Given that the last essay discussed medical interventions like amputation, it seems like a suitable time to take a look at the devices we’ve developed to help people deal with disabilities of many kinds — and what kinds of improvements could still be made.
Defining my terms first: a prosthesis replaces a missing body part, while an assistive device is anything meant to help the user function more effectively, specifically in situations of disability. (You could make a semantic argument that, say, my phone is an assistive device for helping me remember appointments, but that’s not the sense I’m looking at here.) Overall the aim of a prosthesis tends to be to restore function in the missing part, but that category also includes things like artificial eyes, which — so far! — are not able to provide any visual input. They’re only there to normalize the wearer’s appearance.
Which, right there, is a whole can of worms on the disability front. Modern materials engineering has poured huge amounts of effort into making prostheses lighter and more comfortable to wear for long periods of time; we are long past the limitations of, say, a wooden leg. But there can still be pressure for an individual to wear a prosthesis for other people’s comfort, even if that’s not so great for them, so that nobody has to confront the sight of an amputated limb. Although much of the attention here will be on function, that’s hardly the only aspect in play: how much expectation is there of “normal appearance,” versus acceptance of differences?
But the main idea behind a prosthesis is that it should restore at least some functionality. The three main categories for limb prostheses are passive, body-powered, and externally powered, of which the former is the oldest type by thousands of years: we’ve got the foot of a New Kingdom Egyptian mummy from around 1000 BCE that sports a wooden toe, whose wear patterns show the user definitely walked on it. (Our absolute oldest archaeological evidence of a prosthesis is a cosmetic false eye in Iran; that one predates the toe by another two thousand years.) You can find examples of these in mythology, too! After Demeter failed to notice that Tantalus had served up his son to feed the gods and noshed on his shoulder, Hephaestus made him a replacement out of ivory.
Passive prostheses were historically made out of wood or metal, with various arrangements of straps and so forth to hold them on. As you can imagine, this means they were very heavy compared to their modern counterparts. And while some of them were (and are) adjustable — for example, a hand that can be locked in an open or closed position — the functionality they provide is limited. Someone with a wooden foot or leg can walk, but it takes much more energy than usual; someone with a metal hand can pin objects in place, or even swap the hand out for specialized prostheses like a pen or a knife, but they won’t have the full dexterity of a healthy hand. (And yes, sometimes a hand prosthesis takes the form of a hook. J.M. Barrie didn’t make that up.)
With modern materials, these limitations can be greatly improved. Back in 2008, the Olympics wrestled with a dispute over Oscar Pistorius, a runner who used “blade”-style prosthetics in place of his amputated feet; although officials ultimately ruled that the reduction in energy usage granted by the prosthetics did not outweigh his overall disadvantages, it conjured the image of a future where prosthetics may become more effective than what nature granted us. We aren’t there yet, but the notion isn’t an absurd one.
Development isn’t only about improving passive function, though. Especially for hands, there’s a lot to be gained from making fingers and wrists that can respond to the wearer, providing a greater range of capability. Body-powered prostheses rely on harnesses and cables to achieve this effect, while externally powered ones use electrodes to read impulses from nearby muscles and spark a response in the prosthesis. I’ve definitely seen science fictional extrapolations of this, where an artificial limb is controlled by the brain in essentially the same fashion as a biological one: all I have to do is decide to pick up my water glass, and my hand will perform that task. I’ve yet to see a magical equivalent, though — if anybody has examples, please mention them in the comments!
Assistive devices occupy a much broader range, because they encompass anything that can help a person carry out tasks more easily and effectively. This includes everything from a stick to help a blind person detect obstacles or Braille to help them read, to ear trumpets (a few hundred years old) or hearing aids (recent) to amplify sound for someone hard of hearing, to the glasses and contact lenses many of us wear, to OXO’s Good Grips line of kitchen utensils — the founder originally created those to help his wife, whose arthritic hands made ordinary utensils difficult to use without pain.
Mobility devices are a huge category here, because mobility problems are something a huge percentage of the population faces sooner or later. The use of a staff or a cane for balance and support in walking is truly ancient, to the point where such a thing is a common symbol for old age. Wheelchairs have a more complex history; the earliest use of wheeled seats to transport someone seems to be from China around the second century BCE, though truly purpose-built devices came about seven or eight hundred years later. (Europe caught up to this idea about a thousand years after China.) The older forms of those, however, required someone else to roll you around. The issue of weight again rears its head: the first self-propelled wheelchair was essentially a hand bike, relying on gearing to create enough force to move the mass of the chair plus its occupant. The basic design that’s common now wasn’t invented until the 1930s, at which point you finally had lightweight, foldable chairs that allowed users to control their own movements.
Which is the point I want to end on. There are multiple reasons for the backlash against “cure narratives” for disability in fiction, but one of them is that it points people’s attention toward a goal that may or may not ever be feasible, and away from the changes that can improve the lives of people with disabilities right now. Improvements in prostheses, creative development of assistive devices, and changes in the physical and social environment (like the U.S. Americans with Disabilities Act, which mandates things like wheelchair-accessible entrances) make an enormous difference in people’s ability to live full and satisfying lives. Speculative fiction often gives us magic or futuristic technology that waves these problems out of existence; it devotes much less thought to how those elements could be used to make incremental improvements instead.
But I owe my kitchen full of comfortable gadgets to Betsy Farber’s arthritic hands. What else might we create, if speculative fiction gave us the idea?