Voices in the Silence
January 16, 2008
Mental health services, in the young deaf community, have many issues pertaining to providing adequate care. Living in profound silence, 43% of deaf youth struggle to prevail in life with mental illness. Counselors and psychiatrist are sacrificing to meet their unique needs. This is a look at the young deaf culture, their mental health dilemma, and the sacrifice developing to accommodate the silent world.
Voices in the Silence
“The voices tell me to cut myself. It makes me feel… feel as if I have control over just one thing in my life.” Suzann replied in sign language, when I signed to her about her schizophrenia and cutting ritual. She is 17 years young. A prominent student in high school, she also was in several extra-curricular activities. The schedule in front of me was staggering. “When I take my medication I have better days. I like to stay busy; it helps me to deal with the inner problems,” Suzann continued. “I am lucky; we have a counselor at school, which referred me for services, so many people receive no help at all.” She is not alone fighting a sever mental illness. Her plight echoes through out the young deaf community.
Mental illness issues affect 43% of the deaf youth in America. (Eldik, 2004) The illnesses range the full gamut, from depression to schizophrenia; all of which are very hard to treat in the hearing community, under the best of circumstances. Medications and therapy treatment assigned for the youth must be changed and altered to get the right balance. Chemical consistency in the individual is remarkably different from one person to another; balance in the brain enzymes and medication application can incur many trial and error efforts to discover what works best, with the least side effects. My own treatment and observations through the last 26 years of mental illness still takes time and proper communication with the professionals to achieve and maintain a feasible balance. Trying and accommodating the various medications in different dosages over time to find a combination that stabilizes the illness takes patience, trust, and communication. Continuing close relationships with psychiatrist and therapist help as medications build a tolerance in the brain and are changed to have continuing good results. This is an intricate dance between the patient and the professionals.
Communication is Vital
The young deaf community are susceptible to challenges the hearing world seem to be unable to conceive. This is manifest in the communication situation. Communication interferences in the postlingually deaf subjects determine a predisposition to mental distress. The subject observes the loss as more of a disability than prelingually deaf individuals do. De Graff (2002) found correlations in the prelingually deaf population as having a better self-image and quality of life than their postlingual counterparts. (DeGraff, 2002) Accordingly, DeGraff surmised the postlingual group felt socially isolated, less accepted by there hearing peers and more likely to have additional medical and social problems. Sign Language and speech reading in addition to written language are used to assess the deaf for mental difficulties. Various mental issues, in the hearing-impaired community, have no relative association with the level of imparity in the hearing. (Wallis, 2004) Internal and external manifestations studied in the subjects to determine the viability of treatment may gain the psychiatric personnel insight into the depth of illness. Truly, communication is imperative to the well being of the patient.
Progress serving this dynamic group of deaf youth marches forward. Psychiatrist, counselors, therapist, and social workers are reaching out to gather and treat this vast array of people. The loving dedication of counselors and therapist learning to use American Sign Language with their deaf patients is cause for great pride. Providing translators for deaf clients is a hard job. Fifty-six percent of the deaf in one important study were unable to find accessible mental health care for lack of translators. (Steinberg, 1998) Casework and management plans effectively in place help benefit the youth so they are able to make a fulfilling life. Positive reinforcement and patience is a virtue. Deaf who are able to read and write are often disadvantaged by linguistic barriers. The use of the English language for the deaf is very different from what a hearing person uses. The lack of use of conjunctions, prepositions, time continuum, and phrases cause many problems also in diagnosing adequately the specific symptoms of some forms of mental illness. Deaf think in pictorials and sign language, how does one ask, “Do you hear voices?” (a sign of schizophrenia) (Shapira,1999) A few moments of fast signing by a patient can be seen as a manic state rather than a change in emotion. Expressions of emotions by the deaf are also a conveyance of their language; they rely on the facial expressions and body actions to understand or express the situation. This also is at times miss-read by a well-meaning clinician. The language of sign does not have adequate words for a variety of emotions; this can pose so many issues. This is why emotional behavior and facial expressions are imperative to the deaf so they gain insight. The deeper study of kinesics in the culture would help professionals diagnose illness more effectively.
The Hope for Development
Schools and mental health agencies are encouraging the deaf to become professionals in the mental health fields. The hope for the future of the deaf culture is healthy productive individuals that direct the members of their society to prosper and strive to build a well-educated peer base. The development project in place is to increase the number of signing members in the mental health and counseling community. Adapting test for mental evaluations will also help. Time and patience are encouraged by all involved. The protocol now is to have a double evaluation before commitment, this second opinion procedure is in place to secure the diagnoses and stop miss-understandings that cause wrongful commitment.
I hope that someday the mental health of deaf youth will be as easy to acquire as it is for the hearing world. I have 26 years of experience with the mental health system and 28 years working with the deaf. I intend on having many more years ahead to continue my work. Anthropology is the study of humanity and the contemporary human diversity. I am so profoundly touched by the deaf culture as a whole. The voices in the silence are many. Deaf youth have issues. There are answers. The best of care takes time. Time takes the voices away.
American Annals of the Deaf 148:5, Eldik, V. (2004). . In Volume 148, (Spring Ed.), (pp.390-395 ). : .
DeGraff, (2002). . Mental Health Functioning In Deaf Children and Adolescents (Ed.), (pp. ). .
Shapira, N. A. MD, PhD (1999) Evaluation of bipolar in inpatients with prelingual deafness. The American Journal of Psychiatry, 156(8), 1267-1269
Steinberg, A.G. MD, Eckhart, E.A.CSW (1998, July) Cultural and Linguistic Barriers to Mental Health Services From the Deaf Consumers Prospective. The American Journal of Psychiatry, 155(7), 982-984
Wallis, (2004) Journal of Deaf Studies and Deaf Education 2004. . In (Ed.), (9: pp2-14 ). : . http://jdsde.oxfordjournals.org/cgi/content/abstract/9/1/2