The Hearing Health Care Journey: Putting Beans in Your Cups

Abstract

One of the areas MarkeTrak has explored is the customer journey through hearing health care. The survey has asked question regarding how long they had a hearing loss before they took some type of action, where did they start their journey, why did they obtain hearing instruments or not, and what the hearing instruments cost. To put that journey in perspective, this article looks at the journey of one specific individual and explores their attitudes about their hearing loss through the eyes of a psychologist.

A familiar scenario . After a perfunctory handshake and a palpable scowl, Fred informed me that his wife told him to see a shrink and get his hearing checked. I was his first stop. “Nice to meet you, too,” I quipped. He forced a smile. He looked older than his age of 67 with disheveled apparel and a worn out, fatigued countenance. My immediate task was to acknowledge that although his wife had pressured him to see a shrink, she had no power to dictate our conversation. So, I inquired about his own concerns, being careful not to be perceived as his wife's ally. Although Fred was not about to explicitly mention the words “hearing loss,” he would provide an eventual segue to this emotionally charged topic, perhaps because he knew of my specialization.

He told me of a gnawing sense that everything was becoming “too bloody difficult.” Seemingly a lifetime ago, he would look forward to trying new restaurants with friends—he even toyed with becoming another Phantom Gourmet. Always on the go and meeting new people, he was a poster child for extroversion. But all too insidiously, his joie de vivre became subjugated by a dread of leaving the solitude of his home. Nothing seemed easy anymore. He became listless and irritable, common symptoms of depression. The prospect of socializing caused him paralyzing anxiety that demolished his self-identity of being the life of the party. To make matters even worse, his career in sales depended on networking in noisy restaurants and group settings—venues in which he previously flourished. He was sure his job was in jeopardy.

He talked about hearing loss without uttering those two dirty words. He seemed straight out of the MarkeTrak 10 (MT10) survey which documented that eventual owners of hearing aids have been aware of their hearing difficulty for an average of 14.6 years, and that once aware of hearing difficulty, it takes 4 to 5 years to see a professional and approximately 6 years to get a hearing aid ( Fig. 1 ).

Figure 1.

Average number of years to take each step after becoming aware of hearing difficulty.

Although hearing loss has been described as an invisible disability to others, one's shield of psychological denial often initially renders it invisible to the individual. I imagined that Fred felt that explicitly verbalizing that awareness would give his hearing difficulty even more power to ruin his life. What you don't talk about can't hurt you. Although ultimately, the opposite is true—that giving one's fears a voice is an important step to lessening their power (silence is poison)—Fred wasn't ready to do this and my prematurely uttering those words would be disrespectful at best and would probably cause a “Don't call me, I'll call you” escape.

Instead, for the remainder of the hour, he described in vivid detail countless situations in which he felt what we ultimately came to label as isolated in a crowd , a ubiquitous experience for persons with hearing loss. He lamented how his peers would laugh at jokes, but he missed the punchline and he was sure people were beginning to think he was demented or a snob. He was obviously in a lot of emotional pain that he allowed to be visible to me. His affective openness and candor were surprising, given his initial guardedness. He would much later explain that he felt less threatened by a psychologist than by an audiologist; that the imminent diagnostic confirmation of his hearing loss would be a slippery slope for impending infirmity and ultimately his own death. While his present existence was beset by isolation and depression, at least for now anyway, he would be spared worse news.

Fred also surprised me by requesting a second meeting, although he was again careful to qualify his intent as “getting my wife off my back.” My sense was that he knew that I knew that he wasn't, in fact, automatically capitulating to his wife; for almost a decade, he politely, and not so politely, resisted her repeated requests, pleadings, and threats for him to get help. Like many persons with an undiagnosed disorder, Fred hadn't been psychologically ready to acknowledge what his wife, family, and friends had known for years. MT10 reported that roughly one in ten individuals in the United States has self-reported hearing difficulty; that just over one-third of those with hearing difficulty have a hearing aid fit by a hearing care professional; and that the majority of nonowners are not yet willing to admit they have loss to others ( Fig. 2 ).

Figure 2.

( A ) Hearing aid adoption rate. ( B ) Hearing difficulty rate.

After Fred left, I wondered whether he was indirectly asking me to broach this verboten topic; in a sense, to become his wife's surrogate. I would find out soon enough. He appeared for our next session approximately 15 minutes late with the apology of bad traffic. “In the middle of the day?” I privately noted. I surmised that his tardiness reflected his ambivalence about opening that topic. He wanted to talk about it but didn't want to talk about it. After some initial chit-chat, I asked him if he would tell me more about his frustration in dark, noisy settings.

“I know where you're going with this, doc!” He displayed a clear scowl, but this time it was accompanied by a tentative smirk. I interpreted that as an invitation to continue, but it would be important to explicitly ask his permission.

“We don't have to talk about this now, but can I ask you a question?”

“Sure” came his ambivalent reply.

“Can I mention that “H” word?”

“Have you been talking to my wife?” He glared at me with unconvincing intensity.

“We had a long talk last night, till 2 AM, and she also wanted me to remind you to take out the trash.” My attempt at humor.

He smiled. A sign that I could continue.

“What would it mean to you if you're having these problems because of unaided hearing loss?”

His smile left him and he became quiet, averted eye contact, and sunk in his chair. The air became very heavy. We sat motionless for several moments. I finally broke the silence. I told him of a hard of hearing Air Force veteran who said, “Not being able to understand what people are saying at parties is more terrifying to me than parachuting out of burning airplanes!”

Then Fred's eyes lit up and he made firm eye contact with me while leaning forward. “More terrifying than jumping out of airplanes?”

“ Burning airplanes,” I emphasized. “Any ideas why he may have felt this way?” I asked. He answered me assuredly and without any hesitation. “He could parachute out of planes but couldn't hear. He felt like a deaf and dumb idiot. Like a loser. He was embarrassed.” It wasn't necessary for me to explain the psychological mechanism of projection as he assuredly already knew he was really talking about himself.

His embarrassment wasn't surprising as I routinely hear this sentiment from patients who haven't yet “come out” as having hearing difficulties. It is also consistent with MT10 which indicated that the majority of people who do not own hearing aids are reluctant to admit they have loss to others and some feel too young and embarrassed to wear hearing aids.

However, another interesting MT10 finding, particularly relevant to Fred, was that few hearing aid owners actually feel embarrassed to wear hearing aids ( Fig. 3 ). The survey concluded that hearing aid owners are much further along in their mental journey, being much more willing to publicly admit they have loss, and more likely to feel they can/do benefit from amplification.

Figure 3.

Frequency of experiences.

While I was thinking about the implications of MT10 for Fred, he came out with a surprising confession. “You know, I had a hearing test a long time ago.”

“You what?” I exclaimed. Fred had an audiologic evaluation approximately 10 years ago, again at the behest of his wife. I asked him what happened. His reply: “I'll never forget when the doctor said ‘You didn’t hear that?'” He paused and his eyes turned upward, indicating that he was reliving that scene. “I realized she obviously needed to know if I heard the tone and she asked it nicely but it felt like I was flunking a test. I felt like a pariah! She said I had a moderate-to-severe sloping sensorineural hearing loss, with normal hearing sensitivity through 1000 Hertz, but I told my wife that the doc said my hearing was fine.”

I was impressed that Fred recalled the details of his audiogram, and that he also recalled how he had felt. Even though it was a decade ago, the impact of the audiologist's reasonable question lingered large. While already feeling victimized by his suspicions of worsening hearing, the audiologist's diagnostic query—“something she needed to know”—catalyzed him to emotionally spin out of control and feel indicted as a pariah. Although Fred had verbalized that he wanted his hearing tested, he didn't want his hearing tested; he wasn't emotionally ready. A familiar refrain of ambivalence.

And then to add insult to injury, the audiologist had even recommended hearing aids! While I suspect that, on a content level, she was quite correct that hearing aids would have helped Fred, her correct statement felt dismissive to him on a process level and demolished his emotional defenses. Psychologists refer to this state as internal fragmentation , like a shattered mirror. It left him feeling powerless and shamed. Unlike guilt, which is the feeling of doing something wrong, shame is internalized as, “There is something basically wrong with me .” Shame is psychologically toxic as it spawns feelings of inadequacy, humiliation, and terror.

Why might this dynamic occur? Fred's shame in reaction to that audiologist was because of the so-called traumatic transference, an unconscious psychological dynamic that happens when someone has been traumatized, such as by hearing loss, and is later in a situation that reminds him/her of that trauma, such as an audiologic appointment. ^{1 2} Fred transferred the shame-based emotions associated with his progressive hearing loss on to the unsuspecting audiologist. He felt out of control and victimized in both situations. Another example of traumatic transference is when a war veteran reflexively goes into combat position when hearing thunder, mistaking it for gunfire or bombs.

An important principle : Exercising one's personal agency—empowerment—is vital for anyone who has been victimized by any traumatic experience which, by definition, is experienced as beyond one's control. Compensatory reactions of control come in many forms. I thought of my terror and helplessness during that long afternoon on 9/11/2001. After being glued to the repeated video clip of the planes crashing into the World Trade Center, I spent countless hours weeding my garden, making sure the rows were exactly straight and all the weeds discarded. From a nonpsychological perspective, this makes no sense. But psychologically, what was going on was quite clear to me, even at the time. It felt like one of the few things I could control in the midst of a world that felt very much out of control.

In Man's Search for Meaning , psychiatrist Victor Frankl wrote how he coped when imprisoned at Auschwitz concentration camp. During select times of the day, he took care to wiggle his fingers in a specific sequence: perhaps first moving his thumb, then index finger, then his first finger, other times the reverse, in different permutations at different times. Again, from a nonpsychological perspective, this makes no sense. What's the big deal? Answer: While subjugated in an environment in which he felt helpless, in every case, he himself controlled the sequence of how he moved his fingers.

Back to Fred . He agreed to a third meeting and this time, he showed up on time. I shared with him a piece of wisdom from a hard of hearing social worker, Holly Elliot, about ferreting out what she could control about her hearing loss. She said,” Shifting gears is a process by which we choose change. Now that may seem crazy because we sure didn't ‘choose’ hearing loss. But we can choose how we manage it.” I would ask Fred many “How would you …?” questions, as this line of inquiry would serve to highlight his personal agency, his ability to exercise choices.

For example, I asked him how he would advise the next audiologist— whom he may, or may not, choose to visit —to conduct an evaluation. Instantaneously, he produced a long list in a clear almost oratory voice. “She shouldn't tell me that I need hearing aids even if she knows I need them. She should explain their benefits—how they would help me at work, with my wife, my kids, my grandkids—but she should also explain their drawbacks and limitations—the cost, the upkeep, and how some people may pity me. She shouldn't tell me that there's no reason to feel crappy about having hearing loss. And she should ask me to raise my hand or something to show if I can hear the tone, without asking me ‘Did you hear that?’ And she should take a deep breath and let me decide about hearing aids, not rush me to death.” His fist made a loud thud as it hit the chair.

Fred's idiom—“not rush me to death” was noteworthy but I would bookmark that for later. What seemed important now was that he seemed stronger, more self-assured, getting ready to go “back into the ring.” I told him I imagined him as Rocky Balboa (Sylvester Stallone) running up the steps in Philadelphia. He smiled, but then suddenly looked down toward the floor. Then a sigh and perhaps a hidden tear. His strength evaporated. Now in a soft voice, almost a whisper, he said, “I get how losing my hearing loss has messed up my life.”

“You're taking a huge step in the right direction, but I respectfully disagree,” I countered. “Your undiagnosed and therefore untreated hearing loss is the culprit—not your hearing loss per se. Until recently, you weren't ready to acknowledge it and take action, but now you're entering a new life chapter.” He looked straight ahead, obviously processing this important distinction. I then seemingly changed the subject. “Many people don't realize they have the power to place their beans in different cups.”

“Huh?”

“Let me show you.” I gave Fred some paper cups—the kind that you would put pills in—and a magic marker and asked him to label some cups with a core value that he had—what was important to him for his life. After mulling this over a bit, he labeled seven cups with the following core values: Family, Job, Socializing, Health, Cooking, Golf, and Single Malt Scotch. I then gave him 30 beans and asked him to put a certain number of beans into his core value cups according to how important each internal value was to him. He placed the beans as follows:

• Family: 8

• Job: 7

• Socializing: 6

• Health: 5

• Cooking: 2

• Golf: 1

• Single Malt Scotch: 1

I asked Fred which core values were affected by unaided hearing loss. He needed no time to ponder, immediately replying “Family, Job, and Socializing.” He described common communication problems that occur in these interpersonal contexts.

“How about your Health cup?” I asked.

“Thankfully, I'm perfectly healthy, knock on wood,” he replied.

“Hold on a minute,” I said. “You told me you often get fatigued because of straining to understand people. And you said that you frequently get headaches from that strain and it messes up your sleep.” I continued to confirm with Fred that he was experiencing other stress-related and depression symptoms, such as impaired appetite, constipation, concentration difficulties, listlessness, and difficulty feeling pleasure (anhedonia). He nodded his head slowly. I ended with, “So what you've told me is that Family, Job, Socializing, and Health account for 26 out of 30 (about 85%) of your core value beans and that those beans are in jeopardy!”

“You really know how to make a guy feel good, doc.” He looked at me askance.

“I'm sorry for that, but you have a ton of control over your beans and cups,” I quickly replied. He raised his shoulders in a “What the hell are you talking about?” manner. I began by highlighting the three cups with which he had the most control. I asked Fred to tell me more about the two beans he put in his cooking cup. Probably relieved at the change of subject, he told me all about his diverse culinary tastes and his yen for spicy foods. He even knew that the Scoville rating (a measure of the hotness of a chili pepper) of Chipotle, his favorite spice, was between 5,000 and 10,000 units!

I asked him about his Single Malt Scotch cup and discovered that he favored Lagavulin and had even visited the distillery in Scotland! He recited how various grains (barley, corn, rye, and wheat) are used for different varieties, and that whisky is typically aged in wooden casks, generally made of charred white oak. Now he was on a roll, not short on words. About his golf cup, he pontificated for well over 10 minutes about various types of golf drivers, irons, hybrids, putters, wedges, shafts, grips, etc. Then he returned to cooking and then to tell me more about several more Scotch distilleries that he was planning to visit.

We exchanged a smile and I told him I was truly quite impressed with his detailed knowledge and intense passion for these three cups, and that I was particularly impressed with his determination to try any and all tools, techniques, devices, and technologies that would enable him to achieve what totaled to only 4 out of 30 beans, under 15%, of his core life goals. I think he knew where this conversation was going. He was no longer smiling.

“What about your other 26 beans?” came my next question. “You know, hearing aids also have versions of Scoville ratings, malted grains and putters: for example, directional microphones, telecoils, smart phone apps, blue tooth connectivity, rechargeable batteries, tinnitus masking, Wi-Fi, wide dynamic range compression, automatic gain control, feedback suppression, direct audio input, etc.” As a psychologist, I had absolutely no idea what I was talking about, but Fred understood my intent and now managed a smile. (I was reading from a list that an audiologist colleague gave me.).

Then he punted back with “Mike, would you be so kind as to tell me how the wide dynamic range compression interacts with the direct audio input?”

“They interact well,” I replied and we both laughed. Unfortunately, our time was up as I was having fun. (Psychotherapy can be fun.)

I began our next session by asking if we could talk about his Health cup. He lunged back in his seat and gave me tentative permission. I recounted when he had told me that a diagnosis of hearing loss would be a slippery slope for impending infirmity and essentially for his own death. I asked for clarification.

“My eyes are going bad, I have chronic back pain, high blood pressure, and I'm forgetting more stuff than I used to. My weeks are filled with endless doctors' appointments. And doctors keep stuffing things in my body. I've already had one knee replacement with one more coming. My cardiologist is talking about a pacemaker. And now how am I supposed to feel at the prospect of someone stuffing hearing aids in my ears?” He ended by quoting Charles de Gaulle: “Old age is a shipwreck.”

I replied that it certainly made sense that he wouldn't welcome yet one more diagnosis, and that the journey of aging includes feeling crappy, as he had once put it. I thought of the MT10 findings that those with hearing difficulty have a higher rate of various physical and psychological conditions and that most of these conditions increase with age ( Fig. 4 ). I also thought of my own parents' terminal health challenges and then a version of Fred's shipwreck quotation flashed through my mind, “People say that age is just a state of mind. I say it's more about the state of your body.” (British author Geoffrey Parfitt.)

Figure 4.

Those with hearing difficulty are 3.5+ times more likely to have each of the conditions listed within the graph.

Our conversation was in imminent danger of spiraling down to a very dark place, but I needed to introduce yet one more, dark subject before a hopeful rebound. I told Fred of a woman with hearing loss who had been diagnosed with pancreatic cancer.

He interrupted me with “And this is supposed to cheer me up? Where did you get your degree again? Mike, I'd love to stay but–”

“Will you cut me some slack? It'll get better in a couple of minutes, I promise.” He looked straight at me, gritting his teeth, but at least he didn't say “No.” I recounted how that woman obviously would have given anything for a cancer remission but barring that, she found that, in her own words, “I'm appreciating and staying close to my family and close friends more. I don't care what people think of me anymore. I don't sweat the small stuff. Every second of my remaining time has become precious. Frankly, in some ways, I'm happier than I used to be.” I commented to Fred that she had gained the wisdom that often takes people a lifetime to learn.

“I know, I know,” he shook his head. “My wife tells me all the time to ‘Smell the roses’ but I have bad allergies.” He was attempting to lighten up this discussion a bit.

“Thankfully, you don't have a Rose cup so not to worry. I have a question, though. You've taken care of your cooking, golf and single malt Scotch beans, but I wonder, in the remaining years you have left (many more I hope), what would you like to do with your other 26 beans? Can you imagine what it would be like to be able to understand your grandchildren? Your kids, your wife, the TV, lectures about food, distilleries, and golf? You used to love going to the symphony! Making more comfortable sales calls on the job? Can you imagine being able to do all of that? And can you imagine what that also would do for your Health cup?”

Fred looked at me with a tentative but discernable smile. A good sign to my relief, as he undoubtedly had been lectured before about the advantages of amplification. I didn't mean to get on my soap box. As with all patients, now it would be important for me to give the lectern to Fred—for me not to talk so much. Rather, I would assist him in creating a so-called memory of the future: a plan for his future that he stores in his memory; one that he cherishes and is able to control; one that requires hearing aids, and one that is the opposite of infirmity and death. I shared with Fred a story of a man with multiple sclerosis who refused to use a wheelchair until he wanted to fulfill his bucket list wish of visiting ancient Greek relics that were surrounded by cobblestones.

It is the absence of memories of the future that causes apathy, hopelessness, and clinical depression. Note that one important function of the frontal lobe is creating such a memory and the greatest anatomical and functional deterioration with age is found within the frontal lobes. ³ Hence, older people such as Fred are at higher neurological risk for this impediment—above and beyond the psychological sequelae of untreated hearing difficulties.

Given our earlier humorous exchange about wide dynamic range compression interacting with audio input, I felt he could tolerate a serious direct inquiry: “So if you were to make a decision to try hearing aids, how do you think that will affect those 26 beans of yours?” I asked.

Interestingly, he was ready for this topic. “I know that my ears won't ever work as well as they used to when I was 25—same as any other body part [we exchanged an empathic smirk] but at least I've been told that sound will be clearer, although I don't know how much. At least it'll help me locate where sounds are coming from and I have trouble with that now. I was told that you can set hearing aids to make the sounds in the speaking range louder. I guess you can program it with many profiles, you know, like for my living room and at the neighborhood bar where I watch the Red Sox. I'm not going to hold my breath though.”

“You've obviously been doing some research,” I remarked. [He nodded] “But see these? [I placed his Family, Job, Socializing, and Health cups in front of him] Would you flush out a bit how hearing aids may help these cups with your 26 beans?”

He thought for a minute and, I think, internally made a decision to take the plunge. He pointed toward the Family cup. “Well, I told you about my grandchildren, Kristy is six and Evan just turned four. They're both adorable kids and they always sit on my lap and tell me stories about a play that they're in, or about their favorite desserts, TV characters or whatever. But what they tell me doesn't matter that much because most of it sounds like gibberish.” As indicated in MT10, a significant number of respondents indicated they had difficulty in the same type of situations as Fred ( Fig. 5 ).

Figure 5.

Key BHI hearing check items.

He shook his head.

“And what would it be like for you if their gibberish would become clearer and more understandable?”

He didn't respond with words, but he didn't have to. His mind left the room for a moment and I could tell his grandchildren were sitting on his lap and that he understood absolutely every word they said. He let out a smile that I had never seen before and tears came to his eyes. We sat silently, made eye contact, and we both relished that epiphany.

This was a critical trail marker of Fred's hearing health care journey, but there were some remaining steps. It would be important for me to ask him versions of “Tell me more” with a psychological intervention called thickening the narrative . I would ask him a series of questions to explore all aspects of his story, to elicit more details, and then to create a richer story: one that would describe the reciprocal influences among his cups—for example, how fulfilling his Family cup would help his Health cup; how his Socializing cup would help his Job cup and, in turn, would help his culinary adventures.

You can think of this intervention as the COSI (Client Oriented Scale of Improvement) on steroids. One comes to realize how the myriad improvements across several domains (aka bean cups) amplify each other (pun intended); how an improvement in one cup affects all the others; how the gestalt—quality of life—is more than the sum of the cups. There is something magical and transformative about a face-to-face exchange (not via a form), with eye contact, elaboration, affirmation, laughter, etc. My role with Fred would be to simply be curious and ask questions; in essence, to be an investigative reporter. Our verbal and nonverbal exchanges would serve to thicken his narrative, his memory for the future, and, in turn, to facilitate him owning the possibilities for his life. In Motivational Interviewing parlance, the more a person voices the so-called change talk, the more likely s/he will change. As shown in MT10 ( Fig. 6 ), significant changes in social and emotional behaviors occur as a result of obtaining hearing instruments.

Figure 6.

Observed changes attributed to hearing aids.

We devoted the next two sessions to this mode of inquiry. I asked Fred to thicken his narrative, his memory for the future, about his Family cup:

• “How do you think Kristy and Evan would feel if you were able to understand them?”

• “What do you think that would mean for them?”

• “Many years from now, as they think back and remember more and more conversations with their grandpa, what do you think they'll tell their children about you? Their grandchildren?”

• “As your wife watches these exchanges, what do you think she will feel? What might she say to you? How would you then feel? How might this change your relationship with your wife?”

• “What would you like to teach Kristy and Evan when they notice what's ‘stuffed in your ears’?”

• “What wisdom do you think your words will impart to them as they grow up and eventually be senior citizens themselves?”

• “As Kristy and Evan's mother (your daughter) witnesses you having fuller conversations with them, what might she feel? What may she tell you? How would you then feel? How might this change your relationship with your daughter?”

Then I asked Fred to elaborate his memory of the future for another cup. He chose Socializing and realistically predicted that, although group situations will still be challenging and often frustrating, he might do better, particularly with programmable hearing aids and directional technology. Among my questions:

• “What would you say to your friends about these changes?

• “How do you think your renewed life will change your social relationships?

• “Who do you think would notice your renewed presence first? Second?

• “What might they say to you? What would you say back?”

• “What qualities about you had they previously missed before you decided to hear better? How do you think they would feel about that?”

• “And when they tell you this, how will you then feel? What will you do differently?”

Then he chose his Health cup. He summarized literature on the “Mind-Body connection” and predicted that his renewed zest for life would have health benefits. Among my questions:

• “How do you think all of this will affect your sleep, appetite, your concentration?”

• “How do you think improved health will affect your sex drive?” (He had been disinterested in sex.)

“And what about your Job cup?” I asked. Fred had envisioned a sales approach that would entail saying to customers that because he has a hearing loss, they would get his undivided attention since, even with hearing aids, one-to-one communication is much easier. He was eager to try, as he put it, his innovative marketing strategy. Among my questions:

• “What do you anticipate the rapport-building potential of your hearing aids to be on sales?”

• “What can your work peers learn from how you incorporate your hearing loss into your sales approach?”

My final question to Fred toward the end of our last scheduled session was, “Can you imagine that as you connect to people whom you love and who love you, and do things you enjoy and feel successful at, you won't hasten your life, but extend it?” He paused and then gave me an unambiguous thumbs up. We sat together in a comfortable, contemplative silence that he eventually ended: “This is a hell of a lot easier than parachuting out of airplanes.” We both let out hearty laughs.

He said he'd call me for another appointment in a while because he had “things to do.”

A month later, I got an email from Fred telling me that he got top of the line hearing aids which “are great” and that he'd be in touch. His note is a testament to how being fit with hearing aids can paradoxically be a pinnacle but anticlimactic event. While it is a quality-of- life–saving trail marker that one is far along in their hearing health care journey, for some people, finally making that decision seems effortless and uncomplicated. Reportedly, Fred woke up one morning and spontaneously made the appointment. Simple as that! However, as exemplified by the long and winding road of his journey, typically many layers of psychological scaffolding must first be erected to empower one to finally take that critical step.

Fred made an appointment with me a few weeks later. He sauntered into my office and proudly pointed to his binaural hearing aids and told me that they are “a godsend” that have enabled him to reclaim his life! He told me that he had added two more core value cups and five beans to his repertoire: a spirituality and Pickleball cup. “You never told me that hearing aids will get me more cups and beans!” he quipped.

“You never asked,” came my reply. I smiled but he didn't smile back. Something seemed off. His upbeat words didn't match his flat affect.

“This is great,” he continued. “I've begun going to church because they have a loop system. It's kind of amazing actually. It's a special type of sound system called an audio induction loop that transmits a magnetic, wireless signal that's picked up by my hearing aid when I set it to the T setting. That cup has 3 beans. And I put 2 beans in my Pickleball basket. It's a racket sport which originated in Bainbridge Island, Washington, in 1965 and ….” At least his penchant for reciting details was alive and well.

His subdued demeanor notwithstanding, Fred's words exemplified the MT10 finding that hearing aid users show more signs of living full lives when compared with nonowners with comparable levels of hearing loss; that hearing aid users exercise more, regularly socialize; and that over half say hearing aids improve their quality of life ( Fig. 7 ).

Figure 7.

Comparison on quality of life measures.

But what was up with Fred? While he said all the “right things”—his words were unrestrained and referenced happy topics—he exuded a deep level of sadness that I couldn't quite put my finger on. I interrupted his chronicling the intricacies of induction loops and Pickleball by asking him if anything was wrong.

My query stopped him in his tracks. His affect changed from flat to markedly sullen, he shook his head a few times and then became silent and still. I could hear a pin drop. Tears began trickling down his face—sad tears that seemingly came out of nowhere. He looked down at the floor. We were silent for several long moments as I waited for what would come next.

Then in a soft, frail voice, he said, “I can't quite wrap my head around all the time I've wasted.” More tears.

“What do you mean?” I knew his answer.

“I've been such a stubborn bastard, a proud bastard, a male thing maybe, I don't know, but I didn't want to admit that there was something wrong with my ears. I couldn't deal with anything else that was wrong with my body, but I knew I was losing my hearing long before we met, long before my first hearing test, and now I'm enjoying so much of my life. I'm so happy, I'm with my family, I'm with my friends! It's a dream come true! But it'll all end at some point and I could have had so much more of it!” His voice had become louder and he banged his fist on his knee.

I waited a minute to see if more was coming, but he was finished for now and looked away. His burst of anger had abated and was replaced by a pervasive sadness. “You know,” I finally said, “Women also often resist getting hearing aids stuffed in their ears, as you once put it; it's not just a man thing. Grieving what you lost is a normal human feeling. When people come to ‘see the light’ they grieve because they realize that have been trapped in darkness.” I told him that it is commonplace, for example, that a person whose clinical depression is in remission, to feel relief and gratitude but also to grieve lost time.

Fred nodded his head. “You know, before, I used to get really depressed when I couldn't hear well. Now, I appreciate more what I do hear!” We both paused to let this important piece of wisdom sink in.

“One of my favorite sodas is Cherry Coke,” I said, “and it tastes much better the last few gulps when the can is almost empty. We tend to appreciate things more when they're limited.” I could have, and perhaps should have, explicitly connected this concept to appreciating the finiteness of life, but we had already gone down that road.

“I'm a Dr. Pepper fan myself,” he remarked, and then on a more serious note he said, “I wish I knew then what I know now. I'd like to help other people with hearing loss not waste as much time as I did. Hey, maybe you could write an article about me!”

“Maybe I will.”