Journal articles on the topic 'Janette Turner Hospital'

Janette Turner Hospital is the author of eight novels, four collections of short stories, a novella published only in French, and a crime thriller under the pseudonym Alex Juniper. Her work has been published in 20 countries, and in 12 languages other than English. She is the recipient of a number of overseas literary awards, and both Griffith University (in 1996) and the University of Queensland (in 2003) have conferred honorary doctorates upon her. In 2003 she won the Queensland Premier's Literary Award for Best Fiction Book for her most recent novel, Due Preparations for the Plague, and the Patrick White Award for Lifetime Literary Achievement.

In January 1967 Janette Turner Hospital left Queensland for Boston. She was unpublished. 25 years of age, and very much the product of a loving but fundamentalist childhood that she understood as the ‘source of all comfort and security, but also the source of all harm’. She has called America. India. Canada and France ‘home’ and has also frequently taught in other European countries. Although she has two adult children who have made their lives in the United States and Canada, her parents and three younger brothers remain in Brisbane, so she returns regularly to sustain family ties.

Despite the current preoccupation with globalisation, literary criticism remains heavily focused on national cultures. In the context of Australian literature, comparisons are regularly made with the literatures of other British Commonwealth nations, but surprisingly infrequently with that of Britain's first and most successful colony, the United States. This article explores thematic and cultural connections between the work of American-born modernist poet and novelist H.D. (1886–1961) and the Australian-born postmodern novelist Janette Turner Hospital (born 1942). It suggests that the transnational phenomenon of ecstatic Protestantism, which originated in northern Europe and was disseminated widely around the globe along the channels of commerce and colonisation, has been a key influence in shaping the literary imaginations of these writers. Indeed, Protestantism – far from being a spent or reactive force – continues to generate new forms of modernity as its emphasis on transformation is exported from somewhat inward-looking religious communities into broader cultural domains.

Brisbane is the kind of city that if it did not exist would have to be invented — and indeed it has by many of its writers. Its history of settlement and its political conservatism of the slash, burn and bulldoze variety has urged writers like Sam Watson in his novel The Kadaitcha Sung to depict it as a place of punishment, violence, racism and red-necked parochialism. The same sense of oppression informs David Malouf's mixed nostalgic references to the city as a place of beauty and boredom, a city you can love and hate in Johnno. In similar vein, Jessica Anderson in Tirra Lirra by the River, Angelika Fremd in The Glass Inferno and Janette Turner Hospital in both short stories and novels, depict Brisbane as a place one needs to leave but also a place where epiphanies are possible, and where the past haunts the present with a ferocious insistence. For novelists Rosie Scott, Janette Turner Hospital and Venero Armanno, Brisbane is simultaneously Paradise Lost and Paradise Regained. Many writers depict Brisbane as a great place to grow up in but you wouldn't want to live there — unless you are Hugh Lunn. Brisbane has been, and arguably still is by some writers, seen both favourably and unfavourably as a provincial backwater, unsophisticated and straight — still a frontier town in the popular and literary imagination if not in reality, a place where it is likely that you will know somebody who knows somebody you know. This is pointed out repeatedly by John Birmingham, author of the whimsical He Died With a Felafel in his Hand, by way of a distinguishing feature of flat life in Brisbane in contrast to other (Southern) capitals. In Brisbane, Birmingham writes: Everyone's stories intersect, crossing over and through each other like sticky strands of destiny and DNA. (Birmingham, 42)

Jean-Martin Charcot (1825–1893), thanks to his insight as a clinician can be said to be one of the precursors of scientific psychology. Charcot’s 30 years of activity at La Salpêtrière hospital display an intellectual trajectory that decisively changed the idea of human psychology by favouring the emergence of two concepts: the subconscious and the unconscious. It was his collaboration with Pierre Janet (1859–1947), a philosopher turned physician, that led to this evolution, relying on the search for hysteria’s aetiology, using hypnosis as a method of exploration. Focusing on clinical psychology that was experimental and observational, Janet built a theory of psychic automatism, “the involuntary exercise of memory and intelligence” leading to “independence of the faculties, freed from personal power.” From all that came the idea of the subconscious, a functioning as a passive mental mechanism, resulting from a more or less temporary dissociation of previously associated mental content.

List of abstacts and authors:1. Integrating the art and science of psychiatryEugene Allers2. Chronic pain as a predictor of outcome in an inpatient Psychiatric populationEugene Allers and Gerhard Grundling3. Recent advances in social phobiaChrister Allgulander4. Clinical management of patients with anxiety disordersChrister Allgulander5. Do elephants suffer from Schizophrenia? (Or do the Schizophrenias represent a disorder of self consciousness?) A Southern African perspectiveSean Exner Baumann6. Long term maintenance treatment of Bipolar Disorder: Preventing relapseCharles L. Bowden7. Predictors of response to treatments for Bipolar DisorderCharles L. Bowden8. Aids/HIV knowledge and high risk behaviour: A Geo-graphical comparison in a schizophrenia populationP Buckley, S van Vuuren, L Koen, J E Muller, C Seller, H Lategan, D J H Niehaus9. Does Marijuana make you go mad?David J Castle10. Understanding and management of Treatment Resistant SchizophreniaDavid J Castle11. Workshop on research and publishingDavid J Castle12. From victim to victor: Without a self-help bookBeatrix Jacqueline Coetzee13. The evaluation of the Gender Dysphoric patientFranco Colin14. Dissociation: A South African modelA M Dikobe, C K Mataboge, L M Motlana, B F Sokudela, C Kruger15. Designated smoking rooms...and other "Secret sins" of psychiatry: Tobacco cessation approaches in the severely mentally illCharl Els16. Dual diagnosis: Implications for treatment and prognosisCharl Els17. Body weight, glucose metabolism and the new generation antipsychoticsRobin Emsley18. Neurological abnormalities in first episode Schizophrenia: Temporal stability and clinical and outcome correlatesRobin Emsley, H Jadri Turner, Piet P Oosthuizen, Jonathan Carr19. Mythology of depressive illnesses among AfricansSenathi Fisha20. Substance use and High school dropoutAlan J. Flisher, Lorraine Townsend, Perpetual Chikobvu, Carl Lombard, Gary King21. Psychosis and Psychotic disordersA E Gangat 22. Vulnerability of individuals in a family system to develop a psychiatric disorderGerhard Grundling and Eugene Allers23. What does it Uberhaupt mean to "Integrate"?Jürgen Harms24. Research issues in South African child and adolescent psychiatryS M Hawkridge25. New religious movements and psychiatry: The Good NewsV H Hitzeroth26. The pregnant heroin addict: Integrating theory and practice in the development and provision of a service for this client groupV H Hitzeroth, L Kramer27. Autism spectrum disorderErick Hollander28. Recent advances and management in treatment resistanceEric Hollander29. Bipolar mixed statesM. Leigh Janet30. Profile of acute psychiatric inpatients tested for HIV - Helen Jospeh Hospital, JohannesburgA B R Janse van Rensburg31. ADHD - Using the art of film-making as an education mediumShabeer Ahmed Jeeva32. Treatment of adult ADHD co-morbiditiesShabeer Ahmed Jeeva33. Needs and services at ward one, Valkenberg HospitalDr J. A. Joska, Prof. A.J. Flisher34. Unanswered questions in the adequate treatment of depressionModerator: Dr Andre F JoubertExpert: Prof. Tony Hale35. Unanswered questions in treatment resistant depressionModerator: Dr Andre F JoubertExpert: Prof. Sidney Kennedy36. Are mentally ill people dangerous?Sen Z Kaliski37. The child custody circusSean Z. Kaliski38. The appropriatenes of certification of patients to psychiatric hospitalsV. N. Khanyile39. HIV/Aids Psychosocial responses and ethical dilemmasFred Kigozi40. Sex and PsychiatryB Levinson41. Violence and abuse in psychiatric in-patient institutions: A South African perspectiveMarilyn Lucas, John Weinkoove, Dean Stevenson42. Public health sector expenditure for mental health - A baseline study for South AfricaE N Madela-Mntla43. HIV in South Africa: Depression and CD4 countM Y H Moosa, F Y Jeenah44. Clinical strategies in dealing with treatment resistant schizophreniaPiet Oosthuizen, Dana Niehaus, Liezl Koen45. Buprenorphine/Naloxone maintenance in office practice: 18 months and 170 patients after the American releaseTed Parran Jr, Chris Adelman46. Integration of Pharmacotherapy for Opioid dependence into general psychiatric practice: Naltrexone, Methadone and Buprenorphine/ NaloxoneTed Parran47. Our African understanding of individulalism and communitarianismWillie Pienaar48. Healthy ageing and the prevention of DementiaFelix Potocnik, Susan van Rensburg, Christianne Bouwens49. Indigenous plants and methods used by traditional African healers for treatinf psychiatric patients in the Soutpansberg Area (Research was done in 1998)Ramovha Muvhango Rachel50. Symptom pattern & associated psychiatric disorders in subjects with possible & confirmed 22Q11 deletional syndromeJ.L. Roos, H.W. Pretorius, M. Karayiorgou51. Duration of antidepressant treatment: How long is long enough? How long is too longSteven P Roose52. A comparison study of early non-psychotic deviant behaviour in the first ten years of life, in Afrikaner patients with Schizophrenia, Schizo-affective disorder and Bipolar disorderMartin Scholtz, Melissa Janse van Rensburg, J. Louw Roos53. Treatment, treatment issues, and prevention of PTSD in women: An updateSoraya Seedat54. Fron neural networks to clinical practiceM Spitzer55. Opening keynote presentation: The art and science of PsychiatryM Spitzer56. The future of Pharmacotherapy for anxiety disordersDan J. Stein57. Neuropsychological deficits pre and post Electro Convulsive Therapy (ECT) thrice a week: A report of four casesUgash Subramaney, Yusuf Moosa58. Prevalence of and risk factors for Tradive Dyskinesia in a Xhosa population in the Eastern CapeDave Singler, Betty D. Patterson, Sandi Willows59. Eating disorders: Addictive disorders?Christopher Paul Szabo60. Ethical challenges and dilemmas of research in third world countriesGodfrey B. Tangwa61. The interface between Neurology and Psychiatry with specific focus on Somatoform dissociative disordersMichael Trimble62. Prevalence and correlates of depression and anxiety in doctors and teachersH Van der Bijl, P Oosthuizen63. Ingrid Jonker: A psychological analysisL. M. van der Merwe64. The strange world we live in, and the nature of the human subjectVasi van Deventer65. Art in psychiatry: Appendix or brain stem?C W van Staden66. Medical students on what "Soft skills" are about before and after curriculum reformC W van Staden, P M Joubert, A-M Bergh, G E Pickworth, W J Schurink, R R du Preez, J L Roos, C Kruger, S V Grey, B G Lindeque67. Attention deficit hyperactivity disorder (ADHD) - Medical management. Methylphenidate (Ritalin) or Atomoxetine (Strattera)Andre Venter68. A comprehensive guide to the treatment of adults with ADHDW J C Verbeeck69. Treatment of Insomnia: Stasis of the Art?G C Verster70. Are prisoners vulnerable research participants?Merryll Vorster71. Psychiatric disorders in the gymMerryl Vorster72. Ciprales: Effects on anxiety symptoms in Major Depressive DisorderBruce Lydiard

South East Queensland’s subtropical hinterlands—the mountainous, forested country lying between the cities of the coast and the Great Dividing Range—are sites of a regional variation of Australian Gothic. Hinterland Gothic draws its atmosphere and metaphors from the specificities of regional landscapes, climate, and histories.In works by Eleanor Dark, Judith Wright, Janette Turner Hospital, and Inga Simpson, South East Queensland’s Gold Coast and Sunshine Coast hinterlands are represented as Gothic regions “beyond the visible and known” (“Hinterland” in Oxford Dictionaries Online 2019), where the subtropical climate gives rise to an unruly, excessive nature.In Gothic literature, excess is related to the unspeakable or the repressed. Bringing Gothic, postcolonial, and ecocritical perspectives to bear on the literature of South East Queensland’s hinterlands reveals a preoccupation with the regions’ repressed histories of colonial violence, which are written on the landscape through Gothic metaphors.

Photo by Richard Catabay on Unsplash ABSTRACT COVID-19 exposed deep-rooted structural inequities. Allocation protocols developed during COVID-19 may cause furtherance of structural inequalities. In this essay, I specifically address the issue of structural inequities in the context of resource allocation during a period of crisis standard of care. In response to the increasing evidence of structural inequities during the pandemic, physicians and bioethicists Douglas White and Bernard Lo proposed incorporating a correction factor into resource allocation protocols. According to them, this would provide an advantage for disadvantaged individuals. The proposed correction factors use the Area Deprivation Index to determine eligibility. I argue that the correction factor is ethically justified and supported by Rawls’s difference principle, Daniels’s equality of opportunity, and Harris’s double jeopardy argument. I also suggest that the proposed correction factor does not go far enough, particularly if used with other objective factors, such as SOFA scoring. At least one study shows that using SOFA scoring for resource allocation during COVID-19 has a discriminatory effect on non-Hispanic black patients. One problem with the correction factor using the ADI is that it only applies to those currently in the reflected socioeconomic status. Additionally, when only one hospital serves a largely socioeconomically disadvantaged community, all admissions will fall within the targeted category for application of the correction factor. Thus, further actions are needed to dismantle structural inequities, such as implementing load balancing or the planned sharing of resources among healthcare systems. INTRODUCTION COVID-19 forced deep-rooted structural inequities to the surface. SARS-CoV-2 was a novel virus, but the connection between structural inequities and the disparate impact of the virus on marginalized populations is not. The history of pandemics reflects how much structural inequities negatively influence health equity.[1] The lack of preparedness and response to the structural inequities exemplify “blistering systemic failures.”[2] Despite warnings from prior threats from SARS and H1N1, we were unprepared for COVID-19. Antommaria and Chelen show that one-half of responding hospitals did not have an allocation protocol in place.[3] When an influx of critically ill patients and limited resources required implementing a crisis standard of care, many hospitals quickly established protocols addressing the allocation of scarce resources. Most crisis standard of care (CSC) protocols reflect public health’s utilitarian focus on saving the most lives.[4] The utilitarian focus ignores the disproportionate impact resulting from structural inequities. In December 2020, two physicians and bioethicists, Douglas White and Bernard Lo responded to the increasing evidence of the disproportionate impact of COVID-19 on disadvantaged communities by adding a correction factor to their CSC resource allocation protocol. The correction factor adjusts triage scores of individuals living in the most disadvantaged neighborhoods by subtracting one point from the triage score.[5] Patients with lower triage scores are more likely to receive life-saving care. Thus, subtracting a point provides an advantage. The correction factor uses a composite measure of disadvantage to determine eligibility called the Area Deprivation Index (ADI).[6] The ADI is a geographic measure of socioeconomic disadvantage that calculates an aggregate disadvantage score on a 10-point scale. The ADI measures seventeen elements of disadvantage related to poverty, education, employment, physical environment, and infrastructure.[7] The correction factor compensates for structural injustices by using ADI scores of patients in the highest quartile of socioeconomic disadvantage or having an ADI score of 8 to 10 since the strongest association between ADI scores and health outcomes occurs at the highest ADI levels.[8] l. Ethical Justifications Various theories of justice support applying the correction factor in the allocation of scarce resources. Rawls’s difference principle provides an ethical justification for the correction factor as it benefits the worse off in the event of resource allocation.[9] Applying the correction factor and subtracting one point from the triage score admittedly creates inequality among two otherwise like patients, but it is justified under Rawls’s theory since it gives the advantage to the least advantaged, addressing equity. Norman Daniels’ argument for protecting fair “equality of opportunity” also supports the correction factor.[10] The correction factor protects the equality of opportunity for those denied access to care because of deep-rooted structural inequities exacerbated by the pandemic. Using the correction factor to provide access to life-saving resources compensates patients with diminished opportunities in other arenas like the social determinants of health. Derek Parfit’s deontic egalitarianism supports the correction factor. Under Parfit’s view of deontic egalitarianism, justification of giving an advantage to the worse off depends on the reason for the inequality. If the unequal status results from circumstances such as a genetic condition or an accidental injury, like Daniel’s equality of opportunity, deontic egalitarianism does not support giving an advantage to the worse-off. If the unequal position results from the unjust actions of another, such as discriminatory treatment of people of color, deontic egalitarianism supports providing the advantage to address the inequity.[11] The disproportionate impact of resource allocation results from unjust treatment such as discrimination and structural inequity.[12] John Harris’s double jeopardy argument adds additional support to the correction factor in that[13] the socioeconomically disadvantaged or those facing racial or ethnic discrimination may have had an increased risk of contracting COVID-19 or having a severe case or death due to structural inequities. If the triage procedures do not compensate for the structural inequities and they are precluded access to critical care based only on traditional triage, they will suffer double jeopardy. The correction factor avoids this double jeopardy. ll. Operationalizing the Correction Factor Those opposing the correction factor might assert the infeasibility of mitigating inequities during a pandemic.[14] Yet one large US health system successfully applied similar criteria in allocating remdesivir[15] and the National Academy of Medicine endorsed disparity-mitigating criteria for allocating scarce vaccines.[16] Applying the correction factor is neither time nor resource intensive. It will not divert resources from the goal of treating illness and reducing morbidity. With the data available about COVID-19’s disproportionate impact, not applying an available tool to lessen inequities is an abrogation of ethical duty. One utilitarian argument asserts that we will save fewer lives if the prioritized patients are more likely to die despite interventions. Yet society bears responsibility for the social policies that created the disparities. Thus, there is an obligation to mitigate those societal problems, even when doing so might save fewer lives.[17] Some clinicians argue that they should have discretion in determining triage scores. This objection to the correction factor in formulating triage procedures reflects the conflict between clinical and public health ethics. Implementing a CSC protocol shifts decision-making from the clinician to a triage committee and from an individual focus to a community focus. Allowing clinicians to determine triage protocols would increase the risk of decisions based on bias and subjectivity. Another open question is whether the correction factor will achieve the intended goal. Nancy Kass suggests that without evidence to support the effectiveness, we cannot ethically implement the policy.[18] Thus, applying the Kass analysis, diverting a scarce resource to someone less likely to survive should require proof that doing so systematically would resolve or improve structural inequity. There is limited empirical evidence, but we may proceed with caution based on the presumptive data and the hypothesis that a triage allocation that uses a correction factor could help. Computer-based modeling or “tabletop” exercises applying the framework to actual patients but not enacting the protocols could assess the possible effects of the protocols.[19] Perhaps the most robust rebuttal in response to the opposition of applying a correction factor is in an argument proffered by Douglas White that no reasonable triage framework maximizes health outcomes if it creates significant inequalities.[20] White’s argument emphasizes the importance of addressing inequity. lll. A More Robust Version of the Correction Factor The burdens associated with any public health intervention typically fall into three categories:[21] privacy and confidentiality, risk to liberty and self-determination, and justice. Most burdens associated with allocating scarce resources fall under the justice category. I not only disagree with the arguments against using a correction factor, but I also argue that the correction factor does not go far enough. First, using the ADI neglects consideration of people of color disproportionately affected by COVID-19 no longer living in a neighborhood with the highest ADI scores. Based on new research, Sequential Organ Failure Assessment (SOFA) scores are also potentially discriminatory and not ideal for addressing structural inequity, racism, or ethnic discrimination in the triage setting, although they are applied to triage.[22] Second, public hospitals in socioeconomically depressed communities and rural locations may serve a population in which nearly the entire community will have ADI scores that qualify for application of the correction factor. lV. Relying on ADI cannot protect all people disadvantaged due to their race or ethnicity The ADI uses seventeen measures of socioeconomic disadvantage. Some racial inequality in healthcare is unrelated to socioeconomic status and can be missed by ADI. Racial inequality in healthcare may be directly related to implicit and explicit bias and past and current discrimination. But the correction factor will not help the Black patient not currently residing in a highly disadvantaged neighborhood or experiencing other vestiges of racism in the form of socioeconomic disadvantage. A correction factor that uses more information than ADI could make up for some of the weaknesses of SOFA as well. V. When all patients have high ADI Scores What happens when triaging occurs in hospitals serving populations where almost all patients have ADI scores of 8 to 10? To illustrate, I will use the example of Belle Glade, Florida, in western Palm Beach County.[23] The overwhelming majority of the neighborhoods served by the one public hospital, Lakeside Medical Center, is at a level 10 state decile, with a few neighborhoods at 8 and 9 state decile.[24] During a surge in that hospital, the correction factor will apply to every patient. The hospital must then resort to other considerations, such as random allocation. This potential dilemma suggests the need to consider further steps, such as load balancing, to lessen the inequities. Vl. Load Balancing Load balancing is a plan in which hospitals report daily census and available beds. Patients are diverted or transferred to hospitals with open beds when one hospital is at maximum capacity. Although identified as a method to avoid the need for triaging, I suggest load balancing is also equity balancing, especially when the overwhelmed hospital is in a high ADI area. Failures in load balancing exacerbate the harm to disadvantaged populations. Disadvantaged individuals are more likely to seek treatment in hospitals with limited ability to increase capacity or care for many critically ill patients. During surges in COVID-19, hospitals in poor neighborhoods were overrun by admissions and lacked resources to treat, while nearby private hospitals had available beds and resources.[25] The Arizona Department of Health Services developed an effective load-balancing system to coordinate the statewide transfer of patients from overloaded hospitals to other hospitals.[26] The system dramatically improved access to care for people of color and rural populations.[27] One of the state’s foremost responsibilities is safeguarding the health and well-being of people threatened when health systems fail to cooperate. Voluntary load balancing is preferable, but if the healthcare systems are unwilling to cooperate and if voluntary efforts are ineffective, state governments should intervene and require private hospitals to take part in load balancing. When needed, public health officials should issue emergency orders to require hospitals to participate in load-balancing efforts, including accepting patient transfers that are not part of their covered population. CONCLUSION Rawls’s difference principle, Daniels’s equality of opportunity, Parfit’s deontic egalitarianism, and Harris’s double jeopardy argument all justify and may even compel using the correction factor. COVID-19 turned academic and hypothetical discussions and debates about allocating scarce resources and making untenable choices of who lives and who dies to real-life responsibilities. Once hospitals move to a crisis standard of care, they may need to allocate scarce resources, so having systems in place that can compensate for past inequities and improve fairness in access to care is the ethical imperative. Dismantling structural inequities and reassessing allocation protocols should incorporate the correction factor as a new foundational framework and then build on it using load balancing and exercising caution if applying SOFA. It is an ethical responsibility to use these tools to dismantle the pervasive structural inequities when allocating scarce resources. - [1] Goldberg, Daniel S. “Against the Medicalization of Public Health (Ethics).” Public Health Ethics 14, no. 2 (2021): 117–19. https://doi.org/10.1093/phe/phab024. [2] Morrissey, Mary Beth, and Jorge L. Rivera-Agosto. “Protecting the Public's Health in Pandemics: Reflections on Policy Deliberation and the Role of Civil Society in Democracy.” Frontiers in Public Health 9 (June 1, 2021): 6. https://doi.org/10.3389/fpubh.2021.678210. [3] Antommaria, Armand H., Tyler S. Gibb, Amy L. McGuire, Paul Root Wolpe, Matthew K. Wynia, Megan K. Applewhite, Arthur Caplan, et al. “Ventilator Triage Policies during the Covid-19 Pandemic at U.S. Hospitals Associated with Members of the Association of Bioethics Program Directors.” Annals of Internal Medicine 173, no. 3 (April 4, 2020): 188–94. https://doi.org/10.7326/m20-1738; Chelan, Julia S., Douglas B. White, Stephanie Zaza, Amanda N. Perry, Deborah S. Feifer, Maia L. Crawford, and Amber E. Barnato. “US Ventilator Allocation and Patient Triage Policies in Anticipation of the Covid-19 Surge.” Health Security 19, no. 5 (2021): 459–67. https://doi.org/10.1089/hs.2020.0166. [4] Lin, Janet Y., and Lisa Anderson-Shaw. “Rationing of Resources: Ethical Issues in Disasters and Epidemic Situations.” Prehospital and Disaster Medicine 24, no. 3 (2009): 215–21. https://doi.org/10.1017/s1049023x0000683x. [5] Executive Summary Allocation of Scarce Critical Care Resources during a ...,” April 9, 2021. https://ccm.pitt.edu/sites/default/files/Model%20hospital%20policy%20for%20allocation%20of%20critical%20care_2020-03-23%20web.pdf. [6]. Executive Summary Allocation of Scarce Critical Care Resources during a ...,” April 9, 2021. https://ccm.pitt.edu/sites/default/files/Model%20hospital%20policy%20for%20allocation%20of%20critical%20care_2020-03-23%20web.pdf. [7] https://www.neighborhoodatlas.medicine.wisc.edu/mapping; Executive Summary Allocation of Scarce Critical Care Resources during a ...,” April 9, 2021. [8] White, Douglas B., and Bernard Lo. “Structural Inequities, Fair Opportunity, and the Allocation of Scarce ICU Resources.” Hastings Center Report 51, no. 5 (2021): 42–47. https://doi.org/10.1002/hast.1285 [9] McKie, John, and Jeff Richardson. “The Rule of Rescue.” Social Science and Medicine 56 (2003): 2407–19 [10] Daniels, Norman. “Justice, Health, and Health Care.” Essay. In Medicine and Social Justice Essays on the Distribution of Health Care, edited by Rosamond Rodes, Margaret P Battin, and Anita Silvers, Seconded., 17–33. Oxford University Press, n.d. [11] Brock, Dan W. “Priority to the Worse Off in Health Care Resource Prioritization .” Essay. In Medicine and Social Justice Essays on the Distribution of Health Care, edited by Rosamond Rhodes, Margaret Battin, and Anita Silvers, 155–64. Oxford University Press, n.d. [12] Brock, Dan W. “Priority to the Worse Off in Health Care Resource Prioritization .” Essay. In Medicine and Social Justice Essays on the Distribution of Health Care, edited by Rosamond Rhodes, Margaret Battin, and Anita Silvers, 155–64. Oxford University Press, n.d. [13] Harris, J. “Qualifying the Value of Life.” Journal of Medical Ethics 13, no. 3 (1987): 117–23. https://doi.org/10.1136/jme.13.3.117. [14] White, Douglas B., and Bernard Lo. “Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic.” American Journal of Respiratory and Critical Care Medicine 203, no. 3 (February 1, 2021): 287–95. https://doi.org/10.1164/rccm.202010-3809cp. [15] White, Douglas B., and Bernard Lo. “Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic.” American Journal of Respiratory and Critical Care Medicine 203, no. 3 (February 1, 2021): 287–95. https://doi.org/10.1164/rccm.202010-3809cp. [16] White, Douglas B., and Bernard Lo. “Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic.” American Journal of Respiratory and Critical Care Medicine 203, no. 3 (February 1, 2021): 287–95. https://doi.org/10.1164/rccm.202010-3809cp. [17] White, Douglas B., and Bernard Lo. “Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic.” American Journal of Respiratory and Critical Care Medicine 203, no. 3 (February 1, 2021): 287–95. https://doi.org/10.1164/rccm.202010-3809cp. [18] Kass, Nancy E. “An Ethics Framework for Public Health.” American Journal of Public Health 91, no. 11 (November 2001): 1776–82. https://doi.org/10.2105/ajph.91.11.1776. [19] White, Douglas B., and Bernard Lo. “Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic.” American Journal of Respiratory and Critical Care Medicine 203, no. 3 (February 1, 2021): 287–95. https://doi.org/10.1164/rccm.202010-3809cp. [20] White, Supra.12 [21] Kass, Nancy E. “An Ethics Framework for Public Health.” American Journal of Public Health 91, no. 11 (November 2001): 1776–82. https://doi.org/10.2105/ajph.91.11.1776. [22] Tolchin, Benjamin, Carol Oladele, Deron Galusha, Nitu Kashyap, Mary Showstark, Jennifer Bonito, Michelle C. Salazar, et al. “Racial Disparities in the SOFA Score among Patients Hospitalized with Covid-19.” PLOS ONE. Public Library of Science, September 17, 2021. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0257608; SOFA is a prognostic scoring system that assigns points for organ failure evidence within six different organ systems. Higher SOFA scores correlate with higher mortality. New research by Tolchin reveals the flaws in SOFA due to its failure to account for delays in seeking care and overestimates of Black mortality. Also see Antommaria, Armand H., Tyler S. Gibb, Amy L. McGuire, Paul Root Wolpe, Matthew K. Wynia, Megan K. Applewhite, Arthur Caplan, et al. “Ventilator Triage Policies during the Covid-19 Pandemic at U.S. Hospitals Associated with Members of the Association of Bioethics Program Directors.” Annals of Internal Medicine 173, no. 3 (April 4, 2020): 188–94. https://doi.org/10.7326/m20-1738; Chelen, Julia S., Douglas B. White, Stephanie Zaza, Amanda N. Perry, Deborah S. Feifer, Maia L. Crawford, and Amber E. Barnato. “US Ventilator Allocation and Patient Triage Policies in Anticipation of the Covid-19 Surge.” Health Security 19, no. 5 (2021): 459–67. https://doi.org/10.1089/hs.2020.0166; and Pence, Gregory E. Pandemic Bioethics. Peterborough: Broadview Press, 2021. [23] Black – population 59.28 % Median Household income 24,322 Population 20,276 Education: 31.$ HS; 21.71% less than 95 grade, Postsecondary Asso-7%, Bachelors 6.7, ttps://worldpopulationreview.com/us-cities/belle-glade-fl-population [24] Neighborhood atlas®. Neighborhood Atlas - Mapping. (n.d.). Retrieved February 15, 2022, from https://www.neighborhoodatlas.medicine.wisc.edu/mapping [25] White, Douglas, Keynote Address, American Society of Bioethics and Humanities, October 13, 2021, COVID-19 at the Crossroads, https://eventpilotadmin.com/web/planner.php?id=ASBH21 [26] Angelo, A. (2020, May 26). Latest Covid-19 Model Shows Arizona can Meet a Health Care Surge. Retrieved February 15, 2022, from https://communityimpact.com/phoenix/chandler/coronavirus/2020/05/26/latest-covid-19-model-shows-arizona-can-meet-a-health-care-surge/ [27] White, Douglas, Keynote Address, American Society of Bioethics and Humanities, October 13, 2021, COVID-19 at the Crossroads, https://eventpilotadmin.com/web/planner.php?id=ASBH21

In a TEXT essay in 2004, Philip Edmonds wrote about the publication prospects of graduates of creative writing programs. He depicted the publishing industry of the 1970s and 1980s as a field driven by small presses and literary journals, and lamented the dearth of these publications in today’s industry. Edmonds wrote that our creative writing programs as they stand today are under-performing as they do not deliver on the prime goal of most students: publication. “Ultimately,” he wrote, “creative writing programs can only operate to their full potential alongside an expanding and vibrant publishing culture” (1). As a creative writing and publishing lecturer myself, and one who teaches in the field of publishing and editing, this anxiety rings quite true. I am inherently interested in the creation of a strong and vibrant publishing industry so that promising students and graduates might get the most out of their degrees. As the popularity of creative writing programs grows, what relationships are being formed between writing programs and the broader publishing industry? Furthermore, does a role and responsibility exist for universities themselves to foster the publication of the emerging writers they train? Edmonds argued that the answer could be found not in universities, but in state writers’ centres. He advocated a policy whereby universities and the Australia Council funded the production of literary magazines through state writers’ centres, resulting in a healthier publishing marketplace for creative writing graduates (6). This paper offers a second alternative to this plan, arguing that university presses can play a role in the development of a healthier Australian publishing industry. To do so, it cites three examples of university press interactions with both the broad writing and publishing industry, and more specifically, with creative writing programs. The paper uses these examples—University of Queensland Press, University of Western Australia Press, and Giramondo Publishing (UWS)—in order to begin a broader conversation regarding the role universities can play in the writing and publishing industry. Let us begin by thinking about the university and its traditional role in the development of literature. The university can be thought of as a multi-functional literary institution. This is not a new concept: for centuries, there has been an integral link between the book trade and the university, with universities housing “stationers, scribes, parchment makers, paper makers, bookbinders, and all those associated with making books” (Clement 317). In universities today, we see similar performances of the various stages of literary production. We have students practising creative writing in both undergraduate and postgraduate coursework programs. We have the editing of texts and mentoring of writers through postgraduate creative writing supervision. We have the distribution of texts through sales from university bookshops, and the mass storage and loans of texts in university libraries. And we have the publication of texts through university presses.This point of literary production, the publication of texts through university presses, has traditionally been preoccupied with the publication of scholarly work. However, a number of movements within the publishing industry towards the end of the twentieth century resulted in some university presses shifting their objectives to incorporate trade publishing. The globalization of the publishing industry in the early 1990s led to a general change in the decision-making process of mainstream publishers, where increasingly, publishers looked at the commercial viability of texts rather than their cultural value. These movements, defined by the takeover of many publishing houses by media conglomerates, also placed significant financial pressure on smaller publishers, who struggled to compete with houses now backed by significantly increased fiscal strength. While it is difficult to make general statements about university presses due to their very particular nature, one can read a trend towards trade publishing by a number of university presses in an attempt to alleviate some of these financial pressures. This shift can be seen as one interaction between the university and the broader creative writing discipline. However, not all university presses waited until the financial pressures of the 1990s to move to trade publishing. For some presses, their trade lists have played a significant role in defining their relationship with literary culture. One such example in the Australian landscape is University of Queensland Press. UQP was founded in 1948, and subsisted as purely a scholarly publisher until the 1960s. Its first movements into trade publishing were largely through poetry, originally publishing traditional hardback volumes before moving into paperback, a format considered both innovative and risky at the time. David Malouf found an early home at UQP, and has talked a number of times about his relationship with the press. His desire to produce a poetry format which appealed to a new type of audience spawned the press’s interest in trade publishing. He felt that slim paperback volumes would give poetry a new mass market appeal. On a visit to Brisbane in 1969 I went to talk to Frank Thompson (general manager) at the University of Queensland Press… I told him that I did have a book but that I also had a firm idea of the kind of publication I wanted: a paperback of 64 pages that would sell for a dollar. Frank astonished me by saying … that if his people told him it was financially viable he would do it. He picked up the phone, called in his production crew … and after a quarter of an hour of argument and calculations they came up with the unit cost of, I think, twenty-three cents. ‘Okay, mate,’ Frank told me, ‘you’re on.’ I left with a firm undertaking and a deadline for delivery of the manuscript. (Malouf 72-73) That book of poetry, Bicycle and Other Poems, was Malouf’s first solo volume. It appeared in bookstores in 1970 alongside other slim volumes by Rodney Hall and Michael Dransfield, two men who would go on to become iconic Brisbane poets. Together, these three bold experiments in paperback poetry publishing sold a remarkable 7,000 copies and generated these sales without school or university adoptions, and without any Commonwealth Literary Fund assistance, either. UQP went on to publish 159 new titles of poetry between 1968 and 1996, becoming a significant player in the Australian literary landscape. Through University of Queensland Press’s poetry publishing, we see a way of how the university can interact with the broader writing and publishing industry. This level of cohesion between the publishing house and the industry became one of the distinguishing features of the press in this time. UQP garnered a reputation for fostering Australian writing talent, launching the careers of a generation of Australian authors. Elizabeth Jolley, Roger McDonald, Beverley Farmer, Thea Astley, Janette Turner Hospital, and Peter Carey all found their first home at the press. The university’s publishing house was at the forefront of Australian literary development at a time when Australia was beginning to blossom, culturally, as a nation. What this experience shows is the cultural importance and potential cultural benefit of a high level of cohesion between the university press and the broader writing and publishing industry. UQP has also sought to continue a high level of social cohesion with the local community. The press is significant in that it inhabits a physical space, the city of Brisbane, which is devoid of any other significant trade publishers. In this sense, UQP, and by association, the University of Queensland, has played a leading role in the cultural and literary development of the city. UQP continues to sponsor events such as the Brisbane Writers Festival, and publishes the winning manuscript for the Emerging Queensland Author award at the annual Queensland Premier’s Literary Awards. Another point of interest in this relationship between the press and the university at University of Queensland can be seen in the relationship between UQP and some of the staff in the university’s creative writing department. Novelist, Dr Venero Armanno, senior lecturer in the creative writing program at UQ, shifted from a major international publisher back to his employer’s publishing house in 2007. Armanno’s move to the press was coupled with the appointment at UQP of another University of Queensland creative writing senior lecturer, Dr Bronwyn Lea, as poetry editor (Lea has recently left this post). This sort of connection shapes the public face of creative writing within the university, and heightens the level of cohesion between creative writing programs and university publishing. The main product of this interaction is, perhaps, the level of cohesion between university press and creative writing faculty that the relationship outwardly projects. This interaction leads us to question whether more formal arrangements for the cohesion between creative writing departments and university presses can be put in place. Specifically, the two activities beg the question: why can’t university publishers who publish trade fiction make a commitment to publish work that comes out of their own creative writing programs, and particularly, work out of their research higher degrees? The short answer to this seems to be caught up in the differing objectives of university presses and creative writing programs. The matter is not as cut-and-dry as a press wanting to publish good manuscripts, and a creative writing program, through its research by creative practice, providing that work. A number of issues get in the way: quality of manuscripts, editorial direction of press, areas of specialisation of creative writing faculty, flow of numbers through creative writing programs, to name a few. University of Western Australia Publishing recently played with the idea of how these two elements of creative writing within the university, manuscript production and trade publishing, could work together. UWA Publishing was established in 1935 as UWA Press (the house changed its name to UWA Publishing in 2009). Like University of Queensland Press, the house provides an important literary and cultural voice in Perth, which is not a publishing hub on the scale of Sydney or Melbourne. In 2005, the press, which had a tradition as a strong scholarly publisher and emerging trade publisher, announced a plan to publish a new series of literary fiction written by students in Australian creative writing courses. This was a new idea for UWA Publishing, as the house had previously only published scholarly work, along with natural history, history and children’s books.UWA Publishing fiction series editor Terri-Ann White said that the idea behind the series was to use creative writing postgraduate degrees as a “filter” to get the best emerging writing in Australia.There’s got to be something going for a student writer working with an experienced supervisor with all of the resources of a university. There’s got to be an edge to that kind of enterprise. (In Macnamara 3) As this experiment began in 2005, the result of the press’s doctrine is still unclear. However, it could be interesting to explore the motivations behind the decision to focus fiction publishing on postgraduate student work. Many presses publish student work—N.A. Bourke’s The Bone Flute and Julienne van Loon’s Road Story come to mind as two examples of successful work produced in a creative writing program—but few houses advertise where the manuscript has come from. This is perhaps because of the negative stigma that goes along with student work, that the writing is underdeveloped or, perhaps, formulaic, somehow over-influenced by its supervisor or home institution. UWA Publishing’s decision to take fiction solely from the pool of postgraduate writers is a bold one, and can be seen perhaps as noble by those working within the walls of the university. Without making any assumptions about the sales success of the program, the decision does shape the way in which the press is seen in the broader writing and publishing industry. We can summise from the decision that the list will have a strong literary focus, that the work will be substantial and well-researched, to the point where it could contribute to the bulk of a Masters degree by research, or PhD. The program would also appear to appeal to writing students within the university, all of whom go through their various degrees being told how difficult publication can be for first time writers. Another approach to the relationship between university presses and the broader writing and publishing industry can be seen at the University of Western Sydney. UWS founded a group in 2005 called the Writing and Society Research Group. The group manages the literary journal Heat Magazine and the Giramondo book imprint. Giramondo Publishing was established in 1995 with “the aim of publishing quality creative and interpretative writing by Australian authors”. It states its objectives as seeking to “build a common ground between the academy and the marketplace; to stimulate exchange between Australian writers and readers and their counterparts overseas; and to encourage innovative and adventurous work that might not otherwise find publication because of its subtle commercial appeal” ("Giramondo History"). These objectives demonstrate an almost utopian idea of engaging with the broader writing and publishing industry—here we have a university publisher actively seeking to publish inventive and original work, the sort of work which might be overlooked by other publishers. This philosophical approach indicates the gap which university presses (in an ideal world) would fill in the publishing industry. With the financial support of the university (and, in the case of Giramondo and others, funding bodies such as the Australia Council), university presses can be in a unique position to uphold more traditional literary values. They can focus on the cultural value of books, rather than their commercial potential. In this way, the Writing and Society Research Group at UWS demonstrates a more structural approach to the university’s engagement with the publishing industry. It engages with the industry as a stakeholder of literary values, fulfilling one of the roles of the university as a multi-functional literary institution. It also seeks directly to foster the work of new and emerging writers. Not all universities and university presses will have the autonomy or capacity to act in such a way. What is necessary is constant thought, debate and action towards working out how the university press can be a dynamic and relevant industry player. References Clement, Richard. “Cataloguing Medieval and Renaissance Manuscripts.” The Library Quarterly 55 (1985): 316-326. Edmonds, Philip. “Respectable or Risqué: Creative Writing Programs in the Marketplace.” TEXT 8.1 (2004). 27 Jan. 2010 < http://www.textjournal.com.au/april04/edmonds.htm >. “Giramondo History.” Giramondo Publishing. 27 Jan. 2010 < http://www.giramondopublishing.com/history >. Greco, Albert N., Clara E. Rodriguez, and Robert M. Wharton. The Culture and Commerce of Publishing in the 21st Century. Stanford: Stanford Business Books, 2007. Macnamara, Lisa. “Big Break for Student Writers.” The Australian 2 Nov. 2005: Features 3. Malouf, David. In Munro, Craig, ed. UQP: The Writer’s Press: 1948 – 1998. St Lucia: University of Queensland Press, 1998.

Australian suburbia, historically and culturally, has been viewed as a feminised domain, associated with the domestic and family, routine and order. Where “the city is coded as a masculine and disorderly space… suburbia, as a realm of domesticity and the family, is coded as a feminine and disciplinary space” (Wilson 46). This article argues how the treatment of suburbia in fiction as “feminine” has impacted not only on the representation and development of the character of the “suburban female”, but also on the shape and form of her narrative journeys. Suburbia’s subordination as domestic and everyday, a restrictive realm of housework and child rearing, refers to the anti-suburban critique and establishes the dichotomy of suburbia/feminine/domesticity in contrast to bush or city/masculine/freedom as first observed by Marilyn Lake in her analysis of 1890s Australia. Despite the fact that suburbia necessarily contains the “masculine” as well as the “feminine”, the “feminine” dominates to such an extent that positive masculine traits are threatened there. In social commentary and also literature, the former is viewed negatively as a state from which to escape. As Tim Rowse suggests, “women, domesticity = spiritual starvation. (Men, wide open spaces, achievement = heroism of the Australian spirit)” (208). In twentieth-century Australian fiction, this is especially the case for male characters, the preservation of whose masculinity often depends on a flight from the suburbs to elsewhere—the bush, the city, or overseas. In Patrick White’s The Tree Of Man (1955), for example, During identifies the recurrent male character of the “tear-away” who “flee(s) domesticity and family life” (96). Novelist George Johnston also establishes a satirical depiction of suburbia as both suffocatingly feminine and as a place to escape at any cost. For example, in My Brother Jack (1964), David Meredith “craves escape from the ‘shabby suburban squalor’ into which he was born” (Gerster 566). Suburbia functions as a departure point for the male protagonist who must discard any remnants of femininity, imposed on him by his suburban childhood, before embarking upon narratives of adventure and maturation as far away from the suburbs as possible. Thus, flight becomes essential to the development of male protagonist and proliferates as a narrative trajectory in Australian fiction. Andrew McCann suggests that its prevalence establishes a fictional “struggle with and escape from the suburb as a condition of something like a fully developed personality” (Decomposing 56-57). In this case, any literary attempt to transform the “suburban female”, a character inscribed by her gender and her locale, without recourse to flight appears futile. However, McCann’s assertion rests on a literary tradition of male flight from suburbia, not female. A narrative of female flight is a relatively recent phenomenon, influenced by the second wave feminism of the 1970s and 1980s. For most of the twentieth century, the suburban female typically remained in suburbia, a figure of neglect, satire, and exploitation. A reading of twentieth-century Australian fiction until the 1970s implies that flight from suburbia was not a plausible option for the average “suburban female”. Rather, it is the exceptional heroine, such as Teresa in Christina Stead’s For Love Alone (1945), who is brave, ambitious, or foolish enough to leave, and when she does there were often negative consequences. For most however, suburbia was a setting where she belonged despite its negative attributes. These attributes of conformity and boredom, repetition, and philistinism, as presented by proponents of anti-suburbanism, are mainly depicted as problematic to male characters, not female. Excluded from narratives of flight, for most of the twentieth-century the suburban female typically remained in suburbia, a figure of neglect, satire, and even exploitation, her stories mostly untold. The character of the suburban female emerges out of the suburban/feminine/domestic dichotomy as a recurrent, albeit negative, character in Australian fiction. As Rowse states, the negative image of suburbia is transferred to an equally negative image of women (208). At best, the suburban female is a figure of mild satire; at worst, a menacing threat to masculine values. Male writers George Johnston, Patrick White and, later, David Ireland, portrayed the suburban female as a negative figure, or at least an object of satire, in the life of a male protagonist attempting to escape suburbia and all it stood for. In his satirical novels and plays, for example, Patrick White makes “the unspoken assumption… that suburbia is an essentially female domain” (Gerster 567), exemplifying narrow female stereotypes who “are dumb and age badly, ending up in mindless, usually dissatisfied, maternity and domesticity” (During 95). Feminist Anne Summers condemns White for his portrayal of women which she interprets as a “means of evading having to cope with women as unique and diverse individuals, reducing them instead to a sexist conglomerate”, and for his use of women to “represent suburban stultification” (88). Typically “wife” or “mother”, the suburban female is often used as a convenient device of oppositional resistance to a male lead, while being denied her own voice or story. In Johnston’s My Brother Jack (1964), for example, protagonist David Meredith contrasts “the subdued vigour of fulfillment tempered by a powerful and deeply-lodged serenity” (215) of motherhood displayed by Jack’s wife Shelia with the “smart and mannish” (213) Helen, but nothing deeper is revealed about the inner lives of these female characters. Feminist scholars identify a failure to depict the suburban female as more than a useful stereotype, partially attributing the cause of this failure to a surfeit of patriarchal stories featuring adventuresome male heroes and set in the outback or on foreign battlefields. Summers states how “more written words have been devoted to creating, and then analysing and extolling… [the] Australian male than to any other single facet of Australian life” (82-83). Where she is more active, the suburban female is a malignant force, threatening to undermine masculine goals of self-realisation or achievement, or at her worst, to wholly emasculate the male protagonist such that he is incapable of escape. Even here the motivations behind her actions are not revealed and she appears two-dimensional, viewed only in relation to her destructive effect on the weakened male protagonist. In her criticism of David Ireland’s The Glass Canoe (1976), Joan Kirkby observes how “the suburbs are populated with real women who are represented in the text as angry mothers and wives or simply as the embodiment of voraciously feral sexuality” (5). In those few instances where the suburban female features as more than an accessory to the male narrative, she lacks the courage and inner strength to embark upon her own journey out of suburbia. Instead, she is depicted as a victim, misunderstood and miserable, entrapped by the suburban milieu to which she is meant to belong but, for some unexplored reason, does not. The inference is that this particular suburban female is atypical, potentially flawed in her inability to find contentment within a region strongly designated her own. The unhappy suburban female is therefore tragic, or at least pitiable, languishing in a suburban environment that she loathes, often satirised for her futile resistance to the status quo. Rarely is she permitted the masculine recourse of flight. In those exceptional instances where she does leave, however, she is unlikely to find what she is looking for. A subsequent return to the place of childhood, most often situated in suburbia, is a recurrent narrative in many stories of Australian female protagonist, but less so the male protagonist. Although this mistreatment of the suburban female is most prevalent in fiction by male writers, female writers were also criticised for failing to give a true and authentic voice to her character, regardless of the broader question of whether writers should be truthful in their characterisations. For example, Summers criticises Henry Handel Richardson as “responsible for, if not creating, then at least providing a powerful reinforcement to the idea that women as wives are impediments to male self-realisation” with characters who “reappear, with the monotonous regularity of the weekly wash, as stereotyped and passive suburban housewives” (87-88). All this changed, however, with the arrival of second wave feminism leading to a proliferation of stories of female exodus from the suburbs. A considered portrait of the life of the suburban female in suburbia was neglected in favour of a narrative journey; a trend attributable in part to a feminist polemic that granted her freedom, adventure, and a story so long as she did not dare choose to stay. During the second wave feminism of the 1970s and 1980s, women were urged by leading figures such as Betty Friedan and Germaine Greer to abandon ascribed roles of housewife and mother, led typically in the suburbs, in pursuit of new freedoms and adventures. As Lesley Johnson and Justine Lloyd note, “in exhorting women to ‘leave home’ and find their fulfillment in the world of work, early second wave feminists provided a life story through which women could understand themselves as modern individuals” (154) and it is this “life story” which recurs in women’s fiction of the time. Women writers, many of whom identified as feminist, mirrored these trajectories of flight from suburbia in their novels, transplanting the suburban female from her suburban setting to embark upon “new” narratives of self-discovery. The impact of second wave feminism upon the literary output of Australian women writers during the 1970s and 1980s has been firmly established by feminist scholars Johnson, Lloyd, Lake, and Susan Sheridan, who were also active participants in the movement. Sheridan argues that there has been a strong “relationship of women’s cultural production to feminist ideas and politics” (Faultlines xi) and Johnson identifies a “history of feminism as an awakening” at the heart of these “life stories” (11). Citing Mary Morris, feminist Janet Woolf remarks flight as a means by which a feminine history of stagnation is remedied: “from Penelope to the present, women have waited… If we grow weary of waiting, we can go on a journey” (xxii). The appeal of these narratives may lie in attempts by their female protagonists to find new ways of being outside the traditional limits of a domestic, commonly suburban, existence. Flight, or movement, features as a recurrent narrative mode by which these alternative realities are configured, either by mimicking or subverting traditional narrative forms. Indeed, selection of the appropriate narrative form for these emancipatory journeys differed between writers and became the subject of vigorous, feminist and literary debate. For some feminists, the linear narrative was the only true path to freedom for the female protagonist. Following the work of Carolyn G. Heilbrun and Elaine Showalter, Joy Hooton observes how some feminist critics privileged “the integrated ego and the linear destiny, regarding women’s difference in self-realization as a failure or deprivation” (90). Women writers such as Barbara Hanrahan adopted the traditional linear trajectory, previously reserved for the male protagonist as bushman or soldier, explorer or drifter, to liberate the “suburban female”. These stories feature the female protagonist trading a stultifying life in the suburbs for the city, overseas or, less typically, the outback. During these geographical journeys, she is transformed from her narrow suburban self to a more actualised, worldly self in the mode of a traditional, linear Bildungsroman. For example, Hanrahan’s semi-autobiographical debut The Scent of Eucalyptus (1973) is a story of escape from oppressive suburbia, “concentrating on that favourite Australian theme, the voyage overseas” (Gelder and Salzman, Diversity 63). Similarly, Sea-green (1974) features a “rejection of domestic drabness in favour of experience in London” (Goodwin 252) and Kewpie Doll (1984) is another narrative of flight from the suburbs, this time via pursuit of “an artistic life” (253). In these and other novels, the act of relocation to a specific destination is necessary to transformation, with the inference that the protagonist could not have become what she is at the end of the story without first leaving the suburbs. However, use of this linear narrative, which is also coincidentally anti-suburban, was criticised by Summers (86) for being “masculinist”. To be truly free, she argued, the female protagonist needed to forge her own unique paths to liberation, rather than relying on established masculine lines. Evidence of a “new” non-linear narrative in novels by women writers was interpreted by feminist and literary scholars Gillian Whitlock, Margaret Henderson, Ann Oakley, Sheridan, Johnson, and Summers, as an attempt to capture the female experience more convincingly than the linear form that had been used to recount stories of the journeying male as far back as Homer. Typifying the link between the second wave feminism and fiction, Helen Garner’s Monkey Grip features Nora’s nomadic, non-linear “flights” back and forth across Melbourne’s inner suburbs. Nora’s promiscuity belies her addiction to romantic love that compromises her, even as she struggles to become independent and free. In this way, Nora’s quest for freedom­—fragmented, cyclical, repetitive, impeded by men— mirrors Garner’s “attempt to capture certain areas of female experience” (Gelder and Salzman, Diversity 55), not accessible via a linear narrative. Later, in Honour and Other People’s Children (1980) and The Children’s Bach (1984), the protagonists’ struggles to achieve self-actualisation within a more domesticated, family setting perhaps cast doubt on the efficacy of the feminist call to abandon family, motherhood, and all things domestic in preference for the masculinist tradition of emancipatory flight. Pam Gilbert, for instance, reads The Children’s Bach as “an extremely perceptive analysis of a woman caught within spheres of domesticity, nurturing, loneliness, and sexuality” (18) via the character of “protected suburban mum, Athena” (19). The complexity of this characterisation of a suburban female belies the anti-suburban critique by not resorting to satire or stereotype, but by engaging deeply with a woman’s life inside suburbia. It also allows that flight from suburbia is not always possible, or even desired. Also seeming to contradict the plausibility of linear flight, Jessica Anderson’s Tirra Lirra by the River (1978), features (another) Nora returning to her childhood Brisbane after a lifetime of flight; first from her suburban upbringing and then from a repressive marriage to the relative freedoms of London. The poignancy of the novel, set towards the end of the protagonist’s life, rests in Nora’s inability to find a true sense of belonging, despite her migrations. She “has spent most of her life waiting, confined to houses or places that restrict her, places she feels she does not belong to, including her family home, the city of Brisbane, her husband’s house, Australia itself” (Gleeson-White 184). Thus, although Nora’s life can be read as “the story of a very slow emergence from a doomed attempt to lead a conventional, married life… into an independent existence in London” (Gelder and Salzman, Diversity 65), the novel suggests that the search for belonging—at least for Australian women—is problematic. Moreover, any narrative of female escape from suburbia is potentially problematic due to the gendering of suburban experience as feminine. The suburban female who leaves suburbia necessarily rejects not only her “natural” place of belonging, but domesticity as a way of being and, to some extent, even her sex. In her work on memoir, Hooton identifies a stark difference between the shape of female and male biography to argue that women’s experience of life is innately non-linear. However, the use of non-linear narrative by feminist fiction writers of the second wave was arguably more conscious, even political in seeking a new, untainted form through which to explore the female condition. It was a powerful notion, arguably contributing to a golden age of women’s writing by novelists Helen Garner, Barbara Hanrahan, Jessica Anderson, and others. It also exerted a marked effect on fiction by Kate Grenville, Amanda Lohrey, and Janette Turner Hospital, as well as grunge novelists, well into the 1990s. By contrast, other canonical, albeit older, women writers of the time, Thea Astley and Elizabeth Jolley, neither of whom identified as feminist (Fringe 341; Neuter 196), do not seek to “rescue” the suburban female from her milieu. Like Patrick White, Astley seems, at least superficially, to perpetuate narrow stereotypes of the suburban female as “mindless consumers of fashion” and/or “signifiers of sexual disorder” (Sheridan, Satirist 262). Although flight is permitted those female characters who “need to ‘vanish’ if they are to find some alternative to narrow-mindedness and social oppression” (Gelder and Salzman, Celebration 186), it has little to do with feminism. As Brian Matthews attests of Astley’s work, “nothing could be further from the world-view of the second wave feminist writers of the 1980s” (76) and indeed her female characters are generally less sympathetic than those inhabiting novels by the “feminist” writers. Jolley also leaves the female protagonist to fend for herself, with a more optimistic, forceful vision of “female characters who, in their sheer eccentricity, shed any social expectations” to inhabit “a realm empowered by the imagination” (Gelder and Salzman, Celebration 194). If Jolley’s suburban females desire escape then they must earn it, not by direct or shifting relocations, but via other, more extreme and often creative, modes of transformation. These two writers however, were exceptional in their resistance to the influence of second wave feminism. Thus, three narrative categories emerge in which the suburban female may be transformed: linear flight from suburbia, non-linear flight from suburbia, or non-flight whereby the protagonist remains inside suburbia throughout the entire novel. Evidence of a rejection of the flight narrative by contemporary Australian women writers may signal a re-examination of the suburban female within, not outside, her suburban setting. It may also reveal a weakening of the influence of both second wave feminism and anti-suburban critiques on this much maligned character of Australian fiction, and on suburbia as a fictional setting. References Anderson, Jessica. Tirra Lirra by the River. Melbourne: Macmillan, 1978. Astley, Thea. “Writing as a Neuter: Extracts from Interview by Candida Baker.” Eight Voices of the Eighties: Stories, Journalism and Criticism by Australian Women Writers. Ed. Gillian Whitlock. St Lucia, Qld: U of Queensland P, 1989. 195-6. Durez, Jean. “Laminex Dreams: Women, Suburban Comfort and the Negation of Meanings.” Meanjin 53.1 (1994): 99-110. During, Simon. Patrick White. Melbourne: Oxford UP, 1996. Friedan, Betty. The Feminine Mystique. Harmondsworth, Middlesex: Penguin, 1965. Garner, Helen. Honour and Other People’s Children. Ringwood, Vic.: Penguin, 1982. ———. The Children’s Bach. Melbourne: McPhee Gribble, 1984. ———. Monkey Grip. Camberwell, Vic.: Penguin, 2009. Gelder, Ken, and Paul Salzman. The New Diversity. Melbourne: McPhee Gribble, 1989. ———. After the Celebration. Melbourne: UP, 2009. Gerster, Robin. “Gerrymander: The Place of Suburbia in Australian Fiction.” Meanjin 49.3 (1990): 565-75. Gilbert, Pam. Coming Out from Under: Contemporary Australian Women Writers. London: Pandora Press, 1988. Gleeson-White, Jane. Australian Classics: 50 Great Writers and Their Celebrated Works. Sydney: Allen & Unwin, 2007. Goodwin, Ken. A History of Australian Literature. Basingstoke: Macmillan Education, 1986. Greer, Germain. The Female Eunuch. London: Granada, 1970. Hanrahan, Barbara. The Scent of Eucalyptus. St Lucia, Qld: U of Queensland P, 1973. ———. Sea-Green. London: Chatto & Windus, 1974. ———. Kewpie Doll. London: Hogarth Press, 1989. Hooton, Joy. Stories of Herself When Young: Autobiographies of Childhood by Australian Women Writers. Melbourne: Oxford UP, 1990. Ireland, David. The Glass Canoe. Melbourne: Macmillan, 1976. Johnson, Lesley. The Modern Girl: Girlhood and Growing Up. Sydney: Allen & Unwin, 1993. ———, and Justine Lloyd. Sentenced to Everyday Life: Feminism and the Housewife. New York: Berg, 2004. Johnston, George. My Brother Jack. London: Collins/Fontana, 1967. Jolley, Elizabeth. “Fringe Dwellers: Extracts from Interview by Jennifer Ellison.” Eight Voices of the Eighties: Stories, Journalism and Criticism by Australian Women Writers. Ed. Gillian Whitlock. 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Tiffany is running down a suburban street with headphones and a hoodie on. Her breath is clearly audible, rhythmic, steady, and in pace with her footsteps. The Tiffany’s Story video testimonial on the Be Smart. Be Well. website then cuts to Tiffany sitting at home describing her earlier experiences with asthma: “The hospital became like my second home... I couldn’t breathe on my own.” Dr. Wolf, who has been treating Tiffany since she was diagnosed with asthma at age 8, joins in, “At that time she had really severe asthma. It was very difficult to manage and remained very difficult to manage for many years” (Be Smart. Be Well). As a child, Tiffany could never run, with steady breath, as she did at the beginning of the video, titled The Right Meds Keep Her in the Ring (Be Smart. Be Well). But after figuring out a treatment regime that worked, Tiffany became a healthy teenager; the video features her in contexts where she is jogging, smiling radiantly with her mother, and holding up victory belts from her boxing matches. From a child unable to breathe on her own, to a teenager with dreams of going to the Olympics, Tiffany’s asthma story underscores some of the defining narratives of contemporary asthma care. Her experience moves from uncontrolled asthma that limited her activities to a well-managed condition where she is able to pursue her aspirations without interference. Her Olympic dreams fit perfectly, reproduce even, the iconic image of the asthmatic athlete. It’s an image that has been in circulation since the early years of the contemporary asthma epidemic, a moment in the 1990s when federal health agencies and advocacy organizations worked to give the growing population of child asthmatics hope and encouragement to overcome their asthma. Yet the figure of the athletic asthmatic, and other accomplished icons with well-controlled asthma, also promotes an idealized image of health: “you can be greater than you are,” when you take your medication. The messages, of course, are well intentioned, designed to educate and show kids that asthma does not equate with disability. Yet these messages frequently work on logic where drugs control symptoms to enable you to do better in life. In some corners of asthma care, concern with symptoms is subsumed by narratives of activity and accomplishment. This article sketches shifts in the meaning of health and disease in the context of asthma treatment, moving from a time when treatments were not disease-specific and illness was seen as debilitating, to the contemporary moment where pharmaceutical companies market disease and promote health through direct-to-consumer advertising (DTCA). It’s a move situated within a broader, biomedicalized context where health isn’t just achieved, it’s augmented. Tiffany’s story is typical of someone with severe or even moderate asthma: uncontrolled symptoms, use of emergency care, unresponsive to medications, and an inability to live life as fully as desired. Symptoms and the threat of symptoms prevent people from undertaking routine activities (such as exercise, visiting friends, or attending work or school) and going into spaces that might trigger an attack. Asthma, in other words, can prevent people from living a “normal” life. But it can also be more than a chronic inconvenience that shapes behaviors; in the U.S., asthma still kills more than 3,000 people each year (Moorman et al. 20). Medical practitioners, researchers, and patients persistently search for insight into asthma’s causes and possible cures (Whitmarsh). Both cause and cure still allude, but preventative measures have improved dramatically in the last thirty years, through both pharmaceutical advancements and better public health approaches. Whereas a century ago, or even 30 years ago, severe asthmatics would have lead quite restricted lives—confined to their homes and unable to be active—today’s asthmatics are not limited by their condition to the degree they were decades before. We see this in asthma research that shows improved morbidity, decreased hospitalizations, and better quality of life (Moorman et al. 1-67). We also see this in DTCA, asthma advocacy campaigns, and even public health messages that actively combat the historic image of the weak, invalid asthmatic with stories of famous athletes, entertainers, or politicians who overcame asthma to achieve great things. It moves the discourse from an overly negative image—as one asthmatic interlocutor conveyed, “there was a stereotype in the 80s, in the movies, where the nerdy wimpy kid always had asthma, and the inhaler was associated with that”—to an extraordinarily positive image of high achieving asthmatics. Inhalers, formerly a sign of weakness, are now common in competitive sport contexts (Arie 344). The contrast between these representations—the 1980s nerdy wimp and the 21st century athlete—is stark. The latter image participates in the shift towards augmented health, where active bodies have become the new idealized norm. The shifting representations of asthmatics, even over the last twenty years, makes sense in the context of biomedicalization (Clarke et al. 172), where treatment regimes moved from a focus on “attaining control over the body” under medicalization, to “enabling the transformation of bodies to include desired new properties and identities” (Clarke et al. 183). The right treatment will allow you to do things that your body wouldn’t let you do otherwise. The question is: should treatment be sold on this premise? What would have been considered a return to health a hundred years ago wouldn’t be considered doing enough to manage your asthma today. A hundred years ago, the absence of symptoms would have been a success; today, the focus is on the degree to which one feels limited and how much you can accomplish in the span of 24-hours. Missed school and work days are a key measure in asthma epidemiology and care; these public health measures not only signal uncontrolled asthma, but do so by counting absence in the context of labor. The discursive shift can also be seen in the change from the urge to “breathe easy” (language from the Centers for Disease Control) to suggestions in pharmaceutical ads that you can “breathe better.” What new selves are being created by emergent health rhetorics, as Metzel asks (6), rhetorics which seem to be consumerist and neoliberal as much as they are biomedical? Role Reversal Historically, those with severe asthma led their lives carefully, or in reclusion. French novelist Marcel Proust, in addition to his literary accomplishments, spent much of his life confined to his home. Despite searching through medical texts and experimenting with various treatments, Proust’s asthma “dominated” his daily life, in the words of Mark Jackson (6). Writing of asthma’s history, Jackson continues, Proust constitutes the archetypal asthmatic, whose breathlessness and discomfort echo across space and time. Proust’s intimate descriptions of his symptoms—‘an asthmatic never knows if he will be able to breathe’ he wrote to the novelist Andre Gide in 1919—bear striking similarities both to Greek and medieval accounts of asthma many centuries earlier and to recent surveys suggesting that, at the turn of the millennium, many asthmatics continue to suffer from severe attacks that prevent them from speaking or make them fear for their lives. (8) In Proust’s time, advertisements for asthma and other respiratory treatments focused on providing symptom relief; some even purported to cure respiratory woes. These advertisements were rarely asthma specific, in part, because manufacturers sought the widest possible customer base, but also because it was difficult to distinguish one respiratory illness from another (Jackson 201). Asthmatics like Proust tried a range of remedies, including asthma cigarettes, the Carbolic Smoke Ball, and various forms of early inhalers. Most of these early asthma remedies instructed customers to use their product when in need of relief. Some ads stated that more regular use could stave off symptoms as well remedy them in the moment, but prevention wasn’t the primary message. The principle focus was addressing symptoms at hand. Just about a hundred years later, at the beginning of the U.S. asthma epidemic, symptoms were still center stage. National attention turned towards the asthmatic condition as the public health effects of severe asthma became visible—asthma-related deaths and hospitalizations had increased, along with rising prevalence rates. Asthma—formerly kept hidden in homes and in low-income communities—emerged as a major public health issue (Mitman 245). Advocacy campaigns were created on the heels of the epidemic’s emergence; they aimed to make asthma visible and show kids that their condition didn’t have to get in the way of life. Elite athletes became central figures in these campaigns. The Asthma All-Stars program, which featured Olympic medalists Jackie Joyner-Kersee and Amy Van Dyken, as well as Pittsburgh Steeler Jerome Bettis, worked to educate the public through acknowledgement of the condition as well as treatment advocacy. The National Library of Medicine’s exhibit on asthma, “Breath of Life” (1999), exemplifies this period with a showcase of famous asthmatics. In the exhibit, more than half the profiles of contemporary asthmatics feature Olympic or all-star athletes; entertainers, politicians, and scientists round out the exhibit. The legacy of the asthmatic athlete persists today; it’s still common to see sports figures speaking at fundraisers or spearheading events. These images are important, particularly for patient populations who truly feel limited and unable to do things because of their asthma. Athletes who speak about their condition are always clear: well-controlled asthma comes from adherence to treatment. The importance of these images also stems from the use of the image of the All-Star asthmatic to counter the historical stereotype of the weak, invalid asthmatic, who, like Proust, could not even leave the house. The man who recalled the stereotyped asthmatic from the 1980s, stated “I think I mapped myself onto that [stereotype], like, this is a disability, right, the media tells me this is a disability cause it’s always the kids who can’t do anything who are puffing their puffers.” In step with emergent 21st century health rhetoric, and increasing asthma prevalence, the image of the asthmatic was revised, falling in line with newly normalized health ideals (Clarke et al. 181; Metzel 2; Sinding 262). Active Asthmatics If 19th and early 20th century inhaler advertisements declared their products could relieve if not cure respiratory symptoms, at the beginning of the 21st century asthma treatment went beyond simply relieving symptoms; advertisements and medical discourse emphasized preventative symptom control, improved lung function, and better breathing. With the development of long-term controller medications, many asthmatics could reliably prevent symptoms a majority of the time. When combination inhalers hit the market in the early 2000s, the mood of advertisements could be summed up by a line from a GlaxoSmithKline commercial, “Coping is not the same as controlling” (GlaxoSmithKline). Prevention rather than symptom relief was the order of the new century. And yet just in the last ten years, pharmaceutical messages have shifted yet again, moving from an emphasis on controlling symptoms to living a better life: don’t let asthma slow you down, or stop you from living the life you want to live. It’s a message predicated on a particular view of what a normal life should look like, one characterized as augmented health. A 2012 Advair commercial reflects the tone of augmented health, “Asthma can hold you back, but it doesn’t always have to. Advair is clinically proven to significantly increase symptom free days, to help you do more of the things you like to do, more of the things you have to do, and more of what you want to do” (Advair). Strategically placed throughout the commercial, a voice chimes in “GO!” as the hero of the commercial, a middle aged asthmatic man, bikes down a wooded trail; moves through a busy hallway where he greets one person after the next, all of whom hand him file folders or blue prints; dances at a nightclub; and walks down bleachers to join a group of friends at a ballgame. The commercial ends with the man arriving home well after dark, comfortably settling into bed, and then energetically waking up to do it all over again the next day. Marked by words like increase, more, and go, the Advair commercial depicts a life full of activity. Not only that, the commercial leverages contexts that are commonly problematic for asthmatics: being outside and in foliage rich areas; biking and dancing, or other physical activities that could leave one breathless; and sleeping comfortably—nighttime attacks are common among asthmatics. The message is clear: look at all the things asthmatics can do when their condition is well controlled—with Advair, of course. It’s a message that builds on an earlier trend in asthma advocacy, during the 1990s, when well-known asthmatic athletes were used to bring visibility to asthma. If asthma control in the 1990s emphasized that asthmatics didn’t need to be held back, 21st century ads suggest that one could do more. By augmenting your health, asthma control can transform your life by allowing you to do more.Today, DTCA for asthma drugs are just as likely to emphasize improved lung function as they are symptom control, and, as advertised in the Advair commercial, improved lung function enables one to do more. A man featured in a 2012 Symbicort commercial explains, “Symbicort helps significantly improve my lung function, starting within five minutes… With Symbicort, today I’m breathing better” (Symbicort). The man’s renewed capacity to go on fishing trips with loved ones is the example in this commercial. Control, relief, and cure are nowhere to be found in these DTC advertisements; symptoms have been dropped from the frame. Rather than work off illness, or the older stereotype of the weak, homebound asthmatic, the new wave of DTCA champions augmented health: a higher quality of life, where patient-consumers can “do” whatever they like. What would have been considered a return to normal a hundred years ago, in Proust’s time, wouldn’t be considered doing enough to manage your asthma today. A hundred years ago, getting out of the house would have been enough; today, it’s a question of how much can you accomplish in the span of 24-hours. The portrayal of health in these DTCA calls to mind Lauren Berlant’s description of OTC cold medicine, which claim to make you feel better, but are really more concerned with making sure people can stay productive (28). Conclusion Had Proust lived a century later, he may have, like Tiffany, led a less restricted life. Or as Dr. Wolf put it, “A normal life. Busy and as active as she’d like to be. But she needs to take medication to do it” (Be Well. Be Smart). Symptom-free doesn’t seem to be enough anymore. Contemporary images of asthmatics—as an all-star athlete, an aspiring boxer, and a hyper-busy city dweller—are shaped by an imagined healthy norm. Advocacy campaigns originally intended to combat long-standing negative representations partake in the promotion of augmented health. Increasingly, health is no longer defined by the absence of symptoms, but by how active you are and how much you do. Busy and productive is a gold standard of the idealized norm, a norm that circulates—to a greater or lesser extent—in direct-to-consumer advertising, asthma advocacy campaigns, and public health messages (Sinding 262). Without doubt, the pharmaceutical industry plays a tremendous role in shaping contemporary health norms. Yet, as Joseph Dumit describes it, "the pharmaceutical industry is a massive elephant. Like the blind men of the famous parable, we each catch a hold of a tiny piece of it -- leg, tail, trunk -- and think we have a handle on it" (18). A powerful force with influence on many aspects of contemporary life, the pharmaceutical industry could be understood through the lens of biomedicalization: Biomedicalization imposes new mandates and performances that become incorporated into one’s sense of self. The subjectivities that arise out of these performances of what it is to be healthy (e.g., proactive, prevention-conscious, neo-rational) suggest how biomedical technoscience indicates a type of governmentality that can enact itself at the level of subjective identities and social relations. (Clarke et al. 182) Disease marketing—prevalent in the 1990s—is no longer needed or effective; health marketing has taken over and pharmaceutical companies are not at the table alone (Elliott 97). Instead of working through disease difference, health marketing attempts to level ground through images and standards that everyone can work towards, asthmatics included. Of course, pharmaceutical marketing simultaneously renders invisible socioeconomic conditions that contribute to asthma incidence, and marginalized populations that struggle to access medication and medical care in the first place. Augmented health works to flatten difference across social, economic, political, and ecological scales, as if these inequalities didn’t matter for disease management. Scholars writing about emergent modes of health—how health is imagined, constructed, studied, and sold—have documented how new health regimes work off potential risk categories, race, class, and gendered ideologies, or hoped-for modes of living. Some are literally “against health” (the title of Metzel and Kirkland’s edited volume). But to be against health, as Metzel writes is not to be against needed treatment (9). To examine the ways in which DTCA or advocacy campaigns promote specific, idealized images of health—images where people are athletic, outgoing, and busy—and question whether these drugs go above and beyond the restoration of health, should not be equated with a statement about whether medication is necessary. Epidemiological evidence and clinical studies are clear that contemporary treatments help reduce the burden of asthma in various ways: through reduced hospitalizations, lower death rates, and better-controlled asthma. Drugs keep many asthmatics relatively symptom-free. The point, rather, is that health is complex, structured by various institutions, actors, politics, and materials. One of the valences of the new health regime is augmented health, seen in the context of this paper at work in DTCA and possibly emerging in other corners of the asthma care arena as well. To date, most writing on augmentation has focused on how advancements in science and technology extend the capacity of human bodies—from prosthetics and fertility drugs, to steroids and life support (Hogle 696). Less has been written on the ways in which chronic conditions like diabetes, heart disease, and asthma—conditions where life hinges on medications, but are common enough that they are deemed unexceptional—produce a rhetoric of augmentation; where the new healthy is augmented living. It’s not the drugs for life rhetoric that works off new risk categories, as Dumit has shown (201); asthmatics are symptomatic, always at risk anyways, and often already on drugs for life. Drugs for chronic conditions like asthma may simply control symptoms, but they’re increasingly sold on the promise of enhancing life capacities as well. As Elliott has observed, it’s part of a move from disease marketing to health marketing (97). The discursive shift in asthma care, and perhaps other chronic disease contexts as well, doesn’t register as enhancement or augmentation because it mirrors the new health norm that is part of the broader context of biomedicalization. As the frame of health shifts, questions about bodies, ethics, and enhancement technologies might need to shift as well. Linda Hogle’s question is apt here: “what is necessary to sustain health? At which point does repair become something more than restorative, and for which (and whose) purposes are interventions defined as 'therapeutic'” (697). Since health norms have become augmented in the last ten years, this question becomes all the more difficult to answer. Within these new health regimes, potential has not only become open-ended, it also seems to be a therapeutic goal. References Arie, Sophie. “What Can We Learn from Asthma in Elite Athletes?” British Medical Journal 344 (2012). Be Smart. Be Well. “The Right Meds Keep Her in the Ring.” Be Smart. Be Well. 14 Aug. 2013. 1 Dec. 2013 ‹http://www.besmartbewell.com/childhood-asthma/tiffany.htm›. Clarke, Adele, Janet Shim, Laura Mamo, Jennifer Fosket, and Jennifer Fishman. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review 68 (2003): 161-194. Dumit, Joseph. Drugs for Life: How Pharmaceutical Companies Define Our Health. Durham: Duke University Press, 2012. Elliott, Carl. Better than Well: American Medicine Meets the American Dream. New York: W.W. Norton & Company, 2012. GlaxoSmithKline. “Advair Commercial – 2012.” 14 Sep. 2013. 1 Dec. 2013 ‹http://www.youtube.com/watch?v=OZ4hgIfU4AI›. GlaxoSmithKline. “GlaxoSmithKline (GSK) Commercial – Asthma.com.” 1 Aug. 2013. 14 Sep. 2013. ‹http://www.youtube.com/watch?v=bvyxbX3Jnp4›. Hogle, Linda. “Enhancement Technologies and the Body.” Annual Review of Anthropology 34 (2005): 695-716. Jackson, Mark. Asthma: A Biography. Oxford: Oxford University Press, 2009. Metzl, Jonathan M., and Anna Kirkland. Against Health: How Health Became the New Morality. New York: New York University Press, 2010. Moorman, J.E., L.J. Akinbami, C.M. Bailey, et al. “National Surveillance of Asthma: United States, 2001–2010. National Center for Health Statistics.” Vital Health Stat 3.35 (2012). Mitman, Gregg. Breathing Space: How Allergies Shape Our Lives and Landscapes. New Haven: Yale University Press, 2007. National Library of Medicine. “Breath of Life.” National Library of Medicine Archives, 1999. 31 Aug. 2013. 1 Dec. 2013 ‹http://www.nlm.nih.gov/archive/20120918/hmd/breath/breathhome.html›.Sinding, Christiane. “The Power of Norms: Georges Canguilhem, Michel Foucault, and the History of Medicine.” In Locating Medical History: Their Stories and Meanings, eds. Frank Huisman and John Harley Warner. Baltimore: Johns Hopkins University Press, 2004. Symbicort. “Symbicort Fishing Video.” 1 Jan. 2013. 13 Sep. 2013 ‹http://www.youtube.com/watch?v=oG9MxLwnapE› . Whitmarsh, Ian. Biomedical Ambiguity: Race, Asthma, and the Contested Meaning of Genetic Research in the Caribbean. Ithaca: Cornell University Press, 2008.

Introduction With a deluge of mouthwatering pre-publicity, the opening of The Spotted Pig, the USA’s first self-identified British-styled gastropub, in Manhattan in February 2004 was much anticipated. The late Australian chef, food writer and restauranteur Mietta O’Donnell has noted how “taking over a building or business which has a long established reputation can be a mixed blessing” because of the way that memories “can enrich the experience of being in a place or they can just make people nostalgic”. Bistro Le Zoo, the previous eatery on the site, had been very popular when it opened almost a decade earlier, and its closure was mourned by some diners (Young; Kaminsky “Feeding Time”; Steinhauer & McGinty). This regret did not, however, appear to affect The Spotted Pig’s success. As esteemed New York Times reviewer Frank Bruni noted in his 2006 review: “Almost immediately after it opened […] the throngs started to descend, and they have never stopped”. The following year, The Spotted Pig was awarded a Michelin star—the first year that Michelin ranked New York—and has kept this star in the subsequent annual rankings. Writing Restaurant Biography Detailed studies have been published of almost every type of contemporary organisation including public institutions such as schools, hospitals, museums and universities, as well as non-profit organisations such as charities and professional associations. These are often written to mark a major milestone, or some significant change, development or the demise of the organisation under consideration (Brien). Detailed studies have also recently been published of businesses as diverse as general stores (Woody), art galleries (Fossi), fashion labels (Koda et al.), record stores (Southern & Branson), airlines (Byrnes; Jones), confectionary companies (Chinn) and builders (Garden). In terms of attracting mainstream readerships, however, few such studies seem able to capture popular reader interest as those about eating establishments including restaurants and cafés. This form of restaurant life history is, moreover, not restricted to ‘quality’ establishments. Fast food restaurant chains have attracted their share of studies (see, for example Love; Jakle & Sculle), ranging from business-economic analyses (Liu), socio-cultural political analyses (Watson), and memoirs (Kroc & Anderson), to criticism around their conduct and effects (Striffler). Eric Schlosser’s Fast Food Nation: The Dark Side of the All-American Meal is the most well-known published critique of the fast food industry and its effects with, famously, the Rolling Stone article on which it was based generating more reader mail than any other piece run in the 1990s. The book itself (researched narrative creative nonfiction), moreover, made a fascinating transition to the screen, transformed into a fictionalised drama (co-written by Schlosser) that narrates the content of the book from the point of view of a series of fictional/composite characters involved in the industry, rather than in a documentary format. Akin to the range of studies of fast food restaurants, there are also a variety of studies of eateries in US motels, caravan parks, diners and service station restaurants (see, for example, Baeder). Although there has been little study of this sub-genre of food and drink publishing, their popularity can be explained, at least in part, because such volumes cater to the significant readership for writing about food related topics of all kinds, with food writing recently identified as mainstream literary fare in the USA and UK (Hughes) and an entire “publishing subculture” in Australia (Dunstan & Chaitman). Although no exact tally exists, an informed estimate by the founder of the Gourmand World Cookbook Awards and president of the Paris Cookbook Fair, Edouard Cointreau, has more than 26,000 volumes on food and wine related topics currently published around the world annually (ctd. in Andriani “Gourmand Awards”). The readership for publications about restaurants can also perhaps be attributed to the wide range of information that can be included a single study. My study of a selection of these texts from the UK, USA and Australia indicates that this can include narratives of place and architecture dealing with the restaurant’s location, locale and design; narratives of directly food-related subject matter such as menus, recipes and dining trends; and narratives of people, in the stories of its proprietors, staff and patrons. Detailed studies of contemporary individual establishments commonly take the form of authorised narratives either written by the owners, chefs or other staff with the help of a food journalist, historian or other professional writer, or produced largely by that writer with the assistance of the premise’s staff. These studies are often extensively illustrated with photographs and, sometimes, drawings or reproductions of other artworks, and almost always include recipes. Two examples of these from my own collection include a centennial history of a famous New Orleans eatery that survived Hurricane Katrina, Galatoire’s Cookbook. Written by employees—the chief operating officer/general manager (Melvin Rodrigue) and publicist (Jyl Benson)—this incorporates reminiscences from both other staff and patrons. The second is another study of a New Orleans’ restaurant, this one by the late broadcaster and celebrity local historian Mel Leavitt. The Court of Two Sisters Cookbook: With a History of the French Quarter and the Restaurant, compiled with the assistance of the Two Sisters’ proprietor, Joseph Fein Joseph III, was first published in 1992 and has been so enduringly popular that it is in its eighth printing. These texts, in common with many others of this type, trace a triumph-over-adversity company history that incorporates a series of mildly scintillating anecdotes, lists of famous chefs and diners, and signature recipes. Although obviously focused on an external readership, they can also be characterised as an instance of what David M. Boje calls an organisation’s “story performance” (106) as the process of creating these narratives mobilises an organisation’s (in these cases, a commercial enterprise’s) internal information processing and narrative building activities. Studies of contemporary restaurants are much more rarely written without any involvement from the eatery’s personnel. When these are, the results tend to have much in common with more critical studies such as Fast Food Nation, as well as so-called architectural ‘building biographies’ which attempt to narrate the historical and social forces that “explain the shapes and uses” (Ellis, Chao & Parrish 70) of the physical structures we create. Examples of this would include Harding’s study of the importance of the Boeuf sur le Toit in Parisian life in the 1920s and Middlebrook’s social history of London’s Strand Corner House. Such work agrees with Kopytoff’s assertion—following Appadurai’s proposal that objects possess their own ‘biographies’ which need to be researched and expressed—that such inquiry can reveal not only information about the objects under consideration, but also about readers as we examine our “cultural […] aesthetic, historical, and even political” responses to these narratives (67). The life story of a restaurant will necessarily be entangled with those of the figures who have been involved in its establishment and development, as well as the narratives they create around the business. This following brief study of The Spotted Pig, however, written without the assistance of the establishment’s personnel, aims to outline a life story for this eatery in order to reflect upon the pig’s place in contemporary dining practice in New York as raw foodstuff, fashionable comestible, product, brand, symbol and marketing tool, as well as, at times, purely as an animal identity. The Spotted Pig Widely profiled before it even opened, The Spotted Pig is reportedly one of the city’s “most popular” restaurants (Michelin 349). It is profiled in all the city guidebooks I could locate in print and online, featuring in some of these as a key stop on recommended itineraries (see, for instance, Otis 39). A number of these proclaim it to be the USA’s first ‘gastropub’—the term first used in 1991 in the UK to describe a casual hotel/bar with good food and reasonable prices (Farley). The Spotted Pig is thus styled on a shabby-chic version of a traditional British hotel, featuring a cluttered-but-well arranged use of pig-themed objects and illustrations that is described by latest Michelin Green Guide of New York City as “a country-cute décor that still manages to be hip” (Michelin 349). From the three-dimensional carved pig hanging above the entrance in a homage to the shingles of traditional British hotels, to the use of its image on the menu, website and souvenir tee-shirts, the pig as motif proceeds its use as a foodstuff menu item. So much so, that the restaurant is often (affectionately) referred to by patrons and reviewers simply as ‘The Pig’. The restaurant has become so well known in New York in the relatively brief time it has been operating that it has not only featured in a number of novels and memoirs, but, moreover, little or no explanation has been deemed necessary as the signifier of “The Spotted Pig” appears to convey everything that needs to be said about an eatery of quality and fashion. In the thriller Lethal Experiment: A Donovan Creed Novel, when John Locke’s hero has to leave the restaurant and becomes involved in a series of dangerous escapades, he wants nothing more but to get back to his dinner (107, 115). The restaurant is also mentioned a number of times in Sex and the City author Candace Bushnell’s Lipstick Jungle in relation to a (fictional) new movie of the same name. The joke in the book is that the character doesn’t know of the restaurant (26). In David Goodwillie’s American Subversive, the story of a journalist-turned-blogger and a homegrown terrorist set in New York, the narrator refers to “Scarlett Johansson, for instance, and the hostess at the Spotted Pig” (203-4) as the epitome of attractiveness. The Spotted Pig is also mentioned in Suzanne Guillette’s memoir, Much to Your Chagrin, when the narrator is on a dinner date but fears running into her ex-boyfriend: ‘Jack lives somewhere in this vicinity […] Vaguely, you recall him telling you he was not too far from the Spotted Pig on Greenwich—now, was it Greenwich Avenue or Greenwich Street?’ (361). The author presumes readers know the right answer in order to build tension in this scene. Although this success is usually credited to the joint efforts of backer, music executive turned restaurateur Ken Friedman, his partner, well-known chef, restaurateur, author and television personality Mario Batali, and their UK-born and trained chef, April Bloomfield (see, for instance, Batali), a significant part has been built on Bloomfield’s pork cookery. The very idea of a “spotted pig” itself raises a central tenet of Bloomfield’s pork/food philosophy which is sustainable and organic. That is, not the mass produced, industrially farmed pig which produces a leaner meat, but the fatty, tastier varieties of pig such as the heritage six-spotted Berkshire which is “darker, more heavily marbled with fat, juicier and richer-tasting than most pork” (Fabricant). Bloomfield has, indeed, made pig’s ears—long a Chinese restaurant staple in the city and a key ingredient of Southern US soul food as well as some traditional Japanese and Spanish dishes—fashionable fare in the city, and her current incarnation, a crispy pig’s ear salad with lemon caper dressing (TSP 2010) is much acclaimed by reviewers. This approach to ingredients—using the ‘whole beast’, local whenever possible, and the concentration on pork—has been underlined and enhanced by a continuing relationship with UK chef Fergus Henderson. In his series of London restaurants under the banner of “St. John”, Henderson is famed for the approach to pork cookery outlined in his two books Nose to Tail Eating: A Kind of British Cooking, published in 1999 (re-published both in the UK and the US as The Whole Beast: Nose to Tail Eating), and Beyond Nose to Tail: A Kind of British Cooking: Part II (coauthored with Justin Piers Gellatly in 2007). Henderson has indeed been identified as starting a trend in dining and food publishing, focusing on sustainably using as food the entirety of any animal killed for this purpose, but which mostly focuses on using all parts of pigs. In publishing, this includes Hugh Fearnley-Whittingstall’s The River Cottage Meat Book, Peter Kaminsky’s Pig Perfect, subtitled Encounters with Some Remarkable Swine and Some Great Ways to Cook Them, John Barlow’s Everything but the Squeal: Eating the Whole Hog in Northern Spain and Jennifer McLagan’s Fat: An Appreciation of a Misunderstood Ingredient, with Recipes (2008). In restaurants, it certainly includes The Spotted Pig. So pervasive has embrace of whole beast pork consumption been in New York that, by 2007, Bruni could write that these are: “porky times, fatty times, which is to say very good times indeed. Any new logo for the city could justifiably place the Big Apple in the mouth of a spit-roasted pig” (Bruni). This demand set the stage perfectly for, in October 2007, Henderson to travel to New York to cook pork-rich menus at The Spotted Pig in tandem with Bloomfield (Royer). He followed this again in 2008 and, by 2009, this annual event had become known as “FergusStock” and was covered by local as well as UK media, and a range of US food weblogs. By 2009, it had grown to become a dinner at the Spotted Pig with half the dishes on the menu by Henderson and half by Bloomfield, and a dinner the next night at David Chang’s acclaimed Michelin-starred Momofuku Noodle Bar, which is famed for its Cantonese-style steamed pork belly buns. A third dinner (and then breakfast/brunch) followed at Friedman/Bloomfield’s Breslin Bar and Dining Room (discussed below) (Rose). The Spotted Pig dinners have become famed for Henderson’s pig’s head and pork trotter dishes with the chef himself recognising that although his wasn’t “the most obvious food to cook for America”, it was the case that “at St John, if a couple share a pig’s head, they tend to be American” (qtd. in Rose). In 2009, the pigs’ head were presented in pies which Henderson has described as “puff pastry casing, with layers of chopped, cooked pig’s head and potato, so all the lovely, bubbly pig’s head juices go into the potato” (qtd. in Rose). Bloomfield was aged only 28 when, in 2003, with a recommendation from Jamie Oliver, she interviewed for, and won, the position of executive chef of The Spotted Pig (Fabricant; Q&A). Following this introduction to the US, her reputation as a chef has grown based on the strength of her pork expertise. Among a host of awards, she was named one of US Food & Wine magazine’s ten annual Best New Chefs in 2007. In 2009, she was a featured solo session titled “Pig, Pig, Pig” at the fourth Annual International Chefs Congress, a prestigious New York City based event where “the world’s most influential and innovative chefs, pastry chefs, mixologists, and sommeliers present the latest techniques and culinary concepts to their peers” (Starchefs.com). Bloomfield demonstrated breaking down a whole suckling St. Canut milk raised piglet, after which she butterflied, rolled and slow-poached the belly, and fried the ears. As well as such demonstrations of expertise, she is also often called upon to provide expert comment on pork-related news stories, with The Spotted Pig regularly the subject of that food news. For example, when a rare, heritage Hungarian pig was profiled as a “new” New York pork source in 2009, this story arose because Bloomfield had served a Mangalitsa/Berkshire crossbreed pig belly and trotter dish with Agen prunes (Sanders) at The Spotted Pig. Bloomfield was quoted as the authority on the breed’s flavour and heritage authenticity: “it took me back to my grandmother’s kitchen on a Sunday afternoon, windows steaming from the roasting pork in the oven […] This pork has that same authentic taste” (qtd. in Sanders). Bloomfield has also used this expert profile to support a series of pork-related causes. These include the Thanksgiving Farm in the Catskill area, which produces free range pork for its resident special needs children and adults, and helps them gain meaningful work-related skills in working with these pigs. Bloomfield not only cooks for the project’s fundraisers, but also purchases any excess pigs for The Spotted Pig (Estrine 103). This strong focus on pork is not, however, exclusive. The Spotted Pig is also one of a number of American restaurants involved in the Meatless Monday campaign, whereby at least one vegetarian option is included on menus in order to draw attention to the benefits of a plant-based diet. When, in 2008, Bloomfield beat the Iron Chef in the sixth season of the US version of the eponymous television program, the central ingredient was nothing to do with pork—it was olives. Diversifying from this focus on ‘pig’ can, however, be dangerous. Friedman and Bloomfield’s next enterprise after The Spotted Pig was The John Dory seafood restaurant at the corner of 10th Avenue and 16th Street. This opened in November 2008 to reviews that its food was “uncomplicated and nearly perfect” (Andrews 22), won Bloomfield Time Out New York’s 2009 “Best New Hand at Seafood” award, but was not a success. The John Dory was a more formal, but smaller, restaurant that was more expensive at a time when the financial crisis was just biting, and was closed the following August. Friedman blamed the layout, size and neighbourhood (Stein) and its reservation system, which limited walk-in diners (ctd. in Vallis), but did not mention its non-pork, seafood orientation. When, almost immediately, another Friedman/Bloomfield project was announced, the Breslin Bar & Dining Room (which opened in October 2009 in the Ace Hotel at 20 West 29th Street and Broadway), the enterprise was closely modeled on the The Spotted Pig. In preparation, its senior management—Bloomfield, Friedman and sous-chefs, Nate Smith and Peter Cho (who was to become the Breslin’s head chef)—undertook a tasting tour of the UK that included Henderson’s St. John Bread & Wine Bar (Leventhal). Following this, the Breslin’s menu highlighted a series of pork dishes such as terrines, sausages, ham and potted styles (Rosenberg & McCarthy), with even Bloomfield’s pork scratchings (crispy pork rinds) bar snacks garnering glowing reviews (see, for example, Severson; Ghorbani). Reviewers, moreover, waxed lyrically about the menu’s pig-based dishes, the New York Times reviewer identifying this focus as catering to New York diners’ “fetish for pork fat” (Sifton). This representative review details not only “an entree of gently smoked pork belly that’s been roasted to tender goo, for instance, over a drift of buttery mashed potatoes, with cabbage and bacon on the side” but also a pig’s foot “in gravy made of reduced braising liquid, thick with pillowy shallots and green flecks of deconstructed brussels sprouts” (Sifton). Sifton concluded with the proclamation that this style of pork was “very good: meat that is fat; fat that is meat”. Concluding remarks Bloomfield has listed Michael Ruhlman’s Charcuterie as among her favourite food books. Publishers Weekly reviewer called Ruhlman “a food poet, and the pig is his muse” (Q&A). In August 2009, it was reported that Bloomfield had always wanted to write a cookbook (Marx) and, in July 2010, HarperCollins imprint Ecco publisher and foodbook editor Dan Halpern announced that he was planning a book with her, tentatively titled, A Girl and Her Pig (Andriani “Ecco Expands”). 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IntroductionIn Britain, hunger is often hidden in the privacy of the home. Yet otherwise private hunger is currently being rendered public and visible in the growing queues at charity-run food banks, where emergency food parcels are distributed directly to those who cannot afford to feed themselves or their families adequately (Downing et al.; Caplan). Food banks, in providing emergency relief to those in need, are responses to crisis moments, actualised through an embodied feeling of hunger that cannot be alleviated. The growing queues at food banks not only render hidden hunger visible, but also serve as reminders of the corporeal vulnerability of the human body to political and socio-economic shifts.A consideration of corporeality allows us to view the world through the lived experiences of the body. Human beings are “creatures of the flesh” who understand and reason, act and interact with their environments through the body (Johnson 81). The growing academic interest in corporeality signifies what Judith Butler calls a “new bodily ontology” (2). However, as Butler highlights, the body is also vulnerable to injury and suffering. An application of this ontology to hunger draws attention to eating as essential to life, so the denial of food poses an existential threat to health and ultimately to survival. The body’s response to threat is the physiological experience of hunger as a craving or longing that is the “most bodily experience of need […] a visceral desire locatable in a void” in which an empty stomach “initiates” a series of sounds and pangs that “call for action” in the form of eating (Anderson 27). Food bank queues serve as visible public reminders of this precariousness and of how social conditions can limit the ability of individuals to feed themselves, and so respond to an existential threat.Corporeal vulnerability made visible elicits responses that support societal interventions to feed the hungry, or that stigmatise hungry people by withdrawing or disparaging what limited support is available. Responses to vulnerability therefore evoke nurture and care or violence and abuse, and so in this sense are ambiguous (Butler; Cavarero). The responses are also normative, shaped by social and cultural understandings of what hunger is, what its causes are, and whether it is seen as originating in personal or societal failings. The stigmatising of individuals by blaming them for their hunger is closely allied to the feelings of shame that lie at the “irreducible absolutist core” of the idea of poverty (Sen 159). Shame is where the “internally felt inadequacies” of the impoverished individual and the “externally inflicted judgments” of society about the hungry body come together in a “co-construction of shame” (Walker et al. 5) that is a key part of the lived experience of hunger. The experience of shame, while common, is far from inevitable and is open to resistance (see Pickett; Foucault); shame can be subverted, turned from the hungry body and onto the society that allows hunger to happen. Who and what are deemed responsible are shaped by shifting ideas and contested understandings of hunger at a particular moment in time (Vernon).This exploration of corporeal vulnerability through food banks as a historically located response to hunger offers an alternative to studies which privilege representations, objectifying the body and “treating it as a discursive, textual, iconographic and metaphorical reality” while neglecting understandings derived from lived experiences and the responses that visible vulnerabilities elicit (Hamilakis 99). The argument made in this paper calls for a critical reconsideration of classic political economy approaches that view hunger in terms of a class struggle against the material conditions that give rise to it, and responses that ultimately led to the construction of the welfare state (Vernon). These political economy approaches, in focusing on the structures that lead to hunger and that respond to it, are more closed than Butler’s notion of ambiguous and constantly changing social responses to corporeal vulnerability. This paper also challenges the dominant tradition of nutrition science, which medicalises hunger. While nutrition science usefully draws attention to the physiological experiences and existential threat posed by acute hunger, the scientific focus on the “anatomical functioning” of the body and the optimising of survival problematically separates eating from the social contexts in which hunger is experienced (Lupton 11, 12; Abbots and Lavis). The focus in this article on the corporeal vulnerability of hunger interweaves contested representations of, and ideas about, hunger with the physiological experience of it, the material conditions that shape it, and the lived experiences of deprivation. Food banks offer a lens onto these experiences and their complexities.Food Banks: Deprivation Made VisibleSince the 1980s, food banks have become the fastest growing charitable organisations in the wealthiest countries of North America, Europe, and Australasia (Riches), but in Britain they are a recent phenomenon. The first opened in 2000, and by 2014, the largest operator, the Trussell Trust, had over 420 franchised food banks, and more recently was opening more than one per week (Lambie-Mumford et al.; Lambie-Mumford and Dowler). British food banks hand out emergency food relief directly to those who cannot afford to feed themselves or their families adequately, and have become new sites where deprivation is materialised through a congregation of hungry people and the distribution of food parcels. The food relief parcels are intended as short-term immediate responses to crisis moments felt within the body when the individual cannot alleviate hunger through their own resources; they are for “emergency use only” to ameliorate individual crisis and acute vulnerability, and are not intended as long-term solutions to sustained, chronic poverty (Perry et al.). The need for food banks has emerged with the continued shrinkage of the welfare state, which for the past half century sought to mediate the impact of changing individual and social circumstances on those deemed to be most vulnerable to the vicissitudes of life. The proliferation of food banks since the 2009 financial crisis and the increased public discourse about them has normalised their presence and naturalised their role in alleviating acute food poverty (Perry et al.).Media images of food bank queues and stacks of tins waiting to be handed out (Glaze; Gore) evoke collective memories from the early twentieth century of hunger marches in protest at government inaction over poverty, long queues at soup kitchens, and the faces of gaunt, unemployed war veterans (Vernon). After the Second World War, the spectre of communism and the expansionist agenda of the Soviet Union meant such images of hunger could become tools in a propaganda war constructed around the failure of the British state to care for its citizens (Field; Clarke et al; Vernon). The 1945 Labour government, elected on a social democratic agenda of reform in an era of food rationing, responded with a “war on want” based on the normative premise that no one should be without food, medical care, shelter, warmth or work. Labour’s response was the construction of the modern welfare state.The welfare state signified a major shift in ideational understandings of hunger. In the seventeenth and eighteenth centuries, ideas about hunger had been rooted in a moralistic account of divine punishment for individual failure (Vernon). Bodily experiences of hunger were seen as instruments for disciplining the indigent into a work ethic appropriate for a modern industrialised economy. The infamous workhouses, finally abolished in 1948, were key sites of deprivation where restrictions on how much food was distributed served to punish or discipline the hungry body into compliance with the dominant work ethic (Vernon; Foucault). However, these ideas shifted in the second half of the nineteenth century as the hungry citizen in Britain (if not in its colonies) was increasingly viewed as a victim of wider forces beyond the control of the individual, and the notion of disciplining the hungry body in workhouses was seen as reprehensible. A humanitarian treatment of hunger replaced a disciplinarian one as a more appropriate response to acute need (Shaw; Vernon). Charitable and reformist organisations proliferated with an agenda to feed, clothe, house, and campaign on behalf of those most deprived, and civil society largely assumed responsibility for those unable to feed themselves. By the early 1900s, ideas about hunger had begun to shift again, and after the Second World War ideational changes were formalised in the welfare state, premised on a view of hunger as due to structural rather than individual failure, hence the need for state intervention encapsulated in the “cradle to grave” mantra of the welfare state, i.e. of consistent care at the point of need for all citizens for their lifetime (see Clarke and Newman; Field; Powell). In this context, the suggestion that Britons could go to bed hungry because they could not afford to feed themselves would be seen as the failure of the “war on want” and of an advanced modern democracy to fulfil its responsibilities for the welfare of its citizens.Since the 1980s, there has been a retreat from these ideas. Successive governments have sought to rein in, reinvent or shrink what they have perceived as a “bloated” welfare state. In their view this has incentivised “dependency” by providing benefits so generous that the supposedly work-shy or “skivers” have no need to seek employment and can fund a diet of takeaways and luxury televisions (Howarth). These stigmatising ideas have, since the 2009 financial crisis and the 2010 election, become more entrenched as the Conservative-led government has sought to renew a neo-liberal agenda to shrink the welfare state, and legitimise a new mantra of austerity. This mantra is premised on the idea that the state can no longer afford the bloated welfare budget, that responsible government needs to “wean” people off benefits, and that sanctions imposed for not seeking work or for incorrectly filling in benefit claim forms serve to “encourage” people into work. Critics counter-argue that the punitive nature of sanctions has exacerbated deprivation and contributed to the growing use of food banks, a view the government disputes (Howarth; Caplan).Food Banks as Sites of Vulnerable CorporealityIn these shifting contexts, food banks have proliferated not only as sites of deprivation but also as sites of vulnerable corporeality, where people unable to draw on individual resources to respond to hunger congregate in search of social and material support. As growing numbers of people in Britain find themselves in this situation, the vulnerable corporeality of the hungry body becomes more pervasive and more visible. Hunger as a lived experience is laid bare in ever-longer food bank queues and also through the physiological, emotional and social consequences graphically described in personal blogs and in the testimonies of food bank users.Blogger Jack Monroe, for example, has recounted giving what little food she had to her child and going to bed hungry with a pot of ginger tea to “ease the stomach pains”; saying to her curious child “I’m not hungry,” while “the rumblings of my stomach call me a liar” (Monroe, Hunger Hurts). She has also written that her recourse to food banks started with the “terrifying and humiliating” admission that “you cannot afford to feed your child” and has expressed her reluctance to solicit the help of the food bank because “it feels like begging” (Monroe, Austerity Works?). Such blog accounts are corroborated in reports by food bank operators and a parliamentary enquiry which told stories of mothers not eating for days after being sanctioned under the benefit system; of children going to school hungry; of people leaving hospital after a major operation unable to feed themselves since their benefits have been cut; of the elderly having to make “hard choices” between “heat or eat” each winter; and of mixed feelings of relief and shame at receiving food bank parcels (All-Party Parliamentary Inquiry; Beattie; Cooper and Dumpleton; Caplan; Perry et al.). That is, two different visibilities have emerged: the shame of standing or being seen to stand in the food bank queue, and blogs that describe these feelings and the lived experience of hunger – both are vulnerable and visible, but in different ways and in different spaces: the physical or material, and the virtual.The response of doctors to the growing evidence of crisis was to warn that there were “all the signs of a public health emergency that could go unrecognised until it is too late to take preventative action,” that progress made against food poverty since the 1960s was being eroded (Ashton et al. 1631), and that the “robust last line of defence against hunger” provided by the welfare state was failing (Loopstra et al. n.p). Medical professionals thus sought to conscript the rhetorical resources of their professional credibility to highlight that this is a politically created public health crisis.This is not to suggest that acute hunger was absent for 50 years of the welfare state, but that with the closure of the last workhouses, the end of hunger marches, and the shutting of the soup kitchens by the 1950s, it became less visible. Over the past decade, hunger has become more visible in images of growing queues at food banks and stacked tins ready to be handed out by volunteers (Glaze; Gore) on production of a voucher provided on referral by professionals. Doctors, social workers or teachers are therefore tasked with discerning cases of need, deciding whose need is “genuine” and so worthy of food relief (see Downing et al.). The voucher system is regulated by professionals so that food banks are open only to those with a public identity constructed around bodily crisis. The sense of something as intimate as hunger being defined by others contrasts to making visible one’s own hunger through blogging. It suggests again how bodies become caught up in wider political struggles where not only is shame a co-construction of internal inadequacies and external judgements, but so too is hunger, albeit in different yet interweaving ways. New boundaries are being established between those who are deprived and those who are not, and also between those whose bodies are in short-term acute crisis, and those whose bodies are in long-term and chronic crisis, which is not deemed to be an emergency. It is in this context that food banks have also become sites of demarcation, shame, and contestation.Public debates about growing food bank queues highlight the ambiguous nature of societal responses to the vulnerability of hunger made visible. Government ministers have intensified internal shame in attributing growing food bank queues to individual inadequacies, failure to manage household budgets (Gove), and profligate spending on luxury (Johnston; Shipton). Civil society organisations have contested this account of hunger, turning shame away from the individual and onto the government. Austerity reforms have, they argue, “torn apart” the “basic safety net” of social responses to corporeal vulnerability put in place after the Second World War and intended to ensure that no-one was left hungry or destitute (Bingham), their vulnerability unattended to. Furthermore, the benefit sanctions impose punitive measures that leave families with “nothing” to live on for weeks. Hungry citizens, confronted with their own corporeal vulnerability and little choice but to seek relief from food banks, echo the Dickensian era of the workhouse (Cooper and Dumpleton) and indict the UK government response to poverty. Church leaders have called on the government to exercise “moral duty” and recognise the “acute moral imperative to act” to alleviate the suffering of the hungry body (Beattie; see also Bingham), and respond ethically to corporeal vulnerability with social policies that address unmet need for food. However, future cuts to welfare benefits mean the need for relief is likely to intensify.ConclusionThe aim of this paper was to explore the vulnerable corporeality of hunger through the lens of food banks, the twenty-first-century manifestations of charitable responses to acute need. Food banks have emerged in a gap between the renewal of a neo-liberal agenda of prudent government spending and the retreat of the welfare state, between struggles over resurgent ideas about individual responsibility and deep disquiet about wider social responsibilities. Food banks as sites of deprivation, in drawing attention to a newly vulnerable corporeality, potentially pose a threat to the moral credibility of the neo-liberal state. The threat is highlighted when the taboo of a hungry body, previously hidden because of shame, is being challenged by two new visibilities, that of food bank queues and the commentaries on blogs about the shame of having to queue for food.ReferencesAbbots, Emma-Jayne, and Anna Lavis. Eds. Why We Eat, How We Eat: Contemporary Encounters between Foods and Bodies. Farnham: Ashgate, 2013.All-Party Parliamentary Inquiry. “Feeding Britain.” 2014. 6 Jan. 2016 <https://foodpovertyinquiry.files.wordpress.com/2014/12/food>.Anderson, Patrick. “So Much Wasted:” Hunger, Performance, and the Morbidity of Resistance. 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