Bionic Vision, Social Work, and Community Development: A Research Participant’s Reflections

Bionic Vision, Social Work, and Community Development: A Research Participant’s Reflections Abstract This article discusses bionic vision through the author’s experiences as Australia’s first research participant in an early prototype bionic eye trial. During her two-year participation, she drew on various theoretical perspectives, including critical and community development approaches that not only influence her professional social work perspective, but extend to her personal worldview. In a rapidly emerging biotechnological age, this article contributes a holistic perspective, bringing into focus theory and practice; issues of human experience, human rights, and oppressive relationships; tensions between agency and structure (particularly relating to disability from a social model of disability and the medical model); and practical applications of artificial vision. Beyond its practical applications, illuminated is the relevance of community development values and principles such as a sense of connectedness, participation, and empowerment, which are understood in terms of an antioppressive perspective. The article concludes by recognizing the potential benefit of bionic vision for vision-impaired and blind people in their everyday lives. anti-oppressive practice, bionic vision, community development, disability In 1984 when I was diagnosed with retinitis pigmentosa (RP) and told I was losing my eyesight, and eventually would go blind, I never imagined I would become a social worker, undertake PhD research, or lecture at a university. Moreover, in 2010 when I received an invitation to attend the Royal Victorian Eye and Ear Hospital to discuss the bionic eye research, I never imagined I would be asked to take part in it. The invitation quickly filled my mind with inquiry and curiosity. What an opportunity, I first thought. How many people would ever have a chance to do something like this? Was it safe? How would the device be implanted? How long was the research? Was the device easy to remove? With my curiosity satisfied about the medical safety of the procedure, I became the first of three research participants to have an early Australian 24-electrode prototype bionic eye device implanted in my eye. However, although I felt excitement about being the first in the world to participate in this type of technological miracle, for me it initially raised dilemmas about how disability is understood. From a medical model the aim is to fix the problem, but from my personal and social work perspective, being valued and accepted as an equal for one’s difference, whatever that might be, was a source of conflict for me. The following is my critique of this tension through different theories that influence my worldview as I reflect on my two-year participation in the early prototype bionic eye trial. With a focus on human rights and social justice the discussion is critical (Allan, Pease, & Briskman, 2003), but it is also holistic because it includes a community development (CD) perspective (Ife, 2013; Kenny & Connors, 2017) with my experience with this biotechnical phenomenon. What Is a Bionic Eye? According to the Bionics Institute (2015), a bionic eye mimics the function of the retina to restore sight for those with severe vision loss. It uses a retinal implant connected to a video camera to convert images into electrical impulses that activate remaining retinal cells which then carry the signal back to the brain. (para. 1) Now beyond theory, this visual prosthesis (bionic eye), is being researched and developed and is becoming reality for vision-impaired and blind people in different countries across the world. For example, the Argus II device, initially developed in the United States by Second Sight to restore vision in people with RP, is now commercially available in the United States and Europe. More recently, on July 21, 2015, in Manchester, England, this device was successfully implanted in an eighty-year-old man who has the dry form of age-related macular degeneration (Second Sight, n.d.; Walsh, 2015). Other examples of devices currently being researched and clinically evaluated include the Alpha IMS, developed by the University of Tübingen in Germany (Anthony, 2013); arrays with micrometer pixels developed by Pixium Vision in France (The Scientist Magazine, 2014); and even a bionic eye using a wireless chip in the brain rather than in the retina, developed by the Monash Institute of Medical Engineering in Australia (Smith, 2015). Bionic Vision Australia (BVA), a consortium of world-leading experts from disciplines of ophthalmology; biomedical engineering; electrical engineering; materials science; neuroscience; vision science; psychophysics; wireless technology; integrated-circuit design; and surgical, preclinical, and clinical practice is also developing different bionic eye devices. This includes a 98-electrode wide-view device, a 256-electrode high acuity device, and a 44-electrode prototype device that will continue the learning from the earlier 24-electrode prototype device that I tested (BVA, 2015a). The Australian Prototype Bionic Eye Building on technologies used in cochlear implants, this 24-channel prototype device comprised a 19 mm long and 8 mm wide intraocular platinum electrode array in a medical-grade silicon base, which was surgically implanted behind the retina in the suprachoroidal space between the choroid and sclera. A lead ran under the skin from the array to a percutaneous connector behind the ear that allowed direct stimulation (Ayton et al., 2014). A small external camera situated on the bridge of a pair of glasses captured images that were processed by the vision processing software to stimulate corresponding electrodes on the array. The remaining retinal cells and the visual pathway (optic nerve and visual cortex in the brain) responded to produce phosphene or artificial vision. A semiportable stimulator that was housed in a backpack allowed mobility while using the bionic eye device (BVA, 2015b). This device was suitable for people like me with advanced-stage RP, because although there is significant degeneration of photoreceptor cells in the retina, the remaining retinal cells and the optic nerve are still able to process the electrical stimulation. When I agreed to take part in this research, these light-sensitive cells in my retina had deteriorated to a level where I only had light perception vision; I could not recognize forms at all. Indeed, through a mass of swirls, I had only perceived light and dark for over 20 years, which is how I viewed my world after the research trial finished and still do, at this time of writing. What Happened? On May 22, 2012, the early prototype device was surgically implanted in my left eye. Once my eye healed, on July 16, 2012, the device was switched on. This was a day of historical significance as it was the day the scientists, engineers, and doctors found out the device worked. The electrical current sent to the electrodes produced spots of light, what they call phosphenes. While in theory these phosphenes were expected to be circular as a direct representation of the electrodes, their shapes were varied and diverse. I felt joy and was filled with warmth when I saw these images, even though at that stage they were abstract and had no meaning. As I explain later in the text, it wasn’t until later on that the significance of seeing these phosphenes became apparent. For the next two years, I continued helping the scientists test the device (for further detail see Ashworth, 2014). My Reflections Starting the Research Journey Indeed, those two years were a learning journey for me, too. In my capacity as a research participant testing this visual prosthesis I was clearly advancing science, but it also raised tension for me around the human or, more specifically, the relationship between this development and people with vision impairment or who are blind. From my social work perspective, I wondered about why artificial sight would benefit them. Initially I thought, would it provide opportunity, acceptance, and social justice for them? One of the questions in my mind was, why do people need artificial vision if they are accepted as equals and have equal opportunity? As such, one of the tensions I experienced when I first began testing this early prototype bionic eye was whether I was helping scientists to make blind people “normal.” As a lecturer in social work, teaching students both theory and practice, I was well aware of the tension between the medical model and social work—how the medical model interprets disability in terms of illness or disease (Titchkosky & Michalko, 2009). From a medical perspective, disability is something to overcome (Zitzelsberger, Odette, Rice, & Whittington-Walsh, 2002) or make normal, whatever that is. The notion of normalcy evokes robust debate (for example, see Foucault, 1973), but I will not elaborate on it here other than saying that I understand it as a divisive and oppressive social category of ableism symptomatic of our unequal economic capitalist society (Oliver, 2009). Thus, accompanying my internal conversation about participating in the early prototype bionic eye trial was my identity as a normal person alongside the medical model that aims to fix the problem. This was problematic for me as my loss of vision was not a problem, and in fact I had achieved far more being blind than when I had sight. Indeed, despite identifying as a normal person who was now doing the same but in a different way, it was others’ attitudes and their assumptions that I found problematic. This reflects tension between the social model of disability largely attributed to Michael Oliver (1983, 1990), who asserted that people with disabilities are disabled because of social attitudes and behaviors. According to Oliver (1983, 1990), shifting attention toward the social was intended to provide an alternative for those working with people with disabilities commonly framed within an individual medical model (Oliver, 2013). Indeed, bringing into light the assumptions, power, and control of the medical model (Davis, 1995) and its relationship with individual experience in many respects contributes to an agency or structure discourse that raises awareness of oppressive practice (Oliver, 2013). As a “blind” person I have certainly experienced this oppressive relationship, and it is one that I consciously resist (Beckett & Campbell, 2015). However, I have never lost confidence in being abled (and normal), and my identity of myself remains stable. Over time, I have internalized how others relate to me by adapting different coping strategies, for example, being proactive to overcome assumptions and at other times withdrawing to avoid judgment. One theoretical perspective that explains this relationship is an anti-oppressive perspective (Thompson, 2012) through the personal, cultural, and structural levels of society intertwining as unequal power relations. Other theories I draw on to explain this oppression include a feminist perspective that asserts that the personal is the political, or those in positions of power who have influence over how people relate and identify a relationship, a relationship that Foucault (1972) explained in terms of social discourse, and one that Bourdieu described in terms of power and competition (Bourdieu, 1993; Bourdieu & Wacquant, 1992). CD, as I understand it, is “the process of establishing, or re-establishing, structures of human community within which new ways of relating, organising social life, promoting human rights and meeting human needs become possible” (Ife, 2013, p. 9), and it is an approach that I hold close to my heart and, thus, its values, principles, and philosophy accompanied my thoughts into the research. Through CD I embrace principles of human rights, diversity, interdependence, reciprocity, participation, balance, process, holism, inclusion, and acceptance, valuing the local and more (Ife, 2013). We are all equal and experts in our own rights, and with this in mind, I worked with the scientists throughout the clinical trial. It is interesting to note that, from a social model of disability perspective, this meant that I was challenging the superiority of the medical model, but at the same time, through the values espoused by CD, I was embracing my own and its expertise. CD is certainly part of my critical thinking, and its principles guide my coping mechanism as I resist oppressive relationships of power and competition that are associated with dominant ideologies of our contemporary life. Hence, for me a CD perspective brings relationships alive, and I understand the importance of connecting and having a sense of community. Indeed, it is something I consciously related to throughout the research. For instance, when walking to the testing booth at the Bionics Institute early on in the study with one of the scientists, I was asked what my reaction might be if there was public outcry and protest from the blind community or others against it. What would I do if I had eggs thrown at me by some members of the deaf community (for example, those belonging to the Big D deaf community), like the research participants who tested the bionic ear 30 years before did? Thankfully I didn’t experience any hostility, but it did make me reflect on the similarities and differences between the deaf and blind community. For me this highlighted how some sections of the deaf community similar to what I was internally struggling with in the beginning of my participation in this prototype bionic eye research, were resisting the medical notion of normalcy with artificial hearing, too. Curiously, reflecting on my own experiences, I became aware that this sense of community was not as prevalent for me as a blind person. As a social worker, I wondered why. What might the link between the personal and political be? Does society discriminate and oppress one group more than the other? Does being blind physically limit activity and social connection? Does internalization of wider social beliefs, attitudes, and actions explain this response? These questions, and more, I took with me as I proceeded in the trials. Thus, my mind was full of inquiry extending from different ways of understanding my participation in the early prototype bionic eye trials, and as the science unfolded so, too, did my theoretical understanding of it. The following is a brief account of the research, one that is recalled by me as a well-informed participant and is therefore not to preside over other reports of the Centre for Eye Research Australia or BVA research results. My Research Journey Psychophysics With goggles on and wire running from the side of my head to the computer, one day a week, I sat in the testing booth testing different electrical parameters of the device as the scientists sent an electrical current to it. During these test sessions, referred to as psychophysics sessions, they measured the levels of my thresholds, or the lowest point at which I could detect something. They learned what my phosphenes looked like as I drew them in the air with a motion sensor attached to my finger. They learned the area of vision where I saw these spots of light as I plotted the positions of them on a board. Later on they tested my ability to detect direction of movement through variation of speed and size of horizontal, vertical, and diagonal bars. They learned that it was not easy to replicate letters and numbers with my unorthodox 24-electrode phosphene map, although I reliably recognized the shape of the number 7. What did I learn from psychophysics? I learned that although the device was safe and the aesthetics of these visual percepts were nice to look at, I couldn’t fully comprehend them as useful in my everyday life. Camera Information gathered from psychophysics was also contributing to the software that operated the camera. Positioned on the bridge of the goggles, this camera conveyed information from the surrounding environment to activate relevant electrodes that in turn produced corresponding phosphenes. Testing the camera, the scientists first learned that the phosphenes reliably helped me identify the difference between light and dark. Later on they learned that using brightness, the phosphenes enabled me to identify the direction of moving shapes and the rotating gap in a letter C eye test presented on an electronic screen. They learned also that phosphenes produced by the camera were sufficient for me to identify varying bars running in different directions. They learned that after some time, brain plasticity occurred. Rather than being aware of the information coming from the camera, I experienced an intuition that the information was coming through my eye! What did I learn from the camera? I started thinking that there might be some practical application for the bionic eye in everyday life. I became aware that the brain is amazing and can adapt as it interprets and makes sense of new information. Semiportable Unit A backpack housing the computer powered by batteries meant the prototype device could be tested beyond the research booth. Through using contrast in a controlled environment, the scientists learned that it is possible to identify different objects. They also learned that sometimes it is difficult to differentiate between object and light reflection when I moved about. What did I learn from testing the semiportable device? I learned that too much information can hinder rather than help. I learned that perceiving brightness on the move created more questions about the environment than provide answers. I learned that I was more cautious about information I did not understand. However, I also learned that in controlled environments that emphasized contrast, my brain adapted and I became more comfortable and quicker with practice. I also felt, at this point, that I would not want this version of a bionic eye. Semiportable Unit Using Depth Perception Using a depth perception camera while moving about, it is possible to detect, negotiate, and avoid obstacles according to their mass, regardless of their brightness and contrast. The scientists learned that a depth perception camera can add a sense of distance and is an effective way to identify items beyond a flat surface. What did I learn from depth perception? I learned that the phosphenes produced through depth perception were more reliable when navigating obstacles than those produced by contrast of brightness. I learned that with practice I became quicker at understanding the phosphenes and therefore their familiarity meant I became quicker at negotiating obstacles. I learned that this was my preferred version of the prototype bionic eye I tested—it had more practical applications and would be something I would be happy to have later on, once the device was available. It was at this point of testing this prototype bionic eye that I realized how practical I am! I wasn’t worried about aesthetics but, rather, how bionic vision could help me until . . . Semiportable Unit Outside In the last week of testing, the researchers gained ethical approval for me to use the semiportable unit using brightness perception outside. Walking up the street I saw lighter color cars in the traffic as they drove by. Through the brightness of their clothing, too, the phosphenes told me there were people in front of me waiting for the green light to cross the road. Around the corner I went. As I curiously tried to figure out if the phosphenes were telling me there was an obstacle in front of me, one of the researchers let me know I was looking at sunlight flickering through the branches onto the footpath, which confirmed to me that a bionic eye using brightness was not practical in this instance. However, as I looked up I could see the light and dark stripes painted on the side of the building. This gave me information that previously eluded my visual concept of an environment I walked with my guide dog every week. Now aesthetics had meaning. But even more important, as I stood in the café ordering a coffee, I saw the barista for the first time. Not only was this prototype bionic eye practical in this instance, it was social, too! I felt connected to my environment, an amazing feeling, as this picture speaks more than a thousand words. This last day of testing was a significant one for me also. I learned that there is practical and social use for both brightness and depth perception when using a bionic eye. Being able to select between one and the other mode in different situations would be ideal. End of My Research Journey On July 29, 2014, I had the working elements of the bionic eye surgically removed: the first clinical trial of this Australian prototype bionic eye research was over. The scientists were thrilled with what they had learned, and I had grown also. After months of contemplation, I look back and “see” my own views on the bionic eye and disability in a clearer light. My critical thinking has indeed brought together theory and practice as I consolidate, develop, and extend my own reflections on bionic vision and its relationship to people who are blind or vision impaired. So with my research participant hat officially hung up, and my social work one firmly on, similar to my previous views, I am still very aware of the relevance of the social model of disability in terms of challenging power relationships that oppress and marginalize people with disabilities. I still appreciate that these relationships are not always recognized, and subsequently inequality is unconsciously perpetuated through the interaction between individuals and different layers of social structure. I still identify as normal and resist the idea of the medical model prescribing a bionic eye to fix my problem or addressing my sense of normalcy. I still celebrate human rights, social justice, and the values and principles of CD such as participation, inclusion, acceptance, reciprocity, holism, mutuality, and more. However, through my critical reflections and participation in the early prototype bionic eye trial, I am now more aware of its beneficial implications; on the horizon I see positive application for bionic vision not only for individuals, but also for community and society alike. It is interesting to note that this is more than just a simple discussion of the contrast between the medical model and social model of disability. Rather, as Shakespeare and Watson (2001) recognized, a holistic approach to the social model of disability is required to fully appreciate the intrinsic relationship between agency and structure. As such, this brings forward my awareness of how social relationships, including oppressive ones, interrelate on a personal, cultural, and structural level (Thompson, 2012), but surprisingly, as I will explain, it also shines light on the CD perspective, subsequently reinforcing my belief in and passion for its relevance in all areas of contemporary life. What I learned in the first instance was that instead of a cure to blindness provided by the medical model, this device has potential to be a useful aid for people with vision impairment or who are blind. The information conveyed through brightness and depth perception by the phosphenes can have practical relevance in their everyday life. This will be an adaptation and interpretation of new information in relation to the surrounding environment. Like training with a guide dog, or a cane, or learning to use a computer using a screen reader, I believe that bionic vision can benefit those people who learn to use it. But understanding that using a bionic eye can be a social experience, too, which extends the ripples of its beneficial implications. Being able to interact visually when I was ordering my coffee, even though it was not normal vision, increased my sense of connection and community. This was an “aha!” moment for me, as it raised my awareness of the need for human beings to connect with each other. And as this happens on many levels, for example through sensations of sound, touch, and even smell, being able to connect through seeing and interacting with people around me brought with it joy. This was a powerful experience and, as such, increased my sense of confidence. From that moment, I realized the significance of bionic vision for people who are blind or vision impaired. I realized its potential to strengthen their sense of self, and with confidence they can resist oppression (and its subsequent internalization). Furthermore, with participation and wider social connection, they can raise awareness and develop a sense of community that in turn continues to strengthen their sense of self. According to CD, everything that happens is part of the bigger picture, relationships are complex and interrelated, there is no beginning or end, problems do not have simple causes or solutions, and knowledge and action as well as theory and practice are linked, which well supports the relevance of how relationships are holistic (Ife, 2013). Subsequently, through their sense of connection and community, people using bionic vision can address oppression and thus human rights and social justice issues experienced by people with disabilities organically (Ife, 2013), rather than a discovery of their own oppression and struggling to become “self-affirming subjects of their own destiny,” as Freire (1972, p. 83) asserted. In essence, when participation in society occurs, there is scope to bridge the personal and political by challenging oppressive discourses and shifting unequal relationships of power and promoting mutual acquaintance (Bourdieu, 1986). This is what I describe as anti-oppressive practice within a CD framework that focuses on assets rather than deficits (Kenny & Connors, 2017). Promoting mutual acquaintance also highlights the importance of understanding process rather than just the outcome (Ife, 2013), or the importance of how the experience of seeing with bionic vision unfolds for people, and not just fixing the problem of being vision impaired or blind. Moreover, increased interaction between personal experience and others also provides opportunity to challenge cultural and societal perceptions about being disabled and replacing it with a common human experience of difference. In my experience with a variety of media during the prototype bionic eye trials, this is something I certainly promoted. Indeed, on the wider social structural stage in contemporary life where technology is increasingly merging as part of everyday activity, there was real opportunity for me as a blind person to open a conversation by sharing how technology has enabled me to achieve a PhD and teach at a university, in other words, how I was doing the same as other students and lecturers do, but in a different way. In essence, I was continuing the conversation created by the social model of disability in the last century in the aim to raise awareness (and subsequent policy change) through media, education, and communication. Through my personal experience I was using anti-oppressive practice guided by the values of CD in an attempt to educate wider society’s attitudes toward social inclusion and acceptance, and celebrating diversity and difference as normal. This is what the social model of disability frames in terms of raising “disability consciousness” both personally and socially within a “disabling society” (Campbell & Oliver, 1996), and it is a conversation that people using bionic vision who experience an increased sense of confidence and agency have potential to widen and contribute to social change, too (Always, 1995; Corker & Shakespeare, 2002). Thus, at the end of my research experience, as I look back on it through my critical social work lens, I clearly see the importance of different ways to understand a situation and that many perspectives contribute to genuine positive change. My hope is that bionic vision has potential to help vision-impaired and blind people both practically and socially, and enable others in society to see the human beyond his or her disability. Although my reflections on my participation in this early prototype bionic eye trial convey only one voice in a larger biotechnical conversation, for me they have certainly reinforced the values and principles of CD and an anti-oppressive approach as part of my social work critical thinking, particularly when resisting dominant ideologies, challenging oppressive relationships, and working toward human rights and social justice. As such, from my previous thoughts as I look ahead, my vision for bionic vision is that it enhances life. This is not to be confused with shallow notions of elusiveness or experiencing diversity where one stands alone in the space of privilege, taking in and from those who are other. But rather where one is fundamentally moved—transformed utterly. The end result of this transformation is mutuality, partnership, and community. (Scapp, cited in hooks, 2003, p. 115) Conclusion Participating in the Australian early prototype bionic eye research was an extraordinary experience, one indicative of the biotechnological age of contemporary life. Although it is certainly an expansive time in which technology is advancing, it is also a time we are yet to fully appreciate its uses and implications (Ife, 2013). Through my experience of bionic vision, I became aware of several ways this artificial sight can benefit people who are vision impaired or blind. First, it has potential to help people with the activities of their everyday lives. For example, when I think about what my own life with bionic vision might be like, I imagine standing with my guide dog at the corner where the phosphenes alert me to a stationary hybrid car silently idling before I can safely cross the road, or standing at the front of the classroom seeing my students, or finding that article of clothing the wind blew off my clothesline onto the grass, or seeing my family including my children and grandchildren. But beyond its practical application, interacting and connecting to one’s environment is social, too. As I learned, this is an empowering experience, one that gave me confidence and a sense of community as I visually connected to my immediate environment. When understanding the value of holism, and how relationships interact, as CD does, this highlights potential for social change through this personal interaction with a wider social structure. In other words, from a CD perspective, rather than the medical model simply fixing a problem, through its new way of relating, bionic vision has potential to reestablish structures of human community, promote human rights, and meet human needs (Ife, 2013). Indeed, increased participation through bionic vision is an anti-oppressive practice, too. We are surely standing on a new exciting horizon—a place where the sun is rapidly rising over the meeting ground of medicine and technology. When I turn my attention to the future, I recognize real potential for bionic vision to help vision-impaired and blind people in their everyday lives on many levels. As this discussion concludes, I leave it wondering about bionic vision as an aid connecting vision-impaired and blind people to their social world, not just to help them with tasks of everyday living but to increase their participation and sense of community, which has potential to increase their confidence and agency and further social interaction, which can contribute to break down barriers of oppression. As I complete this writing, the scientists are preparing for the second stage of the prototype bionic eye trial to continue the learning from the 24-electrode early prototype version I tested. This is an exciting step as the next trial research participants will test a 44-electrode device not only in the research laboratory, but also in their home environments where they will interact with others and undertake their everyday activities. As a critical reflective social worker, I wonder what their experience and reflections might be. References Allan, J., Pease, B., & Briskman, L. ( 2003). Critical social work: An introduction to theories and practices . Sydney, New South Wales, Australia: Allen & Unwin. Always, J. ( 1995). Critical theory and political possibilities.  Westport, CT: Greenwood Press. Anthony, S. ( 2013, February 22). The first real, high-resolution, user-configurable bionic eye. Retrieved from http://www.extremetech.com/extreme/149106-the-first-real-high-resolution-user-configurable-bionic-eye Ashworth, D. ( 2014). I spy with my bionic eye . Pittsburgh: Dorrance Publishing. Ayton, L. N., Blamey, P. J., Guymer, R. H., Luu, C. D., Nayagam, D.A.X., Sinclair, N. C., et al.  . ( 2014, December 18). First-in-human trial of a novel suprachoroidal retinal prosthesis. PLOS One. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115239 Beckett, A. E., & Campbell, T. ( 2015). The social model of disability as an oppositional device. Disability & Society , 30, 270– 283. Google Scholar CrossRef Search ADS   Bionics Institute. ( 2015). Fact sheet: Bionic eye. Retrieved from http//:www.bionicsinstitute.org/publications/Documents/FactSheet_BionicEye.pdf Bionic Vision Australia. ( 2015a). The bionic eye devices. Retrieved from http://bionicvision.org.au/eye/prototypes Bionic Vision Australia. ( 2015b). BVA—Book 2015. Retrieved from http://bionicvision.org.au/__data/assets/pdf_file/0009/1693926/BVA-Book-2015.pdf Bourdieu, P. ( 1986). The forms of capital. In J. G. Richardson (Ed.), Handbook of theory and research for the sociology of education  (pp. 241– 258). New York: Greenwood. Bourdieu, P. ( 1993). Sociology in question  (Richard Nice, trans.). London: Sage Publications. Bourdieu, P., & Wacquant, L.J.D. ( 1992). An invitation to reflexive sociology . Chicago: University of Chicago Press. Campbell, J., & Oliver, M. ( 1996). Disability politics: Understanding our past, changing our future . Abingdon, Oxfordshire, UK: Routledge. Corker, M., & Shakespeare, T. ( 2002). Disability/postmodernity: Embodying disability theory . London: Continuum. Davis, L. J. ( 1995). Enforcing normalcy: Disability, deafness, and the body . London: Verso. Foucault, M. ( 1972). The archaeology of knowledge . New York: Pantheon. Foucault, M. ( 1973). The birth of the clinic: An archaeology of medical perception . London: Tavistock. Freire, P. ( 1972). Pedagogy of the oppressed . Harmondsworth, UK: Penguin Books. hooks, b. ( 2003). Teaching community: A pedagogy of hope . New York: Routledge. Ife, J. ( 2013). Community development in an uncertain world: Vision, analysis and practice . Melbourne, Australia: Cambridge University Press. Kenny, S., & Connors, P. ( 2017). Developing communities for the future  ( 5th ed.). Melbourne: Cengage Learning Australia. Oliver, M. ( 1983). Social work with disabled people . Basingstoke, UK: Macmillan. Google Scholar CrossRef Search ADS   Oliver, M. ( 1990). The politics of disablement . Basingstoke, UK: Macmillan. Google Scholar CrossRef Search ADS   Oliver, M. ( 2009). Understanding disability: From theory to practice  ( 2nd ed.). New York: Palgrave Macmillan. Google Scholar CrossRef Search ADS   Oliver, M. ( 2013). The social model of disability: Thirty years on. Disability & Society , 28, 1024– 1026. Google Scholar CrossRef Search ADS   The Scientist Magazine. ( 2014, October 1). The bionic eye. Retrieved from http://www.the-scientist.com/?articles.view/articleNo/41052/title/The-Bionic-Eye/ Second Sight. (n.d.). Second Sight [home page]. Retrieved from http://www.secondsight.com Shakespeare, T., & Watson, N. ( 2001). The social model of disability: An outdated ideology? In S. Barnartt & B. Altman (Eds.), Exploring theories and expanding methodologies: Where we are and where we need to go  (pp. 9– 28). London: Emerald Group Publishing. Google Scholar CrossRef Search ADS   Smith, B. ( 2015, May 5). Human trials for bionic eye with ‘wireless brain chip’ to start next year. Retrieved from http://www.smh.com.au/technology/sci-tech/human-trials-for-bionic-eye-with-wireless-brain-chip-to-start-next-year-20150504-1mz9i2.html Thompson, N. ( 2012). Anti-discriminatory practice: Equality, diversity, and social justice.  New York: Palgrave Macmillan. Google Scholar CrossRef Search ADS   Titchkosky, T., & Michalko, R. ( 2009). Rethinking normalcy: A disability studies reader . Toronto: Canadian Scholars’ Press. Walsh, F. ( 2015, July 21). Bionic eye implant world first. Retrieved from http://www.bbc.com/news/health-33571412 Zitzelsberger, H., Odette, F., Rice, C., & Whittington-Walsh, F. ( 2002). Building bridges across physical difference and disability. In S. M. Abbey (Ed.), Ways of knowing in and through the body: Diverse perspectives on embodiment  (pp. 259– 261). Toronto: Soleil, Welland. © 2017 National Association of Social Workers http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Health & Social Work Oxford University Press

Bionic Vision, Social Work, and Community Development: A Research Participant’s Reflections

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Abstract

Abstract This article discusses bionic vision through the author’s experiences as Australia’s first research participant in an early prototype bionic eye trial. During her two-year participation, she drew on various theoretical perspectives, including critical and community development approaches that not only influence her professional social work perspective, but extend to her personal worldview. In a rapidly emerging biotechnological age, this article contributes a holistic perspective, bringing into focus theory and practice; issues of human experience, human rights, and oppressive relationships; tensions between agency and structure (particularly relating to disability from a social model of disability and the medical model); and practical applications of artificial vision. Beyond its practical applications, illuminated is the relevance of community development values and principles such as a sense of connectedness, participation, and empowerment, which are understood in terms of an antioppressive perspective. The article concludes by recognizing the potential benefit of bionic vision for vision-impaired and blind people in their everyday lives. anti-oppressive practice, bionic vision, community development, disability In 1984 when I was diagnosed with retinitis pigmentosa (RP) and told I was losing my eyesight, and eventually would go blind, I never imagined I would become a social worker, undertake PhD research, or lecture at a university. Moreover, in 2010 when I received an invitation to attend the Royal Victorian Eye and Ear Hospital to discuss the bionic eye research, I never imagined I would be asked to take part in it. The invitation quickly filled my mind with inquiry and curiosity. What an opportunity, I first thought. How many people would ever have a chance to do something like this? Was it safe? How would the device be implanted? How long was the research? Was the device easy to remove? With my curiosity satisfied about the medical safety of the procedure, I became the first of three research participants to have an early Australian 24-electrode prototype bionic eye device implanted in my eye. However, although I felt excitement about being the first in the world to participate in this type of technological miracle, for me it initially raised dilemmas about how disability is understood. From a medical model the aim is to fix the problem, but from my personal and social work perspective, being valued and accepted as an equal for one’s difference, whatever that might be, was a source of conflict for me. The following is my critique of this tension through different theories that influence my worldview as I reflect on my two-year participation in the early prototype bionic eye trial. With a focus on human rights and social justice the discussion is critical (Allan, Pease, & Briskman, 2003), but it is also holistic because it includes a community development (CD) perspective (Ife, 2013; Kenny & Connors, 2017) with my experience with this biotechnical phenomenon. What Is a Bionic Eye? According to the Bionics Institute (2015), a bionic eye mimics the function of the retina to restore sight for those with severe vision loss. It uses a retinal implant connected to a video camera to convert images into electrical impulses that activate remaining retinal cells which then carry the signal back to the brain. (para. 1) Now beyond theory, this visual prosthesis (bionic eye), is being researched and developed and is becoming reality for vision-impaired and blind people in different countries across the world. For example, the Argus II device, initially developed in the United States by Second Sight to restore vision in people with RP, is now commercially available in the United States and Europe. More recently, on July 21, 2015, in Manchester, England, this device was successfully implanted in an eighty-year-old man who has the dry form of age-related macular degeneration (Second Sight, n.d.; Walsh, 2015). Other examples of devices currently being researched and clinically evaluated include the Alpha IMS, developed by the University of Tübingen in Germany (Anthony, 2013); arrays with micrometer pixels developed by Pixium Vision in France (The Scientist Magazine, 2014); and even a bionic eye using a wireless chip in the brain rather than in the retina, developed by the Monash Institute of Medical Engineering in Australia (Smith, 2015). Bionic Vision Australia (BVA), a consortium of world-leading experts from disciplines of ophthalmology; biomedical engineering; electrical engineering; materials science; neuroscience; vision science; psychophysics; wireless technology; integrated-circuit design; and surgical, preclinical, and clinical practice is also developing different bionic eye devices. This includes a 98-electrode wide-view device, a 256-electrode high acuity device, and a 44-electrode prototype device that will continue the learning from the earlier 24-electrode prototype device that I tested (BVA, 2015a). The Australian Prototype Bionic Eye Building on technologies used in cochlear implants, this 24-channel prototype device comprised a 19 mm long and 8 mm wide intraocular platinum electrode array in a medical-grade silicon base, which was surgically implanted behind the retina in the suprachoroidal space between the choroid and sclera. A lead ran under the skin from the array to a percutaneous connector behind the ear that allowed direct stimulation (Ayton et al., 2014). A small external camera situated on the bridge of a pair of glasses captured images that were processed by the vision processing software to stimulate corresponding electrodes on the array. The remaining retinal cells and the visual pathway (optic nerve and visual cortex in the brain) responded to produce phosphene or artificial vision. A semiportable stimulator that was housed in a backpack allowed mobility while using the bionic eye device (BVA, 2015b). This device was suitable for people like me with advanced-stage RP, because although there is significant degeneration of photoreceptor cells in the retina, the remaining retinal cells and the optic nerve are still able to process the electrical stimulation. When I agreed to take part in this research, these light-sensitive cells in my retina had deteriorated to a level where I only had light perception vision; I could not recognize forms at all. Indeed, through a mass of swirls, I had only perceived light and dark for over 20 years, which is how I viewed my world after the research trial finished and still do, at this time of writing. What Happened? On May 22, 2012, the early prototype device was surgically implanted in my left eye. Once my eye healed, on July 16, 2012, the device was switched on. This was a day of historical significance as it was the day the scientists, engineers, and doctors found out the device worked. The electrical current sent to the electrodes produced spots of light, what they call phosphenes. While in theory these phosphenes were expected to be circular as a direct representation of the electrodes, their shapes were varied and diverse. I felt joy and was filled with warmth when I saw these images, even though at that stage they were abstract and had no meaning. As I explain later in the text, it wasn’t until later on that the significance of seeing these phosphenes became apparent. For the next two years, I continued helping the scientists test the device (for further detail see Ashworth, 2014). My Reflections Starting the Research Journey Indeed, those two years were a learning journey for me, too. In my capacity as a research participant testing this visual prosthesis I was clearly advancing science, but it also raised tension for me around the human or, more specifically, the relationship between this development and people with vision impairment or who are blind. From my social work perspective, I wondered about why artificial sight would benefit them. Initially I thought, would it provide opportunity, acceptance, and social justice for them? One of the questions in my mind was, why do people need artificial vision if they are accepted as equals and have equal opportunity? As such, one of the tensions I experienced when I first began testing this early prototype bionic eye was whether I was helping scientists to make blind people “normal.” As a lecturer in social work, teaching students both theory and practice, I was well aware of the tension between the medical model and social work—how the medical model interprets disability in terms of illness or disease (Titchkosky & Michalko, 2009). From a medical perspective, disability is something to overcome (Zitzelsberger, Odette, Rice, & Whittington-Walsh, 2002) or make normal, whatever that is. The notion of normalcy evokes robust debate (for example, see Foucault, 1973), but I will not elaborate on it here other than saying that I understand it as a divisive and oppressive social category of ableism symptomatic of our unequal economic capitalist society (Oliver, 2009). Thus, accompanying my internal conversation about participating in the early prototype bionic eye trial was my identity as a normal person alongside the medical model that aims to fix the problem. This was problematic for me as my loss of vision was not a problem, and in fact I had achieved far more being blind than when I had sight. Indeed, despite identifying as a normal person who was now doing the same but in a different way, it was others’ attitudes and their assumptions that I found problematic. This reflects tension between the social model of disability largely attributed to Michael Oliver (1983, 1990), who asserted that people with disabilities are disabled because of social attitudes and behaviors. According to Oliver (1983, 1990), shifting attention toward the social was intended to provide an alternative for those working with people with disabilities commonly framed within an individual medical model (Oliver, 2013). Indeed, bringing into light the assumptions, power, and control of the medical model (Davis, 1995) and its relationship with individual experience in many respects contributes to an agency or structure discourse that raises awareness of oppressive practice (Oliver, 2013). As a “blind” person I have certainly experienced this oppressive relationship, and it is one that I consciously resist (Beckett & Campbell, 2015). However, I have never lost confidence in being abled (and normal), and my identity of myself remains stable. Over time, I have internalized how others relate to me by adapting different coping strategies, for example, being proactive to overcome assumptions and at other times withdrawing to avoid judgment. One theoretical perspective that explains this relationship is an anti-oppressive perspective (Thompson, 2012) through the personal, cultural, and structural levels of society intertwining as unequal power relations. Other theories I draw on to explain this oppression include a feminist perspective that asserts that the personal is the political, or those in positions of power who have influence over how people relate and identify a relationship, a relationship that Foucault (1972) explained in terms of social discourse, and one that Bourdieu described in terms of power and competition (Bourdieu, 1993; Bourdieu & Wacquant, 1992). CD, as I understand it, is “the process of establishing, or re-establishing, structures of human community within which new ways of relating, organising social life, promoting human rights and meeting human needs become possible” (Ife, 2013, p. 9), and it is an approach that I hold close to my heart and, thus, its values, principles, and philosophy accompanied my thoughts into the research. Through CD I embrace principles of human rights, diversity, interdependence, reciprocity, participation, balance, process, holism, inclusion, and acceptance, valuing the local and more (Ife, 2013). We are all equal and experts in our own rights, and with this in mind, I worked with the scientists throughout the clinical trial. It is interesting to note that, from a social model of disability perspective, this meant that I was challenging the superiority of the medical model, but at the same time, through the values espoused by CD, I was embracing my own and its expertise. CD is certainly part of my critical thinking, and its principles guide my coping mechanism as I resist oppressive relationships of power and competition that are associated with dominant ideologies of our contemporary life. Hence, for me a CD perspective brings relationships alive, and I understand the importance of connecting and having a sense of community. Indeed, it is something I consciously related to throughout the research. For instance, when walking to the testing booth at the Bionics Institute early on in the study with one of the scientists, I was asked what my reaction might be if there was public outcry and protest from the blind community or others against it. What would I do if I had eggs thrown at me by some members of the deaf community (for example, those belonging to the Big D deaf community), like the research participants who tested the bionic ear 30 years before did? Thankfully I didn’t experience any hostility, but it did make me reflect on the similarities and differences between the deaf and blind community. For me this highlighted how some sections of the deaf community similar to what I was internally struggling with in the beginning of my participation in this prototype bionic eye research, were resisting the medical notion of normalcy with artificial hearing, too. Curiously, reflecting on my own experiences, I became aware that this sense of community was not as prevalent for me as a blind person. As a social worker, I wondered why. What might the link between the personal and political be? Does society discriminate and oppress one group more than the other? Does being blind physically limit activity and social connection? Does internalization of wider social beliefs, attitudes, and actions explain this response? These questions, and more, I took with me as I proceeded in the trials. Thus, my mind was full of inquiry extending from different ways of understanding my participation in the early prototype bionic eye trials, and as the science unfolded so, too, did my theoretical understanding of it. The following is a brief account of the research, one that is recalled by me as a well-informed participant and is therefore not to preside over other reports of the Centre for Eye Research Australia or BVA research results. My Research Journey Psychophysics With goggles on and wire running from the side of my head to the computer, one day a week, I sat in the testing booth testing different electrical parameters of the device as the scientists sent an electrical current to it. During these test sessions, referred to as psychophysics sessions, they measured the levels of my thresholds, or the lowest point at which I could detect something. They learned what my phosphenes looked like as I drew them in the air with a motion sensor attached to my finger. They learned the area of vision where I saw these spots of light as I plotted the positions of them on a board. Later on they tested my ability to detect direction of movement through variation of speed and size of horizontal, vertical, and diagonal bars. They learned that it was not easy to replicate letters and numbers with my unorthodox 24-electrode phosphene map, although I reliably recognized the shape of the number 7. What did I learn from psychophysics? I learned that although the device was safe and the aesthetics of these visual percepts were nice to look at, I couldn’t fully comprehend them as useful in my everyday life. Camera Information gathered from psychophysics was also contributing to the software that operated the camera. Positioned on the bridge of the goggles, this camera conveyed information from the surrounding environment to activate relevant electrodes that in turn produced corresponding phosphenes. Testing the camera, the scientists first learned that the phosphenes reliably helped me identify the difference between light and dark. Later on they learned that using brightness, the phosphenes enabled me to identify the direction of moving shapes and the rotating gap in a letter C eye test presented on an electronic screen. They learned also that phosphenes produced by the camera were sufficient for me to identify varying bars running in different directions. They learned that after some time, brain plasticity occurred. Rather than being aware of the information coming from the camera, I experienced an intuition that the information was coming through my eye! What did I learn from the camera? I started thinking that there might be some practical application for the bionic eye in everyday life. I became aware that the brain is amazing and can adapt as it interprets and makes sense of new information. Semiportable Unit A backpack housing the computer powered by batteries meant the prototype device could be tested beyond the research booth. Through using contrast in a controlled environment, the scientists learned that it is possible to identify different objects. They also learned that sometimes it is difficult to differentiate between object and light reflection when I moved about. What did I learn from testing the semiportable device? I learned that too much information can hinder rather than help. I learned that perceiving brightness on the move created more questions about the environment than provide answers. I learned that I was more cautious about information I did not understand. However, I also learned that in controlled environments that emphasized contrast, my brain adapted and I became more comfortable and quicker with practice. I also felt, at this point, that I would not want this version of a bionic eye. Semiportable Unit Using Depth Perception Using a depth perception camera while moving about, it is possible to detect, negotiate, and avoid obstacles according to their mass, regardless of their brightness and contrast. The scientists learned that a depth perception camera can add a sense of distance and is an effective way to identify items beyond a flat surface. What did I learn from depth perception? I learned that the phosphenes produced through depth perception were more reliable when navigating obstacles than those produced by contrast of brightness. I learned that with practice I became quicker at understanding the phosphenes and therefore their familiarity meant I became quicker at negotiating obstacles. I learned that this was my preferred version of the prototype bionic eye I tested—it had more practical applications and would be something I would be happy to have later on, once the device was available. It was at this point of testing this prototype bionic eye that I realized how practical I am! I wasn’t worried about aesthetics but, rather, how bionic vision could help me until . . . Semiportable Unit Outside In the last week of testing, the researchers gained ethical approval for me to use the semiportable unit using brightness perception outside. Walking up the street I saw lighter color cars in the traffic as they drove by. Through the brightness of their clothing, too, the phosphenes told me there were people in front of me waiting for the green light to cross the road. Around the corner I went. As I curiously tried to figure out if the phosphenes were telling me there was an obstacle in front of me, one of the researchers let me know I was looking at sunlight flickering through the branches onto the footpath, which confirmed to me that a bionic eye using brightness was not practical in this instance. However, as I looked up I could see the light and dark stripes painted on the side of the building. This gave me information that previously eluded my visual concept of an environment I walked with my guide dog every week. Now aesthetics had meaning. But even more important, as I stood in the café ordering a coffee, I saw the barista for the first time. Not only was this prototype bionic eye practical in this instance, it was social, too! I felt connected to my environment, an amazing feeling, as this picture speaks more than a thousand words. This last day of testing was a significant one for me also. I learned that there is practical and social use for both brightness and depth perception when using a bionic eye. Being able to select between one and the other mode in different situations would be ideal. End of My Research Journey On July 29, 2014, I had the working elements of the bionic eye surgically removed: the first clinical trial of this Australian prototype bionic eye research was over. The scientists were thrilled with what they had learned, and I had grown also. After months of contemplation, I look back and “see” my own views on the bionic eye and disability in a clearer light. My critical thinking has indeed brought together theory and practice as I consolidate, develop, and extend my own reflections on bionic vision and its relationship to people who are blind or vision impaired. So with my research participant hat officially hung up, and my social work one firmly on, similar to my previous views, I am still very aware of the relevance of the social model of disability in terms of challenging power relationships that oppress and marginalize people with disabilities. I still appreciate that these relationships are not always recognized, and subsequently inequality is unconsciously perpetuated through the interaction between individuals and different layers of social structure. I still identify as normal and resist the idea of the medical model prescribing a bionic eye to fix my problem or addressing my sense of normalcy. I still celebrate human rights, social justice, and the values and principles of CD such as participation, inclusion, acceptance, reciprocity, holism, mutuality, and more. However, through my critical reflections and participation in the early prototype bionic eye trial, I am now more aware of its beneficial implications; on the horizon I see positive application for bionic vision not only for individuals, but also for community and society alike. It is interesting to note that this is more than just a simple discussion of the contrast between the medical model and social model of disability. Rather, as Shakespeare and Watson (2001) recognized, a holistic approach to the social model of disability is required to fully appreciate the intrinsic relationship between agency and structure. As such, this brings forward my awareness of how social relationships, including oppressive ones, interrelate on a personal, cultural, and structural level (Thompson, 2012), but surprisingly, as I will explain, it also shines light on the CD perspective, subsequently reinforcing my belief in and passion for its relevance in all areas of contemporary life. What I learned in the first instance was that instead of a cure to blindness provided by the medical model, this device has potential to be a useful aid for people with vision impairment or who are blind. The information conveyed through brightness and depth perception by the phosphenes can have practical relevance in their everyday life. This will be an adaptation and interpretation of new information in relation to the surrounding environment. Like training with a guide dog, or a cane, or learning to use a computer using a screen reader, I believe that bionic vision can benefit those people who learn to use it. But understanding that using a bionic eye can be a social experience, too, which extends the ripples of its beneficial implications. Being able to interact visually when I was ordering my coffee, even though it was not normal vision, increased my sense of connection and community. This was an “aha!” moment for me, as it raised my awareness of the need for human beings to connect with each other. And as this happens on many levels, for example through sensations of sound, touch, and even smell, being able to connect through seeing and interacting with people around me brought with it joy. This was a powerful experience and, as such, increased my sense of confidence. From that moment, I realized the significance of bionic vision for people who are blind or vision impaired. I realized its potential to strengthen their sense of self, and with confidence they can resist oppression (and its subsequent internalization). Furthermore, with participation and wider social connection, they can raise awareness and develop a sense of community that in turn continues to strengthen their sense of self. According to CD, everything that happens is part of the bigger picture, relationships are complex and interrelated, there is no beginning or end, problems do not have simple causes or solutions, and knowledge and action as well as theory and practice are linked, which well supports the relevance of how relationships are holistic (Ife, 2013). Subsequently, through their sense of connection and community, people using bionic vision can address oppression and thus human rights and social justice issues experienced by people with disabilities organically (Ife, 2013), rather than a discovery of their own oppression and struggling to become “self-affirming subjects of their own destiny,” as Freire (1972, p. 83) asserted. In essence, when participation in society occurs, there is scope to bridge the personal and political by challenging oppressive discourses and shifting unequal relationships of power and promoting mutual acquaintance (Bourdieu, 1986). This is what I describe as anti-oppressive practice within a CD framework that focuses on assets rather than deficits (Kenny & Connors, 2017). Promoting mutual acquaintance also highlights the importance of understanding process rather than just the outcome (Ife, 2013), or the importance of how the experience of seeing with bionic vision unfolds for people, and not just fixing the problem of being vision impaired or blind. Moreover, increased interaction between personal experience and others also provides opportunity to challenge cultural and societal perceptions about being disabled and replacing it with a common human experience of difference. In my experience with a variety of media during the prototype bionic eye trials, this is something I certainly promoted. Indeed, on the wider social structural stage in contemporary life where technology is increasingly merging as part of everyday activity, there was real opportunity for me as a blind person to open a conversation by sharing how technology has enabled me to achieve a PhD and teach at a university, in other words, how I was doing the same as other students and lecturers do, but in a different way. In essence, I was continuing the conversation created by the social model of disability in the last century in the aim to raise awareness (and subsequent policy change) through media, education, and communication. Through my personal experience I was using anti-oppressive practice guided by the values of CD in an attempt to educate wider society’s attitudes toward social inclusion and acceptance, and celebrating diversity and difference as normal. This is what the social model of disability frames in terms of raising “disability consciousness” both personally and socially within a “disabling society” (Campbell & Oliver, 1996), and it is a conversation that people using bionic vision who experience an increased sense of confidence and agency have potential to widen and contribute to social change, too (Always, 1995; Corker & Shakespeare, 2002). Thus, at the end of my research experience, as I look back on it through my critical social work lens, I clearly see the importance of different ways to understand a situation and that many perspectives contribute to genuine positive change. My hope is that bionic vision has potential to help vision-impaired and blind people both practically and socially, and enable others in society to see the human beyond his or her disability. Although my reflections on my participation in this early prototype bionic eye trial convey only one voice in a larger biotechnical conversation, for me they have certainly reinforced the values and principles of CD and an anti-oppressive approach as part of my social work critical thinking, particularly when resisting dominant ideologies, challenging oppressive relationships, and working toward human rights and social justice. As such, from my previous thoughts as I look ahead, my vision for bionic vision is that it enhances life. This is not to be confused with shallow notions of elusiveness or experiencing diversity where one stands alone in the space of privilege, taking in and from those who are other. But rather where one is fundamentally moved—transformed utterly. The end result of this transformation is mutuality, partnership, and community. (Scapp, cited in hooks, 2003, p. 115) Conclusion Participating in the Australian early prototype bionic eye research was an extraordinary experience, one indicative of the biotechnological age of contemporary life. Although it is certainly an expansive time in which technology is advancing, it is also a time we are yet to fully appreciate its uses and implications (Ife, 2013). Through my experience of bionic vision, I became aware of several ways this artificial sight can benefit people who are vision impaired or blind. First, it has potential to help people with the activities of their everyday lives. For example, when I think about what my own life with bionic vision might be like, I imagine standing with my guide dog at the corner where the phosphenes alert me to a stationary hybrid car silently idling before I can safely cross the road, or standing at the front of the classroom seeing my students, or finding that article of clothing the wind blew off my clothesline onto the grass, or seeing my family including my children and grandchildren. But beyond its practical application, interacting and connecting to one’s environment is social, too. As I learned, this is an empowering experience, one that gave me confidence and a sense of community as I visually connected to my immediate environment. When understanding the value of holism, and how relationships interact, as CD does, this highlights potential for social change through this personal interaction with a wider social structure. In other words, from a CD perspective, rather than the medical model simply fixing a problem, through its new way of relating, bionic vision has potential to reestablish structures of human community, promote human rights, and meet human needs (Ife, 2013). Indeed, increased participation through bionic vision is an anti-oppressive practice, too. We are surely standing on a new exciting horizon—a place where the sun is rapidly rising over the meeting ground of medicine and technology. When I turn my attention to the future, I recognize real potential for bionic vision to help vision-impaired and blind people in their everyday lives on many levels. As this discussion concludes, I leave it wondering about bionic vision as an aid connecting vision-impaired and blind people to their social world, not just to help them with tasks of everyday living but to increase their participation and sense of community, which has potential to increase their confidence and agency and further social interaction, which can contribute to break down barriers of oppression. As I complete this writing, the scientists are preparing for the second stage of the prototype bionic eye trial to continue the learning from the 24-electrode early prototype version I tested. This is an exciting step as the next trial research participants will test a 44-electrode device not only in the research laboratory, but also in their home environments where they will interact with others and undertake their everyday activities. As a critical reflective social worker, I wonder what their experience and reflections might be. References Allan, J., Pease, B., & Briskman, L. 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Retrieved from http://www.smh.com.au/technology/sci-tech/human-trials-for-bionic-eye-with-wireless-brain-chip-to-start-next-year-20150504-1mz9i2.html Thompson, N. ( 2012). Anti-discriminatory practice: Equality, diversity, and social justice.  New York: Palgrave Macmillan. Google Scholar CrossRef Search ADS   Titchkosky, T., & Michalko, R. ( 2009). Rethinking normalcy: A disability studies reader . Toronto: Canadian Scholars’ Press. Walsh, F. ( 2015, July 21). Bionic eye implant world first. Retrieved from http://www.bbc.com/news/health-33571412 Zitzelsberger, H., Odette, F., Rice, C., & Whittington-Walsh, F. ( 2002). Building bridges across physical difference and disability. In S. M. Abbey (Ed.), Ways of knowing in and through the body: Diverse perspectives on embodiment  (pp. 259– 261). Toronto: Soleil, Welland. © 2017 National Association of Social Workers

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