Psychologist Sally Austen reflects on a career shaped by changing deaf identities, shifting services and her own hearing loss
Being deaf is not just about a lack of hearing, but is layered in with questions of identity.
Writing for Limping Chicken, the deaf culture and news site, Dr Sally Austen, a clinical psychologist, traces how the meanings of “deaf” and “Deaf” have shifted inside the NHS and beyond, and how those changes have filtered into her own sense of self as her hearing has altered.
Early in her career, work at the National Deaf Mental Health Service in London introduced Austen to clients who embraced Deaf identity and pride. Many were supported by Deaf mentors and role models, and saw sign language and Deaf culture as central to who they were. That experience shaped her understanding of deafness as more than a medical condition.
A later move into ENT services revealed a very different picture. At a well-known NHS Ear, Nose and Throat hospital, many patients experienced hearing loss as something to grieve and reverse. They resisted the label “deaf” and focused on treatment and restoration.
Need for more Deaf professionals
Austen argues that the absence of Deaf professionals and role models within medical teams narrowed the options available to these patients.
Age-related hearing loss added another recurring theme: concealment and shame. Austen notes that many older adults delay using hearing aids and often hide them once prescribed. Social stigma and a growing market for discreet private devices can increase isolation. This sits alongside clear evidence that hearing loss rises sharply with age and that access to and sustained use of hearing technology remain uneven.
When she returned to Deaf services in Birmingham, Austen encountered a younger generation with hybrid identities. Many move between sign and speech or choose a lower-case “deaf” to reflect mixed linguistic and audiological positions.
Preferred terminology
While editing a clinical book in 2021, she and her colleagues deliberately used each contributor’s preferred terminology rather than enforcing a single label. For Austen, this reflected a broader shift towards person-led language in practice.
Her own hearing loss adds a personal layer to the piece. Long accustomed to introducing herself as a hearing psychologist who works with sign language users, she now describes the discomfort of being “a bit deaf” and letting go of old binaries. Clinicians, she writes, are not immune to the identity dynamics they work with.
Integrated services
Austen also points to institutional change. ENT and speech and language therapy services are now more integrated, with specialist provision for deaf and hard-of-hearing adults, including clinicians with sign language skills and clearer pathways for communication rehabilitation. These developments widen options beyond a simple medical-versus-cultural divide.
“We see every day that hearing loss isn’t just about audiograms or devices,” said Abigail Pillay, a Clinical Audiologist at Hearology®. “People arrive with beliefs about what being ‘deaf’ means, shaped by age, work, family and culture. Services work best when they recognise that identity is part of the clinical picture, not something separate from it.”
The core argument of the post is clear. Deaf identities are plural, fluid and sometimes contradictory. Services, training and professional language need to be flexible enough to accommodate that complexity. As Austen puts it, identity is messy, and healthcare systems should be designed to hold that messiness rather than smooth it away.
References
Dr Sally Austen: A journey through deaf identity (and my own identity) during my career as an NHS psychologist (BSL) - Sally Austen’s Limping Chicken blog post
Psychological services for deaf people - Dr Sally Austen’s expert credentials
