# Perspectives on Hearing Science and Hearing Treatment Will Styler - LIGN 113 --- ### The Plan - The Clinical Perspective on Hearing Science - Problematic Ideologies in Hearing Science - Considering the Deaf perspective and Deaf Culture - Guidelines for Compassionate Discussion and Care --- ## Hearing Science is a difficult topic for many - For Deaf people, hearing science can be viewed very skeptically as a field - ... and the kinds of discussions we're going to have can cause strong emotional reactions - This is, in part, because of a historical difference in perspective --- ## The 'Clinical Perspective' --- ### For many, 'hearing' is treated as the norm and goal - Many take a more medical approach, 'restoring towards common function' - Many talk about 'diagnosing and treating' hearing loss - And many focus on Cochlear implants and Hearing Aids and their effects on quality of life --- ### This is the clinical perspective - Many audiologists and otolaryngologists see the world in this way - Your textbook talks about things this way - We're going to predominantly talk in this way, to prepare you for the audiological world - ... and for many hearing people, this feels like an intuitive approach --- ### Hearing Loss feels like a loss to hearing folks! - Many people view hearing loss as a genuine loss, and want it 'fixed' - Reduction in their ability to perceive or understand the languages they know - Loss of ability to hear and attend to environmental sounds - 'Something I had is gone, and I want it back!' --- ### This can lead to a set of problematic perspectives and ideologies - "Deafness is a disorder and disability which can sometimes be cured" - "The goal of hearing science is to fix hearing whenever possible" - "We should focus on restoring hearing and helping people interact with hearing people using spoken language" - "Cochlear implants can finally let deaf people hear like normal people!" - "Anything that can be done to restore any amount of hearing is a good thing!" --- ## Pushing back against these views --- ### These views can be very offensive to many Deaf people - Not every Deaf person feels this way, and I don't pretend to speak for Deaf culture - ... but let's look at how these ideologies can be hurtful, and what we can do to be compassionate! --- ### "Deafness is a disorder and disability which can sometimes be cured" - "Different" isn't the same as 'bad', and many people are perceptually different - Deafness is a part of many people's personal and cultural identity - People can lead happy and fulfilling lives with limited or no hearing - For many Deaf people, this is equivalent to saying that other identities (e.g. race, orientation) can and should also be 'cured' - **Deaf people are different, but not 'broken' or 'disordered' or in need of a cure** --- ### "The goal of hearing science is to fix hearing whenever possible" - This statement removes **agency**, and makes 'hearing' seem like an inherent good - This also turns Deaf culture and signed language into a 'last resort' - This also sets up conflicts with, e.g., Deaf parents of a Deaf infant - Prescriptive statements like "It's irresponsible not to try to fix your child's hearing" - Statements like 'We can eliminate deafness through genetic engineering' are often described as feeling 'genocidal' by those in the Deaf community - **Hearing science can and should research and provide options for those who choose to take them!** --- ### "We should focus on restoring hearing and helping Deaf people interact with hearing people using spoken language" - This is an outgrowth of the 'oral language approach' to deaf education - "Integrate the Deaf into the hearing world, teach them to speak, to speech-read, restore what hearing you can, and don't bother with sign, most people don't understand it anyways." - In some cases, people actively attempt to prevent signing and exposure to sign, which is... not wise. - The goal of this approach is to make deaf people as functionally similar to hearing people as they can be - ... but it's a perspective with a lot of problems! --- ### "We should focus on restoring hearing and helping Deaf people interact with hearing people using spoken language" - Intelligible speech is difficult for the deaf, speechreading is difficult *and* unreliabe - c.f. Tyler 1993, "Cochlear Implants and the Deaf Culture", among many others - Hearing 'restoration' is unreliable at best, and often not sufficient for easy use of spoken language - Forcing Deaf people away from the Deaf community and away from Signed language often makes for poor outcomes! - There is literally no harm to exposing (all!) children to signed language - **Why push people into a language and culture in which they face difficulties, when signed language and Deaf culture are perfectly suited to their needs?** --- ### "Cochlear implants can finally let deaf people hear like normal people!" - This is patently false - CIs are amazing, and can restore some sensation of sound - CIs can help some people to understand and produce spoken language better - CI-mediated hearing is *massively* different from natural hearing - Many children still don't learn spoken language, even with CIs - **CIs do not magically turn Deaf children into hearing children!** - ... and that's a problematic goal! --- ### "Anything that can be done to restore any amount of hearing is a good thing!" - This deemphasizes the costs of interventions - Financial costs (e.g. of CIs, hearing aids, training, medical consults) - Temporal costs (e.g. doctor's visits, insurance claims, speech therapy) - Physical and medical costs (e.g. massively invasive surgeries and implanted equipment) - Emotional and Social costs (e.g. time spent 'denying who you are', social disapproval) - **Limited hearing can certainly be helpful, but the costs can *far* outweigh the benefits** --- ### This is part of the reason you can see some strong pushback in the Deaf community about CIs (especially for kids) - For some, it's ideological and emotional - "Why is expensive and invasive surgery preferable to a child embracing my language and identity?" - For some, it's practical - "This often doesn't give good enough outcomes to merit the suffering and costs" - ... and many see it as a matter of choice - [Gallaudet University](https://www.gallaudet.edu/) has an audiology program, and does work with CIs and CI technology! --- ### There are many views! - Each person has a different perspective on hearing loss, Deafness and Deaf Culture, and what's best for themselves, their children, and society - The important thing is understanding! --- ## Guidelines for Compassionate Care in Hearing Science --- ### Remember that hearing loss and deafness mean different things to different people - For some, lack of hearing can be felt as an intense problem and disability which needs to be fixed - For others, lack of hearing can be a part of their identity and culture, rather than a disability or 'problem' - For parents, it can be very scary to learn that your children may not sense the world as you do - This is true for both Deaf and hearing parents! - **Don't assume anything about people's perspectives or desires, instead, ask!** --- ### Remember that Deaf Culture and Signed languages are very real and very rich - The choice is *not* between CIs and a lifetime of solitude - People can have beautiful and functional language with no hearing at all - Deaf culture is open to anybody, of any age, and is always a choice - **Deaf culture and signed languages allow Deaf people to live rich and full lives without *any* medical interventions** --- ### Remember that bilingualism is *not* a problem - This argument is made over and over again in the US, even with spoken language - People learn multiple languages in most places around the world and turn out fine - "Oh no, if you speak [language] around your kids, they'll never learn English!" - ... and when you flip over that ideological rock, a lot of ugly bugs come crawling out --- ### Bilingualism is a benefit! - Children can learn signed languages at the same time they learn spoken languages - Even if a child or family later decides to attempt a medical intervention, why not start signing now? - There are no 'cognitive harms' done by learning signed languages and it doesn't make learning English harder - Teaching signed language can improve outcomes for Deaf children who later learn spoken languages - c.f. Hassanzadeh 2012 "Outcomes of cochlear implantation in deaf children of deaf parents: comparative study" - **There is no harm in teaching signed languages to children, and there's massive harm from withholding language from children!** --- ### Language deprivation *is* a problem - If a child has little exposure to signed language while 'waiting to be able to speak and hear', they're being *language deprived*. - Language deprivation causes social, emotional, cognitive, and linguistic harm in *all* languages! - c.f. Humphries et. al 2016 Avoiding Linguistic Neglect of Deaf Children - Tom Humphries (Dept of Ed. Studies) and Carol Padden (Dean of Social Sciences, Dept of Communication) are UCSD people! - If hearing interventions fail, or the child struggles to acquire spoken language, they may miss the critical period for language acquisition - This could leave the child struggling to be fluent in any language, *signed or spoken* - **Teaching and using signed language with Deaf children is important, and lack of language does harm!** --- ### Think about what we're discussing in terms of options - Hearing testing and screening at all ages gives people information to help them make decisions - Teaching signed language to Deaf and hard of hearing children gives them an immediate option, and helps preserve options for later spoken language use - Diagnosis and understanding of underlying pathologies gives people a better sense of their reality - Different interventions have different costs, side effects, effectiveness, and outcomes - **It is your role to help people understand their hearing and their options, so that they can make the right decision *for them*!** --- ### There are many perspectives on hearing science - ... and it's important to be mindful of your framings, biases, and the consequences of your advice to your clients - This class (and text) will take a mostly medical view, and focus on restoration and rehabilitation - ... but that's for convenience and to reflect the general field - It's crucial to remember that this is a sensitive issue for many people - ... and that your advice and perspective can make all the difference, positively, or negatively - ... and ultimately, it's all about offering knowledge and choices! --- ## For Next Time - We'll start in on anatomy! --- <huge>Thank you!</huge>