Five ways ‘Sound of Metal’ is misleading: Interview with Dr Dalia Tsimpida

Sound of Metal was released to rave reviews from critics and audiences alike. It scores 97% ratings on Rotten Tomatoes, 90% from audiences and was described as ‘astonishing’ and ‘sublime’ by Mark Kermode in his 5* review to the Guardian. The film has since scooped multiple industry prizes including two Oscars and a BAFTA Award. The plot centres on Ruben (Riz Ahmed), a drummer in an avant-metal band called Blackgammon and his partner Lou (Olivia Cooke) who is also the band’s guitarist and singer. The opening of the film focuses on their touring lifestyle, immersing us in the loud fog of their gigs and the quiet mornings spent in their RV. Then, quite suddenly, we step with Ruben into his hearing loss. The film’s sound editing allows us to experience the muffled noises that the character is hearing and to understand his stress and frustration as he tries to clear his sinuses, hopeful that this is just a temporary problem. This is the jumping-off point for the rest of the story, which follows Ruben as he tries to adjust to life without sound.

I loved Sound of Metal. The performances were convincing, the sound editing created an immersive experience and the plot was gripping. It is rare for films on disability to break through, so it was also a welcome change to Prime’s usual offerings. I did have some questions, though: aspects of the film that jarred and didn’t ring true to my experience as a healthcare professional and a psychologist. To explore these queries with someone who really knows about this stuff, I reached out to Dr Dalia Tsimpida. Dr Tsimpida is a Chartered Psychologist and postdoctoral researcher at the University of Manchester who is an expert in audiology and health policy. She is currently leading the PLACE study into hearing loss prevalence in the UK, and has previously published several studies in this area. Dr Tsimpida became interested in hearing loss through her previous occupation as an Aircraft Weapons Technician. During her work, she and her colleagues were exposed to high levels of noise but many chose not to protect their hearing, with some experiencing significant hearing loss at an early age. When I spoke with her, Dr Tsimpida was highly sceptical about Sound of Metal, highlighting five misleading inaccuracies in its portrayal:

  1. Hearing loss is usually gradual, not sudden like Ruben’s.

“Hearing loss nearly always develops gradually and people don’t see it as a dramatic health problem” Dr Tsimpida explained. “In fact, on average people persevere with declining hearing for approximately 10 years before they seek help and take up a hearing aid.” Dr Tsimpida also highlighted that it is usually specific pitches or frequencies which are lost before loudness or decibels become a concern. “This harder to detect yourself” she said, “because the frequencies unaffected in the range of the average human speech (see image below) appear pure and clear”.

  1. Sudden hearing loss would not result from over-exposure to loud noise.

“In the film, there is no explanation of what caused Reuben’s hearing loss” Dr Tsimpida observed, “and the cumulative effect of several risk factors such as noise exposure wouldn’t lead to a sudden hearing loss like this.” Dr Tsimpida instead suggested that hearing deterioration is a lifelong process. A hearing loss event such as the one shown in the film would be considered an acute “emergency”, and would most likely have a specific and identifiable cause.

  1. Hearing loss diagnoses do not occur on the spot.

In Sound of Metal, Ruben goes to a pharmacist who immediately refers him to an audiologist who then diagnoses him and gives him a long-term prognosis, all within the same day. “This doesn’t happen. It’s so misleading” Dr Tsimpida said. “It takes a lot of time for the problem even to be acknowledged and identified. This usually happens in primary care, and then there’s a referral to secondary care. It takes some months for sure. Then, after an intervention such as a hearing aid, there are follow ups with the audiologist, to ensure that the hearing aids are working at the right levels by completing real ear measurements”.

  1. Support for hearing loss is easy to access and doesn’t involve living in a commune.

In the film, we see Ruben drive out to an isolated spot in the countryside where he joins a commune-style community for the deaf. The purpose of the community is about supporting deaf people and integrating those with new hearing loss into the Deaf community. “I am not aware of any communities like this”, Dr Tsimpida responded. “There are communities known as ‘Deaf Clubs’ but these do not operate as communes and are primarily made up of people who are born deaf and who communicate with Sign Language. They are not designed to accept people who have suddenly become deaf and need supporting.” Dr Tsimpida was also concerned that this portrayal would detract from the wealth of support that is available in the general community. She said, “For example, the National Association for Deafened People in the UK is a hard of hearing community which brings together people with different levels of hearing loss and different communication needs. Members learn of different support available, such as lip-speaking, sign supported language, speech to text reporting (real time captioning) and assistive listening devices such as hearing aids and cochlear implants, whatever works for them.”

  1. People are extensively prepared and supported for receiving a Cochlear Implant

Sound of Metal shows Ruben waking up from his Cochlear Implant operation, apparently unaware that it involved the by-passing of his ear canal and surprised by his total deafness. He then seemed further surprised when the implant was activated and he couldn’t immediately understand the sounds he was hearing. “In reality, there is a whole process before someone gets a Cochlear Implant” Dr Tsimpida explained. “They meet with other Cochlear Implant users and learn from them what will happen. The Hearing Loss Association of America has also responded to this in their statement. Afterwards, there is activity therapy and psychological therapy to help individuals to gradually become used to it. It’s not like going to the dentist!!”

Despite all this, Dr Tsimpida suggested there was one surprisingly accurate aspect of Sound of Metal. This was its portrayal of a strong ideological difference between Deaf communities and the use of Cochlear Implants, which I thought must have been exaggerated. “Yes, this can happen” she said. “Being a member of Deaf Communities means rejecting the view that deafness is an impairment. They have their own language and they do not feel that they lack anything. They do not feel they need to be fixed. They can even be offended by people who think that their cultural identity is not enough, and that they should rehabilitate their hearing.” In fact, Dr Tsimpida thought that Joe’s (Paul Raci) polite rejection of Ruben following his Cochlear Implant operation is an accurate representation of the reality.

Unsurprisingly, overall, Dr Tsimpida said she was disappointed with the film. “They approached the topic in a black and white way – he had to join either the Deaf community or receive a Cochlear Implant – and both sides were presented inaccurately.”

Primarily, Dr Tsimpida felt the film was a wasted opportunity to highlight truths about hearing loss and to tell people how they can protect their hearing. “There is a stigma that hearing loss is something that happens only to older people. However, my research suggests that hearing loss is closely related to lifestyle, rather than just age.  Hearing loss is largely preventable while young and it can also be increased by unhealthy lifestyles like poor diet, smoking, and chronic exposure to high intensity sound. The World Health Organization currently estimates that over 1 billion young people are at risk of hearing loss due to unsafe personal use of portable music devices! I would have liked the film to recommend things that young people could do to prevent their health.”


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