Models of deafness

Deafness, or the state of being deaf, is most commonly defined as the inability of the unaided ear to perceive sounds.

There are three models of deafness which are rooted in either the social or biological sciences. The models are: the medical (or infirmity) model, the social model, and the cultural model. The model used affects how deaf persons are treated and their identity. The medical model sees deafness as an undesirable condition to be treated. The social model sees the design of the deaf person's environment as the major disabling factor, while in the cultural model, the Deaf belong to a culture in which they are not infirm or disabled. The three models are expanded below.

Medical model
The idea of the medical (or infirmity) model of deafness was created by those who advocate the cultural model of deafness, and it is used in contrast with their own view. It is important to note that those who are labeled as the adherent of the medical model, especially medical doctors and scientists, may not find such label to be valid.

The medical model of deafness originates from scientific, social welfare and majority cultural notions of the absence of the ability to hear as being an illness or a physical disability. It stems from a more comprehensive and far-reaching medical model of disability. Moreover, it is asserted that this is the view of deafness which is held by most people in the biological sciences and health and social welfare professions, as well as by the majority of people throughout the world. People who experience hearing loss after acquiring a mastery of language usually identify with this model. Also, people who describe themselves as hard-of-hearing or hearing impaired are likely to identify with it. The medical model encompasses the idea that an individual affected by hearing impairment may be admired for their accommodation of the infirmity or their courage in struggling with it, but the infirmity itself is generally seen as undesirable. This model has the direct effect of challenging the premise that deafness can be viewed from a conceptual framework of Cultural Deafness, a view which is not universally shared, but which is not unknown, among people who embrace the medical model. Deafness is therefore conceptualized from a "personal tragedy" stance, with implicit questions naturally arising such as: By what criteria and by whom is the impairment construed as an infirmity; how did the infirmity arise; what are the risks and benefits of the available treatment, if any; what can be done to minimize the disabling effects of the infirmity?

However, it is important to note that medical ethics/law dictate that it is up to the patient (or his legal representative) to decide the treatments she or he wishes. For this very reason, the question as to whether deafness is physical impairment or personal tragedy to be overcome is secondary to medical doctors and health professions. Similarly, doctors and scientists who engage in research are doing so simply because there is demand for information and for techniques which can restore hearing.

The view that deafness is a disability has economic consequences in political environments concerned with social welfare. It is the basis on which the governments in many developed countries provide financial support for the cost of cochlear implants and other therapies. It is also the basis on which governments provide deaf people with financial support and educational services which aren't available for members of other cultural minority groups.

Social model
The social model of deafness is a part of a more comprehensive and far-reaching social model of disability that seeks to distinguish and distance itself from the medical model. The concept of social disability arose in large part from disabled people themselves, their families, friends, and associated social and political networks. Invoked here are professionals in the human services fields and the social sciences instead of physicians and the physical sciences. In defining disability, proponents of this model make two assertions concerning the view of disability as oppression:


 * 1) first, that "the concept of disability is in part a historical product of social forces, not merely a biological necessity"; and
 * 2) second, that "the disabled mode of living has value in its own right, even as the conditions that gave rise to the disability are condemned."

Disabled people affirm that the design of the environment often disables them. In better-designed environments, they are disabled less, or not at all. This affirmation arises in part from the understanding that while medical intervention can improve the health issues inherent in certain forms of disability, it does not address societal issues that prevail regardless of the extent or success of medical intervention. In conjunction with this view of changing the environment from a disabling to an enabling atmosphere, advocates of the social model persevere in the de-institutionalization of disabled persons by encouraging maximum integration with non-disabled peers, especially, but not exclusively, in the school environment.

Cultural model
The cultural model of deafness arises from, but is not limited to, deaf people themselves, especially pre-lingually deaf people whose primary language is the sign language of their nation or community, as well as their children, families, friends and other members of their social networks. Invoked also are people within the social science professions which seek to identify, define and conceptualize the very essence of what constitutes a culture or cultural model of human experience. Also included are professionals in mediating roles between cultures, notably persons engaged in activities of simultaneous interpretation, and schools. This cultural model of deafness represents the natural evolution of the social networks of a minority language group. In this view the conceptualization of deafness is seen from a "community asset" stance. From the conceptual framework of the cultural model come implicit questions, such as: How is deafness influenced by the physical and social environment in which it is embedded; What are the interdependent values, mores, art forms, traditions, organizations, and language that characterize this culture?

Both the medical model and the social model are seen, at the least, to be in conflict with, and at the most, inapplicable to deafness when viewed from the cultural model of deafness.

Cultural deafness and the medical model
In contrast to the medical model of Deafness, the deaf community, rather than embrace the view that deafness is a "personal tragedy," sees all aspects of the deaf experience as positive. The birth of a deaf child is seen as a cause for celebration and deaf people are known to travel great distances to see a deaf child. Deaf people point to the perspective on child rearing they share with hearing people. Both hearing and deaf parents understand that it is easier for a hearing parent to raise a hearing child because of their intimate understanding of the hearing state of being. It follows that a deaf parent will have an easier experiences raising a deaf child since deaf parents have an intimate understanding of the deaf state of being. Evidence of deaf parental success is revealed in scholastic achievement. Deaf children who have deaf parents that communicate in sign language perform better than all other deaf children in academic achievement and acquisition of the majority language regardless of the manner in which the children adapted to deafness. This includes children who adapted using speech and lipreading, prosthetic devices such as the cochlear implant, artificial language systems such as Signing Exact English and Cued Speech, and hearing aid technology.

According to research in the social sciences, membership in the deaf community is a matter of culturally determined behaviors and not of medical diagnosis. Thus membership is not seen as the act of admittance by an insider group or even by anyone at all, but by examining individual behavior to determine how closely it resembles the known culturally determined behaviors found in the community of deaf people. Since sign language stands as the single most valued aspect of deaf culture, it reveals whether an individual belongs to this language minority in the same manner as embracing the Spanish language reveals identity with Hispanic-American culture, another example of a language minority. Groups disadvantaged by majority culture and practices, such as the deaf community, have commonalities with other groups. People with disabilities, gay people, women, and, arguably, African-Americans, are not linguistic minorities, as are members of the deaf community, since their culturally determined behaviors do not center on a unifying language as in the communities of Hispanic-Americans and Native-Americans. Gay culture and American deaf culture, both of which experience the disadvantages of being minority cultures, bear resemblance to one another in that most members of these two minority groups do not share their minority identity with their parents and cannot develop it at home. However, gay culture does not rally around a unifying language as is seen with a minority language group like the community of deaf people.

Cultural deafness and the social model
Members of the deaf communities most certainly do find a parallel with peoples with disabilities, but no more or less than they do with African-Americans, and Hispanic-Americans, all of whom are disadvantaged by the beliefs and practices of the majority culture. However, a line is drawn in deaf culture in the case of disabilities when "respecting that unique organization of life while regretting the conditions that create it" represents a conception of the highest quality of life. It is a conception that is considered inappropriate in deaf culture.

The residential schools for deaf children provide an example for illustration. The residential schools, now declining in numbers but still in operation in many states, served as a vital link in the transmission of deaf culture and language and typically provided what their former students believe was a rich quality of life. Deaf cultural values find abhorrent the dismantling of the residential schools since they were considered the best possible environment, the highest quality of life, in which to acquire and enrich sign language fluency and pass on deaf cultural values that serve as tools and solutions to challenges in a predominantly hearing world. This view sharply contrasts with the Social Model of Disability, which finds abhorrent segregated schooling of disabled children in special residential schools and prefers the all-inclusive environment of neighborhood schools. This view has prevailed in most countries to the point that almost all deaf children attend neighborhood schools, despite very few of these schools teaching, using, or sometimes even permitting sign language. In spite of the nearly universal dismantling of residential schools, research literature shows that no matter whether deaf people adapted to the hearing world using sign language, speech, or assistive technology like the hearing aid and the cochlear implant prosthesis, in the absence of residential schools the majority of deaf adults eventually marry another deaf person and join the deaf community to share in the rewards of the language and culture. This act of marrying another deaf person and seeking out the deaf community demonstrates how dispersing or isolating deaf people until adulthood delays a rich quality of life that could have been enjoyed in childhood and adolescence, which is a period of profound importance in terms of social, emotional and academic growth and progress.

The deaf cultural model points out that these acts also demonstrate an example of respecting and embracing the totality of the deaf experience rather than regretting it. The conflict or inappropriateness of the Social Model rests on this and many other examples in which efforts to promote an all-inclusive environment produces negative impact on deaf people. Proponents of the social model, understandably, are generally aware of this dilemma and have a great respect for deaf cultural views. Yet to yield to the unique construction of deaf culture would be, for other people with disabilities, to yield at the expense of their own needs and their own agenda in societies that commonly disburse empowerment at the pleasure of prevailing political or economic climate, or societies which do not consider, or are economically unable to consider, the diverse range of negative outcomes when attempting to respond identically to the full range of conditions viewed as disabling.

Summary on cultural deafness
Because there is a deaf community with its own language and culture, there is a cultural frame in which to be deaf is not to be infirm or disabled. To the contrary, it is an asset of and for the deaf community to be deaf in behavior, values, knowledge and fluency in sign language. It is within this community bonded by shared culture and language that lives defined by diagnosis, disadvantages imposed by majority beliefs and practices, and disabilities tied to inappropriate models of language and social enrichment, that, according to the cultural model of deafness, deaf people find themselves both enabled and socially advantaged. The experience of a language minority such as the deaf thus seen, amounts to a social disadvantage no more or less troubling than it would be for any language minority. In terms of its effect on mental health, deaf cultural attitudes conclude that a minority language group's disadvantages are preferred to a lifetime of viewing one's self or one's group as infirm or disabled.