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Original article Edit

Authors Edit

David Veale

Source Edit

The Journal of Deaf Studies and Deaf Education 2006 11(3):369-372; doi:10.1093/deafed/enj043

Abstract Edit

A case is described of a patient who has a compelling and persistent desire to become deaf. She often kept cotton wool moistened with oil in her ears and was learning sign language. Living without sound appeared to be a severe form of avoidance behavior from hyperacusis and misophonia. She had a borderline personality disorder that was associated with a poor sense of self. Her desire to be deaf may be one aspect of gaining an identity for herself and to compensate for feeling like an alien and gaining acceptance in the Deaf community. Will a compelling desire for deafness ever become a recognized mental disorder one day for which hearing patients may be offered elective deafness after a period of assessment and living like a deaf person? Those working in the field of deafness should be aware that individuals may occasionally be seeking elective deafness or self-inflicting deafness to obtain a hearing aid.

Analysis Edit

Will a compelling desire for deafness ever become a recognized mental disorder one day for which hearing patients may be offered elective deafness after a period of assessment and living like a deaf person?

That would be good, but we're not holding our breath. It's not going to happen until the medical community changes many of their attitudes and stop being so responsive to negative noises the media makes when they sensationalise such acts as the elective amputations that happened in Falkirk.

A second example is individuals with amputee identity disorder have a compelling and persistent desire for one or more digits or limbs to be amputated.

Good to draw the comparison with BIID, though the author uses AID instead. Why did the author not use the more recent, and accurate label of Body Integrity Identity Disorder?

In the face of opposition from surgeons, some individuals hasten amputation (e.g. chainsaw wound) or carry out self-amputation

Yes, if surgeons refuse to assist, we have no option but to resort to self-injury. Is this not a strong argument in favour of providing surgery? Is it more ethical to let someone risk their very lives by attempting self-injury than to help someone safely become an amputee, deaf, or paralysed?

Furthermore, patients who have had surgical amputation claim to have had a successful

What's this "claim" about?

We find it interesting that realised wannabes all say that they are happier after acquiring their amputation, but that the majority of the health professionals and writers on BIID all doubt these statements. Why has there been no study of these realised wannabes, putting in one place the experience and evidence of the success of surgery?

It is argued that amputee identity disorder is therefore more akin to a gender identity disorder in which an individual feels that his or her genitalia do not belong to him or her and that he or she is trapped in a body of the wrong gender.

Yes, there are strong similarities between the Gender Identity Disorder experience and that of Body Integrity Identity Disorder.

She desired medical assistance with a sympathetic surgeon as she did not want to take the risk complications by using methods such as repeated sounding of a claxon horn in her ears or ototoxic drugs.

She had been tested as having normal hearing but felt she was a 'deaf person in a hearing person's body.'

Using the language familiar to transsexuals, or of most of those of us who are transabled. It fits.

She had a past psychiatric history of bipolar disorder and the onset had occurred after his birth.

It seems to us that the selection of study candidate is skewed. As with other papers, the subjects selected for the paper have a long list of complicating psychiatric issues that are not representative of the majority of people with BIID.

She was not psychotic and had no command hallucinations or delusions.

It's been said in many other papers, people with BIID are not deluded, nor psychotic!

She fulfilled criteria for borderline, schizoid, schizotypal, narcissistic, obsessive-compulsive personality disorders.

And here again, seems like this shopping list of disorders aims to discredit the validity of BIID, but isn't representative of the majority of transabled individuals.

No previous cases of deliberately self-induced or medically assisted deafness have been described in the literature.

Which is not to say that this subject's experience is isolated and that there haven't been many people requiring deafness that achieved it by self-inflicted methods.

There was no evidence of Munchausen's syndrome

Because BIID is not about attention, and is unrelated to Munchausen's syndrome.

My opinion to Ms. A was that no psychiatrist would sanction elective deafness and that no surgeon would assist her in her desired goal.

Unfortunately, that is probably a fair assessment of the situation.

I discussed such a program with Ms. A, but she felt that the treatment was too similar to aversion therapy or "retraining" a gay person to become "the norm" of being heterosexual and that the alternative of becoming deaf was not being seriously considered.

And so the response from nearly every health professional is some form of therapy or other, some "program". Ms.A was right. Ms.A knows what she needs, just as we know what we need. Listen to your client's needs, they often know the solution.

Will a compelling desire for deafness ever become a recognized mental disorder for which patients may be offered elective deafness after a period of assessment and living like a deaf person?

We certainly hope it will be recognised, though not as a new mental disorder, but as part of the Body Integrity Identity Disorder umbrella, just like a desire for amputation, or for paraplegia, or blindness.

The desire for elective deafness is in the author's view a new "symptom" or abnormal coping mechanism rather than a new disorder.

Then perhaps the author ought to spend more time talking with other individuals who have BIID.

The thing is, it's not a new disorder. It's been around for centuries. It just is now being recognised.

It is not inconceivable that elective deafness could one day be offered to such patients as a logical extension of patient choice and acceptance of diversity and avoidance as a means of coping.

That would be good. But it's unlikely to happen until professionals such as the author change their perception of our condition.

Such cases are likely to remain extremely rare, but a survey on the Internet group of deaf "wannabes" is now being undertaken.

We look forward to see the results of this survey, and hope that they are tabulated in line with the idea that needing to be deaf is just another aspect of BIID, and not a stand-alone condition.

Those working in the field of deafness should be aware that some individuals may be seeking elective deafness or self-inflicting deafness to obtain a hearing aid.

Yes, those working in the field should be aware, to be better able to assist people who suffer with BIID. This last comment from the author sounds like a dire and negative warning: Beware, for there are strange and messed up people coming to you.

And as far as inflicting deafness, we're willing to bet that it isn't about obtaining hearing aids, but about becoming who they should be.