What’s On Your Mind? By Michael Harvey

How we deal with our friends and relatives who need hearing aids but refuse to wear them.

 Dear Dr. Harvey,

My 69-year-old father has been losing his hearing for several years and has become much more withdrawn. My mother and I finally convinced him to see an audiologist who fitted him with two top-of-the-line, digital hearing aids. When he complained about the expense, I paid for them! Although he happily reported that he can understand conversations much better, he hardly ever wears them! And it seems that no matter what we try to do for him -– for example, including him in activities like golf (which he admitted he still loves) -– he withdraws even more. His typical remark is that “Fun makes me nervous,” and then he says he doesn’t want to talk to me anymore. It doesn’t make sense! I would be grateful for any suggestions you have.

M.P., Boulder, Colorado

 Dear M.P.:

 It is a well-documented fact that, unfortunately, most people who can benefit from hearing aids do not use them. The possible reasons are numerous and complex: e.g., one’s denial of hearing loss, level of comfort with assistive technology, stigma, physical discomfort with the aid, prohibitive cost, difficulty manipulating its tiny controls, confusion about treatment, poor rapport with the audiologist, and unrealistic expectations. Depression is another common reason -– one that may be relevant to your father, particularly in light of his having withdrawn from engaging in enjoyable activities.

You noted that “It doesn’t make sense” that he doesn’t do activities that he enjoys and is nervous about having fun. Fear of happiness often goes with depression. One’s thought pattern may go something like this:

“Although it doesn’t feel good to stay withdrawn, at least I won’t be disappointed. But if I allow myself to be happy and engage with the world, I’ll be setting myself up for a letdown; it’s worse to become depressed after being happy, as opposed to tolerating constant depression. So, rather than risk major disappointment, I’ll continue doing what at least I can rely on: I’ll erect a protective barrier from the world.”

What do alcohol abuse, compulsive working and failure to take advantage of hearing amplification have in common? Answer: all may function as protective barriers; they keep one numb to experiencing life’s disappointments and, also, true happiness. Joan, a middle-aged, late-deafened woman, articulately described this dynamic:

“After being fitted with my hearing aids, I was finally able to again hear the baritones of my favorite operas, beautiful birds singing, and my grandchildren’s voices. I should have felt nothing but pure happiness and gratitude! But I didn’t count on feeling terrified: a sudden, deep fear that all this might be taken away from me. Sometimes, it’s easier hiding and being depressed.”

Your father may be experiencing a similar crisis associated with being able to hear and participate in activities better; without his protective barrier, he gets his hopes up and risks major disappointments. I would suggest that you ask him if he would mind you and he meeting with the audiologist together, for the purpose of helping you understand the treatment of his hearing loss better. The audiologist will also further assess the accommodations for his not using amplification.

Similarly, it may also be helpful for you to ask your father’s permission to arrange a conjoint appointment with a mental health clinician. Lest your dad think you’re accusing him of going crazy -– a common response -– you can honestly assure him that one reason for the visit is to help you know how to be most helpful, when to get “off his back,” and, overall, to work on improving your relationship. You can also openly state that a therapist can evaluate him for depression and recommend treatment, as needed; and that it makes you sad to see him so phobic of having fun.

Often treatment isn’t as simple as providing people with the right tools to fully live their lives. Like Joan, quoted above, an essential part of your father’s treatment may be to help him articulate and tolerate his fear of happiness and fulfillment: the psychological crisis which was brought on, in part, by effective, “top-of-the-line” hearing aids.

 Michael A. Harvey, Ph.D., is a noted author and clinical psychologist whose specialty is psychotherapy for persons with hearing loss. He regularly lectures both nationally and internationally, including at several SHHH Conventions over the past 20 years. In addition to a private practice in Framingham, Massachusetts, he holds adjunct faculty positions at Boston University; Pennsylvania College of Optometry, School of Audiology; and previously at Gallaudet University. His latest book is titled The Odyssey of Hearing Loss: Tales of Triumph, published by Dawn Sign Press and available from the SHHH Publications Catalog. His fourth book -- Family Narratives of Hearing Loss: The Transformative Power of Dialogue -- is due out this year.