Dr Sally Austen: A journey through deaf identity (and my own identity) during my career as an NHS psychologist (BSL)

Since 1989 I have worked in the NHS. At first, I told my clients and colleagues,  ‘I am a psychologist, I am hearing, I work with sign language users in the NHS’. Within my job, I have experienced a lot of discussion about deaf identity.

As I look back on my career, I realise I’ve experienced a lot of discussion around deaf identity. But this is not just one identity. There have been a lot of changes in the identity of my clients – and in my identity!

Here is a summary of the work I did and what I learned about identity at different stages…

The National Deaf Mental Health Service, London. My clients are proud to be Deaf.

Just after qualifying, I started at Springfield Hospital, National Deaf Services, London (then called Old Church and now called Bluebell) with no signing skills. My first Deaf mentor was Herbert Klein, and I’m proud to say that some of my ways and signs still reflect his influence.

I was hearing and my patients were encouraged to refer to themselves as Deaf and to be proud. It was 1991. It was so easy back then.

Royal Throat Nose and Ear Hospital (RNTNE). My clients do not want to be deaf. (1999)

My next role was in the RNTNE, a hospital that works with people who struggle to feel pride in their presentation. My clients would mostly say they were losing something: their hearing, their balance or the silence they took for granted before their tinnitus set in. My clients rejected the word ‘deaf’ and wanted their life back. I tried to provide space for them explore any possible positivity about their changing selves. I would have liked to have introduced these clients to positive deaf role models – but there weren’t any. Deaf professionals did not want to be part of the ‘medical model’ and HR departments had never considered recruiting or training deaf staff.

Non-organic hearing loss (NOHL) team. My clients are trying to make themselves deaf. (2000)

Whilst few of the mainstream clients were embracing being deaf, in 2001, things took an unusual direction. A national team of cochlear implant audiologists were concerned that some people wanted cochlear implants who were not profoundly deaf – some people wanted to eradicate their hearing to have a sense of belonging in the Deaf Community. The reasons people were doing this was variable and complex. But they were hearing or partially deaf people, who felt that life would be better if they made themselves profoundly deaf. Whereas my RNTNE patients wanted to be more hearing, my NOHL patients wanted to be more deaf.

Age related hearing loss. My clients are hiding their hearing loss. (2001)

No deaf or Deaf pride in this group of clients. This huge proportion of the population were clearly denying their loss of hearing. One in three people over the age of 65 experience hearing loss. A classic quote is that women tend to get hearing aids 5 years after they need them – and men 10 years after.  Of those people who were prescribed NHS hearing aids many shoved them straight in drawers, embarrassed to wear them or to request any behavioural or communication changes from the hearing people around them. These clients told no one that that they were deaf/hard of hearing and became increasingly isolated. This feeling of shame was fuelled by the multimillion-pound private hearing ‘hidden’ hearing aid industries, with whom I remain really cross!

National Deaf Mental Health Services, Birmingham. A signing service including clients who don’t sign.

In 2002, I moved back to a signing world. Things were changing. The younger adult clients had duel (or multiple) language and identities – and as clinicians we noticed more people with language deprivation and more oral communicators who were being failed by mainstream services.

Deaf academics were promoting the use of a small d (deaf) to include everyone of whatever PTA, language or community – whilst my previous clients were only just getting the confidence to describe themselves with a big D (Deaf).

In 2021, Dr Ben Holmes and I edited and published a book aimed at hearing professionals working in our field. Within the cohort of our 40 amazing authors, we had people who referred to themselves as Deaf, deaf, Hard of Hearing, partially deaf, having a hearing loss – and hearing. We tried our very best to ensure our language respected people of all experiences and identities. We had hoped that we might find one word that suited everyone. But it was impossible. Instead, we used the terminology that aligned with each author’s preference.

No longer in the NHS. Still a psychologist. But am I still hearing?

I have watched my jobs and clients change. Now it seems, as I race towards 60, it is my turn to change. My hearing is deteriorating. My family tutted at the increased volume of my TV. The audiologist wore masks and the receptionists shouted out names into the screen-less waiting room (grr!!). I wondered if I was a fraud. I have always been your ‘hearing’ psychologist. What would people say?!

Of course, no one says anything. A change in identity only affects me. But it is a strange way to start semi-retirement. My hearing aids are marvellous: less tinnitus, more discernible consonants and a happy family who don’t cringe at the TV volume.

But who am I? It feels inauthentic to say that I am hearing or that I am deaf. And I am not ready for Hard of Hearing.  How do I introduce myself? This was me with a new client last week…

‘Hi, I am Sally, the psychologist. I am hearing. Actually, a bit deaf. Not totally deaf. Early old age deafness. Not that I am old. Just hearing loss and hearing aids.’

Identity? It’s messy!

By Dr Sally Austen, consultant clinical psychologist