Few physicians have been trained to deal effectively with deaf patients, a situation that has created barriers to successful treatment of this population. To remedy that, psychiatrists at Howard University in Washington, D.C., and the University of Virginia (UVA) in Charlottesville created special rotations and electives for trainees on deaf units of affiliated psychiatric hospitals.

Barbara Haskins, M.D., an associate professor of clinical psychiatry at UVA and a specialist in treating deaf patients, has worked with about 150 third-year medical students on the deaf ward of Western State Hospital in Staunton, Va., since the rotation began in 1988.

"I wanted medical students to be exposed to deaf patients to understand the range of cognitive capacities and the similarities with and differences from hearing people," said Haskins.

About 70 psychiatrists who belong to APA’s Caucus of Psychiatrists Working with Deaf and Hard of Hearing Persons, work with this population out of an estimated total of 50,000 psychiatrists in the United States, said Haskins.

Typically, two third-year medical students spend about one day a week on the deaf ward as part of their six-week psychiatry rotation.

Haskins recommends the sign language class at Western State Hospital to medical students but added that only about 50 percent take it. "Some people do not have an aptitude for foreign languages including American Sign Language. We are fortunate to have a full-time interpreter at UVA and Western State Hospital."

In addition to experiential learning on the ward, medical students are required to read the first chapters of Seeing Voices by neurologist Oliver Sacks, M.D., and write about their reactions.

The book presents the history of deaf people in the United States, including "the often outrageous ways in which they have been seen and treated in the past, and their continuing struggle for acceptance in a hearing world," according to Sacks’s Web page. "It also examines the amazing and beautiful visual language of the deaf—sign—which only in the past decade has been recognized fully as a language. . . ."

Campbell commented, "Sacks approaches sign language from a biological basis and refers to studies that show that children who learn American Sign Language at an early age develop the ability to think complex and abstract thoughts."

Rinku Mehra, another third-year medical student, wrote, "Before working on the deaf ward and reading this chapter in Oliver Sacks’s book, I had never given much thought to the world or language of the deaf, mainly because of lack of exposure. . .

"According to Sacks, deaf students who had been allowed to learn sign were highly literate and educated. In contrast, the suppression of sign, fueled by the oralists’ view that the deaf should learn only to speak, resulted in a dramatic deterioration in the educational achievement of deaf children and the literacy of the deaf generally."

Haskins meets weekly with the medical students assigned to the deaf ward to discuss issues raised in Sacks’s book such as the presence of cognitive deficits in older deaf children and adults.

"The main point I make is that language deprivation affects cognitive function. Research on deaf children shows that there is a window of opportunity to acquire language," said Haskins.

"I have seen cognitive deficits in some of my adult deaf patients raised by hearing parents in rural areas who communicated only orally or in limited gestures. My patients only saw talking heads and moving lips, which did not stimulate the left side of the brain that sets up rules for language and thought."

For example, despite repeated attempts to explain the germ theory to a deaf patient with AIDS, he has not been able to grasp the concept, said Haskins.

"Another deaf patient is not able to fractionate time, so when we ask him when something happened, he can answer only yesterday," added Haskins.

Another topic she discusses with medical students is the importance of schools for the deaf in preserving deaf culture. "For deaf children raised by hearing parents, this often is their first exposure to deaf peers, sign language, and even deaf jokes," said Haskins.

She believes deaf children should be given a choice between attending mainstream and deaf schools. "Mainstream schools are tough on deaf children’s social life because they are totally dependent on an interpreter to communicate," said Haskins.

Luther Robinson, M.D., an associate professor of psychiatry emeritus at Howard University College of Medicine in Washington, D.C., developed a similar rotation for third-year medical students on a deaf unit at St. Elizabeths psychiatric hospital also in Washington, D.C.

Robinson, who has worked with the deaf population for over 35 years, told Psychiatric News that for most medical students this is their first contact with deaf people with mental illness.

Robinson begins the five-week psychiatry clerkship by discussing the mental health implications of being deaf. In the overview, he explains the implications of being born deaf in contrast to losing one’s hearing later in life, the silent world and social isolation, deaf people as a subculture, the attitudes of the hearing society toward deaf people, and mental health issues, according to Robinson.

Usually two third-year medical students choose to spend about half a day a week on the deaf ward at St. Elizabeths. Medical student aHoward Francois told Psychiatric News, "This clerkship helped me to understand the unique obstacles deaf patients face and to separate their communication problems from mental illness."

The students spend most of their time on the deaf ward observing psychiatrists evaluating and treating deaf patients through an interpreter.

Robinson pioneered the mental health services program for deaf patients at St. Elizabeths in the 1960s. The services include group psychotherapy, individual psychotherapy, psychodrama, dance and art therapy, family therapy, and educational therapy, said Robinson.

He also developed the training opportunities for medical students and residents beginning with an internship in 1966-67. Robinson’s goal is to stimulate interest in working long-term with deaf patients.

About a decade ago, he implemented a one-month elective titled "Mental Health Issues in Deaf People" at Howard University. Trainees participate in selected therapies for deaf patients at St. Elizabeths and visit Gallaudet University, a university for the deaf in Washington, D.C. Students are encouraged to learn sign language and audit psychology classes at Gallaudet.

Robinson encourages other medical schools to offer similar and even more in-depth training opportunities.