Made to Hear is an ethnographic account following hearing families as they explore therapeutic intervention for their deaf children via cochlear implantation (CI). Readers of DSQ are familiar with different cultural approaches to deafness (and disability more broadly), most often characterized as distinct medical and social models, which are frequently set in theoretical opposition. However, Mauldin follows Shakespeare and Watson (2001), Kafer (2013) and others in recognizing that conceiving of the medical and social models as polarized and mutually exclusive obscures a myriad of gains and losses associated with biotechnical interventions and ways people navigate and utilize both ideological orientations. Mauldin's theorization of what she calls ambivalent medicalization (3) draws our attention to how individuals (and families) not only surrender to, but are also empowered by, medicalization. Detailed ethnography within clinics and support groups, and a specific focus on interviews with mothers, reveals nuance in how families exercise agency within these biomedical and biotechnical structures. The book exposes how understandings of deafness and disability are shaped by cultural frameworks in therapeutic environments and how biomedical agendas become more authoritative and "natural" when understood as apolitical and acultural.

CI, the surgical placement of an electronic sound amplification device, is a particularly salient example of biomedicalization, or transformation through technoscientific procedure. A child who "overcomes deafness" through the use of hearing and spoken language (valued in ablest and audist perspectives over deafness and sign language) is the measure of "success" by CI proponents. Central to Mauldin's analysis is the inseparability of pediatric implantation from family life. She highlights the gendered patterns of care involved in therapeutic intervention for deaf children, one that compels mothers to engage in "scientific motherhood" (Apple 1995) to acquire specific scientific and medical expertise and skills through sustained, prescribed regimens. Characterization of the CI as a neuroprosthetic renders the brain as the site of intervention—shifting the focus from sensory difference (hearing status) to a neurological (or processing) issue. CI outcomes are determined by the intensive labor of mothers, who must subscribe—and dedicate themselves—to a therapeutic plan throughout implantation, a process that can span many years. Mauldin makes a case that even as the CI device is held up by its supporters as a technological achievement, its efficacy is ultimately dependent upon dutiful work—transferring responsibility from the technology to the individual, in this case, mothers of deaf children who are expected to "train the brain" (15-17).

Mauldin outlines the process of implantation as a multi-faceted socialization process, not a stand-alone surgical event. Participant observation in clinical settings and parent support groups provide a description of what she terms the "anticipatory structures" of the CI process, essentially a stepwise plan of biomedical enculturation. The process begins with newborn hearing screenings and diagnosis. We then follow Mauldin's participants though the "parent-centered approach" of early intervention, where parents are encultured to a CI-specific brand of ethopolitics, or a "moral economy of hope" (Rose 2006) and are recruited and trained to implement the lion's share of the child's service plan. Because compliance is key to CI success, only those families deemed sufficiently compliant in the initial two stages (identification and early intervention) are transitioned to candidacy for implementation.

Mauldin draws correlation between biases among CI professionals regarding socioeconomic status and cultural background and whose children are seen as "appropriate" candidates for CIs. Examination of the social criteria by which children and families are evaluated for implantation candidacy is perhaps Made to Hear's most important contribution to the literature but also raises some cautionary reminders. Mauldin describes how parental behaviors and resources (or "soft criteria"), pair with "hard criteria" (audiological tests, overall health and physiology) to create a comprehensive profile for review by the CI team. The expectation for families to comply with institutionally-sanctioned standards and practices underscores the CI team's candidacy decisions and Mauldin's analysis. Mauldin makes the argument that middle-class parenting styles often align with institutional goals (Blum 2007; Lareau 2003: Francis 2012) and associates future-driven, high-intervention parenting with white, middle-class families. Families who may feel distanced from CI-related, institutionally-driven goals are often pathologized by CI professionals; as these families are framed as being "in denial," while decisions to implant are portrayed as rational and resistance to implantation as irrational. Underscoring how biases regarding class and cultural background shape CI-specific ideas about candidacy is important because it reveals discrepancies in access to CI-related resources and opportunities.

The author's stated ambivalence toward CI technology (and critique of CI patterns of culture) bears repeating; Mauldin's goal is not to suggest that more children should be implanted. Instead, she reflects on the consequences of "new social worlds" spawned by biotechnological sub-cultures like CI and its potential impact on d/Deaf communities. For instance, she offers, "Adherence to implantation techniques and fulfillment of labor imperatives by mostly white, middle-class families may reproduce social inequalities and leave intact normative narratives of disability and mothering" (p. 165). Finally, Mauldin's examination of how "concerted cultivation" (Lareau 2003) and a high-intervention parenting style align with compliance to institutional goals and standards (including medicalization and the therapeutic model of CI organized therapies) may prove important to scholars as a model that may be generalized to other institutions. However, social scientists need to exercise caution to actively avoid unintentionally perpetuating essentializing and unjust "culture of poverty" tropes suggesting families' values or tastes are deterministic.

For example, I was uneasy to find, in a book studying hearing families with deaf children, reference to Lareau's (2003) suggestion that middle-class families have what was described as a "relationship" with language in which "they enjoy words for their own sake, ascribing an intrinsic pleasure to them…" (Lareau 2003, 107 cited in Mauldin, pg. 105). I hesitate at the potential this reference creates for presumptions about families who are not middle class: does enjoyment of language predict how—or to what extent—families prioritize language (regardless of form or modality) for their deaf children? Language is a critical flashpoint for all hearing families with deaf children, any suggestion otherwise is unsubstantiated and unfair. To be clear, Mauldin does not draw deprecating conclusions, but a clearer and more critical acknowledgement of the precariousness of these claims would be appreciated. After all, our task should be to identify the ideologies that lie at the heart of institutional bias and condemn firmly the ways they pathologize and "blame the poor" (Greenbaum 2015).

Mauldin, a trained sign language interpreter and sociologist, recognizes that any debate over implantation involves the politics of language, pointing out that hearing parents are the primary consumers of CIs, not d/Deaf persons. Fundamental to the CI enculturation Mauldin describes is acknowledgement that a parent's choice to implant is a choice against sign language. Like many hearing parents of deaf children in other contexts, participants are told to avoid sign language so children can "learn to" hear and speak, even though research illustrates ways many deaf children, including implanted children, can learn to speak alongside learning sign language, and that sign language is not an impediment to learning to speak (Gárate 2011; Pfister 2017; Yoshinaga-Itano 2006). Mauldin is careful to remind readers that she does not endeavor to determine whether implantation is "good" or "bad." Instead, she describes how new ways of being and new communities emerge through the use of biotechnical tools like CIs, and that some of the consequences they usher in include the potential to threaten existing communities, particularly sign language centered Deaf communities. Therefore, another important takeaway message from Made to Hear is that the consequences and tensions generating these new ways of being deserve our critical attention.

Works Cited

  • Blum, Linda M. 2007. "Mother-Blame in the Prozac Nation: Raising Kids with Invisible Disabilities." Gender & Society 21(2): 202-226. https://doi.org/10.1177/0891243206298178
  • Francis, Ara. 2012. "Stigma in an Era of Medicalisation and Anxious Parenting: How Proximity and Culpability Shape Middle-Class Parents' Experiences of Disgrace." Sociology of Health & Illness 34(6): 927-942. https://doi.org/10.1111/j.1467-9566.2011.01445.x
  • Gárate, Maribel. 2011. Educating Children with Cochlear Implants in an ASL/English Bilingual Classroom. In Raylene Paludneviciene and Irene W. Leigh (eds.). Cochlear Implants: Evolving Perspectives. Washington, D.C.: Gallaudet University Press.
  • Greenbaum, Susan. 2015. Blaming the Poor: The Long Shadow of the Moynihan Report on Cruel Images about Poverty. New Brunswick: Rutgers University Press. https://doi.org/10.2307/j.ctt15sk7xn
  • Kafer, Alison. 2013. Feminist, Queer, Crip. Bloomington: Indiana University Press.
  • Lareau, Annette. 2003. Unequal Childhoods: Class, Race and Family Life. Berkeley: University of California Press.
  • Pfister, Anne E. 2017. Forbidden Signs: Deafness and Language Socialization in Mexico City. Ethos. 45(1):139-161. https://doi.org/10.1111/etho.12151
  • Shakespeare, Tom and Nicholas Watson. 2001. "The Social Model of Disability: An Outdated Ideology?" Research in Social Science and Disability 2 (June): 9-28. https://doi.org/10.1016/S1479-3547(01)80018-X
  • Yoshinaga-Itano, C. 2006. Early Identification, Communication Modality and the Development of Speech and Spoken Language Skills: Patterns and Considerations. In P.E. Spencer & M. Marschark (Eds.), Advances in the Spoken Language Development of Deaf and Hard of Hearing Children (pp. 298-327). New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195179873.003.0013
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