Made to Hear: Cochlear Implants and Raising Deaf Children by Laura Mauldin (review)

Cochlear implants for deaf children, a mother observes at the beginning of Laura Mauldin's Made to Hear, have significantly contributed to the decrease of sign language programs in deaf education; eventually they might lead to the extinction of sign language and Deaf culture altogether. Cochlear implants (CIs), which circumvent a nonfunctioning inner ear, are the most common form of neuroprosthetics. Originally devised for deaf adults, among whom they gained popularity only slowly, they are now mainly implanted in infants and toddlers—this is usually celebrated as a medical triumph. Deaf community members, however, have often rejected CIs, fearing for the future of their language and culture. Sociologist Laura Mauldin brings much-needed, nuanced analysis to these highly divisive perspectives. Focusing on the experiences of families—principally moth-ers—with implanted children, she provides emphatic insight into the social factors, economic inequalities, and ideologies at play. She starkly illustrates that CIs are not the instantaneous miracle cure they are generally portrayed to be, but rather a technology that depends on specific clinical settings, social norms, and medical beliefs. Thus, the book follows the five stages of implantation, from identification of hearing loss and early intervention, to candidacy for surgery and surgery itself, and finally to the highly involved, long-term therapy upon which CI success depends. Throughout this process, parents are socialized into what Mauldin calls the "medicalized script of deafness" that perceives it as tragedy to be overcome through biomedical interventions and hard work. The perspectives and insights of Deaf adults (in common usage, deaf denotes a person with hearing loss and Deaf a signing member of the Deaf community), on the other hand, remain mostly excluded.

The first chapter takes us to a large New York hospital where Mauldin observed mothers learning about their children's hearing loss. She finds in place a set of "anticipatory structures," a preexisting set of practices built to manage parents' emotions in this stressful situation and to compel them into compliance with follow-up care. These structures guarantee that parents have access to information and services, but they also mirror deeply embedded beliefs about normalcy and disability. In the everyday activities of the clinic these beliefs are continuously enforced, while alternate, "deviant" perspectives such as those from Deaf adult sign language users are systematically excluded. These structures set parents toward an almost automatic path toward CIs as the sole and exclusive option for managing hearing loss. This strategy provides a calming vision of future normalcy, yet is misleading, given that not all deaf children are considered good candidates.

With children diagnosed with hearing loss at ever younger ages, responsibility for their care and therapy has been moving from residential schools to parents. The early intervention programs described in the second chapter support parents in acquiring skills and knowledge quickly. These programs provide a therapeutic culture that offers relief to parents anxious over their child's needs and future, yet also constantly evokes these anxieties. In a panoptical setting, professionals constantly monitor parental compliance with therapeutic measures and "good parenting" styles, not only in the clinic, but also in their home environment. The majority of parents in Mauldin's sample indeed did comply with these requirements, but there were also those whose "resistance" to precut medical solutions, or inability to advance adequately, marked them as deviant, "difficult moms."

Compliance and deviance provide the main themes for the analysis of CI candidacy in the third chapter. Children from white, middle-class families are implanted at a much higher rate than those from other socioeconomic, racial, and cultural backgrounds, though professionals hardly ever address the reasons for these disparities. Once a child has been medically cleared, professionals assess "parents' performance as auditory trainers and overall participants in the therapeutic mode" (85). Here, a background that is not white, English-speaking, and middle class is seen as a hindrance for parental ability or willingness to perform the required, extensive, long-term therapeutic tasks, including...