Academic literature on the topic 'Mentally ill older people Services for Australia'

This article outlines a Healthy Lifestyles Programme (HLP) for chronically mentally ill people in the South Coast Regional Health Authority in Australia, in the area of integrated mental health services. This programme has provided practical community-based experiences for chronically mentally ill people, focusing on functional deficits in daily living skills. Major reforms in service delivery in mental health have resulted in a move to community-based care. The 1994 Queensland Mental Health Plan set out specific objectives and strategies for the implementation of mental health service reform. One of the immediate priorities for Queensland is the establishing of mainstream integrated services to promote continuity of care across service components. The HLP reflects this priority in providing a community-based service in an integrated mental health setting, using the principles of community-based integration, family support, collaboration, rehabilitation and case management, as outlined in the community care model.

SummaryMental health services in the state of Victoria, Australia, have undergone enormous change over the past 15 years, with the closure of all stand-alone psychiatric hospitals and a shift of resources and services into the community. Although successful overall, various areas cause concern, including pressure on acute beds, a paucity of alternative residential options, and suboptimal integration of government and non-government agencies concerned with the care of people with mental illnesses. Certain groups, notably those with complex symptom sets such as substance use and mental illness, intellectual disability and forensic problems, remain poorly catered for by the system. Finally, community stigma and lack of work inclusion for mentally ill individuals are ongoing challenges.

Background: The finding by Lawrence, Holman and Jablensky (Duty to Care) that mortality among the mentally ill in Western Australia was 2.5 times that of the general population, seemingly, has great significance for public policy concerning the mentally ill. ‘Mortality’ could be a useful outcome measure for mental health services. Objectives: To replicate that study in the Australian Capital territory (ACT), comparing mortality rates in the mentally ill with those of the total population. Method: A list of all people who contacted the ACT mental health services between 1985 and 2000 was compiled. Using the national register of deaths (Australian Institute of Health and Welfare), persons known to the mental health services who died between 1990 and 2000 were identified and sex, date of birth, date of death, cause of death and place of death were noted. Using Australian Bureau of Statistics data for all deaths in the ACT, deaths in the total population and in the mentally ill population were tabulated for the period 1996–2000. With 1996 data as the base, using total population data from the ABS and mental health population data derived by amending ‘the list’ to remove duplications, pre1996 deaths and post1996 additions, mortality rates for the period 1996–2000 were compared. Results: The gender and age distribution of the mentally ill population and the total population, and of deaths in those populations, were very different. One third of all deaths in the mentally ill occurred outside of the ACT. Compared with the general population, mortality in the mentally ill (including deaths outside of the ACT) was only slightly excessive for ‘all causes’ and ischaemic heart disease but grossly excessive for ‘suicide’. Conclusions: This study did not confirm the excessive mortality rate in the mentally ill reported by Lawrence et al. except for suicide. Many methodological issues in using population studies to attempt to measure the size of the increase were identified. Differences in method between the ACT and WA studies probably explain the differences in results. Caution is urged in using the results of mortality studies as determinants of public policy or to evaluate services.

ABSTRACTBackground: As ageing is a personal experience, an attitude to ageing questionnaire is essential for capturing the most realistic appraisal of this important stage of life. Our aim was to study the psychometric properties of the Attitudes to Ageing Questionnaire (AAQ) in a sample of Spanish older people.Methods: A total of 242 participants aged 60 years and older were recruited from community centers, primary care centers, and family associations for the mentally ill and dementia. In addition to the AAQ, participants provided information on demographics, self-perception of health, comorbidity, health status (SF-12), depressive symptoms (GDS-30), and quality of life (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using standard psychometric techniques with SPSS v15.0.Results: No floor and ceiling effects were found, and missing data were low. The internal consistency measured by Cronbach's alpha for AAQ subscales were 0.59, 0.70, and 0.73. Exploratory Factor Analysis produced a three-factors solution accounting for 34% of the variance. A priori expected associations were found between some AAQ subscales with WHOQOL-BREF domains, with WHOQOL-OLD, SF-12, and the GDS-30 indicating good construct validity. In general, AAQ subscales differentiated between participants with lower and higher levels of education, and between a priori defined groups of older people (non-depressed vs. depressed; those with higher vs. lower physical comorbidities, and non-carers vs. carers).Conclusions: The Spanish version of the AAQ questionnaire showed acceptable psychometric properties in a convenience sample of Spanish older people. It is a useful measure of attitude for use with older people in social and clinical services.

Pelayanan kesehatan jiwa di Australia telah berkembang menjadi pelayanan yang berorientasi pada komunitas dan sensitive terhadap kebutuhan dan hak klien dengan gangguan jiwa. Perkembangan ini mempunyai implikasi pada system kesehatan jiwa komunitas., kebijakan tentang kesehatan jiwa, legalisasi, pelayanan kesehatan jiwa, pelayanan pembauran, begitu pula implikasi terhadap praktek keperawatan. Perubahan dalam pelayanan kesehatan jiwa menuntut perawat untuk memiliki pengetahuan yang teoritis yang lebih baik dan kemampuan untuk melakukan praktek keperawatan secara professional.Di Indonesia, kajian yang ekstensif tentang kebutuhan masyarakat dengan masalah kesehatan jiwa, sumber yang tersedia untuk memenuhi kebutuhan tersebut, serta keyakinan, nilai dan sikap tenaga professional kesehatan jiwa tentang ilmu kedokteran dan perilaku dari negara barat yang mempengaruhi pelayanan kesehatan jiwa, sangat diperlukan untuk pengembangan system kesehatan jiwa yang lebih efektif dan efesien. The mental health services in Australia have been developed to be more community based services and sensitive to the needs and rights of the mentally ill. This development has implications for mental health system and the community, mental health policy, legislation, mental health services, mainstreaming services as well as implications for nursing practice. The change in mental health services required the nurse to have the better theoretical knowledge and competence to practice professionally. In Indonesia, the extensive study on the needs of the people with mental health problem and the existing resource to meet those needs, as well as the current beliefs, values and attitudes held by mental health professionals towards the Western medical and behavioral science influence on mental health services is an important process in developing more efficient and effective mental health system.

Mental illness in old age is one of the most important healthcare issues of our times: if dementia were a country, it would be the world's 18th largest economy (Alzheimer's Disease International, 2010). In 1989, the UK Department of Health formally recognized old age psychiatry as a specialty in its own right, and by 2010 it had come of age. This anniversary was commemorated with a special edition of Old Age Psychiatrist, the newsletter of the Royal College of Psychiatrists, Faculty of Old Age Psychiatry (2011). To produce this, we called for “Janus” articles drawing on past experiences and giving thought to the future. Thirty-seven authors, ranging from students to retired colleagues, responded. Most contributors were UK-based but five worked elsewhere and provided an international perspective. The majority were psychiatrists who had devoted many years to the specialty, but their thoughts were set in context by representatives from other disciplines closely aligned to specialist healthcare services for mentally ill older people.

Court diversion schemes have been running for a decade in New Zealand and are increasing in number in Australia. This paper aims to give an international and historical context to these developments, by reference to psychiatric initiatives at courts in the US and in England and Wales. From a review of the specialist literature, an account is given of three forms of psychiatric intervention in courts over the last 90 years: court psychiatric clinics and mental health courts in the US, and court diversion schemes in England and Wales. High levels of psychiatric morbidity among prisoners, coupled with a continuing increase in prisoner numbers, demonstrate the need for systems for dealing with mentally ill people who come before the courts. Court diversion in England and Wales developed as part of a system where the mentally ill who are found guilty are sent to hospital in lieu of any other sentence. Its focus is on a form of psychiatric triage, and its ethos is the health of the patient. Court psychiatric clinics in the US grew up as an alternative to assessment in prison. Their focus has been on full psychiatric evaluation in an insanity and incompetence jurisdiction. The ethos has been that of serving the court. Mental health courts are heavily influenced by ideas of therapeutic jurisprudence, and their emphasis has been on a judge holding minor offenders in community care through the threat of judicial sanction. Experience in England and Wales has shown that court diversion can be a powerful and effective intervention. In order for it to function properly, those running court schemes need direct admission rights to psychiatric beds, both open and locked. Court diversion schemes are best as part of a spectrum of services to police stations, courts and prisons, which involved both general and forensic psychiatrists.

ObjectivesTo estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms.DesignA community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale—Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively.SettingUrban and rural areas of the Yangon Region, Myanmar.ParticipantsA total of 2377 men and women aged 18–49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded.ResultsOverall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men.ConclusionsChildhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.

Prelude: 2020 in Words Each year the Australian National Dictionary Centre, based at the Australian National University (ANU), selects “a word or expression that has gained prominence in the Australian social landscape”. In 2020, “iso” took out first place, with “bubble” following close behind. On the Centre’s website, Senior Researcher Mark Gywnn explains that “iso” was selected not only for its flexibility, merrily combining with other words to create new compound words (for instance “being in iso”, doing “iso baking” and putting on “iso weight”), but also because it “stood out as a characteristically Aussie abbreviation” (Australian National Dictionary Centre). Alongside the flexibility of the word “iso” and its affinity with the Australian English tradition of producing and embracing diminutives, iso’s appeal might well be that it does not carry the associations that the word “bubble” has acquired in the time of COVID. While COVID-19 has put many of us in various forms of “iso”, the media imagery—and indeed experiences—of many older people living in residential aged care during COVID has shifted some of the associations of the word “bubble”, heightening its associations with fragility and adding vulnerability and helplessness into the mix. 2020 was not the first time “bubble” has appeared in the Australian word of the year list. In 2018 “Canberra bubble” took out the first spot. What interests us about bubble’s runner-up position behind “iso” in 2020’s word of the year is what this might also reveal about the way ideas of independence vs dependence, and youthfulness vs aged underlie and inflect new usages of these words. In the era of COVID-19, the buoyancy of “iso” is tied to its association with a particular kind of Aussie-youth-speak, while the sense of heaviness and negative resonances that now accompany the word bubble are tied to its associations with the experiences of those in aged care. In 2020 “bubble”—a word that has primarily been associated with children and the child-like (bubble baths, bubble tea)—took on new associations and overtones. As the pandemic unfolded, “bubble” also became intertwined with media depictions of and popular discourses around those in later life, many of whom experienced “iso” much more brutally than the easy-Aussie-speak of “iso” would convey. There is much less play—and a lot less mingling—in the Australian National Dictionary Centre description of new uses of the word “bubble”: “a district, region, or a group of people viewed as a closed system, isolating from other districts, regions, or groups as a public health measure to limit the spread of Covid-19”. There have been various kinds of “closed system[s]”, isolated groups and regions constructed in the management of the pandemic, but there is one group—and one kind of location—that has been “bubbled” in quite specific ways. While the sectioning off and isolating of older age people in the name of protecting their health has often been ineffectively—and in some places, disastrously—managed in terms of disease prevention, it has been very effective in reducing the rights and voices of those it acts in the name of. Speaking from Ireland but commenting on the situation in the UK and parts of Europe, Anne Fuchs and colleagues write that “the discursive homogenization and ‘frailing’ of the over 65s meant that people in this category were an object of public discourse rather than participants in the debate” (2). In many instances the “bubbling” of older people, particularly those in aged care residences, has served to both isolate and render largely voiceless the residents of these care homes. Although the global impact of COVID-19 on the aged has been significant, including across many affluent societies, it has been particularly disastrous in Australia. At the time of writing (1 January 2021), of the 909 COVID-related deaths in Australia to date, 693 have been of people aged 80 or over: in other words, more than 75% of COVID-related deaths in Australia have been of people over 80. According to the federal government’s records of COVID-19 deaths by age group and sex, 685 of these deaths have been of aged care residents. It is not surprising therefore that many speak of the heavy impact of COVID-19 on older people as a form of genocide. Public discourse and government policies and priorities around COVID-19 have thrown into relief and exacerbated some of the deeply troubling ways that older people, particularly those living in aged care residences, are not recognised or treated as “equal partners in our future” (Royal Commission into Aged Care 1). Both the management of and public discourse around COVID-19 have highlighted and escalated the forms of ageism, especially ageism around later life, that have become embedded in Australian culture. In late 2019 the Royal Commission into Aged Care Quality and Safety released its Interim Report, titled simply Neglect. In the Foreword, the commissioners write: the Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people. (Royal Commission into Aged Care 1) Written and released before the COVID-19 pandemic, the Interim Report highlighted the “fundamental fact that our aged care system essentially depersonalises older people” (Royal Commission into Aged Care 6) and identified many ways “the aged care system fails to meet the needs of our older, often very vulnerable, citizens” (Royal Commission into Aged Care 1). In 2020 we saw some of the effects of these failures in the often disastrous mismanagement of disease transmission prevention in many aged care residences in Australia. Equally troubling, the resulting deaths have at times been accompanied by a general acceptance of the loss of so many in later life to COVID-19. The fact that these deaths are often regarded as somehow more inevitable, or as less significant than the deaths of others, is an indication of how deeply “Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities” (Royal Commission into Aged Care 1). It assumes that one’s later-life years are of less significance and value (to oneself, to the community) than one’s younger years. At various times in the pandemic, sizable parts of the global population have been variously asked, advised, or required by their governments to remain within their household or residential “bubble”. These COVID-related “bubbles” are more buoyant for some. Jackie Gulland has written a feminist analysis of the ways that the UK COVID-19 lockdown rules are premised on “neo-liberal assumptions about the family as autonomous and sufficient for the provision of reproductive labour” (330). In many places the requirement to stay within one’s “household bubble” both assumes that the home is safe for all, and that most care and dependency requirements are provided and received within a household. As Gulland’s essay demonstrates, the idea of the household bubble constructs an image or idea of who and what constitutes a household, and which relationships “count”. Drawing on critiques of neo-liberal and able-ist ideas about autonomy by feminist and disability scholars, Gulland “shows how the failure of policymakers to take account of interdependency has made lockdown more difficult for carers and those in receipt of care” (330). In this essay we look at some of the ways that the required and/or imagined COVID-19 bubbles for people in later life are thought of differently to the COVID-19 bubbles that younger, and mixed age, households are imagined as forming. This is particularly the case, we argue, for those in aged care residences. Younger and mixed age COVID bubbles often include extended or linked households (as we will discuss below in relation to the idea of the compassionate bubble) and function as a bubble that can link and enclose. In contrast, COVID bubbles in and for aged care and those in later life, work to isolate and separate. They function as bubbles that close off and shut out, as if placing the older person and older people behind glass (in some cases, quite literally). Likewise, while the COVID-19 bubbles for the “general” population (a category from which those in later life are often excluded) are regarded as temporary structures that will in time be dissolved to re-allow social movement and intermingling, the later life and aged care COVID-19 bubble is imagined very differently. This is because it is overlaid upon a pre-existing conception of later life—and in particular the fourth age—as itself a kind of bubbled existence, a fragile state held somewhat separate and apart from the general population and moving inexorably toward death—a bubble that pops. Bubbling the Fourth Age The idea that later life can be divided into different stages and ages has a long history, although the shape, meaning and valuing of different ages in later life is historically specific. Back in the late 1980s the Cambridge historian Peter Laslett proposed that rather than falling into three main stages—childhood, adulthood and old age—there are in fact four stages and that “later life can be divided into a ‘third age’ and a ‘fourth age’” (Gilleard and Higgs, “The Fourth Age” 368). Laslett’s distinction between a third age (active and characterised by personal fulfillment) and a fourth age (for Laslett an age of infirmity) has become increasingly significant in both age studies and in the provision and imagining of aged care. While the third age is increasingly depicted as something that, when managed “successfully”, can expand and fill with rich experiences and rewards (assuming one has the economic and social privilege and mobility to embrace these rich offerings—see Katz and McHugh cited in Zeilig, “Critical Use of Narrative”), the fourth age, on the other hand, is associated with frailty, increased dependence, vulnerability, precarity (see Lloyd; Gilleard and Higgs; and Morganroth Gullette on the fourth age). Of course, experiences of vulnerability, dependency and precarity run throughout the life course and cannot be reduced to chronological age. However, the distinction between a third and fourth age tends to assume that once one “leaves” the third age, it is a one-way path to “the three ‘Ds’: decrepitude, dependence, and death” (Laslett). The fourth age becomes associated with those aspects of ageing that are culturally rejected and pushed aside—in particular physical dependence which, as in much able-ist thinking, is rendered abject. As Morganroth Gullette has argued, a “savage contradiction” underlies and fuels this distinction, as “fantasies of the longevity bonanza proliferate alongside growing terrors of living too long” and becoming a “‘burden’” (21). In other words, those aspects of ageing—indeed those aspects of being human—that are seen as undesirable and/or abject are associated with the fourth age and imagined as somehow exclusive to it: they are placed elsewhere, contained in a fourth age “bubble”. The understanding of the fourth age as a kind of bubble is evident in and enabled by various kinds of cultural representations and institutional discourses around later life, including the kind of language used (particularly language connoting precarity and fragility and liminality) and recurrent media imagery in which people in their “fourth age” are depicted as mentally and physically out of reach (for instance isolated behind glass). Legislation around the movements of residents, visitors, and staff in aged care residence does not simply create “protective” bubbles around aged care residences but also constructs and imagines these residences and their inhabitants as “bubbled”, removed, and voiceless. Vulnerability, ephemerality, precarity and decline have become increasingly significant in representations of and discourses around ageing. Much of the media coverage of those in later life, particularly those living in aged care residences, has further fuelled what Sally Chivers has called the “nursing home specter” and delivered, in heightened and often spectacularised form, the “life-course narrative that dominant culture provides—an unliveable mind and unrecognizable body, mountainous expense” (Morganroth Gullette, 24). The discourse on ageing is characterised by the use of metaphor and metonymy, of which “the bubble” or “bubbling” is only one notable example. The culture of fear that surrounds the fourth age stems from the presumption that ageing inevitably leads to decay and decline in quality of life, and that the experience of ageing is characterised by various forms of physical and cognitive deterioration, such as dementia. Cultural gerontologist Hannah Zeilig has drawn attention to the pervasive use of metaphors—in both medical journals and mass media reports—to describe the experience of living with dementia. These metaphors attempt to capture and simplify the complexities of being, speaking, and knowing experienced by people with dementia. They are frequently used to communicate these experiences to people who do not live with dementia. The cultural metaphors of dementia are potent examples of ageism. They are not neutral in their connotations or implicit value judgements. These metaphors reveal wider social anxieties around ageing, despite the fact that people in their 40s and 50s can have dementia (Dementia Australia). As Zeilig has pointed out, many of these metaphors have presented a negative framing of dementia, describing the rising numbers of dementia diagnoses in apocalyptic, biblical terms such as “plague”, “crisis”, and “epidemic” (“Cultural Metaphor” 260). While this hyperbole may be grounded in statistics and the realities of an ageing population, it has nevertheless been alarming. This rhetoric has often been a necessary tactic for dementia organisations as part of their efforts to secure media coverage, raise public awareness of dementia, and lobby for increased government and private investment in funding research and support services. Despite these noble intentions, this rhetoric can risk excluding or marginalising the voices of people living with dementia. Some of the metaphors that have been used to describe dementia are particularly dehumanising and stigmatising, such as the perception of Alzheimer’s disease as a form of “living death”. This conception of Alzheimer’s, which Susan M. Behuniak has observed in both scholarly and popular discourse, elicits strong negative emotional responses of revulsion and fear. It constructs people with Alzheimer’s as abject zombie-like figures living a half-life or twilight existence. These trends in dementia discourse that Zeilig and Behuniak identified in the first half of the 2010s are also apparent in media imagery and discourse about older people in the COVID-19 pandemic. Much like the cultural narratives of dementia, these representations often reinforce the fourth age’s association with forms of vulnerability, decline and decay that are rendered abject. In contrast to this negative framing of both dementia and the fourth age, the trope of “living in a bubble” can also present a more ambivalent conception of both living with dementia and, by extension, the sociocultural experience of living in the fourth age during the time of COVID-19. “Bubbling” can serve a protective function for the person living with dementia by reducing sensory overload and cognitive confusion that may lead to anxiety and emotional distress. In dementia care, bubble wands and bubble wrap are two of the most commonly used tools in sensory therapy for reducing anxiety and agitation, and providing comfort (DailyCaring). These examples remind us of the materiality of the bubble, which functions as both cultural trope and material condition that affects people’s lives (to borrow from Helen Deutsch and Felicity Nussbaum, cited in Vivian Sobchack’s essay on metaphor and materiality). Within the diversity and range of caring practices encompassed by the trope of “bubbling”, there is clear potential for the bubble to be enabling, rather than disabling, if it is used to enhance quality of life and wellbeing for older people, rather than to separate, marginalise and isolate. Despite the multivalent possibilities of the bubble for enhancing quality of life for people with dementia, the bubble’s association with precarity has been heightened by its deployment to protect older people during the COVID-19 pandemic. This is a source of ambivalence around the COVID-19 bubble, a public health response that is acknowledged as having both protective and harmful effects. It involves “bubbling” older people, especially those living in residential care, by physically isolating them and limiting their contact with family and friends to conversations mediated by digital technology or a windowpane. By restricting physical and direct contact with the outside world in order to reduce and contain transmission of the virus, the COVID-19 bubble is intended to protect the physical health of older adults. But as Karra Harrington and Martin J. Sliwinski caution, this can also risk the cognitive health and mental wellbeing of older people by creating social isolation. These concerns about the negative health impacts of the COVID-19 bubble compound the existing popular understanding of late life as isolated and isolating, perpetuating the ageist assumptions that characterise the social imaginary around the fourth age. Creating Compassionate Bubbles The distress of separation caused by COVID-19 lockdowns and restrictions is felt by all generations, not just older people. Recognising the costs to our emotional and mental wellbeing of living in isolation to protect our bodies and our communities from viral invasion, Australian epidemiologist Mary-Louise McLaws has called for “a compassionate germ bubble”, modelled on New Zealand’s concept of an extended bubble that allows close contacts beyond one household. This alternative approach to “bubbling” is designed to strike a better balance between physical and mental health. Writing during Melbourne’s strict and prolonged lockdown following a second wave of cases in the winter of 2020, McLaws argued that “a compassionate germ bubble may foster resilience by reducing a sense of isolation for people living alone and friends, extended family and partners distressed by the separation”. There have been a number of creative and compassionate responses to the necessity of the COVID-19 bubble for protecting those most vulnerable to the virus. Aged care residences have developed innovative ways to safely maintain in-person visits and provide opportunities for face-to-face contact between residents and their families and friends. One example reported in the Australian media (Steger) is “The Window of Love” in Perth, which demonstrates the positive potential of the bubble—represented here as a pane of glass bordered by a painted frame—for facilitating social connection and supporting wellbeing despite restrictions on physical contact. The media reporting of these innovations tends to spectacularise the residents of these homes, reinforcing their fragility and vulnerability as they are framed behind plastic or glass. In December 2020, international media outlets The Guardian, RTE News, and Star Media posted a Reuters video story on their respective YouTube channels about a “hug bubble” created in an aged care home in Jeumont, France. This inflatable plastic tunnel allows physical touch between those living in the home and those outside it through hermetically sealed sleeves. Separating the resident from their visitors is a clear plastic sheet, which is disinfected by staff in between each visit. Recognising the importance of physical contact for wellbeing, nursing staff reported that the hug bubble has brought comfort to the residents, whose previous contact with family and friends since the outbreak of COVID-19 in March 2020 had been limited to video calls or talking through a window. Viewer comments reveal divergent responses to this media story across all three YouTube channels. Some viewers applaud the innovation while others disparage the hug bubble as “cruel” and “disgraceful”. Other comments register viewers’ ambivalence, recognising the good intentions behind the idea while despairing at the need for it. Several comments offer a snapshot of the cynical, often incoherent views about the pandemic commonly found on social media platforms like Facebook and Twitter, while also demonstrating the persistence of ageist attitudes that regard the elderly as a burden. These negative responses are striking in contrast with the positive framing of the original media report, which is presented as a “feel good” human interest story through brief interviews with family members and nursing home staff, reflecting on the residents’ experiences using the hug bubble. This positive framing is reinforced by the gentle music track accompanying the video posted on the RTE News channel. Beyond the institutional context of aged care residences, many families and communities have also engineered solutions to reduce the stress of separation. Craving physical contact after months of isolation, they have embraced the materiality and tactility inherent in the bubble trope. People have improvised using household objects, such as plastic sleeves attached to transparent shower curtains, to build “cuddle curtains”, and “hug machines” to enable safe—and playful—physical contact. These innovations and adaptations tap into the bubble’s playful qualities, while also “going viral” as families document their creativity, delight and joy through their own video stories shared on YouTube. As we move into the second year of the COVID-19 pandemic, with case numbers and the death toll continuing to climb globally, the concept of the COVID-19 bubble and its role in protecting the community will continue to be debated, refined and reconfigured in both public health responses and media discourse. Despite Australia’s relatively good fortune in terms of total number of COVID-related deaths compared to other Western nations such as the US and the UK, the disproportionately high number of deaths among Australians in aged care is a sobering reminder of the systemic failures in Australia’s aged care residences. As we move in and out of periods of social isolation, restrictions and lockdowns, it will become increasingly important to address the mental health impacts of “living in a bubble” and to consider creative, compassionate alternatives that challenge ageism and maintain quality of life for fourth age Australians. *** As COVID-19 and its management continue to reshape our world(s) and our relations to each other, its impacts continue to be unevenly felt, particularly for those in later life. For this reason, it becomes increasingly important to be alert to the ways in which “bubbling” the fourth age in response to COVID-19 risks reinforcing a homogenising view of older people as vulnerable and isolated, defenceless against viral invasion and voiceless in expressing agency and maintaining social connection. This essay responds to Hannah Zeilig’s earlier call to “radically rethink the ways in which age and ageing have been culturally configured” (“Critical Use of Narrative” 16). One of the purposes of this essay has been to critically assess some of the ways that the relatively new discourse of a fourth age—as somehow both qualitatively and quantifiably different to and separate from the third age—entails a homogenising view of older people. This view has enabled forms of ageism that have often been particularly brutal in their impact during the pandemic. In this essay we have argued that popular conceptions of and public health discourse and policy around the fourth age have often enabled—or, at the very least, supported—forms of ageism. This ageism has been further heightened through both the discourse and the imagery of the COVID-19 bubble. The fourth age, we argued, has often been understood as bubble-like: as a “stage” of life when one is somehow separated from the larger community and culture. The fourth age is configured as physically fragile and precarious, transient and temporary, ephemeral, and enclosed in—and as—its own world. Created in the name of protecting “our most vulnerable”, the bubble in the time of COVID-19 has heightened these pre-existing social anxieties around the fourth age. The challenge, as we move into the second year of the pandemic in Australia, is to find new ways of protecting the health and wellbeing of people in later life, while creating opportunities for connection, agency and play that are supported, rather than hindered, by the COVID-19 bubble. References Australian National Dictionary Centre. “2020 Word of the Year.” Canberra: School of Literature, Languages and Linguistics, ANU College of Arts and Social Sciences, Australian National University. 17 Nov. 2020. 12 Jan. 2021 <https://slll.cass.anu.edu.au/centres/andc/news/2020-word-year>. Behuniak, Susan M. “The Living Dead? The Construction of People with Alzheimer’s Disease as Zombies.” Ageing & Society 21 (2011): 70–92. Chivers, Sally. “‘Blind People Don’t Run’: Escaping the ‘Nursing Home Specter’ in Children of Nature and Cloudburst.” Journal of Aging Studies 34 (2015): 134–41. “COVID-19 Deaths by Age Group and Sex.” Australian Government Department of Health: Coronovirus (COVID-19) Current Situation and Case Numbers. 1 Jan. 2021 <https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-and-deaths-by-age-and-sex>. DailyCaring. “6 Alzheimer’s Sensory Activities Reduce Anxiety without Medication.” 12 Jan. 2021 <https://dailycaring.com/6-alzheimers-sensory-activities-reduce-anxiety-without-medication/>. Dementia Australia. “What Is Dementia?” 12 Jan. 2021 <https://www.dementia.org.au/about-dementia/what-is-dementia>. Fuchs, Anne, Desmond O'Neill, Mary Cosgrove, and Julia Langbein. “Report on COVID-19 – Reframing Ageing Webinar 12 June 2020.” Preprint. Aug. 2020. DOI: 10.13140/RG.2.2.34508.44161. Gilleard, Chris, and Paul Higgs. “Aging without Agency: Theorizing the Fourth Age.” Aging and Mental Health 14.2 (2010): 121–28. Gilleard, Chris, and Paul Higgs. “Ageing Abjection and Embodiment in the Fourth Age.” Journal of Aging Studies 25.2 (2011): 135–42. Gilleard, Chris, and Paul Higgs. “The Fourth Age and the Concept of a ‘Social Imaginary’: A Theoretical Excursus.” Journal of Aging Studies 27 (2013): 368–76. Gulland, Jackie. “Households, Bubbles, and Hugging Grandparents: Caring and Lockdown Rules during COVID-19.” Feminist Legal Studies 28 (2020): 329–39. Harrington, Karra, and Martin J. Sliwinski. “The Loneliness of Social Isolation Can Affect Your Brain and Raise Dementia Risk in Older Adults.” The Conversation 4 Aug. 2020. 12 Jan. 2021 <https://theconversation.com/the-loneliness-of-social-isolation-can-affect-your-brain-and-raise-dementia-risk-in-older-adults-141752>. Laslett, Peter. A Fresh Map of Life: The Emergence of the Third Age. London: Weidenfeld and Nicolson, 1989. Lloyd, Liz. “The Fourth Age.” Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. London: Routledge, 2015. 20 Dec. 2020 <https://www.routledgehandbooks.com/doi/10.4324/9780203097090.ch33>. McLaws, Mary-Louise. “What Is the COVID ‘Bubble’ Concept, and Could It Work in Australia?” The Conversation 1 Sep. 2020. 12 Jan. 2021 <https://theconversation.com/what-is-the-covid-bubble-concept-and-could-it-work-in-australia-144938>. Morganroth Gullette, Margaret. “Aged by Culture.” Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. London: Routledge, 2015. 28 Dec. 2020 <https://www.routledgehandbooks.com/doi/10.4324/9780203097090.ch3>. Royal Commission into Aged Care Quality and Safety. Neglect. Interim Report Volume 1. Canberra: Commonwealth Government of Australia, 31 Oct. 2019. 12 Jan. 2021 <https://agedcare.royalcommission.gov.au/publications/interim-report>. Sobchack, Vivian. “A Leg to Stand On: Prosthetics, Metaphor, and Materiality.” In The Prosthetic Impulse: From a Posthuman Present to a Biocultural Future. Cambridge: MIT Press, 2006. 17–41. Steger, Sarah. “Coronavirus Crisis: Oryx Communities Aged Care Home Creates ‘Window of Love’ to Help Residents Stay Connected to Families.” The West Australian 5 Apr. 2020. 12 Jan. 2021 <https://thewest.com.au/news/coronavirus/coronavirus-crisis-oryx-communities-aged-care-home-creates-window-of-love-to-help-residents-stay-connected-to-families-ng-b881510245z>. Zeilig, Hannah. “The Critical Use of Narrative and Literature in Gerontology.” International Journal of Ageing and Later Life 6.2 (2011): 7-37. ———. “Dementia as a Cultural Metaphor.” The Gerontologist 54.2 (2013): 258–67. ———. “What Do We Mean When We Talk about Dementia? Exploring Cultural Representations of ‘Dementia’.” Working with Older People 19.1 (2015): 12–20.

She leant lazily across the picnic hamper and reached for my hearing aid in my open-palmed hand. I jerked away from her, batting her hand away from mine. The glare of the summer sun blinded me. I struck empty air. Her tendril-fingers seized the beige seashell curve of my hearing aid and she lifted the cargo of sound towards her eyes. She peered at the empty battery-cage before flicking it open and shut as if it was a cigarette lighter, as if she could spark hearing-life into this trick of plastic and metal that held no meaning outside of my ear. I stared at her. A band of horror tightened around my throat, strangling my shout: ‘Don’t do that!’ I clenched my fist around the new battery that I had been about to insert into my hearing aid and imagined it speeding like a bullet towards her heart. This dream arrived as I researched my anthology of memoir-style essays on deafness, The Art of Being. I had already been reflecting and writing for several years about my relationship with my deaf-self and the impact of my deafness on my life, but I remained uneasy about writing about my deaf-life. I’ve lived all my adult life entirely in the hearing world, and so recasting myself as a deaf woman with something pressing to say about deaf people’s lives felt disturbing. The urgency to tell my story and my anxiety to contest certain assumptions about deafness were real, but I was hampered by diffidence. The dream felt potent, as if my deaf-self was asserting itself, challenging my hearing persona. I was the sole deaf child in a family of five muddling along in a weatherboard war commission house at The Grange in Brisbane during the nineteen fifties and nineteen sixties. My father’s resume included being in the army during World War Two, an official for the boxing events at the 1956 Melbourne Olympic Games and a bookie with a gift for telling stories. My mother had spent her childhood on a cherry orchard in Young, worked as a nurse in war-time Sydney and married my father in Townsville after a whirlwind romance on Magnetic Island before setting up home in Brisbane. My older sister wore her dark hair in thick Annie-Oakley style plaits and my brother took me on a hike along the Kedron Brook one summer morning before lunchtime. My parents did not know of any deaf relatives in their families, and my sister and brother did not have any friends with deaf siblings. There was just me, the little deaf girl. Most children are curious about where they come from. Such curiosity marks their first foray into sexual development and sense of identity. I don’t remember expressing such curiosity. Instead, I was diverted by my mother’s story of her discovery that I was deaf. The way my mother tells the story, it is as if I had two births with the date of the diagnosis of my deafness marking my real arrival, over-riding the false start of my physical birth three years earlier. Once my mother realized that I was deaf, she was able to get on with it, the ‘it’ being to defy the inevitability of a constrained life for her deaf child. My mother came out swinging; by hook or by crook, her deaf daughter was going to learn to speak and to be educated and to take her place in the hearing world and to live a normal life and that was that. She found out about the Commonwealth Acoustics Laboratory (now known as Australian Hearing Services) where, after I completed a battery of auditory tests, I was fitted with a hearing aid. This was a small metal box, to be worn in a harness around my body, with a long looping plastic cord connected to a beige ear-mould. An instrument for piercing silence, it absorbed and conveyed sounds, with those sounds eventually separating themselves out into patterns of words and finally into strings of sentences. Without my hearing aid, if I am concentrating, and if the sounds are made loudly, I am aware of the sounds at the deeper end of the scale. Sometimes, it’s not so much that I can hear them; it’s more that I know that those sounds are happening. My aural memory of the deep-register sounds helps me to “hear” them, much like the recollection of any tune replays itself in your imagination. With and without my hearing aids, if I am not watching the source of those sounds – for example, if the sounds are taking place in another room or even just behind me – I am not immediately able to distinguish whether the sounds are conversational or musical or happy or angry. I can only discriminate once I’ve established the rhythm of the sounds; if the rhythm is at a tearing, jagged pace with an exaggerated rise and fall in the volume, I might reasonably assume that angry words are being had. I cannot hear high-pitched sounds at all, with and without my hearing aids: I cannot hear sibilants, the “cees” and “esses” and “zeds”. I cannot hear those sounds which bounce or puff off from your lips, such as the letters “b” and “p”; I cannot hear that sound which trampolines from the press of your tongue against the back of your front teeth, the letter “t”. With a hearing-aid I can hear and discriminate among the braying, hee-hawing, lilting, oohing and twanging sounds of the vowels ... but only if I am concentrating, and if I am watching the source of the sounds. Without my hearing aid, I might also hear sharp and sudden sounds like the clap of hands or crash of plates, depending on the volume of the noise. But I cannot hear the ring of the telephone, or the chime of the door bell, or the urgent siren of an ambulance speeding down the street. My hearing aid helps me to hear some of these sounds. I was a pupil in an oral-deaf education program for five years until the end of 1962. During those years, I was variously coaxed, dragooned and persuaded into the world of hearing. I was introduced to a world of bubbles, balloons and fingers placed on lips to learn the shape, taste and feel of sounds, their push and pull of air through tongue and lips. By these mechanics, I gained entry to the portal of spoken, rather than signed, speech. When I was eight years old, my parents moved me from the Gladstone Road School for the Deaf in Dutton Park to All Hallows, an inner-city girls’ school, for the start of Grade Three. I did not know, of course, that I was also leaving my world of deaf friends to begin a new life immersed in the hearing world. I had no way of understanding that this act of transferring me from one school to another was a profound statement of my parents’ hopes for me. They wanted me to have a life in which I would enjoy all the advantages and opportunities routinely available to hearing people. Like so many parents before them, ‘they had to find answers that might not, for all they knew, exist . . . How far would I be able to lead a ‘normal’ life? . . . How would I earn a living? You can imagine what forebodings weighed on them. They could not know that things might work out better than they feared’ (Wright, 22). Now, forty-four years later, I have been reflecting on the impact of that long-ago decision made on my behalf by my parents. They made the right decision for me. The quality of my life reflects the rightness of their decision. I have enjoyed a satisfying career in social work and public policy embedded in a life of love and friendships. This does not mean that I believe that my parents’ decision to remove me from one world to another would necessarily be the right decision for another deaf child. I am not a zealot for the cause of oralism despite its obvious benefits. I am, however, stirred by the Gemini-like duality within me, the deaf girl who is twin to the hearing persona I show to the world, to tell my story of deafness as precisely as I can. Before I can do this, I have to find that story because it is not as apparent to me as might be expected. In an early published memoir-essay about my deaf girlhood, I Hear with My Eyes (in Schulz), I wrote about my mother’s persistence in making sure that I learnt to speak rather than sign, the assumed communication strategy for most deaf people back in the 1950s. I crafted a selection of anecdotes, ranging in tone, I hoped, from sad to tender to laugh-out-loud funny. I speculated on the meaning of certain incidents in defining who I am and the successes I have enjoyed as a deaf woman in a hearing world. When I wrote this essay, I searched for what I wanted to say. I thought, by the end of it, that I’d said everything that I wanted to say. I was ready to move on, to write about other things. However, I was delayed by readers’ responses to that essay and to subsequent public speaking engagements. Some people who read my essay told me that they liked its fresh, direct approach. Others said that they were moved by it. Friends were curious and fascinated to get the inside story of my life as a deaf person as it has not been a topic of conversation or inquiry among us. They felt that they’d learnt something about what it means to be deaf. Many responses to my essay and public presentations had relief and surprise as their emotional core. Parents have cried on hearing me talk about the fullness of my life and seem to regard me as having given them permission to hope for their own deaf children. Educators have invited me to speak at parent education evenings because ‘to have an adult who has a hearing impairment and who has developed great spoken language and is able to communicate in the community at large – that would be a great encouragement and inspiration for our families’ (Email, April 2007). I became uncomfortable about these responses because I was not sure that I had been as honest or direct as I could have been. What lessons on being deaf have people absorbed by reading my essay and listening to my presentations? I did not set out to be duplicitous, but I may have embraced the writer’s aim for the neatly curved narrative arc at the cost of the flinty self-regarding eye and the uncertain conclusion. * * * Let me start again. I was born deaf at a time, in the mid 1950s, when people still spoke of the ‘deaf-mute’ or the ‘deaf and dumb.’ I belonged to a category of children who attracted the gaze of the curious, the kind, and the cruel with mixed results. We were bombarded with questions we could either not hear and so could not answer, or that made us feel we were objects for exploration. We were the patronized beneficiaries of charitable picnics organized for ‘the disadvantaged and the handicapped.’ Occasionally, we were the subject of taunts, with words such as ‘spastic’ being speared towards us as if to be called such a name was a bad thing. I glossed over this muddled social response to deafness in my published essay. I cannot claim innocence as my defence. I knew I was glossing over it but I thought this was right and proper: after all, why stir up jagged memories? Aren’t some things better left unexpressed? Besides, keep the conversation nice, I thought. The nature of readers’ responses to my essay provoked me into a deeper exploration of deafness. I was shocked by the intensity of so many parents’ grief and anxiety about their children’s deafness, and frustrated by the notion that I am an inspiration because I am deaf but oral. I wondered what this implied about my childhood deaf friends who may not speak orally as well as I do, but who nevertheless enjoy fulfilling lives. I was stunned by the admission of a mother of a five year old deaf son who, despite not being able to speak, has not been taught how to Sign. She said, ‘Now that I’ve met you, I’m not so frightened of deaf people anymore.’ My shock may strike the average hearing person as naïve, but I was unnerved that so many parents of children newly diagnosed with deafness were grasping my words with the relief of people who have long ago lost hope in the possibilities for their deaf sons and daughters. My shock is not directed at these parents but at some unnameable ‘thing out there.’ What is going on out there in the big world that, 52 years after my mother experienced her own grief, bewilderment, anxiety and quest to forge a good life for her little deaf daughter, contemporary parents are still experiencing those very same fears and asking the same questions? Why do parents still receive the news of their child’s deafness as a death sentence of sorts, the death of hope and prospects for their child, when the facts show – based on my own life experiences and observations of my deaf school friends’ lives – that far from being a death sentence, the diagnosis of deafness simply propels a child into a different life, not a lesser life? Evidently, a different sort of silence has been created over the years; not the silence of hearing loss but the silence of lost stories, invisible stories, unspoken stories. I have contributed to that silence. For as long as I can remember, and certainly for all of my adult life, I have been careful to avoid being identified as ‘a deaf person.’ Although much of my career was taken up with considering the equity dilemmas of people with a disability, I had never assumed the mantle of advocacy for deaf people or deaf rights. Some of my early silence about deaf identity politics was consistent with my desire not to shine the torch on myself in this way. I did not want to draw attention to myself by what I did not have, that is, less hearing than other people. I thought that if I lived my life as fully as possible in the hearing world and with as little fuss as possible, then my success in blending in would be eloquence enough. If I was going to attract attention, I wanted it to be on the basis of merit, on what I achieved. Others would draw the conclusions that needed to be drawn, that is, that deaf people can take their place fully in the hearing world. I also accepted that if I was to be fully ‘successful’ – and I didn’t investigate the meaning of that word for many years – in the hearing world, then I ought to isolate myself from my deaf friends and from the deaf culture. I continued to miss them, particularly one childhood friend, but I was resolute. I never seriously explored the possibility of straddling both worlds, despite the occasional invitation to do so. For example, one of my childhood deaf friends, Damien, visited me at my parents’ home once, when we were both still in our teens. He was keen for me to join him in the Deaf Theatre, but I couldn’t muster the emotional dexterity that I felt this required. Instead, I let myself to be content to hear news of my childhood deaf friends through the grape-vine. This was, inevitably, a patchy process that lent itself to caricature. Single snippets of information about this person or that person ballooned into portrait-size depictions of their lives as I sketched the remaining blanks of their history with my imagination as my only tool. My capacity to be content with my imagination faltered. * * * Despite the construction of public images of deafness around the highly visible performance of hand-signed communication, the ‘how-small-can-we-go?’ advertorials of hearing aids and the cochlear implant with its head-worn speech processor, deafness is often described as ‘the invisible disability.’ My own experience bore this out. I became increasingly self-conscious about the singularity of my particular success, moderate in the big scheme of things though that may be. I looked around me and wondered ‘Why don’t I bump into more deaf people during the course of my daily life?’ After all, I am not a recluse. I have broad interests. I have travelled a lot, and have enjoyed a policy career for some thirty years, spanning the three tiers of government and scaling the competitive ladder with a reasonable degree of nimbleness. Such a career has got me out and about quite a bit: up and down the Queensland coast and out west, down to Sydney, Melbourne, Canberra, Adelaide and Hobart, and to the United Kingdom. And yet, not once in those thirty years did I get to share an office or a chance meeting or a lunch break with another deaf person. The one exception took place in the United Kingdom when I attended a national conference in which the keynote speaker was the Chairman of the Audit Commission, a man whose charisma outshines his profound deafness. After my return to Australia from the United Kingdom, a newspaper article about an education centre for deaf children in a leafy suburb of Brisbane, prompted me into action. I decided to investigate what was going on in the world of education for deaf children and so, one warm morning in 2006, I found myself waiting in the foyer for the centre’s clinical director. I flicked through a bundle of brochures and newsletters. They were loaded with images of smiling children wearing cochlear implants. Their message was clear: a cochlear implant brought joy, communication and participation in all that the world has to offer. This seemed an easy miracle. I had arrived with an open mind but now found myself feeling unexpectedly tense, as if I was about to walk a high-wire without the benefit of a safety net. Not knowing the reason for my fear, I swallowed it and smiled at the director in greeting upon her arrival. She is physically a small person but her energy is large. Her passion is bracing. That morning, she was quick to assert the power of cochlear implants by simply asking me, ‘Have you ever considered having an implant?’ When I shook my head, she looked at me appraisingly, ‘I’m sure you’d benefit from it’ before ushering me into a room shining with sun-dappled colour and crowded with a mess of little boys and girls. The children were arrayed in a democracy of shorts, shirts, and sandals. Only the occasional hair-ribbon or newly pressed skirt separated this girl from that boy. Some young mothers and fathers, their faces stretched with tension, stood or sat around the room’s perimeter watching their infant children. The noise in the room was orchestral, rising and falling to a mash of shouts, cries and squeals. A table had been set with several plastic plates in which diced pieces of browning apple, orange slices and melon chunks swam in a pond of juice. Some small children clustered around it, waiting to be served. When they finished their morning fruit, they were rounded up to sit at the front of the room, before a teacher poised with finger-puppets of ducks. I tripped over a red plastic chair – its tiny size designed to accommodate an infant’s bottom and small-sausage legs – and lowered myself onto it to take in the events going on around me. The little boys and girls laughed merrily as they watched their teacher narrate the story of a mother duck and her five baby ducks. Her hands moved in a flurry of duck-billed mimicry. ‘“Quack! Quack! Quack!” said the mother duck!’ The parents trilled along in time with the teacher. As I watched the children at the education centre that sunny morning, I saw that my silence had acted as a brake of sorts. I had, for too long, buried the chance to understand better the complex lives of deaf people as we negotiate the claims and demands of the hearing world. While it is true that actions speak louder than words, the occasional spoken and written word must surely help things along a little. I also began to reflect on the apparent absence of the inter-generational transfer of wisdom and insights born of experience rather than academic studies. Why does each new generation of parents approach the diagnosis of their newborn child’s disability or deafness with such intensity of fear, helplessness and dread for their child’s fate? I am not querying the inevitability of parents experiencing disappointment and shock at receiving unexpected news. I accept that to be born deaf means to be born with less than perfect hearing. All the same, it ought not to be inevitable that parents endure sustained grief about their child’s prospects. They ought to be illuminated as quickly as possible about all that is possible for their child. In particular, they ought to be encouraged to enjoy great hopes for their child. I mused about the power of story-telling to influence attitudes. G. Thomas Couser claims that ‘life writing can play a significant role in changing public attitudes about deafness’ (221) but then proceeds to cast doubt on his own assertion by later asking, ‘to what degree and how do the extant narratives of deafness rewrite the discourse of disability? Indeed, to what degree and how do they manage to represent the experience of deafness at all?’ (225). Certainly, stories from the Deaf community do not speak for me as my life has not been shaped by the framing of deafness as a separate linguistic and cultural entity. Nor am I drawn to the militancy of identity politics that uses terms such as ‘oppression’ and ‘oppressors’ to deride the efforts of parents and educators to teach deaf children to speak (Lane; Padden and Humphries). This seems to be unhelpfully hostile and assumes that deafness is the sole arbitrating reason that deaf people struggle with understanding who they are. It is the nature of being human to struggle with who we are. Whether we are deaf, migrants, black, gay, mentally ill – or none of these things – we are all answerable to the questions: ‘who am I and what is my place in the world?’ As I cast around for stories of deafness and deaf people with which I could relate, I pondered on the relative infrequency of deaf characters in literature, and the scarcity of autobiographies by deaf writers or biographies of deaf people by either deaf or hearing people. I also wondered whether written stories of deafness, memoirs and fiction, shape public perceptions or do they simply respond to existing public perceptions of deafness? As Susan DeGaia, a deaf academic at California State University writes, ‘Analysing the way stories are told can show us a lot about who is most powerful, most heard, whose perspective matters most to society. I think if we polled deaf/Deaf people, we would find many things missing from the stories that are told about them’ (DeGaia). Fighting my diffidence in staking out my persona as a ‘deaf woman’ and mustering the ‘conviction as to the importance of what [I have] to say, [my] right to say it’ (Olsen 27), I decided to write The Art of Being Deaf, an anthology of personal essays in the manner of reflective memoirs on deafness drawing on my own life experiences and supported by additional research. This presented me with a narrative dilemma because my deafness is just one of several life-events by which I understand myself. I wanted to find fresh ways of telling stories of deaf experiences while fashioning my memoir essays to show the texture of my life in all its variousness. A.N.Wilson’s observation about the precarious insensitivity of biographical writing was my guiding pole-star: the sense of our own identity is fluid and tolerant, whereas our sense of the identity of others is always more fixed and quite often edges towards caricature. We know within ourselves that we can be twenty different persons in a single day and that the attempt to explain our personality is doomed to become a falsehood after only a few words ... . And yet ... works of literature, novels and biographies depend for their aesthetic success precisely on this insensitive ability to simplify, to describe, to draw lines around another person and say, ‘This is she’ or ‘This is he.’ I have chosen to explore my relationship with my deafness through the multiple-threads of writing several personal essays as my story-telling vehicle rather than as a single-thread autobiography. The multiple-thread approach to telling my stories also sought to avoid the pitfalls of identity narrative in which I might unwittingly set myself up as an exemplar of one sort or another, be it as a ‘successful deaf person’ or as an ‘angry militant deaf activist’ or as ‘a deaf individual in denial attempting to pass as hearing.’ But in seeking to avoid these sorts of stories, what autobiographical story am I trying to tell? Because, other than being deaf, my life is not otherwise especially unusual. It is pitted here with sadness and lifted there with joy, but it is mostly a plateau held stable by the grist of daily life. Christopher Jon Heuer recognises this dilemma when he writes, ‘neither autobiography nor biography nor fiction can survive without discord. Without it, we are left with boredom. Without it, what we have is the lack of a point, a theme and a plot’ (Heuer 196). By writing The Art of Being Deaf, I am learning more than I have to teach. In the absence of deaf friends or mentors, and in the climate of my own reluctance to discuss my concerns with hearing people who, when I do flag any anxieties about issues arising from my deafness tend to be hearty and upbeat in their responses, I have had to work things out for myself. In hindsight, I suspect that I have simply ignored most of my deafness-related difficulties, leaving the heavy lifting work to my parents, teachers, and friends – ‘for it is the non-deaf who absorb a large part of the disability’ (Wright, 5) – and just got on with things by complying with what was expected of me, usually to good practical effect but at the cost of enriching my understanding of myself and possibly at the cost of intimacy. Reading deaf fiction and memoirs during the course of this writing project is proving to be helpful for me. I enjoy the companionability of it, but not until I got over my fright at seeing so many documented versions of deaf experiences, and it was a fright. For a while there, it was like walking through the Hall of Mirrors in Luna Park. Did I really look like that? Or no, perhaps I was like that? But no, here’s another turn, another mirror, another face. Spinning, twisting, turning. It was only when I stopped searching for the right mirror, the single defining portrait, that I began to enjoy seeing my deaf-self/hearing-persona experiences reflected in, or challenged by, what I read. Other deaf writers’ recollections are stirring into fresh life my own buried memories, prompting me to re-imagine them so that I can examine my responses to those experiences more contemplatively and less reactively than I might have done originally. We can learn about the diversity of deaf experiences and the nuances of deaf identity that rise above the stock symbolic scripts by reading authentic, well-crafted stories by memoirists and novelists. Whether they are hearing or deaf writers, by providing different perspectives on deafness, they have something useful to say, demonstrate and illustrate about deafness and deaf people. I imagine the possibility of my book, The Art of Being Deaf, providing a similar mentoring role to other deaf people and families.References Couser, G. Thomas. Recovering Bodies: Illness, Disablity, and Life Writing. Wisconsin: University of Wisconsin Press, 1997. Heuer, Christopher Jon. ‘Deafness as Conflict and Conflict Component.’ Sign Language Studies 7.2 (Winter 2007): 195-199. Lane, Harlan. When the Mind Hears: A History of the Deaf. New York: Random House, 1984 Olsen, Tillie. Silences. New York: Delta/Seymour Lawrence. 1978. Padden, Carol, and Tom Humphries. Deaf in America: Voices from a Culture. Cambridge, Mass.: Harvard University Press, 1998. Schulz, J. (ed). A Revealed Life. Sydney: ABC Books and Griffith Review. 2007 Wilson, A.N. Incline Our Hearts. London: Penguin Books. 1988. Wright, David. Deafness: An Autobiography. New York: Stein and Day, 1969.

I examined the factors that led to the rise and fall of psychiatric hospitals and its impact on two select groups of individuals: adults and older adults with severe mental illness. To explore the reasons behind these fluctuations, the State of Texas was used as a case study. Additionally, the fluctuations occurred for different reasons in public vs. for-profit investor-owned psychiatric hospitals. Using an investor-owned psychiatric hospital organization as a case study, I investigated the differences in factors that influenced the growth and/or demise in public vs. investor-owned psychiatric hospitals. Evolution and devolution of psychiatric hospitals was assessed during select time periods: 1700 to1930, 1940 to1970, 1980 to 2000, and 2000 to present. Time period selections were relevant to the important drivers of the span of time that influenced the psychiatric hospitals. Historical review and trend analysis was used to identify the total number of psychiatric hospitals and/or total number of psychiatric hospital beds and psychiatric hospitals by type. Analysis showed there was a cyclical pattern of evolution and devolution of psychiatric hospitals and each cycle altered the form, function, and role of the psychiatric hospital along with altering the location of care for adults and older adults with severe mental illness. The research results suggest a long-stay residential facility, specializing in evidence-based treatment for adults and older adults with severe mental illness, to counter the dire shortage of psychiatric hospital beds.

Thesis (Ph. D.)--Florida State University, 2006.
Advisor: Jill Quadagno, Florida State University, College of Social Sciences, Dept. of Sociology. Title and description from dissertation home page (viewed Sept. 20, 2006). Document formatted into pages; contains viii, 126 pages. Includes bibliographical references.