Like any group, the deaf community is affected by mental illness. Compared with the mainstream population, however, deaf people often face extra challenges when seeking treatment. NAMI talked with psychologist Robert Pollard, Ph.D. professor of psychiatry at the University of Rochester and director of the Deaf Wellness Center, to learn more about the past, present and future of mental health care for deaf people.
Is there the same incidence of mental illness within the deaf community as in the larger population?
of Rochester's Deaf Wellness Center produced two public service
announcements about mental health targeted to the deaf community.
The very little research we have in the deaf mental health field tells us that mental illnesses are at least as prevalent in the deaf population as in the hearing population.
Are Axis II disorders and substance abuse more common among deaf people?
There might be a greater incidence of Axis II disorders because so many deaf kids grow up in family, school and neighborhood situations which are very detrimental to the development of normal mental health. The Axis II diagnosis of mental retardation, for instance, would likely be more prevalent among deaf people because the same medical conditions which cause congenital hearing loss may be related to other problems.
How have opportunities for deaf people improved over time?
Though the deaf mental health field began to improve around 1975, the movement can be traced all the way back to 17th century Spain.
There is a lot of literature on deafness and mental health—from as far back as Aristotle, whose belief that since deaf people cannot talk, deaf people cannot think—prevented deaf education from ever being attempted until the late 1600s. At that time, Spanish inheritance laws required that heirs be literate. A very wealthy Spanish family needed to teach their deaf kids how to read so that they could inherit the family's property, and this is one of the origins of deaf education.
Aristotle said that since deaf people cannot talk, deaf people cannot think. This statement prevented deaf education from even being attempted for centuries.
In the very late 1960s, linguists began to recognize that American Sign Language (ASL) was a legitimate language and, by 1975, books and articles began to appear which put forth the idea that not all deaf people live with mental illness.
Since that time, and even up to this day, the vast majority of literature in the deaf mental health field is still undoing the damage that was done prior to 1975. Few people in the U.S. other than the University of Rochester Deaf Wellness Center or Gallaudet University are doing forward-thinking research. One of the questions we’re looking at is how you would adapt existing types of psychotherapy and make them work for the deaf population.
What keeps deaf people out of treatment?
Most clinicians don't know the ways that deaf people are different from hearing people but still normal from a deaf population perspective.
The first thing that keeps people out of treatment is the lack of providers who have sufficient knowledge of ASL and how it differs from English as well as the basics about deaf education and development. They also need to understand the similarities and differences deaf people share—or do not share—with hearing people.
Qualified practitioners also have to also know how mental illnesses can present themselves differently in deaf people than they might in hearing people. Unlike hearing people who exhibit “clanging”—or putting together language based on structure rather than meaning—deaf people might put together a sentence that uses the same ASL hand shape.
How do problems with literacy factor into treatment challenges?
Literacy limitations are important, but even more crucial is what I call the "fund of information difference" that most deaf people manifest, meaning the amount of accumulated factual knowledge. Deaf people, who do not acquire information by radio or TV soundtracks, often have significant gaps in basic information compared to hearing people.
Concepts like "side effect," "mania" and "anorexia" are not commonly known by deaf people due to differences in fund of information.
For example, it is quite typical for an average deaf patient not be familiar with concepts like “side effect” or “anorexia.” I was just doing an interview with someone the other day who had never heard of anything like my description of mania. We often have to teach the deaf person about these concepts before we can ask them questions.
So do common misconceptions among mental health practitioners—about literacy and language—keep some deaf people from seeking treatment?
Exactly. If I can’t trust my local mental health center to offer me someone who’s competent to deal with me, why should I go?
The number one issue in deaf people not getting treatment is trust.
The number one issue that prevents deaf people from getting treatment is trust. And it's a well-placed mistrust because a) there are not enough clinicians skilled in treating deaf people and b) because of the long history of misdiagnosis and mistreatment of deaf people. I’ve seen it happen many times where a deaf person is misdiagnosed as mentally retarded because of the fund of information gap, inappropriate psychological testing or limited literacy. Or I have often seen deaf people be misdiagnosed as psychotic because the notes they are writing to the doctor reflect ASL syntax.
The mistrust that many people in the deaf community feel about hearing people who have medical authrity is very well known. For all these reasons, we need more ASL-fluent and otherwise qualified clinicians.
Aren't there some positive developments for deaf people because of the Internet and videos?
Yes, deaf people use webcams to create "vlogs"—video blogs about all sorts of things including mental health experiences, which is helping the fund of information problem. I just finished a project funded by the AP Foundation that produced two television commercials in ASL on the topic of depression awareness and the importance of seeking help for depression. They were broadcast on local television in Rochester and got a tremendous response which we saw reflected in our intakes for clinical services at the Deaf Wellness Center.
reason why a deaf person can’t pursue a master’s degree in clinical
psychology or go to medical school and become a psychiatrist.
What's another positive development in the deaf mental health care field?
Compared to 10 years ago, more and more deaf people are pursuing degrees in the mental health services field. The University of Rochester School of Medicine and Dentistry, the National Technical Institute for the Deaf at the Rochester Institute of Technology and Gallaudet University are part of a new task force dedicated to opening the doors of health careers for deaf people.
Training more and more clinicians competent in the care of deaf people, including young deaf people, will move us closer to solving some of the mental health problems affecting that community. There's no reason why a deaf person can’t pursue a master’s degree in clinical psychology or go to medical school and become a psychiatrist.
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