The Impact Of Hearing Loss On Verbal Communication

René Rivard

They say that a good understanding of the problem is the first step towards finding the solution to that problem.

The "problem" we are addressing is: "What happens to communication between two or more individuals when one of them experiences a hearing loss?" These individuals may be in personal relationships as friends, as spouses or in professional relationships such as co-workers or support providers. For the person with a hearing loss, this could also involve their relationship with society in general affecting such activities as watching television, listening to the news, going to the theatre or to a concert. All of these circumstances are opportunities for communication, the essence of our participation in our society. They all suffer as a consequence of hearing loss.

I am hearing, absolutely no hearing loss that I am aware of. Why then do I dare to address such a group with the pretense that I may be able to provide some insight into communication issues that affect them? I have worked in the field of mental health for many years and think I have gathered and understanding of the link between communications and mental health issues. Please don’t be offended by my use of the terms "mental health issues". We all have mental health issues, many of them arising from losses in our lives. Hearing loss is one of those losses. However, it is more significant and pervasive in that it affects the communication process. It disrupts all our human relationships, be they with families, friends or co-workers. Not only does one suffer a loss, one is also affected by the inability to communicate with others about that loss.

The first thing one must understand is that individuals have different ways of communicating and we must respect the other's style of communication, which may be based on personality, but also on other more fundamental physical abilities as basic as the ability to hear spoken words. Communication involves at least two persons who take turns in the roles of transmitter and receiver. If some individuals can not hear certain words, they cannot be expected to readily understand full sentences and conversations and thereby participate equally in the process. However, when there is a hearing loss, the responsibility for the consequent mis-communication is usually attributed solely to the person with the hearing loss. But, regardless of hearing capacity or other similar communication challenge that the other may face, it is important that the communicator, if he or she values being understood, ensures that the other party has access to the information relevant to the communication, even more so if they are expected to participate as equals in the communication process. This is especially important if the other person has difficulty hearing. Persons with a hearing loss may feel that their hearing counterparts are lacking in this area and they may often be right. We must try to understand why. People often try to hide their hearing loss and when they do, the other cannot understand and therefore cannot compensate in their role in the communication process.

There has been considerable talk in recent years of the wonderful innovations and development that have taken place in the world of technology. Many of these technological developments have had an enormous impact on persons with a hearing loss, opening a whole new world of interaction between people over the internet. Such tools as the ICQ has opened communication highways throughout the world. Deaf, deafened and hard of hearing individuals have been able to use these tools to finally gain access to countless services and limitless sources of information. However, this may have overshadowed our attempts to understand and improve our understanding of the one-to-one, face-to-face communication between two individuals. What happens when one of the two individuals can only hear a fraction of the words being said by the other? And is not the most important component of communication the face-to-face interactions with facial expression and body language?

But before we begin, I would like to play a little game with you. We will let our imaginations wander. I will present you with a number of situations which I will ask you to imagine for yourself. You may be as brief or elaborate as you wish but spontaneity is important. If you change your mind, you may want to remember that later.

Icebreaker: Path, Woods, Cup, Fence, Bear, Telephone, Lake, House.

I have always found this to be a fun and revealing test and I hope you were able to laugh with it. However, I would now like to ask you: "Would your answers have been different before your hearing loss? And if so, how?" I do not expect you to answer these questions now, in public but ask you to answer them for yourselves and think about how they reflect the changes that have occurred in your life as a result of your hearing loss. My hope is that this understanding of changes in your perception of your immediate environment combined with an understanding of the changes in the communication process will help you, and your family, friends, peers and employers find communication strategies that clarify the causes of miscommunication and offer solutions that alleviate frustrations experienced by both parties.

I would like to explore these ideas with you. Loss of communication is the primary impact of hearing loss. This loss of communication manifests itself in two ways. The most obvious is the inability to hear that results in the hard of hearing persons reduced access to the full context of the conversation. A less obvious effect is the change in the manner of organizing and communicating information.

I am sure we can all share experiences, both humourous and less so, that we have lived, and the consequent frustrations, anger and isolation.. However, it is not my intent here to talk about the emotional impacts of hearing loss. I do not plan to address the changes in the relationships between the persons who is becoming hard of hearing or deafened and others, either in the workplace or with family and friends. I believe these topics have already been discussed at length by others. It is rather my intent to discuss the mechanics of verbal communication and the changes that occur with hearing loss. The intended result is twofold:

1. If we understand what is actually happening with our use of words as a result of the hearing loss, we will be in a better position to make more efficient use of those words.
2. When both hearing and hard of hearing persons realize that there is a mechanical process that is changing and understand how this process is changing, we will tend to become much less frustrated with each other.

The substance of this paper originated in my personal experience as a hearing mental health counsellor trying to understand why my "proven" clinical skills appeared to become inefficient with a person with a hearing loss. I could not understand why clinical skills that had proven successful in the past now appeared inefficient. It finally occurred to me that the problem might not be with the counselling techniques but rather with the process of communication between myself and the client. Although the client and myself obviously understood each other, felt that the client/therapist relationship and trust was established, wanted to continue the process, at some point, communications broke down. I no longer knew what was the focus of the client’s concerns and decided to explore the communication process. I will not delve into detail about that specific situation but I will say that research into that led me to some relevant observations about communication with hard of hearing individuals. That is what I would like to share with you at this time. I should add that, at very early stages of this endeavor, I presented these ideas to a group of couples where one of the partners was experiencing a hearing loss and, although at the time little research has been completed, they all supported my observations with regards to the reason for the breakdown of communications. That convinced me to expand my observations to progressive hearing loss as well as to early onset deafness.

Some of what I will present at the beginning of this session may appear technical and scientific but please don’t let that deter you. It is meant to show that there is scientific research that supports what I am saying and I will try to present that information in such a way as to build up to the more important content, the practical knowledge that will facilitate day to day communication.

Hearing loss has a dramatic impact on daily verbal communication between individuals, be it in the context of personal family life, the work environment or social relationships. It is important to understand how communication is affected if we are to find ways to reduce the frustrations of all parties involved. When we understand why communication is breaking down, we can compensate for that and reduce the frustration experienced by all.

That being said, let us look at concrete examples of the communication process. I have tried to develop visual examples of changes in the communication process that result from hearing loss and the impact on the thought processes. Let us look at a sentence that would be quite normal and acceptable in most conversations between hearing individuals.

Last night I saw my brother who told me that he had just got back from Tuscany where he had a wonderful trip

SLIDE # 1

What happens to this sentence when the listener experiences a hearing loss? If the hearing loss is minimal, the listener may miss a few words and hear something like this:

Last night I saw my brother who told me that he had just got back from Tuscany where he had a wonderful trip.

            week                sister               she              Germany            she

SLIDE # 2

As the loss of hearing progresses, the number of words that can be misunderstood increases to create an effect similar to the following:

week

month she called our father them Italy found

That year he met his mother him she heard Germany she sailed ship.

Last night I saw my brother who told me that he had just got back from Tuscany where he had a wonderful trip.

One day we asked her sister us they Hungary they heard dreadful song.

time her

SLIDE # 3

For a number of the words expressed, the person with the hearing loss will have to decide between a number of possibilities before coming to a conclusion about the actual meaning of what was expressed. The person with a hearing loss will have to consider a number of options before making an "educated guess" at what was actually said before he can begin to formulate a response. If the understanding of only one of the primary elements is wrong, the person with a hearing loss risks major embarrassment by answering completely off topic.

It is important for both hearing and hard of hearing individuals to understand that this slows the communication process. Whereas a hearing person can usually be reasonably certain of the conclusion of the sentence well before it is fully expressed the hard of hearing person must wait until the other has finished speaking before attempting to put the pieces together in the hope of having made the correct guesses. This may only be fractions of a second but still considerably more time than what the hearing person requires to process the same information. Only then is the hard of hearing individual able to begin formulating a response. By then it is likely that the hearing individual has either become frustrated at the lack of response or gone on to formulate a new idea. Chances are that the hearing person will feel that the other is just not interested and gives up in frustration. On the other hand, the person with a hearing loss will feel frustrated and stupid. The result is a breakdown of communication and mutual isolation for both parties even though both may very well know that they share an understanding and positive relationship.

Hearing individuals communicate in a linear fashion. The individual who undergoes a hearing loss also experiences a change in the communication process. As the hearing loss progresses, the communication becomes less linear. Where in the hearing sentence, all the elements are presented in a linear fashion, to such an extent that we can usually predict the end of the sentence before we have heard it, when there is a hearing loss, some of the elements are lost and the listener must compose with partial information. The linear aspect is lost and the person with a hearing loss must begin to improvise, to compose with a number of variables that could fit into the context and make grammatical sense. However, they may differ significantly from what was actually said and lead to significant misunderstanding.

There has been scientific research that suggests that this change in mode of communication is not only due to changes in the quantity of information perceived but also in the way the brain actually processes that information. Studies suggest that, as hearing loss progresses and the perception and expression of language is affected there are changes in the area of the brain that processes the information. More research is required but some neurological studies indicate that as the perception of language changes, the part of the brain that processes information also changes. It would appear that the processing of linguistic information moves from the part of the brain that processes auditory information to that which processes visual information. This may be explained by the fact that, in communication, one makes greater use of the eyes for speech reading or sign language for example, than of the ears. The important aspect of this information is that the communication problems that occur are not the result of ill-will by either the speaker or the listener. They are in great part due to changes in the way the body and the brain process that information. It is not a matter of choice or of self-indulgence, it is a matter of physiological changes that occur in the body, primarily in the brain as a result of the hearing loss.

I hope that these illustrations help you understand what happens to communication between a hearing individual and a person who is experiencing a hearing loss. The most important factor to remember is that neither is at fault. That is important to note because both the hearing individual and the individual experiencing a hearing loss, for lack of understanding the situation, can easily develop feelings of frustration and resentment towards the other. That is the major reason why hearing loss can destroy what may have been sincere, caring and long-lasting relationships.

Aside from the linear/non-linear aspect to communication, we must also explore the concept of communication context. That is, communication can occur in high context or in low context. What does this mean? I refer to E.T. Hall and his writings in Beyond Culture. He studies high-context and low-context communication between individuals.

Let me try to explain the difference. In high-context communication, all or almost all of the information is included in the formulated statement with the words that are spoken. The combination of the words expressed and heard contain all the relevant information necessary for successful communication. In low-context communication, much of the information is implicit and not necessarily expressed as spoken words. This is what happens when hearing loss limits the capture of spoken words. Whereas the speaker may have included all the elements to clarify the context relevant to the communication, the listener, being hard of hearing, only captures a portion of that information. The context then becomes implicit and the listener must imagine, assume, guess at a major part of the information in order to try to understand the detailed communication.

Another aspect that needs consideration is that, as hearing individuals, we are used to being provided with all the information in context. As a result, we have lost our ability to use intuition and body language as a means of communication. I believe that persons who experience a hearing lost must automatically learn to re-develop those skills and to trust them. These skills may not be infallible but they certainly comprise a significant component of the communication process.

When a person experiences a hearing loss, much of the information provided by speech is lost and the individual must rely on implied or deduced information. That is the need to choose between the different possibilities of words as shown above with the sample sentences.

As you can see, the non-linear and the high/low context are very closely related. As one loses hearing, one must compose with fewer elements of the conversation. This forces one to forego the linear communication process and adapt to a non linear manner of communication. Simultaneously, the individual with a hearing loss must also adjust the manner in which the information is stored and processed. There must always be an opportunity to substitute one detail of information for another which may be a very subtle variance on the basic theme yet may have a major impact on the fundamental communication.

In all fairness, we should also try to understand this situation from the perspective of the hearing person: spouse, child, friend or colleague. The hearing person also experiences frustration at the breakdown of communication with a person who is a valued family member, friend or colleague. That frustration is just as real as that experienced by the person with a hearing loss. Is it easy to imagine the other, hearing, thinking these thoughts:

"I am frustrated with trying to communicate with you. I have done nothing wrong. I can hear. I can communicate. I am trying. You are the one who has a problem! You are the one who is defective and makes me feel insufficient, but I am normal!! Why should I feel bad for being normal? How should I know what to do differently? You're the one who has changed." That is a valid perspective. I am sure many individuals have felt that way at some time or another.

However, we must all remember that the hearing spouse or colleague is dealing with a communications problem with a single individual while the person experiencing a hearing loss is dealing with the communication problem with everyone they know. The person with a hearing loss is also dealing with all the issues around loss and grieving. Until one experiences the loss, one has most likely believed many of the common concepts of disability as a deficiency. How then to reconcile these long held concepts with the fact that they now apply to me? I have become deficient. I have become a lesser person. It is therefore my responsibility, my fault.

Logically and in a politically correct environment, we all know that this is dreadfully wrong, that both the perspectives presented above are dreadfully wrong. Yet, in serious introspection, we all know that they are the ones that prevail initially within ourselves, however hard we try to distance ourselves from those feelings.

I do not believe that we will ever truly be able to discard those feelings. They are real and we must learn to deal with them. They only become frustrating and troublesome when we do not understand them. And, understanding them does not mean removing them or eliminating them. It means first and foremost being aware of them. It also means accepting them as legitimate and normal. No one is to blame. No one is the bad guy. These are all legitimate feelings that arise from an unexpected and misunderstood situation. Unfortunately, there usually occurs a considerable amount of pain and frustration before the parties begin to understand that there is a physical explanation behind it all.

How do we create an awareness that will help understand the situation before such feelings develop? And, once we understand the nature of the problem, how do we remedy, reverse the effect of the pain and misunderstanding that has already occurred? One must reflect back on upon the situation that created the stress and try to understand what happened, but in the context of the new understanding. It should then be relatively easy to forgive and forget, opening the door to new complementary communication and self-acceptation.

I realize that I have not offered solutions to the communication challenges people face as a result of a hearing loss. I hope that I have contributed to a better understanding of what happens in the process and that this will help reduce some of the frustration and other negative feelings that result from the challenges of a hearing loss.