Are Deaf or Hearing Impaired People More Susceptible to Mental Illnesses?
American Sign Language Are deaf or hard of hearing people more susceptible to mental illnesses? The ability to communicate is at the heart of good mental health.Within any large group of people, one may expect to find a smaller group with mental health issues.However, in addition to conquering the difficulties associated with the inability to effectively communicate, individuals in the deaf community must also attempt to find mental health facilities that can accommodate their special circumstances.
With all the challenges that face these individuals, it would come to no surprise to learn whether they are more prone to mental health problems than hearing individuals.
First, any diagnoses of any mental health issue in the United States comes from one book, the DSM IV- the Diagnostic and Statistical Manual of Mental Disorders, Version IV. This bible of the mental health field is separated into five sections, though the first two are most prevalent in the studies to follow.
The first section is Axis I, listing and describing the Clinical disorders including major mental disorders and learning disorders, such as depression, schizophrenia, ADHD, and bipolar disorder. Axis II lists Personality disorders such as paranoid personality disorder and dependent personality disorder, and mental retardation. In diagnosing children with sensory problems it is important to remember that early onset of significant hearing impairment can have a profound effect on the child’s development, with adverse consequences for mental health, both in childhood and adult life. 0% of deaf children born to hearing parents risk developmental delays in language and vocabulary, resulting in consequences in emotional, psychological, and educational growth (du Feu, 2003). In the past, these consequences manifested themselves in lower expectations for deaf children, and difficulties in teaching them led to the absence of correctly diagnosing mild learning disabilities, attention deficit disorder, and even autism. The children’s behaviors were instead attributed to their deafness. As a result, deaf children have an increased prevalence of mental health problems, 45-50% ersus an average of 25% for the general population. Interestingly enough, deaf children from deaf families do not show this increased level of mental health problems (du Feu, 2003). Because hearing loss so readily interferes with the acquisition of vocabulary, the mean English literacy of deaf high school graduates is at the 4. 5 grade level. (Reed, 2006) To compound this problem, a great many deaf people are not fluent in American Sign Language either, leaving the individual with a gross inability to communicate in general.
Or, assuming the deaf person knows at least some ASL, written sentences may be choppy, incomplete, written in ASL syntax versus English grammar, and therefore may be misleading to the physician. Many mental help providers mistake normal language and communication issues for developmental delays, mental illness or mental retardation. However, misdiagnosing a non-fluent deaf person as psychotic is just as prevalent as mistaking psychosis as merely poor communication. The fear of being misdiagnosed due to language and cultural differences is one reason why deaf people may be reluctant to seek treatment for a mental health problem.
Early studies found that schizophrenia was more common in deaf individuals than hearing people; however, the redirection of diagnoses from schizophrenia to adjustment disorders and organic problems occurred as the diagnostic process became more accurate and clearly defined (Black, 2006). In addition, deaf people are far less likely to be diagnosed with psychotic diagnoses if they are served in a deaf psychiatric program versus the mainstream population; understandably, those specific deaf psychiatric programs are not always readily available in the individual’s vicinity.
Another reason deaf people may hesitate to seek treatment for mental disorders is the lack of providers who have knowledge of ASL and how it differs from English as well as the basics about deaf education and development (Pollard, 2010). Mental health providers must also learn deaf culture to differentiate what can be considered normal behavior in a deaf patient. For instance, a deaf person may stomp loudly on the floor to gain one’s attention; behavior that would be considered aggressive by hearing tandards but accepted as quite normal in a deaf community. Deaf people are also very animated in their “talk”, relying on vivid display of expression and strong emotion to convey their feelings. These theatrics which are a normal part of ASL and deaf language are considered unnecessary in the general hearing public. Energetic signing may make people appear to be excitable or aggressive. Deaf people’s eye contact, use of personal space and way of touching others to gain attention may all be misinterpreted as they can appear direct or intrusive. du Feu, 20063) Clinicians often labeled rapid signing as a symptom of psychotic behavior rather than the change of mood that was actually indicated by the patient. (Reed, 2006) Deaf patients were more often misunderstood than correctly diagnosed, leading to unnecessary and sometimes potentially harmful treatment and even detainment. “If I can’t trust my local mental health center to offer me someone who’s competent to deal with me, why should I go? ” (Pollard, 2010)
More recent studies, though admittedly not “experts” in completely understanding the deaf culture and language, have had more reliable results in the prevalence of mental disorders among the deaf. The frequency of mental illness among deaf people is at least as high as in the population at large. (Mueller, 2006) Findings also reveal the rate of Axis I disorders (depression, psychotic disorders) does not differ between hearing and deaf populations, including schizophrenia, but Axis II (personality disorders, mental retardation) and childhood behavior problems are three to six times more prevalent for deaf persons.
The high rate of personality disorders may be related to attachment difficulties in some hearing families with deaf children. Deaf children and adolescents exhibit higher levels of behavioral and attention-deficit/hyperactivity disorders than the general population. (Haskins, 2000) Posttraumatic stress disorder is noted as being the most common diagnosis found in the deaf community. (Mueller, 2006) Deaf patients are also less likely to be diagnosed with psychotic or substance abuse disorder and more likely to be diagnosed with a mood, anxiety, or developmental disorder than members of the hearing population.
However, providers still have limited knowledge of deafness or deaf culture which continues to seriously impact the ability to accurately assess and/or diagnose. (Mueller, 2006) While the hearing population can open a phone book and choose one of many, many providers to seek treatment for their problems, the deaf community has very little options. Aside from the difficult task of finding a signing counselor, one may allow an interpreter to accompany in the in the intensely personal session; that may also prove uncomfortable for the deaf patient and the interpreter, and it may skew the relationship with the clinician.
In the past, therapists believed deaf people showed a low incidence of depression; in reality, it is more likely that the deaf just choose not to seek help. In addition to the challenges presented in childhood and adulthood for deaf patients, they must continue on their journey into retirement and beyond, frequently becoming more and more isolated as medical conditions start to accumulate with old age. Few residential or nursing homes or psychogeriatric services have experience with deaf people who sign.
In conclusion, I’ve proven my theory that deaf people are more susceptible to some mental health issues due to the obstacles faced everyday with communicating with others. Correct diagnosis and appropriate treatment, however, are both difficult steps to the rehabilitation process. In research for this project, I learned of a 28 year old deaf woman who was born to hearing parents. The parents were advised early on not to learn to sign, and to discourage her from learning as well.
Instead, they tried to have an instructor teach her the oral method, at least initially. Extremely unhappy, the girl developed behavior problems in childhood that increased in adolescence and carried over to early adulthood. She tried to socialize at the local deaf club but only knew a little ASL. She was barely literate, unable to hold a job or have a satisfying life. Upon eventual hospitalization, she was hostile and withdrawn. Frustrated at being unable to communicate with her, the woman’s parents asked the intake person to sign to the woman that they loved her.
The woman signed the bitter response that she had wasted her entire childhood trying to learn to speak and her parents had not spent a single hour learning to sign. (du Feu, 2003) Ignorance isn’t always bliss. Bibliography Advances in Psychiatric Treatment, Margaret du Feu, 2003, volume 9, pp95-103 Deaf People: Mental Illness; Mental Illness in the Deaf Community: Increasing Awareness and Identifying Needs, Sandra Mueller, 2006, www. lifeprint. com Serving and Assessing Deaf Patients; Implications for Psychiatry, B.
Haskins, Psychiatric Times, December 2000, volume XVII, Issue 12 Demographics, Psychiatric Diagnoses, and Other Characteristics of North American Deaf and Hard of Hearing Inpatients, Patricia Black, Riverview Psychiatric Center, jdsde. oxfordjournals. org Interview with Robert Pollard, Ph. D. , Professor of Psychiatry at University of Rochester and director of Deaf Wellness Center, 2010, www. healthbridges. info Mental Health Issues in the Deaf Community, Kimberly Reed, About. com guide 2006 bipolar. about. com/od/socialissues/a/000425_deaf. htm