How society defines deafness is important because the description defines a deaf person’s social identity and impacts their ability to access the world around them. There are different viewpoints to explain ‘deafness’ – one view defines a person by their (in)ability to hear, the other by a person’s inability to access the world around them. We have added another model that focuses on how some deaf people prefer to communicate. By explaining the different perspectives on deafness we hope to encourage readers to define deafness differently.

1. The medical model of deafness:

The medical model is the most prevalent view and focuses on (the lack of) ability to hear. It is seen as an impairment that affects a person’s ability to function in society. The medical model does not distinguish between the person and what is ‘wrong’ with them.

Healthcare industries dedicated to correcting deafness have grown significantly. In 2018, the hearing aid market was valued at $5.1 billion. Other services include audiology, speech therapy, educational psychology, teachers of the deaf, cochlear implant departments and so on.

Hearing Loss ‘categories’:

The medical model of hearing loss and deafness focuses on correcting the difficulty in speech recognition. Audiology assessments put hearing loss/deafness into four categories:

• Mild: Loss of hearing resulting in difficulty picking up softer speech sounds such as f,s and th.
• Moderate: Loss of hearing which results in losing additional speech sounds and shapes (e.g. m,b,p), particularly in noisy places.
• Severe: Loss of hearing results in losing all speech sounds and some louder sounds e.g. a dog barking.
• Profound: No hearing other than being aware of exceptionally loud noises such as an aeroplane taking off or roadworks drill.

 People with mild deafness

may experience some difficulty understanding speech, especially in noisy situations.

May benefit from a hearing aid and may lipread.

May no longer hear sounds such as birdsong or people whispering.

 People with moderate deafness

may experience difficulty understanding speech without a hearing aid, even in ordinary conditions.

Most can use a voice telephone with an amplifier and/or inductive coupler if they wear a hearing aid.

May miss out on many speech sounds.

People with severe deafness

may struggle to understand speech, even with a hearing aid.

Will rely more on lipreading.

Find it difficult to use a voice telephone, even with powerful amplification. May be born severely deaf or become deaf in childhood or may have become deaf as adults.

May use Sign Language.

May not hear noises such as lorries etc. may need a textphone or videophone.

 High Frequency and Low Frequency Deafness

Deafness is rarely spread evenly across the range of frequencies used in speech. One of the most common types of deafness is the loss of high frequencies/tones. Vowel sounds (a,e, i,o,u) have a·1ow frequency, and so they may be heard, but many consonants have a high frequency sound (e.g. s,t,k,p, etc), and if they cannot be heard, then words cannot be easily discriminated from each other.

Here are some examples:

People with high-frequency deafness are only able to hear the lower frequencies, e.g. girls voices. They may be unable to hear consonant sounds

 People with low-frequency deafness can only hear the higher frequencies, e.g., women’s voices. They may not be able to hear vowels. High-frequency deafness is commonly associated with ageing.

 Sounds can build up in intensity so that there may be a sudden increase in perceived loudness to the point at which it is painful. This is known as recruitment. It can make amplification and tolerance of noisy situations difficult.

 Tinnitus

Tinnitus may be caused by damage to the hearing process associated with loud noise or ageing, but it can have other causes – an emotional upset, illness, injury or a reaction to certain medication. Any of these can over­ stimulate or damage hair cells in the inner ear, causing them to send a confused stream of messages to the brain. Some causes of tinnitus are reversible; others are not. Permanent tinnitus can be either mild or severe.

Tinnitus affects around 17% of the population. It is·not always associated with deafness, and not all deaf people suffer from tinnitus, but those who do may find their tinnitus seriously affects their ability to communicate.

 People with profound deafness

iii may find hearing aids will be of very little or no benefit..

iii rely heavily on lipreading.

ii   may use sign language.

ii   may be unable to use a voice telephone, even with amplification.

iiiii may use a textphone or videophone.

iii may not hear sounds such as a pneumatic drill, aircraft etc.

Deaf people who don’t see themselves as members of the Deaf Community

 Most deaf and hard-of-hearing people do not identify with the Deaf World.

Those who lose their hearing later in life usually do not seek to become members of the Deaf Community.

Deaf, deafened or hard-of-hearing people who use spoken and written language as their first or preferred language will identify with the hearing community/culture. The majority of these deaf people belong to the hearing community.

There are a large number of people who become deaf from birth or early childhood, but who may never develop an identification with the Deaf Community. They are likely to have hearing parents and to be educated in schools for hearing children or oral schools for deaf children. Some of these deaf people may participate in the activities of the Deaf Community, but they are not always accepted as members. While they are audiologically deaf, socially they are not.

Some parents are reluctant to allow their deaf child to use Sign Language and develop a deaf identity. They will attempt to integrate the deaf child into the majority-hearing community. Some of these children may grow up feeling lost between the Deaf and hearing communities

Hard-of-hearing people and most deaf people usually identify with the hearing community and hearing culture. However, many deafened people feel lost between the two communities.

‘Fixing’ people:

The major problem with the medical model is that everything is focused on the individual. By ‘fixing’ the hearing loss, the individual can manage in the outside world. Unfortunately, the medical model fails to take into account the impact of hearing loss and deafness in the real world. There are a number of barriers that prevent people with any level of hearing loss from achieving their potential and accessing the world around them.

The medical model also fails to explain that equipment such as hearing aids and cochlear implants only enable access to sound, not language. If aids enabled access to language, individuals would not need the additional support of speech therapy, lip-reading classes or British Sign Language.

Whilst deafness itself may not be life-threatening, most people think of deafness as an impairment to be ‘fixed’. This view can have a detrimental effect on a person’s mental and physical well being.

2. The social model:

The social model of deafness accepts that there are differences in hearing ability and the barriers preventing access to the world, need to be removed. Adjusting services to accommodate these differences removes barriers and enable access. For example, a deaf person going to the cinema would need subtitles to access the dialogue in a film.

The social model acknowledges an individual’s difference, not as a disability or something that is wrong with an individual but as a difference that needs to be accommodated. The model acknowledges factors such as unconscious bias can lead to negative attitudes and discrimination.

Disability arises when services have not been adequately adjusted to accommodate individual differences. e.g. expecting everyone to use steps – providing a ramp for wheelchair users would be a reasonable adjustment

The social model accepts that individuals are different, including the way they communicate or how they behave and focuses on addressing the barriers that prevent individuals from being part of the community. This is a more holistic approach and acknowledges that individuals are part of the wider community.

Reasonable adjustments:

Unfortunately, many services simply do not see accessibility as their responsibility. Some services take the view that they are ‘accessible’ in the sense that anyone can use their services. These services fail to understand that they need to make reasonable adjustments, so their service can be accessed and used as intended.

Failing to make reasonable adjustments applies to all areas of life including sport, leisure, council services, health services and businesses open to the public e.g. cinemas.

The social model also applies to employment. Job seekers and employees need to participate in social activities at work. Activities will include meetings, phone calls, training sessions and social events. Unfortunately, there are common misconceptions about communication that can impact a person’s involvement in the social aspects of working. However, someone with hearing loss or deafness can participate in these activities with the right adjustments, (often at little or no cost).

3. A ‘cultural’ model?

Finally, there is the cultural model of deafness. This model usually refers to individuals who are profoundly deaf and use British Sign language (BSL) for communication.

People who identify as Deaf with a big ‘D’ see themselves as part of a linguistic minority who have a rich linguistic culture. Most ‘Deaf’ community members use have used BSL from birth to adulthood and use sign language as their first and only method of communication. They usually only socialise or go to activities that involve other people from the Deaf community, as there is a common cultural understanding.

Understanding ‘deaf with a Big D ‘: A Cultural Identity

Deaf with a capital D is sometimes used to indicate those who identify themselves as part of the Deaf Community and Culture. In the UK this means:

using British Sign Language as their first or preferred language common shared life experiences as a deaf person being proud to belong to the Deaf Community, seeing themselves as part of a linguistic minority

ii    don’t see themselves as disabled

ii           being part of Deaf Culture and history

The Deaf Community

 Who belongs to the Deaf Community? Those people who:

iii   use BSL (or another national Sign Language e.g. American Sign Language)

iii may have been born deaf or become deafened in early childhood 

iii may attend Deaf Centres or other Deaf Community events

ii       some hearing people may belong to the Deaf Community e.g. hearing children/brothers and sisters of deaf parents who use BSL as their first language and are part of Deaf Culture. They will be bilingual in the spoken and Sign Language.

iii     as the teaching of BSL grows there will be an increasing number of hearing people using BSL, but will they become part of the Deaf Community? At present membership is not based on language alone.

ii    some deaf people who are brought up orally (using speech and written language) may grow up feeling lost between the hearing and the Deaf World.

 Deaf Culture

The term Deaf Culture is used to describe the way in which Deaf people behave or live. This includes:

The traditions, values and lifestyle of Deaf people Deaf people socialising together

Deaf pride, having their own identity as a deaf person a common language – British Sign Language

the partners/spouses of 85-90% of Deaf people are also Deaf Deaf

humour – jokes, folklore, storytelling Deaf art and theatre Deaf history

Organisations at local, national and international level run by Deaf people

to represent Deaf interests eg World Federation of the Deaf, Deaf sports organisations

How Deaf Culture is passed on:

iii A small percentage of deaf children have two deaf parents and there is a very small minority of deaf people who come from families with many generations of deafness. Deaf Culture and Sign Language is passed from generation to generation through these families. iii However, 90% of children who are born deaf have hearing parents, and so are raised in the hearing world. Deaf Culture and language may be passed on via schools for deaf children and deaf centres.

iii Only a minority of members of the Deaf Community acquire their cultural identity and distinctive social skills at home. Most deaf children learn about Deaf Culture in schools for deaf children and from other children.

iii Some hearing parents may be reluctant to allow their deaf children to use SSL and develop a deaf identity. Emphasising the development and use of speech rather than Sign Language and inclusive/mainstreaming in schools attempts to integrate deaf children into the majority hearing culture, rather than giving them pride in their own deaf culture, language and identity.

iii People who are bound together by similar life experiences. Sharing the same Deaf Culture. School friends often last a lifetime. Deaf people continue their association with each other and with pupils from other deaf schools by going to Deaf Centres, or by joining organisations of deaf people (e.g. British Deaf Association). Here they can meet socially, relax among friends who use the same language and take part in social, leisure and sports activities at local and national level. This may change as more deaf children are educated inclusivelv (in mainstream schools).

Deaf Schools:

People who are ‘Deaf’ are also more likely to have gone to a school for the Deaf. However, the majority of specialist deaf schools have now closed down. Most deaf children are now educated in mainstream schools. Unfortunately, this can create an isolating experience.

MK Deaf Zone focuses on the social model of deafness. We focus on helping individuals feel included and part of a community..

Terminology:

Deaf and hard of hearing people do not like to be defined by a label. Hearing ability is only one part of an individual’s sensory input. Nonetheless, there are a variety of terms that mainstream services use to describe deaf or hard of hearing individuals. The term you use when talking to someone will depend on how the individual views their deafness or hearing loss. Some Deaf people view deafness as a social identity, particularly sign language users. It is important to know the range of terms that are currently in use:

• Hearing-impaired: This term refers to a disability category that describes individuals who have lost some of their hearing.
• Hard of hearing: This term is similar to hearing impaired. It describes people with some level of hearing loss.
• Deafened: This term refers to individuals who were hearing but have lost the function of hearing. For example, soldiers who lose their hearing, are described as deafened.
• d/Deaf: This term usually refers to individuals who have severe or profound hearing loss.

Hearing impaired may be used to describe a person who is deaf or hard of hearing. However, some people dislike this phrase as they feel it is a negative term which carries a lot of stigma and stereotyping with it.

 Hard-of-hearing people, despite their mild, moderate, or severe hearing loss, demonstrate resilience. They may have been partially deaf since birth or became so later in life, yet they continue to communicate through speech, with or without amplification and lipreading, inspiring others with their determination.

 The majority of hard-of-hearing people have become so with advancing age. Their ability to read is unaffected by their deafness, except that in elderly people, many may have a dual impairment (i.e., failing sight and hearing). They often benefit from the use of hearing aid(s). Many hearing aid users in this group will also benefit from induction loops, etc.

Deafened people, who become deaf as adults, usually after having acquired spoken language, face significant challenges. Their hearing loss is total or profound, and they derive little or no benefit from a hearing aid. They often feel lost between the hearing community/culture and the deaf community/culture, a struggle that should be acknowledged and empathized with.

Deaf people (sometimes described with the lowercase ‘d’ unless at the beginning of a sentence). ‘deaf people’ can be used as a general term to include the whole range of deaf people. A deaf person may or may not belong to the Deaf Community/Culture.

Deaf people (sometimes described with the upper case ‘D’) see themselves as unique members of a cultural and linguistic group, using British Sign Language (BSL) as their first/preferred language. They share a language and a profound sense of identity that is distinct and should be respected.

Most deaf people are hard of hearing and will identify mainly with the hearing world.

Communication support:

Hearing loss/deafness can happen at any point in a person’s life. There are a range of communication aids:

• Speech-to-text

There are a number of ‘speech to text’ software options, some of which, are free. The software can be used on a smartphone, tablet or PC. Here is a list of options currently available. Of course, technology moves so fast that more and more apps come online and improve accessibility – Google Live captioning is a great example of this:

• Sign Language interpreter:

Sign Language Interpreters are professionals who facilitate communication between deaf and hearing people. Interpreters have extensive knowledge of cultural differences in English and British Sign Language. This enables interpreters to translate from one language to another to achieve linguistic equivalence. There is a national register of qualified interpreters that list over 1,000 interpreters working across the UK.

• Hearing loop:

People who wear hearing aids will use a hearing loop system. The loop picks up sounds from the room and then emits a signal that a hearing aid picks up. A loop cuts out most background noise making the sound clearer.

• Subtitles

Subtitles (or captions) are the text form of dialogue or commentary. They are, usually at the bottom of the screen in films, tv programmes or as stage text at theatre productions.

Conclusion:

This page gives a brief but detailed overview of the information that organisations need to be aware of when making services accessible. Deafness and hearing loss are complex issues that affect each person differently. In other words, there is not a one-size-fits-all approach. This is something many organisations are slowly coming to realise as their customer base shrinks. Customers want to know you have considered their needs, including those who may have lost their hearing.