Spina bifida is a congenital disease that results in physical disabilities: lower limb disabilities, internal disabilities. There is currently an overwhelming amount of information and papers on medical care about spina bifida in Japan. In light of this current situation, when researching spina bifida, a congenital disorder, it will be necessary to consider adults with the condition from not only a medical perspective, but also a psychosocial one. This is pointed out in a recent Japanese paper [1].

In conducting research based on the above perspective, I have clarified the importance of strengths [2]. From a social worker’s point of view, by separating the strengths of the person from the impairments attributed to their disability and leveraging and developing their strengths, the person’s “unconscious strengths” will gradually become conscious. It is suggested that by making use of that strength, they can connect with people and lead to social participation [3].

In addition, in recent years, research has begun to be conducted in Japan on adolescent and adulthood of people with spina bifida. Murayama [4] and Murayama et al. [5] conducted research on the challenges faced by people with spina bifida during the transition from adolescence to adulthood, revealing the following: This study contributed to identification of both challenges and positive aspects in experiences of emerging adults with spina bifida in Japan. Participants shared the unique perspective of how to “become an adult” as a person with spina bifida in Japan. Ever-present were participants’ experiences of struggling during transition to adulthood, especially when trying to find a job, establishing relationships with friends, and making the transition to adult health care.

The above indicates that in Japan, there is a little growing interest not only in research on infants and children with spina bifida, but also in the psychosocial issues of adolescents and adults with spina bifida.

In this paper, I would like to point out the importance of a strengths perspective when considering the mental health of people with spina bifida, and therefore will refer to strengths here. Miley et al. [6] defines strengths as "the things we think we are good at, such as innate abilities, acquired talents, and developed skills," and points out that this includes "not only visible traits, abilities, and behaviors, but also small successes and intangible attributes." Saleebey [7] also states that strengths are "like abilities, resources, and strengths," and specifically states that they include "what people have learned through adversity, the knowledge and wisdom they have acquired through education and life experiences, the characteristics and traits that people possess, their virtues, talents, pride, spirituality, the well-being of their communities, and cultural and personal stories and traditions."

Strength has also been pointed out to be related to empowerment. Komatsu [8] points out that the empowerment approach has developed in tandem with and complemented efforts based on the strength perspective, which emphasizes health and strength. Cowger et al. [9] also emphasized the strength of the users, which they described as their power and strength, as "fuel and energy for empowerment."

Each person with a physical disability has impairments in their abilities due to their physical disability, but strength is a perspective that focuses on and utilizes each person's individual strengths and advantages, which are separate from their disability [2,3]. It is believed that focusing on and utilizing these strengths may also lead to empowerment of the individuals involved. When considering how adolescent and adult people with spina bifida can live mentally healthy lives despite their disability, the perspectives of strength and empowerment are considered to be extremely important concepts [2,3].

Fujita [2] states the following: In Japan, from the 2010s onwards, there has been a relatively large amount of research linking people with disabilities to the strengths model, particularly on people with mental disabilities [Ando et al., 2012; Sakae, 2014; Anpo, 2015; Okawa, 2015; Tokunaga, 2016; Shimoda, 2017]. Other examples include [Ohno (2011)] linking the strengths model in his research on the narratives of people with incurable illnesses, and the Saitama Katsura Kita Independence Support Council/Core Consultation Support Center Preparatory Committee (2015) linking the strengths model in a case study of people with intellectual disabilities. However, there are very few studies in Japan that link people with physical disabilities with strength. Therefore, advancing research in this area in Japan can be said to be one of the challenges.

Although recent strengths research often involves linking strengths to social work and social work practice, for example Ganie [10], Balgopal et al. [11], Prehn [12], there is little research that focuses on the strengths of people with disabilities. On the other hand, it is gaining attention in the field of positive psychology, for example Wehmeyer [13]. This research trend is similar in recent Japan. For example, in recent years Yamashita [14], has developed a model for how to utilize and strengthen the strengths of people with mental disabilities and promote their employment, but even in Japan there is very little research on the strengths of people with disabilities. This suggests the significance of utilizing a strengths perspective for people with disabilities.

I will discuss the significance of utilizing a strengths perspective for people with spina bifida after introducing some findings from my research [2] introduced in the introduction.

Through life story interviews, I clarified the "meaning of self-affirmation" and "meaning of the true nature of disability." The meaning of self-affirmation includes 1) the realization that "I can't do this because I have a disability" but also "there are things I can do even with a disability," and 2) the feeling that I have been useful, both of which are deeply related to strengths.

People with spina bifida and other physical disabilities will often be keenly aware of the things they cannot do because of their disability. If a person suffers from these things, it will cause mental stress and lead to a mentally exhausted state.

At times like these, what would happen if people with spina bifida were able to become aware of their own strengths through the comments of someone important to people with spina bifida? At first, they may not understand the strengths that are pointed out to them. However, as time passes and they suddenly realize in their daily lives that this may be one of their strengths, they may gradually begin to try to use it in their studies, work, or hobbies, for example. Through this, they realize not only what they cannot do because of their disability, but also what they can do.

As a result, they may make friends and colleagues, and at times may find themselves supporting and helping the friends and colleagues they are with, and through these experiences, they may find their self-esteem improve. This also relates to “Social interest” in Individual psychology [15], which has been pointed out to influence increasing happiness.

Interest in individual psychology has grown in Japan since the publication of "The Courage to be Disliked" in 2013. It has been pointed out that social interest in individual psychology increases by school age, so the publication of this book has sparked a great deal of interest in children's social interests. For example, in last year's research on social interest in Japan, five papers focused on the social interest of elementary and junior high school students, and in recent years there have been many papers on the social interest of children [16–20]. In particular, research on societal interest has been appearing frequently recently. On the other hand, there have been no papers in Japan that focus on the social interests of people with disabilities, and Fujita [21] and Fujita [2] were the first to do so.

Social interest was originally called Gemeinschaftsgefühl in German, and it has been shown in many previous studies to be closely related to a heightened subjective well-being. Social interest is composed of three factors, “self-esteem” (“self-esteem” is also called positive sense of self), “sense of belonging” (“sense of belonging” is also called feelings of belonging society and trust in society), and “sense of contribution” (sense of contribution is also called feelings of contribution). Self-esteem is the feeling of being okay with yourself. Sense of belonging is a feeling of belonging somewhere and being able to trust the people around us. Sense of contribution is the feeling of not only being supported but also supporting someone and being of use to someone.

In Japan, the above content was defined by Noda [22], and the above three-factor structure was subsequently confirmed by the social interest scales independently developed by Kosaka [23] and Fujita [2,21]. Recently Yamada [24], has offered the following commentary on sense of community: While Adler himself did not provide a precise definition, sense of community is interpreted as "the issue of friendship and relationships with peers, as well as the accompanying sincerity, trust, and tendency to cooperate, as well as concern for one's country, race, and humanity." This refers to the presence of a vector of concern not only for oneself but also for others. Furthermore, he argues that not only is a sense of connection with others necessary, but also a desire to contribute to them. To achieve this, one must "see with other people's eyes, hear with other people's ears, and feel with other people's hearts," that is, to have an empathetic attitude that masters the perspective of others. At the same time, this fosters a sense of belonging to the community, leading to peace of mind. A sense of belonging is not something that is bestowed upon one by the community; rather, it is something one acquires and seeks for by contributing to the community.

Looking at it this way, if people with spina bifida become aware of their own strengths and try to make use of them, it seems ultimately social interest and its three sub-factors will increase, leading to a greater sense of happiness and empowerment for the individual.

This would also lead to the empowerment approach, which originated in Solomon [25] in social work, for example. The empowerment approach has become one of the mainstream approaches in Japan in recent years.

From the above, it can be said that people with spina bifida and other physical disabilities can become aware of strengths that are separate from their disability and, by utilizing these, can participate in society, increase their social interest, and through this, become empowered and feel a greater sense of happiness. This may be seen as an indication that how to raise awareness of the strengths of people with spina bifida is important.

It is not easy for people with spina bifida to recognize their own strengths because they tend to focus on what they cannot do due to their disability and are not aware of their own strengths. So how to raise awareness of the unrecognized strengths of people with spina bifida becomes the problem.

I believe that finding a solution to this problem is one of the most important issues, but so far, I have not seen any relevant research in Japan. Considering the current state of research in Japan, I am currently conducting research on people with spina bifida entitled "Establishing a method of employment support that utilizes the strengths of individuals with congenital physical disabilities."

Speaking from my experience as a social worker supporting people with disabilities in finding employment, it is important for social workers to first distinguish between the part of disability and the part of person. The former includes what cannot be done due to a disability, while the latter includes what a person can do, in other words, their strengths. Therefore, it will be important for social workers and other interpersonal support professionals to focus on the latter and use this to discover the strengths of the disabled person themselves.

A method I have actually used to find the strengths of people with disabilities when providing employment support to them in Japan is to have them write down 10 to 20 of their weaknesses on the left side of a piece of paper, and then rephrase those words in a positive way without changing their meaning. These positively phrased words represent the person's strengths. After using this method, even if the person with a disability does not immediately understand the strengths that have been identified, they will gradually become aware of their own strengths as they slowly come to understand them over time. This method was developed by myself while working as a social worker providing employment support for people with disabilities, and is based on individual psychology (e.g., Adler, 1929 [15]).

Another method besides the above is to use strength cards, which were developed in Japan. Each strengths card has a word written on it that represents a person's strengths or virtues. You can choose a card that you think represents your own strength, or in group work, someone else can choose a card that they think represents their strength and pass it on to someone else. Through the Strengths Cards, people can gain an opportunity to become aware of the strengths within themselves. Strength cards were developed by Takeda [26], and papers on the effects of using strength cards began to appear around 2015 in Japan. In recent years Endo and Yamamoto [27], have pointed out the impact that group work using strength cards has on resilience.

The above methods have been largely effective in my own practice as a social worker, but the lack of evidence is an issue, as their effectiveness has not been verified through research.

This paper points out the importance of a strengths perspective in the mental health of people with spina bifida in Japan. In other words, it was suggested that people with spina bifida can become aware of strengths that they were not aware of and increase their social interest by utilizing these strengths in their studies, work, and hobbies, which in turn increases their sense of happiness and leads to them living life as themselves.

This paper was supported by JSPS KAKENHI Grant Number JP 24K16562.