By Max S. Chartrand Ph.D.
Untold millions of Americans go to unbelievable lengths to avoid exposure of their hearing impairment.
In the U.S. today, there are an estimated 28 million individuals with hearing loss severe enough to need hearing instruments, assistive devices or cochlear implants. The current penetration rate of that market stands at roughly 4% of individuals with mild losses (25-40 dB PTA); 35% of individuals with moderate losses (40-70 dB PTA) and 52% of individuals with severe and profound losses (greater than 70 dB PTA).1 Many of these untold millions of Americans go to unbelievable lengths to avoid exposure of their hearing impairment and the necessary help for their hearing loss. These hearing-impaired individuals are still in denial and refuse the help that is available to them. They basically live in nearly constant fear of being found out.2 To cover communicative difficulties, they find themselves bluffing their way through even the most mundane social situations.
It is easier to understand why so many (96%) individuals with mild hearing loss are in denial. The invisibility of hearing loss and lack of internal reference makes it almost transparent to the sufferer. Why, however, do 65% of individuals with moderate hearing impairment still deny they have a problem or that they need help? Perhaps it is because the worse the loss becomes, the more psychosocially inhibited the hearing-impaired individual becomes. This keeps them from seeking and accepting the help that is available to them. Furthermore, it is still surprising to learn that 48% of the hearing-impaired population who suffer with severe and profound hearing loss still avoid hearing solutions.
The social equivalent of "fight or flight" becomes a survival mechanism for individuals who fail to seek and accept available hearing solutions. The is in staying and dutifully "being there" or "putting up with." The flight is in the conscious avoidance of any potentially uncomfortable situation (church, family gatherings, noisy restaurants or clubs) which could test the hearing-impaired individual's (bluffing) ability to the max.
Spontaneity is the most important aspect in everyday human communication, from impromptu greetings to more formal group conversations.3 Spontaneous interchange is also vital in the human bonding process. To maintain a facade of spontaneity in any given situation, a hearing-impaired individual who has not sought hearing help must too often laugh heartily at the unheard punchline or vigorously applaud for no other reason than everyone else is doing so. Better to bluff one's way through, they surmise, than to spoil the moment and be thought of as different or, worse,
out of it. There would be greater humiliation in exposing the missed humor or feigned appreciation. Bluffing one's way through becomes the modus operandi to avoid socially inappropriate behavior.2
CASE HISTORIES
Case history #1: A 66-year-old male suffering from an uncorrected 50 dB PTA sloping high-frequency hearing loss. This subject has vehemently avoided accepting amplification as a solution to his problem. He "gets by," he claims. In this example, one situation calls for him to visit with a handful of friends and relatives in his living room with the lights low and television blaring in the background. Instead of relaxing and enjoying the moment, he is in the throes of almost insurmountable communicative obstacles. A sense of feeling left out takes over and he becomes increasingly resentful. There is no relaxation for him. He feels intellectually challenged as the topic of discussion keeps changing before he can even add his two cents worth. Interaction with the others becomes stilted and forced because of belabored repetition or, worse, his inappropriate responses. The feeling, the spontaneity is lost, the details missed along the way. This otherwise outgoing and socially active man, one with great intellectual capability and a strong emotional need for meaningful contact with others, wants so badly to be a part of, to be in the inner-circle, to lead or be led in the consensus. He, however, is locked out because of his untreated hearing impairment. His reaction to this roadblock brings him to the proverbial fork in the road of anger and resignation: anger being the high road of continuous struggle for achievement and recognition; resignation the low road of diminishing self-esteem and retreat from future social mishaps.
Case History #2: A seven-year-old female whose mild bilateral loss of 25 dB PTA has yet to be discovered. The subject is among hundreds of thousands of children with a similar profile. During her first three years of life, she suffered from repeated episodes of middle ear infections and blocked Eustachian tubes and was wrongly classified by her school as a "slow learner." In her second year of first grade, she quickly learned that inattention can bring severe and humiliating consequences, whether she was called upon to answer the question not heard, or to read a passage where she had no idea where the last person left off. Her apparent lack of auditory attention ability caused her to be misdiagnosed with "attention deficit disorder" or ADDH.4 Ignoring her hearing deficiency entirely, or need for amplification and/or classroom FM soundfield, she is instead placed on a speed-class prescription medication to "help her focus." From such early ingrained experience, she begins to live in constant fear that this personal tragedy will repeat itself over and over in all social situations. As a result, she attempts to avoid situations that will expose her to embarrassment by limiting her circle of friend-ships. As she grows older, she avoids opportunities to develop socially.
In both case histories, the fear of being found out is a fear that brings seemingly irrational social fear, defensiveness and personal insecurity. To the normal hearing observer such behavior would decidedly appear to constitute social paranoia or withdrawal. To the sufferer it is merely social survival.
We should keep in mind that a hearing-impaired person who is unaware of their impairment suffers these effects a great deal more than one who knows and accepts his/her limitations.5,6,7 Likewise, persons who associate with the hearing-impaired individual, who are not aware of the true nature of the handicap, will likely respond to these limitations as if they were voluntary or intentional.8 Many third parties tend to delay acknowledging that there is an impairment either by denying its existence or attributing blame for its effects upon other factors.9
Other Effects of Uncorrected Hearing Loss
Paranoia: Is it any wonder that, when a hearing-impaired person walks into a room full of laughing people, they immediately become self-conscious? They may wonder what these people are talking about. When they ask someone, that person may give an indistinct reply. Strained from a few repetitive attempts they give up and say, "Oh, never mind. It's nothing important." The hearing-impaired person may then turn to a friend or loved one for help. More often than not the response is, "I'll tell you later." Of course, "later" never comes ,and long after the social event the hearing-impaired individual wonders if it was he/she the group was talking about. One cannot blame the normal-hearing friend or loved one, for while they were repeating what had been said to the hearing-impaired individual, they themselves missed the rest of what was said. In essence, they are being the hearing instrument for the hearing-impaired person. Unfortunately, it is a no-win situation for both parties. The beginning of social paranoia, isolation and withdrawal, followed by depression and, finally, severely lowered self-esteem starts when the hearing-impaired individual desires to be a part of the group while attempting to function in a nearly impossible listening situation.
Depression: Depression is generally classified as a cognitive disorder in the sense that it colors one's perception of reality and the larger world around them. Many recent studies examining hearing impairment and Alzheimer's Disease in the elderly consistently show a positive correlation between the two afflictions.10 Most of these studies note a remarkable reduction of the symptoms of dementia when the hearingimpaired/demented subjects are fitted with the proper hearing instruments. This is no minor coincidence. Studies have shown that uncorrected hearing impairment causes depression and cognitive dysfunction.12,13
The Solution
Only an intimate and exceptional knowledge of the forces that shape hearing-impaired individuals' quality of life coupled with hearing instruments, cochlear implantation and/or assistive devices will return the hearing-impaired individual to greater fulfillment and enjoyment in life.
References
1. Chartrond MD: Psychosocial Demographics in Patient Core Seminar I continuing education course. Nationai inst. for Hearing Instruments Studies, Livonia, Ml, 1999,
2. Chartrand, MS: Psychosocial effects of hearing impairment- Hearing Instrument Science and Fitting Practices. 1st edition. Robert Sandlin (edi National Inst. for Hearing Instruments Studies, Livonia, Ml, 1997.
3. Trychin S: Helping people cope with hearing loss. Effective counseling in audiology: Perspectives one/ Practices. JG Clarke and FN Martin (eds). Simon and Schuster Co., Englewood Cliffs, NJ. 1994; pg 247-277.
4- Chartrond MS: The unreported story: schools still foiling in nearing health. Hearing Health, May 1997.
5. Bandura A; Self-efficacy: Toward a unifying theory of behavoria! change Psychological Review 1977; 84:192-215.
6. Van Hecke ML; Emotional responses to hearing loss Effective counseling in audiology. Perspectives and Practices JG Clarke and FN Martin (eds). Prentice-Hall, Englewood Cliffs, NJ, 1994, pg 92.115.
7. Chartrond MS: Audition, Cognition & the Human Brain. A continuing education course. National Inst. for Hearing Instruments Studies, Livonia, Ml, 1999.
8. Schlesinger HS: The Psychology of Hearing Loss. Adjustment to Adult Hearing Loss. H. Orlans (ed) College-Hill Press, San Diego, CA, 1985.
9. Jacobson NS and Bussod N: Marital and family therapy. The Clinical Psychology Handbook. M Hanson, AE Kosdin and AS Bellock (eds). Pergamon Press, New York, NY, 1983.
10. Palmer CV, Adams SW, DurrontJD, Bourgeois M, Rossi M: Managing Hearing Loss in a Patient with Alzheimer Disease. JAm Head Audiol 1998; 9:275-284.
11. Herbst K & Humphrey C: Hearing impairment and the mental state in the elderly living at home. Br MedJ Clin Res, 1980; 281:903-905.
12. Jones D, Victor C & Veter H; Hearing difficulty and its psychological implications for the elderly, j Epidemiol Community Health, 1984; 38:75.
13. Eastwood M, Corbin S & Reed M: Acquired hearing loss and psychiatric illness: an estimate of prevalence and comorbidity in a geriatric setting. BrJ Psychiatric, 1985; 147:552.
14. Mulrow C, Aguilar C & Endicott J: Association between hearing impairment and the quality of life of elderly individuals, j of the American Geriatric Society. 1990; 38:45-50,
