Michele Ilana Friedner. (2022). Sensory Futures: Deafness and Cochlear Implant Infrastructures in India. Minneapolis - London: ISBN: 9781517912130

Emma Swai

swaie [at] hope [dot] ac [dot] uk

In Sensory Futures, Michele Ilana Friedner provides a nuanced and perceptive insight into the multiple perspectives on cochlear implant infrastructures in India. Friedner’s own experience as a bilateral implantee lends both authority and insight, as she negotiates the complex relationships between politics and medicine, business and society. Cochlear implants are becoming ‘more ubiquitous’ in India; as she looks into the “how” and “why” of the situation, Friedner also observes that, concurrently, ‘sensory, modal and relational possibilities for deaf children and those with whom they engage diminish’ (p. 3).

Prior to reading Sensory Futures, I had no knowledge about either cochlear implants or the Deaf community in India, but Friedner guides her reader through essential information in such a way that you have exactly what you need at the relevant points in her narrative. By interlinking personal stories, case studies, social history and theory, nothing is detached from real-life experience and this adds to the understated power of this book. On many occasions issues are shown and not told, in the sense that the stories of participants in Friedner’s interviews and case study observations raise questions for the reader, without any sense of lecturing or patronisation. In this way, Sensory Futures is accessible enough for students, but will be of particular interest to academics working at the intersection between sensory anthropology and disability studies, on account of the amount of evidence Friedner has collated in this volume.

The book is very much arranged thematically, with each chapter having a broad focus. Within this, Friedner provides a variety of theoretical, historical, observational and anecdotal evidence. She also adds examples from her personal experience, which illustrates the contrast between her American experience and that of those within the Indian infrastructure. The disparate nature of the range of evidence can mean that, at points, the narrative can feel disjointed. However, the personal and relatable case studies, as well as the necessity of the provided background, make the additional effort of linking the threads of argument together rewarding, as to leave out some of these elements would not provide as rounded a depiction as Friedner attempts to provide.

Friedner introduces Sensory Futures with the story of Neera, the first pediatric cochlear implant case in India, now an adult, to underline the human side to the tension of unknown futures. She outlines how cochlear implants are, in India, seen as “the best solution” for deafness, by the medical establishment and, consequently, by the population following their advice. Neera’s story highlights that there are complex relationships at play, which are expanded upon in the following chapters.

Chapter 1 focuses on different aspects of the governmental perspective. The large-scale implementation of cochlear implant technology is shown to be part of a political strategy to promote “local” Indian manufacturing, with bureaucracy attempting to manipulate and control medical success. The government focus on cochlear implant infrastructure illustrates the attitude of those in power on “fixing” the individual, rather than general societal infrastructure. Perhaps the most shocking aspect to chapter 1, though perhaps it should not be given that the situation occurs in most countries, is the relationship between the state and private corporations. There is a specific moment of clarity where Friedner observes how language, the government talking of “beneficiaries” and the corporations talking of “recipients,” conceals the business relationship involved in purchasing cochlear implants. Friedner does not need to spell out that the surgeons ‘hold[ing] on to the idea of cochlear implantation as a gift’ and arguing that it is “not a surgery from which to make money” are fighting a losing battle (p. 43).

Auditory verbal therapy (AVT) is explored in chapter 2, as ‘a specific therapeutic method with great purchase in cochlear implant infrastructures’ (p. 65). However, at Friedner’s time of writing there were only five certified practitioners in India. AVT certification is affected by class, education and linguistic privilege; more practitioners are needed as the number of implants grows, but expertise is guarded by gatekeepers. Friedner provides examples of the use of AVT from different viewpoints, but from the perspective that ‘no single resource is a panacea’ (p. 92). Following on from this, in chapter 3 Friedner examines the burden that India’s cochlear implant infrastructure places, disproportionately, on mothers, transforming “mothering practices” and attempting to retrain them in how to parent their children. Friedner illustrates how mothers are having to become therapists, critiqued by professionals for failing to work hard enough, in not correctly narrating every aspect of daily life, all whilst dealing with multiple age designations for their children (chronological age, deaf age, hearing age, implantation age) and being constantly faced with the guilt of not intervening early enough to help their child “catch up.” Friedner finishes her section on ‘Mother’s Work’ by stating that ‘Rather than looking at such mothers as failures, as many therapists do, [she is] interested in the forms of care, support, facilitation, and engagement they provide and the signals that they apprehend and transduce’ (p. 124). Unfortunately, there is not the time or space within Sensory Futures for this to be explicitly examined, yet there is the undoubted impression that Friedner has much more to say on the positive provisions the mothers she observed provide for their children, outside of the restrictions imposed upon them.

Perhaps one of the most important aspects of the cochlear implant infrastructure that Friedner discusses, in chapter 4, is how the problematic nature of maintenance costs contributes to the tension regarding unknown futures, particularly for those children with implants. In many ways, Friedner’s observations highlight how India’s cochlear implant infrastructure is ‘designed for not by’ those receiving implants (p.129). She discusses how the complex nature of the implants, as well as intellectual property regimes, create something of what patients call “a hostage situation” and how companies prevent patients from deciding when or how to upgrade their own devices. At one point, Friedner comments how Deaf organisations in India are against cochlear implants, but also gives an example where a rights-based organisation campaigns for a particular child to receive one; it would have been useful to learn a little bit more about the dynamic between Deaf organisations and the cochlear implant infrastructure, though there is a clear sense in Friedner’s narrative that the two are largely separate.

In chapter 5, Friedner argues, supported by a substantial reference to theory, there should be serious concern for the narrowing or contraction of social possibility caused by the cochlear implant infrastructure in India. Highlighting, again, that the pursuit of “normal” aims for a state which is not fixed or stable, she exemplifies what a reconceptualization normal could be like, drawing together the various threads of perspectives presented throughout Sensory Futures, from paternalistic government ministers, with whom Friedner obviously disagrees, to those who see ISL not as the failure it is portrayed to be, but a viable option, should it be given the same investment as the government’s “flagship” surgical policy. In conclusion, Friedner makes a ‘call for deaf futurism…that is not teleological and open to multiple permutations of becoming’ (p. 194).

Although Friedner writes with an understated and non-judgemental tone, she obviously, and vehemently, disagrees with the aims of the cochlear implant infrastructures in India to eradicate deafness. Perhaps at points this disagreement could be more explicitly stated, but then this might lessen the impact of the personal stories recounted by Friedner – these scenarios are always allowed to communicate for themselves. A powerful example of this is where Friedner outlines the performative nature of “disability camps,” politically performative spaces set up in honour of a dignitary’s birthday, where disabled people are forced to wait, tired and hungry, expected to be grateful for a “one size fits all” piece of equipment that does not meet their needs. Friedner needs to do no more that curate the facts of real-life occurrences, something she does in Sensory Futures very effectively.

Sensory Futures is an important study in displaying concern for state intervention in bodies and in how those in power shape attitudes towards those bodies. Friedner takes her concern further, by showing how the effects of a government focus on a surgical solution for disability affects the lives of everyday people, in some instances trapping them within systems they cannot succeed in or escape from. ‘Despite the aspirations [of the state infrastructure]…there is a limit on how many surgeries can be done and in how many bodies the state can materialize itself’ (p.40), meaning that there is space and time for other ways of becoming and being to be promoted, with the appropriate investment.