Academic journal article Health Sociology Review

Disciplining the Audiological Encounter

Academic journal article Health Sociology Review

Disciplining the Audiological Encounter

Article excerpt

INTRODUCTION

There has been abundant literature on the physician-patient relationship with critiques of medical authority in the 1970s and 1980s (Friedson 1970; Strong 1979; Waitzkin 1979; Cicourel 1987; Beisecker 1990). Advocates of these critiques have called for the demedicalisation of repressed lay people and a shift towards individualised, patient-centred relationships (Mishler 1984). Encouraging individuals to 'take control' from physicians and to acquire medical knowledge for themselves assists in shifting responsibility for social welfare from the state to the 'individual' citizen (Miller and Rose 2008:262).

The interaction between the audiologist and the patient in the audiological encounter1 remains relatively understudied. Here subjects with adult onset hearing impairment2 and seeking technological assistance in order to retain a 'normal' level of hearing are confronted with specifi c constructions and classifi cations of hearing disability and hearing disabled identities. However, as with many other patients who in medical discourse are labelled as 'non-compliers'3 as regards the prescribed regimen (Guimn 1995; Conway et al 1996; Javors and Bramble 2003; Cocosila and Archer 2005; Cortet and Bnichou 2006; Small and Dubois 2007), many hearing impaired people do not continue to use their hearing aids after the fi tting, and that those who do use them continue to report communication diffi culties in their everyday life (Stephens 2001; Hickson and Worrall 2003; Helvik, Jacobsen and Hallberg 2006). This also indicates that medical and clinical discourses which prescribe hearing technologies as the main solution to resolving communication diffi culties are potentially problematic. The importance of the impact of medical discourses thus seems to surpass the medical encounter as these micro-level issues take place within a larger sphere. Approximately 16 percent of the adult population of Europe have a hearing impairment where the provision of a hearing aid according to the medical discourse would provide a benefi t (Sorri et al 2001) and for people of working age, the proportion is approximately 11 percent. Hearing impairment is associated with an increased rate of non-participation in employment of approximately 12 percent (Hogan et al 2009) and, among those who are employed, a higher percentage of hearing impaired people are in the lower grades of employment (Mohr et al 2000). In this way, hearing impairment and the resulting discrimination cause problems in all aspects of working life, including obtaining work and functioning at work (Ruben 2000).

The aim of this paper is to better understand how the medical discourse with it's classifi cations of hearing impairment impact upon the people classifi ed as hearing impaired in the audiological encounter (Hacking 2004). This is because non-compliance with hearing aid treatment may coincide with patients' perspectives being at variance with medical construction of hearing disability and hearing disabled identities. Through the analysis of empirical data, the paper will provide insight into the audiological encounter and hearing impairment rehabilitation strategies. It will show how medicalised institutional frameworks impact on the audiologist/ patient encounters, reproducing the structural patterns of domination to the subordination of the patient subject. It will be shown that medical knowledge is enacted on premises that are not always explicit. What is said in the audiological encounter, what can be said, what is possible, what is meaningful, what knowledges 'count' as viable and the kind of experiences and knowledge that patients are authorised to bring to the audiological encounter are explored (May et al 2006).

The paper is divided into four sections. First, there is a presentation of theories helpful in explaining how the formats of audiologists' talk and actions refl ect relations of knowledge/power (Foucault 1973, 1980), and how people are constituted, can defi ne themselves and are understood by others in such interactions (Goffman 1959, 1963, 2005). …

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