Hearing Voices

This is a moving article from Karen Sinnott in The Journal via @JeminaNapier in which she talks about the experience of mental health care as a Deaf person in Ireland.

When you start to work with Deaf people with psychosis, as I did in 1996, you learn very quickly that 'deaf people with psychosis often hear voices', and it takes a long time (well - it took me a long time) to ask what does that mean and how do you know? 

Diagnosing psychiatric disorder is hard. It is exponentially harder with a Deaf patient - even if you are a Deaf clinician - because the definition of schizophrenia (for example) is based upon statistical analyses of symptoms described at interview by hearing patients to hearing researchers, and so the diagnostic criteria come from a fundamentally hearing phenomenology of psychosis. A clinician will ask "do you hear voices" and the patient will say yes (or no). For hearing clinicians and patients what they each mean by the English word "voice" likely has considerable overlap, and - arguably - that answer suffices.

For a Deaf person, in a signed clinical interview, you do not have that shared vocabulary. Signing clinicians, or interpreters, have to make an interpreting decision about how to ask that question in BSL/ISL. Do you sign voice with a mouth-like handshape, or a V-hand? Where do you sign it? At the throat? Near the ear? In a neutral space (if there is one)? Is your sign more akin to talk as opposed to speak? Given time and care, you need to ask a series of many specific questions about the language of the 'voice', the modality, the location, the patient's confidence in their own description and so on, and then base the diagnosis on that. If you are interviewing via an interpreter, that whole process becomes all the more complicated, and potentially also opaque. My friend, and genius, Jo Atkinson has researched this and published on it, for example here.

But to me it leads to more fundamental questions about the nature of communication and interaction. Is it sufficient to assume that the person means the same thing as you when you say "voice"? We naturally do this in conversation; we use highly familiar catch-all terms that, because we use them all the time, we assume that any pair of us means the same thing by that word. Only much later on in the conversation, if at all, do we realise we have been talking at cross-purposes.

What does your Deaf patient mean when they report 'hearing voices'?

And why, when we are super-cautious about taking as read the patient's claim of being followed at all times, or of being an African prince, are we so wiling to accept at face value their claim to be hearing voices?

NOTE: This post is in no way intended to doubt Karen's own account of her own particular experiences. Rather I thank her for her important and courageous article, and the opportunity it presents to me to raise broader questions.

Jim Cromwell