• Corpus ID: 44098303

Understanding the Stigma Associated with Hearing Loss in Older Adults

@inproceedings{Gagn2010UnderstandingTS,
  title={Understanding the Stigma Associated with Hearing Loss in Older Adults},
  author={Jean-Pierre Gagn{\'e} and Mary Beth Jennings and Kenneth Southall},
  year={2010}
}

• J. Gagné, M. Jennings, K. Southall
• Published 2010
• Sociology

Stigma has been defined as “the possession of, or belief that one possesses, some attribute or characteristic that conveys a social identity that is devalued in a particular social context” (Crocker, Major, & Steele, 1998). In most developed societies there is a stigma associated with hearing loss. Many people with hearing loss experience self-stigma. That is, not only are they aware of the prejudicial views held by others, but they themselves (consciously or not) hold similar views about people with hearing loss. Self-stigma constitutes a major obstacle to seeking rehabilitation services. The goal of this chapter is to describe the effects that stigma and selfstigma have on people with hearing loss. First, the general phenomenon of stigma and self-stigma are described. Then, a contemporary model of self-stigma (the Address correspondence to: Jean-Pierre Gagné, PhD, École d’orthophonie et d’audiologie, Institut universitaire de gériatrie de Montréal, Université de Montréal, Montréal, Québec, Canada, [e-mail]. 1 École d’orthophonie et d’audiologie, Université de Montréal, C.P. 6128, succursale centre-ville, Montréal Québec, Canada H3C3J7 2 Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Université de Montréal, 4655, chemin Queen-Mary Montréal, Québec, H3W 1W5 3 School of Communication Sciences and Disorders, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada, N6G 1H1 4 National Centre for Audiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada, N6G 1H1 Hearing Care for Adults 2009 204 ited as a member of their society. In modern times, any deviant trait or personal attribute (physical, behavioral, personality, psychological, etc.) that brings discredit to a person may be a source of stigma (Goffman, 1963). For example, in some societies attributes such as obesity, cognitive impairment, religious beliefs or some activities (such as hunting, riding motorcycles, smoking, etc.) may constitute a stigmatizing trait. Goffman (1963) suggested that stigma signifies marks that designate the bearer of a spoiled identity and that this person was less valued in society. More recently still, stigma has been defined as “the possession of or belief that one possesses some attribute or characteristic that conveys a social identity that is devalued in a particular social context” (Crocker, Major, & Steele, 1998). Based on this description, two characteristics of social stigma are worthy of discussion in relation to hearing loss. First, in many cases, it is possible for an individual to conceal the attribute that defines the stigma. Quinn (2006, p.84) defined a concealable stigma as, “a stigmatized identity that is not immediately knowable in a social interaction”. While some stigmatizing traits such as skin color or physical deformity are not easily concealed, other traits such as hearing loss can be hidden. In many circumstances, individuals may choose to conceal (or not disclose) their acquired hearing loss from the people with whom they interact. Research has shown that, relative to conspicuous stigmatizing attributes, possessing inconspicuous stigmas have both advantages and disadvantages. There are some benefits associated with concealing a stigmatizing trait from others. First, by keeping the stigma hidden, the individual avoids potentially stigmatizing situations. To a large extent, it is up to the individual to decide if, when and to whom they reveal the existence and nature of the stigmatizing trait. However, there are also some drawbacks associated with concealing a stigmatizing attribute. For example, there is a constant discomfort associated with the possibility of having the trait disclosed during a social interaction (Smart & Wegner, 2000). Studies have also shown that concealing a stigmatizing trait increases the cognitive load required to take part in social interactions (Lane & Wegner, 1995; Smart & Wegner, 1999; Smart & Wegner, 2000). In addition to exerting the cognitive effort normally required to participate in a social interaction, a person attempting to conceal a stigmatizing trait (e.g., a hearing loss) expends supplementary cognitive resources by attempting to avoid being identified as “hearing impaired”. A second issue that is noteworthy to this discussion is that stigma is a social construct (a label created and attached by society: Major & O’Brien, 2005). Within this context, the term “society” is defined from a sociological perspective, meaning: “a group of persons regarded as forming a single community” or “any organized group of people joined together because of some interest in common” (McKechnie, 1976). Stigmatization occurs in social settings where two groups of people exist: the outsiders and the insiders (Link & Phelan, 2001; Link & Phelan, 2006; Oyserman & Swim, 2001). Stigma may be considered from an “outsider’s perspective”; that is, from the vantage point of people who do not possess the stigmatizing trait (Gagné, Southall, & Jennings, 2009; Goffman, 1963; Heijnders & Van Der Meij, 2006; Major & O’Brien, 2005). Outsiders report that people with hearing loss are senile (Oyer & Oyer, 1985), socially unfit (Jones, et al., 1984), and uninteresting communication partners (Heine & Browning, 2002; Hétu, 1996). However, stigma may also be considered from the perspective of “insiders”; that is, from the vantage point of people who possess a stigmatizing trait (Green, Davis, Karshmer, Marsh, & Straight, 2005; Jacoby, 1994; Scambler, 2006; Scambler, Heijnders, & van Brakel, 2006). Insiders are aware of the prejudicial views held by outsiders, and understand that some people devalue their identity. This distinction between insiders and outsiders implies that individuals who acquire their stigmatizing attribute in adulthood (as is the case for many individuals with hearing loss) likely realize that they now possess a trait that they may once have stigmatized. Hétu (1996) observed that for some individuals it may be difficult to reconcile this dilemma: negative and stigmatizing perceptions about people with hearing loss differ from non-negative perceptions about themselves. These conflicting and self-deprecating views often lead to high levels of stress (Crocker, et al., 1998; Major & O’Brien, 2005; Steele, Spencer, & Aronson, 2002), poorer self-image and lower self-esteem and self-efficacy (Heine & Browning, 2002; Hétu, 1996). The phenomenon of holding prejudicial views about one’s own stigmatizing trait is known as self-stigma (Gagné, et al., 2009; Major & O’Brien, 2005). Self-stigma serves as a threat to one’s own identity (Major & O’Brien, 2005) and is a major obstacle to health care. To avoid situations of perceived identity threat, many people who display self-stigma adopt (mal)adaptive coping strategies such as concealment, denial, avoidance, and social isolation (Hallberg & Carlsson, 1993; Hallberg & Barrenas, 1995; Hétu, Getty, & Waridel, 1994; Link, stigma. In our view, most of the concepts described in the model are applicable to the social stigma associated with hearing loss, and to the way that people with hearing loss feel and behave when their self-image is diminished because of the social stigma associated with their impairment. Moreover, we believe that hearing health care professionals will benefit from having a better understanding of the self-stigmatizing process and its effects on people who have a hearing loss. Furthermore, integrating aspects of this model into the domain of audiologic rehabilitation will serve to complement and extend the current level of knowledge concerning stigma. Undoubtedly, a more comprehensive understanding of the self-stigmatizing process will lead to the development of more appropriate rehabilitation services for people who experience self-stigma due to their hearing loss. A Perceived Identity Threat Model of Self-Stigma Major and her colleagues have proposed a model of stigma that is based on two premises. The first premise of this model is that stigma puts a person at risk of experiencing threats to his or her social identity (Crocker, et al., 1998; Major & O’Brien, 2005; Steele, et al., 2002). The second premise is that having one’s social identity devalUnderstanding the Stigma Associated with Hearing Loss in Older Adults 205 Struening, Neese-Todd, Asmussen, & Phelan, 2001; Major & Schmader, 1998; Perlick, et al., 2001; Ritsher & Phelan, 2004; Steele, 1997). Moreover, to avoid being labelled by others as someone with a stigmatizing trait, individuals with high levels of self-stigma might also refuse to seek rehabilitation services, because this act would disclose the fact that they have a stigmatizing trait. For example, a person with hearing loss may refuse to use hearing aids because that would divulge their hearing loss, and in turn that would trigger identity threats. Similarly, even though they are known to be effective, many individuals with hearing loss will not request the use of communication strategies (e.g., reducing the ambient noise level, requesting visual-speech cues, the use of clear speech) because doing so would divulge to their interlocutor that they have a hearing loss. Although these (mal)adaptive strategies may be successful in reducing the level of self-stigma, they might also lead to an increase in communication breakdowns, and to the development of self deprecating behaviors that lead to stress, withdrawal, isolation, loneliness and even depression. In recent years, there have been significant breakthroughs in understanding how a social stigma may be perceived and experienced from the perspective of the insiders (i.e., persons being stigmatized). In the next section, we describe one contemporary model of selfFigure 1. Conceptual framework displaying the elements of the Stigma-induced identity threat model described by Major and O’Brien, 2005. (Reproduced with permission). ued leads to potentially stress