Hearing Loss and Grief

When a patient suspects they have a hearing loss, they often enter the grieving process. But, what does this mean exactly? 

Do patients navigate through the grieving process and THEN purchase hearing aids? Do patients still grieve even after they're fit with hearing aids? 

You see, grief is not linear. This means that patients do not enter the denial stage, then anger stage, then bargaining stage, etc. In this episode, Blaise reviews the five stages of grief and connects Erik Erikson's Psychosocial Stages of Development to the hearing aid fitting and counseling process. The five stages of grief, thanks to the wonderful work of Dr. Elizabeth Kubler-Ross include: 

1. Denial 
2. Anger 
3. Bargaining 
4. Depression 
5. Acceptance 

Why is the mind-brain connection so important when you're fitting patients with hearing aids? As humans, we don't necessarily respond well to change. When a patient suspects they present with hearing loss, enters the grieving process, and is then fit with hearing aids...well...this is a lot of change at once! As hearing care providers, we need to continue to place heavy emphasis on the hearing aid counseling process and understand what the mindset of the patient is. If you suspect that a patient needs additional assistance and you need to refer to a clinical psychologist or therapist, be sure to have that conversation with your patient.

If you are interested in listening to Dr. Andrew Huberman's podcast episode on grief, you can do so by clicking here. 

If you are a current or future hearing aid user, give yourself grace. If you need assistance finding a hearing healthcare provider in your area, please send us an email and we will connect with you a trusted hearing healthcare provider. 

Transcript

Blaise M. Delfino, M.S. - HIS (00:06):

You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology, best practices, and a growing national epidemic: Hearing Loss. Before we kick this episode off, a special thank you to our partners: Sycle - Built for the entire hearing care practice. Weave - the all-in-one patient communication and engagement platform. Redux - Faster. Drier. Smarter. Verified. Fader Plugs - the world's first custom adjustable earplug. Welcome back to another Hearing Matters podcast. And as a friendly reminder, this podcast is separate from my position at Starkey. Now, with all that said, let's dive into this episode. A little disclaimer here. We are going to go deep during this episode and for the past couple of weeks now, I would say I've just been mentally preparing myself for this episode because I believe that grief and hearing loss, there's a lot to unpack here. And one thing that we as humans really do have in common is suffering.

(01:12):

And most of us, if not all of us, have experienced grief in the past. So, for those of you who know me, you'll know I do have a deep passion for personal development, self-improvement, and I like to approach life with curiosity. The human mind really does intrigue me, and I believe that the mind-brain connection just isn't discussed enough in the field of audiology. It's discussed to the point of explaining how hearing technology positively influences the brain, but I believe we can go deeper, and this is such an opportunity for our field. Dr. Caroline Leaf, who is a world renowned neuroscientist, actually joined us on the Hearing Matters podcast April of 2021, believe. And since that episode, I really started to think more so about the psychology of the hearing impaired. And this brings me back to my full-time position as a hearing instrument specialist, as a private practice owner.

(02:22):

And I have a great opportunity of entering the family practice at age 26. So, this was 2017 following graduate school. And working with clients in the clinic, specifically, uh, patients who present with or who need assistance with articulation, language, uh, swallowing. That is what I went to school for. I have a Master's in Speech-Language Pathology. So I was able to really bring those experiences into the hearing healthcare industry and working with patients who present hearing loss. Full vulnerability and transparency, I feel that experience really is the greatest teacher because as the years went on, I was better able to counsel patients, have a deeper, and gain a deeper understanding of understanding where they're coming from. Couple of weeks ago, um, I'm a huge Andrew Huberman fan. If you haven't tuned into the Huberman Lab, it's a podcast. Feel free to check out his show after you listen to this episode.

(03:29):

In May of 2022, he released a podcast episode titled "The Science and Process of Healing From Grief." Now in the field of audiology and hearing healthcare, uh, hearing care professionals often discuss how patients go through the five stages of grief. However, hearing matters podcast, we wanted to go and dig a little deeper and understand the why before the aforementioned. And again, speaking from experience, disclaimer, I'm not a psychologist. I'm not a medical doctor. I am a hearing care provider who goes at life with a sense of curiosity. So, I'm not going to give anyone medical advice or anything of that nature. Speaking from sources is what we'll be doing today, but again, carrying the experience I've had in private practice and the evolution as a hearing care provider, you know, we talk about putting in our 10,000 hours and working with as many patients as I've been blessed and had the opportunity to work with,

(04:28):

y,ou really do start to learn about humans. So at some point in our lives, we've experienced grief, whether that be losing a pet, a friend, a family member. Looking at this from the angle of hearing healthcare. This episode, I just encourage and challenge you all to put your curiosity hat on. This episode is gonna be thought-provoking. I hope that you leave this episode thinking a little bit more about grief and hearing loss, because this is more or less going to be a series. We're going to invite some hearing aid users, uh, cochlear implant users, uh, onto this show to extend on this conversation. So, this is really the foundation. Being that at some point in our life we experience grief. And oftentimes it's about losing something, whether it be a, a place or a thing. And I've just been thinking with patients who present with hearing loss, well, we all have an identity, we all have a self-identity, if you will.

(05:28):

And I'd be curious to know if, when patients start to feel that sense of, "You know, I might be losing my hearing" or "I'm not hearing as well as I could," are they losing? Do they, are they grieving that sense of self? And it's important to note to our hearing care professionals tuned in right now, but even individuals who are interested in being fit with hearing technology, understanding that grief is a process. So, what do I mean by that? Grief is not linear. And what I struggle to accept as a hearing care provider are the headlines, you know, from denial to acceptance. Because again, the grieving process is not linear and patients may go from denial and then to anger, and then back to denial, then to bargaining, then back to denial. So, it's so important that as hearing care providers, but even as patients giving yourself grace, understanding, you know, this is a process and it is okay to feel how I'm feeling, try not to fight that.

(06:30):

What I found to be really interesting about listening to Dr. Huberman's podcast episode, specifically about grief, was that grief and depression often overlap in terms of symptomology, but they are different in terms of processes. And he reports that grief is a motivational state. And I bring this up because we talk about untreated hearing loss being linked to depression. At what point do we as hearing care providers make that recommendation to seek speaking to a clinical psychologist or therapist? So it, it's really important that we understand the difference between complicated and non-complicated grief. Now, you may be questioning and wondering, "Well, what are the stages of grief and what do patients with hearing loss experience?" Well, let's go back to Dr. Elizabeth Kubler-Ross, who actually introduced the five stages of grief. And these include the first stage, which is denial. Now, an example of something in the denial stage for someone who presents with hearing loss, uh, may be blaming others for their inability to hear clearly.

(07:42):

And I've heard this time and time again, examples of this are, "You know, they mumble" or, you know, "This music just has really poor sound quality." And then also stigma associated with hearing loss and hearing aids or the fear of negative social consequences. We've, and I've seen this time and time again of when you put the demo hearing aids on patients, they ask, "Well, can you see them?" Or they would ask their wife or their husband, "Can you see them?" And it's more or less like, I don't want anyone to know that I have a hearing aid and I present with hearing loss because that might make me look less capable, if you will. So, those are two examples of individuals who present with hearing loss that might be thinking in the denial stage, if you will. And the second stage is anger. And I am sure if you're tuned in, you've probably had an experience or episode where you've just been angry.

(08:33):

I mean, we're all humans, we are all bundles of energy, <laugh> and emotions. So, you've probably been angry at one point in your life. And when individuals who present with hearing loss enter the anger stage of grief, they might be asking questions of why me? This isn't fair. You know, they recognize that they present with a hearing loss. And I recall a few patients in the past who came to the office, and I'm sure providers tuned in right now can attest to this. I've had patients come in incredibly angry, standoffish, and after they go through the test and after we've listened to them, because as humans, we just want someone to hear us out. We want someone to listen to us. And throughout the grieving process, that's really, really important. And we've had patients again, come to the office standoffish and they leave excited. You know, we've had patients -

(09:27):

We've gotten so many hugs in the past of, "You know, thank you so much for just educating me and listening to me." Because when a patient says, "Well, you know, this sucks. Like, why me? This isn't fair." The last thing we as hearing care providers want to say is, it isn't fair, but we can help you. Maybe a small percentage of patients will accept that, but how about going at it in this way of "I'm with you, it isn't fair." Recognizing their feelings is really important as we go through that counseling process as hearing care providers. So, the first stage is denial. Second stage is anger. Now, the third stage is bargaining. And this is, and can be referred to as that, you know, negotiation phase. For example, you know, if I did this or if I just did that. And, and I wonder too, if patients in this bargaining stage that present with hearing loss who worked in noisy environments are saying things like, "You know, what if I just wore earplugs during my time at the manufacturing plant?"

(10:32):

Or, you know, if they worked in a, in a machine shop, we've had so many patients who have worked in machine shops and they never wore hearing protection because back then it really wasn't a thing. There wasn't as much education. So, that bargaining, it's like, if I just did this or if I just did that. And you know, patients in this stage start to compare and they'll say, "Well, I can't really hear things, but at least I have my health." Or they might start to devalue. For example, we've heard this time and time again, and I've had patients who have said this, um, "Well, who really cares if I can hear? I don't like that music anyway. So, if I can't go to the concert, it is what it is." So, there's comparing and devaluing is more or less like a subset under the bargaining stage of grief.

(11:16):

And then the fourth stage, we have depression. And if patients are unable to hear sounds they once enjoyed, like their favorite music, artist, or band or you know, of the like, this can result in social isolation. Now, we are social beings. We like to be around people. Even if you are an introvert and or an ambivert introvert, you really like your alone time. And again, I'm not gonna go into the characteristics that make an introvert, however, as humans, we are social beings and it might be difficult to motivate individuals to rejoin social situations. As humans, we do often have our cup filled, whether you are an introvert, ambivert, or extrovert by being around people. And with the social isolation, when patients present with untreated hearing loss, what is happening is they're noticing that they can't understand speech as clearly. Maybe they are responding inappropriately. And I'd be curious to know if when this, during this stage, even leading up to this stage, these patients have been around family, they've been around friends, maybe their friends have said, "Ah, you can't hear me anyways, so I'm not gonna repeat myself."

(12:31):

And this patient time and time again, is now being conditioned to say, "Well, I'm a burden on them." And to patients who present with hearing loss, you're not a burden by any means. Addressing your hearing loss is absolutely essential and at a really important, uh, stage here. But with social isolation, we've personally seen this in the clinic with our patients. What I think is so incredible though is, is after we've counseled our patients correctly, we've listened to our patients. What is amazing is we've seen patients go out and, you know, we've trademarked Hear Life's Story. They've gone out and they've, they've rejoined these social groups because they've regained that confidence of, "I can hear so much better now." There's so much more to life, I feel rejuvenated, and it's such a beautiful thing. So, uh, didn't want to go off on a tangent there during the depression stage of grief.

(13:29):

And then the last stage number five is acceptance. People with strong support systems really do enter this stage. We've seen this time and time again, and this is why it's so important when patients call the office to make their first appointment, it is essential to encourage the patient to bring a familiar voice, to bring a family member with them to the appointment. For many things. Number one is really support. Personally, I don't like going to the doctor alone if, you know, I am worried or, or scared of being told that I might present with X, Y, and Z. So, having that support system is really essential during this acceptance stage. And just so many incredible stories I've personally as a hearing care provider have seen of husbands, you know, they are the patients and, and their wives accountability buddy essentially. And it's so cool to see because when you fit a patient for the first time with hearing technology, number one, their eyes just light up.

(14:35):

It, it can be a very emotional appointment when they've accepted, "You know what, I'm acknowledging my feelings, you know, negative feelings about my hear- hearing loss." But you're not letting these feelings interfere with relationships in one's daily life is, is pretty awesome. And that's really what happens during this acceptance stage of grief. The importance of that support system. And if you don't have a close family, think of like a friend. They can be your accountability buddy. And especially with untreated hearing loss, especially in the hearing healthcare industry, this can be, even if it is a friend, they are social beings. So, they understand the importance of communication. Now, wanted to go through those stages and how they are connected to hearing loss in and of itself. Now, I forewarned you this episode was going to be a little deep and really the- this is going to act as the framework for future episodes because again, we want to discuss grief more.

(15:38):

So, I'm gonna take a quick swig of my cup of Joe here. I'm in Arizona right now and uh, the high today is gonna be 97. So, um, it's rather, it's rather hot in the studio right now. So, I wanted to bring you through these stages of grief and how they connect to hearing loss. And again, I've firsthand have experienced, you know, five years in private practice, hundreds of patients go through these stages and every patient is in a different stage. And what was really eyeopening and enlightening to me was accepting the fact that when patients come in and they might have that standoffish attitude, number one, they're, they're in one of those stages of grief. But number two, as a hearing care professional and provider, we can't take things personally. That's in life and that's in the clinic, because it is not a reflection of us.

(16:37):

So again, going a little bit deeper, like I said, I really love learning about the mind. I love learning about human behavior. I love learning how we can impact patients lives. And I had this thought the other day, my first psychology class in college was, uh, 2010. So, I was a freshman in 2010. Just gave you my age there if you're really good at quick math. Uh, but I loved learning about humans cuz if you think about it, we are always going to be in contact with humans throughout our entire life. Why not understand <laugh> us as a species, if you will. So, it wasn't until I believe my junior year of college undergrad, and our professor, we were reviewing, um, Erik Erikson's Psychosocial Stages of Development. Now hang on here. Okay, just bear with me Erik Erikson's Psychosocial Stages of Development. And I had this thought and I did some research, some digging.

(17:47):

We are working with patients who are navigating through the psychosocial stages of development. They're grieving their hearing loss and they're now being faced with purchasing technology that we know will help them communicate better. They might not know that and they might not have buy-in right now because of everything else that's going on in their mind. It's a lot for our patients at once. So, what are Erik Erikson's Psychosocial Stages of Development? So Erikson's eight stages of psychosocial development behaviors that may be associated with healthy and unhealthy expressions of self-development and ego boundary growth during Eriksson's first five development and ego boundary growth during Eriksson's first five psychosocial stages. So, I'm not gonna go through every one, but I would like to go through the stage that our patients are more or less going through. So, they're going through this psychosocial stage of development, they're grieving a hearing loss.

(18:52):

There's a lot going on here. I'm 31. So right now, according to Erik Erikkson's psychosocial stages of development, I am in intimacy verse isolation. And this means that, uh, so this is from 20 to 40 years of age and description here is young adults struggles to form close relationships and to gain capacity for intimate love. So, you have expressions of intimacy which are maintained friendships, participation in games groups, open and willing to interact and you're able to make and keep commitments. Now, the other end of the totem pole there is expressions of isolation and self-absorption. So, you might withdraw, you might avoid, self-defeating behavior, maintaining isolation. So, that's from 20 to 40 years of age. And I had this thought, I'm like, "Hmm, what is the average age of a person buying hearing aids in 2022?" MarkeTrak data shows that the average person, average age of a person buying hearing aids is 60.

(20:00):

And I thought to myself, hmm, this is interesting. So, at 60 years of age, you are considered to be middle adulthood. And this is the generativity versus stagnation stage. And the description of this stage is middle-aged person seeks a sense of contributing to the world through, for example, family and work. Now, expressions of generativity include confident, productive work, you're your own person, uh, willingness to invest in the next generation, achievement, goals, things of that nature. The other side of the coin, expressions of stagnation. So, you have stagnation, complaining, blaming, withdrawing, you know, fatalist attitude. So, as ahearing care provider, think to yourself, what current patients am I working with who might be going through some of these stages? Well, not might they most likely are. Again, these are Erik Erikson's psychosocial stages of development. When I first learned this in my psychology course, I was just mind blown.

(21:04):

I was like, this makes complete sense. This is so interesting. And going at life with that sense of curiosity. So, if the average age of a person who is buying hearing aids is 60, they are in that generativity versus stagnation stage, and they are essentially entering integrity versus despair stage. So, the description for the integrity verse despair stage, this is late adulthood and this is ages 65 years of age and up. Now, the description under the integrity verse despair stage is reflecting on life. The elderly person may experience satisfaction or a sense of failure. So, expressions of integrity include, you know, you're proud, content with self and life, uh, healthy interaction with self, you're self approving, you like being an example to others. Now, the other side of the coin, again, expressions of despair and distrust include deep resentment, low self-esteem, anger at self, others, the world, society; anger at aging and feeling cheated.

(22:16):

Now again, this is so interesting to me because when we understand the psychology of the hearing impaired, when we understand the psychosocial stages of development, when we understand the grieving process, imagine how many more patients we are going to be able to help and introduce them to their new hearing world. Again, I forewarned you this episode was going to be deep. We wanted to lay the framework here, but I've just been thinking about this for the past couple of weeks and wanted to share this with you, our incredible listeners, supporters. This really had me thinking because when we are working with patients and, and fitting them, most of our patients are either in that generativity versus stagnation stage, or they're integrity versus despair. Now, I understand and us too, when I was practicing full-time, I have fit patients in that young adulthood stage. And what's interesting is younger patients had greater acceptance of the technology in and of itself, which was really interesting to see.

(23:26):

And I'd love to see maybe if there is a research study that's been conducted, um, or maybe there needs to be one conducted of, you know, the difference in individuals who are in the young adult intimacy versus isolation stage and acceptance of hearing technology, how they approach the grieving process versus maybe someone in middle adult and late adulthood. For my hearing care providers out there, I hope that this episode brought to light why it's so important to listen twice as much as we speak, but go into every single appointment with a sense of curiosity. And understanding too that if a patient is having a down day or a bad day, do not take that personal. Cuz the minute we take that personally, the minute we are unable to objectively provide that best, first class service. And, you know, leaving them with a sense of increase. We want every patient to leave the office with the feeling of increase.

(24:29):

So again, we went over the stages of grief, briefly discussed Erik Erikson's psychosocial stages of development and the importance of understanding those stages and meeting, this is really what I wanted to say, uh, meeting our patients where they are at. So, when we talk about that identity piece and individuals are grieving, are our patients looking at the person they used to be and having a difficult time accepting their new reality, their new identity, the identity of self? I've really been thinking about that because when you're grieving, again, you're in that stage of well what if, what if, um, and patients are remembering the individual they used to be with normal hearing. And I'll leave you with that. A book recommendation that I would highly recommend to our providers tuned in right now to current hearing aid users tuned in right now is "The Power of Now" by Eckhart Tolle.

(25:36):

So, as individuals, 47% of humans are unconscious. So, what do I mean by that? They're thinking of the past, which again, that identity piece with our patients through thinking of the past, they're not mindful, they're not being present, they're not here, they're not "Now." This paradigm shift, this mindset shift, the importance of counseling a patient who was just fit or even is about to being fit with hearing technology is so important. And again, the importance of referring out to a psychologist, if you are seeing signs that a patient does need that additional step and additional care, uh, in their hearing journey is, is really important. So, again, that book recommendation is "The Power of Now." Most of us, majority of us, half of us are fighting the present moment. Our patients might be thinking of the past, or they're thinking of the future. So, it's up to us as hearing care providers when our patients leave our office, having them feel that sense of increase.

(26:39):

And to our current hearing aid users tuned in right now, whether you are currently wearing hearing technology or you're thinking of visiting a hearing healthcare professional, take the first step. I am super proud of you. I'm excited for your new journey. And oftentimes we hear patients say, "I wish I did this sooner." Again, let's meet the patient where they are at. Let's understand the psychology of the hearing impaired. And really it's the psychology of humans. I want to thank you all so much for tuning in today. Again, this episode was laying the groundwork. It was essentially the foundation for future episodes of us addressing grief and hearing loss. You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology, best practices, and a growing national epidemic: Hearing Loss. I'm your host, Blaise Delfino. We'll see you next week and until next time, Hear Life's Story.