By Jacques Gourguechon, MA, LPC, NCC
All people with disabilities face particular emotional challenges. No surprise. We who are abled are more than lucky. We do not face the stares and suffer the avoidance disabled people do. We do not have to confront social isolation through no particular fault of our own. We do not become a burden to our parents and family sometimes for life.
Yet, certain disabilities track down otherwise able people late in life. We know that eyesight begins to decline at age forty in almost everybody. (Where did I leave my magnifiers?) But there is another widely shared disability that strikes many people later in life and that’s hearing loss.
There all kinds and degrees of hearing loss from slight to profound hearing deficits. Such losses can be across the entire frequency spectrum or just in part of it depending on the nature of the loss. Losses arise from aging, continuous exposure to loud noises, diseases of the auditory system or from diseases in other parts of the body. For example, Diabetes can cause hearing impairment in some people. High fevers can burn out the tiny hairs (cilia) inside our ears that pick up high frequency sounds.
That’s what happened to me at age five. A high fever for a week that rose to 105 degrees wiped out the cilia in both ears. Normally people have cilia at the rate of 10,000 per square inch; I’ve been told I have 1,000 per square inch. My hearing at low frequencies is normal. However, I am profoundly impaired at certain high frequencies. When I was young, hearing aids could not distinguish between the two. So I am an unconscious face reader. Today’s hearing aids can be tuned for amplification at different frequencies
Hearing loss, no matter how slight or profound, can be considered the invisible disability. It cannot be seen and causes little few outward restrictions. Hard of hearing folks can move just as well as their peers, perform the same tasks (more or less) and look fine. They just have trouble hearing. Or can’t hear at all. Most often for those of us who are hearing impaired but not profoundly deaf, we hear people talking to us but have trouble making out all the words.
A word here or there comes through maybe even a sentence, but very often I can’t make out the larger meaning, the message of what a person is saying to me. I am constantly interpreting what I do hear within the context of the conversation, who the person is to me and the purpose of why we are together in the first place in order to come up with a coherent whole. Of course, the noisier the environment, the worse the problem becomes.
Hearing, one of our key senses and constitutes a real loss when curtailed. When otherwise healthy people age the onset of hearing loss can be a shock. They are not used to coping and it is very disorienting. There are a lot of seniors suffering hearing loss. Twenty-five percent of seniors between the ages of 65 to 74 have significant hearing deficits. As seniors age the numbers go up. Fifty percent of seniors 75 years old and older have significant hearing loss – so says the National Institute of Deafness.
The impact of hearing impairment goes beyond struggling with what people are saying to you. Studies by Columbia University and others have found that hearing loss effects cognitive ability. Seniors with hearing problems are at greater risk of social isolation, anxiety, depression and even dementia. It’s a fact that the elderly who are hard of hearing are more susceptible to falls and accidents. Hearing loss that forces social isolation promotes alcoholism. People with hearing loss are fifty percent more likely to drink in excess. All the way around being hearing impaired makes a huge difference in one’s quality of life.
Often, people close to someone with a hearing loss make appropriate adjustments. The sophisticated person who is hearing impaired is well aware that they can annoy the people close to them by constantly saying “what?” or “give me that again”. It’s understandable. If someone is even a little stressed or angry about something in their life having nothing to do with hearing impaired partner or relative with hearing loss, not being understood the first time can get on their nerves. This happens a lot.
Similarly, the hard of hearing person can get annoyed with their partner who seems perpetually insensitive to their limitations. The hearing person in a couple says something to the hearing impaired from the next room. The hearing impaired person usually knows that someone is saying something and probably is saying it to him or her but hasn’t the slightest idea of what is being said. When it happens to me, and my wife is well aware of the “next room issue” I have to stop what I’m doing, get up, walk into the room where she happens to be and intone my usual mantra, “I didn’t hear what you said”. If I happen to be anxious, preoccupied or just plane crabby, my tone and exasperation can be a problem.
Can this translate into a mental health issue? You bet. Social isolation very often leads to depression. Alcoholism is also a possibility and serious matter. When people get annoyed or angry with you or you get angry with them. If it happens to often it’s bad for the relationship. For the hearing impaired partner sooner or later can lead to humiliation and shame if one is at all susceptible to this twin demons.
Consider this. You are hearing impaired and someone says something to you looking right at you and you can’t make it out. You hear words and may even understand most of them but can’t get the critical one. What you’ve heard does not make any sense. You stare blankly at them. They then say, “Did you hear me?” and you shake your head “yes” when you have no idea what was said or what the question is they are asking and they catch you! The strongest, stoutest person can feel like a chastised child in those moments. The hearing defect becomes a character defect.
Of course, there are hearing aids and they do help greatly but are not perfect. And, they are very expensive rarely covered by insurance. It is estimated that only twenty-five percent of hearing impaired individual use hearing aids. Even the best and most advanced do not do much in noisy environments such as loud restaurants, receptions and even family parties where of course everyone is talking at the same time. That’s not to say ignore hearing aids; they do help greatly in other circumstances. In addition to using hearing devices, an informed therapist can be of great help to the hearing impaired. Consider the following:
Helping your client cope with the impacts described above; frustration, isolation, embarrassment, shame and humiliation, can yield when they are aired in the presence of a trusted empathetic. A therapist who knows the challenges of hearing impairment can provide such an outlet.
If vanity is keeping your client from seeking help by way of hearing aids or other treatment, the therapist can help overcome that barrier. Vanity gets in the way of relief more often then one might think. The very idea of having hearing aids can make someone who resists aging feel they are old. There is even a hearing aid manufacturer that advertises that their hearing aids are invisible to others. (They don’t work so well either.)
The knowledgeable therapist can help with strategies that go beyond the benefit one can get from hearing aids.
Interacting with the Uninformed. Learn how to inform others you interact with how to accommodate to your hearing loss without embarrassment or shame. A few simple changes in practice can make a big difference. The reality is most people have no idea what to do. They will talk to you with their back turned walking away. Speak to you from another room. (You will start such distant conversations often enough.) Some begin yelling at you when you tell them you are head of hearing.
There are those that equate hearing impairment with feeblemindedness. What an affront. in a calm and respectful way you have to be able to tell them that there is no need to raise their voice. You need to be able to ask them, without hesitation or embarrassment, to allow you to look at their face while they talk to you. Medical personnel who you would think know better, are famous for this when they are saying things that are essential for you to understand while turned away looking at a computer screen.
You need to help them help you. The hearing impaired person has to take the lead. Jump in and ask the uninformed to please repeat what they said – that you did not quite understand. You can help manage their anxiety and frustration at having to repeat themselves – something they are not used to. Teach your client to inform them calmly in an understanding manner usually works even with the most exasperated busy person. Say, for example, “I am hearing impaired and I didn’t quite get that and I really want to understand what you’re telling me”.
As a therapist can help your client understand these strategies, identify others and practice them in the safety of the therapeutic relationship.
Identify and Learn to Use New Techniques. Help your client delve into techniques that work for them. For instance, face-reading has replaced lip-reading. Face-reading allows one to use a variety of clues to understand what is being said to you. Yes, you can pick up letters and words from the way someone forms their lips and tongue, if you can see it, but that’s only one clue. Use their facial expressions and other forms of non-verbal communication as well. Therapists are good at this and can teach the technique. This all takes practice, trial and error and may cause emotional reactions. Working on these adaptations within the counseling session or reporting on the ups and downs with your client help with this hard and often frustrating work
Be Proactive. The frustration of not hearing someone well enough to catch the jest of what they are saying or understand the details of an important message, overtime, can lead to a sense of worthlessness and even depression. When you repeatedly can’t hear what is being said in a conversation you risk becoming irrelevant or think you’re becoming irrelevant. It happens all the time.
Music is playing in a coffee shop while you are trying to enjoy a conversation with a friend. That music might be soothing and pleasant for the hearing customers but it is driving the hearing impaired person crazy. It blurs just enough of the conversation to make understanding impossible. It is important to stand up for yourself. Explain to the people behind the counter that you are hearing impaired and ask if they would mind turning the music off or down. They usually will. If they refuse, leave. At noisy gathering, ask the person you are speaking to step to a quieter corner of the room, into the hall or outside.
Tell people you don’t hear as well as you use to , unfortunately, , but would they please say what they just said again or in a different way. The different way approach is very effective. You did not hear the first time because some word or words or a particular sound is unmanageable for you. If they can say their piece in a different way, it’s possible those challenging sounds or words will be avoided.
Taking control requires that you make yourself vulnerable and opening up to vulnerability takes courage and support. Work with your counselor on this process: become vulnerable (you may have to withstand rejection) become proactive and take control of your hearing environment. When you can’t control that environment, make the suggestion to make a change where you can control it. That may be out of character for you and doing so may seem like a big challenge. Hence it can be stressful. Your counselor can help in these circumstances.
Dealing with Hearing Challenges. Working the room at a family gathering, having a conversation with friends in a crowded restaurant, maintaining relevance at a party or reception or just genuinely wanting to be with those you love and admire can be exhausting for the hearing impaired person. It takes intense focus and concentration to listen for meaning and understanding. People can think you are weird when you don’t respond or delay your response to something said immediately. You’re busy filling in the blanks in what you heard. Busy processing the words you did hear in the context of your relationship to the person, what they are interested in, what the reason for the get together happens to be. This takes intense concentration. It is similar to conversing in a language you are just beginning to learn. After a couple of hours of this you’re tired and need a break.
Take care of yourself. Take that break. If you can ask a trusted friend to sit with you in a quiet place away from the action without talking, do so. Move into mindfulness. Your therapist can help you learn this wonderful practice. Calm your mind, do some slow deep breathing. Relax that computer in your head. It is important to acknowledge yourself for what you have just done in spite of the hardship and to allow self-compassion to wash over you.
Mindfulness practice can be applied in all kinds of situations where your hearing disability, and that is what it is, come into play. It offers relief from anxiety, peacefulness, confirms your place in the world and makes you feel alive. Mindful practices can be called upon anytime in almost any place and circumstances. Such practices can be as short as a few quiet breaths or an extended period. Simple and centering, these practices put body and mind together and rekindle energy to engage with others in spite of the difficulties hearing and make you feel good about yourself.