Harvard Medicine

More... Share to Twitter Share to Facebook
The Sounds of Silence

Those without sound respond to vibrations, the motion of lips, and the dance of expressive hands.

Photo by Scott Laumann

Modern neurobiology suggests that the human senses are more numerous than the five Aristotle identified. They are also less distinct; they overlap and intertwine.

Lip readers like me, for example, experience seeing as hearing. My mind creates a voice for everyone I meet. I once “heard” the high, melodic voice of a woman until I realized that she was actually male, and the voice I had imagined dropped an octave. On another occasion, I finally caught the word “London” on the lips of a young scientist with whom I had been struggling to converse. The word triggered a mental filtering; when I reassigned him a British accent and diction, he was instantly audible.

I came to lip reading relatively late. I began losing my hearing in late childhood; by early adulthood, I was deaf. And although my musical training has stayed with me—I can play a symphony in my head or a fugue on the piano—my perception of physical, linguistic, and social space has changed remarkably.

Perception of body language, for example, has replaced perception of intonation. And an acute awareness of vibrations has replaced hearing through walls. We all respond to the feel of sound. Deaf people sometimes hold balloons while dancing at parties, as the light vibrations of the balloons transmit the music’s bass line and beat. Physical vibrations, in fact, can often be heard. Aspirated consonants produce an audible puff of air; the p in spot, for example, as compared with that in stop. Remarkably, a puff of air felt on the back of the hand can make listeners perceive an unaspirated consonant as aspirated.

At the same time, what I see can change what I think I hear. I learned American Sign Language as an adult, so my mind still gives lip reading priority over signing. I can be blind to perfectly clear sign language when I see a different word on a speaker’s lips. The more readily I can predict a speaker’s words, of course, the better I will hear them. “Paper or plastic?” is easy to catch at the cash register. The frustrating corollary is that the most interesting information is always the most difficult to hear—I’ll hear a joke but miss its punch line.

Despite these new perceptions, I still compose a soundtrack for life, imagining footfalls, a teakettle’s whistle, even road noises while driving.

Listening to Reason

Real hearing exists on a continuum, from the supernormal hearing of many children and musicians, through the many degrees of hearing impairment and deafness, to the rare cases in which hearing is entirely absent. While a deaf person’s broken ears can seem tragic to hearing people, a nonsigning person’s inexpressive hands can seem just as lamentable to signers.

For hearing people, the acquisition of language is effortless and its ongoing use largely unconscious. As a result, a dividing line seems to fall somewhere at the level of being able to use the telephone and to make dinner-table conversation; those with hearing above that line are often unkind to those with hearing below.

That attitude can sometimes soften. I serve as a consultant psychiatrist to the American School for the Deaf. In its surrounding community of West Hartford, Connecticut, the culture has shifted toward inclusivity. Instead of floundering in discomfort, local restaurant and store employees communicate flexibly with deaf customers, writing on tablecloths, engaging in rudimentary sign language, and accepting some awkwardness. There, the deaf person feels invited to belong to society. Disability does not inhere within the body, after all; it is created equally by physical status and societal response.

Marginalization within society is a potential loss for people without hearing, yet some deaf people experience a deficit even more profound. The most disturbing symptom among the deaf patients in my psychiatric practice, and the focus of my research, is language dysfluency caused by language deprivation. Children learn sign languages early, as they do spoken ones, with a nearly complete comprehension of grammar by age three. Those not exposed to usable language by the age of four will never learn any language fluently. And a child with no exposure by seven or eight will acquire a form of mental retardation.

Sound is not language. We know little about how our innate capacity for language allows us to transform into linguistic beings. Even when hearing aids or cochlear implants provide some sound, children may fail to master a language. They can be deprived of language when early intervention services are skimpy, when educational methods fail, or when grieving parents cannot bring themselves to learn sign language. Whatever the reason, the result is heartbreaking.

A young deaf man who had not been exposed to sign language until age nine once signed to me, “That in a you know people me deaf same want want that you know stay family love lost communication fail.” Straining, my interpreter and I guessed that he was saying that, for ease of communication, he would rather live in a group home with other deaf people than with his family, whom he loved. Nonsigning observers might mistakenly believe that he was signing fluently. Psychiatrists unfamiliar with language deprivation might misdiagnose him as psychotic or cognitively impaired. His lack of language had shattered his life.

In less severe cases, language deprivation results in diminished fluency. Deaf adolescents may sign like children, and their achievements as adults may be vastly compromised. Language deprivation also correlates dramatically with aggression and self-injury. Deprived children may lash out when they can neither communicate their feelings in words nor manage those feelings internally through language.

Lending an Ear

I had loved music and spoken language so much while growing up that I could never have predicted how I would feel about deafness. But my experience confirms what linguists have found—that sign languages, often the most natural forms of communication for deaf people, are the equals of spoken. My experience also confirms what disability advocates contend: that “health” and happiness are not the same.

The hard-of-hearing me cranked my hearing aids to full volume, trained my eyes on the speaker’s mouth, and gamely guessed at the words. The deaf me has shed hearing devices, experiences an expanded peripheral vision, and reads the light and joyous dance of signing hands.

There are many ways to hear. One can hear a singer’s voice, pure and soaring in an auditorium. One can hear a speaker’s animated mouth. Or one can hear a signer’s blessedly evocative hands. Metaphorically, hearing is about attending to and understanding one another. Those with sound still have much to learn about listening to the deaf.

Sanjay Gulati, MD, is an HMS instructor in psychiatry. He serves as a child psychiatrist for both the Deaf and Hard of Hearing Service at the Cambridge Health Alliance and the Deaf and Hard of Hearing Program at Children’s Hospital Boston.


Add new comment