Audism and Its Implications for Audiology Purpose Two healthcare providers with hearing loss, one neuropsychologist, and one audiologist, explore the concept of audism and its implications within the field of audiology. Method Literature review and frank contemplation. Results The present investigation found no peer-reviewed literature on the topic of audism within the ... Article
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Article  |   December 19, 2017
Audism and Its Implications for Audiology
Author Affiliations & Notes
  • Jaime A. B. Wilson
    Independent Private Practice, Wilson Clinical Services, PLLC, Tacoma, WA
  • Samuel R. Atcherson
    Department of Audiology and Speech Pathology, University of Arkansas at Little Rock/University of Arkansas for Medical Sciences, Little Rock, AR
  • Disclosures
    Disclosures ×
  • Financial: Portions of this paper was presented by the first author at the biennial 2015 Association of Medical Professionals with Hearing Losses (AMPHL) conference in Ann Arbor, MI. The second author was an active participant in the presentation.
    Financial: Portions of this paper was presented by the first author at the biennial 2015 Association of Medical Professionals with Hearing Losses (AMPHL) conference in Ann Arbor, MI. The second author was an active participant in the presentation.×
  • Nonfinancial: Jaime A.B. Wilson has no relevant nonfinancial interests to disclose. Samuel R. Atcherson has no relevant nonfinancial interests to disclose.
    Nonfinancial: Jaime A.B. Wilson has no relevant nonfinancial interests to disclose. Samuel R. Atcherson has no relevant nonfinancial interests to disclose.×
Article Information
Hearing Disorders / Part 1
Article   |   December 19, 2017
Audism and Its Implications for Audiology
Perspectives of the ASHA Special Interest Groups, December 2017, Vol. 2, 18-28. doi:10.1044/persp2.SIG8.18
History: Received January 23, 2017 , Revised August 28, 2017 , Accepted September 28, 2017
Perspectives of the ASHA Special Interest Groups, December 2017, Vol. 2, 18-28. doi:10.1044/persp2.SIG8.18
History: Received January 23, 2017; Revised August 28, 2017; Accepted September 28, 2017

Purpose Two healthcare providers with hearing loss, one neuropsychologist, and one audiologist, explore the concept of audism and its implications within the field of audiology.

Method Literature review and frank contemplation.

Results The present investigation found no peer-reviewed literature on the topic of audism within the audiology discipline. Awareness of audism and its manifestations have implications for helping audiologists and other hearing healthcare professionals to improve patient satisfaction and treatment compliance.

Conclusions Audism is the notion that one is superior based on one's ability to hear or to behave in the manner of one who hears. Strong consideration should be given to including language and cultural studies of the Deaf community within audiology graduate training curriculums. Suggestions for overcoming audism—whether intentional or unintentional—are provided along with research recommendations.

The term, audism, is yet another –ism not unlike other familiar terms such as racism and sexism and less familiar terms such as classism, ableism, anti-Semitism, ageism, and heterosexism. Each term describes some form of differential treatment, oppression, or institutional control by one group over another (Aosved & Long, 2006; Grillo & Wildman, 1991; Robinson, 2016). Audism is perhaps the most unfamiliar and misunderstood ism in many academic, healthcare, and professional circles.
While audism shares many characteristics with ableism, it is inherently unique because of the type of disability in question (i.e., hearing-related) and the group to which it is applied (Gertz, 2003). Given the increased attention audism already has received (Bauman, 2004), it is important that audiologists become familiar with this term. This term has its roots in the discrimination of individuals with hearing loss. Though audiologists are “hearing health professionals” with years of training and expertise in helping patients with hearing loss, audiologists are frequently labeled as audists or are accused of perpetuating acts of audism (Hauser, O'Hearn, McKee, Steider, & Thew, 2010). Knowledge of audism has implications for helping audiologists and other healthcare professionals understand the perspective of their patients who belong to the Deaf community. Awareness of the term might also engender greater empathy, which has been known to result in higher patient satisfaction and compliance with treatment (Kim, Kaplowitz, & Johnston, 2004; Street, Makoul, Arora, & Epstein, 2009). Thus, the purpose of this article is to encourage awareness of audism by exploring the concept of disability, provide a brief etymological background on the term and its implications, discuss what audiologists can do to evaluate and address the issue, and provide potential future research avenues. To improve the readability of this paper, we will use the term deaf or hard of hearing as a general reference to individuals with hearing loss, and Deaf culture or Deaf community as a reference to individuals with hearing loss who share a common language (Barnett et al., 2011), common experiences and values, and a common way of interacting with each other, and with hearing people.
The Concept of Disability and Etymology of Audism
For the purposes of this article, the term disability is dichotomized. In the Medical Model of Disability, a disability is the result of a physical condition, which from a mainstream viewpoint, reduces the individual's quality of life. Thus, a human with a disability is viewed as an entity that needs to be fixed to conform to society's normative values (Paley, 2002). Audiologists and other healthcare professionals are trained to assess, diagnose, and treat disabilities as they relate to their field of expertise.
The Social Theory of Disability maintains that society is the contributing factor to disability (Abberley, 1987; Hughes & Paterson, 1997). A disability may be unnecessarily imposed on top of an individual's impairments through isolation, exclusion, or negative attitudes (Shakespeare, 2006). For example, employers may preclude those with disabilities, believing that individuals with disabilities cannot or should not work.
It is from the Social Theory of Disability paradigm that audism primarily arises. Prior to Dr. Tom Humphries' coinage of the term in 1975, there existed a lexical gap—or lack of an appropriate term to describe discrimination and prejudice against individuals with hearing loss. As defined by the American Heritage Dictionary of the English Language, audism is “the belief that people with hearing are superior to those who are deaf or hard of hearing” (Editors of the American Heritage Dictionaries 2015). Beliefs of hearing superiority can take place on an individual or systemic/institutional level.
In many countries and cultures, when someone is referred to as “deaf,” the term carries the connotation that the individual can only aspire to a limited education or that one's career choice will be severely restricted (Lane, 2002). A new term that explicitly captures these social constructions that make being deaf problematic was needed. The historical origins of mainstream society's perceived limitations of deaf individuals are explored briefly in the following section.
A Glimpse into the Historical Origins of Audism
As racism is linked to differences in ethnicities or skin color, audism arises out of what is thought to be the main difference between humans and non-humans: language (Fedurek & Slocombe, 2011; Hauser, Chomsky, & Fitch, 2002). The ability of humans to create abstract and grammatical systems of language is considered the key asset that has permitted humans a dominant role in the animal kingdom (Berwick, Friederici, Chomsky, & Bolhuis, 2013).
Traditional Western views argue that language—derived from the Latin word tongue—could only be vocal-auditory in nature. This viewpoint likely planted the seeds of audism (Bolinger, 1946; Siple, 1978). Since sign language violates the vocal-auditory schema, signing only served to further validate historical views of deaf individuals as having less than human status. In his seminal article, Bauman (2004)  cited several prominent historical figures (pertaining to the Deaf community) going back to the early 18th century that substantiated the Western audist orientation. Brueggemann (1999)  sums up these historical writings:
“Language is human;
speech is language;
therefore deaf people are inhuman, and deafness is a problem” (p. 11).
Charles Darwin's natural selection and biological evolution theory, Survival of the Fittest, probably contributed to at least some of the principles of audism as well (Baynton, 1995). Under the premise of “Social Darwinism,” hearing and speech may have been a very strong survival instinct in the world before civilization and technology. Deaf humans were likely to be considered a biological threat to the survival of the species, and thus, the desire for their exclusion may also have evolved, at least subconsciously, on many levels over the centuries. The instances of describing how deaf individuals have been excluded or oppressed are numerous throughout the annals of history, some of which are discussed in the next section.
Implications of Audism
History has shown that the worst atrocities of humankind have had their origins when perpetrators perceive an individual as less than human (Smith, 2011). For example, Smith wrote that the Nazis referred to Jewish people as rats; Hutu extremists involved in the Rwanda genocide called Tutsis cockroaches; and slave owners throughout history referred to slaves as subhuman animals.
Given the history of dehumanization, it is no surprise that the deaf population has been victim of genocide attempts. For example, in Nazi Germany, teachers of the deaf participated in acts of forced sterilization on over 1,200 deaf pupils (Biesold, 1999). Although these acts are not unexpected given their occurrence as part of the Nazi movement, it may surprise people that there are examples of eugenics against deaf people in the United States.
Alexander Graham Bell was connected to the eugenics movement in the late 19th to early 20th century America (Van Cleve, 2007). Human eugenics can be in the form of selective breeding of positive traits or characteristics versus selective sterilization. Strongly discouraging marriage and reproduction in individuals with negative traits or characteristics are of the same ilk (Osborn, 1937). In an address to the National Academy of Sciences entitled, “Memoir upon the Formation of a Deaf Variety of the Human Race,” Bell noted that one option to stem the growth of the deaf community was legislation prohibiting the intermarriage of congenitally deaf people.
However, Bell later seemingly softened his stance on the potential prohibition of deaf-deaf marriages. In 1891, Bell  delivered an address on the Gallaudet campus, which consisted of a mostly deaf audience. Addressing marriage, he stated,

I have no intention of interfering with your liberty of marriage. You can marry whom you choose, and I hope you will be happy. It is not for me to blame you for marrying to suit yourselves, for you all know that I myself, the son of a deaf mother, have married a deaf wife. It is the duty of every good man and every good woman to remember that children follow marriage, and I am sure that there is no one among the deaf who desires to have this affliction handed down to his children. [emphasis added]

Unbeknownst to Bell, future research would indicate that over 90% of deaf children are born to hearing parents, while less than five percent have at least one deaf parent (Mitchell & Karchmer, 2004). Aside from the pursuit of deaf eugenics, Bell attempted to implement preventative measures, such as the elimination of deaf schools, prohibition of sign language, and termination of deaf teachers and administrators (Greenwald, 2009). Bell's actions can be described as intentional audism, one of three subtypes of audism discussed next.
Three Subtypes of Audism
Audism can be manifest in three ways, including intentional audism, unintentional audism, and dysconscious audism. As the name suggests, intentional audism is blatant. Perhaps not as brazen as the compulsory sterilization and eugenics movements, instances of deliberate audism are evident. For example, during a 2009 legislative debate in the North Carolina General Assembly regarding whether or not deaf individuals should be allowed to serve on a jury, Representative Ronnie Sutton (D-NC) stated,

You know, we don't have quadriplegics running track. Nor do we need to have deaf persons serving on juries…. But if you think about this realistically, folks, as an attorney, I'm never going to let a deaf person serve on a jury. It's not going to happen. And no other responsible attorney, do I think, would allow that.

Other incidences of intentional audism can be found in magazines, newspaper articles, and reader commentaries, which frequently reference the sign language using deaf community with epithets such as extremists, small numbers, and dying culture (“Audism: Our Reality, Our Battle,” 2013). A recent op-ed described a Deaf contestant, Nyle DiMarco's, 2016 Dancing With the Stars Mirror Ball Trophy win as a hoax not based on skill but on the use of American Sign Language (ASL), making for “dramatic television, which garners higher ratings” (Goldstein, 2016).
The second subtype of audism—unintentional audism—can be defined as audist acts that are often unconscious, especially to those who perpetrate them. Unintentional audism is akin to unintentional racism, which is also known as “blink of the eye” racism or unconscious bias (Moule, 2009; Woosley, 2010). A real-life example of unintentional audism occurred when the first author, a neuropsychologist, made a video relay service (VRS) phone call to a patient's insurance company to find out what services would be covered. The VRS operator, whose job is to facilitate communication and refrain from providing counsel, advice, or personal communication, signed the phone tree options, “Press 1 if you are a patient; Press 2 if you are a doctor; Press 3 for all other inquiries.” When told to press two, the VRS operator responded, “No —you misunderstood, number two is for doctors. You are not a doctor.” After clarifying that the caller was, in fact, a doctor, the operator embarrassingly admitted her mistake and apologized.
The VRS operator's faux pas had elements of the fundamental attribution error (FAE),a concept related to unintentional audism. The FAE is defined as the tendency to overestimate the effect of disposition or personality and underestimate the effect of the situation in explaining social behavior (Harman, 1999). Attributions tend to happen without awareness of the underlying processes or biases that lead to a given inference (Schwarz, 2006). FAEs occur most often when faced with an uncommon scenario; otherwise, the VRS operator would have pressed two without second thought. Other examples of unintentional audism are provided in Table 1.
Table 1. Examples of Potential Unintentional Audism.
Examples of Potential Unintentional Audism.×
• Speaking into a deaf or hard of hearing person's ear.
• Raising voice when speaking to a deaf or hard of hearing person.
• Dimming the lights in a room where visual cues are integral to communication.
• Table decorations (e.g., vase of flowers) that block visual cues for communication.
• Complimenting a deaf or hard of hearing person's speech.*
• Offering unsolicited feedback on a deaf or hard of hearing individual's English writing.
• Not providing reasonable accommodations (e.g., failing to turn on closed captioning).
• Giving up on efforts to communicate when an individual reveals that he or she is deaf.
• Not making an effort to use alternative means of communication when necessary (i.e., writing, gesturing, learning the manual fingerspelling alphabet or other ASL vocabulary).
• Overlooking a deaf or hard of hearing patient's input and feedback when hearing amplification issues are discussed.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.×
Table 1. Examples of Potential Unintentional Audism.
Examples of Potential Unintentional Audism.×
• Speaking into a deaf or hard of hearing person's ear.
• Raising voice when speaking to a deaf or hard of hearing person.
• Dimming the lights in a room where visual cues are integral to communication.
• Table decorations (e.g., vase of flowers) that block visual cues for communication.
• Complimenting a deaf or hard of hearing person's speech.*
• Offering unsolicited feedback on a deaf or hard of hearing individual's English writing.
• Not providing reasonable accommodations (e.g., failing to turn on closed captioning).
• Giving up on efforts to communicate when an individual reveals that he or she is deaf.
• Not making an effort to use alternative means of communication when necessary (i.e., writing, gesturing, learning the manual fingerspelling alphabet or other ASL vocabulary).
• Overlooking a deaf or hard of hearing patient's input and feedback when hearing amplification issues are discussed.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.×
×
Dr. Genie Gertz (2003)  coined the final subtype of audism. Dysconscious audism refers to a deaf individual's internalization of audist attitudes. A deaf person may subscribe to the ideology that because hearing society is dominant, it is more appropriate than the values/norms of the Deaf community. In this way, deaf and hard of hearing individuals can perpetuate audism toward others like them by striving to behave as hearing persons, while shunning or despising those who embrace a culturally Deaf identity (“Audism: Our Reality, Our Battle,” 2013; Gertz, 2008).
Are Audiologists Audist?
Do audiologists, who are trained to diagnose, treat, and manage hearing loss, automatically have an audist orientation? The authors do not believe audiologists and other healthcare professionals who treat hearing and/or speech disorders are automatically audists. This is not to say that some providers may carry theoretical orientations that are labeled by the Deaf community as having audist connotations.
Consider a very real hypothetical scenario of a provider using a directive approach to counsel parents of a deaf child in the use of auditory-verbal therapy (AVT). AVT is a therapeutic intervention that promotes listening and spoken language through the use of hearing technology (e.g., Estabrooks, Maclver-Lux, & Rhoades, 2016). While there is research that suggests that AVT may be an effective intervention (Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010; Fairgray, Purdy, & Smart, 2010), the Deaf community may view the intensive work of AVT as aligning with turn of the 20th century oralism methods brought forth by proponents of the Alexander Graham Bell Association. For every individual with hearing loss successfully using AVT or listening and spoken language, there are just as many individuals who never fully integrate into a hearing society throughout all phases of their life (Eckert & Rowley, 2013). This is troublesome when one considers that alternative means of communication (e.g., visually reliant methods) were not an option or may have been discouraged when parents of a child with hearing loss have consulted with the initial provider.
What might be considered paradoxical is the idea that audiology interventions may be pursued to provide a fighting chance of potentially escaping the injustices of audism. Given the barriers to employment or vocational success that many deaf individuals experience, audiological technology solutions are frequently sought (for examples, see United Postal Services deaf discrimination lawsuit [Greenhouse, 2003 ]; Deaf 7-Eleven convenience store manager fired [Kirkwood, 2011 ]; Wal-Mart discriminates deaf [Rotstein, 2001 ]; Deaf medical student case [Charmatz, 2013 ]). These accommodations may be sought independently or at the request of a loved one with the hopes that the technology might help to integrate the individual more seamlessly into hearing society.
The motivation of the individual seeking out an audiology intervention is, of course, related to several factors, one of which may be due to a patient's perceptions of audism in the healthcare encounter. Perceived audism at any point of a healthcare encounter could lead a patient to feel disempowered by their hearing loss. The patient then might attempt to empower himself or herself by routinely missing appointments (Harvey, 2010). How an audiologist or another healthcare professional recognizes and addresses the psychological landmines of audism may impact compliance with treatment interventions. Table 2 lists some examples of audism specific to audiology that may be construed as either intentional or unintentional.
Table 2. Potential Examples of Audism in Audiology (Intentional or Unintentional).
Potential Examples of Audism in Audiology (Intentional or Unintentional).×
• Returning phone calls using only one telecommunication option and not considering other telecommunication options.
• Leaving voice messages without any indication that the patient will comprehend the information.
• Making a priori judgments about a new patient based only on audiogram information from a referral source.
• Not recommending or teaching about the many benefits of telecoils.
• Not sharing information about non-acoustic assistive technologies.
• Calling for a patient in the lobby without first establishing eye contact (i.e., visual access).
• Assuming a patient with profound hearing loss can “get by” without a loaner during repair.
• Assuming that a patient with profound hearing loss will want a cochlear implant.
• Not checking for or maximizing comprehension during all stages of appointments, especially with appropriate communication technology or interpreting services.
• Minimizing the educational benefit of exposure to Deaf Culture and American Sign Language.
• Forming audiologic rehabilitation groups that are not inclusive or accessible to those with communicative and/or cultural differences.
• Television, videos, or other informational media in patient waiting areas that are not accessible.
• Assuming patients do not enjoy music.
• Assuming a patient does not need a communication accommodation because they speak so well.
• Using or developing clinical materials that are not appropriate or has not been validated for use with members of the Deaf community.
• Not speaking directly to the patient in the presence of a sign language interpreter.
• Asking the interpreter questions about the patient.
• Assuming all patients can read lips.
• Over-advocating or being overly-accommodating.
• Counseling interested patients out of a career in audiology on the basis of hearing loss alone.
Table 2. Potential Examples of Audism in Audiology (Intentional or Unintentional).
Potential Examples of Audism in Audiology (Intentional or Unintentional).×
• Returning phone calls using only one telecommunication option and not considering other telecommunication options.
• Leaving voice messages without any indication that the patient will comprehend the information.
• Making a priori judgments about a new patient based only on audiogram information from a referral source.
• Not recommending or teaching about the many benefits of telecoils.
• Not sharing information about non-acoustic assistive technologies.
• Calling for a patient in the lobby without first establishing eye contact (i.e., visual access).
• Assuming a patient with profound hearing loss can “get by” without a loaner during repair.
• Assuming that a patient with profound hearing loss will want a cochlear implant.
• Not checking for or maximizing comprehension during all stages of appointments, especially with appropriate communication technology or interpreting services.
• Minimizing the educational benefit of exposure to Deaf Culture and American Sign Language.
• Forming audiologic rehabilitation groups that are not inclusive or accessible to those with communicative and/or cultural differences.
• Television, videos, or other informational media in patient waiting areas that are not accessible.
• Assuming patients do not enjoy music.
• Assuming a patient does not need a communication accommodation because they speak so well.
• Using or developing clinical materials that are not appropriate or has not been validated for use with members of the Deaf community.
• Not speaking directly to the patient in the presence of a sign language interpreter.
• Asking the interpreter questions about the patient.
• Assuming all patients can read lips.
• Over-advocating or being overly-accommodating.
• Counseling interested patients out of a career in audiology on the basis of hearing loss alone.
×
It should be noted that the Deaf community's perception of what constitutes audism appears to be more poignant now than at any previous time in history (e.g., Wolsey, Clark, Van der Mark, & Suggs, 2016). Perceptions of audism may be ascribed in part to well-intentioned intervention programs burgeoning on the audiology scene. Instances of these programs include Early Hearing Detection & Intervention (Dallman, Holcomb, & McMillan, 2016), cochlear implant technology, and genetic testing for prenatal diagnosis of hearing loss (Sparrow, 2005; Stern et al., 2002).
A prior survey of 100 audiologists found that many perceived their role as problem- solvers to help people with hearing loss gain a more normal life by using what residual hearing they had to communicate orally (Trace, 1996). The audiologist who conducted the survey, Dr. Teri James Bellis, appropriately noted that views of hearing loss as a disability to be overcome in order to succeed in a hearing world could put hearing healthcare providers at odds with the Deaf community.
Addressing the Issues of Audism in Audiology or Other Healthcare Settings
It is essential that audiologists or other healthcare professionals validate all perceptions of audism that a patient might share. Moreover, avoiding the use of the term out of fear that it may only heighten tension between deaf and hearing individuals may serve to perpetuate the illusion of inclusion on the part of the provider. Promoting awareness of the term by incorporating the concept into a professional issues or cultural competency graduate-level course is one idea that may help foster better recognition of audism. If this approach is taken, it is recommended that a healthcare professional from the Deaf community take the lead on teaching this kind of a course. To exclude healthcare professionals from the Deaf community could serve to perpetuate the common tendency of mainstream society to make decisions about behaviors and best practices on behalf of minority groups.
Because audiologists are in prime position to witness either firsthand, or by proxy, audism acts that occur in their patients' lives, an open, honest, and straightforward discussion of the issue is needed. Sharing or even teaching patients – regardless of the options they want to implement for themselves – the concept of audism (i.e., what it means, the different types, current examples) may help the patient to feel understood and validated. Knowledge of audism (that it exists and has a name) can empower a person to formulate a response for when it happens in their lives.
Recognition of audism by the provider can increase empathy and lead to higher patient satisfaction and treatment compliance (Mercer & Reynolds, 2002). There appears to be a significant lack of communication between the Deaf community and hearing healthcare professionals (Trace, 1996). The lack of communication can be partially attributed to perceptions of biases in terms of providers only promoting interventions that constitute hearing technologies or speech-reading methods of communication. This is as opposed to taking a holistic approach and sharing all intervention options, even if some practitioners may not know how to use some of these options (e.g., ASL).
Once issues of audism are recognized, the challenge becomes what to do to address them. Addressing the issues may be as simple as providing a referral for counseling with a culturally- and linguistically-appropriate provider. Resources for finding an appropriate counseling referral include Gallaudet University's directory of deaf-friendly mental health service providers (Gallaudet University, 2011) and the directory found on Deaf Health's website (2017; Wilson & Schild, 2014).
When warranted, providing information on pursuing legal recourse can help the patient feel validated and empowered. Options for recourse are manifold and include contacting the human resources department, a state's labor or vocational rehabilitation department, an employment union, or the local Equal Employment Opportunity Commission (EEOC filings should be within 180 days of the alleged discrimination; Foster, 2014). Provision of referral resources may help the patient view the healthcare provider confidently as a trusted advocate. When discussing legal recourse options, it is critical that the patient understands the importance of documentation, especially if legal action may be needed. Documentation should include the date of discrimination, as well as the time, where it took place, and description of exactly what happened.
Wanted: Research
Although the term “audist” surfaced in a cover story, Narrowing the Gap Between Audiology and Deaf Culture (Trace, 1996), a search of the literature turned up no peer-reviewed articles on the topic of audism (e.g., meaning, implications, addressing the issues) within the audiology discipline. Further retrospective studies may assist in bringing awareness regarding audism and its manifestations. Interested researchers might also assist in gathering data on perceptions of audism among deaf and hard of hearing patients across different categories of the lifespan (i.e., children, teenagers, adults, and the elderly). Specific avenues and strategies for overcoming perceptions of audism, increasing a sense of empowerment in patients, and improving compliance with audiology interventions may be explored.
Another area where research could be helpful is on the overall experiences of deaf and hard of hearing patients who receive services from audiologists or other hearing health professionals who can communicate fluently in sign. Comparing patients' experiences with providers who rely on other means of communication (i.e., sign language interpreter, writing notes, and exaggerated lip-reading) could have implications for including ASL and cultural etiquette-related classes as part of a core academic curriculum. Research regarding the extent that audiology is affected by audism as a field, if any, is also needed.
Finally, examination of audiologists' or other hearing healthcare providers' attitudes towards and practices with Deaf individuals who use ASL to communicate as opposed to an oral method could shed light on otherwise implicit biases. The examination of attitudes and practices might include questions of (a) whether hearing technologies are considered a necessary intervention for restoring or enhancing cognitive function, (b) whether ASL-only communication is thought to limit educational and career opportunities, and (c) if recommendation of ASL interventions should be routinely included as an option in consultations with patients or parents of patients.
Conclusions
Through gaining an awareness of and addressing issues of audism, audiologists and other healthcare providers may assist patients in alleviating the adverse effects of discrimination. Knowledge of audism can provide a means for the field of audiology to bridge the divide between the ideologies of the Deaf signing and oral/lip-reading worlds. A better understanding of the two ideologies may improve patient attitudes towards treatment options and decrease perceptions of bias.
Recognizing personal acts of audism does not mean the acts were intentional, but rather that we may have unwittingly displayed behaviors that cause perceived audism (Ballenger, 2013). Audiologists and other healthcare professionals cannot be classified as intentionally audist without having in-depth understanding, knowledge, and experiences of the other side of the Deaf community paradigm. If a given provider's theoretical orientation (e.g., speaking and listening) are offered as the only acceptable methods of addressing a hearing loss despite that provider's knowledge of the Deaf community, only then can an act be construed as intentional audism.
Regarding the term audism, Humphries stated, “I want others to recognize that beyond [the difference of hearing loss] we are all the same with the same needs and hurts and fighting the same basic -isms that differ only on the surface” (p. 11, 1977). The antithesis of the above quote is also true, and as we recognize human diversity, we will acknowledge that there is no panacea. Treatment of the human condition can only be approached heterogeneously. Only then can audism and other –isms be defeated.
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Table 1. Examples of Potential Unintentional Audism.
Examples of Potential Unintentional Audism.×
• Speaking into a deaf or hard of hearing person's ear.
• Raising voice when speaking to a deaf or hard of hearing person.
• Dimming the lights in a room where visual cues are integral to communication.
• Table decorations (e.g., vase of flowers) that block visual cues for communication.
• Complimenting a deaf or hard of hearing person's speech.*
• Offering unsolicited feedback on a deaf or hard of hearing individual's English writing.
• Not providing reasonable accommodations (e.g., failing to turn on closed captioning).
• Giving up on efforts to communicate when an individual reveals that he or she is deaf.
• Not making an effort to use alternative means of communication when necessary (i.e., writing, gesturing, learning the manual fingerspelling alphabet or other ASL vocabulary).
• Overlooking a deaf or hard of hearing patient's input and feedback when hearing amplification issues are discussed.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.×
Table 1. Examples of Potential Unintentional Audism.
Examples of Potential Unintentional Audism.×
• Speaking into a deaf or hard of hearing person's ear.
• Raising voice when speaking to a deaf or hard of hearing person.
• Dimming the lights in a room where visual cues are integral to communication.
• Table decorations (e.g., vase of flowers) that block visual cues for communication.
• Complimenting a deaf or hard of hearing person's speech.*
• Offering unsolicited feedback on a deaf or hard of hearing individual's English writing.
• Not providing reasonable accommodations (e.g., failing to turn on closed captioning).
• Giving up on efforts to communicate when an individual reveals that he or she is deaf.
• Not making an effort to use alternative means of communication when necessary (i.e., writing, gesturing, learning the manual fingerspelling alphabet or other ASL vocabulary).
• Overlooking a deaf or hard of hearing patient's input and feedback when hearing amplification issues are discussed.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.
Note. According to Eckert and Rowley (2013), such sentiments resemble an idea that people are created equal, but some being more equal than others.×
×
Table 2. Potential Examples of Audism in Audiology (Intentional or Unintentional).
Potential Examples of Audism in Audiology (Intentional or Unintentional).×
• Returning phone calls using only one telecommunication option and not considering other telecommunication options.
• Leaving voice messages without any indication that the patient will comprehend the information.
• Making a priori judgments about a new patient based only on audiogram information from a referral source.
• Not recommending or teaching about the many benefits of telecoils.
• Not sharing information about non-acoustic assistive technologies.
• Calling for a patient in the lobby without first establishing eye contact (i.e., visual access).
• Assuming a patient with profound hearing loss can “get by” without a loaner during repair.
• Assuming that a patient with profound hearing loss will want a cochlear implant.
• Not checking for or maximizing comprehension during all stages of appointments, especially with appropriate communication technology or interpreting services.
• Minimizing the educational benefit of exposure to Deaf Culture and American Sign Language.
• Forming audiologic rehabilitation groups that are not inclusive or accessible to those with communicative and/or cultural differences.
• Television, videos, or other informational media in patient waiting areas that are not accessible.
• Assuming patients do not enjoy music.
• Assuming a patient does not need a communication accommodation because they speak so well.
• Using or developing clinical materials that are not appropriate or has not been validated for use with members of the Deaf community.
• Not speaking directly to the patient in the presence of a sign language interpreter.
• Asking the interpreter questions about the patient.
• Assuming all patients can read lips.
• Over-advocating or being overly-accommodating.
• Counseling interested patients out of a career in audiology on the basis of hearing loss alone.
Table 2. Potential Examples of Audism in Audiology (Intentional or Unintentional).
Potential Examples of Audism in Audiology (Intentional or Unintentional).×
• Returning phone calls using only one telecommunication option and not considering other telecommunication options.
• Leaving voice messages without any indication that the patient will comprehend the information.
• Making a priori judgments about a new patient based only on audiogram information from a referral source.
• Not recommending or teaching about the many benefits of telecoils.
• Not sharing information about non-acoustic assistive technologies.
• Calling for a patient in the lobby without first establishing eye contact (i.e., visual access).
• Assuming a patient with profound hearing loss can “get by” without a loaner during repair.
• Assuming that a patient with profound hearing loss will want a cochlear implant.
• Not checking for or maximizing comprehension during all stages of appointments, especially with appropriate communication technology or interpreting services.
• Minimizing the educational benefit of exposure to Deaf Culture and American Sign Language.
• Forming audiologic rehabilitation groups that are not inclusive or accessible to those with communicative and/or cultural differences.
• Television, videos, or other informational media in patient waiting areas that are not accessible.
• Assuming patients do not enjoy music.
• Assuming a patient does not need a communication accommodation because they speak so well.
• Using or developing clinical materials that are not appropriate or has not been validated for use with members of the Deaf community.
• Not speaking directly to the patient in the presence of a sign language interpreter.
• Asking the interpreter questions about the patient.
• Assuming all patients can read lips.
• Over-advocating or being overly-accommodating.
• Counseling interested patients out of a career in audiology on the basis of hearing loss alone.
×
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