Journal articles on the topic 'Japanese americans – california – social conditions'

Health studies on older Asian Americans based on national and statewide representative data are scarce. This study examined subgroup differences in demographic, socioeconomic and general health status, health conditions, and access to health care services among five groups of Asian Americans aged 60 or older (Chinese, Filipino, Japanese, Korean, and Vietnamese), using data from the 2001 California Health Interview Survey. Significant differences in demographic and socioeconomic characteristics, health status, chronic conditions, and coverage and use of health care services were found in the five groups, indicating the complexity, diversity, and heterogeneity of older Asian American populations. Practice and research implications are discussed.

A prospective international study of cardiovascular disease among Japanese men living in Japan, Hawaii and California in 1965 provided the opportunity of comparing the levels of blood pressure and hypertension among men aged 45 to 68 years, and of examining the factors which accounted for the differences. In addition, within the group of 8, 006 men from Hawaii, a subsample of men were examined 15 years later when they were aged 60 to 80 to study the influence of migration, the stressful aspects of culture change, diet, life-style, Type A behaviour and biological characteristics for association with blood pressure and as predictors of hypertension. At the initial examination, the men in California had the highest levels of blood pressure and hypertension, the men in Japan had the lowest levels, and the men born in Hawaii had intermediate levels. When blood pressure was adjusted for relative weight, the differences among the groups disappeared. Within the Hawaii cohort, bivariate and multivariate analyses of more than 50 variables indicated that age, obesity, alcohol intake, serum glucose and parental history of hypertension were the major variables independently associated with cross-sectional levels of blood pressure and, except for alcohol intake, with longitudinal changes in blood pressure. Reported dietary intake of calcium, magnesium, potassium, protein and other nutrients were all inversely associated with blood pressure levels. The intake of those nutrients was so highly correlated with each other that it was not possible to identify the independent association of any single dietary factor. The results suggested that the foods which are major sources of the nutrients (vegetables, fruits, whole grains and low fat dairy products) may be protective against hypertension. Blood pressure was not associated with salt, or salty Japanese foods, either in the international comparisons or in the group from Hawaii. Among the psychosocial factors, there was no evidence that measures of theoretically stressful social situations, social support or the Jenkins measure of Type A personality were associated with blood pressure within the Hawaiian group. From the perspective of prevention of hypertension in the elderly, these data suggest that obesity, alcohol intake and low intake of minerals found in fruits, vegetables and whole grains are the factors which should receive primary consideration.

AbstractConsidering the aesthetic and social value of music making amongIssei, first generation Japanese in California, opens a line of inquiry into how this immigrant population negotiated their cultural and political identities in a nation that racially marginalized them. As an integral aspect of Japanese culture, music was a medium through which Issei leaders chose to claim a cultural space in the United States. Their efforts to establish themselves within the social fabric of mainstream American society reveal the social and political forces that prevented their acceptance and assimilation. Issei responded by showcasing traditional Japanese music to educate white Americans about their revered heritage, singing songs for comfort and familiarity, and encouraging their children to perform Western music as an acculturative strategy. Caught between two nations, Issei emerged with alternative identities that ultimately failed due to the racist ideology governing American citizenship.

The numbers of Asian American men are continually increasing, yet limited research exists on this understudied population. Addressing this lack of research is necessary to better inform how best to improve quality of care. This study examined health outcome differences across ethnically diverse groups of Asian American men in California, compared with non-Hispanic White men. Using data from the 2007, 2009, and 2011-2012 California Health Interview Survey, distributions of health status and health-related characteristics across ( n = 43,030) racial/ethnic groups of men (Chinese, Japanese, Korean, Filipino, Vietnamese, Other Asian Americans, and non-Hispanic Whites) were calculated. Compared with non-Hispanic Whites, odds of reporting fair or poor health were higher among Vietnamese, while odds of diabetes were higher among Korean, Filipino, and Other Asian Americans. Odds of high blood pressure were higher among Filipino and Vietnamese but lower among Other Asian Americans, while odds of disability were lower across all ethnic groups except Filipino and Vietnamese. This study’s findings highlight the importance of understanding ethnic heterogeneity to develop culturally appropriate health interventions for Asian American men.

Abstract Global migration has greatly affected intergenerational family support beyond national borders, in particular adult children’s transnational family caregiving for elderly parents. Specifically, the COVID-19 pandemic has largely influenced transnational caregiving due to the travel restrictions. Transnational caregiving for older adults includes adult children’s periodical returning to their home country and/or adult children’s caregiving for their parents in their settled country. The goal of this study was to identify trajectories between adult children’s transnational caregiving for their parents and caregivers’ wellness in Japanese Americans before and during the pandemic. We conducted semi-structured interviews with Japanese Americans 40 to 59 years of age (N=20) in California before the lockdown and during the increasing number of patients infected with the Delta variant. The qualitative data analysis showed some Japanese Americans periodically returned to Japan to provide caregiving for their parents before the pandemic, while others didn’t. However, the former group currently relied on their families in their home country more than before. The limitations led to not only distress over uncertainty but also release from a strong sense of reciprocity and filial responsibility, by changing from physical support to emotional and financial support via online. They also enhanced cultural identity as Japanese Americans, by thriving from discrimination against Asian Americans. Thus, our findings demonstrate important factors that impacted on transnational caregiving and caregivers' wellness, including cultural identity, family norms, beliefs and practices of intergenerational support, social and historical contexts, financial remittance, ICT use, and healthcare policies among the underrepresented populations across the Pacific.

The Gate of Heaven, which toured the United States for two years marking the 50th anniversary of the Dachau concentration camp liberation and commemorating the heroism of Japanese-American soldiers in World War II, imagines the friendship between a Japanese-American veteran and the Holocaust survivor he saves at the gates of Dachau in 1945. While the playwright-performers set out simply to celebrate their family histories – Lane Nishikawa is a third-generation Japanese American and Victor Talmadge lost many relatives in the Holocaust – the commemorative politics they encountered at each stop on the tour transformed the meaning of their play. A reconstruction of the social framework the play encountered at four venues, including the US Holocaust Memorial Museum and the Old Globe Theatre in southern California, demonstrates the malleable nature of race relations in America and the instability of Holocaust representation.

Abstract Whereas previous studies of internment have emphasized the political and psychological dimensions of the incarceration of Japanese Americans during World War II, this essay considers the entanglement of land use, urban segregation, and water politics that underlies the construction of Manzanar War Relocation Center. In unearthing the multilayered histories underlying the formation of Manzanar War Relocation Center, this essay shows how the evacuation of Japanese Americans to California's Owens Valley emerges out of and draws into relief the region's overlapping histories of environmental and social injustice, as evident in regional conflicts such as the California water wars, that extend beyond the scope of World War II. In doing so, this essay advances an environmental critique of US imperialist expansion and settler colonialism by focusing on recurrent environmental tropes in two works that cast internment and adjacent sites of racial containment as interlinked spaces of unequal political status: Jeanne Wakatsuki Houston's memoir Farewell to Manzanar (1973), coauthored with her husband James D. Houston, and Nina Revoyr's novel Southland (2003). These texts suggest that the racial geography of the United States has been shaped by the concentration of people of color in devitalized landscapes, intended sites of environmental ruin and economic disinvestment, that serve to assimilate or alienate ethnic populations.

Abstract This study examined factors affecting the feelings of loneliness among older Korean Americans. Data were drawn from a survey with older Korean Americans aged 60 or over (N = 2,150) in five states (California, New York, Texas, Hawaii, and Florida), conducted during 2017−2018. In hierarchical multiple regression models, loneliness was regressed on five blocks of variables: (1) demographic/health (age, gender, education, financial status, chronic conditions, and physical disabilities); (2) immigration-related (length of stay in the U.S., and acculturation); (3) social engagement (having meals alone, family network, friend network, activity participation, and community engagement); (4) negative family interactions; and (5) interactions of negative family interactions with social engagement variables. A significant interaction was found in the relationship between friend network and negative family interactions: the impact of negative family interactions on loneliness was buffered by friend network. Implications of findings were discussed regarding working with older immigrants with limited social networks.

The largest and most controversial WW II era confinement site for Japanese Americans was at Tule Lake in extreme northern California. Though decommissioned in 1946, the camp has left an indelible mark in the local landscape and in the lives of those confined there. Tule Lake has had a unique set of circumstances that allowed for the camp to take on a second life. Its utility infrastructure is still in use today and the distribution and repurposing of its barracks buildings contributed to the success of the last phase of area homesteading by WW II veterans. It is now also the site of organized pilgrimage events by Japanese Americans with personal connections to it and as such, serves as the epicenter for a virtual community of interested persons. This paper investigates the camp’s continued legacy by examining its effect on community development, what remains physically, the imprint of place on former incarcerees, and, what the future holds for its interpretation as a National Historic Site. The topic is addressed by examining the social and aesthetic implications of the continued use of its infrastructure, the post-war movement and repurposing of its buildings, the retention of an intact barbed-wire-enclosed portion for housing, and the touchstones visited by former incarcerees and their families today. Research methods included field inventory, archive and literature review, participation in a pilgrimage event, and nearly four decades of personal interaction with the site and its community.

This article examines Japanese governmental responses to memorial statues dedicated to ‘comfort women’ – women across the Asia-Pacific whom the Japanese military forced into conditions now recognised as sexual slavery before and during World War Two. This article discusses four cases around the world in which Japanese government officials have demanded the removal of comfort women statues: 1) Glendale, California; 2) San Francisco; 3) Manila; and 4) Berlin. The global expansion of comfort women memorialisation is significant to contemporary statue politics and crises of memory in three ways. Firstly, East Asian diasporas have become important actors in the remembrance of Japanese colonialism and the Asia-Pacific War outside East Asia. Secondly, these statues constitute attempts by diasporas to recover and reclaim a traumatic past through material culture. Thirdly, despite the global geographical reach of comfort women memory activism, neither nationalism nor the power of the nation-state have declined in today’s transnational world.

Abstract About one in five Americans is engaged in providing care to a family member. Caregivers (unpaid family members or friends) support older adults and persons with disability with a variety of conditions, including challenges in physical, cognitive, and mental health. In California, 4.5 million family caregivers are assisting individuals over the age of 18. The CA Department of Health Care Services funds 11 Caregiver Resource Centers (CRC) to support caregivers and, in 2019, provided support to expand information technology services through adoption of a statewide online assessment platform and client portal, CareNav™, to serve as a client record and referral tool. CareNav™ facilitates collection of consistent state-wide data that can inform program improvement and policy. This study evaluated the implementation process from the perspective of 35 CRC team members in guided focus group discussions. CRC staff identified several potential benefits to adopting CareNav™, including ease of client access and convenience, the ability to aggregate data to inform planning and policy, and a streamlined process for resource sharing. Challenges included customizing site-specific data needs, as well as concerns about equitable access to internet services. Ongoing evaluation will focus on validation and visualization of data, and translation of data into actionable information to improve quality and reach.

Implicit in most recent social science explanations of human behavior is a conception of man as universal homo economicus. Although such a conception is capable of giving a powerful account of a great deal of human action, its account of the nature and variety of human values is inadequate. Cultural assumptions about the meaning of “self” and “others,” and about relations between human beings, are likely to vary from one society to another. These assumptions affect the collective decision processes of political elites under conditions of complexity, uncertainty, and ambiguity. The author first addresses the question of how to construct a compelling cultural explanation, and then offers evidence which suggests that, because Chinese, Japanese, and Russians tend to hold somewhat different conceptions of “self” and “others” than do Americans (the former tending to be more collectivist than the latter), these different conceptions have implications for collective decision making.

Emily S. Rosenberg, A Date Which Will Live: Pearl Harbor in American Memory (Durham: Duke University Press, 2003, £18.95). Pp. 248. ISBN 0 8223 3206.Greg Robinson, By Order of the President: FDR and the Internment of Japanese Americans (Cambridge, MA: Harvard University Press, 2003, £12.95). Pp. 322. ISBN 0 674 01118 X.Tetsuden Kashima, Judgment without Trial: Japanese American Imprisonment during World War II (Seattle: University of Washington Press, 2003, $35.00). Pp. 336. ISBN 0 295 98299 3.Gerald Early, This Is Where I Came in: Black America in the 1960s (Lincoln, NE: University of Nebraska Press, Abraham Lincoln Lecture Series, 2003, £11. 50). Pp. 144. ISBN 0 80302 1823 0.Deborah Davis Jackson, Our Elders Lived It: American Indian Identity in the City (DeKalb, IL: University of Northern Illinois Press, 2002, $20.00). Pp. 191. ISBN 0 87580 591 4.Yen Le Espiritu, Home Bound: Filipino American Lives across Cultures, Communities, and Countries (Berkeley, Los Angeles and London: University of California Press, 2003, $21.95). Pp. 271. ISBN 0 520 23527 4.Elizabeth Boosahda, Arab-American Faces and Voices: The Origins of an Immigrant Community (Austin: The University of Texas Press, 2003, £18.95). Pp. 288. ISBN 0 292 70919 6.John Kerry, patrician Massachusetts liberal, war hero, and yet dissident from the Vietnam era, vies for the 2004 presidency against George Bush, White House dynastic Republican, self-nominated caring conservative, and yet hard-edged ideologue. Notwithstanding Kerry's Catholicism, or his Jewish family line, both candidates hold sway as heirs to WASP cultural style bolstered by considerable personal fortunes. Howard Dean, New York MD and former Vermont governor, and like Kerry and Bush a Yale graduate, storms the early polls by his activist left-liberal agenda and Internet fundraising. John Edwards, North Carolina senator, personal injuries lawyer, and up-from-the-ranks millionaire, his father a textile factory worker and his mother a postal office employee, conducts a widely agreed good race for the Democratic Party nomination before joining the ticket as would-be Vice President. Had multiculturalism led to any shift of paradigm in connection with canonical whiteness? Or, to put matters more plainly, were not the front-runners once again executive white men, whatever their respective merits or social origins?

This article aims at describing the social life of the American people in several places that made the adventures of John Steinbeck as the author of the novel Travels with Charley in Search of America around the 1960s. American people’s lives are a part of world civilizations that literary readers need to know. This adventure was preceded by an author’s trip in New York City, then to California, Connecticut, Rhode Island, New Hampshire, Massachusetts, Maine, New Jersey, Saint Lawrence, Quebec, Niagara Falls, Ohio, Chicago, Illinois, Michigan, North Dakota, the Rocky Mountains, Washington, the West Coast, Oregon, Arizona, New Mexico, Texas, New Orleans, Salinas, and again ended in New York. In processing research data, the writer uses one of the methods of literary research, namely the Dynamic Structural Approach which emphasizes the study of the intrinsic elements of literary work and the involvement of the author in his work. The intrinsic elements emphasized in this study are the physical and social settings. The research data were obtained from the results of a literature study which were then explained descriptively. The writer found a number of descriptions of the social life of the American people in the 1960s, namely the life of the city, the situation of the inland people, and ethnic discrimination. The people of the city are busy taking care of their profession and competing for careers, inland people living naturally without competing ambitions, and black African Americans have not enjoyed the progress achieved by the Americans. The description of American society related to the fictional story is divided by region, namely east, north, middle, west, and south. The social condition in the eastern region is dominated by beaches and mountains, and is engaged in business, commerce, industry, and agriculture. The comfortable landscape in the northern region spends the people time as breeders and farmers. The natural condition in the middle region of American is very suitable for agriculture, plantations, and animal husbandry. Many people in the western American region facing the Pacific Ocean become fishermen. The natural conditions from the plains and valleys to the hills make the southern region suitable for plantation land.

ObjectivesThe aim of this study was to investigate the association of living condition (deprivation and urbanisation level) with loneliness and social isolation.Study designCross-sectional study.MethodsData were retrieved from the Japan COVID-19 and Society Internet Survey, a nationwide online cohort study, conducted from September to October 2021. Area Deprivation Index and Densely Inhabited District data were used as indicators of living condition. The Japanese version of the University of California, Los Angeles Loneliness Scale and Lubben Social Network Scale-6 were used to assess loneliness and social isolation, respectively. Analysis of covariance was performed to compare the difference in outcome variables by living conditions (four categories), adjusting for gender, age, educational attainment, income, marital status, people living with, work status and subjective health status.ResultsA total of 27 520 community dwelling people were included in this study. For loneliness, living condition did not show a significant difference in the adjusted model, while deprived area had a tendency to show high loneliness. For social isolation, there was a significant group difference in the adjusted model (p<0.001), and living in a higher urbanisation level and lower deprivation showed the highest score for social isolation.ConclusionOverall, the effects of the living condition on loneliness and social isolation were small. Further study is needed to explore more comprehensive environment factors affecting loneliness and social isolation.

By the “Great Wall of Confinement,” the authors refer to the prison camp system established by the Chinese Communist Party after 1949. The two crucial components of this system are the laogai system (laodong gaizao, translated in the book to “remolding through labour” rather than the more often used “reform through labour”), and the laojiao system (laodong jiaoyang) or “reeducation through labour.” Let me say at once that this book is much more than an analysis of the literature surrounding the phenomenon of the prison camps. Through memoirs from former inmates and reportage literature we learn many detailed facts about the Chinese camp system, details equally valuable to the legal and the social science scholar.The book describes in detail the daily life of the camps, the prison conditions and the system's methods of arrest, detention, solitary confinement, torture for confessions, famine, degradation of prisoners, and a range of practices showing the security forces' discretionary powers and the “flexibilities” of informal sentencing. The authors emphasize both the modern ideology of remoulding and the traditional legalist (fajia) roots of a “very malleable sort of law.” Williams and Wu commendably combine a range of valuable empirical detail with a more general theoretical analysis of the historical, cultural and systemic roots and practices of the camp system.The only exceptions to generally harsh conditions in the PRC camps were the special prisons for high-ranking persons like the famous Fushun prison in Liaoning province which contained the last Manchu emperor, Puyi, high-ranking prisoners of war such as former Kuomintang top military officers, and Japanese prisoners of war.

The relevance of research of the formation of children's play spaces is determined by the gradual transformation from small areas with sand near schools to the first attempts at a design approach to arranging such territories using iron structures and organizing a play environment for children of different ages and physical capabilities. Wartime had a negative impact on the development of gaming spaces, which resulted in the destruction of all iron equipment in the gaming spaces. However, there are positive sides, this period contributed to the development of children's imagination and the creation of adventure themes for games - plots, scenarios, quests began at this time. It is necessary to highlight the period after the war - "The era of novelty." When the playgrounds were traumatic and the equipment was poorly handled Much attention was paid to the safety of children in playgrounds and spaces. A huge step forward was the architectural and design influence, which manifested itself in the form of various forms of iron - rockets, ships, slides, creative tunnels and other figures that were placed in the play spaces. Americans were among the first to start creating entire theme parks (Oxland, California). A large number of artists built exhibits, frescoes, toys and sculptures in the park. The formation of a new architectural and design space on playgrounds has turned into the creation of whole theme parks and amusement parks. Special attention should also be paid to the transformation of children's playgrounds into family play spaces, where both parents and children were equally involved in the game process. This influenced the perception of children, their attitude towards parents and had a positive result in understanding the unity of the family. Each period of time XVIII-XX can be designated by different stages: social, economic, cultural and security stage. They were also due to political relationships between countries (war) and within countries. Thus, we can say that even unfavorable conditions in the country can have a positive effect on the development of children of different ages thanks to the play environment and adapted spaces for this pastime. Keywords: children's play spaces, playgrounds, children's games, history of play spaces, architectural design, formation.

Purpose To identify mammography screening prevalence and predictors in Asian American women, focusing on the potential disparities in race and its influence on screening behaviors. Design A secondary analysis utilized the California Health Interview Survey (CHIS) 2015–2016. Setting California, U.S. Sample Cisgender women who were non-Hispanic (NH) White, Chinese, Filipino, Vietnamese, Japanese, Korean, or “other Asian”, aged 40 or above (unweighted N=13 451). Measures Socioeconomics, chronic health conditions, and preventive care utilization were mesuared as potential risk factors, where up-to-date mammography screening as the outcome variable. Analysis Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening behaviors in relation to potential factors, stratified by race and ethnicity. Results The prevalence for up-to-date mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. In NH-White women, receiving an up-to-date mammogram was associated with age, birthplace, smoking status, diabetes, hypertension, health insurance coverage, and a preventive care visit in the past 12 months, whereas only age and a preventive care visit were significant predictors in Asian women. Conclusions The findings indicate that utilization disparities exist in mammogram in relation to socioeconomics, chronic health conditions, preventive care utilization, when comparing between race and ethnicity. Asian American women with borderline hypertension and no preventive care visits may require more public health outreach and cancer education.

AbstractRobert A. Millikan (1868–1953) was the second American to win the Nobel Prize in physics. At the peak of his influence, no scientist save Einstein was more admired by the American public. Millikan, the head of the California Institute of Technology (Caltech) during its first 24 years, oversaw its rapid growth into one of the leading scientific institutions of the world. However, in response to demands for social justice following the murder of George Floyd, Caltech launched an investigation into Millikan. Caltech reached a decision to strip Millikan of honors (such as the library named after him), following accusations from various sources that he was a sexist, racist, xenophobic, antisemitic, pro-eugenic Nazi sympathizer. In short, Caltech threw the book at him. This article analyzes two accusations against Millikan. The first of these accusations was published in Nature: that he collaborated to deprive Japanese Americans of their rights during their forced relocation to internment camps during the Second World War. An examination of original historical sources will show that this accusation is false. On the contrary, Millikan actively campaigned during the war to promote the rights of Japanese Americans. This article traces the stages of misrepresentation that led to current false beliefs about Millikan. In view of Millikan’s extraordinary position in American science, this misrepresentation is a cautionary tale. The article also treats Caltech’s central accusation against Millikan: he lent his name to “a morally reprehensible eugenics movement” that had been scientifically discredited in his time. The article considers the statements purporting to show that eugenics movement had been denounced by the scientific community by 1938. In a reversal of Caltech’s claims, all three of Caltech’s scientific witnesses against eugenics—including two Nobel laureates—were actually pro-eugenic to varying degrees. This article concludes that Millikan’s beliefs fell within acceptable scientific norms of his day.

Abstract Introduction The Pacific Islander American population is understudied due to being aggregated with Asian Americans. In this study, we conduct a comparative analysis of directly measured body mass index (BMI), body fat percentage (%BF), and blood pressure (BP) between Pacific Islander Americans and Asian Americans from health screenings in Los Angeles, California. We hope to reveal intra-APIA health disparities masked by this data aggregation. Methods We analyzed BMI, %BF, and BP that were objectively measured by trained personnel at health screenings in Los Angeles between January 2011 and December 2019. We performed multivariable multinomial logistic regression models with obesity and hypertensive categories as outcome variables and ethnicity as the primary independent variable of interest. Models controlled for year of visit, participant age, sex, income, education level, years living in the USA, employment status, English proficiency, regular doctor access, and health insurance status. Results A total of 4,832 individuals were included in the analysis. Multivariable analyses revealed that Pacific Islander participants were at significantly higher risks for being classified as obese compared with all Asian American subgroups studied, including Chinese, Korean, Thai, Vietnamese, Filipino, and Japanese. Pacific Islanders also exhibited significantly lower predicted probability of having a normal blood pressure compared with Chinese and Thai participants. Some variation between Asian subgroups were also observed. Conclusions Pacific Islander participants had higher risk of several sentinel health problems compared to Asian American participants. Disaggregation of PI Americans from the APIA umbrella category in future studies is necessary to unmask the critical needs of this important community.

Neither mere flesh nor mere thing, the yellow woman, straddling the person-thing divide, applies tremendous pressures on politically treasured notions of agency, feminist enfleshment, and human ontology. — Anne Anlin Cheng, OrnamentalismIn this (apparently) very versatile piece of clothing, she [Michelle Zauner] smokes, sings karaoke, rides motorcycles, plays a killer guitar solo … and much more. Is there anything you can’t do in a hanbok?— Li-Wei Chu, commentary, From the Intercom IntroductionAnne Anlin Cheng describes the anomaly of being “the yellow woman”, women of Asian descent in Western contexts, by underlining the haunting effects of this artificial identity on multiple politically valent forms, especially through Asian women’s conceived ambivalent relations to subject- and object-hood. Due to the entangled constructiveness conjoining Asiatic identities with objects, things, and ornaments, Cheng calls for new ways to “accommodate the deeper, stranger, more intricate, and more ineffable (con)fusion between thingness and personness instantiated by Asiatic femininity and its unpredictable object life” (14). Following this call, this essay articulates a creative combination of José Esteban Muñoz’s disidentification and Avery Gordon’s haunting theory to account for some hauntingly disidentificatory ways that the performance of diaspora sensibilities reimagines Asian American life and femininity.This essay considers “Everybody Wants to Love You” (2016) (EWLY), the music video of Michelle Zauner’s solo musical project Japanese Breakfast, as a ghostly performance, which features a celebration of the Korean culture and identity of Zauner (Song). I analyse it as a site for identifying the confrontational moments and haunting effects of the diaspora sensibilities performed by Zauner who is in fact Jewish-Korean-American. Directed by Zauner and Adam Kolodny, the music video of EWLY features the persona that I call the Korean woman orchestrated by Zauner, singing in a restroom cubicle, eating a Dunkin Donuts sandwich, shotgunning a beer, shredding a Fender electric guitar on the hood of a truck, riding a motorcycle with her queer lover, and partying with a crowd all in the traditional Korean attire hanbok that used to belong to her late mother. The story ends with Zauner waking up on a bench with a hangover and fleeing from the scene, conjuring up a journey of self-discovery, self-healing, and self-liberation through multiple sites and scenes of everyday life.What I call a ghostly performance is concerned with Avery Gordon’s creative intervention of haunting as a method of social analysis to study the intricate lingering impact of ghostly matters from the past on the present. Jacques Derrida develops hauntology to describe how Marxism continues to haunt Western societies even after its so-called failure. It refers to a status that something is neither present nor absent. Gordon develops haunting as a way of knowing and a method of knowledge production, “forcing a confrontation, forking the future and the past” (xvii). A ghostly performance is thus where ghostly matters are mobilised in “confrontational moments”:when things are not in their assigned places, when the cracks and rigging are exposed, when the people who are meant to be invisible show up without any sign of leaving, when disturbed feelings cannot be put away, when something else, something different from before, seems like it must be done. (xvi)The interstitiality that transgresses and reconfigures the geographical and temporal borders of nation, culture, and Eurocentric discourses of progression is important for understanding the diverse experiences of diaspora sensibilities as critical double consciousness (Dayal 48, 53). As Gordon suggests, confrontational moments force us to confront and expose the interstitial state of objects, subjects, feelings, and conditions. Hence, to understand this study identifies the confrontational moments in Zauner’s performance as a method to identify and deconstruct the triggering moments of diaspora sensibilities.While deconstructing the ghostly performances of diaspora sensibilities, the essay also adopts an object-oriented approach to serve as a focused entry point. Not only does this approach designate a more focused scope with regard to applying Gordon’s hauntology and Muñoz’s disidentification theory, it also taps into a less attended territory of object theories such as Graham Harman’s and Ian Bogost’s object-oriented ontology due to the overlooking of the relationship between objects and racialisation that is much explored in Asian American and critical race and ethnic studies (Shomura). Moreover, while diaspora as, or not as, an object of study has been a contested topic (e.g., Axel; Cho), the objects of diaspora have been less studied.This essay elaborates on two ghostly matters: the hanbok and the manicured nails. It uncovers two haunting effects throughout the analysis: the conjuring-up of the Korean diaspora and the troubling of everyday post-racial America. By defying the objectification of Asian bodies with objects of diaspora and refusing to assimilate into the American nightlife, Zauner’s Korean woman persona haunts a multiculturalist post-racial America that fails to recognise the specificities and historicity of Korean America and performs an alternative reality. Disidentificatory ghostly performance therefore, I suggest, thrives on confrontations between the past and the present while gesturing toward the futurities of alternative Americas. Mobilising the critical lenses of disidentification and ghostly performance, finally, I aver that disidentificatory ghostly performances have great potential for envisioning a better politics of performing and representing Asian bodies through the ghostly play of haunting objects/ghostly matters.The Embodied (Objects) and the Disembodied (Ghosts) of DisidentificationThe sonic-visual lifeworld constructed in the music video of EWLY is, first of all, a cultural public sphere, through which social norms are contested, reimagined, and reconfigured. A cultural public sphere reveals the imbricated relations between the political, the public, and the personal as contested through affective (aesthetic and emotional) communications (McGuigan 15). Considering the sonic-visual landscape as a cultural public sphere foregrounds two dimensions of Gordon’s hauntology theory: the psychological and the sociopolitical states. The emphasis on its affective communicative capacities enables the psychological reach of a cultural production. Meanwhile, the multilayered articulation of the political, the public, and the personal shows the inner-network of acts of haunting even when they happen chiefly on the sociopolitical level. What is crucial about cultural public spheres for minoritarian subjects is the creative space offered for negotiating one’s position in capacious and flexible ways that non-cultural publics may not allow. One of the ways is through imagination and disputation (McGuigan 16). The idea that imagination and disputation may cause a temporal and spatial disjunction with the present is important for Muñoz’s theorisation of disidentification. With such disjunction, Muñoz believes, queer of colour performances create future-oriented visions and coterminous temporality of the present and the future. These future-oriented visions and the coterminous temporality can be thought through disidentifications, which Muñoz identifies asa performative mode of tactical recognition that various minoritarian subjects employ in an effort to resist the oppressive and normalizing discourse of dominant ideology. Disidentification resists the interpellating call of ideology that fixes a subject within the state power apparatus. It is a reformatting of self within the social. It is a third term that resists the binary of identification and counteridentification. (97)Disidentification offers a method to identify specific moments of imagination and disputation and moments of temporal and spatial disjunction. The most distinct example of the co-nature of imagination and disputation residing in the EWLY lifeworld is the persona of the Korean woman orchestrated by Zauner, as she intrudes into the everyday field of American life in a hanbok, such as a bar, a basketball court, and a convenience store. Gordon would call these moments “confrontational moments” (xvi). When performers don’t perform in ways they are supposed to perform, when they don’t operate objects in ways they are supposed to operate, when they don’t mobilise feelings in ways they are supposed to feel, they resist and disidentify with “the oppressive and normalizing discourse of dominant ideology” (Muñoz 97).In addition to Muñoz’s disidentification and Gordon’s confrontational moments, I adopt an object-oriented approach to guide my analysis of disidentificatory ghostly performances. Object theory departs from objects and matters to rediscover identity and experience. My object-oriented approach follows new materialism more closely than object-oriented ontology because it is less about debating the ontology of Asian American experiences through the lens of objects. Instead, it is more about how re-orienting our attention towards the formation and operation of objecthood reveals and reconfigures the vexed articulation between Asian American experiences and racialised objectification. To this end, my oriented-object approach aligns particularly well with politically engaged frameworks such as Jane Bennett’s vital materialism and Eunjung Kim’s ethics of objects.Taking an object-oriented approach in inquiring Asian American identities could be paradoxically intervening because “Asian Americans have been excluded, exploited, and treated as capital because they have been more closely associated to nonhuman objects than to human subjects” (Shomura). Furthermore, this objectification is doubly performed onto the bodies of Asian American women due to the Orientalist conflations of Asia as feminine (Huang 187). Therefore, applying object theory in the case of EWLY requires special attention to the interplay between subject- and object-hood and the line between objecthood and objectification. To avoid the risk of objectification when exploring the objecthood of ghostly matters, I caution against an objects-define-subjects chain of signification and instead suggest a subjects-operate-objects route of inquiry by attending to both the haunting effects of objects and how subjects mobilise such haunting effects in their performance. From a new materialist perspective, it is also important to disassociate problems of objectification from exploration of objecthood (Kim) while excavating the world-making abilities of objects (Bennett). For diasporic peoples, it means to see objects as affective and nostalgic vessels, such as toys, food, family photos, attire, and personal items (e.g., Oum), where traumas of displacement can be stored and rehearsed (Turan 54).What is revealing from a racialised subject-object relationship is what Christopher Bush calls “the ethnicity of things”: things can have ethnicity, an identification that hinges on the articulation that “thingliness can be constituted in ways analogous and related to structures of racialization” (85). This object-oriented approach to inquiry can expose the artificial nature of the affinity between Asian bodies and certain objects, behind which is a confession of naturalised racial order of signification. One way to disrupt this chain of signification is to excavate the haunting objects that disidentify with the norms of the present, that conjure up what the present wants to be done. This “something-to-be-done” characteristic is critical to acts of haunting (Gordon xvii). Such disruptive performances are what I term as “disidentificatory ghostly performances”, connecting the embodied objects with Gordon’s disembodied ghosts through the lens of Muñoz’s disidentificatory reading with a two-fold impact: first exposing such artificial affinity and then suggesting alternative ways of knowing.In what follows, I expand upon two haunting objects/ghostly matters: the manicured nails and the hanbok. I contend that Zauner operates these haunting objects to embody the “something-to-be-done” characteristic by curating uncomfortable, confrontational moments, where the constituted affinity between Koreanness/Asianness and anomaly is instantiated and unsettled in multiple snippets of the mundane post-racial, post-globalisation world.What Can the Korean Woman (Not) Do with Those Nails and in That Hanbok?The hanbok that Zauner wears throughout the music video might be the single most powerful haunting object in the story. This authentic hanbok belonged to Zauner’s late mother who wore it to her wedding. Dressing in the hanbok while navigating the nightlife, it becomes a mediated, trans-temporal experience for both Zauner and her mother. A ghostly journey, you could call it. The hanbok then becomes a ghostly matter that haunts both the Orientalist gaze and the grieving Zauner. This journey could be seen as a process of dealing with personal loss, a process of “reckoning with ghosts” (Gordon 190). The division between the personal and the public, the historical and the present cease to exist as linear and clear-cut forces. The important role of ghosts in the performance are the efforts of historicising and specifying the persona of the Korean woman, which is a strategy for minoritarian performers to resist “the pull of reductive multicultural pluralism” (Muñoz 147). These ghostly matters haunt a pluralist multiculturalist post-racial America that refuses to see minor specificities and historicity.The Korean woman in an authentic hanbok, coupled with other objects of Korean roots, such as a traditional hairdo and seemingly exotic makeup, may invite the Orientalist gaze or the assumption that Zauner is self-commodifying and self-fetishising Korean culture, risking what Cheng calls “Oriental female objectification” operating through “the lenses of commodity and sexual fetishism” (14). However, she “fails” to do any of these. The ways Zauner acts in the hanbok manifests a self-negotiation with her Korean identity through disidentificatory sensibilities with racial fetishism. For example, in various scenes, the Korean woman appears to be drunk in a bar, gorging a sandwich, shotgunning a beer, smoking in a restroom cubicle, messing with strangers in a basketball court, rocking on a truck, and falling asleep on a bench. Some may describe what she does as abnormal, discomforting, and even disgusting in a traditional Korean garment which is usually worn on formal occasions. The Korean woman not only subverts her traditional Koreanness but also disidentifies with what the Asian fetish requires of Asian bodies: obedient, well-behaved model minority or the hypersexualised dragon lady (e.g., Hsu; Shimizu). Zauner’s performance foregrounds the sentimental, the messy, the frenetic, the aggressive, and the carnivalesque as essential qualities and sensibilities of the Korean woman. These rarely visible figurations of Asian femininities speak to the normalised public disappearance of “unwanted” sides of Asian bodies.Wavering public disappearance is a crucial haunting effect. The public disappearance is an “organized system of repression” (Gordon 72) and a “state-sponsored procedure for producing ghosts to harrowingly haunt a population into submission” (115). While the journey of EWLY evolves through ups and downs, the Korean woman does not maintain the ephemeral joy and takes offence at the people and surroundings now and then, such as at an arcade in the bar, at some basketball players, or at the audience or the camera operator. The performed disaffection and the conflicts substantiate a theory of “positive perversity” through which Asian American women claim the representation of their sexuality and desires (Shimizu), engendering a strong and visible presence of the ghostly matters operated by the Korean woman. This noticeable arrival of bodies disorients how things are arranged (Ahmed 163), revealing and disrupting whiteness, which functions as a habit and a background to actions (149). The confrontational performances of the encounters between Zauner and others cast a critique of the racial politics of disappearing by reifying disappearing into confrontational moments in the everyday post-racial world.What is also integral to Zauner’s antagonistic performance of wavering public disappearing and failure of “Oriental female objectification” is a punk strategy of negativity through an aesthetic of nihilism and a mediation of performing objects. For example, in addition to the traditional hairdo that goes with her makeup, Zauner also wears a nose ring; in addition to partying with a crowd, she adopts a moshing style of dancing, being carried over people’s heads in the hanbok. All these, in addition to her disaffectionate, aggressive, and impolite body language, express a negative punk aesthetics. Muñoz describes such a negative punk aesthetics as an energy that can be described “as chaotic, as creating a life without rhyme or reason, as quintessentially self-destructive” (97). What lies at the heart of this punk dystopia is the desire for “something else”, something “not the present time or place” (Muñoz). Through this desire for impossible time and place, utopian is reimagined, a race riot, in Mimi Thi Nguyen’s term.On the other hand, the manicured fingernails are also a major operating force, reminiscent of Korean American immigrant history along with the racialised labor relations that have marked Korean bodies as an alien anomaly (Liu). With “Japanese Breakfast” being written on the screen in neon pink with some dazzling effect, the music video begins in a warm tone. The story begins with Zauner selecting EWLY with her finger on a karaoke operation screen, the first of many shots on her carefully manicured nails, decorated with transparent nail extensions, sparkly ornaments, and hanging fine chains. These nails conjure up the nail salon business in the US that heavily depended on immigrant labor and Korean women immigrants have made significant economic contributions through the manicure business. In particular, differently from Los Angeles where nail salons have been predominantly Vietnamese and Chinese owned, Korean women immigrants in the 1980s were the first ones to open nail salons in New York City and led to the rapid growth of the business (Kang 51). The manicured nails first of all conjure up these recent histories associated with the nail salon business.Moreover, these fingernails haunt post-racial and post-globalisation America by revealing and subverting the invisible, normalised racial and ethnic nature of the labor and objects associated with fingernails cosmetic treatment. Ghostly matters inform “a method of knowledge production and a way of writing that could represent the damage and the haunting of the historical alternatives” (Gordon xvii). They function as a reminder of the damage that seems forgotten or normalised in modern societies and as an alternative embodiment of what modern societies could have become. In the universe of EWLY, the fingernails become a forceful ghostly matter by reminding us of the damage done onto Korean bodies by fixing them as service performers instead customers. The nail salon business as performed by immigrant labor has been a business of “buying and selling of deference and attentiveness”, where white customers come to exercise their privilege while not wanting anything associated with Koreaness or Otherness (Kang 134). However, as a haunting force, the fingernails subvert such labor relations by acting as a versatile agent operating varied objects, such as a karaoke machine, cigarettes, a sandwich, a Fender guitar, and a can of beer. Through such operating, an alternative labor relation is formed. This alternative is not entirely without roots. As promoted in Japanese Breakfast’s Instagram (@jbrekkie), Zauner’s look was styled by a nail artist who appears to be a white female, Celeste Marie Welch from the DnA Salon based in Philadelphia. This is a snippet of a field that is now a glocalised industry, where the racial and gender makeup is more diverse. It is increasingly easier to see non-Asian and non-female nail salon workers, among whom white nail salon workers outnumbered any other non-Asian racial/ethnic groups (Preeti et al. 23). EWLY’s alternative worldmaking is not only a mere reflection of the changing makeup of an industry but also calling out the societal tendency of forgetting histories. To be haunted, as Gordon explains, is to be “tied to historical and social effects” (190). The ghostly matters of the manicure industry haunt its workers, artists, consumers, and businesspeople of a past that prescribes racialised labor divisions, consumption relations, and the historical and social effects inflicted on the Othered bodies. Performing with the manicured nails, Zauner challenges now supposedly multicultural manicure culture by fusing oppositional, trans-temporal identities into the persona of the Korean woman. Not only does she conjure up the racialised labor relations as the child of a Korean mother, she also disidentifies with the worker identity of early Korean women immigrants as a consumer who receives service from an artist who would otherwise never perform such labor in the past.Conclusion: Toward a Disidentificatory Ghostly PerformanceThis essay suggests seeing the disidentificatory ghostly performance of the Korean woman as an artistic incarnation of her lived Othering experience, which Zauner may or may not navigate on an everyday basis. As Zauner lives through what looks like a typical Friday night in an American town, the journey represents an interrogation of the present and the past. When the ghostly matters move through public spaces – when she drinks in a bar, walks down the street, and parties with a crowd – the Korean woman neither conforms to what she is expected to do in a hanbok nor does she get fully assimilated into this American nightlife.Derrida avers that haunting, repression, and hegemony are structurally interlocked and that “haunting belongs to the structure of every hegemony” because “hegemony still organizes the repression” (46). This is why the creative capacity of disidentificatory performances is crucial for acts of haunting and for historically repressed groups of people. Conjoining the future-oriented performative mode of disidentification and the forking of the past and the present by ghostly performances, disidentificatory ghostly performances enable not only people of colour but also particularly diasporic populations of colour to challenge racial chains of signification and orchestrate future-oriented visions, where time is of the most compassion, at its utmost capacity.ReferencesAhmed, Sara. “A Phenomenology of Whiteness.” Feminist Theory 8.2 (2007): 149–168.Axel, Brian Keith. “Time and Threat: Questioning the Production of the Diaspora as an Object of Study.” History and Anthropology 9.4 (1996): 415–443.Bennett, Jane. Vibrant Matter: A Political Ecology of Things. Durham: Duke UP, 2010.Bogost, Ian. Alien Phenomenology, or, What It’s Like to Be a Thing. Minneapolis: U of Minnesota P, 2012.Bush, Christopher. “The Ethnicity of Things in America’s Lacquered Age.” Representations 99.1 (2007): 74–98. Cheng, Anne Anlin. Ornamentalism. New York: Oxford UP, 2019.Cho, Lily. “The Turn to Diaspora.” Topia: Canadian Journal of Cultural Studies 17 (2007): 11–30.Chu, Li-Wei. “MV Throwback: Japanese Breakfast – ‘Everybody Wants to Love You’.” From the Intercom, 23 Aug. 2018. <https://fromtheintercom.com/mv-throwback-japanese-breakfast-everybody-wants-to-love-you/>.Dayal, Samir. “Diaspora and Double Consciousness.” The Journal of the Midwest Modern Language Association 29.1 (1996): 46–62. Derrida, Jacques. Specters of Marx: The State of the Debt, the Work of Mourning, and the New International. London: Routledge, 1994.Gordon, Avery. Ghostly Matters: Haunting and the Sociological Imagination. Minneapolis: U of Minnesota P, 2008. Harman, Graham. Prince of Networks: Bruno Latour and Metaphysics. Melbourne: re.press, 2009.Hsu, Madeline Yuan-yin. The Good Immigrants: How the Yellow Peril Became the Model Minority. Princeton, New Jersey: Princeton UP, 2015.Huang, Vivian L. “Inscrutably, Actually: Hospitality, Parasitism, and the Silent Work of Yoko Ono and Laurel Nakadate.” Women & Performance: A Journal of Feminist Theory 28.3 (2018): 187–203.Japanese Breakfast. “Japanese Breakfast – Everybody Wants to Love You (Official Video).” YouTube, 20 Sep. 2016. <http://www.youtube.com/watch?v=KNT7wuqaykc>.Kang, Miliann. The Managed Hand: Race, Gender, and the Body in Beauty Service Work. Berkeley: U of California P, 2010.Kim, E. “Unbecoming Human: An Ethics of Objects.” GLQ: A Journal of Lesbian and Gay Studies 21.2–3 (2015): 295–320.Liu, Runchao. “Retro Objects, Alien Objects.” In Media Res. 12 Dec. 2018. <http://mediacommons.org/imr/content/retro-objects-alien-objects>.McGuigan, Jim. Cultural Analysis. Los Angeles, CA: SAGE, 2010.Muñoz, José Esteban. Disidentifications: Queers of Color and the Performance of Politics. Minneapolis: U of Minnesota P, 1999.———. “‘Gimme Gimme This ... Gimme Gimme That’: Annihilation and Innovation in the Punk Rock Commons.” Social Text 31.3 (2013): 95–110.Nguyen, Mimi Thi. “Riot Grrrl, Race, and Revival.” Women & Performance: A Journal of Feminist Theory 22.2–3 (2012): 173–196. Oum, Young Rae. “Authenticity and Representation: Cuisines and Identities in Korean-American Diaspora.” Postcolonial Studies 8.1 (2005): 109–125.Sharma, Preeti, et al. “Nail File: A Study of Nail Salon Workers and Industry in the United States.” UCLA Labor Center and California Healthy Nail Salon Collaborative, 2018.Shimizu, Celine Parrenas. The Hypersexuality of Race: Performing Asian/American Women on Screen and Scene. Durham, NC: Duke UP, 2007.Shomura, Chad. “Object Theory and Asian American Literature.” Oxford Research Encyclopedia of Literature. New York: Oxford UP, 2020.Song, Sandra. “Japanese Breakfast Is the Korean-American Songwriter Empowering Everyone to Overcome.” Teen Vogue. 14 July 2017. <http://www.teenvogue.com/story/japanese-breakfast-songwriter-empowering-everyone-overcome>.Turan, Zeynep. “Material Objects as Facilitating Environments: The Palestinian Diaspora.” Home Cultures 7.1 (2010): 43–56.

This study statistically explored public perceptions of the risks and benefits of the agricultural application of gene editing to food crops using online surveys in the US ( n = 2,050), Japan ( n = 1,842), and Germany ( n = 1,962). The American participants exhibited the most positive attitudes toward this emerging technology. Japanese participants demonstrated similar attitudes to German participants regarding risk perceptions and demonstrated closer attitudes to American participants regarding benefit perceptions. Further, the American participants did not highly differentiate between gene-edited and conventionally bred foods when compared to German and Japanese participants. Presentation of information using either animal or plant illustrations did not have any impact on risk perceptions toward gene-edited crops in the three countries, but the German and Japanese people who were given information with plant illustrations showed higher perceptions of benefit than those who were given the same information but with animal illustrations. The study results empirically indicate that despite receiving the same information under the same experimental conditions, perceptions can vary among countries. Our survey and provision of contrasting information illustrations, as well as including participants from an Asian country—Japan—in addition to Americans and Germans broadens the framework of civic epistemology.

Abstract Issue/Problem Cambodian Americans have high rates of mental health conditions, diabetes and cardiovascular disease. Unique risk factors include history of malnutrition, torture, social isolation, and poor social determinants of health. Community CARES is a trauma-informed model applicable to any trauma community with complex chronic health and mental health problems. Description of the problem High-touch, high-tech approaches can improve access to culturally and linguistically appropriate medication therapy management (MTM) services. Over 12 months, pharmacists teamed with community health workers (CHWs) to provide MTM services in Connecticut and California. Face-to-face consultations occurred in Connecticut, while patients and CHWs in California used teleconferencing with the pharmacist in Connecticut. Project goals: improve drug therapy outcomes, reduce inappropriate medication use, improve medication adherence, display cost savings. Results 96 patients, average age 69, completed the project. Patients averaged 6.6 medical conditions and 10.3 medications. Pharmacists identified 604 medication-related problems, resolving 93%. Drug therapy outcomes increased 35%, medication adherence improved 23%, inappropriate medication use decreased 35%, and depression screening scores improved 25%. Return on investment ratio was 6:1, a savings of $3032/patient/year. Health improvements from face-to-face and telehealth MTM consultations were similar. Lessons Healthcare workforce is optimized by linking CHWs with pharmacists and technology to deliver cost-effective MTM services. The approach is generalizable to populations challenged by distance, disability, language, or culture. Public health care policies need to reflect team approaches and value-based payment models. Main messages: The virtual cross-cultural team MTM model for underserved populations has the potential to meet the triple aim goals of better care, better health, and lower costs in multiple settings. Key messages Virtual cross-cultural team MTM model for underserved populations. Meets the triple aim goals of better care, better health, and lower costs in multiple settings.

Abstract Background Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of this study was to evaluate how prevalence of these conditions and risk factors differs across Asian-American and PI ethnic groups and compares with an aggregated All Asian-American racial group. Methods This study used a cohort of 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California health plan members during 2016. The cohort included approximately 274,910 Asian-Americans (Chinese, Filipino, Japanese, Korean, Southeast Asian, South Asian, other), 8450 PIs, 795,080 non-Hispanic whites, 107,200 blacks, and 210,050 Latinos. We used electronic health record data to produce age-standardized prevalence estimates of DM, HTN, CAD, obesity (using standard and Asian thresholds), and smoking for men and women in all racial/ethnic subgroups and compared these subgroups to an aggregated All Asian-American racial group and to whites, blacks, and Latinos. Results We found large differences in health burden across Asian-American ethnic subgroups. For both sexes, there were 16 and > 22 percentage point differences between the lowest and highest prevalence of DM and HTN, respectively. Obesity prevalence among Asian subgroups (based on an Asian BMI ≥ 27.5 kg/m2 threshold) ranged from 14 to 39% among women and 21 to 45% among men. Prevalence of smoking ranged from 1 to 4% among women and 5 to 14% among men. Across all conditions and risk factors, prevalence estimates for Asian-American and PI ethnic groups significantly differed from those for the All Asian-American group. In general, Filipinos and PIs had greater health burden than All Asians, with prevalence estimates approaching those of blacks. Conclusions In a population of middle-aged and older adult Northern California health plan members, we found substantive differences in prevalence of chronic cardiovascular conditions, obesity, and smoking across Asian-American ethnic groups and between Asian-American ethnic groups and an aggregated All Asian racial group. Our study confirms that reporting statistics for an aggregated Asian-American racial group masks meaningful differences in Asian-American ethnic group health.

Objective/Context: In this article, we examine how Chinese demand for pelts—of sea otters and other marine mammals—fueled the eighteenth-century competitive expansion of European and later American merchants and explorers in the Pacific islands and along the Pacific coast of North America. Sea otter pelts were a commodity directly linked to the creation of a Pacific Ocean economy, and California’s colonization resulted from imperial dynamics to which this trade gave rise. Methodology: Using both primary and secondary sources, we examine how these merchants’ quest to supply the lucrative Chinese luxury market with furs—“soft gold”—brought them into contact with indigenous peoples whose livelihoods and commercial networks would also be recruited into this global market but on quite unequal terms and with devastating consequences. Originality: The growth of this Pacific trade throughout the eighteenth century fueled geopolitical rivalries that led to the colonization of California with a system of missions and military garrisons (presidios) and, eventually, to a new ecology as a result of plants and animals brought from New Spain before the Gold Rush and the Treaty of Guadalupe Hidalgo. Many, including Marx and Engels, have claimed that the Gold Rush contributed significantly to the dynamics of industrial capitalism; nevertheless, we argue that its conditions of possibility were laid out centuries earlier via the complex geopolitical and ecological connections through which this Pacific economy was articulated. Conclusions: During the eighteenth century, the Pacific’s products were extracted and commodified in circuits whose demand center was China. It is precisely the prior existence of these global markets—centered on silver and “soft gold,” or sea otter furs—that explains the presence of Europeans and Americans in California eager to prospect for the yellow metal in 1848.

ObjectiveThe recent coronavirus disease 2019 (COVID-19) outbreak has changed people's social connections with others and society. This study aimed to describe changes in the prevalence of social isolation and loneliness by demographic characteristics, socioeconomic status, health conditions, and outbreak situations in residential prefectures among Japanese people between the first year (2020) and the second year (2021) of the COVID-19 pandemic.MethodsWe used data from the Japan COVID-19 and Society Internet Survey (JACSIS) study, a large-scale web-based nationwide survey conducted with 53,657 participants aged 15–79 years in August–September 2020 and September–October 2021 (25,482 and 28,175 participants, respectively). Social isolation was defined as less than once a week in the total frequency of contact with family members or relatives who were living apart and friends/neighbors. Loneliness was assessed using the three-item University of California, Los Angeles (UCLA) Loneliness Scale (score range, 3–12). We used generalized estimating equations to estimate the prevalence of social isolation and loneliness in each year and the difference in prevalence between 2020 and 2021.ResultsThe weighted proportion (95% confidence interval) of social isolation in the total sample was 27.4% (25.9, 28.9) in 2020 and 22.7% (21.9, 23.5) in 2021, representing a change of −4.7 percentage points (−6.3, −3.1). The weighted mean scores of the UCLA Loneliness Scale were 5.03 (4.86, 5.20) in 2020 and 5.86 (5.81, 5.91) in 2021, representing a change of 0.83 points (0.66, 1.00). The detailed trend changes for social isolation and loneliness were noted in the demographic subgroups of socioeconomic status, health conditions, and outbreak situation in the residential prefecture.ConclusionSocial isolation decreased from the first to the second year of the COVID-19 pandemic, whereas loneliness increased. Assessing the COVID-19 pandemic's impact on social isolation and loneliness contributes to understanding who was particularly vulnerable during the pandemic.

Cohesion as a term connotes attraction, unity, and commonness amongst discrete entities. Considering cohesion as a concept is timely with the recent rise of network culture, which comes with both subtle and radical changes in how people connect with, position themselves in relation to, and understand other constituents of society (cf. Varnelis; Castells; Jenkins et al.). Such dis- and inter-connections signify an imminent and immanent epistemological challenge we must confront: how can we understand inherently multi-faceted subjects, components of which are in constant transformation? For researchers, disciplinary complexity is one of the main implications of this situation. While disciplinary integration may be an effective or vital component in pursuit of knowledge (cf. Nicolescu) it may also impart significant conceptual and pragmatic conflicts. What are possible ways to coalesce multiple dimensions of reality that can lead to conceptually cohesive and useful knowledge production? This issue of M/C Journal attempts to answer this question by looking at different perspectives on the notion of cohesion across topical and disciplinary boundaries. Our premise for exploring ‘cohesion’ in this issue is two-fold: first, there is a need to understand the conceptual and experiential significance of social cohesion in the increasingly urbanised and networked contemporary world. In the 1997 OECD report, Societal Cohesion and the Globalising Economy, Michalski, Miller, and Stevens attribute ‘strains of the fabric of OECD societies’ to global economic and political changes, as well as the rapid technological progress. The World Bank places social cohesion as a metonym for social capital; they argue that social cohesion is ‘critical for societies to prosper economically and develop sustainably,’ and that it is ‘the glue’ that holds constituents of the society together. While it is true that the need to build bonds between human beings, and to bring together otherwise disparate experiences and aspirations is evermore crucial to a sustainable future for the world, we doubt that the current pervasive view of cohesion as a measurable parameter for ideal harmony and unity. Rather, in this uncertainty we see opportunities for re-examining the existing definitions of cohesion and further shaping different versions of social/community strengthening. If social cohesion is inherent in the relationships between and amongst entities, ideologies or experiences disagreement and difference or transition are as important or integral as shared ideas. Anheier, Gerhards and Romo have re-imagined Bourdieu’s view of positions individuals inhabit within social spaces as a ‘network, or a configuration, of objective relations among positions.’ From this view the merging of individuals or groups into a cohesive whole becomes less important than the coming together, sometimes only briefly, of ideas into a dynamic and complicated matrix – in other words, the shaping of togetherness through temporary adhesive connections amongst individuals managing various such adhesive networks. We are not necessarily questioning the obvious advantages of a unified society. Rather, we are suggesting a need to enquire into new ways of approaching cohesion, and subsequent implications in viewing, governing, and living in society today, and tomorrow. The second reason for considering cohesion is the development of network technologies, which are embedded in everyday life. Network technologies engender and accentuate multiplicities: multifaceted self-identity, multitasking, and multisensorial experience via interactive media, for example. As we transition from the current network era towards that of ubiquitous computing (ubicomp), our social and technological systems and practices become modular-like (Choi, Foth and Hearn), resonating with what Stone calls ‘continuous partial attention.’ Practice of multi-media communication – for example, concurrently watching television while chatting on Skype on the computer and texting on the mobile phone; another example is Habuchi’s notion of ‘telecocoon’ in which a multitude of constant and partial connections with small, insular social relations are maintained through always-on network technologies. The spatio-temporal zone that is made available, created, and extended by network technologies for expression of the self and communication with others is an inherently in-between space bridging what can be generally considered dichotomous. In this environment, it is cohesion that validates a networked entity by giving it a unified form and/or voice amongst its distributed constituents. The scale of such cohesive process varies from small (individual) to large (collective); examples include individual and community, respectively. As Castells (7) notes, while technology is not entirely responsible for social change, it embodies the capacity for change. Cohesion then, is perhaps best understood as inherently transformative. Thus examining cohesion as a phenomenon should not be focused on the ‘connections’ amongst individual entities but should concern what triggers, sustains, and suspends adhesive interactions, and how such processes relates to overall cohesion within the concerned subject. This notion resonates with the connection – access relation in understanding network culture. As Choi asserts, ‘in a network environment where the connection is a primal element, connection itself cannot be the rationale for interaction; rather, it is access – the act of accessing and being accessed – that becomes the prime motive for participation in network interactions’ (104). This issue of M/C Journal brings together diverse articles that explore the dynamic and challenging concept of cohesion in the current era, where technological, cultural, and structural conditions rapidly co-evolve through communicative networks, thereby reshaping the ontological and epistemological dimensions of various societies. The feature article by Holmes Cohesion, Adhesion and Incoherence explores the creation of a cohesive visual identity for a collective via digital and print-media. Her paper illustrates the ways in which Flickr participants communicate with each other, and how it is possible for networks to come together in an organically cohesive way, if only temporarily. Holmes also provides and insight into the process of and obstacles to establishing and maintaining a cohesive group identity. This feature article provides a framework for the issue as whole that shows how cohesive identity is created through ‘negotiation’ confirms our view that it’s in constant transformation. It also serves as a launching pad for the other articles to continue deconstructing cohesion as a cohesive concept. Glover turns the focus to policy making in the cultural sector. In his paper Failed Fantasies of Cohesion he examines the fantasy of cohesion as fundamental to whole-of-government cultural policy-making undertaken within Arts Queensland in the 1990s and 2000s. The emphasis in this paper is the complexity of cohesion as a critical factor in cultural policy making, and also the paradox that cohesion presents. In the quest for cohesion the potential for important and rich dissent can be discouraged. As Glover eloquently argues, when cohesion is lost all is not lost. This embracing of both the flaws in and potential of cohesion is carried in Publish or Perish. Martin puts forward possible strategies for university presses to work as a cohesive force between emerging writers and the writing industry. He examines the inter-relationship between university presses and the broader publishing industry, and asks whether broader access and sustained co-operation between creative writing departments and university publishing houses or presses could result in a new version of cohesion in the Australian literary landscape. He presents a holistic contour of the contemporary literary industry, using the University of Western Australia and the University of Western Sydney as examples of how entities with competing agendas can come together in a mutually beneficial and innovative way. Leder and colleagues bring the focus to the individual techno-social experience, as exemplified in their ToTeM (Tales of Things and Electronic Memory) project. This project addresses social cohesion through combining personal narratives with Web2.0 and tagging technologies to create a network of shared object-related memories. This paper accentuates the pluralistic nature of cohesion and thus calls for a multiplicity of approaches to cohesion. This issue closes with an artistic piece by Kari Gislason. His personal essay Independent People provides an exploration of Iceland’s financial collapse and its disconnection with the European Union, and calls into question whether a cohesive relationship with its neighbours is possible for or even desired by the Icelandic people. This discussion is played out against the backdrop of competing national identities in his own life and the search for unity. It is in this problematising and challenging of cohesion as a static or permanent state of agreement that this issue found its own cohesive thread. References Anheier, Helmut, Jurgen Gerhards, and P. Romo. “Forms of capital and social structure in cultural fields: Examining Bourdieu’s Social Topography.” The American Journal of Sociology 100.4 (1995) 859-903. Bordieu, Pierre. “Social Space and Symbolic Power.” Sociological Review 7.1 (1989) 14-25. Castells, Manuel. The Rise of the Network Society. Cambridge, MA: Blackwell Publishers, 1996. Choi, Jaz Hee-jeong. "The City, Self, and Connections: Transyouth and Urban Social Networking in Seoul." Youth, Society and Mobile Media in Asia. Eds. Stephanie Hemelryk Donald, Theresa Anderson and Damien Spry. London, New York: Routledge, 2010. 88-107. Choi, Jaz Hee-jeong, Marcus Foth, and Greg Hearn. "Site Specific Mobility and Connection in Korea: Bangs (Rooms) between Public and Private Spaces." Technology in Society 31.2 (2009). Habuchi, Ichiyo. "Accelerated Reflexivity." Personal, Portable, Pedestrian : Mobile Phones in Japanese Life. Eds. Mizuko Ito, Daisuke Okabe and Misa Matsuda. Cambridge, Mass.: MIT Press, 2005. 165-82. Jenkins, Henry, et al. "Confronting the Challenges of Participatory Culture: Media Education for the 21st Century". 2006. 6 Nov. 2006. ‹http://www.digitallearning.macfound.org/site/c.enJLKQNlFiG/b.2108773/apps/nl/content2.asp?content_id=%7BCD911571-0240-4714-A93B-1D0C07C7B6C1%7D&notoc=1 >. Michalski, Wolfgang, Riel Miller, and Barrie Stevens. "Economic Flexibility and Societal Cohesion in the Twenty-First Century." Societal Cohesion and the Globalising Economy. Ed. OECD. Paris: OECD, 1997. 7-26. Nicolescu, Basarab. Manifesto of Transdisciplinarity. Trans. Karen-Claire Voss. New York: State University of New York Press, 2002. Stone, Linda. "Attention: The *Real* Aphrodisiac." O'Reilly Media Emerging Technology Conference. Varnelis, Kazys. Networked Publics. Ed. Annenberg Center for Communication, University of Southern California. Cambridge, Mass.: MIT Press, 2008. World Bank. "Social Capital: The Glue Holding Society Together". 2001. March 18 2010. ‹http://www.worldbank.org/html/prddr/trans/augsepoct00/boxpage31.htm >.

Abstract Introduction Pacific Islanders living in Hawai‘i with ancestral ties to islands in the western Pacific region of Micronesia are common targets of uninhibited forms of prejudice in multiple sectors, including healthcare. Whether the explicit societal-level attitudes toward this group are reflected in implicit attitudes among healthcare providers is unknown; therefore, we designed a pilot study to investigate this question. Our study measures implicit racial bias toward Pacific Islanders from Micronesia among Obstetrician-Gynecologists (OB-GYNs) in Hawai‘i. Methods We developed 4 new implicit association tests (IATs) to measure implicit attitudes and associations (i.e., stereotypes) toward Pacific Islanders from Micronesia in 2 conditions: (1) Micronesians vs. Whites and (2) Micronesians vs. Japanese Americans. Participants were practicing OB-GYNs in Hawai‘i. The study was conducted online and included survey questions on demographic and physician practice characteristics in addition to IATs. The primary outcome was the mean IAT D score. Associations between IAT D scores and demographic and practice characteristics were also analyzed. Results Of the 49 OB-GYNs, 38 (77.6%) were female, mean age was 40 years, 29.5% were Japanese, 22.7% were White, and none were from a Micronesian ethnic group. The mean IAT D score in the Micronesian vs. White condition (N = 29) was 0.181, (SD: 0.465, p < 0.05) for the Attitude IAT and 0.197 (SD: 0.427; p < 0.05) for the Stereotype IAT. Conclusion The findings from this pilot suggest a slight degree of implicit bias favoring Whites over Micronesians within this sample of OB-GYNs and warrant a larger investigation into implicit biases toward this unique and understudied Pacific Islander population.

Introduction Fashion and beauty work are a part of identity that is shaped around normative, idealised, and often gendered bodies, and this has been the subject of much academic and popular attention. While much research focusses on fashion and beauty work as a way to highlight socially desirable traits or trends, it is important to note that fashion is equally important as a tool for the concealment of a visibly stigmatised identity. For people diagnosed with a visibly disfiguring illness, fashion and makeup practices became a way to either reinforce or negotiate stigma. In particular, writing by people diagnosed with Hansen’s disease in 1930s Japan reveals the way in which fashion—in the form of clothing issued by the institution—could reinforce the stigma of their condition, whereas clothing from home, and the use of makeup, allowed for concealment of some of the visible markers of their condition. So associated is the notion of stigma with the condition of Hansen’s disease that “leprosy” or “leper” are used as pejoratives in some languages, to indicate conditions or behaviour out of line with social norms. Yet, it is only relatively recently that stigma and Hansen’s disease have been the subject of academic attention. Since Zachary Gussow’s ground-breaking 1989 work, Leprosy, Racism, and Public Health, however, Hansen’s disease stigma has been extensively studied, with much of the recent scholarship focused on visible stigma and social reintegration. That is to say, much of the attention is focussed on stigma reduction, and creating policies and awareness to decrease stigma by third parties. Few studies have focussed on the way stigma, in the case of Hansen’s disease, has been either reinforced or resisted by the people suffering from Hansen’s disease. Stigma, as “degrading marks that are affixed to particular bodies, people, conditions and places within humiliating social interactions”, serves to mark bodies as abnormal or inferior (Tyler, 8). In the words of Erving Goffman from his classic study on stigma, the term refers to a “spoiled identity,” and limited social participation (Goffman, Stigma 11-15). More recently, in her ground-breaking book Stigma: The Machinery of Inequality, Imogen Tyler argued that stigma is both socially produced and negotiated, and that just as stigma can be leveraged to control unruly bodies, so too can it be a mode of resistance for those who are living with a stigmatised condition such as Hansen’s disease, an illness that was feared because prior to the discovery of Promin in 1943 the disease was incurable. The physical signs of illness, such as deformity of the limbs and loss of hair, made this stigma unmistakable. When sufferers were subject to quarantine, fashion was used to further mark their bodies: patients in public institutions were issued standard garments that identified them as belonging to an institution. At the same time, private clothing and makeup allowed sufferers to use fashion to conceal their stigmatised condition, to fashion liminal identities that in Goffman’s terms are not yet discredited, but “discreditable”, with their stigmatised condition hidden but social exclusion eminent should their diagnosis become clear to those around them (Goffman, Stigma 16). In the works I discuss below, we can see how clothing and makeup function to both reinforce and resist stigma in the case of writers with Hansen’s disease in Japan. This article explores the way in which illness intersected with beauty, fashion, stigma, and identity in the early years of the public institutions. First, I examine how changes in beauty marked sufferers as ill, and how that marked the sufferer as excluded from society. Makeup becomes a way to mask the visible signs of illness and inhabit a liminal space between health and marked by illness. Second, I discuss clothing as part of the process of institutionalisation to examine how clothing further demarcated sufferers. For many people admitted to a public institution, the issuance of standard clothing was another form of social death. The uniform clothing and marks of illness all reinforced patient bodies as abnormal. At the same time, even as their bodies were abject, I argue here that fashion, clothing and makeup could also allow them to inhabit a liminal space, separate from sufferers with advanced physical disfigurement, and allowed them to maintain an affective connection to society. Beauty, Making Up, and Masking Stigma While the study of physical, visible stigma and its intersections with issues of identity and social control have been the subject of renewed attention in recent years, few scholars have explored the way in which makeup is part of a masking, or resistance, of stigmatised conditions. While there is some scholarship that focusses on beauty work as biopolitics, such work often focusses on contemporary, voluntary beauty work, such as cosmetic surgery or makeup (Miller; Elfving-Hwang). At the same time, recently scholars have begun to examine the ways in which ableist standards of beauty and fashion mark physical difference as abnormal, or threatening (Davidson, 1-2). In the case of Hansen’s disease sufferers, facial changes as a manifestation of a stigmatised illness were for many writers a powerful symbol of their isolation from society. Makeup and fashion within the institution became a way for sufferers to resist the stigma associated with their disease. The application of makeup was a performance that signified inclusion in society, and its neglect was symbolic of social exclusion. This is clear in writing by women diagnosed with Hansen’s disease. For example, Hayashi Yukiko (1909-1993), in 1939, wrote that the disease first manifested on her face, in the form of a small red spot under her left eye. She wrote that she used powder to cover it, suspecting what it was. The use of makeup allowed her to continue her job at the post office until, despite her use of makeup, her co-worker noticed it (Hayashi, in Uchida, Seto no Akebono 143). After her subsequent diagnosis, she quit her job and went into isolation at home. Writing of her experience of this time, she again mentions makeup: Untouched since I got sickThe makeup case gathers dustOn the corner of the shelf病みてよりふれぬがままの化粧箱ほこり積りて棚隅にあり (Uchida, Hagi no satojima 61) A second poet, Seto Senshū, expresses similar feelings of hopelessness through an evocation of makeup: The powder that has not touchedMy hands for years Comes out of the jar with a dry rustle年久しく手にふれざりし白粉のかはきて瓶にかさと音立つ (Abe 72) For both of these authors, being quarantined because of their illness meant being cut off from society, and the discontinuance of makeup application became symbolic of social exclusion, an acknowledgement of the fact that fashion as a mode of concealment is no longer necessary. For many sufferers, an early sign of the illness was a loss of eyebrows. This was in part because Hansen's disease affects the nerve endings and the skin, the illness often manifested on the face of sufferers, and marked them as targets for discrimination or loss of social status. As eyebrows were an early sign of the illness, they were a point of concern for patients. Laura Miller and Higuchi Kiyoyuki have pointed to the importance of eyebrows in beauty work in Japan dating back to the Heian period (Miller, 141; Higuchi 81-84). Eyebrows, their shape, and the cosmetics used upon them, then, are important symbols of beauty. In Hansen’s disease literature, then, references to eyebrows and makeup are often indicators of the progress of the disease and how the illness specifically impacts the identity of women. Hayashi Yukiko wrote of her eyebrows: Every morning, every morningThe cloth with which I wipe my faceComes away with my eyebrow hairMy heart sinks朝な朝な我が顔拭ふ手拭に眉毛つき来て心が沈む Difficult to see my motherGaze anxiously at my faceI look down我が顔を気づかはしげに見る母のまみは見難く面ふせにけり (Uchida 61-62) In these poems, Hayashi’s changing appearance is tied to what it means to fashion gendered beauty in Japanese society. To have eyebrows altered in a way that is recognisable as “diseased” is a significant, traumatic impairment. This trauma is made more acute by the fact that the gaze of people is now directed at her with anxiety or fear, a response to her visibly altered body. Imogen Tyler has referred to similar phenomenon as “the stigmatising gaze”, a recognition of “stigmata on the bodies” that can no longer be masked (Tyler 12). This stigma of the illness and the gaze of those around them was particularly heavy on women. Even within the sanatorium, male patients sometimes remarked on the stigmatised beauty of the female patients. Ishikawa Kō (1906-1930), a poet who lived in Kyūshū Sanatorium, hints at the futility of makeup to hide the signs of the illness: In the waiting room in the morningWith sadness, seeing the woman patient, eyes downcastEyebrows pencilled inうつむきし女患者の書き眉をかなしく見たり朝の控所に (Kawamura and Uchida 9) Here, women pencil in their eyebrows to become invisible to the stigmatising gaze, to escape notice as being disfigured even in the hospital. They use makeup to escape the gaze of others rather than attract it, as is clear in the downcast eyes. While more women write about beauty work more than men, it was not only women applying makeup or aware of the gaze of those around them. The men also used makeup to disguise the disfigurement they suffered from their illness. Hōjō Tamio (1914-1937), one of the most famous authors of literature about his experience of illness and quarantine in the Tokyo district hospital, Tama Zenshō-en, writes of protagonist Oda’s process of institutionalisation in his most famous novella, Inochi no shoya (Life’s First Night). Describing Oda’s approach to the sanatorium, Hōjō writes: One eyebrow had thinned because of his illness, and Oda had pencilled it in. When the [local village] men came up next to him, they suddenly ceased to chatter, and as they passed by, they looked with eyes full of curiosity at … Oda … . While Oda looked down silently, he keenly felt their gaze. Similarly, in a haiku Kiyokawa Hachirō describes the act of making up his eyebrows. This poem picks up the seasonal word hatsukagami), referring to the first use of the mirror in the new year: Drawing my eyebrows heavier than usualReflected in the mirror for the first time in the New Year常よりも眉濃くひけり初鏡 (Abe 72) There is a disconnect between the poetic ideas of the first makeup application of the new year and the male author pencilling in thick eyebrows. Poems such as this make clear that eyebrow makeup was a means for both men and women to conceal the effects of their disease and conceal their illness through fashioning a discreditable but not yet discredited identity. At the same time, the poems also expose the futility of using makeup to fully conceal. The poems reveal a preoccupation with what Tyler calls the stigmatising gaze, and the scrutiny of others demonstrates the limits of makeup to conceal their stigmatised identity. Clothing, Institutionalisation, Identity After the 1931 Leprosy Prevention Law, hospitals were designed to be similar to what Erving Goffman calls “total institutions” (xiii). Total institutions such as prisons are characterised by physical boundaries separating residents from the outside world, restricting contact with that outside world, and by further boundaries within the institution separating residents from staff. Many of these elements were present in Japan’s Hansen’s Disease hospitals after 1931. Entrance into the institution involved the creation, or acceptance, of a new identity and new social status. Institutionalisation for the treatment of Hansen’s disease in the 1930s included a disinfectant bath in the presence of medical professionals. As the newly admitted patient bathed, their possessions were taken for disinfection and inspection and their money was confiscated. After this, patients were then issued hospital standard kimonos: typically a plain, vertically striped (referred to as udon shima), cotton garment that marked them clearly as patients. Although the colours or patterns varied across institutions, the garment was the same for all residents, regardless of assigned sex or age (Kimono 3). This served several purposes: first, because patients themselves made and cared for all their clothing, purchasing the same fabric in bulk was economical. At the same time, wearing the same clothing also eliminated class distinctions between residents, and served to downplay the femininity of the female residents (ibid). When working with patients, nurses and doctors dressed in head-to-toe white protective robes, complete with hats, gloves, and face masks. The seriously ill residents, confined to bed, were also issued thin, white cotton sick clothes (byōi). Thus, the boundaries between the sick and the healthy were inscribed on the clothing of individuals working and living in the hospital. The issuance of institutional clothing meant a clear severance with society, and some residents felt the clothing marked them, similar to the way prisoners in jail were identified by matching, stigmatised clothing (Kimono 3). Goffman’s notion of batch living is expressed through standardised kimono as Tamae, a poet at Seishō-en, the Shikoku area institution, expresses here: At the hot water stationThe matching yukataAll hung out to dry湯の宿に揃いの浴衣干してあり (Moshiogusa 20). Figs. 1 & 2: Examples of the standard-issue wear from the 1930s. Images courtesy of the National Hansen’s Disease Museum, Tokyo, Japan. Hōjō Tamio, again in Inochi no shoya, describes the kimono. Oda first glimpses the clothing in a voyeuristic scene, as he peeps at two young women through the hedge demarcating the institution: “Looking in the direction of the sound, he saw two women on the inside of the hedge … . Out of the corner of his eye, he saw that both women were wearing short-sleeved kimonos with the same striped pattern” (Hōjō n.p.). This scene is recalled when Oda is in the bath: a nurse showed him a new kimono as she said, “When you get out, put this on please”. The kimono was of the same striped pattern he had seen the two women wearing as he watched from outside the hedge. With its light sleeves, it looked like a kimono an elementary school student might wear, and when Oda got out of the bath and put it on, he felt he cut a shabby and ludicrous figure. He kept looking down at himself. (Hōjō n.p.) For many hospital residents in the 1930s, these issued garments would be all the clothing they had. The uniform clothing of the institution served as another way to mark the illness of the wearer on the body—fashion becomes an additional mark of stigma. Indeed, in images from that time, sufferers of Hansen’s disease are immediately identifiable not only through the manifestations of the illness on their bodies but through their clothing as well. In the three images shown below, residents wearing institutionally issued kimono are immediately identifiable through their clothing, making a resident wearing what is likely a chequered, personal kimono in the final image stand out. Furthermore, the doctors are also clearly identifiable amongst them, dressed in white and covered from head to toe. Fig. 3: Men sharing tea at a work station, wearing the standard issue kimono. Image courtesy of the National Hansen’s Disease Museum, Tokyo, Japan. Fig. 4: A group of blind patients together with medical professionals. Image courtesy of the National Hansen’s Disease Museum, Tokyo, Japan. Fig. 5: Promotional postcard from Zenshō-en in the early 1930s featuring patients, medical professionals, and an officer together on the veranda of a housing ward. Image from the author’s personal collection. Yet, as can also be seen above, there was still difference in clothing within the institution. First, because all work was performed by residents of the institution, patients would wear work-appropriate clothes, such as the aprons some women wear in fig. 4. Second, as can be seen in fig. 5 in the standing figure second from right, some patients did in fact have their own clothing within the hospital. This was, as I have discussed, fashion as resistance of a stigmatised identity, but for those within the institution personal kimono was also a performance of class and connection to home through their fashion. For example, Nogiku, a writer from Seishō-en, wrote: In the package sent to meA yukata handwoven by my mother送り来し母の手織の浴衣かな (Moshiogusa, 20) A second poem from Hayashi Michiko, also from Seishō-en, expressed similar sentiments years later: This was sewn for meBy my motherWhen it was decided I would go to the leprosarium癩園に行くが決まりしわがために母縫ひくれし単衣ぞこれは (Seishō 18) For many residents, institutionalisation meant a severing of ties with their families and communities. The stigma associated with the illness meant that a family would face discrimination in work and marriage prospects if it were widely known a relative had been diagnosed with Hansen’s disease. For many other patients, even if they were undeterred by the stigma, their families could not afford to send packages or visit. The receipt of a yukata, or Japanese summer garb, or special clothing handmade by the authors’ mothers are not only fashion; they also serve as a physical representation of a continued connection to family and society outside of the institution and of the social status of the poet. The privilege of wearing private clothes in the institution, then, was a marker of both class and continued connection to society beyond the hospital. In that sense, private fashion was also a way to resist the stigma of the disease through a clear association with the uniform of the institution. Conclusion Clothing and makeup are ephemeral objects, often things that are used every day and then discarded when they are worn out or used up. They are items that people often use as routine, without thinking. The fact that writers diagnosed with Hansen’s disease traced their experiences with illness and stigma through makeup and clothing indicates the deep, symbolic meaning these items were imbued with after a diagnosis. More than a way to express oneself, or play with identities, as other contributions in this issue discuss, for people diagnosed with Hansen’s disease, makeup, and clothing became a way to use fashion as concealment, as well as a physical connection to home and social status. Makeup and clothing were a way to resist stigma and fashion to a “not-yet-discredited” identity, to conceal the markers of illness and quarantine. The importance of makeup and fashion as a mode of concealment can be seen in writing by people who experienced illness and quarantine. All translations in this article are the author’s own. Acknowledgements The research for this article was conducted with the support of Grant-in-Aid for Early-Career Scientists 20K12936. References Abe, Masako, ed. Soka [Poems That Resonate]. Tokyo: Kōseisha, 2021. Burns, Susan. Kingdom of the Sick: A History of Leprosy and Japan. University of Hawai’i Press, 2019. Davidson, Michael. “Introduction: Women Writing Disability.” Legacy: A Journal of American Women Writers 30.1 (2013): 1-17. Elfving-Hwang, Joanna. “Cosmetic Surgery and Embodying the Moral Self in South Korean Popular Makeover Culture.” The Asia-Pacific Journal 11.24.2 (2013). 4 Aug. 2022 <https://apjjf.org/2013/11/24/Joanna-Elfving-Hwang/3956/article.html>. Goffman, Erving. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books, Doubleday (1961). ———. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Schuster (1963). Gussow, Zachary. Leprosy, Racism, and Public Health: Social Policy in Chronic Disease Control. Boulder, Colorado: Westview Press, 1989. Higuchi Kiyoyuki. Keshō no bunka shi [A Cultural History of Cosmetics]. Tokyo: Kokusai shōgyō shuppan, 1982. Hirokawa, Waka. Kindai Nihon no Hansen-byō mondai to chiiki shakai [Modern Japan’s Hansen’s Disease Problem and Local Communities]. Osaka: Osaka daigaku shuppankai, 2011. Hōjō Tamio, translated and with an introduction by Kathryn M. Tanaka. “‘Life's First Night’ and the Treatment of Hansen's Disease in Japan.” The Asia-Pacific Journal .13.3 (2015). 4 Aug. 2022 <https://apjjf.org/2015/13/4/Hojo-Tamio/4256.html>. Kawamura Masayuki and Uchida Morito, eds. Hi no kage dai ni shū [The Shade of the Cypress 2]. Kumamoto: Hi no kage hakkojō, 1929. Kokuritsu Hansen-byō shiryōkan, ed. Kimono ni miru ryōyōjo no kurashi [Life in the Sanatoria as Seen through Clothing]. Tokyo: Nihon Kagaku gijutsu shinkō zaidan, 2010. Miller, Laura. Beauty Up: Exploring Contemporary Japanese Body Aesthetics. Los Angeles: U of California P, 2006. Moshiogusa [Eelgrass] 40 (Sep. 1937). Seishō [Young Pine] 21.6 (July 1964). Talley, Heather Laine. Saving Face: Disfigurement and the Politics of Appearance. New York: NYU P, 2014. Tyler, Imogen. Stigma: The Machinery of Inequality. London: Zed Books, 2020. Uchida Morito, ed. Seto no Akebono [Dawn over the Inland Sea]. Tokyo: Fujokaisha, 1939. Uchida Morito, ed. Hagi no satojima [Island of the Bushclover]. Tokyo: Fujokaisha, 1939.

Background “The sense of taste,” write Nelson and colleagues in a 2002 issue of Nature, “provides animals with valuable information about the nature and quality of food. Mammals can recognize and respond to a diverse repertoire of chemical entities, including sugars, salts, acids and a wide range of toxic substances” (199). The authors go on to argue that several amino acids—the building blocks of proteins—taste delicious to humans and that “having a taste pathway dedicated to their detection probably had significant evolutionary implications”. They imply, but do not specify, that the evolutionary implications are positive. This may be the case with some amino acids, but contemporary tastes, and changes in them, are far from universally beneficial. Indeed, this article argues that modern food production shapes and distorts human taste with significant implications for health and wellbeing. Take the western taste for fried chipped potatoes, for example. According to Schlosser in Fast Food Nation, “In 1960, the typical American ate eighty-one pounds of fresh potatoes and about four pounds of frozen french fries. Today [2002] the typical American eats about forty-nine pounds of fresh potatoes every year—and more than thirty pounds of frozen french fries” (115). Nine-tenths of these chips are consumed in fast food restaurants which use mass-manufactured potato-based frozen products to provide this major “foodservice item” more quickly and cheaply than the equivalent dish prepared from raw ingredients. These choices, informed by human taste buds, have negative evolutionary implications, as does the apparently long-lasting consumer preference for fried goods cooked in trans-fats. “Numerous foods acquire their elastic properties (i.e., snap, mouth-feel, and hardness) from the colloidal fat crystal network comprised primarily of trans- and saturated fats. These hardstock fats contribute, along with numerous other factors, to the global epidemics related to metabolic syndrome and cardiovascular disease,” argues Michael A. Rogers (747). Policy makers and public health organisations continue to compare notes internationally about the best ways in which to persuade manufacturers and fast food purveyors to reduce the use of these trans-fats in their products (L’Abbé et al.), however, most manufacturers resist. Hank Cardello, a former fast food executive, argues that “many products are designed for ‘high hedonic value’, with carefully balanced combinations of salt, sugar and fat that, experience has shown, induce people to eat more” (quoted, Trivedi 41). Fortunately for the manufactured food industry, salt and sugar also help to preserve food, effectively prolonging the shelf life of pre-prepared and packaged goods. Physiological Factors As Glanz et al. discovered when surveying 2,967 adult Americans, “taste is the most important influence on their food choices, followed by cost” (1118). A person’s taste is to some extent an individual response to food stimuli, but the tongue’s taste buds respond to five basic categories of food: salty, sweet, sour, bitter, and umami. ‘Umami’ is a Japanese word indicating “delicious savoury taste” (Coughlan 11) and it is triggered by the amino acid glutamate. Japanese professor Kikunae Ikeda identified glutamate while investigating the taste of a particular seaweed which he believed was neither sweet, sour, bitter, or salty. When Ikeda combined the glutamate taste essence with sodium he formed the food additive sodium glutamate, which was patented in 1908 and subsequently went into commercial production (Japan Patent Office). Although individual, a person’s taste preferences are by no means fixed. There is ample evidence that people’s tastes are being distorted by modern food marketing practices that process foods to make them increasingly appealing to the average palate. In particular, this industrialisation of food promotes the growth of a snack market driven by salty and sugary foods, popularly constructed as posing a threat to health and wellbeing. “[E]xpanding waistlines [are] fuelled by a boom in fast food and a decline in physical activity” writes Stark, who reports upon the 2008 launch of a study into Australia’s future ‘fat bomb’. As Deborah Lupton notes, such reports were a particular feature of the mid 2000s when: intense concern about the ‘obesity epidemic’ intensified and peaked. Time magazine named 2004 ‘The Year of Obesity’. That year the World Health Organization’s Global Strategy on Diet, Physical Activity and Health was released and the [US] Centers for Disease Control predicted that a poor diet and lack of exercise would soon claim more lives than tobacco-related disease in the United States. (4) The American Heart Association recommends eating no more than 1500mg of salt per day (Hamzelou 11) but salt consumption in the USA averages more than twice this quantity, at 3500mg per day (Bernstein and Willett 1178). In the UK, a sustained campaign and public health-driven engagement with food manufacturers by CASH—Consensus Action on Salt and Health—resulted in a reduction of between 30 and 40 percent of added salt in processed foods between 2001 and 2011, with a knock-on 15 percent decline in the UK population’s salt intake overall. This is the largest reduction achieved by any developed nation (Brinsden et al.). “According to the [UK’s] National Institute for Health and Care Excellence (NICE), this will have reduced [UK] stroke and heart attack deaths by a minimum of 9,000 per year, with a saving in health care costs of at least £1.5bn a year” (MacGregor and Pombo). Whereas there has been some success over the past decade in reducing the amount of salt consumed, in the Western world the consumption of sugar continues to rise, as a graph cited in the New Scientist indicates (O’Callaghan). Regular warnings that sugar is associated with a range of health threats and delivers empty calories devoid of nutrition have failed to halt the increase in sugar consumption. Further, although some sugar is a natural product, processed foods tend to use a form invented in 1957: high-fructose corn syrup (HFCS). “HFCS is a gloopy solution of glucose and fructose” writes O’Callaghan, adding that it is “as sweet as table sugar but has typically been about 30% cheaper”. She cites Serge Ahmed, a French neuroscientist, as arguing that in a world of food sufficiency people do not need to consume more, so they need to be enticed to overeat by making food more pleasurable. Ahmed was part of a team that ran an experiment with cocaine-addicted rats, offering them a mutually exclusive choice between highly-sweetened water and cocaine: Our findings clearly indicate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals. We speculate that the addictive potential of intense sweetness results from an inborn hypersensitivity to sweet tastants. In most mammals, including rats and humans, sweet receptors evolved in ancestral environments poor in sugars and are thus not adapted to high concentrations of sweet tastants. The supranormal stimulation of these receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus lead to addiction. (Lenoir et al.) The Tongue and the Brain One of the implications of this research about the mammalian desire for sugar is that our taste for food is about more than how these foods actually taste in the mouth on our tongues. It is also about the neural response to the food we eat. The taste of French fries thus also includes that “snap, mouth-feel, and hardness” and the “colloidal fat crystal network” (Rogers, “Novel Structuring” 747). While there is no taste receptor for fats, these nutrients have important effects upon the brain. Wang et al. offered rats a highly fatty, but palatable, diet and allowed them to eat freely. 33 percent of the calories in the food were delivered via fat, compared with 21 percent in a normal diet. The animals almost doubled their usual calorific intake, both because the food had a 37 percent increased calorific content and also because the rats ate 47 percent more than was standard (2786). The research team discovered that in as little as three days the rats “had already lost almost all of their ability to respond to leptin” (Martindale 27). Leptin is a hormone that acts on the brain to communicate feelings of fullness, and is thus important in assisting animals to maintain a healthy body weight. The rats had also become insulin resistant. “Severe resistance to the metabolic effects of both leptin and insulin ensued after just 3 days of overfeeding” (Wang et al. 2786). Fast food restaurants typically offer highly palatable, high fat, high sugar, high salt, calorific foods which can deliver 130 percent of a day’s recommended fat intake, and almost a day’s worth of an adult man’s calories, in one meal. The impacts of maintaining such a diet over a comparatively short time-frame have been recorded in documentaries such as Super Size Me (Spurlock). The after effects of what we widely call “junk food” are also evident in rat studies. Neuroscientist Paul Kenny, who like Ahmed was investigating possible similarities between food- and cocaine-addicted rats, allowed his animals unlimited access to both rat ‘junk food’ and healthy food for rats. He then changed their diets. “The rats with unlimited access to junk food essentially went on a hunger strike. ‘It was as if they had become averse to healthy food’, says Kenny. It took two weeks before the animals began eating as much [healthy food] as those in the control group” (quoted, Trivedi 40). Developing a taste for certain food is consequently about much more than how they taste in the mouth; it constitutes an individual’s response to a mixture of taste, hormonal reactions and physiological changes. Choosing Health Glanz et al. conclude their study by commenting that “campaigns attempting to change people’s perception of the importance of nutrition will be interpreted in terms of existing values and beliefs. A more promising strategy might be to stress the good taste of healthful foods” (1126). Interestingly, this is the strategy already adopted by some health-focused cookbooks. I have 66 cookery books in my kitchen. None of ten books sampled from the five spaces in which these books are kept had ‘taste’ as an index entry, but three books had ‘taste’ in their titles: The Higher Taste, Taste of Life, and The Taste of Health. All three books seek to promote healthy eating, and they all date from the mid-1980s. It might be that taste is not mentioned in cookbook indexes because it is a sine qua non: a focus upon taste is so necessary and fundamental to a cookbook that it goes without saying. Yet, as the physiological evidence makes clear, what we find palatable is highly mutable, varying between people, and capable of changing significantly in comparatively short periods of time. The good news from the research studies is that the changes wrought by high salt, high sugar, high fat diets need not be permanent. Luciano Rossetti, one of the authors on Wang et al’s paper, told Martindale that the physiological changes are reversible, but added a note of caution: “the fatter a person becomes the more resistant they will be to the effects of leptin and the harder it is to reverse those effects” (27). Morgan Spurlock’s experience also indicates this. In his case it took the actor/director 14 months to lose the 11.1 kg (13 percent of his body mass) that he gained in the 30 days of his fast-food-only experiment. Trivedi was more fortunate, stating that, “After two weeks of going cold turkey, I can report I have successfully kicked my ice cream habit” (41). A reader’s letter in response to Trivedi’s article echoes this observation. She writes that “the best way to stop the craving was to switch to a diet of vegetables, seeds, nuts and fruits with a small amount of fish”, adding that “cravings stopped in just a week or two, and the diet was so effective that I no longer crave junk food even when it is in front of me” (Mackeown). Popular culture indicates a range of alternative ways to resist food manufacturers. In the West, there is a growing emphasis on organic farming methods and produce (Guthman), on sl called Urban Agriculture in the inner cities (Mason and Knowd), on farmers’ markets, where consumers can meet the producers of the food they eat (Guthrie et al.), and on the work of advocates of ‘real’ food, such as Jamie Oliver (Warrin). Food and wine festivals promote gourmet tourism along with an emphasis upon the quality of the food consumed, and consumption as a peak experience (Hall and Sharples), while environmental perspectives prompt awareness of ‘food miles’ (Weber and Matthews), fair trade (Getz and Shreck) and of land degradation, animal suffering, and the inequitable use of resources in the creation of the everyday Western diet (Dare, Costello and Green). The burgeoning of these different approaches has helped to stimulate a commensurate growth in relevant disciplinary fields such as Food Studies (Wessell and Brien). One thing that all these new ways of looking at food and taste have in common is that they are options for people who feel they have the right to choose what and when to eat; and to consume the tastes they prefer. This is not true of all groups of people in all countries. Hiding behind the public health campaigns that encourage people to exercise and eat fresh fruit and vegetables are the hidden “social determinants of health: The conditions in which people are born, grow, live, work and age, including the health system” (WHO 45). As the definitions explain, it is the “social determinants of health [that] are mostly responsible for health iniquities” with evidence from all countries around the world demonstrating that “in general, the lower an individual’s socioeconomic position, the worse his or her health” (WHO 45). For the comparatively disadvantaged, it may not be the taste of fast food that attracts them but the combination of price and convenience. If there is no ready access to cooking facilities, or safe food storage, or if a caregiver is simply too time-poor to plan and prepare meals for a family, junk food becomes a sensible choice and its palatability an added bonus. For those with the education, desire, and opportunity to break free of the taste for salty and sugary fats, however, there are a range of strategies to achieve this. There is a persuasive array of evidence that embracing a plant-based diet confers a multitude of health benefits for the individual, for the planet and for the animals whose lives and welfare would otherwise be sacrificed to feed us (Green, Costello and Dare). Such a choice does involve losing the taste for foods which make up the lion’s share of the Western diet, but any sense of deprivation only lasts for a short time. The fact is that our sense of taste responds to the stimuli offered. It may be that, notwithstanding the desires of Jamie Oliver and the like, a particular child never will never get to like broccoli, but it is also the case that broccoli tastes differently to me, seven years after becoming a vegan, than it ever did in the years in which I was omnivorous. When people tell me that they would love to adopt a plant-based diet but could not possibly give up cheese, it is difficult to reassure them that the pleasure they get now from that specific cocktail of salty fats will be more than compensated for by the sheer exhilaration of eating crisp, fresh fruits and vegetables in the future. Conclusion For decades, the mass market food industry has tweaked their products to make them hyper-palatable and difficult to resist. They do this through marketing experiments and consumer behaviour research, schooling taste buds and brains to anticipate and relish specific cocktails of sweet fats (cakes, biscuits, chocolate, ice cream) and salty fats (chips, hamburgers, cheese, salted nuts). They add ingredients to make these products stimulate taste buds more effectively, while also producing cheaper items with longer life on the shelves, reducing spoilage and the complexity of storage for retailers. Consumers are trained to like the tastes of these foods. Bitter, sour, and umami receptors are comparatively under-stimulated, with sweet, salty, and fat-based tastes favoured in their place. Western societies pay the price for this learned preference in high blood pressure, high cholesterol, diabetes, and obesity. Public health advocate Bruce Neal and colleagues, working to reduce added salt in processed foods, note that the food and manufacturing industries can now provide most of the calories that the world needs to survive. “The challenge now”, they argue, “is to have these same industries provide foods that support long and healthy adult lives. And in this regard there remains a very considerable way to go”. If the public were to believe that their sense of taste is mutable and has been distorted for corporate and industrial gain, and if they were to demand greater access to natural foods in their unprocessed state, then that journey towards a healthier future might be far less protracted than these and many other researchers seem to believe. References Bernstein, Adam, and Walter Willett. “Trends in 24-Hr Sodium Excretion in the United States, 1957–2003: A Systematic Review.” American Journal of Clinical Nutrition 92 (2010): 1172–1180. Bhaktivedanta Book Trust. The Higher Taste: A Guide to Gourmet Vegetarian Cooking and a Karma-Free Diet, over 60 Famous Hare Krishna Recipes. Botany, NSW: Bhaktivedanta Book Trust, 1987. Brinsden, Hannah C., Feng J. He, Katharine H. Jenner, & Graham A. MacGregor. “Surveys of the Salt Content in UK Bread: Progress Made and Further Reductions Possible.” British Medical Journal Open 3.6 (2013). 2 Feb. 2014 ‹http://bmjopen.bmj.com/content/3/6/e002936.full›. Coughlan, Andy. “In Good Taste.” New Scientist 2223 (2000): 11. Dare, Julie, Leesa Costello, and Lelia Green. “Nutritional Narratives: Examining Perspectives on Plant Based Diets in the Context of Dominant Western Discourse”. Proceedings of the 2013 Australian and New Zealand Communication Association Conference. Ed. In Terence Lee, Kathryn Trees, and Renae Desai. Fremantle, Western Australia, 3-5 Jul. 2013. 2 Feb. 2014 ‹http://www.anzca.net/conferences/past-conferences/159.html›. Getz, Christy, and Aimee Shreck. “What Organic and Fair Trade Labels Do Not Tell Us: Towards a Place‐Based Understanding of Certification.” International Journal of Consumer Studies 30.5 (2006): 490–501. Glanz, Karen, Michael Basil, Edward Maibach, Jeanne Goldberg, & Dan Snyder. “Why Americans Eat What They Do: Taste, Nutrition, Cost, Convenience, and Weight Control Concerns as Influences on Food Consumption.” Journal of the American Dietetic Association 98.10 (1988): 1118–1126. Green, Lelia, Leesa Costello, and Julie Dare. “Veganism, Health Expectancy, and the Communication of Sustainability.” Australian Journal of Communication 37.3 (2010): 87–102 Guthman, Julie. Agrarian Dreams: the Paradox of Organic Farming in California. Berkley and Los Angeles, CA: U of California P, 2004 Guthrie, John, Anna Guthrie, Rob Lawson, & Alan Cameron. “Farmers’ Markets: The Small Business Counter-Revolution in Food Production and Retailing.” British Food Journal 108.7 (2006): 560–573. Hall, Colin Michael, and Liz Sharples. Eds. Food and Wine Festivals and Events Around the World: Development, Management and Markets. Oxford, UK: Routledge, 2008. Hamzelou, Jessica. “Taste Bud Trickery Needed to Cut Salt Intake.” New Scientist 2799 (2011): 11. Japan Patent Office. History of Industrial Property Rights, Ten Japanese Great Inventors: Kikunae Ikeda: Sodium Glutamate. Tokyo: Japan Patent Office, 2002. L’Abbé, Mary R., S. Stender, C. M. Skeaff, Ghafoorunissa, & M. Tavella. “Approaches to Removing Trans Fats from the Food Supply in Industrialized and Developing Countries.” European Journal of Clinical Nutrition 63 (2009): S50–S67. Lenoir, Magalie, Fuschia Serre, Lauriane Cantin, & Serge H. Ahmed. “Intense Sweetness Surpasses Cocaine Reward.” PLOS One (2007). 2 Feb. 2014 ‹http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000698›. Lupton, Deborah. Fat. Oxford, UK: Routledge, 2013. MacGregor, Graham, and Sonia Pombo. “The Amount of Hidden Sugar in Your Diet Might Shock You.” The Conversation 9 January (2014). 2 Feb. 2014 ‹http://theconversation.com/the-amount-of-hidden-sugar-in-your-diet-might-shock-you-21867›. Mackeown, Elizabeth. “Cold Turkey?” [Letter]. New Scientist 2787 (2010): 31. Martindale, Diane. “Burgers on the Brain.” New Scientist 2380 (2003): 26–29. Mason, David, and Ian Knowd. “The Emergence of Urban Agriculture: Sydney, Australia.” The International Journal of Agricultural Sustainability 8.1–2 (2010): 62–71. Neal, Bruce, Jacqui Webster, and Sebastien Czernichow. “Sanguine About Salt Reduction.” European Journal of Preventative Cardiology 19.6 (2011): 1324–1325. Nelson, Greg, Jayaram Chandrashekar, Mark A. Hoon, Luxin Feng, Grace Zhao, Nicholas J. P. Ryba, & Charles S. Zuker. “An Amino-Acid Taste Receptor.” Nature 416 (2002): 199–202. O’Callaghan, Tiffany. “Sugar on Trial: What You Really Need to Know.” New Scientist 2954 (2011): 34–39. Rogers, Jenny. Ed. The Taste of Health: The BBC Guide to Healthy Cooking. London, UK: British Broadcasting Corporation, 1985. Rogers, Michael A. “Novel Structuring Strategies for Unsaturated Fats—Meeting the Zero-Trans, Zero-Saturated Fat Challenge: A Review.” Food Research International 42.7 August (2009): 747–753. Schlosser, Eric. Fast Food Nation. London, UK: Penguin, 2002. Super Size Me. Dir. Morgan Spurlock. Samuel Goldwyn Films, 2004. Stafford, Julie. Taste of Life. Richmond, Vic: Greenhouse Publications Ltd, 1983. Stark, Jill. “Australia Now World’s Fattest Nation.” The Age 20 June (2008). 2 Feb. 2014 ‹http://www.theage.com.au/news/health/australia-worlds-fattest-nation/2008/06/19/1213770886872.html›. Trivedi, Bijal. “Junkie Food: Tastes That Your Brain Cannot Resist.” New Scientist 2776 (2010): 38–41. Wang, Jiali, Silvana Obici, Kimyata Morgan, Nir Barzilai, Zhaohui Feng, & Luciano Rossetti. “Overfeeding Rapidly Increases Leptin and Insulin Resistance.” Diabetes 50.12 (2001): 2786–2791. Warin, Megan. “Foucault’s Progeny: Jamie Oliver and the Art of Governing Obesity.” Social Theory & Health 9.1 (2011): 24–40. Weber, Christopher L., and H. Scott Matthews. “Food-miles and the Relative Climate Impacts of Food Choices in the United States.” Environmental Science & Technology 42.10 (2008): 3508–3513. Wessell, Adele, and Donna Lee Brien. Eds. Rewriting the Menu: the Cultural Dynamics of Contemporary Food Choices. Special Issue 9, TEXT: Journal of Writing and Writing Programs October 2010. World Health Organisation. Closing the Gap: Policy into Practice on Social Determinants of Health [Discussion Paper]. Rio de Janeiro, Brazil: World Conference on Social Determinants of Health, World Health Organisation, 19–21 October 2011.

In May 1990, in the first case of its kind, the National Gay Rights Advocates (NGRA) secured a California court judgment prohibiting an insurance company from discriminating on the basis of sexual orientation. Great Republic Insurance Company had been using a supplemental questionnaire to screen out “occupations that do not require physical exertion … such as florists, interior decorators, and fashion designers,” as well as to use applicants’ marital status, “living arrangements,” and medical history to assess the likely risk of their exposure to the human immunodeficiency virus (HIV) when denying health care coverage.1 That same year, Moblization for Youth (MFY) Legal Services in New York filed a class action lawsuit on behalf of women living with HIV who had been denied access to Social Security benefits because the government did not recognize their HIV-related conditions as qualifying for state health care coverage under the Medicaid program.2 In one sense, the cases were starkly different: one sought to protect the privately insured from discriminatory scrutiny on the basis of their sexuality while the other attempted to bring a protected class of people into public view to make a claim to health care. Yet both reveal an important truth about the concept of rights in an American context. The structure of the U.S. health care system, one based on private insurance for most and a threadbare, convoluted system of categorical assistance and public insurance for children, the disabled, and the elderly, has shaped Americans’ experience of their own sexuality and bodily autonomy in ways arguably unique to the United States. The public/private hybrid in health care has dramatically curtailed the capacity of those outside the heteronormative family structure to realize their demands for full equality in the wake of the rights revolutions. Efforts to secure a right to sexual or gender identity have foundered on the rocks of the health care system when faced, for example, with a public health crisis like HIV or a lack of health insurance plans willing to fund gender-affirming health care.

The film opens in an unidentified wax museum. The camera pans from right to left, zooming in on key Black historical figures who have been memorialized in wax. W.E.B. Du Bois, Marian Anderson, Booker T. Washington, Frederick Douglass, and Duke Ellington stand out. The final wax figure, a Black man, sits with an empty card box in his right hand and a lit cigarette in his left. The film’s narrator appears: a slim, afroed Black man. He sits to the right of the figure. The only living person in a room full of bodies, he reaches over to grab the cigarette. To his inanimate companion he nonchalantly says “Oh. Thank you very much. Needed that” and ashes the cigarette.The afroed, cigarette-ashing narrator is poet, novelist, and musician Gil Scott-Heron. The film is Black Wax (1982), directed by Robert Mugge. Black Wax is equal parts concert film, social documentary, and political statement by the poet. Set in Washington, D.C. and released in the midst of singer Stevie Wonder’s long campaign to make Martin Luther King Jr.’s birthday a national holiday, Scott-Heron’s film feels, in part, like an extension of Wonder’s wider effort. The year prior, Wonder held a massive rally in the city to demonstrate national support for the creation of the holiday. Reportedly, over 100,000 people attended. Wonder, building on mounting support of the proposed holiday made his song in honor of MLK Jr.—“Happy Birthday”—an integral part of his upcoming tour with Bob Marley. When Marley fell ill, Scott-Heron stepped in to lend his talents to Wonder’s cause. He would then participate in the Washington, D.C. rally that featured speeches from Diana Ross and Jesse Jackson (Cuepoint).Between live performances of various songs from his catalogue, Scott-Heron stages walking interludes wherein his wiry frame ambles through the city. Most are sonically accompanied by verses from his song “Washington, D.C.” He also folds in excerpts from his poems, personal reflections, and critiques of President Ronald Reagan’s administration. Scott-Heron ambulates a historically sedimented reality; namely that Washington, D.C. is a segregated city and that America, more broadly, is a divided nation. Against the backdrop of national monuments, his stroll stages critiques of the country’s racist past. In Black Wax, song becomes walk becomes interlude becomes critique.Throughout the 1970s, Scott-Heron used his politically conscious poetry and music to mount strident critiques of social relations. Songs like “The Revolution Will Not Be Televised”, “Winter in America”, and “Home Is Where the Hatred Is” reflect the artist’s larger concern with the stories Americans tell ourselves about who we are. This carried over into the 1980s. In his 1981 song “B-Movie”, Scott-Heron examines the ascent of Ronald Reagan, from actor to president. For the poet, the distinction is false, since Reagan “acted” his way into office. As an “actor in chief” Reagan represent a politically conservative regime that began before his entry into the White House. Reagan’s conservative politics were present when he was Governor of California and clashing with the Black Panther Party. Scott-Heron seized upon this history in Black Wax, tracing it all the way to the nation’s capital.A tour is “a journey for business, pleasure, or education often involving a series of stops and ending at the starting point” (“Tour”). Tours can offer closed-loop narratives that creates for participants a “safe” distance from the historical conditions which makes the location they are visiting possible. Scott-Heron undermines the certainly of that formulation with this wandering. In song and stride, he fashions himself a tour guide. This is not in the sense of taking the viewer into the “hood” to evidence urban decay. Rather, the poet’s critical amble undermines a national memory project that removes race from histories of the nation’s capital.Scott-Heron, self-styled Bluesologist, traveler, wanders through the world with a marrow-deep knowledge about the historical dynamics animating Black life. Walking richly informs how he relates to space. For Michel de Certeau, “the act of walking is to the urban system what the speech act is to language or to the statements uttered [...] it is a process of appropriation of the topographical system on the part of the pedestrian […] a spatial acting-out of the place […] and it implies relations among differentiated positions” (97-98). For Scott-Heron, the “relations among differentiated positions” is informed by his identity as a Black American. His relationship to race imbues him with what Black geographer Katherine McKittrick calls a “black sense of place.” According to McKittrick,a black sense of place can be understood as the process of materially and imaginatively situating historical and contemporary struggles against practices of domination and the difficult entanglements of racial encounter […][it] is not a steady, focused, and homogenous way of seeing and being in place, but rather a set of changing and differentiated perspectives that are illustrative of, and therefore remark upon, legacies of normalized racial violence that calcify, but do not guarantee, the denigration of black geographies and their inhabitants. (949-950)Scott-Heron elaborates on McKittrick’s concept through a series of walking interludes wherein he refuses a national narrative of harmonious racial progress. He dismisses an American fantasy of race, and it is not new. In “What America Would Be Like without Blacks” writer Ralph Ellison dissects the ways that Americans have historically tried to “get shut” of Black people, all while actively thriving on Black America’s cultural contributions. Scott-Heron’s black sense of place is articulated through a series of ambulant interventions that (subtly) acknowledge national violences while highlighting the often unspoken presence of Black people thriving in the nation’s capital.Visually, the poet sequesters national monuments to the background. Reducing their scale and stripping them of their dwarfing capacity while also actively not naming them. He miniaturizes them. This allows him to centre his critique of national history and politics. For Scott-Heron, the Capital Building and the White House are not sites to be revered. They are symbols of an ongoing betrayal perpetrated by the Reagan administration.The scenes I examine here are not representative. That isn’t my project. I am much more interested in the film as a wandering text, one that pushes at tensions in order to untether the viewer from a constricting narrative about who they might be. According to Sarah Jane Cervenak, “wandering aligns with the free at precisely those moments when it bends away from forces that attempt to translate or read” (15). In this regard, I offer this reading as a suggestion. It does not work towards a particular end other than opening the process(es) through which we make meaning of Scott-Heron’s filmic performance. In effect, don’t worry about where you are doing. Just be in the scene. Invite yourself to view the film and elaborate on descriptions offered here. Wander with him. Wander with me.———In his first walking interlude, the poet strolls along the Potomac River with a boombox hoisted upon his left shoulder. He plays a tape of his song “Washington, D.C.”, and as the opening instrumental creeps into audibility he offers his own introductory monologue:yeah, I forget what Washington did on the Potomac. This is the Potomac. Black folks would sometimes refer to that as the Po-to-mac [...] This here is the Potomac. Saw a duck floating out there a little while ago. Yeah, somebody said now that Reagan is in charge we’re all ducks. Dead ducks. You dig it?Walking along the Potomac, his slow gait is the focus. He stares directly at the camera and speaks to the viewer, to us. His (willful) forgetting of what George Washington “did on the Potomac” suggests that major figures in American history do not hold equal significance for all Americans. In fact, for Scott-Heron, the viewer/we might also do well to forget. His monologue smoothly transitions into the first verse of “Washington, D.C.”:Symbols of democracy, are pinned against the coastOuthouse of bureaucracy, surrounded by a moatCitizens of poverty are barely out of sightOverlords escape near evening, the brother’s on at nightMorning comes and brings the tourists, straining rubber necksPerhaps a glimpse of the cowboy making the world a nervous wreckIt’s a mass of irony for all the world to seeIt’s the nation’s capital, it’s Washington D.C. It’s the nation’s capitalIt’s the nation’s capitalIt’s the nation’s capital, it’s Washington D.C.(mmmm-hmmm)He feigns no allegiance to Washington, D.C. or the city’s touristic artifice. As the lyrics indicate, poverty stricken Americans’ proximity to physical symbols of national wealth belie the idea that democracy is successful. For him, poverty is as symbolic as monuments. Yet Scott-Heron does not visually exploit Americans living in poverty. This isn’t that kind of tour. Instead, he casts his gaze on the “symbol[s] of democracy” that celebrate the “outhouse of bureaucracy” that is Washington, D.C.As the poet continues his stroll along the Potomac, the Jefferson Memorial appears in the background. He has no interest in it. He does not name it, nor does he gesture to it in any way. Instead, he focuses his attention on the camera, the viewer, us. While the camera lags slightly behind him, rather than turn his attention to the river that he walks along, he looks over his right shoulder to re-establish eye contact with the camera. His indifference is reinforced by the nonchalant stride that never breaks. The Jefferson Memorial nor the Potomac River are objects to marvel at. They hold no amount of significance that would require the poet or viewer/us to stop and ponder them or their alleged importance. With eyes and feet, he keeps them where he wants them ... in the background.———In another interlude Scott-Heron, still holding the boombox atop his shoulder, appears in the courtyard area of an apartment complex. The repetition of his outfit, boombox location, and music give continuity to the scene by the Potomac and the unidentified neighborhood. His outfit is the same one he wears when walking by the Potomac and the boombox remains on his shoulder. Reciting the next verse of “Washington, D.C.”, it seems like he’s walking through a tableau.May not have the glitter or the glamour of L.A.It may not have the history or intrigue of PompeiiBut when it comes to making music, and sure enough making newsOr people who just don’t make sense, and people making doSeems a massive contradiction, pulling different waysBetween the folks who come and go, and one’s who’ve got to stayIt’s a mass of irony for all the world to seeIt’s the nation’s capital, it’s Washington, D.C. He strolls along the sidewalk, the camera zooming in on his face. Over his right shoulder two Black kids pose on their bikes as men stand around them. The camera rotates clockwise, giving a slight panoramic view of the apartment building in the background. Residents crowd the doorway, a combination of what appears to be overlapping greetings and farewells. The ambiguous actions of the people in the background smoothly contrasts with the poet’s lean frame while his focus on the camera/viewer enlarges his presence.The scene also includes various people sitting on park benches. We do not know if they are residents or visitors. In many ways, the distinction does not matter. What we see is comfort in the faces and bodies of the Black people immediately behind Scott-Heron. On one bench we see two people. The first is a Black man who hoists his right leg up, resting his foot on the bench. As the boombox plays and the poet raps, the man taps his knee and snaps his fingers. Similarly, a Black woman in a red dress sitting on the same bench responds to Scott-Heron’s presence and his music with a committed head bob and toe tap. On another bench, three young Black men nod coolly as they watch the poet recite the remainder of his verse.It’s the nation’s capitalIt’s the nation’s capitalIt’s the nation’s capital, it’s Washington D.C.He walks us through the partially-animated tableau wherein the folks sitting behind him subtly reinforce the message he directly communicates to the viewer/us.———In another interlude, three scenes are cut into one. In the first, the Capital Building looms in the distance as Scott-Heron enters the frame. He gestures toward the building and notes the ways that tours distract visitors from the real Washington:Let me tell you, those tours are all the same. They bring you around to places like this [gestures toward the Capital Building]. They might even tell you who the jackass is on the horse or the guy on top of the building, but they never show you the real Washington.Should’ve been around the 15th of January. That’s when Stevie Wonder was holding this rally. It was about 50,000 gathered there. They were trying to demonstrate and make Dr. King’s birthday a national holiday. But it’s always the same. The Capital. The Hoover Building. Maybe sometimes they’d even show you the Washington Monument [gestures towards the monument in the distance]. But that’s not a look at the real Washington. The one I’d like to show you is something special. You wanna see what’s happening in the nation’s capital? Come with me… (Black Wax)Since the standard D.C. tour leaves out the real Washington, the poet primes the viewer for the real thing. His mention of Stevie Wonder allows the poet to connect the viewer to that real Washington, Black Washington. This is the Washington that boasts Ben’s Chili Bowl, Howard University, and Scurlock Studios as cultural institutions. This is the Washington that would welcome the creation of a holiday in honor of Martin Luther King Jr. The scene quickly transitions to Scott-Heron walking down the streets of a presumably Black neighborhood. This neighborhood is outside the purview of tour mobile routes. There is nothing remarkable about the neighborhood. Nothing monumental. The street is lined with row houses. In the background, Black pedestrians passively observe or go about their day. One young Black man smokes a cigarette as Scott-Heron casually walks past him. For Scott-Heron, these folks are the “life-blood of the city” yet he does not speak with them, perhaps because his point is not to put these people on display but to formally acknowledge who gets left out of official narratives. The segment concludes with a return to Heron’s stroll along the Potomac, where he picks up another verse to “Washington, D.C.”:Seems to me, it’s still in light time people knifed up on 14th streetMakes me feel it’s always the right time for them people showing up and coming cleanDid make the one seem kind of numbIt’s the nation’s capitalIt’s the nation’s capitalIt’s the nation’s capital, it’s Washington D.C. ConclusionI’ll end with this. In a final scene, the poet walks in along the front gates of the White House. He holds a little Black girl’s hand and smokes a cigarette. Together they stroll along the gates of the White House. Their movement, from right to left, suggest a return. A going back to. However, this return is not nostalgic. It is accusatory. It is a reckoning with the unrealised promises that America doles out to its citizens. He notes:the protests that are launched in this country are not launched necessarily against the government. They are launched in terms of the fact that this country has rarely lived up to its advanced publicity. This is supposed to be the land of justice, liberty, and equality and that’s what everybody over here is looking for. (Black Wax)Perhaps, then, Gil Scott-Heron leaves his viewer/us not with a push to March. No. Walking against the miasma of national nostalgia perpetuated through tourism is one way to maintain a black sense of place.ReferencesBaram, Marcus. “How Stevie Wonder Helped Create Martin Luther King Day.” Cuepoint, 18 Jan. 2015. 15 Jul. 2018 <https://medium.com/cuepoint/how-stevie-wonder-helped-create-martin-luther-king-day-807451a78664>.Cervenak, Sarah Jane. Wandering: Philosophical Performances of Racial and Sexual Freedom. Durham: Duke UP, 2014.De Certeau, Michel. The Practice of Everyday Life. Los Angeles: U of California P, 1984.Gil Scott-Heron: Black Wax. Dir. Robert Mugge, performances by Gil Scott-Heron and the Midnight Band. WinStar Home Entertainment, 1982.McKittrick, Katherine. “On Plantations, Prisons, and a Black Sense of Place.” Social and Cultural Geography 12.8 (2011): 947-963. Scott-Heron, Gil. The Last Holiday: A Memoir. New York: Grove Press, 2012.“Tour.” Merriam-Webster. 15 Jul. 2018.<https://www.merriam-webster.com/dictionary/tour>.

Photo by Sharon McCutcheon on Unsplash ABSTRACT COVID-19 highlighted a disproportionate impact upon marginalized communities that needs to be addressed. Specifically, a focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can provide this great benefit but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. INTRODUCTION COVID-19 disproportionately impacted communities of color and lower socioeconomic status, sparking political discussion about existing inequities in the US.[1] Some states amended their guidelines for allocating resources, including vaccines, to provide care for marginalized communities experiencing these inequities, but there has been no clear consensus on which guidelines states should amend or how they should be ethically grounded. In part, this is because traditional justice theories do not acknowledge the deep-seated institutional and interpersonal discrimination embedded in our medical system. Therefore, a revamped distributive justice approach that accounts for these shortcomings is needed to guide healthcare decision-making now and into the post-COVID era. BACKGROUND Three terms – health disparity, health inequities, and health equity – help frame the issue. A health disparity is defined as any difference between populations in terms of disease incidence or adverse health events, such as morbidity or mortality. In contrast, health inequities are health disparities due to avoidable systematic structures rooted in racial, social, and economic injustice.[2] For example, current data demonstrate that Black, Latino, Indigenous Americans, and those living in poverty suffer higher morbidity and mortality rates from COVID-19.[3] Finally, health equity is the opportunity for anyone to attain his or her full health potential without interference from systematic structures and factors that generate health inequities, including race, socioeconomic status, gender, ethnicity, religion, sexual orientation, or geography.[4] ANALYSIS Health inequities for people of color with COVID-19 have led to critiques of states that do not account for race in their resource allocation guidelines.[5] For example, the Massachusetts Department of Public Health revised its COVID-19 guidelines regarding resource allocation to patients with the best chance of short-term survival.[6] Critics have argued that this change addresses neither preexisting structural inequities nor provider bias that may have led to comorbidities and increased vulnerability to COVID-19. By failing to address race specifically, they argue the policy will perpetuate poorer outcomes in already marginalized groups. As the inequities in COVID-19 outcomes continue to be uncovered and the data continue to prove that marginalized communities suffered disproportionately, we, as healthcare providers, must reconsider our role in addressing the injustices. Our actions must be ethically grounded in the concept of justice. l. Primary Theories of Justice The principle of justice in medical ethics relates to how we ought to treat people and allocate resources. Multiple theories have emerged to explain how justice should be implemented, with three of the most prominent being egalitarianism, utilitarianism, and distributive. This paper argues that distributive justice is the best framework for remedying past actions and enacting systemic changes that may persistently prevent injustices. An egalitarian approach to justice states all individuals are equal and, therefore, should have identical access to resources. In the allocation of resources, an egalitarian approach would support a strict distribution of equal value regardless of one’s attributes or characteristics. Putting this theory into practice would place a premium on guidelines based upon first-come, first-served basis or random selection.[7] However, the egalitarian approach taken in the UK continues to worsen health inequities due to institutional and structural discrimination.[8] A utilitarian approach to justice emphasizes maximizing overall benefits and achieving the greatest good for the greatest number of people. When resources are limited, the utilitarian principle historically guides decision-making. In contrast to the egalitarian focus on equal distribution, utilitarianism focuses on managing distributions to maximize numerical outcomes. During the COVID-19 pandemic, guidelines for allocating resources had utilitarian goals like saving the most lives, which may prioritize the youthful and those deemed productive in society, followed by the elderly and the very ill. It is important to reconsider using utilitarian approaches as the default in the post-COVID healthcare community. These approaches fail to address past inequity, sacrificing the marginalized in their emphasis on the greatest amount of good rather than the type of good. Finally, a distributive approach to justice mandates resources should be allocated in a manner that does not infringe individual liberties to those with the greatest need. Proposed by John Rawls in a Theory of Justice, this approach requires accounting for societal inequality, a factor absent from egalitarianism and utilitarianism.[9] Naomi Zack elaborates how distributive justice can be applied to healthcare, outlining why racism is a social determinant of health that must be acknowledged and addressed.[10] Until there are parallel health opportunities and better alignment of outcomes among different social and racial groups, the underlying systemic social and economic variables that are driving the disparities must be fixed. As a society and as healthcare providers, we should be striving to address the factors that perpetuate health inequities. While genetics and other variables influence health, the data show proportionately more exposure, more cases, and more deaths in the Black American and Hispanic populations. Preexisting conditions and general health disparities are signs of health inequity that increased vulnerability. Distributive justice as a theoretical and applied framework can be applied to preventable conditions that increase vulnerability and can justify systemic changes to prevent further bias in the medical community. During a pandemic, egalitarian and utilitarian approaches to justice are prioritized by policymakers and health systems. Yet, as COVID-19 has demonstrated, they further perpetuate the death and morbidity of populations that face discrimination. These outcomes are due to policies and guidelines that overall benefit white communities over communities of color. Historically, US policy that looks to distribute resources equally (focusing on equal access instead of outcomes), in a color-blind manner, has further perpetuated poor outcomes for marginalized communities.[11] ll. Historical and Ongoing Disparities Across socio-demographic groups, the medical system exacerbates historical and current inequities. Members of marginalized races,[12] women,[13] LGBTQ people,[14] and poor people[15] experience trauma caused by discrimination, marginalization, and failure to access high-quality public and private goods. Through the unequal treatment of marginalized communities, these historic traumas continue. In the US, people of color do not receive equal and fair medical treatment. A meta-analysis found that Hispanics and Black Americans were significantly undertreated for pain compared to their white counterparts over the last 20 years.[16] This is partly due to provider bias. Through interviewing medical trainees, a study by the National Academy of Science found that half of medical students and residents harbored racist beliefs such as “Black people’s nerve endings are less sensitive than white people’s” or “Black people’s skin is thicker than white people’s skin.”[17] More than 3,000 Indigenous American women were coerced, threatened, and deliberately misinformed to ensure cooperation in forced sterilization.[18] Hispanic people have less support in seeking medical care, in receiving culturally appropriate care, and they suffer from the medical community’s lack of resources to address language barriers.[19] In the US, patients of different sexes do not receive the same quality of healthcare. Despite having greater health needs, middle-aged and older women are more likely to have fewer hospital stays and fewer physician visits compared to men of similar demographics and health risk profiles.[20] In the field of critical care, women are less likely to be admitted to the ICU, less likely to receive interventions such as mechanical ventilation, and more likely to die compared to their male ICU counterparts.[21] In the US, patients of different socioeconomic statuses do not receive the same quality of healthcare. Low-income patients are more likely to have higher rates of infant mortality, chronic disease, and a shorter life span.[22] This is partly due to the insurance-based discrimination in the medical community.[23] One in three deaths of those experiencing homelessness could have been prevented by timely and effective medical care. An individual experiencing homelessness has a life expectancy that is decades shorter than that of the average American.[24] lll. Action Needed: Policy Reform While steps need to be taken to provide equitable care in the current pandemic, including the allocation of vaccines, they may not address the historical failures of health policy, hospital policy, and clinical care to eliminate bias and ensure equal treatment of patients. According to an applied distributive justice framework, inequities must be corrected. Rather than focusing primarily on fair resource allocation, medicine must be actively anti-racist, anti-sexist, anti-transphobic, and anti-discriminatory. Evidence has shown that the health inequities caused by COVID-19 are smaller in regions that have addressed racial wealth gaps through forms of reparations.[25] Distributive justice calls for making up for the past using tools of allocation as well as tools to remedy persistent problems. For example, Brigham and Women’s Hospital in Boston, MA, began “Healing ARC,” a pilot initiative that involves acknowledgement, redress, and closure on an institutional level.[26] Acknowledgement entails informing patients about disparities at the hospital, claiming responsibility, and incorporating community ideas for redress. Redress involves a preferential admission option for Black and Hispanic patients to specialty services, especially cardiovascular services, rather than general medicine. Closure requires that community and patient stakeholders work together to ensure that a new system is in place that will continue to prioritize equity. Of note, redress could take the form of cash transfers, discounted or free care, taxes on nonprofit hospitals that exclude patients of color,[27] or race-explicit protocol changes (such as those being instituted by Brigham and Women’s Hospital that admit patients historically denied access to certain forms of medical care). In New York, for instance, the New York State Bar Association drafted the COVID-19 resolutions to ensure that emergency regulations and guidelines do not discriminate against communities of color, and even mandate that diverse patient populations be included in clinical trials.[28] Also, physicians must listen to individuals from marginalized communities to identify needs and ensure that community members take part in decision-making. The solution is not to simply build new health centers in communities of color, as this may lead to tiers of care. Rather, local communities should have a chance to impact existing hospital policy and should also use their political participation to further their healthcare interests. Distributive justice does not seek to disenfranchise groups that hold power in the system. It aims to transform the system so that those in power do not continue to obtain unfair benefits at the expense of others. The framework accounts for unjust historical oppression and current injustices in our system to provide equitable outcomes to all who access the system. In this vein, we can begin to address the flagrant disparities between communities that have always – and continue to – exist in healthcare today.[29] CONCLUSION As equality focuses on access, it currently fails to do justice. Instead of outcomes, it is time to focus on equity. A focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can gain traction in clinical decision-making guidelines and system-level reallocation of resources but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. There should be an emphasis on implementing a distributive justice framework that treats all patients equitably, accounts for historical harm, and focuses on transparency in allocation and public health decision-making. [1] APM Research Lab Staff. 2020. “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.” APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race. [2] Bharmal, N., K. P. Derose, M. Felician, and M. M. Weden. 2015. “Understanding the Upstream Social Determinants of Health.” California: RAND Corporation 1-18. https://www.rand.org/pubs/working_papers/WR1096.html. [3] Yancy, C. W. 2020. “COVID-19 and African Americans.” JAMA. 323 (19): 1891-2. https://doi.org/10.1001/jama.2020.6548; Centers for Disease Control and Prevention. 2020. “COVID-19 in Racial and Ethnic Health Disparities.” Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html. [4] Braveman, P., E. Arkin, T. Orleans, D. Proctor, and A. Plough. 2017. “What is Health Equity?” Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. [5] Bedinger, M. 2020 Apr 22. “After Uproar, Mass. Revises Guidelines on Who Gets an ICU Bed or Ventilator Amid COVID-19 Surge.” Wbur. https://www.wbur.org/commonhealth/2020/04/20/mass-guidelines-ventilator-covid-coronavirus; Wigglesworth, A. 2020 May 11. “Institutional Racism, Inequity Fuel High Minority Death Toll from Coronavirus, L.A. Officials Say.” Los Angeles Times. https://www.latimes.com/california/story/2020-05-11/institutional-racism-inequity-high-minority-death-toll-coronavirus. [6] Executive Office of Health and Human Services Department of Public Health. 2020 Oct 20. “Crises Standards of Care Planning and Guidance for the COVID-19 Pandemic.” Commonwealth of Massachusetts. https://www.mass.gov/doc/crisis-standards-of-care-planning-guidance-for-the-covid-19-pandemic. [7] Emanuel, E. J., G. Persad, R. Upshur, et al. 2020. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine 382: 2049-55. https://doi.org/10.1056/NEJMsb2005114. [8] Salway, S., G. Mir, D. Turner, G. T. Ellison, L. Carter, and K. Gerrish. 2016. “Obstacles to "Race Equality" in the English National Health Service: Insights from the Healthcare Commissioning Arena.” Social Science and Medicine 152: 102-110. https://doi.org/10.1016/j.socscimed.2016.01.031. [9] Rawls, J. A Theory of Justice (Revised Edition) (Cambridge, MA: Belknap Press of Harvard University Press, 1999). [10] Zack, N. Applicative Justice: A Pragmatic Empirical Approach to Racial Injustice (New York: The Rowman & Littlefield Publishing Group, 2016). [11] Charatz-Litt, C. 1992. “A Chronicle of Racism: The Effects of the White Medical Community on Black Health.” Journal of the National Medical Association 84 (8): 717-25. http://hdl.handle.net/10822/857182. [12] Washington, H. A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006). [13] d'Oliveira, A. F., S. G. Diniz, and L. B. Schraiber. 2002. “Violence Against Women in Health-care Institutions: An Emerging Problem.” Lancet. 359 (9318): 1681-5. https://doi.org/10.1016/S0140-6736(02)08592-6. [14] Hafeez, H., M. Zeshan, M. A. Tahir, N. Jahan, and S. Naveed. 2017. “Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 9 (4): e1184. https://doi.org/10.7759/cureus.1184; Drescher, J., A. Schwartz, F. Casoy, et al. 2016. “The Growing Regulation of Conversion Therapy.” Journal of Medical Regulation 102 (2): 7-12. https://doi.org/10.30770/2572-1852-102.2.7; Stroumsa, D. 2014. “The State of Transgender Health Care: Policy, Law, and Medical Frameworks.” American Journal of Public Health. 104 (3): e31-8. https://doi.org/10.2105/AJPH.2013.301789. [15] Stepanikova, I., and G. R. Oates. 2017. “Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race.” American Journal of Preventative Medicine. 52 (1s1): S86-s94. https://doi.org/10.1016/j.amepre.2016.09.024; Swartz, K. “Health Care for the Poor: For Whom, What Care, and Whose Responsibility?” In Cancian, M., and S. Danziger (Eds.). Changing Poverty, Changing Policies (New York: Russell Sage Foundation Press, 2009), 69-74. [16] Meghani, S. H., E. Byun, and R. M. Gallagher. 2012. “Time to Take Stock: A Meta-analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States.” Pain Medicine 13 (2): 150-74. https://doi.org/10.1111/j.1526-4637.2011.01310.x; Williams, D. R., and T. D. Rucker. 2000. “Understanding and Addressing Racial Disparities in Health Care.” Health Care Financing Review 21 (4): 75-90. https://scholar.harvard.edu/davidrwilliams/dwilliam/publications/understanding-and-addressing-racial-disparities-health. [17] Hoffman, K. M., S. Trawalter, J. R. Axt, and M. N. Oliver. 2016. “Racial Bias in Pain assessment and treatment recommendations, and false beliefs about biological Differences Between Blacks and Whites.” PNAS 113 (16): 4296-4301. https://doi.org/10.1073/pnas.1516047113. [18] Pacheco, C. M., S. M. Daley, T. Brown, M. Filipp, K. A. Greiner, and C. M. Daley. 2013. “Moving Forward: Breaking the Cycle of Mistrust Between American Indians and Researchers.” American Journal of Public Health. 103 (12): 2152-9. https://doi.org/10.2105/AJPH.2013.301480. [19] Velasco-Mondragon, E., A. Jimenez, A. G. Palladino-Davis, D. Davis, and J. A. Escamilla-Cejudo. 2016. “Hispanic Health in the USA: A Scoping Review of the Literature.” Public Health Reviews 37:31. https://doi.org/10.1186/s40985-016-0043-2. [20] Cameron, K. A., J. Song, L. M. Manheim, and D. D. Dunlop. 2010. “Gender Disparities in Health and Healthcare Use Among Older Adults.” Journal of Women’s Health (Larchmt) 19 (9): 1643-50. https://doi.org/10.1089/jwh.2009.1701. [21] Bierman, A. S. 2007. “Sex Matters: Gender Disparities in Quality and Outcomes of Care. Canadian Medical Association Journal 177 (12): 1520-1. https://doi.org/10.1503/cmaj.071541; Fowler, R. A., S. Sabur, P. Li, et al. 2007. “Sex-and Age-based Differences in the Delivery and Outcomes of Critical Care. Canadian Medical Association Journal 177 (12): 1513-9. https://doi.org/10.1503/cmaj.071112. [22] McLaughlin, D. K., and C. S. Stokes. 2002. “Income Inequality and Mortality in US Counties: Does Minority Racial Concentration Matter?” American Journal of Public Health 92 (1): 99-104. https://doi.org/.10.2105/ajph.92.1.99; Shea, S., J. Lima, A. Diez-Roux, N. W. Jorgensen, and R. L. McClelland. 2016. “Socioeconomic Status and Poor Health Outcome at 10 years of Follow-up in the Multi-ethnic Study of Atherosclerosis.” PLoS One 11 (11): e0165651. https://doi.org/10.1371/journal.pone.0165651. [23] Han, X., K. T. Call, J. K. Pintor, G. Alarcon-Espinoza, and A. B. Simon. 2015. “Reports of Insurance-based Discrimination in Health care and its Association with Access to Care.” American Journal of Public Health 105 Suppl 3 (Suppl 3): S517-25. https://doi.org/10.2105/AJPH.2015.302668. [24] Aldridge, R. W., D. Menezes, D. Lewer, et al. 2019. “Causes of Death Among Homeless People: A Population-based Cross-sectional Study of Linked Hospitalization and Mortality Data in England.” Wellcome Open Research 4:49. https://doi.org/10.12688/wellcomeopenres.15151.1. [25] Richardson, E. T., M. M. Malik, W. A. Darity Jr., et al. 2021. “Reparations for Black American Descendants of Persons Enslaved in the U.S. and their Potential Impact on SARS-CoV-2 Transmission.” Social Science and Medicine 276: 113741. https://doi.org/10.1016/j.socscimed.2021.113741. [26] Wispelwey, B., and M. Morse. 2021. “An Antiracist Agenda for Medicine.” Boston Review. http://bostonreview.net/science-nature-race/bram-wispelwey-michelle-morse-antiracist-agenda-medicine. [27] Johnson, S. F., A. Ojo, and H. J. Warraich. 2021. “Academic Health Centers’ Antiracism Strategies Must Extend to their Business Practices.” Annals of Internal Medicine 174 (2): 254-5. https://doi.org/10.7326/M20-6203; Golub, M., N. Calman, C. Ruddock, et al. 2011. “A Community Mobilizes to End Medical Apartheid.” Progress in Community Health Partnerships: Research, Education, and Action 5 (3): 317-25. https://doi.org/10.1353/cpr.2011.0041. [28] New York State Bar Association. 2020. “New York State Bar Association House of Delegates: Revised COVID-19 Resolutions.” https://nysba.org/app/uploads/2020/10/Final-Health-Law-Section-COVID-19-Resolutions_10-8-20-1-1.pdf. [29] Egede, L. E. 2006. “Race, Ethnicity, Culture, and Disparities in Health Care.” Journal of General Internal Medicine 21 (6): 667-669. https://doi.org/10.1111%2Fj.1525-1497.2006.0512.x

I A sense of in-between shapes contemporary theoretical perspectives on identity through concepts such as fluidity, hybridity and diaspora. These concepts have traction when theorising global social and cultural orders characterised by ‘a delocalized transnation’. In this formation, Appadurai argues, ‘the formula of hyphenation (as in Italian-Americans, Asian-Americans, and African-Americans) is reaching the point of saturation, and the right-hand side of the hyphen can barely contain the unruliness of the left-hand side’ (803). Yet in the relatively monocultural space of Anglo-Celtic rural Australia, delocalised and hyphenated transnational identities tend to make their presence felt most strongly on television. Rather than fluidity, rigidity appears to be a more appropriate metaphor for reading the divisions in rural settler-Australian identity that function as ‘uneven, local attempts to make sense of the world’ (Gilroy 98). In Lismore on the north coast of NSW, for example, the relatively fixed notion of being “a local” maintains its power. Since returning to my home-town of Lismore in 1999 I have become particularly fascinated by the constant use of the word “local” in everyday conversation and in the local newspapers. When I share my fascination with students and colleagues, I am struck by the emotive engagement, both positive and negative, that the idea of being “a local” stimulates. That these students and colleagues have local knowledge of what it means to be “a local” is no doubt a factor in this emotion and engagement: being “a local” marks a divide in belonging and in the local social order. While there is ample literature regarding “the local” within the context of globalisation, “the local” in place-based and regional research, “local knowledges” in anthropology, or “the local” as metaphor for issues of subjectivity and self in feminism and postcolonial theory, literature on being “a local” is curiously sparse. A strong thread of scholarship comes from Hawai’i (for an example see Ohnuma). Conversely, in the Australian context I am aware of only one publication dealing specifically with the idea of being a local. In Ronnie’s Story, Richard Woolley analyses the performance of being a local at a pub in the Sydney suburb of Redfern. By telling first-person anecdotes about a long-term Redfern local, Ronnie, more recent arrivals position themselves in a local order of being local. Woolley’s analysis indicates the power and significance that the idea of being a local has in Australian society, even in places where populations are relatively fluid. Yet while performance may be one strategy for creating a local order, the key to a successful performance in Woolley’s analysis is a relation with an “authentic” local who has qualities not of fluidity, but of routine and rootedness. It is this latter sense of being local that has salience in Lismore. It functions as a benchmark for authenticity and acceptance. This sense of being “a local” deserves scrutiny because it carries the full weight of traditional settler belonging. In addition, being “a local” deserves careful unpacking because it is a category that excludes. Concealed within the idea is a racial and colonial discourse. An analysis of being local in Lismore reveals that not everyone can be a local and the conditions of acceptance are obscured. One criterion is, however, clear and discussable: if there is a question of one’s status as a local, conversation typically and quickly moves to duration of personal and ancestral residence. II “When I first came to Lismore twenty-five years ago, people told me it takes 25 years to become a local […]. My time’s up. I think I can safely say I’ve made it.” (Nora Vidler-Blanksby qtd. in Satherley) “All [the people I just mentioned were] born and bred in the area, plus John Chant, who has been here for 40 years, which makes him a local.” (Baxter) “[…W]hat I’ve come to understand is that you are never a local unless you are born here. […] I mean even after twenty-odd years people say [to me], well, you’re not a local.” (Irwin) Becoming local takes time: routine every day time spent on the ground. There is a notion here of connection between identity and a “patch of dirt”, of authenticity through autochthony, of a seed planted, of being a child of the soil, of coming from a place as distinct from a womb. Being local weaves identity and place together in this most intimate fashion. A local’s sense of identity emerges through time from a developing everyday personal relationship to place through a meld of history, community and geography (Miller 217). To come from outside Lismore, and move beyond being “just a blow-in” — an unannounced stranger blown off-course — the honorific must be earned through an infusion of soil into one’s blood. The period required for this metamorphosis is clearly open to question: 25 years, 40 years, forever. In a sense, locals were never not there. History begins with their arrival. III The stability of this reading of the local order rests on the concealment of an anxiety: an anxiety that settler autochthony is a fiction. Diffusion of settlers and dispersal of Aborigines was the reality of locals’ “settling”. Aborigines upset the signifying chain of local settler belonging at its source because a straightforward appeal to duration of residence is quickly undermined by 40,000 years of Indigenous tenure. This challenge to autochthony initiates a pre-emptive strategy of avoidance and concealment. The language of the settler “local”, articulated through history, community and geography of necessity excludes Aborigines. In de Certeau’s words “locals” define themselves within a ‘proper place’ — ‘a place appropriated as one’s own’ — ‘in a world bewitched by the invisible powers of the Other’ (1984: 36). An analysis of the use of the word “local” reveals how the idea of being “a local” stabilises local settler belonging through concealment. Local, in this usage, is an adjective doing the work of a noun. By becoming a substitute for the noun, the actual noun which “local” modifies is understood, elided, concealed. ‘So you’re “a local”, huh? A local what?’ we might ask. Turning to local newspapers reveals what the concealed noun is not. Within everyday settler discourse Aborigines cannot be noun-locals. To do so would pollute the proper place of “the local” with the Other. Instead, Aborigines are adjective-locals. In The Northern Star, Lismore’s daily paper, Digby Moran is described as a ‘local […] indigenous artist’ (Redmond). Bill Walker, the co-ordinator of the Bundjalung Nation Aboriginal Cultural Heritage Committee, is a ‘respected local identity’ (“Co-ordinator named”). These instances are illustrative of the repeated use of the term “local” as a regular adjective in reference to Aborigines. Local is a modifier of the nouns “artist” and “identity”, indeed a modifier that refers to an imagined boundary rather than to the land itself. Now and then there is a subversion of this order and someone will refer to an Aborigine as a ‘fair dinkum local’ (Opit). Nevertheless, a qualifier is required. Supporting evidence is needed for the Aboriginal claim to status as “a local” – a fair-dinkum local as opposed to a no-need-to-explain local. If there was a class of nouns to which “local” belonged, we would be justified in labelling them “dispossessives”. IV Being a local is a valued aspect of Australian culture and identity — an embodiment of care for community and place for the long term. In the contemporary moment, characterised in the media by accelerating cultural change and personal and national threat, the local represents tradition through apparently unchanging repetition that tourists, sea-changers and tree-changers seek as a refuge and solace. The locals might be said to offer a community of resistance and trust. The local stands within a clearing in a cluttered and threatening world. As I have attempted to argue, however, the local that is revealed in the light of the clearing contains concealment. As an adjective masquerading as a noun, “local” silences talk of the clearing of Aborigines and in the Aborigines’ place it silently installs the settler as original and autochthonous. As Heidegger writes, the ‘clearing in which beings stand is in itself at the same time concealment. […C]oncealment […] occurs within what is lighted. One being places itself in front of another being, the one helps to hide the other, the former obscures the latter, a few obstruct many, one denies all. […A] being […] presents itself as other than it is.’ (Heidegger 54) While there is much to value in being local, as an everyday contemporary practice of colonialism and exclusion it deserves careful attention and transformation. The transformation is clearly more than a task of defining and reinstating the noun that follows the adjective “local,” and instead requires an ontological earthquake of sorts for settler locals. How could the local order in Australia be otherwise than colonial? How might settler Australians be able to imagine the clearing they inhabit in a way that does not clear the land of Aborigines? Within these questions lies a possible ethics of location for settler Australians. References Appadurai, Arjun. “The Heart of Whiteness.” Callaloo 16 (1993): 796-807. Baxter, Reg. “Six Pack Not So Bad”. The Northern Star 17 Mar. 2004: 11. “Co-ordinator Named”. The Northern Star 18 Feb. 2004: 3. De Certeau, Michel. The Practice of Everyday Life. Trans. Steven Rendall. Berkeley: University of California Press, 1984. Gilroy, Paul. Between Camps: Race, Identity and Nationalism at the End of the Colour Line. Harmondsworth: Allen Lane, 2000. Heidegger, Martin. Poetry, Language, Thought. Trans. Albert Hofstadter. New York: Harper & Row, 1975. Irwin, Ros. Personal communication with author [transcript from tape]. 26 Aug. 2003. Miller, Linn. “Belonging to Country — A Philosophical Anthropology.” Voicing Dissent, New Talents 21C: Next Generation Australian Studies 76 (2003): 215-23, 257-8. Ohnuma, Keiko. “Local Haole – A Contradiction in Terms? The Dilemma of Being White, Born and Raised in Hawai’i.” Cultural Values 6 (2002): 273-85. Opit, G. “Stand Up for the Fair Dinkum Local.” Byron Shire Echo 18 Nov. 2003: 9. Redmond, Renee. “The Perfect Backdrop for Local Artist.” The Northern Star 11 Jul. 2003: 5. Satherley, Zoe “Look Who Wants to Be Mayor.” The Northern Star 30 Jan. 2004: 3. Woolley, Richard. “Ronnie’s Story: Narrative and Belonging to Place.” TASA 2003 Conference. The Australian Sociological Association. University of New England, Armidale. 4-6 December 2003. Citation reference for this article MLA Style Garbutt, Rob. "Local Order." M/C Journal 7.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0501/08-garbutt.php>. APA Style Garbutt, R. (Jan. 2005) "Local Order," M/C Journal, 7(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0501/08-garbutt.php>.

Introduction‘Dream’ has been researched across numerous fields in its multiplicity within both a physical and emotional capacity. For Pagel et al., there is no fixed definition of what ‘dream’ is or are. However, in an advertising context, ’dream’ is the idealised version of our desires, re-visualised in real life (Coombes and Batchelor 103). It could be said that for countless consumers, advertising imagery has elicited dreams of living the perfect life and procuring material pleasures (Manca et al.; Hood). Goodis asserts, “advertising doesn’t always mirror how people are acting but how they are dreaming, in a sense what we are doing is wrapping up your emotions and selling them back to you” (qtd. in Back and Quaade 65). One component of this notion of ‘dream’ in advertising is captured by wishful images of the face and body in their ‘perfect form’ presented in a field of other beauty ideals. For our purposes, ‘dream’ is a “philosophical concept” (Pagel et al. 14) by which dreams are a series of aspirations and desires that consumers internalise, while at the same time, find difficult to achieve. ‘Dream’, then, will be used to critically explore how the beauty and advertising industries collectively employ ethnic ambiguity in addition to other tactics and strategies to sell us dream-like visions of idealised beauty. Forever Dreaming: The Introduction of Ethnic AmbiguityWe can link dreams to beauty as both areas of analysis contain many cultural interpretations and can be deconstructed to reveal different meanings (Sontag). In many ways, beauty is another dream and Sontag notes that the concept of beauty is often linked to certain physical traits that an individual possesses. These physical traits are capitalised upon by product marketing by which Hood claims, aims to enhance one, or even more, of them. For example, lipstick is not marketed as simply as a mixture of wax and pigment but rather a way to “obtain beauty, find romance or gain confidence” (7). As a result, global beauty brands can find long term marketing success through meaningful product marketing. This long-term marketing success relies on influencing human behaviour and perceptions. As a result of meaningful marketing, consumers may find themselves driven to purchase implicit qualities in products advertised to reflect their dreams (Hood).Following the 1980s, this version of meaningful marketing has become a driving purpose for advertising agencies around the globe (Steel). Advertising agencies rely on deeper human insights, identifying latent desires to create a brief that must ultimately sell a dream (Steel). The ideal strategy needs to define something that will build brand loyalty and encourage consumers to have a symbiotic relationship connecting their dreams with the product being sold. As Hood argues, “advertising consists of selling not just things but also dreams”. While this concept is one that “some see as inherently damning”, it is also inherently necessary (7). We understand that people are emotional beings, investing in the artefacts they build, obtain or use with significance “beyond merely utilitarian” (7). For these reasons, beauty advertisers act as the purveyors of dreams in the form of physical perfection as an articulation of consumer’s own aspirations of beauty.These aspirations of dream beauty are a direct representation of our thoughts and feelings. As such, it should be noted that we as consumers are often encouraged to draw inspiration from imagery that is often times seen as ethnically ambiguous. “Ethnic ambiguity” is the absence of any one prominent ethnic or racial feature that is easily discernible to one specific group (Garcia 234; Harrison et al.). An example of this ethnic ambiguity can be seen in marketing campaigns by high end makeup artist and her eponymous range of cosmetics, Charlotte Tilbury. Most notably, in a 2015 launch for her “Makeup Wardrobe”, Tilbury’s makeup palettes boasted 10 aspirational ‘looks’ and personas that could be achieved simply through purchase. The images of women featured on a figurative ‘wheel of fortune’ digital display used to market products online. This digital ‘wheel of fortune’ comprised of ethnically ambiguous models against descriptive persona’s such as “The Dolce Vita” and “The Glamour Muse”. These kinds of digital marketing tools required consumers to make a decision based on what their dream ‘look’ is through an ethnically ambiguous lens and from here are guided to purchase their desired aesthetic. Like Charlotte Tilbury, the beauty industry has seen a growing body of cosmetic brands that employ ethnic ambiguity to sell dreams of homogenised beauty. We will see the ways in which modern day beauty brands, such as Kylie Jenner Cosmetics and Fenty Beauty have come to adopt ethnic ambiguity or embrace entire ethnic and racial groups in order to expand their consumer influence.Aspirational Ambiguity: Dreams of DisempowermentSince the early 2000s, beauty advertising has seen a prominent rise in the use of ethnically ambiguous models. Some see this as an effort to answer the global desire for diversity and inclusion. However, the notion that beauty standards transcend racial boundaries and is inclusive, is simply another form of appropriating and fetishising ethnicity (R. Sengupta). In many ways, these manufactured dream-like versions of beauty have evolved to reach wider markets, in the hope that consumers will be emboldened to both embrace their racial heritage, and at the same time conform to homogenised standards of beauty (Frith et al.; Harrison et al.).In this bid to diversify and extend consumer reach, there are three prominent reasons why ethnically ambiguous models are more likely to be featured over models whose African, Indigenous, and/or Asian heritage is more prominent. Firstly, ethnically ambiguous models do not seem to conform to a particular notion of what is considered beautiful. For many decades, popular culture has been saturated with images of thin, of young, of narrow noses and hips, of blonde, blue eyes, and Caucasian hair textures (Harrison et al.; Hunter; Saraswati). These Westernised beauty ideals have been historically shaped through years of colonial influence, grounded in an imbalance of power and imposed to create a culture of dominance and oppression (Saraswati). Secondly, ethnic models are featured to convey “the sense of the ‘exotic’, and their ‘otherness’ acts to normalise and entrench the dominant ideal of white beauty” (qtd. in Redmond 175). ‘Otherness’ can be defined as the opposite of the majority, in Westernised society this ‘other’ can mean “people who are other than white, male, able bodied, heterosexual” (qtd. in Graycar 74). This ‘otherness’ showcased by ethnically ambiguous models draws viewers in. Physical features that were possessed by one specific ethnic group such as African, Asian, Latinx or Indigenous peoples have now become blended and are no longer confined to one race. Additionally, ethnically ambiguous models enable white consumers to dream about an exotic local or lifestyle, while at the same time providing ethnic audiences a way to see themselves.Finally, it is undeniable that ethnically ambiguous and mixed-race models have become desirable due to a historical preference for light skin (Saraswati). The visual references of light-skinned beauty epitomise a colonial dream and this standardisation has been transferred to indigenous peoples, or ethnic minorities in Western countries. According to Harrison et al, “marketers use mixed-race representations as cultural currency by mythologising mixed-race bodies as the new beauty standard” to represent a racial bridge, “tailored to ameliorate perceived racial divides” (503). Therefore, ethnically ambiguous models have an assumed advantage over their racially dominant counterparts, because they appear to straddle various racial boundaries. They are constructed to embody whomever, from wherever and whenever, fetishising their roleplay for the industry, when it pleases. This further exoticises multi-racial beauty models and renders them a commodified fantasy for many consumers alike. The continued commodification of ethnic ambiguity is problematic as it exploits models with distinctly mixed-race heritage to continue to sell images of white-washed beauty (Solomon et al.). An argument could be made that scarcity contributes to mixed-race models’ value, and therefore the total number of advertising opportunities that are offered to mixed-race models remains limited. To date, numerous studies highlight a limited use of racially diverse models within the beauty industry and does not reflect the growing global body of diverse consumers with purchasing power (Wasylkiw et al.; Redmond; Johnson; Jung and Lee; Frith et al.). In fact, prior to globalisation, Yan and Bissell claim that “each culture had a unique standard of attractiveness, derived from traditional views about beauty as well as the physical features of the people” (197) and over time the construction of dream beauty is characterised using Western features combined with exoticised traits of indigenous ethnic groups. Akinro and Mbunyuza-Memani claim that this “trend of normalising white or 'western' feminine looks as the standard of beauty” has pervaded a number of these indigenous cultures, eventually disseminated through the media as the ultimate goal (308). It can also be argued that the “growing inclusion of mixed-race models in ads is driven less by the motivation to portray diversity and driven more by pragmatism,” and in a more practical sense has implications for the “financial future of the advertised brands and the advertising industry as a whole” (Harrison et al. 513). As a result, uses of mixed-race models “are rather understood as palatable responses within dominant white culture to racial and ethnic minority populations growing in … cultural prominence” (513) in a tokenistic bid to sell a dream of unified beauty.The Dream Girl: Normalisation of Mixed-RaceIn 2017, an article in CNN’s Style section highlighted the growing number of mixed-race models in Japan’s fashion and beauty industry as a modern-day phenomenon from Japan’s interlocking history with the United States (Chung and Ogura). These beauty and fashion influencers refer to themselves as hafu, an exclusionary term that historically represented an “othered” minority of mixed-race heritage in Japanese society signalling complex and troubled interactions with majority Japanese (Oshima). The complications once associated with the term ‘hafu’ are now being reclaimed by bi-racial beauty and fashion models and as such, these models are beginning to defy categorisation and, in some ways, national identity because of their chameleon-like qualities. However, while there is an increasing use of mixed-race Japanese models, everyday mixed-race women are regularly excluded within general society; which highlights the incongruent nature of ‘half’ identity. And yet there is an increasing preference and demand from fashion and beauty outlets to feature them in Japanese and Western popular culture (Harrison et al.; Chung and Ogura). Numéro Tokyo’s editorial director Sayumi Gunji, estimated that almost 30-40 per cent of runway models in present day Japan, identify as either bi-racial mixed-race or multi-racial (Chung and Ogura).Gunji claims:"Almost all top models in the their 20s are hafu, especially the top models of popular fashion magazines ... . [In] the Japanese media and market, a foreigner's flawless looks aren't as readily accepted -- they feel a little distant. But biracial models, who are taller, have bigger eyes, higher noses [and] Barbie-doll-like looks, are admired because they are dreamy looking but not totally different from the Japanese. That's the key to their popularity," she adds. (Qtd. in Chung and Ogura)The "dreamy look" that Gunji describes is attributed to a historical preference toward light skin and a kind of willingness and sensuality, that once, only white models could be seen to tout (Frith et al. 58). Frith et al. and O’Barr discuss that beauty in Japanese advertising mirrors “the way women are portrayed in advertising in the West” (qtd. in Frith et al. 58). The emergence of hafu in Japanese beauty advertising sees these two worlds, a mixture of doll-like and sensual beauty, converging to create a dream-like standard for Japanese consumers. The growing presence of Japanese-American models such as Kiko Mizuhara and Jun Hasegawa are both a direct example of the unattainable ‘dreamy look’ that pervades the Japanese beauty industry. Given this ongoing trend of mixed-race models in beauty advertising, a recent article on Refinery29 talks about the significance of how mixed-race models are disassembling their once marginalised status.A. Sengupta writes:In contrast to passing, in which mixedness was marginalized and hidden, visibly multiracial models now feature prominently in affirmative sites of social norms. Multiracial looks are normalized, and, by extension, mixed identity is validated. There’s no cohesive social movement behind it, but it’s a quiet sea change that’s come with broadened beauty standards and the slow dismantling of social hierarchies.Another example of the normalisation in multi-racial identity is Adwoa Aboah, a mixed-race British model and feminist activist who has been featured on the covers of numerous fashion publications and on runways worldwide. In British Vogue’s December 2017 issue, titled “Great BRITAIN”, Adwoa Aboah achieved front cover status, alongside her image featured other politically powerful names, perhaps suggesting that Aboah represents not only the changing face of a historically white publication but as an embodiment of an increasingly diverse consumer landscape. Not only is she seen as both as a voice for those disenfranchised by the industry, by which she is employed, but as a symbol of new dreams. To conclude this section, it seems the evolution of advertising’s inclusion of multi-racial models reveals a progressive step change for the beauty industry. However, relying simply on the faces of ethnically ambiguous talent has become a covert way to fulfil consumer’s desire for diversity without wholly dismantling the destructive hierarchies of white dominance. Over this time however, new beauty creations have entered the market and with it two modern day icons.Architecting Black Beauty through the American DreamAccording to Kiick, the conception of the ‘American Dream’ is born out of a desire to “seek out a more advantageous existence than the current situation” (qtd. in Manca et al. 84). As a result of diligent hard work, Americans were rewarded with an opportunity for a better life (Manca et al.). Kylie Jenner’s entry into the beauty space seemed like a natural move for the then eighteen-year-old; it was a new-age representation of the ‘American Dream’ (Robehmed 2018). In less than five years, Jenner has created Kylie Cosmetics, a beauty empire that has since amassed a global consumer base, helping her earn billionaire status. A more critical investigation into Jenner’s performance however illustrates that her eponymous range of beauty products sells dreams which have been appropriated from black culture (Phelps). The term cultural appropriation refers to the way dominant cultures “adopt and adapt certain aspects of another’s culture and make it their own” (qtd. in Han 9). In Jenner’s case, her connection to ethnic Armenian roots through her sisters Kourtney, Kim, and Khloe Kardashian have significantly influenced her expression of ‘othered’ culture and moreover ethnic beauty ideals such as curvier body shapes and textured hair. Jenner’s beauty advertisements have epitomised what it means to be black in America, cherry picking racialised features of black women (namely their lips, hips/buttocks and afro-braided hairstyles) and rearticulated them through a white lens. The omission of the ‘black experience’ in her promotion of product is problematic for three reasons. Firstly, representing groups or people without invitation enables room for systemic stereotyping (Han). Secondly, this stereotyping can lead to continued marginalisation of minority cultures (Kulchyski). And finally, the over exaggeration of physical attributes, such as Jenner’s lips, hips and buttocks, reinforces her complicity in exoticising and fetishising the “other”. As a result, consumers of social media beauty advertising may pay less attention to cultural appropriation if they are already unaware that the beauty imagery they consume is based on the exploitation of black culture.Another perspective on Jenner’s use of black culture is in large part due to her cultural appreciation of black beauty. This meaning behind Jenner’s cultural appreciation can be attributed to the inherent value placed on another person’s culture, in the recognition of the positive qualities and the celebration of all aspects of that culture (Han). This is evidenced by her recent addition of cosmetic products for darker complexions (Brown). However, Jenner’s supposed fascination with black culture may be in large part due to the environment in which she was nurtured (Phelps). As Phelps reveals, “consider the cultural significance of the Kardashian family, and the various ways in which the Kardashian women, who are tremendously wealthy and present as white, have integrated elements of black culture as seemingly “natural” in their public bodily performances” (9). Although the Kardashian-Jenner family have faced public backlash for their collective appropriation they have acquired a tremendous “capital gain in terms of celebrity staying power and hyper-visibility” (Phelps 9). Despite the negative attention, Kylie Jenner’s expression of black culture has resurfaced the very issues that had once been historically deemed insignificant. In spite of Jenner’s cultural appropriation of black beauty, her promotion through Kylie Cosmetics continues to sell dreams of idealised beauty through the white lens.In comparison, Rihanna Fenty’s cosmetic empire has been touted as a celebration of diversity and inclusion for modern-age beauty. Unlike Kylie Cosmetics, Fenty’s eponymous brand has become popular for its broader message of inclusivity across both skin tone, body shape and gender. Upon her product release, Fenty Beauty acknowledged a growing body of diverse consumers and as a direct response to feature models of diverse skin tones, cultural background and racial heritage. Perhaps more importantly, Fenty Beauty’s challenge to the ongoing debate around diversity and inclusion has been in stark contrast to Kylie Jenner’s ongoing appropriation of black culture. Images featured at the first brand and product launch of Fenty Beauty and in present day advertising, show South Sudanese model Duckie Thot and hijab-wearing model Halima Aden as central characters within the Fenty narrative, illustrating that inclusion need not remain ambiguous and diversity need not be appropriated. Fenty’s initial product line up included ninety products, but most notably, the Pro Filt’r foundation caused the most publicity. Since its introduction in 2017, the foundation collection contained range of 40 (now 50) inclusive foundation shades, 13 of these shades were designed to cater for much darker complexions, an industry first (Walters). As a result of the brand’s inclusion of diverse product shades and models, Fenty Beauty has been shown to push boundaries within the beauty industry and the social media landscape (Walters). Capitalising on all races and expanding beauty ideals, Fenty’s showcase of beauty subscribes to the notion that for women everywhere in the world, their dreams can and do come true. In conclusion, Fenty Beauty has played a critical role in re-educating global consumers about diversity in beauty (Walters) but perhaps more importantly Rihanna, by definition, has become a true embodiment of the ‘American Dream’.Conclusion: Future Dreams in BeautyIt is undeniable that beauty advertising has remained complicit in selling unattainable dreams to consumers. 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This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. Elsevier Science, 1995. 8 Aug, 2013 ‹http://www.freedomfromtorture.org/sites/default/files/documents/Summerfield-PsychologicalResponses.pdf>. Brune, Michael, Christian Haasen, Michael Krausz, Oktay Yagdiran, Enrique Bustos and David Eisenman. “Belief Systems as Coping Factors for Traumatized Refugees: A Pilot Study.” Eur Psychiatry 17 (2002): 451-58. Canavan, John. “Resilience: Cautiously Welcoming a Contested Concept.” Child Care in Practice 14.1 (2008): 1-7. Chung, Juna. Refugee and Immigrant Survivors of Trauma: A Curriculum for Social Workers. Master’s Thesis for California State University. Long Beach, 2010. 1-29. Eastmond, Maria. “Stories of Lived Experience: Narratives in Forced Migration Research.” Journal of Refugee Studies 20.2 (2007): 248-64. Eyber, Carola “Cultural and Anthropological Studies.” In Forced Migration Online, 2002. 8 Aug, 2013. ‹http://www.forcedmigration.org/research-resources/expert-guides/psychosocial- issues/cultural-and-anthropological-studies>. Graybeal, Clay. “Strengths-Based Social Work Assessment: Transforming the Dominant Paradigm.” Families in Society 82.3 (2001): 233-42. Kleinman, Arthur. “Triumph or Pyrrhic Victory? The Inclusion of Culture in DSM-IV.” Harvard Rev Psychiatry 4 (1997): 343-44. Mares, Sarah, and Louise Newman, eds. Acting from the Heart- Australian Advocates for Asylum Seekers Tell Their Stories. Sydney: Finch Publishing, 2007. Mays, Vicki M. “Identity Development of Black Americans: The Role of History and the Importance of Ethnicity.” American Journal of Psychotherapy 40.4 (1986): 582-93. Nettles, Saundra Murray, and Michael J. Mason. “Zones of Narrative Safety: Promoting Psychosocial Resilience in Young People.” The Journal of Primary Prevention 25.3 (2004): 359-73. Orosa, Francisco J.E., Michael Brune, Katrin Julia Fischer-Ortman, and Christian Haasen. “Belief Systems as Coping Factors in Traumatized Refugees: A Prospective Study.” Traumatology 17.1 (2011); 1-7. Peres, Julio F.P., Alexander Moreira-Almeida, Antonia, G. Nasello, and Harold, G. Koenig. “Spirituality and Resilience in Trauma Victims.” J Relig Health (2006): 1-8. Saleebey, Dennis. “The Strengths Perspective in Social Work Practice: Extensions and Cautions.” Social Work 41.3 (1996): 296-305. Scheper-Hughes, Nancy. “A Talent for Life: Reflections on Human Vulnerability and Resilience.” Ethnos 73.1 (2008): 25-56. Seahorn, Janet, J. and Anthony E. Seahorn. Tears of a Warrior. Ft Collins, USA: Team Pursuits, 2008. Sonn, Christopher, and Adrian Fisher. “Sense of Community: Community Resilient Responses to Oppression and Change.” Unpublished article. Curtin University of Technology & Victoria University of Technology: undated. Summerfield, Derek. “Childhood, War, Refugeedom and ‘Trauma’: Three Core Questions for Medical Health Professionals.” Transcultural Psychiatry 37.3 (2000): 417-433. Tofighian, Omid. “Prolonged Liminality and Comparative Examples of Rioting Down Under”. Fear and Hope: The Art of Asylum Seekers in Australian Detention Centres Literature and Aesthetics (Special Edition) 21 (2011): 97-103. Ungar, Michael. “A Constructionist Discourse on Resilience: Multiple Contexts, Multiple Realities Among at-Risk Children and Youth.” Youth Society 35.3 (2004): 341-365. Ungar, Michael. “A Thicker Description of Resilience.” The International Journal of Narrative Therapy and Community Work 3 & 4 (2005): 85-96. Walsh, Froma. “Traumatic Loss and Major Disasters: Strengthening Family and Community Resilience.” Family Process 46.2 (2007): 207-227. Weiss, Daniel. S., Charles R. Marmar, William. E. Schlenger, John. A. Fairbank, Kathleen Jordon, Richard L. Hough, and Richard A. Kulka. “The Prevalence of Lifetime and Partial Post- Traumatic Stress Disorder in Vietnam Theater Veterans.” Journal of Traumatic Stress 5.3 (1992):365-76. Westoby, Peter, and Ann Ingamells. “A Critically Informed Perspective of Working with Resettling Refugee Groups in Australia.” British Journal of Social Work 40 (2010): 1759-76. Wilson, Michael. “Accumulating Resilience: An Investigation of the Migration and Resettlement Experiences of Young Sudanese People in the Western Sydney Area.” PHD Thesis. University of Western Sydney ( 2012): 1-297. Wu, K. M. “Hope and World Survival.” Philosophy Forum 12.1-2 (1972): 131-48.

IntroductionIt has been nearly half a century since the appearance of Susan Sontag’s landmark essay “The Imagination of Disaster.” The critic wrote of the public fascination with science fiction disaster films, claiming that, on the one hand “from a psychological point of view, the imagination of disaster does not greatly differ from one period in history to another [but, on the other hand] from a political and moral point of view, it does” (224). Even if Sontag is right about aspects of the imagination of disaster not changing, the types, frequency, and magnitude of disasters and their representation in media and popular culture suggest that dynamic conditions prevail on both counts. Disaster has become a significantly urban phenomenon, and highly publicised “worst case” scenarios such as Hurricane Katrina and the Haiti earthquake highlight multiple demographic, cultural, and environmental contexts for visualising cataclysm. The 1950s and 60s science fiction films that Sontag wrote about were filled with marauding aliens and freaks of disabused science. Since then, their visual and dramatic effects have been much enlarged by all kinds of disaster scenarios. Partly imagined, these scenarios have real-life counterparts with threats from terrorism and the war on terror, pan-epidemics, and global climate change. Sontag’s essay—like most, if not all of the films she mentions—overlooked the aftermath; that is, the rebuilding, following extra-terrestrial invasion. It ignored what was likely to happen when the monsters were gone. In contrast, the psychological as well as the practical, social, and economic aspects of reconstruction are integral to disaster discourse today. Writing about how architecture might creatively contribute to post-conflict (including war) and disaster recovery, for instance, Boano elaborates the psychological background for rebuilding, where the material destruction of dwellings and cities “carries a powerful symbolic erosion of security, social wellbeing and place attachment” (38); these are depicted as attributes of selfhood and identity that must be restored. Similarly, Hutchison and Bleiker (385) adopt a view evident in disaster studies, that disaster-struck communities experience “trauma” and require inspired responses that facilitate “healing and reconciliation” as well as material aid such as food, housing, and renewed infrastructure. This paper revisits Sontag’s “The Imagination of Disaster,” fifty years on in view of the changing face of disasters and their representation in film media, including more recent films. The paper then considers disaster recovery and outlines the difficult path that “creative industries” like architecture and urban planning must tread when promising a vision of rebuilding that provides for such intangible outcomes as “healing and reconciliation.” We find that hopes for the seemingly positive psychologically- and socially-recuperative outcomes accompanying the prospect of rebuilding risk a variety of generalisation akin to wish-fulfilment that Sontag finds in disaster films. The Psychology of Science Fiction and Disaster FilmsIn “The Imagination of Disaster,” written at or close to the height of the Cold War, Sontag ruminates on what America’s interest in, if not preoccupation with, science fiction films tell us about ourselves. Their popularity cannot be explained in terms of their entertainment value alone; or if it can, then why audiences found (and still find) such films entertaining is something that itself needs explanation.Depicted in media like photography and film, utopian and dystopian thought have at least one thing in common. Their visions of either perfected or socially alienated worlds are commonly prompted by criticism of the social/political status quo and point to its reform. For Sontag, science fiction films portrayed both people’s worst nightmares concerning disaster and catastrophe (e.g. the end of the world; chaos; enslavement; mutation), as well as their facile victories over the kinds of moral, political, and social dissolution the films imaginatively depicted. Sontag does not explicitly attribute such “happy endings” to wish-fulfilling phantasy and ego-protection. (“Phantasy” is to be distinguished from fantasy. It is a psychoanalytic term for states of mind, often symbolic in form, resulting from infantile wish-fulfilment, desires and instincts.) She does, however, describe the kinds of fears, existential concerns (like annihilation), and crises of meaning they are designed (purpose built) to allay. The fears are a product of the time—the down and dark side of technology (e.g. depersonalisation; ambivalence towards science, scientists, and technology) and changes wrought in our working and personal lives by urbanisation. In short, then as now, science fictions films were both expressions of deep and genuine worries and of the pressing need to inventively set them to rest.When Sontag claims that “the imagination of disaster does not greatly differ” (224) from one period to another, this is because, psychologically speaking, neither the precipitating concerns and fears (death, loss of love, meaninglessness, etc.), nor the ways in which people’s minds endeavour to assuage them, substantively differ. What is different is the way they are depicted. This is unsurprisingly a function of the political, social, and moral situations and milieus that provide the context in which the imagination of disaster unfolds. In contemporary society, the extent to which the media informs and constructs the context in which the imagination operates is unprecedented.Sontag claims that there is little if any criticism of the real social and political conditions that bring about the fears the films depict (223). Instead, fantasy operates so as to displace and project the actual causes away from their all too human origins into outer space and onto aliens. In a sense, this is the core and raison d’etre for such films. By their very nature, science fiction films of the kind Sontag is discussing cannot concern themselves with genuine social or political criticism (even though the films are necessarily expressive of such criticism). Any serious questioning of the moral and political status quo—conditions that are responsible for the disasters befalling people—would hamper the operation of fantasy and its production of temporarily satisfying “solutions” to whatever catastrophe is being depicted.Sontag goes on to discuss various strategies science fiction employs to deal with such fears. For example, through positing a bifurcation between good and evil, and grossly oversimplifying the moral complexity of situations, it allows one to “give outlet to cruel or at least amoral feelings” (215) and to exercise feelings of superiority—moral and otherwise. Ambiguous feelings towards science and technology are repressed. Quick and psychologically satisfying fixes are sought for these by means of phantasy and the imaginative construction of invulnerable heroes. Much of what Sontag says can straightforwardly be applied to catastrophe in general. “Alongside the hopeful fantasy of moral simplification and international unity embodied in the science fiction films lurk the deepest anxieties about contemporary existence” (220). Sontag writes:In the films it is by means of images and sounds […] that one can participate in the fantasy of living through one’s own death and more, the death of cities, the destruction of humanity itself. Science fiction films are not about science. They are about disaster, which is one of the oldest subjects in art. In science fiction films disaster is rarely viewed intensively; it is always extensive. It is a matter of quality and ingenuity […] the science fiction film […] is concerned with the aesthetics of disaster […] and it is in the imagery of destruction that the core of a good science fiction film lies. (212–13)In science fiction films, disaster, though widespread, is viewed intensively as well as extensively. The disturbances constitutive of the disaster are moral and emotional as well as material. People are left without the mental or physical abilities they need to cope. Government is absent or useless. We find ourselves in what amounts to what Naomi Zack (“Philosophy and Disaster”; Ethics for Disaster) describes as a Hobbesian second state of nature—where government is inoperative and chaos (moral, social, political, personal) reigns. Science fiction’s way out is to imaginatively construct scenarios emotionally satisfying enough to temporarily assuage the distress (anomie or chaos) experienced in the film.There is, however, a tremendous difference in the way in which people who face catastrophic occurrences in their lives, as opposed to science fiction, address the problems. For one thing, they must be far closer to complex and quickly changing realities and uncertain truths than are the phantastic, temporarily gratifying, and morally unproblematic resolutions to the catastrophic scenarios that science fiction envisions. Genuine catastrophe, for example war, undermines and dismantles the structures—material structures to be sure but also those of justice, human kindness, and affectivity—that give us the wherewithal to function and that are shown to be inimical to catastrophe as such. Disaster dispenses with civilization while catastrophe displaces it.Special Effects and Changing StorylinesScience fiction and disaster film genres have been shaped by developments in visual simulation technologies providing opportunities for imaginatively mixing fact and fiction. Developments in filmmaking include computer or digital techniques for reproducing on the screen what can otherwise only be imagined as causal sequences of events and spectacles accompanying the wholesale destruction of buildings and cities—even entire planets. Indeed films are routinely promoted on the basis of how cinematographers and technicians have advanced the state of the art. The revival of 3-D movies with films such as Avatar (2009) and Prometheus (2012) is one of a number of developments augmenting the panoramas of 1950s classics featuring “melting tanks, flying bodies, crashing walls, awesome craters and fissures in the earth, plummeting spacecraft [and] colourful deadly rays” (Sontag 213). An emphasis on the scale of destruction and the wholesale obliteration of recognisable sites emblematic of “the city” (mega-structures like the industrial plant in Aliens (1986) and vast space ships like the “Death Star” in two Star Wars sequels) connect older films with new ones and impress the viewer with ever more extraordinary spectacle.Films that have been remade make for useful comparison. On the whole, these reinforce the continuation and predictability of some storylines (for instance, threats of extra-terrestrial invasion), but also the attenuation or disappearance of other narrative elements such as the monsters and anxieties released by mid-twentieth century atomic tests (Broderick). Remakes also highlight emerging themes requiring novel or updated critical frameworks. For example, environmental anxieties, largely absent in 1950s science fiction films (except for narratives involving colliding worlds or alien contacts) have appeared en masse in recent years, providing an updated view on the ethical issues posed by the fall of cities and communities (Taylor, “Urban”).In The Invasion of the Bodysnatchers and its remakes (1956, 1978, 1993), for example, the organic and vegetal nature of the aliens draws the viewer’s attention to an environment formed by combative species, allowing for threats of infestation, growth and decay of the self and individuality—a longstanding theme. In the most recent version, The Invasion (2007), special effects and directorial spirit render the orifice-seeking tendrils of the pod creatures threateningly vigorous and disturbing (Lim). More sanctimonious than physically invasive, the aliens in the 1951 version of The Day the Earth Stood Still are fed up with humankind’s fixation with atomic self-destruction, and threaten global obliteration on the earth (Cox). In the 2008 remake, the suave alien ambassador, Keanu Reeves, targets the environmental negligence of humanity.Science, including science as fiction, enters into disaster narratives in a variety of ways. Some are less obvious but provocative nonetheless; for example, movies dramatising the arrival of aliens such as War of the Worlds (1953 and 2005) or Alien (1979). These more subtle approaches can be personally confronting even without the mutation of victims into vegetables or zombies. Special effects technologies have made it possible to illustrate the course of catastrophic floods and earthquakes in considerable scientific and visual detail and to represent the interaction of natural disasters, the built environment, and people, from the scale of buildings, homes, and domestic lives to entire cities and urban populations.For instance, the blockbuster film The Day After Tomorrow (2004) runs 118 minutes, but has an uncertain fictional time frame of either a few weeks or 72 hours (if the film’s title is to taken literally). The movie shows the world as we know it being mostly destroyed. Tokyo is shattered by hailstones and Los Angeles is twisted by cyclones the likes of which Dorothy would never have seen. New York disappears beneath a mountainous tsunami. All of these events result from global climate change, though whether this is due to human (in) action or other causes is uncertain. Like their predecessors, the new wave of disaster movies like The Day After Tomorrow makes for questionable “art” (Annan). Nevertheless, their reception opens a window onto broader political and moral contexts for present anxieties. Some critics have condemned The Day After Tomorrow for its scientific inaccuracies—questioning the scale or pace of climate change. Others acknowledge errors while commending efforts to raise environmental awareness (Monbiot). Coincident with the film and criticisms in both the scientific and political arena is a new class of environmental heretic—the climate change denier. This is a shadowy character commonly associated with the presidency of George W. Bush and the oil lobby that uses minor inconsistencies of science to claim that climate change does not exist. One thing underlying both twisting facts for the purposes of making science fiction films and ignoring evidence of climate change is an infantile orientation towards the unknown. In this regard, recent films do what science fiction disaster films have always done. While freely mixing truths and half-truths for the purpose of heightened dramatic effect, they fulfil psychological tasks such as orchestrating nightmare scenarios and all too easy victories on the screen. Uncertainty regarding the precise cause, scale, or duration of cataclysmic natural phenomena is mirrored by suspension of disbelief in the viability of some human responses to portrayals of urban disaster. Science fiction, in other words, invites us to accept as possible the flight of Americans and their values to Mexico (The Day After Tomorrow), the voyage into earth’s molten core (The Core 2003), or the disposal of lava in LA’s drainage system (Volcano 1997). Reinforcing Sontag’s point, here too there is a lack of criticism of the real social and political conditions that bring about the fears depicted in the films (223). Moreover, much like news coverage, images in recent natural disaster films (like their predecessors) typically finish at the point where survivors are obliged to pick up the pieces and start all over again—the latter is not regarded as newsworthy. Allowing for developments in science fiction films and the disaster genre, Sontag’s observation remains accurate. The films are primarily concerned “with the aesthetics of destruction, with the peculiar beauties to be found in wreaking havoc, in making a mess” (213) rather than rebuilding. The Imagination of Disaster RecoverySontag’s essay contributes to an important critical perspective on science fiction film. Variations on her “psychological point of view” have been explored. (The two discourses—psychology and cinema—have parallel and in some cases intertwined histories). Moreover, in the intervening years, psychological or psychoanalytical terms and narratives have themselves become even more a part of popular culture. They feature in recent disaster films and disaster recovery discourse in the “real” world.Today, with greater frequency than in the 1950s and 60s films arguably, representations of alien invasion or catastrophic global warming serve to background conflict resolutions of a more quotidian and personal nature. Hence, viewers are led to suspect that Tom Cruise will be more likely to survive the rapacious monsters in the latest The War of the Worlds if he can become less narcissistic and a better father. Similarly, Dennis Quaid’s character will be much better prepared to serve a newly glaciated America for having rescued his son (and marriage) from the watery deep-freezer that New York City becomes in The Day After Tomorrow. In these films the domestic and familial comprise a domain of inter-personal and communal relations from which victims and heroes appear. Currents of thought from the broad literature of disaster studies and Western media also call upon this domain. The imagination of disaster recovery has come to partly resemble a set of problems organised around the needs of traumatised communities. These serve as an object of urban governance, planning, and design conceived in different ways, but largely envisioned as an organic unity that connects urban populations, their pasts, and settings in a meaningful, psychologically significant manner (Furedi; Hutchison and Bleiker; Boano). Terms like “place” or concepts like Boano’s “place-attachment" (38) feature in this discourse to describe this unity and its subjective dimensions. Consider one example. In August 2006, one year after Katrina, the highly respected Journal of Architectural Education dedicated a special issue to New Orleans and its reconstruction. Opening comments by editorialist Barbara Allen include claims presupposing enduring links between the New Orleans community conceived as an organic whole, its architectural heritage imagined as a mnemonic vehicle, and the city’s unique setting. Though largely unsupported (and arguably unsupportable) the following proposition would find agreement across a number of disaster studies and resonates in commonplace reasoning:The culture of New Orleans is unique. It is a mix of ancient heritage with layers and adaptations added by successive generations, resulting in a singularly beautiful cultural mosaic of elements. Hurricane Katrina destroyed buildings—though not in the city’s historic core—and displaced hundreds of thousands of people, but it cannot wipe out the memories and spirit of the citizens. (4) What is intriguing about the claim is an underlying intellectual project that subsumes psychological and sociological domains of reasoning within a distinctive experience of community, place, and memory. In other words, the common belief that memory is an intrinsic part of the human condition of shock and loss gives form to a theory of how urban communities experience disaster and how they might re-build—and justify rebuilding—themselves. This is problematic and invites anachronistic thinking. While communities are believed to be formed partly by memories of a place, “memory” is neither a collective faculty nor is it geographically bounded. Whose memories are included and which ones are not? Are these truly memories of one place or do they also draw on other real or imagined places? Moreover—and this is where additional circumspection is inspired by our reading of Sontag’s essay—does Allen’s editorial contribute to an aestheticised image of place, rather than criticism of the social and political conditions required for reconstruction to proceed with justice, compassionately and affectively? Allowing for civil liberties to enter the picture, Allen adds “it is necessary to enable every citizen to come back to this exceptional city if they so desire” (4). However, given that memories of places and desires for their recovery are not univocal, and often contain competing visions of what was and should be, it is not surprising they should result in competing expectations for reconstruction efforts. This has clearly proven the case for New Orleans (Vederber; Taylor, “Typologies”)ConclusionThe comparison of films invites an extension of Sontag’s analysis of the imagination of disaster to include the psychology, politics, and morality of rebuilding. Can a “psychological point of view” help us to understand not only the motives behind capturing so many scenes of destruction on screen and television, but also something of the creative impulses driving reconstruction? This invites a second question. How do some impulses, particularly those caricatured as the essence of an “enterprise culture” (Heap and Ross) associated with America’s “can-do” or others valorised as positive outcomes of catastrophe in The Upside of Down (Homer-Dixon), highlight or possibly obscure criticism of the conditions which made cities like New Orleans vulnerable in the first place? The broad outline of an answer to the second question begins to appear only when consideration of the ethics of disaster and rebuilding are taken on board. If “the upside” of “the down” wrought by Hurricane Katrina, for example, is rebuilding of any kind, at any price, and for any person, then the equation works (i.e., there is a silver lining for every cloud). If, however, the range of positives is broadened to include issues of social justice, then the figures require more complex arithmetic.ReferencesAllen, Barbara. “New Orleans and Katrina: One Year Later.” Journal of Architectural Education 60.1 (2006): 4.Annan, David. Catastrophe: The End of the Cinema? London: Lorrimer, 1975.Boano, Camillo. “‘Violent Space’: Production and Reproduction of Security and Vulnerabilities.” The Journal of Architecture 16 (2011): 37–55.Broderick, Mick, ed. Hibakusha Cinema: Hiroshima, Nagasaki and the Nuclear Image in Japanese Film. London: Kegan Paul, 1996.Cox, David. “Get This, Aliens: We Just Don’t Care!” The Guardian 15 Dec. 2008 ‹http://www.guardian.co.uk/film/filmblog/2008/dec/15/the-day-the-earth-stood-still›. Furedi, Frank. “The Changing Meaning of Disaster.” Area 39.4 (2007): 482–89.Heap, Shaun H., and Angus Ross, eds. Understanding the Enterprise Culture: Themes in the Work of Mary Douglas. Edinburgh: Edinburgh University Press, 1992. Homer-Dixon, Thomas. The Upside of Down: Catastrophe, Creativity and the Renewal of Civilization. Washington, DC: Island Press, 2006.Hutchison, Emma, and Roland Bleiker. “Emotional Reconciliation: Reconstituting Identity and Community after Trauma.” European Journal of Social Theory 11 (2008): 385–403.Lim, Dennis. “Same Old Aliens, But New Neuroses.” New York Times 12 Aug. 2007: A17.Monbiot, George. “A Hard Rain's A-gonna Fall.” The Guardian 14 May 2004.Sontag, Susan. “The Imagination of Disaster” (1965). Against Interpretation and Other Essays. New York: Dell, 1979. 209–25.Taylor, William M. “Typologies of Katrina: Mnemotechnics in Post-Disaster New Orleans.” Interstices 13 (2012): 71–84.———. “Urban Disasters: Visualising the Fall of Cities and the Forming of Human Values.” Journal of Architecture 11.5 (2006): 603–12.Verderber, Stephen. “Five Years After – Three New Orleans Neighborhoods.” Journal of Architectural Education 64.1 (2010): 107–20.Zack, Naomi. Ethics for Disaster. New York: Rowman and Littlefield, 2009.———. “Philosophy and Disaster.” Homeland Security Affairs 2, article 5 (April 2006): ‹http://www.hsaj.org/?article=2.1.5›.FilmographyAlien. Dir. Ridley Scott. Brandywine Productions, 1979.Aliens. Dir. James Cameron. Brandywine Productions, 1986.Avatar. Dir. James Cameron. Lightstorm Entertainment et al., 2009.The Core. Dir. Jon Amiel. Paramount Pictures, 2003.The Day after Tomorrow. Dir. Roland Emmerich. 20th Century Fox, 2004.The Invasion of the Body Snatchers. Dir. Don Siegel. Allied Artists, 1956; also 1978 and 1993.The Invasion. Dirs. Oliver Hirschbiegel and Jame McTeigue. Village Roadshow et al, 2007.Prometheus. Dir. Ridley Scott. Scott Free and Brandywine Productions, 2012Star Wars Episode IV: A New Hope. Dir. George Lucas. Lucasfilm, 1977.Star Wars Episode VI: Return of the Jedi. Dir. George Lucas. Lucasfilm, 1983.Volcano. Dir. Mick Jackson. 20th Century Fox, 1997.War of the Worlds. Dir. George Pal. Paramount, 1953; also Steven Spielberg. Paramount, 2005.Acknowledgments The authors are grateful to Oenone Rooksby and Joely-Kym Sobott for their assistance and advice when preparing this article. It was also made possible in part by a grant from the Australian Research Council.

I. First Brexit, then Trump: Has the past year or so ushered in a “wave” (Weisberg), a “barrage” (Desmond-Harris) or a “deluge” (Sidahmed) of that notoriously noxious affect, hate? It certainly feels that way to those of us identified with progressive social and political causes—those of us troubled, not just by Trump’s recent electoral victory, but by the far-right forces to which that victory has given voice. And yet the questions still hanging over efforts to quantify emotional or affective states leaves the claim that there has been a clear spike in hate moot (Ngai 26; Massumi 136-7; Ahmed, Promise 3-8). So let’s try asking a different question. Has this same period seen a rise, across liberal media platforms, in the rhetorical work of “hate-attribution”? Here, at least, an answer seems in readier reach. For no one given to scrolling distractedly through liberal Anglophone media outlets, from The New York Times, to The Guardian, to Slate, will be unfamiliar with a species of journalism that, in reporting the appalling activities associated with what has become known as the “alt-right” (Main; Wallace-Wells; Gourarie), articulates those activities in the rubric of a calculable uptick in hate itself.Before the U.S. Presidential election, this fledgling journalistic genre was already testing its wings, its first shudderings felt everywhere from Univision anchor Jorge Ramos’s widely publicized documentary, Hate Rising (2016), which explores the rise of white supremacist movements across the South-West U.S, to an edition of Slate’s Trumpcast entitled “The Alt-Right and a Deluge of Hate,” which broached the torment-by-Twitter of left-wing journalist David French. In the wake of the election, and the appalling acts of harassment and intimidation it seemed to authorize, the genre gained further momentum—leading to the New Yorker’s “Hate Is on the Rise After Trump’s Election,” to The Guardian’s “Trump’s Election led to Barrage of Hate,” and to Vox’s “The Wave of Post-Election Hate Reportedly Sweeping the Nation, Explained.” And it still has traction today, judging not just by James King’s recent year-in-review column, “The Year in Hate: From Donald Trump to the Rise of the Alt-Right,” but by Salon’s “A Short History of Hate” which tracks the alt-right’s meteoric 2016 rise to prominence, and the New York Times’ recently launched hate-speech aggregator, “This Week in Hate.”As should already be clear from these brisk, thumbnail accounts of the texts in question, the phenomena alluded to by the titular term “hate” are not instances of hate per se, but rather instances of “hate-speech.” The word “hate,” in other words, is being deployed here not literally, to refer to an emotional state, but metonymically, as a shorthand for “hate-speech”—a by-now widely conventionalized and legally codified parlance originating with the U.N. Declaration to describe “violent or violence-inciting speech or acts that “aim or intend to inflict injury, or incite prejudice or hatred, against persons of groups” because of their ethnic, religious, sexual or social affiliation. And there is no doubt that, beyond the headlines, these articles do incredibly important work, drawing connections between, and drawing attention to, a host of harmful activities associated with the so-called “alt-right”—from a pair of mangled, pretzel-shaped swastikas graffiti-ed in a children’s playground, to acts of harassment, intimidation and violence against women, African-Americans, Latinos, Muslims, Jews, and LGBTQ people, to Trump’s own racist, xenophobic and misogynistic tweets. Yet the fact that an emotion-term like hate is being mobilized across these texts as a metonym for the “alt-right” is no oratorical curio. Rather, it perpetuates a pervasive way of thinking about the relationship between the alt-right (a political phenomenon) and hate (an emotional phenomenon) that should give pause to those of us committed to mining that vein of cultural symptomatology now consigned, across the social sciences and critical humanities, to affect theory. Specifically, these headlines inscribe, in miniature, a kind of micro-assessment, a micro-geography and micro-theory of hate. First, they suggest that, even prior to its incarnation in specific, and dangerous, forms of speech or action, hate is in and of itself anathema, a phenomenon so unquestioningly dangerous that a putative “rise” or “spike” in its net presence provides ample pretext for a news headline. Second, they propose that hate may be localized to a particular social or political group—a group subsisting, unsurprisingly, on that peculiarly contested frontier between the ideological alt-right and the American Midwest. And third, they imply that hate is so indubitably the single most significant source of the xenophobic, racist and sexist activities they go on to describe that it may be casually used as these activities’ lexical proxy. What is crystallizing here, I suggest, is what scholars of rhetoric dub a rhetorical “constellation” (Campbell and Jamieson 332)—a constellation from which hate emerges as, a) inherently problematic, b) localizable to the “alt-right,” and, c) the primary engine of the various activities and expressions we associate with them. This constellation of conventions for thinking about hate and its relationship to the activities of right-wing extremist movement has coalesced into a “genre” we might dub the genre of “hate-attribution.” Yet while it’s far from clear that the genre is an effective one in a political landscape that’s fast becoming a political battleground, it hasn’t appeared by chance. Treating “hate,” then, less as a descriptive “grid of analysis” (Sedgwick 152), than as a rhetorical projectile, this essay opens by interrogating the “hate-attribution” genre’s logic and querying its efficacy. Having done so, it approaches the concept of “alternatives” by asking: how might calling time on the genre help us think differently about both hate itself and about the forces catalyzing, and catalyzed by, Trump’s presidential campaign? II.The rhetorical power of the genre of hate-attribution, of course, isn’t too difficult to pin down. An emotion so thoroughly discredited that its assignment is now in and of itself a term of abuse (see, for example, the O.E.D’s freshly-expanded definition of the noun “hater”), hate is an emotion the Judeo-Christian tradition deems not just responsible for but practically akin to murder (John 3:1). In part as a result of this tradition, hate has proven thoroughly resistant to efforts to elevate it from the status of an expression of a subject’s pestiferous inner life to the status of a polemical response to an object in the world. Indeed, while a great deal of the critical energy amassing under the rubric of “affect theory” has recently been put into recuperating the strategic or diagnostic value of emotions long scorned as irrelevant to oppositional struggle—from irritation and envy, to depression, anger and shame (Ngai; Cvetkovich; Gould; Love)—hate has notably not been among them. In fact, those rare scholarly accounts of affect that do address “hate,” notably Ahmed’s excellent work on right-wing extremist groups in the United Kingdom, display an understandable reluctance to rehabilitate it for progressive thought (Cultural Politics). It should come as no surprise, then, that the genre of “hate-attribution” has a rare rhetorical power. In identifying “hate” as the source of a particular position, gesture or speech-act, we effectively drain said position, gesture or speech-act of political agency or representational power—reducing it from an at-least-potentially polemical action in or response to the world, to the histrionic expression of a reprehensible personhood. Yet because hate’s near-taboo status holds across the ideological and political spectrum, what is less clear is why the genre of hate-attribution has achieved such cachet in the liberal media in particular. The answer, I would argue, lies in the fact that the work of hate-attribution dovetails all too neatly with liberal political theory’s longstanding tendency to laminate its social and civic ideals to affective ideals like “love,” “sympathy,” “compassion,” and, when in a less demonstrative humor, “tolerance”. As Martha Nussbaum’s Political Emotions has recently shown, this tradition has an impressive philosophical pedigree, running from Aristotle’s philia (16), John Locke’s “toleration” and David Hume’s “sympathy” (69-75), to the twentieth century’s Universal Declaration of Human Rights, with its promotion of “tolerance and friendship among all nations, racial or religious groups.” And while the labour of what Lauren Berlant calls “liberal sentimentality” (“Poor Eliza”, 636) has never quite died away, it does seem to have found new strength with the emergence of the “intimate public sphere” (Berlant, Queen)—from its recent popular apotheosis in the Clinton campaign’s notorious “Love Trumps Hate” (a slogan in which “love,” unfortunately, came to look a lot like resigned technocratic quietism in the face of ongoing economic and environmental crisis [Zizek]), to its revival as a philosophical project among progressive scholars, many of them under the sway of the so-called “affective turn” (Nussbaum; Hardt; Sandoval; hooks). No surprise, then, that liberalism’s struggle to yoke itself to “love” should have as its eerie double a struggle to locate among its ideological and political enemies an increasingly reified “hate”. And while the examples of this project we’ve touched on so far have hailed from popular media, this set of protocols for thinking about hate and its relationship to the activities of right-wing extremist movements is not unique to media circles. It’s there in political discourse, as in ex-DNC chair Debbie Wasserman Schultz’s announcement, on MSNBC, that “Americans will unite against [Trump’s] hatred.” And it’s there, too, in academic media studies, from FLOW journal’s November 2016 call for papers inviting respondents to comment, among other things, on “the violence and hatred epitomized by Trump and his supporters,” to the SCMS conference’s invitation to members to participate in a pop-up panel entitled “Responding to Hate, Disenfranchisement and the Loss of the Commons.” Yet while the labor of hate-attribution to which many progressive forces have become attached carries an indisputable rhetorical force, it also has some profound rhetorical flaws. The very same stigma, after all, that makes “hate” such a powerful explanatory grenade to throw also makes it an incredibly tough one to land. As Ahmed’s analysis of the online rhetoric of white supremacist organizations should remind us (Cultural Politics), most groups structured around inciting and promoting violence against women and minorities identify, perversely, not as hate groups, but as movements propelled by the love of race and nation. And while left-wing pundits pronounce “hate” the signature emotion of a racist, misogynist Trump-voting right, supporters of Trump ascribe it, just as routinely, to the so-called “liberal elite,” a group whose mythical avatars—from the so-called “Social Justice Warrior” or “SJW,” to the supercilious Washington politico—are said to brand “ordinary [white, male] Americans” indiscriminately as racist, misogynistic, homophobic buffoons. Thus, for example, The Washington Post’s uncanny, far-right journalistic alter-ego, The Washington Times, dubs the SPLC a “liberal hate group”; the Wikipedia mirror-site, Conservapedia, recasts liberal objections to gun violence as “liberal hate speech” driven by an “irrational aversion to weapons”; while one blood-curdling sub-genre of reportage on Steve Bannon’s crypto-fascist soapbox, Breitbart News, is devoted to denouncing what it calls “ ‘anti-White Racism.’” It’s easy enough, of course, to defend the hate-attribution genre’s liberal incarnations while dismissing its right-wing variants as cynical, opportunistic shams, as Ahmed does (Cultural Politics)—thereby re-establishing the wellspring of hate where we are most comfortable locating it: among our political others. Yet to do so seems, in some sense, to perpetuate a familiar volley of hate-attribution. And to the extent that, as many media scholars have shown (Philips; Reed; Tett; Turow), our digital, networked political landscape is in danger of being reduced to a silo-ed discursive battleground, the ritual exchange of terminological grenades that everyone seems eager to propel across ideological lines, but that no one, understandably, seems willing to pick up, seems counter-productive to say the least.Even beyond the genre’s ultimate ineffectiveness, what should strike anyone used to reflecting on affect is how little justice it does to the ubiquity and intricacy of “hate” as an affective phenomenon. Hate is not and cannot be the exclusive property or preserve of one side of the political spectrum. One doesn’t have to stretch one’s critical faculties too far to see the extent to which the genre of hate-attribution participates in the emotional ballistics it condemns or seeks to redress. While trafficking in a relatively simple hate-paradigm (as a subjective emotional state that may be isolated to a particular person or group), the genre itself incarnates a more complex, socially dynamic model of hate in which the emotion operates through logics of projection perhaps best outlined by Freud. In the “hate-attribution” genre, that is, hate—like those equally abjected categories “sentimentality,” “worldliness” or “knowingness” broached by Sedgwick in her bravura analyses of “scapegoating attribution” (150-158)—finds its clearest expression in and through the labor of its own adscription. And it should come as no surprise that an emotion so widely devalued, where it is not openly prohibited, might also find expression in less overt form.Yet to say as much is by no means to discredit the genre. As legal scholar Jeremy Waldron has recently pointed out, there’s no particular reason why “the passions and emotions that lie behind a particular speech act” (34)—even up to and including hate—should devalue the speech acts they rouse. On the contrary, to pin the despicable and damaging activities of the so-called “alt right” on “hate” is, if anything, to do an injustice to a rich and complex emotion that can be as generative as it can be destructive. As Freud suggests in “Group Psychology and the Analysis of the Ego,” for example, hate may be the very seed of love, since the forms of “social feeling” (121) celebrated under the liberal rubric of “tolerance,” “love,” and “compassion,” are grounded in “the reversal of what was first a hostile feeling into a positively-toned tie in the nature of an identification” (121; italics mine). Indeed, Freud projects this same argument across a larger, historical canvas in Civilization and its Discontents, which contends that it is in our very struggle to combat our “aggressive instincts” that human communities have developed “methods intended to incite people into identifications and aim-inhibited relationships of love” (31). For Freud, that is, the practice of love is a function of ongoing efforts to see hate harnessed, commuted and transformed. III.What might it mean, then, to call time on this round of hate-attribution? What sort of “alternatives” might emerge when we abandon the assumption that political engagement entails a “struggle over who has the right to declare themselves as acting out of love” (Ahmed, Cultural Politics 131), and thus, by that same token, a struggle over the exact location and source of hate? One boon, I suggest, is the license it gives those of us on the progressive left to simply own our own hate. There’s little doubt that reframing the dangerous and destructive forms of speech fomented by Trump’s campaign, not as eruptions of hate, or even as “hate-speech,” but as speech we hate would be more consistent with what once seemed affect theory’s first commandment: to take our own affective temperature before launching headlong into critical analysis. After all, when Lauren Berlant (“Trump”) takes a stab at economist Paul Krugman’s cautions against “the Danger of Political Emotions” with the timely reminder that “all the messages are emotional,” the “messages” she’s pointing to aren’t just those of our political others, they’re ours; and the “emotions” she’s pointing to aren’t just the evacuated, insouciant versions of love championed by the Clinton campaign, they’re of the messier, or as Ngai might put it, “uglier” (2) variety—from shame, depression and anger, to, yes, I want to insist, hate.By way of jump-starting this program of hate-avowal, then, let me just say it: this essay was animated, in part, by a certain kind of hate. The social critic in me hates the breathtaking simplification of the complex social, economic and emotional forces animating Trump voters that seem to actuate some liberal commentary; the psychologist in me hates the self-mystification palpable in the left’s insistence on projecting and thus disowning its own (often very well justified) aggressions; and the human being in me, hating the kind of toxic speech to which Trump’s campaign has given rise, wishes to be able to openly declare that hatred. Among its other effects, hate is characterized by hypervigilance for lapses or failings in an object it deems problematic, a hypervigilance that—sometimes—animates analysis (Zeki and Romoya). In this sense, “hate” seems entitled to a comfortable place in the ranks of what Nick Salvato has recently dubbed criticism’s creative “obstructions”—phenomena that, while “routinely identified as detriments” to critical inquiry, may also “form the basis for … critical thinking” (1).Yet while one boon associated with this disclosure might be a welcome intellectual honesty, a more significant boon, I’d argue, is what getting this disclosure out of the way might leave room for. Opting out of the game of hurling “hate” back and forth across a super-charged political arena, that is, we might devote our column inches and Facebook posts to the less sensational but more productive task of systematically challenging the specious claims, and documenting the damaging effects, of a species of utterance (Butler; Matsuda; Waldron) we’ve grown used to simply descrying as pure, distilled “hate”. And we also might do something else. Relieved of the confident conviction that we can track “Trumpism” to a spontaneous outbreak of a single, localizable emotion, we might be able to offer a fuller account of the economic, social, political and affective forces that energize it. Certainly, hate plays a part here—although the process by which, as Isabelle Stengers puts it, affect “make[s] present, vivid and mattering … a worldly world” (371) demands that we scrutinize that hate as a syndrome, rather than simply moralize it as a sin, addressing its mainsprings in a moment marked by the nerve-fraying and life-fraying effects of what has become known across the social sciences and critical humanities as conditions of social and economic “precarity” (Muehlebach; Neil and Rossiter; Stewart).But perhaps hate’s not the only emotion tucked away under the hood. Here’s something affect theory knows today: affect moves not, as more traditional theorists of political emotion have it, “unambiguously and predictably from one’s cognitive processing,” but in ways that are messy, muddled and indirect (Gould 24). That form of speech is speech we hate. But it may not be “hate speech.” That crime is a crime we hate. But it may not be a “hate-crime.” One of the critical tactics we might crib from Berlant’s work in Cruel Optimism is that of decoding and decrypting, in even the most hateful acts, an instance of what Berlant, herself optimistically, calls “optimism.” For Berlant, after all, optimism is very often cruel, attaching itself, as it seems to have done in 2016, to scenes, objects and people that, while ultimately destined to “imped[e] the aim that brought [it to them] initially,” nevertheless came to seem, to a good portion of the electorate, the only available exponent of that classic good-life genre, “the change that’s gonna come” (“Trump” 1-2) at a moment when the Democratic party’s primary campaign promise was more of the free-market same. 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All history of this area and the general talk and all of that is that 1973 was a turning point and the Aquarius Festival is credited with having turned this region around in so many ways, but I think that is a myth ... and I have to honour the truth; and the truth is that old Dicke Donelly came and did a Welcome to Country the night before the festival. (Joseph in Joseph and Hanley)In 1973 the Australian Union of Students (AUS) held the Aquarius Arts and Lifestyle Festival in a small, rural New South Wales town called Nimbin. The festival was seen as the peak expression of Australian counterculture and is attributed to creating the “Rainbow Region”, an area with a concentration of alternative life stylers in Northern NSW (Derrett 28). While the Aquarius Festival is recognised as a founding historical and countercultural event, the unique and important relationships established with Indigenous people at this time are generally less well known. This article investigates claims that the 1973 Aquarius Festival was “the first event in Australian history that sought permission for the use of the land from the Traditional Owners” (Joseph and Hanley). The diverse international, national and local conditions that coalesced at the Aquarius Festival suggest a fertile environment was created for reconciliatory bonds to develop. Often dismissed as a “tree hugging, soap dodging movement,” the counterculture was radically politicised having sprung from the 1960s social revolutions when the world witnessed mass demonstrations that confronted war, racism, sexism and capitalism. Primarily a youth movement, it was characterised by flamboyant dress, music, drugs and mass gatherings with universities forming the epicentre and white, middle class youth leading the charge. As their ideals of changing the world were frustrated by lack of systematic change, many decided to disengage and a migration to rural settings occurred (Jacob; Munro-Clarke; Newton). In the search for alternatives, the counterculture assimilated many spiritual practices, such as Eastern traditions and mysticism, which were previously obscure to the Western world. This practice of spiritual syncretism can be represented as a direct resistance to the hegemony of the dominant Western culture (Stell). As the new counterculture developed, its progression from urban to rural settings was driven by philosophies imbued with a desire to reconnect with and protect the natural world while simultaneously rejecting the dominant conservative order. A recurring feature of this countercultural ‘back to the land’ migration was not only an empathetic awareness of the injustices of colonial past, but also a genuine desire to learn from the Indigenous people of the land. Indigenous people were generally perceived as genuine opposers of Westernisation, inherently spiritual, ecological, tribal and communal, thus encompassing the primary values to which the counterculture was aspiring (Smith). Cultures converged. One, a youth culture rebelling from its parent culture; the other, ancient cultures reeling from the historical conquest by the youths’ own ancestors. Such cultural intersections are rich with complex scenarios and politics. As a result, often naïve, but well-intended relations were established with Native Americans, various South American Indigenous peoples, New Zealand Maori and, as this article demonstrates, the Original People of Australia (Smith; Newton; Barr-Melej; Zolov). The 1960s protest era fostered the formation of groups aiming to address a variety of issues, and at times many supported each other. Jennifer Clarke says it was the Civil Rights movement that provided the first models of dissent by formulating a “method, ideology and language of protest” as African Americans stood up and shouted prior to other movements (2). The issue of racial empowerment was not lost on Australia’s Indigenous population. Clarke writes that during the 1960s, encouraged by events overseas and buoyed by national organisation, Aborigines “slowly embarked on a political awakening, demanded freedom from the trappings of colonialism and responded to the effects of oppression at worst and neglect at best” (4). Activism of the 1960s had the “profoundly productive effect of providing Aborigines with the confidence to assert their racial identity” (159). Many Indigenous youth were compelled by the zeitgeist to address their people’s issues, fulfilling Charlie Perkins’s intentions of inspiring in Indigenous peoples a will to resist (Perkins). Enjoying new freedoms of movement out of missions, due to the 1967 Constitutional change and the practical implementation of the assimilation policy, up to 32,000 Indigenous youth moved to Redfern, Sydney between 1967 and 1972 (Foley, “An Evening With”). Gary Foley reports that a dynamic new Black Power Movement emerged but the important difference between this new younger group and the older Indigenous leaders of the day was the diverse range of contemporary influences. Taking its mantra from the Black Panther movement in America, though having more in common with the equivalent Native American Red Power movement, the Black Power Movement acknowledged many other international struggles for independence as equally inspiring (Foley, “An Evening”). People joined together for grassroots resistance, formed anti-hierarchical collectives and established solidarities between varied groups who previously would have had little to do with each other. The 1973 Aquarius Festival was directly aligned with “back to the land” philosophies. The intention was to provide a place and a reason for gathering to “facilitate exchanges on survival techniques” and to experience “living in harmony with the natural environment.” without being destructive to the land (Dunstan, “A Survival Festival”). Early documents in the archives, however, reveal no apparent interest in Australia’s Indigenous people, referring more to “silken Arabian tents, mediaeval banners, circus, jugglers and clowns, peace pipes, maypole and magic circles” (Dunstan, “A Survival Festival”). Obliterated from the social landscape and minimally referred to in the Australian education system, Indigenous people were “off the radar” to the majority mindset, and the Australian counterculture similarly was slow to appreciate Indigenous culture. Like mainstream Australia, the local counterculture movement largely perceived the “race” issue as something occurring in other countries, igniting the phrase “in your own backyard” which became a catchcry of Indigenous activists (Foley, “Whiteness and Blackness”) With no mention of any Indigenous interest, it seems likely that the decision to engage grew from the emerging climate of Indigenous activism in Australia. Frustrated by student protestors who seemed oblivious to local racial issues, focusing instead on popular international injustices, Indigenous activists accused them of hypocrisy. Aquarius Festival directors, found themselves open to similar accusations when public announcements elicited a range of responses. Once committed to the location of Nimbin, directors Graeme Dunstan and Johnny Allen began a tour of Australian universities to promote the upcoming event. While at the annual conference of AUS in January 1973 at Monash University, Dunstan met Indigenous activist Gary Foley: Gary witnessed the presentation of Johnny Allen and myself at the Aquarius Foundation session and our jubilation that we had agreement from the village residents to not only allow, but also to collaborate in the production of the Festival. After our presentation which won unanimous support, it was Gary who confronted me with the question “have you asked permission from local Aboriginal folk?” This threw me into confusion because we had seen no Aboriginals in Nimbin. (Dunstan, e-mail) Such a challenge came at a time when the historical climate was etched with political activism, not only within the student movement, but more importantly with Indigenous activists’ recent demonstrations, such as the installation in 1972 of the Tent Embassy in Canberra. As representatives of the counterculture movement, which was characterised by its inclinations towards consciousness-raising, AUS organisers were ethically obliged to respond appropriately to the questions about Indigenous permission and involvement in the Aquarius Festival at Nimbin. In addition to this political pressure, organisers in Nimbin began hearing stories of the area being cursed or taboo for women. This most likely originated from the tradition of Nimbin Rocks, a rocky outcrop one kilometre from Nimbin, as a place where only certain men could go. Jennifer Hoff explains that many major rock formations were immensely sacred places and were treated with great caution and respect. Only a few Elders and custodians could visit these places and many such locations were also forbidden for women. Ceremonies were conducted at places like Nimbin Rocks to ensure the wellbeing of all tribespeople. Stories of the Nimbin curse began to spread and most likely captivated a counterculture interested in mysticism. As organisers had hoped that news of the festival would spread on the “lips of the counterculture,” they were alarmed to hear how “fast the bad news of this curse was travelling” (Dunstan, e-mail). A diplomatic issue escalated with further challenges from the Black Power community when organisers discovered that word had spread to Sydney’s Indigenous community in Redfern. Organisers faced a hostile reaction to their alleged cultural insensitivity and were plagued by negative publicity with accusations the AUS were “violating sacred ground” (Janice Newton 62). Faced with such bad press, Dunstan was determined to repair what was becoming a public relations disaster. It seemed once prompted to the path, a sense of moral responsibility prevailed amongst the organisers and they took the unprecedented step of reaching out to Australia’s Indigenous people. Dunstan claimed that an expedition was made to the local Woodenbong mission to consult with Elder, Uncle Lyle Roberts. To connect with local people required crossing the great social divide present in that era of Australia’s history. Amy Nethery described how from the nineteenth century to the 1960s, a “system of reserves, missions and other institutions isolated, confined and controlled Aboriginal people” (9). She explains that the people were incarcerated as a solution to perceived social problems. For Foley, “the widespread genocidal activity of early “settlement” gave way to a policy of containment” (Foley, “Australia and the Holocaust”). Conditions on missions were notoriously bad with alcoholism, extreme poverty, violence, serious health issues and depression common. Of particular concern to mission administrators was the perceived need to keep Indigenous people separate from the non-indigenous population. Dunstan described the mission he visited as having “bad vibes.” He found it difficult to communicate with the elderly man, and was not sure if he understood Dunstan’s quest, as his “responses came as disjointed raves about Jesus and saving grace” (Dunstan, e-mail). Uncle Lyle, he claimed, did not respond affirmatively or negatively to the suggestion that Nimbin was cursed, and so Dunstan left assuming it was not true. Other organisers began to believe the curse and worried that female festival goers might get sick or worse, die. This interpretation reflected, as Vanessa Bible argues, a general Eurocentric misunderstanding of the relationship of Indigenous peoples with the land. Paul Joseph admits they were naïve whites coming into a place with very little understanding, “we didn’t know if we needed a witch doctor or what we needed but we knew we needed something from the Aborigines to lift the spell!”(Joseph and Hanley). Joseph, one of the first “hippies” who moved to the area, had joined forces with AUS organisers. He said, “it just felt right” to get Indigenous involvement and recounted how organisers made another trip to Woodenbong Mission to find Dickee (Richard) Donnelly, a Song Man, who was very happy to be invited. Whether the curse was valid or not it proved to be productive in further instigating respectful action. Perhaps feeling out of their depth, the organisers initiated another strategy to engage with Australian Indigenous people. A call out was sent through the AUS network to diversify the cultural input and it was recommended they engage the services of South African artist, Bauxhau Stone. Timing aligned well as in 1972 Australia had voted in a new Prime Minister, Gough Whitlam. Whitlam brought about significant political changes, many in response to socialist protests that left a buoyancy in the air for the counterculturalist movement. He made prodigious political changes in support of Indigenous people, including creating the Aboriginal Arts Board as part of the Australian Council of the Arts (ACA). As the ACA were already funding activities for the Aquarius Festival, organisers were successful in gaining two additional grants specifically for Indigenous participation (Farnham). As a result We were able to hire […] representatives, a couple of Kalahari bushmen. ‘Cause we were so dumb, we didn’t think we could speak to the black people, you know what I mean, we thought we would be rejected, or whatever, so for us to really reach out, we needed somebody black to go and talk to them, or so we thought, and it was remarkable. This one Bau, a remarkable fellow really, great artist, great character, he went all over Australia. He went to Pitjantjatjara, Yirrkala and we arranged buses and tents when they got here. We had a very large contingent of Aboriginal people come to the Aquarius Festival, thanks to Whitlam. (Joseph in Joseph and Henley) It was under the aegis of these government grants that Bauxhau Stone conducted his work. Stone embodied a nexus of contemporary issues. Acutely aware of the international movement for racial equality and its relevance to Australia, where conditions were “really appalling”, Stone set out to transform Australian race relations by engaging with the alternative arts movement (Stone). While his white Australian contemporaries may have been unaccustomed to dealing with the Indigenous racial issue, Stone was actively engaged and thus well suited to act as a cultural envoy for the Aquarius Festival. He visited several local missions, inviting people to attend and notifying them of ceremonies being conducted by respected Elders. Nimbin was then the site of the Aquarius Lifestyle and Celebration Festival, a two week gathering of alternative cultures, technologies and youth. It innovatively demonstrated its diversity of influences, attracted people from all over the world and was the first time that the general public really witnessed Australia’s counterculture (Derrett 224). As markers of cultural life, counterculture festivals of the 1960s and 1970s were as iconic as the era itself and many around the world drew on the unique Indigenous heritage of their settings in some form or another (Partridge; Perone; Broadley and Jones; Zolov). The social phenomenon of coming together to experience, celebrate and foster a sense of unity was triggered by protests, music and a simple, yet deep desire to reconnect with each other. Festivals provided an environment where the negative social pressures of race, gender, class and mores (such as clothes) were suspended and held the potential “for personal and social transformation” (St John 167). With the expressed intent to “take matters into our own hands” and try to develop alternative, innovative ways of doing things with collective participation, the Aquarius Festival thus became an optimal space for reinvigorating ancient and Indigenous ways (Dunstan, “A Survival Festival”). With philosophies that venerated collectivism, tribalism, connecting with the earth, and the use of ritual, the Indigenous presence at the Aquarius Festival gave attendees the opportunity to experience these values. To connect authentically with Nimbin’s landscape, forming bonds with the Traditional Owners was essential. Participants were very fortunate to have the presence of the last known initiated men of the area, Uncle Lyle Roberts and Uncle Dickee Donnely. These Elders represented the last vestiges of an ancient culture and conducted innovative ceremonies, song, teachings and created a sacred fire for the new youth they encountered in their land. They welcomed the young people and were very happy for their presence, believing it represented a revolutionary shift (Wedd; King; John Roberts; Cecil Roberts). Images 1 and 2: Ceremony and talks conducted at the Aquarius Festival (people unknown). Photographs reproduced by permission of photographer and festival attendee Paul White. The festival thus provided an important platform for the regeneration of cultural and spiritual practices. John Roberts, nephew of Uncle Lyle, recalled being surprised by the reaction of festival participants to his uncle: “He was happy and then he started to sing. And my God … I couldn’t get near him! There was this big ring of hippies around him. They were about twenty deep!” Sharing to an enthusiastic, captive audience had a positive effect and gave the non-indigenous a direct Indigenous encounter (Cecil Roberts; King; Oshlak). Estimates of the number of Indigenous people in attendance vary, with the main organisers suggesting 800 to 1000 and participants suggesting 200 to 400 (Stone; Wedd; Oshlak: Joseph; King; Cecil Roberts). As the Festival lasted over a two week period, many came and left within that time and estimates are at best reliant on memory, engagement and perspectives. With an estimated total attendance at the Festival between 5000 and 10,000, either number of Indigenous attendees is symbolic and a significant symbolic statistic for Indigenous and non-indigenous to be together on mutual ground in Australia in 1973. Images 3-5: Performers from Yirrkala Dance Group, brought to the festival by Stone with funding from the Federal Government. Photographs reproduced by permission of photographer and festival attendee Dr Ian Cameron. For Indigenous people, the event provided an important occasion to reconnect with their own people, to share their culture with enthusiastic recipients, as well as the chance to experience diverse aspects of the counterculture. Though the northern NSW region has a history of diverse cultural migration of Italian and Indian families, the majority of non-indigenous and Indigenous people had limited interaction with cosmopolitan influences (Kijas 20). Thus Nimbin was a conservative region and many Christianised Indigenous people were also conservative in their outlook. The Aquarius Festival changed that as the Indigenous people experienced the wide-ranging cultural elements of the alternative movement. The festival epitomised countercultural tendencies towards flamboyant fashion and hairstyles, architectural design, fantastical art, circus performance, Asian clothes and religious products, vegetarian food and nudity. Exposure to this bohemian culture would have surely led to “mind expansion and consciousness raising,” explicit aims adhered to by the movement (Roszak). Performers and participants from Africa, America and India also gave attending Indigenous Australians the opportunity to interact with non-European cultures. Many people interviewed for this paper indicated that Indigenous people’s reception of this festival experience was joyous. For Australia’s early counterculture, interest in Indigenous Australia was limited and for organisers of the AUS Aquarius Festival, it was not originally on the agenda. The counterculture in the USA and New Zealand had already started to engage with their Indigenous people some years earlier. However due to the Aquarius Festival’s origins in the student movement and its solidarities with the international Indigenous activist movement, they were forced to shift their priorities. The coincidental selection of a significant spiritual location at Nimbin to hold the festival brought up additional challenges and countercultural intrigue with mystical powers and a desire to connect authentically to the land, further prompted action. Essentially, it was the voices of empowered Indigenous activists, like Gary Foley, which in fact triggered the reaching out to Indigenous involvement. While the counterculture organisers were ultimately receptive and did act with unprecedented respect, credit must be given to Indigenous activists. The activist’s role is to trigger action and challenge thinking and in this case, it was ultimately productive. Therefore the Indigenous people were not merely passive recipients of beneficiary goodwill, but active instigators of appropriate cultural exchange. After the 1973 festival many attendees decided to stay in Nimbin to purchase land collectively and a community was born. Relationships established with local Indigenous people developed further. Upon visiting Nimbin now, one will see a vibrant visual display of Indigenous and psychedelic themed art, a central park with an open fire tended by local custodians and other Indigenous community members, an Aboriginal Centre whose rent is paid for by local shopkeepers, and various expressions of a fusion of counterculture and Indigenous art, music and dance. While it appears that reconciliation became the aspiration for mainstream society in the 1990s, Nimbin’s early counterculture history had Indigenous reconciliation at its very foundation. The efforts made by organisers of the 1973 Aquarius Festival stand as one of very few examples in Australian history where non-indigenous Australians have respectfully sought to learn from Indigenous people and to assimilate their cultural practices. It also stands as an example for the world, of reconciliation, based on hippie ideals of peace and love. They encouraged the hippies moving up here, even when they came out for Aquarius, old Uncle Lyle and Richard Donnelly, they came out and they blessed the mob out here, it was like the hairy people had come back, with the Nimbin, cause the Nimbynji is the little hairy people, so the hairy people came back (Jerome). References Barr-Melej, Patrick. “Siloísmo and the Self in Allende’s Chile: Youth, 'Total Revolution,' and the Roots of the Humanist Movement.” Hispanic American Historical Review 86.4 (Nov. 2006): 747-784. Bible, Vanessa. Aquarius Rising: Terania Creek and the Australian Forest Protest Movement. BA (Honours) Thesis. University of New England, Armidale, 2010. Broadley, Colin, and Judith Jones, eds. Nambassa: A New Direction. Auckland: Reed, 1979. Bryant, Gordon M. Parliament of Australia. Minister for Aboriginal Affairs. 1 May 1973. Australian Union of Students. Records of the AUS, 1934-1991. National Library of Australia MS ACC GB 1992.0505. Cameron, Ian. “Aquarius Festival Photographs.” 1973. Clarke, Jennifer. Aborigines and Activism: Race, Aborigines and the Coming of the Sixties to Australia. Crawley: University of Western Australia Press, 2008. Derrett, Ross. Regional Festivals: Nourishing Community Resilience: The Nature and Role of Cultural Festivals in Northern Rivers NSW Communities. PhD Thesis. Southern Cross University, Lismore, 2008. Dunstan, Graeme. “A Survival Festival May 1973.” 1 Aug. 1972. Pamphlet. MS 6945/1. Nimbin Aquarius Festival Archives. National Library of Australia, Canberra. ---. E-mail to author, 11 July 2012. ---. “The Aquarius Festival.” Aquarius Rainbow Region. n.d. Farnham, Ken. Acting Executive Officer, Aboriginal Council for the Arts. 19 June 1973. Letter. MS ACC GB 1992.0505. Australian Union of Students. Records of the AUS, 1934-1991. National Library of Australia, Canberra. Foley, Gary. “Australia and the Holocaust: A Koori Perspective (1997).” The Koori History Website. n.d. 20 May 2013 ‹http://www.kooriweb.org/foley/essays/essay_8.html›. ---. “Whiteness and Blackness in the Koori Struggle for Self-Determination (1999).” The Koori History Website. n.d. 20 May 2013 ‹http://www.kooriweb.org/foley/essays/essay_9.html›. ---. “Black Power in Redfern 1968-1972 (2001).” The Koori History Website. n.d. 20 May 2013 ‹http://www.kooriweb.org/foley/essays/essay_1.html›. ---. “An Evening with Legendary Aboriginal Activist Gary Foley.” Conference Session. Marxism 2012 “Revolution in the Air”, Melbourne, Mar. 2012. Hoff, Jennifer. Bundjalung Jugun: Bundjalung Country. Lismore: Richmond River Historical Society, 2006. Jacob, Jeffrey. New Pioneers: The Back-to-the-Land Movement and the Search for a Sustainable Future. Pennsylvania: Penn State Press, 1997. Jerome, Burri. Interview. 31 July 2012. Joseph, Paul. Interview. 7 Aug. 2012. 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Photo by 193001056 © Yee Xin Tan on Dreamstime.com ABSTRACT Suicide and overdose, associated with perinatal mental health conditions, are the leading causes of maternal mortality in the United States. Experts in the field of perinatal mental health are using perinatal mood and anxiety disorders (PMAD) as an umbrella term that includes many mental health conditions and bring to light the lack of screening and treatment for perinatal mental health in the United States. There is a growing need to equip Obstetricians and Gynecologist (OB-GYN) providers with better tools to screen, triage, and refer to mental health services that are equitable and immediately accessible to their patients. Integrating a tech-enabled perinatal collaborative care model with peer-to-peer coaching as the driver of behavior change is a novel approach to addressing the maternal mental health crisis by improving outcomes, reducing disparities, and lowering costs. INTRODUCTION Over the past two decades, maternal mortality and other maternal health outcomes have worsened in the United States disproportionately to those in other developed countries.[1] In 2021, 1,205 pregnant women died in the US, representing a 40 percent increase in maternal death from 2020 and the highest rise in rates since the 1960s.[2] Suicide and overdose associated with perinatal mental health conditions are the leading causes of maternal mortality.[3] Mental health-related deaths are most likely to occur after six weeks postpartum.[4] Despite the postpartum period representing a higher risk for mental health conditions, historically, only a single postpartum visit is performed between 4 and 6 weeks after delivery. 40 percent of women do not attend a postpartum visit.[5] Recent data from Maternal Mortality Review Committees reveal that 80 percent of maternal deaths are preventable. The maternal mental health crisis represents a unique ethical dilemma. For perinatal women, the current healthcare system is unjust. There is a growing need to equip obstetricians and gynecologists (OB-GYNs) with the tools to screen, triage, and refer patients to mental health services that are equitable and immediately accessible to their patients. This paper will analyze the current state of perinatal mental healthcare in America. It will introduce the Psychiatric Collaborative Care Model and demonstrate its effectiveness. I highlight research performed using the Psychiatric Collaborative Care Model in obstetrics as well as barriers to real-world implementation. Lastly, this paper will argue that the integration of a tech-enabled perinatal collaborative care model with peer-to-peer coaching as the driver of behavior change would improve outcomes, reduce disparities, and lower costs. I. Scope of the Problem Prior to the COVID-19 pandemic, the prevalence of postpartum depression ranged from 13.2 percent, to as high as 23.5 percent, of births in the US.[6] The COVID-19 pandemic has exacerbated this issue, with studies revealing up to 1 in 3 postpartum women experiencing postpartum depression.[7] Although postpartum depression has been the focus of perinatal mental health conditions, it is just the tip of the iceberg. Experts in the field of perinatal mental health are now using perinatal mood and anxiety disorders as an umbrella term that includes perinatal depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder, and psychosis from the prenatal period through the first year postpartum. Socio-economically disadvantaged women are at increased risk of experiencing perinatal mood and anxiety disorders and face greater barriers to high-quality mental health care.[8] The American College of Obstetricians and Gynecologists (ACOG) recommends that physicians perform postpartum depression screenings during pregnancy. The Health Resources and Services Administration provides Healthy Start Initiative Grants to communities with high rates of adverse perinatal outcomes. Yet, the Healthcare Effectiveness Data and Information Set (HEDIS) reveals that screening in both pregnancy and the postpartum period occurs in fewer than 20 percent of patients.[9] Furthermore, in the US, if screening does occur, only 22 percent of women who are deemed positive in their screening receive mental health care.[10] The United States is currently experiencing a shortage of mental health providers that is expected to worsen in the upcoming years.[11] Nearly half of all Americans currently live in a mental health professional desert.[12] Waitlists for therapists and psychiatrists average 48 days, and individuals report not seeking mental health care due to cost or lack of insurance coverage.[13] Given the significant mental health provider shortage, obstetric providers have a unique opportunity to care for the “whole patient” during and after pregnancy by addressing not only their physical health but also their mental health. Approximately one-third of women consider their OB-GYN their primary care provider during and after pregnancy, and over 50 percent of OB-GYNs perceive themselves as primary care providers for women, supporting primary, specialty, and preventive care.[14] Medicaid covers 42 percent of all births in the US, and more than half of all births in some states, thus OB-GYNs provide a disproportionate amount of care for poor and minority women as compared to other specialties.[15] Yet, OB-GYN providers commonly feel hesitant to screen for depression due to the shortage of therapists and psychiatrists to address the mental health needs of their patients, particularly in the Medicaid population.[16] As a result, fewer than 10 percent of pregnant women with mental health conditions receive adequate treatment.[17] A recent study of 288 obstetrics fellows revealed that 84 percent prescribed SSRIs to their patients; obstetricians are filling the mental health provider gap and taking ownership over their patients’ mental health.[18] Despite ACOG’s recommendations that obstetrics providers screen for and treat mental health conditions in the perinatal period, OB-GYNs do not receive formal mental health training during residency or fellowship and do not typically use validated tools such as the Diagnostic and Statistical Manual of Mental Disorders-Forth Edition (DSM-IV) for diagnosis of depression or prior to prescribing antidepressants. Their lack of a standard reference can lead to misdiagnoses.[19] In fact, 22 percent of women screened and found to have postpartum depression are later diagnosed with bipolar disorder.[20] Screening and treatment for perinatal mood and anxiety disorders are further impacted by patients’ lack of trust in healthcare providers. Distrust between patients, particularly those receiving Medicaid, and their OB-GYNs in the US is high and strongly associated with worse self-reported health outcomes.[21] Notably, women with Medicaid coverage reported being treated unfairly and with disrespect by providers because of their race and insurance status. They reported a loss of decision-making autonomy during labor and delivery and less postpartum emotional and practical support at home.[22] Many women do not feel comfortable discussing mental disorders with a healthcare provider.[23] Connecting perinatal women to a person with shared lived experiences, known as peer-to-peer engagement or coaching, may be a simple solution. II. Collaborative Care Model The Psychiatric Collaborative Care Model (collaborative care), developed by the University of Washington in 2002, is an integrated behavioral health approach designed to treat common mental health conditions such as depression and anxiety that require measurement-based follow-up due to their chronic nature.[24] Centers for Medicare and Medicaid Services issued billing codes for the Psychiatric Collaborative Care Model in 2016. Medicare adopted them in 2017, and they were widely operationalized in the primary care field.[25] As of 2022, the collaborative care billing codes have been adopted by 19 state Medicaid plans.[26] The collaborative care model facilitates the integration of a behavioral health care manager, typically a licensed therapist or care worker, in the primary care setting. The behavioral health care manager can provide in-person or virtual care and facilitate mental health screenings, symptom monitoring, psychiatric consultations, and care coordination.[27] A psychiatric consultant, typically a board-certified psychiatrist or psychiatric nurse practitioner, is an integrated behavioral health provider on the collaborative care team. Psychiatric consultants do not see patients one on one. Rather, they review complex or treatment-resistant cases and provide psychiatric management recommendations to the primary provider. Thus, the primary care team is expanded by two members who provide behavioral health expertise to the primary care provider, who is ultimately the prescribing provider if any psychoactive medications are indicated.[28] This model has been tested in over 90 randomized clinical trials evaluating efficacy for the treatment of depression and anxiety across multiple medical specialties.[29] Data from the primary care setting indicate that this integrated behavioral health approach is both successful and more cost-effective than usual care for patients with behavioral health conditions.[30] Studies show that the collaborative care model improves clinical outcomes and lowers costs, returning $6.50 for every dollar spent on treatment of depression. Furthermore, the model is effective across diverse patient populations.[31] III. Evidence for Collaborative Care in Obstetrics The success of the collaborative care model for identifying anxiety and depression in the primary care setting and its potential for cost savings suggest that implementation of perinatal collaborative care for perinatal mood and anxiety disorders is a feasible approach.[32] Randomized clinical trials showed significant improvement in quality care, depression severity, and remission rates from before birth to 18 months postbaseline for socioeconomically disadvantaged women.[33] In addition, collaborative care is associated with mitigating racial disparities in antenatal depression care; it may be an equity-promoting intervention for maternal health.[34] The trials faced limitations, including the inability to establish causality, and the researchers recommended further research. Although further research is warranted, the collaborative care model in obstetrics programs has indicated improved depression outcomes. IV. Barriers to Adoption of a Collaborative Care Model in Obstetrics Despite promising results, implementation is limited, and collaborative care is billable under Medicaid in only 19 states.[35] Large health systems have difficulty operationalizing a collaborative care model in obstetrics due to implementation costs, mental health provider shortages, and administrative burdens. More evidence of financial benefits to obstetrics clinics, hospitals, and health systems is needed. Additionally, obstetric practices must adapt to updated care plans, and obstetricians must be motivated to become involved in behavioral health issues and potentially broaden their scope of practice.[36] As this is a major ask from practices and providers, robust evidence is lacking to show that a perinatal collaborative care model can be applied without the resources and infrastructure of a randomized trial. V. Peer-to-Peer Engagement Peer support in healthcare is growing. Peer support is defined as help and support that people with lived experiences can give one another.[37] Effective examples of peer support or engagement are found in addiction, mental health services, and the workforce. Regarding addiction recovery support, a systematic review concluded that peer support interventions have a beneficial effect on participants and positively contribute to substance use outcomes.[38] Peer support is highly used in medicine and other professions when attending physicians or skilled professionals train new colleagues. The nursing profession uses peer support to help deliver quality care and reduce symptoms of burnout.[39] Peer support has been well described in literature, and programs differ in their methodology and delivery. The feasibility and maintenance of peer support programs are possible through collaboration with all healthcare stakeholders.[40] Understanding that shared experiences establish a foundation of trust may help obstetricians see peers as a way to bridge the gap. A peer coach may be valuable in the collaborative care model. VI. Integrating Peer-to-Peer into the Collaborative Care Model for Obstetrics Currently, a start-up based in Boston and Philadelphia, FamilyWell, has piloted tech-enabled peer-to-peer engagement into a collaborative care model for obstetric patients. The company strives to solve the perinatal mental health crisis and close the health equity gap in the US by applying a text messaging platform to connect expecting and newly postpartum mothers with peer coaches. Peer coaches are trained to support perinatal mothers, defined as third-trimester pregnancy through 12 months postpartum, by providing quality support based on the latest research. Coaches have their own unique birth and postpartum stories, making them relatable and equipped to support mothers through the ups and downs of parenthood.[41] Increased education, screening, and treatment for perinatal mood and anxiety disorders co-occur as connections are being made through texting and virtual visits with coaches. On demand texting with coaches ensures no mother feels alone and that mothers have a safe space to ask questions and process emotions. If needed, enrolled moms can request longer virtual coaching sessions of 50 minutes with certified perinatal mental health coaches, who focus on current issues and how to move forward and feel better, accomplished through cognitive behavioral coaching techniques.[42] The platform schedules automated text messages containing educational content. Individual care plans are developed in collaboration with an individual’s OB and include monthly mental health screenings during and post-pregnancy. Notably, at three-week postpartum, participants are sent the Edinburg postnatal depression scale 3 (EPDS-3) questions via text messages.[43] This screening is three weeks prior to the national six-weeks postpartum screening recommendation and focuses on antepartum anxiety, which represents a risk factor for depression.[44] If an individual needs more mental health support compared to coaching, virtual therapy sessions are available through the platform, giving access to licensed therapist, specializing in perinatal mental health without extensive waitlist. Therapists can diagnosis and provide medication management if needed. FamilyWell CEO and founder, Jessica Gaulton, revealed that preliminary data collected during the first two months of the company’s launch, limited to the Philadelphia, PA region and three clinics, indicated that 24 postpartum mothers consented to the program. A total of 3,000 texts were exchanged, and 44.2 percent of those texts came from participants to peer coaches.[45] The platform expediates appropriate referrals, creates individualized maternal wellness treatment plans, and serves as a resource for navigating the medical system. VII. Providing Justice in the Maternal Healthcare System The well-being of mothers is a bellwether for the well-being of society; every injustice in our society shows up in maternal health.[46] Earlier, broader, and more frequent screening combined with direct mental health access is essential to address perinatal mood and anxiety disorders and ultimately the maternal mortality rate. Integrating collaborative care with peer-to-peer coaching provides new mothers with direct support and follow-up care. This simple yet novel integration begins to close the gap by providing equitable care. The tech-based platform’s research and success highlight that a broader focus on screening is critical. Limiting mental illness to depression fails to serve women adequately. Expanding criteria to screen for indicators of future depression, such as anxiety, is a simple, proactive step. A relatable peer may be a critical factor in helping perinatal women feel comfortable openly discussing problems they are facing and beginning conversations not otherwise occurring in a perinatal or postpartum visit. Companies like FamilyWell can contribute to making collaborative care feasible in the OB-GYN setting. Having an outside organization with peer-coaches building a foundation of trust and championing the collaborative care model reduces the burden for overworked obstetricians. Furthermore, the tech-based platform can organize and facilitate interprofessional communications, which rarely take place in the current system.[47] The texting and telehealth approach brings compassion, care, and more frequent contact directly to the patient, which is critical for socioeconomically disadvantaged women as they are the demographic not properly accessing care now. As the coaches and behavior care coordinator make the referrals for mental health services that align with a mother’s insurance coverage, they reduce stress for new mothers who might not know where to begin when navigating the mental health care system. Additionally, obstetricians may feel more comfortable performing mental health screenings knowing their patients can access mental health care. CONCLUSION The perinatal mental health crisis is significant. Women are currently experiencing injustice in the healthcare system due to a lack of trust, screening, and effective, accessible care. The psychiatric collaborative care model has been proven effective in the primary care setting, and randomized clinical trials conclude it is also effective in obstetrics, but barriers exist. Integrating peer-to-peer coaching through a tech-enabled platform into obstetrics collaborative care may eliminate barriers and build trust between patients and the healthcare system. More research is needed to show the efficacy of a tech-enabled model, and more research is critical to demonstrate that this model can be financially sustainable and revenue-generating for hospitals and obstetrics departments. However, this simple novel step may begin to generate equitable care for women and potentially save lives. - [1] Collier, A. R. Y., & Molina, R. L. (2019). Maternal mortality in the United States: updates on trends, causes, and solutions. Neoreviews, 20(10), e561-e574. [2] Hoyert, D. L. (2023). Maternal Mortality Rates in the United States, 2021.Health E-Stats. National Center for Health Statistics. Centers for Disease Control. https://dx.doi.org/10.15620/cdc:124678 [3] Miller, E. S., Grobman, W. A., Ciolino, J. D., Zumpf, K., Sakowicz, A., Gollan, J., & Wisner, K. L. (2021). Increased depression screening and treatment recommendations after implementation of a perinatal collaborative care program. Psychiatric Services, 72(11), 1268-1275. [4] Trost, S. L., Beauregard, J. L., Smoots, A. N., Ko, J. Y., Haight, S. C., Moore Simas, T. A., ... & Goodman, D. (2021). Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008–17: Study examines maternal mortality and mental health. Health Affairs, 40(10), 1551-1559. [5] Blenning, C. E., & Paladine, H. L. (2005). An approach to the postpartum office visit. American Family Physician, 72(12), 2491-2496; ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstetrics and gynecology, 132(3), 784–785. https://doi.org/10.1097/AOG.0000000000002849 [6]Bauman, B. L., Ko, J. Y., Cox, S., D'Angelo Mph, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018. MMWR. Morbidity and mortality weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2 [7] Shuman, C.J., Peahl, A.F., Pareddy, N. (2022) Postpartum depression and associated risk factors during the COVID-19 pandemic. BMC Res Notes 15, 102. https://doi.org/10.1186/s13104-022-05991-8 [8] Grote, N. K., Katon, W. J., Russo, J. E., Lohr, M. J., Curran, M., Galvin, E., & Carson, K. (2015). Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial. Depression and Anxiety, 32(11), 821-834. [9] HESI Annual Report. HESI. (2022, November). Retrieved April 30, 2023, from Special-Report-Nov-2022-Results-for-Measures-Leveraging-Electronic-Clinical-Data-for-HEDIS.pdf (ncqa.org) [10] Byatt, N., Levin, L. L., Ziedonis, D., Moore Simas, T. A., & Allison, J. (2015). Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review. Obstetrics and Gynecology, 126(5), 1048–1058. https://doi.org/10.1097/AOG.0000000000001067 [11] Satiani, A., Niedermier, J., Satiani, B., & Svendsen, D. P. (2018). Projected Workforce of Psychiatrists in the United States: A Population Analysis. Psychiatric Services (Washington, D.C.), 69(6), 710–713. https://doi.org/10.1176/appi.ps.201700344 [12] Bureau of Health Workforce Health Resources and Services Administration (HRSA) U.S. Department of Health & Human Services. (April 27, 2023) Designated Health Professional Shortage Areas Statistics, Second Quarter of Fiscal Year 2023 Designated HPSA Quarterly Summary. https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport [13] Coward, K. (2021). New data shows CCBHCs improve behavioral health access, reduce wait times. Behavioral Health Business. https://bhbusiness.com/2021/05/25/new-data-shows-ccbhcs-improve-behavioral-health-access-reduce-wait-times; The United States Government. (2022, June 17). Reducing the economic burden of unmet mental health needs - CEA. The White House. Retrieved April 30, 2023, from https://www.whitehouse.gov/cea/written-materials/2022/05/31/reducing-the-economic-burden-of-unmet-mental-health-needs/ [14] LaRocco-Cockburn, A., Reed, S. D., Melville, J., Croicu, C., Russo, J. E., Inspektor, M., ... & Katon, W. (2013). Improving depression treatment for women: integrating a collaborative care depression intervention into OB-GYN care. Contemporary clinical trials, 36(2), 362-370. [15] Raney, L. (2020). Cracking the codes: State Medicaid approaches to reimbursing psychiatric collaborative care. Oakland, California Health Care Foundation. [16] Hansen, M. E. D., Tobón, A. L., Haider, U. K., Simas, T. A. M., Newsome, M., Finelli, J., ... & Byatt, N. (2023). The role of perinatal psychiatry access programs in advancing mental health equity. General Hospital Psychiatry. [17] Cox, E. Q., Sowa, N. A., Meltzer-Brody, S. E., & Gaynes, B. N. (2016). The perinatal depression treatment cascade: baby steps toward improving outcomes. The Journal of clinical psychiatry, 77(9), 20901. [18] Taouk, L. H., Matteson, K. A., Stark, L. M., & Schulkin, J. (2018). Prenatal depression screening and antidepressant prescription: obstetrician-gynecologists' practices, opinions, and interpretation of evidence. Archives of women's mental health, 21(1), 85–91. https://doi.org/10.1007/s00737-017-0760-7 [19] Garbarino, A. H., Kohn, J. R., Coverdale, J. H., & Kilpatrick, C. C. (2019). Current Trends in Psychiatric Education Among Obstetrics and Gynecology Residency Programs. Academic psychiatry: the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 43(3), 294–299. https://doi.org/10.1007/s40596-019-01018-w ; [20] Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L.,& Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA psychiatry, 70(5), 490-498 [21] Armstrong, K., Rose, A., Peters, N., Long, J. A., McMurphy, S., & Shea, J. A. (2006). Distrust of the health care system and self-reported health in the United States. Journal of general internal medicine, 21(4), 292–297. https://doi.org/10.1111/j.1525-1497.2006.00396.x [22] Declercq, E., & Zephyrin, L. (2020). Maternal mortality in the United States: A Primer. Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer [23] Scholle, S. H., & Kelleher, K. (2003). Preferences for depression advice among low-income women. Maternal and child health journal, 7(2), 95–102. https://doi.org/10.1023/a:1023864810207https://doi.org/10.1023/a:1023864810207 [24] AIMS Center. (n.d.). Collaborative care. https://aims.uw.edu/collaborative-care [25] Press, M. J., Howe, R., Schoenbaum, M., Cavanaugh, S., Marshall, A., Baldwin, L., & Conway, P. H. (2017). Medicare payment for behavioral health integration. n Engl j Med, 376(5), 405-407. [26] Chang, D., Morrison, D. J., Bowen, D. J., Harris, H. M., Dusic, E. J., Velasquez, M. B., & Ratzliff, A. D. H. (2023). Making It to Sustainability: Evaluating Billing Strategies for Collaborative Care. Psychiatric services (Washington, D.C.), appips20220596. Advance online publication. https://doi.org/10.1176/appi.ps.20220596 [27] Miller, E. S., Jensen, R., Hoffman, M. C., Osborne, L. M., McEvoy, K., Grote, N., & Moses-Kolko, E. L. (2020). Implementation of perinatal collaborative care: a health services approach to perinatal depression care. Primary health care research & development, 21, e30. [28] Raney, L. (2020). Cracking the codes: State Medicaid approaches to reimbursing psychiatric collaborative care. Oakland, California Health Care Foundation. [29] Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr, Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H., Areán, P. A., Hegel, M. T., Tang, L., Belin, T. R., Oishi, S., Langston, C., & IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288(22), 2836–2845. https://doi.org/10.1001/jama.288.22.2836 [30] Raney, L. (2020). [31] Unützer, J., Harbin, H., Schoenbaum, M., & Druss, B. (2013). The collaborative care model: An approach for integrating physical and mental health care in Medicaid health homes. Health Home Information Resource Center, 1-13. [32] Raney, L. (2020). Cracking the codes: State Medicaid approaches to reimbursing psychiatric collaborative care. Oakland, California Health Care Foundation. [33] Grote, N. K., Katon, W. J., Russo, J. E., Lohr, M. J., Curran, M., Galvin, E., & Carson, K. (2015). Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial. Depression and anxiety, 32(11), 821-834 [34] Miller, E. S., Grobman, W. A., Ciolino, J. D., Zumpf, K., Sakowicz, A., Gollan, J., & Wisner, K. L. (2021). Increased depression screening and treatment recommendations after implementation of a perinatal collaborative care program. Psychiatric Services, 72(11), 1268-1275; Snowber, K., Ciolino, J. D., Clark, C. T., Grobman, W. A., & Miller, E. S. (2022). Associations Between Implementation of the Collaborative Care Model and Disparities in Perinatal Depression Care. Obstetrics & Gynecology, 140(2), 204-211. [35] Percent of People Covered By Medicaid/CHIP, 2022. (2022). Medicaid State Fact Sheets. KFF. Retrieved May 1, 2023, from https://www.kff.org/interactive/medicaid-state-fact-sheets/ [36] Miller, E. S., Grobman, W. A., Ciolino, J. D., Zumpf, K., Sakowicz, A., Gollan, J., & Wisner, K. L. (2021). Increased depression screening and treatment recommendations after implementation of a perinatal collaborative care program. Psychiatric Services, 72(11), 1268-1275. [37] Shalaby, R. A. H., & Agyapong, V. I. (2020). Peer support in mental health: literature review. JMIR mental health, 7(6), e15572. [38] Bassuk, E. L., Hanson, J., Greene, R. N., Richard, M., & Laudet, A. (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of substance abuse treatment, 63, 1-9. [39] Eastburg, M. C., Williamson, M., Gorsuch, R., & Ridley, C. (1994). Social support, personality, and burnout in nurses. Journal of Applied Social Psychology, 24(14), 1233-1250. [41] FamilyWell. (2023.). https://familywellhealth.com/ [42] Patients, Family Well (2023). https://familywellhealth.com/patients [43] Providers, Family Well (2023). https://familywellhealth.com/providers [44] Patients, Family Well (2023). https://familywellhealth.com/patients [45] Author interview with Jessica Gaulton, FamilyWell. (2023) [46] Maven (2022). “If moms are unwell, society is unwell.” Recapping our Q&A with Dr. Neel Shah. Maven. https://www.mavenclinic.com/post/if-moms-are-unwell-society-is-unwell-recapping-our-q-a-with-dr-neel-shah#! [47] Klatter, C. K., van Ravesteyn, L. M., & Stekelenburg, J. (2022). Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review. Archives of Women's Mental Health, 25(6), 1029-1039.

Introduction This paper offers a survey of familiar popular music performers and songwriters who reference coffee in their work. It examines three areas of discourse: the psychoactive effects of caffeine, coffee and courtship rituals, and the politics of coffee consumption. I claim that coffee carries a cultural and musicological significance comparable to that of the chemical stimulants and consumer goods more readily associated with popular music. Songs about coffee may not be as potent as those featuring drugs and alcohol (Primack; Schapiro), or as common as those referencing commodities like clothes and cars (Englis; McCracken), but they do feature across a wide range of genres, some of which enjoy archetypal associations with this beverage. m.o.m.m.y. Needs c.o.f.f.e.e.: The Psychoactive Effect of Coffee The act of performing and listening to popular music involves psychological elements comparable to the overwhelming sensory experience of drug taking: altered perceptions, repetitive grooves, improvisation, self-expression, and psychological empathy—such as that between musician and audience (Curry). Most popular music genres are, as a result, culturally and sociologically identified with the consumption of at least one mind-altering substance (Lyttle; Primack; Schapiro). While the analysis of lyrics referring to this theme has hitherto focused on illegal drugs and alcoholic beverages (Cooper), coffee and its psychoactive ingredient caffeine have been almost entirely overlooked (Summer). The most recent study of drugs in popular music, for example, defined substance use as “tobacco, alcohol, marijuana, cocaine and other stimulants, heroin and other opiates, hallucinogens, inhalants, prescription drugs, over-the-counter drugs, and nonspecific substances” (Primack 172), thereby ignoring a chemical stimulant consumed by 90 per cent of adult Americans every day (Lovett). The wide availability of coffee and the comparatively mild effect of caffeine means that its consumption rarely causes harm. One researcher has described it as a ubiquitous and unobtrusive “generalised public activity […] ‘invisible’ to analysts seeking distinctive social events” (Cooper 92). Coffee may provide only a relatively mild “buzz”—but it is now accepted that caffeine is an addictive substance (Juliano) and, due to its universal legality, coffee is also the world’s most extensively traded and enthusiastically consumed psychoactive consumer product (Juliano 1). The musical genre of jazz has a longstanding relationship with marijuana and narcotics (Curry; Singer; Tolson; Winick). Unsurprisingly, given its Round Midnight connotations, jazz standards also celebrate the restorative impact of coffee. Exemplary compositions include Burke/Webster’s insomniac torch song Black Coffee, which provided hits for Sarah Vaughan (1949), Ella Fitzgerald (1953), and Peggy Lee (1960); and Frank Sinatra’s recordings of Hilliard/Dick’s The Coffee Song (1946, 1960), which satirised the coffee surplus in Brazil at a time when this nation enjoyed a near monopoly on production. Sinatra joked that this ubiquitous drink was that country’s only means of liquid refreshment, in a refrain that has since become a headline writer’s phrasal template: “There’s an Awful Lot of Coffee in Vietnam,” “An Awful Lot of Coffee in the Bin,” and “There’s an Awful Lot of Taxes in Brazil.” Ethnographer Aaron Fox has shown how country music gives expression to the lived social experience of blue-collar and agrarian workers (Real 29). Coffee’s role in energising working class America (Cooper) is featured in such recordings as Dolly Parton’s Nine To Five (1980), which describes her morning routine using a memorable “kitchen/cup of ambition” rhyme, and Don't Forget the Coffee Billy Joe (1973) by Tom T. Hall which laments the hardship of unemployment, hunger, cold, and lack of healthcare. Country music’s “tired truck driver” is the most enduring blue-collar trope celebrating coffee’s analeptic powers. Versions include Truck Drivin' Man by Buck Owens (1964), host of the country TV show Hee Haw and pioneer of the Bakersfield sound, and Driving My Life Away from pop-country crossover star Eddie Rabbitt (1980). Both feature characteristically gendered stereotypes of male truck drivers pushing on through the night with the help of a truck stop waitress who has fuelled them with caffeine. Johnny Cash’s A Cup of Coffee (1966), recorded at the nadir of his addiction to pills and alcohol, has an incoherent improvised lyric on this subject; while Jerry Reed even prescribed amphetamines to keep drivers awake in Caffein [sic], Nicotine, Benzedrine (And Wish Me Luck) (1980). Doye O’Dell’s Diesel Smoke, Dangerous Curves (1952) is the archetypal “truck drivin’ country” song and the most exciting track of its type. It subsequently became a hit for the doyen of the subgenre, Red Simpson (1966). An exhausted driver, having spent the night with a woman whose name he cannot now recall, is fighting fatigue and wrestling his hot-rod low-loader around hairpin mountain curves in an attempt to rendezvous with a pretty truck stop waitress. The song’s palpable energy comes from its frenetic guitar picking and the danger implicit in trailing a heavy load downhill while falling asleep at the wheel. Tommy Faile’s Phantom 309, a hit for Red Sovine (1967) that was later covered by Tom Waits (Big Joe and the Phantom 309, 1975), elevates the “tired truck driver” narrative to gothic literary form. Reflecting country music’s moral code of citizenship and its culture of performative storytelling (Fox, Real 23), it tells of a drenched and exhausted young hitchhiker picked up by Big Joe—the driver of a handsome eighteen-wheeler. On arriving at a truck stop, Joe drops the traveller off, giving him money for a restorative coffee. The diner falls silent as the hitchhiker orders up his “cup of mud”. Big Joe, it transpires, is a phantom trucker. After running off the road to avoid a school bus, his distinctive ghost rig now only reappears to rescue stranded travellers. Punk rock, a genre closely associated with recreational amphetamines (McNeil 76, 87), also features a number of caffeine-as-stimulant songs. Californian punk band, Descendents, identified caffeine as their drug of choice in two 1996 releases, Coffee Mug and Kids on Coffee. These songs describe chugging the drink with much the same relish and energy that others might pull at the neck of a beer bottle, and vividly compare the effects of the drug to the intense rush of speed. The host of “New Music News” (a segment of MTV’s 120 Minutes) references this correlation in 1986 while introducing the band’s video—in which they literally bounce off the walls: “You know, while everybody is cracking down on crack, what about that most respectable of toxic substances or stimulants, the good old cup of coffee? That is the preferred high, actually, of California’s own Descendents—it is also the subject of their brand new video” (“New Music News”). Descendents’s Sessions EP (1997) featured an overflowing cup of coffee on the sleeve, while punk’s caffeine-as-amphetamine trope is also promulgated by Hellbender (Caffeinated 1996), Lagwagon (Mr. Coffee 1997), and Regatta 69 (Addicted to Coffee 2005). Coffee in the Morning and Kisses in the Night: Coffee and Courtship Coffee as romantic metaphor in song corroborates the findings of early researchers who examined courtship rituals in popular music. Donald Horton’s 1957 study found that hit songs codified the socially constructed self-image and limited life expectations of young people during the 1950s by depicting conservative, idealised, and traditional relationship scenarios. He summarised these as initial courtship, honeymoon period, uncertainty, and parting (570-4). Eleven years after this landmark analysis, James Carey replicated Horton’s method. His results revealed that pop lyrics had become more realistic and less bound by convention during the 1960s. They incorporated a wider variety of discourse including the temporariness of romantic commitment, the importance of individual autonomy in relationships, more liberal attitudes, and increasingly unconventional courtship behaviours (725). Socially conservative coffee songs include Coffee in the Morning and Kisses in the Night by The Boswell Sisters (1933) in which the protagonist swears fidelity to her partner on condition that this desire is expressed strictly in the appropriate social context of marriage. It encapsulates the restrictions Horton identified on courtship discourse in popular song prior to the arrival of rock and roll. The Henderson/DeSylva/Brown composition You're the Cream in My Coffee, recorded by Annette Hanshaw (1928) and by Nat King Cole (1946), also celebrates the social ideal of monogamous devotion. The persistence of such idealised traditional themes continued into the 1960s. American pop singer Don Cherry had a hit with Then You Can Tell Me Goodbye (1962) that used coffee as a metaphor for undying and everlasting love. Otis Redding’s version of Butler/Thomas/Walker’s Cigarettes and Coffee (1966)—arguably soul music’s exemplary romantic coffee song—carries a similar message as a couple proclaim their devotion in a late night conversation over coffee. Like much of the Stax catalogue, Cigarettes and Coffee, has a distinctly “down home” feel and timbre. The lovers are simply content with each other; they don’t need “cream” or “sugar.” Horton found 1950s blues and R&B lyrics much more sexually explicit than pop songs (567). Dawson (1994) subsequently characterised black popular music as a distinct public sphere, and Squires (2002) argued that it displayed elements of what she defined as “enclave” and “counterpublic” traits. Lawson (2010) has argued that marginalised and/or subversive blues artists offered a form of countercultural resistance against prevailing social norms. Indeed, several blues and R&B coffee songs disregard established courtship ideals and associate the product with non-normative and even transgressive relationship circumstances—including infidelity, divorce, and domestic violence. Lightnin’ Hopkins’s Coffee Blues (1950) references child neglect and spousal abuse, while the narrative of Muddy Waters’s scorching Iodine in my Coffee (1952) tells of an attempted poisoning by his Waters’s partner. In 40 Cups of Coffee (1953) Ella Mae Morse is waiting for her husband to return home, fuelling her anger and anxiety with caffeine. This song does eventually comply with traditional courtship ideals: when her lover eventually returns home at five in the morning, he is greeted with a relieved kiss. In Keep That Coffee Hot (1955), Scatman Crothers supplies a counterpoint to Morse’s late-night-abandonment narrative, asking his partner to keep his favourite drink warm during his adulterous absence. Brook Benton’s Another Cup of Coffee (1964) expresses acute feelings of regret and loneliness after a failed relationship. More obliquely, in Coffee Blues (1966) Mississippi John Hurt sings affectionately about his favourite brand, a “lovin’ spoonful” of Maxwell House. In this, he bequeathed the moniker of folk-rock band The Lovin’ Spoonful, whose hits included Do You Believe in Magic (1965) and Summer in the City (1966). However, an alternative reading of Hurt’s lyric suggests that this particular phrase is a metaphorical device proclaiming the author’s sexual potency. Hurt’s “lovin’ spoonful” may actually be a portion of his seminal emission. In the 1950s, Horton identified country as particularly “doleful” (570), and coffee provides a common metaphor for failed romance in a genre dominated by “metanarratives of loss and desire” (Fox, Jukebox 54). Claude Gray’s I'll Have Another Cup of Coffee (Then I’ll Go) (1961) tells of a protagonist delivering child support payments according to his divorce lawyer’s instructions. The couple share late night coffee as their children sleep through the conversation. This song was subsequently recorded by seventeen-year-old Bob Marley (One Cup of Coffee, 1962) under the pseudonym Bobby Martell, a decade prior to his breakthrough as an international reggae star. Marley’s youngest son Damian has also performed the track while, interestingly in the context of this discussion, his older sibling Rohan co-founded Marley Coffee, an organic farm in the Jamaican Blue Mountains. Following Carey’s demonstration of mainstream pop’s increasingly realistic depiction of courtship behaviours during the 1960s, songwriters continued to draw on coffee as a metaphor for failed romance. In Carly Simon’s You’re So Vain (1972), she dreams of clouds in her coffee while contemplating an ostentatious ex-lover. Squeeze’s Black Coffee In Bed (1982) uses a coffee stain metaphor to describe the end of what appears to be yet another dead-end relationship for the protagonist. Sarah Harmer’s Coffee Stain (1998) expands on this device by reworking the familiar “lipstick on your collar” trope, while Sexsmith & Kerr’s duet Raindrops in my Coffee (2005) superimposes teardrops in coffee and raindrops on the pavement with compelling effect. Kate Bush’s Coffee Homeground (1978) provides the most extreme narrative of relationship breakdown: the true story of Cora Henrietta Crippin’s poisoning. Researchers who replicated Horton’s and Carey’s methodology in the late 1970s (Bridges; Denisoff) were surprised to find their results dominated by traditional courtship ideals. The new liberal values unearthed by Carey in the late 1960s simply failed to materialise in subsequent decades. In this context, it is interesting to observe how romantic coffee songs in contemporary soul and jazz continue to disavow the post-1960s trend towards realistic social narratives, adopting instead a conspicuously consumerist outlook accompanied by smooth musical timbres. This phenomenon possibly betrays the influence of contemporary coffee advertising. From the 1980s, television commercials have sought to establish coffee as a desirable high end product, enjoyed by bohemian lovers in a conspicuously up-market environment (Werder). All Saints’s Black Coffee (2000) and Lebrado’s Coffee (2006) identify strongly with the culture industry’s image of coffee as a luxurious beverage whose consumption signifies prominent social status. All Saints’s promotional video is set in a opulent location (although its visuals emphasise the lyric’s romantic disharmony), while Natalie Cole’s Coffee Time (2008) might have been itself written as a commercial. Busting Up a Starbucks: The Politics of Coffee Politics and coffee meet most palpably at the coffee shop. This conjunction has a well-documented history beginning with the establishment of coffee houses in Europe and the birth of the public sphere (Habermas; Love; Pincus). The first popular songs to reference coffee shops include Jaybird Coleman’s Coffee Grinder Blues (1930), which boasts of skills that precede the contemporary notion of a barista by four decades; and Let's Have Another Cup of Coffee (1932) from Irving Berlin’s depression-era musical Face The Music, where the protagonists decide to stay in a restaurant drinking coffee and eating pie until the economy improves. Coffee in a Cardboard Cup (1971) from the Broadway musical 70 Girls 70 is an unambiguous condemnation of consumerism, however, it was written, recorded and produced a generation before Starbucks’ aggressive expansion and rapid dominance of the coffee house market during the 1990s. The growth of this company caused significant criticism and protest against what seemed to be a ruthless homogenising force that sought to overwhelm local competition (Holt; Thomson). In response, Starbucks has sought to be defined as a more responsive and interactive brand that encourages “glocalisation” (de Larios; Thompson). Koller, however, has characterised glocalisation as the manipulative fabrication of an “imagined community”—whose heterogeneity is in fact maintained by the aesthetics and purchasing choices of consumers who make distinctive and conscious anti-brand statements (114). Neat Capitalism is a more useful concept here, one that intercedes between corporate ideology and postmodern cultural logic, where such notions as community relations and customer satisfaction are deliberately and perhaps somewhat cynically conflated with the goal of profit maximisation (Rojek). As the world’s largest chain of coffee houses with over 19,400 stores in March 2012 (Loxcel), Starbucks is an exemplar of this phenomenon. Their apparent commitment to environmental stewardship, community relations, and ethical sourcing is outlined in the company’s annual “Global Responsibility Report” (Vimac). It is also demonstrated in their engagement with charitable and environmental non-governmental organisations such as Fairtrade and Co-operative for Assistance and Relief Everywhere (CARE). By emphasising this, Starbucks are able to interpellate (that is, “call forth”, “summon”, or “hail” in Althusserian terms) those consumers who value environmental protection, social justice and ethical business practices (Rojek 117). Bob Dylan and Sheryl Crow provide interesting case studies of the persuasive cultural influence evoked by Neat Capitalism. Dylan’s 1962 song Talkin’ New York satirised his formative experiences as an impoverished performer in Greenwich Village’s coffee houses. In 1995, however, his decision to distribute the Bob Dylan: Live At The Gaslight 1962 CD exclusively via Starbucks generated significant media controversy. Prominent commentators expressed their disapproval (Wilson Harris) and HMV Canada withdrew Dylan’s product from their shelves (Lynskey). Despite this, the success of this and other projects resulted in the launch of Starbucks’s in-house record company, Hear Music, which released entirely new recordings from major artists such as Ray Charles, Paul McCartney, Joni Mitchell, Carly Simon and Elvis Costello—although the company has recently announced a restructuring of their involvement in this venture (O’Neil). Sheryl Crow disparaged her former life as a waitress in Coffee Shop (1995), a song recorded for her second album. “Yes, I was a waitress. I was a waitress not so long ago; then I won a Grammy” she affirmed in a YouTube clip of a live performance from the same year. More recently, however, Crow has become an avowed self-proclaimed “Starbucks groupie” (Tickle), releasing an Artist’s Choice (2003) compilation album exclusively via Hear Music and performing at the company’s 2010 Annual Shareholders’s Meeting. Songs voicing more unequivocal dissatisfaction with Starbucks’s particular variant of Neat Capitalism include Busting Up a Starbucks (Mike Doughty, 2005), and Starbucks Takes All My Money (KJ-52, 2008). The most successful of these is undoubtedly Ron Sexsmith’s Jazz at the Bookstore (2006). Sexsmith bemoans the irony of intense original blues artists such as Leadbelly being drowned out by the cacophony of coffee grinding machines while customers queue up to purchase expensive coffees whose names they can’t pronounce. In this, he juxtaposes the progressive patina of corporate culture against the circumstances of African-American labour conditions in the deep South, the shocking incongruity of which eventually cause the old bluesman to turn in his grave. Fredric Jameson may have good reason to lament the depthless a-historical pastiche of postmodern popular culture, but this is no “nostalgia film”: Sexsmith articulates an artfully framed set of subtle, sensitive, and carefully contextualised observations. Songs about coffee also intersect with politics via lyrics that play on the mid-brown colour of the beverage, by employing it as a metaphor for the sociological meta-narratives of acculturation and assimilation. First popularised in Israel Zangwill’s 1905 stage play, The Melting Pot, this term is more commonly associated with Americanisation rather than miscegenation in the United States—a nuanced distinction that British band Blue Mink failed to grasp with their memorable invocation of “coffee-coloured people” in Melting Pot (1969). Re-titled in the US as People Are Together (Mickey Murray, 1970) the song was considered too extreme for mainstream radio airplay (Thompson). Ike and Tina Turner’s Black Coffee (1972) provided a more accomplished articulation of coffee as a signifier of racial identity; first by associating it with the history of slavery and the post-Civil Rights discourse of African-American autonomy, then by celebrating its role as an energising force for African-American workers seeking economic self-determination. Anyone familiar with the re-casting of black popular music in an industry dominated by Caucasian interests and aesthetics (Cashmore; Garofalo) will be unsurprised to find British super-group Humble Pie’s (1973) version of this song more recognisable. Conclusion Coffee-flavoured popular songs celebrate the stimulant effects of caffeine, provide metaphors for courtship rituals, and offer critiques of Neat Capitalism. Harold Love and Guthrie Ramsey have each argued (from different perspectives) that the cultural micro-narratives of small social groups allow us to identify important “ethnographic truths” (Ramsey 22). Aesthetically satisfying and intellectually stimulating coffee songs are found where these micro-narratives intersect with the ethnographic truths of coffee culture. 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Ways of Seeing"Images … define our experiences more precisely in areas where words are inadequate." (Berger 33)"Different skins, you know, different ways of seeing the world." (Morrison)The research question animating this article is: 'How does an individual creative worker re-present themselves as a contemporary - and evolving - brand?' Berger notes that the "principal aim has been to start a process of questioning" (5), and the raw material energising this exploration is the life's work of Richard Morrison, the creative director and artist who is the key moving force behind The Morrison Studio collective of designers, film makers and visual effects artists, working globally but based in London. The challenge of maintaining currency in this visually creative marketplace includes seeing what is unique about your potential contribution to a larger project, and communicating it in such a way that this forms an integral part of an evolving brand - on trend, bleeding edge, but reliably professional. One of the classic outputs of Morrison's oeuvre, for example, is the title sequence for Terry Gilliam's Brazil.Passion cannot be seen yet Morrison conceives it as the central engine that harnesses skills, information and innovative ways of working to deliver the unexpected and the unforgettable. Morrison's perception is that the design itself can come after the creative artist has really seen and understood the client's perspective. As he says: "What some clients are interested in is 'How can we make money from what we're doing?'" Seeing the client, and the client's motivating needs, is central to Morrison's presentation of self as a brand: "the broader your outlook as a creative, the more chance you have of getting it right". Jones and Warren draw attention to one aspect of this dynamic: "Wealthy and private actors, both private and state, historically saw creative practice as something that money was spent on - commissioning a painting or a sculpture, giving salaries to composers to produce new works and so forth. Today, creativity has been reimagined as something that should directly or indirectly make money" (293). As Berger notes, "We never look at just one thing; we are always looking at the relation between things and ourselves…The world-as-it-is is more than pure objective fact, it includes consciousness" (9, 11). What is our consciousness around the creative image?Individuality is central to Berger's vision of the image in the "specific vision of the image-maker…the result of an increasing consciousness of individuality, accompanying an increasing awareness of history" (10). Yet, as Berger argues "although every image embodies a way of seeing, our perception or appreciation of an image depends also upon our own way of seeing" (10). Later, Berger links the meanings viewers attribute to images as indicating the "historical experience of our relation to the past…the experience of seeking to give meaning to our lives" (33). The seeing and the seeking go hand in hand, and constitute a key reason for Berger's assertion that "the entire art of the past has now become a political issue" (33). This partly reflects the ways in which it is seen, and in which it is presented for view, by whom, where and in which circumstances.The creation of stand-out images in the visually-saturated 21st century demands a nuanced understanding of ways in which an idea can be re-presented for consumption in a manner that makes it fresh and arresting. The focus on the individual also entails an understanding of the ways in which others are valuable, or vital, in completing a coherent package of skills to address the creative challenge to hand. It is self-evident that other people see things differently, and can thus enrich the broadened outlook identified as important for "getting it right". Morrison talks about "little core teams, there's four or five of you in a hub… [sometimes] spread all round the world, but because of the Internet and the way things work you can still all be connected". Team work and members' individual personalities are consequently combined, in Morrison's view, with the core requirement of passion. As Morrison argues, "personality will carry you a long way in the creative field".Morrison's key collaborator, senior designer and creative partner/art director Dean Wares lives in Valencia, Spain whereas Morrison is London-based and their clients are globally-dispersed. Although Morrison sees the Internet as a key technology for collaboratively visualising the ways in which to make a visual impact, Berger points to the role of the camera in relation to the quintessential pre-mechanical image: the painting. It is worth acknowledging here that Berger explicitly credits Walter Benjamin, including the use of his image (34), as the foundation for many of Berger's ideas, specifically referencing Benjamin's essay "The work of art in the age of mechanical reproduction". Noting that, prior to the invention of the camera, a painting could never be seen in more than one place at a time, Berger suggests that the camera foments a revolutionary transformation: "its meaning changes. Or, more exactly, its meaning multiplies and fragments into many meanings" (19). This disruption is further fractured once that camera-facilitated image is viewed on a screen, ubiquitous to Morrison's stock in trade, but in Berger's day (1972) particularly associated with the television:The painting enters each viewer's house. There it is surrounded by his wallpaper, his furniture, his mementoes. It enters the atmosphere of his family. It becomes their talking point. It lends its meaning to their meaning. At the same time it enters a million other houses and, in each of them, is seen in a different context. Because of the camera, the painting now travels to the spectator, rather than the spectator to the painting. In its travels, its meaning is diversified. (Berger, 19-20)Even so, that image, travelling through space and time is seen on the screen in a sequential and temporal context: "because a film unfolds in time and a painting does not. In a film the way one image follows another, their succession constructs an argument which becomes irreversible. In a painting all its elements are there to be seen simultaneously." Both these dynamics, the still and the sequence, are key to the work of a visual artist such as Morrison responsible for branding a film, television series or event. But the works also create an unfolding sequence which tells a different story to each recipient according to the perceptions of the viewer/reader. For example, instead of valorising Gilliam's Brazil, Morrison's studio could have been tagged with Annaud's Enemy at the Gates or, even, the contemporary Sky series, Niel Jordan's Riviera. Knowing this sequence, and that the back catalogue begins with The Who's Quadrophenia (1979), changes the way we see what the Morrison Studio is doing now.Ways of WorkingRichard Morrison harnesses an evolutionary metaphor to explain his continuing contribution to the industry: "I've adapted, and not been a dinosaur who's just sunk in the mud". He argues that there is a need to explore where "the next niche is and be prepared for change 'cause the only constant thing in life is change. So as a creative you need to have that known." Effectively, adaptation and embracing innovation has become a key part of the Morrison Studio's brand. It is trumpeted in the decision that Morrison and Ware made when they decided to continue their work together, even after Ware moved to Spain. This demonstrated, in an age of faxes and landlines, that the Morrison Studio could make cross country collaboration work: the multiple locations championed the fact that they were open for business "without boundaries".There was travel, too, and in those early pre-Internet days of remote location Morrison was a frequent visitor to the United States. "I'd be working in Los Angeles and he'd be wherever he was […] we'd use snail mail to actually get stuff across, literally post it by FedEx […]." The intercontinental (as opposed to inter-Europe) collaboration had the added value of offering interlocking working days: "I'd go to sleep, he wakes up […] We were actually doubling our capacity." If anything, these dynamics are more entrenched with better communications. Currah argues that Hollywood attempts to manage the disruptive potential of the internet by "seeking to create a 'closed' sphere of innovation on a global scale […] legitimated, enacted and performed within relational networks" (359). The Morrison Studio's own dispersed existence is one element of these relational networks.The specific challenge of technological vulnerability was always present, however, long before the Internet: "We'd have a case full of D1 tapes" - the professional standard video tape (1986-96) - "and we'd carefully make sure they'd go through the airport so they don't get rubbed […] what we were doing is we were fitting ourselves up for the new change". At the same time, although the communication technologies change, there are constants in the ways that people use them. Throughout Morrison's career, "when I'm working for Americans, which I'm doing a lot, they expect me to be on the telephone at midnight [because of time zones]. […] They think 'Oh I want to speak to Richard now. Oh it's midnight, so what?' They still phone up. That's constant, that never goes away." He argues that American clients are more complex to communicate with than his Scandinavian clients, giving the example that people assume a UK-US consistency because they share the English language. But "although you think they're talking in a tongue that's the same, their meaning and understanding can sometimes be quite a bit different." He uses the example of the A4 sheet of paper. It has different dimensions in the US than in the UK, illustrating those different ways of seeing.Morrison believes that there are four key constants in his company's continuing success: deadlines; the capacity to scope a job so that you know who and how many people to pull in to it to meet the deadline; librarian skills; and insecurity. The deadlines have always been imposed on creative organisations by their clients, but being able to deliver to deadlines involves networks and self-knowledge: "If you can't do it yourself find a friend, find somebody that's good at adding up, find somebody that's good at admin. You know, don't try and take on what you can't do. Put your hand up straight away, call in somebody that can help you". Chapain and Comunian's work on creative and cultural industries (CCIs) also highlights the importance of "a new centrality to the role of individuals and their social networks in understanding the practice of CCIs" (718).Franklin et al. suggest that this approach, adopted by The Morrison Studio, is a microcosm of the independent film sector as a whole. They argue that "the lifecycle of a film is segmented into sequential stages, moving through development, financing, production, sales, distribution and exhibition stages to final consumption. Different companies, each with specialized project tasks, take on responsibility and relative financial risk and reward at each stage" (323). The importance that Morrison places on social networks, however, highlights the importance of flexibility within relationships of trust - to the point where it might be as valid to engage someone on the basis of a history of working with that person as on the basis of that person's prior experience. As Cristopherson notes, "many creative workers are in vaguely defined and rapidly changing fields, seemingly making up their careers as they go along" (543).The skills underlying Morrison's approach to creative collaboration, however, include a clear understanding of one's own strength and weaknesses and a cool evaluation of others, "just quietly research people". This people-based research includes both the capabilities of potential colleagues, in order to deliver the required product in the specified time frame, along with research into creative people whose work is admired and who might provide a blueprint for how to arrive at an individual's dream role. Morrison gives the example of Quentin Tarantino's trajectory to directing: "he started in a video rental and all he did is watch lots and lots of films, particularly westerns and Japanese samurai films and decided 'I can do that'". One of his great pleasures now is to mentor young designers to help them find their way in the industry. That's a strategy that may pay dividends into the future, via Storper and Scott's "traded and untraded interdependencies" which are, according to Gornostaeva, "expressed as the multiple economic and social transactions that the participants ought to conduct if they wish to perpetuate their existence" (39).As for the library skills, he says that they are crucial but a bit comical:It's a bit like being a constant librarian in old-fashioned terms, you know, 'Where is that stuff stored?' Because it's not stored in a plan chest anymore where you open the drawer and there it is. It's now stored in, you know, big computers, in a cloud. 'Where did we put that file? Did we dump it down? Have we marked it up? […] Where's it gone? What did we do it on?'While juggling the demands of technology, people and product The Morrison brand involves both huge confidence and chronic insecurity. The confidence is evident in the low opinion Morrison has of the opportunities offered by professional disruptor sites such as 99designs: "I can't bear anything like that. I can see why it's happening but I think what you're doing is devaluing yourself even before you start […] it would destroy your self-belief in what you're doing". At the same time, Morrison says, his security is his own insecurity: "I'm always out hunting to see what could be next […] the job you finish could be your last job."Ways of BrandingChristopherson argues that there is "considerable variation in the occupational identities of new media workers among advanced economies. In some economies, new media work is evolving in a form that is closer to that of the professional [in contrast to economies where it is] an entrepreneurial activity in which new media workers sell skills and services in a market" (543). For The Morrison Studio, its breadth, history and experience supports their desire to be branded as professional, but their working patterns entirely resonate with, and are integrated within, the entrepreneurial. Seeing their activity in this way is a juxtaposition with the proposition advanced by Berger that:The existing social conditions make the individual feel powerless. He lives in the contradiction between what he is and what he would like to be. Either he then becomes fully conscious of the contradiction and its causes, and so joins the political struggle for a full democracy which entails, among other things, the overthrow of capitalism; or else he lives, continually subject to an envy which, compounded with his sense of powerlessness, dissolves into recurrent day-dreams (148).The role of the brand, and its publicity, is implicated by Berger in both the tension between what an individual is and what s/he would like to be; and in the creation of an envy that subjugates people. For Berger, the brand is about publicity and the commodifying of the future. Referring to publicity images, Berger argues that "they never speak of the present. Often they refer to the past and always they speak of the future". Brands are created and marketed by such publicity images that are often, these days, incorporated within social media and websites. At the same time, Berger argues that "Publicity is about social relationships, not objects [or experiences]. Its promise is not of pleasure, but of happiness: happiness as judged from the outside by others. The happiness of being envied is glamour." It is the dual pressure from the perception of the gap between the individual's actual and potential life, and the daydreaming and envy of that future, that helps construct Berger's powerless individual.Morrison's view, fashioned in part by his success at adapting, at not being a dinosaur that sinks into the mud, is that the authenticity lies in the congruence of the brand and the belief. "A personal brand can help you straight away but as long as you believe it […] You have to be true to what you're about and then it works. And then the thing becomes you [… you] just go for it and, you know, don't worry about failure. Failure will happen anyway".Berger's commentary on publicity is partially divergent from branding. Publicity is generally a managed message, on that is paid for and promoted by the person or entity concerned. A brand is a more holistic construction and is implicated in ways of seeing in that different people will have very different perceptions of the same brand. Morrison's view of his personal brand, and the brand of the Morrison Studio, is that it encompasses much more than design expertise and technical know-how. He lionises the role of passion and talks about the importance of ways of managing deadlines, interlocking skills sets, creative elements and the insecurity of uncertainty.For the producers who hire Morrison, and help build his brand, Berger's observation of the importance of history and the promise for the future remains key to their hiring decisions. Although carefully crafted, creative images are central to the Morrison Studio's work, it is not the surface presentation of those images that determines the way their work is perceived by people in the film industry, it is the labour and networks that underpin those images. While Morrison's outputs form part of the visual environment critiqued in Ways of Seeing, it is informed by the dynamics of international capitalism via global networks and mobility. Although one of myriad small businesses that help make the film industry the complex and productive creative sphere that it is, Morrison Studios does not so much seek to create a public brand as to be known and valued by the small group of industry players upon whom the Studio relies for its existence. Their continued future depends upon the ways in which they are seen.ReferencesBenjamin, Walter. Illuminations: Essays and Reflections. United States of America, 1969.Berger, John. Ways of Seeing. London: Penguin Books, 1972.Brazil. Dir. Terry Gilliam. Universal Pictures. 1985. Film. Chapain, Caroline, and Roberta Comunian. "Enabling and Inhibiting the Creative Economy: The Role of the Local and Regional Dimensions in England." Regional Studies 44.6 (2010): 717-734. Christopherson, Susan. "The Divergent Worlds of New Media: How Policy Shapes Work in the Creative Economy." Review of Policy Research 21.4 (2004): 543-558. Currah, Andrew. "Hollywood, the Internet and the World: A Geography of Disruptive Innovation." Industry and Innovation 14.4 (2007): 359-384. Enemies at the Gates. Dir. Jean-Jacques Annaud. Paramount. 2001. FilmFranklin, Michael, et al. "Innovation in the Application of Digital Tools for Managing Uncertainty: The Case of UK Independent Film." Creativity and Innovation Management 22.3 (2013): 320-333. Gornostaeva, Galina. "The Wolves and Lambs of the Creative City: The Sustainability of Film and Television Producers in London." Geographical Review (2009): 37-60. Jones, Phil, and Saskia Warren. "Time, Rhythm and the Creative Economy." Transactions of the Institute of British Geographers 41.3 (2016): 286-296. Morrison, Richard. Personal Interview. 13 Oct 2016.The Morrison Studio. The Morrison Studio, 2017. 16 June 2017 <https://themorrisonstudio.com/>.Quadrophenia. Dir. Franc Roddam. Brent Walker Film Distributing. 1979. Film.Riviera. Dir. Neil Jordan. Sky Atlantic HD. 2017. Film.Storper, Michael, and Scott, Allen. "The Geographical Foundations and Social Regulation of Flexible Production Complexes". The Power of Geography: How Territory Shapes Social Life. Eds. Jennifer Wolch and Michael Dear. New York: Routledge, 1989. 21-40.

Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk; Kimmelman, J., Hyun, I., Benvenisty, N. et al. Policy: Global standards for stem-cell research. Nature 533, 311–313 (2016). https://doi.org/10.1038/533311a [4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk [5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources: Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research. The New England journal of medicine, 351(3), 207–209. https://doi.org/10.1056/NEJMp048145; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos. The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy, 38(2/3), 264–284. http://www.jstor.org/stable/24439776; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells. The New England journal of medicine, 351(3), 209–211. https://doi.org/10.1056/NEJMp048147; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality. Bosnian journal of basic medical sciences, 4(1), 5–14. https://doi.org/10.17305/bjbms.2004.3453 [6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review. Restorative neurology and neuroscience, 28(4), 589–603. https://doi.org/10.3233/RNN-2010-0543 [7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics. Oxford University Press. [8] Sherley v. Sebelius, 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf [9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text; Bush, G. W. (2006, July 19). Message to the House of Representatives. National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html [10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells [11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells. Social Research, 73(3), 819–834. http://www.jstor.org/stable/40971854 [12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics. 22. 10.1186/s12910-021-00678-4. [13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics, 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight, 49(4). [14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf [18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80, see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia. UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html [20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries. Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech. [26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine, 12(6), 647–656. https://doi.org/10.2217/rme-2017-0035 [29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society, (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics, 25(6), 271–276. https://doi.org/10.1007/s10815-008-9221-6 [66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet). Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en [67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [68] Gert, B. (2007). Common morality: Deciding what to do. Oxford Univ. Press. [69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association.; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html [70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics, 35(7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine, 10(12), 1715–1716. https://doi.org/10.1002/sctm.21-0234 [71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online, 18(5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8 [72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England), 3(3), 306–313. https://doi.org/10.1191/1740774506cn150oa [73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Georgetown University Press, 2012. [74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics, 14(3), 1-17. https://doi.org/10.1177/1747016117739939 [75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics, 8. https://doi.org/10.52214/vib.v8i.9894 [76] Stem Cell Tourism: False Hope for Real Money. Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism, See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. 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The stand-off involving the asylum-seekers on board the Tampa, off the coast of Australia in August-September 2001, represented a critical confluence of security, fear. The Australian government’s response to the issue of stranded asylum-seekers, it is argued here, was a directly calculated political representation aimed at creating fear in the Australian populace: fear of a threat to Australian security. The fear generated by the Australian government, in which the national media was a willing accomplice, allowed for a perception among Australians that the government’s actions, in refusing to allow the Tampa to offload its passengers, were consistent with the provision of national security. The government was preserving the territorial integrity and sovereignty of the state in the face of this constructed ‘threat’ to Australia’s security. The provision of security is central to the state’s reason for being. If the state is not capable of providing security, however that security is to be defined, the continued legitimacy and even existence of the state itself must necessarily be questioned, as Michael Dillon has argued. The power and importance of the security narrative can therefore not be underestimated. Further, Dillon argues, this security has generally been conceived as the security of the ‘self’ against the ‘other’. Attempts to be seen to be ‘doing the job’ of security has throughout history involved the identification and vilification of this other, with the fear of the other consequently constituting or reifying the self and contributing to the legitimacy of governments. The nature of this relationship between identity, security and fear is central to the government’s politics of representing the asylum seekers. The Howard government acknowledged, rightly, that making people afraid of the threat posed by waves of foreign asylum seekers and evoking the narrative of security would contribute to a solidification of the Australian self, and unite the people of Australia behind its political leaders, who were working to protect Australians from this ‘threat’. The fear created by the Australian government was constructed in a number of ways. First, the government argued that Australia was faced with a possible future wave of illegal immigrants, a situation that threatened the future security of the country. Seen in this light, the decision to prevent the Tampa from offloading asylum seekers was a means of achieving security by sending a message to would-be boat people that Australia was not a ‘soft touch’. Second, the government evoked a range of images central to traditional discourses of security, concerned predominantly with the preservation of the nation-state from military attack. As Burke argues, the government variously talked of ‘territorial integrity’, ‘sovereignty’ and ‘national interests’, concepts that, when spoken of together, would seem more suited to a situation of armed conflict rather than one involving the captain of a cargo boat looking to offload asylum seekers for processing in Australia. The consistency of this type of language with earlier depictions of the threat of Japanese invasion during World War II, for example, is not an historical coincidence. It is argued here that the use of such language helped create a context in which the idea of asylum seekers as threatening to Australian security, and therefore to be feared, had resonance with the domestic population. Finally, the government constructed fear through its attempts to depict the asylum-seekers as an ‘other’, foreign to Australian identity. This was achieved in part through questioning the legitimacy of their claims to asylum over others awaiting processing, and also through the very act of depicting them as threats to security. Their religious and ethnic otherness was not played on specifically by the government, although claims that asylum seekers threw children into the ocean, which were to later be proved erroneous, portrayed asylum-seekers as less than human. The combination of these acts constructed a fear in the Australian populace, a fear of the threat to Australian self from a foreign other, thus pointing to the relationship between fear, security and identity. In an excellent recent text on Australian security, Anthony Burke convincingly argues that the government’s response to, or indeed creation of, the Tampa crisis can be viewed as the continuation of an enduring narrative of security and fear that has been the cornerstone of Australian identity and subjectivity since 1788. This narrative, he argues, has been constitutive and reflective of Australia’s sense of self, and has allowed for politics that has denied the rights of the other throughout Australia’s history. This perspective is not limited to the Australian subject. In a seminal text on US security, David Campbell argues that the provision of security in the United States has similarly been linked to identity politics in which the fear of a vilified other was central to the constitution of the self and the legitimacy of governments. The relationship between fear, identity politics and security is particularly evident, Campbell argues, in the McCarthy era attacks on ‘communist dissidents’ during the early years of the Cold War. The point to be made from these examples is that fear is not just implicated in the construction of security and indeed the self: it is integral to that project. Facile as the comparison may be, the approach of the Australian government to this issue is reminiscent of the plot of the 1995 movie, Canadian Bacon. In the film, a US President suffering from low popularity ratings invents a confrontation with Canada in order to unite the American people behind him and enhance his chances of winning a second term in office. In inventing this threat, his administration portrayed Canadians residing in the United States as possible spies for the Canadian administration and also expressed suspicion of the hegemonic aspirations of the Canadian government in general. The fear created through such a depiction, it was hoped, would allow the President enough popularity to be re-elected. Perhaps the central difference between this example and the Howard government’s approach to the asylum seeker ‘threat’ is that the fictional US President in question was not successful in his bid for re-election. Joseph Camilleri has persuasively argued that security is a psychological rather than material state. In other words, security is about feeling rather than being secure. As such, governments must seek to create conditions in which this feeling of security is engendered in order to retain legitimacy. Enter the narrative of fear. Fear creates a basis for perceptions that the government is providing security, because once a population becomes concerned at threats posed by different actors, that population becomes almost necessarily supportive of actors viewed as capable of addressing that threat. Seen in this light, the creation of threat, regardless of the material significance of the threat itself, is a useful tool for governments to maintain legitimacy. Importantly, in the case of the asylum-seekers, these individuals themselves, and the nature of their plight, had limited relevance to the political project of the Australian government. This is aside from the important caveat that they were not of Anglo-Saxon appearance, and therefore ‘different’ to dominant depictions of the Australian self, a difference reinforced by claims of their willingness to endanger the lives of their own children. The fact that many asylum seekers were escaping the oppression of a regime Howard himself had described as evil, and whose invasion he was simultaneously supporting, seems to have slipped through the cracks of popular consciousness. This paradox did not seem to bother the Australian government, whose political representation of asylum seekers did not require any attention to where they had come from or why they had been willing to risk their lives in seeking refuge. The government merely had to point to a future ‘wave of boat-people’: queue-jumping ‘illegals’ who had targeted Australia as an international ‘soft touch’. The fear created by such an image was enough to suppress any lingering form of empathy or, for that matter, rationality. Even a rationalist would struggle to reconcile the government’s commitment to international human rights norms, its support for the war against terrorism and depiction of the evil Taliban regime of Afghanistan, and its commitment to preventing Afghani asylum-seekers from having claims processed in Australia. The government was riding on a wave of fear, a fear that would play a significant role in the re-election of the Howard government and the continued popular support for mandatory detention of asylum-seekers and the government’s ‘Pacific Solution’. Can we imagine a situation in which security can mean something other than the security of the self (in this case the Australian nation-state) at the expense of the other (asylum seekers)? Can we imagine a situation in which security is associated with emancipation of individuals, as Critical Security theorists advocate, rather than the (military) protection of the sovereignty of the state? Burke is sceptical, largely because the narrative of security as fear has permeated Australian politics, and the Australian subject, since the initial dispossession of indigenous people in the eighteenth century. In an international climate where fear still prevails, particularly in the wording of President Bush’s recent State of the Union address in which he warned Americans of the ‘Axis of Evil’, it is difficult to see how, or where, normatively progressive security politics would be located. When government or regime legitimacy can be assisted through recourse to an identity politics predicated on fear, what incentive could we imagine for an acknowledgment of the claims of ‘others’? The answer to this question lies partly in this paper itself, and in the other contributions in this journal to the question of fear and social relations. The power of fear, it is argued here, is necessarily undermined by an analysis of the construction of fear itself. This form of critique, following Foucault, is critical to breaking down a knowledge-power nexus that, in the case of security and the asylum seekers renders us secure through the suffering of others. While we may not expect critical analysis to reconstitute politics and identity in the short-term, we can reasonably expect such analyses to undermine the resonance of such narratives of fear. References Burke, Anthony. In Fear of Security: Australia’s Invasion Anxiety. Sydney: Pluto, 2002. Camilleri, Joseph. ‘The security dilemma revisited: Implications for the Asia-Pacific’, in W. Tow, R. Thakur and I. Hyun eds. Asia’s Emerging Regional Order: Reconciling Traditional and Human Security. Tokyo: UN University Press, 2000. Campbell, David. Writing Security: United States Foreign Policy and the Politics of Identity. Minneapolis: University of Minnesota Press. Dillon, Michael. The Politics of Security: Towards a Philosophy of Continental Thought. London: Routledge, 1996. Foucault, Michel. Discipline and Punish: The Birth of the Prison. New York: Vintage, 1979. Canadian Bacon. Dir. Micheal Moore. PolyGram, 1995 (Screenplay by Michael Moore). Citation reference for this article MLA Style McDonald, Matt. "Fear, Security and the Politics of Representing Asylum Seekers" M/C: A Journal of Media and Culture 5.1 (2002). [your date of access] < http://www.media-culture.org.au/0203/security.php>. Chicago Style McDonald, Matt, "Fear, Security and the Politics of Representing Asylum Seekers" M/C: A Journal of Media and Culture 5, no. 1 (2002), < http://www.media-culture.org.au/0203/security.php> ([your date of access]). APA Style McDonald, Matt. (2002) Fear, Security and the Politics of Representing Asylum Seekers. M/C: A Journal of Media and Culture 5(1). < http://www.media-culture.org.au/0203/security.php> ([your date of access]).

Photo by Nathan Dumlao on Unsplash ABSTRACT The demographic of physicians in the United States has failed to include a proportionate population of Latinos in the United States. In what follows, I shall argue that the medical school admission process places an undue burden on low-income Latino applicants. Hence, the underrepresentation of Latinos in medical schools is an injustice. This injustice relates to the poor community health of the Latino community. Health disparities such as diabetes, HIV infection, and cancer mortality are higher amongst the Latino community. The current representation of Latino medical students is not representative of those in the United States. INTRODUCTION The demographic of physicians in the United States has failed to include a proportionate number of Latinos, meaning people of Latin American origin. Medical schools serve as the gatekeepers to the medical field, and they can alter the profession based on whom they admit. With over 60 million Latinos in the United States, people of Latin American origin comprise the largest minority group in the nation.[1] In 2020-2021, only 6.7 percent of total US medical school enrollees and only 4 percent of medical school leadership identified as Latino.[2] Latino physicians can connect to a historically marginalized community that faces barriers including language, customs, income, socioeconomic status, and health literacy. I argue that the medical school admissions process places an undue burden on low-income Latino applicants. This paper explores the underrepresentation of Latinos in medical schools as an injustice. A further injustice occurs as the barriers to medical education result in fewer Latino doctors to effectively deliver health care and preventive health advice to their communities in a culturally competent way. I. Latino Community Health Data The terms Latino and Hispanic have largely been considered interchangeable. US government departments, such as the US Census Bureau and the Centers for Disease Control and Prevention (CDC), define Hispanic people as those with originating familial ties to native Spanish-speaking countries, most of whom are from Latin America. The term Latino is more inclusive because it refers to all of those with strong originating ties to countries in Latin America, including those coming from countries such as Brazil and Belize who are not native Spanish speakers. Throughout this work, I refer to the term Latino because it is more inclusive, although the data retrieved from US government departments may refer to the population as Hispanic. “Low-income” refers to the qualifying economic criteria for the AAMC’s Fee Assistance Program Poverty Guidelines.[3] The AAMC Fee Assistance Program is designed to help individuals who do not have the financial means to pay the total costs of applying to medical school. For this paper, low-income refers to those who qualify for this program. The US government gathers data about Latino community health and its health risks. The Latino community has a higher poverty rate than the non-Hispanic white community.[4] Latino community health has long trailed that of white people collectively. For example, the Latino community experiences higher levels of preventable diseases, including hypertension, diabetes, and hepatitis, than the non-Hispanic white community does.[5] The CDC collects data about Latino community health and provides statistics to the public. Latinos in the United States trail only non-Hispanic blacks in prevalence of obesity. The Latino adult obesity rates are 45.7 percent for males and 43.7 percent for females.[6] Of the 1.2 million people infected with HIV in the United States, 294,200 are Latino.[7] The infection rate of chlamydia is 392.6 per 100,000 ― 1.9 times the rate in the non-Hispanic white population.[8] The tuberculosis incidence rate is eight times higher than that of non-Hispanic white people at 4.4 per 100,000.[9] Furthermore, Latinos have the third highest death rate for hepatitis C among all races and ethnic groups.[10] The prevalence of total diabetes, diagnosed and undiagnosed, among adults aged 18 and older also remains higher than that of non-Hispanic whites at 14.7 percent compared to 11.9 percent.[11] The high disease rate evidences the poor health of the community. Furthermore, 19 percent of Latinos in the United States remain uninsured.[12] Almost a quarter of the Latino population in the United States lives in poverty.[13] The high incidence of disease, lack of insurance, and high poverty rate create a frail health status for the Latino community in the United States. The medical conditions seen are largely preventable, and the incident rates can be lowered with greater investments in Latino community health. Considering the health disparities between Latino and non-Hispanic White people, there is an ethical imperative to provide better medical care and guidance to the Latino community. II. Ethical and Practical Importance of Increasing the Number of Latino Physicians Minorities respond more positively to patient-physician interactions and are more willing to undergo preventative healthcare when matched with a physician of their racial or ethnic background.[14] Latino medical doctors may lead to an improvement in overall community health through improved communication and trusting relationships. Patient-physician racial concordance leads to greater patient satisfaction with their physicians.[15] Identifying with the ethnicity of a physician may lead to greater confidence in the physician-patient relationship, resulting in more engagement on the patient’s behalf. A randomized study regarding African American men and the race of their attending physician found an increase in requests for preventative care when assigned to a black doctor.[16] Although the subjects were African American men, the study has implications applicable to other minority racial and ethnic groups. The application process is unjust for low-income Latinos. The low matriculation of Latinos in medical schools represents a missed opportunity to alleviate the poor community health of the Latino population in the United States. Medical school also would create an opportunity to address health issues that plague the Latino community. Becoming a physician allows low-income Latinos to climb the social ladder and enter the spaces in health care that have traditionally been closed off to them. Nonwhite physicians significantly serve underserved communities.[17] Increasing the number of Latino doctors can boost their presence, potentially improving care for underserved individuals. Teaching physicians cultural competence is not enough to address the health disparities the Latino community faces. Latino physicians are best equipped to understand the healthcare needs of low-income Latinos. I contend that reforming the application process represents the most straightforward method to augment the number of Latino physicians who wish to work in predominantly Latino or diverse communities, thereby improving healthcare for the Latino community. III. Cultural Tenets Affecting Healthcare Interactions “Poor cultural competence can lead to decreased patient satisfaction, which may cause the patient not to attend future appointments or seek further care.”[18] Latino community health is negatively affected when medical professionals misinterpret cultural beliefs. Cultural tenets like a reservation towards medication, a deep sense of respect for the physician, and an obligation to support the family financially and through advocacy affect how Latinos seek and use the healthcare system.[19] First, the Latino population's negative cultural beliefs about medication add a barrier to patient compliance. It is highlighted that fear of dependence upon medicine leads to trouble with medication regimens.[20] The fear stems from the negative perception of addiction in the Latino community. Taking as little medication as possible avoids the chance of addiction occurring, which is why many take the prescribed medicine only until they feel healthier, regardless of the prescribing regimen. Some would rather not take any medication because of the deep-rooted fear. Physicians must address this concern by communicating the importance of patient compliance to remedy the health issue. Explaining that proper use of the medication as prescribed will ensure the best route to alleviate the condition and minimize the occurrence of dependence. Extra time spent addressing concerns and checking for comprehension may combat the negative perception of medication. Second, the theme of respeto, or respect, seems completely harmless to most people. After all, how can being respectful lead to bad health? This occurs when respect is understood as paternalism. Some patients may relinquish their decision-making to the physician. The physician might not act with beneficence, in this instance, because of the cultural dissonance in the physician-patient relationship that may lead to medical misinterpretation. A well-meaning physician might not realize that the patient is unlikely to speak up about their goals of care and will follow the physician’s recommendations without challenging them. That proves costly because a key aspect of the medical usefulness of a patient’s family history is obtaining it through dialogue. The Latino patient may refrain from relaying health concerns because of the misconceived belief that it’s the doctor’s job to know what to ask. Asking the physician questions may be considered a sign of disrespect, even if it applies to signs, symptoms, feelings, or medical procedures the patient may not understand.[21] Respeto is dangerous because it restricts the patients from playing an active role in their health. Physicians cannot derive what medical information may be relevant to the patient without their cooperation. And physicians without adequate cultural competency may not know they need to ask more specific questions. Cultural competency may help, but a like-minded physician raised similarly would be a more natural fit. “A key component of physician-patient communication is the ability of patients to articulate concerns, reservations, and lack of understanding through questions.”[22] As a patient, engaging with a physician of one’s cultural background fortifies a strong physician-patient relationship. Latino physicians are in the position to explain to the patients that respeto is not lost during a physician-patient dialogue. In turn, the physician can express that out of their value of respeto, and the profession compels them to place the patient’s best interest above all. This entails physicians advocating on behalf of the patients to ask questions and check for comprehension, as is required to obtain informed consent. Latino physicians may not have a cultural barrier and may already organically understand this aspect of their patient’s traditional relationship with physicians. The common ground of respeto can be used to improve the health of the Latino community just as it can serve as a barrier for someone from a different background. Third, in some Latino cultures, there is an expectation to contribute to the family financially or in other ways and, above all, advocate on the family’s behalf. Familial obligations entail more than simply translating or accompanying family members to their appointments. They include actively advocating for just treatment in terms of services. Navigating institutions, such as hospitals, in a foreign landscape proves difficult for underrepresented minorities like Latinos who are new to the United States. These difficulties can sometimes lead to them being taken advantage of, as they might not fully understand their rights, the available resources, or the standard procedures within these institutions. The language barrier and unfamiliar institutional policies may misinterpret patients’ needs or requests. Furthermore, acting outside of said institution’s policy norms may be erroneously interpreted as actions of an uncooperative patient leading to negative interactions between the medical staff and the Latino patient. The expectation of familial contribution is later revisited as it serves as a constraint to the low-income Latino medical school applicant. Time is factored out to meet these expectations, and a moral dilemma to financially contribute to the family dynamic rather than delay the contribution to pursue medical school discourages Latinos from applying. IV. How the Medical School Admission Process is Creating an Undue Burden for Low-Income Latino Applicants Applying a bioethics framework to the application process highlights its flaws. Justice is a central bioethical tenet relevant to the analysis of the MD admissions process. The year-long medical school application process begins with the primary application. The student enters information about the courses taken, completes short answer questions and essays, and uploads information about recommenders. Secondary applications are awarded to some medical students depending on the institutions’ policies. Some schools ask all applicants for secondary applications, while others select which applicants to send secondary requests. Finally, interviews are conducted after a review of both primary and secondary applications. This is the last step before receiving an admissions decision. The medical school application process creates undue restrictions against underserved communities. It is understood that matriculating into medical school and becoming a doctor should be difficult. The responsibilities of a physician are immense, and the consequences of actions or inactions may put the patients’ lives in jeopardy. Medical schools should hold high standards because of the responsibility and expertise required to provide optimal healthcare. However, I argue that the application process places an undue burden on low-income Latino applicants that is not beneficial to optimal health care. The burden placed on low-income Latino applicants through the application process is excessive and not necessary to forge qualified medical students. The financial aspect of the medical school application has made the profession virtually inaccessible to the working class. The medical school application proves costly because of the various expenses, including primary applications, secondary applications, and interview logistics. There is financial aid for applications, but navigating some aid to undertake test prep, the Medical College Admission Test (MCAT), and the travel for interviews proves more difficult. Although not mandatory, prep courses give people a competitive edge.[23] The MCAT is one of the key elements of an application, and many medical schools will not consider applications that do not reach their score threshold. This practically makes the preparatory courses mandatory for a competitive score. The preparatory courses themselves cost in the thousands of dollars. There has been talk about adjusting the standardized test score requirements for applicants from medically underserved backgrounds. I believe the practice of holding strict cutoffs for MCAT scores is detrimental to low-income Latino applicants, especially considering the average MCAT scores for Latinos trail that of white people. The American Association of Medical Colleges’ recent data for the matriculating class of 2021 illustrates the wide gap in MCAT scores: Latino applicants average 500.2, and Latino matriculants average 506.6, compared to white applicants, who average 507.5 and white matriculants, who average 512.7.[24] This discrepancy suggests that considerations beyond scores do play some role in medical school matriculation. However, the MCAT scores remain a predominant factor, and there is room to value other factors more and limit the weight given to scores. The practice of screening out applicants based solely on MCAT scores impedes low-income Latino applicants from matriculating into medical school. Valuing the MCAT above all other admissions criteria limits the opportunities for those from underserved communities, who tend to score lower on the exam. One indicator of a potentially great physician may be overcoming obstacles or engaging in scientific or clinical experiences. There are aspects of the application where the applicant can expand on their experiences, and the personal statement allows them to showcase their passion for medicine. These should hold as much weight as the MCAT. The final indicator of a good candidate should not solely rest on standardized tests. There is a cost per medical school that is sent to the primary application. The average medical school matriculant applies to about 16 universities, which drives up the cost of sending the applications.[25] According to the American Association of Medical Colleges, the application fee for the first school is $170, and each additional school is an additional $42. Sending secondary applications after the initial application is an additional cost that ranges by university. The American Medical College Application Service (AMCAS), the primary application portal for Medical Doctorate schools in the United States and Canada, offers the Fee Assistance Program (FAP) to aid low-income medical school applicants. The program reduces the cost of the MCAT from $325 to $130, includes a complimentary Medical School Admission Requirements (MSAR) subscription, and fee waivers for one AMCAS application covering up to 20 schools.[26] The program is an important aid for low-income Latino students who would otherwise not be able to afford to send multiple applications. Although the aid is a great resource, there are other expenses of the application process that the program cannot cover. For a low-income applicant, the burden of the application cost is felt intensely. A study analyzing the American Medical College Application Service (AMCAS) data for applicants and matriculants from 2014 to 2019 revealed an association between income and acceptance into medical school. They state, “Combining all years, the likelihood of acceptance into an MD program increased stepwise by income. The adjusted rate of acceptance was 24.32 percent for applicants with income less than $50 000, 27.57 percent for $50 000 - $74 999, 29.90 percent for $75 000 - $124 999, 33.27 percent for $125 000 - $199 999, and 36.91 percent for $200,000 or greater.”[27] It becomes a discouraging factor when it is difficult to obtain the necessary funds. The interview process for medical schools may prove costly because of travel, lodging, and time. In-person interviews may require applicants to travel from their residence to other cities or states. The applicant must find their own transportation and housing during the interview process, ranging from a single day to multiple days. Being granted multiple interviews becomes bittersweet for low-income applicants because they are morally distraught, knowing the universities are interested yet understanding the high financial cost of the interviews. The expense of multiple interviews can impede an applicant from progressing in the application process. Medical schools do not typically cover travel expenses for the interview process. Only 4 percent of medical school faculty identify as Latino.[28] The medical school admission board members reviewing the application lack Latino representation.[29] Because of this, it is extremely difficult for a low-income Latino applicant to portray hardships that the board members would understand. Furthermore, the section to discuss any hardships only allows for 200 words. This limited space makes it extremely difficult to explain the nuances of navigating higher education as a low-income Latino. Explaining those difficulties is then restricted to the interview process. However, that comes late in the application process when most applicants have been filtered out of consideration. The lack of diversity among the board members, combined with the minimal space to explain hardships or burdens, impedes a connection to be formed between the Latino applicants and the board members. It is not equitable that this population cannot relate to their admissions reviewers because of cultural barriers. Gatekeeping clinical experience inadvertently favors higher socioeconomic status applicants. Most medical schools require physician shadowing or clinical work, which can be difficult to obtain with no personal connections to the field. Using clinical experience on the application is another way that Latinos are disadvantaged compared to people who have more professional connections or doctors in the family and social circles. The already competitive market for clinical care opportunities is reduced by nepotism, which does not work in favor of Latino applicants. Yet some programs are designed to help low-income students find opportunities, such as Johns Hopkins’ Careers in Science and Medicine Summer Internship Program, which provides clinical experience and health professions mentoring.[30] Without social and professional ties to health care professionals, they are forced to enter a competitive job and volunteer market in clinical care and apply to these tailored programs not offered at all academic institutions. While it is not unique to Latinos, the time commitment of the application process is especially harsh on low-income students because they have financial burdens that can determine their survival. Some students help their families pay for food, rent, and utilities, making devoting time to the application process more problematic. As noted earlier, Latino applicants may also have to set aside time to advocate for their families. Because the applicants tend to be more in tune with the dominant American culture, they are often assigned the family advocate role. They must actively advocate for their family members' well-being. The role of a family advocate, with both its financial and other supportive roles ascribed to low-income Latino applicants, is an added strain that complicates the medical school application. As a member of a historically marginalized community, one must be proactive to ensure that ethical treatment is received. Ordinary tasks such as attending a doctor's appointment or meeting with a bank account manager may require diligent oversight. Applicants must ensure the standard of service is applied uniformly to their family as it is to the rest of the population. This applies to business services and healthcare. It can be discouraging to approach a field that does not have many people from your background. The lack of representation emphasizes the applicant's isolation going through the process. There is not a large group of Latinos in medicine to look to for guidance.[31] The group cohesiveness that many communities experience through a rigorous process is not established among low-income Latino applicants. They may feel like outsiders to the profession. Encountering medical professionals of similar backgrounds gives people the confidence to pursue the medical profession. V. Medical School Admission Data This section will rely on the most recent MD medical school students, the 2020-2021 class. The data includes demographic information such as income and ethnicity. The statistics used in this section were retrieved from scholarly peer-reviewed articles and the Medical School Admission Requirement (MSAR) database. Both sources of data are discussed in more detail throughout the section. The data reveals that only 6.7 percent of medical students for the 2020-2021 school year identify as Latino.[32] The number of Latino students in medical school is not proportional to the Latino community in the United States. While Latinos comprise almost 20 percent of the US population (62.1 million), they comprise only 6.7 percent of the medical student population.[33] Below are three case studies of medical schools in cities with a high Latino population. VI. Medical School Application Process Case Studies a) New York University Grossman School of Medicine is situated in Manhattan, where a diverse population of Latinos reside. The population of the borough of Manhattan is approximately 1,629,153, with 26 percent of the population identifying as Latino.[34] As many medical schools do, Grossman School of Medicine advertises an MD Student Diversity Recruitment program. The program, entitled Prospective MD Student Liaison Program, is aimed such that “students from backgrounds that are underrepresented in medicine are welcomed and supported throughout their academic careers.”[35] The program intervenes with underrepresented students during the interview process of the medical school application. All students invited to interviews can participate in the Prospective MD Student Liaison Program. They just need to ask to be part of it. That entails being matched with a current medical student in either the Black and Latinx Student Association (BALSA) or LGBTQMed who will share their experiences navigating medical school. Apart from the liaison program, NYU participates in the Science Technology Entry Program (STEP), which provides academic guidance to middle and high school students who are underrepresented minorities.[36] With the set programs in place, one would expect to find a significantly larger proportion of Latino medical students in the university. The Medical School Admission Requirement (MSAR) database compiled extensive data about participants in the medical school; the data range from tuition to student body demographics. Of the admitted medical students in 2021, only 16 out of 108 identified as Latino, despite the much larger Latino population of New York.[37] Furthermore, only 4 percent of the admitted students classify themselves as being from a disadvantaged status.[38] The current efforts to increase medical school diversity are not producing adequate results at NYU. Although the Latino representation in this medical school may be higher than that in others, it does not reflect the number of Latinos in Manhattan. The Prospective MD Student Liaison Program intervenes at a late stage of the medical school application process. It would be more beneficial for a program to cover the entire application process. The lack of Latino medical students makes it difficult for prospective students to seek advice from Latino students. Introducing low-income Latino applicants to enrolled Latino medical students would serve as a guiding tool throughout the application process. An early introduction could encourage the applicants to apply and provide a resourceful ally in the application process when, in many circumstances, there would be none. Latino medical students can share their experiences of overcoming cultural and social barriers to enter medical school. b) The Latino population in Philadelphia is over 250,000, constituting about 15 percent of the 1.6 million inhabitants.[39] According to MSAR, the cohort of students starting at Drexel University College of Medicine, located in Philadelphia, in 2021 was only 7.6 percent Latino.[40] 18 percent of matriculated students identify as having disadvantaged status, while 21 percent identify as coming from a medically underserved community.[41] Drexel University College of Medicine claims that “Students who attend racially and ethnically diverse medical schools are better prepared to care for patients in a diverse society.”[42] They promote diversity with various student organizations within the college, including the following: Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), Drexel Black Doctors Network, LGBT Medical Student Group, and Drexel Mentoring and Pipeline Program (DMAPP). The Student Center for Diversity and Inclusion of the College of Medicine offers support groups for underrepresented medical students. The support offered at Drexel occurs at the point of matriculation, not for prospective students. The one program that does seem to be a guide for prospective students is the Drexel Pathway to Medical School program. Drexel Pathway to Medical School is a one-year master’s program with early assurance into the College of Medicine and may serve as a gateway for prospective Latino Students.[43] The graduate program is tailored for students who are considered medically underserved or socioeconomically disadvantaged and have done well in the traditional pre-medical school coursework. It is a competitive program that receives between 500 and 700 applicants for the 65 available seats. The assurance of entry into medical school makes the Drexel Pathway to Medical School a beneficial program in aiding Latino representation in medicine. Drexel sets forth minimum requirements for the program that show the school is willing to consider students without the elite scores and grades required of many schools. MCAT scores must be in the 25th percentile or higher, and the overall or science GPA must be at least 2.9.[44] The appealing factor of this program is its mission to attract medically underserved students. This is a tool to increase diversity in medical school. Prospective low-income Latino students can view this as a graduate program tailored to communities like theirs. However, this one-year program is not tuition-free. It may be tempting to assume that patients prefer doctors with exceptional academic records. There's an argument against admitting individuals with lower test scores into medical schools, rooted in the belief that this approach does not necessarily serve the best interests of health care. The argument asserts that the immense responsibility of practicing medicine should be entrusted to the most qualified candidates. Programs like the Drexel Pathway to Medical School are designed to address the lower academic achievements often seen in underrepresented communities. Their purpose is not to admit underqualified individuals into medical school but to bridge the educational gap, helping these individuals take the necessary steps to become qualified physicians. c) The University of California San Francisco School of Medicine reports that 23 percent of its first-year class identifies as Latino, while 34 percent consider themselves disadvantaged.[45] The Office of Diversity and Outreach is concerned with increasing the number of matriculants from underserved communities. UCSF has instilled moral commitments and conducts pipeline and outreach programs to increase the diversity of its medical school student body. The Differences Matter Initiative that the university has undertaken is a complex years-long restructuring of the medical school aimed at making the medical system equitable, diverse, and inclusive.[46] The five-phase commitment includes restructuring the leadership of the medical school, establishing anti-oppression and anti-racism competencies, and critically analyzing the role race, ethnicity, gender, and sexual orientation play in medicine. UCSF offers a post-baccalaureate program specifically tailored to disadvantaged and underserved students. The program’s curriculum includes MCAT preparation, skills workshops, science courses, and medical school application workshops.[47] The MCAT preparation and medical school application workshops serve as a great tool for prospective Latino applicants. UCSF seems to do better than most medical schools regarding Latino medical students. San Francisco has a population of 873,965, of which 15.2 percent are Latino.[48] The large population of Latino medical students indicates that the school’s efforts to increase diversity are working. The 23 percent Latino matriculating class of 2021 better represents the number of Latinos in the United States, which makes up about a fifth of the population. With this current data, it is important to closely dissect the efforts UCSF has taken to increase diversity in its medical school. Their Differences Matter initiative instills a commitment to diversifying their medical school. As mentioned, the school's leadership has been restructuring to include a diverse administrative body. This allows low-income Latino applicants to relate to the admissions committee reviewing their application. With a hopeful outlook, the high percentage of Latino applicants may reflect comprehension of the application process and the anticipated medical school atmosphere and rigor among Latino applicants and demonstrate that the admissions committee understands the applicants. However, there are still uncertainties about the demographics of the Latino student population in the medical school. Although it is a relatively high percentage, it is necessary to decipher which proportion of those students are low-income Latino Americans. UCSF School of Medicine can serve as a model to uplift the Latino community in a historically unattainable profession. VII. Proposed Reform for Current Medical School Application One reform would be toward the reviewing admissions committee, which has the power to change the class composition. By increasing the diversity of the admissions committee itself, schools can give minority applicants a greater opportunity to connect to someone with a similar background through their application. It would address low-income Latino applicants feeling they cannot “get personal” in their application. These actions are necessary because it is not just to have a representative administration for only a portion of the public. Of the three medical schools examined, the University of California San Francisco has the highest percentage of Latino applicants in their entering class. They express an initiative to increase diversity within their medical school leadership via the Differences Matter initiative. This active role in increasing diversity within the medical school leadership may play a role in UCSF’s high percentage of Latino matriculants. That serves as an important step in creating an equitable application process for Latino applicants. An important consideration is whether the medical school administration at UCSF mirrors the Latino population in the United States. The importance of whether the medical school administration at UCSF mirrors the Latino population in the United States lies in its potential to foster diversity, inclusivity, and cultural competence in medical education, as well as to positively impact the healthcare outcomes and experiences of the Latino community. A diverse administration can serve as role models for students and aspiring professionals from underrepresented backgrounds. It can inspire individuals who might otherwise feel excluded or underrepresented in their career pursuits, including aspiring Latino medical students. Furthermore, a diverse leadership can help develop curricula, policies, and practices that are culturally sensitive and relevant, which is essential for addressing health disparities and providing equitable healthcare. It is also important to have transparency so the public knows the number of low-income Latino individuals in medical school. The Latino statistics from the medical school generally include international students. That speaks to diversity but misses the important aspect of uplifting the low-income Latino population of the United States. Passing off wealthy international students from Latin America to claim a culturally diverse class is misleading as it does not reflect income diversity. Doing so gives the incorrect perception that the medical school is accurately representing the Latino population of the United States. There must be a change in how the application process introduces interviews. It needs to be introduced earlier so the admissions committee can form early, well-rounded inferences about an applicant. The interview allows for personal connections with committee members that otherwise would not be established through the primary application. The current framework has the interviews as one of the last aspects of the application process before admissions decisions are reached. At this point in the application process, many low-income Latinos may have been screened out. I understand this is not an easy feat to accomplish. This will lead to an increase in interviews to be managed by the admissions committee. The burden can be strategically minimized by first conducting video interviews with applicants the admission committee is interested in moving forward and those that they are unsure about because of a weakness in a certain area of the application. The video interview provides a more formal connection between the applicants and admission committee reviewers. It allows the applicant to provide a narrative through spoken words and can come off as a more intimate window into their characteristics. It would also allow for an opportunity to explain hardships and what is unique. From this larger pool of video-interviewed applicants, the admission committee can narrow down to traditional in-person interviews. A form of these video interviews may be already in place in some medical school application process. I believe making this practice widespread throughout medical schools will provide an opportunity to increase the diversity of medical school students. There must be an increase in the number of programs dedicated to serving as a gateway to clinical experience for low-income Latino applicants. These programs provide the necessary networking environment needed to get clinical experience. It is important to consider that networking with clinical professionals is an admissions factor that detrimentally affects the low-income Latino population. One of the organizations that aids underserved communities, not limited to Latinos, in clinical exposure is the Summer Clinical Oncology Research Experience (SCORE) program.[49] The SCORE program, conducted by Memorial Sloan Kettering Cancer Center, provides its participants with mentorship opportunities in medicine and science. In doing so, strong connections are made in clinical environments. Low-income Latinos seek these opportunities as they have limited exposure to such an environment. I argue that it is in the medical school’s best interest to develop programs of this nature to construct a more diverse applicant pool. These programs are in the best interest of medical schools because they are culturing a well-prepared applicant pool. It should not be left to the goodwill of a handful of organizations to cultivate clinically experienced individuals from minority communities. Medical schools have an ethical obligation to produce well-suited physicians from all backgrounds. Justice is not upheld when low-income Latinos are disproportionally represented in medical schools. Programs tailored for low-income Latinos supplement the networking this population lacks, which is fundamental to obtaining clinical experience. These programs help alleviate the burden of an applicant’s low socioeconomic status in attaining clinical exposure. VIII. Additional Considerations Affecting the Medical School Application Process and Latino Community Health A commitment to practicing medicine in low-income Latino communities can be established to improve Latino community health.[50] Programs, such as the National Health Service Corps, encourage clinicians to practice in underserved areas by forgiving academic loans for years of work.[51] Increasing the number of clinicians in underserved communities can lead to a positive correlation with better health. It would be ideal to have programs for low-income Latino medical students that incentivize practicing in areas with a high population of underserved Latinos. This would provide the Latino community with physicians of a similar cultural background to attend to them, creating a deeper physician-patient relationship that has been missing in this community. Outreach for prospective Latino applicants by Latino medical students and physicians could encourage an increased applicant turnout. This effort can guide low-income Latinos who do not see much representation in the medical field. It would serve as a motivating factor and an opportunity to network within the medical field. Since there are few Latino physicians and medical students, a large effort must be made to make their presence known. IX. Further Investigation Required It is important to investigate the causes of medical school rejections of low-income Latinos. Understanding this piece of information would provide insight into the specific difficulties this population has with the medical school application. From there, the requirements can be subjected to bioethical analysis to determine whether those unfulfilled requirements serve as undue restrictions. The aspect of legacy students, children of former alumni, proves to be a difficult subject to find data on and merits further research. Legacy students are often given preferred admission into universities.[52] It is necessary to understand how this affects the medical school admissions process and whether it comes at a cost to students that are not legacy. It does not seem like these preferences are something universities are willing to disclose. The aspect of legacy preferences in admissions decisions could be detrimental to low-income Latino applicants if their parents are not college-educated in the United States, which often is the case. It would be beneficial to note how many Latinos in medical school are low-income. The MSAR report denotes the number of Latino-identified students per medical school class at an institution and the number of students who identify as coming from low resources. They do not specify which of the Latino students come from low-income families. This information would be useful to decipher how many people from the low-income Latino community are matriculating into medical schools. CONCLUSION It is an injustice that low-income Latinos are grossly underrepresented in medical school. It would remain an injustice even if the health of the Latino community in the United States were good. The current operation of medical school admission is based on a guild-like mentality, which perpetuates through barriers to admissions. It remains an exclusive club with processes that favor the wealthy over those who cannot devote money and time to the prerequisites such as test preparation courses and clinical internships. This has come at the expense of the Latino community in the United States in the form of both fewer Latino doctors and fewer current medical students. It is reasonable to hope that addressing the injustice of the underrepresentation of low-income Latinos in the medical field would improve Latino community health. With such a large demographic, the lack of representation in the medical field is astonishing. The Latino population faces cultural barriers when seeking healthcare, and the best way to combat that is with a familiar face. An increase in Latino medical students would lead to more physicians that not only can culturally relate to the Latino community, but that are a part of it. This opens the door for a comprehensive understanding between the patient and physician. As described in my thesis, Latino physicians can bridge cultural gaps that have proven detrimental to that patient population. That may help patients make informed decisions, exercising their full autonomy. The lack of representation of low-income Latinos in medicine is a long-known issue. Here, I have connected how the physician-patient relationship can be positively improved with an increase in low-income Latino physicians through various reforms in the admissions process. My hope is to have analyzed the problem of under-representation in a way that points toward further research and thoughtful reforms that can truly contribute to the process of remedying this issue. - [1] Passel, J. S., Lopez, M. H., & Cohn, D. (2022, February 3). U.S. Hispanic population continued its geographic spread in the 2010s. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ [2] Ramirez, A. G., Lepe, R., & Cigarroa, F. (2021). Uplifting the Latino Population From Obscurity to the Forefront of Health Care, Public Health Intervention, and Societal Presence. JAMA, 326(7), 597–598. https://doi.org/10.1001/jama.2021.11997 [3] Association of American Medical Colleges. (2023). Who is eligible to participate in the fee assistance program? https://students-residents.aamc.org/fee-assistance-program/who-eligble-participate-fee-assistance-mprogram [4] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [5] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm; Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf; Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [6] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm [7] Center for Disease Control and Prevention. (2021, October). Estimated HIV incidence and prevalence in the United States 2015–2019. https://www.cdc.gov/hiv/pdf/group/racialethnic/hispanic-latino/cdc-hiv-group-hispanic-latino-factsheet.pdf [8] Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [9] CDC. (2020). [10] CDC. (2020). [11] Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [12] Office of the Assistant Secretary for Planning and Evaluation. (2021, October). Issue Brief No. HP-2021-2. Health Insurance Coverage and Access to Care Among Latinos: Recent Trends and Key Challenges. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos [13] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [14] Alsan, M., Garrick, O., & Graziani, G. (2019). Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446 [15] Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.24583 [16] Alsan, et. al. (2019). [17] Marrast, L., Zallman, L., Woolhandler, S., Bor, D. H., & McCormick, D. (2014). Minority physicians’ role in the care of underserved patients. JAMA Internal Medicine, 174(2), 289. https://doi.org/10.1001/jamainternmed.2013.12756 (“Nonwhite physicians cared for 53.5% of minority and 70.4% of non-English speaking patients.” Increasing the number of Latino doctors could lead to more nonwhite physicians to care for the underserved populations as they serve those populations at disproportionate rates. This may lead to better care for the patients.) [18] Cersosimo, E., & Musi, N. (2011). Improving Treatment in Hispanic/Latino Patients. The American Journal of Medicine, 124(10), S16–S21. https://doi.org/10.1016/j.amjmed.2011.07.019 [19] Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of Pediatrics, 136(1), 14–23. https://doi.org/10.1016/s0022-3476(00)90043-x [20] Cersosimo & Musi. (2011). [21] Flores. (2000). [22] Torres, D. (2019). Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study. The Permanente Journal. https://doi.org/10.7812/tpp/18-258 [23] The Princeton Review. (n.d.). Score 513+ on the MCAT, Guaranteed! | The Princeton Review. [24] 2021 FACTS: Applicants and Matriculants Data. (2022). AAMC. https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data [25] The Princeton Review. (n.d.). How Many Med Schools Should You Apply To? https://www.princetonreview.com/med-school-advice/how-many-med-schools-should-you-apply-to [26] Association of American Medical Colleges. (n.d.). Fee Assistance Program (FAP). AAMC. https://students-residents.aamc.org/fee-assistance-program/fee-assistance-program-fap [27] Nguyen, M., Desai, M. M., Fancher, T. L., Chaudhry, S. I., Mason, H. R. C., & Boatright, D. (2023). Temporal trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income, 2014-2019. JAMA. https://doi.org/10.1001/jama.2023.5654 [28] Ramirez, et al. (2021). [29] Ko, M. J., Henderson, M. C., Fancher, T. L., London, M., Simon, M., & Hardeman, R. R. (2023). US medical school admissions leaders’ experiences with barriers to and advancements in diversity, equity, and inclusion. JAMA Network Open, 6(2), e2254928. https://doi.org/10.1001/jamanetworkopen.2022.54928 [30] Johns Hopkins University School of Medicine. (n.d.). JHU CSM SIP. Johns Hopkins Initiative for Careers in Science and Medicine - the Summer Internship Program. https://csmsip.cellbio.jhmi.edu/ [31] Figure 18. Percentage of all active physicians by race/ethnicity, 2018 | AAMC. (2018). AAMC. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 [32] Ramirez, et al. (2021). [33] Passel, et al. (2022). [34] Census Reporter. (n.d.). Census profile: Manhattan borough, New York County, NY. https://censusreporter.org/profiles/06000US3606144919-manhattan-borough-new-york-county-ny/ [35] MD Student Diversity Recruitment. (2022). NYU Langone Health. https://med.nyu.edu/our-community/why-nyu-grossman-school-medicine/diversity-inclusion/recruiting-diversity/md-student-diversity-recruitment [36] NYU. (n.d.). STEP Pre-College Program. New York University. https://www.nyu.edu/admissions/undergraduate-admissions/how-to-apply/all-freshmen-applicants/opportunity-programs/pre-college-programs.html [37] Association of American Medical Colleges. (2022). NYU Grossman School of Medicine. Medical School Admission Requirements (MSAR). https://mec.aamc.org/msar-ui/#/medSchoolDetails/152 [38] Association of American Medical Colleges. (2022). [39] U.S. Census Bureau. (2021). U.S. Census Bureau QuickFacts: Philadelphia County, Pennsylvania. Census Bureau QuickFacts. https://www.census.gov/quickfacts/philadelphiacountypennsylvania [40] Association of American Medical Colleges. (2022). Drexel University College of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/833 [41] Association of American Medical Colleges. (2022). [42] Drexel University College of Medicine. (n.d.). Diversity, Equity & Inclusion For Students. https://drexel.edu/medicine/about/diversity/diversity-for-students/ [43] Drexel University College of Medicine. (n.d.-b). Drexel Pathway to Medical School. https://drexel.edu/medicine/academics/graduate-school/drexel-pathway-to-medical-school/ [44] Drexel University College of Medicine. Drexel Pathway to Medical School. [45] Association of American Medical Colleges. (2022). University of California, San Francisco, School of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/108 [46] The Regents of the University of California. (n.d.). Differences Matter. UCSF School of Medicine. https://medschool.ucsf.edu/differences-matter [47] The Regents of the University of California. (n.d.-b). Post Baccalaureate Program | UCSF Medical Education. UCSF Medical Education. https://meded.ucsf.edu/post-baccalaureate-program [48] United States Census Bureau. (2021). U.S. Census Bureau QuickFacts: San Francisco County, California. Census Bureau QuickFacts. https://www.census.gov/quickfacts/sanfranciscocountycalifornia [49] Memorial Sloan Kettering Cancer Center. (n.d.). Student Programs. https://www.mskcc.org/about/leadership/office-faculty-development/student-programs [50] Alsan, et al. (2021). [51] National Health Service Corps. (2021, November 2). Mission, Work, and Impact | NHSC. https://nhsc.hrsa.gov/about-us [52] Elam, C. L., & Wagoner, N. E. (2012). Legacy Admissions in Medical School. AMA Journal of Ethics, 14(12), 946–949. https://doi.org/10.1001/virtualmentor.2012.14.12.ecas3-1212

I first came across etoy in Linz, Austria in 1995. They turned up at Ars Electronica with their shaved heads, in their matching orange bomber jackets. They were not invited. The next year they would not have to crash the party. In 1996 they were awarded Arts Electronica’s prestigious Golden Nica for web art, and were on their way to fame and bitterness – the just rewards for their art of self-regard. As founding member Agent.ZAI says: “All of us were extremely greedy – for excitement, for drugs, for success.” (Wishart & Boschler: 16) The etoy story starts on the fringes of the squatters’ movement in Zurich. Disenchanted with the hard left rhetorics that permeate the movement in the 1980s, a small group look for another way of existing within a commodified world, without the fantasy of an ‘outside’ from which to critique it. What Antonio Negri and friends call the ‘real subsumption’ of life under the rule of commodification is something etoy grasps intuitively. The group would draw on a number of sources: David Bowie, the Sex Pistols, the Manchester rave scene, European Amiga art, rumors of the historic avant gardes from Dada to Fluxus. They came together in 1994, at a meeting in the Swiss resort town of Weggis on Lake Lucerne. While the staging of the founding meeting looks like a rerun of the origins of the Situationist International, the wording of the invitation might suggest the founding of a pop music boy band: “fun, money and the new world?” One of the – many – stories about the origins of the name Dada has it being chosen at random from a bilingual dictionary. The name etoy, in an update on that procedure, was spat out by a computer program designed to make four letter words at random. Ironically, both Dada and etoy, so casually chosen, would inspire furious struggles over the ownership of these chancey 4-bit words. The group decided to make money by servicing the growing rave scene. Being based in Vienna and Zurich, the group needed a way to communicate, and chose to use the internet. This was a far from obvious thing to do in 1994. Connections were slow and unreliable. Sometimes it was easier to tape a hard drive full of clubland graphics to the underside of a seat on the express train from Zurich to Vienna and simply email instructions to meet the train and retrieve it. The web was a primitive instrument in 1995 when etoy built its first website. They launched it with a party called etoy.FASTLANE, an optimistic title when the web was anything but. Coco, a transsexual model and tabloid sensation, sang a Japanese song while suspended in the air. She brought media interest, and was anointed etoy’s lifestyle angel. As Wishart and Bochsler write, “it was as if the Seven Dwarfs had discovered their Snow White.” (Wishart & Boschler: 33) The launch didn’t lead to much in the way of a music deal or television exposure. The old media were not so keen to validate the etoy dream of lifting themselves into fame and fortune by their bootstraps. And so etoy decided to be stars of the new media. The slogan was suitably revised: “etoy: the pop star is the pilot is the coder is the designer is the architect is the manager is the system is etoy.” (Wishart & Boschler: 34) The etoy boys were more than net.artists, they were artists of the brand. The brand was achieving a new prominence in the mid-90s. (Klein: 35) This was a time when capitalism was hollowing itself out in the overdeveloped world, shedding parts of its manufacturing base. Control of the circuits of commodification would rest less on the ownership of the means of production and more on maintaining a monopoly on the flows of information. The leading edge of the ruling class was becoming self-consciously vectoral. It controlled the flow of information about what to produce – the details of design, the underlying patents. It controlled the flows of information about what is produced – the brands and logos, the slogans and images. The capitalist class is supplanted by a vectoral class, controlling the commodity circuit through the vectors of information. (Wark) The genius of etoy was to grasp the aesthetic dimension of this new stage of commodification. The etoy boys styled themselves not so much as a parody of corporate branding and management groupthink, but as logical extension of it. They adopted matching uniforms and called themselves agents. In the dada-punk-hiphop tradition, they launched themselves on the world as brand new, self-created, self-named subjects: Agents Zai, Brainhard, Gramazio, Kubli, Esposto, Udatny and Goldstein. The etoy.com website was registered in 1995 with Network Solutions for a $100 fee. The homepage for this etoy.TANKSYSTEM was designed like a flow chart. As Gramazio says: “We wanted to create an environment with surreal content, to build a parallel world and put the content of this world into tanks.” (Wishart & Boschler: 51) One tank was a cybermotel, with Coco the first guest. Another tank showed you your IP number, with a big-brother eye looking on. A supermarket tank offered sunglasses and laughing gas for sale, but which may or may not be delivered. The underground tank included hardcore photos of a sensationalist kind. A picture of the Federal Building in Oklamoma City after the bombing was captioned in deadpan post-situ style “such work needs a lot of training.” (Wishart & Boschler: 52) The etoy agents were by now thoroughly invested in the etoy brand and the constellation of images they had built around it, on their website. Their slogan became “etoy: leaving reality behind.” (Wishart & Boschler: 53) They were not the first artists fascinated by commodification. It was Warhol who said “good art is good business.”(Warhol ) But etoy reversed the equation: good business is good art. And good business, in this vectoral age, is in its most desirable form an essentially conceptual matter of creating a brand at the center of a constellation of signifiers. Late in 1995, etoy held another group meeting, at the Zurich youth center Dynamo. The problem was that while they had build a hardcore website, nobody was visiting it. Agents Gooldstein and Udatny thought that there might be a way of using the new search engines to steer visitors to the site. Zai and Brainhard helped secure a place at the Vienna Academy of Applied Arts where Udatny could use the computer lab to implement this idea. Udatny’s first step was to create a program that would go out and gather email addresses from the web. These addresses would form the lists for the early examples of art-spam that etoy would perpetrate. Udatny’s second idea was a bit more interesting. He worked out how to get the etoy.TANKSYSTEM page listed in search engines. Most search engines ranked pages by the frequency of the search term in the pages it had indexed, so etoy.TANKSYSTEM would contain pages of selected keywords. Porn sites were also discovering this method of creating free publicity. The difference was that etoy chose a very carefully curated list of 350 search terms, including: art, bondage, cyberspace, Doom, Elvis, Fidel, genx, heroin, internet, jungle and Kant. Users of search engines who searched for these terms would find dummy pages listed prominently in their search results that directed them, unsuspectingly, to etoy.com. They called this project Digital Hijack. To give the project a slightly political aura, the pages the user was directed to contained an appeal for the release of convicted hacker Kevin Mitnick. This was the project that won them a Golden Nica statuette at Ars Electronica in 1996, which Gramazio allegedly lost the same night playing roulette. It would also, briefly, require that they explain themselves to the police. Digital Hijack also led to the first splits in the group, under the intense pressure of organizing it on a notionally collective basis, but with the zealous Agent Zai acting as de facto leader. When Udatny was expelled, Zai and Brainhard even repossessed his Toshiba laptop, bought with etoy funds. As Udatny recalls, “It was the lowest point in my life ever. There was nothing left; I could not rely on etoy any more. I did not even have clothes, apart from the etoy uniform.” (Wishart & Boschler: 104) Here the etoy story repeats a common theme from the history of the avant gardes as forms of collective subjectivity. After Digital Hijack, etoy went into a bit of a slump. It’s something of a problem for a group so dependent on recognition from the other of the media, that without a buzz around them, etoy would tend to collapse in on itself like a fading supernova. Zai spend the early part of 1997 working up a series of management documents, in which he appeared as the group’s managing director. Zai employed the current management theory rhetoric of employee ‘empowerment’ while centralizing control. Like any other corporate-Trotskyite, his line was that “We have to get used to reworking the company structure constantly.” (Wishart & Boschler: 132) The plan was for each member of etoy to register the etoy trademark in a different territory, linking identity to information via ownership. As Zai wrote “If another company uses our name in a grand way, I’ll probably shoot myself. And that would not be cool.” (Wishart & Boschler:: 132) As it turned out, another company was interested – the company that would become eToys.com. Zai received an email offering “a reasonable sum” for the etoy.com domain name. Zai was not amused. “Damned Americans, they think they can take our hunting grounds for a handful of glass pearls….”. (Wishart & Boschler: 133) On an invitation from Suzy Meszoly of C3, the etoy boys traveled to Budapest to work on “protected by etoy”, a work exploring internet security. They spent most of their time – and C3’s grant money – producing a glossy corporate brochure. The folder sported a blurb from Bjork: “etoy: immature priests from another world” – which was of course completely fabricated. When Artothek, the official art collection of the Austrian Chancellor, approached etoy wanting to buy work, the group had to confront the problem of how to actually turn their brand into a product. The idea was always that the brand was the product, but this doesn’t quite resolve the question of how to produce the kind of unique artifacts that the art world requires. Certainly the old Conceptual Art strategy of selling ‘documentation’ would not do. The solution was as brilliant as it was simple – to sell etoy shares. The ‘works’ would be ‘share certificates’ – unique objects, whose only value, on the face of it, would be that they referred back to the value of the brand. The inspiration, according to Wishart & Boschsler, was David Bowie, ‘the man who sold the world’, who had announced the first rock and roll bond on the London financial markets, backed by future earnings of his back catalogue and publishing rights. Gramazio would end up presenting Chancellor Viktor Klima with the first ‘shares’ at a press conference. “It was a great start for the project”, he said, “A real hack.” (Wishart & Boschler: 142) For this vectoral age, etoy would create the perfect vectoral art. Zai and Brainhard took off next for Pasadena, where they got the idea of reverse-engineering the online etoy.TANKSYSTEM by building an actual tank in an orange shipping container, which would become etoy.TANK 17. This premiered at the San Francisco gallery Blasthaus in June 1998. Instant stars in the small world of San Francisco art, the group began once again to disintegrate. Brainhard and Esposito resigned. Back in Europe in late 1998, Zai was preparing to graduate from the Vienna Academy of Applied Arts. His final project would recapitulate the life and death of etoy. It would exist from here on only as an online archive, a digital mausoleum. As Kubli says “there was no possibility to earn our living with etoy.” (Wishart & Boschler: 192) Zai emailed eToys.com and asked them if them if they would like to place a banner ad on etoy.com, to redirect any errant web traffic. Lawyers for eToys.com offered etoy $30,000 for the etoy.com domain name, which the remaining members of etoy – Zai, Gramazio, Kubli – refused. The offer went up to $100,000, which they also refused. Through their lawyer Peter Wild they demanded $750,000. In September 1999, while etoy were making a business presentation as their contribution to Ars Electronica, eToys.com lodged a complaint against etoy in the Los Angeles Superior Court. The company hired Bruce Wessel, of the heavyweight LA law firm Irell & Manella, who specialized in trademark, copyright and other intellectual property litigation. The complaint Wessel drafted alleged that etoy had infringed and diluted the eToys trademark, were practicing unfair competition and had committed “intentional interference with prospective economic damage.” (Wishart & Boschler: 199) Wessel demanded an injunction that would oblige etoy to cease using its trademark and take down its etoy.com website. The complaint also sought to prevent etoy from selling shares, and demanded punitive damages. Displaying the aggressive lawyering for which he was so handsomely paid, Wessel invoked the California Unfair Competition Act, which was meant to protect citizens from fraudulent business scams. Meant as a piece of consumer protection legislation, its sweeping scope made it available for inventive suits such as Wessel’s against etoy. Wessel was able to use pretty much everything from the archive etoy built against it. As Wishart and Bochsler write, “The court papers were like a delicately curated catalogue of its practices.” (Wishart & Boschler: 199) And indeed, legal documents in copyright and trademark cases may be the most perfect literature of the vectoral age. The Unfair Competition claim was probably aimed at getting the suit heard in a Californian rather than a Federal court in which intellectual property issues were less frequently litigated. The central aim of the eToys suit was the trademark infringement, but on that head their claims were not all that strong. According to the 1946 Lanham Act, similar trademarks do not infringe upon each other if there they are for different kinds of business or in different geographical areas. The Act also says that the right to own a trademark depends on its use. So while etoy had not registered their trademark and eToys had, etoy were actually up and running before eToys, and could base their trademark claim on this fact. The eToys case rested on a somewhat selective reading of the facts. Wessel claimed that etoy was not using its trademark in the US when eToys was registered in 1997. Wessel did not dispute the fact that etoy existed in Europe prior to that time. He asserted that owning the etoy.com domain name was not sufficient to establish a right to the trademark. If the intention of the suit was to bully etoy into giving in, it had quite the opposite effect. It pissed them off. “They felt again like the teenage punks they had once been”, as Wishart & Bochsler put it. Their art imploded in on itself for lack of attention, but called upon by another, it flourished. Wessel and eToys.com unintentionally triggered a dialectic that worked in quite the opposite way to what they intended. The more pressure they put on etoy, the more valued – and valuable – they felt etoy to be. Conceptual business, like conceptual art, is about nothing but the management of signs within the constraints of given institutional forms of market. That this conflict was about nothing made it a conflict about everything. It was a perfectly vectoral struggle. Zai and Gramazio flew to the US to fire up enthusiasm for their cause. They asked Wolfgang Staehle of The Thing to register the domain toywar.com, as a space for anti-eToys activities at some remove from etoy.com, and as a safe haven should eToys prevail with their injunction in having etoy.com taken down. The etoy defense was handled by Marcia Ballard in New York and Robert Freimuth in Los Angeles. In their defense, they argued that etoy had existed since 1994, had registered its globally accessible domain in 1995, and won an international art prize in 1996. To counter a claim by eToys that they had a prior trademark claim because they had bought a trademark from another company that went back to 1990, Ballard and Freimuth argued that this particular trademark only applied to the importation of toys from the previous owner’s New York base and thus had no relevance. They capped their argument by charging that eToys had not shown that its customers were really confused by the existence of etoy. With Christmas looming, eToys wanted a quick settlement, so they offered Zurich-based etoy lawyer Peter Wild $160,000 in shares and cash for the etoy domain. Kubli was prepared to negotiate, but Zai and Gramazio wanted to gamble – and raise the stakes. As Zai recalls: “We did not want to be just the victims; that would have been cheap. We wanted to be giants too.” (Wishart & Boschler: 207) They refused the offer. The case was heard in November 1999 before Judge Rafeedie in the Federal Court. Freimuth, for etoy, argued that federal Court was the right place for what was essentially a trademark matter. Robert Kleiger, for eToys, countered that it should stay where it was because of the claims under the California Unfair Competition act. Judge Rafeedie took little time in agreeing with the eToys lawyer. Wessel’s strategy paid off and eToys won the first skirmish. The first round of a quite different kind of conflict opened when etoy sent out their first ‘toywar’ mass mailing, drawing the attention of the net.art, activism and theory crowd to these events. This drew a report from Felix Stalder in Telepolis: “Fences are going up everywhere, molding what once seemed infinite space into an overcrowded and tightly controlled strip mall.” (Stalder ) The positive feedback from the net only emboldened etoy. For the Los Angeles court, lawyers for etoy filed papers arguing that the sale of ‘shares’ in etoy was not really a stock offering. “The etoy.com website is not about commerce per se, it is about artist and social protest”, they argued. (Wishart & Boschler: 209) They were obliged, in other words, to assert a difference that the art itself had intended to blur in order to escape eToy’s claims under the Unfair Competition Act. Moreover, etoy argued that there was no evidence of a victim. Nobody was claiming to have been fooled by etoy into buying something under false pretences. Ironically enough, art would turn out in hindsight to be a more straightforward transaction here, involving less simulation or dissimulation, than investing in a dot.com. Perhaps we have reached the age when art makes more, not less, claim than business to the rhetorical figure of ‘reality’. Having defended what appeared to be the vulnerable point under the Unfair Competition law, etoy went on the attack. It was the failure of eToys to do a proper search for other trademarks that created the problem in the first place. Meanwhile, in Federal Court, lawyers for etoy launched a counter-suit that reversed the claims against them made by eToys on the trademark question. While the suits and counter suits flew, eToys.com upped their offer to settle to a package of cash and shares worth $400,000. This rather puzzled the etoy lawyers. Those choosing to sue don’t usually try at the same time to settle. Lawyer Peter Wild advised his clients to take the money, but the parallel tactics of eToys.com only encouraged them to dig in their heels. “We felt that this was a tremendous final project for etoy”, says Gramazio. As Zai says, “eToys was our ideal enemy – we were its worst enemy.” (Wishart & Boschler: 210) Zai reported the offer to the net in another mass mail. Most people advised them to take the money, including Doug Rushkoff and Heath Bunting. Paul Garrin counseled fighting on. The etoy agents offered to settle for $750,000. The case came to court in late November 1999 before Judge Shook. The Judge accepted the plausibility of the eToys version of the facts on the trademark issue, which included the purchase of a registered trademark from another company that went back to 1990. He issued an injunction on their behalf, and added in his statement that he was worried about “the great danger of children being exposed to profane and hardcore pornographic issues on the computer.” (Wishart & Boschler: 222) The injunction was all eToys needed to get Network Solutions to shut down the etoy.com domain. Zai sent out a press release in early December, which percolated through Slashdot, rhizome, nettime (Staehle) and many other networks, and catalyzed the net community into action. A debate of sorts started on investor websites such as fool.com. The eToys stock price started to slide, and etoy ‘warriors’ felt free to take the credit for it. The story made the New York Times on 9th December, Washington Post on the 10th, Wired News on the 11th. Network Solutions finally removed the etoy.com domain on the 10th December. Zai responded with a press release: “this is robbery of digital territory, American imperialism, corporate destruction and bulldozing in the way of the 19th century.” (Wishart & Boschler: 237) RTMark set up a campaign fund for toywar, managed by Survival Research Laboratories’ Mark Pauline. The RTMark press release promised a “new internet ‘game’ designed to destroy eToys.com.” (Wishart & Boschler: 239) The RTMark press release grabbed the attention of the Associated Press newswire. The eToys.com share price actually rose on December 13th. Goldman Sachs’ e-commerce analyst Anthony Noto argued that the previous declines in the Etoys share price made it a good buy. Goldman Sachs was the lead underwriter of the eToys IPO. Noto’s writings may have been nothing more than the usual ‘IPOetry’ of the time, but the crash of the internet bubble was some months away yet. The RTMark campaign was called ‘The Twelve Days of Christmas’. It used the Floodnet technique that Ricardo Dominguez used in support of the Zapatistas. As Dominguez said, “this hysterical power-play perfectly demonstrates the intensions of the new net elite; to turn the World Wide Web into their own private home-shopping network.” (Wishart & Boschler: 242) The Floodnet attack may have slowed the eToys.com server down a bit, but it was robust and didn’t crash. Ironically, it ran on open source software. Dominguez claims that the ‘Twelve Days’ campaign, which relied on individuals manually launching Floodnet from their own computers, was not designed to destroy the eToys site, but to make a protest felt. “We had a single-bullet script that could have taken down eToys – a tactical nuke, if you will. But we felt this script did not represent the presence of a global group of people gathered to bear witness to a wrong.” (Wishart & Boschler: 245) While the eToys engineers did what they could to keep the site going, eToys also approached universities and businesses whose systems were being used to host Floodnet attacks. The Thing, which hosted Dominguez’s eToys Floodnet site was taken offline by The Thing’s ISP, Verio. After taking down the Floodnet scripts, The Thing was back up, restoring service to the 200 odd websites that The Thing hosted besides the offending Floodnet site. About 200 people gathered on December 20th at a demonstration against eToys outside the Museum of Modern Art. Among the crowd were Santas bearing signs that said ‘Coal for eToys’. The rally, inside the Museum, was led by the Reverend Billy of the Church of Stop Shopping: “We are drowning in a sea of identical details”, he said. (Wishart & Boschler: 249-250) Meanwhile etoy worked on the Toywar Platform, an online agitpop theater spectacle, in which participants could act as soldiers in the toywar. This would take some time to complete – ironically the dispute threatened to end before this last etoy artwork was ready, giving etoy further incentives to keep the dispute alive. The etoy agents had a new lawyer, Chris Truax, who was attracted to the case by the publicity it was generating. Through Truax, etoy offered to sell the etoy domain and trademark for $3.7 million. This may sound like an insane sum, but to put it in perspective, the business.com site changed hands for $7.5 million around this time. On December 29th, Wessel signaled that eToys was prepared to compromise. The problem was, the Toywar Platform was not quite ready, so etoy did what it could to drag out the negotiations. The site went live just before the scheduled court hearings, January 10th 2000. “TOYWAR.com is a place where all servers and all involved people melt and build a living system. In our eyes it is the best way to express and document what’s going on at the moment: people start to about new ways to fight for their ideas, their lifestyle, contemporary culture and power relations.” (Wishart & Boschler: 263) Meanwhile, in a California courtroom, Truax demanded that Network Solutions restore the etoy domain, that eToys pay the etoy legal expenses, and that the case be dropped without prejudice. No settlement was reached. Negotiations dragged on for another two weeks, with the etoy agents’ attention somewhat divided between two horizons – art and law. The dispute was settled on 25th January. Both parties dismissed their complaints without prejudice. The eToys company would pay the etoy artists $40,000 for legal costs, and contact Network Solutions to reinstate the etoy domain. “It was a pleasure doing business with one of the biggest e-commerce giants in the world” ran the etoy press release. (Wishart & Boschler: 265) That would make a charming end to the story. But what goes around comes around. Brainhard, still pissed off with Zai after leaving the group in San Francisco, filed for the etoy trademark in Austria. After that the internal etoy wranglings just gets boring. But it was fun while it lasted. What etoy grasped intuitively was the nexus between the internet as a cultural space and the transformation of the commodity economy in a yet-more abstract direction – its becoming-vectoral. They zeroed in on the heart of the new era of conceptual business – the brand. As Wittgenstein says of language, what gives words meaning is other words, so too for brands. What gives brands meaning is other brands. There is a syntax for brands as there is for words. What etoy discovered is how to insert a new brand into that syntax. The place of eToys as a brand depended on their business competition with other brands – with Toys ‘R’ Us, for example. For etoy, the syntax they discovered for relating their brand to another one was a legal opposition. What made etoy interesting was their lack of moral posturing. Their abandonment of leftist rhetorics opened them up to exploring the territory where media and business meet, but it also made them vulnerable to being consumed by the very dialectic that created the possibility of staging etoy in the first place. By abandoning obsolete political strategies, they discovered a media tactic, which collapsed for want of a new strategy, for the new vectoral terrain on which we find ourselves. Works Cited Negri, Antonio. Time for Revolution. Continuum, London, 2003. Warhol, Andy. From A to B and Back Again. Picador, New York, 1984. Stalder, Felix. ‘Fences in Cyberspace: Recent events in the battle over domain names’. 19 Jun 2003. <http://felix.openflows.org/html/fences.php>. Wark, McKenzie. ‘A Hacker Manifesto [version 4.0]’ 19 Jun 2003. http://subsol.c3.hu/subsol_2/contributors0/warktext.html. Klein, Naomi. No Logo. Harper Collins, London, 2000. Wishart, Adam & Regula Bochsler. Leaving Reality Behind: etoy vs eToys.com & Other Battles to Control Cyberspace Ecco Books, 2003. Staehle, Wolfgang. ‘<nettime> etoy.com shut down by US court.’ 19 Jun 2003. http://amsterdam.nettime.org/Lists-Archives/nettime-l-9912/msg00005.html Links http://amsterdam.nettime.org/Lists-Archives/nettime-l-9912/msg00005.htm http://felix.openflows.org/html/fences.html http://subsol.c3.hu/subsol_2/contributors0/warktext.html Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Wark, McKenzie. "Toywars" M/C: A Journal of Media and Culture< http://www.media-culture.org.au/0306/02-toywars.php>. APA Style Wark, M. (2003, Jun 19). Toywars. M/C: A Journal of Media and Culture, 6,< http://www.media-culture.org.au/0306/02-toywars.php>

Many years ago, while studying in Paris as a novice postgraduate, I was invited to accompany a friend to a seminar with Jacques Derrida. I leapt at the chance even though I was only just learning French. Although I tried hard to follow the discussion, the extent of my participation was probably signing the attendance sheet. Afterwards, caught up on the edges of a small crowd of acolytes in the foyer as we waited out a sudden rainstorm, Derrida turned to me and charmingly complimented me on my forethought in predicting rain, pointing to my umbrella. Flustered, I garbled something in broken French about how I never forgot my umbrella, how desolated I was that he had mislaid his, and would he perhaps desire mine? After a small silence, where he and the other students side-eyed me warily, he declined. For years I dined on this story of meeting a celebrity academic, cheerfully re-enacting my linguistic ineptitude. Nearly a decade later I was taken aback when I overheard a lecturer in philosophy at the University of Sydney re-telling my encounter as a witty anecdote, where an early career academic teased Derrida with a masterful quip, quoting back to him his own attention to someone else’s quote. It turned out that Spurs, one of Derrida’s more obscure early essays, employs an extended riff on an inexplicable citation found in inverted commas in the margins of Nietzsche’s papers: “J’ai oublié mon parapluie” (“I have forgotten my umbrella”). My clumsy response to a polite enquiry was recast in a process of Chinese whispers in my academic community as a snappy spur-of-the-moment witticism. This re-telling didn’t just selectively edit my encounter, but remixed it with a meta-narrative that I had myself referenced, albeit unknowingly. My ongoing interest in the more playful breaches of scholarly conventions of quotation and attribution can be traced back to this incident, where my own presentation of an academic self was appropriated and remixed from fumbler to quipster. I’ve also been struck throughout my teaching career by the seeming disconnect between the stringent academic rules for referencing and citation and the everyday strategies of appropriation that are inherent to popular remix culture. I’m taking the opportunity in this paper to reflect on the practice of scholarly quotation itself, before examining some recent creative provocations to the academic ‘author’ situated inventively at the crossroad between scholarly convention and remix culture. Early in his own teaching career at Oxford University Lewis Carroll, wrote to his younger siblings describing the importance of maintaining his dignity as a new tutor. He outlines the distance his college was at pains to maintain between teachers and their students: “otherwise, you know, they are not humble enough”. Carroll playfully describes the set-up of a tutor sitting at his desk, behind closed doors and without access to today’s communication technologies, relying on a series of college ‘scouts’ to convey information down corridors and staircases to the confused student waiting for instruction below. The lectures, according to Carroll, went something like this: Tutor: What is twice three?Scout: What’s a rice-tree?Sub-scout: When is ice free?Sub-sub-scout: What’s a nice fee??Student (timidly): Half a guinea.Sub-sub-scout: Can’t forge any!Sub-scout: Ho for jinny!Scout: Don’t be a ninny!Tutor (looking offended, tries another question): Divide a hundred by twelve.Scout: Provide wonderful bells!Sub-scout: Go ride under it yourself!Sub-sub-scout: Deride the dunderhead elf!Pupil (surprised): What do you mean?Sub-sub-scout: Doings between!Sub-scout: Blue is the screen!Scout: Soup tureen! And so the lecture proceeds… Carroll’s parody of academic miscommunication and misquoting was reproduced by Pierre Bourdieu at the opening of the book Academic Discourse to illustrate the failures of pedagogical practice in higher education in the mid 1960s, when he found scholarly language relied on codes that were “destined to dazzle rather than to enlighten” (3). Bourdieu et al found that students struggled to reproduce appropriately scholarly discourse and were constrained to write in a badly understood and poorly mastered language, finding reassurance in what he called a ‘rhetoric of despair’: “through a kind of incantatory or sacrificial rite, they try to call up and reinstate the tropes, schemas or words which to them distinguish professorial language” (4). The result was bad writing that karaoke-ed a pseudo academic discourse, accompanied by a habit of thoughtlessly patching together other peoples’ words and phrases. Such sloppy quoting activities of course invite the scholarly taboo of plagiarism or its extreme opposite, hypercitation. Elsewhere, Jacques Derrida developed an important theory of citationality and language, but it is intriguing to note his own considerable unease with conventional acknowledgement practices, of quoting and being quoted: I would like to spare you the tedium, the waste of time, and the subservience that always accompany the classic pedagogical procedures of forging links, referring back to past premises or arguments, justifying one’s own trajectory, method, system, and more or less skilful transitions, re-establishing continuity, and so on. These are but some of the imperatives of classical pedagogy with which, to be sure, one can never break once and for all. Yet, if you were to submit to them rigorously, they would very soon reduce you to silence, tautology and tiresome repetition. (The Ear of the Other, 3) This weariness with a procedural hyper-focus on referencing conventions underlines Derrida’s disquiet with the self-protecting, self-promoting and self-justifying practices that bolster pedagogical tradition and yet inhibit real scholarly work, and risk silencing the authorial voice. Today, remix offers new life to quoting. Media theorist Lev Manovich resisted the notion that the practice of ‘quotation’ was the historical precedent for remixing, aligning it instead to the authorship practice of music ‘sampling’ made possible by new electronic and digital technology. Eduardo Navas agrees that sampling is the key element that makes the act of remixing possible, but links its principles not just to music but to the preoccupation with reading and writing as an extended cultural practice beyond textual writing onto all forms of media (8). A crucial point for Navas is that while remix appropriates and reworks its source material, it relies on the practice of citation to work properly: too close to the original means the remix risks being dismissed as derivative, but at the same time the remixer can’t rely on a source always being known or recognised (7). In other words, the conceptual strategies of remix must rely on some form of referencing or citation of the ideas it sources. It is inarguable that advances in digital technologies have expanded the capacity of scholars to search, cut/copy & paste, collate and link to their research sources. New theoretical and methodological frameworks are being developed to take account of these changing conditions of academic work. For instance, Annette Markham proposes a ‘remix methodology’ for qualitative enquiry, arguing that remix is a powerful tool for thinking about an interpretive and adaptive research practice that takes account of the complexity of contemporary cultural contexts. In a similar vein Cheré Harden Blair has used remix as a theoretical framework to grapple with the issue of plagiarism in the postmodern classroom. If, following Roland Barthes, all writing is “a tissue of quotations drawn from innumerable centers of culture” (146), and if all writing is therefore rewriting, then punishing students for plagiarism becomes problematic. Blair argues that since scholarly writing has become a mosaic of digital and textual productions, then teaching must follow suit, especially since teaching, as a dynamic, shifting and intertextual enterprise, is more suited to the digital revolution than traditional, fixed writing (175). She proposes that teachers provide a space in which remixing, appropriation, patch-writing and even piracy could be allowable, even useful and productive: “a space in which the line is blurry not because students are ignorant of what is right or appropriate, or because digital text somehow contains inherent temptations to plagiarise, but because digital media has, in fact, blurred the line” (183). The clashes between remix and scholarly rules of attribution are directly addressed by the pedagogical provocations of conceptual poet Kenneth Goldsmith, who has developed a program of ‘uncreative writing’ at the University of Pennsylvania, where, among other plagiaristic tasks, he forces students to transcribe whole passages from books, or to download essays from online paper mills and defend them as their own, marking down students who show a ‘shred of originality’. In his own writing and performances, which depend almost exclusively on strategies of appropriation, plagiarism and recontextualisation of often banal sources like traffic reports, Goldsmith says that he is working to de-familiarise normative structures of language. For Goldsmith, reframing language into another context allows it to become new again, so that “we don’t need the new sentence, the old sentence re-framed is good enough”. Goldsmith argues for the role of the contemporary academic and creative writer as an intelligent agent in the management of masses of information. He describes his changing perception of his own work: “I used to be an artist, then I became a poet; then a writer. Now when asked, I simply refer to myself as a word processor” (Perloff 147). For him, what is of interest to the twenty-first century is not so much the quote that ‘rips’ or tears words out of their original context, but finding ways to make new ‘wholes’ out of the accumulations, filterings and remixing of existing words and sentences. Another extraordinary example of the blurring of lines between text, author and the discursive peculiarities of digital media can be found in Jonathan Lethem’s essay ‘An Ecstasy of Influence: A Plagiarism’, which first appeared in Harpers Magazine in 2007. While this essay is about the topic of plagiarism, it is itself plagiarized, composed of quotes that have been woven seamlessly together into a composite whole. Although Lethem provides a key at the end with a list of his sources, he has removed in-text citations and quotation marks, even while directly discussing the practices of mis-quotation and mis-attribution throughout the essay itself. Towards the end of the essay can be found the paragraph: Any text is woven entirely with citations, references, echoes, cultural languages, which cut across it through and through in a vast stereophony. The citations that go to make up a text are anonymous, untraceable, and yet already read; they are quotations without inverted commas. The kernel, the soul — let us go further and say the substance, the bulk, the actual and valuable material of all human utterances — is plagiarism. …By necessity, by proclivity, and by delight, we all quote. Neurological study has lately shown that memory, imagination, and consciousness itself is stitched, quilted, pastiched. If we cut-and-paste ourselves, might we not forgive it of our artworks? (68) Overall, Lethem’s self-reflexive pro-plagiarism essay reminds the reader not only of how ideas in literature have been continuously recycled, quoted, appropriated and remixed, but of how open-source cultures are vital for the creation of new works. Lethem (re)produces rather than authors a body of text that is haunted by ever present/absent quotation marks and references. Zara Dinnen suggests that Lethem’s essay, like almost all contemporary texts produced on a computer, is a provocation to once again re-theorise the notion of the author, as not a rigid point of origin but instead “a relay of alternative and composite modes of production” (212), extending Manovich’s notion of the role of author in the digital age of being perhaps closest to that of a DJ. But Lethem’s essay, however surprising and masterfully intertextual, was produced and disseminated as a linear ‘static’ text. On the other hand, Mark Amerika’s remixthebook project first started out as a series of theoretical performances on his Professor VJ blog and was then extended into a multitrack composition of “applied remixology” that features sampled phrases and ideas from a range of artistic, literary, musical, theoretical and philosophical sources. Wanting his project to be received not as a book but as a hybridised publication and performance art project that appears in both print and digital forms, remixthebook was simultaneously published in a prestigious university press and a website that works as an online hub and teaching tool to test out the theories. In this way, Amerika expands the concept of writing to include multimedia forms composed for both networked environments and also experiments with what he terms “creative risk management” where the artist, also a scholar and a teacher, is “willing to drop all intellectual pretence and turn his theoretical agenda into (a) speculative play” (xi). He explains his process halfway through the print book: Other times we who create innovative works of remix artare fully self-conscious of the rival lineagewe spring forth fromand knowingly take on other remixological styles just to seewhat happens when we move insideother writers’ bodies (of work)This is when remixologically inhabitingthe spirit of another writer’s stylistic tendenciesor at least the subconsciously imagined writerly gesturesthat illuminate his or her live spontaneous performancefeels more like an embodied praxis In some ways this all seems so obvious to me:I mean what is a writer anyway buta simultaneous and continuous fusion ofremixologically inhabited bodies of work? (109) Amerika mashes up the jargon of academic writing with avant-pop forms of digital rhetoric in order to “move inside other writers’ bodies (of work)” in order to test out his theoretical agenda in an “embodied praxis” at the same time that he shakes up the way that contemporary scholarship itself is performed. The remixthebook project inevitably recalls one of the great early-twentieth century plays with scholarly quotation, Walter Benjamin’s The Arcades Project. Instead of avoiding conventional quoting, footnoting and referencing, these are the very fabric of Benjamin’s sprawling project, composed entirely of quotes drawn from nineteenth century philosophy and literature. This early scholarly ‘remixing’ project has been described as bewildering and oppressive, but which others still find relevant and inspirational. Marjorie Perloff, for instance, finds the ‘passages’ in Benjamin’s arcades have “become the digital passages we take through websites and YouTube videos, navigating our way from one Google link to another and over the bridges provided by our favourite search engines and web pages" (49). For Benjamin, the process of collecting quotes was addictive. Hannah Arendt describes his habit of carrying little black notebooks in which "he tirelessly entered in the form of quotations what daily living and reading netted him in the way of 'pearls' and 'coral'. On occasion he read from them aloud, showed them around like items from a choice and precious collection" (45). A similar practice of everyday hypercitation can be found in the contemporary Australian performance artist Danielle Freakley’s project, The Quote Generator. For what was intended in 2006 to be a three year project, but which is still ongoing, Freakley takes the delirious pleasure of finding and fitting the perfect quote to fit an occasion to an extreme. Unlike Benjamin, Freakley didn’t collect and collate quotes, she then relied on them to navigate her way through her daily interactions. As The Quote Generator, Freakley spoke only in quotations drawn from film, literature and popular culture, immediately following each quote with its correct in-text reference, familiar to academic writers as the ‘author/date’ citation system. The awkwardness and seeming artificiality of even short exchanges with someone who responds only in quotes might be bewildering enough, but the inclusion of the citation after the quote maddeningly interrupts and, at the same time, adds another metalevel to a conversation where even the simple platitude ‘thank you’ might be followed by an attribution to ‘Deep Throat 1972’. Longer exchanges become increasingly overwhelming, as Freakley’s piling of quote on quote, and sometimes repeating quotes, demands an attentive listener, as is evident in a 2008 interview with Andrew Denton on the ABC’s Enough Rope: Andrew Denton’s Enough Rope (2008) Denton: So, you’ve been doing this for three years??Freakley: Yes, Optus 1991Denton: How do people respond to you speaking in such an unnatural way?Freakley: It changes, David Bowie 1991. On the streets AKA Breakdance 1984, most people that I know think that I am crazy, Billy Thorpe 1972, a nigger like me is going insane, Cyprus Hill 1979, making as much sense as a Japanese instruction manual, Red Dwarf 1993. Video documentation of Freakley’s encounters with unsuspecting members of the public reveal how frustrating the inclusion of ‘spoken’ references can be, let alone how taken aback people are on realising they never get Freakley’s own words, but are instead receiving layers of quotations. The frustration can quickly turn hostile (Denton at one point tells Freakley to “shut up”) or can prove contaminatory, as people attempt to match or one-up her quotes (see Cook's interview 8). Apparently, when Freakley continued her commitment to the performance at a Perth Centerlink, the staff sent her to a psychiatrist and she was diagnosed with an obsessive-compulsive disorder, then prescribed medication (Schwartzkoff 4). While Benjamin's The Arcades Project invites the reader to scroll through its pages as a kind of textual flaneur, Freakley herself becomes a walking and talking word processor, extending the possibilities of Amerika’s “embodied praxis” in an inescapable remix of other people’s words and phrases. At the beginning of the project, Freakley organised a card collection of quotes categorised into possible conversation topics, and devised a ‘harness’ for easy access. Image: Danielle Freakley’s The Quote Generator harness Eventually, however, Freakley was able to rely on her own memory of an astounding number of quotations, becoming a “near mechanical vessel” (Gottlieb 2009), or, according to her own manifesto, a “regurgitation library to live by”: The Quote Generator reads, and researches as it speaks. The Quote Generator is both the reader and composer/editor. The Quote Generator is not an actor spouting lines on a stage. The Quote Generator assimilates others lines into everyday social life … The Quote Generator, tries to find its own voice, an understanding through throbbing collations of others, constantly gluttonously referencing. Much academic writing quotes/references ravenously. New things cannot be said without constant referral, acknowledgement to what has been already, the intricate detective work in the barking of the academic dog. By her unrelenting appropriation and regurgitating of quotations, Freakley uses sampling as a technique for an extended performance that draws attention to the remixology of everyday life. By replacing conversation with a hyper-insistence on quotes and their simultaneous citation, she draws attention to the artificiality and inescapability of the ‘codes’ that make up not just ordinary conversations, but also conventional academic discourse, what she calls the “barking of the academic dog”. Freakley’s performance has pushed the scholarly conventions of quoting and referencing to their furthest extreme, in what has been described by Daine Singer as a kind of “endurance art” that relies, in large part, on an antagonistic relationship to its audience. In his now legendary 1969 “Double Session” seminar, Derrida, too, experimented with the pedagogical performance of the (re)producing author, teasing his earnest academic audience. It is reported that the seminar began in a dimly lit room lined with blackboards covered with quotations that Derrida, for a while, simply “pointed to in silence” (177). In this seminar, Derrida put into play notions that can be understood to inform remix practices just as much as they do deconstruction: the author, originality, mimesis, imitation, representation and reference. Scholarly conventions, perhaps particularly the quotation practices that insist on the circulation of rigid codes of attribution, and are defended by increasingly out-of-date understandings of contemporary research, writing and teaching practices, are ripe to be played with. Remix offers an expanded discursive framework to do this in creative and entertaining ways. References Amerika, Mark. remixthebook. Minneapolis: University of Minnesota Press, 2011. 29 July 2013 http://www.remixthebook.com/. Arendt, Hannah. “Walter Benjamin: 1892-1940.” In Illuminations. New York, NY: Shocken, 1969: 1-55. Barthes, Roland. “The Death of the Author.” Image Music Text. Trans Stephen Heath. New York: Hill and Wang, 1977: 142-148. Benjamin, Walter. The Arcades Project. Ed. Rolf Tiedemann, trans. Howard Eiland & Kevin McLaughlin. Cambridge, MA: Harvard University Press, 1999. Blaire, Cheré Harden. “Panic and Plagiarism: Authorship and Academic Dishonesty in a Remix Culture.” Media Tropes 2.1 (2009): 159-192. Bourdieu, Pierre, Jean-Claude Passeron, and Monique de Saint Martin. Academic Discourse: Linguistic Misunderstanding and Professorial Power. Trans. Richard Teese. Stanford California: Stanford University Press, 1965. Carroll, Lewis (Charles Dodgson). “Letter to Henrietta and Edwin Dodgson 31 Jan 1855”. 15 July 2013 http://en.wikiquote.org/wiki/Letters_of_Lewis_Carroll. Cook, Richard. “Don’t Quote Me on That.” Time Out Sydney (2008): 8. http://rgcooke.wordpress.com/2008/02/13/interview-danielle-freakley.Denton, Andrew. “Interview: The Quote Generator.” Enough Rope. 29 Feb. 2008. ABC TV. 15 July 2013 http://www.youtube.com/watch?v=AsrGvwXsenE. Derrida, Jacques. Spurs, Nietzsche’s Styles. Trans. Barbara Harlow. London: University of Chicago Press, 1978. Derrida, Jacques. The Ear of the Other: Otobiography, Text, Transference. Trans Peggy Kampf. New York: Shocken Books, 1985. Derrida, Jacques. “The Double Session”. Dissemination. Trans Alan Bass, Chicago, University of Chicago Press, 1981. Dinnen, Zara. "In the Mix: The Potential Convergence of Literature and New Media in Jonathan Letham's 'The Ecstasy of Influence'". Journal of Narrative Theory 42.2 (2012). Freakley, Danielle. The Quote Generator. 2006 to present. 10 July 2013 http://www.thequotegenerator.com/. Goldsmith, Kenneth. Uncreative Writing. New York: University of Colombia Press 2011. Gottlieb, Benjamin. "You Shall Worship No Other Artist God." Art & Culture (2009). 15 July 2013 http://www.artandculture.com/feature/999. Lethem, Jonathan. “The Ecstasy of Influence: A Plagiarism.” Harper’s Magazine, Feb. 2007: 59-71. http://harpers.org/archive/2007/02/the-ecstasy-of-influence/. Manovich, Lev. "What Comes after Remix?" 2007. 15 July 2013 http://manovich.net/LNM/index.html. Markham, Annette. “Remix Methodology.” 2013. 9 July 2013 http://www.markham.internetinquiry.org/category/remix/.Morris, Simon (dir.). Sucking on Words: Kenneth Goldsmith. 2007. http://www.ubu.com/film/goldsmith_sucking.html.Navas, Eduardo. Remix Theory: The Aesthetics of Sampling. New York: Springer Wein, 2012. Perloff, Marjorie. Unoriginal Genius: Poetry by Other Means in the New Century. Chicago: University of Chicago Press, 2010. Schwartzkoff, Louise. “Art Forms Spring into Life at Prima Vera.” Sydney Morning Herald 19 Sep. 2008: Entertainment, 4. http://www.smh.com.au/news/entertainment/arts/art-forms-spring-into-life-at-primavera/2008/09/18/1221331045404.html.Singer, Daine (cur.). “Pains in the Artists: Endurance and Suffering.” Blindside Exhibition. 2007. 2 June 2013 http://www.blindside.org.au/2007/pains-in-the-artists.shtml.