Anyone who suffers from hearing loss or has friends or family members who do should read Katherine Bouton’s important book, Shouting Won’t Help: Why I—and 50 Million Other Americans—Can’t Hear You. Bouton, a former New York Times writer, suffers from severe hearing loss that came on by sudden stages beginning in her thirties. My hearing loss is mild to moderate and it came on gradually with age. But I recognized myself and my brothers (and our father before us) in her description of the physical, psychological, and social effects of hearing loss, how we try to cope with it, and how people with hearing loss are treated.

You probably don’t know how many of your acquaintances have hearing loss. It is a nearly invisible handicap. Those of us with hearing loss, of course, prefer it that way. I don’t hesitate to put on reading glasses when I need them but I am careful to brush my hair over the tiny wires in my ears. Hearing loss has a bad image.

My little helpers. Now you see them …

I try not to ask people to repeat themselves too often because saying “What?” all the time—or “Howzat?” like my father used to say—makes you seem not quite with it, and actually, you aren’t. If you are as old as I am it is also a sign of age. Recent research showing an association between dementia and hearing loss doesn’t help our image at all. My father suffered from dementia along with severe hearing loss in his final years.

… now you don’t.

And so I fake it, pretending to understand, guessing sometimes (and making myself look even more foolish when I get it wrong), and often withdrawing from conversations that spin away from my comprehension. And this is with mild hearing loss. One of my brothers has been deaf in one ear since early childhood and has significant loss in the other ear. He coped by withdrawing, becoming the quiet one. He managed to deflect attention from his handicap so effectively that I never thought of him as hard of hearing until he began wearing a hearing aid in his “good” ear in middle age.

Other people take the opposite tack, initiating (I won’t say dominating) the conversation so they know what’s being said. Another brother tends to do this.

Even if you tell people you have hearing loss they forget and you don’t like to keep reminding them. Or they speak louder, directly into your ear, and that really doesn’t help as the book title implies. More important, they, and you, may assume that if you have hearing aids you should be able to hear normally—and if you don’t you should get better hearing aids. But, as Bouton explains in helpful detail, there is a  disconnect between the job of the ear, which is to register sound, and the job of the brain, which is to interpret it, so hearing aids will never substitute for normal hearing.

As you lose hearing the brain loses the ability to interpret the sounds that do come through. To see what this is like put a pillow over your head and try to carry on a conversation. Hearing aids help the ear but, because sound coming through them is different from sound picked up by the normal naked ear, the brain has to relearn how to interpret it. This is hard work.

I have had a lot of experience learning foreign languages and traveling or living in countries where I understand the language imperfectly. It requires concentration and it is fatiguing. I can speak and understand French very well in the morning but when I get tired at the end of the day I may sit back and let the talk go on without me. The understanding part of my brain stops working.

With hearing loss, understanding my native language is a lot like that. In fact, the first clue that I was losing my hearing was when I began having difficulty understanding plain, spoken English in movies, in overheard conversations, and in conversations in noisy settings like restaurants. The spoken words degenerated into familiar but meaningless strings of sound like Russian at a late-night house party. If I concentrated I might pick up the thread and suddenly start understanding enough that I could fill in the gaps. But I could easily tune out and understand nothing at all.

The other day I had to give up on a conversation with my granddaughter. Toddlers have their own charming language. When I am with her I can usually understand her and if I can’t it’s because she has shifted into Chinese to talk to her daddy or her dolls. But on a cell phone, from a car, with intermittent transmission? It was English for sure (“Gamma! Gamma!”—that’s me) but I could barely understand even her mother’s translation. I think she was saying she wanted to come back to my house.

So here is my advice: Treat people with hearing loss like perfectly normal foreigners. (Unless you are zenophobic, in which case you might not be nice to us, either). Be considerate. Recognize that we may not understand you perfectly, especially on the phone. Look at us when you speak—hurray for Skype and FaceTime—because we need to read lips and faces for additional clues. Speak at normal speed but clearly. Enunciate! Make an effort to include us if we seem to be dropping out of the conversation. Don’t make fun of us. And don’t shout.

For our part, we must not be shy about calling attention to our handicap. Hence this post.