Made to Hear: Cochlear Implants and Raising Deaf Children

(A Quadrant Book)

Visit the link below to download the full version of this book:
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 MADE TO HEAR
Cochlear Implants and Raising Deaf Children

LAURA MAULDIN

A Quadrant Book

University of Minnesota Press

Minneapolis • London
 Quadrant, a joint initiative of the University of Minnesota Press and the Institute for Advanced Study
at the University of Minnesota, provides support for interdisciplinary scholarship within a new, more
collaborative model of research and publication.

http://quadrant.umn.edu.

Sponsored by the Quadrant Health and Society group (advisory board: Susan Craddock, Jennifer Gunn, Alex Rothman, and
Karen-Sue Taussig) and by the Center for Bioethics at the University of Minnesota.

Quadrant is generously funded by the Andrew W. Mellon Foundation.

Portions of chapters 1 and 2 were published in different forms in “Parents of Deaf

Children with Cochlear Implants: A Study of Technology and Community,” Sociology of
Health and Illness: A Journal of Medical Sociology 34, no. 5 (2012): 1–15. A different version
of chapter 4 was published as “Precarious Plasticity: Neuropolitics, Cochlear Implants,
and the Redefinition of Deafness,” Science, Technology, and Human Values 39, no. 1 (2014):
130–53. Portions of chapter 5 were published in “Cochlear Implants and the Mediated
Classroom-Clinic: Communication Technologies and Co-operations across Multiple
Industries,” Disability Studies Quarterly 31, no. 4 (2011), http://dsq-sds.org/article/
view/1713.

Copyright 2016 by the Regents of the University of Minnesota

All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without the prior written permission of the
publisher.

Published by the University of Minnesota Press

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Minneapolis, MN 55401-2520
http://www.upress.umn.edu

Library of Congress Cataloging-in-Publication Data

Names: Mauldin, Laura, author.
Title: Made to hear : Cochlear implants and raising deaf children / Laura Mauldin.
Description: Minneapolis : Univ of Minnesota Press, 2016. | Series: A quadrant book |
Includes bibliographical references and index.
Identifiers: LCCN 2015031932| ISBN 978-0-8166-9724-3 (hc) | ISBN 978-0-8166-9725-0 (pb)
Subjects: LCSH: Hearing impaired children—Means of communication. | Deaf
children—Family relationships. | Hearing disorders in children—Rehabilitation.
Cochlear implants—Social aspects. | BISAC: SOCIAL SCIENCE / People with
Disabilities. | SCIENCE / Philosophy & Social Aspects. | MEDICAL / Audiology &
Speech Pathology.
Classification: LCC HV2391 .M38 2016 | DDC 649/.1512—dc23
LC record available at http://lccn.loc.gov/2015031932

Printed in the United States of America on acid-free paper

The University of Minnesota is an equal-opportunity educator and employer.

22 21 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1
To the memory of my loving grandmother, Helen
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Science is politics by other means.
• S andraHarding,Whose Science? Whose Knowledge?
Thinking from Women’s Lives

For the ethnographer in a medical setting, health care workers

are an exotic tribe. . . . At worst we are voyeurs seeking cheap
thrills; at best we are witnesses reporting on the most profound
dilemmas of the human condition.
• CharlesBosk,The Fieldworker as Watcher and Witness
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CONTENTS

Abbreviations xi
Introduction
Medicalization,Deaf Children,andCochlearImplants 1
1 ADiagnosisof Deafness 27
How Mothers Experience Newborn Hearing Screening

2 EarlyIntervention 55
Turning Parents into Trainers

3 CandidatesforImplantation 77
Class, Cultural Background, and Compliance

4 TheNeuralProject 107
The Role of the Brain

5 SoundinSchool 135
Linking the School and the Clinic

Conclusion
ThePowerandLimitsof Technology 153
Acknowledgments 175
Notes 179
Bibliography 187
Index 203
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ABBREVIATIONS

AAA American Academy of Audiology

AAP American Association of Pediatrics
ABR auditory brainstem response test
ADA Americans with Disabilities Act
AGB Alexander Graham Bell Association
ASHA American Speech-Language-Hearing Association
ASL American Sign Language
AVT Auditory Verbal Therapy
CDC Centers for Disease Control and Prevention
CI cochlear implant
EHDI Early Hearing Detection and Intervention
EI Early Intervention
ENT ear, nose, and throat
FDA Food and Drug Administration
IFSP Individualized Family Service Plan
JCIH Joint Committee on Infant Hearing
LSL listening and spoken language
NBHS newborn hearing screening
NEILS National Early Intervention Longitudinal Study
NICU neonatal intensive care unit
NIDCD National Institute on Deafness and
Communication Disorders
NIH National Institutes of Health
NYS New York State
OAE otoacoustic emissions
TC Total Communication
WHO World Health Organization

xi
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Introduction

MEDICALIZATION,DEAFCHILDREN,
AND COCHLEARIMPLANTS

If practices are foregrounded there is no longer a single

passive object in the middle, waiting to be seen from
the point of view of a seemingly endless series of
perspectives. . . . The body, the patient, the disease, the
doctor, the technician, the technology: all of these are more
than one. More than singular. This begs the question of
how they are related.
• AnnemarieMol,The Body Multiple

How is any parent to know whether to erase or celebrate

a given characteristic?
• AndrewSolomon,Far from the Tree

As I walked up to Jane’s home,1 Halloween decorations hung from

the door, and fallen leaves, matted and damp, were strewn all over
the ground. Once inside, we made tea and stood in her kitchen,
brightly lit by an autumn afternoon sun. Drawings, magnets, and
calendars covered the refrigerator. I leaned against the counter as
she fed her youngest son, who was sitting in his high chair. We were
waiting for her four-year-old daughter, Lucy, to come home on the
bus from school. Lucy is deaf and had recently received a cochlear
implant (CI). She was in a program that focused on spoken language,
relied on speech therapy, and was tailored for children with CIs. As
we waited, Jane told me that Lucy was making amazing progress
in her speech articulation and comprehension. She was smiling and
almost breathless as she talked; it was clear that she was brimming
with excitement about it. Our conversation then drifted into how
Lucy had been in a different classroom previously, a sign language

1
2  INTRODUCTION

program, before transferring to her program now. Her new educa-

tional placement is called auditory-verbal, and it is part of the same
school for deaf children that she was attending. Jane observed that
the number of students in the sign language program had quickly
dwindled in the past two years. More and more students were get-
ting CIs and transferring to the auditory classroom, she told me. I
asked her why she thought enrollment in the sign language program
was going down at Lucy’s school.
“Nobody’s talking about Deaf culture,” she said.2 “With the tech-
nology that we’re being faced with, it will never have the chance
to evolve because it’s not big enough. It’s such a teeny tiny little
culture. We don’t talk about it, and the reason we don’t is because
the majority of parents want their kids to talk.”3 She was pointing
out two factors at play: audiologists’ and other related professionals’
general acceptance of the CI as a tool for learning spoken language
and the erasure of sign language as a viable option for deaf children.
Indeed, Jane celebrated Lucy’s speech development. After all, she
had engaged in an untold number of hours of care, work, and labor
to maintain it, and deeply hoped that Lucy would be able to master
it. Yet she also agonized over the pressures she felt to restrict Lucy’s
language input to only spoken English through the CI. She insisted
that Lucy was still a deaf child and sometimes used signs with her.
Above all, she was extremely anxious about Lucy’s future.
Jane lives near New York City and is one of ten mothers who
participated in my study of raising deaf children with CIs. Her ex-
perience is embedded within a variety of social changes that have
occurred over the past three decades, and her story—as well as the
stories of the other families in this study—offers a glimpse into the
world of families who are raising deaf children with CIs today. This
book identifies the context shaping these families’ experiences. One
important part of this context is technological change and the pow-
erful influence of medical knowledge (e.g., development of the CI
and CI-related clinical and educational programs). Another is the
deeply divisive climate surrounding CIs; there has been an enor-
mous amount of controversy over the device. Health policy changes
(e.g., newborn hearing screening programs and state intervention
services for children with disabilities) have also reshaped the trajec-
 INTRODUCTION 3

tory of parenting a deaf child. Finally, the larger cultural demands on

mothers to rely on medical interventions in child rearing also affect
the way parents respond to their child’s deafness.
Using observations and in-depth interviews, in this book I de-
scribe the institutional structure and culture of CI-related interven-
tions for deaf children. Some of my fieldwork was conducted in a
CI clinic and depicts the organization of and particular therapeutic
culture found in a CI center. Other times my fieldwork took place
with parents in their homes, and as they took their child to school
or attended parent events. In the following chapters is a detailed
description of families’ experiences of the therapeutic culture sur-
rounding the process of learning their child was deaf, deciding to
get the child a CI, and navigating the multiyear process that precedes
and follows surgery. Perhaps the most crucial aspect of implantation
is how much time it takes; it is not a onetime surgical event. Time is
needed to prepare for the CI and to learn to use it. For parents, this
long process is fraught with grief and hope, persistence and frustra-
tion, and conflicting information and emotions. For example, they
are aware of the political battles and controversy over the use of CIs,
but such debates can be alienating because parents’ concerns differ
strikingly from the political battles that play out over the device. In
addition, professional advice for deaf children changes over time;
different professionals give different advice, parents draw from their
own gut instincts, and yet sometimes their “nonmedical” knowledge
is minimized in the context of the clinic. And then there is the unpre-
dictability of the outcome: parents may struggle for months or even
years before observing spoken language in their child, and mastery
does not always come.4 Thus, there is a continual tension between
their present efforts and their hopes for their child’s future. In gen-
eral, clinical research is not too concerned with the struggles that
Jane and other mothers described to me as they learned their child
was deaf, made treatment decisions, and raised a deaf child with a
CI. This book documents those very struggles.
The families’ experiences in my study were powerfully affected by
what I call ambivalent medicalization. Medicalization is an important
sociological concept that describes how we understand conditions
through medical language, medical thinking, or a medical framework.
4  INTRODUCTION

Academic theories and studies of medicalization tend to be concerned

with how medicalization has power over people, especially through
affecting their behaviors and influencing us to see differences between
people not as neutral variations but as medical problems. However,
studies have also shown that people experience medicalization in
ambivalent ways (e.g., Blum 2011). On one level, I use the term am-
bivalent medicalization to include the sometimes ambivalent feelings
that mothers in this study experienced (although more often than not,
they were socialized to not be ambivalent). But on a deeper level, I use
the phrase in conversation with theories of medicalization. Overall,
studies of medicalization emphasize its power and therefore the lack
of agency that individuals have when they encounter it. But ambiva-
lent medicalization emphasizes that individuals are both empowered
by and surrendering to the process of medicalization. In this book, I
argue that medicalization and biotechnological tools create new ways
of being, and that this has, simultaneously, both good aspects and bad
aspects. That is, ambivalence is not just what people might experience
as a result of medicalization, but rather it is characteristic of the pro-
cess itself. Some things are gained while others are lost, or as Riessman
(1983) put it when writing about medicalization and women’s lives, it
is a “double-edged sword.”
Ambivalent medicalization is a concept I develop here to account
for all of this, and it has broad application and a number of features.
Most importantly, it is a tool to close the gap between theorizing
medicalization and the humanistic enterprise of accounting for the
experiences of individuals in society experiencing it. First, it recog-
nizes the sheer triumphs of medicine, the technoscientific feats we
have available to us, and the possibilities and relief these options
often provide to people with all kinds of diagnoses, from minor ail-
ments to those involving death, angst, and pain. But it also acknowl-
edges that there is an underbelly to medicalization. It often requires
individuals to submit themselves to medical thinking and clinical
logic that—despite the hope offered—can be fraught and difficult in
day-to-day living. As I will show, medical interventions can have real
benefit, and it soothes families to have a plan of care in the face of a
troubling diagnosis. Sometimes families actively resist the pressures
that come with these interventions, but most often families are being
enculturated into medical thinking, and in the process they are told
 INTRODUCTION 5

to accept some sets of resources and reject others. The concept of

ambivalent medicalization tries to capture both the gains and the
losses that come with medical and technological advancement; for
while some things may be attained through medicalization, other
ways of being or communities may be lost. Overall, it recognizes the
capability of medicine and the relief it provides, attends to the ac-
companying profound social and ethical implications, accounts for the
labor that medicalization often requires of patients and caregivers,
and grapples with the fact that medicine may not always yield the
best—or even the intended—results.
Through interviews and observations, I show how ambivalent
medicalization works as a set of tensions, a nexus of certain trajec-
tories and conflicting points of view. First, tensions over whether
deafness is a medical problem in the first place play out in par-
ents’ lives. But ultimately almost all parents tend to adopt a certain
“script” about deafness. The different scripts for narrating and giving
meaning to what it means to be deaf serve as a backdrop for under-
standing the many issues surrounding deaf children and CIs, as well
as contribute to the ambivalence experienced by parents. Second,
the availability of CI technology, which is a neuroprosthetic, puts
the development of the brain at the center of all interventions. The
centrality of the brain is the most significant feature of the scripts re-
garding deafness that parents adopt. Third, in the past forty years or
so, responsibility for the care of children with disabilities has shifted
from institutions to the home. I show the consequences of this shift
for motherhood, since it co-occurred with the rise of medicaliza-
tion and mapped directly onto gendered patterns of care work. As
a result, tremendous pressures are put on mothers of children with
disabilities to proactively engage in medical interventions to “over-
come” them. Finally, socioeconomic status (SES) and cultural back-
ground play a significant role in which mothers do this work and
how they are seen by clinicians.

ContextualizingDeafness:DifferentScripts
Framing the “Problem”
Professionals in implantation and many in the general public most
likely agree that deafness is a disability5 and should be fixed. For
6  INTRODUCTION

example, audiologists work to measure the amount and kind of

hearing loss a child has, recommend tools like hearing aids and CIs
to correct or mitigate it, and coordinate with various cooperating
intervention programs to support those goals. Parents are expected
to bring their child to the clinic as needed, maintain the device’s
functioning, and solicit speech therapy—and other services—for
their child. There is little controversy among professionals over these
basic expectations. These accepted norms around treating deaf chil-
dren and the assumption that they should learn to hear and speak
are, however, also a product of a larger culture.
One way of explaining this script about the meaning of deafness
is to go back to the sociological concept of medicalization. In gen-
eral today, medical knowledge has come to dominate how we talk
about, understand, and respond to many things in our society, our
lives, and our bodies. Irving Kenneth Zola’s (1972) work originally
conceptualized medicalization and argued that it was the expansion
of powerful medical knowledge into ever more areas of life. Labeling
something a medical problem is also a key feature of medicalization
(Brown 1995; Schur 1972). Peter Conrad gives a working definition
of medicalization as “defining a problem in medical terms, using
medical language to describe a problem, adopting a medical frame-
work to understand a problem, or using a medical intervention to
‘treat’ it” (1992, 211). As Conrad sees it, the essence of medicalization
is definitional, although this does not mean it is static. For example,
he points out a variety of conditions that were once seen as medical
problems but have now largely been de-medicalized, such as homo-
sexuality. This is partly because of the gay and lesbian movement’s
fight to remove homosexuality from the purview of medicine, and
thus it was removed from the Diagnostic and Statistical Manual of
Mental Disorders (DSM) in 1973 (Conrad 2007). Still, at the same
time, other once “natural” aspects of life—such as death, birth,
and pregnancy—became more medicalized. Determining whether
something is a medical problem is not the goal of sociological work.
Rather, the aim is to show how something is understood as a medical
problem, how this norm is accepted or challenged, and the conse-
quences this has on people’s lives.
To that end, there is another script for deafness. In the 1970s, deaf
people started distinguishing between the lowercase deaf, which
 INTRODUCTION 7

describes one’s audiological or hearing status, and the capitalized

version of Deaf, which refers to an identity of being culturally Deaf
(Padden and Humphries 1990). The beginnings of the Deaf cultural
movement in the United States coincided with a variety of new so-
cial movements in the latter half of the twentieth century, such as
the civil, gay and lesbian, women’s, and disability rights movements.
Many of these movements championed a similar way of thinking
about difference. They took what society deemed a stigmatizing
trait—often framed as a disease or a condition—as, instead, the basis
for an identity, community, and culture to be celebrated. The Deaf
cultural movement argued that deafness is not inherently pathologi-
cal but has been collectively made or constructed as such through
history, the language we use to describe or label people (e.g., medical
language), and systems of power that privilege some people over
others. Today there is extensive literature published on Deaf cul-
ture, a culture with its own history, language, and way of seeing
the world. Much of this work argues that being Deaf is primarily
about the use of sign language to communicate and that cultivating
Deaf culture is of paramount importance as a way to offer a counter-
discourse to that of medicalization. Central to the Deaf critique is
that they are a linguistic minority, and, as the following chapters will
show, the politics of language are at the center of any debate over
implantation.6
During this same time period of new social movements and the
expansion of Deaf culture, the CI was being developed. As Stuart
Blume explains in his book The Artificial Ear (2010), during the 1980s
and 1990s, the CI moved from being an experimental innovation to
being clinically feasible. Early on in its development, while still in
the experimental phase, it was used in adults, who reported various
levels of benefit from the device. Blume (2010) and Mills (2012) both
show how the adult CI users collaborated with the CI designers. But
as the research side of CIs gained attention, the device’s broader via-
bility needed further testing. Clinics needed to identify more candi-
dates to test these developments and improve upon them. Garnering
broader participation required, however, a public message that res-
onated with potential CI candidates. And here there was a problem.
The market for CIs in adults “grew far more slowly than had been
anticipated. . . . Deaf people were not coming forward in anything
8  INTRODUCTION

like the numbers anticipated by professionals and manufacturers”

(Blume 1997, 38). Indeed, Deaf adults—who were part of Deaf
culture—simply did not view their deafness “in the same terms as
medical and audiological professionals: as a loss of hearing” (Blume
1997, 39). To them, nothing needed to be fixed because their deafness
was an identity, their language was American Sign Language (ASL),
and they were part of a culture. Thus, because of these vastly differ-
ent scripts around deafness, adult CI patients turned out to be a less
accessible market than they had hoped.
While Deaf adults failed to be as interested in CIs as professionals
had hoped, changes in the identification and diagnosis of deaf chil-
dren were making a new market for CIs possible. Various changes
in legislation and health policy contributed to deaf children being
identified much earlier, which I explain further in the following chap-
ter. Then in 1995, the National Institutes of Health (NIH) convened
a consensus meeting of specialists in fields related to CI, as well as
representatives from the public. After reading reports, studying data,
and hearing testimony, members of the consensus group concluded
that although the success of implantation was highly variable and
these variations were unexplained, the data also showed a trend in-
dicating that the shorter the duration of deafness, the better the in-
dividual’s performance (e.g., ability to understand and/or produce
speech) with a CI (National Institutes of Health 1995). It was this
fact that resonated most with the group. By 1998, despite protests
by the Deaf community and testimony by some of its members,
the age of implantation was lowered to eighteen months. By 2000,
it was lowered further by the Food and Drug Administration (FDA),
to twelve months.
These two strands of history—the rise of the Deaf cultural move-
ment and the development of the CI—barreled toward each other
on simultaneous timelines. Because of this, deep controversy has
surrounded CIs since their inception. Many who subscribe to the
antimedicalization script about deafness are opposed to CIs. I call
this antimedicalization view of deafness and subsequent opposition
to CIs the Deaf critique. Those arguing against CIs still do so today
by citing the value of Deaf culture and usually depend on an identity
politics that, at its core, emphasizes Deaf culture and the use of sign
language as a kind of biodiversity (Bauman and Murray 2009). This
 INTRODUCTION 9

view asserts the legitimacy of what Deaf scholar Ben Bahan (2008)
calls a “visual way of being” and values the shared experiences of
Deaf culture and, most importantly, the use of sign language.
By contrast, the view that deafness is a medical problem is the
crux of clinical approaches to deafness and a starting point from
which clinical interventions begin. Because more than 90 percent of
deaf children have hearing parents and deafness in children is now
identified much sooner, children under the age of six (the demo-
graphic category used by the National Institute on Deafness and
Communications Disorders [NIDCD]) are the fastest-growing group
of CI recipients (NIDCD 2015). That makes hearing parents the pri-
mary consumers of CIs, not d/Deaf persons. Even though some do
not advocate for such a strict divide over CIs and Deaf culture (e.g.,
Woodcock 2001) and there has been some documentation that the
controversy over CIs has subsided somewhat, “opposition to pediat-
ric implantation among certain members of the Deaf community
continues unabated” (Christiansen and Leigh 2010, 47). It is for these
reasons that this book focuses exclusively on pediatric implantation.
This book focuses on the lives of those parents who opt for im-
plantation because, despite the Deaf cultural movement and its argu-
ments against implantation, the CI has shifted from the peripheries
of innovation to become the most advanced and commonly used
neuroprosthetic. Today, the CI is the world’s largest medical device
market, and, as of 2012, the FDA reports that approximately 58,000
adults and 38,000 children in the United States have been implanted
(NIDCD 2015). The most rapid growth in the industry has occurred
during the past ten years.7 Cochlear, the largest CI manufacturer,
reported that “fifty percent of people implanted with a CI received
it in the last five years, reflecting the exponential growth characteriz-
ing this intervention” (Cochlear Americas Corporation 2008, 1). Yet
even as the Deaf community laments the expansion of implantation,
those who advocate for CIs sound alarms about its underutilization
(e.g., Sorkin 2013), illustrating that there are vastly differing view-
points on the device.
Rather than focus on trying to catalog these viewpoints, I show
how when a child is diagnosed as deaf, parents find themselves in
the middle of two very different scripts on deafness and a fierce
battle over language politics. The Deaf critique of CIs comes from
10  INTRODUCTION

Deaf experience and sees the problem as society’s intolerance of

difference. But deafness is not often passed on genetically, so often,
parents do not have this Deaf experience to draw from. Indeed, it
is genetic in less than 10 percent of the cases, which is why more
than 90 percent of deaf children have hearing parents (NIDCD 2015).
Thus, because medical intervention is so heavily relied on in con-
temporary culture, parents primarily come to understand deafness
via medical institutions that provide the diagnosis. This presents a
starkly different script than the Deaf perspective does, but parents
must grapple with their own desires, expectations, and hopes for
their child. Previous studies of implantation have shown a strong
correlation between parents’ status as hearing and their desire for
their child to develop spoken language. And that desire for the ac-
quisition of spoken language has been documented as the most sig-
nificant factor in the decision to implant.8
But how do these ways of seeing deafness and these debates over
which script to adopt figure into this book? After spending time with
parents of deaf children with CIs, it became clear to me that these
two polarized narratives about deafness, which are also seen in the
public discourse about implantation, are inadequate. Parents do tend
to adopt the medicalized script of deafness, but they do so in a par-
ticular context that funnels them toward this script. Along the way,
they may also experience moments of ambivalence. In chapter 2,
I show how the initial adoption of the medicalized script happens
through interactions and institutional protocols that I call anticipa-
tory structures. Many of the professionals working in fields related to
implantation who were a part of this study actively encourage, and
are complicit in, maintaining strict divides between these competing
scripts of deafness. In the following chapters, I will show how par-
ents are socialized into this medicalized script of deafness, describe
the language debates between speech and ASL, and examine the in-
creasing discourse about the brain.

BiotechnologyandDisability
The simultaneous development of the CI and the Deaf cultural
movement illustrates a paradox that has broader implications beyond
just implantation: Public discourse about diversity and accepting dif-
 INTRODUCTION 11

ference has steadily increased in the United States, yet the tools of
science and medicine that are used to treat various conditions (which
may very well be included under the umbrella of diversity) have
grown more sophisticated and available. We can now engage in at-
tempts to treat, find relief, look or feel more “ideal,” or pass on traits
of normalcy—which have social value—to our children. The families
in this book made decisions that simultaneously reflected dominant
norms regarding the use of biotechnologies and regarding disability.
These two sets of norms cannot be disentangled from one another,
yet both tend to be seen as “common sense” and often go unnoticed.
For example, we often think of science, technology, and medi-
cine as neutral or objective endeavors and authoritative explanations.
However, science and technology studies (STS) scholars have shown
that rather than emerging from an objective or “natural” truth,
science is collectively made through interactions. Sociologists of
knowledge and STS scholars have long said that science and medi-
cine are social and that technological artifacts are not neutral tools
but rather are embedded in and inscribed with social and political
relations.9 More specifically, STS scholars Clarke and colleagues
(2010) argue that medicine is now so interwoven with technologies
that the process of medicalization described by sociologists has
been fundamentally altered into something else: biomedicalization.
Medicalization is more about control over disease processes, while
biomedicalization is about transformation through technoscientific
means (Clarke and Shim 2011).
This technological shift and emergence of biomedicalization have
a number of consequences, one of which is that technologies and
new scientific knowledge change how we understand conditions and
construct those conditions’ meanings; that is, they are intertwined as
sociotechnical systems. Increasingly, the effects of technologies are
being interwoven into sociological examinations of medicine (Casper
and Morrison 2010), and as I will show in chapter 4, the technology
of CIs contributes to an important shift in the definition of deafness.
Because the CI is a neuroprosthetic device, deafness has come to be
redefined from a sensory (hearing) loss to a neurological (processing)
problem. One result of this is that the CI is then constructed as merely
a tool providing access to the brain, which is the site of the “real”
treatments. These “real” treatments are the long-term therapeutic