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Deaf People: What Every Clinician Needs to Know

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Deaf People: What Every Clinician Needs to Know BJPsych Advances (2017), vol. 23, 89–94 doi: 10.1192/apt.bp.116.016154 Deaf people: what every clinician ARTICLE needs to know Margaret du Feu Terminology Margaret du Feu qualified in 1978 SUMMARY from Cambridge University and the Deafness is a common and varied medical, It is important to use the correct terminology Royal London Hospital. She has social and psychological construct that affects a about people who are deaf. Terms used in the worked as consultant psychiatrist in mental health and deafness significant proportion of the population. Restricted past to refer to some ethnic or disabled groups are services in Birmingham (1991–2005) communication and uninformed attitudes have now acknowledged as totally inappropriate, if not and Northern Ireland (2003–2010) adverse effects on the physical and mental health actually offensive, and the same applies to deaf and, since 2005, in the Republic of of deaf people. Clinicians need to know how to people. Terms such as ‘deaf and dumb’ and ‘deaf Ireland. She has been progressively recognise and resolve these difficulties. mute’, which imply that deaf people are stupid or deafened by cochlear otosclerosis and received a cochlear implant in LEARNING OBJECTIVES inarticulate, must be completely discarded. The 1999. She uses British and Irish Sign term ‘hearing impaired’ is still widely used, but Languages. • Be aware of the high prevalence and diverse nature of deafness deaf people themselves prefer deaf, deafened or Correspondence Dr Margaret hard of hearing. du Feu, c/o BJPsych Advances, The • Recognise the importance of effective communi- Royal College of Psychiatrists, 21 cation and how to achieve this with deaf people People who have been profoundly deaf from Prescot Street, London E1 8BB, UK. early life (one in a thousand of the general popula- Email: [email protected] • Understand the potential impact of deafness on tion) and use their national sign language identify mental and physical health Copyright and usage themselves as a cultural/linguistic community © The Royal College of Psychiatrists DECLARATION OF INTEREST and describe themselves as Deaf, with a capital D. 2017. None BOX 2 Degrees of deafness The facts about deafness described in purely Four levels of hearing loss are defined by the quietest audiological terms are easily stated. The World sound that can be heard, measured in decibels (dB). Health Organization (2015) identifies 360 million Mild hearing loss people worldwide with disabling hearing loss. In • Quietest sound: 25–39 dB high-income countries such as the UK, one in six people are affected by deafness (Action on Hearing • This can make following speech difficult, particularly in noisy situations or for long periods of time. People start Loss 2015), including up to one in three older avoiding social situations. people. Common causes of deafness are shown in Box 1. Degrees of deafness are shown in Box 2. Moderate hearing loss • Quietest sound: 40–69 dB • People often have difficulty following speech without BOX 1 Common causes of deafness hearing aids. They are likely to avoid most or all social situations. Early profound Deafness Severe hearing loss • 50% genetic: mainly recessive, about 100 genes • Quietest sound: 70–94 dB identified; some genes have one or more additional effects, including neurological, physical or sight • People usually need to lipread or use sign language, problems and intellectual disability even with hearing aids. They may be eligible for cochlear implants. • 50% non-genetic: birth anoxia, cytomegalovirus, meningitis, neonatal jaundice, ototoxic drugs, Profound deafness prematurity, prenatal rubella • Quietest sound: 95 dB Acquired deafness • People usually need to lipread or use sign language. Hearing aids are often not helpful, but the person may Causes include: age-related changes in the cochlea, head benefit from cochlear implants. injury, infectious diseases, Ménière’s disease, middle-ear infections, noise exposure (Based on Action on Hearing Loss 2015: p. 23) 89 Downloaded from https://www.cambridge.org/core. 01 Oct 2021 at 08:48:26, subject to the Cambridge Core terms of use. du Feu Communication bottleneck or barrier is the first step to over- Every clinical interaction depends on communi- coming it (Middleton 2009). Deaf awareness cation. This can be seriously limited or distorted training is provided by many Deaf organisations when the patient is deaf. It is vital to keep an open (e.g. www.actiononhearingloss.org.uk; www. mind, to ask what patients want or need for full deafhear.ie). This gives information about two-way communication, and to provide it. positive attitudes, communication strategies, sign When meeting a Deaf, deafened or hard of language interpreters, and assistive technology hearing person, a hearing clinician encounters the such as ‘speech to text’ and visual or vibrating interface between them. Deaf people experience alarm systems. this interface all the time, even within their own It is often thought that the key problem for families: people with acquired deafness is the literal reduction in auditory perception, like listening to A young Deaf mother always asked her hearing the radio with the sound turned down. However, sister to come with her when she took her baby out in his stroller. When her sister moved away, the a more apt analogy would be watching television mother would not go out with him. She explained with loud background music, poor reception and that people would look at the baby and smile and no subtitles. Deaf people have difficulty screening say something, and she never knew what they were out background noise, and may have troublesome saying, or even if they were talking to her or to someone else. She did not want to be rude, but did hyperacusis, either from the cause of the deafness not know how to respond, so she avoided going out. or from their hearing aids. They need to ‘hear with their eyes’, using lipreading and visual cues All too often, hearing clinicians feel deskilled (Box 3). and struggle to avoid frustration and impatience. Clinicians who do not sign need an interpreter For the deaf person, the situation is familiar, but with Deaf patients. It cannot be assumed that a there is also frustration, as well as emotions such Deaf signer can lipread or is literate in English, as anger, avoidance or resignation. Recognition which is not their first language. Clinicians are and acknowledgement of the communication often more familiar with working with spoken language interpreters, and need to understand how to use sign interpretation (Box 4). It is well BOX 3 Tips for communicating with hard of hearing people recognised that even bilingual people give a fuller history in their first language (Farooq 2003). • The speaker’s mouth should be visible • Lipreading is difficult and not completely without barriers such as a surgical mask or accurate, with many sounds looking the Nelson Mandela wrote: ‘If you talk to a man in distractions such as frequent movements. same. If a sentence is poorly understood, the language he knows, that goes to his head, if During a medical consultation, the patient rephrase instead of repeating it. you talk to him in his own language, that goes to will not be able to follow the clinician his heart’ (Mandela 2011: p. 144). • Writing can be used if further clarification when the eyes, ears or back are being is needed, provided that the deaf person examined. finds this useful: BOX 4 Communication tips – Deaf signers • The speaker should be at a comfortable A deafened elderly man was in hospital distance, not too far away for speech after an urgent admission. He found it • The tips for communicating with hard of hearing people reception and not too close for lipreading. hard to lipread unfamiliar people and (Box 3) all apply. In addition, the clinician needs to About 4–5 feet (1.2–1.5 m) is usually best. had poor literacy. Investigations showed know how to work with a sign language interpreter. • The deaf person needs to look at the that he had terminal cancer. He was • For professional and medical appointments a qualified speaker. Make sure that there is eye given this information in writing. He registered sign language interpreter must be used. contact before starting to speak, and had no idea what was happening to him pause if the person looks away, for until his wife visited that evening, and • Relatives should not be used as interpreters. example to look at written material. found him in a distressed state holding • The interpreter should sit next to the hearing person • There should be no background noise or the piece of paper. and opposite the Deaf person. This means the Deaf person can face the speaker while watching the visual distractions. Avoid settings that • It is good practice to check that the interpreter, and the speaker looks at and addresses the have poor acoustics, such as large areas information given has been understood. Deaf person. with hard surfaces. Deaf people can get fatigued by the effort • • The deaf person should not have to look of communication, or may have missed or The interpreter will interpret everything that is said or into the light, as this puts the speaker’s misunderstood things without realising it. signed, so no side conversations can take place. • face in shadow. • Be unhurried, positive and friendly. Deaf Speech should be at a normal pace and volume. The • The speaker should speak at a normal people are sensitive to when people interpreter will indicate if they cannot hear or keep up. pace (not too quickly, but not artificially become impatient with them and they • Speech should not include long complicated sentences, slowly) and at normal volume. Shouting can pretend to understand, to placate the double negatives, compound questions or idioms.
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