GOING DEEPER
Medical and Psychological Aspects
of Diving With Disabilities

For Alert Diver Magazine

By BARBARA KROOSS, Ph.D.

The participants in the Wounded Warriors Project are, in many
ways, prime candidates for dive training. Before their injuries,
they were physically and mentally well-conditioned. They’re
young and specially trained to approach physical and mental
difficulties as challenges to be dealt with in a cheerful and
effective manner. They were good candidates for learning to dive
before their injuries, and they still are.

Divers with disabilities are more similar to “ordinary” divers than
they are different. Any diver comes to the sport with a unique
physical and psychological personal profile, and each one
experiences physical and psychological effects from diving.

Divers who are paralyzed or who have muscle weakness have
special mobility considerations in the water, yet they may also
gain mobility in a zero-gravity environment. Persons who are
blind and who focus more intensely on other sensations enjoy the
feeling of floating and the unique sounds of the underwater
world. They may also enjoy the skin sense of touch, provided
that experience with sea urchins, lobsters, fire coral and other
potentially pain-causing creatures are closely monitored by a
buddy. Deaf divers are at an advantage as soon as they leave the
surface; the playing field has been leveled for them to chatter
away using sign language to communicate with each other
underwater.

Even divers who in years past were advised to avoid diving have
seen restrictions modified. Divers with diabetes or asthma may
use special buddy protocols and modified profiles.

Individual challenges
Jim Gatacre, founder of the Handicapped Scuba Association in
San Clemente, Calif., says that instructors quickly realize that
each disabled diver must be considered individually. The most
important consideration is not the disability that the person has,
but rather it’s the person who has the disability, he notes.
Persons with identical diagnoses can vary greatly in their
capabilities, motivation and tolerance of risk.

Some divers with disabilities have acute or chronic physical
illnesses and may have special disease-related considerations or
limitations. Others, like most of the participants in the Wounded
Warrior Project, are essentially healthy individuals who have lost
a limb or limb function. Apart from this logistical consideration,
these divers are often in excellent physical health, although the
presence of scar tissue may place them at greater risk for DCS
because of impaired circulation.

Fortunately, equipment for disabled divers has come along way,
with special adaptations that can be custom-fitted to meet the
person’s special diving needs. Fins may be attached to prosthetic
limbs, and the limbs properly weighted and adjusted to a specific
range of motion. Divers with little or no leg function can use
webbed gloves to assist in propulsion. Positioning and
configuration of buoyancy compensator controls can be
customized.

Consider the physical aspects
In addition, disabled divers must practice buoyancy control
techniques, weighting and positioning in the water column master
these skills at a more complex level. Special entry, exit and buddy
strategies may be required, too. Some instructors feel that these
adaptations place handicapped divers more in the technical diving
realm than in recreational diving.

Some individuals with chronic pain have reported that being
underwater gave them the most reliable, albeit temporary, form
of relief, although this last point has inspired much debate: i.e.,
this relief may be so minimal that is not perceived by divers.
Some divers may get pain relief because they are refocusing their
attention from the body to the demands and enjoyment of their
diving experience.

Think about the mental aspects
Psychologically, these disabled veterans have come from seeing
themselves as extremely fit, independent and adventurous military
personnel who suddenly are experiencing extreme physical and
mental trauma. They received special training to objectify and
distance themselves from emotional responses to unavoidable
military and civilian casualties, but now they are unavoidably,
painfully and personally involved as casualties themselves. One
catastrophic event can leave them disabled, dependent and
potentially depressed wounded veterans. One goes from being
the helper to being the helped.

Tim Boots, 25, Carleton, Pa., described the role reversal between
himself and his wife, Emily, after he lost a leg in Iraq. Said Boots:
“I was the soldier guy, always the solid one. Then when I got
hurt, she was my rock, and she’s been there for me for
everything. I don’t know what I’d do without her. She’s my
center.”

The loss of a core sense of self and social identity can be more
debilitating to some than the actual physical loss of a limb or of
limb function. After all, the sense of self and identity is more
central to who we are than our physical self. We all expect to
change as we age: We lose physical acumen, but we gain in self-
actualization – the successful development and use of personal
talents and abilities.

Physically, these divers can gain strength, control and freedom in
the water. By working in a pool while preparing for diving and
during the dives themselves, these divers can exercise muscles
against the gentle resistance of water. The body can experience a
complete range of motion, extending the range of mobility
without problems due to gravity or weight-bearing on still-
sensitive healing tissues.

Psychologically, a disabled diver may perceive a pool workout in
preparation for a dive as a “sports training” experience, rather
than a “physical therapy” session. This changes the focus from
dealing with a past injury and loss to looking forward to some
future fun, adventure and accomplishment.

Diving allows injured persons to take the social identity of a
participant in a potentially extreme sport, that of a “technical”
diver rather than a disabled person. However, there is a danger in
adopting the behavior and social norms of the stereotyped
classical military or technical diver, which could predispose them
to risk-taking, possibly as what psychoanalysts would call
overcompensation in reaction to their disability.

It’s a general consideration that military divers are tough guys.
Recent research on military divers’ personalities — notably
Robert J. Biersner and his colleagues at the U.S. Navy
Experimental Diving Unit (1970, 1973, 1974, 1979, 1983 and
1996) on U.S. Navy divers and Charles Van Wijk in South
African Navy divers — has supported the classic stereotype of
military divers as being enthusiastic, adventurous, confident, high
in ego strength, assertiveness and self-sentiment (self-esteem).
They are risk-takers, gamblers in fact, and have a strong sense
of control, taking personal responsibility for events others might
attribute to “fate.”

Coupled with the need to prove something to themselves or
others, these ex-military personnel who become divers may be
more vulnerable to the “macho diver” syndrome, similar to that
reported by Jennifer Hunt in her 1996 psychoanalytic study of
technical divers. They may engage in more risky behaviors as a
form of overcompensation or denial of disability.

Wounded veterans who like diving share with many other divers
a love for other kinesthetic sensory experience sports that give an
adrenaline rush, such as skydiving, snow- and water-boarding
and skiing, motorcycling and jet skiing.

A circular effect may be observed here; individuals who enjoy
the feeling of risk and adventure are drawn to these sports, and
participation in the sports and the peer groups associated with
them enhances and supports this attitude. To the extent that it
encourages risky behavior, however, it is dangerous especially
when this risk-taking is coupled with unstable emotions.

Gatacre has observed that some divers with both acute and
chronic disabilities are at greater risk for depression, anger and
mood swings than are divers without disabilities. This may be the
result of post-traumatic disorder, reactive depression, pain or a
rebound from medication taken to deal with pain.

While diving can do much to help alleviate this depression,
monitoring mood is important, as extreme mood swings can
affect judgment and risk-taking behavior. However, this
consideration is not unique to this population; the caveat applies
to all divers.

Sharing the joys and the pain
Talking about an experience such as diving with a peer group
with similar military experiences and problems helps one
overcome feelings of uniqueness and isolation. Helping each
other with gear-handling and buddy-team logistics fosters
independence through cooperation. This is a sport that can be
shared with friends and family.

Diving can be a positive, transformative experience for any
person. It can be especially powerful for individuals who are
recovering from a severe physical loss. A vista is opened to a
new world … the three-fifths of our planet covered with water.
Diving offers opportunities for adventure, learning and
contribution by helping to share this wonderful underwater world
and protect it. And within this vista lies a perfect place to evoke
and nurture new strength and freedom.
CLICK IMAGE
To Enlarge

MOUSE OVER
For Captions

ALL PHOTOS
© Bob Sterner
  • Back to
      Main story



Ahhhhh!
Buoyancy check
Barbara Krooss
Barbara Krooss has a Ph.D. in
clinical neuropsychology and has
earned instructor certifications from
NAUI and the Handicapped Scuba
Association. Her photos and stories
on diving are widely published.
Contact Barbara at:

bkrooss@dcas.nyc.
gov
or info@sternereditorial.com.
Psychologically, a diver with a disability
may perceive a pool workout in
preparation for a dive as a "sports
training" experience rather than a
"physical therapy" session.
REFERENCES

Biersner, R.J. Social development of naval
divers. Aerospace Medicine 1973; 44 (7):
761-763.

Biersner, R.J. and Cameron, B.J. Betting
preferences and personality characteristics
of navy divers. Aerospace Medicine 1970;
41: 1289-1291.

Biersner, R.J. and Ryman, D.H. Psychiatric
incidence among military divers. Military
Medicine 1974; 139 (8): 633-635.

Biersner, R.J. and LaRocco J.M. Personality
Characteristics of US Navy Divers. Journal of
Occupational Psychology 1983; 56: 329-334.

Brauer, R.W., Hogan P.M., Gugon, M,
Macdonald A.G. and Miller, R.W. Patterns of
ineratction of effects of light metabolically
inert gases with those of hydrostatic
pressure as such – A review Undersea
Biomed Res, 9, (4) 353-96, 1983.  

Domoto, H, Nakabayashi, K, Hashimoto, A,
Suzuki, S, & Kitamura, T. Decrease in
platelet count during saturation diving. Aviat
Space Environ Med, 72 (4) 360-4, 2001.

Gatacre, James  Personal communication at
Handicapped Scuba Association Instructor
Training Course in New York City 1996.

Gatacre, James  Handicapped Scuba
Association Instructor’s Manual.

Hunt, J.C., Divers’ Accounts of Normal Risk.
Symbolic Interaction, 18 (4); 439-462 1995.

Rostan, J.C., and Palon, N. Recent
neurochemical basis of inert gas narcosis
and pressure effects. Undersea Hyperbaric
Medicine 33 (3): 197-204, 2006

Thorsen, E, Haave, H, Hofso, D, & Ulvik, R..J
Exposure to hyperoxia in diving and
hyperbaric medicine – effects of blod cell
counts and serum ferretin. Undersea Hyperb
Med 28 (2) 57-62 2002

Turle, N, Saget, A, Zovani, B., and Risso, J.
J. Neurochemical studies of narcosis: a
comparison between the effects of nitrous
oxide and hyperbaric oxygen in the
dopaminergic nigro-striatal pathway
Neurochem Res 23 (7) 997-1003, 1998

Van Wijk, Charles Comparing Personality
Traits of Navy Divers, Navy Non-Divers and
Civilian Sport divers South Pacific
Underwater Medicine Society (SPUMS)
Journal Volume 32 No. 1 March 2002 pages
2 – 8 (Includes peer review).

Van Wijk, C., Waters, A.H. Personality
Characteristics of South African Navy
Submarine Personnel. Military Medicine
2000;165; 656-658.

Van Wijk, Charles and Waters, H.
Personality Characteristics of South African
Navy Divers Undersea & Hyperbaric
Medicine Volume 28, No. 1, Spring 2001
pages 25 – 30

Wlodarczyk, A, McMillan, P.F., Greenfield, S.
A. High pressure effects in anaesthesia and
narcosis. Chem. Soc Rev 35, (10) :890-8,
2006