Includes the following article: The Fear of Being Found
Out: The Dilemma of Denial Questions may be submitted
online through the "contact us" section of this website
or sent directly to: DigiCare Hearing Research &
Rehabilitation, P.O. Box 706, Rye, CO 81069, or faxed to
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along with your request are required in order to receive
a reply from the Digicare team.
THE FEAR OF BEING FOUND OUT: THE DILEMMA OF DENIAL
By Max Stanley Chartrand, M.A.,
DigiCare Hearing Research & Rehabiliation
---Untold millions of Americans go to unbelievable
lengths to avoid exposure of their hearing
impairment----
In the U.S. today, there are an estimated 28 million
individuals with hearing loss severe enough to need
hearing instruments, assistive devices or cochlear
implants. The current penetration rate of that market
stands at roughly 4% of individuals with mild losses
(25-40 dB PTA); 35% of individuals with moderate losses
(40-70 dB PTA) and 52% of individuals with severe and
profound losses (greater than 70 dB PTA).' Many of these
untold millions of Americans go to unbelievable lengths
to avoid exposure of their hearing impairment and the
necessary help for their hearing loss. These
hearing-impaired individuals are still in denial and
refuse the help that is available to them. They
basically live in nearly constant fear of being found
out.2 To cover communicative difficulties, they find
themselves bluffing their way through even the most
mundane social situations.
It is easier to understand why so many (96%) individuals
with mild hearing loss are in denial. The invisibility
of hearing loss and lack of internal reference makes it
almost transparent to the sufferer. Why, however, do 65%
of individuals with moderate hearing impairment still
deny they have a problem or that they need help? Perhaps
it is because the worse the loss becomes, the more
psychosocially inhibited the hearing-impaired individual
becomes. This keeps them from seeking and accepting the
help that is available to them. Furthermore, it is still
surprising to learn that 48% of the hearing-impaired
population who suffer with severe and profound hearing
loss still avoid hearing solutions.
The social equivalent of "fight or flight" becomes a
survival mechanism for individuals who fail to seek and
accept available hearing solutions. The is in staying
and dutifully "being there" or "putting up with." The
flight is in the conscious avoidance of any potentially
uncomfortable situation (church, family gatherings,
noisy restaurants or clubs) which could test the
hearing-impaired individual's (bluffing) ability to the
max.
Spontaneity is the most important aspect in everyday
human communication, from impromptu greetings to more
formal group conversations.3 Spontaneous interchange is
also vital in the human bonding process. To maintain a
facade of spontaneity in any given situation, a
hearing-impaired individual who has not sought hearing
help must too often laugh heartily at the unheard
punchline or vigorously applaud for no other reason than
everyone else is doing so. Better to bluff one's way
through, they surmise, than to spoil the moment and be
thought of as different or, worse,
out of it. There would be greater humiliation in
exposing the missed humor or feigned appreciation.
Bluffing one's way through becomes the modus operandi to
avoid socially inappropriate behavior.2
CASE HISTORIES
Case history #1: A 66-year-old male suffering from an
uncorrected 50
dB PTA sloping high-frequency hearing loss. This subject
has vehemently
avoided accepting amplification as a solution to his
problem. He "gets by," he claims. In this example, one
situation calls for him to visit with a handful of
friends and relatives in his living room with the lights
low and television blaring in the background. Instead of
relaxing and enjoying the moment, he is in the throes of
almost insurmountable communicative obstacles. A sense
of feeling left out takes over and he becomes
increasingly resentful. There is no relaxation for him.
He feels intellectually challenged as the topic of
discussion keeps changing before he can even add his two
cents worth. Interaction with the others becomes stilted
and forced because of belabored repetition or, worse,
his inappropriate responses. The feeling, the
spontaneity is lost, the details missed along the way.
This otherwise outgoing and socially active man, one
with great intellectual capability and a strong
emotional need for meaningful contact with others, wants
so badly to be a part of, to be in the inner-circle, to
lead or be led in the consensus. He, however, is locked
out because of his untreated hearing impairment. His
reaction to this roadblock brings him to the proverbial
fork in the road of anger and resignation: anger being
the high road of continuous struggle for achievement and
recognition; resignation the low road of diminishing
self-esteem and retreat from future social mishaps.
Case History #2: A seven-year-old female whose mild
bilateral loss of 25 dB PTA has yet to be discovered.
The subject is among hundreds of thousands of children
with a similar profile. During her first three years of
life, she suffered from repeated episodes of middle ear
infections and blocked Eustachian tubes and was wrongly
classified by her school as a "slow learner." In her
second year of first grade, she quickly learned that
inattention can bring severe and humiliating
consequences, whether she was called upon to answer the
question not heard, or to read a passage where she had
no idea where the last person left off. Her apparent
lack of auditory attention ability caused her to be
misdiagnosed with "attention deficit disorder" or ADDH.4
Ignoring her hearing deficiency entirely, or need for
amplification and/or classroom FM soundfield, she is
instead placed on a speed-class prescription medication
to "help her focus." From such early ingrained
experience, she begins to live in constant fear that
this personal tragedy will repeat itself over and over
in all social situations. As a result, she attempts to
avoid situations that will expose her to embarrassment
by limiting her circle of friend-ships. As she grows
older, she avoids opportunities to develop socially.
In both case histories, the fear of being found out is a
fear that brings seemingly irrational social fear,
defensiveness and personal insecurity. To the normal
hearing observer such behavior would decidedly appear to
constitute social paranoia or withdrawal. To the
sufferer it is merely social survival.
We should keep in mind that a hearing-impaired person
who is unaware of their impairment suffers these effects
a great deal more than one who knows and accepts
his/her limitations.5-6'7 Likewise, persons who
associate with the hearing-impaired individual, who are
not aware of the true nature of the handicap, will
likely respond to these limitations as if they were
voluntary or intentional.8 Many third parties tend to
delay acknowledging that there is an impairment either
by denying its existence or attributing blame for its
effects upon other factors.9
Other Effects of Uncorrected Hearing Loss
Paranoia: Is it any wonder that, when a hearing-impaired
person walks into a room full of laughing people, they
immediately become self-conscious? They may wonder what
these people are talking about. When they ask someone,
that person may give an indistinct reply. Strained from
a few repetitive attempts they give up and say, "Oh,
never mind. It's nothing important." The
hearing-impaired person may then turn to a friend or
loved one for help. More often than not the response is,
"I'll tell you later." Of course, "later" never comes
,and long after the social event the hearing-impaired
individual wonders if it was he/she the group was
talking about. One cannot blame the normal-hearing
friend or loved one, for while they were repeating what
had been said to the hearing-impaired individual, they
themselves missed the rest of what was said. In essence,
they are being the hearing instrument for the
hearing-impaired person. Unfortunately, it is a no-win
situation for both parties. The beginning of social
paranoia, isolation and withdrawal, followed by
depression and, finally, severely lowered self-esteem
starts when the hearing-impaired individual desires to
be a part of the group while attempting to function in a
nearly impossible listening situation.
Depression: Depression is generally classified as a
cognitive disorder in the sense that it colors one's
perception of reality and the larger world around them.
Many recent studies examining hearing impairment and
Alzheimer's Disease in the
elderly consistently show a positive correlation between
the two afflictions.10 Most of these studies note a
remarkable reduction of the symptoms of dementia when
the hearingimpaired/demented subjects are fitted with
the proper hearing instruments. This is no minor
coincidence. Studies have shown that uncorrected hearing
impairment causes depression and cognitive
dysfunction."-12-13'"
The Solution
Only an intimate and exceptional knowledge of the forces
that shape hearing-impaired individuals' quality of life
coupled with hearing instruments, cochlear implantation
and/or assistive devices will return the
hearing-impaired individual to greater fulfillment and
enjoyment in life.
References
1. Chartrond MD: Psychosocial Demographics in Patient
Core Seminar I continuing education course. Nationai
inst. for Hearing Instruments Studies, Livonia, Ml,
1999,
2. Chartrand, MS: Psychosocial effects of hearing
impairment- Hearing Instrument Science and Fitting
Practices. 1st edition. Robert Sandlin (edi National
Inst. for Hearing Instruments Studies, Livonia, Ml,
1997.
3. Trychin S: Helping people cope with hearing loss.
Effective counseling in audiology: Perspectives one/
Practices. JG Clarke and FN Martin (eds). Simon and
Schuster Co., Englewood Cliffs, NJ. 1994; pg 247-277.
4- Chartrond MS: The unreported story: schools still
foiling in nearing health. Hearing Health, May 1997.
5. Bandura A; Self-efficacy: Toward a unifying theory of
behavoria! change Psychological Review 1977; 84:192-215.
6. Van Hecke ML; Emotional responses to hearing loss
Effective counseling in audiology. Perspectives and
Practices JG Clarke and FN Martin (eds). Prentice-Hall,
Englewood Cliffs, NJ, 1994, pg 92.115.
7. Chartrond MS: Audition, Cognition & the Human Brain.
A continuing education course. National Inst. for
Hearing Instruments Studies, Livonia, Ml, 1999.
8. Schlesinger HS: The Psychology of Hearing Loss.
Adjustment to Adult Hearing Loss. H. Orlans (ed)
College-Hill Press, San Diego, CA, 1985.
9. Jacobson NS and Bussod N: Marital and family therapy.
The Clinical Psychology Handbook. M Hanson, AE Kosdin
and AS Bellock (eds). Pergamon Press, New York, NY,
1983.
10. Palmer CV, Adams SW, DurrontJD, Bourgeois M, Rossi
M: Managing Hearing Loss in a Patient with Alzheimer
Disease. JAm Head Audiol 1998; 9:275-284.
11. Herbst K & Humphrey C: Hearing impairment and the
mental state in the elderly living at home. Br MedJ Clin
Res, 1980; 281:903-905.
12. Jones D, Victor C & Veter H; Hearing difficulty and
its psychological implications for the elderly, j
Epidemiol Community Health, 1984; 38:75.
13. Eastwood M, Corbin S & Reed M: Acquired hearing loss
and psychiatric illness: an estimate of prevalence and
comorbidity in a geriatric setting. BrJ Psychiatric,
1985; 147:552.
14. Mulrow C, Aguilar C & Endicott J: Association
between hearing impairment and the quality of life of
elderly individuals, j of the American Geriatric
Society. 1990; 38:45-50, |
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