Interview with Marion Downs, Audiologist
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Topic: Reflections on 50+ Years In Audiology
AO/Beck: Good morning Marion. It is an honor to speak with you again.
Downs: Thanks Doug, that's very kind.
AO/Beck: Marion, if I may, I'd like to start by asking you to review a little information about your professional and educational background?
Downs: Sure. I graduated from the University of Minnesota presumably with the class of 1935. However, I was married before that and I hadn't finished enough coursework to graduate. I didn't finish those credits until 1948 when I took it by correspondence, so I finally graduated in 1948.
AO/Beck: What degree did you get in 1948? And which school was it from?
Downs: That was my BA. It was from the University of Minnesota, with a major in political science and English.
AO/Beck: That must've been a good time to be in political science!
Downs: Yes, it was great. I was going to go into law because my family has a bunch of lawyers, but I got derailed on that one.
AO/Beck: I'm glad you did! What happened after you earned your BA? Where did you go after that?
Downs: After that, I raised three children for 15 years. Then I arrived in Denver and lived next to the University of Denver, and you know the story from there. I decided I had to register in graduate school for something because the kids were getting older. It was right after the war and the GI's were lining up for a mile in every department. So I looked around and chose the shortest line. That was Speech and Hearing!
AO/Beck: You are an honest woman Marion!
Downs: There were lines everywhere, and at the end of the line was John Gaeth who had just received his PhD from Northwestern. He was a wonderful guy. He originated the concept of phonemic regression remember? I took both speech pathology and audiology coursework, and I just loved audiology. It was a natural for me.
AO/Beck: What year was it that you finished with your master's?
Downs: 1951.
AO/Beck: Okay, and after you received your master's, what happened?
Downs: It was one of those lucky things. I was at the right place at the right time, with hopefully the right stuff. After Dr. Gaeth was here for a year, he left, and then Ed Shutts was here. He was also a new PhD from Northwestern. Those young PhD's from Northwestern were in such great demand all over the country; they could write their own ticket because audiology was the new science on the block. But after a little while they were both gone, and there was nobody around who had a major in audiology, except yours truly. So that summer, the first course I taught was lip reading. Then in the fall, I was the only one there, so I started teaching audiology by default. John and Ed had really built the program; all I did was try to keep it up. But it was really just a matter of being there. There was nobody else available, and they had already put out a curriculum in audiology.
AO/Beck: Can you tell me what typical audiology fees were 52 years ago?
Downs: I started in 1951. We had the veteran's contract at that time, and we did all the veteran's speech pathology and audiology examinations and hearing aid assessments. I charged $10 for an audiogram and $25 for a hearing aid assessment.
AO/Beck: Oh my goodness. That's quite a bit more than I expected!
Downs: They got it cheap! We had some great people in audiology. The VA actually gave contracts to different universities, and to make sure the contracts were carried out correctly, they had some of their best men monitor the universities' contracts. All men of course, there were really very few women at that time in audiology.
AO/Beck: That's turned around! I think the profession is about 70 percent female at this time. Marion, why didn't you pursue a Ph.D.?
Downs: Frank Glassman was my VA monitor at that time. He's one of the finest audiologists. But I must tell you, I remember when he and I discussed whether or not I should get my Ph.D. He said Marion, don't get a PhD. Women with doctorates price themselves out of the field, he said they won't be accepted by the male PhD's, and besides, they won't be doing much research.
AO/Beck: I see.
Downs: Frank is now a great supporter of feminism. But that's the way it was 50 years ago. Again, there were very few women in the profession.
AO/Beck: Well, it seems like women weren't really welcomed into the profession!
Downs: Well, that was part of it. I was so lucky.
AO/Beck: Can I change subjects a little? Back in the early days, what was your perception of non-organic hearing loss? Was that something you saw a lot of?
Downs: That was an interesting situation. After the war, there were all these veterans getting $200 a month for hearing losses incurred during service, and of course, a great many of them were non-organic hearing losses. In order to sort them out we had to do PGSR (psychogalvanic skin response), complete with electric shock.
AO/Beck: Aaah, the good old days! I cannot imagine you doing that.
Downs: That's right. And of course, that was one thing I really should have balked at, but I didn't. I resisted and hesitated a little, but once I was over it I just shocked with a vengeance!
AO/Beck: I am starting to create a very different picture of you, Marion!
Downs: Frankly, I got mad at those veterans for trying to fake their hearing loss and get paid by our tax money. It was very obvious a lot of them were doing it deliberately. From that experience, I concluded there was no such thing as true psychogenic hearing loss.
AO/Beck: What's your thought on that now?
Downs: I still believe it, I still believe it's deliberate in a great many ways. I think it's self-determined and they are essentially, malingerers. Over the years, there was a big deal about psychogenic hearing losses, implying that some are perhaps real psychogenic hearing loss. But whenever I got somebody who had been declared by the psychiatrist as psychogenic, I would still find normal hearing on PGSR. If this were true hearing loss, it would withstand PGSR. That was my feeling. But remember, my theories have been wrong many times -- but for what they're worth, I give them to you.
AO/Beck: I remember a wonderful story one of my professors told me in the early 1980s. He really hated doing PGSR, and they discovered a different way to find malingerers, and it worked particularly well with females. They would pretend to accidentally leave the microphone on while the patient was in the booth and somebody would come up wearing a white lab coat and say to the audiologist, Oh, have you got Mrs. Smith in the booth? And the audiologist would say, Yes, of course. Then the fellow in the white coat would say, Oh, I don't think she's aware yet, but we have her test results, she's pregnant. They would whisper that at about 20 dB, so then if Mrs. Smith went a little crazy, they would conclude, She heard that.
Downs: My trick was the same, but I dealt mostly with men. I'd say at 20 dB Your fly is open. That was really effective too.
AO/Beck: Aaah, the good old days! Please tell me about how you got involved with hearing in children?
Downs: Well I'll tell you, I was fortunate. Doreen Pollick came to the University of Denver when she first came over from England. She had worked with children early on and she showed me that children could be tested as babies. That was fairly shocking 50 years ago! She and I used to test babies all over the place. We were an awfully good pair. We found hearing losses in very young babies and we put hearing aids on them 'cause we figured they needed it. The children turned out wonderfully, and the earlier we put hearing aids on them, the better they turned out. You couldn't help but to realize that the earlier the better. A lot of people were saying there were critical periods for language development and the stimulation has to start very young. Being an extremist, I said very young means at birth, and that seems to have stood the test of time.
AO/Beck: One thing that I've always enjoyed, and I want to get your reflections on now, is that in one of your books which I read twenty years ago, you described hearing loss in a child as 15 decibels. Is that still your definition?
Downs: No question about it. Young children really need perfect hearing to develop perfect language. No question about it. Even a 15 decibel loss, negatively impacts language. This can be shown based on unilateral hearing loss. Fred Bess has shown that children with a unilateral hearing loss in the right ear, tend to lose one grade in school. All of those kids, regardless of the side of the unilateral hearing loss have problems in school and reduced IQs. Remember that a unilateral loss gives you a soundfield loss of about 10 dB. I think there's no question that even minimal hearing loss is a significant problem and needs to be treated with amplification.
AO/Beck: What are your thoughts on auditory processing disorders (APD)?
Downs: Actually, I really haven't' dealt with APD in children. Just plain old hearing loss has been my thing. You can't be everything, Doug! But what I do know about auditory processing disorders is based on my own experience with testing done on me in the old timer's project down in New Orleans.
They've done extensive testing on all sorts of different things. One of the things was the test of how fast it takes the impulse to go from your ear up to your brain and back. And that's where I was really deficient. My central auditory processing time is dramatically slowed down. But I'll be 90 years old in January, 2004. I have to hear from the bottom up. Is that what you call it?
AO/Beck: Yes. Top Down and Bottom Up processing.
Downs: Bottom up is my way. I have to replay the tape quickly to get what has been said. The sound gets in, but it gets in late, and I have to replay it to be sure I understand it.
AO/Beck: That's a great strategy though. Understanding how one learns and processes allows you to manage that information, to make it more accessible by doing what needs to be done.
Downs: Yes, that's right. It doesn't bother me because I handle it.
AO/Beck: Are there other things you can share with us, based on your own hearing loss?
Downs: Oh indeed there are. I've discovered all sorts of things through my own hearing loss. For instance, there's one thing I would like to do a research project on; I have seen lots of people who have had trouble with hearing aids, and lots of people who haven't had trouble with hearing aids. I'm one of those that doesn't have any trouble with hearing aids. I thought initially, it was because I know so much about hearing and listening that it doesn't bother me. As it turns out, that isn't the point at all. What I've found is that when I speak to people who have trouble with hearing aids, they report that they were the ones who could only study and concentrate in complete silence! As soon as there were other noises around, they would be distracted. In my case, the only way I could study was with noise!
AO/Beck: That's really interesting. So are you saying it's the issue of afferent versus efferent auditory efficiency? Being able to squelch the noise, so to speak?
Downs: I'm absolutely convinced of it, and I think we can prove it using otoacoustic emissions (OAEs).
AO/Beck: For me personally, during undergraduate and graduate school, and even now, I read and write all day long in absolute quiet. I need total sensory deprivation to concentrate. If I turn on music or anything else in the background, I am totally distractible.
Downs: Doug, don't ever lose your hearing! According to my theory - you'll be a bad hearing aid user. You can test it yourself when you have clients who wear hearing aids, the good users and the bad users are those who can study in noise, and those who must have quiet, respectively.
AO/Beck: Tell me if you can, do you have particular thoughts you would like to share with young audiologists, people just starting their careers?
Downs: I believe they must pick an area of expertise. Very few people can be experts in the whole profession, there's just too much to know. I think the earlier they identify their interests, the better. And then once they go into their chosen area, fully commit to it. I think that would be the best thing.
AO/Beck: What are your thoughts on mandatory Universal Newborn Hearing Screenings?
Downs: Well, I'm delighted. We credit lots of disciplines and scientists for having determined there are critical periods for the development of language, which I knew 50 years ago just from observation. And now it's come about as a truth, so I'm simply delighted. The thing that I've been disappointed with is that we didn't look ahead and see how many educational audiologists we needed to take care of the influx of babies with hearing loss! Many hospitals were unprepared for the massive amounts of tests and treatment needed. We were fortunate in Denver, because we've been doing it for so many years; our public health department was on the ball for a long time. But lots of places haven't done that, and it brings up the necessity of having a revised audiology curriculum offered by universities, specifically for early education. I would like very much to have audiologists do the early education. I think trying to adapt speech pathologists to audiology is a harder task than getting audiologists to do it! But, audiologists need special training in this highly specialized area.
AO/Beck: Marion, can you tell me a little about your personal life these days, if you don't mind? Where do you live, what do you do, are you still seeing patients?
Downs: Oh heavens no -- no patients! All I'm doing is occasionally writing. Ross Roeser and I have just put together a new addition of Hearing Disorders in School Children.
AO/Beck: Oh that's exciting. When does that come out?
Downs: It should come out next year. So I do a little writing here and there, and a little speaking here and there. People ask me to come, and if they ask me, I go.
AO/Beck: I know you received an honorary doctorate recently. Can you tell me about that?
Downs: Oh yes. That was from my own institution, the University of Colorado.
They awarded me the highest award they can, the Doctor of Science. I was really thrilled by that. I also received an award from the University of Minnesota years ago, the Alumni Achievement Award, a beautiful gold medal.
AO/Beck: That is fabulous. Are you still skiing?
Downs: I just got new parabolic skis and they're heaven.
AO/Beck: And when did you last ski?
Downs: Oh, about two months ago.
AO/Beck: Okay. Well, as long as this interview is spinning out of control, please tell me your thoughts on drinking wine - is that a good thing to do?
Downs: Yes. I always have one glass of wine before dinner every night. That's my limit.
AO/Beck: What is your preference? What type of wine do you like?
Downs: I like Merlot.
AO/Beck: And lastly, please tell me, how many great-grandchildren do you have?
Downs: I have 3 children, 11 grandchildren, and 19 great-grandchildren.
AO/Beck: That is phenomenal.
Downs: And I tell you, those great-grandchildren they're growing up too. What's so wonderful is I've been flying all over the country as the great-grandchildren are getting awards in school, or doing something in their classes, and when they say Granny you should come and visit. Granny does.
AO/Beck: Marion, it's been an absolute pleasure to chat with you. Thank you so much for your time.
Downs: Thank you, Doug. It's been fun for me too.
Downs: Thanks Doug, that's very kind.
AO/Beck: Marion, if I may, I'd like to start by asking you to review a little information about your professional and educational background?
Downs: Sure. I graduated from the University of Minnesota presumably with the class of 1935. However, I was married before that and I hadn't finished enough coursework to graduate. I didn't finish those credits until 1948 when I took it by correspondence, so I finally graduated in 1948.
AO/Beck: What degree did you get in 1948? And which school was it from?
Downs: That was my BA. It was from the University of Minnesota, with a major in political science and English.
AO/Beck: That must've been a good time to be in political science!
Downs: Yes, it was great. I was going to go into law because my family has a bunch of lawyers, but I got derailed on that one.
AO/Beck: I'm glad you did! What happened after you earned your BA? Where did you go after that?
Downs: After that, I raised three children for 15 years. Then I arrived in Denver and lived next to the University of Denver, and you know the story from there. I decided I had to register in graduate school for something because the kids were getting older. It was right after the war and the GI's were lining up for a mile in every department. So I looked around and chose the shortest line. That was Speech and Hearing!
AO/Beck: You are an honest woman Marion!
Downs: There were lines everywhere, and at the end of the line was John Gaeth who had just received his PhD from Northwestern. He was a wonderful guy. He originated the concept of phonemic regression remember? I took both speech pathology and audiology coursework, and I just loved audiology. It was a natural for me.
AO/Beck: What year was it that you finished with your master's?
Downs: 1951.
AO/Beck: Okay, and after you received your master's, what happened?
Downs: It was one of those lucky things. I was at the right place at the right time, with hopefully the right stuff. After Dr. Gaeth was here for a year, he left, and then Ed Shutts was here. He was also a new PhD from Northwestern. Those young PhD's from Northwestern were in such great demand all over the country; they could write their own ticket because audiology was the new science on the block. But after a little while they were both gone, and there was nobody around who had a major in audiology, except yours truly. So that summer, the first course I taught was lip reading. Then in the fall, I was the only one there, so I started teaching audiology by default. John and Ed had really built the program; all I did was try to keep it up. But it was really just a matter of being there. There was nobody else available, and they had already put out a curriculum in audiology.
AO/Beck: Can you tell me what typical audiology fees were 52 years ago?
Downs: I started in 1951. We had the veteran's contract at that time, and we did all the veteran's speech pathology and audiology examinations and hearing aid assessments. I charged $10 for an audiogram and $25 for a hearing aid assessment.
AO/Beck: Oh my goodness. That's quite a bit more than I expected!
Downs: They got it cheap! We had some great people in audiology. The VA actually gave contracts to different universities, and to make sure the contracts were carried out correctly, they had some of their best men monitor the universities' contracts. All men of course, there were really very few women at that time in audiology.
AO/Beck: That's turned around! I think the profession is about 70 percent female at this time. Marion, why didn't you pursue a Ph.D.?
Downs: Frank Glassman was my VA monitor at that time. He's one of the finest audiologists. But I must tell you, I remember when he and I discussed whether or not I should get my Ph.D. He said Marion, don't get a PhD. Women with doctorates price themselves out of the field, he said they won't be accepted by the male PhD's, and besides, they won't be doing much research.
AO/Beck: I see.
Downs: Frank is now a great supporter of feminism. But that's the way it was 50 years ago. Again, there were very few women in the profession.
AO/Beck: Well, it seems like women weren't really welcomed into the profession!
Downs: Well, that was part of it. I was so lucky.
AO/Beck: Can I change subjects a little? Back in the early days, what was your perception of non-organic hearing loss? Was that something you saw a lot of?
Downs: That was an interesting situation. After the war, there were all these veterans getting $200 a month for hearing losses incurred during service, and of course, a great many of them were non-organic hearing losses. In order to sort them out we had to do PGSR (psychogalvanic skin response), complete with electric shock.
AO/Beck: Aaah, the good old days! I cannot imagine you doing that.
Downs: That's right. And of course, that was one thing I really should have balked at, but I didn't. I resisted and hesitated a little, but once I was over it I just shocked with a vengeance!
AO/Beck: I am starting to create a very different picture of you, Marion!
Downs: Frankly, I got mad at those veterans for trying to fake their hearing loss and get paid by our tax money. It was very obvious a lot of them were doing it deliberately. From that experience, I concluded there was no such thing as true psychogenic hearing loss.
AO/Beck: What's your thought on that now?
Downs: I still believe it, I still believe it's deliberate in a great many ways. I think it's self-determined and they are essentially, malingerers. Over the years, there was a big deal about psychogenic hearing losses, implying that some are perhaps real psychogenic hearing loss. But whenever I got somebody who had been declared by the psychiatrist as psychogenic, I would still find normal hearing on PGSR. If this were true hearing loss, it would withstand PGSR. That was my feeling. But remember, my theories have been wrong many times -- but for what they're worth, I give them to you.
AO/Beck: I remember a wonderful story one of my professors told me in the early 1980s. He really hated doing PGSR, and they discovered a different way to find malingerers, and it worked particularly well with females. They would pretend to accidentally leave the microphone on while the patient was in the booth and somebody would come up wearing a white lab coat and say to the audiologist, Oh, have you got Mrs. Smith in the booth? And the audiologist would say, Yes, of course. Then the fellow in the white coat would say, Oh, I don't think she's aware yet, but we have her test results, she's pregnant. They would whisper that at about 20 dB, so then if Mrs. Smith went a little crazy, they would conclude, She heard that.
Downs: My trick was the same, but I dealt mostly with men. I'd say at 20 dB Your fly is open. That was really effective too.
AO/Beck: Aaah, the good old days! Please tell me about how you got involved with hearing in children?
Downs: Well I'll tell you, I was fortunate. Doreen Pollick came to the University of Denver when she first came over from England. She had worked with children early on and she showed me that children could be tested as babies. That was fairly shocking 50 years ago! She and I used to test babies all over the place. We were an awfully good pair. We found hearing losses in very young babies and we put hearing aids on them 'cause we figured they needed it. The children turned out wonderfully, and the earlier we put hearing aids on them, the better they turned out. You couldn't help but to realize that the earlier the better. A lot of people were saying there were critical periods for language development and the stimulation has to start very young. Being an extremist, I said very young means at birth, and that seems to have stood the test of time.
AO/Beck: One thing that I've always enjoyed, and I want to get your reflections on now, is that in one of your books which I read twenty years ago, you described hearing loss in a child as 15 decibels. Is that still your definition?
Downs: No question about it. Young children really need perfect hearing to develop perfect language. No question about it. Even a 15 decibel loss, negatively impacts language. This can be shown based on unilateral hearing loss. Fred Bess has shown that children with a unilateral hearing loss in the right ear, tend to lose one grade in school. All of those kids, regardless of the side of the unilateral hearing loss have problems in school and reduced IQs. Remember that a unilateral loss gives you a soundfield loss of about 10 dB. I think there's no question that even minimal hearing loss is a significant problem and needs to be treated with amplification.
AO/Beck: What are your thoughts on auditory processing disorders (APD)?
Downs: Actually, I really haven't' dealt with APD in children. Just plain old hearing loss has been my thing. You can't be everything, Doug! But what I do know about auditory processing disorders is based on my own experience with testing done on me in the old timer's project down in New Orleans.
They've done extensive testing on all sorts of different things. One of the things was the test of how fast it takes the impulse to go from your ear up to your brain and back. And that's where I was really deficient. My central auditory processing time is dramatically slowed down. But I'll be 90 years old in January, 2004. I have to hear from the bottom up. Is that what you call it?
AO/Beck: Yes. Top Down and Bottom Up processing.
Downs: Bottom up is my way. I have to replay the tape quickly to get what has been said. The sound gets in, but it gets in late, and I have to replay it to be sure I understand it.
AO/Beck: That's a great strategy though. Understanding how one learns and processes allows you to manage that information, to make it more accessible by doing what needs to be done.
Downs: Yes, that's right. It doesn't bother me because I handle it.
AO/Beck: Are there other things you can share with us, based on your own hearing loss?
Downs: Oh indeed there are. I've discovered all sorts of things through my own hearing loss. For instance, there's one thing I would like to do a research project on; I have seen lots of people who have had trouble with hearing aids, and lots of people who haven't had trouble with hearing aids. I'm one of those that doesn't have any trouble with hearing aids. I thought initially, it was because I know so much about hearing and listening that it doesn't bother me. As it turns out, that isn't the point at all. What I've found is that when I speak to people who have trouble with hearing aids, they report that they were the ones who could only study and concentrate in complete silence! As soon as there were other noises around, they would be distracted. In my case, the only way I could study was with noise!
AO/Beck: That's really interesting. So are you saying it's the issue of afferent versus efferent auditory efficiency? Being able to squelch the noise, so to speak?
Downs: I'm absolutely convinced of it, and I think we can prove it using otoacoustic emissions (OAEs).
AO/Beck: For me personally, during undergraduate and graduate school, and even now, I read and write all day long in absolute quiet. I need total sensory deprivation to concentrate. If I turn on music or anything else in the background, I am totally distractible.
Downs: Doug, don't ever lose your hearing! According to my theory - you'll be a bad hearing aid user. You can test it yourself when you have clients who wear hearing aids, the good users and the bad users are those who can study in noise, and those who must have quiet, respectively.
AO/Beck: Tell me if you can, do you have particular thoughts you would like to share with young audiologists, people just starting their careers?
Downs: I believe they must pick an area of expertise. Very few people can be experts in the whole profession, there's just too much to know. I think the earlier they identify their interests, the better. And then once they go into their chosen area, fully commit to it. I think that would be the best thing.
AO/Beck: What are your thoughts on mandatory Universal Newborn Hearing Screenings?
Downs: Well, I'm delighted. We credit lots of disciplines and scientists for having determined there are critical periods for the development of language, which I knew 50 years ago just from observation. And now it's come about as a truth, so I'm simply delighted. The thing that I've been disappointed with is that we didn't look ahead and see how many educational audiologists we needed to take care of the influx of babies with hearing loss! Many hospitals were unprepared for the massive amounts of tests and treatment needed. We were fortunate in Denver, because we've been doing it for so many years; our public health department was on the ball for a long time. But lots of places haven't done that, and it brings up the necessity of having a revised audiology curriculum offered by universities, specifically for early education. I would like very much to have audiologists do the early education. I think trying to adapt speech pathologists to audiology is a harder task than getting audiologists to do it! But, audiologists need special training in this highly specialized area.
AO/Beck: Marion, can you tell me a little about your personal life these days, if you don't mind? Where do you live, what do you do, are you still seeing patients?
Downs: Oh heavens no -- no patients! All I'm doing is occasionally writing. Ross Roeser and I have just put together a new addition of Hearing Disorders in School Children.
AO/Beck: Oh that's exciting. When does that come out?
Downs: It should come out next year. So I do a little writing here and there, and a little speaking here and there. People ask me to come, and if they ask me, I go.
AO/Beck: I know you received an honorary doctorate recently. Can you tell me about that?
Downs: Oh yes. That was from my own institution, the University of Colorado.
They awarded me the highest award they can, the Doctor of Science. I was really thrilled by that. I also received an award from the University of Minnesota years ago, the Alumni Achievement Award, a beautiful gold medal.
AO/Beck: That is fabulous. Are you still skiing?
Downs: I just got new parabolic skis and they're heaven.
AO/Beck: And when did you last ski?
Downs: Oh, about two months ago.
AO/Beck: Okay. Well, as long as this interview is spinning out of control, please tell me your thoughts on drinking wine - is that a good thing to do?
Downs: Yes. I always have one glass of wine before dinner every night. That's my limit.
AO/Beck: What is your preference? What type of wine do you like?
Downs: I like Merlot.
AO/Beck: And lastly, please tell me, how many great-grandchildren do you have?
Downs: I have 3 children, 11 grandchildren, and 19 great-grandchildren.
AO/Beck: That is phenomenal.
Downs: And I tell you, those great-grandchildren they're growing up too. What's so wonderful is I've been flying all over the country as the great-grandchildren are getting awards in school, or doing something in their classes, and when they say Granny you should come and visit. Granny does.
AO/Beck: Marion, it's been an absolute pleasure to chat with you. Thank you so much for your time.
Downs: Thank you, Doug. It's been fun for me too.
