Articoli di riviste sul tema "Career Intern Program (U.S.)"

Internship credit has been offered for nearly 30 years. In more recent years, it has been formalized with specific guidelines developed in setting up an individual student program. Internship opportunities are facilitated through a career day, which has moved from fall to spring semester in which over 25 firms come on campus to present their opportunities. A detailed packet of information is distributed to the perspective intern and cooperator. A memorandum of agreement is developed with student, cooperator and internship coordinator which details credit, description of the program and hourly wage. Students are required to submit weekly reports and upon returning to campus must present an oral report to a student group and a written report to the internship coordinator. The cooperator does a summary evaluation, which is submitted to the coordinator. A final interview with each student is done with the internship coordinator and a S/F grade is assigned.

Current and former Missouri Master Gardeners were asked to respond how strongly they agreed or disagreed with a list of benefits provided by the Master Gardener program. The survey instrument was an adaptation of Rohs and Westerfield's (1996) Master Gardener Societal and Personal Benefits survey. Questions were assigned to one of the six principal components of volunteer motivation developed by Clary et al. (1998): Understanding, Values, Enhancement, Social, Protective, and Career. Master Gardeners who are currently active volunteers in the program were more likely to respond favorably to many of the benefits provided by the Master Gardener program. Respondents most strongly indicated their agreement that the Master Gardener program, more than any other similar organization, provides benefits related to new learning experiences, exercising knowledge, skills, and abilities, categorized as understanding (U). The overall mean for U was 4.35 on the 5-point Likert scale, a significantly higher score than any other category according to Duncan's multiple range test. Benefits related to personal growth and self-esteem, labeled enhancement (E); those related to altruism and humanitarian concern, labeled values (V); and guilt reduction over being more fortunate than others and addressing one's own personal problems, labeled protective (P), formed the second tier of benefit importance. Benefits related to preparation for a new career or maintaining career-relevant skills, categorized as career (C) were next. Benefits concerning relationships with others, classified as social (S), concluded the list.

Introduction: Adding developmental networks (DN) to grant-writing coaching can significantly enhance ESIs’ research careers. Herein, we present study design, ESIs’ characteristics and encountered challenges/lessons learned and their resolutions when deploying/implementing (a) NCR algorithm(s), (b) recruitment/retention and (c) implementing DN intervention. Methods: Nested Cluster Randomization (NCR) design governs this study implementation. The sample size is 220 ESIs intending to submit an NIH K, R, U, and/or Minority Supplement application(s). Primary outcome: intensity/sustainability of grant submission(s)/funding(s), measured by time to/between application(s). Outcome(s) analyses modes: summaries, Kaplan Meir and Cox proportional hazard models as a function of randomization groups and other predictors of outcomes. Results: In the present study, we recruited two cohorts of ESIs (N = 85): 39% African Americans, 18% Latinx, 18% Whites, 20% Asians and 6% Hawaiian/Pacific Islander/other ethnicities; 65% are women; 73% are assistant professors, 4% are Associate Professors and 23% are instructors/scientists/post-doctoral. Participants’ disciplines: 32% basic/biomedical, 36% clinical/translational and 32% social/behavioral. Proposal(s) mechanisms: 61% research grants (R series), 31% career development (K series), 7% support of competitive research (SCORE) and 1% National Science Foundation applications. NCR did produce balance in the distribution of ESIs’ demographics, sex at birth, ethnicity, professional appointments, background disciplines, and mechanism of sought funding. Lessons learned/challenges: NCR implementation was methodologically challenged during implementation by added constraints (e.g., assigning coaches to the same randomization arm of their participants as well as blinding them to ESIs’ randomization group). Recruitment and retention were hampered by the COVID-19 pandemic and more progressive and innovative strategies were needed to heighten the visibility and outreach of this program. DN delivery was also affected by the pandemic and monitoring of ESIs’ engagement and facilitation of communications interventions were needed. Resolution of these challenges effectively reconfigured NCR algorithms, recruitment/retention plans, and DN intervention delivery. We intend to recruit an additional 135 ESIs focusing on underrepresented scholars from RCMIs, CTSAs, and other programs. COVID-19 rendered this program 100% virtual, with recruitment/retention challenges and substantial disruption of ESIs’ research. We may extend the grant writing period, coaching, and Mock Study Section support.

Introduction:In 2014, the residency program adopted a new chief resident model. Multiple other programs had adopted a similar style of having all final-year residents have a “chief” role. Chief residents are meant to be leaders in the residency, have a direct influence on the program, and serve as liaisons with other department chiefs.Method:Prior to 2014, the program had three chief residents a year: one Admin, one Academic, and one Recruitment. They were chosen using a vote amongst residents/faculty, with the ultimate decision made by the residency leadership. Many other residents were interested, and often qualified, but were ultimately not chosen. In 2014, the all-chief model was adopted. Each PGY-3 would have a responsibility. The goal was to give each a leadership opportunity, and a tangible product as they transition to fellowships or new jobs. The residents were allowed to pick their position, with some influence by residency leadership. Residents were encouraged to create new roles which aligned with their personal interests or career goals. Examples included Medical Director Chief, U/S chief, PEM chief and Wellness Chief.Results:Some residents thrived when given responsibility, while others did not. Some could not manage more responsibility: there was a clear disparity in the effort. At the start of this, all residents’ total shifts/month decreased equally. This created some controversy when the workload was not equal. The alteration of details, requirements, and expectations occurred every year in an attempt to correct the failures.Conclusion:Ultimately, the all-chief model was a failure. The program reverted to a traditional chief model, allowing only those the residency leadership felt could manage chief responsibilities to have a role. Those not doing a chief role were given additional shifts and those with less added work were given only a partial shift reduction.

Eating habits develop during the first years of a child's life, children learn what, when, and how much to eat through direct experience with food and by observing the eating habits of others. The aim of this study is to get a clear picture of the Eating program Healthy, starting from the planning, implementation, supervision, and evaluation as a case study of nutrition education; to get information about the advantages, disadvantages and effects of implementing a healthy eating program for children. This research was conducted through a case study with qualitative data analysed using Miles and Huberman techniques. Sample of children in Ananda Islāmic School Kindergarten. The results showed the Healthy Eating program could be implemented well, the diet was quite varied and could be considered a healthy and nutritious food. The visible impact is the emotion of pleasure experienced by children, children become fond of eating vegetables, and make children disciplined and responsible. Inadequate results were found due to the limitations of an adequate kitchen for cooking healthy food, such as cooking activities still carried out by the cook himself at the Foundation's house which is located not far from the school place; use of melamine and plastic cutlery for food; the spoon and fork used already uses aluminium material but still does not match its size; does not involve nutritionists. Keywords: Early Childhood, Eating Healthy Program References: Bandura, A. (1977). Social learning theory. Englewood Cliffs: Prentice-Hall. Bandura, Albert. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660 Battjes-Fries, M. C. E., Haveman-Nies, A., Renes, R. J., Meester, H. J., & Van’T Veer, P. (2015). Effect of the Dutch school-based education programme “Taste Lessons” on behavioural determinants of taste acceptance and healthy eating: A quasi-experimental study. Public Health Nutrition, 18(12), 2231–2241. https://doi.org/10.1017/S1368980014003012 Birch, L., Savage, J. S., & Ventura, A. (2007). Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Canadian Journal of Dietetic Practice and Research : A Publication of Dietitians of Canada = Revue Canadienne de La Pratique et de La Recherche En Dietetique : Une Publication Des Dietetistes Du Canada, 68(1), s1– s56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19430591%0Ahttp://www.pubmedcentral.nih.gov/a rticlerender.fcgi?artid=PMC2678872 Coulthard, H., Williamson, I., Palfreyman, Z., & Lyttle, S. (2018). Evaluation of a pilot sensory play intervention to increase fruit acceptance in preschool children. Appetite, 120, 609–615. https://doi.org/10.1016/j.appet.2017.10.011 Coulthard, Helen, & Sealy, A. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite, 113, 84–90. https://doi.org/10.1016/j.appet.2017.02.003 Crain, W. C. (2005). Theories of development: Concepts and applications. Upper Saddle River: Pearson Prentice Hall. Dazeley, P., Houston-Price, C., & Hill, C. (2012). Should healthy eating programmes incorporate interaction with foods in different sensory modalities? A review of the evidence. British Journal of Nutrition, 108(5), 769–777. https://doi.org/10.1017/S0007114511007343 Derscheid, L. E., Umoren, J., Kim, S. Y., Henry, B. W., & Zittel, L. L. (2010). Early childhood teachers’ and staff members’ perceptions of nutrition and physical activity practices for preschoolers. Journal of Research in Childhood Education, 24(3), 248–265. https://doi.org/10.1080/02568543.2010.487405 Eliassen, E. K. (2011). The impact of teachers and families on young children’s eating behaviors. YC Young Children, 66(2), 84–89. Elliott, E., Isaacs, M., & Chugani, C. (2010). Promoting Self-Efficacy in Early Career Teachers: A Principal’s Guide for Differentiated Mentoring and Supervision. Florida Journal of Educational Administration & Policy, 4(1), 131–146. Emm, S., Harris, J., Halterman, J., Chvilicek, S., & Bishop, C. (2019). Increasing Fruit and Vegetable Intake with Reservation and Off-reservation Kindergarten Students in Nevada. Journal of Agriculture, Food Systems, and Community Development, 9, 1–10. https://doi.org/10.5304/jafscd.2019.09b.014 Flynn, M. A. T. (2015). Empowering people to be healthier: Public health nutrition through the Ottawa Charter. Proceedings of the Nutrition Society, 74(3), 303–312. https://doi.org/10.1017/S002966511400161X Franciscato, S. J., Janson, G., Machado, R., Lauris, J. R. P., de Andrade, S. M. J., & Fisberg, M. (2019). Impact of the nutrition education Program Nutriamigos® on levels of awareness on healthy eating habits in school-aged children. Journal of Human Growth and Development, 29(3), 390–402. https://doi.org/10.7322/jhgd.v29.9538 Froehlich Chow, A., & Humbert, M. L. (2014). Perceptions of early childhood educators: Factors influencing the promotion of physical activity opportunities in Canadian rural care centers. Child Indicators Research, 7(1), 57–73. https://doi.org/10.1007/s12187-013-9202-x Graham, H., Feenstra, G., Evans, A. M., & Zidenberg-Cherr, S. (2002). Healthy Eating Habits in Children. California Agriculture, 58(4), 200–205. Gucciardi, E., Nagel, R., Szwiega, S., Chow, B. Y. Y., Barker, C., Nezon, J., ... Butler, A. (2019). Evaluation of a Sensory-Based Food Education Program on Fruit and V egetable Consumption among Kindergarten Children. Journal of Child Nutrition & Management, 43(1). Holley, C. E., Farrow, C., & Haycraft, E. (2017). A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood. Current Nutrition Reports, 6(2), 157–170. https://doi.org/10.1007/s13668-017-0202-1 Hoppu, U., Prinz, M., Ojansivu, P., Laaksonen, O., & Sandell, M. A. (2015). Impact of sensory- based food education in kindergarten on willingness to eat vegetables and berries. Food and Nutrition Research, 59, 1–8. https://doi.org/10.3402/fnr.v59.28795 Jarpe-Ratner, E., Folkens, S., Sharma, S., Daro, D., & Edens, N. K. (2016). An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3–8. Journal of Nutrition Education and Behavior, 48(10), 697-705.e1. https://doi.org/10.1016/j.jneb.2016.07.021 Jones, A. M., & Zidenberg-Cherr, S. (2015). Exploring Nutrition Education Resources and Barriers, and Nutrition Knowledge in Teachers in California. Journal of Nutrition Education and Behavior, 47(2), 162–169. https://doi.org/10.1016/j.jneb.2014.06.011 Jung, T., Huang, J., Eagan, L., & Oldenburg, D. (2019). Influence of school-based nutrition education program on healthy eating literacy and healthy food choice among primary school children. International Journal of Health Promotion and Education, 57(2), 67–81. https://doi.org/10.1080/14635240.2018.1552177 Lwin, M. O., Malik, S., Ridwan, H., & Sum Au, C. S. (2017). Media exposure and parental mediation on fast-food consumption among children in metropolitan and suburban Indonesian. Asia Pacific Journal of Clinical Nutrition, 26(5), 899–905. https://doi.org/10.6133/apjcn.122016.04 Mc Kenna, & L, M. (2010). Policy Options to Support Healthy Eating in Schools. Canadian Journal of Public Health, 101(2), S14–S18. https://doi.org/10.1007/BF03405619 Menkes, R. PERATURAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 41 TAHUN 2014. , Menteri Kesehatan Republik Indonesia § (2014). Mitsopoulou, A. V., Magriplis, E., Dimakopoulos, I., Karageorgou, D., Bakogianni, I., Micha, R., ... Zampelas, A. (2019). Association of meal and snack patterns with micronutrient intakes among Greek children and adolescents: data from the Hellenic National Nutrition and Health Survey. Journal of Human Nutrition and Dietetics, 32(4), 455–467. https://doi.org/10.1111/jhn.12639 Moffitt, A. (2019). Early Childhood Educators and the Development of Family Literacy Programs: A Qualitative Case Study. ProQuest Dissertations and Theses, 96. Retrieved from http://proxy.mul.missouri.edu/login?url=https://search.proquest.com/docview/2242479347 ?accountid=14576%0Ahttps://library.missouri.edu/findit?genre=dissertations+%26+theses &title=Early+Childhood+Educators+and+the+Development+of+Family+Literacy+Progra ms%3A+ Mustonen, S., & Tuorila, H. (2010). Sensory education decreases food neophobia score and encourages trying unfamiliar foods in 8-12-year-old children. Food Quality and Preference, 21(4), 353–360. https://doi.org/10.1016/j.foodqual.2009.09.001 Myszkowska-Ryciak, J., & Harton, A. (2019). Eating healthy, growing healthy: Outcome evaluation of the nutrition education program optimizing the nutritional value of preschool menus, Poland. Nutrients, 11(10), 1–17. https://doi.org/10.3390/nu11102438 Nekitsing, C., Hetherington, M. M., & Blundell-Birtill, P. (2018). Developing Healthy Food Preferences in Preschool Children Through Taste Exposure, Sensory Learning, and Nutrition Education. Current Obesity Reports, 7(1), 60–67. https://doi.org/10.1007/s13679- 018-0297-8 Noura, M. S. pd. (2018). Child nutrition programs in kindergarten schools implemented by the governmental sector and global nutrition consulting companies: A systematic review. Current Research in Nutrition and Food Science, 6(3), 656–663. https://doi.org/10.12944/CRNFSJ.6.3.07 Oh, S. M., Yu, Y. L., Choi, H. I., & Kim, K. W. (2012). Implementation and Evaluation of Nutrition Education Programs Focusing on Increasing Vegetables, Fruits and Dairy Foods Consumption for Preschool Children. Korean Journal of Community Nutrition, 17(5), 517. https://doi.org/10.5720/kjcn.2012.17.5.517 Osera, T., Tsutie, S., & Kobayashi, M. (2016). Using Soybean Products in School Lunch for Health Education may improve Children’s Attitude and Guardians’ Knowledge in Kindergarten. Journal of Child and Adolescent Behaviour, 04(05). https://doi.org/10.4172/2375-4494.1000310 Park, B. K., & Cho, M. S. (2016). Taste education reduces food neophobia and increases willingness to try novel foods in school children. Nutrition Research and Practice, 10(2), 221–228. https://doi.org/10.4162/nrp.2016.10.2.221 Pendidikan, K., & Kebudayaan, D. A. N. Menteri Pendidikan Dan Kebudayaan Republik Indonesia Nomor 137 Tahun 2013 Tentang Standar Nasional Pendidikan Anak Usia Dini. , (2015). Prima, E., Yuliantina, I., Nurfadillah, Handayani, I., Riana, & Ganesa, R. eni. (2017). Layanan Kesehatan,Gizi dan Perawatan. Jakarta: Direktorat Pembinaan Pendidikan Anak Usia Dini Direktorat Jenderal Pendidikan Anak Usia Dini dan Pendidikan Masyarakat Kementerian Pendidikan dan Kebudayaan. Resor, J., Hegde, A. V., & Stage, V. C. (2020). Pre-service early childhood educators’ perceived barriers and supports to nutrition education. Journal of Early Childhood Teacher Education, 00(00), 1–17. https://doi.org/10.1080/10901027.2020.1740841 Rizqie Aulianaca5804p200-169314. (2011). Gizi Seimbang Dan Makanan Sehat Untuk Anak Usia Dini. Journal of Nutrition and Food Research, 2(1), 1–12. Retrieved from http://staff.uny.ac.id/sites/default/files/pengabdian/rizqie-auliana-dra-mkes/gizi-seimbang- dan-makanan-sehat-untuk-anak-usia-dini.pdf Sandell, M., Mikkelsen, B. E., Lyytikäinen, A., Ojansivu, P., Hoppu, U., Hillgrén, A., & Lagström, H. (2016). Future for food education of children. Futures, 83, 15–23. https://doi.org/10.1016/j.futures.2016.04.006 Schanzenbach, D. W., & Thorn, B. (2019). Food Support Programs and Their Impacts on Young Children. Health Affairs, (march). Retrieved from https://www.healthaffairs.org/briefs Schmitt, S. A., Bryant, L. M., Korucu, I., Kirkham, L., Katare, B., & Benjamin, T. (2019). The effects of a nutrition education curriculum on improving young children’s fruit and vegetable preferences and nutrition and health knowledge. Public Health Nutrition, 22(1), 28–34. https://doi.org/10.1017/S1368980018002586 Sekiyama, M., Roosita, K., & Ohtsuka, R. (2012). Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia. Asia Pacific Journal of Clinical Nutrition, 21(4), 558–567. https://doi.org/10.6133/apjcn.2012.21.4.11 Sepp, H., & Ho, K. (2016). Food as a tool for learning in everyday activities at preschool exploratory study from Sweden. Food & Nurtition Research, 1, 1–7. Shor, R., & Friedman, A. (2009). 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Problem solving skills are very important in supporting social development. Children with problem solving skills can build healthy relationships with their friends, understand the emotions of those around them, and see events with other people's perspectives. The purpose of this study was to determine the implementation of playing unplugged coding programs in improving early childhood problem solving skills. This study used a classroom action research design, using the Kemmis and Taggart cycle models. The subjects of this study were children aged 5-6 years in Shafa Marwah Kindergarten. Research can achieve the target results of increasing children's problem-solving abilities after going through two cycles. In the first cycle, the child's initial problem-solving skills was 67.5% and in the second cycle it increased to 80.5%. The initial skills of children's problem-solving increases because children tend to be enthusiastic and excited about the various play activities prepared by the teacher. The stimulation and motivation of the teacher enables children to find solutions to problems faced when carrying out play activities. So, it can be concluded that learning unplugged coding is an activity that can attract children's interest and become a solution to bring up children's initial problem-solving abilities. Keywords: Early Childhood, Unplugged Coding, Problem solving skills References: Akyol-Altun, C. (2018). Algorithm and coding education in pre-school teaching program integration the efectiveness of problem-solving skills in students. Angeli, C., Smith, J., Zagami, J., Cox, M., Webb, M., Fluck, A., & Voogt, J. (2016). A K-6 Computational Thinking Curriculum Framework: Implications for Teacher Knowledge. Educational Technology & Society, 12. Anlıak, Ş., & Dinçer, Ç. (2005). Farklı eğitim yaklaşımları uygulayan okul öncesi eğitim kurumlarına devam eden çocukların kişilerarası problem çözme becerilerinin değerlendirilmesi. Ankara Üniversitesi Eğitim Bilimleri Fakülte Dergis. Aranda, G., & Ferguson, J. P. (2018). Unplugged Programming: The future of teaching computational thinking? Pedagogika, 68(3). https://doi.org/10.14712/23362189.2018.859 Arinchaya Threekunprapa. (2020). Patterns of Computational Thinking Development while Solving Unplugged Coding Activities Coupled with the 3S Approach for Self_Directed Learning. European Journal of Educational Research, 9(3), 1025–1045. Arı, M. (2003). Türkiye’de erken çocukluk eğitimi ve kalitenin önemiNo Title. Erken Çocuklukta Gelişim ve Eğitimde Yeni Yaklaşımlar. Armoni, M. (2012). Teaching CS in kindergarten: How early can the pipeline begin? ACM Inroads, 3(4), 18–19. https://doi.org/10.1145/2381083.2381091 Aydoğan, Y. (2004). İlköğretim ikinci ve dördüncü sınıf öğrencilerine genel problem çözme becerilerinin kazandırılmasında eğitimin etkisinin incelenmesi. Bell, T., Alexander, J., Freeman, I., & Grimley, M. (2009). Computer Science Unplugged: School students doing real computing without computers. 10. Berk, L. E. (2013). Bebekler ve çocuklar: Doğum öncesinden orta çocukluğa. N. Işıkoğlu Erdoğan, Çev. Bers, M. U. (2018). Coding, playgrounds, and literacy in early childhood education: The devel_opment of KIBO robotics and Scratch Jr. IEEE. Brackmann, C. P., Moreno-León, J., Román-González, M., Casali, A., Robles, G., & Barone, D. (2017). Development of computational thinking skills through unplugged activities in primary school. ACM International Conference Proceeding Series, 65–72. https://doi.org/10.1145/3137065.3137069 Brennan, K., & Resnick, M. (2012). New frameworks for studying and assessing the development of computational thinking. 25. Deek, F. P. (1999). 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The importance of the ability to develop lesson plans requires educators to be able to understand and master learning content as well as understand various ways to complete it. The learning device information system (SIPP) as one of the results of technology is here to help educators complete this task. The purpose of this study was to demonstrate the effectiveness and efficiency of SIPP in developing learning plans in early childhood education. The research was conducted using a quantitative approach, with descriptive statistical analysis presented in the form of a frequency distribution table. The questionnaire was distributed using a Likert scale, which contains items regarding goal achievement, quality, output, and user response as indicators of effectiveness and contains items regarding the use of time, cost, effort, and use of paper materials as indicators of efficiency. The results showed that the four indicators of effectiveness were met with an average score of 385.8. Efficiency which includes four indicators achieves an average score of 19.3. The availability of components in templates that are adjusted to the applicable provisions and can be used automatically allows users to complete their tasks in a relatively faster time. The availability of components in templates that are adjusted to the applicable provisions and can be used automatically allows users to complete their tasks in a relatively faster time. The conclusion is that SIPP is very effective and efficient for preparing lesson plans so that it can facilitate and save the teacher's time in completing the task. Keywords: learning device information; early childhood education, lesson plan References: Abdurohman, M., Kuspriyanto, Sutikno, S., & Sasongko, A. (2010). Perancangan Aturan Transformasi UML-Systemic dalam Perancangan Embedded System. Jurnal Ilmu Komputer Dan Informasi, 3(2), 91–97. https://doi.org/hhttps://doi.org/10.21609/jiki.v3i2.146 Adnan, K., & Bataineh, A. (2014). 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Photo by Nathan Dumlao on Unsplash ABSTRACT The demographic of physicians in the United States has failed to include a proportionate population of Latinos in the United States. In what follows, I shall argue that the medical school admission process places an undue burden on low-income Latino applicants. Hence, the underrepresentation of Latinos in medical schools is an injustice. This injustice relates to the poor community health of the Latino community. Health disparities such as diabetes, HIV infection, and cancer mortality are higher amongst the Latino community. The current representation of Latino medical students is not representative of those in the United States. INTRODUCTION The demographic of physicians in the United States has failed to include a proportionate number of Latinos, meaning people of Latin American origin. Medical schools serve as the gatekeepers to the medical field, and they can alter the profession based on whom they admit. With over 60 million Latinos in the United States, people of Latin American origin comprise the largest minority group in the nation.[1] In 2020-2021, only 6.7 percent of total US medical school enrollees and only 4 percent of medical school leadership identified as Latino.[2] Latino physicians can connect to a historically marginalized community that faces barriers including language, customs, income, socioeconomic status, and health literacy. I argue that the medical school admissions process places an undue burden on low-income Latino applicants. This paper explores the underrepresentation of Latinos in medical schools as an injustice. A further injustice occurs as the barriers to medical education result in fewer Latino doctors to effectively deliver health care and preventive health advice to their communities in a culturally competent way. I. Latino Community Health Data The terms Latino and Hispanic have largely been considered interchangeable. US government departments, such as the US Census Bureau and the Centers for Disease Control and Prevention (CDC), define Hispanic people as those with originating familial ties to native Spanish-speaking countries, most of whom are from Latin America. The term Latino is more inclusive because it refers to all of those with strong originating ties to countries in Latin America, including those coming from countries such as Brazil and Belize who are not native Spanish speakers. Throughout this work, I refer to the term Latino because it is more inclusive, although the data retrieved from US government departments may refer to the population as Hispanic. “Low-income” refers to the qualifying economic criteria for the AAMC’s Fee Assistance Program Poverty Guidelines.[3] The AAMC Fee Assistance Program is designed to help individuals who do not have the financial means to pay the total costs of applying to medical school. For this paper, low-income refers to those who qualify for this program. The US government gathers data about Latino community health and its health risks. The Latino community has a higher poverty rate than the non-Hispanic white community.[4] Latino community health has long trailed that of white people collectively. For example, the Latino community experiences higher levels of preventable diseases, including hypertension, diabetes, and hepatitis, than the non-Hispanic white community does.[5] The CDC collects data about Latino community health and provides statistics to the public. Latinos in the United States trail only non-Hispanic blacks in prevalence of obesity. The Latino adult obesity rates are 45.7 percent for males and 43.7 percent for females.[6] Of the 1.2 million people infected with HIV in the United States, 294,200 are Latino.[7] The infection rate of chlamydia is 392.6 per 100,000 ― 1.9 times the rate in the non-Hispanic white population.[8] The tuberculosis incidence rate is eight times higher than that of non-Hispanic white people at 4.4 per 100,000.[9] Furthermore, Latinos have the third highest death rate for hepatitis C among all races and ethnic groups.[10] The prevalence of total diabetes, diagnosed and undiagnosed, among adults aged 18 and older also remains higher than that of non-Hispanic whites at 14.7 percent compared to 11.9 percent.[11] The high disease rate evidences the poor health of the community. Furthermore, 19 percent of Latinos in the United States remain uninsured.[12] Almost a quarter of the Latino population in the United States lives in poverty.[13] The high incidence of disease, lack of insurance, and high poverty rate create a frail health status for the Latino community in the United States. The medical conditions seen are largely preventable, and the incident rates can be lowered with greater investments in Latino community health. Considering the health disparities between Latino and non-Hispanic White people, there is an ethical imperative to provide better medical care and guidance to the Latino community. II. Ethical and Practical Importance of Increasing the Number of Latino Physicians Minorities respond more positively to patient-physician interactions and are more willing to undergo preventative healthcare when matched with a physician of their racial or ethnic background.[14] Latino medical doctors may lead to an improvement in overall community health through improved communication and trusting relationships. Patient-physician racial concordance leads to greater patient satisfaction with their physicians.[15] Identifying with the ethnicity of a physician may lead to greater confidence in the physician-patient relationship, resulting in more engagement on the patient’s behalf. A randomized study regarding African American men and the race of their attending physician found an increase in requests for preventative care when assigned to a black doctor.[16] Although the subjects were African American men, the study has implications applicable to other minority racial and ethnic groups. The application process is unjust for low-income Latinos. The low matriculation of Latinos in medical schools represents a missed opportunity to alleviate the poor community health of the Latino population in the United States. Medical school also would create an opportunity to address health issues that plague the Latino community. Becoming a physician allows low-income Latinos to climb the social ladder and enter the spaces in health care that have traditionally been closed off to them. Nonwhite physicians significantly serve underserved communities.[17] Increasing the number of Latino doctors can boost their presence, potentially improving care for underserved individuals. Teaching physicians cultural competence is not enough to address the health disparities the Latino community faces. Latino physicians are best equipped to understand the healthcare needs of low-income Latinos. I contend that reforming the application process represents the most straightforward method to augment the number of Latino physicians who wish to work in predominantly Latino or diverse communities, thereby improving healthcare for the Latino community. III. Cultural Tenets Affecting Healthcare Interactions “Poor cultural competence can lead to decreased patient satisfaction, which may cause the patient not to attend future appointments or seek further care.”[18] Latino community health is negatively affected when medical professionals misinterpret cultural beliefs. Cultural tenets like a reservation towards medication, a deep sense of respect for the physician, and an obligation to support the family financially and through advocacy affect how Latinos seek and use the healthcare system.[19] First, the Latino population's negative cultural beliefs about medication add a barrier to patient compliance. It is highlighted that fear of dependence upon medicine leads to trouble with medication regimens.[20] The fear stems from the negative perception of addiction in the Latino community. Taking as little medication as possible avoids the chance of addiction occurring, which is why many take the prescribed medicine only until they feel healthier, regardless of the prescribing regimen. Some would rather not take any medication because of the deep-rooted fear. Physicians must address this concern by communicating the importance of patient compliance to remedy the health issue. Explaining that proper use of the medication as prescribed will ensure the best route to alleviate the condition and minimize the occurrence of dependence. Extra time spent addressing concerns and checking for comprehension may combat the negative perception of medication. Second, the theme of respeto, or respect, seems completely harmless to most people. After all, how can being respectful lead to bad health? This occurs when respect is understood as paternalism. Some patients may relinquish their decision-making to the physician. The physician might not act with beneficence, in this instance, because of the cultural dissonance in the physician-patient relationship that may lead to medical misinterpretation. A well-meaning physician might not realize that the patient is unlikely to speak up about their goals of care and will follow the physician’s recommendations without challenging them. That proves costly because a key aspect of the medical usefulness of a patient’s family history is obtaining it through dialogue. The Latino patient may refrain from relaying health concerns because of the misconceived belief that it’s the doctor’s job to know what to ask. Asking the physician questions may be considered a sign of disrespect, even if it applies to signs, symptoms, feelings, or medical procedures the patient may not understand.[21] Respeto is dangerous because it restricts the patients from playing an active role in their health. Physicians cannot derive what medical information may be relevant to the patient without their cooperation. And physicians without adequate cultural competency may not know they need to ask more specific questions. Cultural competency may help, but a like-minded physician raised similarly would be a more natural fit. “A key component of physician-patient communication is the ability of patients to articulate concerns, reservations, and lack of understanding through questions.”[22] As a patient, engaging with a physician of one’s cultural background fortifies a strong physician-patient relationship. Latino physicians are in the position to explain to the patients that respeto is not lost during a physician-patient dialogue. In turn, the physician can express that out of their value of respeto, and the profession compels them to place the patient’s best interest above all. This entails physicians advocating on behalf of the patients to ask questions and check for comprehension, as is required to obtain informed consent. Latino physicians may not have a cultural barrier and may already organically understand this aspect of their patient’s traditional relationship with physicians. The common ground of respeto can be used to improve the health of the Latino community just as it can serve as a barrier for someone from a different background. Third, in some Latino cultures, there is an expectation to contribute to the family financially or in other ways and, above all, advocate on the family’s behalf. Familial obligations entail more than simply translating or accompanying family members to their appointments. They include actively advocating for just treatment in terms of services. Navigating institutions, such as hospitals, in a foreign landscape proves difficult for underrepresented minorities like Latinos who are new to the United States. These difficulties can sometimes lead to them being taken advantage of, as they might not fully understand their rights, the available resources, or the standard procedures within these institutions. The language barrier and unfamiliar institutional policies may misinterpret patients’ needs or requests. Furthermore, acting outside of said institution’s policy norms may be erroneously interpreted as actions of an uncooperative patient leading to negative interactions between the medical staff and the Latino patient. The expectation of familial contribution is later revisited as it serves as a constraint to the low-income Latino medical school applicant. Time is factored out to meet these expectations, and a moral dilemma to financially contribute to the family dynamic rather than delay the contribution to pursue medical school discourages Latinos from applying. IV. How the Medical School Admission Process is Creating an Undue Burden for Low-Income Latino Applicants Applying a bioethics framework to the application process highlights its flaws. Justice is a central bioethical tenet relevant to the analysis of the MD admissions process. The year-long medical school application process begins with the primary application. The student enters information about the courses taken, completes short answer questions and essays, and uploads information about recommenders. Secondary applications are awarded to some medical students depending on the institutions’ policies. Some schools ask all applicants for secondary applications, while others select which applicants to send secondary requests. Finally, interviews are conducted after a review of both primary and secondary applications. This is the last step before receiving an admissions decision. The medical school application process creates undue restrictions against underserved communities. It is understood that matriculating into medical school and becoming a doctor should be difficult. The responsibilities of a physician are immense, and the consequences of actions or inactions may put the patients’ lives in jeopardy. Medical schools should hold high standards because of the responsibility and expertise required to provide optimal healthcare. However, I argue that the application process places an undue burden on low-income Latino applicants that is not beneficial to optimal health care. The burden placed on low-income Latino applicants through the application process is excessive and not necessary to forge qualified medical students. The financial aspect of the medical school application has made the profession virtually inaccessible to the working class. The medical school application proves costly because of the various expenses, including primary applications, secondary applications, and interview logistics. There is financial aid for applications, but navigating some aid to undertake test prep, the Medical College Admission Test (MCAT), and the travel for interviews proves more difficult. Although not mandatory, prep courses give people a competitive edge.[23] The MCAT is one of the key elements of an application, and many medical schools will not consider applications that do not reach their score threshold. This practically makes the preparatory courses mandatory for a competitive score. The preparatory courses themselves cost in the thousands of dollars. There has been talk about adjusting the standardized test score requirements for applicants from medically underserved backgrounds. I believe the practice of holding strict cutoffs for MCAT scores is detrimental to low-income Latino applicants, especially considering the average MCAT scores for Latinos trail that of white people. The American Association of Medical Colleges’ recent data for the matriculating class of 2021 illustrates the wide gap in MCAT scores: Latino applicants average 500.2, and Latino matriculants average 506.6, compared to white applicants, who average 507.5 and white matriculants, who average 512.7.[24] This discrepancy suggests that considerations beyond scores do play some role in medical school matriculation. However, the MCAT scores remain a predominant factor, and there is room to value other factors more and limit the weight given to scores. The practice of screening out applicants based solely on MCAT scores impedes low-income Latino applicants from matriculating into medical school. Valuing the MCAT above all other admissions criteria limits the opportunities for those from underserved communities, who tend to score lower on the exam. One indicator of a potentially great physician may be overcoming obstacles or engaging in scientific or clinical experiences. There are aspects of the application where the applicant can expand on their experiences, and the personal statement allows them to showcase their passion for medicine. These should hold as much weight as the MCAT. The final indicator of a good candidate should not solely rest on standardized tests. There is a cost per medical school that is sent to the primary application. The average medical school matriculant applies to about 16 universities, which drives up the cost of sending the applications.[25] According to the American Association of Medical Colleges, the application fee for the first school is $170, and each additional school is an additional $42. Sending secondary applications after the initial application is an additional cost that ranges by university. The American Medical College Application Service (AMCAS), the primary application portal for Medical Doctorate schools in the United States and Canada, offers the Fee Assistance Program (FAP) to aid low-income medical school applicants. The program reduces the cost of the MCAT from $325 to $130, includes a complimentary Medical School Admission Requirements (MSAR) subscription, and fee waivers for one AMCAS application covering up to 20 schools.[26] The program is an important aid for low-income Latino students who would otherwise not be able to afford to send multiple applications. Although the aid is a great resource, there are other expenses of the application process that the program cannot cover. For a low-income applicant, the burden of the application cost is felt intensely. A study analyzing the American Medical College Application Service (AMCAS) data for applicants and matriculants from 2014 to 2019 revealed an association between income and acceptance into medical school. They state, “Combining all years, the likelihood of acceptance into an MD program increased stepwise by income. The adjusted rate of acceptance was 24.32 percent for applicants with income less than $50 000, 27.57 percent for $50 000 - $74 999, 29.90 percent for $75 000 - $124 999, 33.27 percent for $125 000 - $199 999, and 36.91 percent for $200,000 or greater.”[27] It becomes a discouraging factor when it is difficult to obtain the necessary funds. The interview process for medical schools may prove costly because of travel, lodging, and time. In-person interviews may require applicants to travel from their residence to other cities or states. The applicant must find their own transportation and housing during the interview process, ranging from a single day to multiple days. Being granted multiple interviews becomes bittersweet for low-income applicants because they are morally distraught, knowing the universities are interested yet understanding the high financial cost of the interviews. The expense of multiple interviews can impede an applicant from progressing in the application process. Medical schools do not typically cover travel expenses for the interview process. Only 4 percent of medical school faculty identify as Latino.[28] The medical school admission board members reviewing the application lack Latino representation.[29] Because of this, it is extremely difficult for a low-income Latino applicant to portray hardships that the board members would understand. Furthermore, the section to discuss any hardships only allows for 200 words. This limited space makes it extremely difficult to explain the nuances of navigating higher education as a low-income Latino. Explaining those difficulties is then restricted to the interview process. However, that comes late in the application process when most applicants have been filtered out of consideration. The lack of diversity among the board members, combined with the minimal space to explain hardships or burdens, impedes a connection to be formed between the Latino applicants and the board members. It is not equitable that this population cannot relate to their admissions reviewers because of cultural barriers. Gatekeeping clinical experience inadvertently favors higher socioeconomic status applicants. Most medical schools require physician shadowing or clinical work, which can be difficult to obtain with no personal connections to the field. Using clinical experience on the application is another way that Latinos are disadvantaged compared to people who have more professional connections or doctors in the family and social circles. The already competitive market for clinical care opportunities is reduced by nepotism, which does not work in favor of Latino applicants. Yet some programs are designed to help low-income students find opportunities, such as Johns Hopkins’ Careers in Science and Medicine Summer Internship Program, which provides clinical experience and health professions mentoring.[30] Without social and professional ties to health care professionals, they are forced to enter a competitive job and volunteer market in clinical care and apply to these tailored programs not offered at all academic institutions. While it is not unique to Latinos, the time commitment of the application process is especially harsh on low-income students because they have financial burdens that can determine their survival. Some students help their families pay for food, rent, and utilities, making devoting time to the application process more problematic. As noted earlier, Latino applicants may also have to set aside time to advocate for their families. Because the applicants tend to be more in tune with the dominant American culture, they are often assigned the family advocate role. They must actively advocate for their family members' well-being. The role of a family advocate, with both its financial and other supportive roles ascribed to low-income Latino applicants, is an added strain that complicates the medical school application. As a member of a historically marginalized community, one must be proactive to ensure that ethical treatment is received. Ordinary tasks such as attending a doctor's appointment or meeting with a bank account manager may require diligent oversight. Applicants must ensure the standard of service is applied uniformly to their family as it is to the rest of the population. This applies to business services and healthcare. It can be discouraging to approach a field that does not have many people from your background. The lack of representation emphasizes the applicant's isolation going through the process. There is not a large group of Latinos in medicine to look to for guidance.[31] The group cohesiveness that many communities experience through a rigorous process is not established among low-income Latino applicants. They may feel like outsiders to the profession. Encountering medical professionals of similar backgrounds gives people the confidence to pursue the medical profession. V. Medical School Admission Data This section will rely on the most recent MD medical school students, the 2020-2021 class. The data includes demographic information such as income and ethnicity. The statistics used in this section were retrieved from scholarly peer-reviewed articles and the Medical School Admission Requirement (MSAR) database. Both sources of data are discussed in more detail throughout the section. The data reveals that only 6.7 percent of medical students for the 2020-2021 school year identify as Latino.[32] The number of Latino students in medical school is not proportional to the Latino community in the United States. While Latinos comprise almost 20 percent of the US population (62.1 million), they comprise only 6.7 percent of the medical student population.[33] Below are three case studies of medical schools in cities with a high Latino population. VI. Medical School Application Process Case Studies a) New York University Grossman School of Medicine is situated in Manhattan, where a diverse population of Latinos reside. The population of the borough of Manhattan is approximately 1,629,153, with 26 percent of the population identifying as Latino.[34] As many medical schools do, Grossman School of Medicine advertises an MD Student Diversity Recruitment program. The program, entitled Prospective MD Student Liaison Program, is aimed such that “students from backgrounds that are underrepresented in medicine are welcomed and supported throughout their academic careers.”[35] The program intervenes with underrepresented students during the interview process of the medical school application. All students invited to interviews can participate in the Prospective MD Student Liaison Program. They just need to ask to be part of it. That entails being matched with a current medical student in either the Black and Latinx Student Association (BALSA) or LGBTQMed who will share their experiences navigating medical school. Apart from the liaison program, NYU participates in the Science Technology Entry Program (STEP), which provides academic guidance to middle and high school students who are underrepresented minorities.[36] With the set programs in place, one would expect to find a significantly larger proportion of Latino medical students in the university. The Medical School Admission Requirement (MSAR) database compiled extensive data about participants in the medical school; the data range from tuition to student body demographics. Of the admitted medical students in 2021, only 16 out of 108 identified as Latino, despite the much larger Latino population of New York.[37] Furthermore, only 4 percent of the admitted students classify themselves as being from a disadvantaged status.[38] The current efforts to increase medical school diversity are not producing adequate results at NYU. Although the Latino representation in this medical school may be higher than that in others, it does not reflect the number of Latinos in Manhattan. The Prospective MD Student Liaison Program intervenes at a late stage of the medical school application process. It would be more beneficial for a program to cover the entire application process. The lack of Latino medical students makes it difficult for prospective students to seek advice from Latino students. Introducing low-income Latino applicants to enrolled Latino medical students would serve as a guiding tool throughout the application process. An early introduction could encourage the applicants to apply and provide a resourceful ally in the application process when, in many circumstances, there would be none. Latino medical students can share their experiences of overcoming cultural and social barriers to enter medical school. b) The Latino population in Philadelphia is over 250,000, constituting about 15 percent of the 1.6 million inhabitants.[39] According to MSAR, the cohort of students starting at Drexel University College of Medicine, located in Philadelphia, in 2021 was only 7.6 percent Latino.[40] 18 percent of matriculated students identify as having disadvantaged status, while 21 percent identify as coming from a medically underserved community.[41] Drexel University College of Medicine claims that “Students who attend racially and ethnically diverse medical schools are better prepared to care for patients in a diverse society.”[42] They promote diversity with various student organizations within the college, including the following: Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), Drexel Black Doctors Network, LGBT Medical Student Group, and Drexel Mentoring and Pipeline Program (DMAPP). The Student Center for Diversity and Inclusion of the College of Medicine offers support groups for underrepresented medical students. The support offered at Drexel occurs at the point of matriculation, not for prospective students. The one program that does seem to be a guide for prospective students is the Drexel Pathway to Medical School program. Drexel Pathway to Medical School is a one-year master’s program with early assurance into the College of Medicine and may serve as a gateway for prospective Latino Students.[43] The graduate program is tailored for students who are considered medically underserved or socioeconomically disadvantaged and have done well in the traditional pre-medical school coursework. It is a competitive program that receives between 500 and 700 applicants for the 65 available seats. The assurance of entry into medical school makes the Drexel Pathway to Medical School a beneficial program in aiding Latino representation in medicine. Drexel sets forth minimum requirements for the program that show the school is willing to consider students without the elite scores and grades required of many schools. MCAT scores must be in the 25th percentile or higher, and the overall or science GPA must be at least 2.9.[44] The appealing factor of this program is its mission to attract medically underserved students. This is a tool to increase diversity in medical school. Prospective low-income Latino students can view this as a graduate program tailored to communities like theirs. However, this one-year program is not tuition-free. It may be tempting to assume that patients prefer doctors with exceptional academic records. There's an argument against admitting individuals with lower test scores into medical schools, rooted in the belief that this approach does not necessarily serve the best interests of health care. The argument asserts that the immense responsibility of practicing medicine should be entrusted to the most qualified candidates. Programs like the Drexel Pathway to Medical School are designed to address the lower academic achievements often seen in underrepresented communities. Their purpose is not to admit underqualified individuals into medical school but to bridge the educational gap, helping these individuals take the necessary steps to become qualified physicians. c) The University of California San Francisco School of Medicine reports that 23 percent of its first-year class identifies as Latino, while 34 percent consider themselves disadvantaged.[45] The Office of Diversity and Outreach is concerned with increasing the number of matriculants from underserved communities. UCSF has instilled moral commitments and conducts pipeline and outreach programs to increase the diversity of its medical school student body. The Differences Matter Initiative that the university has undertaken is a complex years-long restructuring of the medical school aimed at making the medical system equitable, diverse, and inclusive.[46] The five-phase commitment includes restructuring the leadership of the medical school, establishing anti-oppression and anti-racism competencies, and critically analyzing the role race, ethnicity, gender, and sexual orientation play in medicine. UCSF offers a post-baccalaureate program specifically tailored to disadvantaged and underserved students. The program’s curriculum includes MCAT preparation, skills workshops, science courses, and medical school application workshops.[47] The MCAT preparation and medical school application workshops serve as a great tool for prospective Latino applicants. UCSF seems to do better than most medical schools regarding Latino medical students. San Francisco has a population of 873,965, of which 15.2 percent are Latino.[48] The large population of Latino medical students indicates that the school’s efforts to increase diversity are working. The 23 percent Latino matriculating class of 2021 better represents the number of Latinos in the United States, which makes up about a fifth of the population. With this current data, it is important to closely dissect the efforts UCSF has taken to increase diversity in its medical school. Their Differences Matter initiative instills a commitment to diversifying their medical school. As mentioned, the school's leadership has been restructuring to include a diverse administrative body. This allows low-income Latino applicants to relate to the admissions committee reviewing their application. With a hopeful outlook, the high percentage of Latino applicants may reflect comprehension of the application process and the anticipated medical school atmosphere and rigor among Latino applicants and demonstrate that the admissions committee understands the applicants. However, there are still uncertainties about the demographics of the Latino student population in the medical school. Although it is a relatively high percentage, it is necessary to decipher which proportion of those students are low-income Latino Americans. UCSF School of Medicine can serve as a model to uplift the Latino community in a historically unattainable profession. VII. Proposed Reform for Current Medical School Application One reform would be toward the reviewing admissions committee, which has the power to change the class composition. By increasing the diversity of the admissions committee itself, schools can give minority applicants a greater opportunity to connect to someone with a similar background through their application. It would address low-income Latino applicants feeling they cannot “get personal” in their application. These actions are necessary because it is not just to have a representative administration for only a portion of the public. Of the three medical schools examined, the University of California San Francisco has the highest percentage of Latino applicants in their entering class. They express an initiative to increase diversity within their medical school leadership via the Differences Matter initiative. This active role in increasing diversity within the medical school leadership may play a role in UCSF’s high percentage of Latino matriculants. That serves as an important step in creating an equitable application process for Latino applicants. An important consideration is whether the medical school administration at UCSF mirrors the Latino population in the United States. The importance of whether the medical school administration at UCSF mirrors the Latino population in the United States lies in its potential to foster diversity, inclusivity, and cultural competence in medical education, as well as to positively impact the healthcare outcomes and experiences of the Latino community. A diverse administration can serve as role models for students and aspiring professionals from underrepresented backgrounds. It can inspire individuals who might otherwise feel excluded or underrepresented in their career pursuits, including aspiring Latino medical students. Furthermore, a diverse leadership can help develop curricula, policies, and practices that are culturally sensitive and relevant, which is essential for addressing health disparities and providing equitable healthcare. It is also important to have transparency so the public knows the number of low-income Latino individuals in medical school. The Latino statistics from the medical school generally include international students. That speaks to diversity but misses the important aspect of uplifting the low-income Latino population of the United States. Passing off wealthy international students from Latin America to claim a culturally diverse class is misleading as it does not reflect income diversity. Doing so gives the incorrect perception that the medical school is accurately representing the Latino population of the United States. There must be a change in how the application process introduces interviews. It needs to be introduced earlier so the admissions committee can form early, well-rounded inferences about an applicant. The interview allows for personal connections with committee members that otherwise would not be established through the primary application. The current framework has the interviews as one of the last aspects of the application process before admissions decisions are reached. At this point in the application process, many low-income Latinos may have been screened out. I understand this is not an easy feat to accomplish. This will lead to an increase in interviews to be managed by the admissions committee. The burden can be strategically minimized by first conducting video interviews with applicants the admission committee is interested in moving forward and those that they are unsure about because of a weakness in a certain area of the application. The video interview provides a more formal connection between the applicants and admission committee reviewers. It allows the applicant to provide a narrative through spoken words and can come off as a more intimate window into their characteristics. It would also allow for an opportunity to explain hardships and what is unique. From this larger pool of video-interviewed applicants, the admission committee can narrow down to traditional in-person interviews. A form of these video interviews may be already in place in some medical school application process. I believe making this practice widespread throughout medical schools will provide an opportunity to increase the diversity of medical school students. There must be an increase in the number of programs dedicated to serving as a gateway to clinical experience for low-income Latino applicants. These programs provide the necessary networking environment needed to get clinical experience. It is important to consider that networking with clinical professionals is an admissions factor that detrimentally affects the low-income Latino population. One of the organizations that aids underserved communities, not limited to Latinos, in clinical exposure is the Summer Clinical Oncology Research Experience (SCORE) program.[49] The SCORE program, conducted by Memorial Sloan Kettering Cancer Center, provides its participants with mentorship opportunities in medicine and science. In doing so, strong connections are made in clinical environments. Low-income Latinos seek these opportunities as they have limited exposure to such an environment. I argue that it is in the medical school’s best interest to develop programs of this nature to construct a more diverse applicant pool. These programs are in the best interest of medical schools because they are culturing a well-prepared applicant pool. It should not be left to the goodwill of a handful of organizations to cultivate clinically experienced individuals from minority communities. Medical schools have an ethical obligation to produce well-suited physicians from all backgrounds. Justice is not upheld when low-income Latinos are disproportionally represented in medical schools. Programs tailored for low-income Latinos supplement the networking this population lacks, which is fundamental to obtaining clinical experience. These programs help alleviate the burden of an applicant’s low socioeconomic status in attaining clinical exposure. VIII. Additional Considerations Affecting the Medical School Application Process and Latino Community Health A commitment to practicing medicine in low-income Latino communities can be established to improve Latino community health.[50] Programs, such as the National Health Service Corps, encourage clinicians to practice in underserved areas by forgiving academic loans for years of work.[51] Increasing the number of clinicians in underserved communities can lead to a positive correlation with better health. It would be ideal to have programs for low-income Latino medical students that incentivize practicing in areas with a high population of underserved Latinos. This would provide the Latino community with physicians of a similar cultural background to attend to them, creating a deeper physician-patient relationship that has been missing in this community. Outreach for prospective Latino applicants by Latino medical students and physicians could encourage an increased applicant turnout. This effort can guide low-income Latinos who do not see much representation in the medical field. It would serve as a motivating factor and an opportunity to network within the medical field. Since there are few Latino physicians and medical students, a large effort must be made to make their presence known. IX. Further Investigation Required It is important to investigate the causes of medical school rejections of low-income Latinos. Understanding this piece of information would provide insight into the specific difficulties this population has with the medical school application. From there, the requirements can be subjected to bioethical analysis to determine whether those unfulfilled requirements serve as undue restrictions. The aspect of legacy students, children of former alumni, proves to be a difficult subject to find data on and merits further research. Legacy students are often given preferred admission into universities.[52] It is necessary to understand how this affects the medical school admissions process and whether it comes at a cost to students that are not legacy. It does not seem like these preferences are something universities are willing to disclose. The aspect of legacy preferences in admissions decisions could be detrimental to low-income Latino applicants if their parents are not college-educated in the United States, which often is the case. It would be beneficial to note how many Latinos in medical school are low-income. The MSAR report denotes the number of Latino-identified students per medical school class at an institution and the number of students who identify as coming from low resources. They do not specify which of the Latino students come from low-income families. This information would be useful to decipher how many people from the low-income Latino community are matriculating into medical schools. CONCLUSION It is an injustice that low-income Latinos are grossly underrepresented in medical school. It would remain an injustice even if the health of the Latino community in the United States were good. The current operation of medical school admission is based on a guild-like mentality, which perpetuates through barriers to admissions. It remains an exclusive club with processes that favor the wealthy over those who cannot devote money and time to the prerequisites such as test preparation courses and clinical internships. This has come at the expense of the Latino community in the United States in the form of both fewer Latino doctors and fewer current medical students. It is reasonable to hope that addressing the injustice of the underrepresentation of low-income Latinos in the medical field would improve Latino community health. With such a large demographic, the lack of representation in the medical field is astonishing. The Latino population faces cultural barriers when seeking healthcare, and the best way to combat that is with a familiar face. An increase in Latino medical students would lead to more physicians that not only can culturally relate to the Latino community, but that are a part of it. This opens the door for a comprehensive understanding between the patient and physician. As described in my thesis, Latino physicians can bridge cultural gaps that have proven detrimental to that patient population. That may help patients make informed decisions, exercising their full autonomy. The lack of representation of low-income Latinos in medicine is a long-known issue. Here, I have connected how the physician-patient relationship can be positively improved with an increase in low-income Latino physicians through various reforms in the admissions process. My hope is to have analyzed the problem of under-representation in a way that points toward further research and thoughtful reforms that can truly contribute to the process of remedying this issue. - [1] Passel, J. S., Lopez, M. H., & Cohn, D. (2022, February 3). U.S. Hispanic population continued its geographic spread in the 2010s. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ [2] Ramirez, A. G., Lepe, R., & Cigarroa, F. (2021). Uplifting the Latino Population From Obscurity to the Forefront of Health Care, Public Health Intervention, and Societal Presence. JAMA, 326(7), 597–598. https://doi.org/10.1001/jama.2021.11997 [3] Association of American Medical Colleges. (2023). Who is eligible to participate in the fee assistance program? https://students-residents.aamc.org/fee-assistance-program/who-eligble-participate-fee-assistance-mprogram [4] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [5] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm; Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf; Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [6] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm [7] Center for Disease Control and Prevention. (2021, October). Estimated HIV incidence and prevalence in the United States 2015–2019. https://www.cdc.gov/hiv/pdf/group/racialethnic/hispanic-latino/cdc-hiv-group-hispanic-latino-factsheet.pdf [8] Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [9] CDC. (2020). [10] CDC. (2020). [11] Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [12] Office of the Assistant Secretary for Planning and Evaluation. (2021, October). Issue Brief No. HP-2021-2. Health Insurance Coverage and Access to Care Among Latinos: Recent Trends and Key Challenges. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos [13] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [14] Alsan, M., Garrick, O., & Graziani, G. (2019). Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446 [15] Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.24583 [16] Alsan, et. al. (2019). [17] Marrast, L., Zallman, L., Woolhandler, S., Bor, D. H., & McCormick, D. (2014). Minority physicians’ role in the care of underserved patients. JAMA Internal Medicine, 174(2), 289. https://doi.org/10.1001/jamainternmed.2013.12756 (“Nonwhite physicians cared for 53.5% of minority and 70.4% of non-English speaking patients.” Increasing the number of Latino doctors could lead to more nonwhite physicians to care for the underserved populations as they serve those populations at disproportionate rates. This may lead to better care for the patients.) [18] Cersosimo, E., & Musi, N. (2011). Improving Treatment in Hispanic/Latino Patients. The American Journal of Medicine, 124(10), S16–S21. https://doi.org/10.1016/j.amjmed.2011.07.019 [19] Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of Pediatrics, 136(1), 14–23. https://doi.org/10.1016/s0022-3476(00)90043-x [20] Cersosimo & Musi. (2011). [21] Flores. (2000). [22] Torres, D. (2019). Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study. The Permanente Journal. https://doi.org/10.7812/tpp/18-258 [23] The Princeton Review. (n.d.). Score 513+ on the MCAT, Guaranteed! | The Princeton Review. [24] 2021 FACTS: Applicants and Matriculants Data. (2022). AAMC. https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data [25] The Princeton Review. (n.d.). How Many Med Schools Should You Apply To? https://www.princetonreview.com/med-school-advice/how-many-med-schools-should-you-apply-to [26] Association of American Medical Colleges. (n.d.). Fee Assistance Program (FAP). AAMC. https://students-residents.aamc.org/fee-assistance-program/fee-assistance-program-fap [27] Nguyen, M., Desai, M. M., Fancher, T. L., Chaudhry, S. I., Mason, H. R. C., & Boatright, D. (2023). Temporal trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income, 2014-2019. JAMA. https://doi.org/10.1001/jama.2023.5654 [28] Ramirez, et al. (2021). [29] Ko, M. J., Henderson, M. C., Fancher, T. L., London, M., Simon, M., & Hardeman, R. R. (2023). US medical school admissions leaders’ experiences with barriers to and advancements in diversity, equity, and inclusion. JAMA Network Open, 6(2), e2254928. https://doi.org/10.1001/jamanetworkopen.2022.54928 [30] Johns Hopkins University School of Medicine. (n.d.). JHU CSM SIP. Johns Hopkins Initiative for Careers in Science and Medicine - the Summer Internship Program. https://csmsip.cellbio.jhmi.edu/ [31] Figure 18. Percentage of all active physicians by race/ethnicity, 2018 | AAMC. (2018). AAMC. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 [32] Ramirez, et al. (2021). [33] Passel, et al. (2022). [34] Census Reporter. (n.d.). Census profile: Manhattan borough, New York County, NY. https://censusreporter.org/profiles/06000US3606144919-manhattan-borough-new-york-county-ny/ [35] MD Student Diversity Recruitment. (2022). NYU Langone Health. https://med.nyu.edu/our-community/why-nyu-grossman-school-medicine/diversity-inclusion/recruiting-diversity/md-student-diversity-recruitment [36] NYU. (n.d.). STEP Pre-College Program. New York University. https://www.nyu.edu/admissions/undergraduate-admissions/how-to-apply/all-freshmen-applicants/opportunity-programs/pre-college-programs.html [37] Association of American Medical Colleges. (2022). NYU Grossman School of Medicine. Medical School Admission Requirements (MSAR). https://mec.aamc.org/msar-ui/#/medSchoolDetails/152 [38] Association of American Medical Colleges. (2022). [39] U.S. Census Bureau. (2021). U.S. Census Bureau QuickFacts: Philadelphia County, Pennsylvania. Census Bureau QuickFacts. https://www.census.gov/quickfacts/philadelphiacountypennsylvania [40] Association of American Medical Colleges. (2022). Drexel University College of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/833 [41] Association of American Medical Colleges. (2022). [42] Drexel University College of Medicine. (n.d.). Diversity, Equity & Inclusion For Students. https://drexel.edu/medicine/about/diversity/diversity-for-students/ [43] Drexel University College of Medicine. (n.d.-b). Drexel Pathway to Medical School. https://drexel.edu/medicine/academics/graduate-school/drexel-pathway-to-medical-school/ [44] Drexel University College of Medicine. Drexel Pathway to Medical School. [45] Association of American Medical Colleges. (2022). University of California, San Francisco, School of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/108 [46] The Regents of the University of California. (n.d.). Differences Matter. UCSF School of Medicine. https://medschool.ucsf.edu/differences-matter [47] The Regents of the University of California. (n.d.-b). Post Baccalaureate Program | UCSF Medical Education. UCSF Medical Education. https://meded.ucsf.edu/post-baccalaureate-program [48] United States Census Bureau. (2021). U.S. Census Bureau QuickFacts: San Francisco County, California. Census Bureau QuickFacts. https://www.census.gov/quickfacts/sanfranciscocountycalifornia [49] Memorial Sloan Kettering Cancer Center. (n.d.). Student Programs. https://www.mskcc.org/about/leadership/office-faculty-development/student-programs [50] Alsan, et al. (2021). [51] National Health Service Corps. (2021, November 2). Mission, Work, and Impact | NHSC. https://nhsc.hrsa.gov/about-us [52] Elam, C. L., & Wagoner, N. E. (2012). Legacy Admissions in Medical School. AMA Journal of Ethics, 14(12), 946–949. https://doi.org/10.1001/virtualmentor.2012.14.12.ecas3-1212

In my career as a writing teacher, I have frequently encountered writers who struggle with their writing. Common ways of teaching writing may be partly to blame. David Smith et al. found in their research that students do not necessarily learn to write better essays “by following prescriptions for good writing and/or imitating examples of good writing” (337), which is, unfortunately, a common way for teaching writing. Smith et al.’s study showed that in order to become better writers, students need “conceptual understandings of the essay writing process” (327). Having too narrow a concept of what writing is also poses a problem for students. Jonathan Alexander et al. argue that teachers need to adopt new metaphors for writing so that they can “take into account the expanded sense of literate possibilities available to those whom we teach” (120). Analysing common metaphors that describe the writing process, Alexander et al. assert that we need new metaphors for thinking about the writing process because doing so will provide us with a more expansive understanding of the conceptions of and practices of writing in which people engage. While Alexander et al. do not suggest having students create their own metaphors, my sense was that the process of creating new writing metaphors could help students become better writers by inviting them to conceptualise a more expansive and personally meaningful sense of writing processes. In this essay, I explore how metaphors can be useful in writing pedagogy because they can help students be more successful writers through expanding their conceptions of the writing process. An expanded sense of the writing process can thus contribute to students’ wellbeing as writers. What is the connection between metaphors and wellbeing? In offering a definition, George Lakoff and Mark Johnson posit that “the essence of metaphor is understanding and experiencing one kind of thing in terms of another” (5). Lakoff and Johnson highlight that “our ordinary conceptual system, in terms of which we both think and act, is fundamentally metaphorical in nature” (p. 3). Based on this assertion, being aware of our metaphors is important because “our concepts structure what we perceive, how we get around in the world, and how we relate to other people. Our conceptual system thus plays a central role in defining our everyday realities” (Lakoff and Johnson 3). Wellbeing is less easily defined, given that there is little agreement across and even within disciplines about what it is and what it includes. There seem to be two dominant strands of definitions – one that is labelled “hedonistic” and focusses on wellbeing as being about positive feelings, and another that is labelled “eudemonic” and associated with “meeting full potential as a member of society” (Simons and Baldwin 990). Gemma Simons and David Baldwin offer a definition that combines these two main strands: “wellbeing is a state of positive feelings and meeting full potential in the world” (990). Other scholars focus on the process through which wellbeing is created when they define the term. While he focusses less on positive feelings than other scholars do, Amartya Sen adds an important dimension to the definition of wellbeing, arguing that “one’s capability set determines one’s wellbeing by providing one with the ability to live out a meaningful life that one has reason to value” (Jongbloed and Andres 3). Richard Davidson’s extensive neural research adds another dimension to the conversation, arguing that wellbeing is a skill that we can learn and strengthen through expanding our ways of thinking and being in the world. If we consider these three definitions together, we arrive at a useful combined definition of wellbeing, one that emphasises the importance of having positive feelings and meeting one’s full potential through capably developing the skills that meaningfully contribute to one’s sense of potential in society. When we put this definition of wellbeing in conversation with the definition of metaphor, we can see the ways that our metaphors can contribute to wellbeing by helping us clarify and expand our thinking about our practices and their effects in the world. The metaphors we use to conceptualise our experiences, thus, can contribute to our wellbeing. Helen Spandler et al.’s research illustrates this point clearly. They researched a men’s mental health program that used football as a metaphor for talking about emotions. They found that using the football metaphor was an effective way for the participants because it “helped to make the discussion of psychological issues safer, accessible, and comprehensible. This familiarity helped participants re-frame their own lives, understand them differently and learn new coping strategies” (Spandler et al. 552). By providing the men with familiar and valued language through which they could “do emotion” (Spandler et al. 552), the metaphor helped to challenge the stigma attached to mental health services. The football metaphor served as a “cognitive bridge’ (Stott et al.) which enables personal experiences and emotions to be understood and communicated” (Spandler et al. 552). There was nothing magical about the football metaphor itself; rather, it was important that the metaphor have value for the individuals and provide them with a conceptual lens through which to re-see their experiences and practices. It follows, then, that different metaphors of writing could be “cognitive bridges” that provide different language to conceptualise writing practices. These metaphors could influence writing practices in dynamic ways. As Lakoff and Johnson assert, “new metaphors have the power to create a new reality ... . Changes in our conceptual system do change what is real for us and affect how we perceive the world and act upon those perceptions” (145-6). Therefore, new writing metaphors have the potential to strengthen writing wellbeing through expanding our conceptions of writing practices and skills. This sense of possibility led me to create an assignment for my college-level students that asked them to create new writing metaphors for themselves. These writers’ metaphors highlight the power of metaphors to shape perceptions and guide actions. Although all of my students’ metaphors were fascinating, I share three in particular that illustrate how metaphors can be used in education to help students increase positive attitudes toward writing, imagine ways that writing can help them develop their sense of purpose, and explore how their writing connects them to society – which are all important aspects of wellbeing. (Please note that the students’ writing I quote from in this article was collected through study procedures approved by my institution’s Institutional Research Board. I have written permission from these individuals to quote from the essays that they wrote for my class, and I am using a pseudonym for each of them.) Astrid’s Confidence When she entered my class, Astrid lacked confidence in her writing and was frustrated because “writing and confidence are going to be very important in my future professional writing goals. How can I become a successful writer if I am not confident in my writing?” Because of previous experiences she had had with writing in school, she had decided that she was not a very good writer. However, one night she watched episodes of Dancing with the Stars, a reality television show in which celebrities are paired together to win a dance competition, and she realised that her writing mirrored the path of learning illustrated by the dancers in the show. Watching the dancers develop skills inspired Astrid to reconceptualise her writing experiences. Astrid’s creation of her metaphor helped her see that she was a growing writer who would continue to develop. She began to see herself as in process. Comparing her writing to Dancing with the Stars gave her hope that her confidence in herself would grow. She wrote: by the end of the season, the person who wins the mirrorball trophy has no doubt in themselves whatsoever and that star knows they deserved to be exactly where they are. For my writing, I want to experience this feeling. I want to be self-confident in my writing and know that I have achieved everything in my writing for a reason. Even though I have not reached that goal right now that is okay because I am stuck in a ‘very uncomfortable tango’ and my new metaphor is going to help me sway with the dance one ‘week’ at a time. Astrid acknowledged that to be successful in achieving her goals, she had to build a different relationship with writing. The process helped her to re-imagine that relationship through the lens of what Carol Dweck calls a growth mindset which helped her develop more positive feelings about her writing and her potential. Astrid’s wellbeing as a writer increased as she conceptualised her practices differently. Through the construction of a new metaphor, she gained an understanding of her underlying conceptions of writing and how they were impacting on her. Creating a more positive. relatable metaphor helped her in the ways that the football metaphor helped the men in Spandler et al.’s study, giving her a new language to reconceptualise her writing practices. As Sen argues, our sense of wellbeing can increase when we expand our capabilities. By focussing on writing as a set of improvable skills, Astrid was able to begin to build a more positive relationship with writing. Kyle’s Infinite Space Kyle’s metaphor compared writing to a loosely defined idea of “space”, which he defines as “an infinite area that’s filled with infinite possibilities and infinite stars and planets that continue to expand into infinity”. As he wrote in his essay for my class, though, the process of creating a metaphor was not necessarily an easy one: every time that I had thought about a potential metaphor for this project, it never really clicked with me. Nothing that I could think of felt right or felt that had fit in a way. Even now, with the metaphor that I’ve chosen, ‘Space,’ I still feel unsure about that being my true choice. But his fascination with space and its sense of infinite possibilities attracted him to the metaphor. In his reflections on the process of creating a new metaphor, he admitted that “persisting through my own thoughts to get to the metaphor that resonated with me ... really made me think about my writing and how I felt about my future with it”. He related to this metaphor in much the same way that the men in Spandler et al.’s study related to football, and it thus built a cognitive bridge for him between a concept that he valued (space) and a practice that challenged him (writing). Even with his reservations about this metaphor, Kyle found the new metaphor to be helpful in providing him with “a way to think about the infinite possibilities that I possess”. In the past, Kyle had experienced stress when thinking about his writing projects because they became all-encompassing in his mind. His new metaphor helped him to re-conceptualise the purpose of his writing: “space allows me to think about the future of my writing with no stress. With it, I recognize my own place in the universe and the grand scheme of things”. Gaining this new perspective on writing freed Kyle “to make sure that doing writing that I love is the only writing that I’m doing ... . I want to continue to have those infinite possibilities and those infinite ideas to span across my career. Space contextualizes that idea in just one word”. As Helen Sword advocates, “ideally, your chosen metaphor will exemplify your core values, reflect your own lived experience, and lead you toward a pleasurable space of writing” (241). Kyle’s metaphor did exactly this: it improved his wellbeing as a writer by managing the stress of taking himself and everything he does too seriously. His metaphor provided a form of reassurance to myself. It helps contextualize that idea and how I can empower my own writing to become only writing that I want to write. To encourage myself in the future with my career to make choices that can make writing and my life the best and most enjoyable it can be. To ensure myself of my decisions, rather than stressing over little minute things. It allows my writing to become my writing, the way it is now, and the way that it will grow until the heat death of the universe. There is a sense of hope and humility in the vision of writing that his metaphor encourages him to adopt. What seems clear from Kyle’s metaphor is that the process of creating it helped him clarify his sense of his purpose in the world. The Greater Good Science Center at Berkeley University identifies purpose as one their Ten Keys to Wellbeing, which are based on extensive scientific research on wellbeing and happiness. The Center’s Website describes purpose as follows: “to psychologists, purpose is an abiding intention to achieve a long-term goal that is both personally meaningful and makes a positive mark on the world” (Greater Good, “Purpose”). Kyle’s metaphor spoke to his purpose to write material that is valuable to him. He wanted his own personally constructed meanings to be the guiding force in his writing career and the writing he undertakes. Creating a new writing metaphor, although challenging for him, showed him “how stepping into a metaphor to represent a part of your life can change how you view that part from a new angle”. Through his space metaphor, Kyle was able to identify and connect more deeply to his purpose, thus the process of metaphor creation enhanced his wellbeing. Through a more expansive sense of writing that gave him more positive feelings toward his capabilities, Kyle’s metaphor likewise strengthened his wellbeing as a writer. Jasper’s Community Jasper’s metaphor compared the process of writing to the experience of making s’mores around a campfire with friends. Embracing “the entirety of the experience”, Jasper’s metaphor emphasised that while writing may seem like a solitary adventure, it’s actually a very social experience, a view which challenges the dominant narrative of the writer writing alone. Through the creation of the metaphor, Jasper reflected on the ways his community both shapes his writing and supports him as a writer. Social connection played a significant role in Jasper’s “making s’mores” metaphor. He wrote that “the community that surrounds writing in all its forms is crucial to an individual’s writing development and skills ... . The joy and inspiration I am gifted from these people makes writing a pleasurable experience that is meant to be shared, rather than a task that is to be completed”. The community emphasised in his metaphor helped Jasper to conceptualise writing through a positive lens that illustrated writing’s social meaning. In describing his metaphor, Jasper was careful to emphasise that the joy comes not necessarily from eating s’mores (i.e. the final product) but comes through the process of making s’mores (i.e. the writing process). Through his metaphor, he thought about his writing practices more expansively. Jasper acknowledges that those around him inspired and shaped his writing, that his ideas are socially influenced: the ideas I get for things like characters or plot often come from people that I know personally, or they existed historically. In the novel I am currently working on, one of my integral characters (specifically their friendship with the main character) is based on certain aspects of a friendship I developed during my first semester of school ... . These relationships are important to me in real life so why would they not be heavily reflected in my writing? His metaphor foregrounded a sense of connection he felt with those in his life and creating the metaphor allowed him to recognise that his writing was situated in the fabric of his life. Another of the Greater Good Science Center’s Ten Keys to Wellbeing is social connection, which they define as “a valuable resource in life, creating moments of positivity and fun, supporting us through good times and bad, and exposing us to new ideas and new people” (Greater Good, “Social Connection”). Creating this new writing metaphor emphasised for Jasper that his community was not only a source of inspiration but also of support. Jasper’s metaphor emphasises this sense of connection, and makes him more aware of the important role that it plays in his writing wellbeing. This view of writing aids his wellbeing as a writer because it provides him with what he calls a “coping mechanism” that helps him to be more successful in his writing: “when my assignments and personal projects become daunting and frightening, I know that I just need to go sit by the fire, take a deep breath, and make myself a s’more”. Thus, his metaphor helps him reach his writing potential more fully. Conclusion What these three examples reveal is that creating new writing metaphors can enhance writing wellbeing by increasing confidence in writing, clarifying sense of purpose for writing, and highlighting the importance of social connections to writing. By experiencing one thing in terms of another – metaphorical thinking – students were able to create writing metaphors that supported their writing wellbeing through increasing their positive feelings about writing, expanding their sense of possibilities with/in writing, and illustrating the meaning their writing can have to them and their communities. The metaphor assignment thus helped students build important cognitive bridges that helped them be more successful writers and strengthened their writing wellbeing. References Alexander, Jonathan, Karen Lunsford, and Carl Whithaus. “Toward Wayfinding: A Metaphor for Understanding Writing Experiences.” Written Communication 37.1 (2020): 104–131. Davidson, Richard. “The Four Keys to Wellbeing.” Greater Good Magazine 21 Mar. 2016. <https://greatergood.berkeley.edu/article/item/the_four_keys_to_well_being>. Dweck, Carol. Mindset: The New Psychology of Success. New York: Random House, 2007. Greater Good Science Center. “What Is Purpose.” Greater Good Magazine 8 June 2023. <https://greatergood.berkeley.edu/topic/purpose/definition#what-is-purpose>. Greater Good Science Center. “Social Connection Defined.” Greater Good Magazine 8 June 2023 .<https://greatergood.berkeley.edu/topic/social_connection/definition#why-practice-social-connection>. Jongbloed, Janine, and Lesley Andres. “Elucidating the Constructs Happiness and Wellbeing: A Mixed-Methods Approach.” International Journal of Wellbeing 5.3 (2015): 1–20. Lakoff, George, and Mark Johnson. Metaphors We Live By. Chicago: U of Chicago P, 2003. Sen, Amartya. Commodities and Capabilities. Oxford: Oxford UP, 1999. Simons, Gemma, and David Baldwin. “A Critical Review of the Definition of ‘Wellbeing’ for Doctors and Their Patients in a Post Covid-19 Era.” International Journal of Social Psychiatry 67.8 (2021): 984–991. Smith, David, et al. “The Impact of Students’ Approaches to Essay Writing on the Quality of Their Essays.” Assessment & Evaluation in Higher Education 24.3 (1999): 327–338. Spandler, Helen, et al. “Football Metaphor and Mental Well-Being: An Evaluation of It’s a Goal! Programme.” Journal of Mental Health 22.6 (2013): 544–554. Stott, Richard, et al. Oxford Guide to Metaphor in CBT: Building Cognitive Bridges. Oxford: Oxford UP, 2010. Sword, Helen. Writing with Pleasure. New Jersey: Princeton University Press, 2023.

Are male porn stars full-fledged citizens? Recent political developments make this question more than rhetorical. The Bush Justice Department, led by Attorney General John Ashcroft, has targeted the porn industry, beginning with its prosecution of Extreme Associates. More recently, the President requested an increase in the FBI’s 2005 budget for prosecuting obscenity, one of the few budget increases for the Bureau outside of its anti-terrorism program (Schmitt A1). To be sure, the concept of “citizen” is itself vexed. Citizenship, when obtained or granted, ostensibly legitimates a subject and opens up pathways to privilege: social, political, economic, etc. Yet all citizens do not seem to be created equal. “There is, in the operation of state-defined rules and in common practices an assumption of moral worth in which de facto as opposed to de jure rights of citizenship are defined as open to those who are deserving or who are capable of acting responsibly,” asserts feminist critic Linda McDowell. “The less deserving and the less responsible are defined as unworthy of or unfitted for the privileges of full citizenship” (150). Under this rubric, a citizen must measure up to a standard of “moral worth”—an individual is not a full-fledged citizen merely on the basis of birth or geographical placement. As McDowell concludes, “citizenship is not an inclusive but an exclusive concept” (150). Thus, in figuring out how male porn stars stand in regard to the question of citizenship, we must ask who determines “moral worth,” who distinguishes the less from the more deserving, and how people have come to agree on the “common practices” of citizenship. Many critics writing about citizenship, including McDowell, Michael Warner, Lauren Berlant, Russ Castronovo, Robyn Wiegman, Michael Moon, and Cathy Davidson (to name only a few) have located the nexus of “moral worth” in the body. In particular, the ability to make the body abstract, invisible, and non-identifiable has been the most desirable quality for a citizen to possess. White men seem ideally situated for such acts of “decorporealization,” and the white male body has been installed as the norm for citizenship. Conversely, women, people of color, and the ill and disabled, groups that are frequently defined by their very embodiment, find themselves more often subject to regulation. If the white male body is the standard, however, for “moral worth,” the white male porn star would seem to disrupt such calculations. Clearly, the profession demands that these men put their bodies very much in evidence, and the most famous porn stars, like John C. Holmes and Ron Jeremy, derive much of their popularity from their bodily excess. Jeremy’s struggle for “legitimacy,” and the tenuous position of men in the porn industry in general, demonstrate that even white males, when they cannot or will not aspire to abstraction and invisibility, will lose the privileges of citizenship. The right’s attack on pornography can thus be seen as yet another attempt to regulate and restrict citizenship, an effort that forces Jeremy and the industry that made him famous struggle for strategies of invisibility that will permit some mainstream acceptance. In American Anatomies, Robyn Wiegman points out that the idea of democratic citizenship rested on a distinct sense of the abstract and non-particular. The more “particular” an individual was, however, the less likely s/he could pass into the realm of citizen. “For those trapped by the discipline of the particular (women, slaves, the poor),” Wiegman writes, “the unmarked and universalized particularity of the white masculine prohibited their entrance into the abstraction of personhood that democratic equality supposedly entailed” (49). The norm of the “white masculine” caused others to signify “an incontrovertible difference” (49), so people who were visibly different (or perceived as visibly different) could be tyrannized over and regulated to ensure the purity of the norm. Like Wiegman, Lauren Berlant has written extensively about the ways in which the nation recognizes only one “official” body: “The white, male body is the relay to legitimation, but even more than that, the power to suppress that body, to cover its tracks and its traces, is the sign of real authority, according to constitutional fashion” (113). Berlant notes that “problem citizens”—most notably women of color—struggle with the problem of “surplus embodiment.” They cannot easily suppress their bodies, so they are subjected to the regulatory power of a law that defines them and consequently opens their bodies up to violation. To escape their “surplus embodiment,” those who can seek abstraction and invisibility because “sometimes a person doesn’t want to seek the dignity of an always-already-violated body, and wants to cast hers off, either for nothingness, or in a trade for some other, better model” (114). The question of “surplus embodiment” certainly has resonance for male porn stars. Peter Lehman has argued that hardcore pornography relies on images of large penises as signifiers of strength and virility. “The genre cannot tolerate a small, unerect penis,” Lehman asserts, “because the sight of the organ must convey the symbolic weight of the phallus” (175). The “power” of male porn stars derives from their visibility, from “meat shots” and “money shots.” Far from being abstract, decorporealized “persons,” male porn stars are fully embodied. In fact, the more “surplus embodiment” they possess, the more famous they become. Yet the very display that makes white male porn stars famous also seemingly disqualifies them from the “legitimacy” afforded the white male body. In the industry itself, male stars are losing authority to the “box-cover girls” who sell the product. One’s “surplus embodiment” might be a necessity for working in the industry, but, as Susan Faludi notes, “by choosing an erection as the proof of male utility, the male performer has hung his usefulness, as porn actor Jonathan Morgan observed, on ‘the one muscle on our body we can’t flex’” (547). When that muscle doesn’t work, a male porn star doesn’t become an abstraction—he becomes “other,” a joke, swept aside and deemed useless. Documentary filmmaker Scott J. Gill recognizes the tenuousness of the “citizenship” of male porn stars in his treatment of Ron Jeremy, “America’s most famous porn star.” The film, Porn Star: The Legend of Ron Jeremy (2001), opens with a clear acknowledgment of Jeremy’s body, as one voiceover explains how his nickname, “the Hedgehog,” derives from the fact that Jeremy is “small, fat, and very hairy.” Then, Gill intercuts the comments of various Jeremy fans: “An idol to an entire generation,” one young man opines; “One of the greatest men this country has ever seen,” suggests another. This opening scene concludes with an image of Jeremy, smirking and dressed in a warm-up suit with a large dollar sign necklace, standing in front of an American flag (an image repeated at the end of the film). This opening few minutes posit the Hedgehog as super-citizen, embraced as few Americans are. “Everyone wants to be Ron Jeremy,” another young fan proclaims. “They want his life.” Gill also juxtaposes “constitutional” forms of legitimacy that seemingly celebrate Jeremy’s bodily excess with the resultant discrimination that body actually engenders. In one clip, Jeremy exposes himself to comedian Rodney Dangerfield, who then sardonically comments, “All men are created equal—what bullshit!” Later, Gill employs a clip of a film in which Jeremy is dressed like Ben Franklin while in a voiceover porn director/historian Bill Margold notes that the Freeman decision “gave a birth certificate to a bastard industry—it legitimized us.” The juxtaposition thus posits Jeremy as a “founding father” of sorts, the most recognizable participant in an industry now going mainstream. Gill, however, emphasizes the double-edged nature of Jeremy’s fame and the price of his display. Immediately after the plaudits of the opening sequence, Gill includes clips from various Jeremy talk show appearances in which he is denounced as “scum” and told “You should go to jail just for all the things that you’ve helped make worse in this country” and “You should be shot.” Gill also shows a clearly dazed Jeremy in close-up confessing, “I hate myself. I want to find a knife and slit my wrists.” Though Jeremy does not seem serious, this comment comes into better focus as the film unfolds. Jeremy’s efforts to go “legit,” to break into mainstream film and leave his porn life behind, keep going off the tracks. In the meantime, Jeremy must fulfill his obligations to his current profession, including getting a monthly HIV test. “There’ll be one good thing about eventually getting out of the porn business,” he confesses as Gill shows scenes of a clearly nervous Jeremy awaiting results in a clinic waiting room, “to be able to stop taking these things every fucking month.” Gill shows that the life so many others would love to have requires an abuse of the body that fans never see. Jeremy is seeking to cast off that life, “either for nothingness, or in a trade for some other, better model.” Behind this “legend” is unseen pain and longing. Gill emphasizes the dichotomy between Jeremy (illegitimate) and “citizens” in his own designations. Adam Rifkin, director of Detroit Rock City, in which Jeremy has a small part, and Troy Duffy, another Jeremy pal, are referred to as “mainstream film directors.” When Jeremy returns to his home in Queens to visit his father, Arnold Hyatt is designated “physicist.” In fact, Jeremy’s father forbids his son from using the family name in his porn career. “I don’t want any confusion between myself and his line of work,” Hyatt confesses, “because I’m retired.” Denied his patronym, Jeremy is truly “illegitimate.” Despite his father’s understanding and support, Jeremy is on his own in the business he has chosen. Jeremy’s reputation also gets in the way of his mainstream dreams. “Sometimes all this fame can hurt you,” Jeremy himself notes. Rifkin admits that “People recognize Ron as a porn actor and immediately will ask me to remove him from the final cut.” Duffy concurs that Jeremy’s porn career has made him a pariah for some mainstream producers: “Stigma attached to him, and that’s all anybody’s ever gonna see.” Jeremy’s visibility, the “stigma” that people have “seen,” namely, his large penis and fat, hairy body, denies him the abstract personhood he needs to go “legitimate.” Thus, whether through the concerted efforts of the Justice Department or the informal, personal angst of a producer fearing a backlash against a film, Jeremy, as a representative of an immoral industry, finds himself subject to regulation. Indeed, as his “legitimate” filmography indicates, Jeremy has been cut out of more than half the films he has appeared in. The issue of “visibility” as the basis for regulation of hardcore pornography has its clearest articulation in Potter Stewart’s famous proclamation “I know it when I see it.” But as Bob Woodward and Scott Armstrong report in The Brethren, Stewart was not the only Justice who used visibility as a standard. Byron White’s personal definition was “no erect penises, no intercourse, no oral or anal sodomy” (193). William Brennan, too, had what his clerks called “the limp dick standard” (194). Erection, what Lehman has identified as the conveyance of the phallus, now became the point of departure for regulation, transferring, once again, the phallus to the “law.” When such governmental regulation failed First Amendment ratification, other forms of societal regulation kicked in. The porn industry has accommodated itself to this regulation, as Faludi observes, in its emphasis on “soft” versions of product for distribution to “legitimate” outlets like cable and hotels. “The version recut for TV would have to be entirely ‘soft,’” Faludi notes, “which meant, among other things, no erect penises and no semen” (547). The work of competent “woodsmen” like Jeremy now had to be made invisible to pass muster. Thus, even the penis could be conveyed to the viewer, a “fantasy penis,” as Katherine Frank has called it, that can be made to correlate to that viewer’s “fantasized identity” of himself (133-4). At the beginning of Porn Star, during the various homages paid to Jeremy, one fan draws a curious comparison: “There’s Elvis, and then there’s Ron.” Elvis’s early career had certainly been plagued by criticism related to his bodily excess. Musicologist Robert Fink has recently compared Presley’s July 2, 1956, recording of “Hound Dog” to music for strip tease, suggesting that Elvis used such subtle variations to challenge the law that was constantly impinging on his performances: “The Gray Lady was sensitive to the presence of quite traditional musical erotics—formal devices that cued the performer and audience to experience their bodies sexually—but not quite hep enough to accept a male performer recycling these musical signifiers of sex back to a female audience” (99). Eventually, though, Elvis stopped rebelling and sought respectability. Writing to President Nixon on December 21, 1970, Presley offered his services to help combat what he perceived to be a growing cultural insurgency. “The drug culture, the hippie elements, the SDS, Black Panthers, etc., do not consider me as their enemy or as they call it, The Establishment,” Presley confided. “I call it America and I love it” (Carroll 266). In short, Elvis wanted to use his icon status to help reinstate law and order, in the process demonstrating his own patriotism, his value and worth as a citizen. At the end of Porn Star, Jeremy, too, craves legitimacy. Whereas Elvis appealed to Nixon, Jeremy concludes by appealing to Steven Spielberg. Elvis received a badge from Nixon designating him as “special assistant” for the Bureau of Narcotics and Dangerous Drugs. Presumably Jeremy invests his legitimacy in a SAG card. Kenny Dollar, a Jeremy friend, unironically summarizes the final step the Hedgehog must take: “It’s time for Ron to go on and reach his full potential. Let him retire his dick.” That Jeremy must do the latter before having a chance for the former illustrates how “surplus embodiment” and “citizenship” remain inextricably entangled and mutually exclusive. References Berlant, Lauren. “National Brands/National Body: Imitation of Life.” Comparative American Identities: Race, Sex and Nationality in the Modern Text. Ed. Hortense Spillers. New York: Routledge, 1991: 110-140. Carroll, Andrew, ed. Letters of a Nation: A Collection of Extraordinary American Letters. New York: Broadway Books, 1999. Castronovo, Russ and Nelson, Dana D., eds. Materializing Democracy: Toward a Revitalized Cultural Politics. Durham: Duke University Press, 2002. Faludi, Susan. Stiffed: The Betrayal of the American Man. New York: William Morrow and Company, Inc., 1999. Fink, Robert. “Elvis Everywhere: Musicology and Popular Music Studies at the Twilight of the Canon.” Rock Over the Edge: Transformations in Popular Music Culture. Eds. Roger Beebe, Denise Fulbrook, and Ben Saunders. Durham: Duke University Press, 2002: 60-109. Frank, Katherine. G-Strings and Sympathy: Strip Club Regulars and Male Desire. Durham: Duke University Press, 2002. Gill, Scott J., dir. Porn Star: The Legend of Ron Jeremy. New Video Group, 2001. Lehman, Peter. Running Scared: Masculinity and the Representation of the Male Body. Philadelphia: Temple University Press, 1993. McDowell, Linda. Gender, Identity and Place: Understanding Feminist Geographies. Minneapolis: University of Minnesota Press, 1999. Moon, Michael and Davidson, Cathy N., eds. Subjects and Citizens: From Oroonoko to Anita Hill. Durham: Duke University Press, 1995. Schmitt, Richard B. “U. S. Plans to Escalate Porn Fight.” The Los Angeles Times 14 February 2004. A1. Wiegman, Robyn. American Anatomies: Theorizing Race and Gender. Durham: Duke University Press, 1995. Woodward, Bob and Armstrong, Scott. The Brethren: Inside the Supreme Court. New York: Simon and Schuster, 1979. MLA Style Russell, David. "The Tumescent Citizen: The Legend of Ron Jeremy." M/C Journal 7.4 (2004). 10 October 2004 <http://www.media-culture.org.au/0410/01_citizen.php>. APA Style Russell, D. (2004 Oct 11). The Tumescent Citizen: The Legend of Ron Jeremy, M/C Journal, 7(4). Retrieved Oct 10 2004 from <http://www.media-culture.org.au/0410/01_citizen.php>

Introduction -- Making Sense of the (Virtual) World Computer games are never "just games". Computer games are models of reality and if they were not, we would never be able to understand them. Models serve three functions; they capture important, critical features of that which is to be represented while ignoring the irrelevant, they are appropriate for the person and they are appropriate for the task -- thereby enhancing the ability to make judgements and discover relevant regularities and structures (Norman 1993). Despite the inherently unvisualisable nature of computer code -- the flexible material of which all software constructs are built -- computer code is still the most "salient" ingredient in computer games. Less salient are those assumptions that are "built into" the software. By filtering out those parts of reality that are deemed irrelevant or unnecessary, different sorts of assumptions, different sorts of bias are automatically built into the software, reified in the very computer code (Friedman 1995, Friedman and Nissenbaum 1997). Here I will analyse some of the built-in structures that constitute the fabric of a special sort of game, a MUD. A MUD is an Internet-accessible "multi-participant, user-extensible virtual reality whose user interface is entirely textual" (Curtis, 1992). The specific MUD in question is a nine-year old Swedish-language adventure MUD called SvenskMUD ("SwedishMUD") that is run by Lysator, the academic computer club at Linköping University, Sweden. I have done field studies of SvenskMUD over a period of three and a half years (Pargman, forthcoming 2000). How is the SvenskMUD adventure world structured and what are the rules that are built into the fabric of this computer game? I will describe some of the ways in which danger and death, good and evil, courage, rewards and wealth are handled in the game. I will conclude the paper with a short analysis of the purpose of configuring the player according to those structures. Revocable Deaths Characters (personae/avatars) in SvenskMUD can be divided into two categories, players and magicians. Making a career as a player to a large part involves solving quests and killing "monsters" in the game. The magicians are all ex-players who have "graduated" and gone beyond playing the game of SvenskMUD. They have become the administrators, managers and programmers of SvenskMUD. A watchful eye is kept on the magicians by "God", the creator, owner and ultimate custodian of SvenskMUD. My own first battle in the game, in a sunlit graveyard with a small mouse, is an example of a bit-sized danger suitable for newcomers, or "newbies". I correctly guessed that the mouse was a suitably weak opponent for my newborn character, but still had to "tickle" the mouse on its belly (a euphemism for hitting it without much force) 50 times before I managed to kill it. Other parts of this epic battle included 45 failed attempts of mine to "tickle" the mouse, 39 successful "tickles" of the mouse and finally a wild chase around the graveyard before I caught up with the mouse, cornered it and managed to kill it and end the fight. Although I was successful in my endeavour, I was also more than half dead after my run-in with the mouse and had to spend quite some time engaged in more peaceful occupations before I was completely healed. It was only later that I learned that you can improve your odds considerably by using weapons and armour when you fight... Should a SvenskMUD player fail in his (or less often, her) risky and adventurous career and die, that does not constitute an insurmountable problem. Should such a thing pass, the player's ghost only has to find the way back to a church in one of the villages. In the church, the player is reincarnated, albeit with some loss of game-related abilities and experience. The way the unfortunate event of an occasional death is handled is part of the meta-rules of SvenskMUD. The meta-rules are the implicit, underlying rules that represent the values, practices and concerns that shape the frame from which the "ordinary" specific rules operate. Meta-rules are part of the "world view that directs the game action and represents the implicit philosophy or ideals by which the world operates" (Fine 1983, 76). Despite the adventure setting with all its hints of medieval lawlessness and unknown dangers lurking, SvenskMUD is in fact a very caring and forgiving environment. The ultimate proof of SvenskMUD's forgiveness is the revocable character of death itself. Fair Dangers Another SvenskMUD meta-rule is that dangers (and death) should be "fair". This fairness is extended so as to warn players explicitly of dangers. Before a dangerous monster is encountered, the player receives plenty of warnings: You are standing in the dark woods. You feel a little afraid. East of you is a small dark lake in the woods. There are three visible ways from here: east, north and south. It would be foolish to direct my character to go east in this situation without being adequately prepared for encountering and taking on something dangerous in battle. Those preparations should include a readiness to flee if the expected danger proves to be superior. If, in the example above, a player willingly and knowingly directs a character to walk east, that player has to face the consequences of this action. But if another player is very cautious and has no reason to suspect a deadly danger lurking behind the corner, it is not considered "fair" if that player's character dies or is hurt in such a way that it results in damage that has far-reaching consequences within the game. The dangerous monsters that roam the SvenskMUD world are restricted to roam only "dangerous" areas and it is considered good manners to warn players in some way when they enter such an area. Part of learning how to play SvenskMUD successfully becomes a matter of understanding different cues, such as the transition from a safe area to a dangerous one, or the different levels of danger signalled by different situations. Should they not know it in advance, players quickly learn that it is not advisable to enter the "Valley of Ultimate Evil" unless they have reached a very high level in the game and are prepared to take on any dangers that come their way. As with all other meta-rules, both players and magicians internalise this rule to such an extent that it becomes unquestionable and any transgression (such as a dangerous monster roaming around in a village, killing newbie characters who happen to stray its way) would immediately render complaints from players and corresponding actions on behalf of the magicians to rectify the situation. Meta-Rules as "Folk Ideas" Fine (1983, 76-8) enumerates four meta-rules that Dundes (1971) has described and applies them to the fantasy role-playing games he has studied. Dundes's term for these meta-rules is "folk ideas" and they reflect existing North American (and Western European) cultural beliefs. Fine shows that these folk ideas capture core beliefs or central values of the fantasy role-playing games he studied. Three of Dundes's four folk ideas are also directly applicable to SvenskMUD. Unlimited Wealth The first folk idea is the principle of unlimited good. There is no end to growth or wealth. For that reason, treasure found in a dungeon doesn't need a rationale for being there. This folk idea is related to the modernist concept of constant, unlimited progress. "Some referees even 'restock' their dungeons when players have found a particular treasure so that the next time someone enters that room (and kills the dragon or other beasties guarding it) they, too, will be rewarded" (Fine 1983, 76). To restock all treasures and reawaken all killed monsters at regular intervals is standard procedure in SvenskMUD and all other adventure MUDs. The technical term is that the game "resets". The reason why a MUD resets at regular intervals is that, while the MUD itself is finite, there is no end to the number of players who want their share of treasures and other goodies. The handbook for SvenskMUD magicians contains "design guidelines" for creating quests: You have to invent a small story about your quest. The typical scenario is that someone needs help with something. It is good if you can get the story together in such a way that it is possible to explain why it can be solved several times, since the quest will be solved, once for each prospective magician. Perhaps a small spectacle a short while after (while the player is pondering the reward) that in some way restore things in such a way that it can be solved again. (Tolke 1993, my translation) Good and Evil The second folk idea is that the world is a battleground between good and evil. In fantasy literature or a role-playing game there is often no in-between and very seldom any doubt whether someone encountered is good or evil, as "referees often express the alignment [moral character] of nonplayer characters through stereotyped facial features or symbolic colours" (Fine 1983, 77). "Good and evil" certainly exists as a structuring resource for the SvenskMUD world, but interestingly the players are not able to be described discretely in these terms. As distinct from role-playing games, a SvenskMUD player is not created with different alignments (good, evil or neutral). All players are instead neutral and they acquire an alignment as they go along, playing SvenskMUD -- the game. If a player kills a lot of mice and cute rabbits, that player will turn first wicked and then evil. If a player instead kills trolls and orcs, that player first turns good and then saint-like. Despite the potential fluidity of alignment in SvenskMUD, some players cultivate an aura of being good or evil and position themselves in opposition to each other. This is most apparent with two of the guilds (associations) in SvenskMUD, the Necromancer's guild and the Light order's guild. Courage Begets Rewards The third folk idea is the importance of courage. Dangers and death operate in a "fair" way, as should treasures and rewards. The SvenskMUD world is structured both so as not to harm or kill players "needlessly", and in such a way that it conveys the message "no guts, no glory" to the players. In different places in the MUD (usually close to a church, where new players start), there are "easy" areas with bit-sized dangers and rewards for beginners. My battle with the mouse was an example of such a danger/reward. A small coin or an empty bottle that can be returned for a small finder's fee are examples of other bit-sized rewards: The third folk idea is the importance of courage. Dangers and death operate in a "fair" way, as should treasures and rewards. The SvenskMUD world is structured both so as not to harm or kill players "needlessly", and in such a way that it conveys the message "no guts, no glory" to the players. In different places in the MUD (usually close to a church, where new players start), there are "easy" areas with bit-sized dangers and rewards for beginners. My battle with the mouse was an example of such a danger/reward. A small coin or an empty bottle that can be returned for a small finder's fee are examples of other bit-sized rewards: More experienced characters gain experience points (xps) and rise in levels only by seeking out and overcoming danger and "there is a positive correlation between the danger in a setting and its payoff in treasure" (Fine 1983, 78). Just as it would be "unfair" to die without adequate warning, so would it be (perceived to be) grossly unfair to seek out and overcome dangerous monsters or situations without being adequately rewarded. And conversely, it would be perceived to be unfair if someone "stumbled over the treasure" without having deserved it, i.e. if someone was rewarded without having performed an appropriately difficult task. Taken from the information on etiquette in an adventure MUD, Reid's quote is a good example of this: It's really bad form to steal someone else's kill. Someone has been working on the Cosmicly Invulnerable Utterly Unstoppable Massively Powerful Space Demon for ages, leaves to get healed, and in the interim, some dweeb comes along and whacks the Demon and gets all it's [sic] stuff and tons of xps [experience points]. This really sucks as the other person has spent lots of time and money in expectation of the benefits from killing the monster. The graceful thing to do is to give em [sic] all the stuff from the corpse and compensation for the money spent on healing. This is still a profit to you as you got all the xps and spent practically no time killing it. (Reid 1999, 122, my emphasis) The User Illusion An important objective of the magicians in SvenskMUD is to describe everything that a player experiences in the SvenskMUD world in game-related terms. The game is regarded as a stage where the players are supposed to see only what is in front of, but not behind the scenes. A consistent use of game-related terms and game-related explanations support the suspension of disbelief and engrossment in the SvenskMUD fantasy world. The main activity of the MUD users should be to enter into the game and guide their characters through a fascinating (and, as much as possible and on its own terms, believable) fantasy world. The guiding principle is therefore that the player should never be reminded of the fact that the SvenskMUD world is not for real, that SvenskMUD is only a game or a computer program. From this perspective, the worst thing players can encounter in SvenskMUD is a breakdown of the user illusion, a situation that instantly transports a person from the SvenskMUD world and leaves that person sitting in front of a computer screen. Error messages, e.g. the feared "you have encountered a bug [in the program]", are an example of this. If a magician decides to change the SvenskMUD world, that magician is supposed to do the very best to explain the change by using game-related jargon. This is reminiscent of the advice to "work within the system": "wherever possible, things that can be done within the framework of the experiential level should be. The result will be smoother operation and greater harmony among the user community" (Morningstar and Farmer 1991, 294). If for some reason a shop has to be moved from one village to another, a satisfactory explanation must be given, e.g. a fire occurring in the old shop or the old shop being closed due to competition (perhaps from the "new", relocated shop). Explanations that involve supernatural forces or magic are also fine in a fantasy world. Explanations that remind the player of the fact that the SvenskMUD world is not for real ("I moved the shop to Eriksros, because all magicians decided that it would be so much better to have it there"), or even worse, that SvenskMUD is a computer program ("I moved the program shop.c to another catalogue in the file structure") are to be avoided at all costs. Part of socialising magicians becomes teaching them to express themselves in this way even when they know better about the machinations of SvenskMud. There are several examples of ingenious and imaginative ways to render difficult-to-explain phenomena understandable in game-related terms: There was a simple problem that appeared at times that made the computer [that SvenskMUD runs on] run a little slower, and as time went by the problem got worse. I could fix the problem easily when I saw it and I did that at times. After I had fixed the problem the game went noticeably faster for the players that were logged in. For those occasions, I made up a message and displayed it to everyone who was in the system: "Linus reaches into the nether regions and cranks a little faster". (Interview with Linus Tolke, "God" in SvenskMUD) When a monster is killed in the game, it rots away (disappears) after a while. However, originally, weapons and armour that the monster wielded did not disappear; a lucky player could find valuable objects and take them without having "deserved" them. This specific characteristic of the game was deemed to be a problem, not least because it furthered a virtual inflation in the game that tended to decrease the value of "honestly" collected weapons and loot. The problem was discussed at a meeting of the SvenskMUD magicians that I attended. It was decided that when a monster is killed and the character that killed it does not take the loot, the loot should disappear ("rot") together with the monster. But how should this be explained to the players in a suitable way if they approach a magician to complain about the change, a change that in their opinion was for the worse? At the meeting it was suggested that from now on, all weapons and shields were forged with a cheaper, weaker metal. Not only would objects of this metal "rot" away together with the monster that wielded them, but it was also suggested that all weapons in the whole game should in fact be worn down as time goes by. (Not to worry, new ones appear in all the pre-designated places every time the game resets.) Conclusion -- Configuring the Player SvenskMUD can easily be perceived as a "blooming buzzing confusion" for a new player and my own first explorations in SvenskMUD often left me confused even as I was led from one enlightenment to the next. Not everyone feels inclined to take up the challenge to make sense of a world where you have to learn everything anew, including how to walk and how to talk. On the other hand, in the game world, much is settled for the best, and a crack in a subterranean cave is always exactly big enough to squeeze through... The process of becoming part of the community of SvenskMUD players is inexorably connected to learning to become an expert in the activities of that community, i.e. of playing SvenskMUD (Wenger 1998). A player who wants to program in SvenskMUD (thereby altering the fabric of the virtual world) will acquire many of the relevant concepts before actually becoming a magician, just by playing and exploring the game of SvenskMUD. Even if the user illusion succeeds in always hiding the computer code from the player, the whole SvenskMUD world constitutes a reflection of that underlying computer code. An implicit understanding of the computer code is developed through extended use of SvenskMUD. The relationship between the SvenskMUD world and the underlying computer code is in this sense analogous to the relationship between the lived-in world and the rules of physics that govern the world. All around us children "prepare themselves" to learn the subject of physics in school by throwing balls up in the air (gravity) and by pulling carts or sledges (friction). By playing SvenskMUD, a player will become accustomed to many of the concepts that govern the SvenskMUD world and will come to understand the goals, symbols, procedures and values of SvenskMUD. This process bears many similarities to the "primary socialisation" of a child into a member of society, a socialisation that serves "to make appear as necessity what is in fact a bundle of contingencies" (Berger and Luckmann 1966, 155). This is the purpose of configuring the player and it is intimately connected to the re-growth of SvenskMUD magicians and the survival of SvenskMUD itself over time. However, it is not the only possible outcome of the SvenskMUD socialisation process. The traditional function of trials and quests in fantasy literature is to teach the hero, usually through a number of external or internal encounters with evil or doubt, to make the right, moral choices. By excelling at these tests, the protagonist shows his or her worthiness and by extension also stresses and perhaps imputes these values in the reader (Dalquist et al. 1991). Adventure MUDs could thus socialise adolescents and reinforce common moral values in society; "the fantasy hero is the perfectly socialised and exemplary subject of a society" (53, my translation). My point here is not that SvenskMUD differs from other adventure MUDs. I would imagine that most of my observations are general to adventure MUDs and that many are applicable also to other computer games. My purpose here has rather been to present a perspective on how an adventure MUD is structured, to trace the meaning of that structure beyond the game itself and to suggest a purpose behind that organisation. I encourage others to question built-in bias and underlying assumptions of computer games (and other systems) in future studies. References Berger, P., and T. Luckmann. The Social Construction of Reality: A Treatise in the Sociology of Knowledge. London: Penguin, 1966. Curtis, P. "MUDding: Social Phenomena in Text-Based Virtual Realities." High Noon on the Electronic Frontier. Ed. P. Ludlow. Cambridge, MA: MIT P, 1996. 13 Oct. 2000 <http://www.ibiblio.org/pub/academic/computer-science/virtual-reality/communications/papers/muds/muds/Mudding-Social-Phenomena.txt>. Dalquist, U., T. Lööv, and F. Miegel. "Trollkarlens lärlingar: Fantasykulturen och manlig identitetsutveckling [The Wizard's Apprentices: Fantasy Culture and Male Identity Development]." Att förstå ungdom [Understanding Youth]. Ed. A. Löfgren and M. Norell. Stockholm/Stehag: Brutus Östlings Bokförlag Symposion, 1991. Dundes, A. "Folk Ideas as Units of World View." Toward New Perspectives in Folklore. Ed. A. Paredes and R. Bauman. Austin: U of Texas P, 1971. Fine, G.A. Shared Fantasy: Role-Playing Games as Social Worlds. Chicago: U of Chicago P, 1983. Friedman, B. and H. Nissenbaum. "Bias in Computer Systems." Human Values and the Design of Computer Technology. Ed. B. Friedman. Cambridge, UK: Cambridge UP, 1997. Friedman, T. "Making Sense of Software: Computer Games and Interactive Textuality." Cybersociety: Computer-Mediated Communication and Community. Ed. S. Jones. Thousand Oaks, CA: Sage, 1995. Morningstar, C. and F. R. Farmer. "The Lessons of Lucasfilm's Habitat." Cyberspace: The First Steps. Ed. M. Benedikt. Cambridge: MA, MIT P, 1991. 13 Oct. 2000 <http://www.communities.com/company/papers/lessons.php>. Norman, D. Things That Make Us Smart: Defending Human Attributes in the Age of the Machine. Reading, MA: Addison-Wesley, 1993. Pargman, D. "Code Begets Community: On Social and Technical Aspects of Managing a Virtual Community." Ph.D. dissertation. Dept. of Communication Studies, Linköping University, Sweden, forthcoming, December 2000. Reid, E. "Hierarchy and Power: Social Control in Cyberspace." Communities in Cyberspace. Ed. M. Smith and P. Kollock. London, England: Routledge, 1999. Tolke, L. Handbok för SvenskMudmagiker: ett hjälpmedel för byggarna i SvenskMUD [Handbook for SvenskMudmagicians: An Aid for the Builders in SvenskMUD]. Printed and distributed by the author in a limited edition, 1993. Wenger, E. Communities of Practice: Learning, Meaning and Identity. Cambridge, UK: Cambridge UP, 1998. Citation reference for this article MLA style: Daniel Pargman. "The Fabric of Virtual Reality -- Courage, Rewards and Death in an Adventure MUD." M/C: A Journal of Media and Culture 3.5 (2000). [your date of access] <http://www.api-network.com/mc/0010/mud.php>. Chicago style: Daniel Pargman, "The Fabric of Virtual Reality -- Courage, Rewards and Death in an Adventure MUD," M/C: A Journal of Media and Culture 3, no. 5 (2000), <http://www.api-network.com/mc/0010/mud.php> ([your date of access]). APA style: Daniel Pargman. (2000) The Fabric of Virtual Reality -- Courage, Rewards and Death in an Adventure MUD. M/C: A Journal of Media and Culture 3(5). <http://www.api-network.com/mc/0010/mud.php> ([your date of access]).

When we think of disability today in the Western world, Christopher Reeve most likely comes to mind. A film star who captured people’s imagination as Superman, Reeve was already a celebrity before he took the fall that would lead to his new position in the fame game: the role of super-crip. As a person with acquired quadriplegia, Christopher Reeve has become both the epitome of disability in Western culture — the powerful cultural myth of disability as tragedy and catastrophe — and, in an intimately related way, the icon for the high-technology quest for cure. The case of Reeve is fascinating, yet critical discussion of Christopher Reeve in terms of fame, celebrity and his performance of disability is conspicuously lacking (for a rare exception see McRuer). To some extent this reflects the comparative lack of engagement of media and cultural studies with disability (Goggin). To redress this lacuna, we draw upon theories of celebrity (Dyer; Marshall; Turner, Bonner, & Marshall; Turner) to explore the production of Reeve as celebrity, as well as bringing accounts of celebrity into dialogue with critical disability studies. Reeve is a cultural icon, not just because of the economy, industrial processes, semiotics, and contemporary consumption of celebrity, outlined in Turner’s 2004 framework. Fame and celebrity are crucial systems in the construction of disability; and the circulation of Reeve-as-celebrity only makes sense if we understand the centrality of disability to culture and media. Reeve plays an enormously important (if ambiguous) function in the social relations of disability, at the heart of the discursive underpinning of the otherness of disability and the construction of normal sexed and gendered bodies (the normate) in everyday life. What is distinctive and especially powerful about this instance of fame and disability is how authenticity plays through the body of the celebrity Reeve; how his saintly numinosity is received by fans and admirers with passion, pathos, pleasure; and how this process places people with disabilities in an oppressive social system, so making them subject(s). An Accidental Star Born September 25, 1952, Christopher Reeve became famous for his roles in the 1978 movie Superman, and the subsequent three sequels (Superman II, III, IV), as well as his role in other films such as Monsignor. As well as becoming a well-known actor, Reeve gained a profile for his activism on human rights, solidarity, environmental, and other issues. In May 1995 Reeve acquired a disability in a riding accident. In the ensuing months, Reeve’s situation attracted a great deal of international attention. He spent six months in the Kessler Rehabilitation Institute in New Jersey, and there gave a high-rating interview on US television personality Barbara Walters’ 20/20 program. In 1996, Reeve appeared at the Academy Awards, was a host at the 1996 Paralympic Games, and was invited to speak at the Democratic National Convention. In the same year Reeve narrated a film about the lives of people living with disabilities (Mierendorf). In 1998 his memoir Still Me was published, followed in 2002 by another book Nothing Is Impossible. Reeve’s active fashioning of an image and ‘new life’ (to use his phrase) stands in stark contrast with most people with disabilities, who find it difficult to enter into the industry and system of celebrity, because they are most often taken to be the opposite of glamorous or important. They are objects of pity, or freaks to be stared at (Mitchell & Synder; Thomson), rather than assuming other attributes of stars. Reeve became famous for his disability, indeed very early on he was acclaimed as the pre-eminent American with disability — as in the phrase ‘President of Disability’, an appellation he attracted. Reeve was quickly positioned in the celebrity industry, not least because his example, image, and texts were avidly consumed by viewers and readers. For millions of people — as evident in the letters compiled in the 1999 book Care Packages by his wife, Dana Reeve — Christopher Reeve is a hero, renowned for his courage in doing battle with his disability and his quest for a cure. Part of the creation of Reeve as celebrity has been a conscious fashioning of his life as an instructive fable. A number of biographies have now been published (Havill; Hughes; Oleksy; Wren). Variations on a theme, these tend to the hagiographic: Christopher Reeve: Triumph over Tragedy (Alter). Those interested in Reeve’s life and work can turn also to fan websites. Most tellingly perhaps is the number of books, fables really, aimed at children, again, on a characteristic theme: Learning about Courage from the Life of Christopher Reeve (Kosek; see also Abraham; Howard). The construction, but especially the consumption, of Reeve as disabled celebrity, is consonant with powerful cultural myths and tropes of disability. In many Western cultures, disability is predominantly understood a tragedy, something that comes from the defects and lack of our bodies, whether through accidents of birth or life. Those ‘suffering’ with disability, according to this cultural myth, need to come to terms with this bitter tragedy, and show courage in heroically overcoming their lot while they bide their time for the cure that will come. The protagonist for this this script is typically the ‘brave’ person with disability; or, as this figure is colloquially known in critical disability studies and the disability movement — the super-crip. This discourse of disability exerts a strong force today, and is known as the ‘medical’ model. It interacts with a prior, but still active charity discourse of disability (Fulcher). There is a deep cultural history of disability being seen as something that needs to be dealt with by charity. In late modernity, charity is very big business indeed, and celebrities play an important role in representing the good works bestowed on people with disabilities by rich donors. Those managing celebrities often suggest that the star finds a charity to gain favourable publicity, a routine for which people with disabilities are generally the pathetic but handy extras. Charity dinners and events do not just reinforce the tragedy of disability, but they also leave unexamined the structural nature of disability, and its associated disadvantage. Those critiquing the medical and charitable discourses of disability, and the oppressive power relations of disability that it represents, point to the social and cultural shaping of disability, most famously in the British ‘social’ model of disability — but also from a range of other perspectives (Corker and Thomas). Those formulating these critiques point to the crucial function that the trope of the super-crip plays in the policing of people with disabilities in contemporary culture and society. Indeed how the figure of the super-crip is also very much bound up with the construction of the ‘normal’ body, a general economy of representation that affects everyone. Superman Flies Again The celebrity of Christopher Reeve and what it reveals for an understanding of fame and disability can be seen with great clarity in his 2002 visit to Australia. In 2002 there had been a heated national debate on the ethics of use of embryonic stem cells for research. In an analysis of three months of the print media coverage of these debates, we have suggested that disability was repeatedly, almost obsessively, invoked in these debates (‘Uniting the Nation’). Yet the dominant representation of disability here was the cultural myth of disability as tragedy, requiring cure at all cost, and that this trope was central to the way that biotechnology was constructed as requiring an urgent, united national response. Significantly, in these debates, people with disabilities were often talked about but very rarely licensed to speak. Only one person with disability was, and remains, a central figure in these Australian stem cell and biotechnology policy conversations: Christopher Reeve. As an outspoken advocate of research on embryonic stem-cells in the quest for a cure for spinal injuries, as well as other diseases, Reeve’s support was enlisted by various protagonists. The current affairs show Sixty Minutes (modelled after its American counterpart) presented Reeve in debate with Australian critics: PRESENTER: Stem cell research is leading to perhaps the greatest medical breakthroughs of all time… Imagine a world where paraplegics could walk or the blind could see … But it’s a breakthrough some passionately oppose. A breakthrough that’s caused a fierce personal debate between those like actor Christopher Reeve, who sees this technology as a miracle, and those who regard it as murder. (‘Miracle or Murder?’) Sixty Minutes starkly portrays the debate in Manichean terms: lunatics standing in the way of technological progress versus Christopher Reeve flying again tomorrow. Christopher presents the debate in utilitarian terms: CHRISTOPHER REEVE: The purpose of government, really in a free society, is to do the greatest good for the greatest number of people. And that question should always be in the forefront of legislators’ minds. (‘Miracle or Murder?’) No criticism of Reeve’s position was offered, despite the fierce debate over the implications of such utilitarian rhetoric for minorities such as people with disabilities (including himself!). Yet this utilitarian stance on disability has been elaborated by philosopher Peter Singer, and trenchantly critiqued by the international disability rights movement. Later in 2002, the Premier of New South Wales, Bob Carr, invited Reeve to visit Australia to participate in the New South Wales Spinal Cord Forum. A journalist by training, and skilled media practitioner, Carr had been the most outspoken Australian state premier urging the Federal government to permit the use of embryonic stem cells for research. Carr’s reasons were as much as industrial as benevolent, boosting the stocks of biotechnology as a clean, green, boom industry. Carr cleverly and repeated enlisted stereotypes of disability in the service of his cause. Christopher Reeve was flown into Australia on a specially modified Boeing 747, free of charge courtesy of an Australian airline, and was paid a hefty appearance fee. Not only did Reeve’s fee hugely contrast with meagre disability support pensions many Australians with disabilities live on, he was literally the only voice and image of disability given any publicity. Consuming Celebrity, Contesting Crips As our analysis of Reeve’s antipodean career suggests, if disability were a republic, and Reeve its leader, its polity would look more plutocracy than democracy; as befits modern celebrity with its constitutive tensions between the demotic and democratic (Turner). For his part, Reeve has criticised the treatment of people with disabilities, and how they are stereotyped, not least the narrow concept of the ‘normal’ in mainstream films. This is something that has directly effected his career, which has become limited to narration or certain types of television and film work. Reeve’s reprise on his culture’s notion of disability comes with his starring role in an ironic, high-tech 1998 remake of Alfred Hitchcock’s Rear Window (Bleckner), a movie that in the original featured a photojournalist injured and temporarily using a wheelchair. Reeve has also been a strong advocate, lobbyist, and force in the politics of disability. His activism, however, has been far more strongly focussed on finding a cure for people with spinal injuries — rather than seeking to redress inequality and discrimination of all people with disabilities. Yet Reeve’s success in the notoriously fickle star system that allows disability to be understood and mapped in popular culture is mostly an unexplored paradox. As we note above, the construction of Reeve as celebrity, celebrating his individual resilience and resourcefulness, and his authenticity, functions precisely to sustain the ‘truth’ and the power relations of disability. Reeve’s celebrity plays an ideological role, knitting together a set of discourses: individualism; consumerism; democratic capitalism; and the primacy of the able body (Marshall; Turner). The nature of this cultural function of Reeve’s celebrity is revealed in the largely unpublicised contests over his fame. At the same time Reeve was gaining fame with his traditional approach to disability and reinforcement of the continuing catastrophe of his life, he was attracting an infamy within certain sections of the international disability rights movement. In a 1996 US debate disability scholar David T Mitchell put it this way: ‘He’s [Reeve] the good guy — the supercrip, the Superman, and those of us who can live with who we are with our disabilities, but who cannot live with, and in fact, protest and retaliate against the oppression we confront every second of our lives are the bad guys’ (Mitchell, quoted in Brown). Many feel, like Mitchell, that Reeve’s focus on a cure ignores the unmet needs of people with disabilities for daily access to support services and for the ending of their brutal, dehumanising, daily experience as other (Goggin & Newell, Disability in Australia). In her book Make Them Go Away Mary Johnson points to the conservative forces that Christopher Reeve is associated with and the way in which these forces have been working to oppose the acceptance of disability rights. Johnson documents the way in which fame can work in a variety of ways to claw back the rights of Americans with disabilities granted in the Americans with Disabilities Act, documenting the association of Reeve and, in a different fashion, Clint Eastwood as stars who have actively worked to limit the applicability of civil rights legislation to people with disabilities. Like other successful celebrities, Reeve has been assiduous in managing his image, through the use of celebrity professionals including public relations professionals. In his Australian encounters, for example, Reeve gave a variety of media interviews to Australian journalists and yet the editor of the Australian disability rights magazine Link was unable to obtain an interview. Despite this, critiques of the super-crip celebrity function of Reeve by people with disabilities did circulate at the margins of mainstream media during his Australian visit, not least in disability media and the Internet (Leipoldt, Newell, and Corcoran, 2003). Infamous Disability Like the lives of saints, it is deeply offensive to many to criticise Christopher Reeve. So deeply engrained are the cultural myths of the catastrophe of disability and the creation of Reeve as icon that any critique runs the risk of being received as sacrilege, as one rare iconoclastic website provocatively prefigures (Maddox). In this highly charged context, we wish to acknowledge his contribution in highlighting some aspects of contemporary disability, and emphasise our desire not to play Reeve the person — rather to explore the cultural and media dimensions of fame and disability. In Christopher Reeve we find a remarkable exception as someone with disability who is celebrated in our culture. We welcome a wider debate over what is at stake in this celebrity and how Reeve’s renown differs from other disabled stars, as, for example, in Robert McRuer reflection that: ... at the beginning of the last century the most famous person with disabilities in the world, despite her participation in an ‘overcoming’ narrative, was a socialist who understood that disability disproportionately impacted workers and the power[less]; Helen Keller knew that blindness and deafness, for instance, often resulted from industrial accidents. At the beginning of this century, the most famous person with disabilities in the world is allowing his image to be used in commercials … (McRuer 230) For our part, we think Reeve’s celebrity plays an important contemporary role because it binds together a constellation of economic, political, and social institutions and discourses — namely science, biotechnology, and national competitiveness. In the second half of 2004, the stem cell debate is once again prominent in American debates as a presidential election issue. Reeve figures disability in national culture in his own country and internationally, as the case of the currency of his celebrity in Australia demonstrates. In this light, we have only just begun to register, let alone explore and debate, what is entailed for us all in the production of this disabled fame and infamy. Epilogue to “Fame and Disability” Christopher Reeve died on Sunday 10 October 2004, shortly after this article was accepted for publication. His death occasioned an outpouring of condolences, mourning, and reflection. We share that sense of loss. How Reeve will be remembered is still unfolding. The early weeks of public mourning have emphasised his celebrity as the very embodiment and exemplar of disabled identity: ‘The death of Christopher Reeve leaves embryonic-stem-cell activism without one of its star generals’ (Newsweek); ‘He Never Gave Up: What actor and activist Christopher Reeve taught scientists about the treatment of spinal-cord injury’ (Time); ‘Incredible Journey: Facing tragedy, Christopher Reeve inspired the world with hope and a lesson in courage’ (People); ‘Superman’s Legacy’ (The Express); ‘Reeve, the Real Superman’ (Hindustani Times). In his tribute New South Wales Premier Bob Carr called Reeve the ‘most impressive person I have ever met’, and lamented ‘Humankind has lost an advocate and friend’ (Carr). The figure of Reeve remains central to how disability is represented. In our culture, death is often closely entwined with disability (as in the saying ‘better dead than disabled’), something Reeve reflected upon himself often. How Reeve’s ‘global mourning’ partakes and shapes in this dense knots of associations, and how it transforms his celebrity, is something that requires further work (Ang et. al.). The political and analytical engagement with Reeve’s celebrity and mourning at this time serves to underscore our exploration of fame and disability in this article. Already there is his posthumous enlistment in the United States Presidential elections, where disability is both central and yet marginal, people with disability talked about rather than listened to. The ethics of stem cell research was an election issue before Reeve’s untimely passing, with Democratic presidential contender John Kerry sharply marking his difference on this issue with President Bush. After Reeve’s death his widow Dana joined the podium on the Kerry campaign in Columbus, Ohio, to put the case herself; for his part, Kerry compared Bush’s opposition to stem cell research as akin to favouring the candle lobby over electricity. As we write, the US polls are a week away, but the cultural representation of disability — and the intensely political role celebrity plays in it — appears even more palpably implicated in the government of society itself. References Abraham, Philip. Christopher Reeve. New York: Children’s Press, 2002. Alter, Judy. Christopher Reeve: Triumph over Tragedy. Danbury, Conn.: Franklin Watts, 2000. Ang, Ien, Ruth Barcan, Helen Grace, Elaine Lally, Justine Lloyd, and Zoe Sofoulis (eds.) Planet Diana: Cultural Studies and Global Mourning. Sydney: Research Centre in Intercommunal Studies, University of Western Sydney, Nepean, 1997. Bleckner, Jeff, dir. Rear Window. 1998. Brown, Steven E. “Super Duper? The (Unfortunate) Ascendancy of Christopher Reeve.” Mainstream: Magazine of the Able-Disabled, October 1996. Repr. 10 Aug. 2004 http://www.independentliving.org/docs3/brown96c.html>. Carr, Bob. “A Class Act of Grace and Courage.” Sydney Morning Herald. 12 Oct. 2004: 14. Corker, Mairian and Carol Thomas. “A Journey around the Social Model.” Disability/Postmodernity: Embodying Disability Theory. Ed. Mairian Corker and Tom Shakespeare. London and New York: Continuum, 2000. Donner, Richard, dir. Superman. 1978. Dyer, Richard. Heavenly Bodies: Film Stars and Society. London: BFI Macmillan, 1986. Fulcher, Gillian. Disabling Policies? London: Falmer Press, 1989. Furie, Sidney J., dir. Superman IV: The Quest for Peace. 1987. Finn, Margaret L. Christopher Reeve. Philadelphia: Chelsea House Publishers, 1997. Gilmer, Tim. “The Missionary Reeve.” New Mobility. November 2002. 13 Aug. 2004 http://www.newmobility.com/>. Goggin, Gerard. “Media Studies’ Disability.” Media International Australia 108 (Aug. 2003): 157-68. Goggin, Gerard, and Christopher Newell. Disability in Australia: Exposing a Social Apartheid. Sydney: UNSW Press, 2005. —. “Uniting the Nation?: Disability, Stem Cells, and the Australian Media.” Disability & Society 19 (2004): 47-60. Havill, Adrian. Man of Steel: The Career and Courage of Christopher Reeve. New York, N.Y.: Signet, 1996. Howard, Megan. Christopher Reeve. Minneapolis: Lerner Publications, 1999. Hughes, Libby. Christopher Reeve. Parsippany, NJ.: Dillon Press, 1998. Johnson, Mary. Make Them Go Away: Clint Eastwood, Christopher Reeve and the Case Against Disability Rights. Louisville : Advocado Press, 2003. Kosek, Jane Kelly. Learning about Courage from the Life of Christopher Reeve. 1st ed. New York : PowerKids Press, 1999. Leipoldt, Erik, Christopher Newell, and Maurice Corcoran. “Christopher Reeve and Bob Carr Dehumanise Disability — Stem Cell Research Not the Best Solution.” Online Opinion 27 Jan. 2003. http://www.onlineopinion.com.au/view.asp?article=510>. Lester, Richard (dir.) Superman II. 1980. —. Superman III. 1983. Maddox. “Christopher Reeve Is an Asshole.” 12 Aug. 2004 http://maddox.xmission.com/c.cgi?u=creeve>. Marshall, P. David. Celebrity and Power: Fame in Contemporary Culture. Minneapolis and London: U of Minnesota P, 1997. Mierendorf, Michael, dir. Without Pity: A Film about Abilities. Narr. Christopher Reeve. 1996. “Miracle or Murder?” Sixty Minutes. Channel 9, Australia. March 17, 2002. 15 June 2002 http://news.ninemsn.com.au/sixtyminutes/stories/2002_03_17/story_532.asp>. Mitchell, David, and Synder, Sharon, eds. The Body and Physical Difference. Ann Arbor, U of Michigan, 1997. McRuer, Robert. “Critical Investments: AIDS, Christopher Reeve, and Queer/Disability Studies.” Journal of Medical Humanities 23 (2002): 221-37. Oleksy, Walter G. Christopher Reeve. San Diego, CA: Lucent, 2000. Reeve, Christopher. Nothing Is Impossible: Reflections on a New Life. 1st ed. New York: Random House, 2002. —. Still Me. 1st ed. New York: Random House, 1998. Reeve, Dana, comp. Care Packages: Letters to Christopher Reeve from Strangers and Other Friends. 1st ed. New York: Random House, 1999. Reeve, Matthew (dir.) Christopher Reeve: Courageous Steps. Television documentary, 2002. Thomson, Rosemary Garland, ed. Freakery: Cultural Spectacles of the Extraordinary Body. New York: New York UP, 1996. Turner, Graeme. Understanding Celebrity. Thousands Oak, CA: Sage, 2004. Turner, Graeme, Frances Bonner, and David P Marshall. Fame Games: The Production of Celebrity in Australia. Melbourne: Cambridge UP, 2000. Wren, Laura Lee. Christopher Reeve: Hollywood’s Man of Courage. Berkeley Heights, NJ : Enslow, 1999. Younis, Steve. “Christopher Reeve Homepage.” 12 Aug. 2004 http://www.fortunecity.com/lavender/greatsleep/1023/main.html>. Citation reference for this article MLA Style Goggin, Gerard & Newell, Christopher. "Fame and Disability: Christopher Reeve, Super Crips, and Infamous Celebrity." M/C Journal 7.5 (2004). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0411/02-goggin.php>. APA Style Goggin, G. & Newell, C. (Nov. 2004) "Fame and Disability: Christopher Reeve, Super Crips, and Infamous Celebrity," M/C Journal, 7(5). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0411/02-goggin.php>.

I love Darwin, I love it up here, I love the north, I love the swamp. It’s the energy; it’s unpredictable, totally unpredictable. Whether that’s because people are coming and going… It’s probably because of the changeability of the weather; I love the wet season, it’s a dynamic place. I am eventually planning to move down south for a while, I have to, I’ve got family commitments and so on and the thing that worries me most is that it’s all so predictable down there. So Darwin has an energy, it’s alive, I absolutely love it, I absolutely love it. The people that come up here come here because they read that energy I believe; it’s a dynamic place, a very exciting place. Enthusiasm drives all people to make decisions and act, often without thorough thought. It is an important aspect of human life and is needed for development and risk-taking. Much has been written about the key driving role played by enthusiasm in the creative industries in enabling them to thrive (Hesmondhalgh; Leadbeater and Miller). Indeed, much of the focus around enthusiasm and the creative industries has concerned itself with the degree to which exploitation of labour is made possible by the eagerness of creatives to ‘get a foot in the door’, or simply to do the work they love; this is most often discussed in terms of ‘precarious labour’ (Kucklich; Luckman; Neilson and Rossiter; Ross; Terranova). Precarious labour practices , as explained by Neilson and Rossiter, “generate new forms of subjectivity and connection, organised about networks of communication, cognition, and affect”. However there are also other ways in which enthusiasm can be apparent in the work of creative practitioners; for example, not only in relation to their work, but how this relates to, and is inspired by, the spaces and communities within which it is undertaken. As Drake recently argued, the relationship to locality is an important part of creative practice and can, in and of itself, be “a source of aesthetic inspiration” (Drake 512). This article will explore the relationship between enthusiasm, creative industries and place, using interview transcript data generated as part of the ARC funded Linkage project ‘Creative Tropical City: Mapping Darwin’s Creative Industries’. In keeping with the migration statistics which point to Darwin as a city with considerable population turn-over, many of the people who were interviewed discussed moving to Darwin and the reasons they have stayed. This poses important questions, for example: what has enthused people to move to Darwin to practice within their creative industries, and what has motivated them to stay?The Relationship between ‘Enthusiasm’ and ‘Motivation’ Enthusiasm, defined here as “the dynamic motivator that keeps one persistently working toward his goal” (Peale 4) can be manifested in a number of ways. It can enhance creative activities, enable a move, and it can be a motivating factor in creating change. As Kant explains of enthusiasm: “The idea of the good to which affection is superadded is enthusiasm. This state of mind appears to be sublime: so much so that there is a common saying that nothing great can be achieved without it” (90). For enthusiasm to take hold there must first be a passion from which leads to an excitement that appears to be ‘sublime’ (Kant 90). It could be argued that this leads to decisions being made that may be regrettable, however the question remains, what enthuses us to make decisions that will greatly impact our life? There are many decisions that require enthusiasm for a final answer to be produced. Excitement must be present and well established for an enthused decision to be made. Cultural enthusiasm can be produced through mass motivation. As we will see here, the people of Darwin drawn upon here demonstrate such enthusiasm in regards to their creative community, especially when this has involved moving to (distant) Darwin, and leaving family, friends and existing networks. It is arguable that enthusiasm cannot exist without motivation, while motivation can exist without enthusiasm (Maslow, Toward). Motivation drives us to begin and carry through certain acts. Enthusiasm allows us the excitement and passion to create a change but motivation is needed to carry it through. Motivation is another step in the process of decision making from enthusiasm. A person can be enthused to take action, but there needs to be motivation to follow through on the decision. Max Weber argues that there is a “rational understanding of motivation, which consists in placing the act in an intelligible and more inclusive context of meaning” (Weber, Henderson & Parsons, 95). There are rational motivational factors that enable a person to participate in an activity, such as payment or reward. Motivation can be found through both paid and unpaid work, as Weber discusses “elements of the motivation of economic activity under the conditions of a market economy: … the fact that they fun the risk of going entirely without provisions, both for themselves and for those personal dependents, such as children, wives, sometimes parents” (110). Within contemporary capitalist culture there is a requirement to work to be able to provide for oneself as well as family. These opportunities require employment and/or an income. However, as the literature on precarious labour in the creative industries all too readily attests to, volunteer and unpaid work too, require forms of motivation, such a love of one’s work or the possibility of making more lucrative opportunities arise. ‘Enthusiasm’ for Darwin as a Creative Place Enthusiasm can be achieved in many ways, however, in the case of the Darwin creative industry interviewees, what enthuses them to move to, or back to, Darwin? What is attracting them to stay? While leaving one’s home and/or established place of residence is always a big move, the choice to move to and stay in a small, extremely isolated city such as Darwin is almost always circumscribed by a strong emotional connection to the place. It is in this emotional relationship to place that a sense of the sublime can start to become evident, often expressed in terms of the city’s tropical savannah climate or unique remoteness from Australia, but proximity to Asia: It’s just a marvellous place, in terms of the natural environment, I am mesmerised by it and feel a real connection to it, because it is just so marvellous. The other positives are you can't beat the lifestyle, living in shorts and t-shirts and literally outside all the time. And the other thing I love about it is, in terms of the demography of the place, there really is no such thing as the best suburb, or the best street, it is incredible mix, so you can have million dollar mansions with a housing commission block of flats right next door, that you do have black and white and all the shades in between, living in the one street. My entire professional career, has been about promoting understanding and fostering tolerance and appreciation of other cultures. … The community here consider that Asian expanse just to our north as a connecting space.So there are a number of factors connecting creative people to Darwin. On top of the more basic, yet nonetheless motivated reasons for working, there is an enthusiasm evident in peoples’ productive-creative lives. It is a remote area that allows people the time and space to be able to practice their creative activities, including architecture, painting, dance and music as well as the time to think. There are a number of locations that the 61 people who have acknowledged having moved to Darwin from. Some were born in Darwin and moved away for education only to return to practice their creative activities. For example, one acknowledged bringing her skills back with her: Originally from here, I was born in Darwin, so – and I left here when I was 21, and went to live in London, and then I lived in New Zealand for a while. I lived in Sydney … as well, and then came back again. So, bringing those skills, obviously, with me and to try and set up something that you’d find interstate. Inspiration is a vital aspect of enthusiasm. Wordsworth speaks of inspiration in relation to the bible suggesting, “it has an ever-growing adaptation to the future, as the future rises into the present” (420). This idea of inspiration can be carried through to the people of Darwin, as they are inspired to complete works and to stay in Darwin their future ideas meld with the present and are acted out. As one interviewee discusses Darwin is full of inspiration: “The whole of Darwin inspires us because of what Darwin is, because of the natural environment, because of those special characteristics that Darwin has as a city, its different to the other cities in Australia.” In the context of what motivated people to come to Darwin, for some the enthusiasm lies in the people and the situations that Darwin can offer: “One of the reasons I moved here and what I’ve discovered is …It’s less competitive …[there is a] welcoming nature [to] the arts community.” While there may be momentary excitement for an idea following an initial bout of enthusiasm, motivation is required for the idea to progress and manifest into a long-term situation. For a significant proportion of the Darwin-based creative practitioners interviewed as part of this study, this enthusiasm is sustained by the nature and environment of the city which, they believe, encourages and motivates them to stay. As one interviewee suggests: “Absolutely, I think everyone, you'd be hard-pressed to find anyone that doesn’t appreciate the beauty of living here.” There are numerous factors about Darwin that have enthused people to relocate to the area. The main themes discussed were nature, the weather and family and the opportunities that were available. Interestingly, the isolation provided by Darwin is a factor that enthused people to move to the city: I mean that’s why I came up here, not to Darwin initially; I went out bush for 5 years because isolation, I love it. Darwin’s not truly isolated but it is a long way away from the supposed centres. Darwin is in fact a centre itself but it’s just far away from the other centres. Such enthusing factors are prominent throughout the interviews. Darwin gives the creative community an opportunity to slow down and have the time and space to think, which is not offered by cities such as Melbourne or Sydney. Although some did not specify, six people moved to Darwin from Melbourne, five from Sydney and five from Adelaide. There are opportunities that are offered by Darwin that cannot be matched by such large and tightly packed cities. As will be discussed more shortly, such concepts relate to Abraham Maslow’s theories of Self-Actualisation: the need for privacy, “Independence of culture and environment; resisting enculturation” can lead to people moving to areas such as Darwin that allow for isolation and time (Monte 658). These elements allows the realisation of an individual which relies “on own judgement; trusts in self; resists pressure from others and social norms; able to ‘weather hard knocks’ with calm; resists identification with cultural stereotypes; has autonomous values carefully considered” (Monte 658). By fulfilling their ego, people are able to reach a stage of enthusiastic sublime, where enthusiasm is “an affect, the imagination unbridled” (136). Darwin has the space to allow such functions as resisting the social norms; this is not a function that towns such as Sydney or Melbourne are able to provide. The motivation to slow down and reinspire and re-energise as another interviewee discusses is an important factor that enthused some to move to Darwin: “Darwin produces the most amazing artists, you know, like it's such a wonderful place where you can feel inspired all the time. It's got that lovely country town feeling, but still being big enough to be a city, which makes it really unique.” It is important for Darwin to create enthusiasm such as this regarding the creative roles and opportunities available as for Darwin “creativity is the driving force of economic growth” (Florida xv). This is not the case for all economic growth, however, Darwin requires these creative people. As is explained by Luckman et al.: These sorts of aims (cultural flow, artistic influence, networking) appear to us more fitting reasons for seeking greater numbers of creative class professionals from southern states as ‘desirable residents’, rather than the usual emphasis on their bringing with them entrepreneurial skills, investment and cultural capital (especially given the need to find ways of accepting racial alterity). (6) Darwin’s economy depends on tourism and the creative community. Darwin’s strengths arise from the isolation and the seclusion that is available to artists of all kinds, as is discussed by one person: “I think that its strength lies in its isolation from the rest of the country and the fact that it’s a tropical city.” In regards to the weather of Darwin as an integral part of the charm the interviewee continues, “I think that’s a great selling point in that during the bleak weeks of winter down south you can actually come to a city and be part of an outdoor festival, which you’re not going to freeze, and it actually has a different feel than anywhere else in the country.” Many people have found the extreme weather conditions to be have a positive impact on their work. While some move away for the wet season others use it as time to be the most creative as it gives them time to think. For some it was the weather that enthused them to move to Darwin over any other Australian state, “I just came up for the warm weather really.” For others the wet season allows them time to be creative within different areas: “I like the wet season, I’d prefer it to the dry. It’s too dry for me at this time of the year, I like the rain and I like the humidity and all of that, that’s why I’m here.” Enthusiasm, Creativity and Maslow’s Hierarchy of Needs As in the case of one interviewee there were motivating factors that caused them to move back to Darwin, but there was not necessarily any enthusiasm involved. “I came back to Darwin actually to look after my grandmother and I’ve been back in Darwin and that’s when I’ve just been in the process of just continuing on with my choreography.” It is not to suggest that there is not enthusiasm involved in the process; however the motivating factors far outweigh the enthusing factors. Not all of the participants who have moved to Darwin have remained enthused about the decision and have very little motivation to stay. As one participant discussed, “I’m here because I’ve got my business here. That’s the only reason now.” Although some have lost their passion for the city, there is a wealth of enthusiasm amongst the majority of interviewees in regards to moving to Darwin to practice their creativity. Maslow establishes motivation as a vital factor in the human condition. There is a certain hierarchy of needs that have to be met for a person to survive and to thrive. “Freedom, love, community feeling, respect, philosophy, may all be waved aside as fripperies that are useless, since they fail to fill the stomach. Such a man may fairly be said to live by bread alone” (Maslow 37). There are many needs that have to be met for a person to be happy and satisfied beyond instinctual gratifications, such as sustenance, habitation and sex. Motivation allows a person to strive for certain needs and standards. For the people of Darwin, creativity, space, isolation, weather and community can be motivating factors to stay within the city. Once one need has been met, others will emerge and motivations will shift. As Maslow explains: The physiological needs, along with their partial goals, when chronically gratified cease to exist as active determinants or organizers of behaviour. They now exist only in a potential fashion in the sense that they may emerge again to dominate the organism if they are thwarted. But a want that is satisfied is no longer a want. (38) Although somewhat simplistic, Maslow’s hierachical schema is useful to deploy amongst the complexity of contradictory gratifications of interviewees. There needs to be both long term and short enthusiasm for a new want and motivation to achieve goals. Motivation needs to be upheld in order for enthusiasm for the practices to be maintained. Within the creative industries there is a constant need for goals to be met, such as sales or delivering quality goals, and there has to be enthusiasm to do so, especially in the face of unsure or no financial return on work or it will not be achieved. Motivations in life will shift and change with the change of lifestyle, job or situation. Darwin needs to be able to motivate the Creative Industry in order to sustain enthusiasm in the long term. There are certain standards and hierarchies that are present in every person’s life. Once the basic needs of life have been met, motivation can lead to self-actualisation. By moving to Darwin, Creative Industry people are allowing for opportunities for the fulfilment of self-actualisation. As Maslow argues: So far as motivational status is concerned, healthy people have sufficiently gratified their basic needs for safety, belongingness, love, respect and self-esteem so that they are motivated primarily by trends to self-actualisation (defined as ongoing actualisation of potentials, capacities and talents, as fulfilment of mission (or call, fate, destiny, vocation), as a fuller knowledge of, and acceptance of, the person’s own intrinsic nature, as an unceasing trend toward unity, integration or synergy within the person. (25) The people who are practicing within the industry have goals and potentials that need to be met and which motivate them into action; for many of the interviewees in this project, a key action undertaken to enable this was moving to or staying in Darwin. As such Darwin is able to absorb the surplus labour of other cities and use it to enhance local industry on its own terms. Here there is an enthusiasm and passion for creative work that operates on a different level to that present in larger, more built-up cities, which cannot be matched by them. Creative work is inherently motivating through the self-actualisation it allows the creative practitioner. While Darwin allows for these aspects of the creative industries, its relatively small size, and slower pace than bigger cities works to enthuse a unique local creative community, which on a national level punches above its weight. AcknowledgementsThis research was supported under the Australian Research Council’s Linkage Project funding scheme (project number LP0667445). ReferencesDrake, Graham. “‘This Place Gives Me Space’: Place and Creativity in the Creative Industries.” Geoforum 34.4 (2003): 511-524.Florida, Richard. The Rise of the Creative Class. USA: Pluto Press, 2003.Hesmondhalgh, David. Cultural Industries. London: Sage, 2002.Leadbeater, Charles, and Paul Miller. 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