Culture, Medicine, and Psychiatry

, Volume 41, Issue 3, pp 431–452 | Cite as

Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children

  • Natassia F. BrenmanEmail author
  • Anja Hiddinga
  • Barry Wright
Cultural Case Study


Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0–18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on ‘norms’ based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.


Intersectionality Deaf culture Autism Diagnosis Child and adolescent mental health 



The authors thank all the staff at the Deaf Service, who provided a base for the fieldwork. We also thank all practitioners from other services who participated, and are grateful to the sign language interpreters who assisted the data collection where necessary. The authors would like to thank the MRC for their support of a closely related project to improve autism assessments for deaf children (Grant reference: MR/K015435/1) through the Biomedical Catalyst: Developmental Pathway Funding Scheme. Finally, we would like to thank the anonymous reviewers for their care and attention in commenting on the text.

Compliance with Ethical Standards

Conflict of interest

The third author, Barry Wright, is the clinical lead of the National Deaf Child and Adolescent Mental Health Service in England. Barry Wright is also leading a Medical Research Council Research Grant to improve autism assessments in deaf children (see acknowledgments section in manuscript for further details). The first author, Natassia Brenman declares she has no conflict of interest. The second author, Anja Hiddinga, declares she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Amsterdam and NHS Research and Development IRAS procedures), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.Department of AnthropologyUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Hull York Medical School and Leeds and York Partnership NHS Foundation Trust, Lime Trees Child, Adolescent and Family UnitYorkUK

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