Ruiz Empowering the deaf . Let the deaf be deaf

Deafness is often regarded as just a one and only phenomenon. Accordingly, deaf people are pictured as a unified body of people who share a single problem. From a medical point of view, we find it usual to work with a classification of deafness in which pathologies attributable to an inner ear disorder are segregated from pathologies attributable to an outer/middle ear disorder. Medical intervention is thus concerned more with the origin, degree, type of loss, onset, and structural pathology of deafness than with communicative disability and the implications there may be for the patient (mainly dependency, denial of abnormal hearing behaviour, low self esteem, rejection of the prosthetic help, and the breakdown of social relationships). In this paper, we argue that hearing loss is a very complex phenomenon, which has many and serious consequences for people and involves many factors and issues that should be carefully examined. The immediate consequence of deafness is a breakdown in communication whereby the communicative function needs to be either initiated or restored. In that sense, empowering strategies—aimed at promoting not only a more traditional psychological empowerment but also a community one—should primarily focus on the removal of communication barriers. (J Epidemiol Community Health 2000;54:40–44) Pathology/disability model versus sociocultural model of deafness Over the past few years, two opposing perspectives of conceptualising deafness in contemporary society have been reported and discussed in scientific literature. The first one defines deafness as a pathological condition, while the second one regards deafness as a cultural identifier. Consequently, both models have conditioned how recent research on deafness has been conducted, and have strongly aVected and determined the social view of deaf people and their education. The pathology perspective focuses on the failure of the hearing mechanism. Deafness is defined as a medical condition that requires some kind of remediation, either through correction or compensation. This model finds that moderately and profoundly hearing impaired people can be analysed and grouped together for study. Moreover, it emphasises the need to encourage speech and lip reading based on the assumption that competency in a spoken language is the only means for cognitive development in the child. Its direct consequence is, therefore, the rejection of the use of sign language in schools. However, an ever increasing number of deaf people do not consider themselves to be handicapped or disabled but claim to be seen and respected as a distinct cultural group with its own beliefs, needs, opinions, customs and language. Members of the deaf community define deafness as a cultural rather than an audiological term. The sociocultural model recognises significant sociolinguistic diVerences between people who label themselves deaf and people who label themselves hard of hearing, people who feel proud of their belonging to the deaf community and those who reject it, because in general they belong to separate cultural and linguistic realities. It is therefore reasoned that hearing impaired people need to be grouped separately for analysis. As we have just put forward, both perspectives are contradictory because they uphold diVering notions of deafness. When confronted, people who share one or the other standpoint usually end up in unsolvable conflicts, which are nothing but the result of diVering expectations about each other’s behaviour that necessarily clash. An example of this can be found at present in some schools for deaf children, in which deaf parents’ advocacy of the use of sign language as part of the school curriculum in the education of their children comes into conflict with the hearing teachers anchorage in a still pretended importance of competency in a spoken language as the only legitimate way of educating deaf children. 9 The hearing community versus the deaf community THE HEARING COMMUNITY Historically, the dominant hearing culture has relegated deaf people to social categories such as “handicapped” and “outsider”. The history of oppression and exclusion of the deaf community—although with important variations depending on the countries—and the ignorance and rejection of the natural and preferred means of communication of many of them is a well known and many times denounced phenomenon. However, deaf people are disabled more by their transactions with the hearing world than by the pathology of their hearing impairment. Unfortunately, the social image of deafness is still marked nowadays in too many countries not only by a deeply rooted pathological stigma 11 but also by negative stereotypes and prejudiced attitudes 14 toward the deaf that—attributable mainly to an extensive social lack of knowledge about communication mechanisms and how they work in conjunction J Epidemiol Community Health 2000;54:40–44 40 Department of Public Health, Edificio de Ciencias Sociales, Universidad de Alicante, Apdo de correos 99, 03080 Alicante, Spain