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Hearing and understanding are not the same

– Sarah Sparks

Hearing and understanding are not the same. Hearing sound is not just about the ear. AN image of a white woman with black pulled back hair holds a hand behind her ear.

Deaf and hard of hearing professionals who use hearing technologies sometimes find ourselves in challenging situations. Whether at conferences, in daily work environments, or in other professional settings, we encounter frequent misunderstandings about our hearing abilities. At times, hearing colleagues mistakenly believe that we understand everything that is said so long as we have heard it. We might need to advocate extra strongly for ourselves when a conference organizer declines to provide American Sign Language interpreters, CART services, FM systems or other accommodations because we have access to sound. Colleagues who see us every day might assume that we have access to information when we do not: that we understood an oral exchange simply because we heard it.

The following is repost from Sarah’s blog and you can see Sarah sign her blog in ASL at this link.


Family members of deaf and hard of hearing (DHH) people sometimes ask me questions like this one: “My deaf child seemed not to hear when I asked if she finished her math homework, but she understood when I said, ‘Dinner is ready!’ Why did she hear one but not the other?”

Like many DHH people, I have experienced hearing without understanding. As an audiologist and cochlear implant user, I know to expect this from myself. But awkward situations do occur sometimes. I might find out that a neighbor spoke to me in the hallway and now believes that I’m rude because I didn’t answer. Or a friend thinks that I don’t care about their problem because they mentioned it while I wasn’t looking and I didn’t catch all of what was said. Or a family member is confused because I understood, “What movie do you want to watch?” but missed, “Could you do the laundry tonight?”

Explaining, “I heard it, but I didn’t understand it,” can be a challenge. Most people, including our hearing friends and families, have never had to think about the differences between hearing and understanding. What are those differences, anyway? To answer that question, we need to consider the following:

Hearing devices do not provide “normal” hearing. Hearing aids, cochlear implants, and other devices are great technologies. Many DHH people use them for access to sound, but they do not provide “normal” hearing. DHH people have more access to sound with hearing devices than we have without them, but these technologies do not work like eyeglasses that correct to 20/20 vision.

Hearing is not just about the ear. We hear with our brains, not just our ears. Hearing aids and cochlear implants do not repair damage to the tiny nerve cells in the inner ear, the bones in the middle ear, and other parts of the ear’s anatomy that may be affected. Because of this, DHH people who listen through hearing devices do not necessarily receive the same sound input to the brain as hearing people.

Hearing that sound is happening is not the same as processing sound. Determining where a sound is, how far away it is, what kind of sound it is, and whether it is different from other sounds: all of these are possible because of auditory processing in the brain. When a hearing person is listening, they have access to subtle auditory cues. These are variations in sounds that we need for differentiating one sound from another. They play an important role in auditory processing. Even with hearing devices, most DHH people will miss some of these cues. In some situations, these cues are missing for hearing people too. Have you ever struggled to understand someone speaking through a megaphone, intercom system, or out-of-tune radio? Hearing a spoken message does not necessarily mean that all of its information was accessible.

What might happen if a DHH person heard the message, but some of the information in it was not accessible? A few examples:

  • Misunderstanding words and sentences: the DHH person heard, “The samurai” instead of “The sand is dry.”
  • Misunderstanding the tone of the message: the speaker was excited, but the DHH person heard their tone of voice as angry.
  • Difficulty hearing in background noise: the speaker’s voice seemed distorted by the noises in a restaurant or at a party, and the DHH person did not hear the words clearly.
  • Perceiving a sound as far away when it is nearby: the speaker was near the DHH person in the hallway, but the sound of their voice seemed farther away. The DHH person did not know that the speaker wanted their attention.
  • Perceiving two similar but different sounds as the same: the DHH person consistently hears /m/ and /n/ as the same, so words like “moo” and “new” also sound the same.

Listening for understanding requires cognitive effort. Auditory processing isn’t the only thing that the brain does with sound. Language processing is a whole other topic for another day (and spoken language is not the only kind of language!). For now: making sense of sounds and understanding their meanings within a spoken language requires effort and energy from our brains. That effort is greater for DHH people who use hearing devices because the auditory input that we receive is not the same as hearing people receive. Noise in the background means that even more cognitive effort is required for listening. When a person has to use more cognitive resources to listen, their ability to comprehend and remember auditory information decreases.

Think of it like the gas tank in a car: when the road is clear and you’re driving at a steady speed with no delays, you will use less gasoline than you would when driving the same distance in a rush hour traffic jam. For most hearing people, daily listening involves clear roads and steady speeds with a few pockets of occasional traffic. The day ends, and a new day begins with a full tank of gas. But for DHH people, there are fewer clear roads. The day is full of traffic jams and roadblocks like background noise, lack of access to visual cues, and complex listening situations where auditory information is missed. The day ends, but our gas tanks never get refilled completely. Our hearing coworkers and classmates might be ready for a nap by the end of a long day while we were exhausted and in need of a listening break (and maybe a nap too!) by noon.

Why did the DHH person in your life hear what you said just now but didn’t seem to hear you five minutes ago? Maybe they heard you talking five minutes ago but didn’t know that you were talking to them. Maybe because they thought you were talking to someone else, they opted to save some of their listening energy for later. Maybe they heard what you said five minutes ago but another sound was happening at the same time and their brain prioritized that sound instead. Maybe the speech sounds of what you said five minutes ago were more challenging to understand than the speech sounds of what you said just now. Maybe the DHH person is exhausted from a long day of nonstop auditory input, and what you said five minutes ago required more listening effort than what you said just now. Or maybe you spoke more softly five minutes ago and they didn’t hear you at all. There are many possible reasons that a DHH person might not have understood a spoken message.


A smiling, young white woman with glasses wears her dark hair back to show her cochlear implant.

Dr. Sparks holds a clinical Doctorate in Audiology (Au.D.) from Gallaudet University. She is the founder of Audiology Outside the Box, an audiologic counseling and aural (re)habilitation-focused telepractice. She also works part time at another clinic, providing cochlear implant, hearing aid, and diagnostic testing services. Currently, she is studying at Gallaudet for a Ph.D. in Hearing, Speech, and Language Sciences. Her clinical and research interests include pediatrics, vestibular assessment and rehabilitation, cochlear implants, the audiologist’s role in counseling and self-advocacy skill development, and audiology services provided in American Sign Language. Her Ph.D. dissertation research will focus on vestibular dysfunction and its impact on deaf/HoH children.

Making your in-person and remote workplaces accessible for your deaf/HoH colleagues

The new year brings a fresh start to our lives; it’s a natural time to reflect on the year past and make plans for the coming year. In what is becoming a The Mind Hears New Year tradition (see posts from 2019 and 2020), we have updated our list of recommendations for making your workplace accessible. The listing now includes best practices for remote meetings, a format that dominated our professional interactions in 2020 and will play a role in ‘normal’ operations going forward. While many presume that remote work increases accessibility for deaf/HoH, this is not always the case (see post on suddenly remote teaching and post on accommodating a pandemic). You can view and download the full list of recommendations for making your in-person and remote workplaces accessible for your deaf and hard of hearing colleagues at this link. Here we outline the best approach for increasing workplace accessibility and provide links to blog posts that explore particular aspects in detail.

Universally design your workplace: Our spaces become more inclusive for all when we improve access for any subgroup of our community. Consequently, by increasing the accessibility of our workplaces for our deaf and hard of hearing colleagues, we create a better workplace for everyone (see post on the impact of the Mind Hears). This includes hearing folks who have auditory processing disorder, use English as their second language, or are acquiring hearing loss during their careers. Chances are that someone in your department has hearing loss, whether they’ve disclosed this or not, and will benefit from your efforts to make your workplace more accessible (see post on Where are the deaf/HoH academics). This is why you should universally design your workplace now and not wait until someone who is struggling asks you to make modifications.

Sharing the work: With a google search you can find several resources on workplace accessibility for deaf/HoH employees, such as the Hearing Loss Association of America’s (HLAA) very useful employment toolkit. One drawback of these resources is that nearly all of the suggestions are framed as actions for the deaf/HoH employee. While deaf and hard of hearing academics need to be strong self-advocates and take steps to improve their accommodations, our hearing colleagues can help us tremendously by sharing the work and not expecting us to bear all of the burden of creating accessible workplaces. Speech reading conversations, planning accommodations and making sure that technology/accommodations function is never-ending and exhausting work that we do above and beyond our teaching, research, and service (see post on making an impact at high stakes conferences, post on conquering faculty meetings, and post on teaching very large classes). Your understanding and your help changing our workplaces can make a huge difference to us.  For example, if a speaker doesn’t repeat a question, ask them to repeat, even if you heard the question just fine. The people who didn’t hear the question are already stressed and fatigued from working hard to listen, so why expect them to do the added work of ensuring speakers repeat questions (see post on listening fatigue and post on the mental gymnastics of hearing device use)? Repeating the question benefits everyone. The changes you make today can also help your workplace align with equal opportunity requirements for best hiring practices (see The Mind Hears blog posts about applying for jobs when deaf/HoH here and here).

One size doesn’t fit all: If a participant requests accommodation for a presentation or meeting, follow up with them and be prepared to iterate to a solution that works. It may be signed interpreters (see post on working with sign interpreters and post on networking with deaf colleagues who use interpreters), oral interpreters, CART (see post on Captions and Craptions), or FM systems (see post on Using FM systems at conferences). It could be rearranging the room or modifying the way that the meeting is run. Keep in mind that what works for one deaf/HoH person may not work for another person with similar deafness. What works for someone in one situation may not work at all for that same person in another situation, even if the situations seem similar to you. The best solution will probably not be the first approach that you try nor may it be the quickest or cheapest approach; it will be the one that allows your deaf and hard-of-hearing colleagues to participate fully and contribute to the discussion. Reaching the goal of achieving an academic workplace accessible to deaf/HoH academics is a journey.

Want to be a better ally and make your workplace accessible for your deaf and hard of hearing colleagues? Follow this link to read our list of recommendations. We welcome your comments and suggestions either to this post or directly within the document at this link.

A brown-skinned woman wearing a blue patterned dress, a gray headwrap, and hearing aids sits on a bench looking to the right. To her right, a white cane stands upright.

“Moving Together”: Or Researching Health Care Access as a Disabled Academic

–Arrianna

This is a repost of post published on 11 March 2018 by Dr. Arrianna Planey on her blog. You can see the original post at this link and her gorgeous blog at this link.

As I work on my dissertation, one question arises over and over: whether my disability status as a researcher matters, and how much.

I vacillate between foregrounding my experience as someone with disabilities and downplaying my disability status. That choice depends on the context. If my credibility as a researcher is in question, I’d rather people not focus on my social status, because the “ideal” academic researcher is still white, non-disabled, and well-off. The “view from nowhere” is the “ideal” academic’s gaze.

A brown-skinned woman wearing a blue patterned dress, a gray headwrap, and hearing aids sits on a bench looking to the right. To her right, a white cane stands upright.

But I am compelled to foreground my experience as a Black woman who is also deafblind when I talk about why I choose to research health care accessibility and help-seeking among disabled adults in the U.S.- especially people with sensory and mobility-related disabilities. My interest in this research is driven by my own experience- the foregone care, the delayed diagnoses, and systemic barriers that undergird those outcomes.

Moreover, it is necessary to contextualize those systemic barriers with the fact that many disabled adults remain “dependents” due to a confluence of policies that simultaneously penalize benefits recipients for not having enough of a work history and penalize those who have too many assets. For further context, the recent push for Medicaid “work requirements” in states across the US (even states with Democrat governors), means that disabled people potentially face worsening access to health care- a particularly pernicious circumstance given that their access to Medicaid may be predicated on having a diagnosis that affirms their disabled status, which presumes access to health care. I mention this because disability status is not necessarily the same as one’s medical status- estimates of disability prevalence based on diagnosis by definition undercount by excluding people who do not have access or have not procured a diagnosis that corroborates their disability status.

For this reason, my project looks at both health care providers- their location decisions, their clinical practice- AND patients as I study health care access as a process. In the U.S. health care providers play a key gatekeeper role in the medico-legal complex that comprises the social safety net.

For this reason, my project looks at both health care providers- their location decisions, their clinical practice- AND patients as I study health care access as a process. In the U.S. health care providers play a key gatekeeper role in the medico-legal complex that comprises the social safety net.

More specifically to the field of Geography and the subfield of health geography, the question of the researcher’s subject and social position is important methodologically. Currently, much of the debate over emergent qualitative methodologies- e.g. ‘mobile methods’- presumes that the researcher is able-bodied. Within the ‘new mobilities paradigm’ (Sheller & Urry, 2006), the ‘walking interview’ is a popular method for capturing participants’ experiences of place. However, much of the literature on the ‘walking interview’ provides methodological guidelines and considerations that assume that (1) walking is the normative mode of mobility, (2) that the researcher can balance managing the recording equipment with conducting the interview (no fine motor skill constraints or no need to use a cane or operate their wheelchair), and (3) they assume a power imbalance between the researcher and participant on the basis of disability status (Sheller & Urry, 2006; Finlay & Bowman, 2016; Hein, Evans & Jones, 2008).

Parent (2016) makes an important intervention in this literature, providing her experience as a researcher who uses a wheelchair as she uses mobile methods in her work. She found that her status as a disabled person was overlooked by even disabled research participants, with whom she initially corresponded via email. One blind participant suggested meeting at a coffee shop, assuming that the researcher was able-bodied. The coffee shop was not wheelchair accessible, and the author’s disability status became the initial subject of conversation, rather than the respondent’s sense of place in their activity space. Later in that same interaction, the author made a comment to the tune of “This is going so smoothly!” to which the blind participant replied

“Yes, it’s true. It seems to be going well, but you know, I can never say that to myself. I always have to take one step at a time. Too often I thought it was going well, and then I hit my head on something. Even when you think it’s going well, you can go one step at the time and think ‘OK, this is good. My foot and my face didn’t hit anything. I am fine.”

(Parent 2016, 528)

This foregrounds the importance of intersubjectivity, a concept taken for granted in the broader literature on ‘mobile methods,’ which emphasizes “moving together” without considering that each person in an interaction may have a different form of mobility that structures the interaction itself (Novoa, 2015). For example, in the above example, the interview was punctuated with the researcher’s verbal descriptions of the path to enable the blind participant to navigate the space safely. They had to “move together” through spaces that were not designed with them in mind.

Moreover, a human geography tradition that centers disability as a variation in human experience is one that moves from thinking of space in  in terms of what is empirically measurable, or that which ‘contains’ the social toward a relational and dynamic understanding of space that is constituted by social relations (which are ever shifting). Casey (2001) sums it up nicely in the term ‘co-ingredience’- “There is no place without the self and there is no self without place” (pp 684). The social scientific methods that best apprehend these dynamics in space are what Sayer (1992) terms to be “intensive” methods, which tease out the working of processes among a small number of cases with greater attention to context and applicable social theories that may inform their interpretation. They must begin with an understanding of social structures as conditions of possibility (context-dependence). These methods may be coupled with quantitative data collection and analysis, such as qualitative GIS and travel diaries. However, we must return to “moving together” with a greater attentiveness to intersubjectivity- between disabled and non-disabled people, between disabled people (because disabilities are heterogeneous*), among networks of people within a neighborhood, and between caregivers and care recipients.

* Said heterogeneity among disabilities (lived experiences with disabilities, as well as comparative types and degrees of “limitations” across social spaces designed for and by non-disabled people) is overlooked or ignored in law and policy regarding “accessibility” for disabled people in public spaces.

References:

  1. Chouinard, V and Grant, A. (1995). On Being Not Even Anywhere Near ‘The Project’: Ways of Putting Ourselves in the Picture. Antipode. 27. 137-16
  2. Finlay, J.M. and Bowman, J.A. (2016). Geographies on the move: a practical and theoretical approach to the mobile interview. Professional Geographer 69(2), 263-274. 
  3. Hein, J.R., Evans, J. and Jones, P. (2008). Mobile methodologies: theory, technology and practice. Geography Compass 2(5): 1266-1285.
  4. Merriman, P. (2014). Rethinking mobile methods. Mobilities 9:2, 167-187. 
  5. Novoa, A. (2015). Mobile ethnography: emergence, techniques and its importance to geography. Human Geographies 9:1, DOI:10.5719/hgeo.2015.91.7
  6. Parent, L. (2016). The wheeling interview: mobile methods and disability. Mobilities 11(4), 521-532. 
  7. Sayer, A. (1992). Method in Social Science: A Realist Approach. 2nd ed. Routledge: London and New York
  8. Sheller, M. and Urry, J. (2006). The new mobilities paradigm. Environment and Planning A 38, 207-226
A dark skinned woman with glasses and head scarf smiles to the camera

Biography: My name is Arrianna Marie Planey, and I am an Assistant Professor in the Department of Health Policy and Management in the Gillings School of Global Public Health at University of North Carolina, Chapel Hill. I am a health/medical geographer with expertise in measuring and conceptualizing health care access, health and healthcare equity, and spatial epidemiology. My research and teaching focuses include the application of spatial analytic/statistical/epidemiologic methods to study interactions between health(care) policies, healthcare access and utilization and underlying, population-level health inequities, and identify points of intervention at structural- and system-levels. At the core of my research agenda is equity in access and outcomes, with attention to the intersections of race, class, gender, and disability status. I earned my PhD in Geography from the University of Illinois at Urbana Champaign, after earning my Master’s and Bachelor’s degrees at the University of Chicago and the University of California, Berkeley respectively

Applying for jobs – When should you reveal your deafness?

-Ana

Graduate students, postdocs, and other academics applying for jobs face a hypercompetitive job market, limited geographic options, and a potentially withering assessment of their research productivity, teaching abilities, and overall potential. If you are deaf or hard of hearing, add to this scenario the weighty decision of when you should reveal your deafness during the job application process. In the United States employers are prohibited from discriminating against job applicants based on disability. However, not all countries offer this protection, and even in the U.S. many of us worry that unconscious, or even conscious, bias can often taint the work of search committees.

So what is a deaf/HoH job applicant to do? Do you reveal your deafness in your CV? Once you are offered an interview? When you are on site for an interview or visit? Do you reveal it to the search committee chair? To the human resources department? Do you request accommodations when invited for an interview, or do you wing it? Answers to these questions may vary depending on your degree of hearing loss, the ethos of the institution or position you are applying to, and your personal style. Answers may even vary depending on whether you are applying for a job today or several years ago, and your perception of the societal climate at the time.

The Mind Hearswould like to learn from academics who have navigated (or are navigating) the job search phase about the choices they have made, what they wish they had done differently, and what they have found particularly effective. Please help us out by answering this short survey (5-10 minutes) about your experiences. The survey will be available until July 18, 2019:

https://forms.gle/BWVjspLQAhuZLSreA

We would like to collate this collective knowledge and experiences into a compendium of anonymized comments to be posted at the end of summer as a blog post. By sharing the strategies we have tried, we hope to create a resource that can serve as a guide for all of us, and particularly for the upcoming generation of students and postdocs.