One in six Australians has hearing loss, and the projection is that one in four will have it by 2050, as our population ages (Australian Network on Disability, n.d.). Thus, even if you never have a profoundly deaf client come to your rooms, you are likely to see someone at some stage who is hearing-impaired. If not the client, it may be that the person coming is frustrated because of having to deal with the hearing loss of a loved one. The abundance of hearing aids and other assistive listening devices these days would seem to mean that it’s a “no-brainer” to improve someone’s hearing: just get fitted with an appropriate device, and watch their quality of life take off, right?

We wish it were that simple. Although 95% of people with hearing impairment could be helped by device(s), fewer than 20% of those affected avail themselves of the technology that would vastly decrease the embarrassment, social isolation, negative workplace outcomes, and relational stress of dealing with not hearing well (McCormick, 2014; Wallhagen, 2010). Why is this? Simply put, there is a stigma around using technology such as hearing aids that does not accompany similar use of eye glasses, wheelchairs, canes, or other tools to help those with disabilities. This post is about looking into that stigma and what you can do to help clients overcome it: either for themselves or for someone they care about.

Not a modern phenomenon, but a serious one

The word “stigma” originated with the Greeks, who used the word to refer to bodily signs that exposed something negative about a person’s moral status (Wallhagen, 2010). Children with hearing loss used to be regarded as having an intellectual disability because they had difficulty learning. It was not until the 1700s that people began to believe that young people with hearing problems could even learn! People viewed the deaf and hard of hearing “with a mixture of fear, scorn, distaste, misunderstanding and pity” (Healthy Hearing, 2013). Sadly, this situation continues in modern times. Yet the ability to share ideas and relate in both intimate and non-intimate ways, participate in all activities, and experience one’s surroundings depends greatly on the capacity to hear. Without being able to hear, we miss critical information about the presence of danger; sirens, smoke alarms, and warning shouts require hearing.

Research shows that people with a mild hearing loss are twice as likely to develop dementia as those with normal hearing, and this risk increases with the severity of the hearing loss. Hearing loss is also associated with higher incidence of heart disease, diabetes, and depression (Eberts, 2018). Hearing loss significantly impacts one’s health, ability to communicate, and full participation in life, with multiple negative effects on the person with hearing loss as well as his or her partner.

Dimensions of the stigma

Margaret Wallhagen (2010) looked into what, exactly, the stigma was about in a longitudinal study of couples in which one of the pair had hearing impairment and was “naïve” to wearing hearing aids. Over the year, interviews were conducted with the couples at various points on the continuum from initial acceptance of hearing loss to beginning to wear hearing aids, with three interrelated findings: that the frequent stigma in using them related to alterations in self-perception, ageism, and vanity. When we put on our counsellor hats, we can understand that most, if not all, of those dimensions relate to an experience of toxic shame: especially when we consider that people wait an average of seven years after noticing hearing loss to do something about it (Eberts, 2018)! We have examined shame in several recent articles, but in case you missed them, let us say here that shame is about a sense that “I am bad”, “I am defective”, “I am pitiful”, or something similar (as opposed to the guilt of having done something bad), and it often originates in childhood experiences. It’s not too hard to get that clients might not want to see themselves as being “disabled” or “old” (possibly when they are still middle-aged or younger). So how do we help them feel less stigmatised about their (or a loved one’s) hearing loss?

Up front and up close

The answer lies in a combination of psychoeducation and working with the shame. We have detailed how to do the latter in our recent blogs, but it does come down to the client (or their loved one) accepting themselves on an “as is, where is” basis: just as they are, hearing loss and all. Part of the capacity to do that (as with shame generally) is to bring it out of the shadows; it “festers” when not exposed to the light of understanding. And part of how to do that is through psychoeducation: not only for themselves, but for all others in their life sphere. Here are some suggestions (we direct these to the client with loss, but clients may need to relay them to their loved one):

  1. Give your client the statistics and facts about hearing loss (start with ours above)
  2. Denial is harmful! Urge the person to get their hearing tested and treat it if there is loss. Hearing aids or cochlear implants may be necessary. Hearing can best be preserved by exposing it to (appropriate) sound. Moreover, not hearing sounds — or hearing them clearly — creates the eventual problem that the brain must re-learn how to process sound. The aids must be worn!
  3. Hearing is a valuable sensory modality to protect, so protective actions such as turning down volumes and wearing ear plugs are important.
  4. Help your client create a “coming-out” plan. The client can start being “up front” with people they are closest to, and work their way outward through increasingly distant or threatening social circles. At some point, the person’s employer needs to be told.
  5. Role play or help the client practice how to inform others of their condition. They can state the facts, followed by disclosing their (often intense) emotions about the situation, and include the most challenging aspect of the loss to them. This should be followed up by letting the other person know how they can help, which usually includes:
    • Looking at the hearing-impaired person when speaking (as individuals with hearing loss usually read lips partially)
      Not shouting, but speaking a little bit more strongly and clearly
    • educing environmental noise as much as possible (turning off noisy televisions and dishwashers at home, finding a quiet corner table at a (quiet) restaurant, and getting out of the way of other conversations happening nearby)
    • Ensuring that the lighting is good in the area where any conversation will take place
    • Offering compassionate understanding when the hearing-impaired person is dealing with the overwhelm of hard-to-understand sound; listening intently and trying to make sense of only partially understood words makes hearing-impaired individuals fatigued quickly.
    • Saying the person’s name before beginning to talk to them, so that they are paying full attention from the beginning of the utterance
    • Identifying the context, as the hearing-impaired do much better if they know the context at the start of the conversation (e.g., “About Saturday’s football game” or “Now, relevant to the Johnson Project we are working on… “)
    • Suggesting that, rather than exact repetition (as they may still not get it on the repeat), the other person should rephrase what they said in a slightly different way.
    • Noting that the ideal listening distance for someone hearing-impaired is less than two metres away. Every 30 cm. beyond that renders speech exponentially harder to understand (Australian Government, Department of Health, n.d.; Healthy Hearing, 2013; Phonak, n.d.)
  6. Coach your client that, when they do ask for repetition, they say specifically what was missed (e.g., “So what was it that your doctor said about the joint inflammation?”) (Australian Government Department of Health, n.d.).

Any kind of disability or impairment requires time to “digest” and accept, and means that the client may need to modify their self-perception. On top of that, discrimination against the hearing-impaired is a real phenomenon and does attract stigma, but both you and your client can play your part in reducing it by bringing the impairment — and the stigma — out of the shadows and attending to the practicalities of making chosen sounds (such as speech) as accessible as possible.

References

  • Australian Government Department of Health. (n.d.). Communication strategies for people affected by hearing loss. Author. Retrieved on 30 May, 2018, from: Hyperlink.
  • Australian Network on Disability. (n.d.). What is disability? Australian Network on Disability. Retrieved on 31 May, 2018, from: Hyperlink.
  • Eberts, S. (2018). We must break the stigma of hearing loss. Psychology Today blogs. Retrieved on 31 May, 2018, from: Hyperlink.
  • Healthy Hearing. (2013). Overcoming social stigmas of hearing aids. Healthy Hearing. Retrieved on 31 May, 2018, from: Hyperlink.
  • McCormick, B. (2014). Overcoming the stigma associated with hearing loss. Starkey. Retrieved on 31 May, 2018, from: Hyperlink.
  • Phonak. (n.d.) How to talk to someone with hearing loss. Phonak. Retrieved on 31 May, 2018, from: Hyperlink.
  • Wallhagen, M. I. (2010). The stigma of hearing loss. Gerontologist. 2010 Feb; 50(1): 66—75. Published online 2009 Jul 10. doi: 10.1093/geront/gnp107