Articles de revues sur le sujet « Kathleen Murray »

Stoekl, Allan. 2021. The Three Sustainabilities: Energy, Economy, Time. Minneapolis, MN: University of Minnesota Press. 307 pp. ISBN 978-1517908188.Carrasco, Anita. 2020. Embracing the Anaconda: A Chronicle of Atacameño Life and Mining in the Andes. Lanham, MD: Lexington Books. 182 pp. ISBN 978-1498575157.Sullivan, Kathleen M., and James H. McDonald, eds. 2020. Public Lands in the Western US: Place and Politics in the Clash between Public and Private. 226 pp. Lanham, MD: Lexington Books. ISBN 978-1793637062.Hirsch, Shana Lee. 2020. Anticipating Future Environments: Climate Change, Adaptive Restoration, and the Columbia River Basin. Seattle, WA: University of Washington Press. 232 pp. ISBN 978-0295747293.O’Gorman, Emily. 2021. Wetlands in a Dry Land: More-Than-Human-Histories of the Murray–Darling Basin. Seattle, WA: University of Washington Press. 288 pp. ISBN 978-0-295-74915-0.Styles, Megan. 2019. Roses from Kenya: Labor, Environment, and the Global Trade in Cut Flowers. Seattle, WA: University of Washington Press. 232 pp. ISBN 978-0-295-74650-0.Boyce, James K. 2019. The Case for Carbon Dividends. Medford, MA: Polity Press. 140 pp. ISBN 978-1-5095-2655-0.Rahder, Micha. 2020. An Ecology of Knowledges: Fear, Love, and Technoscience in Guatemalan Conservation. Durham, NC: Duke University Press. 316 pp. ISBN 978-1-4780-0691-6.Lewis, Simon L., and Mark A. Maslin. 2018. The Human Planet: How We Created the Anthropocene. New Haven, CT: Yale University Press. 496 pp. ISBN 978-0-241-28088-1.Braverman, Irus, and Elizabeth R. Johnson, eds. 2020. Blue Legalities: The Life & Laws of the Sea. Durham, NC: Duke University Press. 342 pp. ISBN 978-1-4780-0654-1.Chaney, Robert. 2020. The Grizzly in the Driveway: The Return of Bears to a Crowded American West. Seattle, WA: University of Washington Press. 288 pp. ISBN 978-0-295-74793-4.

Thomas Nagel’s 1974 essay “What Is It Like to Be a Bat?”[1] is one of the most cited texts on the problem of consciousness, and its theses have been discussed and debated in many different fields, from philosophy of mind to animal cognition and animal ethics. Nagel’s argument, that it is ultimately impossible for us to know what it is like to be a bat for a bat given the extreme differences in sensory experience between humans and bats, has come under fire from very different and even opposed perspectives: if, on the one hand, science-oriented philosophers and scholars accused him of underestimating and ultimately curtailing the power of scientific inquiry, on the other researchers in the humanities and animal ethics indicted him of defeatism for dismissing the power of imagination in bridging the species gap. In what follows, I will present and contrast two such positions, the critique of Nagel by neurophilosopher[2] Kathleen Akins and a very different approach to bat lives through poetry, exemplified by two poems by Ted Hughes (1930-1998) and Les Murray (1938-2019). The goal of counterposing these two different ways of looking at bats is not only or not much that of suggesting a preferable approach to bats’ otherness (though this is also what I will do), but also of emphasizing the aesthetic dimension of our relationship with the animal other and the role it plays in our ethical decision-making. [1] T. Nagel, “What Is It Like to Be a Bat?”, in The Philosophical Review, vol. 83, n. 4, 1974, pp. 435-450. [2] Neurophilosophy is an interdisciplinary field at the intersection of philosophy and the neurosciences in which traditional philosophical problems about the nature of the mind are approached through current findings within the neurosciences.

-Chuck Meide, Kathleen Deagan ,Columbus's outpost among the Taínos: Spain and America at La Isabela, 1493-1498. New Haven CT: Yale University Press, 2002. x + 294 pp., José María Cruxent (eds)-Lee D. Baker, George M. Fredrickson, Racism: A short history. Princeton NJ: Princeton University Press, 2002. x + 207 pp.-Evelyn Powell Jennings, Sherry Johnson, The social transformation of eighteenth-century Cuba. Gainesville: University Press of Florida, 2001. x + 267 pp.-Michael Zeuske, J.S. Thrasher, The island of Cuba: A political essay by Alexander von Humboldt. Translated from Spanish with notes and a preliminary essay by J.S. Thrasher. Princeton NJ: Markus Wiener; Kingston: Ian Randle, 2001. vii + 280 pp.-Matt D. Childs, Virginia M. Bouvier, Whose America? The war of 1898 and the battles to define the nation. Westport CT: Praeger, 2001. xi + 241 pp.-Carmelo Mesa-Lago, Antonio Santamaría García, Sin azúcar no hay país: La industria azucarera y la economía cubana (1919-1939). Seville: Consejo Superior de Investigaciones Científicas, Universidad de Sevilla y Diputación de Sevilla, 2001. 624 pp.-Charles Rutheiser, Joseph L. Scarpaci ,Havana: Two faces of the Antillean Metropolis. Chapel Hill: University of North Carolina Press, 2002. x + 437 pp., Roberto Segre, Mario Coyula (eds)-Thomas Neuner, Ottmar Ette ,Kuba Heute: Politik, Wirtschaft, Kultur. Frankfurt am Main, Germany: Vervuert, 2001. 863 pp., Martin Franzbach (eds)-Mark B. Padilla, Emilio Bejel, Gay Cuban nation. Chicago: University of Chicago Press, 2001. xxiv + 257 pp.-Mark B. Padilla, Kamala Kempadoo, Sun, sex, and gold: Tourism and sex work in the Caribbean. New York: Rowman & Littlefield, 1999. viii + 356 pp.-Jane Desmond, Susanna Sloat, Caribbean dance from Abakuá to Zouk: How movement shapes identity. Gainesville: University Press of Florida, 2002. xx + 408 pp.-Karen Fog Olwig, Nina Glick Schiller ,Georges woke up laughing: Long-distance nationalism and the search for home. Durham NC: Duke University Press, 2001. x + 324 pp., Georges Eugene Fouron (eds)-Karen Fog Olwig, Nancy Foner, From Ellis Island to JFK: New York's two great waves of immigration. Chelsea MI: Russell Sage Foundation, 2000. xvi + 334 pp.-Aviva Chomsky, Lara Putnam, The company they kept: Migrants and the politics of gender in Caribbean Costa Rica, 1870-1960. Chapel Hill: University of North Carolina Press, 2002. xi + 303 pp.-Rebecca B. Bateman, Rosalyn Howard, Black Seminoles in the Bahamas. Gainesville: University Press of Florida, 2002. xvii + 150 pp.-Virginia Kerns, Carel Roessingh, The Belizean Garífuna: Organization of identity in an ethnic community in Central America. Amsterdam: Rozenberg. 2001. 264 pp.-Nicole Roberts, Susanna Regazzoni, Cuba: una literatura sin fronteras / Cuba: A literature beyond boundaries. Madrid: Iberoamericana/Frankfurt am Main, Germany: Vervuert, 2001. 148 pp.-Nicole Roberts, Lisa Sánchez González, Boricua literature: A literary history of the Puerto Rican Diaspora. New York: New York University Press, 2001. viii + 216 pp.-Kathleen Gyssels, Ange-Séverin Malanda, Passages II: Histoire et pouvoir dans la littérature antillo-guyanaise. Paris: Editions du Ciref, 2002. 245 pp.-Sue N. Greene, Simone A. James Alexander, Mother imagery in the novels of Afro-Caribbean women. Columbia MO: University of Missouri Press, 2001. x + 215 pp.-Gert Oostindie, Aarón Gamaliel Ramos ,Islands at the crossroads: Politics in the non-independent Caribbean., Angel Israel Rivera (eds)-Katherine E. Browne, David A.B. Murray, Opacity: Gender, sexuality, race, and the 'problem' of identity in Martinique. New York: Peter Lang, 2002. xi + 188 pp.-James Houk, Kean Gibson, Comfa religion and Creole language in a Caribbean community. Albany: State University of New York Press, 2001. xvii + 243 pp.-Kelvin Singh, Frank J. Korom, Hosay Trinidad: Muharram performances in an Indo-Caribbean Diaspora.Philadelphia: University of Pennsylvania Press, 2003. viii + 305 pages.-Lise Winer, Kim Johnson, Renegades: The history of the renegades steel orchestra of Trinidad and Tobago. With photos by Jeffrey Chock. Oxford UK: Macmillan Caribbean Publishers, 2002. 170 pp.-Jerome Teelucksingh, Glenford Deroy Howe, Race, war and nationalism: A social history of West Indians in the first world war. Kingston: Ian Randle/Oxford UK: James Currey, 2002. vi + 270 pp.-Geneviève Escure, Glenn Gilbert, Pidgin and Creole linguistics in the twenty-first century. New York: Peter Lang Publishing, 2002. 379 pp.-George L. Huttar, Eithne B. Carlin ,Atlas of the languages of Suriname. Leiden, The Netherlands: KITLV Press/Kingston: Ian Randle, 2002. vii + 345 pp., Jacques Arends (eds)

Abstract Background Poly (ADP-ribose) polymerase inhibitors (PARPi) have demonstrated efficacy in treating solid tumors with Homologous Recombination Deficiency (HRD), the inability to repair DNA double-stranded breaks through the Homologous Recombination Repair (HRR) pathway. Specific genetic and epigenetic alterations result in defective HRR function. Bi-allelic loss of BRCA1 or BRCA2 principally drives HRR deficiency. While BRCA1/2 are instrumental to HRR, multiple genes, including PALB2, impact the HRR pathway. PALB2 mutations occur in an estimated 0.97% to 3.66% of solid tumors [AACR GENIE PALB2] and are associated with susceptibility to various cancers. No clinically approved therapies specifically targeting PALB2 currently exist. Emerging evidence suggests that patients with germline or somatic PALB2 mutations may benefit from PARPi treatment, which has potential to be a new tumor agnostic therapy option across a wide range of solid tumors. Methods PAVO is a pan-tumor, single-arm, multicenter Phase-II study assessing the safety and efficacy of niraparib (a PARPi) in patients who harbor a confirmed PALB2 mutation. The study plans to enroll up to 110 adult subjects. Eligible participants must have: locally advanced or metastatic solid tumor(s); confirmed pathogenic or likely pathogenic somatic or germline PALB2 mutation; received all standard of care (SOC) therapy for their tumor type, or are unlikely to derive benefit from SOC therapy in the opinion of the treating physician; ECOG performance status of 0 or 1; life expectancy of ≥ 12 weeks with adequate organ/bone marrow function. Exclusion criteria include a confirmed somatic or germline BRCA1/2 mutation, prior treatment with any PARPi, ovarian or prostate cancer, or rapid progression while on platinum-based therapy in the metastatic setting. Niraparib will be administered in 28 day cycles with daily dosing, as outlined in the protocol. Participants will continue study treatment until documented radiographic progression, unacceptable toxicity, death, or consent withdrawal. The primary study endpoint is objective response rate (ORR), defined as the proportion of participants who have partial or complete response to therapy as assessed by Independent Central Review. Secondary endpoints include DOR, PFS, and CBR. PAVO is sponsored by Tempus with support from GSK (GlaxoSmithKline). The trial opened in March 2022. Tempus molecular data tracking (integrated NGS and EMR data) and the TIME Trial program (rapid match of patients to Just in TIME sites for clinical trials), enable patient identification and prescreening. Enrollment occurs through a combination of TIME and prospective clinical sites, where individualized prescreening models are in development. New site identification and referral of molecularly eligible patients to enrolling centers are ongoing. Clinical Trial Registry: NCT05169437 Citation Format: Tian Zhang, Thomas Weart, Matthias Weiss, Drew Murray, Minaxi Jhawer, Edward Huynh, Shumei Kato, Amy Cummings, Lydia Usha, Arvinder Bhinder, Rajiv Desai, Brad Johnson, Anjali Avadhani, Cecile Rose T. Vibat, Lauren Lopez, Brynna Driscoll, Annajane Ward, Christie K. Rice, Blathnaid Donovan, Scott Sherrin, Mykel Robble, Stephanie O'Leary, Kimberly Blackwell, Amine Aziez, Stephanie Petrone, Kathleen Harnden, Kimberly Strickland, Sonya Reid, Mark Robson, Andrew S. Paulson, Afshin Dowlati. PAVO: A phase-II, open label, single arm study of niraparib in patients with locally advanced/metastatic PALB2 mutated tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT055.

Abstract Metastatic breast cancer (MBC) remains incurable due to inevitable development of therapeutic resistance. Although tumor cell intrinsic mechanisms of resistance in MBC are beginning to be elucidated by bulk sequencing studies, the roles of the tumor microenvironment and intratumor heterogeneity in therapeutic resistance remain underexplored due to both technological barriers and limited availability of samples. To comprehensively capture these characteristics we have adapted a research biopsy protocol to collect tissue for an array of single-cell and spatio-molecular assays whose performance we have optimized for MBC, including single-cell and single-nucleus RNA sequencing, Slide-Seq, Multiplexed Error-Robust FISH (MERFISH), Expansion Sequencing (ExSEQ), Co-detection by Indexing (CODEX) and Multiplexed Ion Beam Imaging (MIBI). To date, we have successfully performed single-cell or single-nucleus RNAseq in 67 MBC biopsies and generated detailed accompanying clinical annotations for each. These samples provide a representation of the clinicopathological diversity of MBC including different breast cancer subtypes (44 HR+/HER2-, 3 HR-/HER2+, 3 HR+/HER2+, 16 TNBC, 1 unknown), common anatomic sites of metastasis (37 liver, 9 axilla, 7 breast, 5 bone, 3 chest wall, 3 neck, 1 brain, 1 lung, 1 skin), metastatic presentations (53 recurrent, 14 de novo) and histologic subtypes in the breast (45 IDC, 7 ILC, 6 mixed, 3 DCIS, 1 mucinous, 5 unknown/NA). Following optimization, both single-cell and single-nucleus RNA seq perform well in these MBC biopsies recovering all expected cell types including the malignant, stromal (e.g. fibroblasts, endothelial cells), myeloid (e.g. monocytes, macrophages) and lymphoid compartments (e.g. T cells, B cells, NK cells) as well as relevant oncogenic programs (e.g. cell cycle programs in all compartments; EMT-like and ER signaling programs in the malignant compartment, immune checkpoint programs in the lymphoid compartment; and fibroblast activation and vascular homeostasis programs in the stromal compartment). In addition to differences between the two techniques, these data demonstrate substantial intratumor heterogeneity in cell type composition. For example in liver biopsies the average number of cells per sample compartment by single nucleus RNA-seq was 6745 malignant (56%, SD 4216), 4637 stromal (41%, SD 3727), 1196 lymphoid (8%, SD 1617) and 874 myeloid (6%, SD 852); in breast biopsies the average number of cells per compartment by single nucleus RNA-seq was 6421 malignant (70%, SD 3497), 1628 stromal (24%, SD 117), 333 lymphoid (4%, SD 170) and 213 myeloid (3%, SD 117). Additionally, we find both inter- and intra-tumor heterogeneity in expression patterns and programs including, for example, expression of ER, PR and HER2 within clinical receptor subtypes (log normalized counts for ER expression in tumor cells by single cell RNA-seq: HR+/HER2- 0.921 (SD 0.714); HR+/HER2+ 0.768 (SD 0.624); HR-/HER2+ 0.018 (SD 0.122); and HR-/HER2- 0.005 (SD 0.066). For a subset of 13 biopsies we are also completing the spatiomolecular characterization methods on serial sections of a single adjacent biopsy. This unique experimental setup was designed to enable efficient comparison and integration of these assays. In spite of differences between experimental techniques and readouts, cell typing can be approached by annotation transfer from matching single cell or single nucleus RNAseq data, enabling exploratory analyses including evaluation of spatial phenotypes and cell type colocalization. Overall, these single cell and spatial data afford a comprehensive atlas including cell types, cell states/programs, cell interactions and spatial organization in MBC lesions. Future analyses will include serial biopsies over time and integration of clinicopathologic data including therapeutic response and resistance. Citation Format: Daniel L Abravanel, Johanna Klughammer, Timothy Blosser, Yury Goltsev, Sizun Jiang, Yunjao Bai, Evan Murray, Shahar Alon, Yi Cui, Daniel R Goodwin, Anubhav Sinha, Ofir Cohen, Michal Slyper, Orr Ashenberg, Danielle Dionne, Judit Jané-Valbuena, Caroline BM Porter, Asa Segerstolpe, Julia Waldman, Sébastien Vigneau, Karla Helvie, Allison Frangieh, Laura DelloStritto, Miraj Patel, Jingyi We, Kathleen Pfaff, Nicole Cullen, Ana Lako, Madison Turner, Isaac Wakiro, Sara Napolitano, Abhay Kanodia, Rebecca Ortiz, Colin MacKichan, Stephanie Inga, Judy Chen, Aaron R Thorner, Asaf Rotem, Scott Rodig, Fei Chen, Edward S Boyden, Garry P Nolan, Xiaowei Zhuang, Orit Rozenblatt-Rosen, Bruce E Johnson, Aviv Regev, Nikhil Wagle. Spatio-molecular dissection of the breast cancer metastatic microenvironment [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD6-03.

BackgroundUp to 70% of people with systemic sclerosis (SSc) report impaired physical function[1,2], which can negatively impact quality of life[3]. The Health Assessment Questionnaire Disability Index (HAQ DI) is a self-administered measure of function, where higher scores (range 0-3) indicate worse function.ObjectivesTo identify trajectories, clinical correlates and associations of functional disability in SSc.MethodsAustralian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc recruited within 5 years of SSc onset were included. Participants needed to have ≥2 HAQ DI scores available within 10 years of SSc onset. Group based trajectory modelling (GBTM) was used to identify the number and shape of HAQ DI score trajectories over 10 years. Between group comparisons were made using the chi-squared test for discrete variables and the two-sample t-test or Wilcoxon rank sum test for continuous variables. Generalised estimating equations were used to model longitudinal data involving repeated measures. Survival analyses were performed using Kaplan Meier and Cox proportional hazard modelling.Results426 participants were included with incident SSc and ≥2 HAQ DI scores, with median time between HAQ DI scores of 1.1 (IQR 1.0-1.4) years. Median age at SSc onset was 53 years (IQR 44-61 years), 83% were female and 33% had dcSSc.We found two HAQ DI trajectory groups: low/stable disability (n=221, 52%), and high/increasing disability (n=205, 48%; Figure 1). Participants with high/increasing disability were older (p=0.01) and more likely to have dcSSc (p<0.01), PAH (p<0.01) and multiple cardiovascular risk factors (p<0.01; Table 1). High/increasing disability was associated with markers of poor hand function such as digital ulcers and synovitis (p<0.01), upper and lower GI involvement (both p<0.01) and proximal muscle weakness and atrophy (both p<0.001). Use of immunosuppression (p<0.001), including prednisolone (p<0.001), was more frequent in those with high/increasing disability.Those with high/increasing disability had worse survival after adjusting for age, sex, dcSSc, PAH and ischaemic heart disease (HR 1.9, 95% CI 1.0-3.8, p=0.05), as did those with increasing baseline HAQ DI scores (HR 1.8, 95%CI 1.2-2.7, p=0.01).ConclusionTwo trajectories of functional disability in SSc were identified. Those with poorer function had a distinct clinical phenotype and survival compared to those with less functional disability. Further work is required to identify if amelioration of disease-specific features associated with higher HAQ DI scores results in a commensurate improvement in physical function.References[1]Zaghlol RS, Dawa GA, Makarm WK. Functional Disability Among Systemic Sclerosis Patients: Relation to Disease Characteristics and Quality of Life Parameters.Curr Rheumatol Rev2021.[2]Guillevin L, Hunsche E, Denton CP, et al. Functional impairment of systemic scleroderma patients with digital ulcerations: results from the DUO Registry.Clin Exp Rheumatol2013;31(2 Suppl 76): 71-80.[3]Hossain S, Choudhury MR, Haque MM, Yeasmin S, Hossain F, Zaman MM. Functional disability and health-related quality of life among systemic sclerosis patients in Bangladesh.BMC Rheumatol2022;6(1): 60.Figure 1: Trajectory groupsTable 1: Clinical features and treatments in trajectory groupsVariableHigh/Increasing HAQ DI(N = 205)Low/Stable HAQ DI(N= 221)p-valueAge at SSc onset (y)56 (44-63)52 (41-59)<0.01DcSSc97 (47%)43 (20%)<0.01ANA Centromere64 (32%)104 (47%)<0.01Scl 7042 (21%)32 (15%)0.09IHD32 (16%)15 (7%)<0.01HTN126 (62%)85 (39%)<0.01PAH22 (11%)8 (4%)<0.01ILD78 (63%)54 (69%)0.358Digital ulcers117 (57%)90 (41%)<0.01Synovitis118 (58%)89 (40%)<0.01Proximal weakness75 (37%)31 (14%)<0.01Muscle atrophy64 (31%)24 (11%)<0.01Upper GI symptoms196 (96%)193 (87%)<0.01Lower GI symptoms188 (92%)175 (79%)<0.01Immunosuppression165 (81%)121 (55%)<0.01Prednisolone126 (62%)81 (37%)<0.01AcknowledgementsJLF holds a NHMRC Postgraduate Scholarship (GNT2013842) and an Australian Government Research Training Program Scholarship. LR holds an Arthritis Australia – ARA Victoria Fellowship. MN holds an NHMRC Investigator Grant (GNT1176538). KB holds an NHMRC Investigator Grant (GNT1197169).Disclosure of InterestsJessica Fairley Speakers bureau: Boerhinger Ingelheim, Dylan Hansen: None declared, Murray Baron: None declared, Susanna Proudman Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Jo-Anne Sahhar Speakers bureau: Boehringer Ingelheim, Gene-Siew Ngian: None declared, Jenny Walker Speakers bureau: Boehringer Ingelheim, Lauren Host: None declared, Kathleen Morrisroe: None declared, Wendy Stevens Consultant of: Boehringer Ingelheim, Laura Ross: None declared, Mandana Nikpour Speakers bureau: Janssen, Boehringer Ingelheim, GSK, Consultant of: Janssen, Boehringer Ingelheim, Astra Zeneca, GSK.

Prehistory and Protohistory ; Sarah C. Murray, The Collapse of the Mycenaean Economy. Imports, Trade and Institutions 1300–700 BCE / Chrysanthi Gallou, Death in Mycenaean Laconia. A Silent Place /James C. Wright and Mary K. Dabney (with contributions by Phoebe Acheson, Susan F. Allen, Kathleen M. Forster, Paul Halstead, S.M.A. Hoffman, Anna Karabatsoli, Konstantina Kaza-Papageorgiou, Bartłomiej Lis, Rebecca Mersereau, Hans Mommsen, Jeremy B. Rutter, Tatiana Theodoropoulou, and Jonathan E. Tomlinson), The Mycenaean Settlement on Tsoungiza Hill (Nemea Valley Archaeological Project III) – Oliver Dickinson ; Gioulika-Olga Christakopoulou, To Die in Style! The Residential Lifestyle of Feasting and Dying in Iron Age Stamna, Greece – John Bintliff ; Archaic to Hellenistic ; Oliver Hülden, Das griechische Befestigungswesen der archaïschen Zeit. Entwicklungen – Formen – Funktionen – Hans Lohmann ; Peter van Alfen and Ute Wartenberg (eds) (with Wolfgang Fischer-Bossert, Haim Gitler, Koray Konuk, and Catharine C. Lorber), White Gold: Studies in Early Electrum Coinage – Keith Rutter ; Marta González González, Funerary Epigrams of Ancient Greece: Reflections on Literature, Society and Religion – Fabienne Marchand ; Robert S. Wagman, The Cave of the Nymphs at Pharsalus. Studies on a Thessalian Country Shrine – Maria Mili ; Natascha Sojc (ed.), Akragas. Current Issues in the Archaeology of a Sicilian Polis – Johannes Bergemann ; Roman to Late Roman ; Laura Pfuntner, Urbanism and Empire in Roman Sicily. – Michalis Karambinis ; Walter Scheidel, Escape from Rome. The Failure of Empire and the Road to Prosperity – Bryan Ward-Perkins ; Rinse Willet, The Geography of Urbanism in Roman Asia Minor – Mark P.C. Jackson ; Medieval to Postmedieval ; Charalambos Bouras, Byzantine Athens, 10th-12th Centuries / Nickephoros I. Tsougarakis and Peter Lock (eds), A Companion to Latin Greece / Joanita Vroom (ed.), Medieval and Post-Medieval Ceramics in the Eastern Mediterranean - Fact and Fiction. / Joanita Vroom, Yona Waksman and Roos van Oosten (eds), Medieval Masterchef. Archaeological and Historical Perspectives on Eastern Cuisine and Western Foodways – John Bintliff ; Multiperiod ; María-Paz de Hoz, Juan Luis García Alonso and Luis Arturo Guichard Romero (eds), Greek paideia and local tradition in the Graeco-Roman east – Dorothea Stavrou ; John Ellis Jones and Ourania Kouka, Elis 1969. The Peneios Valley Rescue Excavation Project: British School at Athens Survey 1967 and Rescue Excavations at Kostoureika and Keramidia 1969 / Effie Photos-Jones and Alan J Hall, Eros, mercator and the cultural landscape of Melos in antiquity: The archaeology of the minerals industry of Melos – John Bintliff ; Bleda S. Düring and Claudia Glatz (eds), Kinetic Landscapes, the Cide Archaeological Project: Surveying the Turkish Western Black Sea Coast – James Crow ; J. Rasmus Brandt, Erika Hagelberg, Gro Bjørnstad and Sven Ahrens (eds), Life and Death in Asia Minor in Hellenistic, Roman and Byzantine Times: Studies in Archaeology and Bioarchaeology – Willem M. Jongman ; Caroline Arnould-Béhar and Véronique Vassal (eds), Art et archéologie du Proche-Orient hellénistique et romain. Les circulations artistiques entre Orient et Occident Vol.1 / Caroline Arnould-Béhar and Véronique Vassal (eds), Art et archéologie du Proche-Orient hellénistique et romain. Les circulations artistiques entre Orient et Occident Vol. 2 – Andrew Erskine ; Historiography and Theory ; John Boardman, A Classical Archaeologist’s Life: The Story So Far. An Autobiography – Robin Osborne

A harmonious state of things is often perceived idyllic. It is devoid of cacophony, hostility, and dissension. It denotes peace, accord, and a relationship characterized by a lack of conflict. True harmony goes much deeper than absence of conflict or condemnation for the lack of peace. This paper presents the challenges to harmony using the theory of care ethics. It will unveil the possibilities of care, even if it was initially lodged at home and family. Using an expansive view, this paper claims that harmony is not farfetched if nations bring to the table the ethics of care. Hinged on care ethics are the principles of collective praxis, peace, and solidarity which enrich human potentials and makes interconnections, and solidarity possible. Thus, the paper will employ philosophical and theological analysis that addresses the following: 1) Care ethics as an ethical concept with myriad variants, yet praxis-driven; 2) Pope Francis’ Laudato Si’ as an appeal to foster care for all; 3) A theological reinterpretation of “rada”, and 4) Care ethics as an injunction to revalue care as a social good. Incorporating Pope Francis’ message in Laudato Si’, this paper hopes to underscore promoting a culture of caring through collective dialogue. References Anderlik, Mary R. The Ethics of Managed Care: A Pragmatic Approach. Bloomingdale: Indiana University Press. 2001. Blair-Loy, Mary. Competing Devotions: Career and Family among Women Executives. Cambridge, Massachusetts: Harvard University Press. 2003. Frank Parsons, Susan, ed. The Cambridge Companion to Feminist Theology. Cambridge: Margaret Beaufort Institute of Theology, 2002. Frank Parsons, Susan. Feminism and Christian Ethics. Cambridge: Cambridge University Press, 1996. Gardner, E. Clinton. Justice and Christian Ethics. Cambridge: Cambridge University Press, 1995. Gensler, Harry J., Earl W.Spurgin, and James C.Swindal, eds. Ethics: Contemporary Readings. New York: Routledge, 2004. Greene-Mccreight, Kathryn. Feminist Reconstructions of Christian Doctrine: Narrative Analysis and Appraisal. Oxford: Oxford University Press, 2000. Grimshaw, Jean. Philosophy and Feminist Thinking. Minneapolis: University of Minnesota Press, 1986. Groenhout, Ruth E. “I Can’t Say No: Self-Sacrifice and an Ethics of Care,” in Ruth E. Groenhout and Marya Bower, eds. Philosophy, Feminism, and Faith, pp. 152-174. Bloomington: Indiana University Press, 2003. Groenhout, Ruth E. and Marya Bower, eds. Philosophy, Feminism, and Faith. Bloomington: Indiana University Press, 2003. Hampton, Jean. “Feminist Contractarianism,” in in Louise Antony and Charlotte Witt, eds. A Mind of One’s Own, pp. 227–255. Boulder, Colo.: Westview Press, 1993. Held, Virginia. ‘The Ethics of Care’ in David Copp, ed. The Oxford Handbook of Ethical Theory. New York: Oxford University Press, 2006. Held, Virginia. The Ethics of Care: Personal, Political, and Global. Oxford: Oxford University Press, 2006. Hilkert Andolsen, Barbara. “Agape in Feminist Ethics,” The Journal of Religious Ethics 9 (1981): 69–83. Hoagland, Sarah Lucia. “Some Thoughts on ‘Caring,’” in Claudia Card, ed. Feminist Ethics, pp. 246–63. Lawrence: University Press of Kansas, 1991. Hoffman, Martin L. Empathy and Moral Development: Implications for Caring and Justice. Cambridge: Cambridge University Press, 2000 Homiak, Marcia. “Feminism and Aristotle’s Rational Ideal,” in Louise Antony and Charlotte Witt, eds. A Mind of One’s Own, pp.1–18. Boulder, Colo.: Westview Press, 1993. Hoose, Bernard. Christian Ethics: An Introduction. London: Continuum, 1998. Isherwood, Lisa and Kathleen McPhillips, eds. Post-Christian Feminisms: A Critical Approach. Hampshire. England: Ashgate, 2008. Jardine, Alice and Paul Smith, eds. Men in Feminism. New York: Routledge, 1987. Kieran Cronin. Rights and Christian Ethics. Cambridge: Cambridge University Press, 1992. Macrae, Janet A. Nursing as a Spiritual Practice: A Contemporary Application of Florence Nightingale's Views. New York: Springer Publishing Company. 2001. Michael Slote, Morals from Motives. New York: Oxford University Press, 2001. Murphy, Peter F. Feminism and Masculinities: Oxford Readings in Feminism. Oxford: Oxford University Press, 2004. Murray, Mary. The Law of the Father? Patriarchy in the Transition from Feudalism to Capitalism London: Routledge, 1995. Outka, Gene. “Universal Love and Impartiality.” In Edmund Santurri and William Werpehowski, eds. The Love Commandments: Essays in Christian Ethics and Moral Philosophy. Washington, D.C.: Georgetown University Press, 1992. Parks, Jennifer A. No Place Like Home? Feminist Ethics and Home Health Care. Bloomingdale: Indiana University Press. 2003. Post, Stephen. A Theory of Agape: On the Meaning of Christian Love. Lewisburg, Pa.: Bucknell University Press, 1990. Ramsey, Paul. Basic Christian Ethics. Louisville: Westminster/John Knox Press, 1993.

Contemporary definitions of resilience stress adaptability to changing ecological and economic conditions (Berkes, Colding and Folke; Castleden, McKee, Murray and Leonard 369). But this approach to resilience is a measure of individual ‘fitness’ to an adaptive whole (Hughes 165; McMahon et al.; Walker and Cooper). Not only is this incongruous with the experience of reproductive loss and infertility, it also works to sideline alternative forms or sources of resilience (Cox). In this paper, we share our efforts to build on previous theories of resilience by engaging in intimate dialogues and written reflections about our personal experiences with reproductive loss. Throughout the paper our reflections are interspersed with our ‘findings’ about the relationship between reproduction and resilience. For us, an active process of dialogically grounded reflection opened up the possibility of a different type of theoretical engagement, one that ultimately produced different enactments, and offered unexpected redirections, both of our experience with reproductive resilience, and in the resilience literature at large. This deeply personal, dialogical frame allowed us to move beyond the anecdotal and confessional to encompass a praxis that engaged the acutely affective reality of reproductive resiliency. Katherine: Three years ago, in the wake of the global financial crisis, I became interested in growing references to resilience in the media. I decided to start a graduate reading group on this theme. This was 'serious academic work.' We looked at questions like: Why has the UNDP rebranded itself 'Empowered Lives, Resilient Nations'? But my thinking about resilience was interrupted by a personal crisis. In January 2011, I was surprised and delighted to discover I was pregnant after years of clinically diagnosed 'unexplained infertility.' So my husband and I were devastated when, in May, a medical crisis (for me, not the baby) forced us to abort the pregnancy in its fifth month. Two years of exhausting medical interventions later, I learned that I am unable to bear children of my own—unable to reproduce—a fact which I am still actively struggling to reconcile. Ayumi: Strange the surprising state of affairs that would shift an employer and research lead into an acquaintance, confidante and friend. I initially learned of her challenges to carry a child to full term through proximity. As her teaching assistant I felt obliged to inform her that I had recently experienced an early miscarriage, and that it could possibly disrupt my work in her course. She was visibly pregnant at the time. Soon after, when I was participating in the resilience reading group, she miscarried as well. Reproductive Resilience A year or more passed before we spoke to each other about our losses, but when we did, we realised that we had both been influenced by dominant discourses around reproduction. Identifying the source of these pressures was an important topic of reflection for us. We found that dominant conceptions of reproductive resilience are overshadowed by a biological imperative to reproduce. When a woman is unable to conceive, or experiences a reproductive loss, she is told to ‘try again.’ There can be solace in trying, and in the ‘successful’ cases, a ‘happy resolution’ is achieved in subsequent pregnancies. But in other cases, the woman's body must produce several reproductive losses before medical professionals can understand the causes of her inability to reproduce (McMahon et al. 2007; Sexton, Byrd, and von Kluge 236). A series of increasingly invasive medical interventions can then be employed to increase the likelihood of reproduction. As a biological imperative, this type of reproductive resilience demands “progressive adaptation to a continually reinvented norm” (Walker and Cooper 156) of what it means to be fertile. But this is more than just a medical norm. Increasingly, reproduction also implies “adaptability to extremes of [ecological and economic] turbulence” (ibid.) that establish the conditions in which fertility is both experienced and understood, something that Katherine in particular had faced: Katherine: Why is it that we both ended up in this situation? Why is it that we are far from being alone in being 40 and childless? I am partly a product of the 1980s teen pregnancy hysteria in North America which made it an anathema for young women to ‘jeopardise’ their earning potential by having children. This makes me particularly bitter because I now understand that, at that moment in history, my society decided to prioritise my productive contributions to capital over socialised financing of the conditions that would allow me to produce a family. What I am suggesting is that the discourses which produce the preconceived notions that we attempt to ‘live up to’ are also discourses that we must, in many ways, ‘live with,’ because like it or not, they contributed to producing the situation which is now prompting us to write this paper! In this sense, reproductive resilience also becomes a measure of normalcy, where normalcy includes the adaptability of human bodies and biological process to the demands of a socio-economic system. Reproductive loss or infertility then becomes a source of personal weakness or abnormality that must be overcome, and a cause of personal degradation, which is often kept silent. In our experience, although individual responses differed greatly, either way the failure to reproduce demanded a response: Katherine: After my loss, I became determined to be pregnant again. For me IVF treatments were not so much about wanting to know with certainty my bodily ability to bring a child into the world. I was working under the perhaps rather desperate assumption that they would. I think of my IVF year more as desperation to achieve an end, a fear of failure, a crisis of sustainability, and a disbelief or disassociation from my own physical reality—the fact of my advancing age. The idea of ‘self-enclosed bodily anxiety’ captures this wonderfully for me. Ayumi: I did nothing, not a single consultation with a fertility expert, no visits to herbal medicine specialists, at most, a half-hearted internet search on adoption agencies. My path insisted upon embracing uncertainty over entrusting others with telling me the limits of my bodily integrity. When we began to share our stories with each other, we noticed that, despite having been surrounded by loving families and supportive colleagues at our times of crisis, both of us felt a tremendous sense of isolation as we tried to make sense of and respond to our losses. So a second area of reflection concerned the source of these emotions—both the sense of isolation, and the way in which it reinforced the normalisation of dominant discourses of reproductive resilience. We found that the reproductive industry’s medical interventions and specialised language community codify and reinforce measures of normalcy and sustain a coerced and often isolating process of adaptation to ever-more medicalised norms of fertility (Bonanno 753). This isolation is particularly apparent for women who choose to pursue fertility treatments. The language of medical intelligence is overwhelming and difficult to learn, creating a barrier between insiders and outsiders to fertility interventions (see for example: Kagan et al., S151). Fertility treatments are not only highly technical, but also a very introspective process, making it difficult for fertility partners, let alone friends and family, to fully comprehend what is going on, or to be involved. Meanwhile, support is difficult to find in a fertility clinic’s waiting room at 7am where groups of women silently await blood work to monitor hormone levels, avoiding eye contact by scanning their phones or reading a magazine. Many women turn instead to online forums, such as www.ivf.ca, where there is mutual comprehension wrapped in the security of anonymity. Rather than explain themselves each time they post to a forum, participants take up the language of reproductive medicine to detail their reproductive interventions in codified signature files (see Figure 1 below). Here, lengthy fertility campaigns become a merit badge of adaptability and perseverance. In their messages, participants share jingoistic mantras like ‘It only takes one!’, one harvested egg to have a child, as they cheer each other on in the search for a baby (Figure 2 below). These types of forums can empower insofar as they educate and encourage. However, they can also enclose and isolate as they cut patients off from family and friends, while creating external pressure to achieve a biological imperative suspended in changing parameters for what it means to be fertile. Figure 1: Example of a Signature File from an IVF Discussion Forum Figure 2: “It only takes one!” This kind of isolated adaptation to medicalised norms of fertility can come at a very high cost. For example, one friend was so traumatised by the multiple fertility interventions and failures it took for her to bear a child that she was ultimately unable to connect with the baby that she bore. The forward march of fertility treatments under the mounting pressure of advancing age required her to defer mourning for the multiple losses that she was experiencing: the loss of a child, the loss of normalcy, the loss of voice. She alone sustained the physical and psychological weight of reproductive resilience, and the pressures of achieving a ‘good outcome’ within the biological limits of her fertility window. When her daughter was born, she was engulfed by an avalanche of backlogged emotions—years of accumulated grief and stress. She was eventually diagnosed with post-traumatic stress disorder, and has struggled to develop a meaningful relationship with her child. But we also found that one need not pursue fertility treatments to experience the isolating and normalising effects of dominant conceptions of fertility. Some experienced infertility without feeling the need to consult medical professionals, or discover through initial consultations that a commercial and medicalised system was not the means through which they wanted to create a future for themselves. Others could find it difficult to contemplate the ‘reproduction’ of a ‘family’ when past experiences with family had been difficult. Yet, despite these decisions, changing norms of fertility continued to reinforce the biological imperative of reproduction in ways that become interwoven with tacitly heteronormative conceptualisations of the nature of family and community (Peters, Jackson, & Rudge 132-134). Katherine: Just the other day at the community garden, one of the gardeners, whom I had just met, wanted to know whether I had any children. When I said no, he bluntly asked me, ‘Why not?’ Just like that: ‘Why not?’ How can I even begin to answer this question? I’ve started to look people squarely in the eye and say, ‘I guess I must not be blessed.’ It’s not because I think I’m not blessed—my life is incredibly rewarding. It’s because it’s the best way I can think of to point out how inappropriate that line of questioning is. But I guess it’s also a defence… Ayumi: I do find that there is something deeply gendered and heterosexist about that line of questioning. As if there is some type of biological expectation for women to reproduce as a means to complete the family. And in absentia, in not raising the biological imperative with same-sex couples—in particular men, a whole host of assumptions are built into forming a good family. It’s like a double disrespect. In the first instance, the biological imperative falls on women, and in the second instance, the lack of expectation leaves many others out of the conversation. In total, we found that resilience always came with a modifier; otherwise we were left asking ‘resilience of what?’ ‘Resilience for what?’ Economic resilience, for example implied the adaptability of the capitalist system. Similarly, rather than expanding choices for and beyond women, the reproductive industry reinforced the normalcy of a gendered biological imperative that ultimately rested on the shoulders of an isolated individual. “The criteria of selection may well have shifted. Yet in the last instance, and for all its flexibility, the resilience perspective is no less rigorous in its selective function than Darwinian evolution” (Walker and Cooper 156). Dialogue Ayumi: To my surprise, she wanted to talk about it one day when we went for lunch, as though words would form the reality of her unexpected shift from pregnant to not-pregnant. The psychological experience of my own miscarriage had been devastating, so invisible, unannounced. Only those who needed to know were privy to the situation. Perhaps I quietly believed that if I spoke very little of it, it could almost have been mistaken for nothing other than conjecture or wishful thinking. Our conversation reproduced the reality of my failure to carry my child into childbirth. Her request for an empathetic listener would mean that a solitary introspection to resignify respect for my own body would give way to responding with due respect for her becoming no longer pregnant. Dialogue did more than just allow us to make sense of what we were experiencing. In conversation, reproductive resilience became something other than what we experienced in isolation. As experiences transformed into words, one perspective intermingled with and shaped the other, revealing imaginings that undid the closures and conclusions reached in our own minds, and offered an opportunity to reconsider the expectations of dominant narratives. Other possibilities surrounded, awaited contemplation, discursive engagement, solicitude in the shadows of experiences that coincided and diverged, resting assured that points of disagreement could be articulated as conjecture, wordless acknowledgement or future interactions. Our very different experiences and choices formed a context for conversation. We asked of one another: Why did this happen? How do you relate to your body? What do you feel is expected of you? What do you plan to do now? Upon dialogical reflection, it became clear that bodies, rather than being intentional enactments of adaptation, were more often than not products and reproductions of experiences and discourses: Ayumi: What kinds of biological, familial, technological, and economic imperatives are pressed upon our bodies? I wonder too about the ways in which consumerisation of reproduction plays upon our imagination of what it would be like to be a parent, creating a market and psychological demand for this life-changing acquisition of a human life. Perhaps these imperatives are operationalised as different mediations on the body, which is seen as a passive recipient of these directives. The externalisation and internalisation of our thoughts allowed us to see how our knowledge was suspended between our relationship with our body and the, often unexpressed, expectations of others which were based on their unexamined assumptions of what it meant to be a woman, a sexual being, a member of a family, a contributor to the community. Thinking about the body as something performed allowed us to use words to make real, reflect on, reproduce or recast our experiences: Katherine: I’m so independent, even in my relationship with my husband that I was a bit shocked at how my miscarriage rippled through my networks of friends, colleagues and family. People I hardly knew told me that they cried when they heard! I forget sometimes that my husband also suffered a huge loss, a blow to his identity and confidence, and a challenge to his sense of place. It is not just me who needs to engage with questions of resilience, but so does he, and we also need to do that together, and these processes will ripple through our networks of friends, family and co-workers in ways that affect the overall resiliency of a community of people. Ayumi: I talked to my partner about how deep down sometimes I feel that I've already done my work as a caregiver. I did a lot of volunteer and paid work with children when I was younger. I’ve taken care of so many children who ranged dramatically in age, mental and physical health and mobility, children who were dying and then died, and this took up so much of my teens, twenties and early thirties. I told him that while I've had that experience, he hasn't spent so much time with kids so that I wished for him to think about if this was something he wanted to explore (taking on a care giving / parental role), considering the options that are available to us through adoption or fostering. In dialogue, we figured out how to talk to one another, to locate a sense of fun within urgency, to reach toward mutual understanding, to test borders and to reshape them. Putting experiences and expectations into words allowed us to uncover expansive possibilities—options not considered, courses not taken. Ultimately, we began to think of reproductive resilience not as the means to achieve a biological imperative, but rather as a relational space of production. As we exchanged ideas, we came to question the assumption that reproductive resilience could be channeled through an individual body, and consequently we began to push back on definitions of fertility which served as measures of ‘fitness’ to a mythical adaptive whole. Through dialogue we resignified our individualised and isolated experiences with reproduction, turning what we experienced as vulnerability into a starting point for the reconceptualisation of resilience. This process—we call it ‘resiliency’ to distinguish it from adaptation—became an act of occupying our own reality in and through the relationships that surround us. Whereas resilience was about individual adaptations to shifting but still dominant norms of fertility, resiliency was about negotiating and constituting a fertile world through dialogues: Ayumi: I found our discussion of care a vitalising part of our conversations. Somehow, through forging different relations, the body propels resilience toward resisting external reinforcements to individualise reproduction and calls forth a collective response. Katherine: Today we discussed reproduction as a process of constructing a caring condition. Caring both in the sense of nurturing, but also in the sense of consideration. This was the most personally enriching part of our discussion – I felt empowered to make decisions about how I wanted to engage in caring and nurturing. This opened my mind to the possibility of adoption, but also to the fact that I express myself as a caring being in many other ways. Resiliency suggests actively engaging people and forces in ways that do not impose a certain order or state of affairs. But we struggled to think about how this new vision of reproductive resiliency would articulate with resistance. What does it mean to resist when biological failure renders acceptance of reproductive decline the only possible way forward? Though we can resist the conditions that created our current situations, we cannot resist our own pasts or our own biological reality. Should our inability to reproduce be seen as a victory in the fight against material myths of parental bliss? Or does our inability to reproduce make us the martyrs of the post-modern and neoliberal era? We want reproductive resiliency to offer a different experience of fertility. But we also want it to be a foundation to resist the normalisation of biological adaptation to the demands of a turbulent socio-economic system. We can do this by making a distinction between the biological act of reproduction (producing a baby), and the social reproducibility of care (nurturing, engaging, resisting, being, sharing, performing, etc.). Reproductive resiliency is concerned with nurturing the fertile enactments of human caring. It is on the basis of human caring that we can resist a system that creates the need for fertility adaptations, and it is also on this basis that we can open up room for thinking about reproductive resiliency in a respectful and socially engaged way. References Berkes, Fikret, Johan Colding and Carl Folke. “Introduction.” Navigating Social-Ecological Systems: Building Resilience for Complexity and Change. Ed. F. Berkes, J. Colding and C. Folke. Cambridge, U.K.: Cambridge University Press, 2002. Bonanno, George A. “Uses and Abuses of Resilience Construct: Loss, Trauma, and Health-Related Adversities. Social Science & Medicine 74.5 (2012): 753-756. Castleden, Matthew, Martin McGee, Virginia Murray & Giovanni Leonard. “Resilience Thinking in Health Protection. Journal of Public Health 33.3 (2011): 369-377. Cox, Pamela. “Marginalized Mothers, Reproductive Autonomy, and Repeat Losses to Care.” Journal of Law and Society 39.4 (2012): 541—561. Herrman, Helen, et al. “What Is Resilience?” Canadian J. of Psychiatry 56.5 (2011): 258-265. Hughes, Virginia. “The Roots of Resilience.” Nature 490 (2012): 165-167. Kagan, et al. “Improving Resilience among Infertile Women: A Pilot Study.” Fertility & Sterility 96.3 (2011): S151. McMahon, Catherine A., Frances L. Gibson, Jennifer L. Allen and Douglas Saunders. “Psychosocial Adjustment during Pregnancy for Older Couples Conceiving through Assisted Reproductive Technology.” Human Reproduction 22.4 (2007): 1168-1174. Peters, Kathleen, Debra Jackson, and Trudy Rudge. “Surviving the Adversity of Childlessness: Fostering Resilience in Couples.” Contemporary Nurse 40.1 (2011): 130-140. Sexton, Minden B., Michelle R. Byrd, and Silvia von Kluge. “Measuring Resilience in Women Experiencing Infertility Using the CD: RISC: Examining Infertility-Related Stress, General Stress, and Coping Styles.” Journal of Psychiatric Research 44.4 (2010): 236-241. Walker, Jeremy, and Melinda Cooper. “Genealogies of Resilience: From Systems Ecology to the Political Economy of Crisis Adaptation.” Security Dialogue 14.2 (2011): 143-160.

A young woman in bikini bottoms and a vest top scrunched up to just below her breasts stands facing the camera. Behind her lies the neatened clutter of domestic space with family photographs arranged next to a fish tank. As this gently buzzes in its fluorescent pool of light, she begins to speak: I’ve just finished eating my McDonald’s meal, which was one of the new quarter pounders with the bacon and the cheese and ten nuggets and a large fries but I have not finished my drink. Pausing to hold up her drink to the camera, she shakes the takeaway cup to assess how much remains inside. With her other hand she gently pats her uncovered stomach, saying: I’m feeling very full and very tight on the top… very very tight like, here and here too… like a drum …Very full! But I know that I can probably fit more with liquids so I’m going to top it off with the rest of this drink and them I’m going to fill in all the spaces with the rest of the drink. After drinking the Dr Pepper before the screen fades to black, she says: I think next time I gotta get the double quarter pounder. I probably could take it, I could probably take on that double quarter pounder with the nuggets. So I’ll have to try that next time for you guys. This video on You Tube is one of many on the Internet labelled BBW, which stands for Big Beautiful Woman. This term dates back to the 1979 launch of BBW Magazine, a fashion and lifestyle magazine for women. As it was then, BBW is also used within spaces of size acceptance, such as among the women participating in Alexandra Lescaze’s documentary All of Me, which charts the lives of friends who met through the National Association to Advance Fat Acceptance. In such spaces, as on Internet blogs and discussion pages, BBW is employed to assert the desirability, rather than abjection, of a fat female body; it thereby counters the “stigma that still is associated with being a large person in a small society” as one of the women in All of Me, Dawn, puts it. BBW is also a term that features frequently in ‘fat forums’. These are adult content cyberspaces for, as one homepage states, “plus size models and their admirers.” Alongside these, there is also a genre of BBW pornography in which sexually explicit activity takes place. This is found on dedicated websites as well as in sub-sections of more ‘mainstream’ porn sites. In these latter the videos that feature BBWs are often labelled “fat fetish.” Against this background, this article draws on content analysis conducted between 2013 and 2015 of forty videos posted on You Tube by women who self-identify as fat (see Longhurst) and, specifically, as BBWs. In particular, it focuses on videos to which eating is central. In these, eating is either performed on camera or has taken place just before filming began. In the latter instance eating and its bodily resonances are visible in two ways: the BBW might describe the meal just eaten or her feeling of fullness, or there may be a textual description such as “after a big mac.” These videos have so far received little scholarly attention other than through a lens of sex, as enactments of “fat pornography” (cf. Kulick). Yet, analysing them as porn risks privileging an imagised rather than lived body and implicitly engaging only with a spectator’s viewpoint. It thereby potentially repeats the power dynamics it seeks to interrogate. This article instead suggests that there are key distinctions between these videos and porn. Although a discussion of gender and sexuality is precluded by limited space, focusing on eating offers a way to unpick this analytic conflation whilst also recognising how wider entanglements among sex, power and fat may texture the videos. As such, whilst being careful not to reduce the BBWs in these videos to no more than eating bodies, this focus seeks primarily to pay attention to their agency and embodiment. Drawing on literature that has critically engaged with fat from a variety of perspectives (cf. Evans Braziel and LeBesco; Forth and Leitch; Rothblum and Solovay), this discussion is particularly shaped by recent work that has sought to take account of lived experiences of moving through and encountering the world with a fat female body (cf. Murray; Tischner). In order to think through this, the article reflects on the Internet as a space not only of visuality, but also of viscerality. Defined by Robyn Longhurst et al. as “the sensations, moods and ways of being that emerge from our sensory engagement with the material and discursive environments in which we live” (334), viscerality has been argued to be a way in which to reflect on identity and power by paying attention to the materiality of everyday experiences (Hayes-Conroy and Hayes-Conroy, taste and visceral). It attends to the simultaneity of politics and intimacy as social relations are forged “at the level of the guts” (Probyn 1). In turn, recent attention to eating has suggested this to be an act that forges social connections at myriad scales (see Abbots and Lavis) as people, places and objects are brought into encounter by ingestion and digestion. An attention to what eating is and does in these videos therefore recognises power dynamics between BBWs and viewing Others, whilst also not taking these to preclude other modalities of agency. It elucidates the co-production of bodily materialities and lived experiences, whilst also tracing the multi-directional slippages between consuming and becoming the Other. Engaging with affects and socialities set in motion by eating offers up a vision of this as an act that may be shared among bodies in ways at once disembodied but visceral. Visuality The homepage of a pornographic website describing itself as “the home of BBWs” suggests that the viewer click on links to see women diving into the kinkiest fetishes and activities you’d ever want to see BBWs do! From face-sitting and squashing, to eating anything and everything, these big fat chicks do it. It goes on to state that “these girls are massive, like their stomachs and appetites” and, illustrating assumptions regarding whose gaze is turned on this page, that “your dick won’t know what to do with itself!” The juxtaposition of the seemingly mundane, and also individual, activity of eating with overtly sexual and corporeally social activities such as face-sitting, suggests that to think through BBW videos focused on eating and trace their divergences from porn, we perhaps first need to attend to this wider landscape in which eating features as “kinky fetish”; it involves recognising intersections as well as disconnects. An undercurrent of sex does resonate through some of the eating videos posted on You Tube by BBWs. Although women are clothed and no sexual activity takes place, many of the titles contain the words “sexy BBW.” Likewise, the language used by participants to talk about their bodies during or after eating is often sexually inflected. Just as the BBW above said of her Dr Pepper that she could “take it,” others talk of being “filled” in a way that folds food into an imaginary of penetrative sex. Bodily boundaries are also shown to be porous in further ways as fat is described as “bursting out of trousers.” A woman eating ice cream directs the camera downwards, saying, “look at that, my underwear’s rolling right down […] my tummy cannot be contained anymore.” Furthermore, to shift our analytic positioning for a moment, it is clear that the BBWs in these videos are regarded as sexually desirable by viewers. A You Tube video in which a woman eats a burger is accompanied by a viewer’s comment: Hello beautiful, I wish that I was there so I could do the fondling and caressing of your beautiful, fat belly while you just concentrated on eating your food. This contrasts to other viewers whose derogatory comments range from the denigrating “you are so ugly and disgusting” to the rather less articulate “eww.” These clearly highlight the “derision and even repulsion” (Lupton 3. See also Cain et al., Erdman Farrell) often directed at, especially female, fat. In contrast, by establishing a fat female – and indeed eating – body as desirable, these videos instead denote themselves as spaces of fat acceptance. Self-identified BBW and adult actress April Flores links her work in porn films to a wider politics of fat acceptance, saying: I want to have my work be a catalyst for change in people seeing fat women as sexual beings. Because we are, and we're not viewed that way. Right now, fat women are relegated to being the punch line and I want my work to change that. (Flores quoted in Wischhover) Flores would seem to articulate a neoliberal narrative of pornography as female empowerment (see Gill) here and it is important to recognise the connections between this and a wider context of disempowerment and stigma. Yet, the power dynamics of gaining social and sexual acceptance through a desiring gaze are also problematic. They highlight, as Rachel Colls puts it, “what the risks are for fat, female bodies and a re-framing of fatness more generally when designating acceptance according to a particular space and to ‘an’ admiring audience” (19). This links the pornographic works of April Flores with the eating videos that are the focus of this article. In both spaces, being visually consumed by an Other is invested with the power to circumscribe one’s own body as acceptable. In one video, a woman who has just finished eating pulls up her top to show her belly. Looking directly into the camera, she asks “do you like that?” A well-known self-described BBW, Donna Simpson, has poignantly written about her decision to shut down her website after years of charging 19 dollars a month to watch her eat (Simpson). She states that “the bottom line is that it was a fantasy created for men […] It’s about control” (quoted in Rose). One way in which control manifested was in how largely-male members of her website not only watched her eat but also directed this, circumscribing what she did and did not put into her own body. Although the financial transaction of the membership fee underpinned this access to Donna Simpson by offering the possibility of one-on-one video chats, there is some similar interaction afforded by the comments posted in response to the eating videos on You Tube. Beneath a video of a woman eating cake, one viewer has written “you’re adorable” to which the BBW herself has replied “you're sweet! thank you.” As such, accompanying these videos there are many requests from viewers centred on eating and food, along the lines of “eat this for me.” These are sometimes responded to in follow-up videos or with links to a paying website like Donna Simpson’s. Such requests demonstrate diverse self-positionings on the part of viewers; the more overtly sexual, such as “eat me” and “I wish to be that cake,” are joined by the expression of desire to be close to the BBW: Wow you are one big sexy fatty with a Huge Blubber Belly!! that thing is soo sexy. I would kill to see you waddling to the buffet bar with your fat jiggling and leading the way. But, to more explicitly address the problematic dynamics of power that have resonated through this discussion so far, these comments are commonly joined by a desire to feed the woman in the video. One viewer writes, “I’d love to get a huge funnel and tube and pour gallons upon gallons of beer down your throat and watch your belly expand!!” These words (at least seek to) intervene in and shape the body of the BBW to whom they are directed. It has been suggested that food “and its relations to bodies is fundamentally about power” (Goody 37) and directions to “eat an éclair for me,” for example, draw forth the power dynamics here by illustrating the co-production of corporeal materialities; the BBWs’ body fat is (at least to a certain extent) made and mediated by viewers. Moreover, in this process, some viewers not only position themselves as feeders but also assume the existence of a feeder off-camera, thereby framing the woman’s eating as always directed by an Other rather than autonomous. This aligns these videos with a wider context of feederism (see Giovanelli and Peluso) and this is sometimes made explicit; beneath one video, a viewer writes somewhat aggressively “your feeder's nice with you, you'd be twice that size with me.” The first half of this article has recognised the setting of these videos within a wider cyber-landscape of porn/power/fat/stigma entanglements. Yet, to suggest that although “the single most striking thing about this genre of pornography is that the women who are pictured do not engage in sex” (Kulick 79) and argue that they instead “have food” (79) reveals the problem with calling them porn and ending our analysis there. It defines the videos, and thus the women in them, through that which is absent, swapping sex for food. This risks repeating in analysis “the kind of harmful behavior in which men reduce fat women to sexual objects” (Saguy 553) by implicitly aligning with the viewer. To avoid this necessitates engaging with the BBWs themselves, their modes of embodiment and lived materialities. As Don Kulick notes, “most of the camera work is focused on their stomachs” (79) and it is here that such an engagement begins. Viscerality Reclaiming the ubiquitous imagery of “headless fatties” (Cooper) in media discussions of obesity, one video begins with a full-screen shot of a woman’s stomach. The camera pans to reveal a box of chocolates balanced on her lap and a hand reaches down to take one. Over the next three wordless minutes, as her fingers move between half-glimpsed chocolate box and unseen mouth, the woman rubs her belly with her other hand, folding and kneading her fat before letting it tumble onto her thighs. In other videos BBWs hold their stomachs to the camera to show how “full of food,” as one woman puts it, these are. Others adjust their position, clothing and webcams to enable a better view of their stomachs, or as they are more habitually called, their “bellies.” Rather than read this focus simply as a fetishisation of dislocated body parts, which echoes pornography, here bellies take on significance precisely because they are the “site of incorporation” (Carden-Coyne and Forth 1); they are indexical of eating. Momentarily altering our viewpoint to elucidate this, on the comment board of another video a viewer has simply written “digestion yeah!” Bellies, thus, gain meaning from eating rather than the other way around. This shift from visuality to viscerality draws us back to the viewpoint of the BBWs; their agency, pleasure and lived materiality is brought literally into the line of the camera. In another video, a woman rubs her belly sensuously. To elucidate the contours of this embodied performance, the video’s tagline reads: A family size lasagne a double milkshake a pound of butter melted in mash potatoes with a can of cheese for lunch wait till i get finished stuffing myself becoming fat is the ultimate pleasure. This woman is not alone in asserting the pleasure of becoming fat. Juxtaposed with articulations of the pleasures of food, together these statements suggest that eating on camera is not so much directed outwards to a desiring gaze. Rather, it is turned inwards as women look down at their bodies, roll food around their mouths and lick their fingers. A video in which a woman eats in her parked car begins: Okay, for lunch I’ve got some fried chicken; it’s two pieces with fries, and there’s lots of ketchup here… I also got a gravy and a macaroni salad to go with it… on yeah and I did pay an extra dollar for an extra piece of chicken so it’s three pieces of chicken. Here the BBW’s eating and its pleasures map the space of this video as closed. Yet her simultaneous narration also opens up this savoured moment of ingestion to a listening and viewing Other. This suggests that it may be not so much bodies that are shared or desired in these videos (as they are in pornography, perhaps), but rather the act of eating itself; these spaces invoke a “mimetic desire” (Girard) to be in this food-consuming moment. In another video a woman talks the viewer through the various flavours of cotton candy in her hand before deciding to try the pink vanilla. After taking a bite she offers this to the camera, saying, “you can eat that part […] does it melt on your tongue?” Although the sharing of eating is verbally articulated here, there are many other instances in which this is less explicit but also present, as visceral viewing becomes a moment of eating from afar (Lavis). That viewers often leave comments such as “I can taste that burger” suggests that these videos engender “vicarious consumption” (Kirkwood) that may be a form of eating as affective as taking food into the mouth. As such, here we glimpse the multi-directional flows of agency, affect and sociality engendered by eating. Recent explorations of eating bodies have seen these as entangled in myriad social and material relations. By engaging with eating as instigating encounters between bodies and worlds, this work has thereby argued that “in the act of placing food in the mouth, landscapes, people, objects and imaginings not only juxtapose with and fold into one another, but are also reconstituted and reordered” (Abbots and Lavis 5. See also Probyn). Against this background, “vicarious consumption” (Kirkwood) offered by these videos folds the bodies of viewer and viewed together to reconfigure taken-for-granted notions of outsides and insides, eater and eaten. Visceral viewing as embodied consumption recognises eating as an act that may be shared and thereby take place among many bodies at once. It has been suggested that an attention to viscerality engages with “contextualized and interactive versions of the self and other” (Hayes-Conroy and Hayes-Conroy, visceral, 1273). As such, as consuming the Other slip-slides into becoming Other through mimetic eating, it is now viewers’ bodily materialities that are affected and reshaped; their hungering, salivating bodies are mediated by the BBWs’ moments of eating. In this reversal, our sense of the power dynamics of these videos shifts. As eating becomes shared and contingently and dynamically distributed across bodies, power too is dissipated between the actors that perhaps co-produce these (eating) spaces and bodies. Thus, these videos offer participants on both side of the lens the possibility of being caught up in affective flows, whilst also being “articulating subjects” (Probyn 17) who “reforge new meanings, new identities” (17) through eating. Conclusion By engaging with videos in which self-identified Big Beautiful Women eat online, this article has reflected on the diverse imaginings, socialities and flows of power that texture these spaces. Paying attention to eating has afforded an alternative view of these videos, challenging a pornographic reading by recognising other intimacies and affective connections. As such, this discussion has sought to re-prioritise the experiences and agency of the BBWs in the videos themselves, whilst also interrogating how their bodies may be patrolled and even produced by the gaze of Others. Thus, whilst being careful not to reduce the BBWs to no more than food – “dehumanised as symbols of cultural fear: the body, the belly, the arse, food” as Charlotte Cooper puts it - an attention to eating has responded to her suggestion to “try to get a hold of their humanity” in analysis. This article therefore set out to explore how a visceral attention might forge a more nuanced understanding of these videos. Yet, in so doing, it has also become clear that they inform wider theorisations of eating. Thinking through what eating is and where its boundaries lie in these spaces has illustrated that this is an act that may take diverse forms and be shared among bodies that are spatially and temporally apart. That the visceral viewing of an Other’s ingestion and digestion may itself be a form of eating offers a novel way to think through contingent and affective connections among foods, bodies and persons. References Abbots, Emma-Jayne, and Anna Lavis (eds.) Why We Eat, How We Eat: Contemporary Encounters between Foods and Bodies. Farnham: Ashgate, 2013. All of Me. Dir. Alexandra Lescaze. Mighty Fine Films, 2013. Cain, Trudie, Kerry Chamberlain and Ann Dupuis. “Bound Bodies: Navigating the Margins of Fat Bodies and Clothes.” Fat: Culture and Materiality, eds. Christopher Forth and Alison Leitch. London: Bloomsbury, 2014. 123-40. Carden-Coyne, Ana, and Christopher Forth. “The Belly and Beyond: Body, Self and Culture in Ancient and Modern Times.” Cultures of the Abdomen: Diet, Digestion and Fat in the Modern World, eds. Christopher Forth and Ana Carden-Coyne. New York: Palgrave Macmillan, 2005. 1-11. Colls, Rachel. “Big Girls Having Fun: Reflections on a ‘Fat Accepting Space’.” Somatechnics 2 (2012): 18–37. Cooper, Charlotte. “Headless Fatties.” 2012. 20 Dec. 2014 ‹http://www.charlottecooper.net/docs/fat/headless_fatties.htm›. Erdman Farrell, Amy. Fat Shame: Stigma and the Fat Body in American Culture. New York: New York UP, 2011. Evans Braziel, Jana, and Kathleen LeBesco. Bodies Out of Bounds: Fatness and Transgression. Berkeley: U of California P, 2001. Forth, Christopher, and Alison Leitch. Fat: Culture and Materiality. London: Bloomsbury, 2014. Gill, Rosalind. “Critical Respect: The Difficulties and Dilemmas of Agency and ‘Choice’ for Feminism.” European Journal of Women’s Studies 14 (2007): 69–80. Giovanelli, Dina, and Natalie Peluso. “Feederism: A New Sexual Pleasure and Subculture.” The Handbook of New Sexuality Studies, ed. Steven Seidman. Oxford: Routledge, 2006. 309–314.Girard, René. Anorexia and Mimetic Desire. East Lansing: Michigan State UP, 2013. Goody, Jack. Cooking, Cuisine and Class: A Study in Comparative Sociology. Cambridge: Cambridge UP, 1982. Hayes-Conroy, Allison, and Jessica Hayes-Conroy. “Taking Back Taste: Feminism, Food and Visceral Politics.” Gender, Place & Culture 15.5 (2008): 461–473. Hayes-Conroy, Jessica, and Allison Hayes-Conroy. “Visceral Geographies: Mattering, Relating, and Defying.” Geography Compass 4.9 (2010): 1273–83. Kirkwood, Katherine. “Tasting But Not Tasting: MasterChef Australia and Vicarious Consumption.” M/C Journal 17.1 (2014). 10 May 2015 ‹http://journal.media-culture.org.au/index.php/mcjournal/article/viewArticle/761›. Kulick, Don. “Porn.” Fat: The Anthropology of an Obsession, eds. Don Kulick and Anne Meneley. New York: Tarcher/Penguin, 2005. 77-92. Lavis, Anna. “Imagined Materialities and Material Imaginings: Food, Bodies and the ‘Stuff’ of (Not) Eating.” Gastronomica, forthcoming 2016. Longhurst, Robyn. “Fat Bodies: Developing Geographical Research Agendas”. Progress in Human Geography 29.3 (2005): 247-59. Longhurst Robyn, Lynda Johnston, and Elsie Ho. “A Visceral Approach: Cooking ‘at Home’ with Migrant Women in Hamilton, New Zealand.” Trans Inst Br Geog NSr 34 (2009): 333–345. Lupton, Deborah. Fat. London: Routledge, 2013. Murray, Samantha. “Doing Politics or Selling Out? Living the Fat Body.” Women's Studies 34 (2005): 265-77. Probyn, Elspeth. Carnal Appetites: FoodSexIdentities. London: Routledge, 2000. Saguy, Abigail. “Sex, Inequality, and Ethnography: Response to Erich Goode.” Qualitative Sociology 25.4 (2002): 549-56. Tischner, Irmgard. Fat Lives: A Feminist Psychological Exploration. Hove: Routledge, 2013. Rose, Lisa. “Once 600 Pounds, Mom from Old Bridge Puts Down the Fork and Turns Off the Webcam.” New Jersey.com 18 Dec. 2011. 29 Jan. 2014 ‹http://www.nj.com/news/index.ssf/2011/12/once_600_pounds_mom_from_old_b.htm›. Rothblum, Esther, and Sandra Solovay (eds.). The Fat Studies Reader. New York: New York UP, 2009. Simpson, Donna. “A Fat Christmas Story!” The Huffington Post 21 Dec. 2011. 24 Jan. 2014 ‹http://www.huffingtonpost.com/donna-simpson/a-fat-christmas-story_b_1163496.html›. Wischhover, Cheryl. "I Want People to See Fat Women as Sexual Beings. Because We Are: April Flores, BBW Porn Performer of the Year, Talks about Reclaiming the Term ‘Fat Girl’.” Cosmopolitan 10 Mar. 2015. 22 Apr. 2015 ‹http://www.cosmopolitan.com/sex-love/news/a37554/april-flores-bbw-porn-performer-fat-acceptance›.

Photo by 168502358© Designer491|Dreamstime.com ABSTRACT Psychiatric Advance Directives (PADs) can protect the autonomy of those living with severe mental illness (SMI) and improve their treatment outcomes. However, their uptake is low for several documented reasons. Attempts to increase patient uptake of PADs can circumvent risks of undue provider influence in the facilitation process and promote optimal mental health outcomes with a peer-support model, thereby protecting patient autonomy in accordance with the principle of beneficence. Moreover, policymakers and mental health organizations should devote sufficient resources toward establishing peer-support specialist networks to mitigate the inequities those with SMI face. Capability theory can guide state leaders and directors in justifying the distribution of scarce resources to achieve these outcomes. INTRODUCTION Since the mid-twentieth century, scholars have increasingly rejected a strong paternalistic relationship between physician and patient, emphasizing the right of patients to accept or decline medical treatment.[1] With this greater emphasis on patient autonomy, a healthcare model of shared decision-making ascended in the 1980s.[2] Considering limitations in a patient’s capacity to make informed decisions in their treatment, the US Congress passed the Patient Self-Determination Act in 1990.[3] The act legally obliged hospitals and other care facilities that participate in Medicare and Medicaid to ask patients if they have an advance directive. In the absence of such a directive, these institutions are to ask if patients would like to complete one and to abide by it if presented by the patient.[4] These directives give patients control of future medical decisions in three key areas: entrusting an individual to act as a medical decision-making proxy, preferences for and consent to future treatment, and a statement of overall personal values and preferences to help inform future medical decisions by providers.[5] Although professionals initially crafted the law with end-of-life care in mind, 27 states now have mental health-specific provisions included in advance directive statutes.[6] As a subset of advance directives, psychiatric advance directives (PADs) are meant to protect patient autonomy during the treatment of psychiatric episodes when competence is compromised. Despite their promise and protection, PADs are underutilized by those with serious mental illness (SMI). In a survey of psychiatric patients, only 4-13 percent of respondents across multiple US sites reported having completed a PAD.[7] The same study indicated that 66-77 percent of respondents were interested in completing one if given assistance.[8] Having recognized the gap between patient interest and uptake, researchers have explored the possible reasons for this disparity. Several barriers have been identified and characterized at the system, health-professional, and service-user levels.[9] Although exploring interventions targeted at each level individually may be worthwhile, several barriers may be effectively overcome with one cross-level intervention. Specifically, a network of peer-support facilitators may be able to mitigate resource concerns of the system level, provider fears, reluctance, and lack of knowledge of PADs at the health-professional level, and a lack of trust and support among those with SMI within the service-user level.[10] Although the Patient Self-Determination Act mandated protections for patient autonomy, the law did not provide a sufficient mechanism to ensure the broad use of those protections. Much of the logistical burden falls on those living with SMI to educate themselves and initiate the completion of a PAD.[11] However, many of those living with SMI already face additional burdens that prevent their successful navigation of a complex healthcare system, including poverty, marginal housing, and food insecurity.[12] In addition, individuals with SMI tend to be more socially isolated, with few others to trust besides their providers.[13] Efforts to promote the uptake of PADs by those living with SMI that neglect these additional burdens risk exacerbating health inequities faced by those with SMI. Attempts to increase patient uptake of PADs should circumvent risks of undue provider influence in the facilitation process and promote optimal mental health outcomes with a peer-support model, thereby protecting patient autonomy per the principle of beneficence. Additionally, policymakers and mental health organizations should devote sufficient resources toward establishing peer-support specialist networks to mitigate the inequities those with SMI face. Capability theory can guide state leaders and directors in justifying the distribution of scarce resources to achieve these outcomes. I. System-Level Barriers to Psychiatric Advanced Directive Uptake At least three barriers to PAD uptake exist at the system level. Still, only one can be effectively addressed by peer-support specialists: resource implications to providers and administrators.[14] In one study, 71 percent of administrators and 52 percent of clinicians believed that a shortage of time would prevent adequate facilitation of PAD completion among those with SMI.[15] Logistical difficulties, such as incorporation into routine documentation and making them easily accessible, were mentioned by 25 percent of respondents in another study.[16] Professionals should take clinical burdens seriously since they can impact care and patient outcomes. Shifting to a peer-support model would alleviate these constraints on providers, who could then focus on other aspects of patient care. II. Health Professional-Level Barriers to Psychiatric Advance Directive Uptake Barriers at the health-professional level, which include a lack of knowledge and training, fear of complete treatment refusals, and a reluctance to facilitate PAD creation, keep patient uptake of PADs low.[17] Among these barriers is a need for more knowledge and training among healthcare professionals. In one study, 55 percent of health professionals had never heard of PADs; only 11 percent claimed they were "very familiar" with PADs.[18] In a survey of professionals, 45 percent voiced concern that the potential disadvantages such as the use of PADs to refuse medications could outweigh the benefits.[19] The reluctance of providers to assist service users in completing a PAD stemmed from concerns over time constraints and the providers’ ability to facilitate the completion of a PAD without bias.[20] These concerns are serious and hint at the asymmetrical power dynamic between providers and patients. By removing the responsibility of unbiased communication from the provider and placing it with peer-support facilitators, the risk to patient autonomy would be significantly lessened. III. Service User-Level Barriers to Psychiatric Advance Directive Uptake Several barriers exist at the service-user level that prevent the widespread adoption of PADs. These include a lack of trust, support, and knowledge of PADs, as well as a lack of understanding in completing a PAD.[21] Concerning trust, one study found that 43 percent of patients did not feel they had someone they could trust to help them complete their PAD.[22] Other studies indicated that patients had limited trust in their healthcare professionals.[23] Regarding the lack of support, one survey found that 94 percent of respondents would be unable to complete a PAD without assistance or without a facilitator.[24] Many patients lack knowledge and awareness of PADs, how to complete, and what to include in them.[25] Due to their complex legal nature, over half of the respondents in one survey indicated that they had problems understanding the PAD.[26] Similarly, 79 percent of clients interviewed in one study felt that PADs posed too much of a burden.[27] Through their shared lived experience, peer-support facilitators would be in a greater position to foster trust with patients and create the environment necessary for patients to explore their values and preferences through this process. IV. Circumventing Undue Provider Influence on Patient Autonomy The risk to patient autonomy is pervasive because of the advanced nature of medical practice and the dependence of patients to providers. In their delineation of bioethical principles, Beauchamp and Childress state: "To respect autonomous agents is to acknowledge their right to hold views, to make choices, and to take actions based on their values and beliefs."[28] This duty extends through a respectful attitude toward the patient and respectful action toward the patient.[29] On average, patients with SMI take 14.6 minutes to complete a PAD, which is well within the 30-minute time limit imposed by insurance reimbursement schedules.[30] However, as other researchers have indicated, this time of completion does not take into account the time required to inform and discuss the implications of future treatment decisions adequately.[31] Given that those living with SMI are often affected by cognitive deficits, the ability of a provider to relay complex health and legal information promptly may be further hamstrung.[32] By offloading the burden of providing efficient and practical education to patients with various levels of cognitive impairment, peer-support specialists could provide the necessary space and time to obtain informed consent and protect patient autonomy. Much of the moral force behind advance directives is the respect for patient autonomy, which has been a focus of researchers over the past several years.[33] Because psychiatric episodes severely limit the ability of a patient to make well-informed treatment decisions in a crisis, PADs are a way to protect the patient from paternalistic interventions. This takes on greater weight in treating patients experiencing a psychiatric episode when the threat and use of coercive treatment options are frequent.[34] Moreover, a report in North Carolina has uncovered a "culture of commitment" whereby providers routinely and reflexively override patient PADs through the legal execution of involuntary commitment.[35] This is despite the affirmation of the autonomy of psychiatric patients by the US District Court in Vermont, which concluded in Hargrave v. Vermont that clinicians could not overrule written directives regarding mental health treatment in non-emergency situations.[36] Although the invalidation of a PAD occurs during treatment, well after discussing and creating it, providers holding the view that PADs are of little utility may not accurately or effectively discuss their relevant features with patients. However, this issue could be side-stepped entirely with peer-support specialists who would be responsible for obtaining informed consent from the patient within the value structures espoused by the patient. V. Beneficence Through Peer Support A growing amount of research indicates how peer-support facilitation of PADs can improve the mental health outcomes of those with SMI. Studies show that adults with SMI can complete legally valid PADs with appropriate assistance and that these documents faithfully represent their preferences.[37] At a minimum, service users report no bias against peer specialists in facilitating PADs.[38] Peer-support specialists use their lived experience to foster empowerment among patients, serve as role models, and promote a patient-centered process in successful PAD completion.[39] Mitigating concerns from providers that PAD creation would include complete refusal of treatment, other studies have found that peer-facilitated PADs were significantly more likely to be prescriptive than PADs facilitated by non-peer clinicians.[40] Most importantly, peer-facilitated PADs effectively decrease compulsory hospital admissions and increase mental health outcomes such as self-perceived symptoms, empowerment, and recovery.[41] Providers have a prima facie duty to prevent harm from occurring to others, remove conditions that will cause harm to others, and help persons with disabilities.[42] This is often conceptualized within the patient-provider relationship, but it need not be. Although general beneficence is controversial in ethics circles, providers can promote the welfare of those they may never meet by relinquishing the responsibility of PAD facilitation to peer-support specialists.[43] In doing so, they remove the possibility of unduly influencing patient preferences, thereby reducing the risk of harm. Additionally, providers incur no additional costs, ameliorating concerns that they do not have the time or resources to facilitate PAD creation effectively.[44] Additionally, they would be implicitly endorsing a better treatment option, allowing them to meet the prima facie obligation to help persons with disabilities. VI. Relational Autonomy and Informed Consent in PAD Creation Shifting the burden of PAD facilitation from providers to peer-support specialists may not settle questions of undue influence. However, under their own SMI, peer-support specialists have lived experiences that strongly parallel others with SMI, which may augment patient autonomy overall. In support of this relational turn, Susan H. Williams explains: "Once the social sources of our identities are recognized, it becomes apparent that someone else who shares my culture [experience] might be able to understand me better than I understand myself.” [45] Essentially, the lived experience of peer-support specialists does not necessarily impede autonomy but can effectively enhance it through facilitated support.[46] Recognizing that individuals are embedded in social relations makes it clear that conceptions of autonomy that neglect emotions, communal life, social context, interdependence, reciprocity, and the development of persons over time are exceedingly narrow.[47] Within this framework of relational autonomy, peer-support specialists can guide service users through their struggles with SMI. So long as the interaction allows service users to act intentionally, with understanding, and without external influences, professionals can respect an individual's autonomy.[48] The enhancement in service-user autonomy ultimately arises from the relationship and shared experience with the peer-support specialist. Of course, peer-support specialists would be obligated to the affirmative duties necessary to ensure service users' understanding and informed consent. Peer-support specialists can achieve informed consent through a certification procedure and a manualized structured conversation that guides the patient to understand their preferences better.[49] To achieve informed consent, "the patient must have the capacity to be able to understand and assess the information given, communicate their choices, and understand the consequences of their decision.”[50] To this end, professionals must train peer-support specialists to apply standards of competence to service users prior to PAD facilitation. Although intervening with peer-support specialists can yield substantial benefits—including fewer coercive interventions, a better-working alliance with care providers, and higher odds that individuals will receive and adhere to their preferred medications— professionals must reach informed consent during each facilitation session.[51] VII. Guiding Distributive Justice: Capability Theory Capability theory is an account of justice opportunity that places a fundamental moral significance on individuals' ability to reach proper functioning and well-being.[52] Whether or not an individual can make use of a particular set of resources and convert them into a state of functioning depends on personal, sociopolitical, and environmental conditions ("conversion factors").[53] In this sense, liberty is not the absence of restraint from others or institutions but the freedom achieved through capability-enhancing relationships.[54] Within the context of bioethics, capability theory shifts focus toward creating circumstances by which individuals can direct their lives as they choose.[55] Acting in accordance with the principle of beneficence, peer-support specialists could enhance the capability of patients to be self-determined and autonomous, which would promote patient well-being and empowerment.[56] Those living with SMI, such as schizophrenia and bipolar disorder, are among the most disadvantaged in society, experiencing social and economic hardship related to their illness.[57] These individuals are often feared and rejected by others, which increases depression, lowers self-esteem, and engenders feelings of social isolation.[58] Compounding their challenges, especially for those facing structural inequalities, is insufficient access to appropriate mental health services supporting recovery.[59] Capability theory provides a sound justification for the resource distribution necessary to create and sustain a thriving network of peer-support specialists, to which those with SMI currently do not have access. Establishing this conversion factor would increase the uptake of PADs and motivate continued engagement in treatment, which is crucial for patients with SMI.[60] Governments and private and public mental healthcare organizations should prioritize establishing peer-support facilitator networks to provide those living with SMI with this much-needed resource. Funding should be directed to train peer-support specialists so that available treatment options are clearly communicated and informed consent is achieved. NAMI Peer-to-Peer and Integral Care (Travis County) Peer Support Specialists may provide effective support models. However, policymakers should take note of Virginia's facilitation model implementation efforts and consider potential roadblocks at the state and local levels.[61] Additionally, investment should be made into a nationwide PAD repository that providers can access electronically during intake so that patient preferences are respected throughout treatment. CONCLUSION Those living with severe mental illness experience disproportional disadvantages that limit their ability to access mental health resources that protect their autonomy during a crisis. These disadvantages should be acknowledged and addressed with the creation and sufficient funding of peer-support specialist networks to help these individuals complete and execute psychiatric advance directives during treatment. Efforts that attempt to promote psychiatric advance directive facilitation through providers risk undue influence and poor mental health outcomes, despite the duties of non-maleficence and beneficence. While different models may be explored, peer-support specialists can leverage the advantages of their shared lived experience with patients within a framework of relational autonomy following the principle of beneficence. Capability theory offers state, local, and organizational leaders’ guidance in promoting and justifying peer-support specialist networks, which protect patient autonomy, increase well-being, and decrease harm. PERSONAL PERSPECTIVE As someone who has voluntarily been admitted to a psychiatric health facility twice to treat manic episodes stemming from Bipolar I Disorder, I recognize the autonomy-persevering utility of psychiatric advance directives on a theoretical and experiential level. Through my research and the benefit of hindsight, I believe that a psychiatric advance directive could have facilitated my treatment regimens and perhaps mitigated some of the depersonalization and lack of control I felt. This experience informs my approach and contribution to the academic conversation surrounding the systematic barriers and ethical dilemmas preventing the widespread use of psychiatric advance directives. - [1] Madison K. Kilbride and Steven Joffe, "The New Age of Patient Autonomy," JAMA 320, no. 19 (2018): 1973-1974, https://doi.org/10.1001/jama.2018.14382. [2] Kilbride and Joffe, "The New Age of Patient," 1973-1974. [3] Patient Self-Determination Act, H.R. Res. 5067, 101st Cong. (Nov. 5, 1990) (enacted). [4] Billy Table, Jaime Thomas, and Virginia A. Brown, "Psychiatric Advance Directives as an Ethical Communication Tool: An Analysis of Definitions," The Journal of Clinical Ethics 31, no. 3 (2020): [353-363] [5] Heather Murray and Hal S. Wortzel, "Psychiatric Advance Directives: Origins, Benefits, Challenges, and Future Directions," Journal of Psychiatric Practice 25, no. 4 (2019): 303-307, https://doi.org/10.1097/PRA.0000000000000401. [6] Table, Thomas, and Brown, "Psychiatric Advance," 353-363. [7] J. Swanson et al., "Psychiatric Advance Directives among Public Mental Health Consumers in Five U.S. Cities: Prevalence, Demand, and Correlates.," The Journal of the American Academy of Psychiatry and the Law 34, no. 1 (2006): 43-57. [8] Swanson et al., "Psychiatric Advance," 43-57. [9] Laura S. Shields et al., "A Review of Barriers to Using Psychiatric Advance Directives in Clinical Practice," Administration and Policy in Mental Health and Mental Health Services Research 41, no. 6 (2013): 753-766, https://doi.org/10.1007/s10488-013-0523-3. [10] Charles M. Belden et al., "Appropriateness of Psychiatric Advance Directives Facilitated by Peer Support Specialists and Clinicians on Assertive Community Treatment Teams," Journal of Mental Health 31, no. 2 (2021): 239-245, https://doi.org/10.1080/09638237.2021.1952946.; Shields et al., "A Review," 753-766. [11] Tracy Peto et al., "Support Needed to Create Psychiatric Advance Directives," Administration and Policy in Mental Health 31, no. 5 (2004): 409-419, http://ezproxy.lib.utexas.edu/login?url=https://www.proquest.com/scholarly-journals/support-needed-create-psychiatric-advance/docview/210976273/se-2?accountid=7118. [12] Rachel C. Conrad et al., "Duties toward Patients with Psychiatric Illness," Hastings Center Report 50, no. 3 (2020): 67-69, https://doi.org/10.1002/hast.1139. [13] Murray and Wortzel, "Psychiatric Advance," 303-307. [14] Shields et al., "A Review," 753-766. [15] Christine M. Wilder et al., "A Survey of Stakeholder Knowledge, Experience, and Opinions of Advance Directives for Mental Health in Virginia," Administration and Policy in Mental Health and Mental Health Services Research 40, no. 3 (2013): 232-239, https://doi.org/10.1007/s10488-011-0401-9. [16] Maria J. O’Connell and Catherine H. Stein, "Psychiatric Advance Directives: Perspectives of Community Stakeholders," Administration and Policy in Mental Health 32, no. 3 (2005): 241-265, https://doi.org/10.1007/s10488-004-0843-4. [17] Shields et al., "A Review," 753-766. [18] O’Connell and Stein, "Psychiatric Advance," 241-265. [19] Eric B. Elbogen et al., "Clinical Decision Making and Views about Psychiatric Advance Directives," Psychiatric Services 57, no. 3 (2006): 350-355, https://doi.org/10.1176/appi.ps.57.3.350. [20] Debra Srebnik and Lisa Brodoff, "Implementing Psychiatric Advance Directives: Service Provider Issues and Answers," The Journal of Behavioral Health Services & Research 30, no. 3 (2003): 253-268, https://doi.org/10.1007/BF02287316.; I. Varekamp, "Ulysses Directives in the Netherlands: Opinions of Psychiatrists and Clients," Health Policy 70, no. 3 (2004): 291-301, https://doi.org/10.1016/j.healthpol.2004.03.003. [21] Shields et al., "A Review," 753-766. [22] Richard A. Van Dorn, Jeffrey W. Swanson, and Marvin S. Swartz, "Preferences for Psychiatric Advance Directives among Latinos: Views on Advance Care Planning for Mental Health," Psychiatric Services 60, no. 10 (2009): 1383-1385, https://doi.org/10.1176/ps.2009.60.10.1383. [23] Jeffrey W. Swanson et al., "Psychiatric Advance Directives: A Survey of Persons with Schizophrenia, Family Members, and Treatment Providers," International Journal of Forensic Mental Health 2, no. 1 (2003): 73-86, https://doi.org/10.1080/14999013.2003.10471180. [24] Eric B. Elbogen et al., "Effectively Implementing Psychiatric Advance Directives to Promote Self-determination of Treatment among People with Mental Illness.," Psychology, Public Policy, and Law 13, no. 4 (2007): 273-288, https://doi.org/10.1037/1076-8971.13.4.273. [25] Shields et al., "A Review," 753-766. [26] Marvin S. Swartz et al., "Patient Preferences for Psychiatric Advance Directives," International Journal of Forensic Mental Health 5, no. 1 (2006): 67-81, https://doi.org/10.1080/14999013.2006.10471231. [27] Richard A. Van Dorn et al., "Reducing Barriers to Completing Psychiatric Advance Directives," Administration and Policy in Mental Health and Mental Health Services Research 35, no. 6 (2008): 440-448, https://doi.org/10.1007/s10488-008-0187-6. [28] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (n.p.: Oxford University Press, 2019). [29] Beauchamp and Childress, Principles of Biomedical. [30] Sharad Philip et al., "EAT-PAD: Educating about Psychiatric Advance Directives in India," International Journal of Social Psychiatry 65, no. 3 (2019): 207-216, https://doi.org/10.1177/0020764019834591. [31] Table, Thomas, and Brown, "Psychiatric Advance," 353-363. [32] Julia M. Sheffield, Nicole R. Karcher, and Deanna M. Barch, "Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective," Neuropsychology Review 28, no. 4 (2018): 509, https://doi.org/10.1007/s11065-018-9388-2. [33] Stavroula Tsinorema, "The Principle of Autonomy and the Ethics of Advance Directives," Synthesis Philosophica 59, no. 1 (2015). [34] Marie Chieze et al., "Coercive Measures in Psychiatry: A Review of Ethical Arguments," Frontiers in Psychiatry 12 (2021): https://doi.org/10.3389/fpsyt.2021.790886. [35] Taylor Knopf, "Health Providers Sometimes Ignore Mental Health Patients' Documented Wishes during Treatment," NC Health News, last modified February 7, 2023, https://www.northcarolinahealthnews.org/2023/02/07/health-providers-sometimes-ignore-mental-health-patients-documented-wishes-during-treatment/. [36] Diane McDevitt, "Psychiatric Advance Directives," The Nurse Practitioner 45, no. 4 (2020): 10-13, https://doi.org/10.1097/01.NPR.0000657304.67256.E5. [37] Marvin S. Swartz et al., "Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable," Psychiatric Services 72, no. 2 (2021): 219-221, https://doi.org/10.1176/appi.ps.202000659. [38] Michele M. Easter et al., "Impact of Psychiatric Advance Directive Facilitation on Mental Health Consumers: Empowerment, Treatment Attitudes and the Role of Peer Support Specialists," Journal of Mental Health 30, no. 5 (2020): 585-593, https://doi.org/10.1080/09638237.2020.1714008. [39] Michele M. Easter et al., "Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams," Psychiatric Services 68, no. 7 (2017): 717-723, https://doi.org/10.1176/appi.ps.201600423. [40] Belden et al., "Appropriateness of Psychiatric," 239-245. [41] Aurélie Tinland et al., "Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission among People with Mental Illness," JAMA Psychiatry 79, no. 8 (2022): 752, https://doi.org/10.1001/jamapsychiatry.2022.1627. [42] Beauchamp and Childress, Principles of Biomedical. [43] Beauchamp and Childress, Principles of Biomedical. [44] Shields et al., "A Review," 753-766. [45] Williams, "Comment: Autonomy and the Public-private Distinction in Bioethics and Law," Indiana Journal of Global Legal Studies 12, no. 2 (2005): 483, https://doi.org/10.2979/gls.2005.12.2.483. [46] Carlos Gómez-Vírseda, Yves De Maeseneer, and Chris Gastmans, "Relational Autonomy: What Does It Mean and How Is It Used in End-of-life Care? A Systematic Review of Argument-based Ethics Literature.," BMC Medical Ethics 20, no. 1 (2019): 76, https://doi.org/10.1186/s12910-019-0417-3. [47] Beauchamp and Childress, Principles of Biomedical. [48] Beauchamp and Childress, Principles of Biomedical. [49] Easter et al., "Facilitation of Psychiatric," 717-723. [50] Christine S. Cocanour, "Informed Consent-It's More than a Signature on a Piece of Paper," The American Journal of Surgery 214, no. 6 (2017): 993-997, https://doi.org/10.1016/j.amjsurg.2017.09.015. [51] Easter et al., "Facilitation of Psychiatric," 717-723. [52] Beauchamp and Childress, Principles of Biomedical. [53] Ingrid Robeyns and Morten Fibieger Byskov, "The Capability Approach," Stanford Encyclopedia of Philosophy, last modified December 10, 2020, https://plato.stanford.edu/entries/capability-approach/#toc. [54] Bruce Jennings, "Reconceptualizing Autonomy: A Relational Turn in Bioethics," Hastings Center Report 46, no. 3 (2016): 11-16, https://doi.org/10.1002/hast.544. [55] Beauchamp and Childress, Principles of Biomedical. [56] Easter et al., "Impact of Psychiatric," 585-593. [57] Amy J. Morgan et al., "Interventions to Reduce Stigma towards People with Severe Mental Illness: Systematic Review and Meta-analysis," Journal of Psychiatric Research 103 (2018): 120-133, https://doi.org/10.1016/j.jpsychires.2018.05.017. [58] Rose Weitz, The Sociology of Health, Illness, and Health Care: A Critical Approach, 8th ed. (Cengage, 2020), digital file. [59] Anita Ho and Joshua S. Norman, "Social Determinants of Mental Health and Physician Aid-in-dying: The Real Moral Crisis," The American Journal of Bioethics 19, no. 10 (2019): 52-54, https://doi.org/10.1080/15265161.2019.1654025. [60] Easter et al., "Impact of Psychiatric," 585-593. [61] Heather Zelle, Kathleen Kemp, and Richard J. Bonnie, "Advance Directives for Mental Health Care: Innovation in Law, Policy, and Practice," Psychiatric Services 66, no. 1 (2015): 7-9, https://doi.org/10.1176/appi.ps.201400435.

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. Elsevier Science, 1995. 8 Aug, 2013 ‹http://www.freedomfromtorture.org/sites/default/files/documents/Summerfield-PsychologicalResponses.pdf>. Brune, Michael, Christian Haasen, Michael Krausz, Oktay Yagdiran, Enrique Bustos and David Eisenman. “Belief Systems as Coping Factors for Traumatized Refugees: A Pilot Study.” Eur Psychiatry 17 (2002): 451-58. Canavan, John. “Resilience: Cautiously Welcoming a Contested Concept.” Child Care in Practice 14.1 (2008): 1-7. Chung, Juna. Refugee and Immigrant Survivors of Trauma: A Curriculum for Social Workers. Master’s Thesis for California State University. Long Beach, 2010. 1-29. Eastmond, Maria. “Stories of Lived Experience: Narratives in Forced Migration Research.” Journal of Refugee Studies 20.2 (2007): 248-64. Eyber, Carola “Cultural and Anthropological Studies.” In Forced Migration Online, 2002. 8 Aug, 2013. ‹http://www.forcedmigration.org/research-resources/expert-guides/psychosocial- issues/cultural-and-anthropological-studies>. Graybeal, Clay. “Strengths-Based Social Work Assessment: Transforming the Dominant Paradigm.” Families in Society 82.3 (2001): 233-42. Kleinman, Arthur. “Triumph or Pyrrhic Victory? The Inclusion of Culture in DSM-IV.” Harvard Rev Psychiatry 4 (1997): 343-44. Mares, Sarah, and Louise Newman, eds. Acting from the Heart- Australian Advocates for Asylum Seekers Tell Their Stories. Sydney: Finch Publishing, 2007. Mays, Vicki M. “Identity Development of Black Americans: The Role of History and the Importance of Ethnicity.” American Journal of Psychotherapy 40.4 (1986): 582-93. Nettles, Saundra Murray, and Michael J. Mason. “Zones of Narrative Safety: Promoting Psychosocial Resilience in Young People.” The Journal of Primary Prevention 25.3 (2004): 359-73. Orosa, Francisco J.E., Michael Brune, Katrin Julia Fischer-Ortman, and Christian Haasen. “Belief Systems as Coping Factors in Traumatized Refugees: A Prospective Study.” Traumatology 17.1 (2011); 1-7. Peres, Julio F.P., Alexander Moreira-Almeida, Antonia, G. Nasello, and Harold, G. Koenig. “Spirituality and Resilience in Trauma Victims.” J Relig Health (2006): 1-8. Saleebey, Dennis. “The Strengths Perspective in Social Work Practice: Extensions and Cautions.” Social Work 41.3 (1996): 296-305. Scheper-Hughes, Nancy. “A Talent for Life: Reflections on Human Vulnerability and Resilience.” Ethnos 73.1 (2008): 25-56. Seahorn, Janet, J. and Anthony E. Seahorn. Tears of a Warrior. Ft Collins, USA: Team Pursuits, 2008. Sonn, Christopher, and Adrian Fisher. “Sense of Community: Community Resilient Responses to Oppression and Change.” Unpublished article. Curtin University of Technology & Victoria University of Technology: undated. Summerfield, Derek. “Childhood, War, Refugeedom and ‘Trauma’: Three Core Questions for Medical Health Professionals.” Transcultural Psychiatry 37.3 (2000): 417-433. Tofighian, Omid. “Prolonged Liminality and Comparative Examples of Rioting Down Under”. Fear and Hope: The Art of Asylum Seekers in Australian Detention Centres Literature and Aesthetics (Special Edition) 21 (2011): 97-103. Ungar, Michael. “A Constructionist Discourse on Resilience: Multiple Contexts, Multiple Realities Among at-Risk Children and Youth.” Youth Society 35.3 (2004): 341-365. Ungar, Michael. “A Thicker Description of Resilience.” The International Journal of Narrative Therapy and Community Work 3 & 4 (2005): 85-96. Walsh, Froma. “Traumatic Loss and Major Disasters: Strengthening Family and Community Resilience.” Family Process 46.2 (2007): 207-227. Weiss, Daniel. S., Charles R. Marmar, William. E. Schlenger, John. A. Fairbank, Kathleen Jordon, Richard L. Hough, and Richard A. Kulka. “The Prevalence of Lifetime and Partial Post- Traumatic Stress Disorder in Vietnam Theater Veterans.” Journal of Traumatic Stress 5.3 (1992):365-76. Westoby, Peter, and Ann Ingamells. “A Critically Informed Perspective of Working with Resettling Refugee Groups in Australia.” British Journal of Social Work 40 (2010): 1759-76. Wilson, Michael. “Accumulating Resilience: An Investigation of the Migration and Resettlement Experiences of Young Sudanese People in the Western Sydney Area.” PHD Thesis. University of Western Sydney ( 2012): 1-297. Wu, K. M. “Hope and World Survival.” Philosophy Forum 12.1-2 (1972): 131-48.

Photograph by Gonzalo Echeverria (2010)Declaring War Soon after Al Qaeda’s terrorist attacks on 11 September 2001, the Bush Administration described its new grand strategy: the “Global War on Terror”. This underpinned the subsequent counter-insurgency in Afghanistan and the United States invasion of Iraq in March 2003. Media pundits quickly applied the Global War on Terror label to the Madrid, Bali and London bombings, to convey how Al Qaeda’s terrorism had gone transnational. Meanwhile, international relations scholars debated the extent to which September 11 had changed the international system (Brenner; Mann 303). American intellectuals adopted several variations of the Global War on Terror in what initially felt like a transitional period of US foreign policy (Burns). Walter Laqueur suggested Al Qaeda was engaged in a “cosmological” and perpetual war. Paul Berman likened Al Qaeda and militant Islam to the past ideological battles against communism and fascism (Heilbrunn 248). In a widely cited article, neoconservative thinker Norman Podhoretz suggested the United States faced “World War IV”, which had three interlocking drivers: Al Qaeda and trans-national terrorism; political Islam as the West’s existential enemy; and nuclear proliferation to ‘rogue’ countries and non-state actors (Friedman 3). Podhoretz’s tone reflected a revival of his earlier Cold War politics and critique of the New Left (Friedman 148-149; Halper and Clarke 56; Heilbrunn 210). These stances attracted widespread support. For instance, the United States Marine Corp recalibrated its mission to fight a long war against “World War IV-like” enemies. Yet these stances left the United States unprepared as the combat situations in Afghanistan and Iraq worsened (Ricks; Ferguson; Filkins). Neoconservative ideals for Iraq “regime change” to transform the Middle East failed to deal with other security problems such as Pakistan’s Musharraf regime (Dorrien 110; Halper and Clarke 210-211; Friedman 121, 223; Heilbrunn 252). The Manichean and open-ended framing became a self-fulfilling prophecy for insurgents, jihadists, and militias. The Bush Administration quietly abandoned the Global War on Terror in July 2005. Widespread support had given way to policymaker doubt. Why did so many intellectuals and strategists embrace the Global War on Terror as the best possible “grand strategy” perspective of a post-September 11 world? Why was there so little doubt of this worldview? This is a debate with roots as old as the Sceptics versus the Sophists. Explanations usually focus on the Bush Administration’s “Vulcans” war cabinet: Vice President Dick Cheney, Secretary of Defense Donald Rumsfield, and National Security Advisor Condoleezza Rice, who later became Secretary of State (Mann xv-xvi). The “Vulcans” were named after the Roman god Vulcan because Rice’s hometown Birmingham, Alabama, had “a mammoth fifty-six foot statue . . . [in] homage to the city’s steel industry” (Mann x) and the name stuck. Alternatively, explanations focus on how neoconservative thinkers shaped the intellectual climate after September 11, in a receptive media climate. Biographers suggest that “neoconservatism had become an echo chamber” (Heilbrunn 242) with its own media outlets, pundits, and think-tanks such as the American Enterprise Institute and Project for a New America. Neoconservatism briefly flourished in Washington DC until Iraq’s sectarian violence discredited the “Vulcans” and neoconservative strategists like Paul Wolfowitz (Friedman; Ferguson). The neoconservatives' combination of September 11’s aftermath with strongly argued historical analogies was initially convincing. They conferred with scholars such as Bernard Lewis, Samuel P. Huntington and Victor Davis Hanson to construct classicist historical narratives and to explain cultural differences. However, the history of the decade after September 11 also contains mis-steps and mistakes which make it a series of contingent decisions (Ferguson; Bergen). One way to analyse these contingent decisions is to pose “what if?” counterfactuals, or feasible alternatives to historical events (Lebow). For instance, what if September 11 had been a chemical and biological weapons attack? (Mann 317). Appendix 1 includes a range of alternative possibilities and “minimal rewrites” or slight variations on the historical events which occurred. Collectively, these counterfactuals suggest the role of agency, chance, luck, and the juxtaposition of better and worse outcomes. They pose challenges to the classicist interpretation adopted soon after September 11 to justify “World War IV” (Podhoretz). A ‘Two-Track’ Process for ‘World War IV’ After the September 11 attacks, I think an overlapping two-track process occurred with the “Vulcans” cabinet, neoconservative advisers, and two “echo chambers”: neoconservative think-tanks and the post-September 11 media. Crucially, Bush’s “Vulcans” war cabinet succeeded in gaining civilian control of the United States war decision process. Although successful in initiating the 2003 Iraq War this civilian control created a deeper crisis in US civil-military relations (Stevenson; Morgan). The “Vulcans” relied on “politicised” intelligence such as a United Kingdom intelligence report on Iraq’s weapons development program. The report enabled “a climate of undifferentiated fear to arise” because its public version did not distinguish between chemical, biological, radiological or nuclear weapons (Halper and Clarke, 210). The cautious 2003 National Intelligence Estimates (NIE) report on Iraq was only released in a strongly edited form. For instance, the US Department of Energy had expressed doubts about claims that Iraq had approached Niger for uranium, and was using aluminium tubes for biological and chemical weapons development. Meanwhile, the post-September 11 media had become a second “echo chamber” (Halper and Clarke 194-196) which amplified neoconservative arguments. Berman, Laqueur, Podhoretz and others who framed the intellectual climate were “risk entrepreneurs” (Mueller 41-43) that supported the “World War IV” vision. The media also engaged in aggressive “flak” campaigns (Herman and Chomsky 26-28; Mueller 39-42) designed to limit debate and to stress foreign policy stances and themes which supported the Bush Administration. When former Central Intelligence Agency director James Woolsey’s claimed that Al Qaeda had close connections to Iraqi intelligence, this was promoted in several books, including Michael Ledeen’s War Against The Terror Masters, Stephen Hayes’ The Connection, and Laurie Mylroie’s Bush v. The Beltway; and in partisan media such as Fox News, NewsMax, and The Weekly Standard who each attacked the US State Department and the CIA (Dorrien 183; Hayes; Ledeen; Mylroie; Heilbrunn 237, 243-244; Mann 310). This was the media “echo chamber” at work. The group Accuracy in Media also campaigned successfully to ensure that US cable providers did not give Al Jazeera English access to US audiences (Barker). Cosmopolitan ideals seemed incompatible with what the “flak” groups desired. The two-track process converged on two now infamous speeches. US President Bush’s State of the Union Address on 29 January 2002, and US Secretary of State Colin Powell’s presentation to the United Nations on 5 February 2003. Bush’s speech included a line from neoconservative David Frumm about North Korea, Iraq and Iran as an “Axis of Evil” (Dorrien 158; Halper and Clarke 139-140; Mann 242, 317-321). Powell’s presentation to the United Nations included now-debunked threat assessments. In fact, Powell had altered the speech’s original draft by I. Lewis “Scooter” Libby, who was Cheney’s chief of staff (Dorrien 183-184). Powell claimed that Iraq had mobile biological weapons facilities, linked to Abu Musab al-Zarqawi. However, the International Atomic Energy Agency’s (IAEA) Mohamed El-Baradei, the Defense Intelligence Agency, the State Department, and the Institute for Science and International Security all strongly doubted this claim, as did international observers (Dorrien 184; Halper and Clarke 212-213; Mann 353-354). Yet this information was suppressed: attacked by “flak” or given little visible media coverage. Powell’s agenda included trying to rebuild an international coalition and to head off weather changes that would affect military operations in the Middle East (Mann 351). Both speeches used politicised variants of “weapons of mass destruction”, taken from the counterterrorism literature (Stern; Laqueur). Bush’s speech created an inflated geopolitical threat whilst Powell relied on flawed intelligence and scientific visuals to communicate a non-existent threat (Vogel). However, they had the intended effect on decision makers. US Under-Secretary of Defense, the neoconservative Paul Wolfowitz, later revealed to Vanity Fair that “weapons of mass destruction” was selected as an issue that all potential stakeholders could agree on (Wilkie 69). Perhaps the only remaining outlet was satire: Armando Iannucci’s 2009 film In The Loop parodied the diplomatic politics surrounding Powell’s speech and the civil-military tensions on the Iraq War’s eve. In the short term the two track process worked in heading off doubt. The “Vulcans” blocked important information on pre-war Iraq intelligence from reaching the media and the general public (Prados). Alternatively, they ignored area specialists and other experts, such as when Coalition Provisional Authority’s L. Paul Bremer ignored the US State Department’s fifteen volume ‘Future of Iraq’ project (Ferguson). Public “flak” and “risk entrepreneurs” mobilised a range of motivations from grief and revenge to historical memory and identity politics. This combination of private and public processes meant that although doubts were expressed, they could be contained through the dual echo chambers of neoconservative policymaking and the post-September 11 media. These factors enabled the “Vulcans” to proceed with their “regime change” plans despite strong public opposition from anti-war protestors. Expressing DoubtsMany experts and institutions expressed doubt about specific claims the Bush Administration made to support the 2003 Iraq War. This doubt came from three different and sometimes overlapping groups. Subject matter experts such as the IAEA’s Mohamed El-Baradei and weapons development scientists countered the UK intelligence report and Powell’s UN speech. However, they did not get the media coverage warranted due to “flak” and “echo chamber” dynamics. Others could challenge misleading historical analogies between insurgent Iraq and Nazi Germany, and yet not change the broader outcomes (Benjamin). Independent journalists one group who gained new information during the 1990-91 Gulf War: some entered Iraq from Kuwait and documented a more humanitarian side of the war to journalists embedded with US military units (Uyarra). Finally, there were dissenters from bureaucratic and institutional processes. In some cases, all three overlapped. In their separate analyses of the post-September 11 debate on intelligence “failure”, Zegart and Jervis point to a range of analytic misperceptions and institutional problems. However, the intelligence community is separated from policymakers such as the “Vulcans”. Compartmentalisation due to the “need to know” principle also means that doubting analysts can be blocked from releasing information. Andrew Wilkie discovered this when he resigned from Australia’s Office for National Assessments (ONA) as a transnational issues analyst. Wilkie questioned the pre-war assessments in Powell’s United Nations speech that were used to justify the 2003 Iraq War. Wilkie was then attacked publicly by Australian Prime Minister John Howard. This overshadowed a more important fact: both Howard and Wilkie knew that due to Australian legislation, Wilkie could not publicly comment on ONA intelligence, despite the invitation to do so. This barrier also prevented other intelligence analysts from responding to the “Vulcans”, and to “flak” and “echo chamber” dynamics in the media and neoconservative think-tanks. Many analysts knew that the excerpts released from the 2003 NIE on Iraq was highly edited (Prados). For example, Australian agencies such as the ONA, the Department of Foreign Affairs and Trade, and the Department of Defence knew this (Wilkie 98). However, analysts are trained not to interfere with policymakers, even when there are significant civil-military irregularities. Military officials who spoke out about pre-war planning against the “Vulcans” and their neoconservative supporters were silenced (Ricks; Ferguson). Greenlight Capital’s hedge fund manager David Einhorn illustrates in a different context what might happen if analysts did comment. Einhorn gave a speech to the Ira Sohn Conference on 15 May 2002 debunking the management of Allied Capital. Einhorn’s “short-selling” led to retaliation from Allied Capital, a Securities and Exchange Commission investigation, and growing evidence of potential fraud. If analysts adopted Einhorn’s tactics—combining rigorous analysis with targeted, public denunciation that is widely reported—then this may have short-circuited the “flak” and “echo chamber” effects prior to the 2003 Iraq War. The intelligence community usually tries to pre-empt such outcomes via contestation exercises and similar processes. This was the goal of the 2003 NIE on Iraq, despite the fact that the US Department of Energy which had the expertise was overruled by other agencies who expressed opinions not necessarily based on rigorous scientific and technical analysis (Prados; Vogel). In counterterrorism circles, similar disinformation arose about Aum Shinrikyo’s biological weapons research after its sarin gas attack on Tokyo’s subway system on 20 March 1995 (Leitenberg). Disinformation also arose regarding nuclear weapons proliferation to non-state actors in the 1990s (Stern). Interestingly, several of the “Vulcans” and neoconservatives had been involved in an earlier controversial contestation exercise: Team B in 1976. The Central Intelligence Agency (CIA) assembled three Team B groups in order to evaluate and forecast Soviet military capabilities. One group headed by historian Richard Pipes gave highly “alarmist” forecasts and then attacked a CIA NIE about the Soviets (Dorrien 50-56; Mueller 81). The neoconservatives adopted these same tactics to reframe the 2003 NIE from its position of caution, expressed by several intelligence agencies and experts, to belief that Iraq possessed a current, covert program to develop weapons of mass destruction (Prados). Alternatively, information may be leaked to the media to express doubt. “Non-attributable” background interviews to establishment journalists like Seymour Hersh and Bob Woodward achieved this. Wikileaks publisher Julian Assange has recently achieved notoriety due to US diplomatic cables from the SIPRNet network released from 28 November 2010 onwards. Supporters have favourably compared Assange to Daniel Ellsberg, the RAND researcher who leaked the Pentagon Papers (Ellsberg; Ehrlich and Goldsmith). Whilst Elsberg succeeded because a network of US national papers continued to print excerpts from the Pentagon Papers despite lawsuit threats, Assange relied in part on favourable coverage from the UK’s Guardian newspaper. However, suspected sources such as US Army soldier Bradley Manning are not protected whilst media outlets are relatively free to publish their scoops (Walt, ‘Woodward’). Assange’s publication of SIPRNet’s diplomatic cables will also likely mean greater restrictions on diplomatic and military intelligence (Walt, ‘Don’t Write’). Beyond ‘Doubt’ Iraq’s worsening security discredited many of the factors that had given the neoconservatives credibility. The post-September 11 media became increasingly more critical of the US military in Iraq (Ferguson) and cautious about the “echo chamber” of think-tanks and media outlets. Internet sites for Al Jazeera English, Al-Arabiya and other networks have enabled people to bypass “flak” and directly access these different viewpoints. Most damagingly, the non-discovery of Iraq’s weapons of mass destruction discredited both the 2003 NIE on Iraq and Colin Powell’s United Nations presentation (Wilkie 104). Likewise, “risk entrepreneurs” who foresaw “World War IV” in 2002 and 2003 have now distanced themselves from these apocalyptic forecasts due to a series of mis-steps and mistakes by the Bush Administration and Al Qaeda’s over-calculation (Bergen). The emergence of sites such as Wikileaks, and networks like Al Jazeera English and Al-Arabiya, are a response to the politics of the past decade. They attempt to short-circuit past “echo chambers” through providing access to different sources and leaked data. The Global War on Terror framed the Bush Administration’s response to September 11 as a war (Kirk; Mueller 59). Whilst this prematurely closed off other possibilities, it has also unleashed a series of dynamics which have undermined the neoconservative agenda. The “classicist” history and historical analogies constructed to justify the “World War IV” scenario are just one of several potential frameworks. “Flak” organisations and media “echo chambers” are now challenged by well-financed and strategic alternatives such as Al Jazeera English and Al-Arabiya. Doubt is one defence against “risk entrepreneurs” who seek to promote a particular idea: doubt guards against uncritical adoption. Perhaps the enduring lesson of the post-September 11 debates, though, is that doubt alone is not enough. What is needed are individuals and institutions that understand the strategies which the neoconservatives and others have used, and who also have the soft power skills during crises to influence critical decision-makers to choose alternatives. Appendix 1: Counterfactuals Richard Ned Lebow uses “what if?” counterfactuals to examine alternative possibilities and “minimal rewrites” or slight variations on the historical events that occurred. The following counterfactuals suggest that the Bush Administration’s Global War on Terror could have evolved very differently . . . or not occurred at all. Fact: The 2003 Iraq War and 2001 Afghanistan counterinsurgency shaped the Bush Administration’s post-September 11 grand strategy. Counterfactual #1: Al Gore decisively wins the 2000 U.S. election. Bush v. Gore never occurs. After the September 11 attacks, Gore focuses on international alliance-building and gains widespread diplomatic support rather than a neoconservative agenda. He authorises Special Operations Forces in Afghanistan and works closely with the Musharraf regime in Pakistan to target Al Qaeda’s muhajideen. He ‘contains’ Saddam Hussein’s Iraq through measurement and signature, technical intelligence, and more stringent monitoring by the International Atomic Energy Agency. Minimal Rewrite: United 93 crashes in Washington DC, killing senior members of the Gore Administration. Fact: U.S. Special Operations Forces failed to kill Osama bin Laden in late November and early December 2001 at Tora Bora. Counterfactual #2: U.S. Special Operations Forces kill Osama bin Laden in early December 2001 during skirmishes at Tora Bora. Ayman al-Zawahiri is critically wounded, captured, and imprisoned. The rest of Al Qaeda is scattered. Minimal Rewrite: Osama bin Laden’s death turns him into a self-mythologised hero for decades. Fact: The UK Blair Government supplied a 50-page intelligence dossier on Iraq’s weapons development program which the Bush Administration used to support its pre-war planning. Counterfactual #3: Rogue intelligence analysts debunk the UK Blair Government’s claims through a series of ‘targeted’ leaks to establishment news sources. Minimal Rewrite: The 50-page intelligence dossier is later discovered to be correct about Iraq’s weapons development program. Fact: The Bush Administration used the 2003 National Intelligence Estimate to “build its case” for “regime change” in Saddam Hussein’s Iraq. Counterfactual #4: A joint investigation by The New York Times and The Washington Post rebuts U.S. Secretary of State Colin Powell’s speech to the United National Security Council, delivered on 5 February 2003. Minimal Rewrite: The Central Intelligence Agency’s whitepaper “Iraq’s Weapons of Mass Destruction Programs” (October 2002) more accurately reflects the 2003 NIE’s cautious assessments. Fact: The Bush Administration relied on Ahmed Chalabi for its postwar estimates about Iraq’s reconstruction. Counterfactual #5: The Bush Administration ignores Chalabi’s advice and relies instead on the U.S. State Department’s 15 volume report “The Future of Iraq”. Minimal Rewrite: The Coalition Provisional Authority appoints Ahmed Chalabi to head an interim Iraqi government. Fact: L. Paul Bremer signed orders to disband Iraq’s Army and to De-Ba’athify Iraq’s new government. Counterfactual #6: Bremer keeps Iraq’s Army intact and uses it to impose security in Baghdad to prevent looting and to thwart insurgents. Rather than a De-Ba’athification policy, Bremer uses former Baath Party members to gather situational intelligence. Minimal Rewrite: Iraq’s Army refuses to disband and the De-Ba’athification policy uncovers several conspiracies to undermine the Coalition Provisional Authority. AcknowledgmentsThanks to Stephen McGrail for advice on science and technology analysis.References Barker, Greg. “War of Ideas”. PBS Frontline. Boston, MA: 2007. ‹http://www.pbs.org/frontlineworld/stories/newswar/video1.html› Benjamin, Daniel. “Condi’s Phony History.” Slate 29 Aug. 2003. ‹http://www.slate.com/id/2087768/pagenum/all/›. Bergen, Peter L. The Longest War: The Enduring Conflict between America and Al Qaeda. New York: The Free Press, 2011. Berman, Paul. Terror and Liberalism. W.W. Norton & Company: New York, 2003. Brenner, William J. “In Search of Monsters: Realism and Progress in International Relations Theory after September 11.” Security Studies 15.3 (2006): 496-528. Burns, Alex. “The Worldflash of a Coming Future.” M/C Journal 6.2 (April 2003). ‹http://journal.media-culture.org.au/0304/08-worldflash.php›. Dorrien, Gary. Imperial Designs: Neoconservatism and the New Pax Americana. New York: Routledge, 2004. Ehrlich, Judith, and Goldsmith, Rick. The Most Dangerous Man in America: Daniel Ellsberg and the Pentagon Papers. Berkley CA: Kovno Communications, 2009. Einhorn, David. Fooling Some of the People All of the Time: A Long Short (and Now Complete) Story. Hoboken NJ: John Wiley & Sons, 2010. Ellison, Sarah. “The Man Who Spilled The Secrets.” Vanity Fair (Feb. 2011). ‹http://www.vanityfair.com/politics/features/2011/02/the-guardian-201102›. Ellsberg, Daniel. Secrets: A Memoir of Vietnam and the Pentagon Papers. New York: Viking, 2002. Ferguson, Charles. No End in Sight, New York: Representational Pictures, 2007. Filkins, Dexter. The Forever War. New York: Vintage Books, 2008. Friedman, Murray. The Neoconservative Revolution: Jewish Intellectuals and the Shaping of Public Policy. New York: Cambridge UP, 2005. Halper, Stefan, and Jonathan Clarke. America Alone: The Neo-Conservatives and the Global Order. New York: Cambridge UP, 2004. Hayes, Stephen F. The Connection: How Al Qaeda’s Collaboration with Saddam Hussein Has Endangered America. New York: HarperCollins, 2004. Heilbrunn, Jacob. They Knew They Were Right: The Rise of the Neocons. New York: Doubleday, 2008. Herman, Edward S., and Noam Chomsky. Manufacturing Consent: The Political Economy of the Mass Media. Rev. ed. New York: Pantheon Books, 2002. Iannucci, Armando. In The Loop. London: BBC Films, 2009. Jervis, Robert. Why Intelligence Fails: Lessons from the Iranian Revolution and the Iraq War. Ithaca NY: Cornell UP, 2010. Kirk, Michael. “The War behind Closed Doors.” PBS Frontline. Boston, MA: 2003. ‹http://www.pbs.org/wgbh/pages/frontline/shows/iraq/›. Laqueur, Walter. No End to War: Terrorism in the Twenty-First Century. New York: Continuum, 2003. Lebow, Richard Ned. Forbidden Fruit: Counterfactuals and International Relations. Princeton NJ: Princeton UP, 2010. Ledeen, Michael. The War against The Terror Masters. New York: St. Martin’s Griffin, 2003. Leitenberg, Milton. “Aum Shinrikyo's Efforts to Produce Biological Weapons: A Case Study in the Serial Propagation of Misinformation.” Terrorism and Political Violence 11.4 (1999): 149-158. Mann, James. Rise of the Vulcans: The History of Bush’s War Cabinet. New York: Viking Penguin, 2004. Morgan, Matthew J. The American Military after 9/11: Society, State, and Empire. New York: Palgrave Macmillan, 2008. Mueller, John. Overblown: How Politicians and the Terrorism Industry Inflate National Security Threats, and Why We Believe Them. New York: The Free Press, 2009. Mylroie, Laurie. Bush v The Beltway: The Inside Battle over War in Iraq. New York: Regan Books, 2003. Nutt, Paul C. Why Decisions Fail. San Francisco: Berrett-Koelher, 2002. Podhoretz, Norman. “How to Win World War IV”. Commentary 113.2 (2002): 19-29. Prados, John. Hoodwinked: The Documents That Reveal How Bush Sold Us a War. New York: The New Press, 2004. Ricks, Thomas. Fiasco: The American Military Adventure in Iraq. New York: The Penguin Press, 2006. Stern, Jessica. The Ultimate Terrorists. Boston, MA: Harvard UP, 2001. Stevenson, Charles A. Warriors and Politicians: US Civil-Military Relations under Stress. New York: Routledge, 2006. Walt, Stephen M. “Should Bob Woodward Be Arrested?” Foreign Policy 10 Dec. 2010. ‹http://walt.foreignpolicy.com/posts/2010/12/10/more_wikileaks_double_standards›. Walt, Stephen M. “‘Don’t Write If You Can Talk...’: The Latest from WikiLeaks.” Foreign Policy 29 Nov. 2010. ‹http://walt.foreignpolicy.com/posts/2010/11/29/dont_write_if_you_can_talk_the_latest_from_wikileaks›. Wilkie, Andrew. Axis of Deceit. Melbourne: Black Ink Books, 2003. Uyarra, Esteban Manzanares. “War Feels like War”. London: BBC, 2003. Vogel, Kathleen M. “Iraqi Winnebagos™ of Death: Imagined and Realized Futures of US Bioweapons Threat Assessments.” Science and Public Policy 35.8 (2008): 561–573. Zegart, Amy. Spying Blind: The CIA, the FBI and the Origins of 9/11. Princeton NJ: Princeton UP, 2007.

This article uses a case study of a Melbourne-based youth media project called Youthworx to explore the processes at stake in cultural engagement for marginalised young people. Drawing on ethnographic research conducted between 2008 and 2010, I identify some ways in which the city is implicated in promoting or preventing access to socially valued spaces of creativity and intended social mobility. The ethnographic material presented here has both empirical and theoretical value. It reveals the important relationships between the experience of place, creativity, and social life, demonstrating potentialities and limits of creativity-focused development interventions for marginalised youth. The articulation of these relationships and processes taking place within a particular city setting has theoretical implications. It opens up an opportunity to consider "suburbs" as enacted by specific forms of access, contingencies, and opportunities for a particular demographic, rather than treating "suburbs" as abstract, analytical constructs. Finally, my empirically grounded discussion draws attention to cultural and social consequences that inhabiting certain social worlds and acts of travelling "to and beyond" them have for young people. Youthworx is a community-based youth media initiative employing pathway-based semi-formal creative practices to re-engage young people who have a history of drug or alcohol abuse or juvenile justice, who have been long disconnected from mainstream education, or who are homeless. The focus on media production allows it to tap into, and in fact leverage, popular creativity, tacit knowledge, and familiar media-based activities that young people bring to bear on their media training and work in this context. Underpinned by social and creative industry policy, Youthworx brings together social service agency The Salvation Army (TSA), educational provider Northern Melbourne Institute of TAFE (NMIT), youth community media organisation SYN Media, and researchers at Institute for Social Research, Swinburne University. Its day-to-day operation is run by contractual, part-time media facilitators, social workers (as part of TSA’s in-kind support), as well as media industry experts who provide casual media training. Youthworx is characterised by the diversity of its young demographic. One can differentiate between at least two groups of participants: those who join Youthworx because of the social opportunities, and those who put more value on its skill-development, or vocational creative industries orientation. This social organisation is, however, far from static. Over the two years of research (2008-2010) we observed evolving ideas about the identity of the program, its key social functions, and how they can be best served. This had proceeded with the construction of what the Youthworx staff term "a community of safe belonging" to a more "serious" media work environment, exemplified by the establishment of a social enterprise (Youthworx Productions) in 2010 that offers paid traineeships to the most capable and determined young creators. To accommodate the diversity of literacy levels, needs, and aspirations of its young participants, the project offers a tailored media education program with a mix of diversionary, educational, and commercial objectives. One-on-one media training sessions, accredited courses in Creative Industries (Media), and industry training within Youthworx Productions are provided to help young people develop a range of skills transferable into a variety of personal, social and professional contexts. Its creative studio, where learning occurs, is located in a former jeans factory warehouse in the heart of an industrial area of Melbourne’s northern inner-city suburb of Brunswick. Young people are referred to Youthworx by a range of social agencies, and they travel to Brunswick from across Melbourne. Some participants are known to spend over three hours commuting from outer suburbs such as Frankston or even regional towns such as King Lake. Unlike community-based creative programs reliant on established community structures within local suburbs (for example, ICE in Western Sydney), Youthworx moved into Tinning Street in Brunswick because its industry partner—The Salvation Army—had existing youth service infrastructure there. The program, however, was not tapping into an existing media “community of practice” (Lane and Wenger); it had to forge its own culture of media participation. In the early days of the program, there were necessary material resources and professional expertise (teachers/social workers/a creative venue), but it took a long while, and a high level of dedication, passion, and practical optimism on the part of the project managers and teaching staff, for young people to genuinely engage in media training and production. Now, Youthworx’s creative space is a “practised place” in de Certeau’s sense. As “the street geometrically defined by urban planning is transformed into a space by walkers” (De Certeau 117), so is the Youthworx space produced by practices of media learning and making by professional creative practitioners and young amateur creators (Raffo; for ideas on institutionalised co-creative practice see Spurgeon et al.). The Brunswick location is where our extensive ethnographic research has taken place, including regular participant observation and qualitative interviews with staff and young participants. The ethnographers frequently travelled with young people to other locations within Melbourne, accompanying them on their trips to youth community radio station SYN Media in the CBD, where they produce a weekly radio show, as well as to film shoots and public social events around the city. As an access learning program for marginalised youth from around Melbourne, Youthworx provides an interesting example to explore how the concerns of material and cultural capital, geographic and cultural distance intersect and shape processes of creative participation and social inclusion. I draw on our ethnographic material to illustrate how these metonymic relationships play out in the ways young participants “travel distance” (Dewson et. al.) on the project and across the city, both figuratively and literally. The idea of “distance travelled” is adapted here from evaluation literature (for other relevant references see Dowmunt et al.; Hayes and Edwards; Holdsworth et al.), and builds on the argument made previously (Podkalicka and Staley 5), to encompass both the geographical mobility and cultural transformation that young people are supported to undergo as an intended outcome of their involvement in Youthworx. This paper also takes inspiration from ethnographic approaches that study a productive and transformative relationship between material culture, spatial geography and processes of identity formation (see Miller). What happens to Youthworx young participants as they travel in a trivial, and at first sight perhaps inconsequential, way between the suburbs they live in, the Youthworx Brunswick location and the city is both experientially real and meaningful. “Suburban space” is then a cultural site that simultaneously refers to concrete, literal places as well as “a state of mind”—that is, identification and connections that are generative of a sense of identity and belonging (Ferber et al.). Youthworx is an intermediary point on these young people’s travels, rather than the final destination (Podkalicka and Staley 5). It provides access to various forms of new spatial, social, and creative experiences and modes of expression. Creating opportunities for highly disenfranchised young people to access and develop new social and creative experiences is an important aspect of Youthworx’s developmental agenda, and is played out at both philosophical and practical levels. On the one hand, a strength-based approach to youth work assumes respect for young people’s potential and knowledges—unlike public discourses that deny them agency due to an assumed lack of life experience (e.g., Poletti). In addition to the material provision of "food and shelter" typical of traditional social work, attention is paid the higher levels of the Maslow hierarchy of human needs, with creativity, self-esteem, and social connectedness at the top of the scale (see also Podkalicka and Campbell; Podkalicka and Thomas). Former Manager of The Salvation Army’s Brunswick Youth Services (BYS)—one of Youthworx’s partners—Craig Campbell argues: Things like truth and beauty are a higher order of dreams for these kids. And by truth I don’t mean the simple lies that can be told to get them out of trouble [but] is there a greater truth to life than a grinding existence in the impoverished neighbourhood, is there something like beauty and aesthetics that wakes us up in the morning and calls a larger life out of us? Most of those kids only faintly dream of such a thing, and this dream is rapidly being extinguished under the weight of drugs and alcohol, abusive family systems, savage interaction with law and justice system, and education as a toxic environment and experience. (Campbell) Campbell's articulate reflection captures the way the Youthworx project has been conceived. It is also a pertinent example of the many reflections on experience and practice at Youthworx that were recorded in my fieldwork, which illustrate the way these kinds of social projects can be understood, interpreted and evaluated. The following personal narrative and contextual description introduce some of the important issues at stake. (The names and other personal details of young people have been changed.) Nineteen-year-old Dave is temporarily staying in an inner-city refuge. Normally, however, like most Youthworx participants, he lives in Broadmeadows, a far northern suburb of Melbourne. To get to Brunswick, where he does his accredited media course three days a week, he either catches a train or waits for a mini-bus to drive him there. The early-morning pick-up for about ten young people is organised by the program’s partner—The Salvation Army. At the Youthworx creative studio, located in the heart of Brunswick, right next to railway tracks, young people produce an array of media products: live and pre-recorded radio programs, digital storytelling, mini-documentaries, and original music. Once at Youthworx, they share the local neighbourhood with other artists who have adapted warehouses into art workshops, studios and galleries. The suburb of Brunswick is well-known for its multicultural profile, a combination of industrial and residential estates, high rates of tertiary students due to its proximity to universities, and its place in the recent history of urban gentrification. However, Youthworx participants don’t seek out or engage with the existing, physically proximate creative base, even within the same street. On a couple of occasions, the opposite has been the case: Youthworx students have been involved in acts of vandalism of local residents’ property, including nearby parked cars. Their connections to the Brunswick neighbourhood remain poor, often reflecting their low social capital as a result of unstable residential situations, isolation, and fraught relationships with family. From Brunswick, they often travel to the city on their own, wander around, sit on the steps of Flinders Street train station—an inner-city hub and popular meeting place for locals and tourists alike. Youthworx plays an important role in these young people’s lives, as an important access point to not only creative digital media-based experiences and skill development, but also to greater and basic geographical mobility and experiences within the city. As one of the students commented: They are giving us chances that we wouldn’t usually get. Every day you’re getting to a place, where it’s pretty damn easy to get into; that’s what’s good about it. There are so many places where you have to do so much to get there and half the time, some people don’t even have the bloody bus ticket to get a [job] interview. But [at Youthworx/BYS], they will pick you up and drive you around if you need it. They are friends. It is reportedly a common practice for many young people at Youthworx and BYS to catch a train or a tram (rather than bus) without paying for a ticket. However, to be caught dodging a fare a few times has legal consequences and young people often face court as a result. The program responds by offering its young participants tickets for public transport, ready for pick-up after afternoon activities, or, if possible, "driving them around"—as some young people told me. The program’s social workers revealed that girls are particularly afraid to travel on their own, especially when catching trains to the outer northern suburbs, for fear of being harassed or attacked. These supported travels are as practical and necessary as they are meaningful for young people’s identity formation, and as such are recognised and built into the project’s design, co-ordination and delivery. At the most basic level, The Salvation Army’s social workers pick young people up from the Broadmeadows area in the mornings. Youthworx creative practitioners assist young people to make trips to SYN Media in the city. For most participants, this is either the first or sporadic experience of travelling to the city, something they enjoy very much but are also somewhat daunted by. Additionally, as part of the curriculum, Youthworx staff make a point of taking young people to inner-city movie theatres or public media events. The following vignette from the fieldwork highlights another important connection between physical journey and creative expression. There is an excitement in Dave’s voice when he talks about his favourite pastime: hanging out around the city. “Why would you walk around the streets?” a curious female friend interjects. Dave replies: “No, it’s not the streets, man. It’s just Federation Square, everywhere … There is just all these young wannabe criminals and shit. People don’t know what goes on; and I want to do a doco on the city, a little doco of the people there, because I know a lot of it.” Dave’s interest in exploring the city may be interpreted as a rather common, mundane routine shared by mildly adventurous adolescents of all walks. And yet, there is much more at stake in his account, and for Youthworx young participants more generally. As mentioned before, for many of these young people, it is the first opportunity to travel to the city. This experience then is crucial in a sense of self-exploration and self-discovery. As they overcome their fear of venturing out into the city on their own, they also learn that they have knowledge which others might lack. This moment of realisation is significant and empowering, and they want to communicate this knowledge to others. Youthworx assists them in learning how to translate this knowledge in a creative and constructive way, through an expression that weaves between the free individual and the social voice constructed to enable a dialogue or understanding (Podkalicka; Podkalicka and Campbell; Podkalicka and Thomas; also Soep and Chavez). For an effective communication to occur, a crafted social voice requires skills and a critical awareness of oneself and an audience, which is very different from the modes of expression that these young people might have accessed previously. Youthworx's young participants draw heavily on their life experiences, geographical locations, the suburbs they come from, and places they visit in the city: their cultural productions often reference their homes, music clubs and hang-out venues, inner city streets, Federation Square, and Youthworx’s immediate physical surroundings, with graffiti-covered narrow alleys and railway tracks. The frequent depiction of Youthworx in young people’s creative outputs is often a token of appreciation of the creative, educational and social opportunities it has offered them. Social and professional connections they make there are found to be very valuable. The existing creative industries literature emphasises the importance of social networks to existing communities of interest and practice for human capacity building. Value is argued to lie not only in specific content produced, but in participatory processes that establish a link between personal growth, individual skills and social and professional networks (Hearn and Bridgestock). In a similar vein, Carlo Raffo uses Granovetter’s concept of “weak ties” to suggest that access to “social relations that go beyond the immediate locality and hence their immediate experiences” can provide marginalised young people with “pathways for authentic and informal learning that go beyond the structuring influences of class, gender and ethnicity and into new and emerging economic experiences” (Raffo 11). But higher levels of confidence or social skills are required to make the most of vocational or professional opportunities beyond the supportive context of Youthworx. Connections between Youthworx participants and other creative practitioners within the creative locality of Brunswick have been absent thus far. Transitions into mainstream education and employment have also proven challenging for this group of heavily marginalised youth. As we found during our ongoing fieldwork, even the most talented students find it hard to get into mainstream education courses, or to get or keep jobs. The project serves as a social basis for young people to develop self-agency and determination so they can start engaging with new opportunities and social networks outside the program (Raffo 15). Indeed, the creative practitioners at Youthworx are key facilitators of connections between young people and the external world. They act as positive role models socially, and illustrate what is possible professionally in terms of media excellence and employment (see also Raffo). There are indications that this very supportive, gradual process of social learning is starting to bear fruit for individual students and the Youthworx community as a whole as they grow more confident with themselves, in interactions with others, and the media work they do. Media projects such as Youthworx are examples of what Leadbeater and Wong call “disruptive innovation,” as they provide new ways of learning for those alienated by formal education. The use of digital hands-on media production makes educational processes relevant and engaging for young people. However, as I demonstrate in this paper, there are tangible, material barriers to releasing creativity, or enhancing self-discovery and sociality. There are, as Leadbeater and Wong observe, persistent links between cultural environment, socio-economic status, corresponding attitudes to learning and educational success in the developed world. In the UK, for example, only small percent of those from the lowest socio-economic background go to university (Leadbeater and Wong 10). Youthworx provides an opportunity and motivation for young people to break a cycle of individual self-destructive behaviour (e.g. getting locked up every 6 months), intergenerational reliance on welfare, or entrenched negative attitudes to learning. At the basic level, it encourages and often insists that young people get up in the morning, with social workers often reporting to have to “knock at people’s houses and get them ready.” The involvement in Youthworx is often an important reason to start delineating between day and night, week and weekend. A couple of students commented: I slept a lot. Yeah, I was always sleeping during the day and out at night; I could have still been doing nothing with my life [were it not for Youthworx]. Now people ask if I want to go out during the week, and I just can’t be bothered. I just want to sleep and then go to [Youthworx] and then weekends are when you go out. It also offers a concrete means to begin exploring the city beyond the constraints of their local suburbs. This literal, geographical mobility is interlocked with potential for a changed perception of opportunities, individual transformation and, consequently, social mobility. Dave, as we have seen, is attracted to the idea of exploring the city but also has creative aspirations, and contemplates professional prospects in the creative industries. It is important to note that the participants are resilient in their negotiation between the suburban, Youthworx and inner city worlds they can inhabit. Accessing learning, despite previous negative schooling experiences, is for many of them very important, and reaffirming of life they aspire to. An opportunity to pursue dreams, creative forms of expression, social networks and education is a vital part of human existence. These aspects of social inclusion are recognised in the current articulation of social policy reconceptualised beyond material, economic equality. Creative industry policy, on the other hand, is concerned with fostering creative outputs and skills to generate engagement and employment opportunities in the knowledge-based economies for wide sections of the population. The value is located in human capacity building, involving basic social as well as vocational skills, and links to social networks. The Youthworx project merges these two policy frameworks of the social and creative to test in practice new collaborative approaches to youth development. The spatial and cultural practices of young people described here serve a basis for proposing a theoretical framework that can help understand the term "suburb" in an intrinsically relational, grounded way. The relationships at stake in cultural and social participation for marginalised young people lead me to suggest that the concept of ‘suburb’ takes on two tightly interwoven meanings. The first refers symbolically to a particular locale for popular creativity (Burgess) or even marginal creativity by a group of young people living at the periphery of the social system. The second meaning refers to the interlocked forms of material and cultural capital (and distance), as theorised in Bourdieu’s work (e.g., Bourdieu). It includes physical, spatial conditions and relations, as well as cultural resources and possibilities made available to young participants by the project (e.g., the instituted, supported travel across the city, or the employment of creative practitioners), and interlinked with everyday dispositions, practices, and status of young people (e.g., taste). This empirically-grounded discussion allows to theorise ‘suburbs’ as perceived and socially enacted by concrete, relational forms of access, contingencies, and opportunities for a particular demographic, rather than analytically pre-conceived, designated spaces within an urban system. The ethnographic material reveals that cultural participation for marginalised youth requires an integrated approach, with a parallel focus on material and creative opportunities made available within creative sites such as Youthworx or even the Brunswick creative area. The important material constraints exemplified in this paper concern socio-economic background, cultural disadvantage and geographical isolation and point to the limits of the creative industries-based interventions to address social inclusion if carried out in isolation. They tap into the very basis of risks for this specific demographic of marginalised youth or "youth at risk." The paper suggests that the productive emphasis on the role of media and communication for (youth) development needs to be contextualised and considered along with the actual realities of everyday existence that often limit young people’s educational and vocational prospects (see Bentley et al.; Leadbeater and Wong). On the other hand, an exclusive focus on material support risks cancelling out the possibilities for positive life transitions, such as those triggered by constructive, non-reductionist engagement with “beauty, aesthetics” (Campbell) and creativity. By exploring how participation in Youthworx engenders both the physical mobility between suburbs and the city, and identity transformation, we are able to gain insights into the nature of social exclusion, its meanings for the youth involved and the project managers and staff. Thinking about Youthworx not just as a hub of creative production but as a cultural site—“a space within a practiced place of identity” (De Certeau 117) in the suburb of Brunswick—opens up a discussion that combines the policy language of opportunity and necessity with concrete creative and material possibilities. Social inclusion objectives aimed at positive youth transitions need to be considered in the light of the connection—or disconnection—between the Youthworx Brunswick site itself, young participants’ suburbs, and, by extension, the trajectory between the inner city and other spaces that young people travel through and inhabit. Acknowledgment I would like to thank all the young participants, staff and industry partners involved in the Youthworx project. I also acknowledge the comments of anonymous peer reviewer which helped to strengthen the argument by foregrounding the value of the empirical material. The paper draws on the larger project funded by the Centre of Excellence in Creative Industries and Innovation. Youthworx research team includes: Prof Denise Meredyth (CI); Prof Julian Thomas (CI); Ass/Prof David MacKenzie (CI); Ass/Prof Ellie Rennie; Chris Wilson (PhD candidate), and Jon Staley (Youthworx Manager and PhD candidate). References Bentley, Tom, and Kate Oakley. “The Real Deal: What Young People Think about Government, Politics and Social Exclusion.” Demos. 12 Jan. 2011 ‹http://www.demos.co.uk/files/theRealdeal.pdf›. Bourdieu, Pierre. Distinction: A Social Critique of the Judgement of Taste. Cambridge: Harvard U P, 1987. Burgess, Jean. “Hearing Ordinary Voices: Cultural Studies, Vernacular Creativity and Digital Storytelling.” Continuum 20.2 (2006): 201–14. Campbell, Craig. Personal Interview. Melbourne, 2009. De Certeau, Michel. The Practice of Everyday Life. Los Angeles: University of California Press, 1984. Dewson, Sara, Judith Eccles, Nii Djan Tackey and Annabel Jackson. “Guide to Measuring Soft Outcomes and Distance Travelled.” The Institute for Employment Studies. 12 Jan. 2011‹http:// www.dwp.gov.uk/docs/distance.pdf›. Dowmunt, Tom, Mark Dunford, and N. van Hemert. Inclusion through Media. London: Open Mute, 2007. Ferber, Sarah, Chris Healy, and Chris McAuliffe. Beasts of Suburbia: Reinterpreting Cultures in Australian Suburbs. Melbourne: Melbourne UP, 1994. Hayes, Alan, Matthew Gray, and Ben Edwards. “Social Inclusion: Origins, Concepts and Key Themes.” Australian Institute of Family Studies, prepared for the Social Inclusion Unit, Department of the Prime Minister and Cabinet. 2008.12 Jan. 2011 ‹http://www.socialinclusion.gov.au/Documents/AIFS_SI_concepts_report_20April09.pdf›. Hearn, Gregory, and Ruth Bridgstock. “Education for the Creative Economy: Innovation, Transdisciplinarity, and Networks. Education in the Creative Economy: Knowledge and Learning in the Age of Innovation. Ed. Daniel Araya and Michael Peters. New York: Peter Lang, 2010. 93–116. Holdsworth, Roger, Murray Lake, Kathleen Stacey, and John Safford. “Doing Positive Things: You Have to Go Out and Do It: Outcomes for Participants in Youth Development Programs.” Australian Youth Research Centre. 12 Jan. 2011 ‹http://www.dest.gov.au/NR/rdonlyres/5385FE14-A74C-4B24-98EA-D31EEA8447B2/21803/doing_positive_things1.pdf›. Lave, Jean, and Etienne Wenger. Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge UP, 1991. Leadbeater, Charles, and Annika Wong. “Learning from the Extremes.” CISCO. 12 Jan. 2011 ‹http://www.socialinclusion.gov.au/Documents/AIFS_SI_concepts_report_20April09.pdf›. Miller, Daniel. Stuff. Cambridge: Polity, 2010. Podkalicka, Aneta. “Young Listening: An Ethnography of Youthworx Media's Radio Project." Continuum: Journal of Media & Cultural Studies 23.4 (2009): 561–72. ———, and Jon Staley. “Youthworx Media: Creative Media Engagement for ‘at Risk’ Young People.” 3CM 5 (2009). ———, and Julian Thomas. “The Skilled Social Voice: An Experiment in Creative Economy and Communication Rights.’’ International Communication Gazette 72.4–5 (2010): 395–406. ———, and Craig Campbell. “Understanding Digital Storytelling: Beyond the Politics of Voice in Youth Participation Programs.” seminar.net: Media Technology and Lifelong Learning 6.2 (2010). ‹http://www.seminar.net/index.php/home/75-current-issue/150-understanding-digital-storytelling-individual-voice-and-community-building-in-youth-media-programs›. Poletti, Anna. Intimate Ephemera: Reading Young Lives in Australian Zine Culture. Melbourne: Melbourne University Press, 2008. Raffo, Carlo. "Mentoring Disenfranchised Young People: An Action Research Project on the Development of 'Weak Ties' and Social Capital Enhancement." Education and Industry in Partnership 6.3 (2000): 22–42. Soep, Elizabeth, and Vivian Chavez. Drop That Knowledge: Youth Radio Stories. Berkeley: University of California Press, 2010. Spurgeon, Christina, Jean Burgess, Helen Klaebe, Kelly McWilliam, Jo Tacchi, and Mimi Tsai. “Co-Creative Media: Theorising Digital Storytelling as a Platform for Researching and Developing Participatory Culture.” 2009 ANZC Conference Proceedings. 2009. 16 Nov. 2010 ‹http://eprints.qut.edu.au/25811/2/25811.pdf›.