Sanjay Gulati, M.D., practices psychiatry in a silent world, a world he
resisted, then grew accustomed to, then embraced.
His deafness has given child psychiatrist Sanjay Gulati, M.D., a deeper
insight into the worlds of his patients.
Credit: Aaron Levin
For Gulati, now a child psychiatrist in Cambridge, Mass., the silence
arrived on tiptoes: a move to the front row in high school; good grades in
small, advanced classes in college and poor ones in large introductory ones;
an unexamined preference for the quiet dinner for two rather than the
Finally there was the failed audiogram, the diagnosis of hearing loss, the
steady loss of five decibels a year.
"Otosclerosis is not supposed to strike this hard, or this
young," he recalled in a recent interview. The disease is hereditary
but, unlike his father's case, was not correctable by surgery. A hearing aid
compensated enough to get through undergraduate school at the University of
Virginia. In retrospect, he is amazed at how unaware he was of the vast number
of adaptations to hearing loss he had made without ever recognizing them as
He made a late decision to go to medical school.
"I think it says a lot about how much medicine my parents taught me
that I scored the same in the MCAT on physics, my college major, and biology,
which I didn't study at all!" he said.
Gulati's father was a surgeon (who later retrained as a neuroradiologist)
and his mother an anesthesiologist. Their families left Pakistan for India
after the two countries were partitioned in 1947, and the couple eventually
settled in Nottingham, England, where Sanjay was born. They sailed to the
United States in the 1960s, when Gulati was 9.
"At that point, I was already starting to lose hearing, but I was not
yet aware of it," he recalled. "My piano teacher complained that I
wasn't playing pianissimo, even when I was sure that I was."
His deafness, although progressive, was incremental. He adapted to hearing
loss, but still felt cut off from much of the life going on around him. Before
passage of the Americans With Disabilities Act, medical schools rarely
accommodated the needs of the deaf or others with disabilities, he noted.
"I remember offering to pay for a better microphone during an
observation class and being told no," he said. "As I went through
med school and residency, it felt like I just barely slipped through each door
as it shut behind me."
His increasing deafness might have isolated him from the world, but it had
the opposite effect. He became more attuned to body language and other visual
cues to behavior. Watching sports prompted his own inner game, trying to
intuit what move the pitcher or quarterback would make on the next play.
Gulati applied the same skill later during shifts in the emergency room to
judge if patients were dangerous.
In medical school, he let go of an early interest in surgery—in the
OR, everyone talks and everyone wears masks, precluding lip reading. Other
logical choices for a doctor losing his hearing, such as pathology and
radiology, seemed socially isolating. That led Gulati to his specialty.
"Psychiatry offered a chance to explore the subjective world, a nice
mirror image to my college interest in deeply understanding the objective
one," he said.
Gulati graduated from Eastern Virginia Medical School in Norfolk in 1988,
completed his internship there a year later, did his residency in psychiatry
at Albany Medical College, and then held a child psychiatry fellowship at
Cambridge Hospital. Today, he is an instructor in psychiatry at Harvard
Medical School, works at the Cambridge Health Alliance and Children's Hospital
Boston, and is a consultant to the American School for the Deaf in West
Hartford, Conn. He has co-edited, with Neil Glickman, Ph.D., a textbook,
Mental Health Care for Deaf People: A Culturally Affirmative Approach
(Laurence Erlbaum Associates, 2003).
Gulati did not seek out deaf patients in residency, but had his epiphany
during his child psychiatry fellowship at Cambridge Hospital, recalled Terrell
Clark, Ph.D., director of the Deaf and Hard of Hearing Program in the
Department of Otolaryngology at Children's Hospital Boston, under whom he
"He accompanied a child to the hospital and saw for the first time
the specialty clinic here," said Clark in an interview. "He was
still coping with his own hearing loss but had not yet identified with being
deaf. I know of other deaf physicians and other psychiatrists with signing
skills but not of another deaf psychiatrist. He's been an inspiration for
He was not fluent in sign language when he began, but he soon became
comfortable, she said. Learning to practice medicine in another language was
"For patients, baring your soul through a third party creates an
artificial barrier," she said. "You're not sure if what you said
and how you said it came across. So having a therapist with whom you can
communicate is important."
Gulati's personal and professional experience gives him an edge when
helping patients and families understand complex information they may not want
to hear, said Lauren Esposito, Ph.D., director of the Deaf and Hard of Hearing
Service in the Department of Psychiatry at Cambridge Hospital, and one of
Gulati's former trainees.
"He is good at working in a system that is not used to working with
the deaf," said Esposito in an interview. "The treatment process
can be anxiety-provoking for both patient and staff, especially if the staff
doesn't know about deafness."
When appropriate, he will share his own experience with his patients and
their parents, which can inspire and validate patients, she said.
Issues shared by all psychiatrists take on an added dimension for a
psychiatrist who is deaf. Take the matter of transference.
"I have to deal with transference related to my lucky status as a
late-deafened person who was able to squeak through medical school at a time
when other deaf people could not," he said."
Countertransferentially, I often have to deal with feelings of guilt
around the same issue. I know a young man, for example, who cleans hotel
rooms. It's clear to me that had he had appropriate language exposure and
educational opportunity, he could have gone to college and graduate school as
I did. I think one has to try to turn this anger into appropriately aimed
activism. As a practicing psychiatrist, I keep my activism fairly quiet, but
my current project is to seek wider recognition of the syndrome of language
Gulati has spoken out about the central role of language itself in the
development of young people who are deaf. He believes that early training for
those children in American Sign Language prepares neural pathways in the brain
for general language development and for later acquisition of English.
However, sign language doesn't always lend itself well to diagnostic
language. There are currently four or five different signs in use now for
autism, for example. So Gulati is working with others to agree on conventional
technical terms in American Sign Language.
Beyond the science, though, Gulati appreciates the fluidity and
expressiveness of signing.
He also appreciates the insights of deaf humor in sign language, often used
to get through life's hardships, as it is for other minority groups.
Deaf humor is hard to describe, he said, but often it involves acute
awareness of the divide between the deaf and hearing worlds, sometimes with a
touch of aggression toward the dominant (or oppressive) culture. Usually,
there's some artistic or creative signing involved.
He remembers one deaf woman, signing with her right hand, who momentarily
forgets a word: "She slaps her right hand with her left, as if it were a
malfunctioning television set."
Eventually, the experience that shaped his own life would help shape that
of his patients. What others might see as a handicap and a constriction,
Gulati came to embrace as an opening door into a wider world.
"Had I not lost my hearing, I'd probably have become a competent,
somewhat disconnected physicist," he concluded. "I have instead
become a deeply involved and thoroughly fulfilled physician. It is difficult,
in looking back over the journey so far, to see my hearing loss solely as loss
or affliction. It has brought more into my life than it has taken away."▪