If one is truly to succeed in leading
a person to a specific place, one must
first and foremost take care to find him
where he is and begin there
Søren Kierkegaard, 1859
Introduction
Having a hearing loss affects the personal identity, the relation to the world as well as the body in an often negative and strenuous way. Sometimes these consequences overwhelmingly are felt to be too emotionally painful wherefore the hearing impaired person may turn to psychological help in order to gain strength to each day experiencing and overcoming them.
The consequences as well as what it is felt like having a hearing loss presented here have emerged during psychological sessions between a Danish psychologist and Danish persons with average intellectual abilities seeking psychological help due to their hearing loss. Thus the content of this article is based on clinical psychological work and not on scientific studies.
This article includes only the most important themes connected to hearing loss as well as some thoughts upon the implications of these themes seen in relation to the process of audiological rehabilitation.
Hearing loss and communication
Communication is the “glue” of humanity. Through spoken communication we can express ourselves, share our feelings and feel affiliated (close to) to the rest of humanity. For instance being able to “speak about it” and feel heard and understood decreases one of the existential focal conditions “the aloneness”: “I am not alone in this situation. Others understand me and would feel like I do where they in my situation”.
Hearing loss however affects spoken communication. It cuts off the hearing impaired person from the world of belonging and may very well send the hearing impaired person directly into the hearth of feeling alone, detached and alienated: “I cannot hear what is said without constantly fighting for grasping the essence of the message”. “Due to my handicap I may say strange things that are out of line of what is expected”. “I often act incorrect because I cannot always decode how I ought to act”. “I feel different. Not a part of…”.
Hearing loss will invariably emerge whenever more than one person is present wanting to communicate. Often it is through communication that the person with hearing loss becomes aware of his or hers communicative problem. In such a case it would seem natural that the person with hearing loss simply informed the surroundings about his or hers “hearing needs”. However often the opposite is taking place. How come?
Hearing loss and feelings of shame
The person with hearing loss may for instance seek to hide her disability by pretending to have understood what is being asked. The answer given by the hearing impaired person may therefore be far out – due to fact that she simply has misunderstood the question (for instance: “Did you see Mrs. Carter’s new red hair?” “Oh she went to the fair, did she! I didn’t see her there”). This can lead to confusion on the behalf of the normal hearing person, who hasn’t a clue about why the communication is going in a weird direction. The normal hearing person may then repeat the question making the hearing impaired person realise: “I did it again”. This realisation often results in feelings of shame.
Thus in the centre of how it is felt like having a hearing loss often stand feelings of shame. If the clinician asks the hearing impaired person to give reasons for why he doesn’t want to tell about his or hers hearing loss, the most frequent answer is: “I really don’t know, I just feel so ashamed”. It is through shame that most persons during childhood is taught how to behave in a social acceptable way. If a child does something that is seen as social unacceptable the child will be told to be ashamed of him self and thus will meet inner feelings of shame. The threat connected to shame is that if the child does not behave in a social acceptable way the child will be excluded from his social sphere. Persons with hearing loss constantly break the social rules thus revisiting the painful territory of shame. Fears of being excluded or not considered as equal may develop. Therefore some persons with hearing loss feels it less emotional exhausting to seek isolation that constantly risking meeting the feelings of shame.
Hearing loss, changed identity and stigmatization
Often the hearing loss is hinted at through joking: “Are you deaf or what!” Although this devaluating remark generally is not meant as anything else than a humorous remark, for the person with a hearing loss, this is not felt humorous at all. On the contrary such statements also will lead to feelings of shame or anger as well as an urge to go on concealing the hearing loss. The literature shows that many persons with hearing loss will rather answer wrongly or not answer at all than explain the reason for their behaviour.
Choosing to inform about the hearing loss often can be felt like confessing a shift of identity from belonging to the normal population to belonging to those very different ones that do not really know how to behave and thus are devaluated. This is a perfect example of stigmatization.
According to Goffmann (1973) a stigmatised person is someone who has an attribute or a characteristic which makes him or her differ from what is expected. As a consequence the person is devaluated. However the attribute or characteristic leads to that the person him or her self also feels devaluated or less worth. Thus the person’s identity is reduced to be conducted partly or even completely by the attribute.
When in clinical psychological sessions trying to clarify all the different thoughts and feelings connected to hearing loss what often emerges are expressions like: “I feel so stupid”. “I cannot see myself be like one of them” (with hearing loss).
Considering the thought of for instance telling colleagues of the concealed hearing loss gives rise to thoughts and sayings that would have been more understandable had the person for instance committed a serious crime: “People may turn away from me”, “They may find me unpleasant”, “People will not want to be together with me”, “One doesn’t tell things like that”. Such thoughts emphasize the fact that people with hearing loss seeking psychological help often are suffering in quite a severe degree from shame and stigmatization. It should be noted that such expressions and feelings are uttered both by young, middle-aged and old people and are seen present both at persons born with hearing loss as well as at persons who has acquired the hearing loss later in life.
Hearing loss and feelings of guilt
Feelings of guilt also are attached to hearing loss. In the clinical psychological sessions the hearing impaired person will explain that feeling of the guilt is due to the burden that the hearing loss puts on the others, especially the family and close friends. This is due to the fact that unless there is a clear and simple two-way communication situation persons with hearing loss will be in need of communicative support in most social situations – at work, at home during dinner, at parties, meetings etc. This support can – from the perspective of the hearing impaired person – be felt as “I am constantly giving the others trouble”.
As a result the person with hearing loss may find him or her self in a constant tiring discussion with him or her self about whether one should claim a right to hear what is being said or whether one rather should not. Often compensating behaviour is exerted, like wanting to do everything else very perfect.
Hearing loss and grief
What also emerge during the clinical sessions with hearing impaired persons are profound feelings of sorrow and grief. Hearing loss is a loss. The loss can be about the loss of identity, the loss of the uncomplicated access to sound and/or to communication, the loss of more specific and important sounds like nature, music, children’s voices etc, loss of friends who finds it too complicated to communicate with the hearing impaired person, loss of job due to the hearing loss, etc etc. These losses need to be worked through and if possible transformed into something meaningful in order not to constantly drain the person from the energy connected to grief and eventually develop into depression.
Hearing loss and fatigue
Finally the fatigue connected to hearing loss shall be mentioned. Normal hearing persons only use a minor percentage of the energy on hearing and understanding the spoken communication. Persons with hearing loss however use most of their “daily amount of energy” only on this specific “hearing job”. As a consequence the hearing impaired person is troubled by fatigue, as well as muscular tensions and pain especially in the face, neck and shoulders. A lot of rest during the wake hours is needed but can be felt as an extra burden because it hinders the person in exerting what is felt to be sufficient compensatory behaviour.
Implications of these themes for the process of audiological rehabilitation
Some of the persons seeking psychological help are in the process of considering getting a hearing aid. At this time the person is feeling very vulnerable, because actually the person is on a more subtle level also is considering giving up his identity as a normal hearing person in order to become, what he most of all would resist becoming had he a choice, namely a hearing impaired person. The manifold reasons for such considerations have just been reviewed.
In other words: The acquisition of a hearing aid is felt like an unwanted elucidating of something that should be kept in the dark. The hearing aid is perceived as the visible sign of a not-wanted identity and not as something that will support the person in retaining his normal identity.
This painful dilemma: “I have to wear something that I don’t want to wear” adds to the negative and sad feelings and may very well block for a successful rehabilitation if not taken care of.
Therefore it is of uttermost importance that the rehabilitating person is careful to gently uncovering possible prejudices as well as negative thoughts and feelings attached to the hearing loss in a validating way while at the same time gently trying to support the person in creating other ways on anticipating the hearing loss. Done well the rehabilitation person will be perceived as someone who incorporates all the experiences, feelings and thoughts of many persons with hearing loss and therefore can be trusted to lead through the rehabilitation process even if the person ends up with the not wanted hearing aid.
However, many professionals working in the field of rehabilitating hearing impaired persons with hearing aids express reluctance to do this since they perceive such methods as belonging to the territory of psychologists. This is not the case as there should be no therapeutic intervention in such a process but simply an openness to clarify, witness, validate and normalise human reactions on a new and difficult situation. This is a difficult discipline but it does not demand psychological education. It demands meeting the hearing impaired person where he is, involving both professional audiological skills as well as a willingness to be and act as a human being meeting another human being in a special Life situation.
When working like this it actually results in a better outcome such as satisfied hearing aid users and less return rates. Often also personal development on behalf of the professional may appear.
May 2005-05-08
(edited in January 2006)
Anne-Mette Mohr
Licensed psychologist
Director of The Interdisciplinary Health Clinic
Copenhagen