There are many reasons for hearing loss during adulthood, a situation reflected in governmental data that approximately 2 - 3% of the population between 16 and 64 has hearing difficulty (United States Census Bureau, 2010; Skinner, 1993). Aging is just one factor within the hearing equation, so it is important that medical professionals acknowledge and address the effect of hearing loss in younger people. In particular, the disability addressed by this paper is hearing loss that occurs during the working years, thus excluding childhood and old age related hearing loss. Although hearing loss during any time of life has major physical, social, and psychological impacts on a patient, it is particularly difficult for this irreversible, lifelong sensory loss to occur during the years when a person is expecting to be their most productive fiscally and socially. Not unsurprisingly, researchers have reported significant psychological issues for the patients that accompany hearing loss during this time of life. Anger, denial, isolation, social withdrawal, fatigue and depression are among the psychological results of a loss of hearing during the middle adult years (Kaland and Salvatore, 2002).
Psychologists are uniquely positioned to provide counseling, support, and coping strategies for persons who have undergone loss. Loss of a sense and therefore the acquisition of a disability is an example of the kind of loss that may require the services of a psychologist to most effectively deal with this physical change (Brady, 2007). Researchers have documented profound psychological and social results that can occur without proper attention to the psychology of hearing loss in persons of this age, even if the hearing loss is adequately addressing using hearing aids, cochlear implants, or other physical treatments (Monzani, Galeazzi, Genoveses, Marrara, and Martini, 2008). Therefore, the service of a psychologist with experience counseling persons in loss situations is an appropriate approach to dealing with this particular disability. This aspect of this specific disability is of interest to me personally and professionally because I am acquainted with someone who suffered hearing loss in midlife and I have therefore witnessed firsthand the social and mental problems that loss of hearing at this age can cause.
Because hearing is a central aspect to effective verbal communication and verbal communication is an important component of human social interaction, the results of hearing loss can cause key participation issues in many aspects of the patient’s life. As hearing loss is not currently completely reversible, these problems can be improved with treatment tools but will never leave the patient’s life entirely. The resulting challenges can touch the patient personally, as well as the patient’s relationships with family, friends, co-workers, and all those having social interaction with the patient. Particularly if the hearing loss is not treated, but even after treatment, hearing loss causes newly added difficulties in communication. This affect can be exacerbated if the patient is unwilling to acknowledge or discuss the hearing loss issue with those around them.
This is because hearing loss is what is known as a hidden disability, not outwardly apparent to other people, so no accommodation will be provided to the patient without some affirmative sharing of the existence of the disability on their part (Bouton, 2013b). As the patient can be experiencing reluctance to disclose the disability or even denial of the situation, the impact on social relationships can be negative and will commonly grow more negative over time. Specifically, without the proper knowledge of the situation, hearing loss is often perceived by others as a lack of empathy or interest on the part of the sufferer, a perception that can make a difficult social situations progressively more isolating for the person with the disability (Monzani et al., 2008). Developing an ability to comfortably discuss the hearing loss with others is therefore an important step to a better lifelong outcome for the patient.
The use of the telephone is an illustrative example of a difficult situation that can negatively impact social interaction for those with the disability of hearing loss (Bouton, 2013a). This can be particularly difficult for those in midlife, who have spent the first half of their lives using this tool without any thought or effort. Although there are many devices available to try to make the telephone still accessible for someone with hearing loss, the use of every accommodating device or caption service comes with some compromise and much experimentation and effort on the part of the disabled person. It is not entirely surprising that many persons in this situation simply abandon the use of the phone and switch to almost exclusive communication through the Internet, although this obviously limits the situations and persons available for communication (Bouton, 2013a).
A second key area of participation that can be a problem for a person suffering from hearing disability is the recreation area. The many activities that rely upon hearing for full participation such as listening to music, attending movies without subtitles, or playing sports that rely upon sound, will no longer be available or will be very much changed. Again, the psychological impact of this change in available recreation without accommodation may be a significant issue to someone having to change midlife, depending on the importance of that particular recreation to the patient before the hearing loss (Bouton, 2013c). Certainly it is understandable that someone who found listening to music an important part of his or her lives could be more profoundly affected by the loss of hearing than someone who had never experienced or placed value upon this sensory ability.
Although problems with social interactions and personal recreation can be highly significant to the patient, it is at a job where the disability can have the most financial impact for someone living through midlife hearing loss. Researchers have reported that the physical health and psychological well being of those working with hearing loss is much worse compared to that of hearing persons. This is particularly true for those in high demand and low control work types, that is, work classified as high-stress (Danermark and Gellerstedt, 2004). Because of these physical and psychological documented impacts in the workplace for those with hearing loss, it must be concluded that a healthy psychosocial work environment is a further source of reduced participation for those who suffer from hearing loss at an age where they are earning their living. Persons who have acquired their disability in midlife have reported job loss due to problems associated with facing and dealing with their new disability (Bouton, 2013b). Therefore, psychologists and other medical personnel working with persons with hearing loss disabilities need to address diminished work environments and the potential psychological and fiscal results with their patients.
Researchers adapted the full International Classification of Functioning, Disability, and Health (ICF) into a core set for hearing loss to allow its application to clinical practice (Granberg, Danermark, and Gagné, 2010). This effort culminated in a conference being held in 2012 where a committee produced both a comprehensive and a brief ICF Core Set for hearing loss. The brief core set can be summarized as follows (ICF Research Branch, 2012). The primary body functions identified as being involved in hearing loss include temperament and personality functions, attention functions, memory functions, emotional functions, seeing functions, hearing functions, and sensations associated with hearing and vestibular functions. The primary body structures involved include structures of the brain, external, middle, and inner ear. The activities and participations impacted include listening, handling stress and other psychological demands, communicating with – receiving spoken messages, conversation, using communication devices and techniques, family relationships, school education, remunerative employment, and community life. Finally, the environmental factors involved with hearing loss include products and technology for communication, sound, immediate family, health professionals, individual attitudes of immediate family members, societal attitudes, and health services, systems, and policies (ICF Research Branch, 2012).
The brief core set is a useful collection of evidence-based information that can be used by facilities, researchers, and medical professionals to ensure comprehensive coverage of all issues related to hearing loss. As review of the discussion preceding this section can attest, many of these issues do rise to prominence in the research surrounding this area for those who have lost their hearing in midlife. However, the ICF core set can suggest other topics that could be included in the discussion, for example, the issue of communication with health care professionals by persons with midlife hearing loss is an issue of key importance that does not immediately reveal itself in a review of the scholarship in the area and should be included during psychological treatment. Furthermore, an emphasis on the attitudes of immediate family members does not appear in the first level of research about midlife hearing loss and could present itself as an area that a psychologist should focus upon when working with a patient with such a disability.
One of the primary means of support a psychologist can provide someone with midlife hearing loss is traditional psychological talk therapy. In initiating such a psychological treatment approach, the primary focus of a psychologist treating a person who has suffered midlife hearing loss is that the patient has already developed a complete personality without incorporating hearing loss (Kaland and Salvatore, 2002). With so many parts of their lives already fixed, it can be highly disorienting to lose the sense of hearing. This can result in one or more issues of an identity crisis, reactive depression, and reactive anxiety (Kaland and Salvatore, 2002). It is an intense loss and can trigger the Kubler-Ross five stages of grief, involving denial and isolation, anger, bargaining, depression, and acceptance (1997). Therefore, another important core investigation is determining the precise point the patient with hearing loss is within this set of five psychological stages.
Specific counseling techniques that have proven successful in the situation of hearing loss include behaviorism, phenomenology, and a combination of these two principle approaches known as cognitive counseling (Brady, 2007). Human behaviorism involves measuring the observable behavior of humans rather than focusing on mental events. A method used in this psychological approach is operant conditioning, where good behavior is reinforced and as the behavior is improved more and more reinforcement is provided until the behavior is permanent or habituated (Brady, 2007). An example of operant conditioning in this context could be the use of a specific personal reward in association with continued successful use of a needed aid, such as a hearing aid or caption service, in an effort to develop to more effective communication techniques.
Phenomenology is a counseling approach that takes advantage of the emotional nature of language. For patients with hearing loss, the primary emotion involved could be the social isolation that results from the disability. Therefore the goal of the counseling is to “reduce the feeling of isolation and detachment from family and friends” for the patient rather than a focus on the hearing loss and its negative impacts (Brady, 2007). The psychologist could ask for the patient to keep a diary documenting their social interactions and the experiences in overcoming and dealing with the new communication challenges. If the patient can develop improved self-worth and feelings of acceptance from the counseling interaction, the treatment based on phenomenology is successful (Brady, 2007).
A third kind of counseling that has application to the psychological results of hearing loss is cognitive counseling (Brady, 2007). Cognitive counseling works by modifying the value system of the patient in relation to the issue. In effect, the counseling attempts to move the patient’s mental state from a focus on the negative results of the hearing loss to a focus on the positive result of that better hearing through treatment of the hearing loss can provide (Brady, 2007). A modified mental outlook on the impact of the disability is seen as the key to a self-perpetuating improvement in mental health concerning something that cannot be controlled, that is, the hearing loss itself. Finally, combinations of these three counseling approaches are often found to be the most effective means of dealing with the mental results of hearing loss (Brady, 2007), as well as the more complex situation of midlife loss of hearing.
The loss of hearing at an adult age is the acquisition of a disability with many physical, social, and psychological ramifications. The loss of the sense of hearing has a major impact on the ability to communicate in person and using tools that rely on hearing such as the telephone, thus it alters relationships between the patient and family, friends, co-workers, and healthcare professionals. Hearing loss can have documented negative effects on the work environment at a time when adults are expecting to be at their peak financial productivity. The comprehensive nature of the life impact of hearing loss as a disability is evident even through the summary provided by the brief ICF core set for hearing loss and this useful resource can be referenced by those treating or doing research about hearing loss.
Because of the many psychosocial pressures brought about by this disability, the services of a psychologist are a highly appropriate step in adapting and accommodating the life changes brought about by midlife hearing loss. As with any loss, patients can be expected to go through the traditional stages of grief including denial and isolation, anger, bargaining, depression, and acceptance. A number of specific counseling techniques have been adapted for use in helping patients deal with hearing loss including behaviorism, phenomenology, and cognitive counseling. Importantly, combinations of these techniques are often the most effective. With awareness of the likely issues and the development of an effective treatment approach, treatment by a psychologist using one or more of the counseling approaches discuss in this report is expected to improve lifelong outcomes for those suffering from hearing loss at midlife.
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