Journal articles on the topic 'Medical ethics Victoria'

Background. Statutory registration of Chinese Medicine (CM) practitioners was introduced in Victoria in 2000. The application assessment process for those who were granted registration during the transitional period (2002–04) was resource intensive, as little was known about their age, education, practice and language proficiency. This study offers insights that may be useful for the planning of national registration to commence in 2012. Methods. Data were extracted from registration application forms submitted to the Chinese Medicine Registration Board of Victoria (CMRB) between 2002 and 2004, using pre-defined data collection forms. Results. In 2006, 639 ‘grandparented’ Victorian CM practitioners had been registered, with a median age of 44 years old (range 23–86). There was a higher proportion of younger female, English-speaking, acupuncturists v. a higher proportion of older male, non-English-speaking, Chinese herbalists. There were few CM practitioners in rural areas, particularly herbalists. More than one-third of practitioners had obtained qualifications overseas and almost half of these practitioners provided no evidence of past study in professional issues and medical ethics. Conclusions. Ageing, diversity in qualifications and training, English proficiency, and level of study in professional issues and medical ethics represent major challenges for the implementation of CM national registration in 2012. What is known about the topic? Statutory registration of Chinese Medicine (CM) practitioners was introduced in the state of Victoria in 2000. The process of registering practitioners during the transitional period was resource intensive, because of the diverse background of the workforce. In May 2009, Health Ministers of all States and Territories and the Commonwealth agreed to include the CM profession, from 1 July 2012, in the National Registration and Accreditation Scheme for the health professions. What does this paper add? This paper, based on data from the registration application forms submitted to the Chinese Medicine Registration Board of Victoria (CMRB) between 2002 and 2004, provides a demographic and geographic profile of the 639 Victorian CM practitioners grandparented under the transitional arrangements of the Chinese Medicine Registration Act 2000. This study offers insights that may be useful for the planning of national registration for the Chinese Medicine profession. What are the implications for practitioners? With the introduction of national registration for the CM profession, this study provides critical data for developing effective strategies to implement the grandparenting process in all states and territories in Australia. Particularly, data collected in this study will help to deal with assessing knowledge in ethics and the healthcare system, biomedical sciences and language proficiency as part of the assessment process for a substantial number of applicants during the national registration of CM practitioners.

Background: Assisted dying remains an emotive topic globally with a number of countries initiating legislation to allow individuals access to assisted dying measures. Victoria will become the first Australian state in over 13 years to pass Assisted Dying Legislation, set to come into effect in 2019. Objectives: This article sought to evaluate the impact of Victorian Assisted Dying Legislation via narrative view and case study presentation. Research design: Narrative review and case study. Participants and research context: case study. Ethical considerations: This legislation will provide eligible Victorian residents with the option to request access to assisted dying measures as a viable alternative to a potentially painful, protracted death. Findings: This legislation, while conservative and inclusive of many safeguards at present, will form the basis for further discussion and debate on assisted dying across Australia in time to come. Discussion: The passing of this legislation by the Victorian parliament was prolonged, emotive and divided not only the parliament but Australian society. Conclusion: Many advocates for this legislation proclaimed it was well overdue and will finally meet the needs of contemporary society. Protagonists claim that medical treatment should not provide a means of ending life, despite palliative care reportedly often failing to relieve the pain and suffering of individuals living with a terminal illness.

Aim: To describe the process involved in obtaining ethics approval for a study aiming to recruit women from all maternity hospitals in Victoria, Australia. Design: Observational data of the application process involving 85 hospitals throughout Victoria in 2001. Results: Twenty-three of the 85 hospitals had a Human Research Ethics Committee (HREC) constituted in accordance with the National Health and Medical Council requirements; 27 agreed to accept decisions from other hospitals having HRECs and 27 relied on ethics advisory committees, hospital managers, clinical staff, quality assurance committees or lawyers for ethics decisions. Four of the latter did not approve the study. Eight hospitals no longer provided maternity services in the recruitment period. The process took 16 months, 26 000 sheets of paper, 258 copies of the application and the cost was about $30 000. Approval was eventually obtained for recruitment at 73 hospitals. Discussion: Difficulties exist in obtaining timely ethics approval for multicentre studies due to a complex uncoordinated system. All hospitals should have explicit protocols for dealing with research ethics applications so that they can be processed in a straightforward and timely manner. To facilitate this, those without properly constituted HRECs should be affiliated with one hospital that has an HREC.

AbstractIntroduction:International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.Purpose:The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.Methods:A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.Results:There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).Conclusions:This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.

Objective This study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians’ performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public’s right to access individual clinician-level data was at odds with some medical directors’ belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions Public reporting of identifiable individual healthcare clinicians’ performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic? The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors’ performance attracts contention and debate in Australia. What does this paper add? This paper informs debate around the public reporting of individual clinician-level performance data. Among a discrete cohort of senior hospital administrators in Victoria, Australia, there was strong in-principle support for such public reporting as a means to improve hospital quality and safety. What are the implications for practitioners? Before public reporting of individual clinician performance data could occur in Australia, resolution of issues would be required relating to legality and ethics, data context and interpretation, data quality and timeliness.

IntroductionPoor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID.Methods and analysisUsing an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites.Ethics and disseminationEthics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman’s Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, ‘business as usual’ ED training schedules and university curricula.Trial registration numberACTRN12621001456842.

IntroductionInfants born extremely preterm (EP, <28 weeks’ gestation) or with extremely low birth weight (ELBW,<1000 g) in the era when surfactant has been available clinically are at high risk of health and developmental problems in childhood and adolescence. However, how their health and well-being may be affected in adulthood is not well known. This study aims to compare between EP/ELBW and normal birthweight (NBW) controls: (1) physical health, mental health and socioemotional functioning at 25 years of age and (2) trajectories of these outcomes from childhood to adulthood. In addition, this study aims to identify risk factors in pregnancy, infancy, childhood and adolescence for poor physical health and well-being in EP/ELBW young adults.Methods and analysisThe Victorian Infant Collaborative Study (VICS) is a prospective geographical cohort of all EP/ELBW survivors to 18 years of age born in the State of Victoria, Australia, from 1 January 1991 to 31 December 1992 (n=297) and contemporaneous term-born/NBW controls (n=262). Participants were recruited at birth and followed up at 2, 5, 8 and 18 years. This 25-year follow-up includes assessments of physical health (cardiovascular, respiratory and musculoskeletal), mental health and socioemotional functioning. Outcomes will be compared between the birth groups using linear and logistic regression, fitted using generalised estimating equations (GEEs). Trajectories of health outcomes from early childhood will be compared between the birth groups using linear mixed-effects models. Risk factors for adult outcomes will be assessed using linear and logistic regression (fitted using GEEs).Ethics and disseminationThis study was approved by the Human Research Ethics Committees of the Royal Women’s Hospital, Mercy Hospital for Women, Monash Medical Centre and the Royal Children’s Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the internet and social media.

IntroductionSmoking remains the leading preventable cause of death for Aboriginal and Torres Strait Islander people in Australia. Aboriginal and Torres Strait Islander people who smoke are more likely to make a quit attempt than their non-Aboriginal counterparts but less likely to sustain the quit attempt. There is little available evidence specifically for and by Indigenous peoples to inform best practice smoking cessation care.The provision of a free Koori Quit Pack with optional nicotine replacement therapy sent by mail may be a feasible, acceptable and effective way to access stop smoking support for Aboriginal and Torres Strait Islander peoples.Methods and analysisAn Aboriginal-led, multisite non-randomised single-group, pre–post feasibility study across three states in Australia will be conducted. Participants will be recruited via service-targeted social media advertising and during usual care at their Aboriginal Community Controlled Health Services. Through a process of self-referral, Aboriginal and Torres Strait Islander people who smoke daily will complete a survey and receive mailout smoking cessation support. Data will be collected over the phone by an Aboriginal Research Assistant. This pilot study will inform the development of a larger, powered trial.Ethics and disseminationEthics approval has been obtained from the Aboriginal Health & Medical Research Council Ethics Committee of New South Wales (NSW) (#1894/21) and the University of Newcastle (#H-2022-0174). Findings will be reported through peer-reviewed journals and presentations at relevant local, national and international conferences. The findings will be shared with the NSW and Victoria Quitline, Aboriginal Health and Medical Research Council and Victorian Aboriginal Community Controlled Organisation and the National Heart Foundation.Trial registration numberACTRN12622000654752.

Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each country’s health system model.

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.

IntroductionWhile tobacco smoking prevalence is falling in many western societies, it remains elevated among high-priority cohorts. Rates up to 95% have been reported in women whose pregnancy is complicated by other substance use. In this group, the potential for poor pregnancy outcomes and adverse physical and neurobiological fetal development are elevated by tobacco smoking. Unfortunately, few targeted and effective tobacco dependence treatments exist to assist cessation in this population. The study will trial an evidence-based, multicomponent tobacco smoking treatment tailored to pregnant women who use other substances. The intervention comprises financial incentives for biochemically verified abstinence, psychotherapy delivered by drug and alcohol counsellors, and nicotine replacement therapy. It will be piloted at three government-based, primary healthcare facilities in New South Wales (NSW) and Victoria, Australia. The study will assess the feasibility and acceptability of the treatment when integrated into routine antenatal care offered by substance use in pregnancy antenatal services.Methods and analysisThe study will use a single-arm design with pre–post comparisons. One hundred clients will be recruited from antenatal clinics with a substance use in pregnancy service. Women must be <33 weeks’ gestation, ≥16 years old and a current tobacco smoker. The primary outcomes are feasibility, assessed by recruitment and retention and the acceptability of addressing smoking among this population. Secondary outcomes include changes in smoking behaviours, the comparison of adverse maternal outcomes and neonatal characteristics to those of a historical control group, and a cost-consequence analysis of the intervention implementation.Ethics and disseminationProtocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 17/04/12/4.05), with additional ethical approval sought from the Aboriginal Health and Medical Research Council of NSW (Reference 1249/17). Findings will be disseminated via academic conferences, peer-reviewed publications and social media.Trial registration numberAustralia New Zealand Clinical Trial Registry (Ref: ACTRN12618000576224).

IntroductionThe incidence of acute coronary syndrome is rising in step with the growth of life expectancy. An increase in the age of patients with coronary artery disease has been related to in-hospital mortality, which has seen an upsurge over a short period of time. However, there is no consensus about the percutaneous coronary angioplasty strategy to follow for older patients with multivessel coronary artery disease (MVCAD). Complete revascularisation (CR) or incomplete revascularisation (ICR) strategy depends on prognosis but this has not yet been accurately described because of geriatric conditions and comorbidities. The aim of this study is to evaluate changes of clinical and biochemical parameters in older patients with MVCAD undergoing revascularisation and to establish a prognostic stratification model for CR and ICR.Methods and analysisThis observational, longitudinal, prospective study will include 150 patients with MVCAD and subsequent revascularisation who attend the Hospital Universitario Virgen de la Victoria (Málaga, Spain). Because of the dropout rates, 180 patients will be recruited at the beginning. Sociodemographic characteristics, clinical and angiographic parameters, and biochemical variables, such as cardiovascular, metabolic, inflammatory, stress oxidative biomarkers, will be collected in the admission for coronary revascularisation and three follow-ups at 6, 12 and 18 months. Statistical analyses will be conducted with these data using CR and ICR as the primary exposure variable. Relevant explanatory variables will be selected from a predictive model for their inclusion in a prognostic stratification model. The primary outcome measures will be major adverse cardiovascular events.Ethics and disseminationProtocols and patient information have been approved by the regional research ethics committee (CEIm Provincial de Málaga-PEIBA (PI0131/2020). The results will be disseminated in international peer-reviewed journals, presented at conferences in Cardiology and Gerontology, and sent to participants, medical and health service managers, clinicians and other researchers.

IntroductionIn Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines.Methods and analysisAccess to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication; international normalised ratio measurements for patients on warfarin medication; glycated haemoglobin testing for monitoring patients with diabetes; vitamin D testing; and thyroid function testing.Ethics and disseminationEthics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).

The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians’ and nurses’ perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care. Physicians and nurses identified communication skills as being paramount. Communications concerning ethical issues were highlighted as the most difficult to cope with.

Confidentiality has a pre-eminent status in the medical curriculum for ethics, law, and professionalism because it does not depend on prior clinical learning or scientific knowledge, and it provides students with the opportunity to engage in the work of self-formation in professional practice from the very beginning. The historical tendency to romanticise medical professionalism, and confidentiality in particular as a symbol for this, was able to thrive in previous eras as a result of uncertainty around the boundaries of disclosure. To some extent echoes of this romanticism can still be heard today in rhetorical appeals to the Hippocratic tradition despite the development of detailed clarification in frameworks of law, standards, codes, professional regulation, and guidance from the second half of the 20th century. This paper considers two iconic portrayals of medical professionalism from the romantic period of the Victorian past, contrasting that era with the present-day environment of normative codifications. While ethics is commonly approached in an intellectual mode as a discussion of theory, a purely cognitive understanding is deficient on its own since learning in professional ethics must by definition be reified as sets of practices. The shift to the clinical accountability of today means that practices are of central importance to the undergraduate medical curriculum, not least in the area of confidentiality, for which the General Medical Council guidance sets the UK agenda for medical educational approaches to teaching, learning, and assessment, before students repeat the Hippocratic Oath at graduation as they embark on their future careers as doctors.

ObjectivesOn 19 June 2019, assisted dying became lawful in Victoria, the second most populous state in Australia. Section 8 of the Voluntary Assisted Dying Act is a legislative safeguard that is designed to ensure a patient’s request for assistance to die is voluntary. This section prohibits health practitioners from initiating a conversation about assisted dying with the patient. This article explores the potential implications of this prohibition for effective communication between doctors and their patients, and the ability of doctors to provide high quality end-of-life (EOL) care in some cases.MethodThe authors reviewed and analysed literature on the importance of communication at the EOL including the need to understand and appropriately respond to Desire to Die or Desire to Hasten Death statements. A legal critique of section 8 of the Victorian Voluntary Assisted Dying Act was also undertaken to determine the scope of this new duty and how it aligns with existing legal obligations that would otherwise require doctors to provide information about EOL options requested by a patient.ResultsContemporary literature suggests that open and honest communication between doctor and patient including the provision of information about all EOL options when sought by the patient represents good clinical practice and will lead to optimal EOL care. The provision of such information also reflects professional, ethical and legal norms.ConclusionDespite (arguably) promoting an appropriate policy objective, the legislative prohibition on health professionals initiating conversations about voluntary assisted dying may, in cases where patients seek information about all EOL options, lead to less optimal patient outcomes.

Jessica Straley, "Love and Vivisection: Wilkie Collins's Experiment in Heart and Science"(pp. 348––373) This essay examines the paradox of Wilkie Collins's antivivisection sensation novel, Heart and Science (1883). in the plot of the cruel vivisector Dr. Benjulia and the helpless young woman who almost becomes his latest experiment, the novel draws from a familiar bounty of antivivisectionist propaganda, but, this essay argues, the novel also reveals Collins's thinking about his own literary genre and the unfavorable comparison many critics were making between vivisection and sensation fiction: medical experiments on live animals often electrified their subjects, and sensation novels likewise shocked their readers. More than simply a metaphor, this connection between scientific and literary practices pointed to a late-Victorian anxiety about physiological sensation and moral reasoning. The focus on the body, critics of both practices maintained, bypassed the authority of the soul and turned human agents into passive receptors incapable of the higher functions of rationality and ethics. In its preface, Heart and Science disavows any relation between its narration and the medical dissection it deplores, and much of the novel progresses without the sensation genre's characteristic shocks. But Collins's text also seeks to recover and to redeem physiology as the basis for human emotion and ethics and, in so doing, to redefine sensation fiction as an aid, rather than an inhibitor, to moral agency.

In this paper, the author looks at the arguments for and against placing modern medical records in public archival facilities. She considers the various ethical, legal and practical issues involved in archiving patients' records with the intention of making them available for public access after seventy-five years from the date of last contact of the patient with the hospital or sooner under certain specified circumstances. The range of sampling and selection techniques available for reducing the volume of patient records to be retained is also discussed. Citing the experience of the Public Record Office Victoria, the author concludes that it is justifiable to breach confidentiality by placing modern medical records in public archives but that it will be many years before an assessment can be made of the appropriateness or otherwise of placing modern hospital records in public archives and whether it proves to be worth the effort. (AMRJ, 1989,19(4), 155–161).

Objective: To know the gender difference in the autoimmune profile that is anti TPO antibodies and thyroid profile in patients with hypothyroidism and in euthyroid controls. Study Design: Case Control study. Settings: Medical Out Door Department of Bahawal Victoria Hospital, Bahawalpur. Period: 01/09/2018 to 31/08/2019. Material & Methods: Case control study that was conducted after taking ethical approval from hospital ethical committee. After taking informed consent data was entered on a predesigned questionnaire and 5 ml of venous blood was taken for thyroid profile and anti TPO antibodies. Study population was selected by nonprobability sampling. A total 128 patients in which 69 in the hypothyroid group A and 69 in euthyroid control group were added. Results: Most of the anti TPO positive hypothyroid participants were females but TSH value was more in males. All euthyroid anti TPO participants were females. Female hypothyroid patients were young compared to males. Conclusion: Autoimmune thyroid disorders are more common in females, autoimmunity appears before biochemical failure of thyroid.

Background: Epidemiological data surrounding non-melanomatous skin cancer (NMSC) is highly variable, in part due to the lack of government cancer registries. Several studies employ the use of Medical Australia (MA) rebate data in assessing such trends, the validity of which has not been studied in the past. Conversely, melanoma skin cancer is a notifiable disease, and thus, MA and cancer registry data is readily available. The aim of the current study is to assess the use of MA for epidemiological measures for skin cancers, by using melanoma as a disease sample.Methods: Following ethics approval, data from MA and Victorian Cancer Registry (VCR) from 2004-2008 were extracted. Incidence of MA and VCR unique melanoma cases were compared and stratified by age and local government area (LGA). Regression and a paired-samples t-test were performed.Results:During the study period; 15,150 and 13,886 unique melanoma patients were identified through VCR and MA data sources respectively. An outlier in the >80­ year age group was noted between MA and VCR data. When stratified by age, significant correlation between MA and VCR was observed for all patients (gradient 0.91,R²= 0.936) and following exclusion of >80 patients (gradient 0.96,R²= 0.995). When stratified by LGA, a high degree of observation was observed for all patients (gradient 0.94,R²= 0.977) and following exclusion of >80 patients (gradient 0.996,R²= 0.975).Conclusion:Despite the inclusion of outlier data groups, acceptable correlation between MA and VCR melanoma data was observed, suggesting that MA may be suitable for assessing epidemiological trends. Such principals may be used to validate the use of MA data for similar calculations assessing NMSC trends.

IntroductionAs cancer treatments may impact on fertility, a high priority for young patients with breast cancer is access to evidence-based, personalised information for them and their healthcare providers to guide treatment and fertility-related decisions prior to cancer treatment. Current tools to predict fertility outcomes after breast cancer treatments are imprecise and do not offer individualised prediction. To address the gap, we are developing a novel personalised infertility risk prediction tool (FoRECAsT) for premenopausal patients with breast cancer that considers current reproductive status, planned chemotherapy and adjuvant endocrine therapy to determine likely post-treatment infertility. The aim of this study is to explore the feasibility of implementing this FoRECAsT tool into clinical practice by exploring the barriers and facilitators of its use among patients and healthcare providers.Methods and analysisA cross-sectional exploratory study is being conducted using semistructured in-depth telephone interviews with 15–20 participants each from the following groups: (1) premenopausal patients with breast cancer younger than 40, diagnosed within last 5 years, (2) breast surgeons, (3) breast medical oncologists, (4) breast care nurses (5) fertility specialists and (6) fertility preservation nurses. Patients with breast cancer are being recruited from the joint Breast Service of three affiliated institutions of Victorian Comprehensive Cancer Centre in Melbourne, Australia—Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Royal Women’s Hospital, and clinicians are being recruited from across Australia. Interviews are being audio recorded, transcribed verbatim and imported into qualitative data analysis software to facilitate data management and analyses.Ethics and disseminationThe study protocol has been approved by Melbourne Health Human Research Ethics Committee, Australia (HREC number: 2017.163). Confidentiality and privacy are maintained at every stage of the study. Findings will be disseminated through peer-reviewed scholarly and scientific journals, national and international conference presentations, social media, broadcast media, print media, internet and various community/stakeholder engagement activities.

IntroductionPatellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy.Methods and analysisThis study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other.Ethics and disseminationThis protocol has been approved by the Ethics Committee of Aragon (N° PI15/0017). The trial will be conducted in accordance with the Declaration of Helsinki.Trial registration numberNCT02498795

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Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

As part of the postgraduate ethics sensitisation programme at St. John’s Medical College, the faculty and students read excerpts from the book “God’s Hotel” by Dr. Victoria Sweet. The reading was followed by personal reflection by the speaker and the session concluded with a discussion among the audience. Summarised below are the passages from the book and the reflections from each speaker, with feedback from the audience. The stories explore various dimensions of the doctor-patient relationship, respecting the wishes of patients, care of the terminally ill, coping with colleagues, and dilemmas in patient management.

The Australian state of Victoria legalised voluntary assisted dying (VAD) in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law’s operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession’s opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years.

Abstract Background Dealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process. Methods Seventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically. Results Our results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants. Conclusion The broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately.

IntroductionOne of the trauma system objectives for the ambulance service is to get the right patient to the right hospital in a timely manner. The Review of Trauma and Emergency Services in Victoria, Australia, identified prolonged prehospital scene times of greater than 20 minutes for non trapped patients as a deficiency that may have adverse outcomes for severely injured trauma patients. The objective of this pilot study was to identify the factors that impact on the timely transfer of trauma patients from the scene of an incident to a regional hospital emergency department and justification for the delays, as the basis for a further detailed study.MethodsA retrospective pilot cohort study of trauma patients transported by ambulance to the emergency department of the Latrobe Regional Hospital over a six-month period who had an emergency department triage category of 1, 2 or 3 was undertaken. Data relating to the prehospital care of trauma patients with scene times > 20 minutes and transport times > 30 minutes were extracted from Rural Ambulance Victoria patient care records and hospital patient records. Ethics approval was granted.ResultsThere were 70 trauma patients transported to the hospital during the collection period. Of these 49 patients were available for analysis, 21 cases were excluded due to incomplete time or ED triage details. There were 12 cases where scene times were > 20 minutes. Only one paramedic crew spent an unjustifiably long time at the scene and only one patient had a transport time to hospital > 30 minutes.ConclusionThis pilot study confirms that there are prolonged prehospital scene times involving paramedics, however, the study suggests that most of the extended times are explained by factors outside the control of the attending paramedics. There was only one case where the scene time was not justified. One patient had a transport time > 30 minutes which was due to the patient being taken to a higher level of care. Experiences from this pilot study have led to changes in subsequent prehospital trauma studies.

In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.

Introduction Paramedic education is changing in Australia from a post-employment model in which in-house training is provided by state-based service providers to pre-employment Bachelor degree education in universities. Little is known about how well prepared final year paramedic students nearing the end of their university course perceive themselves to be to enter the workforce. The objective of the study was to investigate perceptions of preparedness for the workforce of final year paramedic students at Victoria University, Melbourne, Australia. Methods A survey was conducted with final year paramedic students in their last semester at Victoria University, Melbourne, Australia. The survey focussed on eight dimensions relating to paramedic practice: theoretical skills, clinical skills; practical skills; interpersonal skills; communication with colleagues and other professionals; coping skills; lifelong learning; and ethics and legal responsibilities. Part 1 of the survey required participants to choose from six possible responses on how well they believe their paramedic course has prepared them in relation to 64 statements. Part 2 consisted of 5 open- ended questions. Data from part 1 was analysed to find the mean ‘preparedness scores’ on the 8 dimensions of paramedic practice. Responses from part 2 of survey were transcribed and imported into NVivo8, where each part of the questions were analysed and grouped into themes. Results Response rate was 14% (n=23). Respondents felt ‘somewhat adequately’ to ‘adequately’ prepared for the workforce. Responses to Part 2 indicated a range of perceptions in relation to preparedness to enter the paramedic workforce, ranging from feeling unprepared to put knowledge into practice, prepared in some aspects but not in others, through to feeling prepared but with a realisation that there would be much to learn on the job. Respondents comments provide paramedic educators with some clear ideas about what final year students value in terms of preparing them for practice: whilst respondents valued the clinical practice opportunities they had had, they wanted more clinical placements with more variety, for example placements in different areas of healthcare. Conclusion This small survey provides paramedic educators with some clear ideas about what final year students value in terms of preparing them for practice. As Australian paramedic education moves from a post-employment training model to a pre-employment model, further consideration is needed of how courses will best address the development of clinical and practical skills of students and meet the requirements of ambulance service employers. Collegiate dialogue between employers, educators and students will assist in addressing this.

Abstract Undertaking recruitment for research in schools is an effective way to recruit young people for research participation but it is not without its challenges. Gaining access and coordinating many levels of different organisations and stakeholders whose cooperation and approval are crucial all add time and sometimes logistical challenges for the research team. In addition, recruiting around sensitive research topics can elicit additional barriers to successful research. The research team aimed to conduct a pragmatic cluster randomised controlled trial involving schools in a local government region in Victoria, Australia, to assess the effect of a vaccination-based educational card game called “Vaxcards” on vaccine consent returns. Schools were contacted via phone and email to determine which staff member would best be a contact point for a face-to-face meeting to discuss the methods and purpose of the study. Email follow-ups were scheduled to follow up non-responsive schools and consent forms. The minimum required sample size was 13. Of 31 eligible schools, 13 were recruited. The research team encountered several unanticipated challenges before achieving the recruitment target. The most common reasons for non-participation were being too busy with other commitments, concerns regarding the topic of vaccination being too sensitive, and concerns that key stakeholders in the school would not approve of the research topic of vaccination. One school required a review by a private research ethics board that rejected the study. Significant hesitancy and misinformation about vaccine science was observed that affected engagement with a small number of schools. This paper highlights the challenges of recruiting schools in the context of public anxieties about vaccines and has several important learning lessons for successful recruitment about sensitive topics. This includes navigating approval processes for research in schools, the importance of local champions, dealing with misinformation and the importance of strong relationships and organisational trust. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001753246. Prospectively registered on 25 October 2018 8:24:21 AM

Abstract Background Males in Australia and many other countries account for three-quarters of all deaths by suicide. School-based programs to support young men’s wellbeing have become increasingly common in recent years and show much promise to tackle the issue of male suicide by fostering protective factors and mitigating harmful factors. However, only a few of these programs have been evaluated. This trial seeks to address the lack of knowledge about the potential for school-based gender-transformative programs to have a positive impact on boys. Breaking the Man Code workshops, delivered by Tomorrow Man in Australia, challenge and transform harmful masculinities with young men with a view to ultimately reducing their suicide risk. The trial aims to examine whether adolescent boys who participate in the Breaking the Man Code workshop demonstrate an increase in their likelihood of seeking help for personal or emotional problems compared to boys waiting to take part in the workshop. Methods A stratified cluster randomized controlled superiority trial with two parallel groups will be conducted. Schools will be randomly allocated 1:1, stratified by location of the schools (rural or urban), state (Victoria, NSW, or WA), and mode of workshop delivery (face-to-face or online), to the intervention group and waitlist control group. Discussion The Breaking the Man Code workshops show great promise as a school-based prevention intervention. The trial will fill a gap in knowledge that is critically needed to inform future interventions with boys and men. Some methodological challenges have been identified related to the COVID-19 pandemic in Australia, such as delays in ethics approvals and the need for Tomorrow Man to introduce an online delivery option for the workshop. The trial protocol has been designed to mitigate these challenges. The findings from the trial will be used to improve the workshops and will assist others who are designing and implementing suicide prevention interventions for boys and men. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12620001134910). Registered on 30 October 2020

Background Like many countries where voluntary assisted dying (VAD) is legal, eligible doctors in Victoria, Australia, have sole legal authority to provide it. Doctors’ attitudes towards legalised VAD have direct bearing on their willingness to participate in VAD and consequently, on whether permissive laws can effectively facilitate access to VAD. The study aimed to explore how some Victorian doctors are perceiving and experiencing the provision of legalised VAD under a recently commenced law. Methods Semi-structured interviews with 25 Victorian doctors with no in-principle objection to legalised VAD were conducted between July 2019-February 2020. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval from the relevant institution was obtained. Results Doctors perceive or experience VAD to fundamentally challenge traditional medical practice. Barriers to access to VAD derive from applicant, communication, and doctor-related factors. Doctors’ willingness to participate in VAD is situation specific.

Even as Wilkie Collins’s Heart and Science continues in the tradition of cautionary tales of medicine and science, it also integrates nineteenth-century discussions of medical ethics, vivisection and women, further building on earlier criticisms of scientific hubris. By indicting a fictional medical doctor and his methodology, Heart and Science depicts the extremes of good and bad, ethical and unethical medicine—whether the doctor can care, and not simply solve the medical enigma—in light of a changing medical field that prized objectivity and distance from the subject over the old holistic way of listening to a patient in order to understand her malady. In reading Collins within his historical context and against a changing environment within the medical sciences, literary critics discern a gendered doctor-patient relationship and observe a Victorian author’s attempts to combat the fears of scientific advancement by using or aligning himself with a proto-feminist perspective.

AbstractThis paper explores how, at the 1875 Royal Commission on Vivisection, the anaesthetised animal was construed as a boundary object around which “cooperation without consensus” (Star, in: Esterbrook (ed) Computer supported cooperative work: cooperation or conflict? Springer, London, 1993) could form, serving the interests of both scientists and animals. Advocates of anaesthesia presented it as benevolently intervening between the scientific agent and animal patient. Such articulations of ‘ethical’ vivisection through anaesthesia were then mandated in the 1876 Cruelty to Animals Act, and thus have had significant downstream effects on the regulation of laboratory animals in Britain and beyond. Constructing this ‘consensus’ around the anaesthetised animal, however, required first excluding abolitionists and inhumane scientists, and secondly limiting the interests of experimental animals to the avoidance of pain through anaesthesia and euthanasia, thereby circumventing the issue of their possible interest in future life. This consensus also served to secure the interests of vivisecting scientists and to limit the influence of public opinion in the laboratory to administrative procedure and scheduled inspection. The focus on anaesthesia was connected with discussions of what supporting infrastructures were required to ensure proper ethical procedure was carried out by scientists. In contrast to the much studied polarisation in British society between pro- and antivivisectionists after 1876, we understand the 1875 Commission as a conflict amongst scientists themselves, while also being an intra-class conflict amongst the ruling class (French in Antivivisection and medical science in Victorian society, Princeton University Press, Princeton, 1975).

Introduction: Patients with history of past or active malignancy are at increased risk of contracting the virus and developing Coronavirus Disease 2019 (COVID-19) related complications. With the global prevalence of cancer and the high transmissibility of Severe Acute Respiratory Syndrome Corona Virus 2 (SARSCoV-2), an understanding of the disease course of COVID-19 and factors influencing clinical outcomes in patients with cancer is necessary and is largely unknown. Aim: To study the laboratory characteristics of patients with malignancy and COVID-19 infection and to evaluate the outcomes in terms of clinical features, severity of infection and mortality of patients with malignancy and COVID-19 infection. Materials and Methods: The present study was a crosssectional study conducted at Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India after obtaining Institutional Ethical Committee (IEC) clearance, involving 72 subjects with COVID-19 infection. The duration of the study was from April-November 2020. Demographic details and data were collected in patients with active or previous malignancy and COVID-19 illness based on Indian Council of Medical Research (ICMR) criteria. Clinical outcome of the patients was measured based on need for Intensive Care Unit (ICU) admission, oxygen therapy and mortality. Descriptive statistics of the explanatory and outcome variables were calculated by mean, Standard Deviation (SD), median and Interquartile Range (IQR) for quantitative variables, frequency and proportions for qualitative variables. Inferential statistics like Chi-square test was applied for qualitative variables. Results: The mean age of the subjects was 52.10±14.512 years with 29 males, 43 females. Among 72 patients with malignancy, patients were classified as mild (23), moderate (22) and severe (27) according to ICMR case type respectively. Among the total patients, 21 (29.2%) were asymptomatic and 51 (70.8%) were symptomatic with 26 (36.1%) symptomatic patients having severe disease. Also, 30 (41.7%) had requirement of O2 and 28 (38.9%) were admitted to ICU. Most common was solid organ (66) lung carcinoma (13), breast (10), compared to haematological malignancies (6). A total of 22 (30.6%) patients had mortality with most common complication being Acute Respiratory Distress Syndrome (ARDS) (20.8%) followed by sepsis (4.2%). Conclusion: The results of present study revealed higher mortality and increased inflammatory markers in patients with severe COVID-19 infection and malignancy.

Introduction It is now commonplace for babies to begin their lives inhabiting media environments characterised by the presence, distribution, and mobility of digital devices and screens. Such arrangements can be traced, in part, to the birth of a new regime of mobile and touchscreen media beginning with the release of the iPhone in 2007 and the iPad in 2010, which stimulated a surge in household media consumption, underpinned by broadband and wireless Internet infrastructures. Research into these conditions of ambient mediation at the beginnings of life, however, is currently dominated by medical and educational literature, largely removed from media studies approaches that seek to understand the everyday contexts of babies using media. Putting aside discourses of promise or peril familiar to researchers of children’s media (Buckingham; Postman), this paper draws on ongoing research in both domestic and social media settings exploring infants’ everyday encounters and entanglements with mobile media and communication technologies. The paper identifies the ways infants’ mobile communication is assembled and distributed through touchscreen interfaces, proxy parent users, and commercial software sorting. It argues that within these interfacial, intermediary, and interactive contexts, we can conceptualise infants’ communicative agency through an emerging repertoire of techniques: accidental, assisted and automated. This assemblage of infant communication recognises that children no longer live with but in media (Deuze), which underscores the impossibility of a path of media resistance found in medical discourses of ‘exposure’ and restriction, and instead points to the need for critical and ethical responses to these immanent conditions of infant media life. Background and Approach Infants, understandably, have largely been excluded from analyses of mobile mediality given their historically limited engagement with or capacity to use mobile media. Yet, this situation is undergoing change as mobile devices become increasingly prominent in children’s homes (OfCom; Rideout), and as touchscreen interfaces lower thresholds of usability (Buckleitner; Hourcade et al.). The dominant frameworks within research addressing infants and media continue to resonate with long running and widely circulated debates in the study of children and mass media (Wartella and Robb), responding in contradictory ways to what is seen as an ever-increasing ‘technologization of childhood’ (McPake, Plowman and Stephen). Education research centres on digital literacy, emphasising the potential of mobile computing for these future digital learners, labourers, and citizens (McPake, Plowman and Stephen). Alternatively, health research largely positions mobile media within the rubric of ‘screen time’ inherited from older broadcast models, with paediatric groups continuing to caution parents about the dangers of infants’ ‘exposure’ to electronic screens (Strasburger and Hogan), without differentiating between screen types or activities. In turn, a range of digital media channels seek to propel or profit from infant media culture, with a number of review sites, YouTube channels and tech blogs promoting or surveying the latest gadgets and apps for babies. Within media studies, research is beginning to analyse the practices, conceptions and implications of digital interfaces and content for younger children. Studies are, for example, quantifying the devices, activities, and time spent by young children with mobile devices (Ofcom; Rideout), reviewing the design and marketing of children’s mobile application software products (e.g. Shuler), analysing digital content shared about babies on social media platforms (Kumar & Schoenebeck; Morris), and exploring emerging interactive spaces and technologies shaping young children’s ‘postdigital’ play (Giddings; Jayemanne, Nansen and Apperley). This paper extends this growing area of research by focusing specifically on infants’ early encounters, contexts, and configurations of mobile mediality, offering some preliminary analysis of an emerging repertoire of mobile communication techniques: accidental, assisted, and automated. That is, through infants playing with devices and accidentally activating them; through others such as parents assisting use; and through software features in applications that help to automate interaction. This analysis draws from an ongoing research project exploring young children’s mobile and interactive media use in domestic settings, which is employing ethnographic techniques including household technology tours and interviews, as well as participant observation and demonstrations of infant media interaction. To date 19 families, with 31 children aged between 0 and 5, located in Melbourne, Australia have participated. These participating families are largely homogeneous and privileged; though are a sample of relatively early and heavy adopters that reveal emerging qualities about young children’s changing media environments and encounters. This approach builds on established traditions of media and ethnographic research on technology consumption and use within domestic spaces (e.g. Mackay and Ivey; Silverstone and Hirsch), but turns to the digital media encountered by infants, the geographies and routines of these encounters, and how families mediate these encounters within the contexts of home life. This paper offers some preliminary findings from this research, drawing mostly from discussions with parents about their babies’ use of digital, mobile, and touchscreen media. In this larger project, the domestic and family research is accompanied by the collection of online data focused on the cultural context of, and content shared about, infants’ mobile media use. In this paper I report on social media analysis of publicly shared images tagged with #babyselfie queried from Instagram’s API. I viewed all publicly shared images on Instagram tagged with #babyselfie, and collected the associated captions, comments, hashtags, and metadata, over a period of 48 hours in October 2014, resulting in a dataset of 324 posts. Clearly, using this data for research purposes raises ethical issues about privacy and consent given the posts are being used in an unintended context from which they were originally shared; something that is further complicated by the research focus on young children. These issues, in which the ease of extracting online data using digital methods research (Rogers), needs to be both minimised and balanced against the value of the research aims and outcomes (Highfield and Leaver). To minimise risks, captions and comments cited in this paper have been de-identified; whist the value of this data lies in complementing and contextualising the more ethnographically informed research, despite perceptions of incompatibility, through analysis of the wider cultural and mediated networks in which babies’ digital lives are now shared and represented. This field of cultural production also includes analysis of examples of children’s software products from mobile app stores that support baby image capture and sharing, and in particular in this paper discussion of the My Baby Selfie app from the iTunes App Store and the Baby Selfie app from the Google Play store. The rationale for drawing on these multiple sources of data within the larger project is to locate young children’s digital entanglements within the diverse places, platforms and politics in which they unfold. This research scope is limited by the constraints of this short paper, however different sources of data are drawn upon here in order to identify, compare, and contextualise the emerging themes of accidental, assisted, and automated. Accidental Media Use The domestication and aggregation of mobile media in the home, principally laptops, mobile phones and tablet computers has established polymediated environments in which infants are increasingly surrounded by mobile media; in which they often observe their parents using mobile devices; and in which the flashing of screens unsurprisingly draws their attention. Living within these ambient media environments, then, infants often observe, find and reach for mobile devices: on the iPad or whatever, then what's actually happening in front of them, then naturally they'll gravitate towards it. These media encounters are animated by touchscreens interfaces that are responsive to the gestural actions of infants. Conversely, touchscreen interfaces drive attempts to swipe legacy media screens. Underscoring the nomenclature of ‘natural user interfaces’ within the design and manufacturer communities, screens lighting up through touch prompts interest, interaction, and even habituation through gestural interaction, especially swiping: It's funny because when she was younger she would go up the T.V. and she would try swiping to turn the channel.They can grab it and start playing with it. It just shows that it's so much part of their world … to swipe something. Despite demonstrable capacities of infants to interact with mobile screens, discussions with parents revealed that accidental forms of media engagement were a more regular consequence of these ambient contexts, interfacial affordances and early encounters with mobile media. It was not uncommon for infants to accidentally swipe and activate applications, to temporarily lock the screen, or even to dial contacts: He didn't know the password, and he just kept locking it … find it disabled for 15 minutes.If I've got that on YouTube, they can quite quickly get on to some you know [video] … by pressing … and they don't do it on purpose, they're just pushing random buttons.He does Skype calls! I think he recognizes their image, the icon. Then just taps it and … Similarly, in the analysis of publicly shared images on Instagram tagged with #babyselfie, there were instances in which it appeared infants had accidentally taken photos with the cameraphone based on the image content, photo framing or descriptions in the caption. Many of these photos showed a baby with an arm in view reaching towards the phone in a classic trope of a selfie image; others were poorly framed shots showing parts of baby faces too close to the camera lens suggesting they accidentally took the photograph; whilst most definitive was many instances in which the caption of the image posted by parents directly attributed the photographic production to an infant: Isabella's first #babyselfie She actually pushed the button herself! My little man loves taking selfies lol Whilst, then, the research identified many instances in which infants accidentally engaged in mobile media use, sometimes managing to communicate with an unsuspecting interlocutor, it is important to acknowledge such encounters could not have emerged without the enabling infrastructure of ambient media contexts and touchscreen interfaces, nor observed without studying this infrastructure utilising materially-oriented ethnographic perspectives (Star). Significantly, too, was the intermediary role played by parents. With parents acting as intermediaries in household environments or as proxy users in posting content on their behalf, multiple forms of assisted infant communication were identified. Assisted Media Use Assisted communication emerged from discussions with parents about the ways, routines, and rationale for making mobile media available to their children. These sometimes revolved around keeping their child engaged whilst they were travelling as a family – part of what has been described as the pass-back effect – but were more frequently discussed in terms of sharing and showing digital content, especially family photographs, and in facilitating infant mediated communication with relatives abroad: they love scrolling through my photos on my iPhone …We quite often just have them [on Skype] … have the computers in there while we're having dinner … the laptop will be there, opened up at one end of the table with the family here and there will be my sister having breakfast with her family in Ireland … These forms of parental mediated communication did not, however, simply situate or construct infants as passive recipients of their parents’ desires to make media content available or their efforts to establish communication with extended family members. Instead, the research revealed that infants were often active participants in these processes, pushing for access to devices, digital content, and mediated communication. These distributed relations of agency were expressed through infants verbal requests and gestural urging; through the ways parents initiated use by, for example, unlocking a device, preparing software, or loading an application, but then handed them over to infants to play, explore or communicate; and through wider networks of relations in which others including siblings, acted as proxies or had a say in the kinds of media infants used: she can do it, once I've unlocked … even, even with iView, once I'm on iView she can pick her own show and then go to the channel she wants to go to.We had my son’s birthday and there were some photos, some footage of us singing happy birthday and the little one just wants to watch it over and over again. She thinks it's fantastic watching herself.He [sibling] becomes like a proxy user … with the second one … they don't even need the agency because of their sibling. Similarly, the assisted communication emerging from the analysis of #babyselfie images on Instagram revealed that parents were not simply determining infant media use, but often acting as proxies on their behalf. #Selfie obsessed baby. Seriously though. He won't stop. Insists on pressing the button and everything. He sees my phone and points and says "Pic? Pic?" I've created a monster lol. In sharing this digital content on social networks, parents were acting as intermediaries in the communication of their children’s digital images. Clearly they were determining the platforms and networks where these images were published online, yet the production of these images was more uncertain, with accidental self-portraits taken by infants suggesting they played a key role in the circuits of digital photography distribution (van Dijck). Automated Media Use The production, archiving, circulation and reception of these images speaks to larger assemblages of media in which software protocols and algorithms are increasingly embedded in and help to configure everyday life (e.g. Chun; Gillespie), including young children’s media lives (Ito). Here, software automates process of sorting and shaping information, and in doing so both empowers and governs forms of infant media conduct. The final theme emerging from the research, then, is the identification of automated forms of infant mobile media use enabled through software applications and algorithmic operations. Automated techniques of interaction emerged as part of the repertoire of infant mobile mediality and communication through observations and discussions during the family research, and through surveying commercial software applications. Within family discussions, parents spoke about the ways digital databases and applications facilitated infant exploration and navigation. These included photo galleries stored on mobile devices, as well as children’s Internet television services such as the Australian Broadcasting Corporation’s catch-up online TV service, iView, which are visually organised and easily scrollable. In addition, algorithmic functions for sorting, recommending and autoplay on the video-sharing platform YouTube meant that infants were often automatically delivered an ongoing stream of content: They just keep watching it [YouTube]. So it leads on form the other thing. Which is pretty amazing, that's pretty interactive.Yeah, but the kids like, like if they've watched a YouTube clip now, they'll know to look down the next column to see what they want to play next … you get suggestions there so. Forms of automated communication specifically addressing infants was also located in examples of children’s software products from mobile app stores: the My Baby Selfie app from the iTunes App Store and the Baby Selfie app from the Google Play store. These applications are designed to support baby image capture and sharing, promising to “allow your baby to take a photo of him himself [sic]” (Giudicelli), based on automated software features that use sounds and images to capture a babies attention and touch sensors to activate image capture and storage. In one sense, these applications may appear to empower infants to participate in the production of digital content, namely selfies, yet they also clearly distribute this agency with and through mobile media and digital software. Moreover, they imply forms of conduct, expectations and imperatives around the possibilities of infant presence in a participatory digital culture. Immanent Ethic and Critique Digital participation typically assumes a degree of individual agency in deciding what to share, post, or communicate that is not typically available to infants. The emerging communicative practices of infants detailed above suggests that infants are increasingly connecting, however this communicative agency is distributed amongst a network of ambient devices, user-friendly interfaces, proxy users, and software sorting. Such distributions reflect conditions Deuze has noted, that we do not live with but in media. He argues this ubiquity, habituation, and embodiment of media and communication technologies pervade and constitute our lives becoming effectively invisible, negating the possibility of an outside from which resistance can be mounted. Whilst, resistance remains a solution promoted in medical discourses and paediatric advice proposing no ‘screen time’ for children aged below two (Strasburger and Hogan), Deuze’s thesis suggests this is ontologically futile and instead we should strive for a more immanent relation that seeks to modulate choices and actions from within our media life: finding “creative ways to wield the awesome communication power of media both ethically and aesthetically” ("Unseen" 367). An immanent ethics and a critical aesthetics of infant mediated life can be located in examples of cultural production and everyday parental practice addressing the arrangements of infant mobile media and communication discussed above. For example, an article in the Guardian, ‘Toddlers pose a serious risk to smartphones and tablets’ parodies moral panics around children’s exposure to media by noting that media devices are at greater risk of physical damage from children handling them, whilst a design project from the Eindhoven Academy – called New Born Fame – built from soft toys shaped like social media logos, motion and touch sensors that activate image capture (much like babyselfie apps), but with automated social media sharing, critically interrogates the ways infants are increasingly bound-up with the networked and algorithmic regimes of our computational culture. Finally, parents in this research revealed that they carefully considered the ethics of media in their children’s lives by organising everyday media practices that balanced dwelling with new, old, and non media forms, and by curating their digitally mediated interactions and archives with an awareness they were custodians of their children’s digital memories (Garde-Hansen et al.). I suggest these examples work from an immanent ethical and critical position in order to make visible and operate from within the conditions of infant media life. Rather than seeking to deny or avoid the diversity of encounters infants have with and through mobile media in their everyday lives, this analysis has explored the ways infants are increasingly configured as users of mobile media and communication technologies, identifying an emerging repertoire of infant mobile communication techniques. The emerging practices of infant mobile communication outlined here are intertwined with contemporary household media environments, and assembled through accidental, assisted, and automated relations of living with mobile media. Moreover, such entanglements of use are both represented and discursively reconfigured through multiple channels, contexts, and networks of public mediation. Together, these diverse contexts and forms of conduct have implications for both studying and understanding the ways babies are emerging as active participants and interpellated subjects within a continually expanding digital culture. Acknowledgments This research was supported with funding from the Australian Research Council (ARC) Discovery Early Career Researcher Award (DE130100735). I would like to express my appreciation to the children and families involved in this study for their generous contribution of time and experiences. References Buckingham, David. After the Death of Childhood: Growing Up in the Age of Electronic Media. Polity Press: Oxford, 2000. Buckleitner, Warren. “A Taxonomy of Multi-Touch Interaction Styles, by Stage.” Children's Technology Review 18.11 (2011): 10-11. Chun, Wendy. Programmed Visions: Software and Memory. Cambridge: MIT Press, 2011. Deuze, Mark. “Media Life.” Media, Culture and Society 33.1 (2011): 137-148. Deuze, Mark. “The Unseen Disappearance of Invisible Media: A Response to Sebastian Kubitschko and Daniel Knapp.” Media, Culture and Society 34.3 (2012): 365-368. Garde-Hansen, Joanne, Andrew Hoskins and Anna Reading. Save as … Digital Memories. Hampshire: Palgrave Macmillan, 2009. Giddings, Seth. Gameworlds: Virtual Media and Children’s Everyday Play. New York: Bloomsbury, 2014. Gillespie, Tarleton. “The Relevance of Algorithms.” Media Technologies: Essays on Communication, Materiality, and Society. Eds. Tarelton Gillespie, Pablo Boczkowski and Kirsten Foot. Cambridge: MIT Press, 2014. Giudicelli, Patrick. "My Baby Selfie." iTunes App Store. Apple Inc., 2015. Highfield, Tim, and Tama Leaver. “A Methodology for Mapping Instagram Hashtags.” First Monday 20.1 (2015). Hourcade, Juan Pablo, Sarah Mascher, David Wu, and Luiza Pantoja. “Look, My Baby Is Using an iPad! An Analysis of Youtube Videos of Infants and Toddlers Using Tablets.” Proceedings of CHI 15. New York: ACM Press, 2015. 1915–1924. Ito, Mizuko. Engineering Play: A Cultural History of Children’s Software. Cambridge: MIT Press, 2009. Jayemanne, Darshana, Bjorn Nansen and Thomas Apperley. “Post-Digital Play and the Aesthetics of Recruitment.” Proceedings of Digital Games Research Association (DiGRA) 2015. Lüneburg, 14-17 May 2015. Kumar, Priya, and Sarita Schoenebeck. “The Modern Day Baby Book: Enacting Good Mothering and Stewarding Privacy on Facebook.” Proceedings of CSCW 2015. Vancouver, 14-18 March 2015. Mackay, Hugh, and Darren Ivey. Modern Media in the Home: An Ethnographic Study. Rome: John Libbey, 2004. Morris, Meredith. “Social Networking Site Use by Mothers of Young Children.” Proceedings of CSCW 2014. 1272-1282. OfCom. Children and Parents: Media Use and Attitudes Report. London: OfCom, 2013. McPake, Joanna, Lydia Plowman and Christine Stephen. "The Technologisation of Childhood? Young Children and Technology in The Home.” Children and Society 24.1 (2010): 63–74. Postman, Neil. Technopoly: The Surrender of Culture to Technology. New York: Vintage, 1993. Rideout, Victoria. Zero to Eight: Children’s Media Use in America 2013. Common Sense Media, 2013. Rogers, Richard. Digital Methods. Boston. MIT Press, 2013. Silverstone, Roger, and Eric Hirsch (eds). Consuming Technologies: Media and Information in Domestic Spaces. London: Routledge, 1992. Shuler, Carly. iLearn: A Content Analysis of the iTunes App Store’s Education Section. New York: The Joan Ganz Cooney Center at Sesame Workshop, 2009. Star, Susan Leigh. “The Ethnography of Infrastructure.” American Behavioral Scientist 43.3 (1999): 377–391. Strasburger, Victor, and Marjorie Hogan. “Policy Statement from the American Academy of Pediatrics: Children, Adolescents, and the Media.” Pediatrics 132 (2013): 958-961. Van Dijck, José. “Digital Photography: Digital Photography: Communication, Identity, Memory.” Visual Communication 7.1 (2008): 57-76. Wartella, Ellen, and Michael Robb. “Historical and Recurring Concerns about Children’s Use of the Mass Media.” The Handbook of Children, Media, and Development. Eds. Sandra Calvert and Barbara Wilson. Malden: Blackwell, 2008.

There is a moment in Al Gore’s 2006 documentary An Inconvenient Truth devised to expose the sheer audacity of fossil fuel lobby groups in the United States. In their attempts to address significant scientific consensus and growing public concern over climate change, these groups are resorting to what Gore’s film suggests are grotesque distortions of fact. A particular example highlighted in the film is the Competitive Enterprise Institute’s (CPE—a lobby group funded by ExxonMobil) “pro” energy industry advertisement: “Carbon dioxide”, the ad states. “They call it pollution, we call it life.” While on the one hand employing rhetoric against the “inconvenient truth” that carbon dioxide emissions are ratcheting up the Earth’s temperature, these advertisements also pose a question – though perhaps unintended – that is worth addressing. Where does life reside? This is not an issue of essentialism, but relates to the claims, materials and technologies through which life as a political object emerges. The danger of entertaining the vested interests of polluting industry in a discussion of climate change and its biopolitics is countered by an imperative to acknowledge the ways in which multiple positions in the climate change debate invoke and appeal to ‘life’ as the bottom line, or inviolable interest, of their political, social or economic work. In doing so, other questions come to the fore that a politics of climate change framed in terms of moral positions or competing values will tend to overlook. These questions concern the manifold practices of life that constitute the contemporary terrain of the political, and the actors and instruments put in this employ. Who speaks for life? And who or what produces it? Climate change as a matter of concern (Latour) has gathered and generated a host of experts, communities, narratives and technical devices all invested in the administration of life. It is, as Malcom Bull argues, “the paradigmatic issue of the new politics,” a politics which “draws people towards the public realm and makes life itself subject to the caprices of state and market” (2). This paper seeks to highlight the politics of life that have emerged around climate change as a public issue. It will argue that these politics appear in incremental and multiple ways that situate an array of actors and interests as active in both contesting and generating the terms of life: what life is and how we come to know it. This way of thinking about climate change debates opposes a prevalent moralistic framework that reads the practices and discourses of debate in terms of oppositional positions alone. While sympathies may flow in varying directions, especially when it comes to such a highly charged and massively consequential issue as climate change, there is little insight to be had from charging the CPE (for example) with manipulating consumers, or misrepresenting well-known facts. Where new and more productive understandings open up is in relation to the fields through which these gathering actors play out their claims to the project of life. These fields, from the state, to the corporation, to the domestic sphere, reveal a complex network of strategies and devices that seek to secure life in constantly renovated terms. Life Politics Biopolitical scholarship in the wake of Foucault has challenged life as a pre-given uncritical category, and sought to highlight the means through which it is put under question and constituted through varying and composing assemblages of practitioners and practices. Such work regards the project of human well-being as highly complex and technical, and has undertaken to document this empirically through close attention to the everyday ecologies in which humans are enmeshed. This is a political and theoretical project in itself, situating political processes in micro, as well as macro, registers, including daily life as a site of (self) management and governance. Rabinow and Rose refer to biopolitical circuits that draw together and inter-relate the multiple sites and scales operative in the administration of life. These involve not just technologies, rationalities and regimes of authority and control, but also politics “from below” in the form of rights claims and community formation and agitation (198). Active in these circuits, too, are corporate and non-state interests for whom the pursuit of maximising life’s qualities and capabilities has become a concern through which “market relations and shareholder value” are negotiated (Rabinow and Rose 211). As many biopolitical scholars argue, biopower—the strategies through which biopolitics are enacted—is characteristic of the “disciplinary neo-liberalism” that has come to define the modern state, and through which the conduct of conduct is practiced (Di Muzio 305). Foucault’s concept of governmentality describes the devolution of state-based disciplinarity and sovereignty to a host of non-state actors, rationalities and strategies of governing, including the self-managing subject, not in opposition to the state, but contributing to its form. According to Bratich, Packer and McCarthy, everyday life is thus “saturated with governmental techniques” (18) in which we are all enrolled. Unlike regimes of biopolitics identified with what Agamben terms “thanopolitics”—the exercise of biopower “which ultimately rests on the power of some to threaten the death of others” (Rabinow and Rose 198), such as the Nazi’s National Socialism and other eugenic campaigns—governmental arts in the service of “vitalist” biopolitics (Rose 1) are increasingly diffused amongst all those with an “interest” in sustaining life, from organisations to individuals. The integration of techniques of self-governance which ask the individual to work on themselves and their own dispositions with State functions has broadened the base by which life is governed, and foregrounded an unsettled terrain of life claims. Rose argues that medical science is at the forefront of these contemporary biopolitics, and to this effect “has […] been fully engaged in the ethical questions of how we should live—of what kinds of creatures we are, of the kinds of obligations that we have to ourselves and to others, of the kinds of techniques we can and should use to improve ourselves” (20). Asking individuals to self-identify through their medical histories and bodily specificities, medical cultures are also shaping new political arrangements, as communities connected by shared genetics or physical conditions, for instance, emerge, evolve and agitate according to the latest medical knowledge. Yet it is not just medicine that provokes ethical work and new political forms. The environment is a key site for life politics that entails a multi-faceted discourse of obligations and entitlements, across fields and scales of engagement. Calculating Environments In line with neo-liberal logic, environmental discourse concerned with ameliorating climate change has increasingly focused upon the individual as an agent of self-monitoring, to both facilitate government agendas at a distance, and to “self-fashion” in the mode of the autonomous subject, securing against external risks (Ong 501). Climate change is commonly represented as such a risk, to both human and non-human life. A recent letter published by the Royal Australasian College of Physicians in two leading British medical journals, named climate change as the “biggest global health threat of the twenty-first century” (Morton). As I have argued elsewhere (Potter), security is central to dominant cultures of environmental governance in the West; these cultures tie sustainability goals to various and interrelated regimes of monitoring which attach to concepts of what Clark and Stevenson call “the good ecological citizen” (238). Citizenship is thus practiced through strategies of governmentality which call on individuals to invest not just in their own well-being, but in the broader project of life. Calculation is a primary technique through which modern environmental governance is enacted; calculative strategies are seen to mediate risk, according to Foucault, and consequently to “assure living” (Elden 575). Rationalised schemes for self-monitoring are proliferating under climate change and the project of environmentalism more broadly, something which critics of neo-liberalism have identified as symptomatic of the privatisation of politics that liberal governmentality has fostered. As we have seen in Australia, an evolving policy emphasis on individual practices and the domestic sphere as crucial sites of environmental action – for instance, the introduction of domestic water restrictions, and the phasing out of energy-inefficient light bulbs in the home—provides a leading discourse of ethico-political responsibility. The rise of carbon dioxide counting is symptomatic of this culture, and indicates the distributed fields of life management in contemporary governmentality. Carbon dioxide, as the CPE is keen to point out, is crucial to life, but it is also—in too large an amount—a force of destruction. Its management, in vitalist terms, is thus established as an effort to protect life in the face of death. The concept of “carbon footprinting” has been promoted by governments, NGOs, industry and individuals as a way of securing this goal, and a host of calculative techniques and strategies are employed to this end, across a spectrum of activities and contexts all framed in the interests of life. The footprinting measure seeks to secure living via self-policed limits, which also—in classic biopolitical form—shift previously private practices into a public realm of count-ability and accountability. The carbon footprint, like its associates the ecological footprint and the water footprint, has developed as a multi-faceted tool of citizenship beyond the traditional boundaries of the state. Suggesting an ecological conception of territory and of our relationships and responsibilities to this, the footprint, as a measure of resource use and emissions relative to the Earth’s capacities to absorb these, calculates and visualises the “specific qualities” (Elden 575) that, in a spatialised understanding of security, constitute and define this territory. The carbon footprint’s relatively simple remit of measuring carbon emissions per unit of assessment—be that the individual, the corporation, or the nation—belies the ways in which life is formatted and produced through its calculations. A tangled set of devices, practices and discourses is employed to make carbon and thus life calculable and manageable. Treading Lightly The old environmental adage to “tread lightly upon the Earth” has been literalised in the metaphor of the footprint, which attempts both to symbolise environmental practice and to directly translate data in order to meaningfully communicate necessary boundaries for our living. The World Wildlife Fund’s Living Planet Report 2008 exemplifies the growing popularity of the footprint as a political and poetic hook: speaking in terms of our “ecological overshoot,” and the move from “ecological credit to ecological deficit”, the report urges an attendance to our “global footprint” which “now exceeds the world’s capacity to regenerate by about 30 per cent” (1). Angela Crombie’s A Lighter Footprint, an instruction manual for sustainable living, is one of a host of media through which individuals are educated in modes of footprint calculation and management. She presents a range of techniques, including carbon offsetting, shifting to sustainable modes of transport, eating and buying differently, recycling and conserving water, to mediate our carbon dioxide output, and to “show […] politicians how easy it is” (13). Governments however, need no persuading from citizens that carbon calculation is an exercise to be harnessed. As governments around the world move (slowly) to address climate change, policies that instrumentalise carbon dioxide emission and reduction via an auditing of credits and deficits have come to the fore—for example, the European Union Emissions Trading Scheme and the Chicago Climate Exchange. In Australia, we have the currently-under-debate Carbon Pollution Reduction Scheme, a part of which is the Australian Emissions Trading Scheme (AETS) that will introduce a system of “carbon credits” and trading in a market-based model of supply and demand. This initiative will put a price on carbon dioxide emissions, and cap the amount of emissions any one polluter can produce without purchasing further credits. In readiness for the scheme, business initiatives are forming to take advantage of this new carbon market. Industries in carbon auditing and off-setting services are consolidating; hectares of trees, already active in the carbon sequestration market, are being cultivated as “carbon sinks” and key sites of compliance for polluters under the AETS. Governments are also planning to turn their tracts of forested public land into carbon credits worth billions of dollars (Arup 7). The attachment of emission measures to goods and services requires a range of calculative experts, and the implementation of new marketing and branding strategies, aimed at conveying the carbon “health” of a product. The introduction of “food mile” labelling (the amount of carbon dioxide emitted in the transportation of the food from source to consumer) in certain supermarkets in the United Kingdom is an example of this. Carbon risk analysis and management programs are being introduced across businesses in readiness for the forthcoming “carbon economy”. As one flyer selling “a suite of carbon related services” explains, “early action will give you the edge in understanding and mitigating the risks, and puts you in a prime position to capitalise on the rewards” (MGI Business Solutions Worldwide). In addition, lobby groups are working to ensure exclusions from or the free allocation of permits within the proposed AETS, with degrees of compulsion applied to different industries – the Federal Government, for instance, will provide a $3.9 billion compensation package for the electric power sector when the AETS commences, to enable their “adjustment” to this carbon regime. Performing Life Noortje Mares provides a further means of thinking through the politics of life in the context of climate change by complicating the distinction between public and private interest. Her study of “green living experiments” describes the rise of carbon calculation in the home in recent years, and the implementation of technologies such as the smart electricity meter that provides a constantly updating display of data relating to amounts and cost of energy consumed and the carbon dioxide emitted in the routines of domestic life. Her research tracks the entry of these personal calculative regimes into public life via internet forums such as blogs, where individuals notate or discuss their experiences of pursing low-carbon lifestyles. On the one hand, these calculative practices of living and their public representation can be read as evidencing the pervasive neo-liberal governmentality at work in contemporary environmental practice, where individuals are encouraged to scrupulously monitor their domestic cultures. The rise of auditing as a technology of self, and more broadly as a technique of public accountability, has come under fire for its “immunity-granting role” (Charkiewicz 79), where internal audits become substituted for external compliance and regulation. Mares challenges this reading, however, by demonstrating the ways in which green living experiments “transform everyday material practices into practices of public involvement” that (118) don’t resolve or pin down relations between the individual, the non-human environment, and the social, or reveal a mappable flow of actions and effects between the public realm and the home. The empirical modes of publicity that these individuals employ, “the careful recording of measurements and the reliable descriptions of sensory observation, so as to enable ‘virtual witnessing’ by wider audiences”, open up to much more complex understandings than one of calculative self-discipline at work. As “instrument[s] of public involvement” (120), the experiments that Mares describe locate the politics of life in the embodied socio-material entanglements of the domestic sphere, in arrangements of humans and non-human technologies. Such arrangements, she suggests, are ontologically productive in that they introduce “not only new knowledge, but also new entities […] to society” (119), and as such these experiments and the modes of calculation they employ become active in the composition of reality. Recent work in economic sociology and cultural studies has similarly contended that calculation, far from either a naturalised or thoroughly abstract process, relies upon a host of devices, relations, and techniques: that is, as Gay Hawkins explains, calculative processes “have to be enacted” (108). Environmental governmentality in the service of securing life is a networked practice that draws in a host of actors, not a top-down imposition. The institution of carbon economies and carbon emissions as a new register of public accountability, brings alternative ways to calculate the world into being, and consequently re-calibrates life as it emerges from these heterogeneous arrangements. All That Gathers Latour writes that we come to know a matter of concern by all the things that gather around it (Latour). This includes the human, as well as the non-human actors, policies, practices and technologies that are put to work in the making of our realities. Climate change is routinely represented as a threat to life, with predicted (and occurring) species extinction, growing numbers of climate change refugees, dispossessed from uninhabitable lands, and the rise of diseases and extreme weather scenarios that put human life in peril. There is no doubt, of course, that climate change does mean death for some: indeed, there are thanopolitical overtones in inequitable relations between the fall-out of impacts from major polluting nations on poorer countries, or those much more susceptible to rising sea levels. Biosocial equity, as Bull points out, is a “matter of being equally alive and equally dead” (2). Yet in the biopolitical project of assuring living, life is burgeoning around the problem of climate change. The critique of neo-liberalism as a blanketing system that subjects all aspects of life to market logic, and in which the cynical techniques of industry seek to appropriate ethico-political stances for their own material ends, are insufficient responses to what is actually unfolding in the messy terrain of climate change and its biopolitics. What this paper has attempted to show is that there is no particular purchase on life that can be had by any one actor who gathers around this concern. Varying interests, ambitions, and intentions, without moral hierarchy, stake their claim in life as a constantly constituting site in which they participate, and from this perspective, the ways in which we understand life to be both produced and managed expand. This is to refuse either an opposition or a conflation between the market and nature, or the market and life. It is also to argue that we cannot essentialise human-ness in the climate change debate. For while human relations with animals, plants and weathers may make us what we are, so too do our relations with (in a much less romantic view) non-human things, technologies, schemes, and even markets—from carbon auditing services, to the label on a tin on the supermarket shelf. As these intersect and entangle, the project of life, in the new politics of climate change, is far from straightforward. References An Inconvenient Truth. Dir. Davis Guggenheim. Village Roadshow, 2006. Arup, Tom. “Victoria Makes Enormous Carbon Stocktake in Bid for Offset Billions.” The Age 24 Sep. 2009: 7. Bratich, Jack Z., Jeremy Packer, and Cameron McCarthy. “Governing the Present.” Foucault, Cultural Studies and Governmentality. Ed. Bratich, Packer and McCarthy. Albany: State University of New York Press, 2003. 3-21. Bull, Malcolm. “Globalization and Biopolitics.” New Left Review 45 (2007): 12 May 2009 . < http://newleftreview.org/?page=article&view=2675 >. Charkiewicz, Ewa. “Corporations, the UN and Neo-liberal Bio-politics.” Development 48.1 (2005): 75-83. Clark, Nigel, and Nick Stevenson. “Care in a Time of Catastrophe: Citizenship, Community and the Ecological Imagination.” Journal of Human Rights 2.2 (2003): 235-246. Crombie, Angela. A Lighter Footprint: A Practical Guide to Minimising Your Impact on the Planet. Carlton North, Vic.: Scribe, 2007. Di Muzio, Tim. “Governing Global Slums: The Biopolitics of Target 11.” Global Governance. 14.3 (2008): 305-326. Elden, Stuart. “Governmentality, Calculation and Territory.” Environment and Planning D: Society and Space 25 (2007): 562-580. Hawkins, Gay. The Ethics of Waste: How We Relate to Rubbish. Sydney: University of New South Wales Press, 2006. Latour, Bruno. “Why Has Critique Run Out of Steam?: From Matters of Fact to Matters of Concern.” Critical Inquiry 30.2 (2004): 225-248. Mares, Noortje. “Testing Powers of Engagement: Green Living Experiments, the Ontological Turn and the Undoability and Involvement.” European Journal of Social Theory 12.1 (2009): 117-133. MGI Business Solutions Worldwide. “Carbon News.” Adelaide. 2 Aug. 2009. Ong, Aihwa. “Mutations in Citizenship.” Theory, Culture and Society 23.2-3 (2006): 499-505. Potter, Emily. “Footprints in the Mallee: Climate Change, Sustaining Communities, and the Nature of Place.” Landscapes and Learning: Place Studies in a Global World. Ed. Margaret Somerville, Kerith Power and Phoenix de Carteret. Sense Publishers. Forthcoming. Rabinow, Paul, and Nikolas Rose. “Biopower Today.” Biosocieties 1 (2006): 195-217. Rose, Nikolas. “The Politics of Life Itself.” Theory, Culture and Society 18.6 (2001): 1-30. World Wildlife Fund. Living Planet Report 2008. Switzerland, 2008.

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. Canberra: Australian War Memorial, 1930.Campbell, A.W. “Remarks on Some Neuroses and Psychoses in War.” Medical Journal of Australia 15 April (1916): 319–23.Damousi, Joy. “Why Do We Get So Emotional about Anzac.” What’s Wrong with Anzac. Ed. Marilyn Lake and Henry Reynolds. Sydney: UNSWP, 2015. 94–109.Dutton, Geoffrey. “Fremantle Arts Centre Press Publicity.” Australian Book Review May (1981): 16.Eager, R. “War Neuroses Occurring in Cases with a Definitive History of Shell Shock.” British Medical Journal 13 Apr. 1918): 422–25.Echterling, L.G., Thomas A. Field, and Anne L. Stewart. “Evolution of PTSD in the DSM.” Future Directions in Post-Traumatic Stress Disorder: Prevention, Diagnosis, and Treatment. Ed. Marilyn P. Safir and Helene S. Wallach. New York: Springer, 2015. 189–212.Facey, A.B. A Fortunate Life. 1981. Ringwood: Penguin, 2005.———. Drafts 1–3. University of Western Australia, Special Collections.———. Transcript. University of Western Australia, Special Collections.First Tuesday Book Club. ABC Splash. 4 Dec. 2012. <http://splash.abc.net.au/home#!/media/1454096/http&>.Foster, Dennis. Confession and Complicity in Narrative. Cambridge: Cambridge UP, 1987.Frank, Arthur. The Wounded Storyteller. London: U of Chicago P, 1995.Fraser, Jane. “CEO Says.” Fremantle Press. 7 July 2015. <https://www.fremantlepress.com.au/c/news/3747-ceo-says-9>.Garton, Stephen. The Cost of War: Australians Return. Melbourne: Oxford UP, 1994.HMAT Aeneas. “Report of Passengers for the Port of Fremantle from Ports Beyond the Commonwealth.” 20 Nov. 1915. <http://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=9870708&S=1>.“Interview with Ray Coffey.” Personal interview. 6 May 2016. Follow-up correspondence. 12 May 2016.Jenkins, Wendy. “Tales from the Backlist: A Fortunate Life Turns 30.” Fremantle Press, 14 April 2011. <https://www.fremantlepress.com.au/c/bookclubs/574-tales-from-the-backlist-a-fortunate-life-turns-30>.Keesing, Nancy. ‘An Enduring Classic.’ Australian Book Review (May 1981). FACP Press Clippings. Fremantle. n. pag.King, Noel. “‘I Can’t Go On … I’ll Go On’: Interview with Ray Coffey, Fremantle Arts Centre Press, 22 Dec. 2004; 24 May 2006.” Westerly 51 (2006): 31–54.Larsson, Marina. “A Disenfranchised Grief: Post War Death and Memorialisation in Australia after the First World War.” Australian Historical Studies 40.1 (2009): 79–95.Lindstrom, Richard. “The Australian Experience of Psychological Casualties in War: 1915-1939.” PhD dissertation. Victoria University, Feb. 1997.Loughran, Tracey. “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and its Histories.” Journal of the History of Medical and Allied Sciences 67.1 (2012): 99–119.Lucas, Anne. “Curator’s Notes.” A Fortunate Life. Australian Screen. <http://aso.gov.au/titles/tv/a-fortunate-life/notes/>.McLeod, Steve. “My Fortunate Life with Grandad.” Western Magazine Dec. (1983): 8.Munro, Craig. Under Cover: Adventures in the Art of Editing. Brunswick: Scribe, 2015.Murphy, Ffion, and Richard Nile. “The Naked Anzac: Exposure and Concealment in A.B. Facey’s A Fortunate Life.” Southerly 75.3 (2015): 219–37.———. “Wounded Storyteller: Revisiting Albert Facey’s Fortunate Life.” Westerly 60.2 (2015): 87–100.“NBC Book Awards.” Australian Book Review Oct. (1981): 1–4.PBL. Prospectus: A Fortunate Life, the Extraordinary Life of an Ordinary Bloke. 1–8.Repatriation Records. Albert Facey. National Archives of Australia.Roberts, Chris. “Turkish Machine Guns at the Landing.” Wartime: Official Magazine of the Australian War Memorial 50 (2010). <https://www.awm.gov.au/wartime/50/roberts_machinegun/>.Semmler, Clement. “The Way We Were before the Good Life.” Courier Mail 10 Oct. 1981. FACP Press Clippings. Fremantle. n. pag.Smith, Sidonie, and Julia Watson. Reading Autobiography: A Guide for Interpreting Life Narratives. 2001. 2nd ed. U of Minnesota P, 2010.Thomson, Alistair. Anzac Memories: Living with the Legend. 1994. 2nd ed. Melbourne: Monash UP, 2013. Tyquin, Michael. Gallipoli, the Medical War: The Australian Army Services in the Dardanelles Campaign of 1915. Kensington: UNSWP, 1993.War Service Records. National Archives of Australia. <http://recordsearch.naa.gov.au/NameSearch/Interface/NameSearchForm.aspx>.Williamson, Geordie. “A Fortunate Life.” Copyright Agency. <http://readingaustralia.com.au/essays/a-fortunate-life/>.

The past two decades have seen the publication of at least half a dozen books that consider the part that fairs, circuses, sideshows and freakshows play in the continuing cultural labour to define, categorise and control the human body, including Robert Bogdan’s Freakshow, Rosemarie Garland-Thomson’s Extraordinary Bodies, and her edited collection Freakery, and Rachel Adams’s Sideshow USA. These writers cast the freakshow as a theatre of culture, worthy of critical attention precisely because of the ways in which it has provided a popular forum for staging, solidifying and transforming ideas about the body and bodily difference, and because of its prominence in the project of modernity (Garland-Thomson “From Wonder to Error” 2-13). They point to the theatrical mechanisms by which the freakshow maps cultural anxieties about corporeal difference across ‘suitable’ bodies. For, as Bogdan (3) says, being a freak is far more than a fact of biology. The freak personae that populate the Western cultural imaginary—the fat lady, the bearded lady, the hermaphrodite and the geek—can only be produced by a performative isolation, manipulation and exaggeration of the peculiar characteristics of particular human bodies. These peculiarities have to be made explicit, in Rebecca Schneider’s (1) terms; the horror-inducing tropes of the savage, the bestial and the monstrous have to be cast across supposedly suitable and compliant flesh. The scopic mechanisms of the freakshow as a theatre, as a cabinet of corporeal curiosities in which spectators are excited, amazed and edified by the spectacle of the extraordinary body, thus support the specific forms of seeing and looking by which freak bodies are produced. It would, however, be a mistake to suggest that the titillating threat of this face-to-face encounter with the Levinasian other fully destabilises the space between signifier and signified, between the specific body and the symbolic framework in which it sits. In a somewhat paradoxical cultural manoeuvre, the ableist, sexist and racist symbolic frameworks of the freakshow unfold according to what Deleuze and Guattari (178) would call a logic of sameness. The roles, relationships and representational mechanisms of the freakshow—including the ‘talkers’ that frame the spectator’s engagement with the extraordinary body of the freak—in fact function to delineate “degrees of deviance” (178) or difference from an illusory bodily norm. So configured, the monstrous corporeality of the freak is also monstrously familiar, and is made more so by the freak spectacle’s frequent emphasis on the ways in which non-normative bodies accommodate basic functions such as grooming and eating. In such incarnations, the scenography and iconography of the freakshow in fact draws spectators into performative (mis)recognitions that manage the difference of other bodies by positioning them along a continuum that confirms the stability of the symbolic order, and the centrality of the able, white, male self in this symbolic order. Singular, specific, extraordinary bodies are subject to what might, in a Levinasian paradigm, be called the violence of categorisation and comprehension (“Is Ontology Fundamental?” 9). The circumstances of the encounter reduce the radical, unreadable difference of the other, transporting them “into the horizon of knowledge” (“Transcendence and Height” 12), and transforming them into something that serves the dominant cultural logic. In this sense, Petra Kuppers suggests, “the psychic effects of the freak spectacle have destabilizing effects, assaulting the boundaries of firm knowledge about self, but only to strengthen them again in cathartic effect” (45). By casting traits they abhor across the freak body (Garland-Thomson Extraordinary Bodies 55-56), spectators become complicit in this abhorrence; comforted, cajoled and strangely pleasured by a sense of distance from what they desire not to be. The subversive potential of the prodigious body evaporates (Garland-Thomson “From Wonder to Error” 3; Extraordinary Bodies 78). An evaporation more fully effected, writers on the freakshow explain, as the discursive construct of the freak was drawn into the sphere of medical spectacle in the late nineteenth century. As the symbolic framework for understanding disabled bodies ‘advances’ from the freak, the monster and the mutant to the medical specimen (Garland-Thomson “From Wonder to Error” 13; Extraordinary Bodies 70, 78-80; Synder and Mitchell 370-373; Stephens 492), the cultural trajectory away from extraordinary bodies with the capacity to expand the classes and categories of the human is complete. The medical profession finally fulfils the cultural compulsion to abstract peculiar bodily characteristics into symptoms, and, as Foucault says in The Birth of the Clinic, these symptoms become surveillable, and controllable, within an objective schema of human biology. Physical differences and idiosyncrasies are “enclosed within the singularity of the patient, in that region of ‘subjective symptoms’ that—for the doctor—defines not only the mode of knowledge, but the world of objects to be known” (xi). The freak body becomes no more than an example of human misfortune, to be examined, categorised and cared for by medical experts behind closed doors, and the freakshow fades from the stage of popular culture (Garland-Thomson Extraordinary Bodies 70). There can, of course, be no denying the need to protect people with disabilities from exploitation at the service of a cultural fetish that enacts a compulsion to define and control bodily difference. However, recent debates in disability, cultural and performance studies have been characterised by the desire to reconsider the freakshow as a site for contesting some of the cultural logics it enacts. Theorists like Synder and Mitchell argue that medical discourse “disarms the [disabled] body of its volatile potency” (378), in the process denying people with disabilities a potentially interesting site to contest the cultural logics by which their bodies are defined. The debate begins with Bogdan’s discussion of the ways in which well-meaning disability activists may, in their desire to protect people with disabilities from exploitative practices and producers, have overlooked the fact that freakshows provided people with disabilities a degree of independence and freedom otherwise impossible (280-81). After all, as disabled performer Mat Fraser says in his documentary Born Freak, The Victorian marvels found fame and some fortune, and this actually raised the visibility, even the acceptability, of disabled people in general during a time when you could be attacked on the streets just for looking different. These disabled performers found independence and commanded respect.… If I had been born a hundred years ago, given the alternatives of—what? living the life of a village monster or idiot or being poked or prodded for cataloguing by medical types—there’s no doubt about it, I would have wanted to be in show business. (Born Freak) This question of agency extends to discussion of whether disabled performers like Fraser can, by consciously appropriating the figures, symbols and scenography of the freakshow, start to deconstruct the mechanisms by which this contested sphere of cultural practice has historically defined them, confronting spectators with their own complicity in the construction of the freak. In her analysis of Coney Island’s Sideshows by the Seashore, Elizabeth Stephens reflects on this contemporary sideshow’s capacity to reclaim the political currency of the freak. For Stephens, sideshows are sites in which norms about the body, its limits and capabilities, are theatricalized and transformed into spectacle, but, in which, for this very reason, they can also be contested. Non-normative bodies are not simply exhibited or put on display on the sideshow stage, but are rather performed as the unstable—indeed, destabilising—product of the dynamic interrelationship between performer, audience and theatrical space. (486) Theorists like Stephens (487) point to disabled performers who manipulate the scopic and discursive mechanisms of the sideshow, street performance and circus, setting them against more or less personal accounts of the way their bodies have historically been seen, to disrupt the modes of subjection the freak spectacle makes possible and precipitate a crisis in prescribed categories of meaning. Stephens (485-498) writes of Mat Fraser, who reperformed the historical personal of the short-armed Sealo the Sealboy, and Jennifer Miller, who reperformed the persona of Zenobia the bearded lady, at Sideshows by the Seashore. Sharon Mazer (257-276) writes of Katy Dierlam, who donned a Dolly Dimples babydoll dress to reperform the clichéd fat lady figure Helon Melon, again at Sideshows by the Seashore, counterposing Melon’s monstrous obesity with comments affirming her body’s potent humanity, and quotes from feminist scholars and artists such as Suzy Orbach, Karen Finley and Annie Sprinkle. Sharon Synder and David Mitchell (383) write of Mary Duffy, who reperforms the armless figure of the Venus de Milo. These practices constitute performative interventions into the cultural sphere, aligned with a broader set of contemporary performance practices which contest the symbolic frameworks by which racial and gender characteristics are displayed on the popular stage in similar ways. Their confrontational performance strategies recall, for instance, the work of American performance artist Guillermo Gómez-Peña, who reappropriates colonial and pop cultural figurations of the racialised body in works like Two Undiscovered Amerindians Visit…, in which he and Coco Fusco cast themselves as two caged savages. In such works, Gómez-Peña and his collaborators use parallel performance strategies to engage the “spectacle of the Other-as-freak” (297). “The idea is to exaggerate the features of fear and desire in the Anglo imagination and ‘spectacularize’ our ‘extreme identities’, so to speak, with the clear understanding that these identities have been invented by the surgery of the global media” (297) Gómez-Peña says. These remobilisations of the monstrous operate within the paradigm of the explicit, a term Schneider coined a decade ago to describe the performance art practices of women who write the animalised, sexualised characteristics with which they are symbolically aligned across their own corporeally ‘suitable’ bodies, replaying their culturally assigned identities “with a voluble, ‘in your face’ vengeance” (100), “a literal vengeance” (109). Such practices reclaim the destablising potential of the freak spectacle, collapsing, complicating or exploding the space between signifier and signified to show that the freak is a discursive construct (22-23), and thus for Schneider, following Benjamin, threatening the whole symbolic system with collapse (2, 6). By positioning their bodies as a ground that manifestly fails to ground the reality they represent, these performers play with the idea that the reality of the freak is really just part of the order of representation. There is nothing behind it, nothing beyond it, nothing up the magician’s sleeve—identity is but a sideshow hall of mirrors in which the ‘blow off’ is always a big disappointment. Bodies marked by disability are not commodified, or even clearly visible, in the Western capitalist scopic economy in the same way as Schneider’s women performers. Nevertheless, disabled performers still use related strategies to reclaim a space for what Schneider calls a postmodern politics of transgression (4), exposing “the sedimented layers of signification themselves” (21), rather than establishing “an originary, true or redemptive body” (21) beneath. The contestational logic of these modes of practice notwithstanding, Stephens (486) notes that performers still typically cite a certain ambivalence about their potential. There are, after all, specific risks for people with disabilities working in this paradigm that are not fully drawn out in the broader debate about critical reappropriation of racist and sexist imagery in performance art. Mobilisations of the freak persona are complicated by the performer’s own corporeal ‘suitability’ to that persona, by the familiar theatrical mechanisms of recognition and reception (which can remain undertheorised in meta-level considerations of the political currency of the freakshow in disability and cultural—rather than performance—studies), and by a dominant cultural discourse that insists on configuring disability as an individual problem detached from the broader sphere of identity politics (Sandahl 598-99). In other words, the territory that still needs to be addressed in this emergent field of practice is the ethics of reception, and the risk of spectatorial (mis)recognitions that reduce the political potency of the freak spectacle. The main risk, of course, is that mobilisations of the freak persona may still be read by spectators as part of the phenomenon they are trying to challenge, the critical counterpositions failing to register, or failing to disrupt fully the familiar scopic and discursive framework. More problematically, the counterpositions themselves may be reduced by spectators to a rhetorical device that distances them from the corporeal reality of the encounter with the other, enabling them to interpret or explain the experience of disability as a personal experience by which an individual comes to accommodate their problems. Whilst the human desire to construct narrative and psychological contexts for traumatic experience cannot be denied, Carrie Sandahl (583) notes that there is a risk that the encounter with the disabled body will be interpreted as part of the broader phenomenon Synder and Mitchell describe in Narrative Prosthesis, in which disability is little more than a metaphor for the problems people have to get past in life. In this interpretative paradigm, disability enters a discursive and theoretical terrain that fails to engage fully the lived experience of the other. Perhaps most problematically, mobilisations of the freak persona may be read as one more manifestation of the distinctively postmodern desire to break free from the constraints of culturally condoned identity categories. This desire finds expression in the increasingly prevalent cultural phenomenon of voluntary enfreakment, in which people voluntarily differentiate, or queer their own experience of self. As Fraser says when he finds out that a company of able-bodied freaks is competing with him for audiences at the Edinburgh Fringe Festival, “[t]he irony is, these days, everyone is trying to get in on our act” (Born Freak). In a brave new world where everybody wants to be a freak, activist artists “must be watchful”, Gómez-Peña warns, “for we can easily get lost in the funhouse of virtual mirrors, epistemological inversions, and distorted perceptions” (288). The reclamation of disability as a positive metaphor for a more dispersed set of human differences in the spectacle of daily life (287-98), and in theoretical figurations of feminist philosophy that favour the grotesque, the monstrous and the mechanical (Haraway Simians, Cyborgs and Women; Braidotti Nomadic Subjects), raises questions for Garland-Thomson (“Integrating Disability, Transforming Feminist Theory” 9) and Sandahl (581-83). If “disability serves as a master trope for difference,” Sandahl says, then anybody can adopt it “…to serve as a metaphor expressing their own outsider status, alienation and alterity, not necessarily the social, economic and political concerns of actual disabled people” (583). The work of disabled performers can disappear into a wider sphere of self-differentiated identities, which threatens to withdraw ‘disability’ as a politically useful category around which a distinctive group of people can generate an activist politics. To negotiate these risks, disabled performers need to work somewhere between a specific, minoritarian politics and a universal, majoritarian politics, as Sedgwick describes in Epistemology of the Closet (91; cf. Garland-Thompson “Integrating Disability, Transforming Feminist Theory” 5; cf. Stephens 493). Performers need to make their experience of otherness explicit, so that their corporeal specificity is not abstracted into a symbolic system that serves the dominant cultural logic. Performers need to contextualise this experience in social terms, so that it is not isolated from the sphere of identity politics. But performers cannot always afford to allow the freak persona to become one more manifestation of the myriad idiosyncratic identities that circulate in the postmodern popular imaginary. It is by negotiating these risks that performers encourage spectators to experience—if only fleetingly, and provisionally—a relationship to the other that is characterised not by generalisation, domestication and containment (Levinas “Substitution” 80, 88), but by respect for the other’s radical alterity, by vulnerability, and, in Derrida’s reformation of Levinasian ethics, by a singular, reciprocal and undecidable responsibility towards the other (Derrida 60-70). This is what Levinas would call an ethical relationship, in which the other exists, but as an excess, a class of being that can be recognised but never seized by comprehension (“Is Ontology Fundamental?” 7, “Transcendence and Height” 17), or sublimated as a category of, or complement to, the same (13, “Meaning and Sense” 51). Mat Fraser’s mobilisation of Sealo the Sealboy is one of the most engaging examples of the way disabled performers negotiate the complexities of this terrain. On his website, Fraser says he has always been aware of the power of confrontational presentations of his own body, and has found live forms that blur the boundaries between freakshow, sideshow and conventional theatre the best forums for “the more brutal and confrontational aspect of my investigation into disability’s difficult interface with mainstream cultural concerns” (MatFraser.co.uk). Fraser’s appropriation of Sealo was born of a fascination with the historical figure of Stanley Berent. “Stanley Berent was an American freakshow entertainer from the 1940s who looked like me,” Fraser says. “He had phocomelia. That’s the medical term for my condition. It literally means seal-like limbs. Berent’s stage name was Sealo the Sealboy” (Born Freak). Fraser first restaged Sealo after a challenge from Dick Zigun, founder of the modern Sideshows by the Seashore. He restaged Berant’s act, focused on Berant’s ability to do basic things like shaving and sawing wood with his deformed hands, for the sideshow’s audiences. While Fraser had fun playing the character on stage, he says he felt a particular discomfort playing the character on the bally platform used to pull punters into the sideshow from the street outside. “There is no powerful dynamic there,” Fraser laments. “It’s just ‘come look at the freak’” (Born Freak). Accordingly, after a season at Sideshows by the Seashore, Fraser readapted the experience as a stage play, Sealboy: Freak, in which Sealo is counterposed with the character Tam, “a modern disabled actor struggling to be seen as more than a freak” (Born Freak). This shift in the theatrical mechanisms by which he stages the freak gives Fraser the power to draw contemporary, politically correct spectators at the Edinburgh Fringe Festival into the position of sideshow gawkers, confronting them with their own fascination with his body. A potent example is a post-audition scene, in which Tam says I read this book once that said that the mainstream will only see a disabled performer in the same way they view a performing seal. Very clever, but just mimicry. No. No it can’t be like that anymore. We’ve all moved on. People are no longer more fascinated by how I do things, rather than what I say. I am an actor, not a fucking freak. (Born Freak) But, as Tam says this, he rolls a joint, and spectators are indeed wrapped up in how he does it, hardly attending to what he says. What is interesting about Fraser’s engagement with Sealo in Sealboy: Freak is the way he works with a complicated—even contradictory—range of presentational strategies. Fraser’s performance becomes explicit, expositional and estranging by turns. At times, he collapses his own identity into that of the freak, the figure so stark, so recognisable, so much more harshly drawn than its real-life referent, that it becomes a simulacrum (cf. Baudrillard 253-282), exceeding and escaping the complications of the human corporeality beneath it. Fraser allows spectators to inhabit the horror, and the humour, his disabled identity has historically provoked, reengaging the reactions they hide in everyday life. And, perhaps, if they are an educated audience at the Fringe, applauding themselves for their own ability to comprehend the freak, and the crudity of sideshow display. However, self-congratulatory comprehension of the freak persona is interrupted by the discomforting encounter with Tam, suspending—if only provisionally—spectators’ ability to reconcile this reaction with their credentials as a politically correct audience. What a closer look at mobilisations of the freak in performances such as Fraser’s demonstrates is that manipulating the theatrical mechanisms of the stage, and their potential to rapidly restructure engagement with the extraordinary body, enables performers to negotiate the risk of (mis)recognition embedded in the face-to-face encounter between self and spectator. So configured, the stage can become a site for contesting the cultural logic by which the disabled body has historically been defined. It can challenge spectators to experience—if fleetingly—the uncertainties of the face-to-face encounter with the extraordinary body, acknowledging this body’s specificity, without immediately being able to abstract, domesticate or abdicate responsibility for it—or abdicate responsibility for their own reaction to it. Whilst spectators’ willingness to reflect further on their complicity in the construction of the other remains an open and individual question, these theatrical manipulations can at least increase the chance that the cathartic effect of the encounter with the so-called freak will be disrupted or deferred. References Adams, Rachel. Sideshow USA: Freaks and the American Cultural Imagination. Chicago, IL: University of Chigaco Press, 2001. Baudrillard, Jean. “The Precision of Simulacra”. Art After Modernism: Rethinking Representation. Ed. Brian Wallis. Boston, MA: David R. Godine, 1984, 253-282. Born Freak. Dir. Paul Sapin. Written Paul Sapin and Mat Fraser. Planet Wild for Channel 4 UK, 2001. Braidotti, Rosi. Nomadic Subjects: Embodiment and Sexual Difference in Contemporary Feminist Thought. New York, NY: Columbia University Press, 1994. Bogdan, Robert. Freakshow: Presenting Human Oddities for Amusement and Profit. Chicago, IL: University of Chicago Press, 1988. Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Trans. Brian Massumi. Minneapolis, MN and London: University of Minnesota Press, 1987. Derrida, Jacques. Gift of Death. Trans. David Wills. Chicago IL: University of Chicago Press, 1995. Fraser, Mat. “Live Art”. MatFraser.co.uk. n.date. 30 April 2008 ‹http://www.matfraser.co.uk/live_art.php›. Foucault, Michel. The Birth of the Clinic: An Archeology of Medical Perception. Trans. AM Sheridan Smith. London: Routledge, 1976. Garland-Thomson, Rosmarie. “Integrating Disability, Transforming Feminist Theory”. NSWA Journal 14.3 (2002): 1-33. ———. Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature. New York, NY: Columbia University Press, 1997. ———. “Introduction: From Wonder to Error—A Genealogy of Freak Discourse”. Freakery: Cultural Spectacles of the Extraordinary Body. Ed. Rosmarie Garland-Thomspon. New York, NY and London: New York University Press, 1996. Gómez-Peña, Guillermo. “Culture-in-extremis: Performing Against the Cultural Backdrop of the Mainstream Bizarre”. The Performance Studies Reader. Ed. Henry Bial. London and New York: Routledge, 2004, 287-298. Haraway, Donna. Simians, Cyborgs and Women. New York, NY: Routledge, 1991. Kuppers, Petra. Disability and Contemporary Performance: Bodies on Edge. New York, NY: Routledge, 2004. Levinas, Emmanuel. “Is Ontology Fundamental?”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 1-10. ———. “Transcendence and Height”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 11-31. ———. “Meaning and Sense”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 33-64. ———. “Substitution”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 79-95. Mazer, Sharon. “‘She’s so fat…’ Facing the Fat Lady at Coney Island’s Sideshows by the Seashore”. Bodies Out of Bounds: Fatness and Transgression. Ed. Jana Evens Braziel and Kathryn LeBesco. Berkeley, CA: University of California Press, 2001, 257-276. Sandahl, Carrie. “Black Man, Blind Man: Disability Identity Politics and Performance”. Theatre Journal 56 (2004): 597-602. Schneider, Rebecca. The Explicit Body in Performance. New York, NY and London: Routledge, 1997. Sedgwick, Eve Kosofsky. Epistemology of the Closet. Berkeley, CA: University of California Press, 1990. Snyder, Sharon L. and David T Mitchell. “Re-engaging the Body: Disability Studies and the Resistance to Embodiment”. Public Culture, 13.3 (2001): 367-389. ———. Narrative Prosthesis: Disability and the Dependencies of Discourse. Ann Arbor, MI: University of Michigan Press, 2000. Stephens, Elizabeth. “Cultural Fixations of the Freak Body: Coney Island and the Postmodern Sideshow”. Continuum: Journal of Media and Cultural Studies 20.4 (2006): 485-498. Acknowledgements An earlier version of this paper was presented at “Extreme States: Issues of Scale—Political, Performative, Emotional”, the Australasian Association for Drama Theatre and Performance Studies Annual Conference 2007.

Introduction: The Creative Arts and Regional Well-BeingThe relationship between regionalism, well-being, and the creative arts has enjoined significant attention from community activists, commercial entrepreneurs, policy analysts, artists, and researchers over recent years (Australia Council for the Arts, “Living Culture”; Australia Council for the Arts, “The Arts in Regional Australia;” Drummond, Keane, and West; Elg; Warren, and West; Woodward, Bremner, and Cahalan). Underpinning most of the activity and research in this area is the understanding (occasionally bordering on an un-critical presumption) that the creative arts make a positive contribution to regional well-being. Commenting on the Live. Love. Life. creative-arts wellness festival in Daylesford, Victoria, Mary-Anne Thomas (Member of Parliament for the state seat of Macedon) stated that the festival will “reinforce Daylesford and the Macedon Ranges’ status as one of the nation’s leading wellness destinations” (Elg). For Thomas, it would appear that the linkage of the creative arts to regional well-being is never in doubt; which is to say, always already available for reinforcement. According to university-based researchers Margaret Woodward, Craig Bremner, and Anthony Cahalan, writing in a more scholarly and critical register, “there is a growing body of research which shows that thriving creative industries and cultural activities are crucial for the health and vitality of a region and its communities” (3). Qualifying this, they add that: “Achieving high levels of community well being through thriving creative activity is not however without its challenges in regional Australia” (3). Similarly, Rozaline Drummond, Jondi Keane, and Patrick West present their work as a test of the efficacy of the creative arts in aiding regional well-being: The opportunity to work collaboratively with a community like the one at Lake Bolac [Victoria] provided an occasion to gauge our discerning and initiating skills within creative-arts research and to test the argument that the combination of our different approaches adds to community and individual well-being. Our approach is informed by Gilles Deleuze’s ethical proposition that the health of a community is directly influenced by the richness of the composition of its parts. (n.p.)Deleuzean philosophy aside, quantitative data indicates that people in regional Australia are increasingly optimistic about the positive impact of the creative arts on their well-being. In 2016, 57% believed the arts impacted their sense of well-being and happiness, up from 52% in 2013 (Australia Council for the Arts, “The Arts in Regional Australia”). Given this article’s emphasis on place and well-being in relation to located creative-arts production, it is worth citing another dataset from the same Australia Council for the Arts publication, which details the “Location of Professional Artists”:There continues to be a concentration of artists in urban areas. Three quarters (74%) live in cities, compared to two thirds of the Australian population. This urban concentration […] may in part be related to concentration of cultural infrastructure in cities.1 in 6 Australian artists live in regional cities or towns (16%) and around 1 in 10 live in rural, remote or very remote areas (11%). (n.p.)Regional artists are a minority voice in the Australian creative arts. But the ways in which a minority voice is constructed, and the (potential) impact a minoritarian position has within the wider debate about regional well-being and the creative arts, requires careful unpacking. Ironically, creative artists themselves have been relatively neglected actors in this space. Working with Tony Birch’s short story, “The Red House”, as a neglected text of regionalism, this article exposes oversights in current understandings of the connection between well-being and regionalism. The Voice of the Regional Artist and “Resistant Speech” It is important to recognise that the “concentration of artists in urban areas” may sometimes lead to situations where non-regional artists, in the undoubtedly well-meaning pursuit of regional well-being, drown out the voices of regional artists in regional places (Australia Council for the Arts, “The Arts in Regional Australia”). Drummond, Keane, and West, all city-based artists, show sensitivity to this problem in their observation that: “It is not for the artists to presume that they can empower a [regional] community.” Certainly, regional artists and communities should take the lead in the development of regional well-being through the creative arts. The problem of (not) speaking for the other is, however, not so easily dealt with (Spivak). While urban artists might adopt the strategy of consciously allowing regional artists a voice, making such allowance could itself be viewed as a play of privilege and power by the city-based practitioner, resourced by their greater “concentration of cultural infrastructure” (Australia Council for the Arts, “The Arts in Regional Australia”). It is notoriously difficult to give the slip to the relatively invisible operations of entitlement. Furthermore, even if the regional artist is given a voice, there are many different ways of being heard or not heard. Gayatri Chakravorty Spivak’s distinction between “speaking” and “talking” is useful here. Discussing “Can the Subaltern Speak?” in an interview with Bulan Lahiri, Spivak notes that: “It was not about talking. It was about: when the subaltern speaks there is not enough infrastructure for people to recognise it as resistant speech. That’s what it means.” In this crucial move, Spivak refines understanding of the issues at stake around the minoritarian position of regional artists. It is not enough for regional artists merely to “talk”; rather, they must be heard with the full impact of “resistant speech” (Lahiri). Obviously, what Spivak means by the “infrastructure” of “resistant speech” differs from the meaning the word “infrastructure” has in the Australia Council for the Arts publication referred to above, which employs the term as part of a governmental and technocratic discourse (“The Arts in Regional Australia”). The distance separating these two usages of “infrastructure” indicates the difference between the quantitative and the qualitative. Working with Spivak, this article’s focus is on the gap or failing in the infrastructure of qualitative research that has led to the relative neglect of Tony Birch’s short story “The Red House” as a significant text of regionalism. The Australia Council for the Arts, with its quantitative and empirical methodology, would not count Birch as a regional writer (to the best of the author’s knowledge, Birch lives and works in Melbourne). Its definition of a regional artist undermines the possibilities of a qualitative research infrastructure. However, recognizing the powerful regional concerns within a text by a primarily city-based writer like Birch is a key move, not only in expanding the definition of who counts as a minoritarian regional writer, but in giving voice to the “resistant speech” of women and children, subalterns on Spivak’s terms, within the regional-urban flux (Lahiri). The aim of this article is to give voice to Tony Birch as a regional writer, at least insofar as he is the author of “The Red House”, while also addressing the issue of well-being (as linked to the curse of domestic violence), through attention to Birch’s artistic re-creation of regionalism. In this way, working with Spivak’s reference to “infrastructure,” the aim is to nurture the growth of a research infrastructure open to a more productive engagement with regionalism, which begins by nuancing the definition of regional. It is not that regional artists, defined either by their demography or (as with Birch) by their creative concerns, are not “talking” rather, what they are saying is not being recognised in Spivak’s strong sense of “speaking”. Indeed, the very fact that Birch is not a regional writer in an empirical sense, and that, as will be explored later in this article, “The Red House” is not even primarily set in a regional location, has at least one important consequence. Potentially, it increases the value of Birch’s short story to an engagement with regionalism, given that “The Red House” unfolds regionalism as a concept always already in productive dialogue with other frameworks of place (such as the urban and the international). To the extent that Birch is a city-based writer of regionalism, and thus on the (urban) margin of the (regional) margin, he enlivens an exquisite position of minoritarian power. Furthermore, “The Red House” contains a diversity of acute insights into the nexus of regionalism and well-being that, to date, critics have overlooked. “The Red House” and the Well-Being of Places Comparatively little scholarly attention has been paid to creative work that itself dramatises and interrogates the issue of regional well-being. Tony Birch’s short story “The Red House” (2006), from his collection of linked stories (which is sometimes referred to as a novel) Shadowboxing, is a particularly interesting candidate to fill this gap in the literature, given how delicately it ranges across, and problematises, the division between the urban and the regional.“The Red House” is the opening story of Shadowboxing. Covering a period of close to a decade, loosely overlapping with the 1960s, and set in different parts of Victoria and Melbourne, it is told in the voice of Michael, who recounts the story of a peripatetic family under stress and struggling to survive. The first sentence reads: “We moved to the red house in the winter after my younger sister, May, died of meningitis” (1). The first page also establishes the place-based coordinates of the story: “In the weeks following our move from Clunes back to Fitzroy, our new house was almost submerged by a rising flood” (1). Birch’s interrogation of regionalism will henceforth operate largely along the Clunes-Fitzroy axis. Fitzroy is an inner-city suburb of Melbourne while Clunes is a small regional town (present population: approximately 2000) about 140 kilometres north-west of Melbourne (Clunes). A flashback section of three pages or so, early on in the story, fills in the events leading up to the return to Melbourne after May’s death in Clunes. Apart from this, the story has a linear structure. The various spatial shifts of “The Red House”, both within Melbourne and between Clunes and Melbourne, are all triggered by threats against, or the pursuit of, multiple modes of well-being. The first move reflects the promise of a fresh romantic union: “It was only after he [Michael’s father] had met my mother and moved with her to my [maternal] grandmother’s house over in Carlton that he had left Fitzroy for the first time in his life” (4–5). This move from Fitzroy to Carlton is followed by a much bigger one: Carlton to Clunes. Implicated in this move are at least two modes of well-being: “The eventual move to the bush had come on the advice of a doctor at the public hospital. He said that the fresh air would help my dad recover from [his] asthma” (5); however, “My grandmother told me years later that the move did not really have all that much to do with his asthma. It was the drink” (5). The context is the husband’s assault of “his six months’ pregnant wife” with “a straight right on the end of her nose” (5). The decision to move to Clunes is made by Michael’s mother: “He fought with her so much that my mother eventually decided that she would have to move away from her mother’s house, for both their sakes. Clunes was a drastic move. But it worked, for a time […]. They appeared happy” (6). This part of “The Red House” unpacks the complexities of how well-being and (physical and mental) health are linked in a social matrix; a physical ailment (asthma) elides an addiction to alcohol, until a doctor’s discourse (validated by the authority of a medical establishment) is subverted by the subalternate voice of Michael’s grandmother. This passage also dramatises the abject scenario of a victim (Michael’s mother) attending to the well-being of her persecutor (Michael’s father) by moving to Clunes “for both their sakes” (6).Subsequently, May is born in Clunes, “a ‘special baby’. She was magical even…” (6). Indeed, “My father’s habit of explosive anger melted before May. He was truly besotted with her” (6). Just before what would have been her second birthday, May dies. “My father wanted to bring May back to Melbourne for burial, but my mother stood up to him and demanded that she be buried in the town where she was born” (6). This is the most powerful enduring connection of Michael’s family to regional Clunes. Significantly, well-being (in the sense of survival and the rebuilding of happiness after the tragic death of a daughter) is dispersed differently, through place, by mother and father, along gendered lines. While the mother wants her daughter’s birthplace and place of death to coincide, the father wants to possess his daughter, almost as if she were an object, by returning her to the city for burial. (Space restrictions preclude further exploration here of the many issues raised by May’s death, including those around the gendered nexus between well-being [happiness] and the proximity or otherwise to a child’s burial place.) After May’s death, Michael’s father’s behaviour deteriorates once more. The domestic violence continues: “It was difficult for my mother to find anything safe to say to him […]. She tried to talk about May with him several times, but he either responded with silence, or swore and yelled at her uncontrollably. He also found his way back to the pubs” (7). The decision to return to Melbourne is made by Michael’s father, against his wife’s wishes: And then one night after he had walked in from the pub he sat down at the table and just said to her, ‘Fuck all this fresh-air bullshit, we’re going back to Melbourne.’ She tried persuading him to stay, talked about his job and my school, but he would not listen. He got sick of her talking and slammed a fist into his heavy palm. ‘We’re fucken going. That’s it. We’re going.’ And that was it.She looked across the table that night and saw once again the man she had married six years earlier, the man who she had deceived herself had faded and eventually disappeared with the move away from the city. (7)In this passage, well-being (even if only imagined rather than real) is explicitly linked to place. Shortly afterwards, the family moves into the red house, where they will remain. The flashback section of the text has already sketched out the chain of events that leads to the return to the city, while also commenting on the agency Michael’s mother exercises in dealing with what, to her, is an unwelcome situation: “Mum […] had argued against coming back to the city. She sensed the looming danger in my father moving back both to his old streets and his old habits. But on realising that she had no real say in the matter, she was determined to ensure that she at least have some say in the house she was moving into” (4). Specifically, Michael’s mother turns her Fitzroy house into the regional house left behind in Clunes. Under her influence, “It wasn’t long before the inside of the house came to life and began to resemble the old place at Clunes” (11). Again: she brings a portrait of May, along with assorted baby belongings, into the Fitzroy house, keeping this secret from her husband. Thus, Michael’s mother infiltrates regional place into urban place as a strategy of (subalternate) well-being. In summary, “The Red House” unpacks well-being as an expansive category shaped by domestic violence, in a negative sense, but also more positively by the actuality or promise of happiness. It also interrogates the fine-grained links between well-being in its incarnations as medical and emotional health. At the same time, it maps the rise and fall of well-being against a human geography of regional and urban places, refusing any simplistic connection of place to well-being (more faintly, there is even the problematising presence of international place, in the character of the Italian landlord, Mr Carboni, and the reference to “the local Italian community [2]). Thus, the text’s regionalism suggests a strategic model, reliant on human intervention in the (re-)creation of place; this is most evident in Michael’s mother’s actions. “The Red House” rewards interpretation as a text of how regional place (Clunes) is re-made in urban place (Fitzroy) through the rehabilitation of a house in the interests of well-being. Well-Being and Domestic Violence across Places It is hard to imagine a greater threat to the well-being of women and children than domestic violence. This makes it all the more surprising that “The Red House” is one of relatively few texts (to the author’s knowledge) to offer a detailed outline of the territory of well-being, in its many forms stretching from the health-based to the emotional, while also including a direct and unflinching consideration of domestic violence. (One cognate text is Kathryn Heyman’s novel The Breaking, which merges medical disability and domestic violence within a broader consideration of regional well-being.) Even more unusual is the way Birch’s story of well-being and domestic violence is mapped in relation to regional and non-regional places. “The Red House” is rare and valuable for its triangulation of well-being, domestic violence, and place; above all, in its refusal to resort to any comforting notion that regional places have essential qualities that make them necessarily better for well-being than the experience of cities. This is perhaps the meaning of the colour of the red house, a colour Michael’s father hates. According to a local know-all, Emu Bailey, the red was originally a form of protest by Ettie Rogers, “‘some sort of communist’” (10). “‘Most everyone around here back then was DLP [Democratic Labour Party]. Still is, some of them. Ettie wasn’t in agreement with the others in the street, so she let them know all about it. Redone it every summer too, the same colour, red’” (10). When Michael’s mother responds to her husband’s injunction to re-paint the house “‘any colour but that fucken red’” (13) by preparing to re-paint it, subversively, “a deep red splash of colour” (19) it is not difficult to discern a silent protest, passed down from woman to woman, against the domestic violence suffered by Michael and his mother. Indeed, Birch comes very close to describing the red of the house as blood-like, labelling it “a rich congealed red” (2). “Congealed” is often used to describe blood. In this way, through a colour that evokes the body, a house becomes a visible and metaphorical protest against the bodily violence (but also emotional and mental torment) that is domestic violence. As Meg Mundell argues, “the body is integral to how literary sense of place is produced” (8). This bodily, coloured protest folds back into the special sort of place the Fitzroy home becomes. If Michael’s mother cannot keep living in Clunes, she can at least paint her city house red. Perhaps attesting to the success of this female protest, there is, towards the end of “The Red House”, a fascinating moment when, as if influenced by the domestic circumstances of transplanted place (from regional Clunes) created by Michael’s mother, domestic violence threatens, but is thwarted. Michael’s mother has just told her husband that she is going to have another baby: “He spun around and moved towards her. I thought that maybe he was going to hit her. But he didn’t. He stopped in front of her. They were toe to toe” (17). Place and (pregnant) body, in an intensified combination (or even, to riff on Spivak’s terminology, as an “infrastructure”), allow the subaltern to “speak” against her oppression. Conclusion: Re-Defining Regionalism through the Literary Creative Arts Tony Birch’s “The Red House” re-creates the regional as something other than a pre-determined place. Regionalism is “activated,” in a strategic mode, within the flux of the urban and the regional. This is particularly evident in the actions of Michael’s mother. She preserves her well-being (located in Clunes, as it were, where her daughter is buried) even after she is forced by her husband to return to Melbourne (the place she left to escape from his domestic violence). The picture of May acts as a talisman of well-being (aptly, given Clunes is described by Michael as “a town where old superstitions held sway over logic” [6]), which Michael’s mother smuggles from regional Clunes into her Melbourne house. “The Red House” is thus a vital literary rejoinder to the conceptualisation of well-being, and regional areas employed by government bodies and commercial entities, which instrumentalizes a binary opposition of the regional/non-regional. By extension, it contests the naïve linkage of regional place to well-being through a nuanced investigation into the complex links between place (regional, urban, even international) and multi-faceted well-being. Birch’s story is a valuable, fine-grained creative analysis of well-being (extending from happiness, comfort and security through to what might be called the “ill-being” of domestic violence), which is matched to an equally fine-grained engagement with multiple modalities of place. It challenges the reader to creatively re-think how regionalism and well-being might align. References Australia Council for the Arts. “Living Culture: First Nations Arts Participation and Wellbeing.” Sydney: Australia Council for the Arts, 2017. 10 Mar. 2019 <https://www.australiacouncil.gov.au/research/living-culture/>.———. “The Arts in Regional Australia: A Research Summary.” Sydney: Australia Council for the Arts, 2017. 10 Mar. 2019 <https://www.australiacouncil.gov.au/research/regional-arts-summary/>.Birch, Tony. “The Red House.” Shadowboxing. Melbourne: Scribe, 2006. 1–19. Clunes, Victoria. Wikipedia. <https://en.wikipedia.org/wiki/Clunes,_Victoria>.Drummond, Rozalind, Jondi Keane, and Patrick West. “Zones of Practice: Embodiment and Creative Arts Research.” M/C Journal 15.4 (2012). 1 Mar. 2019 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/528>.Elg, Hayley. “New Wellness Festival for Daylesford.” The Advocate 22 Jan. 2018. 1 Mar. 2019 <https://www.hepburnadvocate.com.au/story/5182322/the-live-love-life-festival-is-coming-to-daylesford-this-november/>.Heyman, Kathryn. “When I First Wrote about Domestic Violence, No One Talked about It. Now the Shame has Lifted.” The Guardian. 21 May 2017. 10 Mar. 2019 <https://www.theguardian.com/books/2017/may/21/when-i-first-wrote-about-domestic-violence-no-one-talked-about-it-now-the-shame-has-lifted>.Lahiri, Bulan. “In Conversation: Speaking to Spivak.” The Hindu 5 Feb. 2011. 1 Mar. 2019 <https://www.thehindu.com/books/In-Conversation-Speaking-to-Spivak/article15130635.ece>.Mundell, Meg. “Crafting ‘Literary Sense of Place’: The Generative Work of Literary Place-Making.” JASAL: Journal of the Association for the Study of Australian Literature 18.1 (2018): 1–17. 10 Mar. 2019 <https://openjournals.library.sydney.edu.au/index.php/JASAL/article/view/12375>.Spivak, Gayatri Chakravorty. “Can the Subaltern Speak?” Colonial Discourse and Post-Colonial Theory: A Reader. New York: Harvester Wheatsheaf, 1993: 66–111. Warren, Brad, and Patrick West. “From Ecological Creativity to an Ecology of Well-Being: ‘Flows & Catchments’ as a Case Study of NVivo.” Landscapes: The Journal of the International Centre for Landscape and Language 5.2 (2013): 1–15. 1 Mar. 2019 <https://ro.ecu.edu.au/landscapes/vol5/iss2/21/>.Woodward, Margaret, Craig Bremner, and Anthony Cahalan. “Defining the Geography of Creativity in a Regional Australian University.” Proceedings of the 2012 Australian Council of University Art and Design Schools (ACUADS) Conference: Region and Isolation: The Changing Function of Art & Design Education within Diasporic Cultures and Borderless Communities. Australian Council of University Art and Design Schools (ACUADS) Conference 2012. Perth: Australian Council of University Art and Design Schools (ACUADS), 2012: 1–13. 1 Mar. 2019 <https://acuads.com.au/conference/article/defining-the-geography-of-creativity-in-a-regional-australian-university/>.

Introduction: Bubbles and Sport The ephemeral materiality of bubbles – beautiful, spectacular, and distracting but ultimately fragile – when applied to protect or conserve in the interests of sport-media profit, creates conditions that exacerbate existing inequalities in sport and society. Bubbles are usually something to watch, admire, and chase after in their brief yet shiny lives. There is supposed to be, technically, nothing inside them other than one or more gasses, and yet we constantly refer to people and objects being inside bubbles. The metaphor of the bubble has been used to describe the life of celebrities, politicians in purpose-built capital cities like Canberra, and even leftist, environmentally activist urban dwellers. The metaphorical and material qualities of bubbles are aligned—they cannot be easily captured and are liable to change at any time. In this article we address the metaphorical sporting bubble, which is often evoked in describing life in professional sport. This is a vernacular term used to capture and condemn the conditions of life of elite sportspeople (usually men), most commonly after there has been a sport-related scandal, especially of a sexual nature (Rowe). It is frequently paired with connotatively loaded adjectives like pampered and indulged. The sporting bubble is rarely interrogated in academic literature, the concept largely being left to the media and moral entrepreneurs. It is represented as involving a highly privileged but also pressurised life for those who live inside it. A sporting bubble is a world constructed for its most prized inhabitants that enables them to be protected from insurgents and to set the terms of their encounters with others, especially sport fans and disciplinary agents of the state. The Covid-19 pandemic both reinforced and reconfigured the operational concept of the bubble, re-arranging tensions between safety (protecting athletes) and fragility (short careers, risks of injury, etc.) for those within, while safeguarding those without from bubble contagion. Privilege and Precarity Bubble-induced social isolation, critics argue, encourages a loss of perspective among those under its protection, an entitled disconnection from the usual rules and responsibilities of everyday life. For this reason, the denizens of the sporting bubble are seen as being at risk to themselves and, more troublingly, to those allowed temporarily to penetrate it, especially young women who are first exploited by and then ejected from it (Benedict). There are many well-documented cases of professional male athletes “behaving badly” and trying to rely on institutional status and various versions of the sporting bubble for shelter (Flood and Dyson; Reel and Crouch; Wade). In the age of mobile and social media, it is increasingly difficult to keep misbehaviour in-house, resulting in a slew of media stories about, for example, drunkenness and sexual misconduct, such as when then-Sydney Roosters co-captain Mitchell Pearce was suspended and fined in 2016 after being filmed trying to force an unwanted kiss on a woman and then simulating a lewd act with her dog while drunk. There is contestation between those who condemn such behaviour as aberrant and those who regard it as the conventional expression of youthful masculinity as part of the familiar “boys will be boys” dictum. The latter naturalise an inequitable gender order, frequently treating sportsmen as victims of predatory women, and ignoring asymmetries of power between men and women, especially in homosocial environments (Toffoletti). For those in the sporting bubble (predominantly elite sportsmen and highly paid executives, also mostly men, with an array of service staff of both sexes moving in and out of it), life is reflected for those being protected via an array of screens (small screens in homes and indoor places of entertainment, and even smaller screens on theirs and others’ phones, as well as huge screens at sport events). These male sport stars are paid handsomely to use their skill and strength to perform for the sporting codes, their every facial expression and bodily action watched by the media and relayed to audiences. This is often a precarious existence, the usually brief career of an athlete worker being dependent on health, luck, age, successful competition with rivals, networks, and club and coach preferences. There is a large, aspirational reserve army of athletes vying to play at the elite level, despite risks of injury and invasive, life-changing medical interventions. Responsibility for avoiding performance and image enhancing drugs (PIEDs) also weighs heavily on their shoulders (Connor). Professional sportspeople, in their more reflective moments, know that their time in the limelight will soon be up, meaning that getting a ticket to the sporting bubble, even for a short time, can make all the difference to their post-sport lives and those of their families. The most vulnerable of the small minority of participants in sport who make a good, short-term living from it are those for whom, in the absence of quality education and prior social status, it is their sole likely means of upward social mobility (Spaaij). Elite sport performers are surrounded by minders, doctors, fitness instructors, therapists, coaches, advisors and other service personnel, all supporting athletes to stay focussed on and maximise performance quality to satisfy co-present crowds, broadcasters, sponsors, sports bodies and mass media audiences. The shield offered by the sporting bubble supports the teleological win-at-all-costs mentality of professional sport. The stakes are high, with athlete and executive salaries, sponsorships and broadcasting deals entangled in a complex web of investments in keeping the “talent” pivotal to the “attention economy” (Davenport and Beck)—the players that provide the content for sale—in top form. Yet, the bubble cannot be entirely secured and poor behaviour or performance can have devastating effects, including permanent injury or disability, mental illness and loss of reputation (Rowe, “Scandals and Sport”). Given this fragile materiality of the sporting bubble, it is striking that, in response to the sudden shutdown following the economic and health crisis caused by the 2020 global pandemic, the leaders of professional sport decided to create more of them and seek to seal the metaphorical and material space with unprecedented efficiency. The outcome was a multi-sided tale of mobility, confinement, capital, labour, and the gendering of sport and society. The Covid-19 Gilded Cage Sociologists such as Zygmunt Bauman and John Urry have analysed the socio-politics of mobilities, whereby some people in the world, such as tourists, can traverse the globe at their leisure, while others remain fixed in geographical space because they lack the means to be mobile or, in contrast, are involuntarily displaced by war, so-called “ethnic cleansing”, famine, poverty or environmental degradation. The Covid-19 global pandemic re-framed these matters of mobilities (Rowe, “Subjecting Pandemic Sport”), with conventional moving around—between houses, businesses, cities, regions and countries—suddenly subjected to the imperative to be static and, in perniciously unreflective technocratic discourse, “socially distanced” (when what was actually meant was to be “physically distanced”). The late-twentieth century analysis of the “risk society” by Ulrich Beck, in which the mysterious consequences of humans’ predation on their environment are visited upon them with terrifying force, was dramatically realised with the coming of Covid-19. In another iteration of the metaphor, it burst the bubble of twenty-first century global sport. What we today call sport was formed through the process of sportisation (Maguire), whereby hyper-local, folk physical play was reconfigured as multi-spatial industrialised sport in modernity, becoming increasingly reliant on individual athletes and teams travelling across the landscape and well over the horizon. Co-present crowds were, in turn, overshadowed in the sport economy when sport events were taken to much larger, dispersed audiences via the media, especially in broadcast mode (Nicholson, Kerr, and Sherwood). This lucrative mediation of professional sport, though, came with an unforgiving obligation to generate an uninterrupted supply of spectacular live sport content. The pandemic closed down most sports events and those that did take place lacked the crucial participation of the co-present crowd to provide the requisite event atmosphere demanded by those viewers accustomed to a sense of occasion. Instead, they received a strange spectacle of sport performers operating in empty “cathedrals”, often with a “faked” crowd presence. The mediated sport spectacle under the pandemic involved cardboard cut-out and sex doll spectators, Zoom images of fans on large screens, and sampled sounds of the crowd recycled from sport video games. Confected co-presence produced simulacra of the “real” as Baudrillardian visions came to life. The sporting bubble had become even more remote. For elite sportspeople routinely isolated from the “common people”, the live sport encounter offered some sensory experience of the social – the sounds, sights and even smells of the crowd. Now the sporting bubble closed in on an already insulated and insular existence. It exposed the irony of the bubble as a sign of both privileged mobility and incarcerated athlete work, both refuge and prison. Its logic of contagion also turned a structure intended to protect those inside from those outside into, as already observed, a mechanism to manage the threat of insiders to outsiders. In Australia, as in many other countries, the populace was enjoined by governments and health authorities to help prevent the spread of Covid-19 through isolation and immobility. There were various exceptions, principally those classified as essential workers, a heterogeneous cohort ranging from supermarket shelf stackers to pharmacists. People in the cultural, leisure and sports industries, including musicians, actors, and athletes, were not counted among this crucial labour force. Indeed, the performing arts (including dance, theatre and music) were put on ice with quite devastating effects on the livelihoods and wellbeing of those involved. So, with all major sports shut down (the exception being horse racing, which received the benefit both of government subsidies and expanding online gambling revenue), sport organisations began to represent themselves as essential services that could help sustain collective mental and even spiritual wellbeing. This case was made most aggressively by Australian Rugby League Commission Chairman, Peter V’landys, in contending that “an Australia without rugby league is not Australia”. In similar vein, prominent sport and media figure Phil Gould insisted, when describing rugby league fans in Western Sydney’s Penrith, “they’re lost, because the football’s not on … . It holds their families together. People don’t understand that … . Their life begins in the second week of March, and it ends in October”. Despite misgivings about public safety and equality before the pandemic regime, sporting bubbles were allowed to form, re-form and circulate. The indefinite shutdown of the National Rugby League (NRL) on 23 March 2020 was followed after negotiation between multiple entities by its reopening on 28 May 2020. The competition included a team from another nation-state (the Warriors from Aotearoa/New Zealand) in creating an international sporting bubble on the Central Coast of New South Wales, separating them from their families and friends across the Tasman Sea. Appeals to the mental health of fans and the importance of the NRL to myths of “Australianness” notwithstanding, the league had not prudently maintained a financial reserve and so could not afford to shut down for long. Significant gambling revenue for leagues like the NRL and Australian Football League (AFL) also influenced the push to return to sport business as usual. Sport contests were needed in order to exploit the gambling opportunities – especially online and mobile – stimulated by home “confinement”. During the coronavirus lockdowns, Australians’ weekly spending on gambling went up by 142 per cent, and the NRL earned significantly more than usual from gambling revenue—potentially $10 million above forecasts for 2020. Despite the clear financial imperative at play, including heavy reliance on gambling, sporting bubble-making involved special licence. The state of Queensland, which had pursued a hard-line approach by closing its borders for most of those wishing to cross them for biographical landmark events like family funerals and even for medical treatment in border communities, became “the nation's sporting hub”. Queensland became the home of most teams of the men’s AFL (notably the women’s AFLW season having been cancelled) following a large Covid-19 second wave in Melbourne. The women’s National Netball League was based exclusively in Queensland. This state, which for the first time hosted the AFL Grand Final, deployed sport as a tool in both national sports tourism marketing and internal pre-election politics, sponsoring a documentary, The Sporting Bubble 2020, via its Tourism and Events arm. While Queensland became the larger bubble incorporating many other sporting bubbles, both the AFL and the NRL had versions of the “fly in, fly out” labour rhythms conventionally associated with the mining industry in remote and regional areas. In this instance, though, the bubble experience did not involve long stays in miners’ camps or even the one-night hotel stopovers familiar to the popular music and sport industries. Here, the bubble moved, usually by plane, to fulfil the requirements of a live sport “gig”, whereupon it was immediately returned to its more solid bubble hub or to domestic self-isolation. In the space created between disciplined expectation and deplored non-compliance, the sporting bubble inevitably became the scrutinised object and subject of scandal. Sporting Bubble Scandals While people with a very low risk of spreading Covid-19 (coming from areas with no active cases) were denied entry to Queensland for even the most serious of reasons (for example, the death of a child), images of AFL players and their families socialising and enjoying swimming at the Royal Pines Resort sporting bubble crossed our screens. Yet, despite their (players’, officials’ and families’) relative privilege and freedom of movement under the AFL Covid-Safe Plan, some players and others inside the bubble were involved in “scandals”. Most notable was the case of a drunken brawl outside a Gold Coast strip club which led to two Richmond players being “banished”, suspended for 10 matches, and the club fined $100,000. But it was not only players who breached Covid-19 bubble protocols: Collingwood coaches Nathan Buckley and Brenton Sanderson paid the $50,000 fine imposed on the club for playing tennis in Perth outside their bubble, while Richmond was fined $45,000 after Brooke Cotchin, wife of team captain Trent, posted an image to Instagram of a Gold Coast day spa that she had visited outside the “hub” (the institutionally preferred term for bubble). She was subsequently distressed after being trolled. Also of concern was the lack of physical distancing, and the range of people allowed into the sporting bubble, including babysitters, grandparents, and swimming coaches (for children). There were other cases of players being caught leaving the bubble to attend parties and sharing videos of their “antics” on social media. Biosecurity breaches of bubbles by players occurred relatively frequently, with stern words from both the AFL and NRL leaders (and their clubs) and fines accumulating in the thousands of dollars. Some people were also caught sneaking into bubbles, with Lekahni Pearce, the girlfriend of Swans player Elijah Taylor, stating that it was easy in Perth, “no security, I didn’t see a security guard” (in Barron, Stevens, and Zaczek) (a month later, outside the bubble, they had broken up and he pled guilty to unlawfully assaulting her; Ramsey). Flouting the rules, despite stern threats from government, did not lead to any bubble being popped. The sport-media machine powering sporting bubbles continued to run, the attendant emotional or health risks accepted in the name of national cultural therapy, while sponsorship, advertising and gambling revenue continued to accumulate mostly for the benefit of men. Gendering Sporting Bubbles Designed as biosecurity structures to maintain the supply of media-sport content, keep players and other vital cogs of the machine running smoothly, and to exclude Covid-19, sporting bubbles were, in their most advanced form, exclusive luxury camps that illuminated the elevated socio-cultural status of sportsmen. The ongoing inequalities between men’s and women’s sport in Australia and around the world were clearly in evidence, as well as the politics of gender whereby women are obliged to “care” and men are enabled to be “careless” – or at least to manage carefully their “duty of care”. In Australia, the only sport for women that continued during the height of the Covid-19 lockdown was netball, which operated in a bubble that was one of sacrifice rather than privilege. With minimum salaries of only $30,000 – significantly less than the lowest-paid “rookies” in the AFL – and some being mothers of small children and/or with professional jobs juggled alongside their netball careers, these elite sportswomen wanted to continue to play despite the personal inconvenience or cost (Pavlidis). Not one breach of the netballers out of the bubble was reported, indicating that they took their responsibilities with appropriate seriousness and, perhaps, were subjected to less scrutiny than the sportsmen accustomed to attracting front-page headlines. National Netball League (also known after its Queensland-based naming rights sponsor as Suncorp Super Netball) players could be regarded as fortunate to have the opportunity to be in a bubble and to participate in their competition. The NRL Women’s (NRLW) Premiership season was also completed, but only involved four teams subject to fly in, fly out and bubble arrangements, and being played in so-called curtain-raiser games for the NRL. As noted earlier, the AFLW season was truncated, despite all the prior training and sacrifice required of its players. Similarly, because of their resource advantages, the UK men’s and boy’s top six tiers of association football were allowed to continue during lockdown, compared to only two for women and girls. In the United States, inequalities between men’s and women’s sports were clearly demonstrated by the conditions afforded to those elite sportswomen inside the Women’s National Basketball Association (WNBA) sport bubble in the IMG Academy in Florida. Players shared photos of rodent traps in their rooms, insect traps under their mattresses, inedible food and blocked plumbing in their bubble accommodation. These conditions were a far cry from the luxury usually afforded elite sportsmen, including in Florida’s Walt Disney World for the men’s NBA, and is just one of the many instances of how gendered inequality was both reproduced and exacerbated by Covid-19. Bursting the Bubble As we have seen, governments and corporate leaders in sport were able to create material and metaphorical bubbles during the Covid-19 lockdown in order to transmit stadium sport contests into home spaces. The rationale was the importance of sport to national identity, belonging and the routines and rhythms of life. But for whom? Many women, who still carry the major responsibilities of “care”, found that Covid-19 intensified the affective relations and gendered inequities of “home” as a leisure site (Fullagar and Pavlidis). Rates of domestic violence surged, and many women experienced significant anxiety and depression related to the stress of home confinement and home schooling. During the pandemic, women were also more likely to experience the stress and trauma of being first responders, witnessing virus-related sickness and death as the majority of nurses and care workers. They also bore the brunt of much of the economic and employment loss during this time. Also, as noted above, livelihoods in the arts and cultural sector did not receive the benefits of the “bubble”, despite having a comparable claim to sport in contributing significantly to societal wellbeing. This sector’s workforce is substantially female, although men dominate its senior roles. Despite these inequalities, after the late March to May hiatus, many elite male sportsmen – and some sportswomen - operated in a bubble. Moving in and out of them was not easy. Life inside could be mentally stressful (especially in long stays of up to 150 days in sports like cricket), and tabloid and social media troll punishment awaited those who were caught going “over the fence”. But, life in the sporting bubble was generally preferable to the daily realities of those afflicted by the trauma arising from forced home confinement, and for whom watching moving sports images was scant compensation for compulsory immobility. The ethical foundation of the sparkly, ephemeral fantasy of the sporting bubble is questionable when it is placed in the service of a voracious “media sports cultural complex” (Rowe, Global Media Sport) that consumes sport labour power and rolls back progress in gender relations as a default response to a global pandemic. Covid-19 dramatically highlighted social inequalities in many areas of life, including medical care, work, and sport. For the small minority of people involved in sport who are elite professionals, the only thing worse than being in a sporting bubble during the pandemic was not being in one, as being outside precluded their participation. Being inside the bubble was a privilege, albeit a dubious one. But, as in wider society, not all sporting bubbles are created equal. Some are more opulent than others, and the experiences of the supporting and the supported can be very different. The surface of the sporting bubble may be impermanent, but when its interior is opened up to scrutiny, it reveals some very durable structures of inequality. Bubbles are made to burst. They are, by nature, temporary, translucent structures created as spectacles. As a form of luminosity, bubbles “allow a thing or object to exist only as a flash, sparkle or shimmer” (Deleuze, 52). In echoing Deleuze, Angela McRobbie (54) argues that luminosity “softens and disguises the regulative dynamics of neoliberal society”. The sporting bubble was designed to discharge that function for those millions rendered immobile by home confinement legislation in Australia and around the world, who were having to deal with the associated trauma, risk and disadvantage. Hence, the gender and class inequalities exacerbated by Covid-19, and the precarious and pressured lives of elite athletes, were obscured. We contend that, in the final analysis, the sporting bubble mainly serves those inside, floating tantalisingly out of reach of most of those outside who try to grasp its elusive power. Yet, it is a small group beyond who wield that power, having created bubbles as armoured vehicles to salvage any available profit in the midst of a global pandemic. References AAP. “NRL Makes Desperate Plea to Government as It Announces Season Will Go Ahead.” 7News.com.au 15 Mar. 2020. 8 Mar. 2021 <https://7news.com.au/sport/rugby-league/nrl-makes-desperate-plea-to-government-as-it-announces-season-will-go-ahead-c-745711>. Al Jazeera English. “Sports TV: Faking Spectators and Spectacles.” The Listening Post 26 Sep. 2020 <https://www.youtube.com/watch?v=0AlD63s26sQ&feature=youtu.be&t=827>. Barron, Jackson, Kylie Stevens, and Zoe Zaczek. “WAG Who Broke into COVID-19 Bubble for an Eight-Hour Rendezvous with Her AFL Star Boyfriend Opens Up on ‘How Easy It Was’—and Apologises for ‘Really Big Mistake’ That Cost Club $50,000.” The Daily Mail 19 Aug. 2020. 8 Mar. 2021 <https://www.dailymail.co.uk/news/article-8638959/WAG-AFL-star-sacked-season-coronavirus-breach-reveals-easy-sneak-in.html>. Bauman, Zygmunt. Liquid Modernity. Cambridge: Polity Press, 2000. Beck, Ulrich. Risk Society: Towards a New Modernity. London: Sage, 1992. Benedict, Jeff. Public Heroes, Private Felons: Athletes and Crimes against Women. Boston: Northeastern Uni. Press, 1999. Benfante, Agata, Marialaura di Tella, Annunziata Romeo, and Lorys Castelli. “Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact.” Frontiers in Psychology 11 (23 Oct. 2020). Blaine, Lech. “The Art of Class War.” The Monthly. 17 Aug. 2020. 8 Mar. 2021 <https://www.themonthly.com.au/issue/2020/august/1596204000/lech-blaine/art-class-war#mtr>. Brooks, Samantha K., Rebecca K. Webster, Louise E. Smith, Lisa Woodland, Simon Wessely, Neil Greenberg, and Gideon J. Rubin. “The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence.” The Lancet 26 Feb. 2020. 8 Mar. 2021 <https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext>. Caust, Jo. “Coronavirus: 3 in 4 Australians Employed in the Creative and Performing Arts Could Lose Their Jobs.” The Conversation 20 Apr. 2020. 8 Mar. 2021 <https://theconversation.com/coronavirus-3-in-4-australians-employed-in-the-creative-and-performing-arts-could-lose-their-jobs-136505>. Connor, James. “The Athlete as Widget: How Exploitation Explains Elite Sport.” Sport in Society 12.10 (2009): 1369–77. Courage, Cara. “Women in the Arts: Some Questions.” The Guardian 5 Mar. 2012. 8 Mar. 2021 <https://www.theguardian.com/culture-professionals-network/culture-professionals-blog/2012/mar/05/women-in-the-arts-introduction>. Davenport, Thomas H., and John C. Beck. The Attention Economy: Understanding the New Currency of Business. Cambridge, MA: Harvard Business Review Press, 2001. Deleuze, Gilles. Foucault. Trans. and ed. S. Hand. Minneapolis: University of Minnesota Press, 1986. Dennien, Matt, and Lydia Lynch. “Footage Shows Relaxed Scenes from AFL Hub amid Calls for Exception Overhaul.” Brisbane Times 3 Sep. 2020. 8 Mar. 2021 <https://www.brisbanetimes.com.au/national/queensland/footage-shows-relaxed-scenes-from-afl-hub-amid-calls-for-exemption-overhaul-20200903-p55s74.html>. Dobeson, Shanee. “Bailey Defends Qld Border Rules after Grieving Mother Denied Entry to Bury Son.” MyGC.com.au 12 Sep. 2020. 8 Mar. 2021 <https://www.mygc.com.au/bailey-defends-qld-border-rules-after-grieving-mother-denied-exemption-to-bury-son>. Dunn, Amelia. “Who Is Deemed an ‘Essential’ Worker under Australia’s COVID-19 Rules?” SBS News 26 Mar. 2020. 8 Mar. 2021 <https://www.youtube.com/watch?v=0AlD63s26sQ&feature=youtu.be&t=827>. Emiko. “Women’s Unpaid Care Work in Australia.” YWCA n.d. 8 Mar. 2021 <https://www.ywca.org.au/opinion/womens-unpaid-care-work-in-australia>. Fullagar, Simone, and Adele Pavlidis. “Thinking through the Disruptive Effects and Affects of the Coronavirus with Feminist New Materialism.” Leisure Sciences (2020). 8 Mar. 2021 <https://www.tandfonline.com/doi/abs/10.1080/01490400.2020.1773996?journalCode=ulsc20>. Flood, Michael, and Sue Dyson. “Sport, Athletes, and Violence against Women.” NTV Journal 4.3 (2007): 37–46. Goodwin, Sam. “AFL Boss Left Fuming over ‘Out of Control’ Quarantine Party.” Yahoo! Sport 8 Sep. 2020. 8 Mar. 2021 <https://au.sports.yahoo.com/afl-2020-uproar-out-of-control-quarantine-party-224251554.html>. Griffith News. “New Research Shows Why Musicians among the Hardest Hit by COVID-19.” 18 June 2020. 8 Mar. 2021 <https://news.griffith.edu.au/2020/06/18/new-research-shows-why-musicians-among-the-hardest-hit-by-COVID-19>. Hart, Chloe. “‘This Is the Hardest It’s Going to Get’: NZ Warriors Open Up about Relocating to Australia for NRL.” ABC News 8 Aug. 2020. 8 Mar. 2021 <https://www.abc.net.au/news/2020-08-08/nz-warriors-open-up-about-relocation-to-australia-for-nrl/12531074>. Hooper, James. “10 Broncos Hit with Fines as Club Cops Huge Sanction over Pub Bubble Breach.” Fox Sports 18 Aug. 2020. 8 Mar. 2021 <https://www.foxsports.com.au/nrl/nrl-premiership/teams/broncos/nrl-2020-brisbane-broncos-pub-covid19-bubble-breach-fine-sanctions-who-was-at-the-pub/news-story/d3bd3c559289a8b83bc3fccbceaffe78>. Hytner, Mike. “AFL Suspends Season and Cancels AFLW amid Coronavirus Crisis.” The Guardian 22 Mar. 2020. 8 Mar. 2021 <https://www.theguardian.com/sport/2020/mar/22/afl-nrl-and-a-league-press-on-despite-restrictions>. Jones, Wayne. “Ray of Hope for Medical Care across Border.” Echo Netdaily 14 Aug. 2020. 8 Mar. 2021 <https://www.echo.net.au/2020/08/ray-of-hope-for-medical-care-across-border>. Jouavel, Levi. “Women’s Football Shutdowns: ‘It’s Unfair Boys’ Academies Can Still Play’.” BBC News 10 Nov. 2020. 8 Mar. 2021 <https://www.bbc.com/news/newsbeat-54876198>. Keh, Andrew. “We Hope Your Cheers for This Article Are for Real.” The New York Times 16 June 2020. 8 Mar. 2021 <https://www.nytimes.com/2020/06/16/sports/coronavirus-stadium-fans-crowd-noise.html>. Kennedy, Else. “‘The Worst Year’: Domestic Violence Soars in Australia during COVID-19.” The Guardian 1 Dec. 2020. 8 Mar. 2021 <https://www.theguardian.com/society/2020/dec/01/the-worst-year-domestic-violence-soars-in-australia-during-COVID-19>. Keoghan, Sarah. “‘Everyone’s Concerned’: Players Cop 70% Pay Cut.” Sydney Morning Herald 28 Mar. 2020. 8 Mar. 2021 <https://www.smh.com.au/sport/netball/everyone-s-concerned-players-cop-70-per-cent-pay-cut-20200328-p54esz.html>. Knox, Malcolm. “Gambling’s Share of NRL Revenue Could Well Double: That Brings Power.” Sydney Morning Herald. 15 May 2020. 8 Mar. 2021 <https://www.smh.com.au/sport/gambling-s-share-of-nrl-revenue-could-well-double-that-brings-power-20200515-p54tbg.html>. McGrath, Pat. “Racing Victoria Got $16.6 Million in Emergency COVID Funding: Then Online Horse Racing Gambling Revenue Skyrocketed.” ABC News 3 Nov. 2020. 8 Mar. 2021 <https://www.abc.net.au/news/2020-11-03/racing-victoria-emergency-coronavirus-COVID-funding/12838012>. McRobbie, Angela. The Aftermath of Feminism: Gender, Culture and Social Change. Thousand Oaks, CA: Sage, 2009. Madden, Helena. “Lebron James’s Suite in the NBA Bubble Is Fit for a King.” Robb Report 16 Sep. 2020. 8 Mar. 2021 <https://robbreport.com/travel/hotels/lebron-james-nba-bubble-suite-1234569303>. Maguire, Joseph. “Sportization.” The Blackwell Encyclopedia of Sociology. Ed. George Ritzer. Oxford: Blackwell, 2007. 4710–11. Mathieson, Craig. “Michael Jordan Pierces the Bubble of Elite Sport in Juicy ESPN Doco.” Sydney Morning Herald. 13 May 2020. 8 Mar. 2021 <https://www.smh.com.au/culture/tv-and-radio/michael-jordan-pierces-the-bubble-of-elite-sport-in-juicy-espn-doco-20200511-p54rwc.html>. Maurice, Megan. “Australia’s Summer of Cricket during COVID Is about Money and Power—and Men”. 6 Jan. 2021. 8 Mar. 2021 <https://www.theguardian.com/sport/2021/jan/06/australias-summer-of-cricket-during-COVID-is-about-money-and-power-and-men>. Murphy, Catherine. “Cricket Australia Contributed to Circumstances Surrounding Ball-Tampering Scandal, Review Finds”. ABC News 20 Oct. 2018. 8 Mar. 2021 <https://www.abc.net.au/news/2018-10-29/scathing-report-released-into-cricket-australia-culture/10440972>. News.com.au. “How an AFL Star Wide’s Instagram Post Led to a Hefty Fine and a Journalist Being Stood Down.” NZ Herald 3 Aug. 2020. 8 Mar. 2021 <https://www.nzherald.co.nz/sport/how-an-afl-star-wifes-instagram-post-led-to-a-hefty-fine-and-a-journalist-being-stood-down/7IDR4SXQ6QW5WDFBV42BK3M7YQ>. Nicholson, Matthew, Anthony Kerr, and Merryn Sherwood. Sport and the Media: Managing the Nexus. 2nd ed. London: Routledge, 2015. Pavlidis, Adele. “Being Grateful: Materialising ‘Success’ in Women’s Contact Sport.” Emotion, Space and Society 35 (2020). 8 Mar. 2021 <https://www.sciencedirect.com/science/article/abs/pii/S1755458620300207>. Phillips, Sam. “‘The Future of the Season Is in Their Hands’: Palaszczuk’s NRL Warning.” Sydney Morning Herald 10 Aug. 2020. 8 Mar. 2021 <https://www.smh.com.au/sport/nrl/the-future-of-the-season-is-in-their-hands-palaszczuk-s-nrl-warning-20200810-p55k7j.html>. Pierik, Jon, and Ryan, Peter. “‘I Own the Consequences’: Stack, Coleman-Jones Apologise for Gold Coast Incident.” The Age 5 Sep. 2020. 8 Mar. 2021 <https://www.theage.com.au/sport/afl/i-own-the-consequences-stack-apologises-for-gold-coast-incident-20200905-p55spq.html>. Poposki, Claudia, and Louise Ayling. “AFL Star’s Wife Who Caused Uproar by Breaching Quarantine to Go to a Spa Reveals She’s Been Smashed by Vile Trolls.” Daily Mail Australia 29 Aug. 2020. 8 Mar. 2021 <https://www.dailymail.co.uk/news/article-8674083/AFL-WAG-Brooke-Cotchin-breached-COVID-19-quarantine-spa-cops-abuse-trolls.html>. Ramsey, Michael. “Axed Swan Spared Jail over Ex-Girlfriend Assault.” AFL.com.au 2 Dec. 2020. 8 Mar. 2021 <https://www.afl.com.au/news/526677/axed-swan-spared-jail-over-ex-girlfriend-assault>. Read, Brent. “The NRL Is Set to Finish the Season on a High after Stunning Financial Results.” The Australian 1 Dec. 2020. 8 Mar. 2021 <https://www.theaustralian.com.au/sport/nrl/the-nrl-is-set-to-finish-the-season-on-a-high-after-stunning-financial-results/news-story/1ce9c2f9b598441d88daaa8cc2b44dc1>. Reel, Justine, J., and Emily Crouch. “#MeToo: Uncovering Sexual Harassment and Assault in Sport.” Journal of Clinical Sport Psychology 13.2 (2018): 177–79. Rogers, Michael. “Buckley, Sanderson to Pay Pies’ Huge Fine for COVID Breach.” AFL.com.au 1 Aug. 2020. 8 Mar. 2021 <https://www.afl.com.au/news/479118/buckley-sanderson-to-pay-pies-huge-fine-for-COVID-breach>. Richardson, David, and Richard Denniss. “Gender Experiences during the COVID-19 Lockdown: Women Lose from COVID-19, Men to Gain from Stimulus.” The Australia Institute June 2020. 8 Mar. 2021 <https://australiainstitute.org.au/report/gender-experiences-during-the-COVID-19-lockdown>. Rowe, David. “All Sport Is Global: A Hard Lesson from the Pandemic.” Open Forum 28 Mar. 2020. 8 Mar. 2021 <https://www.openforum.com.au/all-sport-is-global-a-hard-lesson-from-the-pandemic>. ———. “And the Winner Is … Television: Spectacle and Sport in a Pandemic.” Open Forum 19 Sep. 2020. 8 Mar. 2021 <https://www.openforum.com.au/and-the-winner-istelevision-spectacle-and-sport-in-a-pandemic>. ———. Global Media Sport: Flows, Forms and Futures. London: Bloomsbury, 2011. ———. “Scandals and Sport.” Routledge Companion to Media and Scandal. Eds. Howard Tumber and Silvio Waisbord. London: Routledge, 2019. 324–32. ———. “Subjecting Pandemic Sport to a Sociological Procedure.” Journal of Sociology 56.4 (2020): 704–13. Schout, David. “Cricket Prepares for Mental Health Challenges Thrown Up by Bubble Life.” The Guardian 8 Nov. 2020. 8 Mar. 2021 <https://www.theguardian.com/sport/2020/nov/08/cricket-prepares-for-mental-health-challenges-thrown-up-by-bubble-life>. Spaaij, Ramón. Sport and Social Mobility: Crossing Boundaries. London: Routledge, 2011. The Sporting Bubble. Dir. Peter Dickson. Nine Network Australia, 2020. Swanston, Tim. “With Coronavirus Limiting Interstate Movement, Queensland Is the Nation’s Sporting Hub—Is That Really Safe?” ABC News 29 Aug. 2020. 8 Mar. 2021 <https://www.abc.net.au/news/2020-08-29/coronavirus-queensland-rules-for-sports-teams-explainer/12542634>. Toffoletti, Kim. “How Is Gender-Based Violence Covered in the Sporting News? An Account of the Australian Football League Sex Scandal.” Women's Studies International Forum 30.5 (2007): 427–38. Urry, John. Mobilities. Cambridge: Polity Press, 2007. Walter, Brad. “From Shutdown to Restart: How NRL Walked Tightrope to Get Season Going Again.” NRL.com 25 May 2020. 8 Mar. 2021 <https://www.nrl.com/news/2020/05/25/from-shutdown-to-restart-how-nrl-walked-tightrope-to-get-season-going-again>. Wade, Lisa. “Rape on Campus: Athletes, Status, and the Sexual Assault Crisis.” The Conversation 7 Mar. 2017. 8 Mar. 2021 <https://theconversation.com/rape-on-campus-athletes-status-and-the-sexual-assault-crisis-72255>. Webster, Andrew. “Sydney Roosters’ Mitchell Pearce Involved in a Drunken Incident with a Dog? And Your Point Is ...?” Sydney Morning Herald 28 Jan. 2016. 8 Mar. 2021 <https://www.smh.com.au/sport/nrl/sydney-roosters-mitchell-pearce-involved-in-a-drunken-incident-with-a-dog-and-your-point-is--20160127-gmfemh.html>. Whittaker, Troy. “Three-Peat Not Driving Broncos in NRLW Grand Final.” NRL.com 24 Oct. 2020. 8 Mar. 2021 <https://www.nrl.com/news/2020/10/24/three-peat-not-driving-broncos-in-nrlw-grand-final>. Yahoo! Sport Staff. “‘Not Okay’: Uproar over ‘Disgusting’ Find inside Quarantine.” Yahoo! Sport 9 July 2020. 8 Mar. 2021 <https://au.sports.yahoo.com/wnba-disturbing-conditions-coronavirus-bubble-slammed-003557243.html>.

In Australia the “intimacy” of citizenship (Berlant 2), is often used to reinforce subscription to heteronormative romantic and familial structures. Because this framing promotes discourses of moral failure, recent political attention to sexuality and same-sex couples can be filtered through insights into coalitional affiliations. This paper uses contemporary shifts in Australian politics and culture to think through the concept of coalition, and in particular to analyse connections between sexuality and governmentality (or more specifically normative bias and same-sex relationships) in what I’m calling post-coalitional Australia. Against the unpredictability of changing parties and governments, allegiances and alliances, this paper suggests the continuing adherence to a heteronormatively arranged public sphere. After the current Australian Prime Minister Julia Gillard deposed the previous leader, Kevin Rudd, she clung to power with the help of independents and the Greens, and clichés of a “rainbow coalition” and a “new paradigm” were invoked to describe the confused electorate and governmental configuration. Yet in 2007, a less confused Australia decisively threw out the Howard–led Liberal and National Party coalition government after eleven years, in favour of Rudd’s own rainbow coalition: a seemingly invigorated party focussed on gender equity, Indigenous Australians, multi-cultural visibility, workplace relations, Austral-Asian relations, humane refugee processing, the environment, and the rights and obligations of same-sex couples. A post-coalitional Australia invokes something akin to “aftermath culture” (Lambert and Simpson), referring not just to Rudd’s fall or Howard’s election loss, but to the broader shifting contexts within which most Australian citizens live, and within which they make sense of the terms “Australia” and “Australian”. Contemporary Australia is marked everywhere by cracks in coalitions and shifts in allegiances and belief systems – the Coalition of the Willing falling apart, the coalition government crushed by defeat, deposed leaders, and unlikely political shifts and (re)alignments in the face of a hung parliament and renewed pushes toward moral and cultural change. These breakdowns in allegiances are followed by swift symbolically charged manoeuvres. Gillard moved quickly to repair relations with mining companies damaged by Rudd’s plans for a mining tax and to water down frustration with the lack of a sustainable Emissions Trading Scheme. And one of the first things Kevin Rudd did as Prime Minister was to change the fittings and furnishings in the Prime Ministerial office, of which Wright observed that “Mr Howard is gone and Prime Minister Kevin Rudd has moved in, the Parliament House bureaucracy has ensured all signs of the old-style gentlemen's club… have been banished” (The Age, 5 Dec. 2007). Some of these signs were soon replaced by Ms. Gillard herself, who filled the office in turn with memorabilia from her beloved Footscray, an Australian Rules football team. In post-coalitional Australia the exile of the old Menzies’ desk and a pair of Chesterfield sofas works alongside the withdrawal of troops from Iraq and renewed pledges for military presence in Afghanistan, apologising to stolen generations of Indigenous Australians, the first female Governor General, deputy Prime Minister and then Prime Minister (the last two both Gillard), the repealing of disadvantageous workplace reform, a focus on climate change and global warming (with limited success as stated), a public, mandatory paid maternity leave scheme, changes to the processing and visas of refugees, and the amendments to more than one hundred laws that discriminate against same sex couples by the pre-Gillard, Rudd-led Labor government. The context for these changes was encapsulated in an announcement from Rudd, made in March 2008: Our core organising principle as a Government is equality of opportunity. And advancing people and their opportunities in life, we are a Government which prides itself on being blind to gender, blind to economic background, blind to social background, blind to race, blind to sexuality. (Rudd, “International”) Noting the political possibilities and the political convenience of blindness, this paper navigates the confusing context of post-coalitional Australia, whilst proffering an understanding of some of the cultural forces at work in this age of shifting and unstable alliances. I begin by interrogating the coalitional impulse post 9/11. I do this by connecting public coalitional shifts to the steady withdrawal of support for John Howard’s coalition, and movement away from George Bush’s Coalition of the Willing and the War on Terror. I then draw out a relationship between the rise and fall of such affiliations and recent shifts within government policy affecting same-sex couples, from former Prime Minister Howard’s amendments to The Marriage Act 1961 to the Rudd-Gillard administration’s attention to the discrimination in many Australian laws. Sexual Citizenship and Coalitions Rights and entitlements have always been constructed and managed in ways that live out understandings of biopower and social death (Foucault History; Discipline). The disciplining of bodies, identities and pleasures is so deeply entrenched in government and law that any non-normative claim to rights requires the negotiation of existing structures. Sexual citizenship destabilises the post-coalitional paradigm of Australian politics (one of “equal opportunity” and consensus) by foregrounding the normative biases that similarly transcend partisan politics. Sexual citizenship has been well excavated in critical work from Evans, Berlant, Weeks, Richardson, and Bell and Binnie’s The Sexual Citizen which argues that “many of the current modes of the political articulation of sexual citizenship are marked by compromise; this is inherent in the very notion itself… the twinning of rights with responsibilities in the logic of citizenship is another way of expressing compromise… Every entitlement is freighted with a duty” (2-3). This logic extends to political and economic contexts, where “natural” coalition refers primarily to parties, and in particular those “who have powerful shared interests… make highly valuable trades, or who, as a unit, can extract significant value from others without much risk of being split” (Lax and Sebinius 158). Though the term is always in some way politicised, it need not refer only to partisan, multiparty or multilateral configurations. The subscription to the norms (or normativity) of a certain familial, social, religious, ethnic, or leisure groups is clearly coalitional (as in a home or a front, a club or a team, a committee or a congregation). Although coalition is interrogated in political and social sciences, it is examined frequently in mathematical game theory and behavioural psychology. In the former, as in Axelrod’s The Evolution of Cooperation, it refers to people (or players) who collaborate to successfully pursue their own self-interests, often in the absence of central authority. In behavioural psychology the focus is on group formations and their attendant strategies, biases and discriminations. Experimental psychologists have found “categorizing individuals into two social groups predisposes humans to discriminate… against the outgroup in both allocation of resources and evaluation of conduct” (Kurzban, Tooby and Cosmides 15387). The actions of social organisation (and not unseen individual, supposedly innate impulses) reflect the cultural norms in coalitional attachments – evidenced by the relationship between resources and conduct that unquestioningly grants and protects the rights and entitlements of the larger, heteronormatively aligned “ingroup”. Terror Management Particular attention has been paid to coalitional formations and discriminatory practices in America and the West since September 11, 2001. Terror Management Theory or TMT (Greenberg, Pyszczynski and Solomon) has been the main framework used to explain the post-9/11 reassertion of large group identities along ideological, religious, ethnic and violently nationalistic lines. Psychologists have used “death-related stimuli” to explain coalitional mentalities within the recent contexts of globalised terror. The fear of death that results in discriminatory excesses is referred to as “mortality salience”, with respect to the highly visible aspects of terror that expose people to the possibility of their own death or suffering. Naverette and Fessler find “participants… asked to contemplate their own deaths exhibit increases in positive evaluations of people whose attitudes and values are similar to their own, and derogation of those holding dissimilar views” (299). It was within the climate of post 9/11 “mortality salience” that then Prime Minister John Howard set out to change The Marriage Act 1961 and the Family Law Act 1975. In 2004, the Government modified the Marriage Act to eliminate flexibility with respect to the definition of marriage. Agitation for gay marriage was not as noticeable in Australia as it was in the U.S where Bush publicly rejected it, and the UK where the Civil Union Act 2004 had just been passed. Following Bush, Howard’s “queer moral panic” seemed the perfect decoy for the increased scrutiny of Australia’s involvement in the Iraq war. Howard’s changes included outlawing adoption for same-sex couples, and no recognition for legal same-sex marriages performed in other countries. The centrepiece was the wording of The Marriage Amendment Act 2004, with marriage now defined as a union “between a man and a woman to the exclusion of all others”. The legislation was referred to by the Australian Greens Senator Bob Brown as “hateful”, “the marriage discrimination act” and the “straight Australia policy” (Commonwealth 26556). The Labor Party, in opposition, allowed the changes to pass (in spite of vocal protests from one member) by concluding the legal status of same-sex relations was in no way affected, seemingly missing (in addition to the obvious symbolic and physical discrimination) the equation of same-sex recognition with terror, terrorism and death. Non-normative sexual citizenship was deployed as yet another form of “mortality salience”, made explicit in Howard’s description of the changes as necessary in protecting the sanctity of the “bedrock institution” of marriage and, wait for it, “providing for the survival of the species” (Knight, 5 Aug. 2003). So two things seem to be happening here: the first is that when confronted with the possibility of their own death (either through terrorism or gay marriage) people value those who are most like them, joining to devalue those who aren’t; the second is that the worldview (the larger religious, political, social perspectives to which people subscribe) becomes protection from the potential death that terror/queerness represents. Coalition of the (Un)willing Yet, if contemporary coalitions are formed through fear of death or species survival, how, for example, might these explain the various forms of risk-taking behaviours exhibited within Western democracies targeted by such terrors? Navarette and Fessler (309) argue that “affiliation defences are triggered by a wider variety of threats” than “existential anxiety” and that worldviews are “in turn are reliant on ‘normative conformity’” (308) or “normative bias” for social benefits and social inclusions, because “a normative orientation” demonstrates allegiance to the ingroup (308-9). Coalitions are founded in conformity to particular sets of norms, values, codes or belief systems. They are responses to adaptive challenges, particularly since September 11, not simply to death but more broadly to change. In troubled times, coalitions restore a shared sense of predictability. In Howard’s case, he seemed to say, “the War in Iraq is tricky but we have a bigger (same-sex) threat to deal with right now. So trust me on both fronts”. Coalitional change as reflective of adaptive responses thus serves the critical location of subsequent shifts in public support. Before and since September 11 Australians were beginning to distinguish between moderation and extremism, between Christian fundamentalism and productive forms of nationalism. Howard’s unwavering commitment to the American-led war in Iraq saw Australia become a member of another coalition: the Coalition of the Willing, a post 1990s term used to describe militaristic or humanitarian interventions in certain parts of the world by groups of countries. Howard (in Pauly and Lansford 70) committed Australia to America’s fight but also to “civilization's fight… of all who believe in progress and pluralism, tolerance and freedom”. Although Bush claimed an international balance of power and influence within the coalition (94), some countries refused to participate, many quickly withdrew, and many who signed did not even have troops. In Australia, the war was never particularly popular. In 2003, forty-two legal experts found the war contravened International Law as well as United Nations and Geneva conventions (Sydney Morning Herald 26 Feb. 2003). After the immeasurable loss of Iraqi life, and as the bodies of young American soldiers (and the occasional non-American) began to pile up, the official term “coalition of the willing” was quietly abandoned by the White House in January of 2005, replaced by a “smaller roster of 28 countries with troops in Iraq” (ABC News Online 22 Jan. 2005). The coalition and its larger war on terror placed John Howard within the context of coalitional confusion, that when combined with the domestic effects of economic and social policy, proved politically fatal. The problem was the unclear constitution of available coalitional configurations. Howard’s continued support of Bush and the war in Iraq compounded with rising interest rates, industrial relations reform and a seriously uncool approach to the environment and social inclusion, to shift perceptions of him from father of the nation to dangerous, dithery and disconnected old man. Post-Coalitional Change In contrast, before being elected Kevin Rudd sought to reframe Australian coalitional relationships. In 2006, he positions the Australian-United States alliance outside of the notion of military action and Western territorial integrity. In Rudd-speak the Howard-Bush-Blair “coalition of the willing” becomes F. Scott Fitzgerald’s “willingness of the heart”. The term coalition was replaced by terms such as dialogue and affiliation (Rudd, “Friends”). Since the 2007 election, Rudd moved quickly to distance himself from the agenda of the coalition government that preceded him, proposing changes in the spirit of “blindness” toward marginality and sexuality. “Fix-it-all” Rudd as he was christened (Sydney Morning Herald 29 Sep. 2008) and his Labor government began to confront the legacies of colonial history, industrial relations, refugee detention and climate change – by apologising to Aboriginal people, timetabling the withdrawal from Iraq, abolishing the employee bargaining system Workchoices, giving instant visas and lessening detention time for refugees, and signing the Kyoto Protocol agreeing (at least in principle) to reduce green house gas emissions. As stated earlier, post-coalitional Australia is not simply talking about sudden change but an extension and a confusion of what has gone on before (so that the term resembles postcolonial, poststructural and postmodern because it carries the practices and effects of the original term within it). The post-coalitional is still coalitional to the extent that we must ask: what remains the same in the midst of such visible changes? An American focus in international affairs, a Christian platform for social policy, an absence of financial compensation for the Aboriginal Australians who received such an eloquent apology, the lack of coherent and productive outcomes in the areas of asylum and climate change, and an impenetrable resistance to the idea of same-sex marriage are just some of the ways in which these new governments continue on from the previous one. The Rudd-Gillard government’s dealings with gay law reform and gay marriage exemplify the post-coalitional condition. Emulating Christ’s relationship to “the marginalised and the oppressed”, and with Gillard at his side, Rudd understandings of the Christian Gospel as a “social gospel” (Rudd, “Faith”; see also Randell-Moon) to table changes to laws discriminating against gay couples – guaranteeing hospital visits, social security benefits and access to superannuation, resembling de-facto hetero relationships but modelled on the administering and registration of relationships, or on tax laws that speak primarily to relations of financial dependence – with particular reference to children. The changes are based on the report, Same Sex, Same Entitlements (HREOC) that argues for the social competence of queer folk, with respect to money, property and reproduction. They speak the language of an equitable economics; one that still leaves healthy and childless couples with limited recognition and advantage but increased financial obligation. Unable to marry in Australia, same-sex couples are no longer single for taxation purposes, but are now simultaneously subject to forms of tax/income auditing and governmental revenue collection should either same-sex partner require assistance from social security as if they were married. Heteronormative Coalition Queer citizens can quietly stake their economic claims and in most states discreetly sign their names on a register before becoming invisible again. Mardi Gras happens but once a year after all. On the topic of gay marriage Rudd and Gillard have deferred to past policy and to the immoveable nature of the law (and to Howard’s particular changes to marriage law). That same respect is not extended to laws passed by Howard on industrial relations or border control. In spite of finding no gospel references to Jesus the Nazarene “expressly preaching against homosexuality” (Rudd, “Faith”), and pre-election promises that territories could govern themselves with respect to same sex partnerships, the Rudd-Gillard government in 2008 pressured the ACT to reduce its proposed partnership legislation to that of a relationship register like the ones in Tasmania and Victoria, and explicitly demanded that there be absolutely no ceremony – no mimicking of the real deal, of the larger, heterosexual citizens’ “ingroup”. Likewise, with respect to the reintroduction of same-sex marriage legislation by Greens senator Sarah Hanson Young in September 2010, Gillard has so far refused a conscience vote on the issue and restated the “marriage is between a man and a woman” rhetoric of her predecessors (Topsfield, 30 Sep. 2010). At the same time, she has agreed to conscience votes on euthanasia and openly declared bi-partisan (with the federal opposition) support for the war in Afghanistan. We see now, from Howard to Rudd and now Gillard, that there are some coalitions that override political differences. As psychologists have noted, “if the social benefits of norm adherence are the ultimate cause of the individual’s subscription to worldviews, then the focus and salience of a given individual’s ideology can be expected to vary as a function of their need to ally themselves with relevant others” (Navarette and Fessler 307). Where Howard invoked the “Judaeo-Christian tradition”, Rudd chose to cite a “Christian ethical framework” (Rudd, “Faith”), that saw him and Gillard end up in exactly the same place: same sex relationships should be reduced to that of medical care or financial dependence; that a public ceremony marking relationship recognition somehow equates to “mimicking” the already performative and symbolic heterosexual institution of marriage and the associated romantic and familial arrangements. Conclusion Post-coalitional Australia refers to the state of confusion borne of a new politics of equality and change. The shift in Australia from conservative to mildly socialist government(s) is not as sudden as Howard’s 2007 federal loss or as short-lived as Gillard’s hung parliament might respectively suggest. Whilst allegiance shifts, political parties find support is reliant on persistence as much as it is on change – they decide how to buffer and bolster the same coalitions (ones that continue to privilege white settlement, Christian belief systems, heteronormative familial and symbolic practices), but also how to practice policy and social responsibility in a different way. Rudd’s and Gillard’s arguments against the mimicry of heterosexual symbolism and the ceremonial validation of same-sex partnerships imply there is one originary form of conduct and an associated sacred set of symbols reserved for that larger ingroup. Like Howard before them, these post-coalitional leaders fail to recognise, as Butler eloquently argues, “gay is to straight not as copy is to original, but as copy is to copy” (31). To make claims to status and entitlements that invoke the messiness of non-normative sex acts and romantic attachments necessarily requires the negotiation of heteronormative coalitional bias (and in some ways a reinforcement of this social power). As Bell and Binnie have rightly observed, “that’s what the hard choices facing the sexual citizen are: the push towards rights claims that make dissident sexualities fit into heterosexual culture, by demanding equality and recognition, versus the demand to reject settling for heteronormativity” (141). The new Australian political “blindness” toward discrimination produces positive outcomes whilst it explicitly reanimates the histories of oppression it seeks to redress. The New South Wales parliament recently voted to allow same-sex adoption with the proviso that concerned parties could choose not to adopt to gay couples. The Tasmanian government voted to recognise same-sex marriages and unions from outside Australia, in the absence of same-sex marriage beyond the current registration arrangements in its own state. In post-coalitional Australia the issue of same-sex partnership recognition pits parties and allegiances against each other and against themselves from within (inside Gillard’s “rainbow coalition” the Rainbow ALP group now unites gay people within the government’s own party). Gillard has hinted any new proposed legislation regarding same-sex marriage may not even come before parliament for debate, as it deals with real business. Perhaps the answer lies over the rainbow (coalition). As the saying goes, “there are none so blind as those that will not see”. References ABC News Online. “Whitehouse Scraps Coalition of the Willing List.” 22 Jan. 2005. 1 July 2007 ‹http://www.abc.net.au/news/newsitems/200501/s1286872.htm›. Axelrod, Robert. The Evolution of Cooperation. New York: Basic Books, 1984. Berlant, Lauren. The Queen of America Goes to Washington City: Essays on Sex and Citizenship. Durham: Duke University Press, 1997. Bell, David, and John Binnie. The Sexual Citizen: Queer Politics and Beyond. Cambridge, England: Polity, 2000. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1990. Commonwealth of Australia. Parliamentary Debates. House of Representatives 12 Aug. 2004: 26556. (Bob Brown, Senator, Tasmania.) Evans, David T. Sexual Citizenship: The Material Construction of Sexualities. London: Routledge, 1993. Foucault, Michel. Discipline and Punish: The Birth of the Prison. Trans. A. Sheridan. London: Penguin, 1991. ———. The Will to Knowledge: The History of Sexuality. Vol. 1. Trans. Robert Hurley. London: Penguin, 1998. Greenberg, Jeff, Tom Pyszczynski, and Sheldon Solomon. “The Causes and Consequences of the Need for Self-Esteem: A Terror Management Theory.” Public Self, Private Self. Ed. Roy F. Baumeister. New York: Springer-Verlag, 1986. 189-212. Human Rights and Equal Opportunity Commission. Same-Sex: Same Entitlements Report. 2007. 21 Aug. 2007 ‹http://www.hreoc.gov.au/human_rights/samesex/report/index.html›. Kaplan, Morris. Sexual Justice: Democratic Citizenship and the Politics of Desire. New York: Routledge, 1997. Knight, Ben. “Howard and Costello Reject Gay Marriage.” ABC Online 5 Aug. 2003. Kurzban, Robert, John Tooby, and Leda Cosmides. "Can Race Be Erased? Coalitional Computation and Social Categorization." Proceedings of the National Academy of Sciences 98.26 (2001): 15387–15392. Lambert, Anthony, and Catherine Simpson. "Jindabyne’s Haunted Alpine Country: Producing (an) Australian Badland." M/C Journal 11.5 (2008). 20 Oct. 2010 ‹http://journal.media-culture.org.au/index.php/mcjournal/article/view/81›. Lax, David A., and James K. Lebinius. “Thinking Coalitionally: Party Arithmetic Process Opportunism, and Strategic Sequencing.” Negotiation Analysis. Ed. H. Peyton Young. Michigan: University of Michigan Press, 1991. 153-194. Naverette, Carlos, and Daniel Fessler. “Normative Bias and Adaptive Challenges: A Relational Approach to Coalitional Psychology and a Critique of Terror Management Theory.” Evolutionary Psychology 3 (2005): 297-325. Pauly, Robert J., and Tom Lansford. Strategic Preemption: US Foreign Policy and Second Iraq War. Aldershot: Ashgate, 2005. Randall-Moon, Holly. "Neoliberal Governmentality with a Christian Twist: Religion and Social Security under the Howard-Led Australian Government." Eds. Michael Bailey and Guy Redden. Mediating Faiths: Religion and Socio- Cultural Change in the Twenty-First Century. Farnham: Ashgate, in press. Richardson, Diane. Rethinking Sexuality. London: Sage, 2000. Rudd, Kevin. “Faith in Politics.” The Monthly 17 (2006). 31 July 2007 ‹http://www.themonthly.com.au/monthly-essays-kevin-rudd-faith-politics--300›. Rudd, Kevin. “Friends of Australia, Friends of America, and Friends of the Alliance That Unites Us All.” Address to the 15th Australian-American Leadership Dialogue. The Australian, 24 Aug. 2007. 13 Mar. 2008 ‹http://www.theaustralian.com.au/national-affairs/climate/kevin-rudds-address/story-e6frg6xf-1111114253042›. Rudd, Kevin. “Address to International Women’s Day Morning Tea.” Old Parliament House, Canberra, 11 Mar. 2008. 1 Oct. 2010 ‹http://pmrudd.archive.dpmc.gov.au/node/5900›. Sydney Morning Herald. “Coalition of the Willing? Make That War Criminals.” 26 Feb. 2003. 1 July 2007 ‹http://www.smh.com.au/articles/2003/02/25/1046064028608.html›. Topsfield, Jewel. “Gillard Rules Out Conscience Vote on Gay Marriage.” The Age 30 Sep. 2010. 1 Oct. 2010 ‹http://www.theage.com.au/national/gillard-rules-out-conscience-vote-on-gay-marriage-20100929-15xgj.html›. Weeks, Jeffrey. "The Sexual Citizen." Theory, Culture and Society 15.3-4 (1998): 35-52. Wright, Tony. “Suite Revenge on Chesterfield.” The Age 5 Dec. 2007. 4 April 2008 ‹http://www.theage.com.au/news/national/suite-revenge-on-chesterfield/2007/12/04/1196530678384.html›.