10.6092/issn.2038-3460/17475
Feminist scholars were among the first to argue for the importance of including ageing and later life in STS research. Remarkably, most studies on technoscience and ageing only address technologies external to bodies. Although this scholarship has provided important insights into the many different ways in which technologies intersect with ageing I suggest that it is important to expand our analyses to technologies inside bodies. How can we understand ageing and agency in times when technologies become increasingly implanted in our bodies? In this article I will present three conceptual approaches that correspond to growing discussions at the cross-roads of STS, age and disability studies, and feminist scholarship, including cyborg theory, constructivist perspectives on vulnerability and resilience, and intersectional approaches. I will build on some of my previous theoretical and empirical work on pacemakers and implantable cardioverter-defibrillators to discuss how age matters when technologies move under the skin.
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2038-3460
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Nelly Oudshoorn
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vulnerability and resilience
Graying the Cyborg Revisited. How Age Matters when Technologies Move under the Skin
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Lectures
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Nelly Oudshoorn
2020
10.6092/issn.2038-3460/17475
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vulnerability and resilience
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Graying the Cyborg Revisited. How Age Matters when Technologies Move under the Skin
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11
                                                                             Lecture

Graying the Cyborg Revisited
How Age Matters when Technologies Move under
the Skin

Nelly Oudshoorn
University of Twente, NL



     Abstract: Feminist scholars were among the first to argue for the im-
     portance of including ageing and later life in STS research. Remarkably,
     most studies on technoscience and ageing only address technologies exter-
     nal to bodies. Although this scholarship has provided important insights in-
     to the many different ways in which technologies intersect with ageing I
     suggest that it is important to expand our analyses to technologies inside
     bodies. How can we understand ageing and agency in times when technolo-
     gies become increasingly implanted in our bodies? In this article I will pre-
     sent three conceptual approaches that correspond to growing discussions
     at the cross-roads of STS, age and disability studies, and feminist scholar-
     ship, including cyborg theory, constructivist perspectives on vulnerability
     and resilience, and intersectional approaches. I will build on some of my
     previous theoretical and empirical work on pacemakers and implantable
     cardioverter-defibrillators to discuss how age matters when technologies
     move under the skin.

     Keywords: technology and ageing; graying the cyborg; technologies inside
     bodies; pacemakers and cardioverter-defibrillators; vulnerability and resili-
     ence.

     Submitted: September 4, 2020 - Accepted: November 16, 2020

     Corresponding author: Nelly Oudshoorn, Department of Science,
     Technology and Policy Studies, University of Twente, the Netherlands.
     Email: n.e.j.oudshoorn@gmail.com




1. Introduction

   Cyborgs are ageing. This applies to bodies implanted with
technologies, the people we study, and the very notion of cyborg itself. In
her seminal Cyborg Manifesto, Donna Haraway (1985) appropriated the

TECNOSCIENZA
Italian Journal of Science & Technology Studies
11 (2) pp. 13-32 - ISSN 2038-3460
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14                                                         Tecnoscienza - 11 (2)

cyborg figure to call for a critical engagement with the politics of techno-
science and for taking responsibility for technology (Gray, 2011).
Criticizing approaches that merely celebrate or condemn the increasing
dependency of humans on technology, she challenged us to rethink
human ontology to grasp what constitutes our contemporary life. In a
world permeated by techno-science, bodies and technologies should no
longer be considered as ontologically separate but as co-producing each
other (Oudshoorn 2020). In her feminist intervention into cyborg
discourse, Haraway not only challenged the rigid binary opposition
between organisms and machines but also other long-standing dualisms
such as nature/culture and male/female (Balsamo, 1996). By redefining
the meaning of cyborg from a technical metaphor1 into a concept that can
be used to subvert and displace troublesome dualisms, Donna Haraway
urged us to create alternative views, languages, and practices of techno-
science and hybrid subjects.
    In this article I will discuss three conceptual approaches to understand
the agency of old people living with technologies inside their bodies.
Although Donna Haraway did not attend to the ageing of cyborgs,
understanding the relationship between technology and ageing has
become an important, emerging theme in Science and Technology Studies
(STS). Feminist scholars were among the first to argue for the importance
of including ageing and later life in our research agenda. In Graying the
Cyborg, Kelly Joyce and Laura Mamo (2006) argued that new research in
STS should address the intersection between age, science, technology,
and gender. Age should no longer be neglected because older people are
increasingly targeted as consumers of new technologies such as assisted
living devices, entertainment technologies and pharmaceuticals. Equally
important, developments in biomedicine, including the rise of anti-ageing
medicine, construct and redefine the ageing body as a “set of age-related
diseases as well as a site for continual restoration and improvement”
(Joyce and Mamo 2006, p. 99). In this important and very timely call,
Kelly Joyce and Laura Mamo developed a research agenda that is still
valid today. They encourage us to study the ways in which technoscience
constitutes the experiences and meaning of ageing, the ageism underlying
the design, marketing and use of technological devices, as well as the ways
in which older people give meaning to and negotiate technological
applications in their daily life.
    More recent studies on the relationship between ageing and
technoscience draw the attention to policy discourses which create a
‘triple win narrative’ in which technological innovation is portrayed as the
ultimate solution to diminish the socio-economic consequences of ageing
populations. In this promissory narrative, technological innovation
emerges as a crucial actant in improving the life of old people, generating
new businesses and stimulation economic growth (Joyce et al. 2017;
Neven 2011, 2015; Neven and Peine 2017; Peine et al. 2015; Robert and
Mort 2009). These scholars argue that this discourse is problematic
Oudshoorn                                                               15
because it reinforces a negative rhetoric about ageing and old people such
as frailty and impairment (Peine and Neven 2011; Vines et al. 2015).
Moreover, it embraces a perspective in which ageing and technological
development are understood as separate processes, thus neglecting how
technoscience is already inextricably intertwined with the definition,
meaning and practices of ageing (Loe 2010; Peine et al. 2015). By
introducing the notion of “socio-material constitution of later life”,
Alexander Peine and his colleagues encourage us to study how the
interaction between ageing and technoscience both shape and is shaped
by a wide range of social, institutional, economic, policy, and material
settings, relationships and practices that surround ageing (Peine at al.
2015).
     Similar co-constitutive approaches to theorizing ageing and
technology 2 underly many STS studies on ageing and later life. This
research has created important insights of how sociotechnical imaginaries
construct ageing3, the ways in which these imaginaries4 are represented
and incorporated into design practices, and how elderly people are
included or excluded in technological design5. The latter studies highlight
how “design paternalism” is a key characteristic of many design practices
(Peine et al. 2014). This notion refers to practices in which designers
construct old people as passive, technology-averse, or technologically
illiterate users “who should follow what designers offer them” (Peine et
al. 2017, 927). This approach is very problematic because it leads to
technological objects that are useful for a very limited group of elderly
people (Bergschöld et al. 2020; Peine et al. 2017; Peine and Neven 2019).
Scholars therefore aim to go beyond the one-size-fits-all approach in
design practices by emphasizing the importance of taking into account
and accounting for the diversity of old people (Östlund 2005; Peace and
Hughes 2010; Peine et al. 2017). Equally important, feminist scholars
have provided a critical intervention into practices of design paternalism
by conceptualising old people as active agents of technological change or
“technogenarians”: “individuals who create, use, and adapt technologies
to negotiate health and illness in daily life” (Joyce and Loe 2010, 171)6.
This important research shows how old people often are early adopters of
new technologies, actively engage in tinkering with objects which inspires
innovation in technological design, participate in developing Do It
Yourself (DIY) technologies, or negotiate a meaningful space for
technology in their daily lives. These studies thus challenge long-standing
imaginaries about old people and innovation7.
     Remarkably, Kelley Joyce’s and Laura Mamo’s agenda-setting article
Graying the Cyborg only addresses technologies external to bodies. Alt-
hough they shortly mention technologies implanted in bodies, particularly
cardiac implants, they don’t include any further reflections on how hu-
man-technology relations may change when technologies move under the
skin. More recent studies on ageing and technology show a similar prefer-
ence for studying technologies external to bodies, including rolling walk-
16                                                         Tecnoscienza - 11 (2)

ers and drugs8, care robots9, and assisted living and telecare technologies,
such as remote alarms, sensors and automated pill dispensers10. Although
this scholarship has provided important insights into the many different
ways in which technologies intersect with ageing I suggest that it is im-
portant to expand our analyses to technologies inside bodies. How can we
understand ageing and agency in times when technologies become in-
creasingly implanted in our bodies? In what follows I will present three
conceptual approaches that correspond to growing discussions at the
cross-roads of STS, age and disability studies, and feminist scholarship,
including cyborg theory, constructivist perspectives on vulnerability and
resilience, and intersectional approaches. I will build on some of my pre-
vious theoretical and empirical work on pacemakers and implantable car-
dioverter-defibrillators (Oudshoorn 2015; 2020) to discuss how age mat-
ters when technologies move under the skin.


2. Rematerializing the Cyborg

    In contrast to the dominant images of the cyborg in science fiction and
popular media, hybrids of humans and machines are not only young men
(Haddow et al. 2015; Joyce and Mamo 2006; Joyce et al. 2017). Because
of the rise of anti-ageing or longevity medicine and gerontology, bodies of
older people are increasingly subjected to medical interventions, includ-
ing implants (Joyce and Mamo 2006; Joyce and Loe 2010). In recent dec-
ades we have seen the introduction of more and more technologies that
operate under the surface of the body, including artificial hips, knees, and
hearts, breast and cochlear implants, prosthetic arms and legs, spinal cord
stimulators, pacemakers, implantable cardioverter-defibrillators, and
emerging human enhancement technologies such as brain implants and
nano-chips for diagnosis and drugs delivery (Oudshoorn 2020). This
trend towards developing technologies that merge with bodies is also il-
lustrated by the Gartner Hype Cycle for Digital Government Technology
(Moore 2018), in which five of the technologies that are expected to have
“the most transformational benefit for government organizations over the
next 10 years” concern techniques that blur the boundaries between hu-
mans and machines, including bio-chips, artificial human tissues, and
brain-computer interfaces (Moore 2018; Noort 2018). Although some of
these technologies are used by people of all ages, older people constitute
the major ‘users’ of these medical devices.
    As anthropologists of medicine have argued, the increased attention to
ageing in biomedicine has constructed old age as a medical problem and
shaped and reinforced cultural ideals of ageing as undesirable, abnormal
and even pathological, as well as the cultural belief in extending life11.
Medical interventions in older people have increased substantially over
the past decades, as exemplified by the ICD, a life-extending heart im-
plant that has become a routine and standard treatment of older people in
Oudshoorn                                                                 17
wealthy, industrialized countries (Jeffrey 2001). As Sharon Kaufman and
her colleagues have described, the growing use of these medical devices
also includes the very old, particularly but not exclusively in the U.S.,
where twenty percent of ICDs are implanted in persons aged 80 and
above (Kaufman and Fjord 2011). In contemporary medicine saying no to
life-sustaining technologies has become extremely difficult (Kaufman
2015). Decisions about appropriate medical treatment are driven by the
availability and values given to technological interventions, particularly
the newest and most advanced technologies. This ‘treatment imperative’
(Fuchs, 1968) has increasingly become a moral obligation for clinicians to
continue medical interventions in ever older persons (Kaufman and Fjord
2011; Koenig 1988; Shim et al. 2008).
    For many older people, cyborgs are therefore not just fictional or
speculative imaginaries of the future but a lived reality, they are “everyday
cyborgs”. Gill Haddow and her colleagues introduced this term as a heu-
ristic to acknowledge the importance of the “participant voice currently
missing in existing cyborg literatures and imaginations” (Haddow et al.
2015, 484). But how can we understand the agency of people living with
medical implants? At first glance we may think that technologies inside
bodies assume a passive role of everyday cyborgs because they work au-
tomatically inside their bodies, taking them beyond the control of their
hosts. Technologies implanted in bodies thus challenge a long-standing
tradition of theorizing human-technology relations in STS and the philos-
ophy of technology that only address external technologies that can be
used at specific moments and places and are more or less under the con-
trol of humans12. However, most devices that operate under the surface of
the body delegate no agency to its “users” in terms of how they are sup-
posed to interact with these technologies13. Pacemakers and ICDs, for ex-
ample, are designed in such a way that agency is delegated only to the de-
vice. Pacemakers give electric pulses to the heart when the heartbeat is
too slow. The ICD is designed to do the opposite. It may give very fast
pulses or small or larger electric shocks to intervene into very fast, life-
threatening heart rhythms. These programs of action thus concern the in-
teractions between the heart and the device rather than with their users
(Oudshoorn 2020). Compared with external devices, most people living
with technologies inside their bodies cannot decide when, where, or how
to ‘use’ them. Although pharmaceuticals also intervene in the body, one
can decide to stop taking medicines. In contrast, people living with medi-
cal implants such as pacemakers and defibrillators cannot turn these de-
vices off (Oudshoorn 2020). Equally important, most of these medical
implants are inserted into bodies to stay there until the end of life. Or, as
Sherry Turkle (2008, 12) phrases it: “becoming cyborgs is not a reversible
step”. Technologies implanted in bodies are thus not bounded by a tem-
porality of use, but should be understood as continuous devices, which is
in sharp contrast to STS theories that conceptualize the interactions be-
tween humans and technologies as finite and limited temporal events,
18                                                          Tecnoscienza - 11 (2)

such as Actor-Network approaches and the Social Construction of Tech-
nology (SCOT)14.
    Although pacemakers and ICDs are designed in such a way that agen-
cy is delegated only to the device, the absence of programs of action for
its users still raises the question of whether everyday cyborgs are really so
passive. As I argued in Resilient Cyborgs (2020), any discourse or policy
that assumes a passive role of implanted persons silences the fact that
keeping cyborgs alive involves their active engagement. Many of them
participate in a lifelong trajectory of specialized monitoring to check
whether the devices still function properly, whether they need replace-
ment, and to adjust the agencies of the devices and to the agencies of the
body. Moreover, they have to learn to cope with the vulnerabilities of
their technologically transformed bodies, which may involve changes in
daily routines and social relations and a re-appropriation of how they ex-
perience their bodies. To understand the work involved in sustaining hy-
brid bodies, it is important to rematerialize the cyborg. As feminist schol-
ars have argued, the linguistic turn in cyborg studies and other fields ne-
glects the materiality of bodies (Dalibert 2014; 2016; Jain 1999; Sobchack
2006). According to Vivian Sobchack, who lives with a prosthetic leg, the
use of the cyborg or prosthetic figure as a metaphor has resulted in a dis-
course in which “the literal and material ground is forgotten or even disa-
vowed” (Sobchack 2006, 20). Cyborgs have thus lost their materiality. Re-
cent feminist post-humanist studies on the intimate relationships between
bodies and technologies, therefore call for new conceptual tools to recog-
nize and account for the intimacy of human-technology relations as mate-
rial and normative as well as the agency of cyborgs (Alaimo and Hekman
2008; Dalibert 2014; 2016; Lettow 2011; Oudshoorn 2015; 2020).
    One way to account for agency of everyday cyborgs is to look at their
sensory experiences. As Jones (2006) suggested, experiences with one’s
body are not just discursive or linguistic but include sensory experiences.
Most importantly, technologies may participate in creating new sensory
experiences (Dalibert 2014; Jones 2006). People living with pacemakers
or defibrillators, for example, face new sensory experiences mediated by
electric pulses and shocks that countermand or take over their heartbeats.
A focus on how people living with internal devices use their sensory expe-
riences as a resource to sense and make sense of their technologically
transformed bodies thus provides an important approach to conceptualize
the agency of everyday cyborgs (Oudshoorn 2020). Because older people
are a major target group of many new and emerging implants, under-
standing how sensory experiences shape later life and vice versa is im-
portant to include in future research.
Oudshoorn                                                                 19
3. Constructivist Perspectives on Vulnerability and
   Resilience
    Technologies often do much more than they are supposed to do. Ac-
knowledging these unintended consequences, scholars in STS, medical
sociology and anthropology emphasized the transformative potential of
medical technologies that contributes to a remaking of bodies that has
important implications for what it means to live with disorders and to be
human (Brown and Webster 2004; Clarke 1995; Lehoux 2006; Rose 2007).
This transformative quality of technology is also important to take into
account if we want to understand what it means to live with technologies
implanted in bodies. Through the years, ageing bodies may become more
vulnerable. This also concerns people living with technologies inside their
bodies. However, these everyday cyborgs may experience a multi-layered
vulnerability because there may be something wrong with their bodies,
their implants and/or the interactions between them. Although there exist
high expectations and promises about what medical implants can do,
technologies, like humans, can fail. These implants not only contribute to
solving or diminishing specific health problems, thus reducing the vulner-
ability of everyday cyborgs, but may also introduce new vulnerabilities.
First, everyday cyborgs face new kinds of vulnerability because they have
to live with the continuous, inextricable intertwinement of technologies
with their bodies. Take the example of pacemakers and ICDs. Although
wired heart cyborgs, as I call them, are already familiar with their heart
problems, internal heart devices transform their awareness of the fragility
of their heart. The proper working of the heart now depends on the ad-
justment of the electric pulses of their implants to the malfunctioning
electric stimuli of their heart. Crucially, an improper programming of the
pacemaker or ICD may not only result in a decreased quality of life but
may even lead to an untimely death (Tseng 2015). The vulnerability of
these heart cyborgs can thus be conceptualized as the harm caused by a
disturbance of the delicate balance between the material agencies of bod-
ies and internal devices. Second, people living with implants may experi-
ence new vulnerabilities because their devices can fail. Compared with
many technologies external to the body, anticipating the harm caused by
malfunctioning implants may involve other kinds of anticipation because
you can never run away from a technology implanted in your body. Medi-
cal implants thus constitute a sense of being at the mercy of the agency of
the implant, including its failures (Oudshoorn 2020).
    Technologies inside bodies thus not only challenge dominant views on
agency but also invite us to rethink dominant approaches to vulnerabili-
ties. Medical discourses on the fragility of humans often adopt an instru-
mental or essentialist view that consider vulnerabilities as given or static
characteristics of humans and technologies. However, STS scholars have
convincingly argued that vulnerability should not be considered as an “an
intrinsic and static characteristic” (Bijker et al. 2014, 14) of technological
20                                                           Tecnoscienza - 11 (2)

systems or human existence. This constructivist approach invites us to
view vulnerability as an “emergent property” (Bijker et al. 2014, 6) that
results from and depends on specific circumstances in technological cul-
tures rather than on the inherent capacities of technologies or humans.
Given the vulnerabilities everyday cyborgs may face, building resilience
becomes a key concern for people living with implants and medical pro-
fessionals and is important to include in technology and ageing studies as
well. As vulnerability, resilience should not be considered as pre-given or
fixed. Whereas early psychological studies of resilience adopted an essen-
tialist view in which resilience was conceptualized as a personality trait,
constructivist approaches no longer consider resilience as static but as
something that unfolds over a person’s life time, as a multi-faceted pro-
cess. This shift in approaching resilience is important because the essen-
tialist perspective runs the risk of blaming the individual for not being
able to cope with stress or trauma, and turns resilience into an extraordi-
nary capacity of people who survive in times of crises (Graber et al. 2015).
     The conceptualization of resilience as a process rather than a fixed
personality trait provides an important heuristic for understanding what it
takes to become a resilient cyborg. However, there is one conceptual hur-
dle to take because technology is largely overlooked in theorizing resili-
ence. As I argued in Resilient Cyborgs (Oudshoorn 2020), we can distin-
guish two ways in which technologies matter. On the one hand, technolo-
gy may contribute to resilience by making people aware of the vulnerabil-
ity of human existence. On the other hand, technical devices may provide
important resources that people can draw from to build resilience. In-
spired by Noortje Marres (2012), I argue that technological objects make
a distinctive form of resilience possible. Any understanding of what makes
people resilient or not should acknowledge that technologies may provide
important resources for adapting positively to potentially traumatic events
and the risks people face in everyday life, including threats posed by
technologies. A focus on the materiality of resilience thus enables us to go
beyond the view that people living with medical implants are passive ‘vic-
tims’ of their implants. To do so I introduced the notion of techniques of
resilience (Oudshoorn 2020). In addition to sensory experiences, tech-
niques of resilience provide an important heuristic for understanding the
agency of everyday cyborgs in coping with the vulnerabilities of their hy-
brid body.
     But what about ageing? I suggest that adopting an age lens is crucial
because older, everyday cyborgs may not have equal access to the re-
sources that enable them to become resilient cyborgs. During my inter-
views with people living with ICDs I learned that older people may expe-
rience more difficulties in developing techniques to build resilience. Let
me take one example. When heart cyborgs visit the cardiology policlinic
for a yearly check-up of their device, technicians run several tests to inves-
tigate the non-human parts of the hybrid, including the lifetime of the
battery. When it is empty, it cannot be charged from the outside: people
Oudshoorn                                                                  21
have to undergo surgery again to get a new implant. Controlling the life-
time of the battery is crucial because heart devices simply fail to work
when the battery is weak or empty. For people implanted with an ICD it
may imply the risk of an untimely death because their implant does not
have enough power to give a shock, or it will take longer to become active
because of a longer charging time. When technicians notice that a battery
will soon be empty, they tell patients to return to the hospital for an extra
control visit within several months. However, the responsibility to detect
empty batteries is not only delegated to technicians. Wired heart cyborgs
are expected to monitor the lifetime of the battery as well. When the bat-
tery is almost empty, the implants will give beeps at a pre-set time, usually
at 8 or 9 o’clock in the morning. These beeping sounds introduce new
sensory experiences: bodies with ICDs (and pacemakers) can produce
machine-like beeps. People have to learn to listen, in this case literally, to
their hybrid bodies.
     Detecting the alarm signals is not an easy task, because they need to be
distinguished from the beeps of many other electronic devices in our in-
creasingly densely populated technical soundscape. Most people I inter-
viewed did not notice the beeps immediately because they thought the
sound was caused by someone or something else: the cell phone of some-
one nearby, or an ambulance passing the home, or their own watch.
However, wired heart cyborgs can also be very creative in developing
techniques to detect the beeps. These resilience techniques included
switching off all the electronic devices at home to make sure whether the
beeps were not caused by another device, or going to more quiet places
such as the bathroom to detect the beeps. Importantly, the sounds are not
just a feedback signal of electronic devices that happen to be inside bod-
ies. For wired heart cyborgs they create an awareness of the existence and
vulnerability of their hybrid bodies that can cease to function if one does
not detect the beeps in time and take the appropriate action. Whereas
many wired heart cyborgs experience difficulties in detecting the alarm
signals of an empty battery, but eventually learn the techniques to do so,
elderly people may not be able to develop these resilience techniques due
to hearing loss15. Because weak or empty batteries produce a rather quiet
high frequency sound, many older people may not be able to hear them.
Age-related hearing loss thus constitutes a serious constrain in building
resilience for people living with ICDs and other medical implants that use
beeps as signals for the proper working of the device.
     This is just one example of the problems older people may face in
keeping their hybrid bodies alive. Because older, everyday cyborgs may
face other vulnerabilities as well and may engage in other practices to live
with their technologically transformed bodies, studying techniques of re-
silience is an important theme for future studies of how technologies co-
constitute ageing and later life.
22                                                            Tecnoscienza - 11 (2)

4. Intersectionality: Gender, Age and Passing
    An important contribution of feminist studies of technology is that age
is not the only dimension that matters if we want to understand how
technology shapes later life and vice versa. In Graying the Cyborg, Kelly
Joyce and Laura Mamo (2006) argued that adopting an intersectional lens
is crucial to understand how the meaning, access, and use of technologies
is constituted not only by age but also by gender, race, class and sexuality.
The intersectional approach, introduced by the feminist African-
American legal scholar Kimberlé Crenshaw (1989), emphasizes that so-
cially and culturally constructed categories such as gender, race, ethnicity,
sexuality, and disability do not act independently of one another but in-
teract on multiple levels. The intersectional perspective is important as
well to understand how everyday cyborgs build resilience. In Resilient
Cyborgs I describe how gender and age intersect in the ways in which
women learn to live with pacemakers and ICDs. During my fieldwork I
learned that scars resulting from the implantation of pacemakers and
ICDs constitute a major problem, particularly for women. Although these
heart devices are inserted under the skin, they leave their marks on the
body. Pacemakers and ICDs are visible as a roundish quadrangular shape
near the (usually left) collarbone, and scars may mark the site of the im-
plant as well. After implantation, people are thus confronted with a visibly
changed body. As scholars in medical sociology and disability studies
have described, learning to live with a marked body can be very conse-
quential because one’s physical appearance is no longer how it used to be.
Visible traces of surgeries and implants act as continuous reminders of the
physically changed body, making it more difficult to forget what hap-
pened to your body (Slatman et al. 2016; Dalibert 2014; 2016; Pollock
2008).
    Although all wired heart cyborgs have to learn to live with their
marked bodies, women may face more difficulties because their bodies
are more subjected to the gazes of others than male bodies (Bordo 1997).
As feminist scholars have described, western cultural norms on femininity
continue to mold women’s bodies into idealized imaginaries of how a
woman should look, emphasizing their smooth bodily contours (de Boer
2016; Dalibert 2014). Moreover, women’s clothing makes it more difficult
to hide the implant from the inquiring looks of others. In this respect, the
very site of the implant, near the collarbone, reflects an unintended gen-
der bias because the scars and the implant can be more easily concealed
by men’s than women’s clothes. To conceptualize how women learn to
live with their visibly marked bodies, it is important to expand the inter-
sectional lens with the theory on passing developed by disability scholars.
According to Jeffrey Brune and Daniel Wilson, passing is an important
part of the everyday life of people living with disabilities. Passing refers to
the ways in which “people conceal social markers of impairment to avoid
the stigma of disability and pass as ‘normal’” (Brune and Wilson 2013, 1).
Oudshoorn                                                                23
As Robert McRuer (2006) has suggested, passing as normal is crucial be-
cause of the ‘compulsory able-bodiedness’ that governs Western culture
in which able bodies are valued over other forms of embodiment. The
preference for able-bodiedness constitutes a cultural and social imperative
to conceal traces of disability and illness. Consequently, many people who
deviate from what is considered normal engage in developing multiple
techniques of passing in order to not be differentiated from others
(Siebers, 2008).
    Importantly, passing techniques are not restricted to physically disa-
bled people but are enacted by wired heart cyborgs as well. Women living
with pacemakers and defibrillators often engage in concealing their scars
and the bulges of their implants, a practice that can be considered as a
very specific form of creating resilient cyborgs. In women’s accounts of
how people respond to their visibly marked bodies, age emerges as an im-
portant trigger of reactions. Many women share their experiences with
talking to people who simply don’t want to believe that they are implant-
ed with a pacemaker or defibrillator. Or as one of them described: “YOU
have a pacemaker? Aren’t you TOO YOUNG??” (Oudshoorn 2020,
165). It can easily be imagined that these kinds of questions from
strangers are not particularly helpful for women trying to become resilient
cyborgs because they emphasize the vulnerability of their bodies, which
may make their lives more stressful. The casual remarks of strangers only
add to increasing these anxieties and vulnerabilities because they impose a
specific disability on women. Young women with scarred bodies implant-
ed with heart devices are told that they are not able to conform to the cul-
tural imperative of having a healthy body with feminine smooth bodily
contours. Importantly, the remarks of strangers also convey age-specific
messages about the pacemakers and ICDs themselves. Usually the com-
ments not only address the age of the women but also refer to the devices
as being only for old people. The example of pacemakers thus shows an
intriguing dynamic of the co-constitution of gender, age and technology
that creates the image of pacemakers as signifiers of old age16.
    Because women can become pretty desperate from explaining all the
time what happened to their bodies, some of them decide to hide the visi-
ble traces of their implants. In the online communities I studied, women
actively engage in sharing experiences about what they should do to make
them less vulnerable to the gazes of others. Adjusting one’s clothing is one
of these techniques, for example not wearing clothes that show the site of
the implant, such as strapless shirts or dresses, or low-cut blouses and
tops, or concealing their scars with tattoos. Women use these passing
techniques because they enable them to be in control of their bodies as
visible objects. This “image management” (Slatman et al. 2016, 1620) is
needed in a culture which resists female bodies that don’t conform to the
highly idealized imagery of femininity and beauty. Or, as Theresy Beery in
her study of women living with pacemakers put it: “Can a woman be
scarred and still be feminine?” (Beery et al. 2002, 20). Passing techniques
24                                                         Tecnoscienza - 11 (2)

can therefore be understood as a very specific way of enacting femininity
as well. The pressure to conform to cultural norms about female bodies is
particularly strong for younger women. Pacemakers and defibrillators
thus constitute specific gender and age relations in which only older
women are allowed to deviate from the cultural norm of healthy smooth
bodies. Like other bodies, cyborg bodies are thus not outside the cultural
norms of femininity, beauty, ageing, and compulsory able-bodiedness
(McRuer, 2006; Dalibert, 2016).


5. To Conclude
    My account of how people having medical implants learn to live with
their technologically transformed bodies confirms one of the major argu-
ments of feminist studies on graying the cyborg. As elderly users of exter-
nal technologies, everyday cyborgs are technogenarians. Far from being
passive consumers or feeble individuals, elderly women and men should
be considered as “knowledgeable technoscience users” (Joyce and Mamo,
2006). In this respect there are no differences between the ways people
relate to external or internal devices. However, studying the interrelations
between humans and medical implants challenges us to develop heuristic
tools to understand what agency may emerge when technologies don’t
delegate actions to their ‘users’, which is the case of many medical im-
plants. In this article I introduced three perspectives that enable us to go
beyond the view of everyday cyborgs as passive. The rematerializing-the-
cyborg approach provides a very useful analytical lens by foregrounding
sensory experiences as an important notion to conceptualize the agency of
people living with technologies inside their bodies. Given the persistent
and increasing presence of medical implants for older people, under-
standing the agency of elderly everyday cyborgs remains an urgent theme,
not only for academic reasons. Ultimately, many medical implants consti-
tute a crucial case for persons having these implants also because the
proper working of these devices depends on their active engagement. To
study this active participation, the techniques of resilience approach is an
important heuristic because it enables us to account for the vulnerabilities
of hybrid bodies without turning cyborgs into passive victims of their im-
plants. Moreover, accounting for difference is important as well. I argued
that a focus on intersectionality provides an important lens for grasping
the ways in which age and gender interact and shape one another in
building resilience. I suggested that combining the intersectional ap-
proach with the concept of passing enables us to understand how age and
gender matter in the ways in which everyday cyborgs learn to cope with
the vulnerabilities of their technological transformed bodies. Equally im-
portant, comparing and contrasting different age groups provides a very
useful method to study the complex interactions between age, gender and
technology. Although this article did not address other differences, such
Oudshoorn                                                                        25
as race, ethnicity, sexuality, or disability, these are relevant to include in
our research agenda as well.
    Finally, I would like to suggest that it is important to include the last
phase of cyborg life in ageing studies. Accounting for dying and death is
crucial because the passage from life to death of everyday cyborgs is not
the same as for those who live without internal devices. Medical implants
may introduce new vulnerabilities and anxieties about whether implants
should be turned off before death and/or removed after death. They may
also make everyday cyborgs and their close relatives anxious about
whether they will be able to die with an active implant. Equally important,
medical implants may introduce anxieties about the kind of death every-
day cyborgs will experience (Kaufman 2015; Oudshoorn 2020). Dying
and death should thus be considered as integral part of future studies of
ageing cyborgs.


Acknowledgements

    Parts of this article were first published in chapters 1,2, 3, 6, 8 and 10 of my
book Resilient Cyborgs. Living and Dying with Pacemakers and Defibrillators
(Palgrave Macmillan, 2020) and Oudshoorn (2015).


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     1
       The notion of the cyborg was framed as a technical term in the context of the space
race during the cold war and referred to a literal fusion of human/animal and machine
(Clynes and Kline 1960). See Markussen et al. (2000) and Bjorn and Markussen (2013) for a
further reconstruction of the history of the term “cyborg”.
     2
       For a further elaboration of this approach see Peine and Neven (2019; 2020).
     3
       Exemplary studies about how sociotechnical imaginaries construct specific meanings
and practices of ageing and later life, include Joye and Mamo (2006); Joyce et al. (2017);
Peine and Moors (2015); Peine (2019); Peine and Neven (2020); Higgs and Gilleard (2020).
     4
       I borrow this distinction in three lines of research from Kelley Joyce and her colleagues
(Joyce et al. 2017).
     5
       Exemplary studies include Fischer et al. (2020); Östlund et al. (2015); Neven (2011);
Peine and Neven (2011); Peine et al. (2014).
     6
       A more detailed discussion of studies of the co-constitution of technoscience and age-
ing and later life is beyond the scope of this article, but see Joyce et al. (2017), Peine (2019),
and Peine and Neven (2020) for an extensive overview and discussion of this literature.
     7
       Bergschöld et al. 2020; Berridge (2017); Giaccardi et al. (2016); Gibson et al. (2019);
Loe (2010); López Gómez (2015); Östlund and Linden (2011); Peine et al. (2015); Peine et
al. (2017); Pols (2017).
     8
       Joyce and Loe (2010); Loe (2010).
     9
       Joyce et al. (2015); Peine and Moors (2015); Frennert (2020).
     10
        For exemplary studies see Callen et al. (2009); Loe (2015); Mort et al. (2015);
Oudshoorn (2011); Pols and Willems (2011); Schillmeyer and Domenech (2010).
     11
        See Lock (1993) and Shim et al. (2008).
     12
        See, for example, Bruno Latour’s influential approach to human and non-human
agency (2005), in which he used external technical devices such as car seat belts and door
keys as key examples to theorize agency.
     13
        Some of the more recently introduced implants delegate some agency to their users.
Deep brain stimulation implants introduced for the treatment of Parkinson and spinal cord
stimulation implants, developed for the treatment of chronic pain, allow patients to interact
32                                                                       Tecnoscienza - 11 (2)




with the device in order to raise or lower stimulation levels (Morrison and Bliton 2011; Da-
libert 2014).
     14
        See Dalibert (2014) and Verbeek (2008) for a similar criticism on STS and the philos-
ophy of technology.
     15
        Hearing loss is considered as the third most common chronic health problem in older
adults (Newman and Sandridge 2004).
     16
        This is in sharp contrast to the pacemaker implantation rates which indicate that
women constitute 45,3 % (The Netherlands) to 49% (US) of the total number of pacemaker
users (Boorsma and Zaadstra 2011; Williams and Stevenson 2017).
