The Psychology of Hidden Disability

My hidden disability is hearing loss, but the psychological, emotional, and professional ramifications I experience are true for anyone with a hidden disability.

Most hidden disabilities are considered in some way shameful or devaluing. Hearing loss is seen as a sign of aging and is often associated with mental retardation. Asperger's as a form of mental illness. Mental illness as something to be feared. Eating disorders as personal weakness. Epilepsy as a frighteningly uncontrollable disorder (it's not). Depression as a sign of unreliability. PTSD as a condition that means people can't work in a stressful work environment.

For that reason, many many people with these conditions keep them a secret. Lynne Soroya wrote a very good column about this: "Disability, Discrimination and Disclosure: Being 'Out' in the Workplace." I also wrote about this in an article for the Times Sunday Business section: "Quandary of Hidden Disabilities: Conceal or Reveal."

Keeping a secret like that, living every day pretending you're something you're not, is tremendously debilitating. It undermines your self confidence. You wonder all the time if the disability is affecting your job performance and you just don't know it. You worry your employer or your colleagues will find out and you'll lose your job. Yes, this last is illegal under the Americans With Disabilities Act, but employers manage to find many ways around it.

There is also the stress of having a condition that may get worse. With hearing loss, the progression is often unpredictable. I first lost my hearing in one ear when I was 30. I never dreamed that by the age of 60 I'd be deaf in both ears. Since the cause of my hearing loss is undiagnosed, I also live with the worry that it may be part of a larger medical condition. That was partly borne out a couple of years ago when I began suffering incapacitating vertigo two or three times a week. It was my psychotherapist, a psychiatrist, working with my ENT, who worked out a drug regimen that brought it under control.

People with hidden disabilities also tend to withdraw, to isolate themselves. It's hard enough faking it through the things you have to do—like work. It's often not worth it to fake your way what should be pleasurable experiences.

As anyone reading this knows—since you're interested in psychology—that isolation and withdrawal contribute to depression. They also contribute to cognitive decline, and cognitive decline puts you at risk for Alzheimer's and dementia.

Everyone in the helping professions should understand the psychology of disability. Therapists need to recognize the symptoms of a hidden disability with new patients, and draw them out about it, and then confront the issues that that disability contributes to.

People in the medical profession need to recognize depression, anxiety, Asperger's, yes even hearing loss, when a patient comes in with what seems to be an unrelated complaint. It may in fact not be unrelated at all.

Anyone who works with the elderly needs to recognize hearing loss and not mistake it for dementia.(They also need to recognize depression and anxiety, which are very common in the elderly.) I've heard stories of nursing home staff taking away a person's hearing aids so they wouldn't lose them or damage them—that leaves the individual trapped in a world where he or she can't hear, can't communicate. They may not have the cognitive facility to ask for the hearing aids back, but being able to hear will help fend off further mental deterioration.

The issues that come with hearing loss—and any hidden disability—should be familiar to psychotherapists, social workers, school counselors and others. 48 million people in this country have some degree of hearing loss. Most of them are under the age of 60. And some of them are undoubtedly among any therapist's patient or client population. They may not understand how their hearing loss is affecting them, but the therapist should.