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1

Turabian, Jose Luis. "Doctor-Patient Relationship: The Difficult Balance between Patient Psychology and Community Sociology." Community Medicine and Health Education Research 1, no. 1 (December 20, 2019): 40–50. http://dx.doi.org/10.33702/cmher.2019.1.1.6.

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Psychology and sociology share a common object of study, human behaviour, but from different perspectives. Sociologists have focused on macro variables, such as social structure, education, gender, age, race, etc., while psychology has focused on micro variables such as individual personality and behaviours, beliefs, empathy, listening, etc. Despite the importance of interpersonal relationship skills, they depend on the community or social context in which communication takes place, and by themselves may have little relevance in the consultation. The purely psychological analysis of the doctor-patient relationship often leads to an idyllic vision, with the patient-centred consultation as the greatest exponent, which rarely occurs in real life. The purely sociological or community / social analysis of the doctor-patient relationship leads to a negative view of the consultation, which is always shown as problematic. But, the psychological system in the doctor-patient relationship cannot be neglected, and its study is of importance, at least as an intermediate mechanism that is created through socio-community relations. Although the same social causes are behind the doctor-patient relationship, when acting on psychological factors in the consultation, they act as an optical prism scattering socio-community relations that affect the doctor and the patient, giving rise to a beam of different colors of doctor-patient relationship. In doctor-patient relationship there is a modality of psychotherapy, where attitudes, thoughts and behaviour of the patient, can be change, as well as it can be extended on the way of understanding and therefore changing, his social context. Because of the distance between socio-community relations and the form of doctor-patient relations is growing in complex societies, under these conditions, the sociological factor gives the important place to the psychological factor. Given these difficulties of the doctor-patient relationship one may ask how general medical practice can persist with the usual model of doctor-patient relationship. Pain and the desire to relieve them are the basic reasons for the patient and the doctor, and they do not disappear due to the contradictions of the doctor-patient relationship. In this way, the confrontation between sociological and psychological vision is replaced by an alliance of both currents, and each of them takes on meaning only in the general vision.
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Roque Pereira, M., A. Fornelos, and A. R. Figueiredo. "Challenging Patient-doctor Interactions in Psychiatry – Difficult Patient Syndrome." European Psychiatry 41, S1 (April 2017): S719. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1297.

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IntroductionThe factors contributing to a challenging interaction between the roles of patient and physician may come from several sources. Each interrelation has its own modus operandis in which one of the individuals may not condone the persona the other individual is portraying. A mental illness or diagnosis is often stigmatised by the burden of stereotypical bizarre associations. That means the patient is generally not guilty and this is not another label they should carry. Though the mental health professional should be impervious to this, some degree of discomfort may throw some shadow on the clinical mediation of the interview and management of the pathology.ObjectiveTo provide an overview of what is beyond the label “difficult patient” in mental health care.AimsEvaluation of conflicts inside the patient-illness-physician triad.MethodsSearch for articles in Pubmed, Athens, Google Scholar databases, along with the hospital library.ResultsCharacteristics of problematic interactions in psychiatric care were described consistently across our references. Causality for these difficulties is vast and surpasses the patient's behaviour. Plus they are not unique in psychiatry. They can be explained by individual, interpersonal, and social factors.ConclusionSituational issues, along with patient and physician characteristics, modulate and frame what should potentially be a productive encounter. To become aware of what contributes to difficult clinical encounters and to be prepared to address them while cultivating good interpersonal communication skills is fundamental.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Choy, Melinda Ada, Elizabeth Sturgiss, Felicity Goodyear-Smith, and Gavin JD Smith. "Digital Health Tools and Patients With Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case-Finding and Help Assessment Tool (eCHAT)." Journal of Medical Internet Research 22, no. 9 (September 14, 2020): e19256. http://dx.doi.org/10.2196/19256.

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Background One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states. Objective The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders. Methods A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis. Results The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy. Conclusions eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor.
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Jose Luis, Turabian. "Psychotropic drugs prescription block the positive effects of the doctor-patient communication and relationship." Archives of Psychiatry and Mental Health 5, no. 1 (February 18, 2021): 014–17. http://dx.doi.org/10.29328/journal.apmh.1001029.

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The fact that general practitioner (GP) or psychiatrist understands the psychosocial effects of prescribing on the doctor-patient relationship is as important, if not more so, than knowing pharmacology. Any prescription of drugs modifies the doctor-patient relationship. Drugs, especially psychotropic drugs, act on symptoms and change thoughts, feelings, and behaviors; they can create both physical and psychological dependency; they can discourage a deep search for real solutions, both on the part of the doctor and the patient; they can affect the doctor’s access to the patient and the problem will be out of their reach. Psychotropic drugs can make the effect of the doctor in himself as a drug more difficult, favor an insignificant or problematic or little human relational context, where the GP/psychiatrist does not delve into the true meaning of the symptoms, and the patient tends not to get involved, to make an emotional withdrawal, to be passive before the prescribed drug, and can result in the chronification and structuring of functional symptoms that become organic, with lack of cooperation of the doctor and the patient, and paradoxically with over-compliance or therapeutic discontinuity and the lack of pharmacological adherence, absences to appointments or delays or cancellations of visits, and the denial of responsibility of both the doctor and the patient.
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Doh, Young Yim, Bugeun Kim, Seul Lee, and Gahgene Gweon. "The Cyclic Value-Context Reinforcement Model of Problematic Internet Use: Empirical Validation Using a Thematic Analysis of Children’s Counseling Data." Journal of Medical Internet Research 22, no. 7 (July 14, 2020): e17996. http://dx.doi.org/10.2196/17996.

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Background Research on problematic internet use has focused on devising diagnostic criteria or describing the factors that influence internet overuse. However, a paradigm shift is necessary in studying the phenomenon of increased internet use not just from a pathological point of view but also from a developmental point of view that considers children’s behavior of adapting to a technology-oriented society. Objective In this paper, we propose the Cyclic Value-Context Reinforcement Model (CVCRM) to understand problematic internet use behavior. The purpose of our study was to construct a developmental process model that provides a holistic understanding of problematic internet use behavior of children and to empirically validate the proposed model by conducting a thematic analysis on actual counseling data. Methods To validate the CVCRM, we conducted thematic analysis using the counseling data from 312 Korean children aged 7-18 years. For the coding process, 7 master’s and doctoral student researchers participated as coders, and 2 professors supervised the coding process and results. Results This project was funded from October 2015 to September 2019 to analyze counseling data from 312 children who participated in counseling sessions during January 2012 to May 2014. Based on the data analysis, we present the CVCRM, which integrates existing theoretical approaches and encompasses the 3 interacting aspects that induce and reinforce problematic internet use in children: psychosocial value, environmental context, and internet utility. Specifically, using counseling data, we empirically ascertained that problematic internet use behavior feeds into children’s psychosocial values and environmental contexts, which in turn facilitates problematic internet use in a cyclical manner. Conclusions Through this empirical validation, the CVCRM can provide a theoretical framework and an integrated perspective on the developmental mechanism of problematic internet use behavior of children.
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Nguyen, Thi Thu Huong, Katherine M. White, Marguerite C. Sendall, and Ross McD Young. "Patterns of drinking alcohol and intentions to binge drink among medical students in Vietnam." Health Education Research 34, no. 4 (June 5, 2019): 447–59. http://dx.doi.org/10.1093/her/cyz019.

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Abstract Alcohol use is common among Vietnamese students. Previous qualitative findings showed Vietnamese medical students believed they were not binge drinkers while reporting many binge drinking occasions they participated in or witnessed. This dichotomy warrants examination. This study aims to establish drinking patterns and examine the factors underlying Vietnamese medical students’ binge drinking intention and behaviour. This study used a prospective-correlational design, with two waves of data collection, drawing from established health behaviour models. At Time 1, 206 students completed the Alcohol Use Disorder Identification Test, the standard Theory of Planned Behaviour measures (attitude, subjective norm and perceived behavioural control) and their underlying beliefs, as well as group norm, role identity, drinking culture and past binge drinking behaviour. At Time 2, 156 medical students reported their binge drinking behaviour 2 weeks later. Only 6.8% of participants were classified as problematic drinkers and few participants reported binge drinking occasions at the 2-week follow-up. Perceived behavioural control, friends’ group norms, role identity as future doctors, and past behaviour significantly predicted binge drinking intentions and key beliefs were identified. This study indicated Vietnamese medical students’ limited engagement with binge drinking and identified key factors to address for those with risky drinking behaviour intentions.
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Arekeeva, Svetlana Timofeevna. "DRAMATURGIC CREATIVITY OF THE UDMURT WRITER-EDUCATOR I. S. MIKHEEV: PROBLEMATICS OF PLAYS, NATURE OF CONFLICTS." Yearbook of Finno-Ugric Studies 13, no. 3 (September 25, 2019): 446–54. http://dx.doi.org/10.35634/2224-9443-2019-13-3-446-454.

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The content of the study is an analysis of the plays by the Udmurt writer-educator I. S. Mikheev in the aspect of identifying their problems, the nature and types of conflicts depicted. Since the conflict is a key category of the dramatic work, the nature of its forming speaks both of the playwright’s skill and the pressing problems that worried him. According to the author of the article, in the works of I. S. Mikheev social, moral, national and socio-political problems are brought up to date, which are revealed through a variety of conflicts. In the plays “En Lushka” (“Do not steal”) and “Viz’tem Onton” (“Stupid Onton”), the playwright depicts the dramatic fate of heroes whose behavior, from the point of view of those around them, contradicts generally accepted morality: in the first case, attention is focused on the role of the “institute” of community, regulating the normative behavior of people in a way of lynching; in another case, on the immutability of God's punishment in relation to a person who has transgressed the permitted line. The playwright devoted his other plays to a rational, culturally enlightened person, free from obsolete habits and prejudices: “Pellyashch’kishch’” (“Fortune-teller”), “Udmurt Doktor” (“Udmurt doctor”); to people who identify themselves with the Udmurt culture and their native language with a wide scope of application: “Udmurt Dyshetyshch” (“Udmurt teacher”); to the independent and possessing equal rights Udmurt people, free from national and social oppression: “Udmurtyoslen revolyutsi poton azh’yn ulemzy” (“Life of the Udmurts before the revolution”). The study of plot conflicts made it possible to establish that the playwright develops a confrontation between the individual and the community, between the individual and the collective; depicts the battle between the old, the obsolete and the advanced, progressive; actualizes the generational gap; reveals social and interethnic contradictions and demarcations.
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Oruh, Emeka Smart, Chima Mordi, Akeem Ajonbadi, Bashir Mojeed-Sanni, Uzoechi Nwagbara, and Mushfiqur Rahman. "Investigating the relationship between managerialist employment relations and employee turnover intention." Employee Relations: The International Journal 42, no. 1 (January 6, 2020): 52–74. http://dx.doi.org/10.1108/er-08-2018-0226.

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Purpose The purpose of this paper is to investigate the relationship between managerialist employment relations and employee turnover intention in Nigeria. The study context is public hospitals in Nigeria, which have a history of problematic human resource management (HRM) practice, a non-participatory workplace culture, managerialist employment relations and a high employee turnover intention. Design/methodology/approach Based on a qualitative, interpretive approach, this paper investigates the process by which Nigerian employment relations practices trigger the employee turnover intention of doctors using 33 semi-structured interviews with key stakeholders in public hospitals. Findings This study found that Nigeria’s managerialist employment relations trigger the employee turnover intention of medical doctors. Additionally, it was found that although managerialist employment relations lead to turnover intention, Nigeria’s unique, non-participatory and authoritarian employment relations system exacerbates this situation, forcing doctors to consider leaving their employment. Research limitations/implications Studies on the interface between managerialism and employment relations are still under-researched and underdeveloped. This paper also throws more light on issues associated with managerialist employment relations and human resources practice including stress, burnout and dissatisfaction. Their relationship with doctors’ turnover intention has significant implications for employment policies, engagement processes and HRM in general. The possibility of generalising the findings of this study is constrained by the limited sample size and its qualitative orientation. Originality/value This paper contributes to the dearth of studies emphasising employer–employee relationship quality as a predictor of employee turnover intention and a mediator between managerialist organisational system and turnover intention. The study further contributes to the discourse of employment relations and its concomitant turnover intention from developing countries’ perspective within the medical sector.
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Waddington, Ivan, Andrea Scott-Bell, and Dominic Malcolm. "The social management of medical ethics in sport: confidentiality in English professional football." International Review for the Sociology of Sport 54, no. 6 (October 9, 2017): 649–65. http://dx.doi.org/10.1177/1012690217733678.

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This paper examines one of the major ethical challenges in the practice of sports medicine, confidentiality. Drawing on interview and questionnaire data with doctors and physiotherapists working in English professional football clubs, it explores the degree to which ethical compliance has improved since the publication of, and publicity surrounding, an earlier study of medical practice in professional football conducted by Waddington and Roderick. Thus, it provides an updated empirical examination of the management of medical ethics in sport. The data illustrate how the physical and social environmental constraints of sports medicine practice impinge upon the protection of athlete-patient confidentiality, how ethical codes and conflicting obligations converge to shape clinician behaviour in relation to lifestyle and injury issues, and the ethically problematic contractual constraints under which clinicians and athletes operate. It demonstrates that medical ethical practice continues to be very variable and draws on Freidson’s work on medical ‘work settings’ to argue that there is a need to augment existing confidentiality policies with more structurally oriented approaches to ensure both professional autonomy and medical ethical compliance in sport.
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Markovic, Lovro, Daragh T. McDermott, Sinisa Stefanac, Radhika Seiler-Ramadas, Darina Iabloncsik, Lee Smith, Lin Yang, Kathrin Kirchheiner, Richard Crevenna, and Igor Grabovac. "Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study." International Journal of Environmental Research and Public Health 18, no. 13 (June 27, 2021): 6895. http://dx.doi.org/10.3390/ijerph18136895.

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Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients’ experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician–patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient–physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.
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Brajović, Mina, Mark Bellis, Andreja Kukec, Nataša Terzić, Adriana Baban, Dinesh Sethi, and Lijana Zaletel-Kragelj. "Impact of adverse childhood experiences on alcohol use in emerging adults in Montenegro and Romania." Slovenian Journal of Public Health 58, no. 3 (June 26, 2019): 129–38. http://dx.doi.org/10.2478/sjph-2019-0017.

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Abstract Background Aiming at generating evidence for formulating targeted and cost-effective public health interventions for the effective control of alcohol use (AU) in emerging adults in South Eastern Europe. The study’s objective was to assess if alcohol users experience adverse childhood experiences (ACE) more often than non-users, and to identify which ACE victims are the most vulnerable to AU. Methods The data was collected in 2010–2012 in two cross-sectional studies conducted in university settings in Montenegro and Romania (overall response rate 89.1%). In the present study, 3,283 students were included. The international ACE Study Questionnaires were used as a base for study instruments for collecting information on ACEs, health behaviours, and socio-economic factors. The association between AU and individual ACEs, adjusted to background factors, was assessed by using logistic regression. Results From the child maltreatment group, three ACEs were included in the final model as statistically significantly associated with AU, all of them from physical neglect/abuse types: frequently being hit so hard to have marks or being injured (OR=1.68; p=0.012), frequently being spanked (OR=1.38; p=0.012), and frequently having no person to take to the doctor if necessary (OR=0.58; p=0.031). From the household dysfunction group, two ACEs were included in the final model: exposure to mental health problems in the household (OR=2.85; p<0.001), and living with a problematic drinker/alcoholic (OR=1.51; p=0.019). Conclusions The effect of exposure to ACEs on AU persists into emerging adulthood. This should be considered when developing cost-effective response to AU burden through targeted interventions, in particular in settings with scarce resources.
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Toth, Gabor, Krisztian Kapus, David Hesszenberger, Marietta Pohl, Gabor Kosa, Julianna Kiss, Gabriella Pusch, Eva Fejes, Antal Tibold, and Gergely Feher. "Internet Addiction and Burnout in A Single Hospital: Is There Any Association?" International Journal of Environmental Research and Public Health 18, no. 2 (January 13, 2021): 615. http://dx.doi.org/10.3390/ijerph18020615.

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The extensive availability of the internet has led to the recognition of problematic internet use, the so-called Internet Addiction (IA), mostly involving adolescents. Burnout can lead to substance abuse or addictive behaviour (such as internet addiction) as a coping method. There are insufficient data about internet addiction and its possible association with burnout in adults, especially among healthcare workers. The aim of our present study was to focus on prevalence and the risk factors of internet addiction and its possible association with burnout among healthcare workers in a single hospital applying a questionnaire-based survey. In total, 49 doctors (10.1%), 198 nurses (40.9%), 123 medical assistant (25.4%), 73 other healthcare workers (15.1%), and 42 (1.7%) healthcare associated workers (cleaning, laundry, etc.) have completed our survey. In a multivariate analysis, IA was associated with age between 18 and 25 (OR: 2.6, p = 0.024), surfing on the internet >5 h daily (OR 25.583, p < 0.001), being single (OR: 4.275, p = 0.006), being childless (OR: 3.81, p = 0.011), working less than five years (OR 2.135, p = 0.048) and job type (being healthcare associated worker, OR: 2.907, p = 0.009). Illicit drug intake (OR 52.494, p < 0.001), and diabetes (OR: 4.122, p = 0.043) were also significantly associated with internet addiction. No association of burnout and IA could be found. A small but significant proportion of our healthcare workers suffered from IA, which was associated with substance abuse and diabetes in multivariate analysis. Our study also draws attention to the risk factors of IA such as younger age, family status, working type and working hours internet use. The possible association of burnout and IA merits further investigation.
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Gorkovaya, Irina Alekseyevna. "Fears among children and overcoming them." Pediatrician (St. Petersburg) 5, no. 3 (September 15, 2014): 128–33. http://dx.doi.org/10.17816/ped53128-133.

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The article examines the fears of children, which are divided into three following groups: the “instinctive” fears (fear of death, death of relatives, fear of doctors, injections, etc.), fears of “interpersonal relations” (fear of being late, did not catch, fear of inability to cope with feelings, fear of disapproval from peers, etc.) and “technological” fears (fear of fire, fly a plane, explosions, etc.). According to the research of 2008- 2011, almost all children revealed a fear of losing their parents. Change is observed in the content side: children 4-6 years were afraid of losing their parents because parents provide their lives. The perception of parents is changing at the age of 7-9 years and children realize love for them, in 10-11 years signs of the partnership and its value appear. Also the fear of school can be attributed like one of the most frequent fears in children and adolescents. The results of our study showed that almost every third child in the preschool group does not want to go to school and / or nega-tively assesses its educational opportunities. Number of school fears decreases with age and in early adolescence 11-12 years is about 20 %. The article contains a description of such ways to overcome fears as: creation of conditions to transfer interactions and feelings on the toy to defuse a tension; drawing as a way of expressing positive and negative emotions; a variety of fairy tales including in the form metaphors of the life path; parent’s ability to control the amount of crisis situations in children using the Diary of a gradual change of the child problematic behaviour and etc. The study examined the phenomenon of “no fear” in children, which has been found in almost every tenth child. Discusses its possible causes and negative sides.
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Hybinette, Karl, Karin Pukk Härenstam, and Mirjam Ekstedt. "A First-line management team’s strategies for sustaining resilience in a specialised intensive care unit—a qualitative observational study." BMJ Open 11, no. 3 (March 2021): e040358. http://dx.doi.org/10.1136/bmjopen-2020-040358.

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ObjectivesAcute care units manage high risk patients at the edge of scientifically established treatments and organisational constraints while aiming to balance reliability to standards with the needs of situational adaptation (resilience). First-line managers are central in coordinating clinical care. Any systemic brittleness will be evident only in retrospect through, for example, care quality measures and accident statistics. This challenges us to understand what successful managerial strategies for adaptation are and how they could be improved. The managerial work of balancing reliability and adaptation is only partially understood. This study aims to explore and describe how system resilience is enhanced by naturally occurring coordination performed in situ by a management team under variable circumstances.DesignAn explorative observational study of a tertiary neonatal intensive care unit (NICU) in Sweden. One year of broad preparatory work followed by focused shadowing observations of coordination analysed through inductive–deductive content analysis from a perspective of resilience engineering.ParticipantsA team of managers (ie, clinical coordinators, head nurses, senior medical doctors).ResultsThe results describe a functional relationship between operational stress and a progression of adjustments in the actual situation, expressed through recurring patterns of adaptation. Managers focused on maintaining coherence in escalating problematic situations by facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations.ConclusionsCoordination supports a coherent goal setting by increased team collaboration and is supported by team members’ abilities to predict the behaviour of each other. Our findings suggest that in design of future research or training for coordination, the focus of assessment and reflection on adaptive managerial responses may lie on situations where the system was ‘stretched’ or ‘needed reorganisation’ and that learning should be about whether the actions were able to achieve short-term goals while preserving the long-term goals.
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Viktorsson, Lisa, Pia Yngman-Uhlin, Eva Törnvall, and Magnus Falk. "Healthcare utilisation and health literacy among young adults seeking care in Sweden: findings from a cross-sectional and retrospective study with questionnaire and registry-based data." Primary Health Care Research & Development 20 (2019). http://dx.doi.org/10.1017/s1463423619000859.

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Abstract Aim: The objective of this study was to examine young adults’ healthcare utilisation and its possible association with health literacy. Background: Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20–29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor. Method: This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischer’s exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation. Findings: Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002). Conclusion: Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults’ reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.
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Puplampu, Adiki. "Unhealthy Communication: Health Care Communication Between Majority and Minority Cultural Groups." MacEwan University Student eJournal 4, no. 1 (November 30, 2020). http://dx.doi.org/10.31542/muse.v4i1.1893.

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Effective communication is important in almost every aspect of life. Within the medical setting, effective communication is paramount because the consequences of miscommunication can be deadly. In health care contexts interpersonal communication is not only affected by the nature of the interaction but also the power differentials between the people participating. The purpose of this paper is to examine how health care communication is affected by power dynamics. Specifically, it will look at the communication between majority-culture doctors and minority patients in order to advance the following argument: the asymmetrical power relationship between doctors and patients is exacerbated when doctors are from majority cultural backgrounds and patients are from minority cultural backgrounds, this is problematic because communication within a medical context is important for patient satisfaction, recall of information, and outcomes. Following the introduction, the literature review explores some of the trends in medical communication literature; these trends include discussions in the literature about the variables and behaviours that affect doctor-patient communication and the critical approach of research done on intercultural medical communication. The section after the literature review establishes that power gaps exist between doctors and patients as well as majority and minority cultural groups. The following paragraphs discuss the negative effects these power differentials have on the intercultural communication between patients and doctors when it comes to patient satisfaction, information recall, and outcomes, before coming to the conclusion that without clear expressions of their communicative differences the communication between these two groups will be compromised.
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Mahmood, Javed Iqbal, Kjersti Støen Grotmol, Martin Tesli, Torbjørn Moum, Ole Andreassen, and Reidar Tyssen. "Life satisfaction in Norwegian medical doctors: a 15-year longitudinal study of work-related predictors." BMC Health Services Research 19, no. 1 (October 22, 2019). http://dx.doi.org/10.1186/s12913-019-4599-7.

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Abstract Background Despite many recent studies on burn-out and dissatisfaction among American medical doctors, less is known about doctors in the Scandinavian public health service. The aims of this study were to analyse long-term work-related predictors of life satisfaction among established doctors in Norway and to identify predictors in a subgroup of doctors who reported a decline in life satisfaction. Methods Two nationwide cohorts of doctors (n = 1052), who graduated medical school 6 years apart, were surveyed at graduation from medical school (T1, 1993/94 and 1999), and 4 (T2), 10 (T3), and 15 (T4) years later. Work-related predictors of life satisfaction (three items) obtained at T2 to T4 were analysed. Individual and lifestyle confounders were controlled for using mixed-models repeated-measures analyses, and logistic regression analyses were applied to identify predictors of the decrease in life satisfaction. Results Ninety per cent (947/1052) responded at least once, and 42% (450/1052) responded at all four times. Work-related predictors of higher life satisfaction in the adjusted model were work–home stress (β = − 0.20, 95% confidence interval [CI] = − 0.25 to − 0.16, p < 0.001), perceived job demands (β = − 0.10, CI = − 0.15 to − 0.05, p < 0.001), and colleague support (β = 0.05, CI = 0.04 to 0.07, p < 0.001). The new adjusted individual predictors that we identified included female gender, reality weakness trait, and problematic drinking behaviour. Neuroticism trait and low colleague support predicted a decrease in life satisfaction. Conclusions Work–home stress, perceived job demands, and colleague support were the most important predictors of life satisfaction related to doctors’ work. When personality traits were controlled for, female doctors were more satisfied with their life than male doctors. These findings suggest that improving work-related factors with targeted interventions, including a supportive work environment, may increase life satisfaction among doctors.
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Poole, Brian R. "Examining the doctoral viva: Perspectives from a sample of UK academics." London Review of Education, December 1, 2015. http://dx.doi.org/10.18546/lre.13.3.12.

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The doctoral viva voce examination has existed in Britain since the PhD (or DPhil) was introduced at Oxford University almost a hundred years ago. However, despite some recent research studies, it seems that the viva remains somewhat under-researched and that viva voce examinations continue to take place according to largely unchanged and unchallenged procedures. This paper presents evidence collected via questionnaire and interview from a sample of UK academics working in education departments at 16 universities in England. It is shown that individuals within the sample hold contrasting views about the purpose, value, and degree of reliability associated with oral assessment at doctoral level. The paper critically examines eight aspects of the viva's design, purpose, conduct, and outcomes, under such headings as 'examiner judgement', 'examiner behaviour/attitudes' and 'the viva as opportunity'. The question of whether examiners should have the power to waive the viva under certain circumstances is also addressed. Rather than attempting to provide definitive answers to such questions, the paper highlights a series of inter-related issues which seem problematic. The author's intention is to spark further discussion in academia about the viva's current and possible future content, conduct, and purposes.
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Milasauskiene, Egle, Julius Burkauskas, Aurelija Podlipskyte, Orsolya Király, Zsolt Demetrovics, Laurynas Ambrasas, and Vesta Steibliene. "Compulsive Internet Use Scale: Psychometric Properties and Associations With Sleeping Patterns, Mental Health, and Well-Being in Lithuanian Medical Students During the Coronavirus Disease 2019 Pandemic." Frontiers in Psychology 12 (August 26, 2021). http://dx.doi.org/10.3389/fpsyg.2021.685137.

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Background: The increase in problematic Internet use (PIU) among medical students and resident doctors during the coronavirus disease 2019 (COVID-19) pandemic may be leading to significant impairments in everyday functioning, including sleeping patterns, anxiety, depressive symptoms, and overall well-being. The Compulsive Internet Use Scale (CIUS) has been developed to assess the severity of PIU, however, it has not been elucidated whether this scale is also applicable to medical students and resident doctors. The first aim of this study was to explore the psychometric properties of the Lithuanian version of the CIUS. The second aim was to examine associations between subjectively reported mental health symptoms and PIU during the COVID-19 pandemic.Methods: A total of 524 medical students and resident doctors (78.60% women, mean age 24 [SD 3] years old) participated in an online survey between December 2020 and February 2021. Participants completed the CIUS, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Assessment-7 (GAD-7), and the WHO—Five Well-Being Index questionnaire (WHO-5).Results: The confirmatory factor analysis (CFA) suggested brief versions (CIUS-5, CIUS-7, and CIUS-9) rather than the original (CIUS-14) version of the CIUS questionnaire as reliable and structurally stable instruments that can be used to measure compulsive Internet use severity in the sample of medical students and resident doctors. The most prevalent online behaviors were social media use (90.1%), online shopping (15.6%), and online gaming/gambling (11.3%). Students with higher CIUS scores reported significantly lower academic achievements during the 6 months (r = 0.12–0.13; p &lt; 0.006), as well as more severe depressive and anxiety symptoms, worsened sleep quality, and lower sense of well-being (r = 0.21–0.41; p's &lt; 0.001). Both, during workdays (d = 0.87) and weekend (d = 0.33), students spent more time online than resident doctors (p's &lt; 0.001).Conclusion: The brief, 5-, 7-, and 9-item versions of the Lithuanian CIUS are reliable and valid self-report screening instruments for evaluating the severity of PIU symptoms among the medical student population. Symptoms of PIU during the COVID-19 period were associated with worsened self-reported mental health and everyday functioning.
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"Workplace Incivility: Causes and Consequences among Nurses." International Journal of Recent Technology and Engineering 8, no. 4S5 (February 5, 2020): 82–86. http://dx.doi.org/10.35940/ijrte.d1030.1284s519.

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Workplace Incivility is labelled by way of rudeness, impolite behaviour towards the employees. This is an alarmingly an important problematic thing for all the organization. Discovering the motives for the Workplace Incivility is the main and primary step for every administration to overcome the problem. This Workplace Incivility comes from both the direction of Supervisor as well as coworker. In this paper, we are going to highlight the reasons of Workplace Incivility from Supervisor and Coworker among nurses and which is leaving the intention to quit the Job. Individuals who are engaging in uncivil behaviour or activities might not have the intention to bully others. Advanced development has been taking place in all the fields, especially in the field of Healthcare. Nurses who are the most trusted professionals in the healthcare industry. After getting advice from the doctors, nurses are the people who are taking care of the patients well and good. The care and wellbeing of nurses also should be taken care by the organization. This paper attempts to bring out the reasons and outcomes of Workplace Incivility among nurses of Karaikudi region. The sample consists of 160 respondents, who were the private hospital nurses at Karaikudi. Convenient sampling technique was followed to collect the sample. In this paper, we have also provided suggestions for the hospital nurses to overcome Workplace Incivility and how to overcome it. ANOVA, Chi-Square, and Garrett Ranking Methods have been adopted to find out the relationships and association between the variables.
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21

Mills, Brett. "Those Pig-Men Things." M/C Journal 13, no. 5 (October 17, 2010). http://dx.doi.org/10.5204/mcj.277.

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Since its return in 2005 the science fiction series Doctor Who (BBC1) has featured many alien creatures which bear a striking similarity to non-human Earth species: the Judoon in “Smith and Jones” (2007) have heads like rhinoceroses; the nurses in “New Earth” (2006) are cats in wimples; the Tritovores in “Planet of the Dead” (2009) are giant flies in boilersuits. Yet only one non-human animal has appeared twice in the series, in unrelated stories: the pig. Furthermore, alien races such as the Judoon and the Tritovores simply happen to look like human species, and the series offers no narrative explanation as to why such similarities exist. When the pig has appeared, however, it has instead been as the consequence of experimentation and mutation, and in both cases the appearance of such porcine hybrids is signalled as horrific, unsettling and, in the end, to be pitied. The fact that the pig has appeared in this way twice suggests there is something about the human understanding of this animal which means it can fulfil a role in fiction unavailable to other Earth species. The pig’s appearance has been in two stories, both two-parters. In “Aliens of London”/“World War Three” (2005) a spaceship crashes into London’s Thames river, and the pilot inside, thought to be dead, is sent to be scientifically examined. Alone in the laboratory, the pathologist Doctor Sato is startled to find the creature is alive and, during its attempt to escape, it is shot by the military. When the creature is examined The Doctor reveals it is “an ordinary pig, from Earth.” He goes on to explain that, “someone’s taken a pig, opened up its brain, stuck bits on, then they’ve strapped it in that ship and made it dive-bomb. It must have been terrified. They’ve taken this animal and turned it into a joke.” The Doctor’s concern over the treatment of the pig mirrors his earlier reprimand of the military for shooting it; as he cradles the dying creature he shouts at the soldier responsible, “What did you do that for? It was scared! It was scared.” On the commentary track for the DVD release of this episode Julie Gardner (executive producer) and Will Cohen (visual effects producer) note how so many people told them they had a significant emotional reaction to this scene, with Gardner adding, “Bless the pig.” In that sense, what begins as a moment of horror in the series becomes one of empathy with a non-human being, and the pig moves from being a creature of terror to one whose death is seen to be an immoral act. This movement from horror to empathy can be seen in the pig’s other appearance, in “Daleks in Manhattan”/“Evolution of the Daleks” (2007). Here the alien Daleks experiment on humans in order to develop the ability to meld themselves with Earthlings, in order to repopulate their own dwindling numbers. Humans are captured and then tested; as Laszlo, one of the outcomes of the experimentation, explains, “They’re divided into two groups: high intelligence and low intelligence. The low intelligence are taken to becomes Pig Slaves, like me.” These Pig Slaves look and move like humans except for their faces, which have prolonged ears and the pig signifier of a snout. At no point in the story is it made clear why experimentations on low intelligence humans should result in them looking like pigs, and a non-hybrid pig is not seen throughout the story. The appearance of the experiments’ results is therefore not narratively explained, and it does not draw on the fact that “in digestive apparatus and nutrient requirements pigs resemble humans in more ways than any mammal except monkeys and apes, which is why pigs are much in demand for [human] medical research” (Harris 70); indeed, considering the story is set in the 1930s such a justification would be anachronistic. The use of the pig, therefore, draws solely on its cultural, not its scientific, associations. These associations are complex, and the pig has been used to connote many things in Western culture. Children’s books such as The Sheep-Pig (King-Smith) and Charlotte’s Web (White) suggest the close proximity of humans and pigs can result in an affinity capable of communication. The use of pigs to represent Poles in Maus: A Survivor’s Tale (Spiegelman), on the other hand, has been read as offensive, drawing on the animal’s association with dirt and greed (Weschler). These depictions are informed by debates about pigs in the real world, whereby an animal which, as mentioned above, is similar enough to humans to be useful in medical research can also, for the food industry, go through a slaughtering process described by Bob Torres as “horribly cruel” (47). Such cruelty can only be justified if the boundaries between the pig and the human are maintained, and this is why pig-human representations are capable of being shocking and horrific. The hybrid nature of the human-pig creature draws on the horror trope that Noël Carroll refers to as “fusion” which works because it “unites attributes held to be categorically distinct” such as “inside/outside, living/dead, insect/human, flesh/machine” (43). He explains that this is why characters in horror narratives do not find such creatures simply fearful, but also “repellent, loathsome, disgusting, repulsive and impure” (54); their failure to conform to accepted cultural categories destabilises assumed norms and, perhaps most horrifically, undermines ‘the human’ as a stable, natural and superior category. As Donna Haraway notes, “‘The species’ often means the human race, unless one is attuned to science fiction, where species abound” (18). Science fiction therefore commonly plays with ideas of species because it is often interested in “the image of the scientist ‘playing god’” (Jones 51) and the horrific outcomes of “the total severing of scientific concerns from ethical concerns” (53). That the result of human/non-human experimentation should be regarded as horrific is evidence of the need to maintain the distinctions between humans and other creatures; after all, a pig/human can only be thought of as horrific if it as assumed that there is something unnatural about the destabilisation of the human category. And it is precisely the human which matters in this equation; it is not really as if anyone cares about the pig’s categorical stability in all of this. In both these stories, the appearance of the pig-creature is narratively structured to be surprising and shocking, and is withheld from the audience for as long as possible. The first appearance of a Pig Slave in “Daleks in Manhattan” constitutes that episode’s pre-credits cliff-hanger, with the creature appearing out of the shadows and bearing down upon the camera, directly towards the audience viewing at home. At this point, the audience has no idea why such a creature exists; the meaning of the pig-human hybrid is contained purely in its visual appearance, with the horrific fact of its contradictory appearance perhaps drawing on the pig’s historical association with evil and the Devil (Sillar and Meyler 82). Similarly, in “Aliens of London” we see Sato’s shocked reaction to the pig far earlier than we actually see the creature ourselves, and Sato’s scream is clearly intended to construct what we have yet to encounter as horrific. The Doctor’s search for the creature is similarly signalled, as he roams dimly-lit corridors trying to find it, following the trail of the grunts and noises that it makes. That the pig might constitute a horrific—or at least unsettling—site for humans is unsurprising considering the cultural roles it has often played. There is, after all, an “opposition between civilization and piggishness” (Ashley, Hollows, Jones and Taylor 2) in which (incorrect) assumptions about pigs’ filthy behaviour helps mark out humanity’s cleaner and more civilised way of living. While this is true of all human/non-human interactions, it is argued that the pig occupies a particular role within this system as it is a “familiar beast” (4) because for centuries it has been a domesticated animal which has often lived alongside humans, usually in quite close proximity. In that sense, humans and pigs are very similar. Demarcating the human as a stable and natural “conceptual category ... in which we place all members of our own species and from which we exclude all non-members” (Milton 265-66) has therefore required the denigration of non-humans, at least partly to justify the dominion humans have decided they have the right to hold over other creatures such as pigs. The difficulties in maintaining this demarcation can be seen in the documentary The Private Life of Pigs (BBC2 2010) in which the farmer Jimmy Docherty carries out a number of tests on animals in order to better understand the ‘inner life’ of the pig. Docherty acknowledges the pig’s similarity to humans in his introductory piece to camera; “When you look in their piggy little eyes with their piggy little eyelashes you see something that reflects back to you—I don’t know—it makes you feel there’s a person looking back.” However, this is quickly followed by a statement which works to reassert the human/non-human boundary; “I know we have this close relationship [with pigs], but I’m often reminded that just beneath the surface of their skin, they’re a wild animal.” Perhaps the most telling revelation in the programme is that pigs have been found to make certain grunting noises only when humans are around, which suggests they have developed a language for ‘interacting’ with humans. That Docherty is uncomfortably startled by this piece of information shows how the idea of communication troubles ideas of human superiority, and places pigs within a sphere hitherto maintained as strictly human. Of course, humans often willingly share domestic spaces with other species, but these are usually categorised as pets. The pet exists “somewhere between the wild animal and the human” (Fudge 8), and we often invest them with a range of human characteristics and develop relationships with such animals which are similar, but not identical, to those we have with other humans. The pig, however, like other food animals, cannot occupy the role afforded to the pet because it is culturally unacceptable to eat pets. In order to legitimise the treatment of the pig as a “strictly utilitarian object; a thing for producing meat and bacon” (Serpell 7) it must be distinguished from the human realm as clearly as possible. It is worth noting, though, that this is a culturally-specific process; Dwyer and Minnegal, for example, show how in New Guinea “pigs commonly play a crucial role in ceremonial and spiritual life” (37-8), and the pig is therefore simultaneously a wild animal, a source of food, and a species with which humans have an “attachment” (45-54) akin to the idea of a pet. Western societies commonly (though not completely) have difficulty uniting this range of animal categories, and analogous ideas of “civilization” often rest on assumptions about animals which require them to play specific, non-human roles. That homo sapiens define their humanity in terms of civilization is demonstrated by the ways in which ideas of brutality, violence and savagery are displaced onto other species, often quite at odds with the truth of such species’ behaviour. The assumption that non-human species are violent, and constitute a threat, is shown in Doctor Who; the pig is shot in “Aliens of London” for assumed security reasons (despite it having done nothing to suggest it is a threat), while humans run in fear from the Pig Slaves in “Evolution of the Daleks” purely because of their non-human appearance. Mary Midgley refers to this as “the Beast Myth” (38) by which humans not only reduce other species to nothing other than “incarnations of wickedness, … sets of basic needs, … crude mechanical toys, … [and] idiot children” (38), but also lump all non-human species together thereby ignoring the specificity of any particular species. Midgley also argues that “man shows more savagery to his own kind than most other mammal species” (27, emphasis in original), citing the need for “law or morality to restrain violence” (26) as evidence of the social structures required to uphold a myth of human civilization. In that sense, the use of pigs in Doctor Who can be seen as conforming to centuries-old depictions of non-human species, by which the loss of humanity symbolised by other species can be seen as the ultimate punishment. After all, when the Daleks’ human helper, Mr Diagoras, fears that the aliens are going to experiment on him, he fearfully exclaims, “What do you mean? Like those pig-men things? You’re not going to turn me into one of those? Oh, God, please don’t!” In the next episode, when all the Pig Slaves are killed by the actions of the Doctor’s companion Martha, she regrets her actions, only to be told, “No. The Daleks killed them. Long ago”, for their mutation into a ‘pig-man thing’ is seen to be a more significant loss of humanity than death itself. The scene highlights how societies are often “confused about the status of such interspecies beings” (Savulescu 25). Such confusion is likely to recur considering we are moving into a “posthumanist” age defined by the “decentering of the human” (Wolfe xv), whereby critiques of traditional cultural categories, alongside scientific developments that question the biological certainty of the human, result in difficulties in defining precisely what it is that is supposedly so special about homo sapiens. This means that it is far too easy to write off these depictions in Doctor Who as merely drawing on, and upholding, those simplistic and naturalised human/non-human distinctions which have been criticised, in a manner similar to sexism and racism, as “speciesist” (Singer 148-62). There is, after all, consistent sympathy for the pig in these episodes. The shooting of the pig in “Aliens of London” is outrageous not merely because it gives evidence of the propensity of human violence: the death of the pig itself is presented as worth mourning, in a manner similar to the death of any living being. Throughout the series the Doctor is concerned over the loss of life for any species, always aiming to find a non-violent method for solving conflicts and repeatedly berating other characters who resort to bloodshed for solutions. Indeed, the story’s narrative can be read as one in which the audience is invited to reassess its own response to the pig’s initial appearance, shifting from fear at its alien-ness to sympathy for its demise. This complication of the cultural meanings of pigs is taken even further in the two-part Dalek story. One of the key plots of the story is the relationship between Laszlo, who has been transmuted into a Pig Slave, and his former lover Tallulah. Tallulah spends much of the story thinking Laszlo has disappeared, when he has, in fact, gone into hiding, certain that she will reject him because of his post-experimentation porcine features. When they finally reunite, Laszlo apologises for what has happened to him, while Tallulah asks, “Laszlo? My Laszlo? What have they done to you?” At the end of the story they decide to try re-establishing their relationship, despite Laszlo’s now-complicated genetic make-up. In response to this Martha asks the Doctor, “Do you reckon it’s going to work, those two?” The Doctor responds that while such an odd pairing might be problematic pretty much anywhere else, as they were in New York they might just get away with it. He reflects, “That’s what this city’s good at. Give me your tired, your poor, your huddled masses, and maybe the odd Pig Slave Dalek mutant hybrid too.” While there is an obvious playfulness to this scene, with the programme foregrounding the kinds of narrative available to the science fiction genre, it is also clear that we are invited to find this a good narrative conclusion, a suitable resolution to all that has preceded it. In that sense, the pig and the human come together, dissolving the human/non-human divide at a stroke, and this is offered to the audience as something to be pleased about. In both narratives, then, the pig moves from being understood as alien and threatening to something if not quite identical to human, then certainly akin to it. Certainly, the narratives suggest that the lives, loves and concerns of pigs—even if they have been experimented upon—matter, and can constitute significant emotional moments in primetime mainstream family television. This development is a result of the text’s movement from an interest in the appearance of the pig to its status as a living being. As noted above, the initial appearances of the pigs in both stories is intended to be frightening, but such terror is dependent on understanding non-human species by their appearance alone. What both of these stories manage to do is suggest that the pig—like all non-human living things, whether of Earth or not—is more than its physical appearance, and via acknowledgment of its own consciousness, and its own sense of identity, can become something with which humans are capable of having sympathy; perhaps more than that, that the pig is something with which humans should have sympathy, for to deny the interior life of such a species is to engage in an inhuman act in itself. This could be seen as an interesting—if admittedly marginal—corrective to the centuries of cultural and physical abuse the pig, like all animals, has suffered. Such representations can be seen as evoking “the dreaded comparison” (Spiegel) which aligns maltreatment of animals with slavery, a comparison that is dreaded by societies because to acknowledge such parallels makes justifying humans’ abusive treatment of other species very difficult. These two Doctor Who stories repeatedly make such comparisons, and assume that to morally and emotionally distinguish between living beings based on categories of species is nonsensical, immoral, and fails to acknowledge the significance and majesty of all forms of life. That we might, as Gardner suggests, “Bless the pig”—whether it has had its brain stuffed full of wires or been merged with a human—points towards complex notions of human/non-human interaction which might helpfully destabilise simplistic ideas of the superiority of the human race. References Ashley, Bob, Joanne Hollows, Steve Jones and Ben Taylor. Food and Cultural Studies. London and New York: Routledge, 2004. Carroll, Noël. The Philosophy of Horror, or, Paradoxes of the Heart. New York and London: Routledge, 1990. Dwyer, Peter D. and Monica Minnegal. “Person, Place or Pig: Animal Attachments and Human Transactions in New Guinea.” Animals in Person: Cultural Perspectives on Human-Animal Intimacies. Ed. John Knight. Oxford and New York: Berg, 2005. 37-60. Fudge, Erica. Pets. Stocksfield: Acumen, 2008. Haraway, Donna J. When Species Meet. Minneapolis and London: University of Minnesota Press, 2008. Harris, Marvin. “The Abominable Pig.” Food and Culture: A Reader. Ed. Carole Counihan and Penny Van Esterik. New York and London: Routledge, 1997. 67-79. Jones, Darryl. Horror: A Thematic History in Fiction and Film. London: Arnold, 2002. King-Smith, Dick. The Sheep-Pig. London: Puffin, 1983. Midgley, Mary. Beast and Man. London and New York: Routledge, 1979/2002. Milton, Kay. “Anthropomorphism or Egomorphism? The Perception of Non-Human Persons by Human Ones.” Animals in Person: Cultural Perspectives on Human-Animal Intimacies. Ed. John Knight. Oxford and New York: Berg, 2005. 255-71. Savulescu, Julian. “Human-Animal Transgenesis and Chimeras Might be an Expression of our Humanity.” The American Journal of Bioethics 3.3 (2003): 22-5. Serpell, James. In the Company of Animals: A Study of Human-Animal Relationships. Cambridge: Cambridge University Press, 1996. Sillar, Frederick Cameron and Ruth Mary Meyler. The Symbolic Pig: An Anthology of Pigs in Literature and Art. Edinburgh and London: Oliver and Boyd, 1961. Singer, Peter. “All Animals are Equal.” Animal Rights and Human Obligations. Ed. Tom Regan and Peter Singer. New Jersey: Prentice-Hall, 1989. 148-62. Spiegel, Marjorie. The Dreaded Comparison: Human and Animal Slavery. London and Philadelphia: Heretic Books, 1988. Speigelman, Art. Maus: A Survivor’s Tale. New York: Pantheon Books, 1986/1991. Torres, Bob. Making a Killing: The Political Economy of Animal Rights. Edinburgh, Oakland and West Virginia: AK Press, 2007. Weschler, Lawrence. “Pig Perplex.” Lingua France: The Review of Academic Life 11.5 (2001): 6-8. White, E.B. Charlotte’s Web. London: Harper Collins, 1952. Wolfe, Cary. What is Posthumanism? Minneapolis and London: University of Minnesota Press, 2010.
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Guo, Weirong, and Bin Xu. "Dignity in Red Envelopes: Disreputable Exchange and Cultural Reproduction of Inequality in Informal Medical Payment." Social Psychology Quarterly, September 25, 2021, 019027252110448. http://dx.doi.org/10.1177/01902725211044815.

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Disreputable exchanges are morally disapproved and often legally prohibited exchanges that exacerbate and reproduce social inequality but remain ubiquitous. Although previous literature explains the phenomenon by material interests and structural relations, we propose a cultural approach based on three major conceptions of culture: culture in relations, culture in interactions, and culture in inequality. We illustrate this approach by a case study of China’s hongbao (the red envelope) exchange, a typical disreputable exchange through informal medical payment. Drawing on interviews with doctors and patients, we find that participants of the exchange mobilize items from their cultural repertoires, such as professional ethics, face, power, fairness, and affection, to redefine different situations of interactions and project positive self–images to render their problematic exchanges morally acceptable to each other. Moreover, as the participants’ responses to our vignettes show, they negatively evaluate the exchanges in general moral terms, such as equality and fairness, but culturally justify their own involvement. This discrepancy between saying and doing tends to legitimize the disreputable exchange amid enduring public outrage and institutional prohibition. These cultural processes contribute to the reproduction of unequal access to scarce health care resources. Findings of this research not only offer insights into understanding disreputable exchanges but also contribute to research on other cases of social problems in which deviant behaviors are morally and culturally justified.
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Teague, Christine, Lelia Green, and David Leith. "An Ambience of Power? Challenges Inherent in the Role of the Public Transport Transit Officer." M/C Journal 13, no. 2 (April 15, 2010). http://dx.doi.org/10.5204/mcj.227.

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In the contemporary urban environment of mass transit, it falls to a small group of public officers to keep large number of travellers safe. The small size of their force and the often limited powers they exert mean that these public safety ‘transit officers’ must project more authority and control than they really have. It is this ambience of authority and control which, in most situations they encounter and seek to influence, is enough to keep the public safe. This paper examines the ambience of a group of transit officers working on the railway lines of an Australian capital city. We seek to show how transit officers are both influenced by, and seek to influence, the ambience of their workplace and the public spaces they inhabit whilst on duty, and here we take ambience to apply to the surrounding atmosphere, the aura, and the emotional environment of a place or situation: the setting, tone, or mood. For these transit officers to keep the public safe, they must themselves remain safe. A transit officer who is disabled in a confrontation with a violent offender is unable to provide protection to his or her passengers. Thus, in the culture of the transit officers, their own workplace safety takes on a higher significance. It affects not just themselves. The ambience exuded by transit officers, and how transit officers see their relationship with the travelling public, their management and other organisational work groups, is an important determinant of their work group’s safety culture. Researching the Working Lives of Transit Officers in Perth Our discussion draws on an ethnographic study of the working lives and communication cultures of transit officers (TOs) employed by the Public Transport Authority (PTA) of Western Australia (WA). Transit officers have argued that to understand fully the challenges of their work it is necessary to spend time with them as they undertake their daily duties: roster in, roster out. To this end, the research team and the employer organisation secured an ARC Linkage Grant in partnership with the PTA to fund doctoral candidate and ethnographer Christine Teague to research the workers’ point of view, and the workers’ experiences within the organisation. The two-hundred TOs are unique in the PTA. Neither of the other groups who ride with them on the trains, the drivers and revenue protection staff (whose sole job is to sell and check tickets), experiences the combination of intense contact with passengers, danger of physical injury or group morale. The TOs of the PTA in Perth operate from a central location at the main train station and the end stations on each line. Here there are change lockers where they can lock up their uniforms and equipment such as handcuffs and batons when not on duty, an equipment room where they sign out their radios, and ticket-checking machines. At the main train station there is also a gym, a canteen and holding cells for offenders they detain. From these end stations and central location, the TOs fan out across the network to all suburbs where they either operate from stations or onboard the trains. The TOs also do ‘delta van’ duty providing rapid, mobile back-up support for their colleagues on stations or trains, and providing transport for arrested persons to the holding cell or police lock up. TOs are on duty whenever the trains are running–but the evenings and nights are when they are mainly rostered on. This is when trouble mostly occurs. The TOs’ work ends only after the final train has completed its run and all offenders who may require detaining and charging have been transferred into police custody. While the public perceive that security is the TOs’ most frequent role, much of the work involves non-confrontational activity such as assisting passengers, checking tickets and providing a reassuring presence. One way to deal with an ambiguous role is to claim an ambience of power and authority regardless. Various aspects of the TO role permit and hinder this, and the paper goes on to consider aspects of ambience in terms of fear and force, order and safety, and role confusion. An Ambience of Fear and Force The TOs are responsible for front-line security in WA’s urban railway network. Their role is to offer a feeling of security for passengers using the rail network after the bustle of the work day finishes, and is replaced by the mainly recreational travels of the after hours public. This is the time when some passengers find the prospect of evening travel on the public transport rail network unsettling–so unsettling that it was a 2001 WA government election promise (WA Legislative Council) that every train leaving the city centre after 7pm would have two TOs riding on it. Interestingly, recruitment levels have never been high enough for this promise to be fully kept. The working conditions of the TOs reflect the perception, and to an extent, the reality that some late night travel on public transport involves negotiating an edgy ambience with an element of risk, rubbing shoulders with people who may be loud, rowdy, travelling in a group, and or drug and alcohol affected. As Fred (all TO names are pseudonyms) comments: You’re not dealing with rational people, you’re not dealing with ‘people’: most of the people you’re dealing with are either drunk or under the influence of drugs, so they’re not rational, they don’t hear you, they don’t understand what you’re saying, they just have no sense of what’s right or wrong, you know? Especially being under the influence, so I mean, you can talk till you’re blue in the face with somebody who’s drunk or on drugs, I mean, all you have to say is one thing. ‘Oh, can I see your ticket please’, ‘oh, why do I need a fucking ticket’, you know? They just don’t get simple everyday messages. Dealing with violence and making arrest is a normal part of this job. Jo described an early experience in her working life as a TO:Within the first week of coming out of course I got smacked on the side of the head, but this lady had actually been certified, like, she was nuts. She was completely mental and we were just standing on the train talking and I’ve turned around to say something to my partner and she was fine, she was as calm as, and I turned around and talked to my partner and the next thing I know I ended up with her fist to the side of my head. And I went ‘what the hell was that’? And she went off, she went absolutely ballistic. I ended up arresting her because it was assault on an officer whether she was mental or not so I ended up arresting her.Although Jo here is describing how she experienced an unprovoked assault in the early days of her career as a TO, one of the most frequent precursors to a TO injury occurs when the TO is required to make an arrest. The injury may occur when the passenger to be arrested resists or flees, and the TO gives chase in dark or treacherous circumstances such as railway reserves and tunnels, or when other passengers, maybe friends or family of the original person of concern, involve themselves in an affray around the precipitating action of the arrest. In circumstances where capsicum spray is the primary way of enforcing compliance, with batons used as a defence tool, group members may feel that they can take on the two TOs with impunity, certainly in the first instance. Even though there are security cameras on trains and in stations, and these can be cued to cover the threatening or difficult situations confronting TOs, the conflict is located in the here-and-now of the exchanges between TOs and the travelling public. This means the longer term consequence of trouble in the future may hold less sway with unruly travellers than the temptation to try to escape from trouble in the present. In discussing the impact of remote communications, Rubert Murdoch commented that these technologies are “a powerful influence for civilised behaviour. If you are arranging a massacre, it will be useless to shoot the cameraman who has so inconveniently appeared on the scene. His picture will already be safe in the studio five thousand miles away and his final image may hang you” (Shawcross 242). Unfortunately, whether public aggression in these circumstances is useless or not, the daily experience of TOs is that the presence of closed circuit television (CCTV) does not prevent attacks upon them: nor is it a guarantee of ‘civilised behaviour’. This is possibly because many of the more argumentative and angry members of the public are dis-inhibited by alcohol or other drugs. Police officers can employ the threat or actual application of stun guns to control situations in which they are outnumbered, but in the case of TOs they can remain outnumbered and vulnerable until reinforcements arrive. Such reinforcements are available, but the situation has to be managed through the communication of authority until the point where the train arrives at a ‘manned’ station, or the staff on the delta vehicle are able to support their colleagues. An Ambience of Order and Safety Some public transport organisations take this responsibility to sustain an ambience of order more seriously than others. The TO ethnographer, Christine Teague, visited public transport organisations in the UK, USA and Canada which are recognised as setting world-class standards for injury rates of their staff. In the USA particularly, there is a commitment to what is called ‘the broken windows’ theory, where a train is withdrawn from service promptly if it is damaged or defaced (Kelling and Coles; Maple and Mitchell). According to Henry (117): The ‘Broken Windows’ theory suggests that there is both a high correlation and a causal link between community disorder and more serious crime: when community disorder is permitted to flourish or when disorderly conditions or problems are left untended, they actually cause more serious crime. ‘Broken windows’ are a metaphor for community disorder which, as Wilson and Kelling (1982) use the term, includes the violation of informal social norms for public behaviour as well as quality of life offenses such as littering, graffiti, playing loud radios, aggressive panhandling, and vandalism.This theory implies that the physical ambience of the train, and by extension the station, may be highly influential in terms of creating a safe working environment. In this case of ‘no broken window’ organisations, the TO role is to maintain a high ‘quality of life’ rather than being a role predominantly about restraining and bringing to justice those whose behaviour is offensive, dangerous or illegal. The TOs in Perth achieve this through personal means such as taking pride in their uniforms, presenting a good-natured demeanour to passengers and assisting in maintaining the high standard of train interiors. Such a priority, and its link to reduced workforce injury, suggests that a perception of order impacts upon safety. It has long been argued that the safety culture of an organisation affects the safety performance of that organisation (Pidgeon; Leplat); but it has been more recently established that different cultural groupings in an organisation conceive and construct their safety culture differently (Leith). The research on ‘safety culture’ raises a problematic which is rarely addressed in practice. That problematic is this: managers frequently engage with safety at the level of instituting systems, while workers engage with safety in terms of behaviour. When Glendon and Litherland comment that, contrary to expectations, they could find no relationship between safety culture and safety performance, they were drawing attention to the fact that much managerial safety culture is premised upon systems involving tick boxes and the filling in of report forms. The broken window approach combines the managerial tick box with managerial behaviour: a dis-ordered train is removed from service. To some extent a general lack of fit between safety culture and safety performance endorses Everett’s view that it is conceptually inadequate to conceive organisations as cultures: “the conceptual inadequacy stems from the failure to distinguish between culture and behavioural features of organizational life” (238). The general focus upon safety culture as a way of promoting improvements in safety performance assumes that compliance with a range of safety systems will guarantee a safe workplace. Such an assumption, however, risks positioning the injured worker as responsible for his or her own predicament and sets up an environment in which some management officials are wont to seek ways in which that injured worker’s behaviour failed to conform with safety rules or safety processes. Yet there are roles which place workers in harm’s way, including military duties, law enforcement and some emergency services. Here, the work becomes dangerous as it becomes disorderly. An Ambience of Roles and Confusion As the research reported here progressed, it became clear that the ambience around the presentation of the self in the role of a TO (Goffman) was an important part of how ‘safety’ was promoted and enacted in their work upon the PTA (WA) trains, face to face with the travelling public. Goffman’s view of all people, not specifically TOs, is that: Regardless of the particular objective which the individual has in mind and of his motive for having this objective, it will be in his interests to control the conduct of the others, especially their responsive treatment of him. This will largely be through influencing the perception and definition that others will come to formulate of him. He will influence them by expressing himself in such a way that the kind of impression given off will lead them to act voluntarily in accordance with his own plan. (3)This ‘influencing of perception’ is an important element of performing the role of a TO. This task of the TOs is made all the more difficult because of confusions about their role in relation to two other officers: police (who have more power to act in situations of public safety) and revenue project officers (who have less), as we now discuss. The aura of the TO role borrows somewhat from those quintessential law and order officers: the police. TOs work in pairs, like many police, to support each other. They have a range of legal powers including the power of arrest, and they carry handcuffs, a baton and capsicum spray as a means of helping ensure their safety and effectiveness in circumstances where they might be outnumbered. The tools of their trade are accessibly displayed on heavy leather belts around their waists and their uniforms have similarities with police uniforms. However, in some ways these similarities are problematic, because TOs are not afforded the same respect as police. This situation underlines of the ambiguities negotiated within the ambience of what it is to be a TO, and how it is to conduct oneself in that role. Notwithstanding the TOs’ law and order responsibilities, public perceptions of the role and some of the public’s responses to the officers can position these workers as “plastic cops” (Teague and Leith). The penultimate deterrent of police officers, the stun gun (Taser), is not available to TOs who are expected to control all incidents arising on duty through the fact that they operate in pairs, with capsicum spray available and, as a last resort, are authorised to use their batons in self defence. Furthermore, although TOs are the key security and enforcement staff in the PTA workforce, and are managed separately from related staff roles, they believe that the clarity of this distinction is compromised because of similarities in the look of Revenue Protection Officers (RPOs). RPOs work on the trains to check that passengers have tickets and have paid the correct fares, and obtain names and addresses to issue infringement notices when required. They are not PTA employees, but contracted staff from an outside company. They also work in pairs. Significantly, the RPO uniform is in many respects identical to that of the TO, and this appears to be a deliberate management choice to make the number of TOs seem greater than it is: extending the TO ambience through to the activities of the RPOs. However, in the event of a disturbance, TOs are required and trained to act, while RPOs are instructed not to get involved; even though the RPOs appear to the travelling public to be operating in the role of a law-and-order-keeper, RPOs are specifically instructed not to get involved in breaches of the peace or disruptive passenger behaviour. From the point of view of the travelling public, who observe the RPO waiting for TOs to arrive, it may seems as if a TO is passively standing by while a chaotic situation unravels. As Angus commented: I’ve spoken to quite a few members of public and received complaints from them about transit officers and talking more about the incident have found out that it was actually [RPOs] that are dealing with it. So it’s creating a bad image for us …. It’s Transits that are copping all the flak for it … It is dangerous for us and it’s a lot of bad publicity for us. It’s hard enough, the job that we do and the lack of respect that we do get from people, we don’t need other people adding to it and making it harder. Indeed, it is not only the travelling public who can mistake the two uniforms. Mike tells of an “incident where an officer [TO] has called for backup on a train and the guys have got off [the train at the next station] and just stood there, and he didn’t realise that they are actually [revenue protection] officers, so he effectively had no backup. He thought he did, but he didn’t.” The RPO uniform may confer an ambience of power borrowed from TOs and communicated visually, but the impact is to compromise the authority of the TO role. Unfortunately, what could be a complementary role to the TOs becomes one which, in the minds of the TO workforce, serves to undermine their presence. This effect of this role confusion is to dilute the aura of authority of the TOs. At one end of a power continuum the TO role is minimised by those who see it as a second-rate ‘Wannabe cop’ (Teague and Leith 2008), while its impact is diluted at the other end by an apparently deliberate confusion between the TO broader ‘law and order’ role, and the more limited RPO revenue collection activities. Postlude To the passengers of the PTA in Perth, the presence and actions of transit officers appear as unremarkable as the daily commute. In this ethnographic study of their workplace culture, however, the transit officers have revealed ways in which they influence the ambience of the workplace and the public spaces they inhabit whilst on duty, and how they are influenced by it. While this ambient inter-relationship is not documented in the organisation’s occupational safety and health management system, the TOs are aware that it is a factor in their level at safety at work, both positively and negatively. Clearly, an ethnography study is conducted at a certain point in time and place, and culture is a living and changing expression of human interaction. The Public Transport Authority of Western Australia is committed to continuous improvement in safety and to the investigation of all ways and means in which to support TOs in their daily activities. This is evident not only in their support of the research and their welcoming of the ethnographer into the workforce and onto the tracks, but also in their robust commitment to change as the findings of the research have progressed. In particular, changes in the ambient TO culture and in the training and daily practices of TOs have already resulted from this research or are under active consideration. Nonetheless, this project is a cogent indicator of the fact that a safety culture is critically dependent upon intangible but nonetheless important factors such as the ambience of the workplace and the way in which officers are able to communicate their authority to others. References Everett, James. “Organizational Culture and Ethnoecology in Public Relations Theory and Practice.” Public Relations Research Annual. Vol. 2. Eds. Larissa Grunig and James Grunig. Hillsdale, NJ, 1990. 235-251. Glendon, Ian, and Debbie Litherland. “Safety Climate Factors, Group Differences and Safety Behaviour in Road Construction.” Safety Science 39.3 (2001): 157-188. Goffman, Erving. The Presentation of the Self in Everyday Life. London: Penguin, 1959. Henry, Vincent. The Comstat Paradigm: Management Accountability in Policing, Business and the Public Sector. New York: Looseleaf Law Publications, 2003. Kelling, George, and Catherine Coles. Fixing Broken Windows: Restoring Order and Reducing Crime in Our Communities. New York: Touchstone, 1996. Leith, David. Workplace Culture and Accidents: How Management Can Communicate to Prevent Injuries. Saarbrücken: VDM Verlag, 2008. Leplat, Jacques. “About Implementation of Safety Rules.” Safety Science 29.3 (1998): 189-204. Maple, Jack, and Chris Mitchell. The Crime Fighter: How You Can Make Your Community Crime-Free. New York: Broadway Books, 1999. Pidgeon, Nick. “Safety Culture and Risk Management in Organizations.” Journal of Cross-Cultural Psychology 22.1 (1991): 129-140. Shawcross, William. Rupert Murdoch. London: Chatto & Windus, 1992. Teague, Christine, and David Leith. “Men of Steel or Plastic Cops? The Use of Ethnography as a Transformative Agent.” Transforming Information and Learning Conference Transformers: People, Technologies and Spaces, Edith Cowan University, Perth, WA, 2008. ‹http://conferences.scis.ecu.edu.au/TILC2008/documents/2008/teague_and_leith-men_of_steel_or_plastic_cops.pdf›. Wilson, James, and George Kelling. “Broken Windows.” The Atlantic Monthly (Mar. 1982): 29-38. WA Legislative Council. “Metropolitan Railway – Transit Guards 273 [Hon Ed Dermer to Minister of Transport Hon. Simon O’Brien].” Hansard 19 Mar. 2009: 2145b.
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Fredericks, Bronwyn, and Pamela CroftWarcon. "Always “Tasty”, Regardless: Art, Chocolate and Indigenous Australians." M/C Journal 17, no. 1 (March 3, 2014). http://dx.doi.org/10.5204/mcj.751.

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Abstract:
Black women are treated as though we are a box of chocolates presented to individual white women for their eating pleasure, so they can decide for themselves and others which pieces are most tasty (hooks 80). Introduction bell hooks equates African-American women with chocolates, which are picked out and selected for someone else’s pleasure. In her writing about white women who have historically dominated the feminist movement, hooks challenges the ways that people conceptualise the “self” and “other”. She uses a feminist lens to question widespread assumptions about the place of Black women in American society. hooks’s work has been applied to the Australian context by Bronwyn Fredericks, to explore the ways that Aboriginal women and men are perceived and “selected” by the broader Australian society. In this paper, we extend previous work about the metaphor of chocolate to discuss the themes underpinning an art exhibition—Hot Chocolate—which was curated by Troy-Anthony Baylis and Frances Wyld. Baylis and Wyld are Aboriginal Australians who are based in Adelaide and whose academic and creative work is centred within South Australia. The exhibition was launched on 14 November 2012 as part of Adelaide’s Visual Arts Program Feast Festival 2012 (CroftWarcon and Fredericks). It was curated in Adelaide’s SASA Gallery (which is associated with the School of Art, Architecture and Design at the University of South Australia). This paper focuses on the development of Hot Chocolate and the work produced by Aboriginal artists contained within it, and it includes a conversation about the work of Pamela CroftWarcon. Moreover, it discusses these works produced by the artists and links them back to the issues of identity and race, and how some Aboriginal people are selected like chocolates over and above others. In this, we are interested in exploring some of the issues around politics, desire, skin, and the fetishisation of race and bodies. The Metaphor of Chocolate This work will focus on how Aboriginal Australians are positioned as “chocolates” and how people of colour are viewed by the wider society, and about whether people have a pliable “soft centre” or a brittle “hard centre.” It uses hooks’s work as a point of reference to the power of the metaphor of chocolate in considering questions about who is “tasty.” In the Australian context, some Aboriginal people are deemed to be more “tasty” than others, in terms of what they say, write, and do (or what they avoid saying, writing, or doing). That is, they are seen as being sweeter chocolates and nicer chocolates than others. We understand that some people find it offensive to align bodies and races of people with chocolate. As Aboriginal women we do not support the use of the term ‘chocolate’ or use it when we are referring to other Aboriginal people. However, we both know of other Aboriginal people who use the metaphor of chocolate to talk about themselves, and it is a metaphor that other people of colour throughout the world similarly might use or find offensive. Historically, chocolate and skin colour have been linked, and some people now see these connections as something that reminds them of a colonial and imperial past (Gill). Some Aboriginal people are chosen ahead of others, perhaps because of their “complementary sweetness,” like an after-dinner mint that will do what the government and decision makers want them to do. They might be the ones who are offered key jobs and positions on government boards, decision-making committees, or advisory groups, or given priority of access to the media outlets (Fredericks). Through these people, the government can say, “Aboriginal people agree with us” or “this Aboriginal person agrees with us.” Aileen Moreton-Robinson is important to draw upon here in terms of her research focused on white possession (2005). Her work explains how, at times, non-Indigenous Anglo-Australians may act in their own interests to further invest in their white possession rather than exercise power and control to make changes. In these situations, they may select Aboriginal people who are more likely to agree with them, ether knowingly or in ignorance. This recycles the colonial power gained through colonisation and maintains the difference between those with privilege and those without. Moreover, Aboriginal people are further objectified and reproduced within this context. The flip side of this is that some Aboriginal people are deemed to be the “hard centres” (who are not pliable about certain issues), the “less tasty” chocolates (who do not quite take the path that others expect), or the “brittle” types that stick in your teeth and make you question whether you made the right choice (who perhaps challenge others and question the status quo). These Aboriginal people may not be offered the same access to power, despite their qualifications and experience, or the depth of their on-the-ground, community support. They may be seen as stirrers, radicals, or trouble makers. These perceptions are relevant to many current issues in Australia, including notions of Aboriginality. Of course, some people do not think about the chocolate they choose. They just take one from the box and see what comes out. Perhaps they get surprised, perhaps they are disappointed, and perhaps their perceptions about chocolates are reinforced by their choice. In 2011, Cadbury was forced to apologise to Naomi Campbell after the supermodel claimed that an advertisement was racist in comparing her to a chocolate bar (Sweney). Cadbury was established in 1824 by John Cadbury in Birmingham, England. It is now a large international corporation, which sells chocolate throughout the world. The advertisement for Cadbury’s Bliss range of Dairy Milk chocolate bars used the strapline, “Move over Naomi, there's a new diva in town” (Moss). Campbell (quoted in Moss) said she was “shocked” by the ad, which was intended as a tongue-in-cheek play on Campbell's reputation for diva-style tantrums and behaviour. “It's upsetting to be described as chocolate, not just for me but for all black women and black people,” she said. “I do not find any humour in this. It is insulting and hurtful” (quoted in Moss). This is in opposition to the Aboriginal artists in the exhibition who, although as individuals might find it insulting and hurtful, are using the chocolate reference to push the boundaries and challenge the audience’s perceptions. We agree that the metaphor of chocolate can take us to the edge of acceptable discussion. But we also believe that being at the edge of acceptability allows us to explore issues that are uncomfortable. We are interested in using the metaphor of chocolate to explore the ways that non-Indigenous people view Aboriginal Australians, and especially, discussions around the politics of identity, desire, skin, and the fetishisation of race and bodies. Developing the Exhibition The Hot Chocolate exhibition connected chocolate (the food) and Hot Chocolate (the band) with chocolate-coloured people. It was developed by Troy-Anthony Baylis and Frances Wyld, who invited nine artists to participate in the exhibition. The invited artists were: Troy-Anthony Baylis, Bianca Beetson, Pamela CroftWarcon, Cary Leibowitz, Yves Netzhammer + Ralph Schraivogel, Nat Paton, Andrew Putter and Dieter Roth (CroftWarcon and Fredericks). The exhibition was built around questions of what hot chocolate is and what it means to individuals. For some people, hot chocolate is a desirable, tasty drink. For others, hot chocolate brings back memories of music from the British pop band popular during the 1970s and early 1980s. For people with “chocolate-coloured skin”, chocolate can be linked to a range of questions about desirability, place, and power. Hot Chocolate, the band, was based in Britain, and was an inter-racial group of British-born musicians and immigrants from Jamaica, the Bahamas, Trinidad and Grenada. The title and ethnic diversity of the group and some of their song lyrics connected with themes for curatorial exploration in the Hot Chocolate exhibition. For example: I believe in miracles. Where you from, you sexy thing? … Where did you come from baby? ... Touch me. Kiss me darling… — You Sexy Thing (1975). It started with a kiss. I didn’t know it would come to this… — It Started With A Kiss (1983). When you can't take anymore, when you feel your life is over, put down your tablets and pick up your pen and I'll put you together again… — I’ll Put You Together Again (1978). All nine artists agreed to use lyrics by Hot Chocolate to chart their journeys in creating artworks for the exhibition. They all started with the lyrics from It Started With A Kiss (1983) to explore ways to be tellers of their own love stories, juxtaposed with the possibility of not being chosen or not being memorable. Their early work explored themes of identity and desirability. As the artists collaborated they made many references to both Hot Chocolate song lyrics and to hooks’s discussion about different “types” of chocolate. For example, Troy-Anthony Baylis’s Emotional Landscape (1997-2010) series of paintings is constructed with multiple “x” marks that represent “a kiss” and function as markers for creating imaginings of Country. The works blow “air kisses” in the face of modernity toward histories of the colonial Australian landscape and art that wielded power and control over Aboriginal subjects. Each of the nine artists linked chocolate with categorisations and constructions of Aboriginality in Australia, and explored the ways in which they, as both Aboriginal peoples and artists, seemed to be “boxed” (packaged) for others to select. For some, the idea that they could be positioned as “hot chocolate”—as highly desirable—was novel and something that they never expected at the beginning of their art careers. Others felt that they would need a miracle to move from their early “box” into something more desirable, or that their art might be “boxed” into a category that would be difficult to escape. These metaphors helped the artists to explore the categories that are applied to them as artists and as Aboriginal people and, particularly, the categories that are applied by non-Indigenous people. The song lyrics provided unifying themes. I’ll Put You Together Again (1978) is used to name the solidarity between creative people who are often described as “other”; the lyrics point the way to find the joy in life and “do some tastin'.” You Sexy Thing (1975) is an anthem for those who have found the tastiness of life and the believing in miracles. In You Sexy Thing, Hot Chocolate ask “Where you from?”, which is a question that many Aboriginal people use to identify each others’ mobs and whom they belong to; this question allows for a place of belonging and identity, and it is addressed right throughout the exhibition’s works. The final section of the exhibition uses the positive Everyone’s A Winner (1978) to describe a place that satisfies. This exhibition is a winner, and “that’s no lie.” Pamela CroftWarcon’s Works In a conversation between this paper’s authors on 25 November 2013, Dr Pamela CroftWarcon reflected on her contributions to the Hot Chocolate exhibition. In this summary of the conversation, CroftWarcon tells the story of her artwork, her concepts and ideas, and her contribution to the exhibition. Dr Pamela CroftWarcon (PC): I am of the Kooma clan, of the Uralarai people, from south-west Queensland. I now live at Keppel Sands, Central Queensland. I have practised as a visual artist since the mid-1980s and have worked as an artist and academic regionally, nationally, and internationally. Bronwyn Fredericks (BF): How did you get involved in the development of Hot Chocolate? PC: I was attending a writing workshop in Brisbane, and I reconnected with you, Bronwyn, and with Francis Wyld. We began to yarn about how our lives had been, both personally and professionally, since the last time we linked up. Francis began to talk about an idea for an exhibition that she and Troy wanted to bring together, which was all about Hot Chocolate. As we talked about the idea for a Hot Chocolate exhibition, I recalled a past discussion about the writing of bell hooks. For me, hooks’s work was like an awakening of the sense and spirit, and I have shared hooks’s work with many others. I love her comment about Black women being “like a box of chocolates”. I can understand what she is saying. Her work speaks to me; I can make sense of it and use it in my arts practice. I thus jumped at the chance to be involved. BF: How do you understand the concepts that frame the exhibition? PC: Many of the conversations I have had with other Aboriginal people over the years have included issues about the politics of living in mixed-race skin. My art, academic papers, and doctoral studies (Croft) have all focused on these issues and their associated politics. I call myself a “fair-skinned Murri”. Many non-Indigenous Australians still associate the colour of skin with authentic Aboriginal identity: you have to be dark skinned to be authentic. I think that humour is often used by Aboriginal people to hide or brush away the trauma that this kind of classification can cause and I wanted to address these issues in the exhibition. Many of the exhibition’s artworks also emphasise the politics of desire and difference, as this is something that we as Indigenous people continually face. BF: How does your work connect with the theme and concepts of the exhibition? PC: My art explores the conceptual themes of identity, place and Country. I have previously created a large body of work that used found boxes, so it was quite natural for me to think about “a box of chocolates”! My idea was to depict bell hooks’s ideas about people of colour and explore ways that we, as Aboriginal people in Australia, might be similar to a box of chocolates with soft centres and hard centres. BF: What mediums do you use in your works for the exhibition? PC: I love working with found boxes. For this work, I chose an antique “Winning Post” chocolate box from Nestlé. I was giving new life to the box of chocolates, just with a different kind of chocolate. The “Winning Post” name also fitted with the Hot Chocolate song, Everyone’s A Winner (1978). I kept the “Winning Post” branding and added “Dark Delicacies” as the text along the side (see Figure 1). Figure 1.Nestle’s “Winning Post” Chocolate Box. Photograph by Pamela CroftWarcon 2012. PC: I bought some chocolate jelly babies, chocolates and a plastic chocolate tray – the kind that are normally inserted into a chocolate box to hold the chocolates, or that you use to mould chocolates. I put chocolates in the bottom of the tray, and put chocolate jelly babies on the top. Then I placed them into casting resin. I had a whole tray of little chocolate people standing up in the tray that fitted into the “Winning Post” box (see Figures 2 and 3). Figure 2. Dark Delicacies by Pamela CroftWarcon, 2012. Photograph by Bronwyn Fredericks 2012. Figure 3. Dark Delicacies by Pamela CroftWarcon, 2012. Photograph by Pamela CroftWarcon 2012. PC: The chocolate jelly babies in the artwork depict Aboriginal people, who are symbolised as “dark delicacies”. The “centres” of the people are unknown and waiting to be picked: maybe they are sweet; maybe they are soft centres; maybe they are hard centres. The people are presented so that others can decide who is “tasty”─maybe politicians or government officers, or maybe “individual white women for their eating pleasure” (hooks) (see Figures 4 and 5). Figure 4. Dark Delicacies by Pamela CroftWarcon, 2012. Photograph by Pamela CroftWarcon 2012. Figure 5. Dark Delicacies by Pamela CroftWarcon, 2012. Photograph by Pamela CroftWarcon 2012. BF: What do you hope the viewers gained from your works in the exhibition? PC: I want viewers to think about the power relationship between Indigenous and non-Indigenous Australians. I want people to listen with their ears, heart, mind, and body, and accept the challenges and changes that Indigenous people identify as being necessary. Icould have put names on the chocolates to symbolise which Aboriginal people tend to be selected ahead of others, but that would have made it too easy, and maybe too provocative. I didn’t want to place the issue with Aboriginal people, because it is mostly non-Indigenous people who do the “picking”, and who hope they get a “soft centre” rather than a “peanut brittle.” I acknowledge that some Aboriginal people also doing the picking, but it is not within the same context. BF: How do you respond to claims that some people might find the work offensive? PC: I believe that we can all tag something as offensive and it seems to be an easy way out. What really matters is to reflect on the concepts behind an artist’s work and consider whether we should make changes to our own ways of thinking and doing. I know some people will think that I have gone too far, but I’m interested in whether it has made them think about the issues. I think that I am often perceived as a “hard-centred chocolate”. Some people see me as “trouble,” “problematic,” and “too hard,” because I question, challenge, and don’t let the dominant white culture just simply ride over me or others. I am actually quite proud of being thought of as a hard-centred chocolate, because I want to make people stop and think. And, where necessary, I want to encourage people to change the ways they react to and construct “self” and “other.” Conclusion The Hot Chocolate exhibition included representations that were desirable and “tasty”: a celebration of declaring the self as “hot chocolate.” Through the connections with the food chocolate and the band Hot Chocolate, the exhibition sought to raise questions about the human experience of art and the artist as a memorable, tasty, and chosen commodity. For the artists, the exhibition enabled the juxtaposition of being a tasty individual chocolate against the concern of being part of a “box” but not being selected from the collection or not being memorable enough. It also sought to challenge people’s thinking about Aboriginal identity, by encouraging visitors to ask questions about how Aboriginal people are represented, how they are chosen to participate in politics and decision making, and whether some Aboriginal people are seen as being more “soft” or more “acceptable” than others. Through the metaphor of chocolate, the Hot Chocolate exhibition provided both a tasty delight and a conceptual challenge. It delivered an eclectic assortment and delivered the message that we are always tasty, regardless of what anyone thinks of us. It links back to the work of bell hooks, who aligned African American women with chocolates, which are picked out and selected for someone else’s pleasure. We know that Aboriginal Australians are sometimes conceptualised and selected in the same way. We have explored this conceptualisation and seek to challenge the imaginations of others around the issues of politics, desire, skin, and fetishisation of race and bodies. References Croft, Pamela. ART Song: The Soul Beneath My Skin. Doctor of Visual Art (Unpublished thesis). Brisbane: Griffith U, 2003. CroftWarcon, Pamela and Bronwyn Fredericks. It Started With a KISS. Hot Chocolate. Exhibition catalogue. Adelaide: SASA Gallery, 24 Oct.-29 Nov. 2012. Fredericks, Bronwyn. “Getting a Job: Aboriginal Women’s Issues and Experiences in the Health Sector.” International Journal of Critical Indigenous Studies 2.1 (2009): 24-35. Gill, Rosalind. Gender and the Media. Malden, MA: Polity, 2007. hooks, bell. Teaching to Transgress Education as the Practice of Freedom. London: Routledge, 1994. Moreton-Robinson, Aileen. “The House That Jack Built: Britishness and White Possession.” ACRAWSA Journal 1, (2005): 21-29. 1 Feb. 2014. ‹http://www.acrawsa.org.au/ejournal/?id=8› Moss, Hilary. “Naomi Campbell: Cadbury Ad “Insulting & Hurtful”. The Huntington Post 31 May (2011). 16 Dec. 2013. ‹http://www.huffingtonpost.com/2011/05/31/naomi-campbell-cadbury-ad_n_868909.html#› Sweney, Mark. “Cadbury Apologises to Naomi Campbell Over ‘Racist’ Ad.” The Guardian 3 Jun. (2011). 16 Dec. 2013. ‹http://www.theguardian.com/media/2011/jun/03/cadbury-naomi-campbell-ad›
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25

Green, Lelia, Leesa Bonniface, and Tami McMahon. "Adapting to a New Identity." M/C Journal 10, no. 2 (May 1, 2007). http://dx.doi.org/10.5204/mcj.2647.

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Apart from its negative literary connotations, the notion of adaptation generally carries an optimistic connotation in the sense that it is most often associated with an improved outcome in the face of challenging circumstances. However, this is not an inevitable response to an adaptive imperative: there are often indicators of significant failure to adapt. In short, there is often evidence of maladaption. Examples include the spiralling rates of heart disease, obesity and adult-onset diabetes that have characterised richer western populations over the past half-century. Arguably, the West as a whole has failed to adapt to the health opportunities provided by plentiful food supplies. Instead, a growing dietary emphasis upon refined carbohydrates (including simple sugars) and animal-sourced protein (including dairy foods) is harming these populations. This paper applies the metaphors of adaptation and maladaptation to the development of a new sense of self following a diagnosis of heart disease. There is a range of evidence to suggest that newly-diagnosed heart patients resist accepting the implications of lifestyle-related heart disease. Such a lack of acceptance can impact upon short-term health, exercise and diet priorities, as well as upon long-term life expectancy. While this paper does not describe a medical, but a cultural approach to the well-adapted self as heart patient, it is also important to stress that there is a significant range of heart conditions that are not lifestyle related. Counterproductively, the links increasingly made between lifestyle choices and heart disease mean that many heart patients feel “punished” by people with healthy hearts who seem to assume that the patient is to “blame”. Nonetheless, there are few heart patients who cannot positively impact their health and recovery prospects by improving lifestyle choices. Ladwig and his research team argue that the challenge lies in getting heart patients to take their illness seriously without precipitating a traumatically negative view of the experience of illness. Such a negative view may, in itself, facilitate poor outcomes. These perspectives indicate that issues of communication and identity—that is, cultural imperatives—are important determinants of a healthy recovery. This paper records and analyses recent research relating to heart patients who are members of an online support community, HeartNET. HeartNET is an experimental Website funded by two Australian Research Council Linkage Grants (2004-10), with the National Heart Foundation (WA Division) as the industry partner. The authors/researchers speculate that engagement in the HeartNET online community enables the positive adaptation of an individual’s sense of self (rather than the fostering of a maladaptive identity, including a denial of the implications of heart disease that can lead to behaviours which promote morbidity). Early indications are that supportive online interactions can foster the development of a positive persona of a “heart patient“. At the optimistic end of the response-spectrum, a positive heart patient is a person who is keenly motivated to maximise their health and—if possible—halt or reverse (see, for example, Esselstyn) the progress of their disease. Such a response can be constituted and enhanced via supportive online interactions. Insofar as medical commentators theorise about reactions to a life-changing health diagnosis, this tends to be in terms of self-image (see, for example, Petrie et al.) and sometimes includes Kubler-Ross’s stages of grief: Denial, Anger, Bargaining, Depression and Acceptance. The results reported here look instead at issues of adapting to a new identity as “heart patient” that potentially involves positive commitment to improved health, partly as a result of giving and receiving social support. The rationale behind this perspective is influenced by significant evidence that compliance with the therapeutic regimes recommended and prescribed by physicians is lacking. It is speculated that patients are enacting a denial of the importance of the health challenges confronting them. For example, Hugtenburg et al. found that “of 232 first-time chronic medicine prescriptions [repeats], 132 were not collected at all (46.1%) or too late (11%).” Noting that 46% of the 232 prescriptions studied were for cardiovascular drugs (353), Hugtenburg et al. conclude that “This kind of non-compliance may result in an increased health risk as well as constituting a waste of a large amount of money” (352). Clearly, more emphasis needs to be placed on communicating constructively with patients and supporting the evolution and reconstitution of an identity that includes positive constructions of self-as-heart-patient and that works to facilitate recovery. The Website that enables the HeartNET community was developed by the National Heart Foundation (WA Branch: NHFWA) and Edith Cowan University (ECU) as part of an ARC-Linkage grant, 2004-6 “Evaluating the effectiveness of online support in building community, promoting healthy behaviours and supporting philanthropy”. The first three months of the Website’s operation (when the tiny number of postings trickled away and then dried up completely) are reported in Bonniface et al. (“Affect”) and graphed below (see Figure 1). They followed on from a careful process of recruitment via databases of existing heart patients that were held by the NHFWA and supportive cardiologists. Participants were approached to gain ethical consent, and would-be Website participants were matched with people who had equivalent heart illness, but who weren’t invited to join the HeartNET community, thus acting as comparisons. Baseline data was collected to compare “before” the HeartNET intervention with the yet-to-be collected “after” data. The idea was to see if there were differences between the online and offline groups that could be attributed to Website activity. Instead, the first version of the supposed-community remained stillborn, and it wasn’t until the Website was thrown open to all comers that it began to thrive. This was a preliminary indication that an invitation to participate in a therapeutic community was not effective, by itself, in encouraging communication with people who shared important health-related experiences. While Website engagement might have fitted comparatively well into a (Kubler-Ross) Bargaining approach to heart patients’ illnesses (“I’ll help others, and they’ll help me”) the default position appeared to be non-engagement, possibly an indication of the patients having become “stuck“ in the first stage of grief, Denial. Even though the initial HeartNET participants were well established as heart patients, and had all been diagnosed some time earlier, it is possible that they preferred to ignore the implications of this for their health. Figure 1 records the patterns of postings made by the 68 people who agreed to join the HeartNET Web community and who signed and returned the ethical consent forms. Of the 68 people recruited, only 53 logged on (despite phone calls to every individual) and of the 53 who logged into the site, only 22 posted (Bonniface et al. “Affect”). The heaviest week’s traffic was 40 postings in Week 4. By Week 12, activity had ceased entirely. The decision to relaunch had been taken a fortnight earlier and the first iteration of the Website was closed down. Figure 1, reprinted from Bonniface et al (“Affect”) The relaunch of the Website made it available for anyone interested in participating, and membership and traffic both grew exponentially. Amongst other innovations were “newbie” icons (to indicate new members to be welcomed and nurtured), guest status (to “try before you buy”), and symbols to indicate whether the member was a heart patient, a family member or supporter, or an administrator. In due course a “ratings system“ was added to indicate the total number of member-postings to date, so that people could gauge an individual’s commitment and contribution to the community. People contributing up to 150 posts to discussion boards were allotted from one to five stars, while Superstar status indicated 1000-plus posts. One of the major differences between the group of heart patients invited to participate in the site’s first iteration, and the group that ultimately launched the Website as a viable and vibrant community, is that the second-stage members were generally recently diagnosed. The research team speculate that they were actively reconstituting their identities as heart patients, and they and their families consequently had many matters and issues they wanted to discuss. In effect, the people who joined the relaunched site were “learning“ to be heart patients. Weis et al., investigating a pharmaceutically-sponsored Website for MS sufferers, argued that “users are diverse” and “communication needs change over time [as the disease progresses]” (146). They found that, of the 943 users who responded to their online survey, indications were that participants used “the website the most during early stages of the disease” (135). However, one area the HeartNET research is investigating is whether a community-member whose persona includes “care and support for my Web community“ will continue to participate even after the first information-seeking phase of their illness is over. Support offered for new heart patients by cardiologists, hospital staff, other specialists and general practitioners is an important part of the enculturation of the self-as-heart-patient, but it leaves unexplored the more personal work of reconstituting the individual’s identity as a person with heart disease (or as a supporter of such a person). It also leaves unaddressed the sense of “aloneness“ that HeartNET members say they feel until they are able to talk regularly with people who understand exactly what they are going through, as a result of having already “been there“ themselves. Although health professionals, family and friends are supportive, that support is only occasionally able to cut through the isolation. Extracts from two (separate) interviews are typical of the kinds of comments made: Murphy: I mean the support from Sandra and the family was all great but—to actually talk to other people who know what you’re feeling and … Yes, nothing against family and friends but they’re [other patients are] going through the same thing, they know what you’re feeling and … you know. Margo: I found friends were pains. It was like “well, okay, but you’re better now, they fixed you.” Well I looked at her and I said, ‘“You’re never fixed, but [it’s] something you live with for the rest of your life that doesn’t go away. …’ The implication is that heart patients have a differential need to communicate with others about their experience of heart disease, and that the communicative imperative is greatest in the first stages of being a heart patient, soon after diagnosis. For the well-established patients invited to contribute to the original HeartNET Website, their status as people-with-heart-disease was no longer problematic. Consequently, they had little to say and very few incentives to revisit the adaptive processes of personal identity construction. People who are used to their status as a heart patient may be theorised as having very different information needs and behaviours compared with the newly diagnosed. There is evidence that at least some of these well established patients were prompted to engage when new patients who needed support joined the site in the second iteration. However, those who are never given the opportunity to interact and learn from others may take longer to reach a level of adaptation. Even worse, they may adopt maladaptive behaviours encompassing issues of denial or self-sabotage—such as rejecting medications or increasing behaviours which progress morbidity, such as smoking and excessive alcohol consumption. Patients’ denial of the implications of heart disease is recognised as a major medical problem. Cooper et al. (234) cite evidence from Petrie et al. that “only a third of eligible patients under 65 years old attended cardiac rehabilitation” while noting that “Ades et al. showed uptake as low as 21% in eligible patients over 62 years”. In another study of patients who did/did not adhere to their pharmacological treatment regime, Horwitz et al. found that “Compared with patients with good adherence, patients with poor adherence were twice as likely to have died within a year of follow-up.” They argue that “adherence may need to be viewed more broadly as encompassing a cluster of health-related behaviours that may influence the outcome of treatment.” The argument advanced in our paper is that such a broader view should also encompass necessary adaptation strategies which introduce positive influences to the formation of patient identity. Compliance with therapeutic and medical regimes has been linked to increased self esteem (Burkhart and Rayens), and the combination of compliance with a positive patient identity may well multiply beneficial health outcomes. Whereas currently a majority of recovering heart patients may be inferred as resisting a revised self-identity that takes their diagnosis and health challenges seriously, the HeartNET Website may offer an effective enticement to positive behavioural change. Bonniface et al. (“Shuffling buddies”) have demonstrated that engagement with HeartNET can influence attitudes to (and involvement in) exercise. The hypothesis regarding identity adaptation is that active HeartNET members, through Website engagement, consistently indicate a willingness to acknowledge their changed health status and work to develop a reconstituted identity as a person with a heart condition who is proactively maximising positive outcomes (and helping others to do so at the same time). This is particularly the case where the online engagement feeds into the offline world: where “shuffling buddies“ have developed mutually supportive walking and exercise regimes, involving social events, consistent with their commitment to health-enhancing activity. Adaptation strategies delivered online offer new ways to counter the maladaptive processes which can follow diagnosis. By using the raw materials of social support and Website engagement, patients can chart new and positive ways in which they progress from denial and bargaining to health-promoting acceptance. For those established patients, online engagement may progress the stages of grief beyond the level of acceptance to the end goal of “support” as they pass on their knowledge, empathy and understanding of illness to the newly diagnosed. References Ades, Philip, M. L. Waldman, W. J. McCann, and S. O. Weaver. “Predictors of Cardiac Rehabilitation Participation in Older Coronary Patients.” Archives of Internal Medicine 152.2 (1992): 1033-5. Bonniface, Leesa, Lelia Green, and Maurice Swanson. “Affect and an Effective Online Therapeutic Community.” M/C Journal 8.6 (2005). 22 Apr. 2007 . Bonniface, Leesa, Arshad Omari, and Maurice Swanson. “Shuffling Buddies—How an Online Community Supports Healthier Lifestyle Choices: An Early Indication of Physical Activity and Exercise Outcomes from the HeartNET Intervention.” Proceedings of the Fifth International Conference on Cultural Attitudes towards Technology and Communication. Eds. F Sudweeks, H Hrachovec and C Ess. Estonia, Tartu: School of Information Technology, Murdoch University, 2006. 90-101. Burkhart, Patricia, and Mary Rayens. “Self-Concept and Health Locus of Control: Factors Related to Children’s Adherence to Recommended Asthma Regimen.” Pediatric Nursing 31.5 (2005): 404-9. Campbell, Colin, and Thomas Campbell. The China Study: Startling Implications for Diet, Weight Loss and Long-Term Health. Dallas, TX: Benbella Books, 2004. Cooper, A., G., Lloyd, J. Weinman, and G. Jackson. “Why Patients Do Not Attend Cardiac Rehabilitation: Role of Intentions and Illness Beliefs.” Heart 82.2 (1999): 234-6. Horwitz, Ralph, Catherine Viscoli, Lisa Berkman, Robert Donaldson, Sarah Horwitz, Carolyn Murray, David Ransohoff, and Jody Sindelar. “Treatment Adherence and Risk of Death after a Myocardial Infarction.” The Lancet 336 (1990): 542-5. Hugtenburg, J. G., A. T. G. Blom, and S. U. Kisoensingh. “Initial Phase of Chronic Medication Use; Patients’ Reasons for Discontinuation.” British Journal of Clinical Pharmacology 61.3 (2005): 352-4. Kubler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. New York: Macmillan, 1969. Ladwig, Karl-Heinz, Andreas Schoefinius, Gerhard Dammann, Reinhold Danner, Rolf Gurtler, and Robert Hermann. “Long-Acting Psychotraumatic Properties of a Cardiac Arrest Experience.” American Journal of Psychiatry 156.6 (1999): 912-9. Esselstyn, C.B. Jr. Prevent and Reverse Heart Disease. New York: Penguin Group, 2007. Petrie, Keith, John Weinman, Sharpe Norman, and Judith Buckley. “Role of Patients’ View of Their Illness in Predicting Return to Work and Functioning after Myocardial Infarction: Longitudinal Study.” British Medical Journal 312 (1996): 1191-4. Weis, Robert, Keith Stamm, Craig Smith, Michael Nilan, Fiona Clark, Joan Weis, and Kate Kennedy. “Communities of Care and Caring: The Case of Mswatch.Com.” Journal of Health Psychology 8.1 (2003): 135-48. Citation reference for this article MLA Style Green, Lelia, Leesa Bonniface, and Tami McMahon. "Adapting to a New Identity: Reconstituting the Self as a Heart Patient." M/C Journal 10.2 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0705/13-bonnifacegreenmcmahon.php>. APA Style Green, L., L. Bonniface, and T. McMahon. (May 2007) "Adapting to a New Identity: Reconstituting the Self as a Heart Patient," M/C Journal, 10(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0705/13-bonnifacegreenmcmahon.php>.
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Howell, Katherine. "The Suspicious Figure of the Female Forensic Pathologist Investigator in Crime Fiction." M/C Journal 15, no. 1 (December 20, 2011). http://dx.doi.org/10.5204/mcj.454.

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Over the last two decades the female forensic pathologist investigator has become a prominent figure in crime fiction. Her presence causes suspicion on a number of levels in the narrative and this article will examine the reasons for that suspicion and the manner in which it is presented in two texts: Patricia Cornwell’s Postmortem and Tess Gerritsen’s The Sinner. Cornwell and Gerritsen are North American crime writers whose series of novels both feature female forensic pathologists who are deeply involved in homicide investigation. Cornwell’s protagonist is Dr Kay Scarpetta, then-Chief Medical Examiner in Richmond, Virginia. Gerritsen’s is Dr Maura Isles, a forensic pathologist in the Boston Medical Examiner’s office. Their jobs entail attending crime scenes to assess bodies in situ, performing examinations and autopsies, and working with police to solve the cases.In this article I will first examine Western cultural attitudes towards dissection and autopsy since the twelfth century before discussing how the most recent of these provoke suspicion in the selected novels. I will further analyse this by drawing on Julia Kristeva’s concept of the abject. I will then consider how female pathologist protagonists try to deflect their colleagues’ suspicion of their professional choices, drawing in part on Judith Butler’s ideas of gender as a performative category. I define ‘gender’ as the socially constructed roles, activities, attributes, and behaviours that Western culture considers appropriate for women and men, and ‘sex’ as the physical biological characteristics that differentiate women and men. I argue that the female forensic pathologist investigator is portrayed as suspicious in the chosen novels for her occupation of the abject space caused by her sex in her roles as investigator and pathologist, her identification with the dead, and her performance of elements of both masculine and feminine conventional gender roles. Scholars such as Barthes, Rolls, and Grauby have approached detective fiction by focusing on intertextuality, the openness of the text, and the possibility of different meanings, with Vargas being one example of how this can operate; however, this article focuses on examining how the female forensic pathologist investigator is represented as suspicious in mainstream crime novels that attract a readership seeking resolution and closure.A significant part of each of these novels focuses on the corpse and its injuries as the site at which the search for truth commences, and I argue that the corpse itself, those who work most closely with it and the procedures they employ in this search are all treated with suspicion in the crime fiction in this study. The central procedures of autopsy and dissection have historically been seen as abominations, in some part due to religious views such as the belief of Christians prior to the thirteenth century that the resurrection of the soul required an intact body (Klaver 10) and the Jewish and Muslim edicts against disfigurement of the dead (Davis and Peterson 1042). In later centuries dissection was made part of the death sentence and was perceived “as an abhorrent additional post-mortem punishment” that “promised the exposure of nakedness, dismemberment, and the deliberate destruction of the corpse,” which was considered “a gross assault on the integrity and the identity of the body, and upon the repose of the soul” (Richardson 154). While now a mainstay of many popular crime narratives, the autopsy as a procedure in real life continues to appall much of the public (Klaver 18). This is because “the human body—especially the dead human body—is an object still surrounded by taboos and prohibitions” (Sawday 269). The living are also reluctant to “yield the subjecthood of the other-dead to object status” (Klaver 18), which often produces a horrified response from some families to doctors seeking permission to dissect for autopsy. According to Gawande, when doctors suggest an autopsy the victim’s family commonly asks “Hasn’t she been through enough?” (187). The forensic pathologists who perform the autopsy are themselves linked with the repugnance of the act (Klaver 9), and in these novels that fact combined with the characters’ willingness to be in close proximity with the corpse and their comfort with dissecting it produces considerable suspicion on the part of their police colleagues.The female sex of the pathologists in these novels causes additional suspicion. This is primarily because women are “culturally associated [...] with life and life giving” (Vanacker 66). While historically women were also involved in the care of the sick and the dead (Nunn and Biressi 200), the growth of medical knowledge and the subsequent medicalisation of death in Western culture over the past two centuries has seen women relegated to a stylised kind of “angelic ministry” (Nunn and Biressi 201). This is an image inconsistent with these female characters’ performance of what is perceived as a “violent ‘reduction’ into parts: a brutal dismemberment” (Sawday 1). Drawing on Butler’s ideas about gender as a culturally constructed performance, we can see that while these characters are biologically female, in carrying out tasks that are perceived as masculine they are not performing their traditional gender roles and are thus regarded with suspicion by their police colleagues. Both Scarpetta and Isles are aware of this, as illustrated by the interior monologue with which Gerritsen opens her novel:They called her the Queen of the Dead. Though no one ever said it to her face, Dr. Maura Isles sometimes heard the nickname murmured in her wake as she travelled the grim triangle of her job between courtroom and death scene and morgue. [...] Sometimes the whispers held a tremolo of disquiet, like the murmurs of the pious as an unholy stranger passes among them. It was the disquiet of those who could not understand why she chose to walk in Death’s footsteps. Does she enjoy it, they wonder? Does the touch of cold flesh, the stench of decay, hold such allure for her that she has turned her back on the living? (Gerritsen 6)The police officers’ inability to understand why Isles chooses to work with the dead leads them to wonder whether she takes pleasure in it, and because they cannot comprehend how a “normal” person could act that way she is immediately marked as a suspicious Other. Gerritsen’s language builds images of transgression: words such as murmured, wake, whispers, disquiet, unholy, death’s footsteps, cold, stench, and decay suggest a fearful attitude towards the dead and the abjection of the corpse itself, a topic I will explore shortly. Isles later describes seeing police officers cast uneasy glances her way, noting details that only reinforce their beliefs that she is an odd duck: The ivory skin, the black hair with its Cleopatra cut. The red slash of lipstick. Who else wears lipstick to a death scene? Most of all, it’s her calmness that disturbs them, her coolly regal gaze as she surveys the horrors that they themselves can barely stomach. Unlike them, she does not avert her gaze. Instead she bends close and stares, touches. She sniffs. And later, under bright lights in her autopsy lab, she cuts. (Gerritsen 7) While the term “odd duck” suggests a somewhat quaintly affectionate tolerance, it is contrasted by the rest of the description: the red slash brings to mind blood and a gaping wound perhaps also suggestive of female genitalia; the calmness, the coolly regal gaze, and the verb “surveys” imply detachment; the willingness to move close to the corpse, to touch and even smell it, and later cut it open, emphasise the difference between the police officers, who can “barely stomach” the sight, and Isles who readily goes much further.Kristeva describes the abject as that which is not one thing or another (4). The corpse is recognisable as once-human, but is no-longer; the body was once Subject, but we cannot make ourselves perceive it yet as fully Object, and thus it is incomprehensible and abject. I suggest that the abject is suspicious because of this “neither-nor” nature: its liminal identity cannot be pinned down, its meaning cannot be determined, and therefore it cannot be trusted. In the abject corpse, “that compelling, raw, insolent thing in the morgue’s full sunlight [...] that thing that no longer matches and therefore no longer signifies anything” (Kristeva 4), we see the loss of borders between ourselves and the Other, and we are simultaneously “drawn to and repelled” by it; “nausea is a biological recognition of it, and fear and adrenalin also acknowledge its presence” (Pentony). In these novels the police officers’ recognition of these feelings in themselves emphasises their assumptions about the apparent lack of the same responses in the female pathologist investigators. In the quote from The Sinner above, for example, the officers are unnerved by Isles’ calmness around the thing they can barely face. In Postmortem, the security guard who works for the morgue hides behind his desk when a body is delivered (17) and refuses to enter the body storage area when requested to do so (26) in contrast with Scarpetta’s ease with the corpses.Abjection results from “that which disturbs identity, system, order. What does not respect borders, positions, rules” (Kristeva 4), and by having what appears to be an unnatural reaction to the corpse, these women are perceived as failing to respect systems and boundaries and therefore are viewed as abject themselves. At the same time, however, the female characters strive against the abject in their efforts to repair the disturbance caused by the corpse and the crime of murder that produced it by locating evidence leading to the apprehension of the culprit. Ever-present and undermining these attempts to restore order is the evidence of the crime itself, the corpse, which is abject not only for its “neither-nor” status but also because it exposes “the fragility of the law” (Kristeva 4). In addition, these female pathologist characters’ sex causes abjection in another form through their “liminal status” as outsiders in the male hierarchy of law enforcement (Nunn and Biressi 203); while they are employed by it and work to maintain its dominance over law-breakers and society in general, as biological females they can never truly belong.Abjection also results from the blurring of boundaries between investigator and victim. Such blurring is common in crime fiction, and while it is most likely to develop between criminal and investigator when the investigator is male, when that investigator is female it tends instead to involve the victim (Mizejewski 8). In these novels this is illustrated by the ways in which the female investigators see themselves as similar to the victims by reason of gender plus sensibility and/or work. The first victim in Cornwell’s Postmortem is a young female doctor, and reminders of her similarities to Scarpetta appear throughout the novel, such as when Scarpetta notices the pile of medical journals near the victim's bed (Cornwell 12), and when she considers the importance of the woman's fingers in her work as a surgeon (26). When another character suggests to Scarpetta that, “in a sense, you were her once,” Scarpetta agrees (218). This loss of boundaries between self and not-self can be considered another form of abjection because the status and roles of investigator and victim become unclear, and it also results in an emotional bond, with both Scarpetta and Isles becoming sensitive to what lies in wait for the bodies. This awareness, and the frisson it creates, is in stark contrast to their previous equanimity. For example, when preparing for an autopsy on the body of a nun, Isles finds herself fighting extreme reluctance, knowing that “this was a woman who had chosen to live hidden from the eyes of men; now she would be cruelly revealed, her body probed, her orifices swabbed. The prospect of such an invasion brought a bitter taste to [Isles’s] throat and she paused to regain her composure” (Gerritsen 57). The language highlights the penetrative nature of Isles’s contact with the corpse through words such as revealed, orifices, probed, and invasion, which all suggest unwanted interference, the violence inherent in the dissecting procedures of autopsy, and the masculine nature of the task even when performed by a female pathologist. This in turn adds to the problematic issue here of gender as performance, a subject I will discuss shortly.In a further blurring of those boundaries, the female characters are often perceived as potential victims by both themselves and others. Critic Lee Horsley describes Scarpetta as “increasingly giv[ing] way to a tendency to see herself in the place of the victim, her interior self exposed and open to inspection by hostile eyes” (154). This is demonstrated in the novel when plot developments see Scarpetta’s work scrutinised (Cornwell 105), when she feels she does not belong to the same world as the living people around her (133), and when she almost becomes a victim in a literal sense at the climax of the novel, when the perpetrator breaks into her home to torture and kill her but is stopped by the timely arrival of a police officer (281).Similarly, Gerritsen’s character Isles comes to see herself as a possible victim in The Sinner. When it is feared that the criminal is watching the Boston police and Isles realises he may be watching her too, she thinks about how “she was accustomed to being in the eye of the media, but now she considered the other eyes that might be watching her. Tracking her. And she remembered what she had felt in the darkness at [a previous crime scene]: the prey’s cold sense of dread when it suddenly realises it is being stalked” (Gerritsen 222). She too almost becomes a literal victim when the criminal enters her home with intent to kill (323).As investigators, these characters’ sex causes suspicion because they are “transgressive female bod[ies] occupying the spaces traditionally held by a man” (Mizejewski 6). The investigator in crime fiction has “traditionally been represented as a marginalized outsider” (Mizejewski 11), a person who not only needs to think like the criminal in order to apprehend them but be willing to use violence or to step outside the law in their pursuit of this goal, and is regarded as suspicious as a result. To place a woman in this position then makes that investigator’s role doubly suspicious (Mizejewski 11). Judith Butler’s work on gender as performance provides a useful tool for examining this. Because “the various acts of gender create the gender itself” (Butler 522), these female characters are judged as woman or not-woman according to what they do. By working as investigators in the male-dominated field of law-enforcement and particularly by choosing to spend their days handling the dead in ways that involve the masculine actions of penetrating and dismembering, each has “radically crossed the limits of her gender role, with her choice of the most unsavoury and ‘unfeminine’ of professions” (Vanacker 65). The suspicion this attracts is demonstrated by Scarpetta being compared to her male predecessor who got on so well with the police, judges, and lawyers with whom she struggles (Cornwell 91). This sense of marginalisation and unfavourable comparison is reinforced through her recollections of her time in medical school when she was one of only four women in her class and can remember vividly the isolating tactics the male students employed against the female members (60). One critic has estimated the dates of Scarpetta’s schooling as putting her “on the leading edge of women moving into professionals schools in the early 1970s” (Robinson 97), in the time of second wave feminism, when such changes were not welcomed by all men in the institutions. In The Sinner, Isles wants her male colleagues to see her as “a brain and a white coat” (Gerritsen 175) rather than a woman, and chooses strategies such as maintaining an “icy professionalism” (109) and always wearing that white coat to ensure she is seen as an intimidating authority figure, as she believes that once they see her as a woman, sex will get in the way (175). She wants to be perceived as a professional with a job to do rather than a prospective sexual partner. The white coat also helps conceal the physical indicators of her sex, such as breasts and hips (mirroring the decision of the murdered nun to hide herself from the eyes of men and revealing their shared sensibility). Butler’s argument that “the distinction between appearance and reality [...] structures a good deal of populist thinking about gender identity” (527) is appropriate here, for Isles’s actions in trying to mask her sex and thus her gender declare to her colleagues that her sex is irrelevant to her role and therefore she can and should be treated as just another colleague performing a task.Scarpetta makes similar choices. Critic Bobbie Robinson says “Scarpetta triggers the typical distrust of powerful women in a male-oriented world, and in that world she seems determined to swaddle her lurking femininity to construct a persona that keeps her Other” (106), and that “because she perceives her femininity as problematic for others, she intentionally misaligns or masks the expectations of gender so that the masculine and feminine in her cancel each other out, constructing her as an androgyne” (98). Examples of this include Scarpetta’s acknowledgement of her own attractiveness (Cornwell 62) and her nurturing of herself and her niece Lucy through cooking, an activity she describes as “what I do best” (109) while at the same time she hides her emotions from her colleagues (204) and maintains that her work is her priority despite her mother’s accusations that “it’s not natural for a woman” (34). Butler states that “certain kinds of acts are usually interpreted as expressive of a gender core or identity, and that these acts either conform to an expected gender identity or contest that expectation in some way” (527). Scarpetta’s attention to her looks and her enjoyment of cooking conform to a societal assumption of female gender identity, while her construction of an emotionless facade and focus on her work falls more in the area of expected male gender identity.These characters deliberately choose to perform in a specific manner as a way of coping and succeeding in their workplace: by masking the most overt signs of their sex and gender they are attempting to lessen the suspicion cast upon them by others for not being “woman.” There exists, however, a contradiction between that decision and the clear markers of femininity demonstrated on occasion by both characters, for example, the use by Isles of bright red lipstick and a smart Cleopatra haircut, and the performance by both of the “feminised role as caretaker of, or alignment with, the victim’s body” (Summers-Bremner 133). While the characters do also perform the more masculine role of “rendering [the body’s] secrets in scientific form” (Summers-Bremner 133), a strong focus of the novels is their emotional connection to the bodies and so this feminised role is foregrounded. The attention to lipstick and hairstyle and their overtly caring natures fulfill Butler’s ideas of the conventional performance of gender and may be a reassurance to readers about the characters’ core femininity and their resultant availability for romance sub-plots, however they also have the effect of emphasising the contrasting performative gender elements within these characters and marking them once again in the eyes of other characters as neither one thing nor another, and therefore deserving of suspicion.In conclusion, the female forensic pathologist investigator is portrayed in the chosen novels as suspicious for her involvement in the abject space that results from her comfort around and identification with the corpse in contrast to the revulsion experienced by her police colleagues; her sex in her roles as investigator and pathologist where these roles are conventionally seen as masculine; and her performance of elements of both masculine and feminine conventional gender roles as she carries out her work. This, however, sets up a further line of inquiry about the central position of the abject in novels featuring female forensic pathologist investigators, as these texts depict this character’s occupation of the abject space as crucial to the solving of the case: it is through her ability to perform the procedures of her job while identifying with the corpse that clues are located, the narrative of events reconstructed, and the criminal identified and apprehended.ReferencesBarthes, Roland. S/Z. Trans. Richard Miller. London: Jonathan Cape. 1975. Butler, Judith. “Performative Acts and Gender Constitution: An Essay in Phenomenology and Feminist Theory.” Theatre Journal. 40.4 (1988): 519–31. 5 October 2011 ‹http://www.jstor.org/stable/3207893›Cornwell, Patricia. Postmortem. London: Warner Books, 1994. Davis, Gregory J. and Bradley R. Peterson. “Dilemmas and Solutions for the Pathologist and Clinician Encountering Religious Views of the Autopsy.” Southern Medical Journal. 89.11 (1996): 1041–44. Gawande, Atul. Complications: A Surgeon’s Notes on an Imperfect Science. London: Profile Books, 2003.Gerritsen, Tess. The Sinner. Sydney: Random House, 2003. Grauby, Francois. “‘In the Noir’: The Blind Detective in Bridgette Aubert’s La mort des bois.” Mostly French: French (in) detective fiction. Modern French Identities, v.88. Ed. Alistair Rolls. Oxford: Peter Lang. 2009.Horsley, Lee. Twentieth Century Crime Fiction. Oxford: Oxford UP, 2005.Klaver, Elizabeth. Sites of Autopsy in Contemporary Culture. Albany: State U of NYP, 2005.Kristeva, Julia. Powers of Horror: Essays on Abjection. New York: Columbia UP, 1982.Mizejewski, Linda. “Illusive Evidence: Patricia Cornwell and the Body Double.” South Central Review. 18.3/4 (2001): 6–20. 19 March 2010. ‹http://www.jstor.org/stable/3190350›Nunn, Heather and Anita Biressi. “Silent Witness: Detection, Femininity, and the Post Mortem Body.” Feminist Media Studies. 3.2 (2003): 193–206. 18 January 2011. ‹http://dx.doi.org/10.1080/1468077032000119317›Pentony, Samantha. “How Kristeva’s Theory of Abjection Works in Relation to the Fairy Tale and Post Colonial Novel: Angela Carter’s The Blood Chamber and Keri Hulme’s The Bone People.” Deep South. 2.3 (1996): n.p. 13 November 2011. ‹http://www.otago.ac.nz/DeepSouth/vol2no3/pentony.html›Richardson, Ruth. “Human Dissection and Organ Donation: A Historical Background.” Mortality. 11.2 (2006): 151–65. 13 May 2011. ‹http://dx.doi.org/10.1080/13576270600615351›Robinson, Bobbie. “Playing Like the Boys: Patricia Cornwell Writes Men.” The Journal of Popular Culture. 39.1 (2006): 95–108. 2 August 2010. ‹http://onlinelibrary.wiley.com/doi/10.1111/j.1540-5931.2006.00205.x/full›Rolls, Alistair. “An Uncertain Place: (Dis-)Locating the Frenchness of French and Australian Detective Fiction.” in Mostly French: French (in) Detective Fiction. Modern French Identities, v.88. Ed. Alistair Rolls. Oxford: Peter Lang. 2009.---. “What Does It Mean? Contemplating Rita and Desiring Dead Bodies in Two Short Stories by Raymond Carver.” Literature and Aesthetics: The Journal of the Sydney Society of Literature and Aesthetics. 18.2 (2008): 88-116. Sawday, Jonathon. The Body Emblazoned: Dissection and the Human Body in Renaissance Culture. London: Routledge, 1996.Summers-Bremner, Eluned. “Post-Traumatic Woundings: Sexual Anxiety in Patricia Cornwell’s Fiction.” New Formations: A Journal of Culture/Theory/Politics. 43 (2001): 131–47. Vanacker, Sabine. “V.I Warshawski, Kinsey Millhone and Kay Scarpetta: Creating a Feminist Detective Hero.” Criminal Proceedings: The Contemporary American Crime Novel. Ed. Peter Messent. London: Pluto P, 1997. 62–87. Vargas, Fred. This Night’s Foul Work. Trans. Sian Reynolds. London: Harvill Secker, 2008.
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27

Garbuzova, Elizaveta. "Addressing Infertility with Uterine Transplant." Voices in Bioethics 7 (April 25, 2021). http://dx.doi.org/10.52214/vib.v7i.8187.

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Photo by Filip Mroz on Unsplash INTRODUCTION The first live births via uterine transplant using deceased donors (UTx) occurred in Brazil in 2017[1] and in the United States in 2019.[2] Prior to that, living donors were the source of uteruses for transplant, with the first successful birth in Sweden in 2014, and the first successful birth in the US in 2017. This achievement in reproductive technology gives women with absolute uterine factor infertility (AUFI) the option to become a biological parent. In the US, 120,000 women of childbearing age are affected by AUFI.[3] Without UTx, their only option for having genetically related children is through gestational surrogacy. Since some religions and cultures prohibit the use of surrogates to achieve motherhood and surrogacy is illegal in many countries, some women would not otherwise have the chance to have biological children. For instance, China, Finland, Germany, Iceland, and other countries prohibit any form of commercial or altruistic surrogacy making adoption the only option for becoming a mother. However, in many cultures, biological ties are central to the understanding of the family. For example, in the Middle East, adoption is uncommon because biological connections are crucial.[4] Therefore, the only option these women would choose to become a mother is UTx. The exclusive value of UTx to these women is being able to experience pregnancy. Thus, UTx gives unique benefits to these women that adoption or surrogacy would not. The procedure entails surgery on a living or deceased donor to acquire the uterus. Then, the recipient undergoes transplantation followed by a course of immunosuppressive medication. After in vitro fertilization (IVF), the embryo is implanted into the transplanted uterus. If the pregnancy progresses, the child is delivered by C-section and the uterus is removed either simultaneously or later. This paper argues that both deceased and living donors should be permitted, while increased-risk donors should not be eligible. ANALYSIS l. Permitting Living Donors or Limiting all UTx to Deceased Donors The ethics of using a uterus from a deceased donor differs from using one from a living donor. The biggest concern for living donation is that it exposes the donor to unacceptable risks, especially considering that the procedure is elective and not life-saving. In other types of transplants, the sacrifice is warranted because the organ is needed to save the recipient's life. For instance, living kidney donations protect against kidney failure.[5] The uterine donor undergoes a four to eight-hour surgery to acquire the uterus for no potential health benefit to themselves or arguably, to the recipient.[6] UTx is not a life-saving procedure. Some argue that because there is no imminent threat to the health of patients with AUFI, it is unnecessary to expose live donors to risks of UTx. While treating AUFI is not technically medically necessary, many women find infertility debilitating to their physical and mental health. As a result, women want their infertility treated. Now that UTx with deceased donors has been successful, the ethical justification for continuing to allow living donation could be questioned. UTx from deceased donors cannot harm the donor and thus has a different overall risk-benefit calculation. It is reasonable to believe that opponents of living donation may view UTx from deceased donors as ethically permissible. From the public health and ethical perspective, retrieving uteruses from deceased donors is a preferable option for the following reasons: First, there is no medical risk to the donor; thus, public resources do not need to be allocated to resolving the potential complications from the procedure. Additionally, acquiring a uterus from a deceased donor takes less time than from a living donor.[7] Using deceased donors also decreases operating room visits compared to living-donor uterus acquisition, and allocates more time for the operating room to perform other procedures. However, without living donors, the pool of available uteruses for transplantation narrows. In 2017, there were 2,200 deceased female donors aged 18-47 in the US, defined as those willing to donate, not those with a procurable and usable uterus, or even a uterus at all.[8] 2,200 is an extremely low number of potential uterus donors considering that there are more than 120,000 women with AUFI in the US. Not every available uterus is suitable for donation; each must pass quality control. These donors could have had a hysterectomy, no pregnancies (having had a pregnancy makes the uterus more suitable for transplant), papillomavirus infection, or other conditions that would prevent them from being uterus donors.[9] Therefore, the number of potentially suitable uteruses from deceased donors is probably lower than 2,200. There is significant uterus scarcity. To expand the donor pool, living-donor transplants should be allowed to continue. Using living donors respects individual autonomy. The uterus does not serve a vital purpose and women who have had successful pregnancies and do not want to become pregnant again can donate without a concern for their own fertility. Because most living donors are related to the recipients, they will also benefit from this procedure since it would enable them to have family relationships, perhaps becoming an aunt or grandparent. By decreasing wait time, allowing living donors also would provide the option of UTx while women are younger and more likely to achieve pregnancy since the IVF would be more likely to succeed increasing the chances that UTx would result in a child. ll. Increased-Risk Donors To further expand the pool of donors, some favor making organs from “increased-risk” donors available to recipients. Increased-risk donors range from those with a history of IV drug use or certain sexual or behavioral histories.[10] The main risk associated with transplantation from increased-risk donors is the possibility of transmission of infections like HIV, hepatitis B, or hepatitis C. Whether the scarcity of transplantable uteruses makes it ethical to include increased-risk donors in the UTx donor pool, assuming there is still a scarcity once other qualified living donors are permitted depends on the risks and benefits. The organs of increased-risk donors are offered to patients for life-saving procedures such as a liver transplant.[11] For example, since the donor pool in South Africa is small, in one case, the best option was for a child to receive a partial liver transplant from his HIV-positive mother. The donation was approved to save the life. The risk of HIV infection, and the need for lifetime antiretroviral therapy paled in comparison to death due to the unavailability of a deceased or low-risk liver donor.[12] Yet, UTx is not a life-saving procedure. Because infertility treatment is not lifesaving, the risks do not outweigh the benefits. Increased-risk donations use the organs that otherwise may have been disposed of (or rejected by potential recipients) categorically even if a donor did not actually have the underlying disease like HIV, hepatitis B, or hepatitis C.[13] Yet increased-risk donations pose ethically unacceptable risks to the recipient and their fetus in the case of UTx. If the patient remained on the waitlist for a uterus transplant, she and the resulting fetus would forgo the risks associated with using an increased-risk donor. It is possible that being on a waitlist could be psychologically traumatizing for a patient. This does not justify the potential to expose the woman and possibly a fetus to HIV, or hepatitis B or hepatitis C if an increased-risk donor provided a uterus and had an undetected condition While infertility may be devastating to the women wanting UTx, UTx should not be treated as a life-saving procedure. Therefore, it is unethical to expand the donor pool to include increased-risk donors. lll. Potential Downsides of the Availability of Uterine Transplant The availability of UTx to the public may impose additional pressure on women affected by infertility to try an additional burdensome procedure before giving up genetic motherhood. In cultures where family ties are important, the spouse or family members may pressure women to undergo UTx for the benefit of having biological children. Moreover, it may add overall pressure on the women to become mothers and exacerbate the deficiency stigma on infertile women. Moreover, the availability of UTx may compromise the future of many children who are waiting for adoption. Adoption may start to be seen by others only as a last resort after attempting to have biological children. This is problematic because there are many already existing children who need parental love. These downsides can be addressed by assurances that women freely enter UTx. Counseling and assurances that women are acting of their own accord and not under duress or societal pressure can mitigate the downsides. The autonomy and the choice to engage in new assisted reproduction should not be dismissed out of a fear that women are choosing UTx for the wrong reasons. CONCLUSION UTx offers women with AUFI unique benefits like the experience of pregnancy and having children genetically related to them. A woman deciding whether to receive a uterus from a living or deceased donor, or not to undergo UTx at all should understand the risks and benefits, including the risk of the UTx not resulting in a viable pregnancy. Doctors or hospitals should decide whether to perform UTx on a case-by-case basis. Increased-risk donation that could expose the recipient and fetus to transmissible disease should be prohibited because the risks associated with increased-risk donation are not morally justified by UTx. Remaining on the transplant list would be safer. While increased-risk UTx should be prohibited, other living-donor procedures should be continued to widen the donor pool. Living-donor UTx will empower the donor since she will voluntarily make the decision to donate, helping another person. Women with infertility whose only chance to have a biological child should not be limited to uteruses supplied by deceased donors. [1] France 24, “First Baby Born after Uterus Transplant in France,” France 24 (France 24, February 17, 2021), https://www.france24.com/en/live-news/20210217-first-baby-born-after-uterus-transplant-in-france. [2] “For the First Time in North America, a Woman Gives Birth After Uterus Transplant From a Deceased Donor,” Health Essentials from Cleveland Clinic (Health Essentials from Cleveland Clinic, July 9, 2019), https://health.clevelandclinic.org/for-the-first-time-in-north-america-woman-gives-birth-after-uterus-transplant-from-deceased-donor/. [3] Max M. Maurer et al., “First Healthy Baby After Deceased Donor Uterus Transplantation: Birth to a New Era?” Transplantation 103, no. 4 (2019): pp. 652-653, https://doi.org/10.1097/tp.0000000000002627. [4] Yassari, N. “Adding by Choice: Adoption and Functional Equivalents in Islamic and Middle Eastern Law.” The American Journal of Comparative Law, 63(4), 927-962. Retrieved April 22, 2021, from https://www.jstor.org/stable/26425445 (Acknowledges that traditional Islamic law prohibits adoption but arguing jurisdictions have worked around the prohibition to create avenues toward adoption.) [5] Though some people might argue that dialysis would be an option, generally kidney transplants are justified by medical necessity and a transplant both saves the life and significantly improves quality of life compared to dialysis. [6] “Uterus Transplants: A New Door Opens,” Penn Medicine, April 29, 2019, https://www.pennmedicine.org/news/internal-newsletters/system-news/2019/may19/uterus-transplants-a-new-door-opens. [7] Niclas Kvarnström et al., “Live versus Deceased Donor in Uterus Transplantation,” Fertility and Sterility 112, no. 1 (2019): pp. 24-27, https://doi.org/10.1016/j.fertnstert.2019.05.029, 25. [8] Max M. Maurer et al., “First Healthy Baby After Deceased Donor Uterus Transplantation: Birth to a New Era?” Transplantation 103, no. 4 (2019): pp. 652-653, https://doi.org/10.1097/tp.0000000000002627, 653. [9] Max M. Maurer et al., “First Healthy Baby After Deceased Donor Uterus Transplantation: Birth to a New Era?” Transplantation 103, no. 4 (2019): pp. 652-653, https://doi.org/10.1097/tp.0000000000002627, 653. [10] Shelly Bansal et al., “Risky Business: Taking the Stigma Out of High-Risk Donation in Lung Transplantation,” The Annals of Thoracic Surgery 100, no. 5 (2015): pp. 1787-1794, https://doi.org/10.1016/j.athoracsur.2015.05.065, 1787. The Centers for Disease Control (CDC) define the high-risk donor if a person meets one or more of the following criteria: “1) men who have had sex with other men in the last 5 years, 2) a history of intravenous drug abuse, 3) persons who have hemophilia, 4) persons who have engaged in sex for money or drugs in the past 5 years, 5) persons who have engaged in sex with individuals who have high-risk behaviors or those that are suspected to have HIV, 6) anyone who has been exposed to HIV in the last 12 months, 7) inmates, and 8) children born to mothers who had HIV or mothers who met the criteria for high risk. [11] Jean Botha et al., “HIV and Solid Organ Transplantation: Where Are We Now,” Current HIV/AIDS Reports 16, no. 5 (April 2019): pp. 404-413, https://doi.org/10.1007/s11904-019-00460-7, 404. Harriet Rosanne Etheredge et al., “Needs Must: Living Donor Liver Transplantation from an HIV-Positive Mother to Her HIV-Negative Child in Johannesburg, South Africa,” Journal of Medical Ethics 45, no. 5 (2019): pp. 287-290, https://doi.org/10.1136/medethics-2018-105216. (A partial liver transplant was done from an HIV-positive mother to an HIV-negative child in South Africa in 2017). [12] Botha, et al. [13] David S. Goldberg and Josh Levitsky, “Transplanting Livers from HCV ‐Infected Donors into HCV ‐Negative Recipients: Promise but Mind the Pitfalls,” American Journal of Transplantation 19, no. 5 (December 2018): pp. 1264-1265, https://doi.org/10.1111/ajt.15193, 1264.
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28

Hackett, Lisa J., and Jo Coghlan. "The History Bubble." M/C Journal 24, no. 1 (March 15, 2021). http://dx.doi.org/10.5204/mcj.2752.

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Introduction Many people’s knowledge of history is gleaned through popular culture. As a result there is likely a blurring of history with myth. This is one of the criticisms of historical romance novels, which blur historical details with fictional representations. As a result of this the genre is often dismissed from serious academic scholarship. The other reason for its disregard may be that it is largely seen as women’s fiction. As ‘women’s fiction’ it is largely relegated to that of ‘low culture’ and considered to have little literary value. Yet the romance genre remains popular and lucrative. Research by the Romance Writers of America in 2016 found that the genre represents 23% of the US fiction market and generates in excess of US$1 billion per year (Romance Writers of America). Since the onset of COVID-19, sales of romance novels in the US have soared, increasing by 17% between January and May 2020. The most popular genre was the historical romance genre. In total during that period, 16.2 million romance e-books were purchased by consumers (NPD). Yet despite its popularity, romance fiction remains stuck in the pulp fiction bubble. This article draws upon an international survey conducted in June 2020 by the authors. The study aimed to understand how readers of historical romance novels (n=813) engage with historical representations in popular culture, and how they navigate issues of authenticity. Consuming History through Popular Culture: “Historical Romance Novels Bring History to Life” Popular culture presents a tangible way in which audiences can engage with history and historical practices. “The spaces scholars have no idea about – the gaps between verifiable fact – are the territory for the writer of fictional history” (de Groot 217). Historical romance writer Georgette Heyer, for example, was influenced by her father’s conviction that “the historical novel was a worthy medium for learning about the past” (Kloester 102), and readers of historical romance often echo this view. One participant in this study considered the genre a way to “learn about history, the mores and customs, the food and clothing of that particular era … and how it contrasts to modern times”. For another participant, “most historical romances are set in countries other than my own. I like learning about these other countries and cultures”. The historical romance genre, in some instances, was not the reason for reading the novel: it was the historical setting. The romance itself was often incidental: “I am more interested in the history than the romance, but if the romance is done well … [then] the tensions of the romance illustrate and highlight historical divisions”. While a focus on history rather than romance, it posits that authors are including historically accurate details, and this is recognised by readers of the genre. In fact, one contributor to the survey argued that as a member of a writers’ group they were aware of that the “majority of the writers of that genre were voracious researchers, so much so that writers of other genres (male western writers for one) were going to them for information”. While fiction provides entertainment and relaxation, reading historical romance provides an avenue for accessing history without engaging it in a scholarly environment. Participants offered examples of this, saying “I like learning about the past and novels are an easy and relaxing way to do it” and “I enjoy historical facts but don’t necessarily need to read huge historical texts about Elizabeth Woodville when I can read The White Queen.” Social and political aspects of an era were gleaned from historical romance novels that may be less evident in historical texts. For one respondent, “I enjoy the description of the attire … behaviours … the social strata, politics, behaviours toward women and women who were ahead of their time”. Yet at the same time, historical fiction provides a way for readers to learn about historical events and places that spurred them to access more factual historical sources: “when I read a novel that involves actual historic happenings, it drives me to learn if the author is representing them correctly and to learn more about the topics”. For another, the historical romance “makes me want to do some more research”. Hence, historical fiction can provide new ways of seeing the past: “I enjoy seeing the similarities between people of the past and present. Hist[orical] Fic[tion] brings us hope that we can learn and survive our present.” A consciousness of how ancestors “survived and thrived” was evident among many participants. For one, history is best learned through the eyes of the people who lived through the era. School doesn’t teach history in a way that I can grasp, but putting myself into the shoes of the ordinary people who experienced, I have a better understanding of the time. Being able to access different perspectives on history and historical events and make an emotional connection with the past allowed readers to better understand the lived experiences of those from the past. This didn’t mean that readers were ignoring the fictional nature of the genre; rather, readers were clearly aware that the author was often taking liberties with history in order to advance the plot. Yet they still enjoyed the “glimpses of history that is included in the story”, adding that the “fictional details makes the history come alive”. The Past Represents a Different Society For some, historical romances presented a different society, and in some ways a nostalgia for the past. This from one participant: I like the attention to eloquence, to good speech, to manners, to responsibility toward each other, to close personal relationships, to value for education and history, to an older, more leisurely, more thoughtful way of life. A similar view was offered by another participant: “I like the language. I like the slowness, the courtship. I like the olden time social rules of honour and respect. I like worlds in which things like sword fights might occur”. For these respondents, there is a nostalgia where things were better then than now (Davis 18). Readers clearly identified with the different social and moral behaviours that they experienced in the novels they are reading, with one identifying more with the “historical morals, ethics, and way of life than I do modern ones”. Representations of a more respectful past were one aspect that appealed to readers: “people are civil to each other”, they are “generally kinder” and have a “more traditional moral code”. An aspect of escapism is also evident: “I enjoy leaving the present day for a while”. It is a past where readers find “time and manners [that are] now lost to us”. The genre reflects time that “seemed simpler” but “of course it helps if you are in the upper class”. Many historical romance novels are set within the social sphere of the elites of a society. And these readers’ views clearly indicate this: honestly, the characters are either wealthy or will be by the end, which releases from the day to day drudgeries and to the extent possible ensures an economic “happily ever after” as well as a romantic one … . I know the reality of even the elite wasn’t as lovely as portrayed in the books. But they are a charming and sometimes thrilling fantasy to escape inside … It is in the elite social setting that a view emerges in historical romance novels that “things are simpler and you don’t have today’s social issues to deal with”. No one period of history appears to reflect this narrative; rather, it is a theme across historical periods. The intrigue is in how the storyline develops to cope with social mores. “I enjoy reading about characters who wind their way around rules and the obstacles of their society … . Nothing in a historical romance can be fixed with a quick phone call”. The historical setting is actually an advantage because history places constrictions upon a plot: “no mobile phones, no internet, no fast cars. Many a plot would be over before it began if the hero and heroine had a phone”. Hence history and social mores “limit the access of characters and allow for interesting situations”. Yet another perspective is how readers draw parallels to the historic pasts they read about: “I love being swept away into a different era and being able to see how relevant some social issues are today”. There are however aspects that readers are less enamoured with, namely the lack of sex. While wholesome, particularly in the case of Christian authors, other characters are heroines who are virgins until after marriage, but even then may be virgins for “months or years after the wedding”. Similarly, “I deplore the class system and hate the inequalities of the past, yet I love stories where dukes and earls behave astonishingly well and marry interesting women and where all the nastiness is overcome”. The Problem with Authenticity The results of the international historical romance survey that forms the basis of this research indicate that most readers and writers alike were concerned with authenticity. Writers of historical romance novels often go to great lengths to ensure that their stories are imbued with historically accurate details. For readers, this “brings the characters and locales to life”. For readers, “characters can be fictional, but major events and ways of living should be authentic … dress, diet, dances, customs, historic characters”. Portraying historical accuracy is appreciated by readers: “I appreciate the time and effort the author takes to research subjects and people from a particular time period to make their work seem more authentic and believable”. Georgette Heyer, whose works were produced between 1921 and 1974, is considered as the doyenne of regency romance novels (Thurston 37), with a reputation for exacting historical research (Kloester 209). Heyer’s sway is such that 88 (10.8%) of the respondents to the romance survey cited her when asked who their favourite author is, with some also noting that she is a standard for other authors to aspire to. For one participant, I only read one writer of historical romance: Georgette Heyer. Why? Sublime writing skills, characterisation, delicious Wodehousian humour and impeccable accurate and research into the Regency period. Despite this prevailing view, “Heyer’s Regency is a selective one, and much of the broader history of the period is excluded from it” (Kloester 210). Heyer’s approach to history is coloured by the various approaches and developments to historiography that occurred throughout the period in which she was writing (Kloester 103). There is little evidence that she approached her sources with a critical eye and it appears that she often accepted her sources as historical fact (Kloester 112). Heyer’s works are devoid of information as to what is based in history and what was drawn from her imagination (Kloester 110). Despite the omissions above, Heyer has a reputation for undertaking meticulous research for her novels. This, however, is problematic in itself, as Alexandra Stirling argues: “in trying to recreate Regency patterns of speech by applying her knowledge of historical colloquialism, she essentially created her own dialect” that has come to “dominate the modern genre” (Stirling). Heyer is also highly criticised for both her racism (particularly anti-Semitism), which is reflected in her characterisation of Regency London as a society of “extreme whiteness”, which served to erase “the reality of Regency London as a cosmopolitan city with people of every skin colour and origin, including among the upper classes” (Duvezin-Caubet 249). Thus Heyer’s Regency London is arguably a fantasy world that has little grounding in truth, despite her passion for historical research. Historical romance author Felicia Grossman argues that this paradox occurs as “mixed in with [Heyer’s] research is a lot of pure fiction done to fit her personal political views” (Grossman), where she deliberately ignores historical facts that do not suit her narrative, such as the sociological implications of the slave trade and the very public debate about it that occurred during the regency. The legacy of these omissions can be found in contemporary romances set in that period. By focussing on, and intensifying, a narrow selection of historical facts, “the authentic is simultaneously inauthentic” (Hackett 38). For one participant, “I don’t really put much stock into “historical accuracy” as a concept, when I read a historical romance, I read it almost in the way that one would read a genre fantasy novel, where each book has its own rules and conventions”. Diversifying the Bubble The intertwining of history and narrative posits how readers separate fact from fiction. Historical romance novels have often been accused by both readers and critics of providing a skewed view on the past. In October 2019 the All about Romance blog asked its readers: “Does Historical Romance have a quality problem?”, leading to a strong debate with many contributors noting how limited the genre had developed, with the lack of diversity being a particular strain of discussion. Just a few weeks later, the peak industry body, the Romance Writers Association of America, became embroiled in a racism controversy. Cultural products such as romance novels are products of a wider white heteronormative paradigm which has been increasingly challenged by movements such as the LGBTQI+, Me Too, and Black Lives Matter, which have sought to address the evident racial imbalance. The lack of racial representation and racial equality in historical novels also provides an opportunity to consider contemporary ideals. Historical romance novels for one participant provided a lens through which to understand the “challenges for women and queers”. Being a genre that is dominated by both female writers and readers (the Romance Writers Association claims that 82% of readers are female), it is perhaps no surprise that many respondents were concerned with female issues. For one reader, the genre provides a way to “appreciate the freedom that women have today”. Yet it remains that the genre is fictional, allowing readers to fantasise about different social and racial circumstances: “I love the modern take on historical novels with fearless heroines living lives (they maybe couldn’t have) in a time period that intrigues me”. Including strong women and people of colour in the genre means those once excluded or marginalised are centralised, suggesting historical romance novels provide a way of fictionally going some way to re-addressing gender and racial imbalances. Coupled with romance’s guarantee of a happy ending, the reader is assured that the heroine has a positive outcome, and can “have it all”, surely a mantra that should appeal to feminists. “Historical romance offers not just escape, but a journey – emotional, physical or character change”; in this view, readers positively respond to a narrative in which plots engage with both the positive and negative sides of history. One participant put it this way: “I love history especially African American history. Even though our history is painful it is still ours and we loved just like we suffered”. Expanding the Bubble Bridgerton (2020–), the popular Netflix show based upon Julia Quinn’s bestselling historical romance series, challenges the whitewashing of history by presenting an alternative history. Choosing a colour-blind cast and an alternate reality where racism was dispelled when the King marries a woman of colour and bestowed honours on citizens of all colours, Bridgerton’s depiction of race has generally been met with positive reviews. The author of the series of books that Bridgerton is adapted from addressed this point: previously, I’ve gotten dinged by the historical accuracy police. So in some ways, I was fearful – if you do that, are you denying real things that happened? But you know what? This is already romantic fantasy, and I think it’s more important to show that as many people as possible deserve this type of happiness and dignity. So I think they made the absolutely right choice, bringing in all this inclusivity (Quinn cited in Flood). Despite the critics, and there have been some, Netflix claims that the show has placed “number one in 83 countries including the US, UK, Brazil, France, India and South Africa”, which they credited partly to audiences who “want to see themselves reflected on the screen” (Howe). There is no claim to accuracy, as Howe argues that the show’s “Regency reimagined isn’t meant to be history. It’s designed to be more lavish, sexier and funnier than the standard period drama”. As with the readers surveyed above, this is a knowing audience who are willing to embrace an alternate vision of the past. Yet there are aspects which need to remain, such as costume, class structure, technology, which serve to signify the past. As one participant remarked, “I love history. I love reading what is essentially a fantasy-realism setting. I read for escapism and it’s certainly that”. “The Dance of History and Fiction” What is evident in this discussion is what Griffiths calls the “dance of history and fiction”, where “history and fiction … are a tag team, sometimes taking turns, sometimes working in tandem, to deepen our understanding and extend our imagination” (Griffiths). He reminds us that “historians and novelists do not constitute inviolable, impermeable categories of writers. Some historians are also novelists and many novelists are also historians. Historians write fiction and novelists write history”. More so, “history doesn’t own truth, and fiction doesn’t own imagination”. Amongst other analysis of the intersections and juxtaposition of history and fiction, Griffiths provides one poignant discussion, that of Kate Grenville’s novel The Secret River (2006). According to the author's own Website, The Secret River caused controversy when it first appeared, and become a pawn in the “history wars” that continues to this day. How should a nation tell its foundation story, when that story involves the dispossession of other people? Is there a path between the “black armband” and the “white blindfold” versions of a history like ours? In response to the controversy Grenville made an interesting if confusing argument that she does not make a distinction between “story-telling history” and “the discipline of History”, and between “writing true stories” and “writing History” (Griffiths). The same may be said for romance novelists; however, it is in their pages that they are writing a history. The question is if it is an authentic history, and does that really matter? References Davis, Fred. Yearning for Yesterday: A Sociology of Nostalgia. Free Press, 1979. De Groot, Jerome. Consuming History Historians and Heritage in Contemporary Popular Culture. Florence Taylor and Francis, 2009. Duvezin-Caubet, Caroline. "Gaily Ever After: Neo-Victorian M/M Genre Romance for the Twenty-First Century." Neo-Victorian Studies 13.1 (2020). Flood, Alison. "Bridgerton Author Julia Quinn: 'I've Been Dinged by the Accuracy Police – but It's Fantasy!'." The Guardian 12 Jan. 2021. 15 Jan. 2021 <https://www.theguardian.com/books/2021/jan/12/bridgerton-author-julia-quinn-accuracy-fantasy-feisty-rakish-artistocrats-jane-austen>. Griffiths, Tom. "The Intriguing Dance of History and Fiction." TEXT 28 (2015). Grossman, Felicia. "Guest Post: Georgette Heyer Was an Antisemite and Her Work Is Not Foundational Historical Romance." Romance Daily News 2021 (2020). <https://romancedailynews.medium.com/guest-post-georgette-heyer-was-an-antisemite-and-her-work-is-not-foundational-historical-romance-fc00bfc7c26>. Hackett, Lisa J. "Curves & a-Lines: Why Contemporary Women Choose to Wear Nostalgic 1950s Style Clothing." Sociology. Doctor of Philosophy, University of New England, 2020. 320. Howe, Jinny. "'Bridgerton': How a Bold Bet Turned into Our Biggest Series Ever." Netflix, 27 Jan. 2021. <https://about.netflix.com/en/news/bridgerton-biggest-series-ever>. Kloester, Jennifer V. "Georgette Heyer: Writing the Regency: History in Fiction from Regency Buck to Lady of Quality 1935-1972." 2004. NPD. "Covid-19 Lockdown Gives Romance a Lift, the NPD Group Says." NPD Group, 2020. 2 Feb. 2021 <https://www.npd.com/wps/portal/npd/us/news/press-releases/2020/covid-19-lockdown-gives-romance-a-lift--the-npd-group-says/>. Romance Writers of America. "About the Romance Genre." 2016. 2 Feb. 2021 <https://www.rwa.org/Online/Romance_Genre/About_Romance_Genre.aspx>. Stirling, Alexandra. "Love in the Ton: Georgette Heyer's Legacy in Regency Romance World-Building." Nursing Clio. Ed. Jacqueline Antonovich. 13 Feb. 2020. <https://nursingclio.org/2020/02/13/love-in-the-ton-georgette-heyers-legacy-in-regency-romance-world-building/>. Thurston, Carol. The Romance Revolution : Erotic Novels for Women and the Quest for a New Sexual Identity. Urbana: University of Illinois Press, 1987.
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Noble, Greg, and Megan Watkins. "On the Arts of Stillness: For a Pedagogy of Composure." M/C Journal 12, no. 1 (January 30, 2009). http://dx.doi.org/10.5204/mcj.130.

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We live in an era in which the ‘active learner’ has become accepted as the fundamental goal of good teaching from early childcare to university education (Silberman; University of Melbourne University). In this paper we reflect upon the arts of stillness in contemporary classrooms based on research in schools across Sydney (Watkins and Noble).Part of the context for this paper is the way ‘activity’ has been uncritically elevated to a pedagogic principle in contemporary education. Over several decades a critique of traditional or more formal approaches to education has produced an increasing emphasis on learning that is said to be more engaged often under labels such as ‘discovery’ or ‘experiential’ learning, enquiry methods or ‘learning by doing’. This desire to give students a greater role in the educational process is admirable. It is also seen to be more democratic and ‘relevant’ to young people (Cope & Kalantzis). Positioned against a straw man of ‘passive learning’, characterised by the dominance of teacher direction, rote learning and individuated desk work, this active learning or progressivist perspective on education privileges student ‘ownership’ of curriculum, group-based activity and the ‘doing’ of things. Stillness is characterised as a ‘problem of passivity’, a ‘disease’ of ‘chalk and talk’ (Lucas 84-85). In its most extreme form, this emphasis on activity has been translated into ‘educational kinesiology’ and ‘brain gym’, in which physical movement is seen to have a direct, beneficial effect on learning, often in place of content-based curriculum (Lucas 50). In this paper we don’t engage in a critique of ‘active learning’ per se; rather, taking seriously Foucault’s insistence on the productivity of discipline, we argue stillness is crucial to scholarly labour.Part of the context for this research is public anxiety about ‘Asian success’ within Australian education systems. Students from ‘Asian’ backgrounds are often perceived as having a cultural proneness towards educational achievement (Duffy 28). These perceptions rest on assumptions about ‘Asian values’ of family, sacrifice, hard work and success (Robinson). These assumptions, however, are problematic (Wu and Singh), and carry a concern that such students are ‘passive’ in the classroom, deferential to traditional forms of education and obsessed with exams. Certainly, despite their success, these students don’t conform to what many teachers favour as the ideal learner within the dominant paradigm of progressivism (Cope & Kalantzis 4). These anxieties have also emerged in response to the proliferation of coaching colleges which are seen to transgress western notions of childhood.The research – based on a parent survey in 10 primary schools, interviews with Year 3 teachers, parents and students and classroom observations in six of these schools – explored the extent to which a ‘disposition’ to academic achievement can be explained by ethnicity or relates to a complex set of socio-cultural factors. The report from this study engages with the broad question of the relationship between ethnicity and, what we call, following Bourdieu, the ‘scholarly habitus’ (Watkins & Noble). Against a pathologising of cultural background, it examines the ways achievement is embodied as orientations to learning through different home and school practices. Here we use examples drawn from the observations to focus on the capacities for self-discipline and stillness that can foster achievement. Against the tendency to equate stillness with inaction, we argue that a 'productive stillness' underlines capacities for sustained attention and self-direction. This bodily discipline entails a state of composure, a 'staying' of movement which entails a readiness for action necessary for academic tasks. While not all stillness is ‘productive’, we argue there are forms of stillness which are conducive to the formation of the 'scholarly habitus' (Bourdieu, Logic). The Bodily Capacity for Scholarly LabourBourdieu (State) refers to dispositions that are valued in education: self-discipline, the ability to work intensively, confidence, independence, contemplation, abstraction and the value of excellence. Yet he is less interested in exploring these capacities in relation to teaching practice than in discussing them as forms of social distinction. Educational applications of Bourdieu also focus on the social reproduction of inequality, separate to the technical competencies of schooling, although Bourdieu does not differentiate between them (Lareau and Weininger). To understand the uneven distribution of educational competencies, however, they first need to be examined as bodily capacities that are enabling.To do this, let us contrast two classrooms in Broughton PS, a large school in a low-to-mid SES area in Sydney’s inner south-west with large numbers of Arabic-speaking and Asian students, and smaller groups of Anglo, Pasifika and African students. One class is an enrichment class, in which high ability students are placed and where there is a strong focus on academic work. The other class has many of the least able students. The enrichment class comprises students of mostly Chinese background, with a smaller number of Vietnamese, Indian and Anglo background. There is one Arabic-speaking student but no Pasifika students. The second class is more diverse, and has many Pasifika students, with fewer Chinese, Arabic and Anglo students.The first time we saw the enrichment class was after recess. Students shuffled into their classroom and sat down at their desks with minimum fuss. Many of them pulled out books and read them while waiting for their teacher, Heather, to enter. If they talked, it was quietly, and often about what they were reading. They sat still: the posture of most students was upright, even when they were working. Some students occasionally rocked back, stretching arms and legs. Overall, however, these students had mastered the arts of stillness. Sonia, of Chinese background, is a case in point – she was always work-focused, sitting still and getting on with it. Even during unstructured discussion she remained task-orientated displaying a substantial investment in her work.In the second class the students bustled in, taking a while to settle. Kids stood around chatting, playing, shoving each other until the teacher, Betty, shouted at them, which she did a lot. The noise of the students never abated, even as the teacher was giving instructions, and it frequently reached high levels. There was constant movement as students came in late, and teachers and students wandered in and out. Kids visited other kids; one student rolled on the floor. When they were directed to sit at the front, several squatted, some sat away from the area, several simply stood. When they were at their desks, many slouched forward or leant back; a large number of the students rocked on their chairs during the sessions, some constantly. The directions of the teacher to put ‘feet on floor’ and ‘hands on heads’, or putting her fingers to her lips to gesture for them to be quiet, shouting or by counting back from 5 had little effect. This class was a very active group, but little work got done. They did not have sustained capacities of stillness appropriate for academic activities. In the enrichment class, the teacher didn’t have to check noise or movement very often – the students had internalised these behaviours as capacities that directed their work. Occasionally, they policed each other if they were disrupted. There was occasional talk, but it tended to be in whispers. If the task required it, there was plenty of discussion; and some of the students didn’t hesitate in challenging the teacher when she made a mistake. These students’ stillness and quiet was by-and-large productive and appropriate. We call this a state of composure, a readiness for activity. When required, this class was capable of concentration and application; or, alternatively, discussion. We call it composure because it links to Foucault’s (162-3) insight that modern forms of discipline rest on a ‘composition of forces’ which not only produce an efficient organisation but individuals with a disposition towards acting skilfully.Betty’s class, in contrast, was in a state of decomposure, with unproductive movement and noise. They were rarely still, posture was poor, and many students spent little time attending to work or the teacher. They were rarely ready for work when the teacher called them to it. Rather they saw a change in activity as a chance for movement and chatter. This was not the caged resentment that Willis described in his analysis of resistance to school amongst working class boys. It was not a form of conscious insubordination, though a similar form of ‘self-damnation’ was evident.Sonny, a Samoan boy in this class, in contrast to Sonia, struggled to stay on-task for more than a few minutes, and clearly had little investment in his work. He generally didn’t care where he was at with the task, and expected the teacher to constantly direct him. Sonny was a very large child – the teacher commented that his physical presence in the class was an ongoing problem as he was unaware of other children, constantly bowling them over. The teacher struggled to manage Sonny’s body. He talked frequently and loudly, and leant back on his chair despite being placed in a way that pinned him against a cupboard. His location in the class was telling. He was sitting at a table with students who followed tasks, separated from the usual troublemakers. This is significant for another reason of which Sonny was not fully conscious. At one stage in the lesson he sat bolt upright and pointing at each of his tablemates, yelled, ‘Miss, why am I sitting with all Chinese?’ Betty apparently hoped that being with the quieter Chinese students Sonny would not only be out of harm’s way, he might absorb the skills of application they possessed!This uneven distribution of capacities was also seen in the way different classes undertook a maths assessment task on fractions. While other classes treated it as a general lesson, in the enrichment class it was completed in test conditions, which the teacher later commented the kids loved. The teacher explained the task and the conditions – that there should be no copying, to work in silence, concentrate on the questions, the amount of time they’d get and what to do when they finished (further maths work). She initiated an enthusiastic class discussion of the topic (fractions), reminded them of work they had completed in this area and got them to go through basic aspects of fractions. The task was distributed and students immediately filled in their name and the date. When they commenced their work she moved around the room monitoring their progress. Occasionally she directed a student to reread the instructions and towards the end she reminded them to check their work and then gave them a five-minute warning. There was little movement, fiddling or talk, unless it was a question of clarification directed to the teacher. Most finished and moved quickly onto their maths workbooks. There was a lively discussion afterwards as the class went through the questions and discussed the answers and procedure. Overall, there was a clear sense of a strong investment in the process and the product: with many showing real annoyance when they got things wrong, and deep pleasure when they were correct. While the contrast between these classes is clear, and show an uneven distribution of particular capacities, we should be careful not to make a simple assumption that stillness, quiet and obedience are good, and their opposites bad. Apart from the fact that the enrichment class showed itself capable of vociferous and physical behaviour (as when they were completing a craft activity), the point is really about the appropriateness and productivity of these embodied competencies for particular tasks, and the ability to move between these capacities when necessary.Stillness, and its attendant capacities described above, is not a good in and of itself. There is another kind of stillness that we found in a class in another school we observed. Chestervale PS was in a middle class area in a northern suburb of Sydney that was favoured by parents of Chinese background. This class was by no means as unruly as Sonny’s – classroom behaviour was generally well managed by the teacher, and the students were fairly adept at following tasks. Two students we observed – Walter (of Chinese background) and Eric (of Anglo background) – seemed at first glance to be well-behaved students who did their work. Watching these boys for several hours, however, we became aware of the fact that for large chunks of the classroom time they did nothing, but were not recognised as doing so. Walter spent 45 minutes without adding anything to his writing – a straightforward comprehension task. This was also run in near-test-like conditions of quiet concentration, and Walter, apart from a few minor distractions, seemed to be focused on the pages in front of him but actually wrote nothing in the lesson. The teacher strolled around checking students’ work and giving advice or praise as needed – she managed the class quite well – but seemed not to notice when she checked Walter’s work that he hadn’t written anything. Eric, rather more obviously distracted, but who nevertheless seemed to complete 1-2 questions, got by with little work by being, like Walter, generally quiet. His distractions amounted to little more than staring at the contents of the shelf next to him and fidgeting. Walter and Eric were acquiring specific types of capacities – skills in getting out of work that are also fundamentally unproductive. Walter’s general abilities allowed him to float through the class, but Eric’s failure to develop productive capacities was demonstrated in his poor reading and writing levels. We don’t wish to participate in the academic romanticisation of such tactics as ‘resistance’, however, because while this ‘ordinary art’ is diversionary it does not ultimately work to ‘the advantage’ of the student (de Certeau 29-31). Rather, it is simply disabling.This example highlights two important points. First, as mentioned, stillness and quiet are not in themselves signs of educational ‘productivity’ – such capacities always have to be seen in context, related to specific tasks and aims. Many teachers may encourage stillness and quiet – even reward it – simply because it produces an orderly classroom. Second, we should be wary of looking to ethnicity as an explanation of the uneven distribution of capacities: Eric, as an Anglo student, isn’t subject to the kind of cultural pathologising usually reserved for students of particular ethnic backgrounds and Walter, clearly, did not match the stereotype of an academically engaged Chinese student. These issues are taken up in the larger report. Disciplining the Scholarly HabitusOur point is not just to outline some differences in abilities, but to begin to analyse how these contribute to the dispositions, or lack thereof, of the scholarly habitus, to think about how these capacities relate to particular kinds of practices at home and school which instil specific kinds of discipline, and thus eventually to elaborate links between schooling and cultural background. Neither popular pathologies of cultural difference nor sociologies of education which reduce these complexities to either class or gender adequately account for the capacities and practices at stake here (Watkins and Noble).The comparative account of these vignettes of classroom practice provide examples of different disciplinary forms demonstrating the ways in which school structures and pedagogic practices affect students’ engagement in learning and overall performance at school. As indicated, the notion of discipline used here does not simply pertain to control, operating as a negative force inhibiting learning – though a disabling discipline of control was apparent in the pedagogy some teachers employed and also framed some whole school practices. Discipline, here, has a broader meaning. As Foucault intended, it also refers to the knowledge and skills which need to be mastered in order to achieve success in particular fields. Foucault famously analyses the roles of discipline in the functioning of modern institutions. He describes the emergence of the school in modern times as ‘a machine for learning’. Despite his much-repeated insistence on the productive and enabling nature of discipline (and his insight that discipline ‘is no longer simply an art of distributing bodies, … but of composing forces in order to obtain an efficient machine’), it is the machine-like and oppressive quality of discipline that is often the focus. In relation to the nineteenth century school, for example, he describes it as a ‘morality of obedience’ based on a prescriptive discipline of absolute silence and a Pavlovian process of ‘signalisation’ and response (164-7).Sonia’s class (the enrichment class), however, is not one where passivity or docility is the rule – and illustrates better the form of disciplined, productive stillness crucial to educational activity. As this first group of students demonstrates, this discipline takes a material form, whereby students’ bodies are capacitated through the control and focus they embody. This recalls Foucault’s other focus captured in his view that ‘a disciplined body is the prerequisite of an efficient gesture’ (152). This discipline predisposes students towards particular types of endeavour; a discipline that takes the form of dispositions as in the scholarly habitus. Differing degrees of discipline resulting from the repeated performance of certain practices is what distinguishes the three groups of students in this paper.Writing, listening and talking in class are all forms of labour that require bodily control as well as forms of knowledge. Sonia, for example, evinced capacities of stillness, quiet, attention, self-direction and self-discipline which disposed her to engaged learning. This is a state of composure which evinces a readiness for activity. When required, she was capable of sustained application. This is not to be mistaken for docility – her stillness and quiet were productive for academic engagement. In contrast, many in Sonny’s class were far from composed. They did not have sustained capacities of stillness and quiet or the capacity for self-control in an educational environment. They manifested different types of bodily capacities which incline them, like Sonny, towards disengagement. Eric and Walter are different cases yet again. They displayed a degree of quiet and stillness that was unproductive, that didn’t ready them for engaged activity.This sense of bodily control also operates at basic levels of mastery as well as readiness for intellectual activity. Indeed, low-order capacities are stepping stones for higher order skills. It is difficult to develop literacy, for example, without mastering the physical skills of writing. Such skills require a certain posture and control for perfecting letter and word formation. Such mastery, for example, is needed for writing to become ‘transparent’: the student stops ‘thinking’ about forming the letter or word with the pen, and concentrates on the content of their writing. The physical nature of the labour of writing stops being a conscious task and becomes a largely unconscious capacity, which lends itself to the development of capacities in composition, analysis and abstraction. Neither Walter nor Eric had developed a mastery of the pen or their own body. In the case of Eric, Deirdre, his teacher, commented that he had ‘immature fine motor skills’, which affected his writing. She pointed out that ‘when your writing doesn’t come easy it is going to take longer’, which meant Eric ‘rarely completes things’. ConclusionAs Vitalis argued thousands of years ago, with writing, the whole body labours (cited in Ong 95). But this form of labour entails stillness, self-control and the bodily capacity for sustained intellectual engagement. Educational practice needs to not only return to an appreciation of the arts of stillness but to rethink the ways in which activity in learning is understood; the ways in which an active mind is reliant upon a composed yet capacitated body and the particular pedagogies that, from the early years of school, can promote this form of corporeal governance. ReferencesBourdieu, Pierre. The Logic of Practice. Trans. Richard Nice. Cambridge: Polity, 1990.———. The State Nobility. Trans. Lauretta Clough. Cambridge: Polity, 1996.Cope, Bill, and Mary Kalantzis. “Introduction.” In The Powers of Literacy. Eds. Bill Cope and Mary Kalantzis. London: Falmer. 1993. 1-21.De Certeau, Michel. The Practice of Everyday Life. Trans. Steven Rendall. Berkeley: U of California P, 1984.Duffy, Michael. “Improved by Asian Work Ethic.” Courier Mail 29 Sep. 2001: 28.Foucault, Michel. Discipline and Punish. Trans. Alan Sheridan. Harmondsworth: Penguin, 1977.Lareau, Annette, and Elliot Weininger. “Cultural Capital in Educational Research.” Theory and Society 32.5/6 (2003): 567-606.Lucas, Bill. Power Up your Mind. London: Nicholas Brealey, 2001.Ong, Walter. Orality and Literacy. London: Methuen, 1982.Robinson, Kathryn. “Looking for Father-Right.” In Race, Colour and Identity in Australia and New Zealand. Eds. John Docker and Gerhard Fischer. Kensington: UNSW P, 2000. 158-173.Silberman, Mel. The Active Learner. Boston: Allyn and Bacon, 1996.University of Melbourne. Active Learning. Academic Skills Unit. 6 Mar. 2009 ‹http://www.services.unimelb.edu.au/asu/resources/study/estudy008.html›.Watkins, Megan, and Greg Noble. Cultural Practices and Learning: Diversity, Discipline and Dispositions in Schooling. Penrith South: U of Western Sydney, 2008.Willis, Paul. Learning to Labour. Aldershot: Gower, 1977. Wu, Jianguo, and Michael Singh. ‘“Wishing for Dragon Children”: Ironies and Contradictions in China’s Educational Reforms and the Chinese Diaspora’s Disappointments with Australian Education.” The Australian Educational Researcher 31.2 (2004): 29-44.
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Hill, Beverley. "Consumer Transformation: Cosmetic Surgery as the Expression of Consumer Freedom or as a Marketing Imperative?" M/C Journal 19, no. 4 (August 31, 2016). http://dx.doi.org/10.5204/mcj.1117.

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IntroductionTransformation, claims McCracken, is the expression of consumer agency and individual freedom in which consumers, as “co-creators of culture,” are empowered to creatively construct new improved selves (xvi). No longer an “extraordinary event for extraordinary creatures,” transformation today is routine and accessible (McCracken xxi). Contemporary consumer culture encourages individuals to enact these transformations by turning to the market to purchase the resources they require to achieve their desired identity (Ellis et al. 179). This market model of transformation embraces the concept of the marketplace exchange where the one party satisfies the needs of the other in a mutually beneficial exchange relationship. For consumers, the market enables transformation through the purchase and consumption of the desired products and services which support identity building.Critics, however, argue that markets have less positive effects. While it is too simplistic to claim that markets manipulate consumers, marketing exchanges constitute an enduring shaping force on individuals and society (Laczniak and Murphy). Markets shape consumer identities by homogenising them and suppressing their self-expressive capabilities (Kozinets 22). As producers become more powerful, “the market is transformed from a consumer-driven mechanism to a sphere where the producers assimilate consumers’ needs to their own through commercial activity” (Sassatelli 76) (my italics). Marketing and promotion have a persuasive influence and their role in the transformation process is a crucial element in understanding the consumer’s impetus to transform. Consumer identity is of course neither fully a “liberatory act” nor “wholly dictated by the market” (Ellis et al. 182), but there is a relationship between consumer autonomy and the dictates of the market which can be explored through focusing on the transformation of identity through the consumption of cosmetic surgery. Cosmetic surgery is an important site of enquiry as a social practice which “merges the attention given to the body by an individual person with the values and priorities of the consumer society” (Martinez Lirola and Chovanec 490). The body, as Kathy Davis highlighted, has long been seen as a commodity which can be endlessly transformed (Davis, Reshaping the Female Body), and the market for cosmetic surgery is at the forefront of this commodification process (Aizura 305). What is new, however, is the increasing marketisation and commercialisation of the cosmetic surgery industry combined with rising consumerism in which surgical transformation can be purchased simply as a “lifestyle choice alongside fashion, fitness and therapy” (Elliott 7). In the cosmetic surgery market, “patients” are consumers. Rather than choosing cosmetic surgery in order to feel whole or normal, contemporary consumers see surgery as a grooming practice which is part of a body maintenance routine (Jones).As the cosmetic surgery market becomes progressively more competitive, it relies more and more on marketing and promotion for its survival. The intense rivalry between providers drives them, in some cases, to aggressive and often unethical promotional practices. In the related field of pharmaceuticals for example, marketers have been charged with explicitly manipulating social understanding of disease in order to increase profits (Brennan, Eagle, and Rice 17). Unlike TV make-over shows whose primary purpose is to entertain, or celebrity culture which influences indirectly through example, cosmetic surgery promotion sets out with intent to persuade consumers to choose surgical transformation. Cosmetic surgery is presented to consumers “through the neoliberal prism of choice,” encouraging women (mostly) to choose surgery as a self-improvement practice in order to “feel good or pamper herself” (Gurrieri, Brace-Govan, and Previte 534). In a promotional culture which valorises external values and ‘the new’ (Fatah 1), the cost, risk, and pain of surgery are downplayed as an increasing array of self-transformative possibilities are presented as consumption choices. This scenario sees the impetus to transform as driven as much by marketing imperatives as by consumers’ free choice. Indeed in mobilising the rhetoric of choice, the “autonomous” consumer, it seems, plays into the hands of the cosmetic surgery industry.This paper explores consumer transformation through cosmetic surgery by focusing on the tension between the rhetoric of consumer autonomy, freedom, and choice and that of the industry’s marketing and promotional practices in the United Kingdom (UK). I argue that while the consumer is an active player, expressing their freedom and agency in choosing self-transformation through surgery, that autonomy is influenced and constrained by the marketing and promotional practices of the industry. I focus on the inherent paradox in the discourse of transformation in consumer culture which advocates individual consumer freedom and creativity yet limits these freedoms to “acceptable” bodily forms constructed as the norm by promotional images of the cosmetic surgery industry. To paraphrase Susan Bordo, those promotions which espouse consumer choice and self-determination simultaneously eradicate individual difference and circumscribe choice (Unbearable Weight 250). Here I explore how ideals of autonomy, freedom, and choice are utilised to support consumer surgical transformation. Drawing on market research, professional publications, blogs and industry webpages used by UK consumers as they search for information, I demonstrate how marketing and promotion adopt these ideals to provide a visual reference and a language for consumer transformation, which has the effect of shaping and limiting consumer freedom and creativity. Consumer Transformation as Expression of Freedom Contemporary consumers need not be content just to admire the appearance of celebrities and film stars, but can actively engage in the creative construction of new improved selves through surgical transformation (McCracken). This transformation is often expressed by consumers as a liberatory act, as is illustrated by the women surveyed for a UK Department of Health report. As one respondent explains, “I think it’s just the fact that they can . . . and I think over the years, women have a battle with their bodies, as they change, different ages, they do, they struggle with trying to accept it over different years and the fact that you can, it’s like ‘wow, so what, it’s a bit of money, let’s just change ourselves’” (UK Department of Health 32). Even young consumers see cosmetic surgery as an easily available transformative option, such as this 16-year-old female research respondent who describes surgery as “Things that you don’t really need but you just feel you want to have them” (UK Department of Health 33). As these women attest, cosmetic surgery is seen as an increasingly normal and everyday practice. By rhetorically constructing the possibility of transformation as an expression of individual consumer empowerment (“wow, so what, it’s a bit of money, let’s just change ourselves”), they distance the practice “from negative associations with vanity” and oppression (Tait 131). This postmodern consumer is no dupe or victim but a “conscious subject who modifies their body as a project of identity” (Gibson 51) and for whom cosmetic surgery transformation is “the route to happiness and personal empowerment” (Tait 119). Surgical transformation is not a way to strive narcissistically after “an elusive beauty ideal” (Heyes 93). Instead, it is expressed as something they choose to do just for themselves—which Bordo calls the “for me” argument (“Braveheart, Babe, and the Contemporary Body”). In an increasingly visual culture, the accessibility and affordability of cosmetic surgery enable consumers, who are already accustomed to digitally editing their photographical images, to “edit” their physical bodies. This is candidly expressed by Singaporean blogger Ang Chiew Ting who writes, "When I learnt how to use Photoshop, the things that I edited about myself, those have now all been done in real life through plastic surgery. Whatever I wanted to change about my face, I have done." Yet, as I illustrate later, the emphasis on transformation as empowerment through exercising choice (“Whatever I wanted to change about my face, I have done"), plays into the hands of the industry as it “reproduces the logic of surgical industries” (Tait 121). In the politics of consumption, driven by neo-liberal ideologies, consumer choice is sovereign (Sassatelli 184), and it is in the ability to exercise choice, choosing surgery and taking responsibility for that choice, that agency and empowerment are expressed (Leve, Rubin, and Pusic). Blogger Stella Lee explains her decision as “I don't want to say I encourage plastic surgery, this is just my personal choice. It is like saying if I dye my hair purple then I want everyone to have purple hair too. It is simply just for me only. If you wish to do so, go ahead. If you're satisfied with what you have, go ahead.” This consumer is a “discerning and knowledgeable consumer” who researches information about potential surgical procedures and practitioners (Gimlin, “Imagining” 58) and embraces the ideology of self-determinism (Heyes). Consumers considering surgery may visit recommended doctors, research doctors online, and peruse beauty magazines (Leve, Rubin, and Pusic). Tatler magazine, for example, publishes an annual Beauty and Cosmetic Surgery Guide which celebrates “the newest, niftiest ways to reclaim your face and your figure” (Tatler nd). In taking responsibility for themselves, the contemporary consumer reflects the neoliberal agenda “that promotes empowerment through consumer choice and responsibility for self-care” (Leve, Rubin, and Pusic 131). Yet, consumer information on the suitability of surgery and alternative providers is often partial. As one research respondent recalled, “I just typed it into Google and then worked through whatever came up; you're trying to go for the names of companies that are a bit more reputable” (UK Department of Health 28). Internet searches most frequently identify promotional information from the surgery providers themselves including customer stories and testimonials, which seem informative in nature but which have persuasive intent to influence choice. Therefore although seemingly exerting agency by undertaking a process of search in order to make an informed choice, that choice is made within a promotional context that the consumer may not be fully aware exists.Consumer Transformation as Marketing ImperativeThe aim of marketing and promotion, as medicine meets consumerism, is to secure clients for cosmetic surgery (Mirivel). As a consequence, the discourse of cosmetic surgery is highly persuasive and commercially motivated, promoting the need for surgery by mobilising the existing ideological link between identity and physical appearance for commercial ends (Martinez Lirola and Chovanec 489). Promotional strategies include drawing attention to possible deficiencies in appearance, creating opportunities for surgery by problematising normal bodily states, promising intangible benefits, and normalising surgery by positioning it within a consumerist vision of success. Consumer transformation can be driven by perceived lack, inadequacy, or deficit, where a part of the body or face does not stand up to scrutiny when compared to media images. Marketing and promotion draw attention to this lack and imply that any deficiency in appearance can be remedied by consumption practices such as the purchase of hair dye, make-up, or, more drastically, cosmetic surgery. As one research respondent considering surgery explains, “I think people want to look their best and media portrays ‘perfect’ looking people or they portray a certain image and then because it’s what you see all the time, it almost feels like if you don't look like that, then it’s wrong” (UK Department of Health 18). The influence of media on the impetus to transform is explored elsewhere (see Wegenstein), so is not addressed further here. However, the insecurity which results from such media images is further exploited by the marketing and promotional strategies adopted by cosmetic surgery providers in an increasingly competitive marketplace. This does not go unnoticed by consumers: as one research respondent noted, “They pick out your insecurities as a tactic for making you purchase stuff . . . it was supposed to be a free consultation but they definitely do pressure you into having stuff” (UK Department of Health 19). In this deficiency model of transformation, the cosmetic surgery consumer is insecure, lacking in power and volition, and convinced of her inadequacy. This is exacerbated by the promotional images of models featured on cosmetic surgery websites against which consumers evaluate their own looks in a process of social comparisons (Markey and Markey 210). This reflects Bernadette Wegenstein’s notion of the cosmetic gaze, a circular process whereby “the act of looking at our bodies and those of others is informed by the techniques, expectations, and strategies of bodily modification” (2). In comparing themselves with the transformed images on surgery websites, consumers are drawn into a process of comparison that tells them how they should look. At the same time as convincing consumers of their inadequacies, providers also tell consumers that they are in control and can act autonomously to transform themselves. For example, a TV advert for The Hospital Group which shows three smiling “transformed” customers claims “If you’re unhappy with your appearance you could change it. If it affects your confidence you could overcome it. If it makes you feel self-conscious, you could take control with cosmetic surgery or dentistry from The Hospital Group” (my italics). In this way marketers marshal the neo-liberal rhetoric of consumer empowerment to encourage the consumption of cosmetic surgery and normalise the practice through the emphasis on choice. Marketing and promotional messages contribute further to these perceived deficits by problematising “normal” bodily conditions resulting from “normal” life experiences such as ageing and pregnancy. Surgeon Ran Rubinstein, for example, draws attention in his blog to thinning lips as an opportunity for lip augmentation: “Lip augmentation might seem like a trend among the younger crowd, but it’s something that people of any age can benefit from getting. As you get older, some areas of your body thin out while some thicken. You might find that you’re gaining weight around your stomach, while your lips and face are getting thin.” Problematising frames a real or perceived physical state as “as a medical problem that requires a medical solution,” subtly implying that cosmetic surgery is “an unavoidable necessity” which is medically justified (Martinez Lirola and Chovanec 503). For example, Jules’s testimonial for facial fillers frames natural, and even positive, features such as smile lines as problematic: “I smile a lot and noticed some smile lines coming through.” Indeed as medicine has historically defined the female body as “deficient and in need of repair,” cosmetic surgery can be legitimately proposed as a solution for “women’s problems with their appearance” (Davis, “A Dubious Equality” 55). Promotional messages emphasise the intrinsic benefits of external transformation, encouraging consumers to opt for surgery in order to align their external appearance with how they feel inside. Much of this discourse calls on consumers’ perceptions of a disparity between how they feel inside and their external body image (Gibson 54). For example, a testimonial from “Carole Anne 69” claims that facial fillers “make me feel like I’m the best version of myself.” (Note that Carole Anne, like all the women providing testimonials for this website, including Carol 50, Jules 38, or Pamela 59, is defined by her looks and by her age.) Although Gimlin’s research suggests that the notions of the “body reflecting the ‘true’ self or re-creating one’s ‘genuine’ appearance” have become less important (“Too Good” 930), they continue to dominate in customer testimonials on surgery websites. For example, Transform breast enlargement client Rebecca exclaims, “I’m still me, but it has completely transformed how I feel about myself on the inside, how I hold and present myself on the outside.” A typical promotional strategy is to emphasise the intangible benefits of cosmetic surgery, such as happiness or confidence. This is encapsulated in a 2011 print advert for Transform Cosmetic Surgery Group which shows a smiling young girl in a bikini holding a placard which reads, “I’ve just had my breasts done, but the biggest change you’ll see is on my face.” In promising happiness or self-confidence, intangible effects which are impossible to measure, marketers avoid the reality of surgery—where a cut is made, what is added or removed, how many stitches are required. Consumers know the world through shopping (Elliott 43), and marketers draw on this behaviour to associate surgery with any other purchase in the life of a successful consumer. Consumers are encouraged to choose from a gallery of looks, to “Browse through our Before and After Gallery for inspiration,” and the purchase is rendered more accessible through the use of discounts, offers, and incentives, which consumers are accustomed to seeing in familiar shopping contexts. Sales intent can be blatant, such as this appeal to disposable income on Realself.com: “Now that your 2015 taxes are (hopefully) filed and behind you, were you fortunate enough to get a refund? If it just so happens that the government will be returning some of your hard-earned cash, what will you be using it for? Electronic gadgets, an island vacation, a shopping spree . . . or plastic surgery?” Providers reduce perceived risk by implying that interventions such as facial fillers are considered normal practice for others, claiming that “Millions of women choose facial fillers, so that they can age exactly the way they want to” and by providing online interactive tools which consumers can use to manipulate facial features to see the potential effect of surgery (This-is-me.com).ConclusionThe aim of this article was to explore the tension between two different views of transformation, one which emphasised consumer autonomy, freedom, and market choice and the other which claims a more restrictive and manipulative influence of the market and its promotional practices. I argue that McCracken’s explanation of transformation as “the expression of consumer agency and individual freedom” (xvi) offers an overly optimistic view of consumer transformation. In the cosmetic surgery market, the expression of consumer autonomy and freedom rests on the discourse of choice. This same discourse is adopted by surgery providers in their persuasive strategies to secure new clients so that the market’s promotional language (e.g. a whole new you) becomes part of the consumer’s understanding of and articulation of cosmetic surgery transformation. I argue that marketing and promotion work to progress consumers along the path to surgery, by giving them reasons to do so. This is achieved by reflecting existing consumer anxieties as deficiencies, by creating new reasons for surgery by problematising normal conditions, by promising intangible benefits, and by normalising the purchase. These promotional practices also regulate and restrict consumers by presenting visual images of transformation which influence how others understand “the perfect you.” The gallery of looks on surgery websites constrains choice by signifying which looks are desirable, and “before and after” rhetoric emphasises the pivotal role of cosmetic surgery in achieving this transformation. ReferencesAizura, Aren. “Where Health and Beauty Meet: Femininity and Racialisation in Thai Cosmetic Surgery Clinics.” Asian Studies Review 33.3 (2009): 303–17.Bordo, Susan. “Braveheart, Babe, and the Contemporary Body.” 3 June 2016 <www.public.iastate.edu/~jwcwolf/Papers/Bordo>.———. Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley: U of California P, 1993.Brennan, Ross, Lynn Eagle, and David Rice. “Medicalization and Marketing.” Journal of Macromarketing 30.1 (2010): 8–22.Davis, Kathy. “‘A Dubious Equality’: Men, Women and Cosmetic Surgery.” Body & Society 8.1 (2002): 49–65.———. 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Bloomington and Indianapolis: Indiana UP, 2008.Mirivel, Julien. “The Physical Examination in Cosmetic Surgery: Communication Strategies to Promote the Desirability of Surgery.” Health Communication 23.2 (2008): 153–70.Sassatelli, Roberta. Consumer Culture: History, Theory and Politics. London: Sage, 2007.Tait, Sue. “Television and the Domestication of Cosmetic Surgery.” Feminist Media Studies 7.2 (2007): 119–35. Tatler Magazine. “Beauty & Cosmetic Surgery Guide 2016.” Tatler 2016. 3 June 2016 <http://www.tatler.com/guides/beauty--cosmetic-surgery-guide/2016>.UK Department of Health Research. “Regulation of Cosmetic Interventions: Research among the General Public and Practitioners.” 28 Mar. 2013. Version 3. 22 Apr. 2016 <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/192029/Regulation_of_Cosmetic_Interventions_Research_Report.pdf>.Wegenstein, Bernadette. The Cosmetic Gaze: Body Modification and the Construction of Beauty. 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Robards, Brady. "Digital Traces of the Persona through Ten Years of Facebook." M/C Journal 17, no. 3 (June 11, 2014). http://dx.doi.org/10.5204/mcj.818.

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Abstract:
When I think, rarely, about the articulation of the set of traces that I am leaving, I have the immediate apprehension that it is not the real me that’s out there on the Web. I know the times when I have censored myself (oh problematic concept!) and when I have performed actions to complement—and frequently to confound—a trace. […] Taken globally, the set of traces that we leave in the world does without doubt add up to something. It is through operations on sets of traces that I understand an event that I take part in. (Bowker 23) Over the past decade, Facebook has become integrated into the everyday lives of many of its 1.28 billion active users to the point that Facebook can no longer be considered “new media.” The site is driven by the “disclosures” (Stutzman, Gross and Acquisti) users make on the site—by uploading photos, writing status updates, commenting on posts made by others, sharing news items, entering biographical details, and so on. These digital traces of life are archived by default, persisting indefinitely as etches in Facebook’s servers around the world. Especially for young users who have grown up using Facebook, significant parts of their social and cultural lives have been played out on the site. As spaces in which the persona is enacted and made visible, social network sites like Facebook also effectively capture growing up stories through a chronicle of mediated, transitional experiences: birthdays, graduations, the beginning (and end) of relationships, first jobs, travel, and so on. For these reasons, Facebook also comes to serve as a site of memorialisation for users who have passed away. To mark its tenth anniversary (2014), Facebook drew attention to the great depth and wealth of experiences users had traced upon its pages through the release of one-minute “look back“ videos, chronicling the life of individual users over their time on Facebook. These videos have become short manifestations of the personas presented on the site, crafted through an algorithmic selection of critical moments in the user’s life (as shared on the site) to tell that user’s story. To turn Bowker’s musings in the above quote into a question, what do these sets of traces that we leave in the world add up to? In this article, I undertake a critical reading of Facebook’s look back videos to argue that they serve as the strongest reminder yet about the function of Facebook as memory archive. I draw on several sources: my own analysis of the structure of the videos themselves, the Facebook corporate blog describing the roll out of the videos, and the public campaign played out on YouTube by John Berlin to have a look back video generated for his deceased son. I argue that Facebook comes to serve two critical functions for users, as both the site upon which life narratives are performed and organised, and also the site through which the variously public and private disclosures that constitute a persona are recalled and reflected upon. In setting out these arguments, I divide this paper into three parts: first, a description and reflection upon my own experience of the look back video; second, a consideration of critical moments selected for inclusion in the look back videos by algorithm as persona; and third, a discussion of death and memorialisation, as a sharp example of the significance of the digital traces we leave behind. The Look Back Video Gentle piano music rises as the “camera” pans across an assortment of photos. The flute joins the piano, and you are reminded that you started your Facebook journey in 2006. Here is your first profile picture—you with your arm around one of your good mates when you were twenty years old. Faster now, and here are “your first moments,” presented as images you have shared: March 2008, some of your closest friends who you met during your undergraduate studies, standing around sharing a drink; April 2008, a photo of a friend eating a biscuit, mid-conversation (she’d hate this one); and one last photo from April 2008, the biscuit-eating friend’s ex-boyfriend looking coy (you no longer speak to him, but he is still on your Friends list). Now enter the violins, seventeen seconds in. Things are getting nostalgic. Here are “your most liked posts”: July 2012, “thesis submitted for examination, yo” (46 likes); November 2012, “Trust me, I’m a Doctor… of Philosophy” (98 likes); February 2013, a mess of text announcing that you’ve found a job and you’ll be leaving your hometown (106 likes). Thirty-five seconds in now, and the pace of the music changes—look how far you have come. Here are some photos you have shared: December 2008, you at a bowling alley with your arm around one of your best friends who now lives overseas; October 2009, friends trying to sleep on your couch, being disturbed by the flash of your camera; June 2010, a family shot at your mother’s birthday. The pace quickens now, as we move into the final quarter of the video: September 2010, you on the beach with friends visiting from overseas; October 2011, you with some people you met in Canada whose names you don’t recall; (images now moving faster and faster) November 2011, ice skating with friends; March 2012, a wedding in Hawaii where you were the best man; December 2012, celebrating the conferral of your PhD with two colleagues; and finally July 2013, farewelling colleagues at a going away party. In the final ten seconds, the music reaches its crescendo and the camera pans backwards to reveal a bigger collage of photos of you and your nearest and dearest. Facebook’s trademark “thumbs up”/like symbol signals the end of the retrospective, looking back on the critical moments from the last eight and a half years of your life. Underneath the video, as if signing off a card accompanying a birthday present, is “Mark” (Zuckerberg, Facebook CEO, in a faux hand-written font) “and the Facebook Team.” Facebook is you, the note seems to imply; for our anniversary, we present you back to yourself (see fig. 1). On 4 February 2014, the look back video feature was made available to all Facebook users. Some 200 million watched their videos, and more than 50% shared them with their networks (Spiridonov and Bandaru). In other words, around 100 million Facebook users held up their own individually generated look back videos as a record of the persona they had crafted through the site, and shared that persona retrospective with their networks. The videos work in the same way that television news programs piece together memorial clips for celebrities who have passed away, blending emotive music with visuals that conjure up memories and reflections. The first point of difference is that Facebook’s look back videos were intended for the living (although this function shifted as I will explain in a case study towards the end of this piece) to reflect on their own personas presented through the site, and then (about half the time) shared with their networks. The second difference is the technical, automated process of piecing together, rendering, storing, and streaming these videos on a large scale. Spiridonov and Bandaru, two Facebook engineers writing on the site’s Engineering Blog, described the rapid development and rollout of the videos. They explain the enormous pool of technical resources and human capital that were brought to bear on the project, including thirty teams across the company, in just 25 days. They end their explanatory post with an homage to “the things [they] love about Facebook culture” that the project represented for them, including “helping hundreds of millions of people connect with those who are important to them” (Spiridonov and Bandaru). The look back videos also serve a deeper purpose that isn’t addressed explicitly in any explanatory notes or press releases: to demonstrate the great depth of disclosures users make and are implicated in by others on the site. In a one-minute look back video, these disclosures come to serve as the very digital traces that Bowker was interested in, forming a longitudinal record of the persona. Algorithms and Critical Moments Although the explanatory post by Spiridonov and Bandaru did not go into details, the algorithm that determines which photos and status updates go into the look back videos appears to consider the quantity of likes and (potentially) comments on posts, while also seeking to sample disclosures made across the user’s time on the site. The latter consideration works to reinforce the perception of the longitudinal nature of the site’s memory, and the extent to which the life of the user has become entangled with, enmeshed in, and mediated through Facebook. Through the logic of the look back algorithm, critical moments in the user’s life course—those experiences that mark out narratives of growing up—become measured not in terms of their value for individuals, but instead through a quantitative metric of “likes.” While after the initial release of the look back feature, Facebook did provide users with the functionality to alter their videos with some limited control over which images could be featured, the default was determined by the algorithm. Social network sites have come to serve as spaces for reflexive identity work, for the development of personas for young people (boyd; Livingstone; Hodkinson and Lincoln; Lincoln; Robards). The transition towards adulthood is punctuated and shaped by “critical moments” (Thomson et al.) such as moving out of home, dropping out of school, entering a relationship, learning to drive, a death in the family, going clubbing for the first time, and so on. In Giddens’ terms, the “fateful moment” (from which Thomson et al. borrow in conceptualising the critical moment), is “highly consequential for a person’s destiny” (121), and should be understood as distinct from but certainly affecting the inconsequential goings-on of daily life. When these critical moments are articulated and made visible on social network sites like Facebook, and then subsequently archived by way of the persistent nature of these sites, they become key markers in a mediated growing up story for young people. Livingstone points towards the role of these sites for young people who are “motivated to construct identities, to forge new social groupings, and to negotiate alternatives to given cultural meanings” (4). Sharing, discussing, and remembering these critical moments becomes an important activity on social network sites, and thus the look back video serves to neatly capture critical moments in a one minute retrospective. Facebook has also started prompting users to record critical moments through predetermined, normative categories (see fig. 2) such as romance (a first kiss), health (losing weight and not smoking), purchases (buying a house and a car), and civic duty (voting and military service). These disclosure prompts operate at a deeper level to the logic of sharing whatever you are doing right now, and instead feed into that longitudinal memory of the site. As I have argued elsewhere (see Robards) it is clear that not all critical moments are disclosed equally on social network sites. Users may choose not to disclose some critical moments – such as breakups and periods of depression or anxiety – instead preferring to present an “idealised self.” Goffman explains that idealised presentations are aspirational, and that individuals will perform the best version of themselves (44). This isn’t a fake persona or a deception, but simply a presentation of what the individual regards to be the best qualities and appearances, contingent upon what Goffman described as the standards of the region (110). What constitutes an “authentic” persona on Facebook is clearly subjective, and dependent on those region specific standards. In my earlier research on MySpace, the quantity of friends one had was an indicator of popularity, or a quantitative measure of social capital, but over time and with the shift to Facebook this appeared to change, such that smaller networks became more “authentic” (Robards). Similarly, the kinds of disclosures users make on Facebook will vary depending on the conventions of use they have established within their own networks. Importantly, the look back algorithm challenges the user’s capacity to value their own critical moments, or indeed any moments or disclosures that might mark out a narrative of self, and instead chooses moments for the user. In this scenario, at least initially, the look back algorithm co-constructs the retrospective persona summary for the user. Only with effort, and only to a certain extent, can the user exercise curatorial control over that process. Death and Other Conclusions Although the initial function of the look back videos was for users to reflect on their own personas presented through Facebook, users who had lost loved ones quickly sought look back videos for the deceased. John Berlin, a Facebook user who had lost his son Jesse in 2012, tried to access a look back video for his son but was unsuccessful. He posted his plea to YouTube, which received almost three million views, and was eventually successful, after his request “touched the hearts of everyone who heard it” including Facebook staff (Price and DiSclafani). After receiving numerous similar requests, Facebook established a form where people could make have videos for deceased users rendered. In the words of Facebook staff, this was part of the site’s commitment to “preserve legacies on Facebook” (Price and DiSclafani). There is a growing body of research on the digital traces we leave behind after death. Leaver points out that when social media users die, the “significant value of the media traces a user leaves behind” is highlighted. Certainly, this has been the case with the look back videos, further supporting Leaver’s claim. John Berlin’s plea to have his deceased son’s look back video made available to him was presented as a key factor in Facebook’s decision to make these videos available to loved ones. Although the video’s narrative was unchanged (still pitched to users themselves, rather than their loved ones) John Berlin shared his son’s look back video on YouTube to a much wider network than he or his son may have previously imagined. Indeed, Gibson has argued that “digital remains cannot easily be claimed back into a private possessive sphere of ownership” (214). Although Jesse Berlin’s look back video did not reach the millions of viewers his father’s plea reached, on YouTube it still had some 423,000 views, clearly moving beyond Gibson’s “private possessive sphere” (214) to became a very public memorial. Bowker makes the observation that his friends and acquaintances who died before 1992 are sparsely represented online. In 1992, the first widely adopted web browser Mosaic made the Internet accessible for ordinary people in an everyday context. Bowker goes on to explain that his friends who died post-Mosaic “carry on a rich afterlife [… they] still receive email messages; links to their website rot very slowly; their informal thoughts are often captured on list-serv archives, on comments they have left on a website” (23). For Bowker, the rise of the Internet has brought about a “new regime of memory practices” (34). The implications of this new “paradigm of the trace” for Facebook users are only now becoming clear, multiplied in depth and complexity compared to the forms of digital traces Bowker was discussing. The dead, of course, have always left traces—letters, bureaucratic documents, photographs, and so on. There is nothing particularly new about the social and cultural traces that the dead leave behind, only in the way these traces persist and are circulated as the Berlin case study makes clear. The look back video brings the significance of the digital trace into a new light, challenging concepts of personal histories and the longevity of everyday personas. Now that Facebook has developed the infrastructure and the processes for rolling out these look back features, there is the possibility that we will see more in the future. The site already provides annual summaries of the user’s year on Facebook in December. It is possible that look back videos could mark out other moments, too: birthdays, new relationships, potentially even the deaths of loved ones. Might Facebook look back videos – in future forms and iterations, no doubt distinct from the ten-year anniversary video described here – come to serve as a central mechanism for memory, nostalgia, and memorialisation? I don’t have the same kind of apprehension that Bowker expresses in the quote at the top of this article, where he reflects on whether or not it is the “real” him out there on the web. Through Goffman’s dramaturgical lens, I am convinced that there is no single “authentic” persona, but rather many sides to the personas we present to others and to ourselves. The Facebook look back video figures into that presentation and that reflection, albeit through an algorithm that projects a curated set of critical moments back to us. In this sense, these videos become mirrors through which Facebook users experience the personas they have mediated on the site. Facebook is surely aware of this significance, and will no doubt continue to build the importance and depth of the digital traces users inscribe on the site into their plans for the future. References Bowker, Geoffrey C. “The Past and the Internet.” Structures of Participation in Digital Culture. New York: Social Science Research Council, 2007. 20-36. boyd, danah. “Social Network Sites as Networked Publics: Affordances, Dynamics, and Implications.” A Networked Self: Identity, Community, and Culture on Social Network Sites. New York: Routledge, 2011. 39-58. Gibson, Margaret. “Digital Objects of the Dead: Negotiating Electronic Remains.” The Social Construction of Death: Interdisciplinary Perspectives. Ed. Leen van Brussel and Nico Carpentier. Palgrave, 2014: 212-229. Giddens, Anthony. Modernity and Self-Identity: Self and Society in the Late Modern Age. London: Palgrave Macmillan, 1993. Goffman, Erving. The Presentation of Self in Everyday Life. London: Penguin, 1959. Hodkinson, Paul, and Sian Lincoln. “Online Journals as Virtual Bedrooms? Young People, Identity and Personal Space.” Young 16.1 (2008): 27-46. Leaver, Tama. “The Social Media Contradiction: Data Mining and Digital Death.” M/C Journal 16.2 (2013). Lincoln, Siân. Youth Culture and Private Space. London: Palgrave Macmillan, 2012. Stutzman, Fred, Robert Capra, and Jamila Thompson. “Factors Mediating Disclosure in Social Network Sites.” Computers in Human Behavior 27.1 (2011): 590-598. Livingstone, Sonia. “Taking Risky Opportunities in Youthful Content Creation: Teenagers' Use of Social Networking Sites for Intimacy, Privacy and Self-Expression.” New Media & Society 10.3 (2008): 393-411. Robards, Brady. “Leaving MySpace, Joining Facebook: ‘Growing Up’ on Social Network Sites.” Continuum 26.3 (2012): 385-398. Thomson, Rachel, et al. “Critical Moments: Choice, Chance and Opportunity in Young People's Narratives of Transition.” Sociology 36.2 (2002): 335-354.
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32

Al-Natour, Ryan J. "The Impact of the Researcher on the Researched." M/C Journal 14, no. 6 (November 18, 2011). http://dx.doi.org/10.5204/mcj.428.

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Doing research is always risky, personally, emotionally, ideologically, and politically, just because we never know for sure just what results our work will have. (Becker 253) Howard Becker accurately captures the various problematic dimensions that researchers encounter. Numerous personal, emotional, ideological and political dimensions impact research projects in sometimes unpredictable ways. In this paper, I examine some of the many impacts that researchers can have on their own projects. In much of the literature on qualitative research that examines interviews, focus groups and similar methodologies, scholars identify that a variety of factors influence the interactions between researchers and their projects. The academic debates regarding the insider/outsider positions of research are significant here. I will draw attention to the complexity of the researcher/researched relationship and argue that, in light of complexity, researchers can find themselves in predicaments where they are just as much part of the research data as their participants. Ultimately, I aim to contribute to an existing rich literature that deals with these issues concerning the relationship between the researcher and the researched. In this paper, I discuss my own experiences researching the Camden controversy and conclude with a number of suggestions for researchers to consider in similar predicaments. It is from these experiences that I aim to highlight the impact researchers have on their data and the complex relationships between researchers and "the researched". Further, it is through my experiences and observations that I address the theme of "impact" of research in the wider community. Insider/Outsider Debates Scholars often debate how researchers impact their projects. In the past 30 years, academics have focused on how researchers interact as "insiders" or "outsiders" (Naples 84; Coloma 15; Smith 137). Ultimately, these debates focus on the positionalities of researchers, and how these positions impact projects. A number of thought-provoking questions surface in these debates, regarding the distance/closeness between the researcher and participant/s. Scholars interested in this relationship often ponder if this distance/closeness affects the richness and quality of the data. Commonly, issues regarding the researcher's gender, "race" and class are topical in these discourses. Young points out that an assumption grew from these debates, which concludes that researchers who do not share these categories with their participants work find it more difficult to gain their participant's trust (187). From this perspective, women interviewing men hold outsider positions as women, "non-whites" interviewing "whites" hold outsider positions as "non-whites", and so on. Such a view leads to a rigid dichotomisation of the insider vs. outsider binary, which scholars have recently challenged (190). Academics now argue that researchers experience insider/outsider placements and various signifiers mark insiders/outsiders (Young 191; Sin 479) beyond the "race"/sex/class categories. These include sexuality, "race", education, gender, ethnicity, language and class (Coloma 14) to name the most common. Further, these markers are dependent upon the socio-political context of the time of research (Naples 83); thus researchers hold fluid insider/outsider positions. As the next generation of cultural researchers, I argue that we should acknowledge the increasingly complicated positions, influences, and relationships that manifest themselves in the stories of the researchers and the researched. We are never truly outsiders, yet never wholly insiders either; however, we are always partial in examining our research results (see Clifford 7). Yet the various insider/outsider positions generate a number of challenges for researchers. I unpack some of these positions and challenges in discussing a recent project I researched called the Camden controversy. The Camden Controversy In 2007-2009, a controversy over a proposed Islamic school took place in Camden, an area located on the greater Sydney fringe. In October 2007, an Islamic charity proposed a Muslim school in the area and within weeks, a local rally against the school took place involving thousands of local residents. A second anti-school rally occurred months later, where some local residents sported the Australian flag, publicly vilified Muslims claiming the school threatened the "nation". A local anti-school group was formed and two white supremacist groups supported locals against the school. Several extreme-right politicians also campaigned against the school which included former One Nation leader, Pauline Hanson, and leader of the Christian Democrats, Fred Nile. Additionally, two pigs heads with an Australian flag and a wooden crucifix were placed on the proposed site. In the end, the Camden Council rejected the application and the Land and Environment Court rejected the Quranic Society's appeal (for more information, see Al-Natour 573-85). I began researching this controversy in 2008, watching the above events unfold. One of my research methods included interviews with local residents. As a non-local, male researcher of Arab descent (specifically, Palestinian Greek Orthodox Christian and a culturally Islamic background), some interviews were challenging. In some cases, interviewees talked of the controversy as though they responded directly to my "Arabness". In other cases, interviewees positioned me as an outsider to the area. At other times, interviewees sub-typed me from "other Muslims" and I was granted some form of insider status. In various complicated ways, my experiences reflect how researchers become the "researched". To articulate these experiences, I discuss my interactions with only two participants (due to article length restrictions) with very different positions on the school. Case Study 1: Grace Grace is a 38 year old Catholic woman of mixed European heritage who is working in a clothing store in Camden. The interview took place with two of her co-workers in the room. Grace is opposed to the idea of a school in Camden. At the beginning, Grace was understandably suspicious about talking to a stranger about the controversy. Grace: So if there is anything I don't wanna answer, I'll just say 'no comment'.[Researcher]: That's ok, that's fine.Grace: So are you a Muslim? Is that why you're doing ya project here?[Researcher]: I'm not Muslim. No.Grace: (puzzled) are you sure?[Researcher]: Umm. I am an Arab though, but not Muslim. If that's what you're asking?Grace: Oh. Well, I can be an Arab too. See! [grabs a pair of men's underwear from a nearby clothing rack and places the underwear on her head] See! Gee wiz, I am one of those Arab ladies! (Interview, 17 July 2009) While her co-workers laughed in the background, Grace began to speak in a gibberish tongue, perhaps imitating "Arabic" (perhaps the men's underwear is supposed to mock a woman's headscarf). This incident may have been a performance for her co-workers, and may not have occurred if the interview did not have an audience. In this situation, Grace's audience and the interviewer influence her "underwear performance". Perhaps there was a look of shock on my face, as Grace then began to explain that she was doing me a favour by participating in the interview and claimed that an Arab would not have agreed because Arabs "are very rude". Again, Grace discusses Arabs perhaps realising her actions were not appropriate at the time. Conceptually, this incident highlights how the interviewee responds to the researcher's ethnicity and her "joke". In the presence of Grace and her co-workers, the performance highlights their "insider" statuses. The vilifying "Arab" clothing and languages were almost like a bonding performance, something that came up as a result of Grace's interaction with an Arab researcher. The interview is a place where Grace negotiates her position on the school and a variety of other issues that she relates to the researcher. She talked about headscarves worn by Muslim women: I don't know why they wear it as they stand out, there's lots of people that wear long skirts, that's fine, but you ["Muslims"] should mingle. I feel comfortable with you [the researcher], because you are not a covering-up-Muslim, but if you're wearing a head thing, I think that I would be uncomfortable, I mean I would think you had a machine gun [laughs]. The fluidity of the researcher's insider/outsider statuses becomes defined as Grace thinks about the school and Muslims. In the case of hijab, Grace uses the "Muslim" researcher to portray Islamic headscarves as outsider items. In the interview, we talked of Catholic nuns and Grace commented that nuns rarely wear headgear anymore. She agrees with modesty, yet defines her position on hijab by expressing her feelings of the researcher. The interview is a place where Grace considers her positions on Muslims, and the researcher in this case influences Grace as she communicates her viewpoints in light of her interviewer. Case Study 2: Andrew Andrew is a 43 year old resident of Anglo-Maltese heritage. He works in the Camden area and supported the proposal for an Islamic school—which would have been only 5 minutes drive from his workplace: [Researcher]: I can see it's [Camden is] different from other areas. It's like a country town.Andrew: I wouldn't say it's a country town anymore. It's not Orange Parks or Bathurst [rural areas]. It's on the outskirts, beginning of the rural area. I have lived here for 8 years. (Interview, 5 Oct. 2009) The differences of opinion on Camden here illustrate broad positions of the insider/outsider researcher (myself). Here, the researcher states their observations of the area as an outsider to Camden. Andrew responds to the researcher and positions himself with a sense of authority as a local. In terms of the contents of the interview, it is obvious that the researcher's dialogue influences the shape of the data. In other parts of the interview, Andrew found common insider ground with the researcher: France has got the highest population of Muslims, I dunno what the statistics are here, but France holds the most Muslim immigrants, they let them in to mix. I mean, look at you, you have mixed in, you even got your ear pierced! Kids mix in, what about the footballer, El-Masri, but look at him, he has mixed in! Everyone loves him! Here, the researcher has insider status when Andrew discusses how Muslims "mix in". Also, the researcher becomes part of the project, as the interview uses the interviewer's items (ear piercing) and a Lebanese-Australian retired footballer (Hazem El-Masri) as evidence of Islamic integration into Australian society. Here, the researcher's appearance specifically impacts the research, unlike the previous instance which focuses on dialogue between the researcher and researched. Given that the literature on qualitative methodologies focuses on the impact of the researcher's "race", ethnicity and so on, it is obvious that these factors relate to the interview itself. As my quote from Becker at the beginning highlights, research results are unpredictable, often to the point where researchers have unforeseen experiences with their participants. Conceptually, we need to think about impact as a complicated process when we reflect upon our projects and make sense of the researcher/researched relationships. Dealing with "Impact" Issues In both insider/outsider positions, the interviews with Grace and Andrew epitomise some instances that show how researchers cannot be separated from their data. Though both participants held different positions on the school, both demonstrated the complicated impact that researchers have on their projects. Further, they challenge the conventional views of qualitative methodology, which see research as a one way process where researchers interview participants and merely (and "objectively") obtain data. In light of the contemporary academic debates regarding the positionality of the researcher, I suggest that the complexities facing researchers destroy the strictly "insider" vs. "outsider" understandings of qualitative research. Though I reach this point by specifically focusing on interviews as research methodologies, I will also point out that even beyond the context of an interview, merely finding research participants and documenting field notes can be challenging. In my case, my Arab identity influenced the ways some residents responded when I asked them whether they would participate in an interview about the school. In some field notes, I documented some of these hostile instances when I approached people in public places and requested their participation in my project: Anonymous Male Resident 1: Look, I don't wanna do the interview, it's not that I am racist, I just can't stand the rag heads, they aren't normal!... in fact if it were up to me, I would probably exterminate them all (laughs). (Field notes, 9 Oct. 2009)Anonymous Male Resident 2: I saw your people on TV last night... the ones that sound like turkeys, Gobble Gobble. (Field notes, 31 July 2009) In these circumstances, prospective-participants frame the researcher as an outsider. Their refusals to participate show us how residents feel towards a researcher, and how these "feelings" impact upon their project. In my case, this meant it was difficult to find some participants, making the researcher's accessibility to interview participants and the obtaining of data a result of their insider/outsider statuses. In researching "race", Duneier suggests that the researcher should hold a "humble commitment" to be open in the field and be aware of their own social position (100). Becker asks how a researcher should react to the challenges of racism. It becomes a practice of balancing two binary opposing ideals: one rejects racist views, and the other which seeks to understand a particular expression/view of racism, which ultimately benefits knowledge. Thus, the researcher is faced with remembering the purpose of the research project—the pursuit of knowledge, not the debates with participants (Becker 247-49). Similarly, Ezzy argues the task of qualitative researchers is "not to attempt to solve political and moral issues, nor to avoid them, but to be aware of and engage with the potential political and moral implications of their writings" (157). In dealing with the various challenges of the project, I had to transform into the "researcher". My role was not to accuse participants of being "racists", rather to map out how certain views, which could be categorised as "racist", made up the qualitative research experience and would impact the fieldwork journey. As a researcher, my job was to investigate the Islamic school controversy in Camden. It was as though I needed to temporarily disregard (not compromise) other parts of my identities and focus on extracting information. It was an opportunity to pinpoint how particulars of my identity—gender, ethnicity, religion, skin colour, appearance, age, and so on, impacted upon the data collection process and the content. Conclusion: Way Forward? Throughout this article, I have argued that the complicated researcher/researched relationships result in the researchers becoming part of the research itself. Given how challenging this process is for researchers, I finish this article by suggesting some thought-provoking strategies and ideas for the next generation of cultural researchers. Given that all research projects vary, the researcher's impact processes also vary. It is also worth pointing out that in some circumstances, the "outsider" researcher can work for the project, where participants might feel the need to explain and elaborate on particular topics they feel the researcher does not know much about. Thus, attributing "positive" or "negative" feelings on the "insider" or "outsider" researcher is, at times, flawed and pointless. Whether the researcher is predominantly positioned as the insider, or the outsider, or remarkably changes between the two consistently, I would suggest a number of issues to help handle the impact of such predicaments on the research project in a way that can benefit the generation of knowledge. These issues include debriefing, strengthening, positioning, limiting and self-challenging topics. These suggestions would vary from one project to another, operating as a guide that should not be "set in stone". While it is difficult at times to determine how the researcher may impact the research data, it is important for researchers to be conscious of mapping out these challenges on their fieldwork journeys. Debrief with fellow scholars: Confidential discussions with supervisors, fellow researchers and other academics are processes that can enable researchers to make sense of these challenging predicaments (as long as the researcher is mindful of the ethical details involved). Debriefing can help release any emotional baggage or frustrations attained by these experiences. Sharing opinions on these instances can be helpful, particularly in identifying any overbearing biases of the researcher in making sense of their data. Furthermore, in circumstances where the researcher is working alone on a project, debriefing can remove a sense of isolation that can be accumulated by a lonely fieldwork project (particularly in the case of a doctoral project!). View the project as an exercise in building your research skills: Any research project, no matter how challenging or demanding is an opportunity to make sense of the world around us. Fieldwork also provides a chance to build character and strengthen the researcher's skills. Being in control of certain behaviours as researchers can be seen as a strength. This is not to say that the researcher compromises their values for the sake of research. Rather, the researcher has a particular role which needs to be seen in a professional light. Be wary of your own expectations and biases: This relates to the previous topic on character building and strengthening the researcher. As Becker argues (as quoted at the beginning), we cannot predict our research results. Researchers should not walk into their fields attempting to manipulate or predict their research results. The project itself could be extremely challenging where the researcher might expect to be "insider"/"outsider" in unexpected situations. Research results may not always be as hypothesised or generally expected. Therefore, researchers should be prepared to be challenged in terms of their own understandings of racism, sexism and other issues (again, depending on the project). Also, Rosaldo points out, "social analysts can rarely, if ever, become detached observers" (Rosaldo 169). Given that scholars challenge the idea of an "objective" researcher, it is best to acknowledge any forms of biases and how they influence the process of collecting and analysing data. Identify the complicated positionality of the researcher: The complicated insider/outsider positions of the researcher need to be acknowledged when examining the data. The researcher needs to be mindful of how they are approached by participants. Furthermore, the researcher should keep in mind that such positions are not fixed but are changing constantly, sometimes instantly and other times gradually. These different positions need to be seen as interrelated. Also, the researcher should remember there are different levels of being the insider and outsider, and both these positions can work for and against the process of collecting data. Map out the limitations of the project: The research field (which does not necessarily refer to an actual physical environment), in some circumstances, can be volatile and dangerous for some researchers. In the case of my own project, an Arab female researcher would have different experiences, some of which could include violence (according to the Isma report conducted by the Australian Human Rights and Equal Opportunities Commission, Arab women are more likely to experience racially-motivated violence than Arab men—see HREOC). I would advise that researchers are mindful of their "fields". Further, I recommend that research is conducted in public places, particularly if they are about contentious issues. Do not give personal details and if a particular topic inflames the participant during the interview to the point where you feel threatened, change the topic to something a lot less "inflammatory". Notes The names of these participants in this article are pseudonyms. Also, their positions on the school do not represent opponents/supporters of the school. Nor do they represent the Camden community. Further, my experiences interviewing these participants are not reflective of all the interviews I conducted in Camden. References Al-Natour, Ryan J. "Folk Devils and the Proposed Islamic School in Camden." Continuum 24.4 (2010): 573-85. Becker, Howard. "Afterword: Racism and the Research Process." Racing Research, Researching Race: Methodological Dilemmas in Critical Race Studies. Eds. F.W.Twine and J.W. Warren. New York: New York UP, 2000. 247-54. Clifford, James. "Introduction." Writing Culture. Eds. J. Clifford and G.E. Marcus. California: U of California P, 1986.1-26. Coloma, Roland Sintos. "Border Crossing Subjectivities and Research: Through the Prism of Feminists of Color." Race, Ethnicity and Education 11.1 (2008):11-27. Duneier, Mitchell. "Three Rules I Go By in My Ethnographic Research on Race and Racism." Researching Race and Racism. Eds. M. Bulmer and J. Solomos. London: Routledge, 2004. 92-103. Ezzy, Douglas. Qualitative Analysis: Practice and Innovation. Crows Nest: Allen and Unwin, 2002. Human Rights and Equal Opportunities Commission (HREOC). Isma – Listen: National Consultations on Eliminating Prejudice against Arab and Muslim Australians. 2004. 9 Nov. 2011 ‹http://www.hreoc.gov.au/racial_discrimination/isma/report/pdf/ISMA_complete.pdf›. Naples, Nancy. "A Feminist Revisiting of the Insider/Outsider Debate: The 'Outsider Phenomenon' in Rural Iowa." Qualitative Sociology 19.1 (1996): 83-106. Rosaldo, Renato. Culture and Truth: The Remaking of Social Analysis. Boston: Beacon P. 1993. Sin, Chih Hoong. "Ethnic-Matching in Qualitative Research: Reversing the Gaze on 'White Others' and 'White' as 'Other'." Qualitative Research 7.4 (2007): 477-99. Smith, Linda T. Decolonizing Methodologies: Research and Indigenous Peoples. Dunedin: U of Otago P, 1999. Young, Alford. "Experiences in Ethnographic Interviewing about Race." Researching Race and Racism. Eds. M. Bulmer and J. Solomos. London: Routledge, 2004. 187-202.
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Beckton, Denise, Donna Lee Brien, and Ulrike Sturm. "From Reluctant Online Contributor to Mentor: Facilitating Student Peer-to-Peer Mentoring Online." M/C Journal 19, no. 2 (May 4, 2016). http://dx.doi.org/10.5204/mcj.1082.

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IntroductionAs the teaching staff working in a university postgraduate program—the Graduate Certificate of Creative Industries (Creative Practice) at Central Queensland University, Australia—an ongoing concern has been to ensure our students engage with the digital course content (delivered via the Moodle learning management system). This is an issue shared across the sector (La Pointe and Reisetter; Dargusch et al.) and, in our case, specifically in the area of students understanding how this online course content and tasks could benefit them in a program that is based around individual projects. As such, we are invested in enhancing student engagement both within the framework of this individual program and at an institution level. Like many institutions which now offer degrees which are either partially or fully online, the program in question offers a blended learning environment, with internal students also expected to engage with online materials (Rovai and Jordan; Colis and Moonen). The program was developed in 2011, first offered in 2012, and conducted two and sometimes three terms a year since then.Within the first year of delivery, low levels of student participation in online learning were identified as problematic. This issue was addressed using strategies that made use of characteristic strengths among our creative industries students, by developing and linking a peer-to-peer mentoring approach to our blended learning course design. Our challenge in this (as project facilitators and as teachers) has been to devise strategies to shift the students from reluctant to engaged online content users. A key strategy has evolved around introducing peer-mentoring as an intrinsic behaviour in the courses in the program. While not using a full case study approach, we do offer this singular instance for consideration as “much can be learned from a particular case” (Merriam 51). The below is based on our own observations, together with formal and informal student feedback gathered since 2012.Mentors and MentoringThe term mentor can have different meanings depending on the context in which the phrase is used. Ambrosetti and Dekkers note that “it is evident from the literature that there is no single definition for mentoring” (42). Drawing on an array of literature from a number of disciplines to qualify the definition of the term mentoring, Ambrosetti and Dekkers have identified a series of theorists whose definitions demonstrate the wide-ranging interpretation of what this act might be. Interestingly, they found that, even within the relatively narrow context of pre-service teacher research, words used to identify the term mentor varied from relatively collegial descriptors for the established teacher such as supporter, friend, collaborator, role model, and protector, to more formalised roles including trainer, teacher, assessor, and evaluator. The role to be played by a mentor—and how it is described—can also vary according to parameters around, and the purpose of, the mentoring relationship. That is, even though “mentoring, as described in literature, generally involves supporting and providing feedback to the mentee without judgment or criteria” (43), the dynamics of the mentor-mentee relationship may influence the perception and the nature of these roles. For example, the mentoring relationship between a teacher and pre-service teacher may be perceived as hierarchical whereby knowledge and feedback is “passed down” from mentor to mentee, that is, from a more authoritative, experienced figure to a less knowledgeable recipient. As such, this configuration implies a power imbalance between the roles.The relationships involved in peer-to-peer mentoring can be similarly defined. In fact, Colvin and Ashman describe the act of peer-mentoring as “a more experienced student helping a less experienced student improve overall academic performance”, and a relationship that “provides advice, support, and knowledge to the mentee” (122). Colvin and Ashman’s research also suggests that “if mentors and mentees do not have a clear sense of their roles and responsibilities, mentors will find it difficult to maintain any sort of self‐efficacy” (122)—a view that is held by others researchers in this field (see Hall et al.; Reid; Storrs, Putsche and Taylor). However, this collective view of peer-to-peer mentorship was not what we aimed to foster. Instead, we wanted our courses and program to both exhibit and inculcate practices and processes which we felt are more in line with our understanding of the creative industries, including a more organic, voluntary and non-hierarchical approach to peer-to-peer mentorship. This could use Ambrosetti and Dekker’s less hierarchical descriptors of supporter, friend, and collaborator listed above.Student CohortThe student cohort in this program regularly includes on-campus and distance education students in approximately equal ratios, with those studying by distance often geographically very widely dispersed across Australia, and sometimes internationally. The students in this program come from a diverse spectrum of creative industries’ art forms, including creative writing, digital media, film, music, and visual arts. Most enter the program with advanced skills, undergraduate or equivalent qualifications and/or considerable professional experience in their individual areas of creative practice and are seeking to add a postgraduate-level of understanding and scholarly extension to this practice (Kroll and Brien; Webb and Brien). Students also utilise a wide range of learning styles and approaches when developing and completing the creative works and research-informed reflective reports which comprise their assessment. All the students in the program’s courses utilise, and contribute to, a single online Moodle site each term. Some also wish to progress to research higher degree study in creative practice-led research projects (Barrett and Bolt) after completing the program.Applying Peer-to-Peer Mentoring in a Project-Based ProgramThe student cohort in this program is diverse, both geographically and in terms of the area of individual creative industries’ specialisation and the actual project that each student is working on. This diversity was a significant factor in the complexity of the challenge of how to make the course online site and its contents and tasks (required and optional) relevant and engaging for all students. We attempted to achieve this, in part, by always focusing on content and tasks directly related to the course learning outcomes and assessment tasks, so that their usefulness and authenticity in terms of the student learning journey was, we hoped, obvious to students. While this is a common practice in line with foundational conceptions of effective learning and teaching in higher education, we also proposed that we might be able to insure that course content was accessed and engaged with, and tasks completed, by linking the content and tasks in Moodle to the action of mentoring. In this, students were encouraged to discuss their projects in the online discussion forum throughout the term. This began with students offering brief descriptions of their projects as they worked through the project development stage, to reports on progress including challenges and problems as well as achievements. Staff input to these discussions offered guidance—both through example and (at times) gentle direction—on how students could also give collegial advice to other students on their projects. This was in terms of student knowledge and experience gained from previous work plus that learned during the program. In this, students reported on their own activities and how learning gained could potentially be used in other professional fields, as for example: “I specifically enjoyed the black out activity and found the online videos exceptional, inspiring and innovating. I really enjoyed this activity and it was something that I can take away and use within the classroom when educating” (‘Student 1’, week 8, Term 1 2015). Students also gave advice for others to follow: “I understand that this may not have been the original intended goal of Free Writing—but it is something I would highly recommend … students to try and see if it works for you” (‘Student 2’, week 5, Term 1 2015). As each term progressed, and trust built up—a key aspect of online collaboration (Holton) as well as a fruitful mentoring relationship (Allen and Poteet)—joint problem solving also began to take place in these discussions.As most of the students never interact face-to-face during the term, the relative impersonality of the online discussions in Moodle, although certainly not anonymous, seemed to provide a safe platform for peer-to-peer mentoring, even when this was offered by those who were also interacting in class as well. As facilitators of this process, we also sought to model best-practice interaction in this communication and ensure that any posts were responded to in an encouraging and timely manner (Aragon). As a result, the traffic within these forums generally increased each week so that, by the end of the term, every student (both external and internal) had contributed significantly to online discussions—even those who appeared to be more reluctant participants in the beginning weeks of the term. Strategies to Facilitate Peer-to-Peer MentoringSeeking to facilitate this process, we identified discrete points within the term’s course delivery at which we would encourage a greater level of engagement with the online resources and, through this, also encourage more discussion in the online discussion forum. One of the strategies we employed was to introduce specific interactions as compulsory components of the course but, at the same time, always ensuring that these mandated interactions related directly to assessment items. For example, a key assessment task requires students to write reflectively about their creative work and processes. We duly included information and examples of reflective writing as resources online. In order to further develop this skill for both internal and external students, we adopted an active and iterative learning approach to this task by asking students to write reflectively, each week, about the online resources provided to them. In asking students to do this, we reiterated that, at the end of term, a core part of the assessment item was that each student would be asked to describe, analyse and reflect on how they used these resources to facilitate their creative practice. At the end of the term, therefore, each student could collate his or her weekly responses, and use these as part of this assessment task. However, before this final reflection needed to be completed, these reflective musings were already being refined and extended as a result of the commentaries offered by other students responding to these weekly reflections. In this, these commenting students were, in fact, playing the role of peer-to-peer mentors, assisting each other to enhance their abilities in reflective thinking and writing.It should be stated that neither formal mentoring roles nor expectations of the process or its outcomes were pre-determined, defined or outlined to students by the teaching staff or communicated directly to them in any way (such as via the course materials). Instead, internal and distance students were encouraged to communicate with each other and offer guidance, help and support to each other (but which was never described as peer-to-peer mentorship) via their use of the Moodle learning managements system as both a group communication tool and a collaborative learning resource (Dixon, Dixon and Axmann). It is common for creative practitioners to collect data in the form of objects, resources, tools, and memories in order to progress their work and this habit has been termed that of the “bowerbird” (Brady). Knowing that it likely that many of our students are already proficient bowerbirds with many resources in their personal collections, we also facilitated a peer-to-peer mentoring activity in the form of an online competition. This competition asked students to post their favourite interactive resource onto the Moodle site, accompanied by a commentary explaining why and how it could be used. Many students engaged with these peer-posted resources and then, in turn, posted reflections on their usefulness, or not, for their own personal practice and learning. This, in turn, engendered more resources to be posted, shared, and discussed in terms of project problem-solving and, thus, became another ongoing activity that encouraged students to act as increasingly valued peer-mentors to each other.The Practical Application of Peer-to-Peer MentoringEach term, it is a course requirement that the student cohort, both internal and external, combine to create a group outcome—an exhibition of their creative work (Sturm, Beckton and Brien). For some students, the work exhibited is completed; for others, particularly part-time students, the work shown is frequently still in progress. Given that the work in the student exhibition regularly includes music and creative writing as well as visual art, this activity forces students to engage with their peers in ways that most of them have not previously encountered. This interaction includes communication across the internal and distance members of the cohort to determine what work will be included in the exhibition, and how work will be sent for display by external students, as well as liaising in relation to range of related considerations including: curatorial (what the exhibition will be named, and how work is to be displayed), cataloguing (how the works, and their contributors, are to be described), and the overall design of the catalogue and invitation (Sturm, Beckton and Brien). Students make these decisions, as a group, with guidance from staff mainly being offered in terms of practical information (such as what days and times the exhibition space can be accessed) and any limitations due to on-site health and safety considerations and other university-wide regulations.Student feedback has been very positive in relation to this aspect of the course (Sturm, Beckton and Brien), and its collective nature is often remarked on in both formal and informal feedback. We are also finding that some prospective students are applying to the program with a knowledge of this group exhibition and some information about how it is achieved. After graduation, students have reported that this experience of peer-to-peer working across the spectrum of creative industries’ art forms has given them a confidence that they were able to apply in real work situations and has, moreover been a factor that directly led to relevant employment. One student offered in unsolicited feedback: “It was a brilliant course that I gained a lot from. One year on, I have since released another single and work as an artist manager, independently running campaigns for other artists. The course also helped make me more employable as well, and I now work … as a casual admin and projects officer” (Student 3, 2015).Issues Arising from Peer-to-Peer MentoringAn intrinsic aspect of facilitating and encouraging this peer-to-peer mentoring was to allow a degree of latitude in relation to student online communication. The week-to-week reflection on the online resources was, for instance, the only mandated activity. Other participation was modeled and encouraged, but left to students as to how often and when they participated, as well as the length of their posts. In each term, we have found student involvement in discussions increased throughout the term, and tended to exceed our expectations in both quantity and quality of posts.We have also found that the level of intimate detail offered, and intimacy developed, in the communications was far greater than we had initially anticipated, and that there were occasions when students raised personal issues. Initially, we were apprehensive about this, particularly when one student discussed past mental health challenges. At the time, we discussed that the creative arts – whether in terms of its creation or appreciation – are highly personal practices (Sternberg), and that the tone taken by many of the creative individuals, theorists, and researchers whose materials we use as resources was often personally revealing (see, for example, Brien and Brady). By not interfering, other than ensuring that the tone students used with each other was always respectful and focused on the professional aspects of what was being discussed, we observed that this personal revelation translated into high levels of engagement in the discussions, and indeed, encouraged peer support and understanding. Thus, in terms of the student who revealed information about past health issues and who at one stage had considered withdrawing from the course, this student later related to staff—in an unsolicited communication—that these discussions led to him feeling well supported. This student has, moreover, continued to work on related creative practice projects after completing the program and, indeed, is now considering continuing onto Masters level studies.ConclusionIn relation to much of the literature of mentoring, this experience of student interaction with others through an online discussion board appears to offer a point of difference. While that literature reports on other examples of peer-to-peer mentoring, most of these follow the seemingly more usual vertical mentoring model (that is, one which is hierarchical), rather than what developed organically in our case as a more horizontal mode. This is, moreover, a mode which has many synergies with the community of practice and collaborative problem solving models which are central to the creative industries (Brien and Bruns).Collings, Swanson, and Watkins have reported on the positive impact of peer mentoring on student wellbeing, integration, and retention. In terms of effects and student outcomes, although we have not yet collected data on these aspects of this activity, our observations together with informal and University-solicited feedback suggests that this peer-to-peer mentoring was useful (in terms of their project work) and affirming and confidence-building (personally and professionally) for students who are both mentors and mentees. These peer-to-peer mentoring activities assisted in developing, and was encouraged by, an atmosphere in which students felt it was appropriate and safe to both offer support and critique of each others’ work and ideas, as well as encouragement when students felt discouraged or creatively blocked. Students, indeed, reported in class and online that this input assisted them in moving through their projects and, as program staff, we saw that that this online space created a place where collaborative problem-solving could be engaged in as the need arose—rather than in a more forced manner. As teachers, we also found these students became our post-graduate colleagues in the way more usually experienced in the doctoral supervisor-student relationship (Dibble and Loon).The above reports on a responsive learning and teaching strategy that grew out of our understanding of our students’ needs that was, moreover, in line with our institution’s imperatives. We feel this was a successful and authentic way of involving students in online discussions, although we did not originally foresee that they would become mentors in the process. The next step is to develop a project to formally evaluate this aspect of this program and our teaching, as well as whether (or how) they reflect the overarching discipline of the creative industries in terms of process and philosophy. ReferencesAllen, Tammy D., and Mark L. Poteet. “Developing Effective Mentoring Relationships: Strategies from the Mentor’s Viewpoint.” The Career Development Quarterly 48.1 (1999): 59–57.Ambosetti, Angelina, and John Dekkers. “The Interconnectedness of the Roles of Mentors and Mentees in Pre-Service Teacher Education Mentoring Relationships.” Australian Journal of Teaching Education 35.6 (2010): 42–55.Aragon, Steven R. “Creating Social Presence in Online Environments.” New Directions for Adult and Continuing Education 100 (2003): 57–68. Barrett, Estelle, and Barbara Bolt, eds. Practice as Research: Approaches to Creative Arts Enquiry. London: I.B. Tauris, 2007.Brady, Tess. “A Question of Genre: Demystifying the Exegesis.” TEXT: Journal of the Australian Association of Writing Programs 4.1 (2000). 1 Mar. 2016 <http://www.textjournal.com.au/april00/brady.htm>.Brien, Donna Lee, and Tess Brady. “Collaborative Practice: Categorising Forms of Collaboration for Practitioners.” TEXT: The Journal of the Australian Association of Writing Programs 7.2 (2003). 1 Mar. 2016 <http://www.textjournal.com.au/oct03/brienbrady.htm>.Brien, Donna Lee, and Axel Bruns. “Editorial.” M/C Journal 9.2 (2006) 1 Mar. 2016 <http://www.textjournal.com.au/oct03/brienbrady.htm>.Central Queensland University. CB82 Graduate Certificate in Creative Industries. 2016. 1 Mar. 2016 <http://handbook.cqu.edu.au/programs/index?programCode=CB82>.Colis, B., and J. Moonen. Flexible Learning in a Digital World: Experiences and Expectations. London: Kogan-Page, 2001.Collings, R., V. Swanson and R. Watkins. “The Impact of Peer Mentoring on Levels of Student Wellbeing, Integration and Retention: A Controlled Comparative Evaluation of Residential Students in U.K. Higher Education.” Higher Education 68 (2014): 927–42.Colvin, Janet W., and Miranda Ashman. “Roles, Risks and Benefits of Peer Mentoring Relationships in Higher Education.” Mentoring and Tutoring: Partnership in Learning 18.2 (2010): 121–34. Dargusch, Joanne, Lois R. Harris, Kerry Reid-Searl, and Benjamin Taylor. “Getting the Message Through: Communicating Assessment Expectations to First Year Students.” Australian Association of Research in Education Conference. Fremantle, WA: 2015.Dibble, Brian, and Julienne van Loon. “The Higher Degree Research Journey as a Three Legged Race.” TEXT: Journal of the Australian Association of Writing Programs 8.2 (2004). 20 Feb. 2016 <http://www.textjournal.com.au/oct04/dibble_vanloon.htm>.Dixon, Robert, Kathryn Dixon, and Mandi Axmann. “Online Student Centred Discussion: Creating a Collaborative Learning Environment.” Hello! Where Are You in the Landscape of Educational Technology: Proceedings ASCILITE. Melbourne: ASCILITE, 2008. 256–264.Hall, Kendra M., Rani Jo Draper, Leigh K. Smith, and Robert V. Bullough. “More than a Place to Teach: Exploring the Perceptions of the Roles and Responsibilities of Mentor Teachers.” Mentoring & Tutoring: Partnership in Learning 16.3 (2008): 328–45.Holton, Judith A. “Building Trust and Collaboration in a Virtual Team.” Team Performance Management: An International Journal 7.3/4 (2001): 36–47.Kroll, Jeri, and Donna Lee Brien. “Studying for the Future: Training Creative Writing Postgraduates for Life after Degrees.” Australian Online Journal of Arts Education 2.1 (2006): 1–13.La Pointe, Loralee, and Marcy Reisetter. “Belonging Online: Students’ Perceptions of the Value and Efficacy of an Online Learning Community.” International Journal on E-Learning 7.4 (2008): 641–65.Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation. San Francisco, CA: Jossey-Bass, 2009.Reid, E. Shelley. “Mentoring Peer Mentors: Mentor Education and Support in the Composition Program.” Composition Studies 36.2 (2008): 51–79.Rovai, A.P., and Hope M. Jordan. “Blended Learning and Sense of Community: A Comparative Analysis with Traditional and Fully Online Graduate Courses.” Virginia: Regent University, 2004. 20 Feb. 2016 <http://www.irrodl.org/index.php/irrodl/article/view/192/274>.Storrs, D., L. Putsche, and A. Taylor. “Mentoring Expectations and Realities: An Analysis of Metaphorical Thinking among Female Undergraduate Protégés and Their Mentors in a University Mentoring Programme.” Mentoring & Tutoring: Partnership in Learning 16.2 (2008): 175–88. Sternberg, Robert. The Nature of Creativity: Contemporary Psychological Perspectives. Cambridge: Cambridge UP, 1988.Sturm, Ulrike, Denise Beckton, and Donna Lee Brien. “Curation on Campus: An Exhibition Curatorial Experiment for Creative Industries Students.” M/C Journal 18.4 (2015). 12 Feb. 2016 <http://journal.media-culture.org.au/index.php/mcjournal/article/view/1000>.Webb, Jen, and Donna Lee Brien. “Preparing Graduates for Creative Futures: Australian Creative Arts Programs in a Globalising Society.” Partnerships for World Graduates: AIC (Academia, Industry and Community) 2007 Conference. Melbourne: RMIT, 28–30 November 2007.
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