Communication Diet Theory: An Extended Foundation for Hearing Rehabilitation

Discussions among audiologists on how to best work with adults with hearing loss usually revolve around pathological or technical issues; for example, how to better understand the physiological aspects of hearing, how to make an accurate diagnosis, or how to optimize the benefits of technology to maximize residual hearing. Although these aspects of audiologic rehabilitation are vitally important, it is additionally helpful to evaluate the impact of interpersonal communication behavior upon communication function and social integration. Communication behavior refers to individual communicative actions that may vary from time to time. Communication function refers to the overall purpose of the collective communication behaviors - namely, social integration.

The simple reason for this additional focus is that communication behavior, whether we hear well or not, has a much more decisive influence upon success or failure in social integration than the simple ability to hear. After all, how we respond to what we hear or perceive is usually the only criteria our communication partners can use to determine how to interact with us. Therefore, an examination of the impact of communication behavior on communication function may be more enlightening as a framework for developing an audiological rehabilitation program than a clinical perspective that considers only pathological or psychological causes of the disabling impact of hearing loss on social integration.

Hearing loss is common, and regardless of the causative factors involved, there are communication behaviors that typically result from it. The inability to hear a conversation clearly as a result of a hearing loss is not much different from being able to hear a conversation but not understand it as a result of a language barrier, as in the case of a non-English speaking immigrant. Neither should be regarded as a psychological or psychosocial disorder. It is helpful to the task of rebuilding a client's communicative confidence to investigate whether the client is using any communication behaviors that could create barriers to successful social integration within his or her culture. This additional clinical focus does not mean that a clinician should deny psychosocial issues caused by hearing loss. It simply suggests that the best foundation for hearing rehabilitation planning is to focus on helping clients restore balance to their communication function.

Two Components of Communication Function

Normal acts of communication involve two components, reception and expression. We receive information about environmental sounds and interpersonal communication through our ears and eyes, and we respond to these stimuli. These responses express our feelings and thoughts and convey messages to others. The resulting interactions determine our effectiveness in interpersonal engagement and social survival. Any impedance to the frequency, quantity, or quality of communication can have a significant impact on the quality and stability of social integration and, if left untreated long enough, a negative impact on mental health. It does not matter whether the impedance is a hearing loss, speech impediment, language barrier, anti-social behavior, or a destructive communication tactic, the result will be the samea negative impact on the ability to engage productively and in healthful ways with other people.

Communication behaviors are culturally derived; they are learned from family and social environments. Hearing is a key determinate of communication behavior as information must first be received accurately in order to learn to respond accurately. Impaired hearing, especially if it is severe and affects the formative years, may impede the ability to adopt expressive communication behavior norms. This interference can be better understood by considering fundamental *attributes of normal communication behavior and how hearing loss can affect those attributes.

The Communication Diet Model

Communication is often called "food for the mind" and is just as necessary to mental health as food is to physical health, so taking a closer look at what happens to the human body when it is deprived of food, can help us to understand what happens to the mind when it is deprived of some of the essential "nutrients" of normal, unhindered communication.

If we neglect to eat an adequate quantity of nutritious food regularly, our bodies become sick unless a correct balance of the essential elements is restored. This is an absolute rule that cannot be ignored without an eventual impact on physical survival. For example, if a person eats regularly, but eats too little or too much, even if their meals are nutritionally well balanced, excessive weight loss or weight gain will result. If a person eats regular, good-sized meals, but eats only junk food devoid of nutritional value, illness will occur. Likewise, a negative effect will happen if a person eats well-balanced, good-sized meals, but skews the frequency by eating too often or too infrequently. Logically then, it should be a reasonable hypothesis that failure to "feed" the mind with an adequate amount of "nutritious" communication at regular intervals, or merely skewing any of the three elements, (regularity, quantity or quality) to one extreme or the other, could trigger the various psychosocial symptoms associated with hearing loss such as loneliness, depression, anxiety, and withdrawal.