Sign Language article... another issue

[Dr. Imago]

I had a separate issue with this column, and one that is neither completely the fault of Randi nor Mary, the reader reporting this incident, but illustrates a couple of important misperceptions about psychiatric care and trying to make armchair diagnoses without having the full picture.

It was this...

[MARY]My take on the situation: she was obsessed with the groovyness of sign language and wanted to be deaf. At the college, I've actually seen several people pose as deaf before, so I'm not too surprised. I was, however, surprised at how my department spent hundreds of dollars providing services for a hearing person just because they came in with the magical, all-powerful doctor's note.

Yeah...I'm still bitter.

[RANDI]We understand your frustration, Mary....

We may understand your frustration, Mary, but I do not think you handled the situation correctly.

The woman that was feigning to be deaf was suffering from conversion disorder. This is a complex psychiatric condition that cannot be dismissed as mere faking or being "obsessed with the grooviness" of being deaf. Mary's post adeptly illustrates what we call in the medical world "counter-transference", and she labels and attempts to 'diagnose' this patient with attributes that she believes to be there based on her own frustrations, misperceptions, and biases. But, I'm not pointing fingers. It's a reasonable human thing and happens often, especially when you don't have training to recognize it in yourself - it's easy to fall into its trap. Counter-transference happens when you have an emotional reaction to a patient (or someone you're providing services for), and when that person starts making you feel that way you have to stop and step outside of the emotion. Otherwise, you counter-transfer your predispositions, emotions, and biases into the situation and get sucked into something that really does not concern, nor is a reflection of, you as an individual.

Instead of taking this situation personally (which is, again, reasonable when one feels "bitter" and embarrassed) and wanting to "slap her boss", Mary should have gone back to him and said, "You know that the patient can hear and actually orally corrected me when I signed incorrectly. She was listening to the entire conversation."

She and the boss should've then called the doctor and informed him. She may have been surprised that this doctor was not aware, to that point in her treatment, that this client was feigning deafness. I'm sure he would have listened very carefully to her, and taken her information seriously and thankfully as any new information from a situation always further elucidates the patient's case. There's no reason to think, based on the information given, that the doctor simply sent a signer to facilitate this woman with an ulterior motive. Mary assumes that she was "set-up", again illustrating that she took this situation personally - which she shouldn't have.

Then, what happened next was that Mary jumped to conclusions about the situation, assumed the doctor was an idiot, and then went on to extrapolate this into an indictment of the "all-powerful doctor's note."

All too often, people think doctors always have all of the information and/or are not amenable to changing their opinions when given new information. The best of physicians cannot often make a full, accurate diagnosis in one sitting, and this is especially true in psychiatric conditions.

I'm not faulting Mary for feeling frustrated and perhaps embarrassed. I think it was wrong to include her in this person's care without knowing the full details of her client's psychiatric condition and care. However, she should not assume that this person is even self-aware enough of the depth of her own problem - and, she did. Again, it would've been more productive to get involved and provide such information to the treating physician - start a dialogue with him - instead of assume that he lazily, maliciously, carelessly (etc.) utilized her services. It may have been a simple oversite. It's still not too late...

I think the only thing this article has proven, and nothing more at this point, is the pitfalls of a communication breakdown. I'm sure that all of this could be solved with a phone call. Until we have more information, I think it's unfair to fault anyone in this case, not the least of whom is the doctor. And, knowing what I know about doctors, I'm willing to give him that latitude.

-TT

 

[Pragmatist]

....and trying to make armchair diagnoses without having the full picture.

The woman that was feigning to be deaf was suffering from conversion disorder.

Hold on a moment...

1. Do you know the person concerned, (the patient) personally, and have you examined her?

2. If not, then how is your diagnosis not an "armchair diagnosis"?

No offence intended, but as a skeptical lay reader in this matter, I cannot differentiate between what you accuse Mary of doing and what you are doing now.

 

[Dr. Imago]

Re: Re: Sign Language article... another issue

Hold on a moment...

1. Do you know the person concerned, (the patient) personally, and have you examined her?

2. If not, then how is your diagnosis not an "armchair diagnosis"?

No offence intended, but as a skeptical lay reader in this matter, I cannot differentiate between what you accuse Mary of doing and what you are doing now.

Exactly on point, Pragmatist! Well done. This is a fair criticism.

But...

Someone who manifests clinical symptoms (e.g., blindness, paralysis, deafness, etc.) and they are not actually suffering from any objectively physiologic deficit is, by definition, a conversion disorder.

http://www.nlm.nih.gov/medlineplus/ency/article/000954.htm

Other than that, you are exactly correct. I do not know the specificities of this exact situation. I am assuming, taking an opposing but equally valid viewpoint from the other side, that the contributor, Mary, and Mr. Randi, in his de facto acceptance of her assertions, have also not done justice to both this patient and this doctor. I don't even know if this patient is in psychiatric care, but I know enough about medicine and have had enough training to know, just based on what was in Mary's post (if it was relayed accurately, which I again will assume it was), that she should be. This is a very straightforward diagnosis. In fact, it's textbook the way it's been presented.

The core of my argument is that a communication breakdown has occurred. And, to start drawing conclusions when we don't have all of the information - whomever is doing it - is unfair to everyone directly involved.

-TT

 

[Ashles]

Someone who manifests clinical symptoms (e.g., blindness, paralysis, deafness, etc.) and they are not actually suffering from any objectively physiologic deficit is, by definition, a conversion disorder.

But surely the point is that she hadn't manifested the symptoms.
Conversion disorder would have consisted of her actually becoming deaf due to psychological reasons. But she could hear, so she had not manifested the symptoms of deafness.

If she is merely pretending to be deaf then that isn't conversion disorder.

 

[Dr. Imago]

But surely the point is that she hadn't manifested the symptoms.
Conversion disorder would have consisted of her actually becoming deaf due to psychological reasons. But she could hear, so she had not manifested the symptoms of deafness.

If she is merely pretending to be deaf then that isn't conversion disorder.

You're right. That would be purely malingering, but in this case (a woman working in the deaf community becomes deaf) would point more to someone who has another psychiatric condition such as borderline personality. Nonetheless, we still do know know the specificities of this woman's condition aside from what Mary supposed. Again, had anyone (i.e., Mary or her boss) talked to the treating doctor? This is a communication breakdown.

I fully agree with the fact that she should not have been sent into that situation without the information on the client. But, she should also not take it personally when something like this happens. Of course, it is natural to be embarrassed, but she should not then jump to conclusions (as she apparently has here and I'm admittedly doing as well) about the motivations of this patient and this doctor.

My sister is a master's level educator who works with children with learning disabilities. In fact, she is the director of the clinic where she routinely sees kids with pathologies ranging from dyslexia to Asperger's syndrome. We talk frequently and she tells me she often runs into this very situation all the time. She has junior clinicians come to her frustrated, humiliated, and embarrassed when a child acts out. They feel that they have failed. They are frustsrated that they can't get anything done and they are mad at the child, get frustrated with the job, start questioning why the doctor sent the kid there, (etc.). A lot of times, they fail to see that these problems are not a reflection on their abilities but a reflection of the patient's condition. My sister spends a lot of time trying to make the less-experienced clinicians realize this, and not to counter-transfer back onto the child. Likewise, if there is a particularly difficult case, she will call and speak directly with the child psychiatrist/psychologist and inform them of their progress. On at least one occassion, a child was removed from the program because it was apparent that there was no benefit being gained due to his extreme limitations and how much he was disrupting the clinic.

A simple phone call solved this. It gave information to the treating doctor that he was willing, and indeed appreciative, to hear.

In Mary's case presentation, the "patient" here may be so sophisticated in her presentation that she may have fooled the doctor. Perhaps the doctor truly believes her to be deaf. I hate to burst everyone's bubble, but you should know the "all-powerful doctor" doesn't always know everything and can even be fooled by very clever and motivated patients.

-TT

 

[Pragmatist]

Re: Re: Re: Sign Language article... another issue

Exactly on point, Pragmatist! Well done. This is a fair criticism.

But...

Someone who manifests clinical symptoms (e.g., blindness, paralysis, deafness, etc.) and they are not actually suffering from any objectively physiologic deficit is, by definition, a conversion disorder.

http://www.nlm.nih.gov/medlineplus/ency/article/000954.htm

Other than that, you are exactly correct. I do not know the specificities of this exact situation. I am assuming, taking an opposing but equally valid viewpoint from the other side, that the contributor, Mary, and Mr. Randi, in his de facto acceptance of her assertions, have also not done justice to both this patient and this doctor. I don't even know if this patient is in psychiatric care, but I know enough about medicine and have had enough training to know, just based on what was in Mary's post (if it was relayed accurately, which I again will assume it was), that she should be. This is a very straightforward diagnosis. In fact, it's textbook the way it's been presented.

The core of my argument is that a communication breakdown has occurred. And, to start drawing conclusions when we don't have all of the information - whomever is doing it - is unfair to everyone directly involved.

-TT

Fair enough. Although, the point of the commentary wasn't all that clear and there are several possible interpretations of what Mary was complaining about. For example, she says:

"I later found out that this "deaf" woman was a top-level sign language interpreter at a local university. She also worked at a store which supplies technological devices for the hearing impaired."

It seems to me that this is prima facie evidence that the woman had no disorder and was actively lying about her deafness. As I understood it, Mary's complaint was the lack of critical thinking on the part of the college who apparently accepted the doctor's note on faith without actually checking anything themselves. I mean, I presume that if the college had checked up on this woman they would have found out about her occupation. Of course one wouldn't expect a college to check every student to this depth, but given the fact that Mary was hired specially at considerable expense solely for this woman's benefit, I think it was incumbent on the college to perform due diligence first.

Another interpretation was that Mary was concerned about the idea of the woman pretending to be deaf because it was "cool" - a typical woo attitude.

Of course, maybe it was both, or possibly some subtler point that I missed. Either way it seems that something was severely wrong and that Mary had valid grounds for complaint - assuming of course the facts have been related correctly, which we really don't have any way of checking.

There are too many unknowns to make a proper judgement in any event. For example, we are assuming the doctor's note was real. But what if it was forged? What if it was not from a real doctor? I get the impression the college didn't even bother to check.

I guess the only way we'd know for sure would be to ask Mary for more details.

 

[Dr. Imago]

Re: Re: Re: Re: Sign Language article... another issue

Fair enough. Although, the point of the commentary wasn't all that clear and there are several possible interpretations of what Mary was complaining about. For example, she says:

"I later found out that this "deaf" woman was a top-level sign language interpreter at a local university. She also worked at a store which supplies technological devices for the hearing impaired."

It seems to me that this is prima facie evidence that the woman had no disorder and was actively lying about her deafness.

Yet, this same passage is why I would lean more towards conversion disorder. Funny how lack of a complete picture skews one's perception towards a particular bias.

Either way, "faking" or actually believing, on some level, that you are suddenly deaf with the associated la belle indifference (another feature I got from this passage) is not a "normal" way for a hearing person to interact, and to me points to some psychological disturbance, be it malingering or conversion disorder.

Likewise, I think it is pertinent to be aware of the "culture of the deaf" and what role that may have played psychologically in her mindset. Perhaps this woman so associates with it that she either believes herself to be deaf, and if she is not consciously aware she is doing this (which would then make it a conversion disorder). Or, she is actually pretending to be deaf (which would be malingering). Either way the bucked stopped there, at least that's the impression I get from the part of the story we got.

What I hope anyone who is reading this issue will take home - and this is my primary point - is that you should not jump to conclusions about a particular situation without getting more evidence. I agree that we (or Mr. Randi should) should ask Mary for more information that would better elucidate this situation. But, I would caution anyone, before hearing their side of the story, to firmly believe that the doctor(s) (or University) have either made a mistake or, if one was indeed made, did so knowingly and willingly. That's the issue I take with Mary's conclusion and the indictment of the "all-powerful doctor's note", along with Mr. Randi's de facto acceptance of her story without a further picture of what this woman may actually be going through psychologically. As a party to this woman's masquerade and beyond the duty of the University's responsibility, Mary clearly has the right to know the full picture on what exactly is going on with this woman. On that point, no arguments here. Either way, I'm sure the American's with disabilities act would handcuff the University no matter what this person's disability actually turns out to be.

If it's any consolation, it would have pissed me off too. The difference between Mary and myself, though, is that upon being corrected I would have stood up, said to this woman calmly but squarely to her face in front of the entire audience, "I was lead to believe you are deaf but, if you can hear, there's no need for me to be here," then I would've smiled, excused myself, and promptly left. And, that would've been the end of it. Nothing taken personally.

-TT

 

[Dr. Imago]

And, just to clarify...

When I say, "it would have pissed me off too," I mean that I would have been upset that I was there wasting my time. I may have felt embarrassed and/or humiliated as well. But, the difference is that I would not have then internalized it, made the next not-necessarily-logical leap and assumed that I was set-up, not wanted to strangle anyone... you get the picture.

It's okay to feel. Feelings aren't bad. Feelings are just feelings. But, it's not okay to then take those feelings and make assumptions about those you perceive made you feel that way.

-TT

 

[DrMatt]

I've met people who were trying to pass themselves off as deaf for large stretches of their lives--yet at home secretly watch tv with the sound on and the captions off. My impression has been that these people are not mentally stable. But that's a general impression, not a clinical judgement. If we cannot watch out for each other without the authority of experts, what good can we do?

 

[Rolfe]

Re: Re: Re: Re: Sign Language article... another issue

"I later found out that this "deaf" woman was a top-level sign language interpreter at a local university. She also worked at a store which supplies technological devices for the hearing impaired."

I wonder if it's possible the woman had no significant psychiatric disorder, but was involved in some sort of exercise? Like conducting an undercover assessment of the quality of service provision for deaf people by that institution? It's conceivable that a more accurate picture could be gleaned by a hearing person than a genuinely deaf person. But then the investigator slipped up by indicating that she'd heard what had been said?

Just a thought.

Rolfe.

 

[BillyJoe]

Is this sign language?

 

[Dr. Imago]

Re: Re: Re: Re: Re: Sign Language article... another issue

I wonder if it's possible the woman had no significant psychiatric disorder, but was involved in some sort of exercise? Like conducting an undercover assessment of the quality of service provision for deaf people by that institution? It's conceivable that a more accurate picture could be gleaned by a hearing person than a genuinely deaf person. But then the investigator slipped up by indicating that she'd heard what had been said?

Just a thought.

Rolfe.

Interesting point, Rolfe. Again, it underscores the lack of information we have (or lack of what was communicated to us) before conclusions were drawn and people indicted for mischief.

Still, unless this woman was part of a particular task force and/or was prepared to do this in a constructive manner and share her results, the situation she created was, at best, inappropriate. Now, if she tasked herself to do this and has made it her personal mission to validate and approve of all signers out there (and embarass them when they don't live up to her standards), I would say she was clearly cuckoo on some level.

We need more information.

-TT

 

[DrMatt]

Is this sign language?

No. It's not a well-formed sentence in anything like a language. And it's not even one of the possible component handshapes in American Sign Language. It's a gesture intended to accompany a (spoken) word, not a sign functioning as a word itself.

The ASL for f*ck uses two hands, both in V shape parallel to the floor, facing each other one atop the other, coming together and pausing when they've made contact. In theory it diagrams two pairs of legs coming together, but it's pretty abstract. A politer ASL sign for sex uses one hand in X shape descending across the cheek and pausing at the chin. I don't know the corresponding signs in any of the other sign languages of the world.

Many ASL natives still use an old sign for Germany, presenting the backs of both hands with the fingers spread in opposite directions and the thumbs crossing in a form resembling the old double-headed eagle. But many use the modern form found in Deutsche Gebaerdensprach, which is D-hand at the forehead--and which incidentally recaps a much earlier German sign for Germany based on the spiked helmet.

Interestingly enough, the only ASL sign I've ever seen for
Netherlands still alludes to the Dutch hat with two starched points which went out of fashion centuries ago.

 

[BillyJoe]

 

[Jeff Corey]

The kids I worked with used the index finger of one hand going in and out of "O" on the other. There were some others that were rather graphic (sic) for other acts.

 

[epepke]

Re: Re: Re: Re: Re: Sign Language article... another issue

I wonder if it's possible the woman had no significant psychiatric disorder, but was involved in some sort of exercise? Like conducting an undercover assessment of the quality of service provision for deaf people by that institution? It's conceivable that a more accurate picture could be gleaned by a hearing person than a genuinely deaf person. But then the investigator slipped up by indicating that she'd heard what had been said?

Just a thought.

A sensible thought, too.

But I do appreciate ThirdTwin's giving us an insight into how easy it is to make something seem high-falutin' in psycho-speak with disorders by definition and all that.

 

[Soapy Sam]

Interesting twists in this thread. My own immediate (and likely wrong) supposition was similar to Rolfe's- that the woman was in some sense "undercover" officially or not. As Third Twin says, we lack data.
I must disagree with TT on the following though-
"upon being corrected I would have stood up, said to this woman calmly but squarely to her face in front of the entire audience, "I was lead to believe you are deaf but, if you can hear, there's no need for me to be here," then I would've smiled, excused myself, and promptly left. And, that would've been the end of it. Nothing taken personally."

I don't doubt your final comment, but this "And, that would've been the end of it."strikes me as rather a naive hope. Medics and their world are systematised and organised. There are procedures. Healthcare admin & politics are legendarily Byzantine. In no way would the matter have ended there. It would have ended in investigative / disciplinary committees, tears, accusation slinging and paperwork.

By the way, TT, have you settled on a hospital yet?

TT

 

[Dr. Imago]

I don't doubt your final comment, but this "And, that would've been the end of it."strikes me as rather a naive hope. Medics and their world are systematised and organised. There are procedures. Healthcare admin & politics are legendarily Byzantine. In no way would the matter have ended there. It would have ended in investigative / disciplinary committees, tears, accusation slinging and paperwork.

Well, I was speaking as if I was in this woman's role as a sign-language interpreter. I imagine, as you suggest, that she would have had to follow-up on some level (i.e., completing some paperwork, etc.), but if I was her I would not have continued offering my services to her - immediately - from that point forward. And, I think any court (or professional board), at least in the U.S., would back me up 100% in that capacity. If the woman could hear, then she would be abusing the system, not the interpreter. If the interpreter would've continued to stay there without notifying someone, then she would have been party to the deception. Certainly, I think she would have been completely justified in doing precisely what I said and without any professional ramifications or repercussions.

By the way, TT, have you settled on a hospital yet?

Nope. The "big day" is in March! I've visited three programs, and still have 8 more to go!!

TT

Didn't you mean "SS"?

-TT

 

[BillyJoe]

Didn't you mean "SS"?

II

 

[DrMatt]

The kids I worked with used the index finger of one hand going in and out of "O" on the other. There were some others that were rather graphic (sic) for other acts.

In the dialects I've seen, that usually means poop, and it diagrams poop emerging from a butthole. But ASL is highly regionalized and evolves quickly, due not only to the dirth of writing (!) and broadcast media in the language but also the way the natives are thinly spread into semi-isolated linguistic islands.