The Distance Learning Center for Addiction Studies
Distance Learning Course
Deaf and Hard of Hearing Substance Abusers Part 1:
The Population and the Problem
3 hours of educational credit
A NAADAC Approved Distance Learning Course
Provider Number 0229
This Distance Learning Course (DLC) was developed for the Distance Learning Center for Addiction Studies (DLCAS) by Frank James John Lala, Jr., Ph.D. It is based on his original work entitled "Counseling the Deaf Substance Abuser." It has been adapted for this distance learning format. It provides the student with a comprehensive look at the Deaf and Hard of Hearing population and the problems of substance abuse. It is the first of a two-part series on this population.
Upon completion of this material, and upon successful completion of the test in Appendix B, you will receive 3 hours of continuing educational credit. Successful students will receive a certificate of completion which will be mailed out after receipt and scoring of the test.
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©2000 by DLCAS
All rights reserved. Do not duplicate or redistribute in any form. No portion of this publication may be reproduced in any manner without the written permission of the publisher.
Conquering tremendous odds and obstacles personally, Dr. Frank Lala's compelling compassion in life began to take shape during his years at California School for the Deaf in Riverside. He wanted to counsel the deaf community in overcoming their formidable obstacles they faced on a daily basis. He worked diligently to educate and learn about the many social, physical and mental problems they encountered - paralleling the same roadblocks in his own life.
Today he continues to be involved in achieving greater inroads so that the deaf community can live a more productive and fulfilled life. As a key speaker he lectures on substance abuse and has authored many publications in the field of deafness, a poem "A Credo for Deaf Americans" along with his recent book, "Counseling the Deaf Substance Abuser".
Other career highlights/professional affilitations include: CSDR's Guest Speaker for 1994's Graduation Class; CEO of Midas Management Co; President and Founder of American Martial Arts Association of the Deaf, General Secretary of International Martial Arts Federation o:f the Deaf, holding Black Belts in Karate and Jujitsu while earning an award in 1993 as the Karate Athlete of the Year; President of Midas Investment Club. As a Chemical Dependency Specialist, Frank was an instrument in founding a recovery program for Deaf and Hard of Hearing Alcohol and Drug Abusers in southern California. tn recognition of his many contributions previous awards are: CSDRAA's Alumnus; Second Alumnus with a Ph.D., Dissertation Advisors Dr. Harlan Lane and Dr. Betty G. Miller; Trustee Alumni Award from Western Maryland College; National Rehabilitation Association's "Bell Greve Memorial Award"; American Police Hall of Fame's "Distinguished Service Award"; International Narcotic Enforcement Officers Association, "In Recognition of Outstanding Accomplishment in the Field of Narcotic Law Enforcement"; and various other honors from the Mayor of the city of Torrance, and the California Legislative Assembly. He was also commissioned as "Kentucky Colonel" by Kentucky Governor, Brereton C. Jones.
Frank Lala holds a B.S. Community Health Education; M.Ed. Deaf Education; Ph.D. Health and Human Services (Public Health); and Certification in Alcohol and Drug Abuse Counseling from University of California, Los Angeles. He resides in Torrance, California.
What makes Distance Learning Packages from the DLCAS different is the use of internet technologies. By visiting our website, you can do any of the following:
Have special needs, or want certain types of training information? Our extensive network of instructors from across the nation will allow us to add coursework that meets the needs of credentialed counselors. Let us know if you have topics of interest.
Organization of the Courses
This information is presented as a 2-part course. Part 1 contains the following information:
introductory materials, including the introduction, the background, the nature of the study, the purpose of the study, the need for and significance of the study, the definition of terms, the assumptions, and the limitations and delimitations;
Relevant Characteristics of the Deaf Population, describes those characteristics of the deaf population that are related to substance abuse and its successful treatment;
a review of the literature on alcoholism as it relates to the deaf;
a review of the literature on drug abuse and the deaf.
Part 2 of the course will cover the following information:
a review of programs for deaf substance abusers that have been described in the literature or described for the writer, at his request, for this course;
a discussion that ties together all the various threads into one coherent whole, and discusses implications of certain viewpoints which have been developed in answer to several pre-eminent and salient questions about deafness, the ramifications of present trends toward prevention and treatment of substance abuse among the deaf, and proposed and/or projected developments in the field;
the summary, conclusions and recommendations for future research and practice to help prevent substance abuse among deaf people and to help deaf substance abusers overcome their disabilities and lead normal, productive lives.
In 1988, some 21 million Americans were identified as having some hearing impairment. These impairments ranged from minimal to severe and were cited as potentially contributing to a variety of psychological, educational, social and vocational disabilities. Perhaps 10% of this group of Americans with hearing loss are severely or profoundly deaf. It is estimated that about 15% of these largely-deaf individuals also suffer from some form of substance abuse.
Comparatively little attention was paid to these multi-disadvantaged Americans until recently. The first published reference to the interaction of hearing disabilities and alcoholism appeared in the Alcoholics Anonymous newsletter Grapevine in 1968. The first treatment program designed specifically for deaf alcoholics dates from a decade ago in the San Francisco area. Programs were developed independently in Minnesota, Michigan, and elsewhere in California, but did not proliferate in the country as a whole.
Deaf alcohol abusers have received little meaningful assistance. Additionally, their quest for sobriety was not studied in a timely manner, so that identification of any special needs of this group had been quite tardy. The earliest studies date from 1978 which deal with the incidence of substance abuse among the deaf. These studies found that the incidence of substance abuse among the deaf was about the same as for the population as a whole; in the absence of detailed demographic studies, this conclusion has remained unchallenged.
While solid, large-scale research remains scanty, ample evidence has accumulated that the network of services developed to help substance abusers works poorly for the deaf. Communication between helpers and clients has been and remains a major problem. Even when steps are taken to solve this problem by providing an interpreter, the deaf client typically: a) needs extra time to absorb the materials, due to the probability that they are difficult to comprehend, b) experiences fatigue sooner than do other clients, c) misses many of the nuances of group interaction, and d) may not even be able to see the interpreter clearly, because of poor lighting. After-treatment and community support services for deaf clients are also often minimal.
Even with these daunting considerations, progress has undoubtedly been made in helping deaf substance abusers. Effective programs are increasingly available, scattered throughout the country. Many small-scale studies using a variety of assessment methods and populations have accumulated in the literature. Still lacking is some kind of synthesis, or even a comprehensive survey.
Background of the Study
The background of the study includes a basic statement regarding types of hearing impairment, the consequences of this disability, and the complicating factor of substance abuse.
Etiologv of Hearing Los
The major causes of deafness are: heredity, illness, accident, aging, and some forms of substance abuse. Heredity is the principal cause, with about half of all deafness in infants the result of genetic factors. Downs syndrome and RH factor incompatibility of the parents blood are two of the many genetic factors implicated.
Many illnesses can cause deafness. Rubella (German measles) damages the auditory nerves of embryos when contracted by the mother in the early stages of pregnancy. Other prenatal diseases can have the same effect, as can premature-birth, Meningitis, mumps, measles, and other diseases of childhood. High fever, infections, and even some medications all can affect hearing.
Experiential and environmental factors are also involved. I. King Jordan, the new president of Gallaudet University, lost his hearing as a result of injuries in an automobile accident. H. Latham Breunig, a former member of the presidential commission on deafness, was born hard-of-hearing, then he lost more hearing after scarlet fever at the age of five, and became deaf at age seven as the result of a skull fracture.
Loud noises, either sudden or prolonged, e.g. explosions or rock concerts, respectively, can also damage hearing severely. Hearing tends to deteriorate with age, additionally, and finally, excessive use of alcohol and drugs can also adversely affect hearing.
Types of Hearing Loss
Four major types of hearing loss are recognized. A central hearing loss results from impairment to the nerves or nuclei of the central nervous system. Conductive hearing losses are the results of disease or obstructions in the outer or middle ear. In conductive hearing loss, typically, all frequencies are evenly affected, and remedial intervention often can be taken. Sensorineural hearing loss comes from damage to the sensory hair cells of the inner ear or the connecting nerves; Hearing loss from this cause can range from mild to profound, and remediation is usually impossible. External hearing aids ameliorate the situation, but not the loss itself. Mixed hearing losses involve both the middle and inner ear. Additionally, some writers have identified psychological or hysterical deafness, where the loss of hearing is psychogenic; when relieved of psychological stresses, persons suffering such cases of deafness can hear again normally.
The extent of hearing loss is an important variable. Approximately two million persons in the United States have a complete, and usually irreversible, loss of hearing. Hearing loss encompasses a wide-range continuum, with many intervals of gradation.
Also crucial is the age at which hearing loss takes place. The most physically disabling condition, albeit not the most emotionally isolating one, occurs when hearing loss precedes the normal development of oral language and speech. In the pre-lingually deaf, oral language development is adversely affected, thus the ensuing emotional and intellectual development of each stage of growth is delayed. Other individuals become deaf at some point after normal language and speech have developed. While these post-lingually deaf have fewer communication difficulties and intellectual disadvantages, loss of hearing at any age can be a traumatic experience requiring medical and psychiatric intervention. Moreover, people who lose their hearing as adults may have to master alternative means of communication at a time when they do not have the advantages of flexibility and mental agility of youth.
The Consequences of Hearing Loss
As with most disabilities, the consequences of deafness can be greatly mitigated, and deafness does not preclude greatness. Many famous men and women were deaf at some point in their lives, perhaps the most remarkable being Ludwig van Beethoven, who composed his greatest music when be could no longer hear. 13 Countless other deaf people achieve great things, despite their handicap.
Today, hearing loss no longer represents the same degree of impediment to success, in most professions, that it formerly did. As Stepp said, Two generations ago, young deaf people were treated as if they were retarded, shunted off to state residential schools, and prepared for blue-collar jobs such as printing and sewing. The next generation began climbing the professional ladder, rung by rung, and todays generation has fully arrived. Today, deaf people have entered most of the professions. Starting salaries for Gallaudet graduates have increased markedly in recent years to be commensurate with salaries of hearing people in the same profession.
Nevertheless, hearing loss is a major impediment that can be overcome only with struggle. Congenitally deaf children cannot learn speech as normal children do, through hearing, repeating, and having their speaking behavior reinforced.To complicate things further, parents of deaf infants may not even realize their childs deafness, and when hearing loss is finally suspected, the family may have difficulty obtaining a definitive diagnosis. Delays, mixed signals from the professional community, and similar problems may result in developmental impediments which may or may not be overcome at a later date. (The literature dealing with this aspect of the problem will be reported in detail in a later chapter.)
In a perceptive review of the literature on linguistic deficiency and thinking, Furth concluded that pre-lingually deaf children normally suffer developmental lags similar to those of culturally-deprived or culturally-different children. Early linguistic and cognitive deficiencies normally are overcome with appropriate interventions.
Unfortunately, however, agreement is not universal on what constitutes appropriate intervention. The deaf, and those who work with them, remain divided on such matters as mainstreaming versus special education and the best way to teach communication skills. Hearing parents with a deaf child may not know which way to turn in the face of conflicting advice.
Numerous studies, up to and including the early 1980s found that deaf people experience a high incidence of psychological problems related to deficiencies in conventional communications skills. Lack of empathy, inadequate insight into the impact of their own behavior, inadequately developed impulse-control mechanisms, relatively mild depression, and an array of personality disturbances are reported in the literature on the deaf. Some of the same writers who cite these findings also note, however, the absence of definition and measurement of both hearing impairment and of mental illness and emotional disturbance. It is also acknowledged that serious mental illness, as measured by the number of hospital admissions, is no greater among the deaf than among the hearing.
More recent studies are less prone to such generalization. Nevertheless, growing up with a hearing handicap and seeking to cope with a hearing world throughout a lifetime does put a strain on an individual who is deaf, just as being in a minority inherently decreases the probability of ones being experientially understood by the majority.
Until recently, deaf people tended to be economically disadvantaged. Although educated non-hearing individuals found employment at about the same rate as their hearing counterparts, the former tended to have lower-paying jobs. Non-hearing people with little education had much higher levels of unemployment than their hearing counterparts. For example, the 1988 unemployment rate for deaf New England young adults was 17%, while for the hearing young adults of the area, the rate was 11.2%. As acknowledged earlier in this chapter, opportunities for deaf persons graduating from colleges and universities today are greater than at any time in the recent past. But earning deficits remain for the mass of relatively uneducated deaf people now in the marketplace.
One study of the employment problem concluded:
Deficient education and underemployment have been clearly documented . . . Obviously, a deaf person victimized by poor education and underemployment and unemployment will suffer in his social, psychological, family, and spiritual achievements and satisfactions.
While this characterization is obviously not relevant to everyone, a significant number of deaf people still feel themselves to be caught in the circularly reinforcing undesirable circumstances. We can understand that these people might turn to alcohol and/or other substances in their search for solace and satisfaction. Of course, the majority of deaf people do not succumb to substance abuse.
The Deaf and Substance Abuse
Studies of small populations indicate that the incidence of substance abuse among the deaf is about the same as that for the general population of the United States. Several authors, extrapolating from these studies, have estimated that in 1980 there were about 73,000 deaf alcoholics; 8,500 deaf heroin users; 14,700 deaf cocaine users; and 110,000 deaf people who use marijuana on a regular basis. There are no reliable national statistics based on direct counting. Extrapolated statistics can probably serve, however, to suggest the general magnitude of the problem.
The principal difference between deaf and hearing substance abusers is that the former often cannot find services readily available to the latter. According to Scanlon:
Where is there an Alanon group for deaf parents of a substance abusing child, and the Alateen, Alatot? These services are provided for the hearing community and they should be available for deaf people. I think were really seeing the need for assertiveness training for many deaf people, especially for deaf women. Where can you set those up?
Nature of the Study
The study is an exhaustive review of the literature dealing with substance abuse among the deaf population of the United States. Considerable background information on deafness, alcoholism, and drug abuse is reviewed and summarized in order to arrive at precepts, methods, and techniques useful in helping deaf substance abusers overcome their self-destructive habits. Exemplary programs have been identified; their literature studied and described.
Purpose of the Study
This study is intended to help those who work with deaf substance abusers by providing them with relevant background information, descriptive material on successful programs, and valid generalizations based on the literature and sound practice. It is given with the hope that it will be useful in itself, and also might later serve as the basis for published reference regarding the best ways to treat deaf substance abusers. Such published materials can then be disseminated to all who are in the helping professions related to deaf substance abusers. This study, and any published materials which might derive from it, might also be useful to policy makers responsible for programs and budgets.
Need for and Significance of the Study
Becoming a victim of alcohol or drugs is a terrible fate for the individual and a loss for society. The losses are compounded when the victim is already handicapped, and when remediation is difficult to find.
There now exist significant impediments for the deaf in using existing social services. Difficulty of communication can be a major barrier, prohibiting access. If the social service agency does not have staff who sign or interpreters for deaf clients, deaf clients are unlikely to receive much benefit from treatment. Virtually all modes of counseling involve talking things out; if counselor and client cannot talk to one another freely, successful treatment is unlikely.
Moreover, even the use of interpreters can pose problems. The deaf client, who typically views his addiction as a fall from grace may find an interpreter a threat to confidentiality, and thus refrain from disclosing to the counselor in the presence of an interpreter. Client and interpreter, moreover, may have differing communication modes, e.g. American Sign Language vs. Pidgin Sign English.
Trust between counselor and client is essential, but may be difficult to develop between a hearing therapist and a deaf client. Many deaf people have received short shrift from institutions and authority figures in the past, and therefore they tend to be mistrustful and skeptical. According to Chough, when deaf people are in need of professional help, they feel diminished as individuals, as a result of paternalistic attitudes on the part of professionals.
Because the deaf community tends to be closely knit, failure to treat one deaf person effectively and with respect can lead to a virtual boycott by the community. Loyalty to those perceived as like them and more than a hint of suspicion towards do-gooders who dont understand are not uncommon.
Finally, the trust that develops over time in a bilateral healing relationship can be difficult to establish when three people (the two plus an interpreter) are linked together, merely because of group and personality dynamics. Alcoholics Anonymous reaches out to all alcoholics, but deaf people have been more likely than other people to lack information regarding the organization and its mission. If deaf people do turn to AA for help, they may find an insuperable language barrier. They may not have the reading skills necessary to comprehend AA literature.
Because deaf substance abusers have such a difficult time finding and receiving the help they require, there is a need for an exhaustive and careful study summarizing facts, experience, and theory scattered in hundreds of published articles. The significance of this study is that it is an honest attempt to meet this very real need.
Definition of Terms
A number of specialized terms have been used in this chapter, and many more will be found in the body of the study. Most of these terms can be defined in context, or they become self-evident if viewed in context. Those which are not self-defining or which are particularly crucial are defined below.
Alcohol abuse: . . . any use of alcoholic beverages that causes damage to the individual or society or both. Abuse implies a lack of control to a point where the individual can no longer function effectively in his/her society.
Communication: The act of transmitting information, thought, or feeling
so that it is satisfactorily received and understood by others. Communication
is broader than the use of words, including art, signs, and body language.
The deaf may communicate by speaking, speech reading, writing, and manual communication. Manual communication includes: 1) American Sign Language (ASL), which has its own vocabulary, idioms, grammar, and syntax, distinct from those of English; 2) Fingerspelling, which is spelling with the fingers in the air, usually used in combination with ASL or with spoken English (Rochester method); 3) Manual English or Pidgin English (PSE), involving the vocabulary of ASL and fingerspelled words presented in English word order; and 4) Cued Speech, a system of communication in which eight hand shapes in four possible positions supplement the information visible on the lips of the speaker. Total communication is a method combining all possible methods of communication to help deaf children acquire language and all deaf persons to understand. Historically, there have been major disagreements between the proponents of the various schools of communication.
Deafness Refers to the inability to hear and understand speech. Hearing impairment comprises the entire range of auditory disorders from less than normal hearing to total deafness.
Drug Abuse: Any use of drugs, licit or illicit, in inappropriate ways or amounts, as determined by adverse effects upon the user and/or his society.
Substance Abuse Any use of alcohol or drugs which interfere with the optimum functioning of the individual or society, or both.
Treatment: The method or technique used to help substance abusers overcome their problem.
Since this is not an experimental or statistical study, only general assumptions have been made. In the broadest sense, it has been assumed that people who are deaf or are hard of hearing may view their hearing loss as a handicap, but that the loss need not be disabling. It is further assumed that the nurturing and development of the rich creative gifts of individual people in what ever physical condition they are, is worthwhile to society, and that time, effort, energy and resources spent enabling people to function at their highest level are worthwhile investments.
Limitations and Delimitations
The principal perceived limitation of the study is one that is typical of any review of literature: since this is not an experimental study, and the writers own experience in dealing with deaf substance abusers will enter only obliquely into the treatment of the subject matter, the study can be only as strong as the literature itself. The study will only be as insightful as the literature is insightful; it will only be as complete as the literature is complete, etc. The writer believes that the literature is vast, varied and often useful, and that this limitation is therefore relatively minor.
In addition, certain delimitations have been imposed on the study by the researcher. Only English-language materials have been used, but these include research from outside the United States. Materials in other languages might have been useful had they been available in English-language translation.
The materials researched were limited to alcoholism, substance abuse, and deafness. Occasionally, the writer found it necessary to search through psychological and social work research for answers to specific questions, but this literature was not covered in any systematic way.
RELEVANT CHARACTERISTICS OF THE POPULATION
The purpose of the course is to help those who work with deaf substance abusers by providing them with relevant background information, descriptive material on programs, and valid generalizations, based on the literature and practice. This chapter shall cover the literature which describes those characteristics of the deaf population that might be relevant to substance abuse and treatment.
This chapter originally was meant to be a comprehensive review of relevant literature using accepted research methodology and dealing with problems of deafness. Unfortunately, some research of this type was found to be misleading and occasionally outlandish. Common problems include the use of atypical populations, such as psychiatric patients, to develop generalizations meant to apply to the deaf population as a whole, extremely small populations, and a lack of understanding of the typical deaf experience. Viewed in its entirety, that literature which purports to be scientific, while falling below the minimum threshold of acceptability, cannot be considered a reliable guide for those who work with deaf substance abusers. Most of such studies, therefore, are not covered in this chapter.
By contrast, some material considered valuable in this researchers opinion, is experiential or in anecdotal form. Experiential means written out of experience, rather than in accordance with such research principles as control groups and statistical procedures. As might be expected, much of this is the work of deaf scholars.
Aspects of Population
The latest available figures on the deaf were cited in Chapter 1 of this study and need not be repeated. It should be noted, however, that all of the figures cited in the literature represent estimates or educated guesses. A recent book on the deaf experience in the United States states flatly: There are no reliable figures on the number of Deaf people in the United States and Canada. Official statistics generally attempt to estimate or count the number of deaf individuals in the country. It is not possible to develop from these numbers, for example, how many of these people cannot hear at all and how many use some variety of sign language.
Moreover, the experience of more than a century and a half of attempting to estimate or count the deaf population indicates that there are not likely to be any easy solutions. Between 1830 and 1930, the United States Bureau of the Census attempted to enumerate the deaf population without success.
Beginning with the 1970s, the Census Bureau adopted a sampling method; in 1975, interviews were conducted in approximately 44,000 households containing about 134,000 people. Even the authors acknowledged that sampling errors might have tainted the results.
In 1978, Stewart attempted to remedy some of the gaps in the official estimates. According to his figures, about 3.2% of the population (some 6.5 million Americans) had significant hearing loss in both ears. Slightly less than 1% of these were severely deaf, unable to hear or understand speech. Still, this enumeration involved nearly two million people.
The pre-vocational deaf (deaf before the age of 19), constituted 2.3% of the population; the prelingual deaf (deaf before the age of 3) represented almost 1% of the population. In addition, Stewart estimated the numbers of individuals with impaired hearing who were also developmentally disabled. These figures included the deaf who were also autistic, cerebral palsied, epileptic, and mentally retarded.
A significant recent study of the demographics of deafness by Karchmer was based on the 1982-3 Annual Survey of Hearing-Impaired Children and Youth, and the 1983 national norming of deaf students on the Stanford Achievement Text. He noted that the number of students reported to the United States Department of Education by the states did not include deaf-blind students, students with hearing loss included under multi-handicapped, or students not being served by the states. It may appear, therefore, that students with severe hearing problems are routinely undercounted.
Vernon discussed a number of present, and probable future, trends that will affect the prevalence of hearing impairments. More liberal sexual practices in the larger society have resulted in the transmission of viral pathogens, herpes simplex, and cyromegalovirus, all of which can infect the fetus and cause deafness, cerebral palsy, mental retardation, and other handicaps. The huge bulge of youth deafened by the 1963-65 rubella epidemic will continue to require post-secondary education, training, and other forms of assistance. Moreover, rubella will continue to pose a threat because:
a) about 20% of women of child-bearing age have not been immunized,
b) the duration of the immunity conferred by existing vaccines is not clear, and
c) the prevalence of rubella as a cause of deafness since the presently used vaccine was licensed in 1969 remains about 12-13%.
Research includes scores of studies dealing with purported psychological problems of the deaf. Many are from foreign countries; some concern themselves with atypical populations, e.g. patients in mental institutions; and all tend to reach conclusions without taking all the variables into account. For example, a British study, after finding that deaf people were over-represented in mental institutions, admitted that the reason might be mislabeling, particularly since there was little communication between patient and staff.
Psychological Health of the Deaf
In a 1969 paper, Vernon surveyed the literature dealing with the psychological factors associated with hearing loss. Some 50 independently-conducted studies indicated that the deaf or hard-of-hearing population has essentially the same distribution of intelligence as the general population. These statistics would seem to indicate that the potential for abstract thought is as prevalent among deaf people as among the hearing. However, educational attainments of the deaf are generally lower than for their hearing counterparts, partly due to neglect or inadequate teaching. As a result, deaf people have been more likely to end up in menial jobs offering little future and financial return, contributing to less than optimum psychological states.
Vernon concluded that the level of schizophrenia was no higher among the deaf than among the general population. However paranoid schizophrenia may be more prevalent among those who became hard-of-hearing later in life than among the prelingually deaf. Less is known about the prevalence of neuroses, character disorders, and other mental problems not considered psychoses. Such kinds of disorders are not easy to diagnose in the deaf population. Vernon offered the following tenuous conclusions from his review of the literature:
Altshuler reported his conclusions based on sixteen years of study of the deaf in New York State psychiatric hospitals. He reasoned that deaf people are precluded from certain accoutrements of sound, in particular the emotionality aroused or transmitted by sound, and therefore often are hampered in the timely development of language. Often oral language usage in people who have not experienced the reinforcing aid of sound is permanently stunted. Awareness of this lack lays an additional burden of stress on the deaf individual trying to communicate orally.
Among deaf schizophrenics, auditory hallucinations occur in about the same proportion as in the hearing population. This is reasonable since hallucinations are presumed to be psychogenic rather than organic in nature.
Altshuler also noted the prevalence of impulsive behavior among the deaf population in New York State mental institutions. He hypothesized that auditory potential was necessary in order for a person to internalize rage. The absence of a given perceptual mode might, he thought, preclude certain adaptive options, while its presence might enable (but not guarantee) the choice. For example, the development of insights which encourage control of ones impulses becomes highly unlikely.
Altshuler collaborated with Rainer in another study of deaf in-patients in New York State mental hospitals. In the area of personality and character disorders, the authors noted:
. . . a lack of empathy, a diminished understanding and regard for the feelings of other people, a lessened awareness of the impact of ones behavior on other people, and the tendency toward impulsive behavior, with limited control and restraint. One corollary of the latter is that rage lies close to the surface without becoming internalized, and indeed little or no retarded, depressive symptomatology was noted.
Paranoid symptoms and projective mechanisms were observed, but were no more prevalent than among the hearing population. However, the writers admitted that they could not tell whether these character traits and symptom patterns were related to absence of verbal language or to deficiencies of parent-child communication in the formative years. The authors state that many observers have noted similarities between some deaf children and culturally-deprived children. They labeled some of their deaf patients primitive personalities, referencing a social and cognitive immaturity found among those who were brought up with minimal communication at home.
Elements of the family backgrounds of some New York State mental hospital deaf patients would seem to have predisposed them to schizophrenia. These factors included disturbances in parent-child relationships, covert maternal wishes of rejection, and denial of the needs and limitations of the child. Nevertheless, there was no increase in the schizophrenic rate among the deaf population there as compared with the hearing patients of that hospital.
In a later article, Altshuler attempted to trace significant developmental differences between deaf and hearing children. The absence of auditory potential in a newborn child limits its ability to its surroundings, and may inhibit its development, he reasoned. Sound soothes a troubled baby during the early, symbiotic period of development. Later, when the child is more clearly learning to individuate and develop a sense of self, hearing its mother in the next room often boosts confidence enough that the toddler is encouraged in exploring the world. Without hearing, spontaneous mimicry and learning derived from that are impossible, Altshuler states. The deaf child has the capacity and readiness for language development, but he/she needs help which may not be readily available. As stated before, without verbal communication between parent and child, the internalization of control by the child is extremely difficult. (Altshuler apparently assumes the deaf child is born into a hearing family; if the parents are able to communicate with the child in nonverbal ways, the consequences sketched by Altshuler would not necessarily follow.)
From the standpoint of hearing parents, deafness in their child is usually an invisible handicap for at least the first few months of life. Parents may note that something is wrong, but may have difficulty finding a doctor who is able to make an accurate diagnosis and provide useful advice. Parental reactive depression may result in confused, ambivalent treatment, then, of the child. Unfortunately, such crises tend to develop at the stage of development when the child is trying to pass from symbiosis to individuation. Once the deaf child enters the world outside the family, there ensues a struggle to teach communication and content. A tendency may develop for the youngster to remain dependent instead of exploring, and to learn largely by rote instead of insight.
In view of the foregoing, Altshuler writes, it is nothing short of miraculous that the majority of deaf children develop to be normal neurotics like the rest of us. With the minor exceptions previously noted, major forms of psychotic illness are no more frequent among the deaf than among the hearing.
However, deaf children are by no means a homogeneous group. Some are born with multiple handicaps, complicating their prognosis for normal development still further. About 10% of all deaf children are born to deaf parents. In this case, most of the factors that militate against development of the deaf child do not apply. The parents know what to expect and how to cope. Deaf parents communication with their deaf child is more facile than that of hearing parents with a deaf child. Deaf children of deaf parents are often described as better adjusted, they have higher achievement test scores, and receive higher teacher ratings on items relating to maturity, responsibility, sociability, initiative and appropriate sex-role behavior than do deaf children born to hearing parents.
In 1978, Altshuler wrote an important paper on the question of whether there really was a psychology of deafness. A number of researchers have reported important differences between hearing and deaf subjects, with the latter being characterized as socially immature, emotionally labile, volatile and brittle, with ego rigidity, having difficulty with abstractions, etc. However, Altshuler points out, the research on which these, and other such, generalizations are based may be tainted by the use of tests on which the deaf might be expected to do less well than hearing people. Almost any study using a standard psychological test interprets results in accordance with data standardized on hearing populations. Moreover, even if the results are taken at face value, there remains the question of whether the outcome is a stereotype or a composite. Not every deaf person will be aberrant in all, or any, of the characteristics measured by particular research instruments; nevertheless, some people view the research as describing a typical deaf person. In addition, those who work closely with deaf persons emerge with clinical impressions, which may be reported, but do not constitute clinical facts.
In order to differentiate between ephemeral and intrinsic factors, the author participated in a cross-cultural study with New York State and Yugoslav colleagues. The study compared psychological test results of normal deaf and hearing adolescents in New York State and Yugoslavia. The two environments were considered so different that the effects of deafness itself, rather than cultural influences might be expected to emerge. The results of the study indicated that the deaf in both countries scored higher for impulsivity than the hearing adolescents in both countries. There was a striking absence of overlap between deaf and hearing sub-groups in both countries. Moreover, a related but separate investigation of deaf patients in Yugoslavian mental hospitals showed that those patients demonstrated impulsive, aggressive, and bizarre symptoms similar to those noted of deaf patients in New York. The results suggest either that the tests are meaningless (deemed unlikely by the author), or that they tapped different aspects of what is considered impulsive behavior. The author suggests that these studies should be expanded to adolescents whose parents were themselves deaf, or of hearing parents who diagnosed the problem early and communicated with their deaf children in sign language. Pending such studies, the author does not believe it possible to interpret what role sound alone plays in development. It would therefore be erroneous to conclude that a psychology of deafness is justified from these studies alone.
A study of the type and prevalence of psychiatric illness among deaf people was published by Lebuffe and Lebuffe. Because hearing is the sense best adapted for the continuous scanning of the environment, it has often been postulated that deafness might dispose the individual toward paranoia. In fact, most of the relevant studies indicate that this outcome is only likely when a hearing person loses the sense of hearing, usually late in life. There is no indication that the pre-lingually deaf are likely to show paranoid traits. Because deafness in an infant might result in major emotional upheavals in the parents, and also might result in faulty mother-child communication, schizophrenia has been thought to be likely to afflict the deaf. However the extreme of psychosis is not verified by empirical evidence, which shows that the pre-lingually deaf are not predisposed to schizophrenia. Severe depression requiring hospitalization is extremely rare among the deaf, as is the classic obsessive-compulsive neurosis. On the other hand, deaf people are not immune to mild and moderate feelings of depression or discouragement.
Here again, there is a difference between the pre-lingually deaf and those who lose their hearing relatively late in life, with the latter being much more prone to severe depression. Deafness is a severely handicapping condition, and yet deaf people do not, as a group, rank significantly at the pathological extreme on the continuum of mental health.
Impulsivity is an often-noted characteristic of the pre-lingually deaf, but it does not normally assume significant proportions (e.g. criminal behavior), and it may well reflect developmental delays rather than any permanent character traits. There is no evidence of increased psychosocial problems among the deaf; their divorce rate, for example, mirrors that of the general population. Despite continuing language problems in some cases, the evidence suggests that deafness delays, but does not limit, the development of intelligence.
Evans and Elliott attempted to develop screening criteria for the diagnosis of schizophrenia in deaf patients. They pointed out that misdiagnosis is all too common; mental health professionals have been known to diagnose individuals with unrecognized deafness as schizophrenic, and to maintain the erroneous classification for 25 years. When confronted with gesticulating, excited patients who cannot be understood, schizophrenia is often used as a wastebasket classification. The authors suggest using Schneiders criteria scales because they do not include symptoms that might be indistinguishable from deafness. Even using these scales, great care is essential, and the patient should, optimally, be interviewed in sign language.
Critchley and his colleagues agreed that communications problems, even when sign language is used, make psychiatric diagnosis of deaf people extremely difficult. Psychiatrists traditionally have noted the presence of thought disorder in the diagnosis of schizophrenia, but the language barrier makes this difficult to access in deaf people. Schneiders criteria, which depend on the analysis of hallucinations, have generally been accepted as the best way to diagnose schizophrenia in deaf populations. An experiment with deaf patients conducted by the authors found that 10 of 12 deaf patients tentatively classified as schizophrenic had experiences which, in hearing patients, would be described as auditory hallucinations, a sign of schizophrenia. Many of the patients used the sign for talk or talking to describe the experience. One patient described hearing a voice like a bell. The authors found this aspect of the experiment difficult to understand. In addition, 10 of the 12 subjects described visual hallucinations. The writers concluded that great caution was necessary in classification because the nature of communication, where thinking ends and vocalization begins, is imperfectly understood.
In a recent interview, Harlan Lane attacked the credibility of much of the psychological research on the deaf, specifically in the area of methodology. Going back to the 1920s, he found that various researchers, usually on the basis of inappropriate tests, had labeled deaf peoples behavioral patterns as: aggressive, androgynous, conscientious, hedonistic, immature, impulsive, lacking in initiative, limited in interests, showing slow motor development, presenting undeveloped personality, possessive, rigid, stubborn, suspicious, and lacking in confidence. The emotional nature of deaf people, if one were to believe every report ever written, would include the following often contradictory and mutually exclusive characteristics: displaying no anxiety, depressive, easily emotionally disturbed, lacking in empathy with other people, explosive, easily frustrated, irritable, moody, showing neurotic behaviors, having a predisposition toward paranoid states, passionate, displaying psychotic reactions, serious, temperamental, and insensitive to others needs.
Clearly these can not all be generic characterizations of deaf people. Extrapolating from one persons observed personality characteristics to assert that they should also apply to other persons, merely on the basis of shared dysfunction of the ears has not shown any validity.
One of Lanes conclusions is that, in order for deaf people to benefit to any significant degree from the aid offered them, they must have control of the systems and agencies directed at them. In particular, deaf professional workers should be involved in the process of designing and administering psychometrics and other measures upon which research is to be based, implying that experience is the only path to understanding.
Lane suggests that deaf people are more inherently qualified to be sensitive to the needs of other deaf people. A problem with implementing this admittedly solipsistic view arises because there have been few, if any, deaf individuals qualified to address the psychological and psychiatric problems of the deaf. The situation is certainly improving, although there are not yet enough deaf mental health professionals to treat all the deaf clients presenting themselves for treatment. In terms of research, deaf psychologists and psychiatrists, with insights borne of their own experience, might have avoided making some of the more gregious generalizations which can be found in literature regarding deaf people.
Much of the stricter research of the recent past seems to agree with Lane. Study after study lists stereotypes of psychological profiles of the deaf offered by very early studies, and concludes that there is no evidence for acceptance of these descriptions. Researchers such as Altshuler concluded that there was no such thing as a psychology of the deaf, but at most, only the psychology of a particular form of socio-cultural deprivation. This deprivation does not stem from the lack of hearing, but from the lack of help from parents, significant others, and helping professionals. The controlling mechanism of possible future pathology is not the auditory deficit, per se, but the quality of interpersonal relationships which develop as a result of that deficit.
To know, merely, that a given individual is deaf is to know nothing significant about that specific persons psychological make-up; group psychological studies are similar to insure statistics in that they contain information about probability, incidence percentage, etc., rather than precise predictions that composite conclusions will apply to any one individual. Pre-lingually deaf people are as varied as are others of the human race. The literature on deaf people is full of clinical observations, case studies, and self-report evidence offering accumulative evidence of personality trends and vulnerability in certain areas. Research makes that point on the basis of reason, evidence, and scientific method rather than on the basis of emotion and undocumented assertion. Moreover, psychological literature on deaf people stresses the importance of early diagnosis and treatment of deafness, to minimize its effects in the lives of deaf people. Current literature reveals graphic examples of the tragic waste of human potential that ensues when deaf children and adults are misclassified and relegated to the back wards of institutions, rather than receiving appropriate and adequate treatment.
The Psychological Consequences of Hearing Loss
Research summarized in the previous section dealt mainly with pre-lingually deaf people. Considerable attention has also been paid to the psychological problems associated with late-onset deafness, particularly deafness among geriatric populations. However, since the problems of the post-lingually deaf are of a different order and are less central to the focus of this work, they will be covered in less detail.
According to Rousey, the loss of hearing, either sudden or gradual, constitutes a threat to psychological integrity of an individual. Loss of hearing results in mourning for something precious that has been lost; the world suddenly (or gradually) has become dead where it was alive before. There is fear of being cut off from ones normal society, even when hearing aids can be used. There is often a loss of self-esteem involved. The loss of hearing often meets with projection and denial. These and related factors greatly complicate the treatment of hearing loss.
Cornforth and Woods generally agree with Rousey. They declare that the impact of sudden severe deafness is one of the most psychotraumatic events that an individual can experience. The most common result is a severe reactive depression, sometimes leading to suicide attempts.
Mahapatra investigated links between hearing loss and mental health. In one experiment, he found a significantly higher incidence of psychiatric illness among post-lingually deaf people than among the general population. The same author in another study used the Cornell Index to show that the post-lingually deaf revealed a greater propensity than did the controls to psychiatric and psychosomatic disturbances.
An article in the British journal, Lancet, summarized what is known about the consequences of deafness that strikes late in life. Depressive reactions are among the most common emotional reactions, and the whole family can be affected. Of the functional psychoses, paranoid psychosis seems to be the most likely outcome of depressive reaction. The writer points out that prelingual deafness constitutes a sensory deficit, acquired deafness a sensory deprivation. While the pre-lingually deaf usually acquire manual language, the elderly deafened cannot be expected to do so. Communication with these individuals is very difficult, adding to the expected negative prognosis of treatment.
One of the few dissenting voices regarding deafness was that of Rosen, who concluded, on the basis of an exhaustive review of the literature, that the hearing impaired as a group have not been established to differ from the general population on psychiatric or psychological variables. Her reasons were:
Rosens conclusions were disputed by Luey, who wrote from the perspective of a social worker. Communication problems almost always cost the deaf person some friends, she noted, because people are often over-extended, and when they believe they cant handle everything well, the first areas to be neglected are extras like sensitivity to people whose needs seem to be different than their own. When a newly-deafened person feels that a friend has let him down, a sense of alienation from society creeps into the disappointment, connecting the hearing loss with the social problem. Newly deafened persons frequently experience an identity crisis as a result of major changes in their lives. At some point in the adjustment process, the deafened individual passes through a crisis similar to that experienced by most people going through catastrophic change. The adjustment process consists of the usual phases of denial, anger, bargaining, and guilt, before a constructive adaptation can take place.
Deafness clearly complicates the psychological or psychiatric treatment that may be required for any psychological illness or condition. Relatively few articles have addressed this problem: some of these are summarized in the following pages.
Before presenting these reports, it should be noted that the field of treatment for psychological disabilities is highly fragmented among theoretical lines. e.g., Peterson lists six major approaches to counseling and psychotherapy:
These broad, general classifications may undercount, e.g., the range of different schools of psychoanalytic theory and practice (Adler, Jung, and Sullivan). Each school of thought interprets psychological problems in the light of its own theoretical perspective and prescribes its own treatment modalities.
Moreover, although the practitioners of particular schools of thought believe that their theories and treatment methods work better than others, empirical evidence has not consistently revealed this. One major evaluation concluded that empirical studies do not produce any clear-cut winners when psychotherapies are compared with each other. This does not mean that some are not more effective than others, but that there is no conclusive evidence to show which is consistently best in te rms of patient outcomes.
On the other hand, all of the respectable therapies do seem to benefit most patients most of the time. All seem to have in common the idea of a helper, or therapist, who attempts to establish a helping relationship with a patient. Why the relationship is helpful has not been answered conclusively by research, but it is thought that providing a person a milieu of unconditional acceptance and offering the unwavering presumption that the client can affect his circumstances, contribute to the development of self-confidence in the client. When the client is given a chance to ventilate thoughts, without fear of being criticized, and to receive insights via gentle interactions, progress in psychological health is often perceived.
In addition, chemotherapeutic interventions have become common and are effective for the treatment of many psychological illnesses. According to one authority, Effective and relatively safe medical treatments are now available for most of the major psychiatric illnesses. Some forms of psychosis, neurosis, and character disorder do not respond well to drugs, however. And, in all cases, a patient under medication needs close medical supervision.
Most researchers have stressed the need to have helping personnel able to converse with patients in their own language. Denmark and Eldridge declared that the most pressing need in dealing with deaf psychiatric patients was for personnel to be trained in sign language. They noted that communication between doctor and patient is more important in psychiatry than in any other branch of medicine, for it is the psychiatrist who relies most completely on his patients powers of verbal expression and his own ability to understand the patient to effect change. While this research is comparatively old, it remains true that, in psychiatry, language is the diagnostic and healing medium.
The same point was made by Altshuler and Rainer. For effective psychiatric work with most deaf patients, a knowledge of manual language is a sine qua non. In New York State mental hospitals, the most widely applicable approach was individual therapy, supportive in nature and designed to achieve insight. Group therapy restricted to members of one sex was ineffective, but results improved when groups were mixed. Self-government in group therapy was not effective because it was soon converted into a dictatorship; firm but flexible leadership by the staff proved the best access to therapy.
In another article, Denmark repeated his belief that many deaf patients can derive a great deal of help from specialized psychiatric services, provided helping personnel are aware of the unique problems of the deaf, and have sign language skills. He cited a report of the International Research Seminar on the Rehabilitation of Deaf Persons which recommended that all personnel dealing with deaf people should be adequately trained in all methods of communicating with the deaf. The author felt there was an urgent need in the United States for the development of such facilities.
Deafness is more than a medical fact; it can include social, emotional, linguistic, and mental facets. Thus, according to Schlesinger and Meadow, the deaf individual may require services from a number of organizations and disciplines, including medicine, audiology, speech therapy, special education, vocational counseling, welfare departments, courts and probate assistance. Even when all these agencies and services are providing parallel, and not contradictory information, the results can be overwhelmingly confusing. An effective program of community psychiatry ideally involves coordinating efforts of all the people involved. In addition, the community psychiatrist is in an ideal position to act as an agent for social change in the area of deaf education.
Robinson reported on a special program for the deaf at St. Elizabeths Hospital in the District of Columbia in 1963. At that time, group therapy sessions using sign language were started, and they soon proved useful. In 1970, the program was expanded into a 30-bed facility with a full-time staff. Sign language and finger spelling are now the principal methods of communication, although other means are not discouraged. The goals of the group therapy sessions are: to allay anxiety, improve self-esteem, improve interpersonal relations, and to expand social interaction. Group therapy may be supplemented with family therapy, and often leads to individual therapy. The advantage of the latter system is that patients will often reveal important sensitive materials in private that they would not in a group. Activity therapies, such as dance, drama and mime, psychodrama, drawing, painting and sculpting have also been found to be useful. Hospital personnel for these services were trained at Gallaudet College.
Shapiro and Harris reported the use of family therapy in treatment of the deaf with psychological problems. The authors believe that problems of deaf individuals are largely related to family problems, and that family therapy, therefore, serves as the best vehicle for treatment. Studies reported elsewhere in this work assert that deaf parents generally cope much more effectively with the psychological needs of a deaf child than do hearing parents, but all families would desire enhanced functioning.
An article by Robinson on the St. Elizabeths psychotherapy program provided these prescriptions for effective treatment: Therapists should not assume that any one method of communication is best for use with the deaf. The method should be negotiated between therapist and patient. Because some deaf people have limited vocabularies, the therapist must personalize the level of sophistication of his/her communication. Some therapists may need to use an interpreter, if their signing skills are inadequate, if the client approves; although questions of confidentiality and rapport discourage this practice. Finally, despite strides made in treating mentally ill deaf persons, demands for service continue to exceed the supply of motivated, qualified therapists.
Hoyt and his colleagues interviewed ten therapists and supervisors with clinical experiences in working with deaf people to determine their views on major issues. These highlights were noted:
Other family therapists, e.g. Satir, Jackson, and Watzlawick, have concentrated on dysfunctional communication and miscommunication which is often common in over-extended families. They speak of the phenomenon of double bind, wherein chronic under-communication and miscommunication work to discourage people to trust their own perceptions. Watzlawick, Beavin and Jackson note: The paradoxical behavior imposed by double-binding. . . is in turn of a double-binding nature, and this leads to a self-perpetuating pattern of communication. The behavior of the most overtly disturbed communicant, if examined in isolation, satisfies the clinical criteria of schizophrenia. Their thesis is that examining an identified patient without due consideration of his milieuprimarily the other people he/she lives with, promotes a false presentation of mental illness symptomatology. When viewed as a whole, family interactions and group dynamics make sense of much that otherwise would be classified as at least bizarre.
Socially Related Emotional Characteristics
This section covers literature review of research articles dealing with sociological and socially matrixed emotional problems of the deaf. These articles are reported in chronological order.
In an article on the quality of life for handicapped people, Jackson and Engstrom report on the success of theatre for deaf people. In 1967, actress Ann Bancroft and director Arthur Penn conceived the idea of a deaf repertory theatre while attending a performance of Othello, given by deaf players at Gallaudet College. They visualized the company as an aesthetic enterprise and as a way of expanding employment opportunities for deaf persons. After deaf people compensate for difficulties in communicating, almost from birth, they tend to excel in non-verbal expression including body language, and therefore are naturally emotive. The National Theatre of the Deaf has been a success commercially, artistically, and as a means of fostering understanding between deaf and hearing communities. Moreover, it served as the spark for the creation of other dramatic groups for deaf people, notably the Chicago Experimental Theatre for the Deaf.
In an experimental British study, Bowyer and Gillies investigated the hypothesis that partially-deaf children have more social-emotional problems than do severely deaf children, and that the former, therefore, should not be mainstreamed. The two groups were studied in four different schools using a combination of written tests and teachers ratings. Bowyer and Gillies found that neither group was maladjusted. The writers attributed this happy conclusion to the better medical care and early treatment of all these children had received, including, the receipt of hearing aids, when they were deemed necessary.
In 1973 a team of New York University researchers surveyed methods of dealing with emotionally disturbed children with identified behavior problems. Among deaf children, 1-3 out of 10 were believed to have emotional and behavioral disorders, and children suspected of having these disorders were being kept out of the classroom. Therefore, educators could not avoid addressing the problem. A model program was developed, using principles which had been shown effective with hearing children. Children were introduced to sign language, and their parents were encouraged to learn sign language also. An atmosphere of genuine concern and acceptance was fostered in the classroom. (Although the researchers did not differentiate between the various program changes which were revealed in overall improved student outcomes on academic measures, it seems likely to this researcher that improving communication between parents and children, and between teachers and children, at least partially contributed to the programs success.)
Jacobs attempted to survey the adult community of the Deaf, describing the group as being closely knit, seeking their own kind for mutual pleasure and benefits, including ease of communication. Because the Deaf comprise such a small portion of the population, Deaf adults usually form only small communities, except perhaps in larger metropolitan areas. They experience the advantages and disadvantages of life in small towns/villages everywhere stemming primarily from the premise that everyone knows everyone else. Gradually the Deaf community has evolved a network of organizations, ranging from local to national levels. While these organizations serve a social function, their primary aim is to be of service to deaf people. These organizations include the National Association of the Deaf, the International Association of Parents of the Deaf, the Gallaudet College Alumni Association, the American Athletic Association of the Deaf, several national /international religious groups, and many others.
McLaughlin and Andrews investigated the reading habits of deaf adults. Their subjects were 36 members of a church organization and were mainly unskilled workers in manual jobs. virtually all of the subjects said they read a local newspaper for an average of 37 minutes a day. In addition, most of the group said they read one or more magazines on a regular basis, with TV Guide the most popular. Relatively few read books, but the Bible was the main choice of those who did. Deaf people over age 50 listed themselves as the most avid readers. Those who had used sign language in school were more interested in reading than were those who had used oral communication. The researchers concluded, from their 36 subjects, that reading habits of deaf adults, as designated by a self-report measure, were not significantly different from those of hearing adults of comparable educational background and occupational category.
Schiff and Ventry reported the results of an investigation into the communication problem of hearing children with deaf parents. The quality of parents speech to their children traditionally has been considered to have significant implications for the childs speech and language development. About half of the 52 children were considered to be developing speech and language normally; most of these had mothers who used sign language with them. However, since 14 of the 52 children were discovered to have severely limiting disabilities, not much can be deduced from the study.
Andrews and Conley developed classroom activities to provide deaf teenagers with information and skills to correct misconceptions they might have had about crime and the law. Deaf students are hardly immune to the temptations prevalent in their society, and temptation comes in a variety of guises, from drugs to shop-lifting. Additionally, deaf children may have obtained a distorted idea of crime because they may have comprehended only a portion of the message portrayed by radio and TV. Glamorized detective shows or programs which offer scant plot to cover the primary offering of high-speed car chases or other stereotypical violence of the genre may, indeed, contribute additionally to deaf teenagers misconceptions about the law. The researchers proposed activities included reading wanted posters, filling out job applications which normally seek information on felony records, compiling a scrapbook of crime stories from the press and magazines, receiving a classroom visit from a police officer, touring the local jail, and role-playing relevant situations. In addition to providing students with a better grasp of concepts of crime and the law, their activities were positively correlated with motivating students to improve their reading and writing skills.
Becker interviewed 200 people in the San Francisco Bay area who were born deaf or who had become deaf in the first few years of life, to determine how they perceived and dealt with stigma. Researcher and subjects communicated in sign language, and accumulatively, results indicated that for most of the subjects, the experience of stigma began at an early age. They were born of hearing parents with whom they were never able to communicate perfectly. Their parents faced the difficult choice of whether to have their children attend a local school to learn speech and lip reading or to go away to school to learn American Sign Language. At the time the subjects were growing up, users of sign language were generally stigmatized. Some parents reinforced this feeling by making clear their distaste for signing. For this reason, and as a result of unpleasant experiences with the hearing world, many of the subjects reported negative experiences of contacts with society in general. The deaf people in the study group tended to form a separate and distinct society as a result of a process Becker calls normalization. The San Francisco area deaf group gave their primary loyalty to their own group, and conformed completely to its norms. As part of the normalization process, they dissociated themselves from others who suffered a different social stigma, such as ethnic and racial minorities, the socially deviant, and those with other disabilities.
The National Technical Institute for the Deaf offers a course called The Psycho-Social Aspects of Deafness to small groups of college-bound deaf students. According to Skyer, the rationale for the course is that students with hearing impairments may lag behind their hearing counterparts in the diversity and richness of prior experiences and in their reservoir of factual information regarding social and personal issues. The major goal of the course is to provide students with opportunities to understand the dynamics of hearing-deaf social and familial interactions, and to comprehend the impact of their deafness on their educational, social and emotional growth. The course outline includes:
The course operates as a seminar in which students are encouraged to participate in discussions and share their feelings. Students enrolled in the course have opportunities to interact with hearing people on campus.
Lisowski investigated the process of living as a deaf person communicating via ASL with 12 pre-lingually deaf persons living in a housing development near a medical center. In all 12 subjects, the socialization process took place at a residential school, wherein the students developed an ad-hoc family life, rather than developing a biological family life. All of the 12 overcame any deprivation of outside society which this may have implied. All but one of these people used sign language predominantly and wrote their messages for hearing people. Whether by choice or necessity, all of the subjects limited their social ties to immediate family or to other deaf individuals. None of the subjects felt deprived; since they had never heard, they did not miss what they had never known. On the whole, they revealed somewhat negative attitudes toward hearing people, perhaps because of their perception that the hearing world discriminated against them, or because of a lack of intimate familiarity with the hearing world. All were considered conservative in social orientation. Although, admittedly, this study was quite small, and used only self-report measures, it may be representative.
Andersson studied sociological variables of deafness in a cross-cultural investigation in Sweden and in the United States. Sweden was at that time a comparatively homogeneous country. Deafness there was considered a serious handicap, and deaf people were mostly segregated, having their own school, clubs, and supportive services, all sponsored and financed by the government. The result, according to Andersson, is that deaf people in Sweden comprise a separate and well-defined group, with little contact the larger society. In the United States, deafness is regarded as being less severely handicapping than it is in Sweden, he notes, and accordingly, in the U.S., the demographics of the deaf population are more diverse. Andersson states that the National Association of the Deaf encourages deaf persons to remain in the larger society, rather than encouraging small group development at state and local levels. In the U.S., some deaf children go to residential schools, while others are mainstreamed within public schools. At the university level, students may attend any school for which they are qualified, providing interpreting services are available. The American ideal is assimilation, but, in fact, deaf people in the U.S. often form separate social groups for a number of reasons. Facile communication is one decided advantage.
Most of the studies surveyed for this section describe the sociology of a particular deaf group, and it would, of course, be erroneous to attribute the same characteristics to other deaf groups or individuals. Extension via accumulative detail is risky. As a welcome alternative, it is instructive to study biographies of deaf persons who have achieved greatness in the larger society. A few examples will suffice to illustrate the contrast. Erastus Deaf Smith lost his hearing at the age of one, but became the greatest scout and legendary fighter of the conflict between Texas and Mexico. Smith coped with his hearing loss by training a dog not to bark but to alert him to intruders by tugging at his pants. John Carlin was born deaf in 1813. Without any formal schooling, he became a major American artist and writer, and he exerted a major influence in the decision to found Gallaudet College. Mabel Hubbard Bell, wife of the inventor of the telephone, developed total deafness at the age of five, but lived an active social life, preventing her husband, a natural recluse, from going into semi-hibernation.
Numerous other examples could be cited; there is hardly a field of endeavor in which profoundly deaf individuals have not flourished, often with neglected or inadequate schooling or other immense hardships to overcome. If it was possible for these individuals to thriveeven excelthen deafness, per se, cannot preclude people from experiencing rich, full lives in their various circumstances.
Cinema and television play important roles in American social and emotional life. Both have been shown to reflect popular opinion and to mold attitudes. Schuchmans book on deafness and the film entertainment industry examines the way deaf people have been portrayed through analysis of more than 200 films and television episodes. The author has much sensitivity to Deaf culture, stemming from the fact that both his parents were profoundly and pre-lingually deaf. Schuchmans thesis is:
. . . the film and television industries have dealt with deafness in a manner similar to their stereotyped treatment of ethnic and racial minorities. Thus, entertainment has been a substantial contributor to the publics general misunderstanding of deafness and to the perpetuation of attitudes that permit discrimination against deaf citizens.
Schuchman acknowledges that the film industry did not create these stereotypes, which even prevail in scholarly literature, created by professional people who should have observed more precisely. The film industry, however, did unthinkingly reinforce these stereotypes.
In the early days of film, the medium was regarded as a great boon by the deaf community. Silent films could be enjoyed by deaf and hearing people alike, on equal terms. Silent films posed no impediment to the use of deaf screen actors, so deaf actors were frequently employed. Since sign language was under massive attack in the United States and abroad, deaf educators used film technology to teach and enrich deaf students. However, even during this golden age, deaf actors usually did not portray deaf characters on the screen; they had little opportunity to influence the popular image of deafness. Increasingly, the stereotype of deaf people as dummies evolved. Hearing aids, ear trumpets, and sign language itself were transformed into visual gimmicks designed to elicit laughter, and it became common for characters to feign deafness in order to catch or trick a villain.
Film makers unable to resist the quick prat-fall may have contributed to further stereotyping deaf people, but at least deaf people enjoyed employment on the silent screen. However, the equal access enjoyed by the deaf as performer and audience came to an end in 1927-28, when the silent era ended and talking pictures emerged.
The advent of talking pictures caused consternation in the deaf community. The inexorable march towards sound deprived deaf people of the ability to participate in what was becoming an important part of American socio-cultural life. A number of distinguished film careers by deaf performers ended abruptly. During the period from 1928 to 1948, the image of deaf characters in film media steadily worsened. Silence was often portrayed as stupidity, as in the film The Dummy; catering to public stereotypes, and erroneous public expectations encouraged further short-cuts by film makers, which distorted reality. Profoundly deaf characters were depicted as perfect speakers, as in the case of Loretta Young playing the deaf wife of Alexander Graham Bell in The Story of Alexander Graham Bell. Characters described as pre-lingually deaf were portrayed as expert lip-readers; and deaf characters were frequently portrayed as steeped in misery because of their affliction. In a revealing twist, film makers produced more convoluted plots by having villains or heroes at times to mask their identities by faking deafness.
Throughout the first two decades of talking pictures, the deaf community complained bitterly about the emerging Hollywood stereotype of deaf people. In particular: It is the word dumb that we despise, detest and loathe, for there is among the hearing public, a wide misconception of the use of the term dumb in reference to the deaf.
Hollywood attempted to correct the demeaning stereotype with the filming of Johnny Belinda, with Jane Wyman, the story of a deaf girl treated like a dummy, who blossoms when taught signs, numbers, and the alphabet. A dozen films, including two musicals, dealing with deafness in some fashion were produced in the 1950s. Flesh and Fury, with Tony Curtis, is the story of a deaf boxer who regains his hearing following an operation and then loses it again during a championship fight. According to Schuchman, the film is more sensitive to deafness than any prior motion picture, particularly in its depiction of Callans/Curtis confusion when his hearing is restored by the operation.
Two films, Crash of Silence and The Story of Esther Costello, dealt fairly realistically with the way deaf children are taught to communicate. Films during the 1950s represented a modest step forward, in that some form of sign language was used, permitting more rounded and believable deaf characters. But most of the ifims contained outlandish sequences and continuing slights to deaf people.
One of the most successful films of the 1960s from the perspective of Deaf culture, was The Miracle Worker, starring Ann Bancroft and Patty Duke, and based on materials from the autobiography of Helen Keller. Although it is emotionally moving and was crafted to gain sympathy for the deaf-blind heroine, it nonetheless equates success with speech.
Children of a Lesser God, was the first film in 60 years to employ deaf actors and actresses in all the deaf parts. Based on a successful Broadway play which received several Tony Awards, the film version was also very well received by the general public. Nevertheless, the film version de-emphasized deaf politics in order to accentuate the love story. Moreover, the camera routinely cut off the signs or obscured their visibility, so as to be largely incomprehensible to deaf audiences. Additionally, there were few captioned versions of the film, so there were relatively few opportunities for deaf audiences to view the film.
Schuchman finds television marginally better than film. Closed-caption technology makes the medium more accessible to deaf people than is film. As a regulated industry, also it is somewhat more responsive to public pressure than is cinema. Following a protest campaign in 1978-1979, the television industry began to hire more deaf actors to play appropriate roles; from 1980 to 1986, there were 24 identifiable deaf roles in TV dramas, of which 18 were portrayed by deaf actors. On the whole, concludes Schuchman, television has not met all of the expectations of deaf people, but it certainly has come a long way since its initial popularity in the 1950s, and it certainly is more accessible than motion pictures."
Padden and Humphries, members of the deaf community, and scholars who study their communitys language and society, attempted to collect, organize, and interpret examples of the cultural life of Deaf people. The result is a rich mosaic of deaf life and a necessary corrective to the literature which studies deaf people as subjects in experiments, but which is inadequate in revealing their inner lives.
Although their book may be difficult to summarize, a few important insights are visible. Scholarly writings about deaf people traditionally have focused on disability and pathology. Classifications have stressed the facts and degrees of hearing impairment as if these were the most important facts about the people being studied. Other facts about them, notably those about their social and cultural lives, are then interpreted as consequences of these classifications. However deaf people have much outside the fact that they do not hear that is salient in describing and understanding them. For instance, they have a rich language of their own, one that is capable of insight, invention, and irony. The larger society could benefit from understanding how deaf people perceive their world.
Children without hearing at birth, or those who lose hearing early in life, do not know they are deaf or different. If they are born into a deaf family, they fall naturally into the patterns of sign language; if children are born into a hearing family, they notice that some people move their lips, but they do not know why. Increasingly, it becomes the outside world which defines them. Sometimes they may be sent away from their families to residential schools. If deaf children were to be raised among deaf people, secure in their sign language and the shared knowledge of the group, they would not need to fall into darkness, nonexistence, and despair, as some do, suggest Padden and Humphries. Deaf people may experience the larger society dictating to them, without signs of empathy or sensitivity. The most flagrant example of this has been the effort, at various times and places, to ban the use of signs in favor of oralism. Padden and Humphries descry this, saying, If signed language is snatched away from deaf people, they can only fall into despair. Padden and Humphries point out that many terms used in sociological research on the deaf convey the message that deaf people have lessened status. For example, the distinction is made in the literature between prelingual and post-lingual deaf, referring to those who lost their hearing before they acquired spoken English and those who became deaf after learning English, respectively.
The distinction ignores those who have learned sign language as a first language, and hence are native users of a human language, like those who are post-lingually deaf. The terms, as would be expected within an official frame with HEARING as its center, emphasize the role of onset of hearing loss and the presence of English, rather than the age at which any human language, including ASL, is acquired.
In the vocabulary of ASL, deaf" represents normality, and hearing the highest degree of deviation from the norm; it is all a question of perspective.
Human children are born with innate abilities for learning language, but they are dependent on other language users to instruct them. Hearing children will babble naturally, gradually forming words and grammatical constructions, with positive reinforcement for increasingly discernible approximations to words their elders use. Similarly, deaf preschool children emulate signing adults. If they are isolated from mature sign users, they will develop their own sign language, intelligible to themselves and their playmates, but not to others.
But in an environment which actively seeks to suppress signing, such children may have their development arrested or distorted. Moreover, they will be deprived of what other children take for granted, a language that is potentially as much an art as it is a means of communication.
Harlan Lane discusses some of these same themes in his introduction to a compilation of some of the classics of deaf language and education (de Fontenay, Desloges, de LEpee, etc.). He points out that the relations between a minority using one language and the enveloping society using another are often the subject of heated dispute. Such a conflict exists between deaf people who wish to educate their children in ASL and the surrounding communities which espouse English. Indeed, the history of the deaf in the United States is the history of a struggle, in which, by a bitter irony, the community of signers is pitted against their would-be benefactors, those English-speakers charged by the nation with improving the plight of the deaf.
According to Lane, the conflict stems from the hearing establishments refusal to view signing as other than pathological. ASL was viewed as a poor substitute for real language; the enlightened solution was to rehabilitate signers with special educators and speech pathologists. Perhaps the objective (to integrate deaf people into the greater American society) was benign, but it was based on ignorance and had deplorable results. Decades of Oralism failed to produce individuals who could speak well enough to make their way in the hearing world.
It is not immediately apparent why an individuals hearing should affect the brain between malfunctioning ears. Nevertheless, a number of studies, primarily based on posited links between language and thought, have tried to investigate deafness in relationship to intelligence. Some scholars assert that the absence of auditory stimulation and the lack of systematic reinforcement of learning through speech interferes with developing intelligence. In passing, we note that arguments still swirl over the nature of intelligence, and whether it exists as one unitary trait or as a collection of variables.
Furth wrote a major article incorporating literature review and research on the thinking of deaf children. He pointed out that pre-lingually deaf children not taught sign language at an early age may grow up without any systematized conventional language. However, these children nevertheless construct their own symbols as they are needed for the development of thinking. The thinking processes of deaf children are presumed to be similar to those of hearing children, and therefore, development of thought processes must be explained without recourse to verbal processes. The author quotes approvingly Jean Piagets view that language is not a constituent element of logical thinking. Evidence provided by a number of researchers with deaf children offers confirmation of Piagets view.
Youniss investigated implications of deafness on intelligence. He acknowledged having once assumed that the growth of intelligence depended on mastery of a language. He cited surveys of deaf adults in New York State and in Frederick County, Maryland, which did not validate such a link. Deaf children deprived through chance or social policy from acquiring a formal language nevertheless showed no deficiencies in intelligence. (Of course, some of these children might have had a signed language.) Youniss also explained this phenomenon in terms of Piagets theories. Crudely put, symbols did not drive intelligence forward, but were created and used by intelligence. Youniss also pleaded with other researchers to be very careful in testing deaf children with conventional measures of inteffigence.
Kusche and her associates assessed the differences in intelligence and achievement of deaf adolescents from three different family constellations. These were:
The tests covered performance scale I.Q., vocabulary, reading comprehension, and language achievement. The deaf students with deaf parents learned to sign earlier, and had higher IQ and achievement scores than did any of the other groups. All the deaf children scored higher than their control groups. The authors speculated that, in families where deafness is hereditary, deaf parents with superior nonverbal intelligence would be the ones most likely to become successful, marry, and have children passing their traits on to their children.
Bonvillian and his colleagues reviewed the educational and psycho-linguistic implications of deafness. They concluded that deaf people are not deficient in intellectual competence, inferring that weaker skills in English and lower educational achievement require other explanations beyond the fact of deafness. Essentially, the deaf use another language entirely, and should not be compared to hearing students using oral language. Sign language is an organized and structured symbolic system whose acquisition mirrors the acquisition of spoken language. The authors believe the case for allowing deaf children to acquire sign-language is very strong. Teaching written English is also important in the education of deaf children in the United States, as written language is the sole means of communication between deaf and hearing worlds. ASL should be used, in the U.S., as the medium to teach English and other disciplines. The wider use of captioned television programs (using ASL) would have educational benefits and serve to reduce the isolation deaf people experience from the dominant hearing community.
According to Hook, back in 1958, 42% of children with hearing loss in a national sample had some learning disability in addition to the loss of hearing. This survey was conducted by the Office of Demographic Studies of Gallaudet College. Since then, medical advances have made it more likely that high-risk infants will survive in greater numbers, so that the incidence of children with multiple handicaps will also have increased. These learning disabilities include: perceptual handicaps, brain injuries, minimal brain dysfunction, dyslexia, and developmental aphasia. Diagnosing and treating these conditions in children with hearing impairments are made more difficult because measurement is virtually impossible. Often, children classified as learning impaired make rapid progress when taught sign language and finger spelling.
Sims and his colleagues offered a statistical study examining the consequences of different methods of instruction on academic achievement and the ability to speak. The subjects were 108 students at the National Technical Institute for the Deaf. Background to the study included conflicting recommendations from different experts on how best to educate the pre-lingually deaf. Oral communication proponents advised parents to have the deaf child live and grow in an atmosphere where orality is stressed from the beginning. The opposing view holds that profoundly deaf children will not learn to speak intelligibly anyway, and only ASL can help them become more skillful in key academic areas. the subjects were divided into two groups, those with relatively good speech and those with poor speech. Both groups were tested for competence in abstract reasoning, reading comprehension, written language, mathematics, and noted regarding overall college grade-point average. There were no statistical differences between the two groups of college students in their academic attainments. According to the authors, 28% of the students who attended schools where oralism was stressed developed functional speaking ability. (The writers do not clarify what they mean by functional.)
Bodner-Johnson pointed out that teachers of deaf children are often called upon to educate the parents as well. How well are they trained to perform this function? A survey indicated that there was considerable interest in the idea, but that little was being done. The answer to this discrepancy between interest and action, the author suggested, might lie in the general need for most universities to cut costs, an underlying conservatism, and in the changing nature of the American family (divorce and working mothers). Moreover, there appeared to be a trend to concentrate academic resources on preschool parent-infant relations and to ignore the relationship of the older deaf child and his/her parents. The author recommends establishing study groups to chart ways of meeting the need in the area of instructing parents of deaf children.
Another study by Bonvillian examined 40 deaf and 20 hearing students free recall of visually presented words varied systematically with respect to signabiity and visual imagery. Signability meant words that could be represented by a single sign. Half of the deaf students had deaf parents, the other half had hearing parents. For deaf students, recall was better for words that had sign-language equivalents and high-imagery values. Hearing students remembered words best that had high imagery values. The hearing students recalled significantly more words. In immediate recall, deaf students with deaf parents reported using a sign language coded strategy more frequently and recalled more words correctly than did the deaf students with hearing parents. These results underlined the importance of sign language in the memory and recall of deaf persons.
Williams surveyed 56 administrators of residential school for the deaf representing the 50 states, the District of Columbia and territories, to determine their admissions policies. The schools enrolled 90% of all the deaf students in residential schools. Student referrals are based primarily on the severity of hearing loss, acceptance depended on the schools ability to provide an appropriate program within staffing and programming limitations. Local school districts are the major sources of referrals for students admitted to state-operated residential schools for the deaf. Seventy percent of the schools surveyed retained a high degree of autonomy in admission decisions to prospective students. In particular, children with multiple handicaps in addition to deafness are likely to be denied admission on the grounds that the schools do not have the capability to adequately serve them. The author questions whether this power is justified, given declining financial resources at the state and local levels and the provisions of Public Law 94-142.
Wolk and Schildroth studied the strategies used by deaf students when taking a reading comprehension test. They found that deaf students favored answers based on association cues unrelated to the overall meanings of the previous paragraph or stimulus sentence. For example, in the type of test where a number of choices follow a paragraph, the deaf students are more likely to focus on the choices and choose one, rather than to focus on the paragraph to be interpreted. Such a choice-dependent strategy will often lead to lower test scores, since comprehension is being tested. The average deaf student comes to a reading comprehension test with relatively stronger word recognition and association skills than his (relatively weaker) linguistic skills of syntactical analysis and interpretation. Therefore, these children tend to focus on what they know best, the words. The authors believe that children with hearing loss need to be taught in ways that will emphasize meaning rather than word acquisition. They question whether multiple choice tests are useful for deaf children. In addition, they believe that providing an experiential basis for reading is even more important for the deaf than for the hearing child.
The most important issue in education for the deaf involves the oral-signing controversy. This controversy seethes more among hearing specialists than among the deaf, themselves, who not only prefer, but love their sign language. Lane repeated approvingly the words of Charles-Michel de lEpee (1712-1789):
Every deaf-mute already has a language. . . He is thoroughly in the habit of using it, and understands others who do. With it, he expresses his needs, desires, doubts, pains, and so on, and makes no mistakes when others express themselves likewise. We want to instruct him and therefore teach him French. What is the shortest and easiest method? Isnt it to express ourselves in his language?
By the middle of the 19th century, growing numbers of deaf children in the United States and Europe studied in sign language. Nearly half of the teachers of the deaf were themselves deaf; today, they are a rarity. Three decades later, the tide turned against sign language. Alexander Graham Bell used his wealth and prestige to promote oralism. The 1880 Congress of Milan, unattended by the Deaf themselves, espoused oralism with the slogan: Long live speech!
At the end of the Civil War in the United States, there were 26 schools for the deaf, all of them using ASL; by 1907, there were 139 schools, and in all of them, ASL was forbidden. In the 1960s and 70s, recognition grew that ASL was indeed a language, unlike English, but with its own rules and richness of expression. Coupled with the patent failure of oral rehabilitation to work, the pendulum has begun to shift once again. Moreover, this time, deaf people are themselves active in causing the change.
There has been considerable research on the vocational needs and status of deaf children and adults. The literature includes both teaching strategies and various aspects of the working world of deaf people.
Rowland described the strengths and weaknesses of deaf workers, as evaluated by their employers and supervisors. From questionnaires sent to 80 businesses in the Los Angeles area, she compiled information. Employers and supervisors most often used oral and written communication with deaf workers, but a significant minority was able to use ASL. Deaf workers were rated generally about the same as hearing employees. In particular, they were rated as safety-conscious as their hearing counterparts; they were not judged to be safety hazards. Principal strengths of these deaf workers were:
Areas of weakness were:
Employers thought that the emphasis in vocational counseling and training should be on developing good work attitudes, rather than on specific skills and knowledge.
Dodd studied occupational stereotypes related to sex and deafness. The subjects were entering freshmen at the National technical Institute for the Deaf, and the instrument was the Job Lists Test. Males tended to stereotype jobs by gender more than females did. Older deaf students tended to stereotype more jobs as inappropriate for deaf people. Students who rated occupations as strongly stereotyped by sex also rated them as strongly appropriate for hearing workers. The author concludes that educators and counselors should liberate young students from such limiting views of their own potential by revealing the fallacies of stereotypes.
Wright studied graduates from the California School for the Deaf at Riverside between 1972 and 1976; there were 123 respondents to a questionnaire. More than 80% of the respondents took some form of postgraduate education. Some 67% were employed; 30% had never found employment. Nearly half of the respondents indicated that their employment was not related to their academic studies. English, reading and mathematics were rated the most useful academic courses and business education and homemaking were ranked as the most valuable vocational courses. Two-thirds of the graduates felt that the California School for the Deaf had prepared them for college but not for the job market, a complaint they share with hearing students of their schools. Two findings of the study indicated the need for more careful preparation of deaf students for the job market:
1) 30% had been unable to find work; and
2) half of the respondents had an annual salary under $5,000 a year.
Considerations such as the comparative merits of vocational training and more abstract educational endeavors, in a long range view, were not addressed in this study.
Farrugia attempted to determine the vocational interests and attitudes of deaf persons aged 16-19, and to see how they differed from hearing persons of the same age. In general, he found that deaf students tended to prefer manual over academic and cultural activities. The deaf students seemed to have lower aspirations than did their hearing counterparts. The students self-report measures indicated that the deaf students scores resembled most the hearing students of ages 12-15. The author suggests that those responsible for vocational training for deaf people might wish to emphasize areas such as art and numbers, where low scores were not linked to hearing loss.
Banowsky attempted to ascertain whether or not certain personality factors relevant to long-term employment differed between pre-lingually deaf adults and the general population. differences in sources of job satisfaction were also considered. The findings of these self-report measures indicated that personality factors associated with long-term employment were different between the two populations. The deaf subjects assessed themselves as being tough minded (self-reliant, unsentimental, acting on practical, logical evidence). There were no differences between the two populations in their views of areas of work, pay, promotions and supervision. The deaf workers had a significantly less positive opinion of their co-workers than did hearing workers. The author concluded that deaf workers may need to come to terms with working in situations where their down to earth approach will not necessarily coincide with the more intuitive approach of their co-workers. However, given the unreliability of assessing personality with self-report measures, the author warns that this studys findings should be regarded only as tentative.
The African-American Deaf
Minorities in the United States historically have had a difficult time gaining respect for their individuality and achieving their rights. The deaf are a case in point, but deaf members of other minorities have had to struggle all the harder. There is a sparse literature on African-American deaf people, but little regarding the deaf of other minority groups, including people of Hispanic culture.
Moores and Oden (1977) discussed the, then current, educational situation of African-American children. They pointed out that census figures indicating a lower incidence of deafness among African-American people are probably misleading, since there is no medical reason to believe that incidence of deafness varies by race. Possibly white researchers undercounted the African-American deaf population because they worked primarily with white deaf groups from which African-American people may have been excluded. African-American people, they stated, were also under-represented in school programs designed for deaf students, perhaps as a consequence of late diagnosis of deafness among African-American people of lower socio-economic means, and thus less access to these programs. Even when the diagnosis of deafness is made in a timely fashion, African-American parents may not be as well informed as white parents regarding services available to them. On occasion, they noted, a deaf African-American child is summarily classified as mentally retarded, and is enrolled in a wildly inappropriate program. This type of error may be responsible for the disproportionately large number of African-American children reported to be mentally retarded. It is possible that other deaf minority children may still be subject to similar neglect and misclassification.
Luetke-Stahlman noted the small number of minority teachers involved in special education, compared to regular education. She suggested a need for teachers who share cultural characteristics with their students, so that these teachers perceptions do not result in self-fulfilling prophecies about a childs limited ability. A 1981 study indicated that the number of African-American deaf students had increased to 17% in the U.S.; yet the number of African-American teachers was only 3.3 percent. The study shed no light on why African-American educators have shunned special education.
Taft queried a sample of 67 African-American deaf residents of the District of Columbia in 1983. African-American deaf people in that sample had a higher job success rate than did clients with other disabilities. More African-American females found work than did African-American males, possibly because the available jobs subsisted largely of clerical and domestic work. Almost all the members of the sample had previous work experience; about half had received vocational training; and about two-thirds obtained jobs in areas related to their work experience or training. The study, accumulatively, indicated that properly trained, deaf, African-American individuals can find employment of some kind.
A major contribution to the literature of deaf Americans of minority extraction was a book written by Hairston and Smith. Black and Deaf in America cites major problems of deaf African-American, such as: under-education, underemployment, poor communication skills and unfavorable self image. Individual differences do exist, however, and stereotyping is not helpful in understanding individual people. African-American deaf people are subject to the same racism experienced by other African-American people, and they may suffer a double stigma in being deaf. There is little socialization of African-American deaf people with deaf Caucasians, although such associations might aid in overcoming misperception. All the problems deaf white children encounter are compounded for deaf African-American children, and the frequent inability of African-American parents to cope with the usual bureaucracies of helping professions can be a further burden, further diminishing the probability that the family unit can adequately fulfill the needs of the African-American deaf.
After surveying the mass of studies which purport to document and/or explain the unique needs of the deaf, it is apparent that more knowledge in all these areas surveyed would aid us in formulating helpful guidelines and techniques to empower deaf people to live whole lives, rather than lives sharply circumscribed by arbitrary limitations of societys willingness and ability to accommodate their non-hearing status. It would also be quite useful for research pertaining primarily to one particular aspect of hearing impairment, e.g. gradual deafness in the elderly, to be clearly labeled as such, since relevant/salient characteristics vary vastly, discouraging generalization. Such areas as susceptibility to depression among deaf persons, e.g., seem clearly to be linked with age, economic means, availability of another person in whom to confide and other such factors, more than with the factor of deafness. Additionally, it would be optimum if investigators would increasingly consider research designs which offer adequate standards of reliability and validity.
Hearing loss has been the focus of research about deaf people for many years, with its assumption of direct correlation to other factors being considered. Although this is sometimes relevant, it clearly is not the entire picture. We need to examine our assumptions about normality which underlie research hypotheses in studies of the Deaf.
DEAFNESS AND ALCOHOL ABUSE
Implications of Alcoholism Research for Deaf People
How vulnerable are deaf and hard-of-hearing people to alcohol abuse? Dr. Betty G. Miller, herself a certified, deaf alcoholism counselor, says,
Alcoholics look for excuses to avoid treatment and we must break through this denial attitude. In the case of a deaf person, the excuse becomes a glaring reality deafness. While the basic elements of the disease are the same, the deaf person tends to feel them with a greater intensity. Loneliness, depression, social alienation, a low self-esteem all these elements are heightened with a deaf person.
Debra Guthmann, of Minnesotas Chemical Dependency Program for Hearing Impaired Youth quotes the Drug Free Schools and Communities Act of 1986 as saying that people are at high risk of developing a drug or alcohol problem if they have experienced mental-health problems or long-term physical pain due to injury. She notes that the Federal Office of Substance Abuse Prevention has developed a number of categories to identify youth with increased risk of developing an abuse problem. Within this list, along with having a parent who abuses substances, or being economically disadvantaged, or a school drop-out, is having a physical disability.
Ms. Guthmann cites three fairly well known recent studies of substance abuse among specific populations of deaf people, (Isaacs, Buckley and Martin, 1979; Johnson and Locke, 1978; and Boros, 1981) summarizing their conclusions to suggest that the incidence of substance abuse among deaf people is no higher than in the larger society. Using Ms. Guthmanns statistic, we deduce that there are some 73,000 deaf alcoholics in the United States, however some estimates posit over one million people with impaired hearing who have exhibited problems handling alcohol.
Waltzer cites studies by Steitler and by Peic, agreeing with their independent conclusions that substance abuse among deaf students appears to be higher than among hearing students. She says that up to one out of seven deaf people who use drugs or alcohol becomes addicted, and states that feelings of isolation, communication difficulties, reduced educational and job opportunities, confusion about cultural identity, and mental health problems contribute to this high vulnerability.
The Institute on Alcohol, Drugs and disability offered a review of the literature relative to alcohol, drugs and disability in 1989. They compiled a comprehensive bibliography of literature relative to alcohol, drugs and disability. It is not the purpose of this work to incorporate the details of existing bibliographies, but to note their availability and helpfulness in listing available studies.
We do not wish to stereotype deaf or hard-of-hearing people or to blunt critical examination via overly simplistic insights. While it is obvious that deaf people are individuals and deserve to be met on a one-to-one basis, with no pre-conceptions interfering with complete perception and reception in each encounter, it is equally obvious that a number of concerned researchers have exerted considerable time and effort trying to deduce if there exist discernible points of commonalty, in order to more adequately meet the needs of deaf and hard of hearing people.
Boros (1981) and Isaacs et al. (1979) specified two problems faced by deaf alcoholics.
Moore (1992) states that many experts believe the incidence of alcoholism among deaf people is at least equal to that of the hearing population. He offers the following supplemental reasons, in addition to mentioning several already noted in this work:
Other factors which may contribute to risks for substance abuse by individuals who are deaf range from a lack of understanding of health education information (Kleinig & Mohay, 1989) to differences in information processing patterns among the deaf (Chalifoux, 1989). The inability of existing social systems to respond to the needs of the deaf also contribute a great deal of elevated risks for substance abuse, and this includes a complete lack of awareness about substance abuse services for persons in the deaf community (Whitehouse, Sherman, & Kozlowski, 1991).
Moore and Ford offer evidence that deaf people may be at increased risk in developing addiction, because of factors inherent in their lives, e.g. ready access to psychoactive drugs for pain or balance maintenance, their decreased visibility in society if they maintain separatism, and acceptability of drug use by others in their peer group. And the late Larry Stewart, who was a psychologist and substance abuse treatment program director, echoed the previously mentioned factors.
Numerous hypotheses abound regarding the physiological way in which deafness impairs peoples functioning. Some of these are more plausible than others, however. McCay Vernon (1969) hypothesized that the dismal educational standing of many deaf children, despite their normal distribution of intelligence, particularly citing their difficulty in learning oral languages, might be accounted for by lesions of the central nervous system, which he presumed accompanied the hearing loss. A few people accept the concept of a deaf psychology, implying that because deaf people have double-burdens, unique personality structures and dynamics may evolve, but evidence has not supported the idea that there is anything intrinsic in deafness to comprise psychological uniqueness.
Levine (1960) implied that if deaf people constitute a unique psychological profile, their differences from the larger population may be attributed, not to inherent, organic variancessuch as deafness, but to socio-cultural factors, such as isolation.
Michael A. Harvey (1989) speaks of the common phenomenon of a disability spreading to become a handicap, or allowing a handicap to be disabling. This implies extending ones objectively-measurable medical condition to include experiential difficulties of adjusting/functioning in ones environment. He reasons that people experiencing self-doubt in adjusting to hearing loss could greatly benefit from knowing that certain stresses normally accompany the process. Open, frank discussions, rather than denial and evasions, about how these stresses affect the individual, the family and friends could be supportive and therapeutic, in and of themselves.
With these cautions in mind, certain parallels may be at least tentatively drawn, which might illuminate the problem of substance abuse among people with hearing loss. Both the abuse of alcohol and the experience of hearing loss are conducive to the individuals retreat from society.
The sense of belonging to and being accepted by a group is important to successful human development; the feeling of not belonging, and of the experience of receiving unequal treatment are often cited by people in the minority. This experience generally results in either of two forms of responses. It may increase group solidarity among those who feel rejected by the dominant element in the community, or it may generate self-denigration, and result in preservation, in attempts to emulate the dominant group. The literature reveals examples of both paths taken by deaf and hard-of-hearing people.
Both the experience of hearing loss and substance abuse/alcoholism frequently are characterized by feelings of isolation and not belonging.151 Bobbie Beth Scoggins, the deaf creator and director of an enormously successful video which features a cartoon character, says, Studies show theres about a 35% rate of use or misuse (of drugs), but I would say its closer to 50% because of isolation, low self-esteem, and lack of employment among the deaf.
Both chronic alcoholism and deafness or hearing loss, to state the obvious, involve physical disability related to receiving sensory input from ones environment, i.e. hearing loss is the physical disability in impaired hearing, which greatly impacts ones communication and may affect ancillary aspects of ones life also. As we have seen from the literature cited earlier in this chapter, studies on alcoholism show multiple disruptions of perception, (e.g. seeing double, balance problems, and hearing loss), among other many physical effects related to chronic alcoholism.
Both deaf or hard-of-hearing people and chronic alcoholics, as shown in the literature, may employ denial and evasion, to avoid facing unpleasant realities. Regarding the tendency to not acknowledge negative aspects of the deaf experience, a great deaf lady, Grace Murphy, noted,
There would be no purpose in writing this book if I pretended that life is only sweetness and light. It has been the pretence (sic) of the deafened (to this effect) that has made half their difficulties.
Isaacs (1979) documented denial on a fairly large scale among deaf alcoholics.
He reported that preliminary efforts to create alcoholism treatment services for people with hearing impairment were met with massive denial by the organized Deaf community, of the existence of the problem, as well as occasional active hostility to its being raised as a possibility.
Closely related to the phenomenon of denial, perhaps overlapping it, is the concept of stigma, alluded to elsewhere in this work. Part of stigma appears to be willingness to accept guilt for something external to oneself, and/or unwillingness to be associated with anything which one believes is somehow shameful. The National Information Center on Deafness reprinted a paper developed by the Virginia Division for the Deaf and Hard of Hearing (1985), which includes the following partial explanation of the cultural stigma deaf people may feel about alcoholism:
The first barrier deaf persons experience in utilizing existing alcoholism treatment programs is the deaf communitys perception of alcoholism. Many deaf persons see alcoholism as a personal weakness and a moral sin. This outdated view of alcoholism if attributed to the isolation deaf persons experience and their limited information on current trends in treatment. The stigma that the deaf community places on alcoholism discourages deaf alcoholics from admitting their drinking problems and from getting treatment.
Also referring to the stigma of alcoholism, Sabin (1988) writes that it still exists in the Deaf community, and Moser says:
A reluctance to enter treatment on the part of the deaf population resulting from the stigma that is attached to the problem, further frustrates the effort to treat. Because the deaf community is tighter and has a strong grapevine, substance abuse carries more of a stigma than in the general population.
In both alcoholism and deafness studies the propensity toward dysfunctional communication and family life are frequently cited as primary problems deterring treatment. Earlier in this chapter we noted the work of family systems therapists, (Satir, Watzlawick, Jackson, etc.) on dysfunctional families. A number of characteristics of dysfunctional family life can be seen to parallel the experience of a person undergoing hearing loss or feeling isolated and ostracized in a hearing world. These characteristics include: a preponderance of mixed messages, renouncing ones own perceptions in favor of others, creation of double binds, in which the individual is perceived as wrongno matter what, accompanying the fear of being abandoned if one does not abrogate individual rights and embrace unacceptable alternatives.
Gordon Aliport noted from his studies of deaf children, that, in order to make a satisfactory life-adjustment, the deaf child needs to know from an early age that his conditions of security are in some respects unlike those of an average child. This awareness of being isolated, of differing qualitatively from the norm, does not usually contribute to a childs natural, healthy psychological development, but often brings first denial, then anger and bitterness. To the extent that these negative emotions have no appropriate outlet and are turned inward, the psychological health of the child is adversely affected.
From accumulative literature considering why disabled people sometimes abuse substances, a number of hypotheses have been presented. Four factors were identified most often:
Psychologist Lee Meyerson, himself deaf, constructed a theory regarding the various social adjustments of deaf people. He noted three perceived patterns.
Pattern number one (1) is comprised of the Deaf community who disassociate themselves from the hearing community and perceive safety in a small but well-ordered world of their fellow Deaf people. People who share the Deaf culture, are fluent in sign language, and have loved ones in the group may tend toward this category. This category also can apply to people who have become deafened late in life, but who have managed to find havens of acclimation via lip-reading, and/or options, primarily in large urban areas, for sympathetic relationships with other people undergoing similar experiences. There has been no research replicated sufficiently to link specific patterns of emotional difficulties with this group of deaf people who have strong emotional support systems.
Pattern number two (2) is identified as practiced by those who resist awareness of their deafness and strive to interact with hearing people without any special consideration. Allport noted many emotional hazards for people who choose the mainstreaming route; the perils include chronic anxiety, self-doubt and ambivalence toward oneself and ones acquaintances, and internalized, debilitating resentment.
Adjustment pattern number three (3) is chosen by people who can, at least in theory, value the large area of commonalty that exists between those who are deaf and those who hear, seeing that the ability to hear is far from central to the core of humanity. Affirming our essential humanness, similar aspirations, needs and emotions helps people to rise a meta-level in their perspective. Thus the individual manifestations of human variegation are seen as just that, and not as labels, indictments or reasons for disaffirming either self or others.
The high moral ground is the ideal, Allport says, but tolerance should be shown to everyone in their individual choices. Indeed the divisions between the three identified adjustment patterns is not rigid nor one-way. Just as people experience variance in their moods and emotions, generally, they may also feel like interacting primarily with people who are most likely to understand them at certain times. They may feel like asserting their uniqueness or to venture to try to understand someone perceived as alien at other times. All this is within the range of normal human variation of mood and confidence level.
Just as the personality profiles of alcoholics in the larger society begin to be less differentiated, and alcoholics assume a common, recognizable profile as their disease encroaches on their lives, deaf people who abuse substances are observed to have characteristics similar to that profile and to each other, and become less individually distinct personalities. Grant, et al., (1982) noted self-doubt, tendency toward paranoia, dependence on external guides rather than internal, low tolerance levels, poor impulse control, poor communication skills, intermittent depression, immaturity and feelings of isolation and inferiority in deaf alcoholics. We do not have conclusive evidence that this personality-cluster was merely the path of least resistance for these people, but we have accumulative research, cited in chapter two, which tags people studied who felt impaired by hearing loss or societal neglect, as vulnerable to these same psychological problems.
Patrick Best, in a dissertation for Wayne State University, found that deaf children manifest a significantly different development pattern of psychological differentiation than do hearing children; he particularly noted abnormally high impulsivity levels in deaf children, as have other researchers such as Altshuler. Does this high impulsivity put them at extra risk of becoming alcoholic, since alcoholics also are observed to display high impulsivity? We dont have clear evidence on this; we do have the observation that trying to discover which came first, (the emotional characteristic of poor impulse control or the addictive behavior) may be impossible and nonproductive, since they seem to mutually reinforce each other.
It may seem self-evident that such things as feelings of isolation and extreme loneliness are unhealthy psychologically for human beings, but explicit research expresses that thought from a positive standpoint. Maslow studied psychologically healthy individuals and deduced their common characteristics. Among healthy people functioning at a high level of self-actualization, a feeling of benevolence toward and empathy with ones world and specifically ones acquaintances was most salient. Prelingually deaf children, playing together, communicating via sign language, and unaware that they may be labeled impaired by others, may approach Maslows outlined ideal of psychological self-actualization as fully as may individuals in any other hypothesized group. They are not mistrustful, bitter, nor inclined to retreat from the world. Until unfortunate experiences with people who do not accept their uniqueness quell the naturally optimistic natures of these deaf children, they are not perceived to be at psychological risk. They are certainly not prime candidates for substance abuse. Therefore, we can deduce that there is not a specific quality inherent in being deaf which predisposes one toward substance abuse.
Sidney Jourard, best known for his work, The Transparent Self, states unequivocally that to be fully healthy psychologically, an individual must have at least one other human being with whom he/she can be completely honest and can disclose ones innermost feelings. He cites the degenerative effects of feelings of isolation and feeling different from ones peers. It would appear that deaf people who, in reaction to wounds to the psyche from insensitive people, retreat into loneliness and tacit rejection of their uniqueness, are at least further distancing themselves from healthy psychological functioning, and may be seen to be making themselves vulnerable to cul-desac retreats such as alcoholism and drug addiction.
Both alcoholism and experiences ensuing from adult-onset hearing loss are perceived to diminish a persons ability to trust his fellow man. Kannapell writes movingly of the trust-mistrust phenomenon among deaf people, generally, and notes that one of the classic characteristics of alcoholics, deaf or hearing, is that they increasingly distrust people. She focuses on five possible reasons for mistrust of hearing people by deaf people. In each instance a perceived difference in personal power between the deaf person and the person mistrusted was involved.
Similarly, Chough discussed factors involved in the lack of trust of people exhibited by deaf people. He reviewed Ericksons developmental stages of life and other theories, and closed with recommendations to help the development of trust between deaf and hearing clients and counselors. Choughs pointers are:
Among the parallels of the deaf experience and an alcoholics experience are various physical and/or physiological aspects which are affected by hearing disorders. Certain hearing disabilities are linked to disturbance of the sense of balance, e.g. Menieres disease, and alcoholism both affect ones sense of balance, and speech centers within the brain have been noted as being affected by both alcoholism and deafness. Even the senses of smell and taste can be affected in both deaf-related circumstances and alcoholism.
These parallel characteristics have been observed by researchers on alcoholism or drug dependency and on deaf people. In certain instances, it may have been assumed by researchers that the variable of deafness was the one observed, however closer scrutiny of the research may offer additional hypotheses to explain the findings. If, however, even some findings are valid, it is imperative that deaf people, who may be at great risk of developing alcoholism or drug addiction, be aware of the potential pitfalls.
Because deaf people do not comprise one homogeneous group, but consist of people born deaf, people who become deaf before they learn oral language, people who gradually become hard-of-hearing, those who become deaf due to accidents and other such circumstantial demarcations, generalizing across the area of hearing-restriction, with respect to emotional characteristics, beliefs and attitudes, vulnerability to addiction, and other variables is neither wise nor helpful.
Harlan Lane (1992) warns of the perils of extrapolating personality characteristics observed in individuals to generalize about deaf people as a whole. He compares various traits accumulatively attributed to the deaf to Burundis outlandish list of traits attributed to Africans by colonialists. Despite the impossibility of so many mutually contradictory qualities applying to a single person, some agreement by two decades of researchers on observed behavioral traits of certain deaf populations, e.g. deaf adolescents born to hearing parents, in a number of aforementioned studies, comprise composite profiles, which may be instructive.
(Table II is a reproduction of traits most consistently ascribed by researchers cited in this chapter to people with adult-onset deafness, parallel to traits attributed to alcoholics by clinicians.) This particular population of deaf people was chosen to proffle primarily because of the great need of early intervention with them regarding vulnerability to addiction.
Table II. A Comparison of Descriptions of People Deafened in Adulthood & Alcoholics (from researchers, clinicians, teachers, therapists, employers & social workers)
Adult-onset deafness has been noted to be conducive to:
Alcoholism has been has noted to contribute to:
Retreat from society - sense of not belonging
Retreat from society Sense of
Feelings of isolation! loneliness
Feelings of loneliness/ being abandoned
Low selfesteem/poor self-image
Intermittent feelings of depression/moodiness
Widely varying moods from euphoria to depression
Denial and/or projection
Denial and projection
Stigma & shame leading to hiding behaviors
Stigma & shame & hiding
Motor skills affected by
Motor skills affected by
Impaired communication systems
Over-extended family life
Troubled or defeated families
Decreased will to overcome/conquer ills of life
Circularly reinforcing defeatist factors
Low frustration tolerance
Increasingly low frustration tolerance
Diminished ability to trust others
Increasing paranoid feelings
Resorting to passive-aggressive or manipulative behaviors
Manipulating others without conscience
Overall sense of helplessness
Gradually enveloping despair
Sometimes psychotic reactions
A list of characteristics ascribed by observers to deaf children compared to alcoholics might list such commonalties as immaturity and poor impulse control, but such a comparison seems specious to this researcher in that many, if not all, children are by definition immature and most everyone has to learn impulse control. Saying that deaf children lag behind other children in this regard could be regarded as tautological, since their sensory impute, from which these qualities derive is limited. Children mature, however, and learn impulse control, while people ensnared in addiction, unless they receive help, worsen in these variables. Thus, even though we might, in theory, be able to identify a precise moment when the psyches of the two groups seem nearly congruent, the directionality of movement in the two populations is opposite. Presumably the overlap of similarity will diminish if the deaf children do not succumb to alcoholism or drug addiction, so pointing out their similarity to alcoholics is pointless. Intervening at their points of vulnerability to addiction, however, is very much to the point.
Some inconsistency and contradiction in characteristics attributed to deaf people as a whole may be due to the wide range and variability of qualities which all people, deaf or hearing, have the potential of expressing. Some of the inconsistency and contradiction, however, may be due to the general publics sloppy use of terminology, including lumping together all populations of the deaf, and extrapolating conclusively from a few instances. We shall venture a few thoughts, using this insight, and then subdivide the category of deaf people, to examine possible relationships in the various people whose hearing is impaired referenced in terms of vulnerability to alcohol abuse.
Pre-lingually Deaf Persons & Other People Who Comprise the Deaf culture:
Among deaf populations, people, such as those known as pre-lingually deaf, born to deaf parents, who have grown up within a loving culture of other people like themselves, who share a common language (e.g. ASL), and have a sense of commitment to their group may not encounter snubs nor impatience they might otherwise feel from the larger society, and thus may not feel isolated or lonely. People who find their social, intellectual, cultural, physical and emotional needs met primarily within a closely-knit group of people may be seen as less vulnerable to the prompting of loneliness toward addiction, than later-deafened people might be, who may not have such peer groups.
While alcohol use in residential schools of the deaf has been cited as a problem in the past, particularly when signing was discouraged, current awareness of the students needs, increasing peer pressure to remain addiction free, and mass education about potential problems of addiction may soon lessen perceived vulnerabilities there.
Characteristics seen in geriatric deaf populations which may predicate addiction:
People who have gradually become deafened, especially late in life, may be more vulnerable to alcoholism due to depression and feelings of isolation than are people fully ensconced in the Deaf community. It has been cryptically noted that elderly hard-of-hearing and newly deafened people dont really fit into the Deaf community, but they see themselves increasingly unable to function in the hearing society. Deaf Life Magazine (1989) states:
People who are losing their hearing usually go through the same psychological process; the stages of adjustment to a loss: first comes denial, then anger, then guilt, and finally, some level of adjustment. But many are afraid of deafness because they dont know how to confront it. Understandably, they may have negative feelings about deafness, and feel bitter and depressed about their own deafness and loss of identity.
Presbycucis, a hearing loss which is frequently noticed after age 60, is a form of nerve deafness. Presbycucis and other disorders in which auditory acuity is lost are frequent in geriatric populations, and are the occasion of much distress. Powers and Powers discuss the hearing problems of elderly persons and the social ramifications of these, citing the increasing sense of isolation as a primary pathological sign. Happily, their subjects sought out more contact and did not report feelings of loneliness any more than did the controls, non-deafened elderly people.
Contributing to the psychology of hearing loss, Rousey focused on psychological defenses, such as denial and projection, which are frequently used to cope with hearing loss. He observed instances of mourning, shame and lowering of self-esteem.
McCartney and Nadler noted that feelings of isolation and depression are often caused by hearing loss in the geriatric population. They discuss possible medical aids and offer some suggestions for their patients with hearing loss, e.g. Initiate conversations rather than waiting for others to speak to you first.
Stevens sought to identify psychological problems in middle-aged and elderly people with hearing loss, and to determine whether or not hearing-aids would ameliorate these. The feeling of social isolation was the principal psychological problem noted, and although the use of an hearing-aid helped, there remained a residual sense of loss which kept the people from resuming their former active, social lives.
Cooper et. al. re-examined the association between acquired deafness and paranoia in the elderly. After taking into consideration the possibility that selection and age factors might have skewed the results, they were still able to draw a few tentative conclusions regarding the observed phenomenon that patients with paranoid psychosis showed more severe hearing loss than did patients with affective illness. They believed that the long interval between the onset of deafness and the emergence of psychosis offered hope in the area of opportunity for prevention of paranoid psychosis in elderly deafened people.
Jones et. al. interviewed a random sample of 657 patients, aged 70 and over, from a general practitioners clientele. These people were asked about their hearing difficulties and also about problems in other areas of their lives. Standardized measures were used to survey the subjects levels of anxiety, depression and memory loss. Hearing loss was associated with both depression and anxiety, both of which are high risk factors in the incidence of alcoholism. But other physical disabilities of the subjects may have weakened the statistical significance shown in the link between age and vulnerability to addiction.
A notable exception to the bulk of studies showing increased amounts of depression, a sense of isolation and a sense of deep loss in the deaf geriatric population is Thomas et. als, in which 259 healthy people between the ages of 60 and 89, who lived independently, stated that their (moderate) hearing loss did not cause them to feel depressed; in fact, they sought out additional contact with their families.
Other Deaf Populations Viewed in terms of Addiction Risk:
Adults deafened suddenly, as in accidents, and people who are moderately hard-of-hearing all their adult lives may also be without peer groups for comfort. Dana Mulvaney, a deaf social worker who took her first sign language class when she was 22, tells of feeling ignored by agencies serving deaf people. She discusses the difficulty of learning to sign adroitly as an adult and the abdication of hope of being able to keep up with a hearing world that is implied in transferring ones attention to communicating primarily with other deaf people. She relies heavily on written communication, and speaks of the frustrations of such methods. Overall, she conveys a sense of loss, of feeling out of place, and of not being adequately understood.
A social worker, Luey, discussed problems of deafened adults, which she perceived as being different from those of people who were born deaf. She notes problems in communicating, social functioning, and in self-acceptance. Similar in its conclusions, but differing in vantage point is Cornforth and Woods study on the effects of sudden or progressive deafness on people. They state that in both sudden and progressive deafness, results are traumatic to the individual experiencing the loss. The individual feels isolated and unable to sustain relationships they had nurtured throughout their lives.
It is understandable that people who feel overwhelmed by changes they do not understand, and people who feel that control of their lives is slipping away from them, might seek help. Some turn to alcohol or chemicals to numb their awareness of all that is unpleasant in their circumstances. It would appear that this group of deaf people, who may be experiencing multiple losses, due to other mixed causes, are quite vulnerable to substance abuse. Factor analysis studies of deaf people who develop alcoholism or drug addiction could develop a scale, similar to the common stress index, which would isolate and take into account such variables as age, general health and life situation.
In addition to the above surveyed populations of deaf people, studies have been done on multi-handicapped deaf people, psychiatric deaf populations, black and Indian deaf people, and deaf children, some of which were cited in the second chapter. To review these here would unnecessarily lengthen this work, but a few summary statements can be deduced. Where psychological implications were offered, the same range of emotions, beliefs, attitudes and value systems as obtain in the larger society were demonstrated. We can excerpt a typical summation, to amplify this concept. Altshuler (1974) wrote:
Early parent-child communication is a traumatic issue between hearing parents and their deaf children. Although the hearing parents talk to and in front of the child, they can only guess at his level of understanding . . . We have laid the special difficulties of the deaf child to the fact that he does not hear the emotionality transmitted by sound, that he does not learn verbal language at the optimal times, and that the presence of his handicap is the starting point of a vicious circle of maladaptive influences, as parental reaction influences him, and his responses in behavior evoke further concerns.
Such a childs prospects are certainly less than optimal, and would encourage every precaution in nurturing and instilling internal resources. In a world where people frequently feel over-extended and inadequate to fulfill their responsibilities, however, offering what might be perceived as extra care may not seem probable.
Referencing specific populations of deaf people in terms of their vulnerability to alcoholism may help to avoid blanket generalizations and absurd characterizations, and provide selection criteria for the most vulnerable people, when limited resource allocation of treatment funds and facilities are also relevant.
Finally, regarding the hodge-podge of theories, explanations and interpretations of the available research results, let us introduce the slot-machine theory, offered by Kinney and Leaton. To become an alcoholic, using the analogy of this theory, one must receive the equivalent of three cherries in life. Some individuals may be born with physiological predisposers or tendencies toward physical problems which would constitute one cherry. The environmental and cultural interactions he experiences may provide a second cherry. The personality, with its unique interactions with the first two areas, may be the third cherry. Any one cherry (major drain on ones resources) may become interwoven with another. With the presence of three major forces contributing to the drain on ones resources, alcoholism or drug addiction is most probable, although not inevitable. The combination of two major forces (cherries) may constitute a sufficient drain on the individuals resources and self-esteem to pull him into alcoholism. One lone cherry, e.g. deafness, is not in and of itself an accurate predictor of who becomes alcoholic.
We have not seen conclusive evidence that deafness, per se induces alcoholism. Deaf people, however, due to cultural factors such as isolation may not have acquired adequate preventive information regarding the dangers of alcoholism. People are, across other variables, all vulnerable to addiction to alcohol or other substances. The very real dangers of alcoholism can threaten anyone, and research literature, cited in this chapter, offers a number of insights which might serve us:
Regardless of the fact that stereotypes
about groups of people die hard, they do ultimately yield to honest examination
of the facts. So, as hearing and deaf people together endeavor to perceive
each other respectfully and to identify the various needs of our shared world
with clarity, it is hoped that factors such as mis-diagnosis, the halo effect
or its converse and labeling-to-avoid-encountering are likely to decrease.
Then, it is hoped, such destroyers of people as alcoholism and substance
abuse may be straight-forwardly addressed, remediated and ultimately prevented
from ensnaring people.
OTHER DRUGS OF ABUSE AND DEAF PEOPLE
Estimates of Incidence and Prevalence of Drug Abuse in the Deaf Population
It has been estimated that there are millions of people in the United States addicted to somethingalcohol, chemical substances or even unhealthy relationships. Experts are naturally reluctant to offer precise estimates, since certain particulars of the scant data available are confidential rather than publicized, e.g. since use of some drugs is illegal, people are not forthcoming about the use of those drugs. Information on drug use often relates to prevalence, rather than incidence, and it usually comes from treatment center populations, thus a certain percentage of recidivism must be taken into consideration. Individuals who do not come to the attention of the law andlor medical treatment units are also not included in those estimates. Mark Gold (1987) states that each year more people die from prescription drugs, which may have been obtained legally, but used improperly, than from all illegal substances combined. Most treatment therapists will venture generalizations, with caveats, as did Rosenthal (1988).
Although there have been positive changes in drug use by American adolescents fewer youngsters, for example, now smoke marijuana overall drug use by teenagers remains extremely high, the highest of any industrialized nation. Moreover, youthful drug abuse has become more life-threatening. Use of cocaine stands at record levels, and the number of frequent users has been increasing.
We do not know the extent of substance abuse among deaf people, for several reasons.
1) Professionals in the substance-abuse field are not, routinely, alert for signs of hearing impairment, and may not recognize or diagnose it accurately.
2) Deaf people with substance-abuse problems may not seek help because,
a) they do not recognize that they need help,
b) they fear the stigma substance abuse might carry,
c) difficulties such as distance and expense seem prohibitive, and
d) they have had frustrating experiences in their previous attempts to gain help from the mainstream society.
3) Limited reporting systems also may undermine attempts to estimate substance abuse among deaf people.
By extrapolation of statistics provided by the U.S. Census Bureau, NIAAA and the National Institute of Drug Abuse, Miller & Cisin (1979) and Zinberg (1980), suggest that there may be 73,000 deaf alcoholics, 3,500 deaf heroin users, 14,700 deaf cocaine users, and some 110,000 deaf people who regularly use marijuana.
Mark Gold (1984) states that some 25 million Americans report having used cocaine at least once. Other researchers, such as Thomas Dixon, also report significant incidence of drug use among the deaf.
In 1989, the California attorney Generals Commission on Disability issued a report stating, There are reliable estimates on the incidence of alcohol and drug abuse among people with disabilities; indications are that it is at least double that of non-disabled people. Laura-Lynne Powell (1992) estimates that at least 35% of deaf and hard-of-hearing people are substance abusers.
In addition to the prevalence of people abusing one specific drug, there are a number of people who abuse drugs indiscriminately and/or in combination. Polydrug use includes simultaneous use of different drugs and also sequential use of assorted drugs. Kinney and Leaton note that different patterns of multiple drug use might be identified. One they discuss in detail involves naive recreational fruit-salad, in which teenagers, e.g. attending a party, would each bring and contribute whatever pills could be gleaned from the familys medicine cabinet. In a sort of chemical roulette, the bowl would be passed around, and each person would take a handful of pills, indiscriminately, to turn-on for the evening. This practice became known to the larger society as more and more teenage party-attendees wound up as victims in emergency rooms, having ingested unknown drugs with unknown effects in unknown quantities.
Sometimes, just as one disorder can mask another, and make diagnosis difficult, one substance abuse can cover another and shield it from scrutiny. In their book, Dual
Disorders: Counseling Clients with Chemical Dependency and Mental Illness, Daley, Moss and Campbell state, Possibly 70% of hospitalized alcoholics have experienced one or more episodes of another substance abuse or psychiatric diagnosis in their lifetimes. Certain drugs, e.g. marijuana and tobacco, also are reputed to have a gateway effect, leading toward the use of more dangerous, life-threatening drugs. In 1990, the New York Times carried a front-page alert regarding the growing incidence of multi-drug users who have no idea of the ways the various drugs combine, exacerbate each others effects, or act synergistically. The trend of cocaine users to expand to crack and then to heroin, especially was noted as an alarming and dangerous trend.
Another form of polydrug abuse revolves around sequential, rather than simultaneous use. Often, for people abusing drugs in this manner, the aim is not to get high, but merely to cope. People under a great deal of stress but with access to ameliorative prescription drugs may get into the habit of taking stimulants, such as amphetamines, in the morning, to get going, then other drugs throughout the day, e.g. to counteract fatigue, and sleeping pills to help them sleep at night. Using chemical assistance to operate at super-human achievement or proficiency levels, however, carries a high physical price tag, and drains emotional capacities as well.
The Etiology of Drug Abuse
A number of researchers have pondered the whys of drug abuse. From hypotheses regarding inherent characteristics of certain people, to musings about social contagion and peer pressure, theories abound regarding why people get hooked on drugs.
Why, then, do people abuse drugs? There are many answers, depending on the type of drug, the type of population, and the life-circumstances of the abusers. Clearly the getting high phenomenon, which has been seen as analogous to joy-riding of the previous generation, but with more extreme consequences, can be seen as quite different in character and scope from the rug use of an elderly person who has gradually become deaf and grieves, inappropriately, by abusing prescription pain killers and sleeping aids. All drug abuse, however, can be construed attempts to escape from reality. Some drug abuse may be seen, additionally, as a misguided coping mechanism.
David LaChar, director of the Psychological Assessment Laboratory of the University of Texas Medical Sciences Institute in Houston says, There isnt one personality associated with substance abuse, and there isnt one path that leads to substance abuse. Indeed, there are many; anyone can be vulnerable. Addiction is multifaceted, and anyone who uses a drug can become addicted to it. The demographics of drug abuse are also fairly inclusive in terms of economic status, age, education level, and geographical region of the U.S.
Focusing on prevention of chemical abuse problems, Seppala (1977) posits several psychological theories, all of which have in common the factor of deficits in self-esteem and consequent disturbances in personal functioning, as markers which may predispose people toward addiction. She says,
Since 1966, research has suggested that the causes of chemical use problems are related to the lack of development of healthy personal functioning. Two significant research results suggest preliminary indications of a casual relationship between development of chemical use problems and deficiencies in personal functioning.
She reviews and summarizes the work of Dr. Ardyth Norem-Hebeisen and Dr. Andrew Ahgren of the University of Minnesota, and also the research conducted by Drs. Cohen, White and Schoolar. These studies suggest that specific traits, such as autonomy and anxiety-free confidence are lacking in drug addicts. The backgrounds of subjects repeatedly revealed patterns of deprivation of parental intimacy. Self-esteem levels of these clients tested at far below average. They conclude that low self-esteem has led to, or has been associated with, the beginning of drug abuse with many people.
People with hearing-impairment experience the same stresses and frustrations that people in the larger society do, and may experience additional ones related to difficulties of functioning in a hearing world. After enumerating disadvantages people ith disabilities face in interacting with other people, the Resource Center on Substance Abuse Prevention and Disability says,
These stresses may predispose people with disabilities to choosing an escape through the use of alcohol or other drugs. Due to medical needs such as pain, spasticity, seizure control, or breathing difficulties, people with disabilities also have more ready access to prescription drugs. It is well documented that medical personnel, attendants, and family members sometimes enable the use and abuse of alcohol and other drugs by a person with a disability, to alleviate their own guilt, provide a perceived pleasurable diversion, or simply avoid conllict.
The staff of the Resource Center point out that approximately 43 million Americans meet the Americans with Disabilities Act disability criteria, and that, although the specifics of their disabilities vary vastly, all of these 43 million people are at increased risk of developing chemical dependencies. In addition to the reasons why anyone might abuse drugs, additional reasons, related to their disability, are relevant. Some of these additional factors include:
Increased frustrations due to miscommunication or inadequate communication, stresses on family life, fewer social supports, and even such things as excess free time were all listed as contributory factors which place disabled persons at higher than average risk in developing drug dependence.
The September / October 1992 issue of Prevention Pipeline carried a staff-written review of treatment focus on substance abusers with assorted hearing impairments. They note that for deaf people, access to information and education about alcohol and drug dependency and relevant treatment programs is inadequate. The authors state, The nature of deafness tends to isolate affected individuals from the general community, further compounding the problems of alcohol and other drug abuse and domestic violence. Because such ideas may not have been directly addressed, preventively, some deaf people may not realize the great difference which exists between taking medication and in using alcohol or other drugs to deal with emotions and difficult situations.
Characteristics of Drug Addicts and of Addiction. with Implications for Deaf People:
As we observed in our survey of the emotional characteristics of alcoholics, cause and effect are hard to separate, since they often form a circle; thus it may be impossible to assert, e.g. that people with poor impulse control are at greater risk of abusing drugs than are people with average impulse control. We can note that poor impulse control is evident, progressively, in substance abusers, but we can not at this point deduce or separate original causes from their cyclical effects. Denial, blaming others for ones circumstances, and rationalization also are typically noted as characteristics of drug addicts, including alcoholics. But whether it is the case that people who are likely to reveal such traits (denial, blaming others and rationalization), are the ones most likely to also turn to drugs, or whether chronic drug abuse creates these personality traits has not been adequately addressed. Most psychotherapists and long-term observers of people who abuse drugs, maintain that each end of the equation exacerbates the other. Thus a circle is created, whereby certain personality traits feed drug abuse, and, in turn, drug abuse flattens a colorful, variegated personality into a diminished profile that only allows those personality characteristics to thrive which maintain drug dependency.
Several adult children of alcoholics and drug addicts have written compellingly regarding the emotional climate in a home torn by chronic substance abuse. Jim Trotter says that growing up in such a home urges the children to learn how to avoid conflict, at all costs. He notes that family members of the alcoholic or drug abuser strive so hard, in trying to ward off the despair which surrounds them that they develop a reactive weakness in their frantic desire to try to please everyone. Such overly-placating behavior stems, inferentially, from the escalating excesses of the family member abusing drugs or alcohol. along with the classic symptom of denial, the characteristics of widely swinging moods (alternating from grandiosity, megalomania and euphoria to deep depression) and of increasingly-demanding interactive behavior are noted consistently by researchers and casual observers alike, as traits of substance abusers.
Mark Gold compiled a profile of the typical cocaine user, after counseling some 100,000 callers to his 1-800-Cocaine hotline. He identified certain commonalties, both demographically and psychologically. Five hundred chronic cocaine users, chosen at random from among the first one hundred thousand people calling the hotline, were surveyed to yield this information. In close-up, these 500 people averaged age 30, with most of them between ages 25-40. The age range, however was from 18 to 78. They averaged about five years of chronic cocaine use. About 1/3 of this 500 were female. Some 85% of these 500 were Caucasian. They were overwhelmingly highly educated and economically somewhat above middle-class. Almost 2/3 of these 500 callers resided in New York, New Jersey, California or Florida.
Despite a number of physical health problems these people had experienced, connected to their cocaine use, nearly all of these people reported that economic considerations were the primary limiting factors in their drug use. Even though they had experienced adverse effects of cocaine, most of these 500 respondents reported that they continued to use the drug. When the high wore off, some 80% of them said they felt severely depressed and fatigued, and approximately 70% reported using alcohol, heroin or other drugs, also, in attempts to re-gain the feelings of euphoria they desired. These respondents reported physical side-effects such as insomnia, chronic fatigue, severe headache, nasal problems and poor or decreased sexual performance. Significant numbers of these addicts additionally reported seizures, loss of consciousness and even such things as nausea and involuntary vomiting.
In the psychological realm, an ever narrowing, mutually-reinforcing, cycle of cause and effect pattern of flattening personality traits is also visible. More than 80% of these addicts admitted to experiencing psychological problems including: severe depression, chronic anxiety, increased irritability, paranoia, and loss of interest in other things (besides drugs), difficulties in concentration and comprehension. Some 53% of these people said they had gotten so desperate and low they had seriously considered suicide as a way out of their difficulties.
Psychological profiles of marijuana users, stereotypically include such descriptors as: un-ambitious, lethargic, deficient incomprehension, paranoid tendencies and showing diminished interest in activities other than taking drugs; presenting a consistent picture of the crumbling ego. By contrast, the novice cocaine user is often achievement-driven. But even though marijuana users typically have not been noted for productivity, and cocaine users have, progressive, chronic use of either drug leads to the semblance of similarity of presenting problems, a narrowing and extinguishing of perceivable personality traits, so that after a period of time the personality, regardless of the drug used, is muted and the persons emotional affect is flat. With chronic abuse, Mr. Gold says, this trend progresses so that ultimately the control of the drug makes disinterest in things, other than taking drugs, become the most visible characteristic of abusers of either drug.
In terms of identifying personality characteristics of substance abusers, this phenomenon would seem worthy of at least cursory attention, as it may help to explain the multi-drug use and sequential drug use, cited earlier in this chapter. An increasing number of therapists are calling attention to the phenomenon of substitute addictions. When one addiction is dissolved, another frequently takes its place. This implies that some fundamental, underlying lack remains which has not been perceived or treated.
Regarding this phenomenon, Kavanaugh (1992) says:
Substitute addictions develop when only one expression of the addictive energy is addressed, because hidden feelings only manifest as another addiction. I have seen this frequently at 12-Step meetings where members report attendance at several different 12-Step groups simultaneously-.-attending one group for alcohol abuse, another for cocaine, another for codependency, etc. Their addictions move sideways, and the addictive energy that has its source in dysfunctional beliefs continues to be expressed in unhealthy ways.
This theory is quite consistent with thoughts, previously introduced, of researchers hypothesizing a lack of self-esteem, a deficiency in the emotional area, as the common factor which might predispose a person to abuse substances. Contributing to poor self-esteem, of course, may be a multitude of life experiences which have in common the clue or suspicion, upon reflection, that one is valueless, or that one handles most situations inadequately or improperly. When piled upon each other, multiple condemning messages reinforce the self-labeling of inadequacy or even badness. Researchers, educators, and psychotherapists almost universally point to such experiential factors in the developing psyche to explain personality disorders, including alcoholism and drug addiction, which are characterized by a poor self-image. Improving the self-image is, thus, seen to be the number one task of psychotherapy, both remedially and preventively, and this is relevant, as we shall demonstrate, in the area of substance abuse among deaf people.
Research regarding deaf people, as we have repeatedly seen, cumulatively notes that deaf people are as much, if not more, at risk in these psychological areas as are people in the larger society. Such factors as isolation, frustration, social stigma and inadequate education contribute to this increased risk of deaf people.
Elaine Walker reports that for some deaf people, using drugs may be a way to feel more a part of the hearing world. She speaks of the need to belong to the greater society, felt by deaf people, as a pull toward antisocial behavior. One deaf person she cited believed that buying friends with drugs would prevent others from rejecting him because of his deafness. Of course, such rationalizations dont affect the reality of the situation that the person hoping to buy acceptance has actually become drug dependent and is no longer able to function or plan his life objectively.
Whether or not the type of incident Ms. Walker reports is typical, there are additional burdens felt by the deaf, which have been explicated in a previous chapter, which may put them at additional risk of drug addiction. Communication difficulties and frustrations in dealing with the hearing world are seen by many researchers as primary areas of vulnerability for deaf people, inducing some of them to fall prey to substance abuse. For a deaf person, trying to communicate with hearing people may be inexplicably and consistently frustrating and unsatisfying, inducing at least discouragement.
The National Information Center on Deafness information service states that more than 90% of parents of deaf children are hearing people with no previous contact with or knowledge of deafness. The developmental years of these deaf children may be laden with frustrations, isolation, a sense of perhaps being unwanted and cumulative evidence of being unacceptable to the larger society.
Larry Stewart wrote very movingly of special needs and problems of deaf substance abusers. He noted that substance abusers with hearing loss constitute a cross-section of the general population, with the same traits as everyone else. Their only common denominator is impairment of hearing and consequent loss of ability, in varying degrees in the communication area.
The impact of substance abuse on the emotional facilities of deaf people is not a pretty picture. Stewart identified four overlapping areas of damage:
1. Substance abuse further complicates the deaf persons adjustment in all areas of life. Personal, family, work, social, and other relationships are jeopardized. The social isolation of the deaf person in the community is increased, particularly when his status as a substance abuser becomes known in the deaf community. Severe loneliness is a result, which increases the need for resort to substance use.
2. The inability to function in a variety of areas has an input on the deaf persons economic self-sufficiency. The need to buy substances may force the deaf individual into criminal activities, which in turn eventually lead to involvement with law enforcement and all the problems that brings.
3. The loss of coping skills attending substance abuse in leading the deaf person to unemployment, also quite often results in the individual becoming reliant upon public assistance. This becomes an added burden to society and further erodes the deaf persons confidence and motivation for rehabilitation.
4. The problems brought to a deaf person by substance abuse inexorably lead toward mental health problems, the breakdown of the family, and dependency.
Therefore, with such massive and debilitating problems being established as associated with substance abuse among the deaf, addressing problems of vulnerability to substance abuse among deaf people, via education and adequate treatment programs is substantially overdue.
Prognosis of Substance Abuse Prevention and Treatment for Deaf People
At present, prevention, via education is just beginning to be recognized as needed, and has not made significant inroads to reach clients who most need the information. If low self-esteem is seen to increase vulnerability to drug abuse, reaching pockets of society in which self-esteem is at risk would certainly be an obvious preventive aid. Yet, lack of personnel, inadequate funds, resistance within the deaf community and other factors have kept this and other such steps from being taken. Clearly, when demand consistently exceeds supply of drugs, one entire area of access to remediation of social ill is being inadequately utilized. The following chapter elaborates on prevention guidelines, as well as citing effective program efforts for creating a drug-free society.
At present, it is much easier to get drugs than it is to get treatment for drug abuse. And even if treatment is available, there is no certainty that treatment will cure addiction. Dennis Moore (1992) reflects on the total picture for therapists regarding the hazards of working with substance abuse people who have other disabilities. He notes that the act of labeling a person handicapped or disabled leads people to focus on that label rather than other salient factors, and often makes diagnosis and implementation of treatment difficult. He also cautions therapists about problems of substance abuse after therapy.
Even among patients with no previous history of substance abuse, the chances of abuse appear to increase following rehabilitation. The person apparently becomes habituated to ingesting or injecting a substance in his/her body, as a first-choice method of dealing with a difficult situation. High-profile advertising of over-the-counter drugs adds to this trend.
Some communities of deaf people still deny the need for drug and alcohol abuse information. The Resource Center on Substance Abuse Prevention and Disability summarizes the research of Boros (1981) and others and suggests that one reason deaf communities have resisted dealing with the problem of addiction is that deaf people have long labored under social stigma, due to being perceived as different, and they see admission of problems with substance abuse as constituting another negative label, which would further isolate them from mainstream society.
Therapists and drug treatment centers are uniformly overwhelmed and inadequate; the need for help far surpasses help available. Still, progress is being made. Successful treatment of addiction may seem incremental and may take diverse forms, but the treatment programs surveyed have in common certain features. Among these features are: detox or withdrawal from the addictive substance, restoring a perception of the ideal (what could be) for the person, building hope and providing assistance in developing alternative living patterns and habits. Hitting bottom, after years of denial, and admitting the need for help have been almost universally proclaimed as inherently necessary in order for help to proceed in the treatment of addiction. In each of these, as well as subsequent recovery steps, mutual communication is mandatory; a monologue from the helping professional is inadequate in that it may not elicit co-operative effort.
In order for successful treatment to occur, creating whatever is necessary for real encounter dialogue is the obvious second step, with full recognition that treatment is needed being the first step. In the case of deaf people, the language of meaningful dialogue in the U.S. will probably be ASL. In order for dialogue to exist between the person seeking help and the helping professional, certain basic ingredients are needed, to create and maintain at least a threshold of a therapeutic environment. Many therapists have written exhaustively about the therapeutic emotional climate, conducive to psychological healing and growth, and summarizing that vast body of literature is not the present task. But the variables identified as inherently therapeutic in interpersonal communication hover first around unconditional acceptance, which includes, among several other things, at least a respect for the humanity and instincts of the persons involved.
The person who is to receive the help is the ultimate judge of how helpful the proffered help actually is. Various features of the proffered treatment may be evaluated from the end of those receiving the treatment. With deaf and hard-of-hearing clients, ease of communication with the helping professionals is a basic need, not a luxury. This means that for deaf people, basics such as deaf therapists or therapists who are fluent in ASL, or at least consistently available, discreet, unobtrusive interpreters are prime requisites for therapy to begin.
Effective drug treatment must become individualized and open-ended, with the needs of the individual client dictating the personnel, strategies, methods and materials of therapy, if the effort expended is not to be wasted. Every therapeutic aid available should be considered, from immediate detoxification of the physical system to having telephones adapted so that deaf people may use them, from unending reassurance that the drug abuser has reason to hope for a better life, to presentation of clear information and offering of specific aids toward achieving a better life. All these things are clinically indicated, and all steps of the therapeutic process are interwoven tightly together, with some vacillating back and forth among the stages of progress.
After detoxification and stabilizing the physical system, establishing emotional rapport between the therapist and client is the next important step. Many approaches may be used in this effort.
Kavanaugh (1992) says:
Emotional addictions are chronic disorders eventually producing symptoms that result from beliefs that we have learned in childhood. Once these chronic symptoms are adequately treated through a combined program of medication (when indicated), uncovering and desensitizing buried feelings, and addressing the beliefs underlying emotional addictions, our healing journeys can successfully continue.
He advocates treating the whole person, rather than focusing solely on the particular addiction which is currently manifesting. Other therapists are likewise recognizing the practicality and long-range efficiency of such concerted approaches. Why treat one addiction only to treat its replacement later, if underlying needs havent been met? Addressing the belief system which allowed the toxic condition power to control the person next becomes salient.
Many drug treatment centers now operate in the U.S., with a variety of results and recidivism rates. These treatment centers treat thousands of addicted people every month; periodically treatment personnel burn out, and periodically long-term planning is required to circumvent the problems, flaws, and patterns of ineffectuality which become visible. Out of these evaluation and re-evaluation sessions, real help may emerge.
In May, 1992, the first national conference was held to address such issues as the isolation of deaf people, their up-to-now inadequate educational/information disseminating facilities for such topics as substance abuse, and other elements which may pre-dispose deaf people toward substance abuse. This conference, held in Minneapolis, Minnesota, involved input from over 200 professional people who work with deaf people in drug treatment centers. Their concerted effort was called Breaking the Silence, and it focused in-depth on these critical issues. Lectures and many specific workshops addressed strategies to overcome substance abuse among people with hearing impairments. Such professional conferences, including the Next Step Conference, held in Denver, CO, on July 5-8, 1992, are springing up nationwide, with enthusiastic, hopeful participation. Participants believe that such meetings of the minds of people in the helping professions, as occurs in these sessions, will aid the effort already in progress in the existing treatment centers, by clarifying special needs of the deaf population for such services, and by generating expertise, facilities and motivation to address these needs.
Summary of Opinion Regarding Pre-Reguisites for Effective Drug Treatment
By analogy, curing the drug infestation in our society has been compared to going to war, i.e. the prevalence of phrases as the war on drugs show such a comparison. Gearing up to meet the challenge is now in progress; recognition that there is a problem is the first step in preparation. We can also see that drug use is, additionally, a business a very profitable one for the sellers, with demand always available for the supply. Decreasing the demand via education may be the best preventive action. Because chemical abuse affects many facets of society, and deterioration of a system is interwoven in all interacting areas, treatment is necessarily complex and convoluted.
Certain elements of our society descry the lack of scientific exactness in the realm of substance abuse treatment programs, pointing to such handicapping factors as vagueness in terminology. e.g. The criteria for establishing abuse of a drug, as differentiated from use of a drug, such as with prescribed medicines, varies. In the realm of illicit drugs, however, any use whatever is officially considered abuse, per Se. Refusal to get beyond preoccupation with trivia such as variation in dependency criteria, however, only translates, in consequence, into a delaying tactic and avoidance gesture; it does not address the larger problem. Gradually pragmatic definitions and therapeutic goals need to emerge, subsuming minor differences in favor of efficacy. Here, our perspective is prerequisite to drug treatment programs, considering infrasystems of society, suggesting the need for deeper reflections regarding the ways society as a whole continues to generate societal problems such as substance abuse.
Swan (1992) writes of the current trend of preferably treating the total person, when drug treatment is requested. She says that this ideal doesnt often happen, because of a limited number of professionals trained and experienced in both chemical dependency treatment and other needed psychological and psychiatric areas. She says:
Within the deaf community we are currently in the pioneering stages of providing appropriate treatment for clients with hearing impairment. It is a big challenge to find people with expertise in deafness and train them in chemical dependency counseling and vice versa.. . This emphasizes the need for team approaches and consultation from other professionals since the availability of individuals with training in all three skills may be 1imited.
In addition to creating or adapting adequate training programs, society, as a whole, must involve itself with the philosophical implications of the problem of substance abuse. Regarding societys apparent ambivalence and lack of clear demarcation in the area of chemical substance abuse, Rosenthal (1988) states that until society resolves some larger questions and adapts some higher standards about what constitutes a good life, what is entertaining, and what enhances health, we will not progress in ameliorating problems such as drug abuse:
What has handicapped efforts to confront drug abuse in this country has not been the lack of adequate treatment resources so much as ambivalent public attitudes. We have been unwilling to use all our muscle informal sanctions as well as drug laws to reduce demand for drugs. Rather, we have taken a narrow view of drug prevention, one that has allowed us to tolerate what misguidedly came to be considered social drug use.
Responding to the hue and cry for drug treatment centers, Trafford (1988) is hopeful, but cautious. She cites statistics which show that only some 20% of drug addicts get any treatment at all. She applauds the increasing interest in treating drug abuse, however, she points out that drug abuse is not only a physical disease, but it reflects problems in other areas as well. We may spend millions of dollars on rehabilitation centers and still not faze the drug abuse problem, she notes. Realistic expectations of chemical dependency treatment should include recognition of, and help in, these other areas.
These viewpoints are included, not in an attempt to be negative, but to present a more realistic, total picture. Charles R. Schuster, director of the NIDA said, I am most concerned about the public feeling that we are capable of a quick fix. My fear is that because we are looking for a quick solution, any failure in that regard will lead to disillusionment. With disillusion, comes lowered motivation toward subsequent effort. So, getting an accurate overview of the scope of the entire problem area first, may be disheartening, but it may preclude self-deception regarding the ease of addressing these issues and prevent later burn-out of staff and dropping out of clients from the remedial process.
At one rehabilitation clinic in Washington, D.C., a cocaine hotline has been available for some four years.Staff records show that of all the people who phone in asking for help, less than half will make an appointment, and of those, only one half will show up. Clinical psychologist Ronald Wynne, who runs the hotline says, Anything is easier to deal with than with crack addicts. They make you feel so impotent.
As people look beyond the allure of a quick fix in the realm of drug rehabilitation, and realize the enormity of the problem, certain parameters, basic principles and guidelines begin to emerge. Beyond being immobilized and overwhelmed, therapists now are taking hard, realistic looks at the magnitude of work to be done. Some are beginning to tackle the work at various access points within their expertise. We will next summarize and discuss these efforts. Part 2 of this course will focus on drug prevention and treatment programs, specifically those which are most accessible to deaf people.
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Directions: In order to receive credits for a DLC, you are required to take the following post test and receive a passing score. We have set a minimum standard of 80% as the passing score in order to insure the highest standard of knowledge retention and understanding.
The test is comprised of either multiple choice questions, true/false questions, or both. To take the test, highlight the test questions below and copy them to your word processing software. Then, print out the questions and select the best response to each question. Then, go to the following site to answer your questions electronically:
Once there, use the pull down box to select the "Deaf and Hard of Hearing Substance Abuser, Part 1" test. This will take you to the online test site. Once there, fill in the appropriate information, then simply click on the selection button for the corresponding question and select from the choices ("a" through "e" for multiple choice questions, or "a" for true, or "b" for false). Once you are done, simply click on the submit button at the bottom of the page. Your answers will be forwarded to the DLCAS electronically for scoring.
Your responses will be scored automatically upon receipt of your answer sheet, and your results will show up immediately on your browser. If your score is at least 80% or greater, you'll be prompted to complete a course evaluation. Once we receive both your test results and your evaluation, your certificate of completion will then be mailed to you. If, however, you do not achieve a passing score you will be notified of your score. You will then be able to re-take the test in order to obtain the necessary score.
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Question 1: The first published reference to the interaction of hearing
disabilities and alcoholism appeared in the Alcoholics Anonymous newsletter
Grapevine in 1968.
Question 2: The earliest studies which deal with the incidence of substance abuse among the deaf have found that the incidence of substance abuse among the deaf was higher than for the population as a whole.
Question 3: The major causes of deafness include all of the following except:
(d) physical deformity of the inner ear.
(e) some forms of substance abuse.
Question 4: __________ results from impairment to the nerves or nuclei of the central nervous system.
(a) Central hearing loss.
(b) Conductive Hearing loss.
(c) Sensorineural hearing loss.
(d) Psychological Deafness.
Question 5: Pre-lingually deaf children normally suffer developmental lags similar to those of culturally-deprived or culturally-different children.
Question 6: Numerous studies, up to and including the early 1980's found that deaf people experience a high incidence of psychological problems related to deficiencies in conventional communications skills due to:
(a) lack of empathy.
(b) inadequate insight into the impact of their own behavior.
(c) inadequately developed impulse-control mechanisms.
(d) Only b and c are correct.
(e) A, b and c are all correct.
Question 7: __________ is the results of disease or obstructions in the outer or middle ear. In conductive hearing loss, typically, all frequencies are evenly affected, and remedial intervention often can be taken.
(a) Central hearing loss.
(b) Conductive Hearing loss.
(c) Sensorineural hearing loss.
(d) Psychological Deafness.
Question 8: The principal difference between deaf and hearing substance abusers is:
(a) that substances abused by the deaf tend to be prescription drugs.
(b) that deaf substance abusers can not easily communicate the need for help.
(c) that the deaf substance abuser often cannot find services readily available to the hearing substance abuser.
(d) All of the above are correct.
(e) None of the above are correct.
Question 9: The deaf client, who typically views his addiction as a "fall from grace" may find an interpreter a threat to confidentiality, and thus prefer a counselor who has skills as an interpreter.
Question 10: Because the deaf community tends to be closely knit, failure to treat one deaf person effectively and with respect can lead to a virtual boycott by the community.
Question 11: The deaf may communicate by:
(b) speech reading.
(d) manual communication.
(e) All of the above.
Question 12: The loss of hearing, either sudden or gradual, constitutes a threat to psychological integrity of an individual.
Question 13: Deafness is more than a medical fact; it can include all of the following except:
(a) social facets.
(b) emotional facets.
(c) linguistic facets.
(d) mental facets.
(e) economic facets.
Question 14: Therapists should not assume that any one method of communication is best for use with the deaf.
Question 15: Census figures indicating a lower incidence of deafness among African-American people are probably misleading, since there is no medical reason to believe that incidence of deafness varies by race.
Question 16: There is evidence that deaf people may be at increased risk in developing addiction because of factors inherent in their lives, such as:
(a) ready access to psychoactive drugs for pain or balance maintenance.
(b) their decreased visibility in society if they maintain separatism.
(c) acceptability of drug use by others in their peer group.
(d) Only a and b are correct.
(e) A, b, and c are all correct.
Question 17: Many deaf persons see alcoholism as a personal weakness and a moral sin. This outdated view of alcoholism is attributed to:
(a) the isolation deaf persons experience.
(b) their limited information on current trends in treatment.
(c) the lack of prevention materials written for deaf persons.
(d) Both a and b are correct.
(e) Both b and c are correct.
Question 18: A number of characteristics of dysfunctional family life can be seen to parallel the experience of a person undergoing hearing loss or feeling isolated and ostracized in a hearing world. These characteristics include which of the following?
(a) A preponderance of mixed messages.
(b) Renouncing one's own perceptions in favor of others'.
(c) Creation of double binds.
(d) Both a and c are correct.
(e) A, b and c are all correct.
Question 19: Factors as to why disabled people sometimes abuse substances include all of the following except:
(a) People with disabilities have relatively easy access to drugs, e.g. painkillers, and widespread avoidance behavior on the part of parents, educators and others keeps recognition of the problem of over-medication or abuse of drugs at bay.
(b) Disabled people often attempt to assuage frustrations and anxieties with alcohol and other chemicals, as they see people in the larger society model such behavior.
(c) The inability for society to select one, uniform method of communication makes it difficult for the deaf community to access information about the problems and difficulties associated with drinking and drug use.
(d) Disabled people often feel that they are an oppressed minority, so a desire for justice creates the phenomenon of entitlement, wherein people, over a period of time, come to believe they deserve compensation for their suffering and possibly unjust treatment.
(e) Disabled people, just as do other people, imitate their peers and are prey to peer pressure to behave similarly to group norms in order to be included.
Question 20: __________ comes from damage to the sensory hair cells of the inner ear or the connecting nerves; hearing loss from this cause can range from mild to profound, and remediation is usually impossible.
(a) Central hearing loss.
(b) Conductive Hearing loss.
(c) Sensorineural hearing loss.
(d) Psychological Deafness.
Question 21: Prelingually deaf children, playing together, communicating via sign language, and unaware that they may be labeled "impaired" by others, may approach Maslow's outlined ideal of psychological self-actualization as fully as may individuals in any other hypothesized group.
Question 22: People who have gradually become deafened, especially late in life, may be more vulnerable to alcoholism due to depression and feelings of isolation than are people fully ensconced in the Deaf community.
Question 23: For some deaf people, using drugs may be a way to feel more a part of the hearing world.
Question 24: __________, where the loss of hearing is psychogenic; when relieved of psychological stresses, persons suffering such cases of deafness can hear again normally.
(a) Central hearing loss.
(b) Conductive Hearing loss.
(c) Sensorineural hearing loss.
(d) Psychological Deafness.
Question 25: The impact of substance abuse on the emotional facilities of deaf people can cause damage in which of the following areas?
(a) The inability to function in a variety of areas has an input on the deaf person's emotional self-sufficiency.
(b) The loss of coping skills attending substance abuse in leading the deaf person to unemployment, also quite often results in the individual becoming reliant upon public assistance.
(c) The problems brought to a deaf person by substance abuse inexorably lead toward mental health problems, the breakdown of the family, and dependency.
(d) Only a and b are correct.
(e) Only b and c are correct.