“the world has gone dead”

Dr Donald Ramsdell (1904–1965) is my hero. He was introduced to me by my lip reading tutor who has studied him (as have all hearing loss professionals).

He acquired his Ph.D. from the Department of Psychology at Harvard University, USA, in 1938. He became the Associate Professor in the then new Department of Psychology within the Department of Arts & Sciences at the University of Alabama. By 1942 he was a Full Proffessor having reorganised courses and established new ones.
In 1946 he worked at the Deshon General Hospital, Army Rehabilitation Centre in Butler, Pennsylvania, which was a Veteran’s Administration Hospital.
Later, he became Chief of the Clinical Psychology Section at the Veterans Administration psychology service, Boston.

Psychological problems for the deaf person.

‘Hearing and Deafness’ is a summary of the status of USA audiology principles in 1978. Chapter 19 of my copy has Donald Ramsdell’s original 1946 psychological analysis of deafened soldiers returned from WW2.

Hearing and Deafness Edited by Hallowell and Silverman Fourth Ed.1978
Pub. Holt, Reinhart andWinston (1947).

Ramsdell responded to the frequently repeated phrase used by deafened soldiers that “the world has gone dead.” His observations and interpretations still remain the basis of the subject today, having remained unchallenged since his first work on the subject.

He established four levels of hearing by exploring how they connect us to life and interact with each other to give us a sense of well being.

1. Understanding speech is the - symbolic level which Informs, educates and entertains.
2. Appreciating sounds that please us is the – aesthetic level which gives pleasure.
3. Recognising sounds that alert us is the – warning level which alerts and prepares us for action.
4. Recognising the changing background sounds of the world around us is the – primitive level which is the auditory background sounds of daily living.

The 1987 edition of the book includes a discussion on the application of his views to the subject of cochlear implants at that time. Thanks to him, it is now established that a hearing impairment will produce some mental adjustment in the deaf individual. These psychological difficulties from hearing loss are likely to be a greater problem than the loss of speech communication. Psychological difficulties do not always present in a proportional way to the severity of the loss, but they are usually related to the time at which the hearing impairment occurred. Those who are born with impaired hearing or who lose their hearing early in life do not seem to have such a severe problem as those who suffer hearing loss after having had normal hearing in adult life. It appears to be psychologically more difficult to lose hearing after having experienced several years of normal hearing than it is to be without hearing for a lifetime. The congenitally deaf person does not realise what he is missing, and so it is easier for him to adjust to his situation.

The effects of early cochlear implants

The cochlear implant principle has been around for fifty years. It was being inserted frequently in the USA in the early 1970s. Those early operations had only one electrode therefore there was no comparison pitch to detect (Ohm’s acoustical Law) leaving the deaf person frustrated by ‘nearly’ intelligible speech limited to only sensing intervals of acoustic pressure (periodicity pitch). Normal hearing, by concentration and attention, can separate the many different sound components by filtering the otherwise random noises that are heard.

The basic principal of the implant is to restore hearing by electrical stimulation of the auditory nerve. More electrodes were needed to advance the hearing ability and it was thought four or five would be best. By sub dividing the sound spectrum into different frequency bands it was hoped intelligible speech could be detected when the corresponding nerve fibre sensory units were stimulated. By the mid 1970s the technical difficulties were still formidable but the surgery for single electrodes was progressing successfully.

These implants restore detection of sound but could not differentiate words. There was no worldwide consensus or standardisation between the developing teams. The direct, hard-wired system did not work well. Electrodes broke and the wires through the skin were sometimes biologically rejected. The alternative subcutaneous coil with inductive coupling became the more reliable connection though there was a problem with accurate positioning of the external component. To achieve more electrodes inserted into the cochlear, multiple holes were attempted by a French team. This needed more lengthy and complicated surgery. The engineering technicalities to go with it proved too difficult. Optimism for the future of multiple electrodes kept research moving forwards and the single electrode did have benefits for the deaf person. It provided a sensory awareness of the environment.

Suitable candidates were chosen from young or middle aged adults who had already learnt speech and language before becoming profoundly or totally deafened. Children or adults deaf from early childhood were not considered suitable. Those implanted, experienced a true sensation of hearing and awareness which was demonstrated in those who could previously get no benefits from hearing-aids now becoming psychologically happier. They no longer thought of the world as ‘dead’ and could feel part of it again. By receiving environmental sound signals their own speech became better too. Unfortunately the single channel, having first been helpful, subsequently became frustrating as the inability to learn and improve the recognition of words meant the recipient could make no further progress. The recognition of speech was impossible other than the brain’s ability to interpret a very restricted vocabulary based on visual clues and syllables. Even just two electrodes, suitably located, could help with a month or two of relearning to discriminate between sounds. What was developing well was the compression of the wide dynamic range of everyday sounds into an effective and tolerable electrical stimulation but ambient noise was troublesome in higher frequency sounds.

Now, in 2015, the technology is far beyond what those pioneers could have imagined. Both the surgical technique and micro-electronics needed for the 20 plus electrode devices now available would have been comic book fantasy. My implant processor will have more computing power than any part of the 1969 mission that put a man on the moon.

Hearing and Deafness Edited by Hallowell and Silverman Fourth Ed.1978

Pub. Holt, Reinhart andWinston (1947).