The Artificial Ear: Cochlear Implants and the Culture of Deafness (review)

Stuart Blume has written an extraordinary book about cochlear implants while at the same time showing how science, technology, medicine, and culture intersect in our postmodern age. The book is in the largest sense about the biopolitical and the biocultural and, as such, will appeal to a wide variety of readers beyond those interested in deafness and the cochlear implant. In my opinion, the book is must reading for medical historians and anyone interested in complex dynamics between a new medical technology and the political-social world into which it must fit.

Most writing on cochlear implants take one of two positions. The first is the biomedical position that cochlear implants increase hearing in deaf people and should therefore be available if not mandatory for all deaf patients. Bioethicists have tended to take this side as well, seeing the cochlear implant as offering either an adult or a child a better life. The Deaf community, activists, and Deaf studies scholars have taken up the contrary position, arguing that cochlear implants spell the end of a shared identity and the eradication of a people who do not regard themselves as abnormal humans but rather as a linguistic minority with a rich history, culture, and, above all, language.¹ They further object that implanting a very young child with a cochlear implant and forbidding the child to use sign language (which is the current protocol of audiologists, surgeons, and the corporations that make these devices) produces children caught between two worlds—neither Deaf nor hearing—and thus unable to be part of either world.

Blume, however, takes a more judicious path, looking carefully at the historical, political, and social forces behind the manufacture and implementation of the cochlear implants as well as the sociological, political, and social aspects of the resistance to the cochlear implants. Yet he is not a disinterested observer either since both of his children are deaf. He describes quite movingly how his role as sociologist to observe objectively sometimes would clash with his desire as a parent to do the right thing for his children (neither of whom were implanted).

What Blume discovers in his work is that a key problem in the development of the cochlear implant was that there was virtually no or only token involvement of the patient population. Hearing doctors and technicians simply assumed that that it was better to hear than to be deaf and that a "cure" for deafness would be widely hailed by all concerned. Indeed, the media picked up on the "miracle cure" theme early on, although even now cochlear implants do not "cure" deafness; they merely act as very good hearing aids. Blume's main point is that anyone who uses a cochlear implant will experience a vastly more complex existence than simply being a deaf person who was cured. He notes that almost no studies were done to see how people with cochlear implants would function from educational, social, and experiential perspectives. In fact, there was very little good quality, evidence-based follow-up research in general. Only Sweden did the kind of research that was needed and concluded that while children and adults have a right to cochlear implants they also have a right to learn sign language. Blume notes that many cochlear implantees, particularly those who were implanted in early childhood, still define themselves as Deaf people who can hear. Their Deaf identity is not eradicated by the implant, but rather the implant creates new categories of Deafness.

The book traces the history and politics of cochlear implants in the United States, United Kingdom, France, Italy, Sweden, and globally, with a chapter on the Netherlands, where the author lives and teaches. The book recommends that medical interventions need to be developed with all stakeholders actively involved, not merely the medical and technological experts. Blume also argues for the integration...