Artykuły w czasopismach na temat „Attachment style and chronic pain syndrome”

Abstract Objective. To examine the role of adult attachment style in the daily affective experiences of older adults with physician-confirmed knee osteoarthritis (OA). Methods. As part of a larger study of racial/ethnic differences in everyday quality of life with OA, 292 persons over the age of 50 completed a baseline interview including the Revised Adult Attachment Scale (RAAS; Collins, 1996). Dimensional RAAS attachment scores were coded into the secure, preoccupied, fearful, and dismissing groups (Bartholomew & Horowitz, 1991). Positive affect (PA), negative affect (NA), and pain were assessed using an experience sampling methodology consisting of 4 daily phone calls over 7 days. These analyses used ANCOVAs to examine 28-call means and SDs for PA, NA, and pain. Results. After controlling for demographics, results indicated significant group differences in average PA, NA, and pain. Pairwise comparisons indicated that participants endorsing a stable attachment style reported significantly more PA and less NA than those with a fearful attachment style. Group differences for pain were marginal and less clear cut. Significant differences also emerged for variability of NA and pain. Individuals with a secure attachment style were significantly less variable in NA than those in the fearful and preoccupied groups. For pain variability, the preoccupied group showed more variability than those with secure or dismissive styles. Implications. Results contribute to a growing understanding of how individual attachment style may underlie the day-to-day affective experience of chronic pain. (Supported by R01-AG041655, D. Smith and P. Parmelee, PIs.)

The present study investigated the relationship between attachment style with adjustment and resiliency in chronic pain patients and probable mediating role of resiliency between attachment and adjustment. Adult Attachment Inventory; Depression‚ Anxiety‚ Stress Scale (DASS_21) Resiliency Scale (CS_RISC) and Roland–Morris Disability Questionnaire (RDQ). Data were analyzed using parson’s correlation and regression. Results revealed that avoidant and ambivalent attachment styles negatively correlated with adjustment (positively correlated with depression, anxiety and stress) and positively with resiliency. Secure attachment wasn’t correlated with none of them. Resiliency didn’t mediate the impact of attachment style on adjustment. These findings suggest that insecure attachment style is a vulnerability factor for adjustment with chronic pain and predicts lower resiliency in these patients. Briefly present the conclusions and importance of the results. Concisely summarize the study’s implications. Please do not include any citations in the abstract.

Introduction. One of the total hip arthroplasty complications is a chronic pain syndrome at different time period. Pain occurs inapproximately 27% ofpatients asdiscomfort and 6% - as persistent pain. Material and methods. We analyzed the results of total hip arthroplasty in140 patients with chronic pain syndrome (85 women and 55 men, mean age 53.4±0.5 years), operated in 2013-2016. As a basic diagnostic causes’s criteria we used hip joint X-ray, methods of ultrasound, magnetic resonance imaging and electroneuromyography. All established pathological processes that trigger the pain were divided into X-ray positiveandX-ray negative. Results. The influence of the following trigger factors ofpain was observed: body weight, age and musculoskeletal system state. Thus, the greatest number of complications and development of pain was seen in patients with excessive body weight or obesity. Spinal column pathology in lumbosacral section led to the reduction in the quality of patient life after total hip arthroplasty. Age up to 50 years and active life style promoted various reactions of bone remodeling in the area of implant pressure. Conclusion. The frequency of complications after surgery leading to chronic pain in our study was consistent with global indexes, and in some cases, was lower.

AIM: To investigate the possible contribution of attachment anxiety (AA) to satisfaction with the outcome of surgery. METHODS: Sixty-three patients with chronic sinusitis who were scheduled for FESS with septoplasty were asked to complete a panel of self-report measures assessing attachment style, quality of life, mental health, and degree of facial pain and nasal obstruction. The questionnaires were filled out two weeks before surgery and one month after surgery. One surgeon performed all procedures. RESULTS: Participants were divided into two groups according to AA scores: high anxiety in attachment and low anxiety in attachment. Postoperatively, the group as a whole showed significant improvement in quality of life, positive thoughts and improvement in pain and sinus congestion. The high AA group reported a significantly lower quality of life than the low AA group. There was an inverse correlation between AA and well-being before and after surgery, and between AA and pain amelioration after surgery. A positive correlation was noted between AA and mental distress. CONCLUSIONS: Even a basic personality factor such as AA can significantly impact patient satisfaction with surgery outcome. Surgeons performing surgery should bear in mind that success is partly related to the patient`s mental state and personality.

Using detailed clinical material from her treatment of three patients referred by physiatrist John E. Sarno, for psychological treatment of chronic pain, Dr Anderson illustrates a relationship between dissociated/repressed affect and the development of chronic musculoskeletal back pain. Sarno, conversant with the fundamentals of psychoanalysis, theorised that the somatic pain, which he termed tension myoneural syndrome (TMS), served as a distraction from emotions that were unbearable. That is, the pain served as a psychological defense or survival tactic. In treatment, the adverse impact of overwhelming physical and emotional experiences on attachment and emotion regulation are identified and discussed. Detailed clinical process, which includes the use of trauma treatment techniques, illuminate how psychological treatment can be used to help patients identify and tolerate feelings associated with early life stress, leading to relief from the somatic pain. Anderson, informed by the psychosomatic theories of Krystal and McDougall and by contemporary attachment theorists, advances the position that the physician as diagnostician functions symbolically as the "parent" who links mind and body, thereby reducing the patient's fear of pain and creating a secure attachment bond. In this secure attachment relationship, the physician "authorises" the patient to experience emotions that were previously disavowed. In the relationship with an empathic relational psychoanalyst, the patient's pain resolves as s/he builds a capacity to identify and tolerate emotions and learns how to use emotions, particularly anger, to enhance relationships and improve their quality of life.

<p style="text-align: justify;">The purpose of the work was to study the psychological mechanisms of the formation of an intrapsychic response to chronic back pain. The hypothesis was the assumption that the internal image of the disorder in patients with chronic back pain differs depending on the subjective perception of pain. Operationalization of the internal image of disorder was carried out in accordance with a four-level concept (sensitive, motivational, emotional, and intellectual levels). Psychodiagnostic tools were used: "McGill's Pain Questionnaire (Kastiro I.V., 2012), "Restoration of the locus of control" questionnaire (Belova N.A., 2002), expert assessment of compliance on a five-point scale, "Psychological factors of attitude to illness and treatment" questionnaire (Rasskazova E.I., 2016). In total, 84 patients aged 54.5&plusmn;14.4 years were examined, including 52 (61.9%) women and 32 (38.1%) men who were at the inpatient stage of medical rehabilitation for dorsopathies with moderate chronic pain syndrome. The pain has lasted for 12.9&plusmn;13.4 years. As a result of the study, it was found that the groups of patients with mixed and nociceptive pain differ from each other in the structure of the internal image of the disorder: patients with mixed pain have no relationship between the motivational and emotional levels with the sensitive &ndash; the level of primary processing of sensory information.</p>

Background: Occipital neuralgia is defined as paroxysmal shooting, or stabbing pain in the posterior part of the scalp, in the distribution of the greater and lesser occipital nerves. Occipital neuralgia may present only as an intermittent stabbing pain, but different opinions exist on its cause and diagnostic criteria.Current Concepts: According to the latest version of headache classification, only paroxysmal stabbing pain is included in the diagnostic criteria, and persistent aching pain is excluded. Pain intensity was also limited to severe cases. It has therefore become difficult to classify existing occipital neuralgia, whose main symptom is persistent pain rather than paroxysmal stabbing pain. Occipital neuralgia is classified as either idiopathic or secondary. Secondary occipital neuralgia is caused by structural lesions innervating the trigeminocervical complex (TCC) in the upper spinal cord, the dorsal root of second cervical cord, and the greater occipital nerve (GON).Discussion and Conclusion: Although idiopathic occipital neuralgia has no cause, the entrapment of the GON in the tendinous aponeurotic attachment of the trapezius muscle at the superior nuchal line has recently been proposed as an etiology. Chronic, irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the TCC receiving convergent input from trigeminal and occipital structures. TCC sensitization induces referred pain in the facial trigeminal area.

OBJECTIVEThe authors conducted a survey to evaluate differences in the understanding and management of shunt-dependent hydrocephalus among members of the American Society of Pediatric Neurosurgeons (ASPN).METHODSSurveys were sent to all 204 active ASPN members in September 2014. One hundred thirty responses were received, representing a 64% response rate. Respondents were asked 13 multiple-choice and free-response questions regarding 4 fundamental problems encountered in shunted-hydrocephalus management: shunt malfunction, chronic cerebrospinal fluid (CSF) overdrainage, chronic headaches, and slit ventricle syndrome (SVS).RESULTSRespondents agreed that shunt malfunction occurs most often as the result of ventricular catheter obstruction. Despite contrary evidence in the literature, most respondents (66%) also believed that choroid plexus is the tissue most often found in obstructed proximal catheters. However, free-text responses revealed that the respondents’ understanding of the underlying pathophysiology of shunt obstruction was highly variable and included growth, migration, or adherence of choroid plexus, CSF debris, catheter position, inflammatory processes, and CSF overdrainage. Most respondents considered chronic CSF overdrainage to be a rare complication of shunting in their practice and reported wide variation in treatment protocols. Moreover, despite a lack of evidence in the literature, most respondents attributed chronic headaches in shunt patients to medical reasons (for example, migraines, tension). Accordingly, most respondents managed headaches with reassurance and/or referral to pain clinics. Lastly, there were variable opinions on the etiology of slit ventricle syndrome (SVS), which included early shunting, chronic overdrainage, and/or loss of brain compliance. Beyond shunt revision, respondents reported divergent SVS treatment preferences.CONCLUSIONSThe survey shows that there is wide variability in the understanding and management of shunt-dependent hydrocephalus and its complications. Such discrepancies appear to be derived partly from inconsistent familiarity with existing literature but especially from a paucity of high-quality publications.

Acute coronary syndrome (ACS) is a group of conditions which often present with similar signs and symptoms while having different outcomes and complications. Therefore it is essential to differentiate between them as soon as possible and provide appropriate management. Acute coronary syndromes are classified into two categories: STE-ACS (ST segment Elevation Acute Coronary Syndrome) and NSTE-ACS (Non ST segment Elevation Acute Coronary Syndrome). STE-ACS stands for ST Elevation Acute Coronary Syndrome all of which demonstrate significant ST elevations on ECG due to complete blockage of artery by thrombus, while NSTE-ACS is due to partial occlusion of artery which exhibit ST segment depression and/or T wave inversions. Patients with NSTE-ACS who do not develop infarction are diagnosed with unstable angina, which itself is a precursor of myocardial infarction. Acute coronary syndromes are considered multifactorial and risk factors most commonly associated with development of acute coronary syndromes include: hypertension, smoking, diabetes, obesity, sedentary life-style, hereditary conditions etc. Chronic stress to the coronary endothelium eventually leads to inflammation and atherosclerotic plaque formation. Plaque at some point with additional stress will rupture and trigger thrombus formation. Probability of plaque rupture depends on its composition: stable plaques contain small fatty core and thick fibrous cap, unstable plaque have larger fatty cores and thin fibrous cap. Patients with acute coronary syndromes present with chest pain and/or discomfort and may experience tightness and pressure sensation; pain may radiate to left or both arms, jaw, back or stomach, sweating, dyspnea and dizziness are also common complaints. Whenever we suspect ACS first diagnostic tests is always ECG (Electrocardiography). If ST segment is persistently elevated STEMI (ST Elevation Myocardial Infarction) can be diagnosed and reperfusion therapy is indicated; but if ST segment is depressed and/or T wave inversion is present laboratory tests are necessary for diagnosis. Cardiac biomarkers mainly used in the clinic are Troponins and CK-MB (Creatine Kinase MB), yet LDH (lactate dehydrogenase), B-type natriuretic peptide and C-reactive protein can be used additionally. Several studies have been conducted in hopes to find other myocardial markers useful for diagnosis of ACS, one of which tested candidate biomarkers such as hFABP (Heart-type fatty acid binding protein), GPBB (Glycogen Phosphorylase Isoenzyme BB), S100, PAPP-A (Pregnancy-associated plasma protein A), TNF (Tumor Necrosis Factor), IL6 (Interleukin 6), IL18 (Interleukin 18), CD40 (Cluster of differentiation 40) ligand, MPO (Myeloperoxidase), MMP9 (Matrix metallopeptidase 9), cell-adhesion molecules, oxidized LDL (Low Density Lipoprotein), glutathione, homocysteine, fibrinogen, and D-dimer, procalcitonin. The idea of this study was to estimate usefulness of combining enzymatic markers with nonenzymatic ones in the clinical settings.

BACKGROUND: Diagnosis of subtypes of chronic constipation has been considered difficult to achieve even in specialized centers. Although colorectal physiologic tests have brought an important contribution, it remains unclear in which patients these tests should be indicated for. AIMS: This study aims to establish a differential diagnosis for chronic constipation cases using clinical assessment and physiologic tests and to identify clinical parameters that could predict which patients need physiologic tests. METHODS: One hundred and seventy nine patients (83% females; mean age, 45) with chronic constipation according to Rome II criteria were initially treated by dietary advice and functional reeducation and those unresponsive (110 or 61.5%) were submitted to colonic transit time, defecography, anorectal manometry and electromyography, as needed. RESULTS: A differential diagnosis was achieved in 63.6% of patients tested. However, 61.5% of 179 patients with chronic constipation (69 with no need to tests and 40 with normal tests) have etiologic diagnosis established only on clinical basis. Irritable bowel syndrome (32%), pelvic floor dysfunction (29%) and functional constipation due to faulty diet and life style habits (22%) were the main causes of chronic constipation. Alternating constipation and nausea/vomiting were symptoms significantly related to the diagnosis of irritable bowel syndrome; younger age, larger intervals between bowel movements, occurrence of fecal impaction and necessity of enema were related to the diagnosis of non-chagasic megacolon and digital assistance to evacuate and large rectocele or spastic pelvic floor on rectal exam were associated to pelvic floor dysfunction. Patients with long-standing constipation, fecal impaction, abdominal pain not eased after defecation, necessity for enemas, digital assistance and evidence of rectocele tended to be in need for physiologic tests to define the cause of chronic constipation. CONCLUSIONS: The etiologic diagnosis of chronic constipation can be achieved in most of patients on a clinical basis and some symptoms may be significantly related to specific diagnoses. Indications for physiologic tests should be based on specific clinical parameters.

Carpal tunnel syndrome (CTS) is an upper-extremity disorder that can cause chronic pain and disability. Although CTS can arise from a wide variety of repetitive tasks with awkward hand/arm positioning, a large percentage of cases are attributed to, or exacerbated by, computer input devices such as keyboards. One potential way to reduce the development of CTS in keyboard users is to warn them about the disease's early symptoms so that corrective actions might be taken before the disease becomes more severe. The present research systematically examines one of the components of a potential CTS warning, pictorial symbols. Participants examined a set of 12 ANSI Z535 style warnings with one, two or four pictorials. They then evaluated them on their perceived effectiveness, specifically on their ability to inform and motivate users to use correct arm and hand posture to avoid further CTS development. The evaluations involved estimating the percentage of people that would comply with the pictorial message if it were located on or near a keyboard. Individual pictorial symbols in a top or a side view of the hands, arms, and wrists, depicted the incorrect posture overlaid with either an “X” (cross-out) or “prohibition symbol” (circle-slash) or the correct posture with no overlay. Warnings with four pictorials (with both postures and views) were given significantly higher evaluations than warnings with one or two symbols. In the one and two pictorial conditions, the top view was preferred over the side view. The two prohibition symbols, shown together with views of the incorrect postures, were perceived to be better than the views of correct postures (with no prohibition symbol). The two prohibition symbol conditions did not differ. The results could serve as a partial basis for the development of a complete CTS warning that also includes textual information. Implications for the benefits of multi-symbol warning messages are offered.

Background: An increasing number of people suffer from neck pain due to life style and prolonged use of computers. Research has revealed that myofascial trigger points (MTrPs) and the intramuscular innervation zone (IZ) are involved in neck pain. MTrPs are induced mainly by IZ dysfunction of the affected skeletal muscle and the 2 do not overlap in location. The question is whether injection treatment in MTrPs or in the IZ is more effective to relieve MTrPs-associated pains. The precise location and body-surface map of the intramuscular IZ in the trapezius muscle and a clinical injection study in the IZ may provide a useful answer to the question. Objectives: This study aimed to investigate the efficacy of lidocaine injection in the intramuscular IZ for the treatment of chronic neck pain caused by MTrPs in the trapezius muscle. Study Design: Prospective observational study, approved by the local research ethics. Setting: University hospital, departments of Anesthesiology and Anatomy. Methods: First, for the determination of IZ distribution and body-surface mapping, a modified intramuscular Sihler’s neural staining technique was applied to elucidate nerve distribution patterns of the trapezius muscle. Then, 120 patients with myofascial pain syndrome (MPS) of the trapezius muscle were randomly divided into 5 groups for analysis. Group 1 (n = 24) received injections of saline (0.9% NaCl) at the MTrPs. Group 2 (n = 24) received injections of 0.5% lidocaine at the MTrPs. Group 3 (n = 24) received injections of saline (0.9% NaCl) at the mid-upper trapezius (Point E). Group 4 (n = 24) received injections of 0.5% lidocaine at Point E. Group 5 (n = 24) received a combined injection of 0.5% lidocaine treatment at both Point E and the lower trapezius (Point F). The injection dose was 4 mL at each injection site. All patients received injections once a week for 4 weeks. The visual analogue scale (VAS) and the frequency of painful days per month (FPD) were obtained before treatment and at 2, 4, and 6 months after treatment. Results: The intramuscular terminal nerve branches presented a “dendritic” distribution in the trapezius muscle and were connected with each other to form an S-shaped IZ belt in the middle of the muscle belly. Compared with the MTrP injection group, lidocaine-injection therapy in the IZ significantly reduced the degree and frequency of neck pain in patients at 6 months after treatment, especially the combined lidocaine-injection therapy in the IZ of both the mid-upper trapezius and the lower trapezius are more effective (all P < 0.05). Conclusions: This study confirms that lidocaine-injection therapy in the IZ significantly reduces the degree and frequency of neck pain in patients at 6 months after treatment. The combined lidocaine-injection therapy in the IZ of both the mid-upper trapezius and the lower trapezius is more effective. In addition, this study establishes a clear distribution map of intramuscular nerves that will be conducive to the future use of chemical blockers and electrical stimulation in the nervous system in treating MPS of the trapezius muscle. Limitations: The small number of patients and the short duration of follow-up. Key words: Neck pain, intramuscular innervation zone, myofascial trigger points, lidocaine

Background:Sjogren Syndrome (SS) is an autoimmune exocrinopathy, resulting mainly in ocular and oral dryness, with approximately half of patients displaying symptoms from different organ systems, further adding to the heterogeneous clinical phenotype of the disease. Fatigue and pain are common systemic symptoms in patients with primary SS and fibromyalgia is a frequent condition associated with chronic diseases.Objectives:The aim of the study was to evaluate the impact of concomitant fibromyalgia in patients with Sjogren Syndrome in terms of clinical features and disease activity.Methods:50 patients with Sjogren Syndrome were enrolled in the study (100% female, age: 53.7 ± 13.2 years and disease duration: 8.7 ± 5.3 years), 25(50.0%) with concomitant fibromyalgia (SS/Fibro-group) and 25(50.0%) without (SS-group). 36 patients with primary fibromyalgia (Fibro-group) were included as control group. At study entry, demographic, educational, life-style and clinical parameters were recorded for each patient. SS was diagnosed according to the American College of Rheumatology (ACR) classification criteria (1) and fibromyalgia was diagnosed according to criteria for fibromyalgia defined by ACR (2). Moreover, each patient with fibromyalgia, with and without concomitant SS, was asked to fill a self-reported questionnaire to assess the impact of Fibromyalgia on multiple physical and psycological domains (Italian-FIQR).Results:Stratifying the study cohorts based on the demographic and life-style characteristics, no significant differences were found comparing SS-group, Fibro-group and SS/Fibro-group. However, considering the different organ involvement, SS/Fibro-group were more likely reporting arthralgia symptoms (100.0%) than SS-group (76.0% p=0.02), despite similar clinical evidence of arthritis-synovitis among the two groups (12.0% in both groups respectively, p=1.00). Moreover, SS/Fibro-group showed significantly lower ESSDAI score (2.8 ± 1.7) and higher ESSPRI score (7.0 ± 0.9) compared to SS-group (ESSDAI: 7.5 ± 3.7 p<0.001 and ESSPRI: 5.2 ± 1.4, p<0.001 respectively). Finally, analyzing the differential distribution of individual scores of physical and psycological domains of the Italian-FIQR Questionnaire, SS/Fibro-group did not differ compared to Fibro-group (p>0.05 for all the 21 questions included).Conclusion:SS is affected by concomitant fibromyalgia in terms of subjective-dependent parameters (i.e. joint complaints) however the concomitant SS does not affect the impact of fibromyalgia on physical and psycological domains, even if disease activity is higher in SS patients without fibromyalgia.References:[1]Shiboski SC et al. Arthritis Care Res, 2012[2]Wolf F. et al. Arthritis Rheum 1990Disclosure of Interests:Annunziata Capacci: None declared, Pietro Rubortone: None declared, Valentina Varriano: None declared, Annamaria Paglionico: None declared, Simone Perniola: None declared, Maria Rita Gigante: None declared, Barbara Tolusso: None declared, Stefano Alivernini: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

Background: Helicobacter pylori are gram-negative bacillus that colonizes the gastrointestinal mucosa. Dyspepsia is a clinical syndrome including manifestations related to the upper gastrointestinal tract, which may include acute, chronic, or recurrent pain or discomfort. Understanding the prevalence and the factors associated with H. pylori seropositivity in dyspeptic persons can provide a guide for health policies. Aim of the research was to study the prevalence and factors associated with H. pylori infection among dyspeptic patients in Chitwan, Nepal. Methods: A descriptive cross-sectional study was conducted in the Department of Microbiology at CMC-TH from July 2019 to June 2021. A non-probability consecutive sampling technique was employed to collect 510 Stool samples from the suspected patients for the detection of H. pylori stool antigen (HpSAg) following the procedures recommended by the manufacturer. A standard questionnaire on the potential risk factors was also designated and completed. Chi-square test was used to study the association of H. pylori colonization with symptoms, life-style findings and socio-economic status. p<0.05 were considered statistically significant. Results: HpSAg was detected in 20.0%. Prevalence was higher (25.0%) among males compared to females (15.56%). Prevalence was higher among middle-aged (21-60 years) people with smoking, alcohol, and tobacco consumption habits. Socioeconomic conditions and family size play an important role in the prevalence. Nausea, sour eructation, bloating, heartburn, and bleaching were the common symptoms among dyspeptic patients. Conclusions: The burden of H. pylori infection in patients with dyspepsia was high. Factors associated with an elevated level of colonization by H. pylori leading to dyspepsia are low income, education up to the primary, habits like smoking, alcohol, and tobacco consumption.

Abstract Introduction: Acute painful episodes, frequently called sickle cell-related pain crises (SCPC), are a substantial cause of morbidity in sickle cell disease (SCD). Although hydroxyurea (HU) is known to decrease the frequency of SCPC in sickle cell anemia, many patients continue to experience acute painful episodes despite such therapy. P-selectin is an adhesion molecule expressed on activated vascular endothelial cells and platelets. It is a key molecule in the initiation of leukocyte rolling on the vessel wall that leads to firm attachment and extravasation to underlying tissues during inflammation. Upregulation of P-selectin on endothelial cells and platelets also contributes to the cell-cell interactions involved in the pathogenesis of SCPC. The SUSTAIN study evaluated the safety of SelG1, a first-in-class humanized anti-P-selectin antibody, and its effect on the frequency of SCPC in SCD patients. Methods: We conducted a randomized, double-blind, placebo-controlled, multinational study. Patients were randomized to receive placebo, 2.5 mg/kg or 5.0 mg/kg SelG1; patients received their initial dose, a dose 14 days later, and then every 4 weeks through week 50 for a total of 14 doses. The primary efficacy endpoint was the annual rate of SCPC in the 5.0 mg/kg SelG1 group vs. placebo. A hierarchical testing procedure was employed (α = 0.05 for high dose vs. placebo, and if significant, low dose vs. placebo). An SCPC was defined as acute sickle cell-related pain that resulted in a visit to a medical facility and required a parenteral or oral narcotic or parenteral NSAID. Acute chest syndrome (ACS), priapism, hepatic and splenic sequestration were also included in this definition. A blinded, independent committee adjudicated all SCPC events. Key inclusion criteria included patients 16 to 65 years of age; diagnosis of SCD (HbSS, HbSC, HbSβ0 thalassemia or HbSβ+ thalassemia); and history of 2 to 10 SCPC in the previous 12 months. Patients receiving HU or erythropoietin were included if prescribed for the preceding 6 months and dose was stable for at least 3 months. The randomization was stratified by historical SCPC in the prior year (2-4 or 5-10) and concomitant HU use (yes or no). Secondary endpoints included annual rate of days hospitalized, times to first and second SCPC and annual rate of uncomplicated SCPC (defined as typical SCPC other than ACS, priapism and hepatic or splenic sequestration) and ACS. Results: 198 SCD patients were randomized for the 1-year study. The Intent-To-Treat (ITT) population included all randomized patients; 67, 66 and 65 patients in the 5.0 mg/kg, 2.5 mg/kg and placebo groups, respectively. Demographic parameters were evenly distributed in the treatment groups. The primary endpoint, the annual rate of SCPC in the ITT population at 5.0 mg/kg vs. placebo, was reduced 47% (medians of 1.6 vs. 3.0, p = 0.010, Table 1). The SelG1 drug effect was dose-dependent as the annual rate of SCPC at 2.5 mg/kg vs. placebo was reduced 33% (medians of 2.0 vs. 3.0, p = 0.180). Time to first SCPC at 5.0 mg/kg vs. placebo was increased 2.9-fold (medians of 4.1 vs. 1.4 months, p = 0.001, Fig. 1) and time to second SCPC was increased 2.0-fold (medians of 10.3 vs. 5.1 months, p = 0.022, Fig. 2). The annual rate of uncomplicated SCPC at 5.0 mg/kg vs. placebo was reduced by 62% (medians of 1.1 vs. 2.9, p = 0.015). ACS events were rare in this study. The annual rate of days hospitalized at 5.0 mg/kg vs. placebo showed a non-significant, 42% reduction (medians of 4.0 vs. 6.9, p = 0.450). Adverse events that occurred in 5% or more of patients in an active dose group and were elevated over placebo by at least 2-fold were arthralgia, pruritus, vomiting, chest pain, diarrhea, road traffic accident, fatigue, myalgia, musculoskeletal chest pain, abdominal pain, influenza and oropharyngeal pain. There were no apparent increases in infections with SelG1 treatment. Five deaths occurred during the study, 2 at 5.0 mg/kg, 1 at 2.5 mg/kg and 2 in placebo; no deaths were deemed related to study drug. Conclusions: The P-selectin inhibitor SelG1 significantly reduced SCPC and appeared to be safe and well tolerated. Significant improvements were also achieved for several secondary endpoints including increases in times to first and second SCPC. Chronic inhibition of P-selectin with once a month IV dosing of SelG1 represents a novel and potentially new disease-modifying, prophylactic treatment option for patients with SCD. clinicaltrials.gov: NCT01895361 Disclosures Kutlar: Novartis Pharmaceuticals: Research Funding. Kanter:Novartis: Consultancy. Rollins:Selexys Pharmaceuticals: Equity Ownership, Other: Previous Employment. Stocker:Selexys Pharmaceuticals: Equity Ownership, Other: Previous Employment. Rother:Selexys Pharmaceuticals: Equity Ownership, Other: Previous Employment.

Background: The present study aimed to determine the relationship of anxious attachment style with catastrophizing, fear of pain, and hypervigilance. Methods: The study sample consisted of 210 students at Tabriz University, Iran, with recent acute pain or the lack of pain experience selected by the convenience sampling method. The subjects responded to the Relationship Scales Questionnaire, Pain Catastrophizing Scale, Fear of Pain Questionnaire, and Pain Vigilance and Awareness Questionnaire. Data were analyzed by Pearson’s correlation coefficient and structural equation modeling. Results: The findings indicated a significant positive relationship between the subscale of anxious attachment and the variables of catastrophizing, fear of pain, and vigilance to pain, as well as a relationship among the variables. Moreover, the modeling showed a structural relationship between anxious attachment and studied variables. Conclusions: Anxious attachment style acts as a vulnerability factor and a predictor of chronic pain in individuals without pain experience. It means that facing catastrophic pain in people with anxious attachment styles can lead to the fear of pain and hypervigilance.

Topicality. Musculoskeletal pain is the most common complaint from office workers is often associated with repetitive computer work. The topical character of the problem is also due to the high level of disability, behind only respiratory diseases. For the treatment and prevention often recommend physical exercises, but patients Express concerns about physical activity and recommended exercises in the aspect of the fear of strengthening existing pain syndrome. Is of considerable clinical interest the answer to the question: can physical exercise to have an adverse effect on the condition of the patient with chronic pain syndrome. As well as what type of physical exercise the most effective for therapeutic and prophylactic purpose of office workers, mostly working with the computer. Purpose – a literature review on the issue the treatment and prevention of musculoskeletal pain with physical exercise among office workers. Conclusions. Exercise significantly improves physical health parameters, helping to reduce musculoskeletal pain and improve quality of life. Improve the ergonomics of the workplace prevents the development of carpal tunnel syndrome in the dominant hand, but does not affect an existing neck pain, shoulder, lumbar spine, and prevent them. Exercises for relaxation in the workplace reduce the sensitivity pericardialna neck muscles, reduce neck pain, headache. Strength training with weights muscle have high clinical significance and lead to significant prolonged relief of muscular pain in the neck. Total training for fitness (Nordic walking, running, Cycling) showed only a small yet statistically significant acute pain reduction. Exercise General fitness can be recommended for the organization of "life style" and improve employability. Organization of free time of an office worker in physical activity may be one way of reducing the incidence of vertebral pathology office workers. Further study of preventive health the value of physical exercise programs.

Statement about the Abnormal Medical Condition Although disc herniation is the most common etiology of compressive radiculopathy [1,2]. Lumbar radiculopathy is indication to operative surgery [3-5]. Purpose of this study is to show the results of regenerative treatment of compressive radiculo-neuropathy in yung girl without neurosurgical treatment. Case report: patient V., 24 years had been treating in Private Scientific Institute ITHEC “Victoria” for 1 year with diagnosis: vertebral osteochondrosis, hernia disk L5-S1 with rightside lateralization, chronic radicular syndrome, compressive radiculo-neuropathy, disk protrusion L4-5. At the moment of coming patient had complaints on pain and hypestesy in lumbar part of back and in the dorsal surface of thigh rightside and in lateral surface of shin and foot, paresis of right foot and gait disorder. From anamnesis-patient was volleyball player for 10 years. In neurological status was determinate segmental loss of sensitivity and paresis of right foot. MRI showed hernia disk L5-S1 rightside localization, size 16mm and compression of radix S1. Patient refused surgery and got start regenerative treatment by “Protocol of medical care for patient with radiculopathy” №V-14.3.3.4.2.13-M54.1. After 4 hours pain reduced and to finish of 2d month paresis was reduced. For 1 year patient hasn’t pain and performed gymnastic yet. MRI-control of lumbar part of spine showed hernia disk reduce (calcification) to 10 mm. was performed style life modification and patient hasn’t pain and paresis for 3 years. The patient is monitored yet. Findings: Regenerative treatment has anti-inflammatory effect and promotes faster regeneration of the radix and peripheral nerve.

Abstract Fibromyalgia (FM) is a disabling syndrome characterized by chronic pain associated with fatigue. Its pathogenesis is unknown, but alterations in central sensitization, involving an imbalance of brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers, appear to be implicated. The aim of this study was to evaluate the impact of attachment-based compassion therapy (ABCT) on levels of BDNF, the inflammatory markers TNF-α, IL-6, IL-10, and the C-reactive protein (CRP), analysing whether biomarkers play a mediating/moderating role in improvements in FM functional status. Thirty-four female patients with FM participated in a RCT and were assigned to ABCT or relaxation therapy. Blood extractions were conducted at baseline and post-intervention, with self-report assessments of functional status (FIQ) at baseline, post-intervention and 3-month follow-up. A pro-inflammatory composite was obtained by summing up IL-6, TNF-α and CRP normalized values. Non-parametric tests, analysis of variance and regression models were used to evaluate treatment and mediation/moderation. Compared to relaxation therapy, ABCT showed significant improvements in FIQ and decreases in BDNF, CRP, and pro-inflammatory composite. Changes in BDNF had a mediating role in FIQ. ABCT seems to reduce BDNF and appears to have anti-inflammatory effects in FM patients. Reductions in BDNF could be a mechanism of FM functional status improvement. Clinical Trial Registration:http://ClinicalTrials.gov, identifier NCT02454244. Date: May 27th, 2015.

IntroductionMusically-inclined people often speak about the soundtrack of their life, with certain songs indelibly linked to a specific moment. When hearing a particular song, it can “easily evoke a whole time and place, distant feelings and emotions, and memories of where we were, and with whom” (Lewis 135). Music has the ability to provide maps to real and imagined spaces, positioning people within a larger social environment where songs “are never just a song, but a connection, a ticket, a pass, an invitation, a node in a complex network” (Kun 3). When someone is lost in the music, they can find themselves transported somewhere else entirely without physically moving. This can be a blessing in some situations, for example, while living in a disaster zone, when almost any other time or place can seem better than the here and now. The city of Christchurch, New Zealand was hit by a succession of damaging earthquakes beginning with a magnitude 7.1 earthquake in the early hours of 4 September 2010. The magnitude 6.3 earthquake of 22 February 2011, although technically an aftershock of the September earthquake, was closer and shallower, with intense ground acceleration that caused much greater damage to the city and its people (“Scientists”). It was this February earthquake that caused the total or partial collapse of many inner city buildings, and claimed the lives of 185 people. Everybody in Christchurch lost someone or something that day: their house or job; family members, friends, or colleagues; the city as they knew it; or their normal way of life. The broken central city was quickly cordoned off behind fences, with the few entry points guarded by local and international police and armed military personnel.In the aftermath of a disaster, circumstances and personal attributes will influence how people react, think and feel about the experience. Surviving a disaster is more than not dying, “survival is to do with quality of life [and] involves progressing from the event and its aftermath, and transforming the experience” (Hodgkinson and Stewart 2). In these times of heightened stress, music can be a catalyst for sharing and expressing emotions, connecting people and communities, and helping them make sense of what has happened (Carr 38; Webb 437). This article looks at some of the ways that popular songs and musical memories helped residents of a broken city remember the past and come to terms with the present.BackgroundExisting songs can take on new significance after a catastrophic event, even without any alteration. Songs such as Do You Know What It Means to Miss New Orleans? and Prayer for New Orleans have been given new emotional layers by those who were displaced or affected by Hurricane Katrina (Cooper 265; Sullivan 15). A thirty year-old song by Randy Newman, Louisiana, 1927, became something of “a contemporary anthem, its chorus – ‘Louisiana, they’re trying to wash us away’ – bearing new relevance” (Blumenfeld 166). Contemporary popular songs have also been re-mixed or revised after catastrophic events, either by the original artist or by others. Elton John’s Candle in the Wind and Beyonce’s Halo have each been revised twice by the artist after tragedy and disaster (Doyle; McAlister), while radio stations in the United States have produced commemorative versions of popular songs to mark tragedies and their anniversaries (Beaumont-Thomas; Cantrell). The use and appreciation of music after disaster is a reminder that popular music is fluid, in that it “refuses to provide a uniform or static text” (Connell and Gibson 3), and can simultaneously carry many different meanings.Music provides a soundtrack to daily life, creating a map of meaning to the world around us, or presenting a reminder of the world as it once was. Tia DeNora explains that when people hear a song that was once heard in, and remains associated with, a particular time and place, it “provides a device for unfolding, for replaying, the temporal structure of that moment, [which] is why, for so many people, the past ‘comes alive’ to its soundtrack” (67). When a community is frequently and collectively casting their minds back to a time before a catastrophic change, a sense of community identity can be seen in the use of, and reaction to, particular songs. Music allows people to “locate themselves in different imaginary geographics at one and the same time” (Cohen 93), creating spaces for people to retreat into, small ‘audiotopias’ that are “built, imagined, and sustained through sound, noise, and music” (Kun 21). The use of musical escape holes is prevalent after disaster, as many once-familiar spaces that have changed beyond recognition or are no longer able to be physically visited, can be easily imagined or remembered through music. There is a particular type of longing expressed by those who are still at home and yet cannot return to the home they knew. Whereas nostalgia is often experienced by people far from home who wish to return or those enjoying memories of a bygone era, people after disaster often encounter a similar nostalgic feeling but with no change in time or place: a loss without leaving. Glenn Albrecht coined the term ‘solastalgia’ to represent “the form of homesickness one experiences when one is still at home” (35). This sense of being unable to find solace in one’s home environment can be brought on by natural disasters such as fire, flood, earthquakes or hurricanes, or by other means like war, mining, climate change or gentrification. Solastalgia is often felt most keenly when people experience the change first-hand and then have to adjust to life in a totally changed environment. This can create “chronic distress of a solastalgic kind [that] would persist well after the acute phase of post-traumatic distress” (Albrecht 36). Just as the visible, physical effects of disaster last for years, so too do the emotional effects, but there have been many examples of how the nostalgia inherent in a shared popular music soundtrack has eased the pain of solastalgia for a community that is hurting.Pop Songs and Nostalgia in ChristchurchIn September 2011, one year after the initial earthquake, the Bank of New Zealand (BNZ) announced a collaboration with Christchurch hip hop artist, Scribe, to remake his smash hit, Not Many, for charity. Back in 2003, Not Many debuted at number five on the New Zealand music charts, where it spent twelve weeks at number one and was crowned ‘Single of the Year’ (Sweetman, On Song 164). The punchy chorus heralded Scribe as a force to be reckoned with, and created a massive imprint on New Zealand popular culture with the line: “How many dudes you know roll like this? Not many, if any” (Scribe, Not Many). Music critic, Simon Sweetman, explains how “the hook line of the chorus [is now] a conversational aside that is practically unavoidable when discussing amounts… The words ‘not many’ are now truck-and-trailered with ‘if any’. If you do not say them, you are thinking them” (On Song 167). The strong links between artist and hometown – and the fact it is an enduringly catchy song – made it ideal for a charity remake. Reworded and reworked as Not Many Cities, the chorus now asks: “How many cities you know roll like this?” to which the answer is, of course, “not many, if any” (Scribe/BNZ, Not Many Cities). The remade song entered the New Zealand music charts at number 36 and the video was widely shared through social media but not all reception was positive. Parts of the video were shot in the city’s Red Zone, the central business district that was cordoned off from public access due to safety concerns. The granting of special access outraged some residents, with letters to the editor and online commentary expressing frustration that celebrities were allowed into the Red Zone to shoot a music video while those directly affected were not allowed in to retrieve essential items from residences and business premises. However, it is not just the Red Zone that features: the video switches between Scribe travelling around the broken inner city on the back of a small truck and lingering shots of carefully selected people, businesses, and groups – all with ties to the BNZ as either clients or beneficiaries of sponsorship. In some ways, Not Many Cities comes across like just another corporate promotional video for the BNZ, albeit with more emotion and a better soundtrack than usual. But what it has bequeathed is a snapshot of the city as it was in that liminal time: a landscape featuring familiar buildings, spaces and places which, although damaged, was still a recognisable version of the city that existed before the earthquakes.Before Scribe burst onto the music scene in the early 2000s, the best-known song about Christchurch was probably Christchurch (in Cashel St. I wait), an early hit from the Exponents (Mitchell 189). Initially known as the Dance Exponents, the group formed in Christchurch in the early 1980s and remained local and national favourites thanks to a string of hits Sweetman refers to as “the question-mark songs,” such as Who Loves Who the Most?, Why Does Love Do This to Me?, and What Ever Happened to Tracey? (Best Songwriter). Despite disbanding in 1999, the group re-formed to be the headline act of ‘Band Together’—a multi-artist, outdoor music event organised for the benefit of Christchurch residents by local musician, Jason Kerrison, formerly of the band OpShop. Attended by over 140,000 people (Anderson, Band Together), this nine-hour event brought joy and distraction to a shaken and stressed populace who, at that point in time (October 2010), probably thought the worst was over.The Exponents took the stage last, and chose Christchurch (in Cashel St. I Wait) as their final number. Every musician involved in the gig joined them on stage and the crowd rose to their feet, singing along with gusto. A local favourite since its release in 1985, the verses may have been a bit of a mumble for some, but the chorus rang out loud and clear across the park: Christchurch, In Cashel Street I wait,Together we will be,Together, together, together, One day, one day, one day,One day, one day, one daaaaaay! (Exponents, “Christchurch (in Cashel St. I Wait)”; lyrics written as sung)At that moment, forming an impromptu community choir of over 100,000 people, the audience was filled with hope and faith that those words would come true. Life would go on and people would gather together in Cashel Street and wait for normality to return, one day. Later the following year, the opening of the Re:Start container mall added an extra layer of poignancy to the song lyrics. Denied access to most of the city’s CBD, that one small part of Cashel Street now populated with colourful shipping containers was almost the only place in central Christchurch where people could wait. There are many music videos that capture the central city of Christchurch as it was in decades past. There are some local classics, like The Bats’ Block of Wood and Claudine; The Shallows’ Suzanne Said; Moana and the Moahunters’ Rebel in Me; and All Fall Down’s Black Gratten, which were all filmed in the 1980s or early 1990s (Goodsort, Re-Live and More Music). These videos provide many flashback moments to the city as it was twenty or thirty years ago. However, one post-earthquake release became an accidental musical time capsule. The song, Space and Place, was released in February 2013, but both song and video had been recorded not long before the earthquakes occurred. The song was inspired by the feelings experienced when returning home after a long absence, and celebrates the importance of the home town as “a place that knows you as well as you know it” (Anderson, Letter). The chorus features the line, “streets of common ground, I remember, I remember” (Franklin, Mayes, and Roberts, Space and Place), but it is the video, showcasing many of the Christchurch places and spaces only recently lost to the earthquakes, that tugs at people’s heartstrings. The video for Space and Place sweeps through the central city at night, with key heritage buildings like the Christ Church Cathedral, and the Catholic Basilica lit up against the night sky (both are still damaged and inaccessible). Producer and engineer, Rob Mayes, describes the video as “a love letter to something we all lost [with] the song and its lyrics [becoming] even more potent, poignant, and unexpectedly prescient post quake” (“Songs in the Key”). The Arts Centre features prominently in the footage, including the back alleys and archways that hosted all manner of night-time activities – sanctioned or otherwise – as well as many people’s favourite hangout, the Dux de Lux (the Dux). Operating from the corner of the Arts Centre site since the 1970s, the Dux has been described as “the city’s common room” and “Christchurch’s beating heart” by musicians mourning its loss (Anderson, Musicians). While the repair and restoration of some parts of the Arts Centre is currently well advanced, the Student Union building that once housed this inner-city social institution is not slated for reopening until 2019 (“Rebuild and Restore”), and whether the Dux will be welcomed back remains to be seen. Empty Spaces, Missing PlacesA Facebook group, ‘Save Our Dux,’ was created in early March 2011, and quickly filled with messages and memories from around the world. People wandered down memory lane together as they reminisced about their favourite gigs and memorable occasions, like the ‘Big Snow’ of 1992 when the Dux served up mulled wine and looked more like a ski chalet. Memories were shared about the time when the music video for the Dance Exponents’ song, Victoria, was filmed at the Dux and the Art Deco-style apartment building across the street. The reminiscing continued, establishing and strengthening connections, with music providing a stepping stone to shared experience and a sense of community. Physically restricted from visiting a favourite social space, people were converging in virtual hangouts to relive moments and remember places now cut off by the passing of time, the falling of bricks, and the rise of barrier fences.While waiting to find out whether the original Dux site can be re-occupied, the business owners opened new venues that housed different parts of the Dux business (live music, vegetarian food, and the bars/brewery). Although the fit-out of the restaurant and bars capture a sense of the history and charm that people associate with the Dux brand, the empty wasteland and building sites that surround the new Dux Central quickly destroy any illusion of permanence or familiarity. Now that most of the quake-damaged buildings have been demolished, the freshly-scarred earth of the central city is like a child’s gap-toothed smile. Wandering around the city and forgetting what used to occupy an empty space, wanting to visit a shop or bar before remembering it is no longer there, being at the Dux but not at the Dux – these are the kind of things that contributed to a feeling that local music writer, Vicki Anderson, describes as “lost city syndrome” (“Lost City”). Although initially worried she might be alone in mourning places lost, other residents have shared similar experiences. In an online comment on the article, one local resident explained how there are two different cities fighting for dominance in their head: “the new keeps trying to overlay the old [but] when I’m not looking at pictures, or in seeing it as it is, it’s the old city that pushes its way to the front” (Juniper). Others expressed relief that they were not the only ones feeling strangely homesick in their own town, homesick for a place they never left but that had somehow left them.There are a variety of methods available to fill the gaps in both memories and cityscape. The Human Interface Technology Laboratory New Zealand (HITLab), produced a technological solution: interactive augmented reality software called CityViewAR, using GPS data and 3D models to show parts of the city as they were prior to the earthquakes (“CityViewAR”). However, not everybody needed computerised help to remember buildings and other details. Many people found that, just by listening to a certain song or remembering particular gigs, it was not just an image of a building that appeared but a multi-sensory event complete with sound, movement, smell, and emotion. In online spaces like the Save Our Dux group, memories of favourite bands and songs, crowded gigs, old friends, good times, great food, and long nights were shared and discussed, embroidering a rich and colourful tapestry about a favourite part of Christchurch’s social scene. ConclusionMusic is strongly interwoven with memory, and can recreate a particular moment in time and place through the associations carried in lyrics, melody, and imagery. Songs can spark vivid memories of what was happening – when, where, and with whom. A song shared is a connection made: between people; between moments; between good times and bad; between the past and the present. Music provides a soundtrack to people’s lives, and during times of stress it can also provide many benefits. The lyrics and video imagery of songs made in years gone by have been shown to take on new significance and meaning after disaster, offering snapshots of times, people and places that are no longer with us. Even without relying on the accompanying imagery of a video, music has the ability to recreate spaces or relocate the listener somewhere other than the physical location they currently occupy. This small act of musical magic can provide a great deal of comfort when suffering solastalgia, the feeling of homesickness one experiences when the familiar landscapes of home suddenly change or disappear, when one has not left home but that home has nonetheless gone from sight. The earthquakes (and the demolition crews that followed) have created a lot of empty land in Christchurch but the sound of popular music has filled many gaps – not just on the ground, but also in the hearts and lives of the city’s residents. ReferencesAlbrecht, Glenn. “Solastalgia.” Alternatives Journal 32.4/5 (2006): 34-36.Anderson, Vicki. “A Love Letter to Christchurch.” Stuff 22 Feb. 2013. <http://www.stuff.co.nz/the-press/christchurch-life/art-and-stage/christchurch-music/8335491/A-love-letter-to-Christchurch>.———. “Band Together.” Supplemental. The Press. 25 Oct. 2010: 1. ———. “Lost City Syndrome.” Stuff 19 Mar. 2012. <http://www.stuff.co.nz/the-press/opinion/blogs/rock-and-roll-mother/6600468/Lost-city-syndrome>.———. “Musicians Sing Praises in Call for ‘Vital Common Room’ to Reopen.” The Press 7 Jun. 2011: A8. Beaumont-Thomas, Ben. “Exploring Musical Responses to 9/11.” Guardian 9 Sep. 2011. <https://www.theguardian.com/music/musicblog/2011/sep/09/musical-responses-9-11>. Blumenfeld, Larry. “Since the Flood: Scenes from the Fight for New Orleans Jazz Culture.” Pop When the World Falls Apart. Ed. Eric Weisbard. Durham: Duke UP, 2012. 145-175.Cantrell, Rebecca. “These Emotional Musical Tributes Are Still Powerful 20 Years after Oklahoma City Bombing.” KFOR 18 Apr. 2015. <http://kfor.com/2015/04/18/these-emotional-musical-tributes-are-still-powerful-20-years-after-oklahoma-city-bombing/>.Carr, Revell. ““We Never Will Forget”: Disaster in American Folksong from the Nineteenth Century to September 11, 2011.” Voices 30.3/4 (2004): 36-41. “CityViewAR.” HITLab NZ, ca. 2011. <http://www.hitlabnz.org/index.php/products/cityviewar>. Cohen, Sara. Decline, Renewal and the City in Popular Music Culture: Beyond the Beatles. Hampshire: Ashgate, 2007. Connell, John, and Chris Gibson. Soundtracks: Popular Music, Identity and Place. London: Routledge, 2003.Cooper, B. Lee. “Right Place, Wrong Time: Discography of a Disaster.” Popular Music and Society 31.2 (2008): 263-4. DeNora, Tia. Music in Everyday Life. Cambridge: Cambridge UP, 2000. Doyle, Jack. “Candle in the Wind, 1973 & 1997.” Pop History Dig 26 Apr. 2008. <http://www.pophistorydig.com/topics/candle-in-the-wind1973-1997/>. Goodsort, Paul. “More Music Videos Set in Pre-Quake(s) Christchurch.” Mostly within Human Hearing Range. 3 Dec. 2011. <http://humanhearingrange.blogspot.co.nz/2011/12/more-music-videos-set-in-pre-quakes.html>.———. “Re-Live the ‘Old’ Christchurch in Music Videos.” Mostly within Human Hearing Range. 7 Nov. 2011. <http://humanhearingrange.blogspot.co.nz/2011/11/re-live-old-christchurch-in-music.html>. Hodgkinson, Peter, and Michael Stewart. Coping with Catastrophe: A Handbook of Disaster Management. London: Routledge, 1991. Juniper. “Lost City Syndrome.” Comment. Stuff 19 Mar. 2012. <http://www.stuff.co.nz/the-press/opinion/blogs/rock-and-roll-mother/6600468/Lost-city-syndrome>.Kun, Josh. Audiotopia. Berkeley: U of California P, 2005. Lewis, George H. “Who Do You Love? The Dimensions of Musical Taste.” Popular Music and Communication. Ed. James Lull. London: Sage, 1992. 134-151. Mayes, Rob. “Songs in the Key-Space and Place.” Failsafe Records. Mar. 2013. <http://www.failsaferecords.com/>.McAlister, Elizabeth. “Soundscapes of Disaster and Humanitarianism.” Small Axe 16.3 (2012): 22-38. Mitchell, Tony. “Flat City Sounds Redux: A Musical ‘Countercartography’ of Christchurch.” Home, Land and Sea: Situating Music in Aotearoa New Zealand. Eds. Glenda Keam and Tony Mitchell. Auckland: Pearson, 2011. 176-194.“Rebuild and Restore.” Arts Centre, ca. 2016. <http://www.artscentre.org.nz/rebuild---restore.html>.“Scientists Find Rare Mix of Factors Exacerbated the Christchurch Quake.” GNS [Institute of Geological and Nuclear Sciences Limited] Science 16 Mar. 2011. <http://www.gns.cri.nz/Home/News-and-Events/Media-Releases/Multiple-factors>. Sullivan, Jack. “In New Orleans, Did the Music Die?” Chronicle of Higher Education 53.3 (2006): 14-15. Sweetman, Simon. “New Zealand’s Best Songwriter.” Stuff 18 Feb. 2011. <http://www.stuff.co.nz/entertainment/blogs/blog-on-the-tracks/4672532/New-Zealands-best-songwriter>.———. On Song. Auckland: Penguin, 2012.Webb, Gary. “The Popular Culture of Disaster: Exploring a New Dimension of Disaster Research.” Handbook of Disaster Research. Eds. Havidan Rodriguez, Enrico Quarantelli and Russell Dynes. New York: Springer, 2006. 430-440. MusicAll Fall Down. “Black Gratten.” Wallpaper Coat [EP]. New Zealand: Flying Nun, 1987.Bats. “Block of Wood” [single]. New Zealand: Flying Nun, 1987. ———. “Claudine.” And Here’s Music for the Fireside [EP]. New Zealand: Flying Nun, 1985. Beyonce. “Halo.” I Am Sacha Fierce. USA: Columbia, 2008.Charlie Miller. “Prayer for New Orleans.” Our New Orleans. USA: Nonesuch, 2005. (Dance) Exponents. “Christchurch (in Cashel St. I Wait).” Expectations. New Zealand: Mushroom Records, 1985.———. “Victoria.” Prayers Be Answered. New Zealand: Mushroom, 1982. ———. “What Ever Happened to Tracy?” Something Beginning with C. New Zealand: PolyGram, 1992.———. “Who Loves Who the Most?” Something Beginning with C. New Zealand: PolyGram, 1992.———. “Why Does Love Do This to Me?” Something Beginning with C. New Zealand: PolyGram, 1992.Elton John. “Candle in the Wind.” Goodbye Yellow Brick Road. United Kingdom: MCA, 1973.Franklin, Leigh, Rob Mayes, and Mark Roberts. “Space and Place.” Songs in the Key. New Zealand: Failsafe, 2013. Louis Armstrong and Billie Holiday. “Do You Know What It Means to Miss New Orleans.” New Orleans Original Motion Picture Soundtrack. USA: Giants of Jazz, 1983 (originally recorded 1947). Moana and the Moahunters. “Rebel in Me.” Tahi. New Zealand: Southside, 1993.Randy Newman. “Louisiana 1927.” Good Old Boys. USA: Reprise, 1974.Scribe. “Not Many.” The Crusader. New Zealand: Dirty Records/Festival Mushroom, 2003.Scribe/BNZ. “Not Many Cities.” [charity single]. New Zealand, 2011. The Shallows. “Suzanne Said.” [single]. New Zealand: self-released, 1985.

I was born illegitimate. Born on an existential precipice. My unwed mother was 36 years old when she relinquished me. I was the fourth baby she was required to give away. After I emerged blood stained and blue tinged – abject, liminal – not only did the nurses refuse me my mother’s touch, I also lost the sound of her voice. Her smell. Her heart beat. Her taste. Her gaze. The silence was multi-sensory. When they told her I was dead, I also lost, within her memory and imagination, my life. I was adopted soon after but not told for over four decades. It was too shameful for even me to know. Imprinted at birth with a psychological ‘death’, I fell, as a Late Discovery Adoptee (LDA), into a socio-cultural and psychological abyss, frozen at birth at the bottom of a parturitive void from where, invisible within family, society, and self I was unable to form an undamaged sense of being.Throughout the 20th century (and for centuries before) this kind of ‘social abortion’ was the dominant script. An adoptee was regarded as a bastard, born of sin, the mother blamed, the father exonerated, and silence demanded (Lynch 28-74). My adoptive mother also sinned. She was infertile. But, in taking me on, she assumed the role of a womb worthy woman, good wife, and, in her case, reluctant mother (she secretly didn’t want children and was privately overwhelmed by the task). In this way, my mother, my adoptive mother, and myself are all the daughters of bereavement, all of us sacrificed on the altar of prejudice and fear that infertility, sex outside of marriage, and illegitimacy were unspeakable crimes for which a price must be paid and against which redemptive protection must be arranged. If, as Thomas Keneally (5) writes, “original sin is the mother fluid of history” then perhaps all three of us all lie in its abject waters. Grotevant, Dunbar, Kohler and Lash Esau (379) point out that adoption was used to ‘shield’ children from their illegitimacy, women from their ‘sexual indiscretions’, and adoptive parents from their infertility in the belief that “severing ties with birth family members would promote attachment between adopted children and parents”. For the adoptee in the closed record system, the socio/political/economic vortex that orchestrated their illegitimacy is born out of a deeply, self incriminating primal fear that reaches right back into the recesses of survival – the act of procreation is infested with easily transgressed life and death taboos within the ‘troop’ that require silence and the burial of many bodies (see Amanda Gardiner’s “Sex, Death and Desperation: Infanticide, Neonaticide, and Concealment of Birth in Colonial Western Australia” for a palpable, moving, and comprehensive exposition on the links between 'illegitimacy', the unmarried mother and child murder). As Nancy Verrier (24) states in Coming Home to Self, “what has to be understood is that separation trauma is an insidious experience, because, as a society, we fail to see this experience as a trauma”. Indeed, relinquishment/adoption for the baby and subsequent adult can be acutely and chronically painful. While I was never told the truth of my origins, of course, my body knew. It had been there. Sentient, aware, sane, sensually, organically articulate, it messaged me (and anyone who may have been interested) over the decades via the language of trauma, its lexicon and grammar cellular, hormonal, muscular (Howard & Crandall, 1-17; Pert, 72), the truth of my birth, of who I was an “unthought known” (Bollas 4). I have lived out my secret fatality in a miasmic nebula of what I know now to be the sequelae of adoption psychopathology: nausea, physical and psychological pain, agoraphobia, panic attacks, shame, internalised anger, depression, self-harm, genetic bewilderment, and generalised anxiety (Brodzinsky 25-47; Brodzinsky, Smith, & Brodzinsky 74; Kenny, Higgins, Soloff, & Sweid xiv; Levy-Shiff 97-98; Lifton 210-212; Verrier The Primal Wound 42-44; Wierzbicki 447-451) – including an all pervading sense of unreality experienced as dissociation (the experience of depersonalisation – where the self feels unreal – and derealisation – where the world feels unreal), disembodiment, and existential elision – all characteristics of Post Traumatic Stress Disorder (PTSD). In these ways, my body intervened, acted out, groaned in answer to the social overlay, and from beyond “the dermal veil” tried to procure access, as Vicky Kirby (77) writes, to “the body’s opaque ocean depths” through its illnesses, its eloquent, and incessantly aching and silent verbosities deepened and made impossibly fraught because I was not told. The aim of this paper is to discuss one aspect of how my body tried to channel the trauma of my secret fatality and liminality: my pre-disclosure art work (the cellular memory of my trauma also expressed itself, pre-disclosure, through my writings – poetry, journal entries – and also through post-coital glossolalia, all discussed at length in my Honours research “Womb Tongues” and my Doctoral Dissertation “The Womb Artist – A Novel: Translating Pre-verbal Late Discovery Adoption Trauma into Narrative”). From the age of thirty onwards I spent twelve years in therapy where the cause of my childhood and adult psychopathology remained a mystery. During this time, my embodied grief and memories found their way into my art work, a series of 5’ x 3’ acrylic paintings, some of which I offer now for discussion (figures 1-4). These paintings map and express what my body knew but could not verbalise (without language to express my grief, my body found other ways to vent). They are symptom and sign of my pre-verbal adoption trauma, evidence that my body ‘knew’ and laboured ceaselessly and silently to find creative ways to express the incarcerated trauma. Post disclosure, I have used my paintings as artefacts to inform, underpin, and nourish the writing of a collection of poetry “Womb Tongues” and a literary novel/memoir “The Womb Artist” (TWA) in an ongoing autoethnographical, performative, and critical inquiry. My practice-led research as a now conscious and creative witness, fashions the recontextualisation of my ‘self’ into my ‘self’ and society, this time with cognisant and reparative knowledge and facilitates the translation of my body’s psychopathology and memory (explicit and implicit) into a healing testimony that explores the traumatised body as text and politicizes the issues surrounding LDAs (Riley 205). If I use these paintings as a memoirist, I use them second hand, after the fact, after they have served their initial purpose, as the tangible art works of a baby buried beneath a culture’s prejudice, shame, and judgement and the personal cries from the illegitimate body/self. I use them now to explore and explain my subclinical and subterranean life as a LDA.My pre-disclosure paintings (Figures 1-4) – filled with vaginal, fetal, uterine, and umbilical references – provide some kind of ‘evidence’ that my body knew what had happened to me as if, with the tenacity of a poltergeist, my ‘spectral self’ found ways to communicate. Not simply clues, but the body’s translation of the intra-psychic landscape, a pictorial and artistic séance into the world, as if my amygdala – as quasar and signal, homing device and history lesson (a measure, container, and memoir) – knew how to paint a snap shot or an x-ray of the psyche, of my cellular marrow memories (a term formulated from fellow LDA Sandy McCutcheon’s (76) memoir, The Magician’s Son when he says, “What I really wanted was the history of my marrow”). If, as Salveet Talwar suggests, “trauma is processed from the body up”, then for the LDA pre-discovery, non-verbal somatic signage is one’s ‘mother tongue’(25). Talwar writes, “non-verbal expressive therapies such as art, dance, music, poetry and drama all activate the sub-cortical regions of the brain and access pre-verbal memories” (26). In these paintings, eerily divinatory and pointed traumatic, memories are made visible and access, as Gussie Klorer (213) explains in regard to brain function and art therapy, the limbic (emotional) system and the prefrontal cortex in sensorimotor integration. In this way, as Marie Angel and Anna Gibbs (168) suggest, “the visual image may serve as a kind of transitional mode in thought”. Ruth Skilbeck in her paper First Things: Reflections on Single-lens Reflex Digital Photography with a Wide-angled Lens, also discusses (with reference to her photographic record and artistic expression of her mother’s death) what she calls the “dark matter” – what has been overlooked, “left out”, and/or is inexplicable (55) – and the idea of art work as the “transitional object” as “a means that some artists use, conceptually and yet also viscerally, in response to the extreme ‘separation anxiety’ of losing a loved one, to the void of the Unknown” (57). In my case, non-disclosure prevented my literacy and the evolution of the image into language, prevented me from fully understanding the coded messages left for me in my art work. However, each of my paintings is now, with the benefit of full disclosure, a powerful, penetrating, and comprehensible intra and extra sensory cry from the body in kinaesthetic translation (Lusebrink, 125; Klorer, 217). In Figure 1, ‘Embrace’, the reference to the umbilical is palpable, described in my novel “The Womb Artist” (184) this way; “two ropes tightly entwine as one, like a dark and dirty umbilical cord snaking its way across a nether world of smudged umbers”. There is an ‘abject’ void surrounding it. The cord sapped of its colour, its blood, nutrients – the baby starved of oxygen, breath; the LDA starved of words and conscious understanding. It has two parts entwined that may be seen in many ways (without wanting to reduce these to static binaries): mother/baby; conscious/unconscious; first person/third person; child/adult; semiotic/symbolic – numerous dualities could be spun from this embrace – but in terms of my novel and of the adoptive experience, it reeks of need, life and death, a text choking on the poetic while at the same time nourished by it; a text made ‘available’ to the reader while at the same narrowing, limiting, and obscuring the indefinable nature of pre-verbal trauma. Figure 1. Embrace. 1993. Acrylic on canvas.The painting ‘Womb Tongues’ (Figure 2) is perhaps the last (and, obviously, lasting) memory of the infinite inchoate universe within the womb, the umbilical this time wrapped around in a phallic/clitorial embrace as the baby-self emerges into the constrictions of a Foucauldian world, where the adoptive script smothers the ‘body’ encased beneath the ‘coils’ of Judeo-Christian prejudice and centuries old taboo. In this way, the reassigned adoptee is an acute example of power (authority) controlling and defining the self and what knowledge of the self may be allowed. The baby in this painting is now a suffocated clitoris, a bound subject, a phallic representation, a gagged ‘tongue’ in the shape of the personally absent (but socially imposing) omni-present and punitive patriarchy. Figure 2. Womb Tongues. 1997. Acrylic on canvas.‘Germination’ (Figure 3) depicts an umbilical again, but this time as emerging from a seething underworld and is present in TWA (174) this way, “a colony of night crawlers that writhe and slither on the canvas, moving as one, dozens of them as thin as a finger, as long as a dream”. The rhizomic nature of this painting (and Figure 4), becomes a heaving horde of psychosomatic and psychopathological influences and experiences, a multitude of closely packed, intense, and dendridic compulsions and symptoms, a mass of interconnected (and by nature of the silence and lie) subterranean knowledges that force the germination of a ‘ghost baby/child/adult’ indicated by the pale and ashen seedling that emerges above ground. The umbilical is ghosted, pale and devoid of life. It is in the air now, reaching up, as if in germination to a psychological photosynthesis. There is the knot and swarm within the unconscious; something has, in true alien fashion, been incubated and is now emerging. In some ways, these paintings are hardly cryptic.Figure 3. Germination.1993. Acrylic on canvas.In Figure 4 ‘The Birthing Tree’, the overt symbolism reaches ‘clairvoyant status’. This could be read as the family ‘tree’ with its four faces screaming out of the ‘branches’. Do these represent the four babies relinquished by our mother (the larger of these ‘beings’ as myself, giving birth to the illegitimate, silenced, and abject self)? Are we all depicted in anguish and as wraithlike, grotesquely simplified into pure affect? This illegitimate self is painted as gestating a ‘blue’ baby, near full-term in a meld of tree and ‘self’, a blue umbilical cord, again, devoid of blood, ghosted, lifeless and yet still living, once again suffocated by the representation of the umbilical in the ‘bowels’ of the self, the abject part of the body, where refuse is stored and eliminated: The duodenum of the damned. The Devil may be seen as Christopher Bollas’s “shadow of the object”, or the Jungian archetypal shadow, not simply a Judeo-Christian fear-based spectre and curmudgeon, but a site of unprocessed and, therefore, feared psychological material, material that must be brought to consciousness and integrated. Perhaps the Devil also is the antithesis to ‘God’ as mother. The hell of ‘not mother’, no mother, not the right mother, the reluctant adoptive mother – the Devil as icon for the rich underbelly of the psyche and apophatic to the adopted/artificial/socially scripted self.Figure 4. The Birthing Tree. 1995. Acrylic on canvas.These paintings ache with the trauma of my relinquishment and LDA experience. They ache with my body’s truth, where the cellular and psychological, flesh and blood and feeling, leak from my wounds in unspeakable confluence (the two genital lips as the site of relinquishment, my speaking lips that have been sealed through non-disclosure and shame, the psychological trauma as Verrier’s ‘primal wound’) just as I leaked from my mother (and society) at birth, as blood and muck, and ooze and pus and death (Grosz 195) only to be quickly and silently mopped up and cleansed through adoption and life-long secrecy. Where I, as translator, fluent in both silence and signs, disclose the baby’s trauma, asking for legitimacy. My experience as a LDA sets up an interesting experiment, one that allows an examination of the pre-verbal/pre-disclosure body as a fleshed and breathing Rosetta Stone, as an interface between the language of the body and of the verbalised, painted, and written text. As a constructed body, written upon and invented legally, socially, and psychologically, I am, in Hélène Cixous’s (“To Live the Orange” 83) words, “un-forgetting”, “un-silencing” and “unearthing” my ‘self’ – I am re-writing, re-inventing and, under public scrutiny, legitimising my ‘self’. I am a site of inquiry, discovery, extrapolation, and becoming (Metta 492; Poulus 475) and, as Grosz (vii) suggests, a body with “all the explanatory power” of the mind. I am, as I embroider myself and my LDA experience into literary and critical texts, authoring myself into existence, referencing with particular relevance Peter Carnochan’s (361) suggestion that “analysis...acts as midwife to the birth of being”. I am, as I swim forever amorphous, invisible, and unspoken in my mother’s womb, fashioning a shore, landscaping my mind against the constant wet, my chronic liminality (Rambo 629) providing social landfall for other LDAs and silenced minorities. As Catherine Lynch (3) writes regarding LDAs, “Through the creation of text and theory I can formulate an intimate space for a family of adoptive subjects I might never know via our participation in a new discourse in Australian academia.” I participate through my creative, self-reflexive, process fuelled (Durey 22), practice-led enquiry. I use the intimacy (and also universality and multiplicity) and illegitimacy of my body as an alterative text, as a site of academic and creative augmentation in the understanding of LDA issues. The relinquished and silenced baby and LDA adult needs a voice, a ‘body’, and a ‘tender’ place in the consciousness of society, as Helen Riley (“Confronting the Conspiracy of Silence” 11) suggests, “voice, validation, and vindication”. Judith Herman (3) argues that, “Survivors challenge us to reconnect fragments, to reconstruct history, to make meaning of their present symptoms in the light of past events”. I seek to use the example of my experience – as Judith Durey (31) suggests, in “support of evocative, creative modes of representation as valid forms of research in their own right” – to unfurl the whole, to give impetus and precedence for other researchers into adoption and advocate for future babies who may be bought, sold, arranged, and/or created by various means. The recent controversy over Gammy, the baby boy born with Down Syndrome in Thailand, highlights the urgent and moral need for legislation with regard to surrogacy (see Kajsa Ekis Ekman’s Being and Being Bought: Prostitution, Surrogacy and the Split Self for a comprehensive examination of surrogacy issues). Indeed, Catherine Lynch in her paper Doubting Adoption Legislation links the experiences of LDAs and the children of born of surrogacy, most effectively arguing that, “if the fate that closed record adoptees suffered was a misplaced solution to the question of what to do with children already conceived how can you justify the deliberate conception of a child with the intention even before its creation of cruelly removing that child from their mother?” (6). Cixous (xxii) confesses, “All I want is to illustrate, depict fragments, events of human life and death...each unique and yet at the same time exchangeable. Not the law, the exception”. I, too, am a fragment, an illustration (a painting), and, as every individual always is – paradoxically – a communal and, therefore, deeply recognisable and generally applicable minority and exception. In my illegitimacy, I am some kind of evidence. Evidence of cellular memory. Evidence of embodiment. Evidence that silenced illegitimacies will manifest in symptom and non-verbal narratives, that they will ooze out and await translation, verification, and witness. This paper is offered with reverence and with feminist intention, as a revenant mouthpiece for other LDAs, babies born of surrogacy, and donor assisted offspring (and, indeed, any) who are marginalised, silenced, and obscured. It is also intended to promote discussion in the psychological and psychoanalytic fields and, as Helen Riley (202-207) advocates regarding late discovery offspring, more research within the social sciences and the bio-medical field that may encourage legislators to better understand what the ‘best interests of the child’ are in terms of late discovery of origins and the complexity of adoption/conception practices available today. As I write now (and always) the umbilical from my paintings curve and writhe across my soul, twist and morph into the swollen and throbbing organ of tongues, my throat aching to utter, my hands ready to craft latent affect into language in translation of, and in obedience to, my body’s knowledges. It is the art of mute witness that reverses genesis, that keeps the umbilical fat and supple and full of blood, and allows my conscious conception and creation. Indeed, in the intersection of my theoretical, creative, psychological, and somatic praxis, the heat (read hot and messy, insightful and insistent signage) of my body’s knowledges perhaps intensifies – with a ripe bouquet – the inevitably ongoing odour/aroma of the reproductive world. ReferencesAngel, Maria, and Anna Gibbs. “On Moving and Being Moved: The Corporeality of Writing in Literary Fiction and New Media Art.” Literature and Sensation, eds. Anthony Uhlmann, Helen Groth, Paul Sheehan, and Stephan McLaren. Newcastle upon Tyne, UK: Cambridge Scholars Publishing, 2009: 162-172. Bollas, Christopher. The Shadow of the Object: Psychoanalysis of the Unthought Known. New York: Columbia UP, 1987. Brodzinsky, David. “Adjustment to Adoption: A Psychosocial Perspective.” Clinical Psychology Review 7 (1987): 25-47. doi: 10.1016/0272-7358(87)90003-1.Brodzinsky, David, Daniel Smith, and Anne Brodzinsky. Children’s Adjustment to Adoption: Developmental and Clinical Issues. California: Sage Publications, 1998.Carnochan, Peter. “Containers without Lids”. Psychoanalytic Dialogues 16.3 (2006): 341-362.Cixous, Hélène. “To Live the Orange”. The Hélène Cixous Reader: With a Preface by Hélène Cixous and Foreword by Jacques Derrida, ed. Susan Sellers. Oxford, UK: Routledge, 1979/1994. 81-92. ---. “Preface.” The Hélène Cixous Reader: With a Preface by Hélène Cixous and Foreword by Jacques Derrida, ed. Susan Sellers. Oxford, UK: Routledge, 1994. xv-xxii.Coull, Kim. “Womb Tongues: A Collection of Poetry.” Honours Thesis. Perth, WA: Edith Cowan University, 2007. ---. “The Womb Artist – A Novel: Translating Late Discovery Adoptee Pre-Verbal Trauma into Narrative”. Dissertation. Perth, WA: Edith Cowan University, 2014. Durey, Judith. Translating Hiraeth, Performing Adoption: Art as Mediation and Form of Cultural Production. Dissertation. Perth, WA: Murdoch University, 2010. 22 Sep. 2011 .Ekis Ekman, Kajsa. Being and Being Bought: Prostitution, Surrogacy and the Split Self. Trans. S. Martin Cheadle. North Melbourne: Spinifex Press, 2013. Gardiner, Amanda. “Sex, Death and Desperation: Infanticide, Neonaticide, and Concealment of Birth in Colonial Western Australia”. Dissertation. Perth, WA: Edith Cowan University, 2014. Grosz, Elizabeth. Volatile Bodies. NSW: Allen &. Unwin, 1994. Grotevant, Harold D., Nora Dunbar, Julie K. Kohler, and Amy. M. Lash Esau. “Adoptive Identity: How Contexts within and beyond the Family Shape Developmental Pathways.” Family Relations 49.3 (2000): 79-87.Herman, Judith L. Trauma and Recovery: From Domestic Abuse to Political Terror. London: Harper Collins, 1992. Howard, Sethane, and Mark W. Crandall. Post Traumatic Stress Disorder: What Happens in the Brain. Washington Academy of Sciences 93.3 (2007): 1-18.Keneally, Thomas. Schindler’s List. London: Serpentine Publishing Company, 1982. Kenny, Pauline, Daryl Higgins, Carol Soloff, and Reem Sweid. Past Adoption Experiences: National Research Study on the Service Response to Past Adoption Practices. Research Report 21. Australian Institute of Family Studies, 2012.Kirby, Vicky. Telling Flesh: The Substance of the Corporeal. New York and London: Routledge, 1997. Klorer, P. Gussie. “Expressive Therapy with Severely Maltreated Children: Neuroscience Contributions.” Journal of the American Art Therapy Association 22.4 (2005): 213-220. doi:10.1080/07421656.2005.10129523.Levy-Shiff, Rachel. “Psychological Adjustment of Adoptees in Adulthood: Family Environment and Adoption-Related Correlates. International Journal of Behavioural Development 25 (2001): 97-104. doi: 1080/01650250042000131.Lifton, Betty J. “The Adoptee’s Journey.” Journal of Social Distress and the Homeless 11.2 (2002): 207-213. doi: 10.1023/A:1014320119546.Lusebrink, Vija B. “Art Therapy and the Brain: An Attempt to Understand the Underlying Processes of Art Expression in Therapy.” Journal of the American Art Therapy Association 21.3 (2004): 125-135. doi:10.1080/07421656. 2004.10129496.Lynch, Catherine. “An Ado/aptive Reading and Writing of Australia and Its Contemporary Literature.” Australian Journal of Adoption 1.1 (2009): 1-401.---. Doubting Adoption Legislation. n.d.McCutcheon, Sandy. The Magician’s Son: A Search for Identity. Sydney, NSW: Penguin, 2006. Metta, Marilyn. “Putting the Body on the Line: Embodied Writing and Recovery through Domestic Violence.” Handbook of Autoethnography, eds. Stacy Holman Jones, Tony Adams, and Carolyn Ellis. Walnut Creek, CA: Left Coast Press, 2013: 486-509.Pert, Candace. Molecules of Emotion: The Science behind Mind-body Medicine. New York: Touchstone, 2007. Rambo, Carol. “Twitch: A Performance of Chronic Liminality.” Handbook of Autoethnography, eds. Stacy Holman Jones, Tony Adams, and Carolyn Ellis. Walnut Creek, CA: Left Coast Press, 2013: 627-638.Riley, Helen J. Identity and Genetic Origins: An Ethical Exploration of the Late Discovery of Adoptive and Donor-insemination Offspring Status. Dissertation. Brisbane: Queensland University of Technology, 2012.---. “Confronting the Conspiracy of Silence and Denial of Difference for Late Discovery Persons and Donor Conceived People.” Australian Journal of Adoption 7.2 (2013): 1-13.Skilbeck, Ruth. “First Things: Reflection on Single-Lens Reflex Digital Photography with a Wide-Angle Lens.” International Journal of the Image 3 (2013): 55-66. Talwar, Savneet. “Accessing Traumatic Memory through Art Making: An Art Therapy Trauma Protocol (ATTP)." The Arts in Psychotherapy 34 (2007): 22-25. doi:10.1016/ j.aip.2006.09.001.Verrier, Nancy. The Primal Wound: Understanding the Adopted Child. Baltimore, MD: Gateway Press, 1993.---. The Adopted Child Grows Up: Coming Home to Self. Baltimore, MD: Gateway Press, 2003. Wierzbicki, Michael. “Psychological Adjustment of Adoptees: A Meta-Analysis.” Journal of Clinical Child Psychology 22.4 (1993): 447-454. doi:10.1080/ 01650250042000131.