Chapter 5: Reproducing a Hegemonic Medical Discourse in the Irish Deaf Education System

This chapter examines how a hegemonic medical discourse of deafness continues in the system today.  In short, this relies on the resources medical professionals can draw upon to give them the authority needed to be recognised as ‘experts’ in deafness. These medical professionals: e.g. physicians, audiologists, speech and language therapists, ear, nose and throat specialists etc, are predominantly hearing, and their interest in deafness tends to be exclusively professional.  In this study, one mother described encountered five specialists ranging from district health nurse to ear nose and throat surgeon (ENT) on her pathway to receiving a medical diagnosis of her child’s deafness. Importantly, since these medical practitioners are gatekeepers to identification and service provision, they have the resources to sustain their authority and the opportunity to dictate the first discourse of deafness that parents experience. Given their professional background, their authority supports a medical model of deafness and nearly always establishes speech as the preferred communication method during early intervention.

Families have the option of perusing speech and/or ISL with their young DHH child. The medical model uses seduction to make speech the most desirable option. As the overwhelming majority of DHH children have hearing parents, the initial seduction towards speech is supported by parental desire for their child to have the same experiences as they had growing up. From parental interviews, however, it was evident that parents were not just compelled to choose speech, but to choose speech instead of signing. Here we see a degree of manipulation being utilized by the gatekeepers. Upon identification, parents are immediately provided with speech-oriented services. Every child in this study was fitted with hearing aids, advised regarding CI, and put on waiting lists for speech and language therapy. By contrast, a degree of silence surrounds ISL during these early stages. Though not criticising the automatic provision of audiology and SLT services, it is worth reviewing why an automatic assumption is made in favour of speech-oriented services. Only one parent in this study recalled receiving information about ISL when their child was identified. Furthermore, parents were often unaware of the challenges of acquiring speech, Chris and Ellen’s parents surmised “you were just sent home with hearing aids on and…you just had to get him talking”. More than a quarter of parents hadn’t heard of the ISL home tuition service. Only half of those who knew about the service availed of it. Moreover, the process of finding and employing an ISL tutor is needlessly complicated. In summary, concentration of resources within the medical field, and the absence of professional endorsement of ISL, reinforces speech as the most desirable option and prompts the continued resourcing of the medical model.

In spite of this, over half of parents within this study deviated from the speech-only route at some stage. In the book, I refer to this as a ‘glitch’ in the system, when parents encounter difficulties in spoken language acquisition and begin to see the benefits of ISL for their child.  However, one trend that was evident is that while many parents deviated from the speech-only route for a while, most returned to using speech only.  When this was examined in more detail, it was evident that while seduction and manipulation worked as modes of power to get parents onto a speech-only route initially, stronger modes of power were used to get parents back to a speech-only route: inducement and coercion. It is here that we see ISL framed as a threat to spoken language acquisition. Fourteen of twenty families recalled that professionals had explicitly, or implicitly, discouraged ISL usage. Parents recounted being told that ISL would make their child “lazy” with speech, their grammar would deteriorate, or that sign would prevent the development of speech. In this study, negative discourse successfully coerced parents back towards the medical model of deafness. Subjectification was also evident at this point. Parents spoke of tactics they used to discourage signing, one mother, for example, recounted ignoring her child’s signed requests to encourage her to speak.

The coercion of parents enables the power of the medical establishment to transcend institutional spaces into the home. At the commencement of school, this medicalization is extended to the classroom. This was evident when parents expressed preference for mainstreaming over placements where ISL use could “interfere” with spoken language acquisition. One mother was disinclined to choose a unit placement, as she worried that “none of them are speaking properly…so how can they learn from each other?” Other children within this study were removed from specialist placement at the recommendation of medical experts to promote spoken language development. Several teachers interviewed in this study, however, expressed that exclusive use of speech in the classroom was problematic for their DHH pupil. These same teachers identified spoken language as a priority learning need for the DHH child in their class. Here we see the institutionalized medical model of deafness prevail, in that it the becomes the responsibility of the child to adjust to the system, rather than the system adjusting to meet the needs of the child.

DHH children in mainstream schools frequently lack Deaf role models. As such, speech is the only viable communication option for many in mainstream since there are no communication partners who have ISL. For many families, the option of sending their child to a DHH specific placement is not geographically viable. In this study, families living close to active Deaf communities were more proactive in their use of ISL and had greater access to alternative discourses of d/Deafness. Though one School for the Deaf offers boarding, one family reflected that “the prospect of sending your four-year-old away to school is very daunting…”. As such, having speech provides access to local schools.

The subjectification of parents, and the medicalization of the school and home, impacts on the DHH child’s ability to identify as Deaf. This results in the subjectification of DHH children, the third stage in the reproduction of a hegemonic medical model of deafness. Many DHH children view the DHH “self” as “other” and the hearing “other” as “self”. As such, traits of deafness are pathologized rather than celebrated, as within Deaf culture. Five-year-old Henry was already showing signs of being conscious of his deviation from the norm in his reluctance to speak in front of other students, and nine-year-old Chris was growing his hair to disguise his hearing aids. These examples show how the hegemonic medical model in the current day has transcended spatio-temporal boundaries to prevail outside medical institutions to move into a mainstream system.