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Deafness In MindReview - Deafness In Mind
Working Psychologically With Deaf People Across The Lifespan
by Sally Austin and Susan Crocker (Editors)
Whurr Publishers, 2005
Review by Jackie Leach Scully, Ph.D.
Jun 18th 2005 (Volume 9, Issue 24)

As the introduction says, this book came into being as a result of Sally Austen's frustration at the mental health services' lack of awareness of the needs of hearing impaired people. It is aimed at mental health professionals, and most of the authors are psychologists or social workers working with hearing impaired people in the United Kingdom and elsewhere.  This focus is the major strength and, as I will discuss in a moment, the major weakness of the book.  

The editors set the scene in the introduction by noting that "deafness refers to an auditory phenomenon that tells us little about a person's psychological state or their identity".  The book starts with an overview by Austen and Emma Coleman of the medical versus cultural models of deafness.  In the medical model, deafness is a disability that should be corrected as soon as possible, while in the cultural model it is seen as a cultural/linguistic variation or even lifestyle choice.  Culturally Deaf people may think of themselves as citizens of the Deaf World rather than disabled persons.  This early chapter is careful and nuanced, avoiding obvious judgment of whether either of these models is preferable, although reading between the lines the authors are patently much less at ease with the cultural model. 

Subsequent chapters cover subjects ranging from the medical and physiological aspects of deafness, to hearing aid and cochlear implant technology, with a survey of psychological models applied to deafness, and chapters focusing on specific aspects of mental health such as service provision to d/Deaf people, the use of interpreters, the psychologist's role in assessment for and adaptation to cochlear implants in children, adolescents and in adults.  The final section considers topics in which the particular needs created by the presence of deafness are rather less central, and in many ways is the most innovative.  Contributions here consider the vulnerability of d/Deaf people in the criminal justice system, particularly in terms of the increased suggestibility that can result from cultural differences, inadequate interpretation or communication breakdown; the effects of stroke on signing; how to train mental health professionals who are themselves hearing impaired; services for older d/Deaf people; and working with d/Deaf survivors of sexual abuse.

It would be impossible to discuss all these contributions thoroughly, so to give a flavor of the combination of breadth and depth that most authors provide, I'll take two chapters that I find particularly interesting, and innovative in their introduction of a specialized issue to a wider readership. In The dynamic roles of interpreters and therapists, Jemima Napier and Andy Cornes, writing from backgrounds in interpreting and clinical social work, draw attention to how professionally odd the therapist is likely to find a situation in which a therapeutic relationship or alliance has to be built up and maintained via a third party, the interpreter. The therapist may, initially at least, assume that the interpreter acts as a kind of neutral conduit between therapist and client, but Napier and Cornes note the difficulty of making this assumption in situations where, for example, the d/Deaf person may be more used to the interpreter taking on the role of advocate.  Faithful and accurate interpretation may be compromised, for example in situations where a patient's free associations may not make any sense to the interpreter, who may then attempt to impose some order onto what is being said, or where the interpreter's own countertransference comes into play.  The authors end with recommendations that include specialist training and the further education of the Deaf community.

Sue O'Rourke and Nigel Beail's chapter Working with survivors of sexual abuse who are Deaf notes that "At first glance deafness may not appear to be a 'special case' and, of course, Deaf people are not so different from hearing people.  However, the language and culture of deafness, the history -- shared and individual -- of Deaf people in relation to the hearing majority, all impact on the understanding of abuse and the way it is approached in therapy." (p.342).  They cite a study suggesting that up to 40% of d/Deaf adults in a community population may have experienced childhood sexual abuse (Ridgeway, 1997).  They also discuss the lack of rigorous empirical research into the effectiveness of different kinds of treatment for d/Deaf (or, for that matter, hearing) survivors of childhood sexual abuse. As an example of the kind of point that the contributors to this volume make (points that are obvious in retrospect but easily missed in everyday practice), the fact that abusers of d/Deaf children are statistically more likely to have been hearing adults may affect cognitions about relationships between deaf and hearing people (which might need to be addressed), and may equally have an effect on the development of trust between (hearing) therapist and client.

What about flaws of the book?  One is the emphasis on practice, and concomitant absence of substantial theorization in any chapter. For many of the readership, who are necessarily mostly practice-orientated, this will not be a flaw. A more obvious, and much more damaging, problem is that the collection gives one perspective -- that of the mental health/social work professional.  This is, of course, the perspective of the target audience.  Nevertheless, the absence of the d/Deaf person's perspective here drastically reduces the volume's effectiveness as a way of giving new insights to those already working with d/Deaf people, or raising the consciousness of therapists and others who occasionally come into contact with hearing impaired clients. Although most of the contributors strive hard for reflexivity and nuance, the collection favors, if not the medical model, then a medicalized and professionalized approach: only one chapter (by Mary Griggs on Deaf Wellness) is recognizable as having been written from within the Deaf world.  The book's highly valuable insistence on the diversity and complexity of the client base is, to my mind, weakened because it is not backed up by diversity in the contributors.

Nevertheless, the book offers a wide-ranging introduction to this issue for workers in mental health, and to anyone interesting in deaf issues or disability studies. A key message, reiterated in various ways, is that "in order to work effectively in the field of mental health and deafness, one must have an understanding of the social, political, economic and historical issues affecting d/Deaf people" (p.18). Throughout, the writers and editors are at pains to emphasize the dangers of easy categorization -- a knowledge of the distinction between "deaf" and "Deaf" does not guarantee that a person will fall neatly into either category, and in any case categorization must evolve as societies, and d/Deaf people's places within them, also change.  This non-dogmatic approach is welcome, and I hope it will stimulate the inquisitive reader to explore further the implications of what the book says, as well as what it does not say.

 

© 2005 Jackie Leach Scully

 

Jackie Leach Scully, Ph.D., Unit for Ethics in the Biosciences, University of Basel, Switzerland


Sally Austen, Consultant Clinical Psychologist, has given the following response to Jackie Leach Scully's review. Published April 19, 2006.

I am very grateful for any reviews of the book. Ms Leach Scully's review was extremely thorough and thought provoking. It is always useful to get feedback on others' perceptions, what they liked, and what they didn't. As a result of this review my second book, which has a single subject focus (Deafness and Challenging Behaviour, Austen and Jeffery (eds) published by Wiley, expected date Oct 2006) will have a chapter focusing on the service users persective of having had challenging behaviour and having been restrained, secluded and medicated against their will. I am grateful to Jackie Leach Scully for inspiring me to tackle this chapter as, within the field of restraint, it will be quite ground breaking.

I have concerns however, about the way in which Ms Leach Scully's review of Deafness in Mind portrays the role and status of my d/Deaf colleagues. Her comments about the lack of a deaf perspective in Deafness in Mind, imply that the only input expected from d/Deaf people would have been as service users. Five out of the 27 contributors to the book are highly qualified and respected d/Deaf or sign language community member professionals. Assumptions about the audiological or cultural status of the contributing authors decry the effort and brilliance that is required of d/Deaf people to beat the barriers to academic and professional training.

Thank you for the opportunity to reply to the review and thank you again to Jackie Leach Scully for the hard work she put into reviewing it.


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