Artykuły w czasopismach na temat „Nerve lisse”

Piepende Monitore, tropfende Infusionen, Beatmungsgeräte, Drainagen, Magensonden – die Liste der Herausforderungen für Physiotherapeuten auf Intensivstation ist lang. Technisches Verständnis ist gefordert, gute Nerven und Muskelkraft. Kolleginnen berichten von ihrem intensiven Alltag, der sie fordert und fördert, der manchmal zermürbt und doch Spaß bereitet.

Background:Biologic disease-modifying antirheumatic drug (bDMARD) therapy has been shown to be effective in the treatment of axial spondyloarthritis (axSpA).1,2 Little is understood about patients’ experience of axSpA treatment from their own perspective.Objectives:To characterize patient experiences and perspectives with bDMARD treatments for axSpA, including satisfaction, and use of supplementary treatments when wear-off between doses is perceived among those currently treated with bDMARD therapy.Methods:Adult US participants (pts) within the ArthritisPower registry with physician-diagnosed axSpA were invited to complete electronic PRO measures, such as the BASDAI (0-10 scale, score ≥4 indicates suboptimal disease control), and an online survey about their perspectives of treatment. Analysis compared pt characteristics and treatment satisfaction by whether or not pt reported wear-off between bDMARD doses.Results:128 pts with axSpA and on bDMARD therapy met inclusion criteria of whom 82.8% were female, with mean age of 47 years. Mean BASDAI scores indicated poor disease control (6.4, SD 1.8), worse for those perceiving wear-off between doses compared with those who did not [6.8 (1.6) vs. 5.9 (2.0), p=0.01]. A majority of pts on a bDMARD reported being somewhat (57.8%) or very satisfied (26.6%) with their current axSpA treatment, and about 53.1% were satisfied with how well it controls axSpA-related pain. However, 60.9% (n=78) of pts reported that their current bDMARD typically wears off before the next dose. Treatment satisfaction was lower for pts experiencing wear-off compared to pts without wear-off (highly satisfied: 21.8% vs. 34%; somewhat satisfied: 60.3% vs. 54%; dissatisfied: 17.9% vs. 12%). 82.1% (n=64) of pts reporting wear-off used additional medications or supplements when that happened, chiefly NSAIDs (68.8%, n=44), muscle relaxers (42.2%, n=27) and/or opioids (37.5%, n=24). Among the 20 pts not satisfied with current axSpA treatment, side effects (6/20, 30.0%), or worry about risk of side effects (2/20, 10%) were the main reasons.Conclusion:In a predominantly female sample of bDMARD-treated axSpA patients with high disease activity, most expressed satisfaction with treatment. However, most experienced wear-off between doses and took supplementary medications, including opioids, to manage.References:[1]Dubash S, et al. Ther Adv Chronic Dis. 2018;9(3):77–8.[2]Van Der Heijde D, et al. Ann Rheum Dis. 2017;76(6):978–91.Table 1.Demographic and clinical characteristics by wear-off between bDMARD doses (n=128)Pts currently on bDMARD(N=128)Wear-off between bDMARD oses(N=78)No wear-off / Not sure(N=50)p-valueNumber or mean (% or SD)Age46.9 (10.3)46.1 (9.2)48.2 (11.8)0.25Female106 (82.8)69 (88.5)37(74.0)0.03White115 (89.8)70 (89.7)45 (90.0)0.96Body Mass Index30.9 (7.8)31.2 (8.5)30.4 (6.6)0.57Current Medications, addition to bDMARDConventional Synthetic DMARD (e.g. methotrexate, sulfasalazine)17 (13.3)15 (19.2)2 (4.0)0.01Prescription NSAID59 (46.1)39 (50.0)20 (40.0)0.27Other prescription medication¥70 (54.7)44 (56.4)26 (52.0)0.62Noticed improvement in symptoms related to axSpA since starting current bDMARD80 (62.5)51 (65.4)29 (58.0)0.40Noticed improvement in symptoms NOT related to axSpA since starting current bDMARD40 (31.3)22 (28.2)18 (36.0)0.35BASDAI‡6.4 (1.8)6.8 (1.6)5.9 (2.0)0.01PROMIS Pain Interference ł65.3 (5.7)66.0 (5.1)64.3 (6.4)0.09PROMIS Physical Function ł36.7 (5.6)36.1 (5.3)37.7 (5.8)0.11PROMIS Sleep Disturbance ł59.8 (8.5)61.2 (7.7)57.6 (9.3)0.02* Statistical significance between groups of pts who experienced wear-off between bDMARD or not, p < 0.05¥ Other prescription medications: muscle relaxers, nerve pain medications or anti-depressants, and opioids‡ BASDAI is scored on a 0-10 scale with score ≥4 indicating suboptimal control of diseaseł PROMIS measures use T-score metric in which 50 is mean, 10 is standard deviation (SD), of US population; higher T-score = more of concept measuredAcknowledgements:This study was sponsored by Eli Lilly and Company. We thank the patients who participated in this study.Disclosure of Interests:W. Benjamin Nowell Grant/research support from: Full-time employee of Global Healthy Living Foundation, an independent nonprofit research organization, which received funding pursuant to a contract from Eli Lilly to conduct the study that is the subject of this abstract; Principal Investigator for studies with grant support from AbbVie, Amgen and Eli Lilly, Kelly Gavigan Grant/research support from: Full-time employee of Global Healthy Living Foundation, an independent nonprofit research organization, which received funding pursuant to a contract from Eli Lilly to conduct the study that is the subject of this abstract, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, William Malatestinic Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Lisse Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Carol Himelein Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Curtis Consultant of: AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer

Ce travail fait le point sur les recherches et idées récentes concernant les Basques dans le golfe du Saint-Laurent et en Acadie atlantique. Des découvertes nouvelles et le retour aux collections existantes ont amplifié la liste des sites basques connus, et ce, dans plusieurs régions. Les recherches en archives ont progressé également, identifiant les lieux de pêche basque dans le sud du golfe, et les lieux d’enterrement de marins décédés. Ce travail révèle la complexité des activités basques selon trois thèmes : la diversité des activités basques, le rapport des Basques d’Espagne avec le pouvoir colonial français, et les rapports entre Basques et Autochtones au xviie siècle, en particulier les Inuits et les Mi’kmaq. Ces thèmes synthétisent les adaptations des Basques au contexte historique qui ne cesse d’évoluer au cours des 250 ans de leur présence. Puisque ces adaptations variaient dans l’espace, ce texte présente les recherches et idées récentes selon quatre régions : la Grande Baie, le sud de Terre-Neuve, l’Acadie atlantique et l’Acadie laurentienne.

Desde a primeira publicação a respeito, em 2001, injeções lipolíticas para gordura localizada tornou-se um procedimento amplamente utilizado na clínica. Consiste de múltiplas injeções subcutâneas de compostos lipolíticos, que podem ter diversos mecanismos de ação. O fármaco mais utilizado atualmente, o desoxicolato de sódio, foi descoberto por acaso, em uma associação com fosfatidilcolina em que sua única função era de veículo da fórmula. Conforme estudos foram sendo realizados, concluiu-se que a ação no tecido era devido ao desoxicolato, um sal biliar que emulsiona os lipídios da membrana celular, resultando em lise do adipócito e consequente necrose do tecido adiposo. Seus principais efeitos adversos, muito frequentemente relatados, incluem dor intensa, edema e formação de nódulos fibrosos nos pontos aplicados. Em decorrência de falhas na aplicação, alguns efeitos adversos mais graves podem ocorrer, como injúria do nervo facial e infecções persistentes. Apesar destes, a utilização de desoxicolato de sódio na camada subcutânea apresenta resultados muito positivos, como publicado em diversos ensaios clínicos, inclusive com relação à satisfação do paciente perante o desfecho final, sendo, portanto, uma boa escolha de técnica para contorno corporal e diminuição de depósitos de gordura localizados. Palavras-chave: injeções lipolíticas, gordura localizada, desoxicolato de sódio, fosfatidilcolina.

Abstract Abstract 4404 Hemolytic anemia and renal failure are among the very rare side effects related to immunoglobulin transfusions. Anti-A/B antibodies are implicated in hemolytic events upon transfusion of high doses, given in short time. Recently several cases of IVIG induced hemolytic anemia have been published as case reports (MJ Thomas et al. Blood 1993; AG Brox et al. Am J Med 1987; Z Daw et al. Transfusion 2008; JR Wilson et al. Muscle Nerve 1997; J Coghill et al. Biol Blood Marrow Transplant 2006; RL Comenzo et al. J Pediatr 1992; F Yin et al. J Hematol 2008). One recent report describes the development of acute kidney injury related to hemoglobinuria as a result of IVIG induced hemolytic anemia (CC Welles et al. Am J Kid Dis 2009). In most cases, high cumulative doses 2gr/kg were administered. Most of the patients showed a positive direct antiglobulin test, and most were of non-O blood type. Various concentrations of anti-A, anti-B, and anti-D hemagglutinin were detected in the different IVIG products that were infused in each case. A systematic comparison of anti A/B and free-light chain content was performed in 5 different, commercially available IVIG preparations. The quantitative estimation of IgG anti-A/B in IVIG preparations is depending on choosing the appropriate method. Thus, hemagglutination, ABO-ELISA, and FACS all detect some form of anti-A/B albeit with different sensitivity and specificity. The immune complex which forms in A1-patients will activate complement and induce the IVIG-associated hemolytic anemia. In such patients the Direct Antiglobulin Test (Coombs Test) will turn reactive. In most countries, health authorities set a limit of anti-A RBC agglutination titers <32 or <64 which is arbitrary of this semi quantitative procedure. Here we subject a hemagglutination system to various cell suspension buffer conditions and look at variations. To achieve high sensitivity in the hemagglutination striking-pattern assay, two type A1 red blood cells (RBC) were selected and the assay performed using 4 different suspension conditions as a function of pH and molarity. Quantitative estimation of light chains was done using nephelometry with polyclonal antibodies against the hidden light chain determinant on free kappa and lambda light chains devoid of cross-reaction with the kappa and lambda epitopes on intact IgG (The Binding Site, Oxford). A BN prospect system was used to evaluate the information. To determine the anti-A/B content a series of dilutions was made and the last agglutinating concentration (mg/(ml) was taken as the final content. The last agglutinating concentration of immunoglobulin preparations 1 to 5 varied from 1.95 to 25 in NaCl. In NaCl+Liss (low ionic strength solution, which enhances antigen-antibody binding) variation was from 6.25 to 25, in phosphate buffered saline (PBS) it varied from 4.4 to 25 and in PBS+Liss it varied from 3.125 to 25. Preparation 2 was the strongest agglutinator and preparation 4 the lowest in all milieus. The 5 IgG preparations assessed contained < 0.3% free kappa of total IgG and < 0.28% free lambda light chains. It is likely that the induction of side effects under usual administration conditions by anti-A is improbable with trigger limits acknowledged by the health authorities; however, transfusions of high doses of IVIG during short times could reach critical limits. High anti-A content IVIG transfusions, especially to A-type recipients, could reach critical limits to cause hemolysis. The FLC content appears at trace concentrations. References on poster Disclosures: Schleis: octapharma USA Inc: Employment. Nydegger:octapharma AG: Consultancy.

In the summer of 1944, American Sergeant Paul Dorsey was hired by the Naval Aviation Photography Unit (NAPU) to capture “the Marines’ bitter struggle against their determined foe” in the Pacific islands (Philips 43). Dorsey had been a photographer and photojournalist before enlisting in the Marines, and was thus well placed to fulfil the NAPU’s remit of creating positive images of American forces in the Pacific. Under the editorial and professional guidance of Edward Steichen, NAPU photographers like Dorsey provided epic images of battle (especially from the air and sea), and also showed American forces at ease – sunbathing, swimming, drinking and relaxing together (Bachner At Ease; Bachner Men of WWII). Steichen – by now a lieutenant commander – oversaw the entire NAPU project by developing, choosing and editing the images, and also providing captions for their reproduction in popular newspapers and magazines such as LIFE. Under his guidance, selected NAPU images were displayed at the famous Power in the Pacific exhibition at the Museum of Modern Art in New York at the end of the war, and distributed in the popular U.S. Navy War Photographs memorial book which sold over 6 million copies in 1945.While the original NAPU photographers (Steichen himself, Charles Kerlee, Horace Bristol, Wayne Miller, Charles Fenno Jacobs, Victor Jorgensen and Dwight Long) had been at work in the Pacific since the summer of 1942, Dorsey was hired specifically to document the advance of American Marines through the Marianas and Volcano Islands. In line with the NAPU’s remit, Dorsey provided a number of famous rear view shots of combat action on Guam, Saipan and Iwo Jima. However, there are a number of his photographs that do not fit easily within that vision of war – images of wounded Marines and dead Japanese soldiers, as well as shots of abject Japanese POWs with their heads bowed and faces averted. It is this last group of enemy images that proves the most interesting, for not only do they trouble NAPU’s explicit propaganda framework, they also challenge our traditional assumption that photography is an inert form of representation.It is not hard to imagine that photographs of abject Japanese POWs reinforced feelings of triumph, conquest and justice that circulated in America’s post-war victory culture. Indeed, images of emaciated and incarcerated Japanese soldiers provided the perfect contrast to the hyper-masculine, hard-bodied, beefcake figures that populated the NAPU photographs and symbolized American power in the Pacific. However, once Japan was rehabilitated into a powerful American ally, and the decision to drop the atomic bomb was questioned once again in America’s Culture Wars of the 1980s and 90s, it was no longer acceptable to feel triumphant in the face of Japanese abjection and suffering. Instead, these images helped foster a new kind of belated patriotism – and a new global disposition – in which Americans generated their own magnanimity by expressing pity, compassion and sympathy for victims of their previous foreign policy decisions (Lisle).While that patriotic interpretive framework tells us much about how dominant formations of American identity are secured by the production – especially the visual production – of enemy others, it cannot account for images or viewer interpretations that exceed, unwork, or disrupt war’s foundational logics of friend/enemy and perpetrator/victim. I focus on Dorsey because he offers one such ‘deviant’ image: This photograph was taken by Dorsey on Guam in July 1944, and its caption tells us that the Japanese prisoner “waits to be questioned by intelligence officers” (Philips 189). As the POW looks into Dorsey’s camera lens (and therefore at us, the viewers), he is subject to the collective gaze of the American marines situated behind him, and presumably others that lay out of the frame, behind Dorsey. What is fascinating about this particular image is the prisoner’s refusal to obey the trope of abjection so readily assumed by other Japanese POWs documented in the NAPU archive and in other popular war-time imagery. Indeed, when I first encountered this image I immediately framed the POW’s return gaze as defiant – a challenging, bold, and forceful reply to American aggression in the Pacific. The problem, of course, was that this resistant gaze soon became reductive; that is, by replicating war’s foundational logics of difference it effaced a number of other dispositions at work in the photograph. What I find compelling about the POW’s return gaze is its refusal to be contained within the available subject positions of either ‘abject POW’ or ‘defiant resistor’. Indeed, this unruliness is what keeps me coming back to Dorsey’s image, for it teaches us that photography itself always exceeds the conventional assumption that it is a static form of visual representation.Photography, Animation, MovementThe connections between movement, stillness and photography have two important starting points. The first, and more general, is Walter Benjamin’s concept of the dialectic image in which the past and the present come together “in a flash” and constitute what he calls “dialectics at a standstill” (N3.1; 463). Unlike Theodore Adorno, who lamented Benjamin’s Medusa-like tendency to turn the world to stone, I read Benjamin’s concept of standstill – of stillness in general – as something fizzing and pulsating with “political electricity” (Adorno 227-42; Buck-Morss 219). This is to deny our most basic assumption about photography: that it is an inert visual form that freezes and captures discrete moments in time and space. My central argument is that photography’s assumed stillness is always constituted by a number of potential and actual mobilities that continually suture and re-suture viewing subjects and images into one another.Developing Benjamin’s idea of a the past and present coming together “in a flash”, Roland Barthes provides the second starting point with his notion of the punctum of photography: “this element which rises from the scene, shoots out of it like an arrow, and pierces me” (25). Conventional understandings of the punctum frame it as a static moment – so powerful that it freezes the viewer, stops them in their tracks, and captures their attention. My point is that the affective punch of the photograph is not a frozen moment at all; rather, the punctum – like the dialectic image – is fizzing with political electricity. Therefore, to suggest that a viewing subject is arrested in the moment of perception – that they are somehow captured by a photograph’s meaning – is to mistakenly understand the act of looking as a static behaviour.I want to use Dorsey’s image of the POW to push these theoretical starting points and explore the mobile dispositions that are generated when a viewing subject encounters a photograph. What most interests me about Dorsey’s photograph is the level of animation it produces. The POW’s return gaze is actually rather blank: it is unclear whether he is angry, weary, bored, insane or none of the above. But it is the viewing subject’s anxiety at such ambivalence – such unknowability – that provokes a powerful desire to name it. The visceral sensations and emotional responses provoked in viewers (are we taken aback? Do we sympathize with the POW? Are we equally blank?) very quickly become settled interpretations, for example, “his defiant gaze resists American power.” What I want to do is explore the pre-interpretive moment when images like Dorsey’s reach out and grab us – for it is in that moment that photography’s “political electricity” reveals itself most clearly.Production, Signification, InterpretationThe mobility inherent in the photograph has an important antecedent at the level of production. Since the Brownie camera was introduced in WWI, photographers have carried their mode of representation with them – in Dorsey’s case, his portable camera was carried with him as he travelled with the Marines through the Pacific (Philips 29). It is the photographer’s itinerary – his or her movement prior to clicking the camera’s shutter – that shapes and determines a photograph’s content. More to the point, the action of clicking the camera’s shutter is never an isolated moment; rather, it is punctured by all of the previous clicks and moments leading up to it – especially on a long photographic assignment like Dorsey’s – and contains within it all of the subsequent clicks and moments that potentially come after it. In this sense, the photographer’s click recalls Benjamin: it is a “charged force field of past and present” (Buck-Morss 219). That complicated temporality is also manifested in the photographer’s contact sheet (or, more recently, computer file) which operates as a visual travelogue of discrete moments that bleed into one another.The mobility inherent in photography extends itself into the level of signification; that is, the arrangements of signs depicted within the frame of each discrete image. Critic Gilberto Perez gives us a clue to this mobility in his comments about Eugène Atget’s famous ‘painterly’ photographs of Paris:A photograph begins with the mobility, or at least potential mobility, of the world’s materials, of the things reproduced from reality, and turns that into a still image. More readily than in a painting, we see things in a photograph, even statues, as being on the point of movement, for these things belong to the world of flux from which the image has been extracted (328).I agree that the origin point of a photograph is potential mobility, but that mobility is never completely vanquished when it is turned into a still image. For me, photographs – no matter what they depict – are always saturated with the “potential mobility of the world’s materials”, and in this sense they are never still. Indeed, the world of flux out of which the image is extracted includes the image itself, and in that sense, an image can never be isolated from the world it is derived from. If we follow Perez and characterize the world as one of flux, but then insist that the photograph can never be extracted from that world, it follows that the photograph, too, is characterized by fluctuation and change – in short, by mobility. The point, here, is to read a photograph counter intuitively – not as an arrest of movement or a freezing of time, but as a collection of signs that is always potentially mobile. This is what Roland Barthes was hinting at when he suggested that a photograph is “a mad image, chafed by reality”: any photograph is haunted by absence because the depicted object is no longer present, but it is also full of certainty that the depicted object did exist at a previous time and place (113-15). This is precisely Benjamin’s point as well, that “what has been comes together with the now” (N3.1; 463). Following on from Barthes and Benjamin, I want to argue that photographs don’t freeze a moment in time, but instead set in motion a continual journey between feelings of absence in the present (i.e. “it is not there”) and present imaginings of the past (i.e. “but it has indeed been”).As Barthes’ notion of the punctum reveals, the most powerful register at which photography’s inherent mobility operates is in the sensations, responses and feelings provoked in viewers. This is why we say that a photograph has the capacity to move us: the best images take us from one emotional state (e.g. passive, curious, bored) and carry us into another (e.g. shocked, sad, amused). It is this emotional terrain of our responses to photography that both Roland Barthes and Susan Sontag have explored in depth. Why are we moved by some images and not others? Are documentary or artistic photographs more likely to reach out and prick us? What is the most appropriate or ethical response to pictures of another’s suffering?Sontag suggests a different connection between photography and mobility in that it enables a particular touristification of the world; that is, cameras help “convert the world into a department store or museum-without-walls in which every subject is depreciated into an article of consumption, promoted to an item for aesthetic appreciation” (On Photography 110). While Sontag’s political economy of photography (with its Frankfurt School echo) continues to be explored by anthropologists and scholars in Tourism Studies, I want to argue that it offers a particularly reductive account of photography’s potential mobilities. While Sontag does address photography’s constitutive and rather complex relationship with reality, she still conceives of photographs themselves as static and inert representations. Indeed, what she wrestled with in On Photography was the “insolent, poignant stasis of each photograph”, and the photograph’s capacity to make reality “stand still” (111-12; 163). The problem with such a view is that it limits our account of interpretation; in short, it suggests that viewers either accept a photograph’s static message (and are thus moved), or reject it (and remain unmoved). But the moving, here, is the sole prerogative of the viewer: there is no sense in which the photograph and its contents are themselves mobile. I want to argue that the relationships established in the act of looking between viewing subjects and the objects contained within an image are much more complex and varied than Sontag’s framework suggests. Photography’s Affective MobilityTo reveal the mobilities underscoring photography’s affective punch, we must redistribute its more familiar power relations through W.J.T. Mitchell’s important question: what do pictures want? Such a question subverts our usual approach to photographs (i.e. what do we want from photographs?) by redeploying the privileged agency of the viewer into the image itself. In other words, it is the image that demands something of the viewer rather than the other way around. What it demands, of course, is a response. Certainly this is an emotional response, for even being bored by a photograph is a response of sorts. But an emotional response is also an affective response, which means that the punch carried by a photograph is as physical as it is metaphorical or visual. Indeed, it is precisely in the act of perception, where the emotional and the affective fuse, that photography’s assumed stillness is powerfully subverted.If Mitchell animates the picture by affording it some of the viewer’s agency, then Gilles Deleuze goes one step further by exploring what happens to agency in the act of perception. For Deleuze, a work of art – for our purposes, a photograph – is not an inert or still document, but rather a “block of sensations” (Deleuze; Deleuze & Guattari; Bogue). It is not a finished object produced by an autonomous artist or beheld in its entirety by an autonomous viewer; rather, it is a combination of precepts (initial perceptions) and affects (physical intensities) that passes through all subjects at the point of visual perception. This kind of relational encounter with an image not only deconstructs Modernity’s foundational distinction between the subject and the object, it also opens up an affective connection between all subjects engaged in the act of looking; in this case, the photographer, the subjects and objects within the photograph and the viewer.From Deleuze, we know that perception is characterized by common physical responses in all subjects: the movement of the optic nerve, the dilation of the pupil, the squint of the eyelid, the craning of the neck to see up close. However small, however imperceptible, these physical sensations are all still movements; indeed, they are movements repeated by all seeing subjects. My point is that these imperceptible modes of attention are consistently engaged in the act of viewing photographs. What this suggests is that taking account of the affective level of perception changes our traditional understandings of interpretation; indeed, even if a photograph fails to move us emotionally, it certainly moves us physically, though we may not be conscious of it.Drawing from Mitchell and Deleuze, then, we can say that a photograph’s “insolent, poignant stasis” makes no sense. A photograph is constantly animated not just by the potentials inherent in its enframed subjects and objects, but more importantly, in the acts of perception undertaken by viewers. Certainly some photographs move us emotionally – to tears, to laughter, to rage – and indeed, this emotional terrain is where Barthes and Sontag offer important insights. My point is that all photographs, no matter what they depict, move us physically through the act of perception. If we take Mitchell’s question seriously and extend agency to the photograph, then it is in the affective register that we can discern a more relational encounter between subjects and objects because both are in a constant state of mobility.Ambivalence and ParalysisHow might Mitchell’s question apply to Dorsey’s photograph? What does this image want from us? What does it demand from our acts of looking? The dispersed account of agency put forward by Mitchell suggests that the act of looking can never be contained within the subject; indeed, what is produced in each act of looking is some kind of subject-object-world assemblage in which each component is characterised by its potential and actual mobilities. With respect to Dorsey’s image, then, the multiple lines of sight at work in the photograph indicate multiple – and mobile – relationalities. Primarily, there is the relationship between the viewer – any potential viewer – and the photograph. If we follow Mitchell’s line of questioning, however, we need to ask how the photograph itself shapes the emotive and affective experience of visual interpretation – how the photograph’s demand is transmitted to the viewer.Firstly, this demand is channelled through Dorsey’s line of sight that extends through his camera’s viewfinder and into the formal elements of the photograph: the focused POW in the foreground, the blurred figures in the background, the light and shade on the subjects’ clothing and skin, the battle scarred terrain, and the position of these elements within the viewfinder’s frame. As viewers we cannot see Dorsey, but his presence fills – and indeed constitutes – the photograph. Secondly, the photograph’s demand is channelled through the POW’s line of sight that extends to Dorsey (who is both photographer and marine Sergeant), and potentially through his camera to imagined viewers. It is precisely the return gaze of the POW that packs such an affective punch – not because of what it means, but rather because of how it makes us feel emotionally and physically. While a conventional account would understand this affective punch as shocking, stopping or capturing the viewer, I want to argue it does the opposite – it suddenly reveals the fizzing, vibrant mobilities that transmit the picture to us, and us to the picture.There are, I think, important lessons for us in Dorsey’s photograph. It is a powerful antecedent to Judith Butler’s exploration of the Abu Graib images, and her repetition of Sontag’s question of “whether the tortured can and do look back, and what do they see when they look at us” (966). The POW’s gaze provides an answer to the first part of this question – they certainly do look back. But as to what they see when they look back at us, that question can only be answered if we redistribute both agency and mobility into the photograph to empower and mobilize the tortured, the abject, and the objectified.That leaves us with Sontag’s much more vexing question of what we do after we look at photographs. As Butler explains, Sontag has denounced the photograph “precisely because it enrages without directing the rage, and so excites our moral sentiments at the same time that it confirms our political paralysis” (966). This sets up an important challenge for us: in refusing conventional understandings of photography as a still visual art, how can we use more dispersed accounts of agency and mobility to work through the political paralysis that Sontag identifies. AcknowledgementsPaul Dorsey’s photograph of the Japanese POW is # 80-G-475166 in the NAPU archive, and is reproduced here courtesy of the United States National Archives.ReferencesAdorno, Theodore. Prisms. 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IntroductionThis paper addresses two separate notions of embodiment – western maternal embodiment and art making as a form of embodied critical resistance. It takes as its subject breeder; my unpublished five minute video installation from 2012, which synthesises these two separate conceptual framings of embodiment as a means to visually and conceptually rupture dominant ideologies surrounding Australian motherhood. Emerging from a paradoxical landscape of fear, loathing and desire, breeder is my dark satirical take on ambivalent myths surrounding suburban Australian motherhood. Portraying my white, heavily pregnant body breeding, cooking and consuming pink, sugar-coated butterflies, breeder renders literal the Australian mother as both idealised nation-builder and vilified, self-indulgent abuser. A feminine reification of Goya’s Saturn Devouring His Children, breeder attempts to make visible my own grapplings with maternal ambivalence, to complicate even further, the already strained position of motherhood within the Australian cultural imaginary. Employing the mediums of video and performance to visually manifest an ambivalent protagonist who displays both nurturing maternal ideals and murderous inclinations, breeder pushes contradictory maternal expectations to their breaking point and challengingly offers the following proposition: “This is what you want; but what you’ll get is so much more than you bargained for” (Grosz 136). Drawing upon critical, feminist theorising that challenges idealised views of motherhood; accounts of motherhood by mothers themselves; as well as my own personal grapplings with maternal expectations, this paper weaves reflexive writing with textual analysis to explore how an art-based methodology of embodied critical resistance can problematise representations of motherhood within Australia. By visualising the disjuncture between dominant representations of motherhood that have saturated Australian mainstream media since the late 1990s and the complex ambivalent reality of some women’s actual experiences of mothering, this paper discusses how breeder’s intimate portrayal of maternal domesticity at the limits of tolerability, critically resists socially acceptable mothering practices by satirising the cultural construct of motherhood as a means “to use it, deform it, and make it groan and protest” (Nietzsche qtd. in Gutting).Contradictory Maternal KnowledgeImages of motherhood are all around us; communicating ideals and stereotypes that tell us how mothers should feel, think and act. But these images and the concepts of motherhood that underpin them are full of contradictions. Cultural representations of the idealised and sometimes “yummy mummy” - middle class, attractive, healthy, sexy and heterosexual – (see Fraser; Johnson), contrast with depictions of “bad” mothers, leading to motherhood being simultaneously idealised and demonised within the popular press (Bullen et al.; McRobbie, Top Girls; McRobbie, In the Aftermath; McRobbie, Reflections on Feminism; Walkerdine et al.). Mothers own accounts of motherhood reflect these unsettling contradictions (Miller; Thomson et al.; Wilkinson). Claiming the maternal experience is both “heaven and hell” due to the daily experience of irreconcilable and contradictory feelings (Coward), mothers (myself included), silently struggle between feelings of extreme love and opposing feelings of failure, despair and hate as we get caught up in trying to achieve a set of ideals that promulgate standards of perfection that are beyond our reach. Surrounded by images of motherhood that do not resonate with the contradictory nature of the lived maternal experience, mothers are “torn in two” as we desperately try to reconcile or find absolution for maternal emotions that dominant cultural representations of motherhood render unacceptable. According to Roszika Parker, this complicated and contradictory experience where a mother has both loving and hating feelings for her child is that of maternal ambivalence; a form of exquisite suffering that oscillates between the overwhelming affect of blissful gratification and the raw edges of bitter resentment (Parker 1). As Parker states, maternal ambivalence refers to:Those fleeting (or not so fleeting) feelings of hatred for a child that can grip a mother, the moment of recoil from a much loved body, the desire to abandon, to smash the untouched plate of food in a toddler’s face, to yank a child’s arm while crossing the road, scrub too hard with a face cloth, change the lock on an adolescent or the fantasy of hurling a howling baby out of the window (5).However, it is not only feelings of hatred that stir up ambivalence in the mother, so too can the overwhelming intensity of love itself render the rush of ambivalence so surprising and so painful. Commenting on the extreme contradictory emotions that fill a mother and how not only excessive hatred, but excessive love can turn dangerously fatal, Parker turns to Simone De Beauvoir’s idea of “carnal plenitude”; that is, where the child elicits from the mother, the emotion of domination; where the child becomes the “other” who is both prey and double (30). For Parker, De Beauvoir’s “carnal plenitude” is imaged by mothers in a myriad of ways, from a desire to gobble up the child, to feelings of wanting to gather the child into a fatal smothering hug. Commenting on her own unsettling love/hate relationship with her child, Adrienne Rich describes her experiences of maternal ambivalences as “the murderous alternation between bitter resentment and raw-edged nerves and blissful gratification and tenderness” (363). Unable to come to terms with this paradox at the core of the unfolding process of motherhood, our culture defends itself against this illogical ambivalence in the mother by separating the good nurturing mother from the bad neglectful mother in an attempt to deny the fact that they are one and the same. Resulting in a culture that either denigrates or idealises mothers, we are constantly presented with images of the good perfect nurturing mother and her murderous alter ego; the bad fatal mother who neglects and smothers. This means that how a mother feels about mothering or the meaning it has for her, is heavily determined by cultural representations of motherhood. Arguing for a creative transformation of the maternal that breaches the mutual exclusivities that separate motherhood, I am called to action by Susan Rubin Suleiman, who writes (quoting psychoanalyst Helene Deutsch): “Mothers don’t write, they are written” (Suleiman 5). As a visual attempt to negotiate, translate and thus “write” my lived experience of Australian motherhood, breeder gives voice to the raw material of contradictory (and often taboo experiences) surrounding maternal embodiment and subjectivity. Hijacking and redeploying contradictory understandings and representations of Australian motherhood to push maternal ideals to their breaking point, breeder seeks to create a kind of “mother trouble” that challenges the disjuncture between dominant social constructions of motherhood designed to keep us assigned to our proper place. Viscerally embracing the reality that much of life with small children revolves around loss of control and disintegration of physical boundaries, breeder visually explores the complex and contradictory performances surrounding lived experiences of mothering within Australia to complicate even further the already strained position of western maternal embodiment.Situated Maternal KnowledgeOver the last decade and a half, women’s bodies and their capacity to reproduce have become centre stage in the unfolding drama of Australian economic policy. In 1999 fears surrounding dwindling birth-rates and less future tax revenue, led then Victorian Premier Jeff Kennett to address a number of exclusive private girls’ schools. Making Australia-wide headlines, Kennett urged these affluent young women to abandon their desire for a university degree and instead invited them to consider motherhood as the ultimate career choice (Dever). In 2004, John Howard’s Liberal government made headlines as they announced the new maternity allowance; a $3000 lump-sum financial incentive for women to leave work and have babies. Ending this announcement by urging the assembled gathering of mostly male reporters to go home and have “one for the Dad, one for the Mum and one for the Country” (Baird and Cutcher 103), Federal Treasurer Peter Costello made a last ditch effort to save Baby Boomers from their imminent pensionless doom. Failing to come to terms with the impending saturation of the retirement market without the appropriate tax payer support, the Liberal Government turned baby-making into the ultimate Patriotic act as they saw in women bodies, the key to prevent Australia’s looming economic crisis. However, not all women’s bodies were considered up to the job of producing the longed for “Good tax-paying Citizen” (Tyler). Kennett only visited exclusive private girls’ schools (Ferrier), headhunting only the highest calibre of affluent breeders. Blue-collar inter-mingling was to be adamantly discouraged. Costello’s 2004 “baby bonus” catch-cry not only caused international ire, but also implicitly relegated the duty of child-bearing patriotism to a normalised heterosexual, nuclear family milieu. Unwed or lesbian mothers need not apply. Finally, as government spokespeople repeatedly proclaimed that the new maternity allowance was not income tested, this suggested that the target nation-builder breeder demographic was the higher than average income earner. Let’s get it straight people – only highly skilled, high IQ’s, heterosexual, wedded, young, white women were required in this exclusive breeding program (see Allen and Osgood; Skeggs; Tyler). And if the point hadn’t already been made perfectly clear, newspaper tabloids, talkback radio and current affairs programs all over the country were recruited to make sure the public knew exactly what type of mother Australia was looking for. Out of control young, jobless single mothers hit the headlines as fears abounded that they were breeding into oblivion. An inherently selfish and narcissistic lot, you could be forgiven for thinking that Australia was running rampant with so-called bogan single mothers, who left their babies trapped in hot airless cars in casino carparks all over the country as they spent their multiple “baby bonus’” on booze, ciggies, LCD’s and gambling (see Milne; O’Connor; Simpson and Dowling). Sucking the economy dry as they leeched good tax-payer dollars from Centrelink, these undesirables were the mothers Australia neither needed nor wanted. Producing offspring relegated to the category of bludgerhood before they could even crawl, these mothers became the punching bag for the Australian cultural imaginary as newspaper headlines screamed “Thou Shalt Not Breed” (Gordon). Seen as the embodiment of horror regarding the ever out-of-control nature of women’s bodies, these undesirable mothers materialised out of a socio-political landscape that although idealised women’s bodies as Australia’s economic saviour, also feared their inability to be managed and contained. Hoarding their capacity to reproduce for their own selfish narcissistic desires, these white trash mothers became the horror par excellence within the Australian cultural imaginary as they were publically regarded as the vilified evil alter-ego of the good, respectable white affluent young mother Australian policy makers were after. Forums all over the country were inundated. “Yes,” the dominant voices seemed to proclaim: “We want to build our population. We need more tax-paying citizens. But we only want white, self-less, nurturing, affluent mothers. We want women who can breed us moral upstanding subjects. We do not want lazy good for nothing moochers.” Emerging from this paradoxical maternal landscape of fear, loathing and desire, breeder is a visual and performative manifestation of my own inability to come to terms with the idealisation and denigration of motherhood within Australia. Involving a profound recognition that the personal is still the political, I not only attempt to visually trace the relationship between popular Australian cultural formations and individual experiences, but also to visually “write” my own embodied grapplings with maternal ambivalence. Following the premise that “critique without resistance is empty and resistance without critique is blind” (Hoy 6), I find art practice to be a critically situated and embodied act that can openly resist the power of dominant ideologies by highlighting maternal corporeal transgressions. A creative destablising action, I utilise the mediums of video and performance within breeder to explore personal, historical and culturally situated expectations of motherhood within Australia as a means to subvert dominant ideologies of motherhood within the Australian cultural imaginary. Performing Maternal KnowledgeReworking Goya’s Romantic Gothic vision of fatherhood in Saturn Devouring His Children, breeder is a five minute two-screen video performance that puts an ironic twist to the “good” and “bad” myths of Australian motherhood. Depicting myself as the young white heavily pregnant protagonist breeding monarch butterflies in my suburban backyard, sugar-coating, cooking and then eating them, breeder uses an exaggerated kitsch aesthetic to render literal the Australian mother as both idealistic nation-builder and self-indulgent abuser. Selfishly hoarding my breeding potential for myself, luxuriating and devouring my “offspring” for my own pleasure and delight rather than for the common good, breeder simultaneously defies and is complicit with motherhood expectations within the suburban Australian imaginary. Filmed in my backyard in the southern suburbs of Perth, Western Australia, breeder manifests my own maternal ambivalence and deliberately complicates the dichotomous and strained position motherhood holds in western society. Breeder is presented as a two screen video installation. The left screen is a fast-paced, brightly coloured, jump-cut narrative with a pregnant protagonist (myself). It has three main scenes or settings: garden, kitchen and terrace. The right screen is a slow-moving flow of images that shows the entire monarch butterfly breeding cycle in detail; close ups of eggs slowly turning into caterpillars, caterpillars creating cocoons and the gradual opening of wings as butterflies emerge from cocoons. All the while, the metamorphic cycle is aided by the pregnant protagonist, who cares for them until she sets them free of their breeding cage. In the left screen, apricot roses, orange trees, yellow hibiscus bushes, lush green lawns, a swimming pool and an Aussie backyard garden shed are glimpsed as the pregnant protagonist runs, jumps and sneaks up on butterflies while brandishing a red-handled butterfly net; dressed in red high heels and a white lace frock. Bunnies with pink bows jump, dogs in pink collars bark and a very young boy dressed in a navy-blue sailor suit all make cameo appearances as large monarch butterflies are collected and placed inside a child’s cherry red insect container. In a jump-cut transition, the female protagonist appears in a stark white kitchen; now dressed in a bright pink and apricot floral apron and baby-pink hair ribbon tied in a bow in her blonde ponytail. Standing behind the kitchen bench, she carefully measures sugar into a bowl. She then adds pink food colouring into the crystal white sugar, turning it into a bright pink concoction. Cracking eggs and separating them, she whisks the egg whites to form soft marshmallow peaks. Dipping a paint brush into the egg whites, she paints the fluffy mixture onto the butterflies (now dead), which are laid out on a well-used metal biscuit tray. Using her fingers to sprinkle the bright pink sugar concoction onto the butterflies, she then places them into the oven to bake and stands back with a smile. In the third and final scene, the female protagonist sits down at a table in a garden terrace in front of French-styled doors. Set for high tea with an antique floral tea pot and cup, lace table cloth and petit fours, she pours herself a cup of tea. Adding a teaspoon of sugar, she stirs and then selects a strawberry tart from a three-tiered high-tea stand that holds brightly iced cupcakes, cherry friands, tiny lemon meringue pies, sweet little strawberry tarts and pink sugar coated butterflies. Munching her way through tarts, pies, friands and cupcakes, she finally licks her lips and fuchsia tipped fingers and then carefully chooses a pink sugar coated butterfly. Close ups of her crimson coated mouth show her licking the pink sugar-crumbs from lips and fingers as she silently devours the butterfly. Leaning back in chair, she smiles, then picks up a pink leather bound book and relaxes as she begins to read herself into the afternoon. Screen fades to black. ConclusionAs a mother I am all fragmented, contradictory; full of ambivalence, love, guilt and shame. After seventeen years and five children, you would think that I would be used to this space. Instead, it is a space that I battle to come to terms with each and every day. So how to strategically negotiate engrained codes of maternity and embrace the complexities of embodied maternal knowledge? Indeed, how to speak of the difficulties and incomparable beauties of the maternal without having those variously inflected and complex experiences turn into clichés of what enduring motherhood is supposed to be? Visually and performatively grappling with my own fallout from mothering ideals and expectations where sometimes all I feel I am left with is “a monster of selfishness and intolerance” (Rich 363), breeder materialises my own experiences with maternal ambivalence and my inability to reconcile or negotiate multiple contradictory identities into a single maternal position. Ashamed of my self, my body, my obsessions, my anger, my hatred, my rage, my laughter, my sorrow and most of all my oscillation between a complete and utter desire to kill each and every one of my children and an overwhelming desire to gobble them all up, I make art work that is embedded in the grime and grittiness of my everyday life as a young mother living in the southern suburbs of Western Australia. A life that is most often mundane, sometimes sad, embarrassing, rude and occasionally heartbreaking. A life filled with such simple joy and such complicated sorrow. A life that in reality, is anything but manageable and contained. Although this is my experience, I know that I am not the only one. As an artist I engage in the embodied and critically resistant practice of sampling from my “mother” identities in order to bring out multiple, conflictive responses that provocatively encourage new ways of thinking and acknowledging embodied maternal knowledge. Although claims abound that this results in a practice that is “too personal” or “too specific” (Liss xv), I do not believe that this in fact risks reifying essentialism. Despite much feminist debate over the years regarding essentialist/social constructivist positions, I would still rather use my body as a site of embodied knowledge then rhetorically give it up. 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