Kübler-Ross (1969) has described five stages of emotions experienced by individuals dealing with death and dying. She points out that individuals do not move through these stages in a linear manner or following any predictable time frame. Analogies to her classifications can be used to describe reactions to hearing loss since it involves permanent changes in an individual’s lifestyle. Individuals who experience sudden-onset severe hearing loss will probably experience these reactions to a stronger degree than those with a gradually progressive loss, but the stages can apply. Family members and close associates of individuals who experience hearing loss also experience the sense of loss and can be said to react in many of the same ways.
First Stage: Denial
As “the invisible disability,” the presence or severity of hearing lossmay be relatively easy to deny. The slow progression of some losses with development of compensatory skills may somewhat account for this. However, responses to the question “Why did you first seek a hearing test?” often reveal that individuals often blame the speech of others or feel that their spouse is overreacting. Initial diagnosis of hearing loss may result in a sense of shock, disbelief and unreality, even when the individual may suspect hearing difficulty. Denial is usually a temporary defense and will be replaced with partial acceptance (Kübler-Ross, 1969, pp. 35-36). The professional can acknowledge the individual’s fears and “offer reassurance and hope that they will be supported as they seek the information, treatment and coping strategies that can help them sustain their quality of life as much as possible” (Van Hecke, 1994, p. 107).
Second Stage: Anger
Individuals with hearing loss often feel angry about what they have lost, and may feel resentment that communication is no longer effortless. They may resent other people who do not seem to appreciate their good hearing. The reactions of other people (for example, when the person with hearing loss responds inappropriately to a misunderstood question or feels left out of a conversation) or the behaviors of other people (such as family members continuing to talk to them from another room) can also cause anger. There may also be a more general type of anger that results from the loss of the illusion that they live in a fair and just world where bad things happen only to bad people. Since there is no one to be angry at, the individual may try to deny this anger. The professional can help them experience and explore their anger, which is a step toward developing “meaningful ways to live with the unfairness that the hearing loss represents” (Van Hecke, 1994, p. 110).
Third Stage: Bargaining
Kübler-Ross describes a stage in which the individual hopes to enter into an arrangement which may postpone the inevitable. This involves the hope of being rewarded for good behavior and being granted a wish for special efforts. This stage has the least direct analogies to the individual with hearing loss, and may involve wanting to “hear for just one more day” or during some special event. She suggests that the need to bargain may involve guilt about the failure or inability to do certain things in the past. This bargaining is often of a private and spiritual nature and may not be mentioned to the professional or to anyone except a spiritual advisor. If such comments are heard, the professional should not ignore them, but explore the possible sources of guilt or refer the individual to another professional who is trained to do so.
Fourth Stage: Depression
Hearing loss can undermine an individual’s self-esteem. Everyday tasks become difficult. Friends and family may come to ignore the individual at gatherings because of difficulty communicating. The resulting social isolation and loneliness can contribute to depression, as can the need to depend on other people. It is difficult for most people to have to ask for help. It can be damaging to self-esteem to have to depend on the kindness of others for good communication. Resentment or guilt can occur in either the giver or receiver of this help. The individual may also mourn their inability to restore their communication function to its previous level or to reduce its negative consequences. Financial concerns, either job uncertainty or the cost of hearing instruments, can also contribute to depression. Professionals can listen to the individual who describes his/her frustration and depression and who begins “to explore what it means to be satisfied with only partial control of their lives” (Van Hecke, 1994, p.109). They can also avoid contributing to the sense of isolation by refraining from ignoring the individual with hearing loss while speaking to his/her hearing companions.
Fifth Stage: Acceptance
Acceptance is the state in which the individual is neither depressed nor angry about the permanent nature of the hearing loss. Acceptance of any loss takes time, and individuals move in and out of acceptance in various ways before finally achieving a final acceptance. Compliance with recommendations concerning hearing instruments, acknowledgment of the loss to others, and use of coping strategies all require acceptance.