There are approximately 20 million hearing-impaired people in the United States, of which about 10% are profoundly deaf (Steinberg, et al, July 1998). These individuals comprise a distinct community of men, women and children who must work daily to function in a world geared for those who can hear. They have to surmount formidable communication barriers with co-workers, employers, neighbors and, in some cases, even friends and family. They must also struggle against stigma and prejudice. In a study lead by Annie Steinberg, MD, 41% of the participants, all of whom were hearing impaired, believed that "communication problems, family stresses, and societal prejudice that accompany it [hearing impairment] could lead to problems ranging from suicidal depression to substance abuse and violent behavior" (Steinberg, July 1998). In addition to these unique needs, members of the deaf community, just as in all cultures, are also struck with the unfortunate reality of severe mental illnesses such as bipolar disorder. In short, this community needs viable mental health resources.
Lack of Interpreters
However, current research indicates that such resources are not readily available. Of the 54 participants in Dr. Steinberg and associates' study, more than half (56%) reported that they had been unable to locate mental health services that were accessible (Steinberg, July 1998). Furthermore, research has also given evidence that psychiatric conditions such as mood disorders are frequently under-diagnosed (Shapira, et al., 1999). Both of these problems seem to be caused by a "lack of and utilization of experienced interpreters, grammatical and syntactic translation problems between American Sign Language and English, and differences in how a deaf individual displays feelings and perceives mental health and the mental health community" (Shapira).
The scope of communication problems between the hearing and the deaf is not always obvious to many. After all, those who are deaf can still read and write. However, this does not, as it might seem, provide an easy solution. 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 (Holt, 1994). One hearing-impaired participant in a study which was evaluating these issues stated, "... many deaf people lack English skills. They are ashamed to write" (Steinberg, July 1998). Also consider that the average deaf adult can lip-read only 26% to 40% of speech (Waldstein & Boothroyd, 1995). Because these communication problems are viewed as such an issue, and for good reason, the majority of participants in a study of cultural and linguistic barriers to mental health service access led by Dr. Annie Steinberg and associates preferred a deaf professional (Steinberg, July 1998). Obviously experienced interpreters are vital.
However, the use of an interpreter is only the first step in resolving the problem of adequate mental health resources. The hurdle of grammatical and syntactic difficulties must still be overcome. In November 1998, Dr. Steinberg and others undertook the task of translating The Diagnostic Interview Schedule into American Sign Language, Signed English and speech reading (November 1998). This research team identified several specific translation problems. One of these is the translation of time. For example, since American Sign Language does not often use conjunctions or prepositions, duration concepts such as "for six months or more" present a problem, and time-within-time ("Have you experienced difficulty sleeping for one month or more during the past year?") are even more difficult to communicate. Another translation problem is the use of English phrases such as "feeling on edge." Additionally, hearing-specific phenomena presented a particular challenge. How does one ask a prelingual deaf person if he has been "hearing voices"?
Subtle and Unexpected Differences
Mental health providers must also learn how to recognize and address the differences in how a deaf individual displays feelings and expressions from those who are hearing. For example, someone who is deaf may pound on the floor to get attention. While this is considered aggressive by those who can hear, it is actually quite accepted and normal within the deaf community. Furthermore, while strong emotional displays are pretty much frowned upon in the hearing community, members of the deaf community count on vivid expression of emotion to convey meaning. As a matter of fact, one retrospective study found that clinicians often labeled rapid signing as a symptom of psychotic behavior rather than the change of mood that was actually indicated (Shapira). Another complicating factor in the expression of emotion is that there is a scarcity of signs within this language that can account for subtle changes in mood (Steinberg, November 1998).