and the experience of facing difficulties together with patients became a major support. And Person A also thought that "the self as a nurse" was supporting "the self that cannot see."
While facing the self that cannot see, what became a major support for Person A was the existence of her child and herself as a mother. The determination, "I must fulfill my role as a mother no matter what," encouraged herself, maintained herself at the limit, and regained the state where she could lead a daily life. And she achieved returning to work as a nurse.
On the other hand, what supported me was the self as a nurse. I was trying to maintain myself desperately with the thought, "I want to return to work as a pediatric nurse and spend time with children again. I want to be a self that can be a support for someone as a nurse. Therefore, I will return to being a nurse as soon as possible." Kado (2018) states that the more established the identity of being a nurse is, the more likely one is to harbor the loss of identity, "I am no longer on the supporting side," when one becomes a patient oneself. I myself also strongly wished, "I am not on the side of being supported, but on the side of supporting." Therefore, I turned my eyes not to the self of the reality that I cannot see, but to the self as a nurse, and was trying to live in that figure. Person A made the choice of creating a clumsy self that is false and not looking at her original self by looking at the false self, but I think I was doing something similar. I created a figure of the self as a nurse working the same way as when I could see, and by turning my eyes to that figure of the self in my fantasy, I think I was making the choice of "not looking" at the self of the reality that I cannot see now. I believed that if I returned to being a nurse, I could return to my original self. The strong determination to return to being a nurse was something that encouraged me. However, because that figure was only a fantasy, it broke easily. And by experiencing being dismissed from my job as a nurse, I experienced a shock even greater than the reality that I "cannot see."
Kado (2018) states that retiring or being removed from one's original job is not just losing a place to work, but losing one's identity as a nurse, and gives a major sense of loss. I thought that the time I became unable to see was the bottom of life, but the true bottom was when I was no longer a nurse. Being a nurse was that important to me, and it was an identity that showed myself. By losing the self that could see, I felt the first collapse of identity, and by no longer being a nurse, I lost the figure of the self as the original self that remained as my only hope, and experienced further collapse of identity.
From there until now, I have lived while feeling various thoughts. At the bottom of life, I experienced days when I couldn't even shed tears, and after that, I also experienced days when I could only shed tears. I cried a lot, got angry a lot, got depressed a lot, and yet I didn't give up on living, and I somehow lived every day. And 8 years later, I have become able to laugh again. I am also able to feel happiness in small joys in daily life. I have become able to think, "Isn't my life not so bad?" However, the path up to here was by no means flat. When I became unable to see and was no longer a nurse, I lost the path of life I had thought, "I will walk this path," as a matter of course until then. The path that should have been in front of my eyes broke into pieces and disappeared. I didn't know at all where I should head and advance, and I completely lost sight of myself and my life. This despair was truly great, and the days from there were filled with fear and anxiety.
However, there were people around me who supported me together through such days. Person A, people at Facility P, family, peers with visual impairment, friends, my guide dog Ojo, walking training instructor, helper, school teacher, student peers, people at the workplace... truly many people are supporting my life. To me, who didn't know which way to advance and didn't know where the path was, they called out, "It's okay if you come this way," pulled my hand, and guided me so that I could advance forward again one step by one step. The fact that I didn't have to worry alone and that there were people who shared pain and suffering with me was a very major support. If it weren't for this support, I think I would have given up on facing the self that became unable to see.
Even now, it is not always that I can perceive it positively. It is a daily life where my heart is often swayed in a state of taking three steps forward and two steps back. Even so, I have the realization that I am able to advance forward one step by one step. This realization is leading to confidence and peace of mind that "I am living my life importantly."

I had felt all along that there was something important ahead of advancing, but I didn't know what it was. However, in this research, by looking back at the process Person A has faced the self that cannot see, I feel that the answer has become visible. I think this answer is surely the resolve to live as my authentic self that cannot see, and the reconstruction of the identity of the self that cannot see. Identity is having a firm self, "I am I," and I have become able to think that it is being able to think, "It is fine as the current authentic self." And I think the identity of the self that cannot see is feeling, "The self that cannot see is also an important self," "The self that feels any feeling about the fact that I cannot see is also an important self," and being able to acknowledge myself and live, "It is fine with this."
〇Item 3 Thoughts on looking back at the process of facing the self that cannot see
By thinking about the process Person A has faced the self that cannot see, I was able to think again about what I wanted to do in this research. I was able to think that what I truly wanted to do was to look back at the process I myself have faced the self that cannot see, and by re-grasping it, I wanted to follow the process of identity reconstruction that Person A has followed, myself as well.
When I face the reality of the self that cannot see and experience frustration or things I cannot do because I cannot see, I often lament the self that became unable to see, "Why... how come..." And I end up harboring thoughts that deny myself, such as "Haven't I accepted the fact that I cannot see yet?" "Haven't I faced the fact that I cannot see yet?" and repeat that I end up hating myself. About 8 years since I became unable to see, I felt that I had become able to acknowledge the self that cannot see little by little during that time and have the resolve to live as the self that cannot see, but I realized again that I am still spending days where my heart is swayed.
Through the interview, while hearing Person A's life milestones and various episodes, I remembered my own experience and performed the work of looking at myself at that time. This work was by no means easy, and real thoughts of the period that was truly painful were awakened, and I experienced them again, and there were times when I became painful. I experienced many times that I was dominated by emotions and couldn't stop crying, and couldn't write anything. The real emotions of the period that was most painful might have been the parts I had put a lid on by myself so as not to see until now. Because I knew that opening that lid would make me painful, I think it was something I had kept in the bottom of my heart all along.
I had talked about the episodes from right around the time I became unable to see many times in front of people, and I thought I had become able to talk about it calmly. However, through this research, I noticed that this was not something I had faced the self at that time in the true sense, but was superficial. To that extent, facing the self at the time I became unable to see required great courage and resolve for me. At that time, I couldn't even cry enough because it was too painful, I just stopped thinking, put a lid on it, and I think I was able to firmly face and move my heart toward the feelings I had locked in the bottom of my heart. By being able to put out various feelings that I couldn't release at that time, I felt that my heart became very light. It was painful, but I think from my heart now that I am glad I was able to perform this work.
I thought that facing each emotion is the work necessary to reconstruct the identity of the self that cannot see and have the resolve to live as my authentic self that cannot see, and it is the path Person A has also walked. I was very relieved that I was able to follow the same path as Person A. Person A states, "As a nurse, there were scenes where I felt that patients would feel relieved if I disclosed this experience of mine, and at such times, I opened the lid even if a little forcibly and put out my feelings. There might be parts where I was supporting while hurting myself. But, that's how I organized my feelings," and she was performing this work while facing the same visually impaired patients as a nurse. While facing the pain and suffering of many patients together, I think she was facing her own emotions and organizing her feelings. And I think she was able to reconstruct the identity of the self that cannot see and have the resolve to live as her authentic self, including the fact that she cannot see.
Person A said at the beginning of the interview, "When I heard the story of this interview, I thought that B (author) surely wants to do this work. And I was happy because I thought that you wanted to do that work together." At that time, I didn't think very deeply about what "this work" represents, and didn't understand it sufficiently. Thinking about it now, "this work" is the process of facing and organizing the emotions locked in the bottom of the heart, and it represented the reconstruction of identity. Okamoto (2007) states that people who have had similar experiences talking to each other promotes positive meaning-giving, and being able to give positive meaning to the experience leads to the reconstruction of self-likeness. Through this dialogue with Person A, I led to perceiving my experience positively, and at the same time, I thought again that Person A, who responded to the interview as one of the supports for me, is indeed "a supporter."

I am still in the middle of this reconstruction of identity even now. From now on as well, my heart will be swayed, and every time, doubts will arise about the meaning and existence of myself, and I might become painful. However, like this time, if I can face and organize each feeling even if it is painful, I thought that my heart would become light and I could become a slightly stronger self. I think that being strong means being able to forgive and being able to acknowledge. The self that harbors various emotions including negative emotions, the self that has many things I cannot do, the self that has many things I can do, the self that cannot be recognized as I thought, the self that harbors difficulty in living, including the environment around me not just myself, accepting various things as they are and being able to forgive, the heart that can think "well, it's fine," I think this is a strong heart. I think that having this strong heart is the figure I am aiming for, and in other words, the charm that Person A possesses. Through this research, I was able to have a little courage and resolve to face the self that cannot see. I want to continue to live while firmly facing myself aiming for the reconstruction of the identity of the self that cannot see, one step by one step from now on.
□Section 2 What it means to "see" and what it means to "not see"
In this thesis, I use words such as "see," "become unable to see," "cannot see," etc., many times. Generally, "cannot see" might imagine a state of total blindness where one cannot feel light or anything, or even if not total blindness, a state of blindness where one cannot obtain information such as characters and surrounding scenery from vision. Actually, among people concerned who have become mid-life visually impaired, there is an activity to widely inform society that "visual impairment = total blindness" is not true. This is because various troubles occur due to the thought "visual impairment = total blindness, person who cannot see = total blind person." In reality, many visually impaired people are not totally blind or blind, but in a state called low vision. They harbor difficulty in seeing due to low visual acuity or narrow visual field, but they can also see using remaining visual acuity. Therefore, even if they use a white cane, they sometimes read books or play games. To that reality, they sometimes experience being called "liar," "you can actually see, right," and being hurt by heartless words. The current situation coming from such misunderstanding is not small even now.
Just like this thought that "white cane = total blindness" is not true, the meaning that people concerned are putting into the word "cannot see" is often not just a state of "cannot see at all" or "cannot see much" such as total blindness or blindness. There might be people concerned who perceive it that way, but I think the word "cannot see" is often used referring to a wider state, "living while harboring difficulty in seeing," regardless of the degree. At least, Person A and I perceived it this way. The state of "cannot see" is not like 0 or 100 of "can see clearly" and "cannot see at all," but just as many numbers are included between 0 and 100, it is something with width. Therefore, even if one says "cannot see," the way of seeing and the degree of difficulty in seeing differ greatly for each person, and what one can do and what one cannot do, and how one is obtaining information are all different.
The state of "can see" differs greatly even between Person A and me, and therefore there are differences in the meaning and usage of words, etc. In the state of blindness, which is my current way of seeing, I cannot grasp characters or images visually. Therefore, I almost never do the work of seeing something using visual acuity, and the means of information acquisition is almost all senses other than vision. On the other hand, Person A, although the difficulty in seeing is quite strong, it is possible to see using visual acuity. She can also see characters and recognize them using vision. It is by no means clear, but she can also see and grasp images using her eyes. Although she has changed much of information acquisition to hearing and touch, it is a state where she is also using vision. Because there is such a difference, the meaning that "can see" and "to see" have differs even between me and Person A.
When we people concerned who have differences in the way of seeing talk, an interesting state occurs. Because I almost never see using visual acuity anymore, I do not perceive the means of information acquisition by dividing it finely. Therefore, regarding things I originally enjoyed seeing with my eyes, such as TV and YouTube, even now that I have become mid-life visually impaired, I use the verb "to see" without particular resistance. In reality, I am not seeing images, but enjoying listening to the flowing sound, but I express this as "seeing TV and YouTube." On the other hand, Person A uses the verb "to listen" for TV and YouTube. She distinguishes between when she actually obtains information using visual acuity and other times, and uses "to see" and "to listen" properly. In reality, Person A should also be obtaining information of TV and YouTube from vision, but it becomes an expression where Person A "listens" and I "see."
I think this occurs because there is a difference in the thoughts and perception toward the word "to see." Person A now, although it is difficult to obtain information by seeing with her eyes, is in a state where "can see" is actually possible, and she can realize "can see." I think this "can see" is something that gives Person A peace of mind that she can still see, and is becoming a support for her heart. That is precisely why "to see with eyes" is a special thing for Person A, and I wonder if she is distinguishing "to see" and "to listen" to confirm that "I can still see."
Actually, even remembering the words of other visual impairment peers, it is often people with low vision, not blind people, who express "listening to TV." Because both "to see" and "to listen" are actually possible, I felt that they are distinguishing and expressing "to see" and "to listen."
On the other hand, why do blind people like me express "seeing TV"? Of course, it is because I have been using the expression "seeing TV" generally since the time I could see. I, who became unable to see, should also have attachment to the word "can see" and the act of "to see" as much as Person A. If so, I feel like it would be fine to express "listening to TV," but I don't have the memory of blind people including me expressing "listening to TV." I speculate that this is because using hearing has replaced vision as a means of information acquisition that is natural for myself, and the acts of "to see" and "to listen" have been replaced. Originally, we humans are performing more than 80% of information collection from the outside world using vision. This information acquisition is the act of "to see." On the other hand, I now use various senses such as touch and smell in addition to hearing, of course, but the information acquisition means I am utilizing most frequently is hearing, and I am obtaining much of the information from the outside world from "listening." The number one information acquisition means has been replaced from "to see" to "to listen." Therefore, I feel that the boundary line between this "to see" and "to listen" might be becoming very vague.
In addition to this, when I see TV, I obtain information from the sound heard from the TV, and based on that information, I am creating images in my head using the memory from when I could see. For example, in a scene introducing a cute puppy, I am listening to the sound of the TV while imagining the image of the puppy in my head. It might be different from the actual image, but images are also visible in my head. That is why it might be "to see."
"To see" and "can see" is to obtain information from the outside world using vision. "Cannot see" is that one cannot obtain that information from vision. "Cannot see" and "become unable to see" is that obtaining information that one had obtained naturally until then becomes difficult. "Become unable to see" is losing this 80% of information. Of course, humans are very excellent, and if information from vision cannot be obtained, they try to collect information using other senses. However, one cannot easily supplement more than 80% of information. And alternative means cannot be acquired easily. Therefore, confusion occurs. Because information cannot be obtained sufficiently, one faces every difficulty. Things that could be done easily if one could see become very difficult. One has to go through hardships that one wouldn't have had to do if one could see. For example, even if everyone around is laughing seeing something, one can understand that everyone is laughing by obtaining information from surrounding sounds, but one cannot obtain information on why everyone is laughing and cannot understand. Even if TV breaking news flows, one knows that breaking news flowed by the signal sound, but because one cannot see the subtitle display, one doesn't know what breaking news it is at all. Because one cannot see and cannot obtain information, one ends up in a state as if only oneself is left behind. As described, because information from vision cannot be obtained sufficiently, one faces various problems. That one cannot obtain information from vision sufficiently is "cannot see," and people who are leading daily life while feeling the difficulty in living due to this not being able to see are the "invisible us" that I and Person A think of.
"Cannot see" is inconvenient and uncomfortable because the information that can be obtained becomes extremely small. If one could see, one could make various judgments and choices based on much information, but in the case of having a visual impairment, the information that becomes the basis for that becomes very small. Therefore, one faces difficulties such as not being able to make appropriate judgments and having very few choices. To supplement that, one is trying to increase the information that can be obtained by utilizing the support of people around and technology, and converting visual information into information in a form that can be understood even if one has a visual impairment, such as sound and touch. By doing so, one is trying to reduce inconvenience and discomfort and resolve the difficulty in living and disability due to "cannot see." If all visual information were replaced by other information and could be obtained easily, the difficulty in living due to "cannot see" might disappear, and it might not be a state of disability. A world that is visible in the sense that one can obtain visual information, although not seeing with eyes, visits us who cannot see now.
Currently, I have become able to obtain quite a lot of information other than vision. It has permeated that information accessibility is necessary, and scenes where one can receive consideration such as converting visual information into auditory information such as sound are increasing. Tools for that are also advancing significantly. I think that scenes where one feels difficulty in living due to "cannot see" are being reduced little by little, but surely. Applications and devices that explain photo images in words, audio commentary for movies and TV, guidance by voice such as emergency earthquake early warning, devices that guide the way to the destination using vibration, etc., the realization of "can see" is advancing in various forms. I think society is approaching little by little to a state of "can see" where one can obtain information well from a state where one cannot obtain information well due to "cannot see."

"Cannot see" is inconvenient and uncomfortable. However, it is by no means "unhappy." There are many people around who try to resolve this inconvenience and discomfort together, and they are trying hard to bring "cannot see" closer to "can see." I am realizing daily that "cannot see" can get closer to "can see" with voice calls such as "the signal has become blue," "because a car is stopped in front, it is okay if you walk a little more to the left," "the train seems to be a little late." And every time, I can feel the kindness of people, and I can feel warm feelings and happy feelings. I think that just this is sufficiently happy.
Of course, if my visual acuity returned to the original state, I would want to return. I think that feeling will never disappear. Person A also thought the same. To that extent, "cannot see" is inconvenient and uncomfortable. However, I do not think I am unhappy at all now. Because no matter how much inconvenience and discomfort there are, it is by no means only that. Even in the uncomfortable state of "cannot see," there are many happy things and fun things, and there are many kindnesses and warmth of people that can be felt precisely because one cannot see. This world where one can feel the warmth of people might be a world that is visible precisely because one cannot see. "Can see" is not just seeing with eyes using visual acuity, but I think there is surely also "can see" that sees using "heart's eye." I who have lost visual acuity am thinking that I am living in this "visible world" that sees with the heart's eye.
□Section 3 Limitations of this research and future tasks
In this thesis, I have thought about "invisible us" based on the lives of two mid-life visually impaired persons, Person A and me. However, this is only a life of a very small part of "invisible us," and furthermore, it is only one aspect of that life. Within "invisible us," there are people who are walking lives that are completely different from each other, and their lives are so diverse that I don't know if it is good to group them together. Therefore, in order to think about "the lives of invisible us," it becomes necessary to consider and examine various backgrounds and factors such as illness, way of seeing, from what period one cannot see, how one became unable to see, what kind of life one is leading, family, work, region where one lives, etc. I think that in the future, by expanding the target to many people, it is necessary to have an effort to think about the essence of "the lives of invisible us" from more diverse lives.
Also, this time, because the theme was mid-life visual impairment, I have thought about "invisible us" only from the perspective of mid-life visual impairment. However, within "invisible us," there are also people with congenital visual impairment who "cannot see" from birth. I think that mid-life visual impairment where what was visible became invisible and congenital visual impairment where one has never experienced seeing might have greatly different thoughts about "can see" and "cannot see," and how they have faced the self that cannot see. In thinking about "the lives of invisible us," I cannot exclude the perspective of how people with congenital visual impairment perceive their own lives that cannot see and the self that cannot see. I think it is necessary to advance the survey about the lives of people with congenital visual impairment in the future as well.
In this research, I have thought about the lives of people concerned and support for people who have become mid-life visually impaired from the perspective of people concerned, but I have not been able to investigate what people who are conducting support feel and what they are thinking. I think it is necessary to know how people who are supporters think about the current situation. From now on, I want to clarify the support needed in the process of facing the self that cannot see seen from the supporter side, and thoughts and issues regarding the current status of visual rehab and mid-life visual impairment support. By thinking from the perspectives of both people concerned and supporters, I think I can lead to the enhancement of mid-life visual impairment support.
Furthermore, the current mid-life visual impairment support does not have sufficient clear legal development and system design, and the support that can be received differs greatly depending on the region where one lives. It is by no means a system where necessary support reaches everyone. And even if a sufficient support system were developed, there is also a problem that it is difficult to reach that support. Visual impairment is a disability of information and movement, and has the characteristic that it is difficult to connect by oneself. Nevertheless, the current situation is that one cannot connect to support unless one accesses by oneself, and that is creating people who cannot connect to the thread of visual impairment support and are worrying and suffering alone. How to create this first connection is a major issue of visual impairment support.

For that purpose as well, while advancing cooperation from medical care to welfare, even within the framework of medical care, I think it is necessary to consider the enhancement of the support system from the perspective of total support that faces and supports as one person, not just treatment. For example, like rehab for spinal cord injury, it is necessary for visual impairment to be able to receive firm rehab within medical care from an early stage, and it is desirable to strengthen low vision care, which currently stays at the function as a window and bridging, into a support system that can conduct sufficient training. After that, I think it is necessary to connect seamlessly from medical low vision care to welfare visual rehab to training in the community that is more rooted in life.
In this low vision care and visual rehab, not only the aspect as mere training, but psychological support that supports people who have become visually impaired to face the self that cannot see is indispensable. Support is necessary so that people who face the major difficulty of facing the self that cannot see are never made to worry and suffer alone. They are always there and watching over us who have lost our sight and wandered into darkness, and delivering the message that you are not alone. I think support that gives major peace of mind like a lighthouse illuminating the darkness is necessary. Advancing the development of a sufficient support system so that the hand of support can be extended firmly to people who need it anywhere and by anyone is a major issue of visual impairment support in the future.

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◇Chapter 6 Conclusion
Finally, there is a thought I want to deliver no matter what. That is that it was good that I lived without throwing away my life. Just as many mid-life visually impaired people face the reality of the self that cannot see and despair of life, I myself also despaired of my own life and thought I wanted to disappear and disappear. I was filled with thoughts that the self that became unable to see had no value anymore, no dreams, no hope, no fun things. Even now, that feeling suddenly wells up and there are times when I become painful. And even now, and from now on as well, I think many things will come out that I give up on because I became unable to see and become painful.
However, my daily life now is by no means only painful things. There are many moments when I can think it is fun even if I cannot see, and moments when I can think it is happy. When I ate delicious things, when I entered a warm bath, when I was listening to my favorite music, when I was talking fun with friends, when I was stroking the ears of my important partner Ojo, when I became able to do what I couldn't do, when I felt I was needed by someone, when I touched the kindness of people, etc., my surroundings are overflowing with things where I can feel happiness. There are also many things that became visible, things that became able to do, people I met, and experiences I obtained precisely because I became unable to see. I have become able to think in these 8 years that there is much happiness even if I cannot see.
My life that became unable to see, a life I once despaired of and threw away thinking I don't care what happens anymore, but I think I am able to lead a life that is happy in its own way now. It might be a little different from the ideal life I had pictured before I became unable to see, but I have become able to think that this life now is also a good life where I can feel the love of many people and dogs, and I am given a place where I can be active in my own way. "It was truly good that I didn't throw away my life at that time," this alone I can say absolutely. When I was struggling and suffering, and no matter what I did, nothing could be done, I couldn't think at all that a day would come when I could say "my life is not bad" while laughing and crying like this again. But, such a day is coming properly.

Therefore, please never give up. Please don't worry alone. There must be someone somewhere who watches over you and extends a hand. There should be many things around you that are not just painful. You might not have been able to find it now, but a day will surely come when you can find it again.
Through this thesis, by having you know about our lives and thoughts, I hope that people who are worrying alone right now will think even a little, "I am not the only one who is painful," "I don't have to worry alone." And just as I met Person A and was saved, I want to become a person who can connect the thread of support to everyone who is suffering from becoming mid-life visually impaired, so that warm light is illuminated, and peers who worry and suffer alone disappear. I want to become a person who can connect the thread of support for that purpose next. I am thinking that I want this thesis to be one of the help for that. Wishing for such a future, I want to finish writing this thesis.
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◇References
Carrol, T.J. (1961). Blindness: What it is, what it does and how to live with it. Boston: Little, Brown and Company. (Carroll, T.J. author, Matsumoto Seiji (supervision), Higuchi Masazumi (translation) (1977). Blindness, Japan Blind Welfare Association)
CB Holdings (2024.7.4). Visually impaired persons with disability certificates, possibility that estimation is "underestimated," pointing out that those corresponding to criteria are more than 3 times, Social Security Council, Disability Subcommittee, Medical Care CBnews
https://www.cbnews.jp/news/entry/20240704170524 (August 10, 2024)
Dentsu (2024.1.9). Visualizing visual impairment "VISIONGRAM," Para Judo Japan national team adopted, web Dentsu-ho
https://dentsu-ho.com/articles/8783 (August 8, 2024)
Erikson, E.H. (1959). Identity and the life cycle. New York: W. W. Norton. (Erikson, E.H. author, Okonogi Keigo (translation) (1973). Ego Identity, Seishin Shobo)
Freud, A. (1936). Das Ich and Abwehrmechanismen.
Internationaler Psychoanalytischer. Verlag. (Freud, A. author, Sotobayashi Daisaku (translation) (1985). The Ego and the Mechanisms of Defense, Seishin Shobo)
Fukasawa Shigetoshi (2012). On the consultation support activities for mid-life blind people by Matsui Shinjiro, Shukutoku University Research Bulletin, 46, 201-215.
Funayama Izumi (2011). "Illness called cancer" experienced by people around cancer patients - Consideration on the experience of communication, Faculty of Letters Bulletin, 102, 117-134.
Hoshika Ryoji (2002). Meaning-giving of "disability" and identity of disabled persons - Regarding denial/affirmation of "disability," Sociologos, 26, 105-120.
Igarashi Nobuyuki (2003). Development and guidance of visually impaired infants (4th edition), Correl Co., Ltd.
Imamura Miha, Masaki Harue, Noguchi Miwako (1997). On the disease acceptance process and nursing support of Parkinson's disease patients, Chiba University School of Nursing Bulletin, 19, 79-87.
Kado Yumiko (2018). Construction of a support model in the process until nurses who experienced cancer continue to work, Aichi Medical University Graduate School of Nursing Master's Thesis
Kashiwakura Hidekatsu (2005). A study on "peer support" at disability community life support centers - From survey analysis of mid-life visually impaired person consultation records at Nagoya City M Ward Disability Community Life Support Center, Social Welfare Studies, 46(1), 86-95.
Public Interest Incorporated Association NEXT VISION (2011). Smart Site, Public Interest Incorporated Association NEXT VISION <https://nextvision.or.jp/%E3%82%B9%E3%83%9E%E3%83%BC%E
3%83%88%E3%82%B5%E3%82%A4%E3%83%88/#:~:text=%E8%A6%96%E8%A6%9A%E9%9A%9C%E5%AE%B3%E8%80%85%E6%94%AF%E6%8F%B4%E3%81%AE,%E9%80%A3%E6%90%BA%E3%81%AB%E5%BD%B9%E7%AB%8B%E3%81%A3%E3%81%A6%E3%81%84%E3%81%BE%E3%81%99%E3%80%82> (August 8, 2024)
Public Interest Incorporated Association Japan Ophthalmologists Association (2023). What is low vision care, site regarding low vision care https://low-vision.jp/about-low-vision-care/ (August 12, 2024)
Ministry of Health and Welfare (1951). Enforcement Regulations of the Act on Welfare of Physically Disabled Persons Appended Table No. 5. Act on Welfare of Physically Disabled Persons <https://www.mhlw.go.jp/content/0000172197.pdf> (August 12, 2024)
Ministry of Health, Labour and Welfare (2022). 2022 Survey on Difficulty in Daily Life, etc. (National Survey on Actual Conditions of Disabled Children/Persons at Home) Report
<https://www.mhlw.go.jp/toukei/list/seikatsu_chousa_r04.html#
contents> (August 12, 2024)
Japan Ophthalmologists Association (2009). Japan Ophthalmologists Association Research Team Report 2006-2008
Certified NPO Kobe Eye Light Association (2024). Report on the status of visual rehab projects and Eye Light, Certified NPO Kobe Eye Light Association
<https://eyelight.eek.jp/p/%E7%A5%9E%E6%88%B8%E3%82%A2%E3%82%A4%E3%83%A9%E3%82%A4%E3%83%88%E5%8D%94%E4%BC%9A%E3%81%AE%E7%8A%B6%E6%B3%81%E3%81%AB%E3%81%A4%E3%81%84%E3%81%A6%E3%81%AE%E3%81%94%E5%A0%B1%E5%91%8A2408.pdf> (August 12, 2024)
Okamoto Yuko (2007). Development of identity life development theory - Crisis of middle age and deepening of heart -, Minerva Shobo
Okuda Hiroko, Okamoto Yuko (2017). Trends and prospects of research on identity of artists with visual impairment, Hiroshima University Graduate School of Education Bulletin Part 3 Education Human Science Related Field, 66, 133-142.
Omae Taichi (2009). Study on psychological changes and processes from injury to social return in mid-life visually impaired persons (I), Nara University Graduate School Research Annual Report, 14, 14-31.
Sakamoto Yoichi (2007). Introduction to visual impairment rehabilitation (revised edition), Chuo Hoki Publishing
San-in Chuo Shimpo (2024.5.18). Visual impairment rehab waiting continues, Shimane, shortage of instructors with qualifications, comprehensive support system urgent (San-in Chuo Shimpo Digital Edition) https://www.sanin-chuo.co.jp/articles/-/576661 (August 10, 2024)
Social Welfare Corporation Japan Blind Welfare Committee (2012). Support manual for visually impaired persons in disasters
Social Welfare Corporation Japan Blind Welfare Association (2017). Survey research project report on effective and efficient operation of functional training offices corresponding to the needs of visually impaired persons
Social Welfare Corporation Japan Lighthouse Training Department (2023). List of functional training facilities (1)
https://www.lighthouse.or.jp/yosei/pdf/sisetsu2023-1.pdf (August 10, 2024)
Social Welfare Corporation Japan Federation of the Visually Impaired (2019). Submitted a request for medical remuneration revision to the Ministry of Health, Labour and Welfare, Social Welfare Corporation Japan Federation of the Visually Impaired
http://nichimou.org/all/news/secretariat-news/190816-jimu/ (August 12, 2024)
Takada Akiko (2003). Survey research on white cane carrying by mid-life visually impaired persons, Social Welfare Studies, 43(2), 125-136.
Takada Akiko, Sato Hisao (2012). Going-out situation and support needs of visually impaired persons living in the community, Social Welfare Studies, 53(2), 94-107.
Ueda Satoshi (1980). Disability acceptance - Regarding its essence and stages, Comprehensive Rehabilitation, 8, 515-52.
Ueda Yukihiko (2004). Psychological changes in rehabilitation of mid-life visually impaired persons, Japanese Journal of Psychology, 75(1), 1-8.

Yamada Yukio, Oishi Masao, Kojima Kiyoko (2012). "Heart care" for people with visual impairment - To become a true heart cane -, Kokodo Shoten
Yamakawa Itsuko (2020). Transformation of life and consciousness of visually impaired persons by living with a guide dog - From the perspective of functional, psychological, and social support -, Yokohama National University Graduate School of Environment and Information Sciences Doctoral Thesis
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◇Appendix Tables
□1 Self-introduction
I am a woman in my late 30s, living with my husband and a guide dog. The eldest daughter of two sisters. I have liked interacting with people since I was young, and have a caring personality. I am free-spirited and not good at staying still. I am often told by people around me that I have a strong sense of justice and hate crooked things. My hobbies are many, such as going out and traveling with my guide dog, choir, Japanese drums, online shopping, watching YouTube, cooking, and home gardening.
My current way of seeing is no light perception in the right eye, hand motion visual acuity in the left eye, and loss of more than 90% of the visual field. I usually walk with a guide dog, and sometimes use a white cane. It is difficult to see characters and people's faces, and information acquisition relies on voice. I have become the current way of seeing within 1 year since developing the disease in my left eye, and since then, no major change has been seen in the way of seeing.

I have liked interacting with people since I was young, and my dream for the future since I was small was to become a pediatric nurse or a teacher at a special support school, and my goal since I was a child was to do a job that supports children who are living with all their might while having illness or disability.
I graduated from the nursing department of a university and worked as a nurse at a pediatric hospital and a university hospital pediatric ward. Currently, I am working as a consultation support specialist at a welfare office. I receive consultations from users with various disabilities, not just visual impairment, and help them lead lives that are like themselves. I loved pediatric nursing work and thought it was my calling. Currently, I also feel great fulfillment in the work of a consultation support specialist, and I think I have met a new calling. Like Person A, being a nurse is an important identity that shows myself to me. Working as a nurse again was a support for facing the self that became visually impaired.
□2 My own answers to the interview guide

Q1: When was the first time you felt that your way of seeing was different from before?
A: I started undergoing surgery for glaucoma, and immediately after surgery, I became almost unable to see, and from there, it took about 1 week to become able to see, and it recovered to the extent that it looked not much different from before surgery, but as I repeated surgery, the recovery of the way of seeing after surgery gradually became worse. Every time I repeated it, it became difficult to see little by little, and by the time I noticed, I couldn't see fine characters, I couldn't see the clock, I couldn't see people's faces, I couldn't understand stairs and steps... the range I could see also became narrower and narrower... and so, there were many moments when I was made to notice, oh, I could see before, at a sudden time.

Q1-1: What did you think at that time?
A: The anxiety of what if I become unable to see like this, the anxiety that I might not be able to return to the original state if I repeat surgery this much was very large, but I desperately chased that anxiety to the corner of my heart, and tried to convince myself that if I have surgery again, I can return to the original state, so it's okay. I thought that there is absolutely no way my eyes will become unable to see. Since the doctor (attending physician) said it's okay, I thought I would believe that.
Q2: What did you think when you were told at the hospital for the first time that you would become visually impaired?

A: After about the 10th surgery, when I recovered little by little from the state where the inflammation after surgery didn't settle down easily, even if the eye symptoms settled down, the way of seeing didn't return to the original state at all, and when I felt myself that it might not return more than this, I was told by the attending physician that it might be difficult to return to being able to see more than now. I was told that it is not known how far it will recover, but that it will be difficult to read characters and walk freely alone as before, and that I have to think about life in a state of being difficult to see. What I felt strongly at that time was vague anxiety about what will happen from now on, thoughts about why this happened, what was wrong, thoughts that there is no such thing, I can absolutely return to the original state, I will return, thoughts that I don't want people around (especially family, people who know my original self) to know, what if they know, how should I hide it, and there were various other thoughts, but I think these thoughts were particularly strong.
Regarding becoming a visually impaired person, I don't know myself whether I had the thought that I don't want to become a disabled person or not. I feel like the resistance to becoming unable to live without borrowing someone's help was larger than the resistance to becoming a visually impaired person.

Q3. Please tell me about the trigger for taking the physical disability certificate.
A: When I was told that the way of seeing would not return to the original state, and when I thought that I would live as a visually impaired person, I thought that if I took the certificate immediately, I could receive various support, and that I needed the certificate to buy a white cane and to buy various voice equipment, so I was able to think honestly that I would go to take the certificate immediately, and I went to take it to the government office immediately by myself. I feel that there was not much resistance to taking the certificate. However, if this had happened when I was in my hometown, not at my current address (O City), I might not have been able to think of going to take the certificate this smoothly. Since I came to O City and my eyes became bad immediately, and acquaintances only knew me who had an eye disease, me who became difficult to see, I might have been able to have the certificate and have a white cane without worrying about the eyes of people around me much.
Q4. I will ask about going out.

4-1: What was the trigger for having a white cane?
A: I was told by a friend that if I don't have a white cane, it's dangerous, so I won't take you out anymore, and I reluctantly came to have it. At first, the thought of how I would be seen by people around me when I have a white cane was strong, and even if I felt it was scary to walk, I couldn't have a white cane easily. Even if I bumped into a utility pole, bumped into people, stumbled on steps and fell, fell from the station stairs, I thought I could manage if I was careful from now on, and couldn't have a white cane. I spent time without a white cane even during hospitalization, but I went out with a friend and was guided, but because I didn't have a white cane at that time, I often bumped into people. I was told by a friend, have a white cane, if you don't, I won't take you out anymore, and I thought that was troublesome, so I decided to have a white cane. However, because I didn't know how I could obtain a white cane, I searched on Amazon and found it, so the first white cane was a white cane that felt like just a metal white stick I bought on Amazon. Because there was no one to teach me how to use it, I was using it appropriately by imitating.

4-2: Were there times when you went out alone?
A: Basically, because I was living alone, I was going out alone. However, during hospitalization, I was told that it is dangerous, so going out alone is no good, and because I was hiding from my family that I was hospitalized, I was taken out together by a friend at the same workplace. After discharge, I came to go out alone again, but I became unable to go out to unknown places at all. After visual acuity declined further, I could go out freely only to the surroundings of the house where there are Braille blocks, the hospital, and the place where I received training.

4-2-2: Were there any impressive episodes among them?
A: Before having a white cane, I was only bumping into people, but after coming to have a white cane, bumping became very few. I think that without me noticing, people around me were watching over me and moving out of the way quietly. There were also many people who called out to me. However, I at the time I had a white cane, the resistance to being helped by people, the resistance to being seen as an existence that must be helped by people around me was very strong, and I think I often had the thought that I want you to leave me alone, rather than gratitude for being called out to. Thinking about it now, I feel that I was doing a very terrible response. But, it is also a fact that the self at that time couldn't maintain myself unless I was strong like that, and I would be grateful if you could think that it can't be helped, that there are such times.

4-3: Are you using accompanied travel support?
A: I am using it


4-3-2: When did you start using it?
A: I think I started using it around after I quit my job.
4-3-3: When are you using it?

A: When going to a place I go for the first time or a place I am not used to. When I want support at the destination (shopping, leisure, etc.)
Currently, I am having them accompany me for daily shopping regularly twice a week + I am using it when I go to play irregularly, when I want to let Ojo play, etc.

4-3-4: How do you feel about using accompanied travel support?
A: At first, I had resistance to having someone help me, but because I couldn't go anywhere alone, I had no choice but to use it. Now, the resistance to having someone help me has decreased quite a bit, but it is not that it has become 0, and the thought that if possible I want to go out alone, only by ourselves, remains. However, I am weighing that resistance and the merit obtained by having someone help me, and when I think the merit is larger, I am requesting it actively. I came to think that requesting necessary support by myself and having someone guide me to go to the destination and achieve the purpose is an important ability for myself.
Q5. Then, I will ask about life at home.

5-1: Are you living with someone now?
A: Yes


5-1-2: When is that from?
A: From about 7 years ago

5-1-3: How was it before that?
A: Before that, I was living alone. Before that, I was living with my family at my parents' house.
5-2: Are there any impressive episodes in life at home? Please tell me a few.
(Example: things you were surprised at yourself, things you were surprised at by people around you, things you were happy about, things you were sad about, etc.)
A: Things that remain very strongly in life at home are things right after I became difficult to see and was discharged from the hospital.
I was proposed from the hospital that I should talk to my family and seek assistance because I think it is difficult to live alone, but the self at that time had resistance to telling my family about the current state no matter what, and I insisted that I am okay alone and returned to life living alone. I thought, surely it is okay, it will manage somehow. But, because I had become quite difficult to see by that time, it didn't manage somehow.
Because I couldn't make meals, I bought things at a convenience store right under the house, but when I tried to warm it with a microwave, even though it should have been a microwave I had been using all along, I didn't know which button I should press. When I pressed various buttons appropriately, it started moving for the time being, so when I was relieved, a dangerous smell came, and it seems I pressed the toast button, and the soba became a terrible thing. Because I didn't know what was happening, I sought help from a friend and had them come, but even if the intercom was pressed, I didn't know the button to unlock the auto-lock, and I couldn't have them enter inside. I didn't know the buttons of the TV remote control, or the switch of the washing machine.
A friend who somehow entered inside put stickers that I can understand by touching on various buttons and explained one by one, and I somehow became able to use the microwave and washing machine. But, there were still things I couldn't do one after another, I thought I would cook rice, but I didn't know the amount of water, I was scared even to hold a kitchen knife, there were things I couldn't do one after another, and it was days of losing confidence more and more. I couldn't make rice, I couldn't withdraw money by myself, I couldn't go out freely... Thinking about it now, I wonder how I was living, but it felt like I was somehow managing every day.
From there, I came to receive training,
I was taught that the water to cook rice can be easily measured with a cup to measure rice, I was taught how to operate an ATM by voice... while accumulating small success experiences one by one that I can do even if I cannot see if I devise, I came to be able to think that if I cannot do it, I should just think of a way I can do it, and I think that was a major change that was very important for regaining my life.


When I was able to make curry by myself for the first time in a long time, I was truly happy. I became unable to do things I had done naturally until then, and I gave up once, but I was able to realize that there are still many things I can do.
Now, regarding cooking, egg rolls are difficult, but I can also make omelet rice, I can also make deep-fried food, I can also make lunch boxes, and making sweets, making bread... I became able to do various things, and I came to be able to think that there might not be things I cannot do because I cannot see. I am enjoying various things, such as doing home gardening, trying to use a sewing machine.
Q6. Next, please tell me about interaction with people.

6-1: Were there any impressive episodes in interaction with family?
A: What remains most impressive in the relationship with family is the relationship at the beginning when I became visually impaired, it is not that the relationship with family was bad and I couldn't tell them, and I am very close with my family, but the thought of not wanting to worry them, and more than that, the anxiety about being seen as a different self from before, such as pitiful or having to help me, was very strong, and the thought of wanting to keep hiding it all along was very strong. Because I had to hide it, there were many painful things, and because of that, I couldn't meet my family, couldn't be helped, had to lie... Thinking about it now, I wonder why I was doing such a thing, but anyway, I was scared of being known. But, it is not that I could keep hiding it all along, and I had been in conflict all along that I had to tell them. Even that I was hospitalized, even that I became visually impaired, in the end, it was known to my family in the form of being exposed, not told by myself. But, thinking about it now, I think it was truly good that it was known. Even after my visual impairment was known, my family treated me as if nothing had changed from before. I was not blamed for hiding it. After regaining the relationship with my family, I hated myself who couldn't trust my family, and at the same time, I truly felt the gratitude of my family. And from there, I became able to obtain the cooperation of my family, and it became very easy both mentally and in life. I think I am still continuing a very good relationship with my family. The self before becoming visually impaired, of course, was close with my family, but I think relying on them was very bad at it. I think the current me is able to connect with my family in a deeper relationship than before while relying on them and being relied on. I think this is a relationship obtained precisely because I became visually impaired and had no choice but to borrow the power of my family even if I didn't like it.

6-2: How about interaction with friends from when you could see?
A: I have almost not come out to friends from when I could see that I became unable to see. Only one or two nurse friends know, and I haven't talked about details to those people either. Only with those two, I sometimes meet and go to eat, or ask about the current state of the previous workplace. The reaction of those two to me has not changed in particular, and they are interacting with me the same as before. I stopped meeting other friends. I also became unable to go to class reunions, etc. Because Facebook has many connections with past friends, I became unable to update it. Many friends in my hometown might still think that I am working as a nurse normally at the hospital. The feeling of wanting to meet friends is of course large, but more than that, the anxiety of how friends will perceive the self that has changed, and how I feel about friends who can see is too strong, so even now, many years after I became unable to see, I am continuing to hide it from friends in my hometown. I am hiding it not only from friends but also from relatives. I don't want neighbors to notice, so when I return to my parents' house, I don't use a white cane, and I don't let Ojo walk as a guide dog. I think there is also a feeling that even if I talk, everyone will accept me without changing just as my family did, but I think the feeling that I still cannot tell them is winning.
6-3: How about the workplace?

A: I returned to the previous workplace immediately after being discharged in a state of being difficult to see, but at that time, because it was not a state where I could hide it, I was informing the staff of the same ward about my way of seeing. However, I had the thought that I didn't want to be known by other hospital staff, so I was using a white cane until the station near the workplace, but I was putting away the white cane on the way and hiding it. Because of that, I also fell, but I didn't have the courage to take out the white cane. And although I informed the staff of the same ward that it became difficult to see, I had strong resistance to being known as the self that became unable to do things, and I think I was pretending to see, pretending to be able to do things. I think I was forcing myself very much, stretching myself, and covering up the difficulty in seeing somehow. I had major resistance to acknowledging things I couldn't do and having someone help me, and I couldn't face and acknowledge the self that couldn't do things, and it was painful days.
Around the time I quit that workplace and entered a rehabilitation facility for visually impaired persons for functional training, I stopped hiding that I couldn't see from the workplace. At that time, it is also large that I became unable to see further and couldn't pretend to see anymore, but I think the factors are that I made many peers who cannot see, I was able to think that I am not the only one, and I became able to think a little that not being able to see is by no means a shameful thing. I am entering university, graduate school, and current workplace as myself who cannot see, after informing that I cannot see. Therefore, because I don't hide it anymore, I became able to convey difficult things, things I want help with, etc., firmly. But, even now, the thought that I want to become able to do things the same way as people who can see is very strong. I often think, why can't I see, why can't I do things, and compare myself with people around me. The moment I feel that I am different from everyone, I feel frustrated.
6-4: How about interaction with visually impaired persons?

A: Regarding interaction with visually impaired persons, at first, the feeling that I want peers with visual impairment was very strong. Even at the hospital where I was hospitalized, everyone around me became able to see when surgery ended, and I didn't meet people who were difficult to see and troubled. There were no such people at the workplace either. Therefore, I didn't know how I should live, how I should work, as a visually impaired person, and I felt strong loneliness in the environment where only I was a visually impaired person. Through an organization doing visual impairment support, I met a nurse, medical worker who has the same visual impairment, knew that I am not alone, and also knew the existence of people who are splendidly supporting people even if they have visual impairment, and I was able to harbor hope that I also want to become like that. But, at the time I entered the rehabilitation facility for visually impaired persons, I couldn't acknowledge the same users, I thought I am different from these people, I don't want to be thought of together, people without ambition, people who are not useful to society, etc., I thought very terrible things, and felt strong rejection that I don't want to be done together, and I had the goal of leaving here as soon as possible and becoming an existence that can be useful to society. I think now that I couldn't get used to the leisurely air of welfare at all, I was impatient alone, and was sharp alone. But, while being placed in that and interacting with users, I was able to notice that the people I had decided on my own were people spending days without change without ambition are people who are doing their best toward some small goal every day, and I was able to notice that they are existences doing their best to live in society, and I came to feel that they are important peers, and they became important teachers who teach me many skills for living as a visually impaired person. I knew the figure of everyone skillfully seeking help from people around, and was taught that requesting necessary support by myself and receiving necessary assistance to achieve something is a very important ability for us. I came to be able to think that "can do" by forcing myself alone and "can do" by having someone help me with difficult parts are the same "can do," and have the same value. I was taught that being helped is by no means a shameful thing.
Interaction with visual impairment people concerned started from resistance that I don't want to be thought of as the same visually impaired person, became good peers/teachers, and now, I think I am important friends, peers who can associate regardless of whether it is visual impairment or not.

6-5: How about people in the world?
A: Regarding people in the world, at first, it is an existence that I am very concerned about how I am seen, and that of course remains even now, but at first, especially, I perceived that I am looked down upon as an existence that must be helped, and the resistance to receiving support was very strong. Even when I was clearly troubled, such as when I was lost, even if they kindly called out to me, "Is there anything you are troubled with?", I was returning coldly, "I am okay (please leave me alone)," or couldn't accept it honestly. Whether I became able to accept it honestly now, it is not that I am accepting it honestly 100%, but I am thinking that being called out to is a grateful thing, and for the sake of other visually impaired persons, I should convey gratitude properly. However, because I have a policy that I want to live without borrowing anyone's hand if possible, I want to do what I can by myself as much as possible. Compared to before, I have become used to being seen as a visually impaired person, and I have also understood that people around me are not that concerned as much as I think, and because there are far more people paying attention to Ojo than me, I think I have stopped being concerned as much as before now. Of course, there are many times when I am hurt, feel frustrated, feel envious, but I have become able to think that I am me, people are people, and it is better to enjoy my life and live than to compare with people.
Q7. Then, I will ask about rehabilitation.

7-1: What did you do about rehabilitation?
A: First of all, I received walking training for commuting, and also had them do training around the house, etc. After that, to receive full-scale training, I entered + attended a functional training facility for about 1 year. I also received vocational training. There, I received various training such as walking, voice computer, ICT equipment, Braille, ink print, movement, training for daily life (cooking, cleaning, handicraft, etc.).

7-2: Are there any impressive episodes in rehabilitation?
A: When starting rehabilitation, I was full of things I couldn't do, and my pet phrase became "impossible, cannot do," but through rehabilitation, I became able to cook rice, I understood how to distinguish bills, I became able to apply makeup, I became able to attach buttons, I became able to write addresses, I could read Braille, I became able to do blind touch, I became able to use the Internet, I became able to go to the station alone, etc., while accumulating small success experiences one by one, by changing from cannot do to can do, I was able to regain confidence in myself. I remember vividly that it was very happy that I became able to read Braille for the first time, and also that I became able to read characters by my own strength. I also remember that I rejoiced very much together with the training instructor when I became able to go to the bathhouse alone. By regaining confidence in myself like that, I became able to think positively, became able to turn my eyes to my surroundings, and became able to have new goals. Also, the existence of peers who worked hard on training while encouraging each other is still very important peers even now. I think I was able to do my best because I wasn't alone.
7-3: What do you think about visual rehab (rehabilitation for visual impairment)?

A: I think visual rehab is very late compared to rehabilitation for other physical disabilities (limbs and hearing), and also very late compared to foreign countries, and it is far from an environment where all visually impaired persons can receive sufficient rehabilitation. There are various problems such as systematic rehabilitation programs and systems for providing rehabilitation not being sufficiently in place, and shortage of human resources who can conduct visual rehab.
The word visual rehab, even I who was a nurse didn't know until I became a person concerned. When I became difficult to see, there was no one to do rehabilitation for visually impaired persons for me who was hospitalized, and there was no one to teach me life tools or prosthetic devices for visually impaired persons. For example, if it were a spinal cord injury, there is a rehabilitation program that was tilted from the acute phase, and one can receive firm rehabilitation at the hospital. Professional occupations such as PT and OT are also developed. OT and PT are also placed in hospitals. There are many hospitals where ST that conducts training for hearing impairment is also placed. Then, who does rehabilitation for visually impaired persons? There is no occupation in the hospital that can conduct visual rehab. It feels like a very small number of orthoptists at a very small number of hospitals are doing just a little. Becoming unable to see requires changing one's life style up to that point greatly, and I think it has a major impact on life, perhaps more than not being able to walk? Even so, we are discharged from the hospital without being taught anything about how to live in a way that cannot see, just as we are. It might be difficult to conduct firm visual rehab at the hospital, but at least I wanted them to help me with the environment for that, such as where I should go to receive training. Even if I was told that I could receive rehabilitation at a functional training facility, there is no vacancy there unless 6 months or 1 year passes. I was told that I was on a 1-year waiting list, and I was at a loss as to how I should live for this 1 year. In addition to it being difficult to connect to appropriate information, even if I connect, I am made to wait because there is no sufficient provision system. That is the current status of visual rehab. I harbor the anxiety of becoming unable to see, the anxiety of becoming difficult to see more and more alone, and shut in without knowing what to do. There are many people who cannot connect to appropriate support for many years and whose lives collapse. There are still many such visually impaired persons. If one can receive proper visual rehab and find a way that suits oneself even if one cannot see, there are many things one can do even if one has a visual impairment. One can also enjoy various things. One can also work and study. I think it is important to create a system of visual rehab where people who need visual rehab can access it easily at an appropriate time. For that purpose as well, I think it is necessary to create a proper system regarding professionals who bear visual rehab and the system that provides visual rehab, like rehabilitation for other disabilities.
Q8. Please tell me about school and work.

8-1: Are you going to school or work now?
A: Yes. Currently, I am doing consultation support work during the day, and attending graduate school at night or on holidays.
8-1: How was it before?

A: Before coming to graduate school, I was a student in the social welfare department of a university
Originally, I graduated from the nursing department of a university and worked as a pediatric nurse for over 10 years. In that process, I became visually impaired, it became difficult to continue employment, and I left my job. After leaving my job, I received various training for 1 year, both in-facility and attending, at an organization that conducts rehabilitation for visual impairment. I also attended vocational training. During that time, I decided to transfer to a university, took the entrance exam, and transferred to the social welfare department.
8-2: What do you think about school (or work)?
A: Regarding school, first of all, I am very grateful to the university I transferred to. When I decided to transfer to the university, I was full of anxiety about whether I could be accepted in a state of not being able to see, whether I could follow the classes, and whether I could go properly in the first place. I also thought about the path of aiming for employment without going to university as it is, but employment for visually impaired persons is truly difficult, and because I had a strong hope to return to interpersonal support work, I chose the path of going to university, thinking that it might be a little detour, but re-learning interpersonal support, studying social welfare, acquiring qualifications, and aiming for future employment utilizing those qualifications. That was the reason on the surface, and I think the reason that I chose university with a reason of being on the defensive, such as because employment is difficult, maybe I can do it if it is advancement, was larger. I think I wanted to make an excuse for not being able to work by obtaining affiliation quickly. It was a university I entered with such feelings, but as a result, I think it was truly good that I went. From the acceptance, they welcomed me very favorably, and I think they stayed with me for 3 years with a stance of thinking together about how I can do it, not what I cannot do. In these 3 years, I experienced various things the same as everyone, and was able to gain confidence that I can truly do it even if I have a visual impairment. I was also able to have the valuable experience of going to overseas training together and interacting with visually impaired persons in Denmark. In practical training, I actually touched users and patients, and was able to realize that there is support I can do. Spending 3 years, finding my own study style and life style, and being given time to face my own disability and life was also large. I participated in club activities and volunteer activities, made many very young friends, met wonderful teachers, was able to feel the many existences that support me with my skin, and was able to have a very fun and fulfilling student life. In these 3 years, I think I became able to perceive myself not as me as a visually impaired person, but as myself including visual impairment.
Student life was truly fun, and I was able to enjoy student life to the extent that I could think I had the most fulfilling student life than anyone else, but job hunting was, after all, very hard. Or rather, I feel like I escaped from being hard again.
I was working on job hunting, but after all, I think I decided myself that employment for visually impaired persons is difficult, and gave up before taking the exam many times. Even so, I think that challenging the facility I wanted to go to firmly even if it was difficult, even if it was just one, became an important experience for myself. Even if I could be evaluated in my thoughts, ideas, experience, various parts, I was made to think again that not being able to see is a major handicap that cannot be supplemented easily no matter how much I try to supplement it elsewhere. And again, on the defensive, I decided to get a job at a facility made by a university teacher for the time being, and again, because I am not able to get satisfactory employment, I thought I have to make more of my strengths, and I also advanced to graduate school.

At the facility I got a job at... because the employment was decided without talking sufficiently with the teacher, there were many parts that passed each other, and it became a very painful state where there was actually no work, and even if I went, I couldn't be entrusted with anything. I had become a state where I couldn't have confidence in myself like when I quit nursing before. However, what was different from that time was that because there was school and there were many existences that helped me, I was able to have mental leeway that it will manage somehow, I can look for work again. Because I was receiving disability pension and I was married and had my husband's income, I think the fact that I was in a state where I could live somehow even if I didn't work immediately was also a factor that could have leeway. Anyway, even if it doesn't connect to work, I want to find a role I can do in society, and while challenging from things I can do little by little, I was able to meet the current consultation support work.
The current work is the work that the self at the time I became unable to see thought at the very beginning that if it is this, I might be able to do it, and I might be able to utilize my career and experience until now. Financially, it might not be a very stable job, but I am able to work fun while feeling fulfillment every day. Even at the current workplace, at first, we didn't know what we could do each other, and started from a state where there was almost nothing I could do, but I found things I could do little by little, and now, I have also acquired qualifications and became able to be entrusted with various things. I was able to remember after a long time that being relied on by people is truly happy and makes me have confidence in myself. Work has become a very important thing for myself that makes me feel my reason for existence.

8-3: Please tell me your thoughts and ideas regarding visually impaired persons learning (or working).
A: I think the image of the world toward visually impaired persons is still "cannot do anything" or "support for visually impaired persons is very hard." For that reason, I think there are truly many cases where it is decided from the beginning that it is impossible in work and school. There were several times when the first word at the open campus was "I think it is impossible." I thought it was surely from this image. After that, I explained that I don't need much special support, and I have spent university life like this, and because I was able to have them understand, I was able to be accepted, and now, I am able to study here like this. But, because I am relatively strong-minded, I was able to retort there, "No, I don't think it is impossible," but when I think about whether many visually impaired persons were able to return words like me, I think it is truly difficult for visually impaired persons who are full of anxiety about whether they will be accepted to overcome that. In current schooling and employment, especially in employment, before our stories can be heard, there are truly many cases where it is said that it is impossible for us just because it is visual impairment. Even in joint interviews for disabled persons, there are many companies that do not interview grade 1 visual impairment. To that extent, it is difficult for visually impaired persons to work. I myself have also been told that many times. Even now, for example, when I visit a facility for continuous employment support type A, when I ask, "Can you accept visually impaired people?", most facilities say it is impossible because there is nothing I can do here. There, I explain one by one, "If it is this work, if you devise, even a visually impaired person can do it," and finally it becomes a feeling, "Then, I will consider it if it is just an experience." Even facilities aiming to employ disabled persons are in such a state, so general employment is truly severe. Even if one graduates from university, graduates from graduate school, acquires national qualifications, there are still many visually impaired persons who cannot work. We are not existences that cannot do anything that much. If one receives training, there are many places where one becomes able to commute alone. Now, a system to support commuting has also been made. Even for computers, if one can use software that suits us, there are many possible tasks. Because I haven't received vocational training firmly, it is impossible, but among visually impaired persons, there are also many people who do programming and do spreadsheet work. Not being able to work even if one wants to work is truly painful. If everyone is required to be able to do the same, there are certainly things we cannot do, and things that are impossible. But, there are also many things we can do. I want society to become a society where everyone can be active in some form, whether one has a visual impairment, has other disabilities, or has no disability, by turning eyes to what one can do, not what one cannot do. Regarding schooling and employment, I don't want you to take away our chances. I want to make it a society where visually impaired persons can live in their own way, even if they cannot see, even if they are difficult to see.
Q9. Finally, please tell me about your past and future as a visually impaired person.

9-1: What do you think about your life as a visually impaired person?
A: In the first place, the sense that I have lived as a visually impaired person is not much, or rather, I don't want to have it. When I became visually impaired, I felt as if visual impairment was everything about me, and I thought that the self that became visually impaired cannot do anything anymore, has no value, and will only become a burden to society, and I despaired of my life. I even thought that I don't care what happens to my life anymore, and that I have no value to live. But, while being supported by many people and receiving courage from many peers, I think the ratio that visual impairment occupies in myself has gradually decreased. Visual impairment is a part of me, and it is just one characteristic of mine, and by no means everything. I think I came to think that before I am me of visual impairment, I am just me, and the existence called me happened to have the characteristic called visual impairment in the middle of life. Therefore, I think I am walking my life without changing before becoming visually impaired and after becoming visually impaired, not a life as a visually impaired person. If anything, because I became visually impaired and became strongly caught up in the fact of visual impairment, I once almost lost sight of my life, but I think it is a feeling that I started walking my original life that doesn't change again because the being caught up in visual impairment decreases. Regarding my life after becoming visually impaired, I don't think it was very good, but I think it is not bad, or rather, I want to think so. I am not leading a life that is only despair at the bottom of unhappiness because I became visually impaired, but I am living while feeling happy fun in its own way every day. Therefore, being decided as unhappy or pitiful is, I think, that thing itself is unhappy. However, if I am asked whether I am happy from the heart, whether it was good with this life, whether I want to live this life again, I still think that a life that can see is of course better. However, no matter how much I wish, no matter how much I lament, no matter how much I whine, no matter how much I get angry, the self that can see will not return, so I have no choice but to live as a self that cannot see. If I live in that situation, I think it is much better to live while turning eyes to fun things, reason for living, etc., than to live while being caught up only in sadness, anger, and suffering. Therefore, I think my life after becoming visually impaired is by no means something I wished for from the heart, but I think it is something not bad in its own way (I want to think). There are many experiences and human relationships obtained precisely because I became visually impaired, and there are many things I could see and things I could feel precisely because I became unable to see. I think those are irreplaceable things obtained precisely because I became visually impaired.

9-2: Are you accepting your own visual impairment?
A: I thought the word disability acceptance was something that people who don't have a disability, including the self when I was sighted, were saying arbitrarily, but in performing this research, while thinking about the word acceptance again, I knew that acceptance = not just accepting, but also has nuances of accepting and facing, and in that sense, I came to think that there are times when I am accepting. But, I think that accepting that I became visually impaired -> it is fine to remain visually impaired as it is, will absolutely not happen for the time being. But, I think I have become able to face the fact that I became visually impaired. When I became visually impaired, I was thinking why did this happen, I am different from other visually impaired persons, I don't want to be thought of together with those people, etc., and I was turning my eyes away from visual impairment and was not trying to face it. Thinking from there, now, even if there is visual impairment, I think that including that is me, and I have no choice but to live while associating well. In that sense, it might become that I am accepting, trying to face it. However, it is not that I can be in such a heart at all times, and when I bump into some wall, fail, or have a disgusting experience, immediately I think why did this happen, I want to return to the self that can see, or I envy people who can see, and I immediately become a self that cannot face it. Therefore, disability acceptance might not be something like completed or finished. I think it might be a feeling that the wave of swaying of feelings was large at first, frequency was also intense, and it was a state like a storm, but along with the passage of time, it gradually becomes smaller, the number of times becomes fewer, and it becomes close to calm, but if some factor is added, it becomes large again.

9-3: How do you want to live your life from now on?

A: Without being caught up too much in the fact that I am visually impaired, I want to spend fun days in my own way. And I want to have my role in society, and not only be supported by people around me, but also become an existence where I myself can become a support for someone.

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Thank you for reading until the end.

I think it was very long and there were many parts that were difficult to read, but thank you very much for reading ♡

If you'd like, I would be happy if you could give me impressions or messages, etc.By making the thesis digital data, I hope it will reach peers who cannot see or are difficult to see. If there is a good method to deliver this thesis to many peers, please tell me by all means.Thank you.