Abstract

Cochlear implants and auditory-verbal therapy are the latest techniques and technologies used to make deaf people learn to listen and speak. This paper provides a genealogical analysis of the Cochlear Implant Program at SickKids Hospital in Toronto, Ontario, Canada and shows how this program exemplifies the medicalization of deafness while denying deaf children the opportunity to learn sign language. Using Foucault's concept of governmentality, the relations between power, knowledge, truth and their influences on the program's practices are revealed in order to provide insight into Canadian society's conceptions of deafness. This analysis reveals the Cochlear Implant Program as a capitalist establishment that is supported by unquestioned reverence of modern medicine and technology, oriented by a quest for normalcy. The paper concludes by encouraging members of the Deaf community and their supporters to challenge the hegemony of normalcy by utilizing alternate research-based knowledge-truths of cochlear implants and sign language.


The education of deaf children has experienced many pedagogical shifts since the late 18th century. Concomitantly, socio-cultural conceptions of deafness, d/Deaf1 people and sign languages have also changed over time and place. There is a long history of hearing people developing techniques and technologies to try and make deaf people learn to hear and speak. Auditory-verbal therapy (AVT), a training method that requires a deaf child to use audition to learn spoken language without the assistance of any visual cues (e.g., facial expressions, gestures, lip-reading, manual signs), and the cochlear implant, a device implanted in the skull with an electrode array inserted into the cochlea to convert sound to electrical signals that stimulate the auditory nerve, are the latest of these techniques and technologies. In 1990, cochlear implants were approved for use in the United States and Canada for children over two years of age and have been implanted in children with increasing frequency and at younger ages since that time (Hanrahan, 2011). In Toronto, infants and children who receive cochlear implants must undergo many years of auditory-verbal therapy to learn to listen and speak. The prevalence of the auditory-oral approach, especially AVT, has no doubt influenced the decline of early sign language use among deaf children and their hearing parents, as AVT strictly prohibits the use of American Sign Language (ASL) (AG Bell Academy for Listening and Spoken Language, 2007; Brennan-Jones, White, Rush, & Law, 2014). As over 90% of deaf infants are born to hearing parents, the number of children potentially denied sign language is significant (Mitchell & Karchmer, 2005). The increasing use of cochlear implants in young children is one factor that has led to the renewed domination of auditory-oral education in Ontario and the decline of bilingual-bicultural education which uses sign language as a language of instruction and teaches the majority spoken and written language as a second language (Small & Cripps 2012). Families who would like their child to have a cochlear implant and learn sign language are either denied the cochlear implant or must teach their child ASL on the sly (Snoddon, 2009).

In this paper, I investigate the history of the Cochlear Implant Program (CI Program) at the Hospital for SickKids in Toronto, using Foucault's concept of governmentality to analyze the program's conditions of emergence, knowledge-truth relied on and produced by the program, and the power relations evident within and around this program that resulted in such a strict no sign language policy. Foucault describes government as an "exercise of power" that is "a 'conduct of conducts' and a management of possibilities" (2003a, p. 138). Government, as defined by Foucault, is not limited to state political and economic structures, but has a broader meaning that includes "any form of activity that aims to shape, guide, or affect the conduct of some person or persons" (Tremain, 2005, p. 8). As interpreted by Tremain, "governmental practices should be understood to include…normalizing technologies that facilitate the systematic objectivization of subjects as deaf, criminal, mad, and so on, and techniques of self-improvement and self-transformation" (2005, p. 8). Investigating the CI Program as a governmental "regime of practices" (Foucault, 2003d, p. 248) is important, as the program propagates and is representative of the majority medical view of deafness as an abnormality to be normed, and through its conduct denies deaf children the opportunity to learn sign language, while they work to transform themselves into hearing, speaking people. An analysis of a regime of practices "means to analyze programs of conduct that have both prescriptive effects regarding what is to be done…and codifying effects regarding what is to be known" (Foucault 2003d, p. 248). Analyzing the development and expansion of this regime of practices, including what is done and what is known, and how power-knowledge influences and is influenced by the procedures and practices followed within the program, provides insight into Canadian society's conceptions of deafness that allowed for such a program to emerge amidst condemnation and resistance from the Deaf community.

The main source of information for this analysis was the CI Program section of the SickKids website (http://www.sickkids.ca/cochlearimplant/cochlear-implant.html). Details regarding the early history and development of the CI Program were obtained from an embedded video presentation of the program's founding director, Dr. Robert Harrison, speaking at the program's 10th annual Nalli-Ingoglia lecture in 2010 (SickKids, 2010). The main audience for the lecture was families of children with CI and professionals involved with the CI Program. Information regarding the current program, including the disciplines involved, the procedures and practices, and information for parents was also available on the website. It should be noted that some information on the website may be outdated (e.g., one page notes that over 500 implant surgeries have been completed, whereas a 2011 flyer advertises a celebration for their 1000th cochlear implant). The information is likely still reflective of current practice, although the length of surgery time and hospital stay may now be shorter than noted on the website (Sheppard, 2011).

The Power of Medical Knowledge-Truth

The Cochlear Implant Program was conceived in 1989 in anticipation of FDA approval of the implants in children in 1990, six years after FDA approval of the device in adults. Dr. Harrison's presentation (SickKids, 2010) provides a starting point for examining the conditions of the program's emergence and the knowledge-truth relied on and produced by the program, as well as knowledge excluded to ensure the program's success. A large portion of Dr. Harrison's presentation outlines how humans gradually came to understand the workings of the human brain, from early crude diagrams linking the brain with perception, to electrical stimulation experiments that allowed for the mapping of the brain, to specific auditory cortex and auditory nerve experiments in the 1950s that resulted in the development of the first permanent implants to stimulate the auditory nerve and produce the perception of hearing in humans. Increased knowledge of the organization of the auditory system, along with technological advancements over the 1960s and 1970s, resulted in the development of the cochlear implant (CI) as we know it today. The conditions of possibility for the CI Program's emergence, as described by Dr. Harrison, therefore include the medical and technological knowledge that allowed for the cochlear implant to be developed. We must also consider the conditions of possibility not discussed by Dr. Harrison that resulted in the development of a hearing prosthesis in the first place, specifically, the knowledge-truth that being deaf is not "normal" and requires "fixing"; that hearing and speaking make one more human than deafness and sign language. It is this longstanding, recurring knowledge-truth that those in the Deaf community resist and counter with Deaf knowledge-truth of the Deaf community as a socio-cultural-linguistic community that uses sign language to communicate2 . Within Deaf culture, deafness is not considered to be an abnormal condition in need of fixing, but rather a celebrated way of life. This Deaf discourse opposes the hegemony of normalcy and is a threat to the CI Program's success.

Foucault explains how power is attached to certain truths more than others: "There is a battle…'around truth'…'the ensemble of rules according to which the true and the false are separated and specific effects of power attached to the true'" (2003c, p. 317). Dr. Harrison alludes to the problems encountered with the Deaf community multiple times throughout his presentation, but does not acknowledge any relevance of the issues raised by the Deaf community: "We had some problems with the Deaf community"; "many in the Deaf community did not regard themselves as having a handicap and therefore why should we be trying to change their deafness." He provided the text of a couple newspaper articles as examples of these problems, and focused on the "ridiculous" claims made by the Deaf community leaders (i.e., that the devices had caused a few cases of death and mental illness in other countries). He makes clear that what he knows as truth, as a hearing doctor, is the real truth. In reference to the newspaper article he notes that, "there's some other things that were reported here which were quite incorrect," in reference to the Deaf community's view that "children should be old enough to make their own decision as to whether they want the procedure or not" (Dale, 1994). Harrison's truth-knowledge, based on his and others' research of the auditory system and speech development, and supported by the longstanding conception of deafness as a disability to be fixed, is more accepted as truth than the Deaf community's truth-knowledge based on their experiences as Deaf people. Leaders within the Deaf community were seen as obstacles, not as contributors or valued sources of information: "We didn't implant any child unless they had an appropriate therapy available and an appropriate school environment. We had to have debates with the Deaf culture over these issues which sucked up a lot of energy, but we're through that now." These debates around therapy and education are significant, but are glossed over. By "appropriate therapy" and "appropriate school environment," Dr. Harrison is referring to auditory-oral therapy and education, as stipulated by the medical professionals; sign language or any use of manual signs was considered inappropriate. These debates would not have been over cochlear implants then, but the strict requirement for auditory-oral language instead of sign language for children with CI. The CI Program's knowledge-truth production therefore expanded from knowledge over the auditory system and how to fix it, to knowing what communication and educational methods to use with deaf children, even though these doctors are not educators or language specialists, and do not have any experience being d/Deaf. This power attached to the doctors' knowledge-truth is illustrative of the longstanding audist3 tradition of hearing people deciding the fate of d/Deaf people and the medicalization of deafness (Ladd, 2003; Lane, 1992).

Dr. Harrison explains that the Deaf community's early resistance to and rallying against cochlear implants was because the CI was considered a "threat to the Deaf culture" which "is not the case now." He does not explain this comment further. Is it "not the case now" because CI has been accepted by the Deaf culture, or because the rallies have ended and the CI Program "won"? This comment gives the audience the impression that the Deaf community is now supportive of the CI Program and further discredits the Deaf culture's counter-discourse. In addition, his wording serves to present the Deaf community's concern as for themselves as a community, instead of for the well being of deaf children and the importance of sign language for language development and establishing a Deaf identity. Mentioning that Deaf people who could be implant recipients but had rejected the implants for themselves and opposed their use in young deaf children, stating that those views were incorrect, and then insinuating that their views had changed ("is not the case now"), seems to serve the point of cementing the CI Program's knowledge as truth. The CI Program's doctors had an agenda to implant children and because of their position as hearing medical professionals and the pervasiveness of audism, they did not need to pay heed to the discourse of Deaf people. As Valente notes, "This has the effect of making the decision about cochlear implants only a medical issue and at the same time devaluing social, cultural, and linguistic perspectives, especially counter standpoints that do not support implantation" (2011, p. 648).

The knowledge-truth relied on, produced by and excluded by the program has changed since its inception, due to research conducted at SickKids and globally. The FDA lowered the age limit from two years to one year (infants as young as six months are now being implanted), and eligibility rules were relaxed so that profound/total deafness is no longer a requirement for implantation. In addition, bilateral implants are now standard despite little research evidence to ensure their efficacy (Lane Medical Library, 2012). The discourses of the Deaf community have also changed. There seems to have been a general, although reluctant, acceptance of cochlear implants in children. Advocacy has shifted away from a fight against cochlear implants to fighting for early sign language exposure in infancy and ASL-English bilingual education (Snoddon, 2009). The use of sign language is supported by more and more scientifically persuasive brain imaging studies demonstrating the benefits of early sign language exposure for literacy skill development (Mayberry, Chen, Witcher, & Klein, 2011) and scientific evidence that visual languages are on par with spoken languages, as the same area of the brain is activated regardless of language modality (Petitto et al., 2000). Even though such medical-scientific research is available to support early sign language exposure, this knowledge is in contradiction to the SickKids CI Program knowledge-truths, and continues to be excluded by the Program.

Power-Knowledge and the Truth of "Normal"

It would be misguided to attribute the increase in infant and child cochlear implantation and the AVT/no sign language policy in Toronto to the power wielded by the doctors and rehabilitation professionals who work in the CI Program at SickKids. Foucault states that, "we must immerse the expanding production of discourses… in the field of multiple and mobile power relations" (1978, p. 98). Power does not simply reside within the CI Program; multiple power relations enable the current discourses on deafness, deaf children, language and education that allow the medical professionals in the CI Program to produce their knowledge-truth and perform their procedures. As mentioned previously, over 90% of deaf infants are born to hearing parents. When hearing parents discover that their infant or child is deaf, it is interpreted as a personal tragedy, a deviation from the hearing norm. Most hearing parents want their deaf child to hear, to fit into their hearing family and hearing society and will do what they can to assist them in leading a "normal" life (Lane, 1992). The parents "know" that their child's best chance of success in life is to be as normal as possible, and this normalcy hinges on the ability to hear and speak. The CI Program would not be successful if parents did not want cochlear implants for their children; parents are not without choice, but as Harlan Lane observes, "The professional expert and the parents generally share the same hearing culture; they tend to evaluate and label the deaf child from that perspective" (Lane, 1992, p. 24). Dr. Harrison's presentation indicates that the professionals within the CI Program are aware of the Deaf culture perspective, but the power relations present between medical professional and parent allows for control of information presented to parents: parents want to be told that their child can learn to listen and speak, that there is "hope", and in the absence of input from Deaf adults, this is precisely what they are told. When asked about the debate with the Deaf community, the current director "says he avoids the debate because he feels it is up to parents and children to make the decisions about what he offers" (Sheppard, 2011), clearly indicating that Toronto's CI Program does not provide any information regarding Deaf culture or sign language to parents. Any discussion regarding sign language would end with parents being told not to expose their deaf children to ASL if they want a cochlear implant (Snoddon, 2009). The circulation of power-knowledge between doctor and parent, parent and child, doctor/therapist and child creates an ever-expanding hegemony of normalcy, supported by Western society's need to measure everyone against the norm and provide intervention for those who are considered to be outside of the norm.

Disciplining the Deaf Body

The CI Program consists of a number of disciplines that act to subjugate the bodies of deaf children, controlling and modifying the processes of hearing and communication. This disciplining of the body is critical to Foucault's concept of governmentality and exemplifies what he calls "bio-power", put simply, "the organization of power over life" (Foucault, 1978, p. 139). The goal of the CI Program's assertion of bio-power is to normalize deaf infants, first by determining their hearing status in relation to the norm, then by implanting a device in their skull to allow access to sound, followed by intensive training to teach the child how to identify sounds and produce speech. Dr. Harrison in his lecture speaks of the importance of the "team approach" and names all of the people and their related disciplines who were involved on the original team. According to the website, the current team includes six audiologists, two otolaryngologists/surgeons, one speech-language pathologist, two auditory-verbal therapists, two researchers, one nurse and one information coordinator, and a psychologist and social worker may also work with the team; a multitude of disciplines working to transform deaf children into hearing children. Aside from mentioning the disciplines involved and providing statistics of the increasing number of implants each year, Dr. Harrison does not describe the practices and procedures of the CI Program in his lecture. Information regarding the practices and procedures was obtained from the CI Program website, and the following information is based on that material unless otherwise stated.

Parents interested in a cochlear implant for their child can apply directly to the program; no doctor referral is necessary. There is no mention of Ontario's Infant Hearing Program (IHP)4 on the website (except as a link on the links page), but as universal newborn hearing screening is mandated by the IHP, most infants are screened for hearing loss at birth (http://www.mountsinai.on.ca/care/infant-hearing-program). Therefore, parents of very young infants may apply to the program. Once the application is accepted, the infant or child then undergoes a long (four to six month) assessment procedure to determine candidacy for the implant (Sheppard, 2011). As noted above, there are a number of professionals who perform a multitude of assessments: an audiologist performs a number of different audiological assessments; a speech language pathologist assesses speech and language abilities; the family meets with the surgeon to learn about the surgery and have any concerns addressed and questions answered; the child undergoes a CT scan and an MRI; the family may meet with a social worker; and "may have appointments with a nurse or other healthcare professionals during the assessment process." The child also begins sessions with an auditory-verbal therapist to learn to "listen with their hearing aid or cochlear implant in order to develop communication skills." In addition, meningitis vaccinations are recommended prior to surgery. If after assessment the child is considered a candidate for CI surgery, the surgery is scheduled.

After spending a day or so in hospital post-surgery, the child is released home, returning to the hospital in three weeks to receive the external CI components that may be either activated that same day, or the following week in the case of young infants. During activation, the audiologist turns on the device and calibrates the speech processor so that the sounds are at the right level for the child. This first day of "MAPping" is often quite traumatic for the children as the sounds are unfamiliar and frightening. The child must return many times for further fine-tuning of their MAP over the first year, after which time MAPping is done every six months and evaluations conducted every year. Yearly evaluations entail audiological testing as well as speech perception tests.

Disciplining of the mind is also part of this disciplining of the body. Even before surgery, parents are prohibited from using sign language with their deaf child and must work towards helping their child identify sounds and produce speech (Cochlear Implant, 2008; Snoddon, 2009). The long-term effect of this bio-power, supported by the medicalized conception of deafness pervasive throughout hearing society, is to ensure that these deaf children internalize that hearing and speaking is normal and deafness and sign language is not: "technologies of power" influence "technologies of self" (Foucault, 2003b, p. 146, 147). This accepted practice of disciplinary control for the treatment of deaf children can be understood in relation to the intertwining of history and life:

If one can apply the term bio-history to the pressures through which the movements of life and the processes of history interfere with one another, one would have to speak of bio-power to designate what brought life and its mechanisms into the realm of explicit calculations and made knowledge-power an agent of transformation of human life. (Foucault, 1978, p. 143)

The bio-power exhibited within the CI Program perpetuates the long audist history of hearing people trying to make deaf people conform to the hearing norm. Children's bodies and minds are disciplined in order to shape them into citizens that will use audition and spoken language. "A power whose task is to take charge of life needs continuous regulatory and corrective mechanisms…such a power has to qualify, measure, appraise, and hierarchize…A normalizing society is the historical outcome of a technology of power centered on life" (Foucault, 1978, p. 144). The weekly (or more) AVT sessions, the parents' constant reminders to their children to use audition instead of vision, auditory-oral education, twice yearly MAPping, yearly evaluations, regular maintenance of the CI, surgery to replace outdated electrical components every 15 years or so (Lane Medical Library, 2012), all serve to ensure that the child continues to listen and speak and hence conform to the norm. As noted by Harlan Lane, "This is bio-power: massive intervention in the life of the child in an attempt to impose the majority's language, culture, and values" (1992, p. 206).

The disciplining of the body within the CI Program is closely related to the regulation of the population, as it is a method to safeguard society through normalization (Foucault, 1978). The current director states that the CI Program, "allows Ontarians with hearing loss to remain or become contributing members of society" (Artuso, 2011), and "We improve the sociability, education and employability of Ontarians" (Brown, 2011). These statements serve to ensure continued government funding by demonstrating that the CI Program is necessary to transform deaf children into productive citizens. There was a justified backlash from members of Toronto's Deaf community to these statements, as they imply that d/Deaf people without cochlear implants are not contributing and respected members of society.

The Cochlear Implant Community

As mentioned previously, Dr. Harrison in his lecture points to the Deaf community as causing problems during the development of the CI Program. While claiming to respect Gary Malkowski, a leader within Toronto's Deaf community and a politician at the time, and to empathize with the Deaf community's feelings regarding cochlear implants, he acknowledges that Malkowski and the Deaf community posed problems. One way that SickKids counteracted this problem was to create their own cochlear implant community, seemingly developed in opposition to the Deaf community. This community or "cochlear implant family" is based around parents, children and health care providers. The functions of the two communities are very different. Toronto's Deaf community is a socio-cultural community based on a shared language (ASL) and Deaf culture and can include Deaf people, their hearing family members and friends. The CI community includes those who have a CI or a family member with a CI as well as the doctors, nurses, audiologists, social workers, speech-language pathologists and AV therapists on the CI Team: it is a community of patients, families and medical professionals. This cochlear implant family appears hierarchical, as the doctors and professionals give the children their CI and access to sound and teach them to listen and speak (and teach their parents how to teach them to listen and speak) and the parents and children are the benefactors of the medical professionals' knowledge and support.

The purpose of the CI community seems on the surface to be a support network for parents and their children, but the inclusion of the medical professionals indicates a political function and acts to conduct the conduct of CI recipients and their families in perpetuity. The CI Program at SickKids publishes a parent newsletter, Sound Waves, only two issues of which are available on their website, Summer 2005 and Summer 2008. In the 2008 newsletter, the CI family is represented as a family contrived by the CI Program in order to ensure continued funding from the hospital and government:

As we get bigger it becomes increasingly important that we stay in touch. The summer picnic, family day, Nalli-Ingoglia lectures, skating party and the cut-a-thon become important places to show your support for the program. Your attachment to us begins at implantation but never ends. It is critical that we 'look big' so that the government and the hospital remember our children. I'll see you there and continue to give you updates on the program's (and by extension our family's) growth. (SickKids, 2008)

The CI family functions to the benefit of the CI Program and "our children" refers to potential future CI recipients. There is an ominous tone to this letter as it insinuates that families should forever be in the debt of the CI Program; attachment to the program never ends. Families should therefore show their support and attend their events. The more family members that show allegiance to their CI family, the better the program will seem to be, and the more outside support (funding) will be received. This is especially important considering the lack of empirical data on speech, language, and educational outcomes supporting the policies and practices of the CI Program (Lane Medical Library, 2012). The CI family is a technology used by the CI Program to govern the CI recipients and their families even after the children are grown and no longer serviced by SickKids. This technology serves to establish the CI Program as important and necessary, to ensure continued funding.

Research, Funding and the Capitalist Regime

Dr. Harrison describes that the CI program at SickKids had a research agenda from the start and an allegiance to the Cochlear Corporation, the sole provider of the cochlear implants used at SickKids, based on the research relationship developed between Dr. Harrison and Cochlear's founder, Graeme Clark, well before the program began. Cochlear implants were first developed by Cochlear Corporation in Australia in the 1970s, to allow deafened adults (people who had lost their hearing in adulthood) regain some sensation of the hearing that they had lost, with the expectation that many d/Deaf adults would want to make use of the technology as well. When their cochlear implants were not sold to nearly as many d/Deaf adults as they had hoped (they did not take the views of the Deaf community into consideration), the focus shifted to deaf children in order to increase the number of potential implantees and their revenue source (Blume, 2010; Lane, 1992). The number of cochlear implant procedures continues to increase as simultaneous bilateral cochlear implants become more common and implantation guidelines become more lenient allowing implants in deaf children who still have some residual hearing, or only have unilateral hearing loss (Lane Medical Library, 2012).

Dr. Harrison's presentation reveals that research is the main interest of the CI Program; there is a quest for knowledge of the relationship between a deaf child's auditory system and how the system can be technologically manipulated to more closely approximate normal hearing. The current director of SickKids CI Program stated at a Stanford Medical Conference, "These kids are just the greatest laboratory we've ever had" (Lane Medical Library, 2012), a disturbing example of a framework that is "more suited to laboratory animals than to human children who have a language, a culture, and a cultural history within which any medical intervention takes place and which determine the final value of the intervention" (Lane 1992, p. 211). There is a chasm between what is best for the child as a complete person versus what is best for the CI Program's research agenda, as discrete areas of the auditory system are researched rather than the lived experiences of the children who receive the implants.

Funding issues add another layer of power relations between the government and hospital, as the CI Program must operate within a specified budget. Dr. Harrison speaks of early funding problems, "we had no money to do cochlear implants" and reports that research grants and donations from charitable foundations paid for the first few implants. Dr. Harrison again mentions Gary Malkowski and his political efforts to prevent government funding for cochlear implants. It is made to seem as if there was a long struggle to lobby the government for funding, when in reality governmental funding, although not as generous as it is now, was obtained within the same year as FDA approval for cochlear implants in 1990.

The practices of the CI Program are heavily dependent on and influenced by government funding, so much so that when research results conflict with funding opportunities, the CI Program's own research knowledge is cast aside to take advantage of funding. In March 2011, the Ontario government pledged extra funding to cover 184 additional cochlear implants in children and adults for a period of one year (SickKids, 2011). The SickKids CI Program used this funding to implant second (bilateral) implants into many children who already had one (unilateral) implant, despite research from their laboratory indicating that a second CI implanted years after the first results in asymmetrical auditory development and would not be cost effective. Furthermore, the doctor performing the surgeries would not recommend anything other than simultaneous bilateral implants: "the long sequentials [a second implant implanted with a long delay after the first CI] I wouldn't do except the government sort of gave us money" (Lane Medical Library, 2012). How this can be is perhaps best explained by Foucault's proposition that a regime of truth is "a condition of the formation and development of capitalism" (2003c, p. 317).

Many people benefit financially from the medicalization of deafness, and cochlear implantation has provided a steady stream of income to a number of health care professionals, as well as the implant manufacturers. Cochlear implant researchers obtain government research grants, the CI Program receives government funding and charitable donations, CI manufacturers gain from the sale of their products, surgeons are paid for performing surgeries, audiologists are paid to perform multiple ongoing assessments, speech language pathologists and auditory-verbal therapists are paid for providing many years of therapy, and then there are the subsidiary professionals who also benefit financially from this program (social workers, psychologists, radiologists, teachers, teaching assistants, tutors). Most disconcerting is the continued close relationship between the CI Program and the Cochlear Company. The director of the program is on the speaker's bureau for the Cochlear Americas Corporation and is the inaugural chair in the Cochlear Americas Auditory Development Research ("Ear implant problems rare", 2011; Who we are, n.d.).

Conclusion

The SickKids CI Program is taken-for-granted as providing an essential service funded by the government to enable profoundly deaf infants to learn to listen and speak, attend regular schools, and become productive members of society. It has emerged out of the audist establishment and is the latest in a long line of technologies to make deaf people conform to the hearing norm by denying deaf children an opportunity to learn a visual language. The CI program is supported by capitalism and Western society's reverence of modern medicine and technology as aids to restoring normalcy. The acceptance of the medical view of deafness is reflective of our society's hegemony of normalcy, and ensures that hearing parents of deaf children will accept and even seek out cochlear implants as a technology to help their children gain normalcy through listening and spoken language.

As the CI Program strictly prohibits sign language, there is no consideration that bilingualism (ASL and English) could be of benefit to deaf children with cochlear implants. Research produced by the CI Program focuses exclusively on discrete auditory system processes and does not consider language and educational outcomes or social-emotional development of the children they implant; there is no indication that they think of the deaf child as any more than a "broken ear with a child attached" (Lane, 1992, p. 228). The Deaf community's knowledge-truth along with research that indicates benefits of learning sign language before spoken language, provide a counter discourse and is hence excluded by the CI Program (Cummins, 2006; 2011; Freel et al., 2011). According to Foucault's thought that "The problem is not changing people's consciousnesses…but the political, economic, institutional regime of the production of truth" (Foucault, 2003c, p. 317), any amount of research indicating the benefits of sign language or other outcomes that run counter to the CI Program's knowledge-truth will not change the thinking of those holding decision-making positions within the CI Program.

How is it possible to change the CI Program's regime of truth? The doctors and researchers within the CI Program have been narrow-minded and injudicious in their focus of research, which creates a fissure in their system that may allow for such a change. It is logical that medical doctors would focus on medical research however the CI Program makes claims that go beyond medicine and beyond what can be proven through their research. Statements to the effect of improving the lives of children with CI by increasing their "sociability, education and employability" are unfounded and should be questioned by the government, their major funder. The stakeholders within the CI Program have realized that there is a lack of outcome data, as they are currently trying to obtain speech-language testing scores from school and community speech-language pathologists and auditory verbal therapists who work with their children. This is an attempt to analyze data that they hope will show speech-language benefits and ensure continued funding: "The government and other funding agencies are incredibly interested in speech & language data" (Speech language forms, n.d.). It is apparent that speech-language outcomes are only of interest to secure funding; the actual experiences of the children do not seem of significance to the CI Program. The funding agencies should question whose interests the CI Program actually serves, the Cochlear Corporation and the medical professionals, or the deaf children they profess to help. This could provide a basis for the Deaf community to lobby the government to decrease funding until the program's research, practice and procedures are shown to be beneficial to the actual child, not just the child's auditory system. It could be (and has been) argued that it is negligent of the CI Program to deny ASL for infants with cochlear implants (Snoddon, 2009; "Ear implant decision raises questions", 2011).

The program's director considers a deaf child's communication choice to be between sign language and spoken language (Lane Medical Library, 2012), but this is not reflective of actual practice at the Provincial Schools for the Deaf where bilingual/bicultural education is offered. ASL is used as the language of instruction, and printed and spoken English is taught as a second language. In addition, other CI Programs have different knowledge-truths and do not have such strict anti-sign language policies. In Sweden, deaf children are mandated to learn sign language before a CI will even be considered (Bagga-Gupta, 2004; Hult & Compton, 2012), and there are early childhood programs in the United States that encourage children with CI to learn both sign and spoken language (Nussbaum, LaPorta & Hinger, 2002). A historical analysis of those programs may provide insight into how to affect change within Toronto's CI Program, but more is needed to be done: it is a matter of "detaching the power of truth from the forms of hegemony, social, economic, and cultural, within which it operates at the present time" (Foucault, 2003c, p. 317). Engaging Toronto's (and Canada's) Deaf community and their supporters, including local and national Deaf associations, the Canadian Hearing Society, and the Canadian Cultural Society of the Deaf, to challenge the hegemony of normalcy and mobilize the support of Gallaudet University's large research base, including Laura Petitto's Brain and Language Lab (http://www.gallaudet.edu/petitto.html), the Gallaudet Research Institute (http://www.gallaudet.edu/gallaudet_research_institute.html), as well as the Laurent Clerc National Deaf Education Center (http://www.gallaudet.edu/clerc_center.html) and the Visual Language & Visual Learning website (VL2) (http://vl2.gallaudet.edu), could spur a change in the knowledge production and dissemination regarding cochlear implants and sign language in Toronto. Perhaps then we could witness a shift in power relations and an understanding of d/Deaf people as more than a "broken ear(s)" in need of repair.

References

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Endnotes

  1. Lower case "d"(deaf) is typically used in reference to deafness as an audiological diagnosis, whereas upper case "D" (Deaf) is used in reference to the cultural concept of deafness. I have used lower case "deaf" in reference to children with cochlear implants as their deafness is treated purely as a medical condition, and "Deaf" when referencing members of the Deaf community.
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  2. Paddy Ladd (2003) provides a comprehensive reading on Deaf Culture and introduces "Deafhood" as a new term to represent positive Deaf identity. Carol Padden (1996) describes the Deaf community's shift to biculturalism.
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  3. Audism generally refers to discrimination based on hearing status. Lane (1992) described audism as "the hearing way of dominating, restructuring, and exercising authority over the deaf community" (p. 43).
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  4. Ontario's IHP began in 2000 with the introduction of universal newborn hearing screening. The disciplines within the IHP serve as the first point of contact for parents of infants identified as deaf and hard of hearing during early infancy. It is within the IHP that parents are provided with information regarding hearing technologies and communication options for their infants. The IHP is an integral part of this system of bio-power, but a detailed analysis of the IHP is out of the scope of this paper.
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