The cochlear implant does not allow you to hear, but rather allows you to do something that resembles hearing. It gives you a process that is (sometimes) rich in information and (usually) devoid of music. Implanted early, it can provide a basis for the development of oral language. It makes the hearing world easier. Is it sound? One might as well ask whether a tree falling in an empty forest makes a noise. Some 219,000 people worldwide, at least 50,000 of them children, had received implants as of the end of 2010. Up to 40 percent of American children diagnosed under three receive an implant, up from 25 percent just five years ago. Some 85 percent of the children who receive them are born to white families with higher-than-average income and education levels. After the device has been surgically implanted, an audiologist works on mapping it, making a series of adjustments to ensure that it is tuned to the brain of the recipient.

The chief executive of the Cochlear corporation, the leading manufacturer of implants, told BusinessWeek BusinessWeek in 2005 that usage represented only 10 percent of the potential market. The implant is sold in more than seventy countries. Some implant opponents complain of the limitations and dangers of the implant itself; according to the FDA, one child in four who receives it experiences adverse reactions and complications, most of which resolve on their own; some require further surgery. Some people have suffered disfiguring facial paralysis, and the implant interferes with diagnostic tests such as magnetic resonance imaging. A wire coming out of your neck can make you look like an extra from in 2005 that usage represented only 10 percent of the potential market. The implant is sold in more than seventy countries. Some implant opponents complain of the limitations and dangers of the implant itself; according to the FDA, one child in four who receives it experiences adverse reactions and complications, most of which resolve on their own; some require further surgery. Some people have suffered disfiguring facial paralysis, and the implant interferes with diagnostic tests such as magnetic resonance imaging. A wire coming out of your neck can make you look like an extra from Star Trek, Star Trek, though it is possible to grow hair so the wire is generally hidden. Much though it is possible to grow hair so the wire is generally hidden. Much of the cant about the danger of implants is alarmist; some propaganda about their transformative power is embellished. of the cant about the danger of implants is alarmist; some propaganda about their transformative power is embellished.

A late-deafened adult who "regained" his hearing with an implant quipped that they make everyone sound like R2-D2 with severe laryngitis. Their approximation of sound often allows people who are already functional in spoken language to make sense of much of what they hear; however, people who have always been deaf and who receive the implants as adults often find them ineffective or just irritating. Unaccustomed to interpreting auditory information, the latter group might find it difficult to do so even if they were given perfect hearing; the brain develops around input, and a brain that has gone through development without sound is not organized to process it. But the extent of any individual's brain plasticity is hard to predict. In a recent interview, a deaf woman who had received what she called "the bionic ear" in early adulthood described having vertigo at first, and then feeling as though golf balls were bouncing around in her head. "I felt like it was a huge mistake for about five hours," she said. The next morning, she went out for a walk. "I stepped on a twig and it cracked. Leaves rustled. It blew me away."

Deafness, which often used to go undetected until age three, is now regularly diagnosed within hours of birth, and almost always before three months. Screenings of newborns are now supported by the federal government. The NAD originally championed these screenings on grounds that deaf infants could get exposure to Sign as early as possible; now those infants often get cochlear implants instead. "That's hugely painful," said the activist Patrick Boudreault, who opposes the implants. "Genetic counselors and implant specialists are the first responders-not Deaf people." Though the device is approved only for children over the age of two, children under a year old have been implanted. Hearing children learn phonemes throughout the first year of life, and their neural plasticity begins to decrease even at a year. A recent Australian study showed improved results for people implanted at seven or eight months, though the advantages to implanting before age one may not be worth the risks associated with anesthesia in babies. In another study, almost half of children implanted at two developed spoken language equivalent to that of hearing children their age; among those implanted at four, only 16 percent did so. For children who become deaf later-from measles, meningitis, or a developmental genetic condition-efficacy is linked to how soon the devices are implanted. Without sound, the neural architecture of the auditory cortex is permanently compromised.

These statistics are muddied, however, by their newness. Will someone implanted at seven months have a linguistic advantage when he's twelve years old? No one has seen how these early cases turn out across the life span because they haven't been done for long enough. Further, the devices being implanted now are different from the ones used even a decade ago. This means that all decisions about how early to implant children are based on speculation rather than experience. implanted at seven months have a linguistic advantage when he's twelve years old? No one has seen how these early cases turn out across the life span because they haven't been done for long enough. Further, the devices being implanted now are different from the ones used even a decade ago. This means that all decisions about how early to implant children are based on speculation rather than experience.

One unintended consequence of the rise in cochlear implants is that they can make the parents of deaf children careless about language acquisition-which the FDA unfortunately failed to establish as one of the criteria for implant success in pediatric populations. Almost all children who have the implants show useful perception of sound, but with older implants, the sound was often too garbled to interpret as language. That problem is reduced but not eliminated with the newer implants. One study showed that almost half of implanted children had greater than 70 percent open speech discrimination (comprehending sound without visual clues); two-thirds had greater than 50 percent; and nine out of ten had greater than 40 percent. In a Gallaudet survey, nearly half of parents of implanted children believed their children "could hear and understand most words," while only one in five said their children could "hear and understand few words."

Nonetheless, a review of the broad literature on this topic concluded that the implant provides only coarse and degraded versions of sound, and therefore children with the implant receive fewer fine distinctions of spoken language than their hearing peers. This means that some implanted children, not exposed to Sign because they are expected to develop speech, may fall into that frightening category of the needlessly impaired who have meager primary language. Cochlear Ltd. has shown that implanted children learn "more and better" oral language, but "more and better" is a little vague if this is to be your sole mode of communication. Parents too often want to believe that the implants make their children hearing and do not secure any special deaf education for them. "You should bring up these children bilingually until it becomes clear that the child can develop satisfactory oral language," Robert Ruben, former chairman of the Unified Department of Otolaryngology at Montefiore Medical Center, advised. "Language of any kind, no matter what kind, must somehow be got into the head of the child soon enough."

The implant destroys all residual hearing. Although accurate hearing tests can be performed on very young children, it is not possible to determine how well those children might be able to use their residual hearing. Anyone with a hearing loss over 90 decibels is classified as profoundly deaf, yet I have met profoundly deaf people who were able to make such good use of their residual hearing that I could talk to them almost as I would to a hearing person. Hearing loss is measured as an average of loss in various registers; most sounds operate at many frequencies, so someone with a 100 decibel hearing loss could still be able to perceive high-frequency sounds. Even Tom Waits and James Earl Jones produce some high-frequency sound waves when they speak. Further, detection of sound and discrimination of sound are two separate abilities. Some people are able to use intuitive abilities, high-frequency functions, and other natural gifts to discriminate sound well beyond their ability to detect it. able to make such good use of their residual hearing that I could talk to them almost as I would to a hearing person. Hearing loss is measured as an average of loss in various registers; most sounds operate at many frequencies, so someone with a 100 decibel hearing loss could still be able to perceive high-frequency sounds. Even Tom Waits and James Earl Jones produce some high-frequency sound waves when they speak. Further, detection of sound and discrimination of sound are two separate abilities. Some people are able to use intuitive abilities, high-frequency functions, and other natural gifts to discriminate sound well beyond their ability to detect it.

The NAD's original response to the implants condemned "invasive surgery on defenseless children, when the long-term physical, emotional, and social effects on children from this irreversible procedure-which will alter the lives of these children-have not been scientifically established." As the devices evolved and came into wider use, the NAD moderated its position somewhat, saying, "The surgery decision represents the beginning of a process that involves a long-term, and likely life-long commitment to auditory training, rehabilitation, acquisition of spoken and visual language skills, follow-up, and possibly additional surgeries," and, "Cochlear implantation is not a cure for deafness."

If you are not in a village in northern Bali where everyone knows Sign, and you opt against the implants for your child, you will find yourself trying to learn a new language at the same time your child is learning it, and children can learn language better than adults can. To choose Sign for your deaf child is, in some significant ways, to surrender him or her to Deaf culture. It is not so easy to give up your own children, and it does not always work out so well for parent or child. Christina Palmer said, "It's the Deaf ethnicity hypothesis. If you come from a hearing family, you don't get the cultural aspect unless you somehow connect with other Deaf people and learn about a Deaf community." Whereas oral communication places strain upon the deaf member of the family, the decision to sign shifts the power base, placing the greater strain of understanding upon the hearing members. In effect, parents can learn Sign and always speak awkwardly to their child, or they can push their child toward oralism and know that he will always speak awkwardly to them. It is a familiar adage of parenthood that the parent should sacrifice for the child rather than the other way around, but to anoint Sign as the righteous choice is to prioritize a specific vision of how the margins understand the mainstream and vice versa.

Nancy and Dan Hessey have fallen passionately on both sides of this debate since their daughter Emma became deaf, and their quest has been as much spiritual as medical. They had both converted to Buddhism in adulthood and met at a Buddhist center in Boulder, Colorado. Nancy had a hysterectomy a few years later and became terribly depressed. When a colleague announced that she and her husband had decided to adopt a baby from Asia, Nancy became determined to do the same thing. Dan was determined that they should not, he laughingly recalled, "because it might get out of control, come to dominate your life"-but Nancy ultimately prevailed. as much spiritual as medical. They had both converted to Buddhism in adulthood and met at a Buddhist center in Boulder, Colorado. Nancy had a hysterectomy a few years later and became terribly depressed. When a colleague announced that she and her husband had decided to adopt a baby from Asia, Nancy became determined to do the same thing. Dan was determined that they should not, he laughingly recalled, "because it might get out of control, come to dominate your life"-but Nancy ultimately prevailed.

On June 29, 1998, Dan and Nancy arrived in Hanoi and headed almost immediately for the orphanage. "It couldn't have been more alienating," Dan said. "Third-world brutalist architecture, big picture of Ho Chi Minh." The deputy head of the orphanage explained that the baby they were to receive had had pneumonia, had lost a quarter of her weight, and had to stay at the orphanage until she finished her course of antibiotics. Nancy asked to meet her. "They put her in my arms, and she looked right in my eyes and smiled," Nancy said. But the smiling baby looked incredibly drawn, and the daughter of the head of the orphanage suddenly said, "I think you should take her to the International Hospital right now."

At the International Hospital, somebody took a chest X-ray, said that the baby's pneumonia was clearing up, and provided a prescription for cephalosporin. When the baby's face flushed, Nancy realized she was having an allergic reaction; soon she was throwing up blood and had bloody diarrhea. For the next ten days, Dan and Nancy lived in the hospital; eventually, they moved back to the hotel. US adoptions of Vietnamese babies had to be processed through Bangkok, so Dan went to Thailand. Nancy took the baby to the hospital daily for nebulizing. Sitting in the waiting room, Nancy saw a card from an Israeli doctor, which said that his clinic serviced the US embassy. Nancy brought him all the medical records, and he did blood work and explained that the baby had both cytomegalovirus and HIV; he assured Nancy that people would take care of the baby until she died, and that they would get another kid they'd be happy with.

Dan was furious. "What were we going to do, throw her back like a fish that wasn't worth the trouble to clean and eat?" he said to me. But American law prohibited the immigration of HIV-positive children. Fortuitously, the Hesseys had once taken in a member of the local Buddhist community who was dying of AIDS, so Dan knew people at the Boulder County AIDS Project who could help them. Meanwhile, Nancy waited and waited for the Vietnamese government to approve the adoption. After two fraught months, both sides came through, and the family all flew home together.

The baby, whom they had named Emma, was admitted on arrival in the United States for a clinical evaluation at Children's Hospital Colorado in Denver. Four days later, a doctor called with news: Emma was not HIV-positive. "The ripples of joy spread everywhere," Nancy said. Two weeks later, Emma couldn't hear anything except a loud bang. She had most likely been exposed to cytomegalovirus in utero, which had caused her hearing to degenerate until it was almost entirely gone.

A deaf member of the Hesseys' community told them how much better life was for deaf children of deaf parents. Nancy and Dan decided to be like those deaf parents. Dan had read the Deaf invectives against cochlear implants, and he and Nancy decided "to respect Emma for who she was rather than to fix her." But there were no deaf schools in Boulder. Their audiologist told them that they should move to Boston, San Francisco, or Austin, where deaf education was strong. So when Emma was fourteen months old, they relocated to Austin and enrolled Emma in early-learning programs at the Texas School for the Deaf. Emma had started walking, but she stopped; her motor focus was entirely on signing. Dan and Nancy began lessons in ASL, but neither showed much of a gift for it. Dan said, "You'd hear these stories like 'This deaf person's parents never learned to sign, how could they have ever done that?' I couldn't learn to sign to save my goddamn life." Nancy said, "But then we visited the public school oral program, and we met kids who were not allowed to sign, and it was horrific. It was very clear to both of us that it was definitely child abuse to try to make a deaf kid oral."

In Texas, Emma developed severe asthma, and the family found themselves in the emergency room weekly. Dan and Nancy had trouble finding work, and the marriage fell apart. Dan said, "Nancy's attention was completely on Emma's survival, which was a genuine issue at that point. But I no longer felt like she could collaborate with me. I had been demoted to being a helper in the background." When Dan announced that he had to return to Colorado, Nancy refused to go with him-but neither did she want to live and die in Texas. She had checked out the Learning Center for the Deaf in Framingham, Massachusetts, and hit it off with the head of the school, who offered her a job. Dan, who didn't want to be half the country away from his daughter, moved to nearby Vermont.

Nancy started working full-time at the school and wanted Dan to take Emma on a schedule; Dan was resentful and also scared of looking after Emma alone. "Compassion is the ability to care unconditionally for another person, not based on fulfilling your expectations," Dan said. "I was good on the theory, and then the bar got raised way high and it was very humbling." Meanwhile, neither of them was good at Sign. "I was failing miserably at ASL, and it was my job, too," Nancy said. She began talking to Dan about cochlear implants. They had both been hailed as heroes by their Deaf friends for moving around the country to ensure their child an optimal Sign education, and now they were getting ready, as they saw it, to betray Deaf values. Sign. "I was failing miserably at ASL, and it was my job, too," Nancy said. She began talking to Dan about cochlear implants. They had both been hailed as heroes by their Deaf friends for moving around the country to ensure their child an optimal Sign education, and now they were getting ready, as they saw it, to betray Deaf values.

When Emma was four, she had one ear implanted in a seven-hour procedure. Nancy took her to postsurgical follow-up and was told that the wound was severely infected and that her daughter might die; Emma was put on IV antibiotics. Her asthma had been linked to allergies to dairy, soy, wheat, and several other foods, and she had been managing well on a restricted diet and inhaled steroids. After the surgery, she became asthmatic again and nothing seemed to help. Nancy quit her job. Though they were divorcing, Dan and Nancy both decided to move back to Boulder. "It's kind of a circle," Nancy said. "She came to Boulder with hearing; she left when she was deaf; she came back when she was starting to hear again."

Meanwhile, Emma was caught between two cultures and two languages-exactly where her parents had hoped she would never be. She went to cochlear implant camp four days a week that summer for audiological training. At Dan's insistence and despite Nancy's bad memories of the first implant surgery, Emma was implanted in her other ear. This time, it all went smoothly. By the time I met Emma, she was nine. Her grammar and usage were not quite at age level, but she was speaking fluidly and unself-consciously. Nancy said, "She's done better than any of the professionals we've worked with have ever seen. They think it's because she was fluent in a language, ASL, before this." With the second implant, Emma shot up from a 25 percent success rate on open-sound recognition to 75 percent.

Dan and Nancy had sworn to keep Emma in a bicultural environment, but that became increasingly difficult. They noticed that when she could sign or speak, she always spoke. Gradually, when Emma was seven or so, they allowed her signing to stop, and they settled into a largely amicable coparenting arrangement. Emma said to me, "We had a hard trip to go home, but we made it because we're all strong and gentle."

Dan said, "When you have a disabled child, you say either, 'I've got this new asset in my life who is going to make me happy and proud,' or, 'I'm enslaved by my child who is going to be full of needs until I get so old and exhausted that I fall over dead.' The truth about this situation always involves both. Buddhism is about nothing else than these dualities. But did that make it easy? No. I had to relearn my Buddhist practice from the point of view of playing for real. I lost my hobby."

Most medical insurance will now cover the implant, the surgery, and the recommended audiological training. The cost can run well over $60,000, but the surgery is still an economically good choice for insurers. Industry-funded studies at Johns Hopkins and the University of California at San Diego have shown that implantation saves an average of $53,000 per child over the cost of other accommodations to deafness. But the calculus here is complex. Many people who have trouble adjusting to implants run up bills; deaf people who develop good Sign early are not as expensive as those who need accommodations for traumatic childhoods. For most hearing parents, the choice seems straightforward. One mother said, "If your child needs glasses, you get glasses. If your child needs a leg, you get a prosthetic. It's the same thing." Another said, "If, at twenty, Dorothy Jane wants to turn off her voice, that's fine. I want her to have a choice." Those with the implants who are reclassed as hearing do not receive the accommodations they would get as disabled people. The problem is that those who do not get implants may be seen as having "chosen" their condition in the face of a "cure," at which point they do not "deserve" the "charity" of taxpayers. The existence of the implants may, therefore, take disability status from other deaf people.

Rory Osbrink was born hearing, an eager and athletic child. One December Friday in 1981, soon after his third birthday, Rory came down with what appeared to be the flu. His parents, Bob and Mary, packed him off to bed, gave him liquids, and kept a close eye on him. He was no better by Saturday, and on Sunday, he suddenly seemed to be much worse, so they brought him to the emergency room. Bob and Mary sat waiting while the doctors ran some tests; eventually, one came out and announced, "We think he'll make it." Stunned, Bob replied, "He's got the flu, right?" They said, "He has rapidly advancing meningitis, and he's gone into a coma." Rory was in an oxygen tent for the next five days; he was in and out of the hospital for forty days. "He was getting repeated spinal taps, and they couldn't give him anesthetic because it would mask the white cell count," Bob recalled. "I was the only one that could hold him while he's screaming through those spinal taps. I still go into shock if I hear a three-year-old cry."

Bob Osbrink was a professional musician, and it had long been his habit to play his guitar and sing to Rory in the evenings. In the hospital, Rory stopped responding to Bob's singing. In an effort to control the Osbrinks' trauma, everyone at the hospital said that Rory's hearing would come back, though the medical staff knew his deafness was permanent. "False hope is brutal," Bob said. They brought Rory home in time for New Year's, and when fireworks went off, they ran up to comfort him, but he slept right through them. When he was well enough to stand, he fell, because meningitis often affects the inner ear as well as the cochlea; he had no sense of balance. "False hope is brutal," Bob said. They brought Rory home in time for New Year's, and when fireworks went off, they ran up to comfort him, but he slept right through them. When he was well enough to stand, he fell, because meningitis often affects the inner ear as well as the cochlea; he had no sense of balance.

Bob Osbrink has been haunted by guilt ever since. "What if I had gotten him in sooner?" he asked. "The experts told me, 'We probably would have diagnosed the flu and said he didn't belong in the hospital.'" Bob and Mary had very different reactions to the experience. Bob became almost manically active, trying to keep Rory engaged, while Mary became quietly protective of her son. "One time she said, 'Does this not bother you at all?'" Bob remembered. "I got mad and I said, 'Of course it bothers me. It's tearing me apart inside. You sit and cry. I can't just sit and not do something.'" Bob gave up music; he didn't even listen to the radio for a year.

Neither Bob nor Mary knew what to do with a deaf child. "He wasn't a real verbal little guy in the first place," Bob said. "His older brother spoke very articulately, specifically, eloquently. He had good speech before he was three. Rory was not as advanced." Bob's parents had an acquaintance who knew Dr. Howard House, founder of the House Ear Institute, and Dr. House told Bob about a brand-new technology, the cochlear implant, which had not yet been approved for children. "We met deaf adults who had had an implant and saw that they could hear sounds. We reviewed studies on the one little girl who had been implanted and saw her reacting to her parents' voices. Rory had already been through so much hospital time. Were we going to put him through more?" Bob was aware that the FDA had not approved the device for children because of concerns about how a developing brain would respond to a foreign object inserted in it. The device was still single-channel, and none of the adults who'd received it had become fully verbal. Then Rory walked into the street and was nearly hit by a fire truck that was speeding past with sirens blaring. At four, Rory became the second child ever to receive an implant. "We thought awareness of sound would improve Rory's safety and would help his lipreading. It was a very emotional day when Rory sat in the testing booth and reacted to a sound." But the sound Rory got was extremely primitive and ultimately not very useful.

His inner-ear damage meant he was still unsteady on his feet. Bob wanted to recapture Rory's athletic promise, a long-term negotiation. Rory was enrolled at mainstream schools and played on the school teams. Bob coached Rory's Little League team and gave him extra practice mornings and afternoons. By the time he was eight, Rory was a star player, had begun to sign, and had joined a deaf team. Bob coached that team as well. Rory would read his lips and then interpret to the players. "You can have an international soccer team where everybody on the field is speaking a different language and yet they will play the game the same," Bob said. "The game itself allows you to connect. It has its own language. It meant he was 'that great ballplayer,' not 'that deaf guy.'" Bob shares music with his older son; sports was his bond with Rory. player, had begun to sign, and had joined a deaf team. Bob coached that team as well. Rory would read his lips and then interpret to the players. "You can have an international soccer team where everybody on the field is speaking a different language and yet they will play the game the same," Bob said. "The game itself allows you to connect. It has its own language. It meant he was 'that great ballplayer,' not 'that deaf guy.'" Bob shares music with his older son; sports was his bond with Rory.

Bob was interested in Sign, but he didn't study it, and Rory asked him to continue to speak to him; he even asked him to keep his mustache. "You talk to me more than anybody, Dad, with the coaching. If I can lip-read you, that keeps me sharp." But later, Bob realized that this was all part of the frequent deaf habit of seeming to get more than you do. "I didn't realize until later how much he was missing all the time," Bob said. "I knew how smart he was and he was not making it in algebra. I said, 'Let me sit in the class.' The teacher was writing formulas on the board and speaking with his back to the room."

In junior high, Rory began working seriously on ASL, and in high school he learned about Deaf identity. He got a baseball scholarship to the University of Arizona and went to meet the coach. "I called him on the phone over and over again, telling him about Rory's situation," Bob said. "'Rory's a great lip-reader. You just need to look him straight in the eye.' So the coach comes in and he's looking down, and Rory says, 'Coach, if you look up, I can really read lips well. Speak a little slower and I'm going to get it.' The coach pulls out a pad, drops it on his desk, and starts writing out notes-with an attitude. Rory wadded up the paper, said, 'I can't play for you,' drove out that night, and went to Gallaudet."

Rory never really came back to the hearing world. At Gallaudet, he majored in Deaf studies and philosophy, was the resident assistant in his dorm, and played on the baseball team. When Rory graduated, the Dodgers offered him a tryout. He got in touch with Curtis Pride, who played pro baseball and is hard of hearing, and who said that no one in the pro sports world was going to help "the deaf guy." Rory turned down the Dodgers' offer and got a master's in education instead. "It all goes back to that experience in Arizona," Bob said. "Every now and then, we'll go to a ball game and watch a guy playing. He'll go, 'Hey, Dad, I was as good as that guy, huh?' And I'll go, 'Yeah, you sure were.'"

Rory later married a woman who was fifth-generation deaf. He turned off his implant and has never used it again; he said that with it he felt like "a duck in a world of chickens." The Deaf world became his home. Rory now teaches deaf children in the fifth and sixth grades. He gave up baseball, but he coaches a Deaf team that has made it to championship level, and he's become a fanatic bicyclist. He has rewritten the course curriculum for California deaf education. "He's told me that he remembers a little bit about sound," Bob said. "But it's not a real vivid memory." Rory has militated against parents implanting their young children. "As for pediatric cochlear implant, it should not be tolerated since it ignores the child's right to choice," he wrote. gave up baseball, but he coaches a Deaf team that has made it to championship level, and he's become a fanatic bicyclist. He has rewritten the course curriculum for California deaf education. "He's told me that he remembers a little bit about sound," Bob said. "But it's not a real vivid memory." Rory has militated against parents implanting their young children. "As for pediatric cochlear implant, it should not be tolerated since it ignores the child's right to choice," he wrote.

Bob said of his own decision, "I did what I thought was right. It was not some big philosophical discussion between Deaf and hearing, because I had no clue about that." Rory understands why his parents made their decision, and Bob understands why his son reversed it. "I realize that when he was in an oral environment, he was getting about ninety percent," Bob said. "That sounds like a lot, but if you really care about people-and he's a very empathetic guy-then you want to get everything. I totally accept and respect who he is and what he wants. I used to tell people I've got one son who is deaf, and I've got three who won't listen to me. Selfishly, I'd love for him to be able to sing and play the guitar with me, and he'd like for me to be fluent in signing."

I wondered whether the child must always win in these debates, whether there is some writ in which a parent's job is rising to the occasion, while a child's job is simply being. Bob Osbrink seemed both prouder and more melancholic than many other people I had interviewed. Rory was deafened at three, and three years is a long time in a parent's life and in a child's. I wondered whether Bob's wistfulness perhaps stemmed from having lost a deep connection with his son not once but twice: first music, and then sports. "The things that hurt me are things I missed, like my not knowing when he acted like he got it when he wasn't getting it," Bob said. "Laughing when everybody laughed but not knowing what the joke was. I'm sad that he had to go through everything he's had to go through. A part of me will always be sad. But I don't think he's sad, and I'm certainly not sad about who he is."

The bioethicist Teresa Blankmeyer Burke said, "It is rare that one grieves for something that one has not lost. Consider gender as an analogy. A woman might wonder what it would be like to be a man, or vice versa; yet, this curiosity is not likely to be expressed in terms of loss." Paula Garfield, artistic director of the London-based Deafinitely Theatre company, and her partner, Tomato Lichy, were thrilled when they found out their daughter was deaf because it gave her "a passport to inclusion in a rich and varied culture." The general culture feels that deaf children are primarily children who lack lack something: they something: they lack lack hearing. The Deaf culture feels that they hearing. The Deaf culture feels that they have have something: they something: they have have membership membership in a beautiful culture. Hearing parents are thrown back on their own dichotomy: do they have a deaf child, or do they lack a hearing one? in a beautiful culture. Hearing parents are thrown back on their own dichotomy: do they have a deaf child, or do they lack a hearing one?

Like Bob Osbrink, Felix Feldman thought that the ability to function in the oral world was valuable-that acculturation was the natural and only goal. When he had a daughter who was deaf, there was no such thing as an implant; when he had grandchildren who were deaf, the implant was advanced and the kids were not interested. Felix has an old-style Jewishness that habitually seeks the cloud accompanying any silver lining. In his view, and despite his love for his progeny, little recommends the experience of having two deaf children, and the arrival of three deaf grandchildren has been no further blessing.

Felix and Rachel Feldman's younger daughter, Esther, was born with cerebral palsy; with a hearing aid, her sound discrimination was sufficient for language development. Just as the family was struggling with her diagnosis, the pediatrician told them that their older daughter, Miriam, was deaf. It was 1961, and Felix and Rachel opted for an oral education for Miriam, same as Esther. The orthodoxy was still that children learning orally should have no exposure to Sign, so it was forbidden in their house. "We would break Miriam's arms if she signed," Felix said. Felix and Rachel went to class themselves to learn how to reinforce the oral lessons at home. Having heard of a good speech therapist in Santa Monica, they moved there. Their lives were focused around deafness. "We had contact with deaf people, but all speaking people," Felix said.

Though Esther now functions relatively well for a person with CP, the path was long and difficult. Miriam, though much more deaf, was a model child. She had speech therapy every day at school, and private tutoring three days a week. Her passion was competitive figure skating. The coach was allowed to give her three signs: one to say when the music started; one at the halfway point to tell her to speed up or slow down; and one at the end to tell her the music was finished. "Competing to music without hearing one note," her father said. "At school, she was always at the top of the class. With all the hearing children. Completely from lipreading the teacher. She never saw herself as handicapped." When Miriam was fifteen, she competed in the 1975 World Winter Games for the Deaf in Lake Placid, New York, and was immersed for the first time in a context where the primary language was Sign. "She picked it up very fast," Felix recalled. "There was nothing we could do."

Miriam said to me, "It was hard, learning Sign. It took many years because I came to it so late, and with so many anxieties, my mom and dad always saying, 'Don't sign, don't sign.' At the Deaf Olympics, everyone else was signing, and I didn't know how. It was humiliating." Felix felt betrayed by Miriam's signing, though he admits that her verbal skills have remained strong. Miriam started and runs the Jewish Deaf Community Center in her California town; she issues publications, organizes social events around Jewish holidays, and is a leader within her community. She conducts about 80 percent of her communication in Sign and about 20 percent in speech. "But dad always saying, 'Don't sign, don't sign.' At the Deaf Olympics, everyone else was signing, and I didn't know how. It was humiliating." Felix felt betrayed by Miriam's signing, though he admits that her verbal skills have remained strong. Miriam started and runs the Jewish Deaf Community Center in her California town; she issues publications, organizes social events around Jewish holidays, and is a leader within her community. She conducts about 80 percent of her communication in Sign and about 20 percent in speech. "But all all my language would be better if I'd been allowed to sign as a child," she said. my language would be better if I'd been allowed to sign as a child," she said.

When cochlear implants became viable, Felix tried to get Miriam, then in her twenties, to have one, but she was enamored of the Deaf culture and the idea was repugnant to her. "We discussed, we fought, we screamed," Felix said. "I lost. We know younger and older people who have had it. They hear you, they use the telephone. They listen to the news, they watch TV. Why wouldn't you have it? Unfortunately, she and her ex-husband feel that it's genocide."

All three of Miriam's children-ages seventeen, fifteen, and thirteen when we met-are deaf. Felix pushed for them to receive oral coaching, but it is hard for parents who cannot hear to support oral instruction in the intensive way it requires. "Miriam took the line of least resistance," Felix said. "If they didn't sign, they would speak. It's heartbreaking." Though Felix can communicate easily with Miriam, he is unable to have a conversation with his grandchildren. Miriam's eldest is now enrolled at the world's only Orthodox Deaf yeshiva and is learning Hebrew and Yiddish. Miriam said, "I had to follow people's lips all day long. I didn't want my kids to go through that. My kids are happy, they know how to spell, and they were signing at eight months old. They were able to tell me how they felt, and what they wanted." I wondered whether they had hearing friends at school. "When my daughter started school, there were no other deaf children in her year. What did she do? She taught the hearing kids to sign, and some of them are still her best friends."

Felix was desperate for the grandkids to have implants. Miriam said, "Any time we get together with the family, that's all we talk about." Felix had offered his grandchildren a million dollars each to have the procedure; he said to me, "I should do it the other way. If they don't have the implants, I will take a million dollars each and give it away." He made a show of lowering his voice and whispered extremely loudly, "The truth is, she doesn't want me to be happy." Miriam turned to me. "I didn't hope for deaf children," she said. "I didn't expect them. Now that I have deaf kids, I am very happy because they are a part of the world that I'm in and they understand where I'm coming from. If I had hearing kids, however, my family would like me more." Then they both started to laugh. Felix said, "Well, that's our story. I think your book should be called hearing kids, however, my family would like me more." Then they both started to laugh. Felix said, "Well, that's our story. I think your book should be called Father Knows Best Father Knows Best."

It will be some time before implanted people can savor the nuance of a Verdi opera or discern the voice of a single turtledove in a forest full of crows, but implant developers are closing in on enabling the perception of sufficient auditory information for the consistent development of verbal fluency. The objections left standing are conceptual. As Felix Feldman bitterly noted, many Deaf activists contend that cochlear implants are part of a genocidal attempt to destroy and eliminate the Deaf community. Some have compared pediatric implantation to intrusive surgeries such as those used to "correct" intersex conditions, which many intersex adults have protested. The British Deaf activist Paddy Ladd refers to implants as "the Final Solution," and Patrick Boudreault speaks of a cultural and linguistic extermination campaign. Northeastern's Harlan Lane wrote, "Could you imagine if somebody stood up and said, 'In a few years, we're going to be able to eliminate black culture'?" He sees the implant as representing just such an assault. "If hearing people saw the Deaf community as an ethnic group with its own language, as opposed to someone who is handicapped, then you wouldn't have such a deep misunderstanding." Is the underlying hearing person being liberated by the implant, or is the authentic Deaf person being obliterated? Hearing specialists and medical clinics have, unfortunately, tended to give little support to campaigns to ensure that parents meet deaf people before implanting their deaf children. Many physicians do not provide parents with Deaf community contacts, and few parents seek out the contacts that are provided to them. Only Sweden has a law that requires such parents to meet with representatives of the Deaf community and learn about their lives before making this major medical decision for their child.

The question, really, is how we define the relationship between parents and children. A hundred years ago, children were effectively property, and you could do almost anything to them short of killing them. Now, children are empowered. But parents still decide what their children should wear, what they should eat, when they should sleep, and so on. Are decisions about bodily integrity also properly the province of parents? Some opponents of implants have proposed that people make their own choice when they turn eighteen. Even putting aside the neural issues that make this impractical, it is a flawed proposition. At eighteen, you are choosing not simply between being deaf and being hearing, but between the culture you have known and the life you have not. By then, your experience of the world has been defined by being deaf, and to give it up is to reject whom you have become. the life you have not. By then, your experience of the world has been defined by being deaf, and to give it up is to reject whom you have become.

Children with implants have experienced social difficulties; if the objective of the implants is to make the children feel good about themselves, the results are mixed. Some become what William Evans of the University of California has called "culturally homeless," neither hearing nor Deaf. The population at large does not like threats to binaries; binaries drive homophobia and racism and xenophobia, the constant impulse to define an us us and a and a them them. The wall between hearing and deaf is being broken down by a broad range of technology: hearing aids and implants that create what some activists call the "cyborg mix," bodies that are physically enhanced in some way.

Though some implanted adolescents disconnect them in their teen years, most perceive them as extremely useful. In one study from 2002, two-thirds of parents reported that their children had never refused to use the implant; there is presumably more adolescent resistance to, for example, seat belts.

Barbara Matusky told her husband, Ralph Comenga, that she would have children if he insisted, and he insisted. She was still working-driving a forklift in a warehouse for Procter & Gamble in West Virginia-when she was nine months pregnant with her son, Nicholas. It was 1987, and she'd never even heard the word audiology audiology. When Nicholas was six months old, she decided to see a specialist; she thought maybe the baby was having ear infections. She had to wait three months for an appointment. The specialist sent the family to Johns Hopkins for further assessment, and another three-month wait. When she finally got the diagnosis, Barbara was offended by everyone's expectation that she would be in despair. But she said to me, "When you asked to do this interview, I said, 'If you're looking for somebody who was devastated by this, don't come here, because I don't have that story.' But I can tell you now that I didn't sleep and I cried a lot at night. I would lay in bed and say, 'If he is deaf and he wants to play football, what?' I did this with everything in his future life, everything."

Barbara and Ralph first chose an oral education for Nick. "I ended up with a teacher who would talk to me about the fabulous therapy she'd done and how successful her kids are," Barbara said. "Every day I would think, 'Today she is going to unleash the wonder.' It never happened." Nick loved garbage trucks, so Barbara would take him out and follow a garbage truck for hours, trying to teach him words to go with what they were watching, hoping that if the words referred to things that interested him, the words themselves would interest him. "Being oral was horrible, everything was about them saying words. It was so intense, so totally unnatural. I was a maniac." Ralph wanted to look at a cochlear implant-at that time, still a new technology-and Barbara refused. "That was not a decision I could make, to cut my kid's head open. You're trying to make a decision for this future adult, but what you've got is a baby. It's about who they are as people, and you don't know that when they're infants." that interested him, the words themselves would interest him. "Being oral was horrible, everything was about them saying words. It was so intense, so totally unnatural. I was a maniac." Ralph wanted to look at a cochlear implant-at that time, still a new technology-and Barbara refused. "That was not a decision I could make, to cut my kid's head open. You're trying to make a decision for this future adult, but what you've got is a baby. It's about who they are as people, and you don't know that when they're infants."

Barbara saw that Nick was too isolated, so she decided to have another child-a hearing sibling who could help translate for him. The day she gave birth, Barbara told the hospital about the protocols for testing hearing in newborns. Brittany, they declared, was hearing. "She is in her crib crying in her room, and I am playing with Nick, and I can remember hollering, 'Brittany, you're okay, you can hear me. Nick needs me.' I didn't know that what I really wanted was another deaf kid. Once I realized she wasn't hearing, which was within the first two months, I called the audiologist and said, 'Order me hearing aids.' I called the school and said, 'She's deaf, she needs to be in a class.' So at three months, she's aided, she's seeing Sign, a whole different situation." When two teachers were assigned to come to the house and work on Barbara's signing and Brittany's language exposure, however, Barbara found their presence oppressive. "I kept saying, 'My kids are right where they need to be,'" she recalled. "So they would say to me, 'Think how much smarter they would be if you had started earlier.' They were right, and I didn't want to hear it."

Brittany produced a broad range of phonemes and was identified as a good candidate for oral education, which Nick was already receiving. Nick, on the other hand, couldn't make a comprehensible speech sound. "I could just see that it wasn't going to work for him. So then it was like 'Do I sacrifice him for her? Or her for him? Because we can't be oral and sign.' So I decided, we're going to start signing."

They lived two hours away from the residential Maryland School for the Deaf, and she enrolled both children there. The school was then doing a version of Bi-Bi, but the school day took place in Sign. Barbara enrolled in an ASL interpreter-training program near the school. Ralph had to settle for an ASL class at a local high school. But she couldn't bear to have them board-"From not wanting kids, I fell in love with my kids"-so she drove them both ways every day. The deaf educators resisted the arrangement, but Barbara was adamant. "That part of it I hated. Deaf of deaf are golden, and deaf of hearing are subservient and not so great. My kids really feel the negative weight of all that. I question the Deaf community every step of the way. I might have said, 'Here, take my kids. Let them live in the dorm. Have at it, you are the experts.' Would my kids have been any further along developmentally? I can tell you, those kids who effectively lose their parents are much further behind." Once she'd done her interpreter's training, Barbara took a volunteer position at the school; eventually, she got a job there as a secretary. Barbara struggled to give her children a feeling of confidence. "The whole time they were growing up, I said, 'You can do anything you want to do. This doesn't limit you.' Then it started to hit me. It's got nothing to do with them. It's got to do with that hearing person across from them at an interview." have said, 'Here, take my kids. Let them live in the dorm. Have at it, you are the experts.' Would my kids have been any further along developmentally? I can tell you, those kids who effectively lose their parents are much further behind." Once she'd done her interpreter's training, Barbara took a volunteer position at the school; eventually, she got a job there as a secretary. Barbara struggled to give her children a feeling of confidence. "The whole time they were growing up, I said, 'You can do anything you want to do. This doesn't limit you.' Then it started to hit me. It's got nothing to do with them. It's got to do with that hearing person across from them at an interview."

In the end, Barbara became a champion of Deaf culture. "I didn't embrace it for a long time," she said. "Now, I meet parents, and I say, 'Look, learning ASL is the hardest thing you will ever do in your life. You will never be good enough. You will still not understand your kid, and you will still not always be able to communicate what you want to say.' That's the truth and it's not easy."

When I met her, Barbara had become the head of family services for the deaf at a local university. Nick and Brittany are much less interested in Deaf activism than she is. Nick had announced that the best thing he could do for deaf people was to go out into the world and work and become himself. This is just fine with Barbara, who worked hard to give her children that confidence. "The Deaf community fills them up with pride, and then they don't want to let them go," Barbara complained. "A kid will be raised in a deaf school. He will go to Gallaudet. Then he will come back to the deaf school and teach. So their knowledge of the world is this. They bring nothing new and nothing diverse." Barbara got her kids enrolled at Northridge instead, where there is a strong Deaf studies program and a large Deaf population.

Both children have made strong showings in written English. While Nick makes little use of vocal language, Brittany decided in college that she was going back to speech therapy and has been thinking about getting an implant. She wants to work in film production, and she wants to be comfortable in the hearing world. "She wants to make it as easy for hearing people as she can," Barbara said. "Brittany has a lot of speech. The problem is, she is embarrassed to use it. She has an interpreter at college, who said to her, 'You shouldn't talk, because deaf people sound horrible when they talk.' So she's sending my husband e-mails saying, 'Does my voice sound horrible?' This is an interpreter, her lifeline to communication. If I saw this woman, I would probably choke her." Brittany has been concerned about how her Deaf friends would react to her getting an implant. "So what does she do?" Barbara said. "Does she give up her dreams and settle? Or does she get this implant if it will make it easier to get her dream job? They're deaf in a hearing world, that's the reality." make it easier to get her dream job? They're deaf in a hearing world, that's the reality."

Barbara worries about her children in that world, but she has no regrets. "If my kids were hearing, my daughter and I would not have gotten along," she said. "We are two strong personalities. My son would have gotten into so much trouble. If I'd had hearing kids, I would have worked and they would have gone to child care. Having deaf kids made me a much better mother. I like fighting for the cause. I like empowering people. We get along really great, the bunch of us, we really do. I hope they have deaf children. I want them to have kids who are just like them."

Deaf people in the hearing world are always going to be at a disadvantage. So the question is whether people prefer to be marginal in a mainstream world, or mainstream in a marginal world, and many people quite understandably prefer the latter. At the same time, those who oppose cochlear implants-and who, in some cases, oppose hearing aids and other technologies-are a noisy bunch, which has often led people to universalize from their views. In fact, these views can be constraining. "There seems to be subtle pressure from some Deaf people to give up hearing aids-sort of a Deaf-liberation equivalent to bra-burning," wrote Kathryn Woodcock, a Canadian deaf woman. "There is prejudice in the Deaf community against any form of listening. At this point in my progressive hearing loss, I can usually still hear a firm, multiple knock on the door of a quiet room. This has earned me suspicious glances and even overt queries as to why I am present in a deaf group. This is absurd." The commentator Irene Leigh has written, "While I perceive myself as sufficiently competent in Deaf ways and as capable of participating within Deaf culture, I can also communicate adequately with users of spoken English. Because of this, I have at times been labeled as 'hearing-mind,' not truly Deaf."

Josh Swiller, a deaf man raised in the hearing world and educated orally, came to Deaf identity late and has written about it beautifully. He used hearing aids and other devices. "Basically, with aids you're constantly translating every line of language into itself. Like the high school sophomore at the college bar with a great fake ID, I could fool everyone into believing I was who I pretended to be. It gnawed at me that this way of navigating the world was based on a fundamentally untenable position, a two-sided lie. To others: I can hear you; to myself: it doesn't matter how much I miss or how alone I feel as long as others think I can hear. It drove me crazy. I kept doing it, it was all I knew." Swiller made his way to Gallaudet. Soon after he arrived, a school newspaper poll asked whether students would take a pill that would give them hearing instantly, and the majority answered that they would not, because they were proud of who they were. Swiller wrote, "But who are we? I wanted to know. Who looks out from our eyes?" Years later, he posted a short biography of himself on his website with this description: "In 2005, Josh had surgery for a cochlear implant. The implant has been a remarkable success. He also, with great pride, uses American Sign Language. He rejects the defensiveness and distrust that divides the deaf community and believes that our similarities should-and will-overcome our divisions." school newspaper poll asked whether students would take a pill that would give them hearing instantly, and the majority answered that they would not, because they were proud of who they were. Swiller wrote, "But who are we? I wanted to know. Who looks out from our eyes?" Years later, he posted a short biography of himself on his website with this description: "In 2005, Josh had surgery for a cochlear implant. The implant has been a remarkable success. He also, with great pride, uses American Sign Language. He rejects the defensiveness and distrust that divides the deaf community and believes that our similarities should-and will-overcome our divisions."

While the debate rages over cochlear implants, implantable hearing aids and other assistive devices for hearing loss continue to be refined and developed. In parallel, research into biological, nonprosthetic cures for deafness has blossomed. There are many kinds of hearing loss, but most come from the loss of the auditory hair cells in the cochlea. These cells, which receive sound in a form in which it can be conveyed along nerve pathways to the brain, are produced in the first three months of the fetal period and are incapable of regenerating-or so conventional wisdom long assumed. In the early 1980s, however, Jeffrey T. Corwin, now at the University of Virginia, noticed that adult sharks have a greater number of receptive hair cells than baby sharks, and subsequent research demonstrated that fish and amphibians produce hair cells throughout life to replace those that have been lost. A few years later, Douglas Cotanche, director of the Laboratory of Cellular and Molecular Hearing Research at Boston University, discovered that baby chicks whose hair cells were completely destroyed by ototoxic poisoning or sound trauma regenerated hair cells. Tests confirmed that these chicks had recovered hearing. These discoveries led researchers to investigate whether such processes could be achieved in human beings.

In 1992, researchers in Corwin's lab fed retinoic acid to embryonic mice; the mice were born with six or nine rows of hair cells, rather than the usual three. Building on this work, in 1993 a group working at Albert Einstein Medical Center published an article in Science Science in which they described their success at causing the regrowth of hair cells by treating the damaged inner ear of an adolescent rat with a mixture of retinoic acid and calf serum. Since most deafness is degenerative (even those born deaf have usually lost auditory hair cells in utero), the question remained whether the new hair cells would survive in the inner ear, or whether they would die off again as their predecessor cells had done. in which they described their success at causing the regrowth of hair cells by treating the damaged inner ear of an adolescent rat with a mixture of retinoic acid and calf serum. Since most deafness is degenerative (even those born deaf have usually lost auditory hair cells in utero), the question remained whether the new hair cells would survive in the inner ear, or whether they would die off again as their predecessor cells had done.

Hinrich Staecker, a professor of otolaryngology at the University of Kansas, is now trying to determine what is necessary for the neuritic stem to grasp on to a hair cell-the process through which the response of the cochlea is transmitted to the brain. In the late 1990s, burgeoning insight into stem cells inspired inquiry into how they might be made to differentiate into auditory hair cells and then be introduced into the inner ear. In 2003, Stefan Heller and his colleagues successfully cultivated auditory hair cells from mouse stem cells. Six years later, a team at the University of Sheffield demonstrated that human fetal auditory stem cells could be cultivated in vitro, and that they would develop into either functional auditory neurons or hair cells; treating the cells with retinoic acid helped this occur. Kansas, is now trying to determine what is necessary for the neuritic stem to grasp on to a hair cell-the process through which the response of the cochlea is transmitted to the brain. In the late 1990s, burgeoning insight into stem cells inspired inquiry into how they might be made to differentiate into auditory hair cells and then be introduced into the inner ear. In 2003, Stefan Heller and his colleagues successfully cultivated auditory hair cells from mouse stem cells. Six years later, a team at the University of Sheffield demonstrated that human fetal auditory stem cells could be cultivated in vitro, and that they would develop into either functional auditory neurons or hair cells; treating the cells with retinoic acid helped this occur.

Genetic research into deafness, which has so angered the Deaf community because of its relevance to selective abortion, is not primarily focused on pregnancy termination. Scientists are hoping to develop gene therapies to promote the growth of auditory hair cells, both in utero and postnatally. With the identification of the ATOH1 gene as essential to the development of auditory hair cells, researchers have focused on developing therapies to introduce and induce the expression of ATOH1 in animals, and to inhibit processes that damage existing cells, including oxidative stress, which appears to be a major contributor to age-related hearing loss. Other currently targeted genes control the function of the transduction channel that conveys messages from the auditory hair cells to the brain.

Technologies now in the works include the implantation of electrodes that stimulate hearing nerve fibers, the miniaturization of implant technology, fully implantable cochlear devices, and implantable hearing aids.

In the early 1960s, a rubella epidemic in the United States resulted in a high incidence of deaf children; this generation, currently in midlife, is called the Rubella Bulge. Vaccines now protect most expectant American mothers from rubella, and most children from rubella and meningitis. The deaf population diminishes. Cochlear implants mean that a large proportion of deaf children are functioning in the hearing world. "From the time God made earth until today, this is probably the best time to be deaf," Greg Hlibok said at the Lexington graduation; yet this is also the moment when the deaf population is dwindling. As it gets better and better to be deaf, it also gets rarer and rarer. Parents cannot understand their deaf child's future by talking to deaf adults, because those adults grew up in a vanished context. Parents who do not implant their children today are choosing a shrinking world. The Deaf movement was born in its modern form only when Stokoe recognized the linguistic complexity of ASL in 1960; some say that its demise commenced when implant surgery received FDA approval in 1984. Patrick Boudreault said, "We are still looking for answers to our own questions. Who we are, for example. What does language mean to us. How does the world interact with deaf people. We're just making these discoveries, and now we're under pressure." Christina Palmer said, "Eugenics and multiculturalism are head-to-head." recognized the linguistic complexity of ASL in 1960; some say that its demise commenced when implant surgery received FDA approval in 1984. Patrick Boudreault said, "We are still looking for answers to our own questions. Who we are, for example. What does language mean to us. How does the world interact with deaf people. We're just making these discoveries, and now we're under pressure." Christina Palmer said, "Eugenics and multiculturalism are head-to-head."

In 2006, a group of Deaf people proposed the founding of a Deaf town, in South Dakota. It was to be called Laurent, after Laurent Clerc, and its anticipated initial population was twenty-five hundred. The man behind the plan, Marvin T. Miller, said, "Society isn't doing that great a job of quote-unquote 'integrating' us. My children don't see role models in their lives: mayors, factory managers, postal workers, business owners. So we're setting up a place to show our unique culture, our unique society." The local county planning commission refused to approve the proposal, and it eventually fell apart. The people of South Dakota reacted to the idea of a deaf town much as a white suburb of the 1950s might have reacted to news of a black one. But even the deaf had rather mixed feelings. Deafweekly.com wrote, "Some question the need for such a town, saying such 'isolation' has gone out of fashion."

It is difficult to imagine the same being said about Bengkala, because that community has developed intergenerationally. It may be perceived by mainstream society as a community of the deficient, a hereditary error writ large. But it is clearly not artificial, and that is because it is vertical. The vertical is deemed natural, and the horizontal, unnatural. Implants come to seem more "natural" than deafness to hearing people such as Felix Feldman; resisting them seems like the artifice. As that perception takes hold, more people get implanted, leaving fewer to make up the marginal culture, creating more pressure to get implants, and so on until few people are left to populate the Deaf world. The loss of Deaf culture would be a great sadness; preventing any individual child from getting implants could be considered cruel. By narrowing a child's options, parents define that child as an extension of themselves, rather than a person of his own. Yet implants may compromise the option of being content in the Deaf world. As any identity becomes a choice, it is irrevocably altered, even for the people who choose it.

For many years, the defining means of deaf life was in-person socializing at deaf social clubs-now largely vanished as deaf people are able to communicate online. The deaf used to congregate at the Deaf theater-but with the advent of captioned television and film, the imperative to do so has faded. Is Deaf culture to be defined simply as a function of a shared language used for in-person interactions? to do so has faded. Is Deaf culture to be defined simply as a function of a shared language used for in-person interactions?

Just as Deaf culture is being forced to assimilate to the mainstream, mainstream culture is assimilating the Deaf world. As many as two million Americans know ASL. The early years of the new millennium saw a 432 percent increase in ASL courses. This made ASL the fifth most taught language in college, and the fifteenth most taught in the general population; a broad population has been bewitched by the perceived poetry of a physical communication system. While teaching Sign to deaf babies is less common in the age of cochlear implants, hearing babies are being taught Sign because they can make use of it before they have the oral muscle control to speak. More hearing people are applying to Gallaudet. Deaf people are ambivalent about all this. They note that the language has separated from the culture, and that many of the students learning it know nothing about Deafhood, a fashionable word for the deep experience of Deaf values. Edna Edith Sayers, a professor of English at Gallaudet, referring to ASL classes taught outside the academic context, noted, "Somehow, ASL's popularity has come at the cost of demotion to some kind of craft or hobby, like quilting or aerobics, taught by volunteer enthusiasts in church basements."

I am fully persuaded that there is a Deaf culture; I am persuaded that it is a rich culture. What social obligations are attached to recognition of a culture? Can we confer on it a societal equivalent to the landmark status with which we mark buildings that are never to be destroyed? Talk of Deaf lineage is fine insofar as any given child and his parents accept it. But we will never have a society in which children are routinely taken from their parents and given to another group of people to raise. The 90 percent or so of deaf children who are born to hearing parents will continue to be brought up as those parents see fit. If the cochlear implant is improved, if gene therapies advance so that children can effectively be cured, then cures will triumph. Vertical identities will go on forever, and horizontal ones won't. Harlan Lane wrote in outrage, "The relation of the hearing parent to the young deaf child is a microcosm of the relation of hearing society to the deaf community; it is paternalistic, medicalizing, and ethnocentric." This is true, but Lane seems not to recognize that parents have definitional license to be paternalistic. While it may be difficult for deaf people to learn speech, it is also difficult for parents to learn Sign-not because they are lazy or smug, but because their own brains are organized around verbal expression, and by the time they are of parenting age, they have lost considerable neural plasticity. Parents implant their children in part so that they can communicate with them. They may be wise to do so; intimacy between parents and children is one of the cornerstones of mental health for both parties. so; intimacy between parents and children is one of the cornerstones of mental health for both parties.

The cochlear implant debate is really a holding mechanism for a larger debate about assimilation versus alienation, about the extent to which standardizing human populations is a laudable mark of progress, and the extent to which it is a poorly whitewashed eugenics. Jack Wheeler, CEO of the Deafness Research Foundation, has said, "We can conquer newborn deafness in America. If we can test every baby born and organize the parents as a political force so every baby gets what it needs, regardless of how much money the parents have, then the twelve thousand babies born deaf every year become twelve thousand babies who self-identify as hearing kids." The question is whether this is desirable. A race is going on. One team consists of the doctors who will make the deaf hear. They are humanitarian miracle-workers. On the other team are the exponents of Deaf culture. They are visionary idealists. Yet each would render the other irrelevant. As Deaf culture grows stronger, it is dying. "Deafness is almost always one generation thick," declared Lawrence Hott and Diane Garey, directors of the film Through Deaf Eyes Through Deaf Eyes; some scholars have called Deafness a "culture of converts."

"In a world full of childhood cures," said Rob Roth, whom I met at the NAD, "I would be neither deaf nor gay. That doesn't make me feel unloved or bad about myself, but I know that it's true." If Deaf culture can be made as visible, powerful, and proud as gay culture now is before before the cure is perfected, then perhaps the accomplishments of the Rubella Bulge activists will allow for a long history of Deaf culture. If the cure comes before that happens, then virtually all hearing parents and many grassroots deaf parents will cure their children, and the tremendous accomplishments that have followed the Gallaudet uprising will be the conclusion rather than the beginning of a story. Then the history recounted here will be as poignant and remote as a tale of Babylon. Jacob Shamberg, who had taken part in the Gallaudet protests, wrote to me, "While I'm pretty comfortable with my disability and don't see CI as an evil force intent on destroying the Deaf culture, I do get a sense of impending extinction. There'll always be deaf people worldwide, but there is a real possibility that it'll be near-eradicated in developed countries within 50 to 100 years. I say 'near' because there'll always be immigrants, untreatable conditions, cultural hold-outs and so on. But no more people like me." the cure is perfected, then perhaps the accomplishments of the Rubella Bulge activists will allow for a long history of Deaf culture. If the cure comes before that happens, then virtually all hearing parents and many grassroots deaf parents will cure their children, and the tremendous accomplishments that have followed the Gallaudet uprising will be the conclusion rather than the beginning of a story. Then the history recounted here will be as poignant and remote as a tale of Babylon. Jacob Shamberg, who had taken part in the Gallaudet protests, wrote to me, "While I'm pretty comfortable with my disability and don't see CI as an evil force intent on destroying the Deaf culture, I do get a sense of impending extinction. There'll always be deaf people worldwide, but there is a real possibility that it'll be near-eradicated in developed countries within 50 to 100 years. I say 'near' because there'll always be immigrants, untreatable conditions, cultural hold-outs and so on. But no more people like me."

Would the world be better with more cultures in it? I believe it would. In the same way that we mourn the loss of species, and fear that reduced biodiversity could have catastrophic effects on the planet, so we should fear the loss of cultures, because diversity of thought and language and opinion is part of what makes the world vibrant. Commenting on the death of tribal languages and traditional storytelling in West Africa, Amadou Hampate Ba, a Malian ethnologist, said, "When an old person dies, it's a library burning down." And yet what is happening to the Deaf has happened also to the Quakers, to Native Americans, to whole tribes and countries. We live in an incinerator of cultures. It is estimated that by the end of this century, fully half of the six thousand languages currently spoken on earth will have vanished. The Tower of Babel is collapsing. With those tongues will go many traditional ways of life. The Australian linguist Nicholas Evans wrote of the urgency of finding "a new approach to language and cognition that places diversity at centre stage," pointing out that we are "the only species with a communication system that is fundamentally variable at all levels." The Deaf will vanish along with many ethnicities, their languages along with many languages. so we should fear the loss of cultures, because diversity of thought and language and opinion is part of what makes the world vibrant. Commenting on the death of tribal languages and traditional storytelling in West Africa, Amadou Hampate Ba, a Malian ethnologist, said, "When an old person dies, it's a library burning down." And yet what is happening to the Deaf has happened also to the Quakers, to Native Americans, to whole tribes and countries. We live in an incinerator of cultures. It is estimated that by the end of this century, fully half of the six thousand languages currently spoken on earth will have vanished. The Tower of Babel is collapsing. With those tongues will go many traditional ways of life. The Australian linguist Nicholas Evans wrote of the urgency of finding "a new approach to language and cognition that places diversity at centre stage," pointing out that we are "the only species with a communication system that is fundamentally variable at all levels." The Deaf will vanish along with many ethnicities, their languages along with many languages.

I think the only locus for hope in the face of these dismaying statistics is to recognize that new cultures are being born all the time. This book chronicles numerous communities that would never have emerged without the Internet and its potential to sort people according to one shared value, even when they are infinitely diverse in location, language, age, and income. Some of those communities are cultures. The computer code that is at this precise moment causing the movement of my fingers to create text on the screen I am gazing at is language, too, and such languages are being generated rapidly. Historic preservation is noble, but it should not forestall invention.

My own father's culture was impoverished; he grew up in a tenement in the Bronx, made his way into the professional class, and raised my brother and me with many advantages. He has sometimes expressed nostalgia for that world he left and has tried to explain it to us. It is not our reality; indeed, it is hardly anyone's reality. The world to which he was born, of recent Jewish immigrants from Eastern Europe doing manual labor and speaking Yiddish, has vanished. There is no question that something has been lost. Yet I prefer the prosperous, American way I grew up. Jackie Roth spoke to me about today's Hasidic Jews. "They feel safe amongst themselves," she said. "They have their Shabbos on Friday night, they go to synagogue. They have their own schools, they have their own traditions, they have their own everything. Why bother with the rest of the world? That's what's happening with the Deaf community. It's going to be smaller and smaller, and the outliers are going to be increasingly marginal. We've got to stop playing deaf."

My first book was about a group of Soviet artists who evinced courage and brilliance in the face of an oppressive and cruel system-and then the Cold War ended, and their tremendous accomplishments became historical, and while a few negotiated the Western art scene's commerce and museums, many never made a decent work of art again. Deaf culture has been a heroic enterprise all this time, a beautiful, ingenious marvel, and now, like Soviet dissidence and Yiddish theater, it is slipping out of relevance. Some things from it will be carried forward, but the occasion of its brave dignity is passing. Every bit of progress kills something, but also encodes its origins. I do not wish for the life my father left behind, but I know that some spirit forged in that particular adversity made me possible. and brilliance in the face of an oppressive and cruel system-and then the Cold War ended, and their tremendous accomplishments became historical, and while a few negotiated the Western art scene's commerce and museums, many never made a decent work of art again. Deaf culture has been a heroic enterprise all this time, a beautiful, ingenious marvel, and now, like Soviet dissidence and Yiddish theater, it is slipping out of relevance. Some things from it will be carried forward, but the occasion of its brave dignity is passing. Every bit of progress kills something, but also encodes its origins. I do not wish for the life my father left behind, but I know that some spirit forged in that particular adversity made me possible.

Looking at the vogue for ASL among hearing people, the activist Carol Padden asked, "How can two conflicting impulses exist at the same time-to eradicate deafness and yet to celebrate its most illustrious consequence, the creation and maintenance of a unique form of human language?" One thing has no bearing on the other. You can admire Deaf culture and still choose not to consign your children to it. The loss of diversity is terrible, but diversity for the sake of diversity is a lie. A Deaf culture kept pure when hearing is available to all would be the equivalent of those historical towns where everyone lives as though it were the eighteenth century. Will those born without hearing continue to have things in common? Will their language remain in use? Of course-just as candles have remained ubiquitous in the age of electricity, just as we wear cotton in a time of microfibers, just as people read books despite television. We will not lose what Deaf culture has given us, and it is a worthy cause to delineate what parts of Deaf culture are precious and why. But vertical demand for medical progress will inevitably outflank any horizontal social agenda.

III

Dwarfs

Until I attended my first dwarf convention-the 2003 Little People of America (LPA) meeting in Danvers, Massachusetts-I had no clue how many kinds of dwarfism there are, nor how many varieties of appearance are collected under the category. Dwarfism is a low-incidence condition, usually occurring because of a random genetic mutation. Since most dwarfs are born to average-height parents, they do not have vertical community. There has been occasional talk about building a town for little people (LPs); there are metropolises where activist LPs have settled; there are high concentrations of otherwise rare dwarfing conditions among the Amish; but there has never been a significant geographic concentration of people of short stature. This means that the national LPA gatherings are not simply occasions to attend lectures and consult medical experts; for some participants, they are the annual exception to a certain kind of loneliness. The gatherings are emotionally intense; one dwarf I met told me she was "happy for one week a year," although others emphasized that they love both of their lives-the one in the larger world, and the one among their LPA friends. More than 10 percent of Americans of short stature belong to LPA, and the organization has a role in the LP community that is greater than that of similar groups for comparable populations.

Arriving at the Sheraton Ferncroft Resort, where the convention was taking place, I was struck by how the concentration of LPs changed my perception of them. Instead of seeing, primarily, short stature, I saw that one was exceptionally beautiful, that one was unusually short even for a dwarf, that one laughed uproariously and often, that one had an especially intelligent face-and so I began to recognize how generically I had responded to little people until then. I understood what a relief it had to be for them that no one was focused on their height. Of course, the LPA convention was all about stature, but it was also the place where stature became blessedly irrelevant. course, the LPA convention was all about stature, but it was also the place where stature became blessedly irrelevant.

It would be difficult for an outsider to acknowledge this particularizing view of, for example, Latinos or Muslims. To say that a person's ethnicity or religion had overwhelmed, even temporarily, one's ability to appreciate his other personal characteristics would seem bigoted. But dwarfism has been the exception to these social rules. According to Betty Adelson, author of The Lives of Dwarfs The Lives of Dwarfs and and Dwarfism, Dwarfism, "The only permissible prejudice in PC America is against dwarfs." Mary D'Alton, chair of Columbia University's Department of Obstetrics and Gynecology and a leader in the field of high-risk pregnancy, told me that dwarfism is the most difficult diagnosis to communicate to expectant parents. "You say that the baby has a hole in his heart," she said, "and they say, 'But you can fix that, right?' But when I tell someone that they will be having a dwarf, they often seem disgusted by the idea." "The only permissible prejudice in PC America is against dwarfs." Mary D'Alton, chair of Columbia University's Department of Obstetrics and Gynecology and a leader in the field of high-risk pregnancy, told me that dwarfism is the most difficult diagnosis to communicate to expectant parents. "You say that the baby has a hole in his heart," she said, "and they say, 'But you can fix that, right?' But when I tell someone that they will be having a dwarf, they often seem disgusted by the idea."

Many of the attendees I met my first day at LPA could identify instantly conditions that I had never heard of or imagined and had certainly never seen. When I went down to the conference disco the first night, I saw a brother and sister who had primordial dwarfism; they were full-grown, perfectly proportioned, and only about twenty-nine inches high. Their parents stood with them to make sure they weren't trampled-a danger even at the dwarf convention. I learned that the girl played percussion in her high school band; she had a classmate who pushed her tiny wheelchair, and she held the drum in her lap-looking, in the words of a dwarf who was herself just three foot eight, "like a marionette." The conference featured athletic competitions; a marathon-length talent show, including acts from Christian music to break dancing; and a fashion show, which revealed a broad range of dressy and casual styles, all tailored to little bodies. The conference also provided an eagerly awaited opportunity for dating. A dwarf comedian cracked, "You know you're a teenager at LPA if you've had more boyfriends this week than you've had in the last year."

When I met Mary Boggs on my second day at LPA, she told me that the organization had changed her life. When her daughter Sam was born in 1988, the obstetrician initially assumed that the baby's diminutive size was a result of her premature arrival. A month later, while she was still in the neonatal intensive care unit, he diagnosed her with achondroplasia. "We would have rather had a child that was deaf or blind," Mary told me. "Just anything besides a dwarf would have been better. When you're thinking about what could go wrong with a pregnancy, this doesn't cross your mind. We were thinking, 'Why did we have another child at all?'" pregnancy, this doesn't cross your mind. We were thinking, 'Why did we have another child at all?'"

Sam came home to her parents' house in the suburbs of Washington, DC, on oxygen and a monitor. After six months, when Sam was declared physically healthy, Mary took her to her first local LPA meeting. When Sam was a year and a half old, she had a shunt inserted in her head to relieve her hydrocephalus (the accumulation of cerebrospinal fluid in the head); fortunately, she did not have the skeletal problems that in later life afflict so many people with achondroplasia. Mary and her husband got step stools and put them all over the house; they purchased light-switch extenders; they moved the faucet on the kitchen sink. These adjustments at home were easier to control than the challenges outside. "We've had people chase us down the grocery aisle to ask questions," Mary said. "We learned to stare back. It frightens them off. I'd watch Sam not playing with the other kids because she's too small to do what they do. You just feel sad."

Before Sam set off for kindergarten, her parents told her that other kids would call her names; they reviewed what some of those names might be and taught her appropriate responses. Mary went to the school and explained Sam's special needs, giving the teacher a book about dwarfs that she could read aloud to the class. The school lowered the sink and water fountain and installed a grab bar so Sam could pull herself up on the toilet. The kids in her class learned her story, but each year it was new to an incoming kindergarten class, and some would call her names. So Sam decided to make a presentation to each incoming class. She would explain, "I'm little, but I'm eight years old. I'm in third grade. I'm a dwarf, and I'm just like you all, but just short." She did that every year through elementary school, and the teasing stopped.