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.

Categories: Psychology, Psychotherapy