How The Deaf Community Is Dealing With Cochlear Implants
Tuesday, November 3, 2009
If you were deaf and had the opportunity to hear, would you choose it? We'll explore the tension in the Deaf community over the ethics of implanting deaf children with a Cochlear implant.
The Ethics Center will host a discussion and screening of the film "Sound and Fury" on Saturday, November 7, 2009, beginning at noon at the Reuben H. Fleet Science Center in Balboa Park.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. The controversy over cochlear implants in the deaf community has been difficult for those in the hearing world to understand. How could a device that allows severe and profoundly deaf people to hear sounds be a bad thing? And why wouldn't parents want to give their deaf children the opportunity to live easily in the hearing world? A documentary released ten years ago called "Sound and Fury" explained the emotionally charged arguments for and against the use of cochlear implants through the experience of one extended family. Now, that film has been updated to document the growing acceptance of cochlear implants within the deaf community.
This morning, we'll learn about cochlear implants, how they are changing the world for deaf people and yet, how the deaf community is managing to retain its identity. I’d like to welcome my guests. First, Josh Aronson, the director of the film, “Sound and Fury,” and its sequel. Good morning, Josh.
JOSH ARONSON (Film Director): Good morning, Maureen. Thank you for having me.
CAVANAUGH: Arthur Boothroyd is professor of speech and hearing at San Diego State University. Arthur, welcome.
ARTHUR BOOTHROYD (Professor of Speech and Hearing, San Diego State University): Thank you. Nice to be here.
CAVANAUGH: Jesse Dubler is an outdoor educator and researcher who is deaf and has a cochlear implant. Welcome, Jesse.
JESSE DUBLER (Cochlear Implant Recipient): (through interpreter) Thank you, and happy to be here.
CAVANAUGH: And Billie Ann McClellan is here as Jesse’s interpreter. We’ll be hearing from them both during our discussion. And we want to invite our listeners to join the conversation. Do you or do you know a deaf person who has had a cochlear implant? How has it changed your life? You can call us at 1-888-895-5727 or you can e-mail us your questions and comments at TheseDays@kpbs.org. Arthur, I’d like to start with you, if I may, and let’s start with some basic questions about how hearing works and how our ears hear.
BOOTHROYD: How hearing works, well, this would be a whole course.
BOOTHROYD: But the – in general science classes in school, people have probably learned that the hearing mechanism has three parts, the outer ear, the middle ear and the inner ear. Actually, there’s a very important fourth part and that is the brain. But most of the work of converting sound into the language that the brain understands is done in the inner ear. There’s a tiny organ in there called the cochlea, looks like a little snail. It’s about the size of an aspirin tablet, and it contains thousands of tiny little cells that pick up vibrations of the sound and convert them into electrical signals that can then be sent to the brain.
CAVANAUGH: And when people are diagnosed or are said to be severely or profoundly deaf, is there generally speaking something wrong with that particular area of the ear?
BOOTHROYD: The kind of deafness that we’re talking about with cochlear implants, that is true, that the problem is usually a loss of those little cells. They’re called hair cells. They’re not real hairs but there are little protrusions on them that look like hairs. And they’re – because hearing is so sensitive, it’s also highly susceptible and there are many reasons why this can happen but the problem we’re really discussing today is a loss of those receptor cells which normally convert sound into electrical signals for the brain.
CAVANAUGH: I’m going to ask you again, one of those larger questions that could probably take a lot longer time than we have, but if you could also synthesize for us how does the cochlear implant work?
BOOTHROYD: Well, the cochlear implant takes over the job of those little cells. It takes sound signals, converts them into electrical current and feeds that directly to the auditory nerve so it can be passed on to the brain.
CAVANAUGH: Now Jesse has a cochlear implant and you can see part of it outside of his ear but there’s also a part surgically implanted within his ear, is that right, Arthur?
BOOTHROYD: This is correct.
BOOTHROYD: The outside portion is doing the job of pulling information from the sound signals and recoding it to be sent to the inner implanted portion which will then stimulate the nerve fibers in the auditory nerve.
CAVANAUGH: Thank you. That is Arthur Boothroyd. He’s professor of speech and hearing at San Diego State University. I want to move on now, if I can, to Josh Aronson, director of the film “Sound and Fury” and it’s sequel, “Sound and Fury: Six Years Later.” The focus of your film, Josh, was about the tension over the cochlear implant about ten years ago. Before we talk about that tension, tell us about this extraordinary family that you profiled in your film, “Sound and Fury.”
ARONSON: Well, this is a family named the Artinians and they’re an Italian-Armenian family and they’ve traced back hereditary deafness in their family back to Italy from over a hundred years ago. And they’ve actually, in this case, they intermarried with another family who had deafness in the family as well. So I came upon this family in which the grandparents are hearing and there are two sons in the family, one is deaf and one is hearing. And the hearing son married a woman who was CODA, which means a child of a deaf adult. And there was a recessive gene in her so that they had two deaf children. So there was – and the deaf son was married to a deaf woman, and they had three deaf children. So there was hearing and deafness running through the family. And the issue of the cochlear implant had just come up when I met them, and the hearing brother had decided to implant his deaf son. And the deaf brother was incensed by this and it caused the beginning of a war that lasted some years in the family. And so we started filming because it looked like such a terrific sort of microcosm of the battle that was going on in the greater deaf world. And then all of a sudden the deaf son’s four-year-old daughter announced that she wanted a cochlear implant. So the deaf brother and his wife had to go on a sort of search for information to decide what to do. So that was the genesis of the film and we followed the family for a year and a half.
CAVANAUGH: And you’ve just finished an update to the “Sound and Fury,” it’s called “Six Years Later.” What happened to this family?
ARONSON: Well, at the end of the first part, which was – we finished the film in 2000. The family was, unfortunately, torn apart by the war over the cochlear implant. They had decided, the deaf brother—his name is Chris—and his wife decided not to implant the five-year-old who had asked for a cochlear implant. So it was heartbreaking and it sort of tore the family apart, and a lot of audiences were incensed by the fact that—hearing audiences, I should say—that Peter and his wife decided not to implant Heather. They moved away and moved down to Frederick, Maryland, and the film ended with the family torn to pieces. And six years later, they had come back and in the film we reveal that Heather finally did get a cochlear implant, that the family had turned around. Her mother got a cochlear implant. And we see in the film the progress that the little girl has made, and she speaks very well. She’s mainstreamed and she and her entire family were very, very happy with the results of the implant and they credited their turnaround basically with education, becoming more used to it, and they just felt that the technology had improved enough so they felt safe doing it.
CAVANAUGH: I want to talk more about the family in “Sound and Fury” and your sort of discovery about this issue and your expertise in it, Josh, but first I want to invite our listeners to join in the conversation at 1-888-895-5727 or you can e-mail us at TheseDays@kpbs.org. Jesse, as I said, you have a cochlear implant and…
CAVANAUGH: …when did you get your cochlear implant?
DUBLER: I got it in 2003 from the House Institute when I was 20.
CAVANAUGH: And was it a difficult decision for you and your family?
DUBLER: Yes, it was. My family, actually both my parents are deaf and I have a hearing brother and a hearing sister. My mom was really against the implant at the beginning, and she was more – just not understanding why. I was really considered older. You usually get the implants – at that time they were giving implants to younger people but I researched it for three years. I spoke with a lot of people who had already been implanted. At the time, it still wasn’t widely accepted in the deaf community and so I was asking around and I was really happy with my decision to go ahead and get it and I’ve never looked back.
CAVANAUGH: How long did it take you to be able to interpret the sounds that you were hearing coming through the cochlear implant since you got this implant when you were 20?
DUBLER: Really, it’s an ongoing process. Every day I’m identifying new sounds. I’m actually still using – still learning how to interpret the sounds.
CAVANAUGH: And I want to ask Arthur and actually everyone, is that sort of the way it is when a cochlear implant is implanted at a later age when the person is no longer a child?
BOOTHROYD: Absolutely. Yeah, the – putting an implant into a very young child, the child’s brain is plastic, it’s ready to learn, it will adapt and learning takes place in a relatively natural way. For the person who has spent the first 15, 20 years of their life without hearing, suddenly acquiring this new ability, it’s not so simple to learn to interpret these sounds and so on. And the results, in general, are by no means as good as they are with either adults who suddenly lose their hearing and then get an implant or children who are implanted at an early age.
CAVANAUGH: And, Josh, that’s what you found in Heather’s mother. Heather’s mother, Nita is – Nina, Nita, wanted to have an implant, got a cochlear implant. What was her experience like?
ARONSON: Well, you know, she, like Jesse, says that she is quite happy with it and is glad that she did it. She – It certainly did not improve her speech but she says it – she enjoys the ambient sounds she’s able to hear and it makes – she feels safer. And she likes the bonding with her daughter who does much better with it because, of course, she was much younger. And as Arthur said, the earlier you get it, the better, but also an operative factor is how much oral training a person had. Heather had been wearing, the little girl, had been wearing hearing aids and been working very hard with speech therapy so when she finally got a cochlear implant, her brain was used to synthesizing sound, if that’s a proper term. Doctor, please feel free to correct me.
BOOTHROYD: No, that’s fine.
ARONSON: Yeah. And in her case with a tremendous amount of work and dedication, she is now understandable and she does very well in class and although she has an interpreter that the school system supplies for her in her mainstream classroom—she’s the only deaf person in that entire school—I’ve filmed her in school and I observed that she never used the interpreter. She never looked at the interpreter in class and she was very attentive with the teacher. She had a transmitter so that she could hear the teacher’s voice transmitted through a speaker on her desktop and the teacher wore a little microphone, which they were very happy to do for Heather. So each case is different. It certainly takes a lot of work for an implanted person and the more oral experience a deaf person has, the better the result will be, and at least that’s in my observation.
CAVANAUGH: I want to introduce my panel again. We’re talking to a lot of people this morning. Josh Aronson, the director of the film “Sound and Fury,” and its sequel, Arthur Boothroyd, professor of speech and hearing at San Diego State. Jesse Dubler is here with us. He is an outdoor educator and researcher who is deaf. He has a cochlear implant, and Billie Ann McClellan is Jesse’s interpreter. You might hear her voice occasionally as she interprets what Jesse is saying for us. Now I want to take a step back with all you – all of you, if I may, and ask why was the cochlear implant such a controversial piece of technology when it was introduced, I suppose when it came into popular use in the 1990s. And, Jesse, I would like to ask you first. Why was it viewed as such a threat to the deaf community?
DUBLER: Well, it’s really a complicated answer. It would take a whole semester to explain that and in a deaf culture class. But, really, the deaf community considered it a threat because the cochlear implant represented a draw away from the use of ASL as their primary mode of communication. People thought that you had to become completely oral to be successful with your cochlear implant, that you couldn’t sign, that you would be damaging your success if you signed and had an implant. A lot of people who got implanted disappeared from the deaf community and so the community felt as though those people were lost. And so people now are finding a middle ground, that they can have the implant and still be a part of the community but – and that still is causing some conflicts. But from the nineties to now, a lot more people are accepting the cochlear implants. It’s really caused a big change in the deaf community. Back in 2003, I actually – when I got my implant, I lost a few friends and I was surprised that it was only a few and there were only like two or three people that I lost. But when they found out that I had the implant, a lot of people were surprised and I said, yeah, that’s true, I can hear with the implant but when I take it off, I’m still deaf. So it was really – I didn’t want – I didn’t reject any of those deaf friends in the deaf community that I had and I’ve noticed that it’s really a fine line that I have to walk since then and with it. But that was really, in a nutshell, the controversy in the deaf community. Arthur, was there anything else that you want to mention on that?
BOOTHROYD: Well, only that there is a 200 year history. Before this there was a debate, not debate but acrimonious argument between the deaf community and supporters of the idea that the best thing to do with a deaf child was teach them how to speak so they could become part of the larger hearing community or you should really teach them sign language and let them be fully participating members of the deaf community. So when the cochlear implant came along, when it first came along, the results were not terribly good, the early versions. But then in the 1980s there were dramatic improvements in performance and the whole presence of the implant simply fed into this longstanding debate about the nature of deafness the nature of the culture of deafness and its role in society at large.
CAVANAUGH: I want to tell anybody who doesn’t understand what ASL is, we’re talking about American Sign Language. And, Arthur, your son is deaf, and is that how you got into the field of speech and hearing?
BOOTHROYD: Yes, it is. I used to be a high school physics teacher.
BOOTHROYD: He was not born with a profound or total hearing loss. He had a relatively moderate hearing loss at the time. It’s got worse over the years, and now he is profoundly deaf but he can still use a hearing aid and, with difficulty, talk on the telephone.
CAVANAUGH: So he does not have a cochlear implant?
CAVANAUGH: I see. And, Josh, I wanted to ask you…
DUBLER: I’m sorry. Could I interject…
CAVANAUGH: Yes, please. Please.
DUBLER: …on that? I would like to go back and add that also a little bit of the history on that was that at the Milan conference, you know – Arthur, do you know what year that was? The Milan conference?
BOOTHROYD: Thank you.
DUBLER: I’m sorry?
DUBLER: The 1880s, thank you. 1880s, back at that conference, it was decided that oralism was going to be the primary method of education for deaf people and that outraged a lot of people in the deaf community. So because of that conference deaf ed made quite a huge shift in the direction that it was going, and the result of that conference showed that that shift was a failure in a lot of people. And so a lot of deaf people who graduated from that program really didn’t become successful in the world. The program really wasn’t showing that it made deaf people successful so there was a shift back to using American Sign Language and bilingual using both some oralism and some, in the school system, some American Sign Language and still trying to get the results. And that has proven to have a lot better results today, and so a lot of people were using just the oralism and having maybe a third grade reading literacy ability versus having a much higher literacy by using the bi-program, using American Sign Language and some speech therapy with that and so we saw quite an improvement when that shifted and was able to maximize on both.
CAVANAUGH: I’m beginning to understand. So what you’re saying is when the idea was to try to teach deaf people to speak and to work in the hearing world that was going to be the main focus of their education. The deaf community said, no, this is never going to work, these people are not going to be successful, so we are going to keep with our American Sign Language and we’re going to main – maximize our potential in the deaf community rather than trying to make some sort of effort to become successful in, exclusively, the hearing world. Is that correct? Pretty much so.
DUBLER: Kind of.
CAVANAUGH: Josh, I’m wondering, were you completely ignorant of this entire cultural controversy when you started the “Sound and Fury” movie ten years ago?
ARONSON: No, it’s learning about the culture that attracted me to the story in the first place.
CAVANAUGH: Oh, I see.
ARONSON: As a hearing person, I knew no – I didn’t know anyone who was deaf and I happened to meet a woman who had had a cochlear implant in, oh, probably ’97, ’98. She was one of the four or five thousand people in America that had an implant at that point. And she told me it improved her hearing, she could talk on the telephone, and life, you know, was much better for her. But, unfortunately, she, like Jesse, lost a number of her friends. In her case, it was many more because it was earlier. And as a hearing person, I was stunned by that statement and I asked her why. And she began to explain the deaf culture and why they were so hostile to the cochlear implant. And that’s when I – that’s what attracted me to the story in the first place, is that conflict and that Arthur referred to, that 200 year conflict. And I saw the battle between oralism and manualism as an increasingly hostile battle and in the eighties when the deaf culture was actually technically formed because of the conflict at the Gallaudet University that we could get into but it’s a long story. But that’s sort of been my view when the deaf cultural community was actually formed as a culture. It was at that point that the cochlear implant, to me, seemed to be the climax of the battle and the film was made for that purpose, to sort of celebrate the climactic moment of a 200 year old battle.
CAVANAUGH: I want to remind our listeners that we’d like to hear from you. If you are deaf or if you know someone who is, you can call us at 1-888-895-5727 or you can write to us at TheseDays@kpbs.org. Yes, Arthur.
BOOTHROYD: Well, I just wanted to pick up on a comment that Josh just made and that is that he had never met a deaf person before in his life. This is true of 90% of – it’s true of the parents of 90% of the children who are born deaf. For deaf children to be born to deaf parents is – that is a very minority situation, maybe 5 or 10% of the deaf children, but most are born to parents who have never met another deaf person.
CAVANAUGH: That’s an amazing statistic. Jesse, I would like to know how the cochlear implant has changed your life.
DUBLER: Well, okay, I’m definitely a lot more collected (sic) with the world. When I started, I went to China. I was the only deaf person in a group of hearing people. I had no interpreter with me. And I spent an entire month in China, just fully immersed in their culture. And I realized that the hearing world had a lot to offer me, and that I wasn’t able to take advantage of what was being offered and so that really prompted my three-year research into the cochlear implant. And, like I said, I walk a thin line between two worlds. I’m very active in the deaf community but at the same time in my field I’m very involved in the hearing world. And I’m really thankful to my cochlear implant for that. It’s given me more confidence. My lip reading has improved by about 30% when I have it on and then when I have it off as well, so…
CAVANAUGH: So, all right. So it has changed things rather extraordinarily for you.
CAVANAUGH: Let’s take a phone call. Curtis is calling from Carlsbad. And, Curtis, welcome to These Days.
CURTIS (Caller, Carlsbad): Thank you. I had a question. I had an acoustic neuroma tumor and it affected my hearing, obviously. I had to have – lose my hearing. The question I had was is it feasible to get a cochlear implant for single side deafness and also, my second question is, does insurance cover it? If not, why?
CAVANAUGH: Okay, I guess – I guess, Arthur, that’s for you.
CURTIS: Yes, please.
BOOTHROYD: The chances are that the surgery for the acoustic neuroma destroyed the auditory nerve and that would make that ear not a candidate for a cochlear implant. There is work being done on implants at a higher level in the brain stem but the results are nothing in – they’re not comparable with those you get from a cochlear implant. As far as insurance is concerned, I don’t, unfortunately, get involved with that too much and I know it is an issue. I believe there are some insurance plans which will foot the bill and others which will not.
ARONSON: You know, if I can interject on that…
DUBLER: And – Oh, sorry.
CAVANAUGH: Okay, Jesse first and then Josh.
DUBLER: Sorry to jump in. But regarding the insurance portion, there are some plans that do provide for the cochlear implant actually as more preferred than a hearing aid. So they will – Although it costs a lot more, that depends on the plan, right. And also on the technological advances, they’ve really gone up over the last few years and you’d really be much better off speaking with your physician and finding out if you’d be a candidate for that. I know that when I went to the Housing (sic) Institute in LA, they were – that was really where the cochlear implant started up in Los Angeles, and so they have a lot of knowledge up there and specialists that could help you more with that.
CAVANAUGH: Okay, thank you. And Josh, you wanted to say something?
ARONSON: Yeah, I just want to say as of, you know, the years that I was involved, you know, and interviewed, oh, hundreds and hundreds of deaf people across the country and I was at the House Ear Institute, I was at New York University’s Hearing Institute, I was at the New York Eye & Ear, Lexington School for the Deaf, and I met many, many, many people with cochlear implants. And I have to say, and it’s important for everyone to know this, that the vast majority of them found that with work—and many implant centers have people who will help you with this—that you can get your insurance company to pay. Now insurance companies will always fight anything like this but, by and large, most people are successful in getting their insurance to pay for the implant. So don’t be discouraged by that.
CAVANAUGH: I want to talk specifically about the cochlear implant for a moment or two. Why do people only have it in one ear? Do people also get implants in both ears ever, Arthur? Or Josh.
BOOTHROYD: Oh, yes.
ARONSON: Yeah. Go ahead. Sorry, Doctor.
BOOTHROYD: Well, I was just going to say that the same thing happened with hearing aids many years ago. It was standard practice to fit one ear and then a movement came and said, well, we have two ears, why aren’t we using both of them? And the same thing is now happening with cochlear implants and it is becoming now much more common for children, for example, to get implanted in both ears at the same time.
CAVANAUGH: And, yes, Josh.
ARONSON: There’s a series of studies that have been done, as the doctor said. I did a film about just this subject for Cochlear Corporation, one of the three manufacturers, and it was on the benefits of bilateral implantation. And over and over again, people who had implants in both ears reported that, you know, they were able to function so much better with two. In the early years, they only implanted one because they wanted to save the other ear in case of a problem with the first one or for some improved technology in the future. But they’ve, you know, they were so consistently excellent with the cochlear implants that there was no need or felt that there was no need to save the other ear and the benefits outweighed the deficits of not getting two.
CAVANAUGH: You know, sometimes there are efforts to try to let hearing people hear what people with cochlear implants hear. There’s, you know, this is the way this will sound with a cochlear implant. And many hearing people are offput by the sounds that the cochlear implant actually gives the deaf person. I’m wondering, Jesse, how might you describe the sounds that you hear with your implant.
DUBLER: Oh. Well, since I lost my hearing at six months old, to be honest, I don’t really know that I can answer that because I don’t have a baseline to compare with so…
CAVANAUGH: And Josh?
ARONSON: Well, it’s a slippery slope, this question, because every person is different. Every person’s experience is different. And, therefore, their brain’s relationship with sound is different. I’ve heard people who were deafened, as Jesse was, early, when they get an implant they describe it at first as computer sounds. You know, like what they imagine computer ditty-dot sounds would be. And then gradually over time, they’re able to make sense of those sounds and recognize them as words. I’ve heard late-deafened people, people who lost their hearing late in life, when they get a cochlear implant, it restores their hearing almost immediately and some people say it’s very similar, other people say it sounds a little echo-y like a monaural sound coming from the end of a hall. But the good news is that those people all report that at the frequency of speech, they can hear very clearly in a room that’s not crowded with other sounds. But I think it’s difficult to, you know, sort of generalize what any one person is going to hear. There’s a broad range. But, certainly, the optimum thing is the more work you put in, the more speech therapy you get with a cochlear implant audiologist, the better the results will be.
CAVANAUGH: And, Jesse, when sounds are very loud or disturbing, do you take the outside section, the magnetic portion of your section…
DUBLER: No, I don’t because there’s a programming map that is set to match up with the sound so that the sound doesn’t become too painful so I think I’ve only removed it maybe two or three times in the last six years due to loud noises. At home, I do tend to take it off because I’m focused on doing computer work or something but when I go outside the door, I put it back on because I feel like a little lost out in the world. I see a car go by but I didn’t hear the car, so I feel like there’s something wrong. So I run back inside and put the implant back on so I can get that full picture.
CAVANAUGH: Now you said something that’s very interesting earlier and it’s something that I’ve also read in my research for this, Jesse, and that is the idea that, you know, you do – you use your cochlear implant to function in the hearing world but when you take it off, you’re still deaf and you still maintain that identity. Tell us a little bit about that. How is it living in both worlds like that?
DUBLER: Well, my friends and I actually have a lot of discussions about that. There’s what’s called ‘capital D-deaf’ and ‘lower d-deaf.’ Lower d-deaf, speaking of just deafness in general, and capital D-deaf talking about the deaf culture and identifying oneself as being deaf. And so sometimes I’ll say that I’m lower d-deaf because I’m very inclusive of the community. But I’m capital D-deaf because I’ve been in the deaf community for such a long time. And so I guess I’m, at this point, just kind of between the two. It’s not an easy line to walk, to be between both worlds, but one of the reasons that I do it is, you know, I am deaf and I don’t want to reject the deaf community. I don’t want to be labeled as hearing.
CAVANAUGH: Interesting. Now, when one of your friends comes to you and says should I get a cochlear implant, do you say yes? Or do you have a long discussion?
DUBLER: You know, I really avoid yes/no answers as much as possible because everyone’s experience is going to be different. And really above all else, I try to tell them to meet with somebody and to go in with realistic expectations, knowing that when you come out you may not benefit from the implant the way that you thought you would or even at all. And so having that kind of attitude about it, you know, I went in and I was very happy with my results but just hearing my comfort with my results may give somebody the wrong idea that they’re going to have the same results. And so I’d want them to have a clear idea that theirs would be different than mine. So I know that captioning and clarity in the results and the broadness and the spectrum of results is a lot more explained than it was in previous years and so because of that, I feel like people are able to go in with a better understanding.
CAVANAUGH: And, Josh, in the minute that we have left, you have been documenting this controversy for ten years now. I’m wondering if you have an idea, is it going to disappear or is it going to change in some way as we go along the road with technology that allows better and better hearing resources for people who have hearing disabilities?
ARONSON: Well, certainly because 90% of the deaf children in the world are born to hearing parents, those people will more and more get cochlear implants because their parents will want them to function in the hearing world. And so the result is the deaf culture will get smaller. But I think that the American Sign Language is such a beautiful language and has such a history and there is so many people that love the culture, very appropriately, and have grown up in it and feel comfortable in it, that I think the deaf culture is with us for a long time and the poetry and the memories and the history of that culture should be part of civilization. And I, for one, hope it lasts a long, long time but it clearly will get smaller and smaller.
CAVANAUGH: We have to end it there. I want to thank all of my guests so much. Thank you Josh Aronson, Arthur Boothroyd, Jesse Dubler, and thank you so much for your work Billie Ann McClellan. I want to let everyone know that the Ethics Center will host a discussion and screening of the film, both films, "Sound and Fury" this Saturday, November 7th beginning at noon at the Reuben H. Fleet Science Center in Balboa Park. You can go to KPBS.org/TheseDays for more information. Thank you for listening. Stay with us for hour two of These Days coming up in just a few minutes.