Deaf People and Society

Psychological, Sociological and Educational Perspectives

Irene W. Leigh, Jean F. Andrews

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781315473796
• Edition: 2
• Topic: Psicologia
• Subtopic: Storia e teoria della psicologia

Deaf People and Society incorporates multiple perspectives related to the topics of psychology, education, and sociology, including the viewpoints of deaf adults themselves. In doing so, it considers the implications of what it means to be deaf or hard of hearing and how deaf adults' lives are impacted by decisions that professionals make, whether in the clinic, the school, or when working with family. This second edition has been thoroughly revised and offers current perspectives on the following topics:

• Etiologies of deafness and the identification process

• 
  
  

• The role of auditory access

• 
  
  

• Cognition, language, communication, and literacy

• 
  
  

• Bilingual, bilingual/bimodal, and monolingual approaches to language learning

• 
  
  

• Educational, legal, and placement aspects

• 
  
  

• Childhood psychological issues

• 
  
  

• Psychological and sociological viewpoints of deaf adults

• 
  
  

• The criminal justice system and deaf people

• 
  
  

• Psychodynamics of interaction between deaf and hearing people

• 
  
  

Each chapter begins with a set of objectives and concludes with suggested readings for further research. This edition contains 10 new and original case studies, including ones on hearing children of deaf adults, sudden hearing loss, a young deaf adult with mental illness, and more. Written by a seasoned deaf/hearing bilingual team, this unique text continues to be the go-to resource for students and future professionals interested in working with deaf and hard-of-hearing persons.

1 Historical Perspectives of Deaf People and Psychology¹

Study the past if you would define the future.

Confucius (551 BC–479 BC)

Figure 1.1 Dr. Gabriel Lomas administers an intelligence test

Source: Courtesy of Dr. Gabriel Lomas. Used with permission.

A 1943 book about deaf people had the following inscription for its dedication:

To Deaf People:

The most misunderstood among the sons of men,

But the gamest of all

(Best, 1943, with apologies for gender)

It took centuries for deaf people to break out of the shackles of misunderstanding. And even today, there continues to be misunderstanding, notwithstanding the fact that deaf people more than ever are achieving their potential in education, communications (thanks to ever-evolving technology), theater, law, and many other areas and can psychologically move on in their efforts to live productive and happy lives. This progress has come about as a consequence of the presence of a more enlightened era and populace that understand diversity and multiculturalism. Within the domains of psychology, sociology, anthropology, linguists, education, and mental health, psychologists, social workers, mental health counselors, sociologists, neuroscientists, anthropologists, linguists, educators, psychiatrists, and allied mental health professionals have served as catalysts that propelled the changes we see today.

Chapter Objectives

In this chapter, we describe historical highlights that played significant roles in facilitating the mental health and well-being of deaf people with primary focus starting in the 1950s and onward. We review critical court decisions in the areas of education and mental health access that have played prominent roles in these historical changes. We also review the impact of the use of sign language by professionals in mental health settings. Readers will learn about the way in which professionals highlighted and tied together American Sign Language (ASL), Deaf culture, and the positive nature of the deaf community, thereby enhancing the quality of service delivery to deaf individuals in need of psychological/mental health services.

Before 1950

Just prior to the 1950s, there were fewer than ten psychologists and no psychiatrists in the United States with full-time commitment to the mental health of deaf and hard-of-hearing people (Levine, 1977). The few available psychologists were located in residential schools for deaf children that had been established in the United States, starting in the 1800s. During those early decades, most of these schools utilized sign language as a vehicle for educating deaf children. Despite the fact that these schools existed to provide deaf children with skills needed to manage their lives, general nineteenth-century perceptions about deaf people’s abilities reflected the belief that because deaf persons had problems with speaking and relied on signing, their intellectual functioning was limited and they were educationally deficient (Pollard, 1992–1993).

In the late 1800s and early 1900s, there were individuals who demonstrated the fallacy of this belief system, starting with William James, a well-known philosopher/psychologist. James encountered two deaf men who demonstrated to him through personal correspondence that abstract cognition could exist even without the mastery of spoken words, explaining how they thought even before starting school and learning language (James, 1893, as cited in Pollard, 1992–1993). For the first time, this upended the belief that language was required prior to abstract cognition. However, it would be decades before cognitive psychologists confirmed the possibility that the existence of thought was not necessarily dependent on internalized language.

In the meantime, the pendulum was swinging towards the use of spoken language, encouraged by Alexander Graham Bell (1847–1922), most popularly known as the inventor of the telephone. With the advent of behaviorism and the stimulus-response theory of learning, psychologists were beginning to focus on how language acquisition was impacted by the inability to hear. Rudolph Pintner (1884–1942) and Donald Paterson (1892–1961) (1915, as cited in Pollard, 1992–1993) were in the forefront of psychologists who noted the unfairness of linguistic requirements in IQ tests used to evaluate the intelligence of deaf children. As an interesting aside, during that time, psychologists not only were testing deaf people but were also testing immigrants at Ellis Island with the ultimate goal of evaluating the use of IQ tests and other psychological instruments with different populations. In many cases, they gave verbal IQ tests in English to both groups, thinking that was appropriate and, as a result, inappropriately classified many individuals as mentally retarded (currently referred to as having an intellectual disability).

Pintner went on to develop a variety of performance-based psychological tests for deaf students, including primary and preschool intelligence tests, a test of educational achievement, as well as research projects focusing on tests to measure deaf children’s personalities and psychosocial functioning. Together with a group of psychologists, he also took a lead in recommending the development of tests covering intellectual abilities and academic achievement that would be standardized with deaf people. Additional recommendations included studies of deaf children’s psychosocial and emotional development within different educational approaches and parenting styles. Finally, the need to research approaches to deal with adult psychopathology was acknowledged (National Research Council, 1929, as cited in Pollard, 1992–1993).

Unfortunately, despite a spate of studies following these recommendations, these studies contradicted each other to the point of creating dissension (Levine, 1977). This was primarily due to limited familiarity with deaf people and their communication needs as well as problematic validity of the measures used with deaf subjects. Reviewing the progress in 1941, after a decade of research, Pintner, Eisenson, and Stanton (1941) concluded that, while variability in IQ scores existed, deaf children on average scored lower compared to hearing peers. This conclusion was to stand until McCay Vernon (1928–2013) (1969) reviewed 21 studies involving IQ results and found that, contrary to popular opinion, if nonverbal performance-type tests were used, the IQs of deaf and hearing children did not significantly differ. This had a significant impact on how schools for the deaf perceived the intellectual functioning of deaf students.

Pintner and colleagues also cautioned that the use of personality measures developed for hearing children would unduly pathologize deaf children. As a matter of fact, this is exactly what happened. Prior to 1950, for example, there had been only 18 studies on behavioral aspects of deafness, all done on children (Vernon & Andrews, 1990). Most of these investigations involved the use of grossly inappropriate psychological tests, many of which were verbal or based on the knowledge of English, which many deaf children were unfortunately deficient in, or behavioral checklists with many items that were biased against deaf youth. The results seemed to demonstrate that multiple types of pathology were present. It took decades to show that many of these studies have been proven false by subsequent, more valid types of testing and assessment (see Chapter 8 for further details). It seems that what was left out of the equation was the lack of awareness that deaf children were in difficult communication situations to which they reacted and that of course reflected different types of adjustment, some of which were pathological. It was not the deaf aspect that was the issue; rather it was the inaccessible environment and the negative attitudes to deaf children that all too often prevailed.

Sadly, between that time and the 1950s, no formal research was done on deaf adults because psychologists working with deaf individuals tended to be employed in schools where they essentially functioned as psychometrists, with the primary responsibility of administering IQ tests to incoming students in order to identify those with low IQs or severe behavior problems. The intention was to exclude from school enrollment those with mental retardation, the label used at the time (currently labeled as intellectual disability) or severe mental illnesses and to refer them to hospitals. Although the state hospitals serving individuals with mental illness or mental retardation were required by law to accept these deaf patients, these deaf patients were not offered access to treatment nor were the hospital staffs trained to provide treatment to deaf inpatients or to communicate with them in sign language (Levine, 1977).

This unfortunate state of affairs had two negative consequences. First, deaf people with mental illness or mental retardation (intellectual disability) got, at best, what was essentially antitherapeutic custodial care, or in other words, they were “warehoused” with no treatment. The second consequence of this dearth of psychologists and psychiatrists was a lack of any quality research into the ways being deaf influenced psychological functioning. That was to change starting in the 1950s.

After 1950

Starting in the 1950s, interest in the implications of being deaf began to increase, partly as the outgrowth of audiological training in response to the influx of World War II veterans returning home with hearing loss. Helmer Myklebust (1910–2008) was a well-known psychologist who did research on deaf children and young adults that exemplifies research done up to 1960. For example, he did work on diagnosing aphasia in deaf youth and wrote on educating aphasic children. He also conducted personality studies using the Minnesota Multiphasic Personality Inventory (MMPI, 1960), a verbal-based psychological instrument, with deaf participants, for which he was vilified because of the inappropriateness of using such a verbally loaded measure that resulted in a negative personality picture of deaf youth. Even though much of his research was not supported by later findings, in part because of the inappropriate use of existing instrumentation at the time, he was a psychological pioneer in the effort to understand the psychological functioning of deaf people. His work and that of his students at Northwestern University were important stages in the process of this effort. In particular, Myklebust (1964) was among the first to emphasize that there might be functionally different ways in which deaf children interact with the world compared with hearing peers. This of course has implications for psychological development. Current neuropsychological research demonstrates this phenomenon, meaning that deaf children function differently, but not in inferior ways compared with hearing peers.

Edna Simon Levine (1910–1992), a contemporary of Myklebust, was for many years a psychologist at the Lexington School for the Deaf in New York City, at that time a prominent school that focused on spoken language for deaf children, and later became a professor at New York University. In the latter role, she conducted research projects on the personalities of deaf children and on children who were deaf due to rubella (popularly known as German measles) that affected their mothers during the first trimester of pregnancy. Most importantly, she was among the first to suggest that the environment was a critical factor in the development of the deaf child, and therefore its influence required critical study (Levine, 1981). In addition to these contributions, Levine also was a major factor in the establishment of the National Theater of the Deaf in 1966, which enhanced the careers of deaf actors. She also authored a fictional story about a deaf child—Lisa and Her Soundless World (1974), which oriented hearing children to what it meant to be deaf.

Psychopathology and Mental Health

Most importantly, Levine played an influential role in determining federal policies impacting deaf children and adults. She spearheaded efforts to develop research and treatment programs for deaf people with mental health problems by taking advantage of some of the funding opportunities created by post-World War II rehabilitation legislation (Levine, 1977). How was this accomplished?

In the early 1950s, Edna Levine and Boyce Williams (1910–1998), the Rehabilitation Services Administration (RSA) administrator, who happened to be deaf, approached Franz Kallman, M.D. (1897–1965), a psychiatrist affiliated with Columbia University in New York City who had done genetic and schizophrenia research with deaf persons, to discuss the establishment of such a program (Vernon & Andrews, 1990). Funding was obtained for the establishment of the first outpatient psychiatric treatment program for the deaf at the New York State Psychiatric Institute in New York City as well as for an inpatient unit at Rockland State Hospital located north of the city. Together with psychiatrists John Rainer, M.D., and Ken Altshuler, M.D., Kallman published the first significant research projects on psychopathology and its identification and treatment in deaf people (Vernon & Daigle-King, 1999).

This has to be considered groundbreaking, as prior to the mid-1950s, there was only one research study on the psychopathology of deaf people to appear in the psychiatric literature, done by a late-deafened Danish psychiatrist, V. C. Hansen (1929). In Denmark, he gathered data on 36 deaf patients in psychiatric hospitals and reported that his numbers represented a 10 times greater prevalence of deaf inmates than would be expected based on the prevalence of deafness in Denmark. He also found deaf patients to be significantly more chronic than hearing patients, with hospital stays being 20 years on average. Almost one-third (31 percent) of the deaf patients were undiagnosed. This is understandable, considering that there was no hospital staff able to communicate with them in sign language, that is, if the patients themselves even knew sign language. It is possible that some had no language.

The work done by the New York State Psychiatric Institute was in the forefront of other research and clinical projects that began shortly afterwards. These projects were located at St. Elizabeth Hospital in Washington, DC; Langley Porter Psychiatric Institute in San Francisco, California; Michael Reese Hospital in Chicago, Illinois; and John Denmark’s psychiatric program in England. The results of their research projects as well as later studies are reported in some detail in a 1999 paper (Vernon & Daigle-King, 1999). They were landmark studies that have had a profound impact on our knowledge of deaf people and mental health as well as on the care these patients receive.

A major finding was that, when deaf patients with mental health issues are placed within a general hospital population and provided no staff or therapists who can communicate with them in sign language, their stays are much longer than those of hearing patients. More recent studies (Daigle, 1994; Trumbetta, Bonvillian, Siedlecki, & Haskins, 2001) indicate that, when provided care by psychologists, psychiatrists, social workers, and nursing staff who can sign and/or when provided round-the-clock sign language interpreting services, deaf patients who know sign language are no more chronic than their hearing counterparts. It is this access to sign language and professional staff knowledgeable about deafness that has been legislated by the Americans with Disabilities Act of 1990 (ADA, amended in 2008) and other civil rights laws. Unfortunately, such services have been provided in only a minority of states. Consent decrees, which involve a settlement of a lawsuit in which hospitals agree to take specific actions without admitting guilt, have had to be used to force compliance when hospitals are sued for lack of access (Katz, Vernon, Penn, & Gillece, 1992).

Even though deaf people generally have not been well served by the mental health system, deaf members of minority ethnic backgrounds have been even more poorly served (Pollard, 1994). In the psychiatric studies reported in the literature, minimal attention has been paid to the relationship between ethnic background and diagnostic categorization for these individuals (Leigh, 2010). However, in these studies, it is important to note that one conclusion was generally agreed upon. The limited availability of American Sign Language (ASL) in the schools and the difficulties deaf people experience when communicating with hearing people, including family members as well as outsiders, were partially responsible for both the type and amount of psychopathology seen in deaf patients and in the educational retardation and lack of general knowledge found in these individuals (Vernon & Daigle-King, 1999).

Much of that literature also suggests that, while the publications of the 1950s and early 1960s on the mental health of deaf adults reflected focus on those who had psychiatric diagnoses, the implication that their pathology was caused in part by their being deaf continued to be perpetuated. In these studies, they were perceived as being concrete thinkers, emotionally immature, and egocentric and having problematic relationships and a tendency to act out. These results permeated general perspectives of the general, nonpsychiatric deaf population, thanks to the “spread” effect.

The only psychiatrist to do a significant amount of research with deaf children was Hilde Schlesinger, who worked together with sociologist Kay Meadow to conduct studies of deaf children and their families (Schlesinger & Meadow, 1972). Their clinical research focused on three primary areas—language acquisition, using sign language, and mother/child interaction comparing deaf and hearing children—in addition to a comparative study of deaf children whose parents were deaf with those deaf children having normally hearing parents. Among their conclusions was that the controversy then raging over methods of communication (spoken versus signed) was detrimental to the mental health of the children involved. They recommended that a combination of signed communication and speech/speechreading be used. This recommendation predates what is being implemented today in the bilingual programs within the educational setting with the focus on ASL and English, as indicated in Chapter 6.

Schlesinger and Meadow (1972) also found that when families used sign language with their young deaf children, acquisition generally paralleled milestones in spoken language acquisition. Knowledge of sign language did not interfere with speech acquisition. Instead, spoken words and speechreading facility increased with sign language acquisition. In addition, the level of communication frustration was decreased in the families they observed who used both spoken and signed communication in combination. Among their other findings were the distinct advantages deaf children with deaf parents enjoyed versus deaf children with hearing parents. The difference manifested in areas such as educational achievement, family climate, maturity, and a number of other variables.

Finally, it is important to note that, even though inpatient and outpatient services have increased in the United States and Europe over the last few decades, most of the significant and relevant research was done more than two decades ago (Vernon & Daigle-King, 1999). However, this has changed, with an emerging number of new research data as described in Chapter 9.

Influence of Psycholinguistics

You will note the frequent references to the role of sign language in working with deaf mental health clients. How has this role emerged, considering the fact that many schools for the deaf were geared towards the use of spoken language? Prior to the 1960s, the typica...