Journal articles: 'National Negro Congress (U.S.)' – Grafiati (2024)

Abstract:

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. hom*ocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, hom*ocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

Abstract:

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Antipsychotics in anxiety disorders</strong></p><p>Christer Allgulander</p><p><strong>2. Anxiety in somatic disorders</strong></p><p>Christer Allgulander</p><p><strong>3. Community rehabilitation of the schizophrenic patient</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera</p><p><strong>4. Dual diagnosis: A theory-driven multidisciplinary approach for integrative care</strong></p><p>David Blackbeard</p><p><strong>5. The emotional language of the gut - when 'psyche' meets 'soma'</strong></p><p>Helen Clark</p><p><strong>6. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>7. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>8. Developing and adopting mental health policies and plans in Africa: Lessons from South Africa, Uganda and Zambia</strong></p><p>Sara Cooper, Sharon Kleintjes, Cynthia Isaacs, Fred Kigozi, Sheila Ndyanabangi, Augustus Kapungwe, John Mayeya, Michelle Funk, Natalie Drew, Crick Lund</p><p><strong>9. The importance of relapse prevention in schizophrenia</strong></p><p>Robin Emsley</p><p><strong>10. Mental Health care act: Fact or fiction?</strong></p><p>Helmut Erlacher, M Nagdee</p><p><strong>11. Does a dedicated 72-hour observation facility in a district hospital reduce the need for involuntary admissions to a psychiatric hospital?</strong></p><p>Lennart Eriksson</p><p><strong>12. The incidence and risk factors for dementia in the Ibadan study of ageing</strong></p><p>Oye Gureje, Lola Kola, Adesola Ogunniyi, Taiwo Abiona</p><p><strong>13. Is depression a disease of inflammation?</strong></p><p><strong></strong>Angelos Halaris</p><p><strong>14. Paediatric bipolar disorder: More heat than light?</strong></p><p>Sue Hawkridge</p><p><strong>15. EBM: Anova Conundrum</strong></p><p>Elizabeth L (Hoepie) Howell</p><p><strong>16. Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit</strong></p><p>Bernard Janse van Rensburg</p><p><strong>17. Dual diagnosis units in psychiatric facilities: Opportunities and challenges</strong></p><p>Yasmien Jeenah</p><p><strong>18. Alcohol-induced psychotic disorder: A comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia</strong></p><p>Gerhard Jordaan, D G Nel, R Hewlett, R Emsley</p><p><strong>19. Anxiety disorders: the first evidence for a role in preventive psychiatry</strong></p><p>Andre F Joubert</p><p><strong>20. The end of risk assessment and the beginning of start</strong></p><p>Sean Kaliski</p><p><strong>21. Psychiatric disorders abd psychosocial correlates of high HIV risk sexual behaviour in war-effected Eatern Uganda</strong></p><p>E Kinyada, H A Weiss, M Mungherera, P Onyango Mangen, E Ngabirano, R Kajungu, J Kagugube, W Muhwezi, J Muron, V Patel</p><p><strong>22. One year of Forensic Psychiatric assessment in the Northern Cape: A comparison with an established assessment service in the Eastern Cape</strong></p><p>N K Kirimi, C Visser</p><p><strong>23. Mental Health service user priorities for service delivery in South Africa</strong></p><p>Sharon Kleintjes, Crick Lund, Leslie Swartz, Alan Flisher and MHaPP Research Programme Consortium</p><p><strong>24. The nature and extent of over-the-counter and prescription drug abuse in cape town</strong></p><p>Liezl Kramer</p><p><strong>25. Physical health issues in long-term psychiatric inpatients: An audit of nursing statistics and clinical files at Weskoppies Hospital</strong></p><p>Christa Kruger</p><p><strong>26. Suicide risk in Schizophrenia - 20 Years later, a cohort study</strong></p><p>Gian Lippi, Ean Smit, Joyce Jordaan, Louw Roos</p><p><strong>27.Developing mental health information systems in South Africa: Lessons from pilot projects in Northern Cape and KwaZulu-Natal</strong></p><p>Crick Lund, S Skeen, N Mapena, C Isaacs, T Mirozev and the Mental Health and Poverty Research Programme Consortium Institution</p><p><strong>28. Mental health aspects of South African emigration</strong></p><p>Maria Marchetti-Mercer</p><p><strong>29. What services SADAG can offer your patients</strong></p><p>Elizabeth Matare</p><p><strong>30. Culture and language in psychiatry</strong></p><p>Dan Mkize</p><p><strong>31. Latest psychotic episode</strong></p><p>Povl Munk-Jorgensen</p><p><strong>32. The Forensic profile of female offenders</strong></p><p>Mo Nagdee, Helmut Fletcher</p><p><strong>33. The intra-personal emotional impact of practising psychiatry</strong></p><p>Margaret Nair</p><p><strong>34. Highly sensitive persons (HSPs) and implications for treatment</strong></p><p>Margaret Nair</p><p><strong>35. Task shifting in mental health - The Kenyan experience</strong></p><p>David M Ndetei</p><p><strong>36. Bridging the gap between traditional healers and mental health in todya's modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>37. Integrating to achieve modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>38. Non-medical prescribing: Outcomes from a pharmacist-led post-traumatic stress disorder clinic</strong></p><p>A Parkinson</p><p><strong>39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research</strong></p><p>Charles Parry</p><p><strong>40. Global mental health - A new global health discipline comes of age</strong></p><p>Vikram Patel</p><p><strong>41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa</strong></p><p>Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium</p><p><strong>42. Personality disorders -The orphan child in axis I - Axis II Dichotomy</strong></p><p><strong></strong>Willie Pienaar</p><p><strong>43. Case Studies in Psychiatric Ethics</strong></p><p>Willie Pienaar</p><p><strong>44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications</strong></p><p>Janus Pretorius</p><p><strong>45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials</strong></p><p>Suvira Ramlall, Jennifer Chipps</p><p><strong>46. Biological basis of addication</strong></p><p>Solomon Rataemane</p><p><strong>47. Genetics of Schizophrenia</strong></p><p>Louw Roos</p><p><strong>48. Management of delirium - Recent advances</strong></p><p>Shaquir Salduker</p><p><strong>49. Social neuroscience: Brain research on social issues</strong></p><p>Manfred Spitzer</p><p><strong>50. Experiments on the unconscious</strong></p><p>Manfred Spitzer</p><p><strong>51. The Psychology and neuroscience of music</strong></p><p>Manfred Spitzer</p><p><strong>52. Mental disorders in DSM-V</strong></p><p>Dan Stein</p><p><strong>53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study</strong></p><p>Ugashvaree Subramaney</p><p><strong>54. Eating disorders: An African perspective</strong></p><p>Christopher Szabo</p><p><strong>55. An evaluation of the WHO African Regional strategy for mental health 2001-2010</strong></p><p>Thandi van Heyningen, M Majavu, C Lund</p><p><strong>56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia</strong></p><p>Jacques J M van Hoof</p><p><strong>57. The origin of mentalisation and the treatment of personality disorders</strong></p><p>Jacques J M Hoof</p><p><strong>58. How to account practically for 'The Cause' in psychiatric diagnostic classification</strong></p><p>C W (Werdie) van Staden</p><p><strong>POSTER PRESENTATIONS</strong></p><p><strong>59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>60. Prevalence of alcohol drinking problems and other substances at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>61. Lessons learnt from a modified assertive community-based treatment programme in a developing country</strong></p><p>Ulla Botha, Liezl Koen, John Joska, Linda Hering, Piet Ooosthuizen</p><p><strong>62. Perceptions of psychologists regarding the use of religion and spirituality in therapy</strong></p><p>Ottilia Brown, Diane Elkonin</p><p><strong>63. Resilience in families where a member is living with schizophreni</strong></p><p>Ottilia Brown, Jason Haddad, Greg Howcroft</p><p><strong>64. Fusion and grandiosity - The mastersonian approach to the narcissistic disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>65. Not being allowed to exist - The mastersonian approach to the Schizoid disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>66. Risky drug-injecting behaviours in Cape Town and the need for a needle exchange programme</strong></p><p>Volker Hitzeroth</p><p><strong>67. Neuroleptic malignant syndrome in adolescents in the Western Cape: A case series</strong></p><p>Terri Henderson</p><p><strong>68. Experience and view of local academic psychiatrists on the role of spirituality in South African specialist psychiatry, compared with a qualitative analysis of the medical literature</strong></p><p>Bernard Janse van Rensburg</p><p><strong>69. The role of defined spirituality in local specialist psychiatric practice and training: A model and operational guidelines for South African clinical care scenarios</strong></p><p>Bernard Janse van Rensburg</p><p><strong>70. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founder population</strong></p><p>Marinda Joubert, J L Roos, J Jordaan</p><p><strong>71. A role for structural equation modelling in subtyping schizophrenia in an African population</strong></p><p>Liezl Koen, Dana Niehaus, Esme Jordaan, Robin Emsley</p><p><strong>72. Caregivers of disabled elderly persons in Nigeria</strong></p><p>Lola Kola, Oye Gureje, Adesola Ogunniyi, Dapo Olley</p><p><strong>73. HIV Seropositivity in recently admitted and long-term psychiatric inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>74. Syphilis seropisitivity in recently admitted longterm psychiatry inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>75. 'The Great Suppression'</strong></p><p>Sarah Lamont, Joel Shapiro, Thandi Groves, Lindsey Bowes</p><p><strong>76. Not being allowed to grow up - The Mastersonian approach to the borderline personality</strong></p><p>Daleen Macklin, W Griffiths</p><p><strong>77. Exploring the internal confirguration of the cycloid personality: A Rorschach comprehensive system study</strong></p><p>Daleen Macklin, Loray Daws, M Aronstam</p><p><strong>78. A survey to determine the level of HIV related knowledge among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p><strong></strong> T G Magagula, M M Mamabolo, C Kruger, L Fletcher</p><p><strong>79. A survey of risk behaviour for contracting HIV among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p>M M Mamabolo, T G Magagula, C Kruger, L Fletcher</p><p><strong>80. A retrospective review of state sector outpatients (Tara Hospital) prescribed Olanzapine: Adherence to metabolic and cardiovascular screening and monitoring guidelines</strong></p><p>Carina Marsay, C P Szabo</p><p><strong>81. Reported rapes at a hospital rape centre: Demographic and clinical profiles</strong></p><p>Lindi Martin, Kees Lammers, Donavan Andrews, Soraya Seedat</p><p><strong>82. Exit examination in Final-Year medical students: Measurement validity of oral examinations in psychiatry</strong></p><p>Mpogisheng Mashile, D J H Niehaus, L Koen, E Jordaan</p><p><strong>83. Trends of suicide in the Transkei region of South Africa</strong></p><p>Banwari Meel</p><p><strong>84. Functional neuro-imaging in survivors of torture</strong></p><p>Thriya Ramasar, U Subramaney, M D T H W Vangu, N S Perumal</p><p><strong>85. Newly diagnosed HIV+ in South Africa: Do men and women enroll in care?</strong></p><p>Dinesh Singh, S Hoffman, E A Kelvin, K Blanchard, N Lince, J E Mantell, G Ramjee, T M Exner</p><p><strong>86. Diagnostic utitlity of the International HIC Dementia scale for Asymptomatic HIV-Associated neurocognitive impairment and HIV-Associated neurocognitive disorder in South Africa</strong></p><p>Dinesh Singh, K Goodkin, D J Hardy, E Lopez, G Morales</p><p><strong>87. The Psychological sequelae of first trimester termination of pregnancy (TOP): The impact of resilience</strong></p><p>Ugashvaree Subramaney</p><p><strong>88. Drugs and other therapies under investigation for PTSD: An international database</strong></p><p>Sharain Suliman, Soraya Seedat</p><p><strong>89. Frequency and correlates of HIV Testing in patients with severe mental illness</strong></p><p>Hendrik Temmingh, Leanne Parasram, John Joska, Tania Timmermans, Pete Milligan, Helen van der Plas, Henk Temmingh</p><p><strong>90. A proposed mental health service and personnel organogram for the Elizabeth Donkin psychiatric Hospital</strong></p><p>Stephan van Wyk, Zukiswa Zingela</p><p><strong>91. A brief report on the current state of mental health care services in the Eastern Cape</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri, Heloise Uys, Mo Nagdee, Maricela Morales, Helmut Erlacher, Orlando Alonso</p><p><strong>92. An integrated mental health care service model for the Nelson Mandela Bay Metro</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri</p><p><strong>93. Traditional and alternative healers: Prevalence of use in psychiatric patients</strong></p><p>Zukiswa Zingela, S van Wyk, W Esterhuysen, E Carr, L Gaauche</p>

Abstract:

The paper describes factors that lead to the United States trade restrictions, particularly export control at the end of the second decade; the challenges of the United States policy, prospects for international trade relations. World trade is expected to grow this year after reducing in the previous one. The outlook for trade development remains with a large degree of uncertainty due to economic, financial risks, effects of struggle against pandemia; national policies. The US trade restriction policies are in focus. Besides imposing import tariffs; controlling exports of software, sensitive equipment, technology has been transformed under Trump’s administration in the context of national security, foreign policy objectives. Limiting access to the most sensitive U.S. technology has been putting in practice along with new export controls on software; restrictions on the emerging and foundational technologies. Export Control Reform that was passed by Congress and signed into law by President Trump has determined a new stage in US policy and may bring more uncertainty as concerning relations with other countries.

Abstract:

The article provides an analysis of the state of affairs in the field of the U.S. missile defense, inherited by the Biden administration from the previous administration. The U. S. missile defense policy can be roughly divided into three components: homeland missile defense, regional missile defense, and advanced developments related to these both parts. Conclusions are made about the prospects of missile defense policy, taking into account such factors as the views of experts from think tanks close to the Democratic Party, funding of programs, and measures taken in the field of missile defense. The development of the homeland missile defense systems faces technological challenges which create uncertainty about the whole architecture. Regional missile defense systems are going to be platforms for development of systems to intercept intercontinental ballistic missiles and hypersonic weapons. The National Space Defense Architecture is planned to include layers which are supposed to be part of homeland and regional defenses. The main obstacles to these programs are the position of Democratic members of the U. S. Congress, an urgent need for funds for recovery of the national economy after the COVID&#8209;19 pandemic, and other defense policy priorities (e. g., nuclear modernization). In connection with these findings, the author presents an overview of options of a missile defense deal between Russia and the United States as part of the arms control regime. Although every option has its disadvantages and potential obstacles, a bilateral executive agreement on transparency in missile defense seems to be the most feasible option.

Abstract:

Covid-19 presented a major external shock to the United States governmental system . The system itself, crafted in the 18th century, was not designed to easily absorb this shock . The U .S . government is divided by the Constitution in two important ways: through a system of federalism in which state power vies with federal power, and through a separated system at the national level in which Congress, the President and the Supreme Court wrestle with each other over lawmaking and policy authority . By 2019, the system was stymied by increasing partisan polarization, magnified by the Presidency of Donald Trump . Responses to Coronavirus would have to be shepherded through a labyrinthian path and would face horizontal (separated powers) and vertical (state, federal, local) challenges, in addition to partisan wrangling . At a more micro level Congress itself faced, in addition to all of the hurdles already mentioned, specific problems in what could be termed “capacity” . Congres- sional policymaking relies on physical presence—in committees, on the floor, in party cau- cuses and in member organizations—to get its business done . With the nation and the world facing quarantines, lockdowns and stay-at-home orders, how could Congress main- tain physical presence? Should it? What alternatives might there be? Along with the rest of the country, Congressional staff adjusted to working from home . Maintaining national security during remote work would be problematic, certainly, but even more basic prob- lems were exposed as it came to light that many congressional offices lacked the technology and equipment to provide staffers with secure means to get their jobs done from remote locations . Covid-19 made clear that the United States Congress was facing 21st Century problems in an organization with 20th (or even 19th or 18th) century procedures and structures . How could it respond to the immediate problem? And, perhaps more importantly, what would be the path forward once the country moved past the crisis?

Abstract:

Abstract In August 2022, the U.S. Congress passed the Inflation Reduction Act (IRA), which intended to accelerate U.S. decarbonization, clean energy manufacturing, and deployment of new power and end-use technologies. The National Renewable Energy Laboratory has examined possible scenarios for growth by 2050 resulting from the IRA and other emissions reduction drivers and defined several possible scenarios for large-scale wind deployment. These scenarios incorporate large clusters of turbines operating as wind farms grouped around existing or likely transmission lines which will result in wind farm wakes. Using a numerical weather prediction (NWP) model, we assess these wake effects in a domain in the U. S. Southern Great Plains for a representative year with four scenarios in order to validate the simulations, estimate the internal wake impact, and quantify the cluster wake effect. Herein, we present a validation of the ”no wind farm” scenario and quantify the internal waking effect for the ”ONE” wind farm scenario. Future work will use the “MID” scenario (more than 8000 turbines) and the “HI” scenario (more than 16,000 turbines) to quantify the effect of cluster wakes or inter-farm wakes on power production.

Abstract:

Abstract At the end of the Mexican-American War in 1848, the United States annexed what had been the Mexican Department of New Mexico, and as it did, it absorbed millions of acres of agro-pastoral land whose parcels had been under a communal system of ownership by Mexican citizen-villagers. From the heirs’ point of view, the subsequent American system of adjudicating ownership of these traditional properties proved inadequate, leading to the loss of two-thirds of their commons to American land speculators and the U. S. National Forest. Like the Native Americans, the heirs of these grants have long seethed in resentment over the steady erosion of their hold on their traditional lands and culture. This article outlines the processes of despoliation of the land grants from their original owners, and, more centrally, suggests the historical cycles of collective struggle that the heirs have mounted since the 1840s in order to retain and wrest back their commons, as well as organize the grants that they have been able to secure. A stubborn land-grant movement has gone through various forms of collective action including clandestine violence, protest confrontation, legal strategies, and political lobbying. In the most recent phase, activists have hopeful signs that the U.S. Congress is ready to respond to their demand for return of commons now under federal jurisdiction.

Abstract:

<p><strong>1. How can we maintain a sustainable private practice in the current political and economic climate?</strong></p><p>Eugene Allers</p><p><strong>2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression</strong></p><p> Eugene Allers, Margaret Nair, Gerhard Grobler</p><p><strong>3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country</strong></p><p>U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn</p><p><strong>4. Neurophysiology of emotion and senses - The interface between psyche and soma</strong></p><p>Eugene Allers</p><p><strong>5. Suicide prevention: From and beyond the psychiatrist's hands</strong></p><p>O Alonso Betanourt, M Morales Herrera</p><p><strong>6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic </strong></p><p>B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge</p><p><strong>7. Treatment of attention deficit hyperactivity disorder in the young child</strong></p><p>Helen Clark</p><p><strong>8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services</strong></p><p>J Dill</p><p><strong>9. Treating Schizophrenia: Have we got it wrong?</strong></p><p>Robin Emsley</p><p><strong>10.Terminal questions in the elderly</strong></p><p>Mike Ewart Smith</p><p><strong>11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia</strong></p><p>Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium</p><p><strong>12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders?</strong></p><p>Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson)</p><p><strong>13. Does unipolar mania merit research in South Africa? A look at the literature</strong></p><p>Christoffel Grobler</p><p><strong>14. Revisiting the Cartesian duality of mind and body</strong></p><p>Oye Gureje</p><p><strong>15. Child and adolescent psychopharmacology: Current trends and complexities</strong></p><p>S M Hawkridge</p><p><strong>16. Integrating mental illness, suicide and religion</strong></p><p>Volker Hitzeroth</p><p><strong>17. Cost of acute inpatient mental health care in a 72-hour assessment uniy</strong></p><p>A B R Janse van Rensburg, W Jassat</p><p><strong>18. Management of Schizophrenia according to South African standard treatment guidelines</strong></p><p>A B R Janse van Rensburg</p><p><strong>19. Structural brain imaging in the clinical management of psychiatric illness</strong></p><p>F Y Jeenah</p><p><strong>20. ADHD: Change in symptoms from child to adulthood</strong></p><p>S A Jeeva, A Turgay</p><p><strong>21. HIV-Positive psychiatric patients in antiretrovirals</strong></p><p>G Jonsson, F Y Jeenah, M Y H Moosa</p><p><strong>22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape</strong></p><p>John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein</p><p><strong>23. Star'd - Critical review and treatment implications</strong></p><p>Andre Joubert</p><p><strong>24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session</strong></p><p>Andre Joubert</p><p><strong>25. My brain made me do it: How Neuroscience may change the insanity defence</strong></p><p>Sean Kaliski</p><p><strong>26. Child andadolescent mental health services in four African countries</strong></p><p>Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium</p><p><strong>27. Individualistic theories of risk behaviour</strong></p><p>Liezl Kramer, Volker Hitzeroth</p><p><strong>28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma?</strong></p><p>Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium</p><p><strong>29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital</strong></p><p>Carri Lewis, Christa Kruger</p><p><strong>30. Mental health and poverty: A systematic review of the research in low- and middle-income countries</strong></p><p>Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium</p><p><strong>31. The cost of scaling up mental health care in low- and middle-income countries</strong></p><p>Crick Lund, Dan Chishlom, Shekhar Saxena</p><p><strong>32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape</strong></p><p>P Milligan, J S Parker</p><p><strong>33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour</strong></p><p>D L Mkize</p><p><strong>34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005)</strong></p><p>N M Moola, N Khamker, J L Roos, P Rheeder</p><p><strong>35. One flew over Psychiatry nest</strong></p><p>Leverne Mountany</p><p><strong>36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry</strong></p><p>Margaret G Nair</p><p><strong>37. Developing the frameor of a postgraduate da programme in mental health</strong></p><p>R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay</p><p><strong>38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital</strong></p><p>J S Parker, P Milligan</p><p><strong>39. Task shifting: A practical strategy for scalingup mental health care in developing countries</strong></p><p>Vikram Patel</p><p><strong>40. Ethics: Informed consent and competency in the elderly</strong></p><p>Willie Pienaar</p><p><strong>41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good</strong></p><p>Willie Pienaar</p><p><strong>42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country</strong></p><p>Duncan Ian Rodseth</p><p><strong>43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry</strong></p><p>Felix Potocnik</p><p><strong>44. Brain stimulation techniques - update on recent research</strong></p><p>P J Pretorius</p><p><strong>45. Holistic/Alternative treatments in psychiatry</strong></p><p>T Rangaka, J Dill</p><p><strong>46. Cognitive behaviour therapy and other brief interventions for management of substances</strong></p><p>Solomon Rataemane</p><p><strong>47. A Transtheoretical view of change</strong></p><p>Nathan P Rogerson</p><p><strong>48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period</strong></p><p>Deleyn Rema, Lindiwe Mthethwa, Christa Kruger</p><p><strong>49. Management of psychogenic and chronic pain - A novel approach</strong></p><p>M S Salduker</p><p><strong>50. Childhood ADHD and bipolar mood disorders: Differences and similarities</strong></p><p>L Scribante</p><p><strong>51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication</strong></p><p>Dinesh Singh, Karl Goodkin</p><p><strong>52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums</strong></p><p><strong></strong>Dan J Stein</p><p><strong>53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study</strong></p><p>Ugash Subramaney</p><p><strong>54. Canabis use in Psychiatric inpatients</strong></p><p><strong></strong>M Talatala, G M Nair, D L Mkize</p><p><strong>55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country</strong></p><p>H S Teh, P P Oosthuizen</p><p><strong>56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa</strong></p><p>Rita Thom</p><p><strong>57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital</strong></p><p>Ronel van der Westhuizen, Christa Kruger</p><p><strong>58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study</strong></p><p>Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein</p><p><strong>59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)?</strong></p><p>Werdie van Staden</p><p><strong>60. What every psychiatrist needs to know about scans</strong></p><p>Herman van Vuuren</p><p><strong>61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series</strong></p><p>Urvashi Vasant, Dinesh Singh</p><p><strong>62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress</strong></p><p>Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein</p><p><strong>63. Approaching the dual diagnosis dilemma</strong></p><p>Lize Weich</p><p><strong>64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction</strong></p><p>Denise White</p><p><strong>65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD</strong></p><p>Dora Wynchank</p>

Abstract:

In response to a 2010 mandate from Congress, the National Oceanic and Atmospheric Administration (NOAA) produced a specifically-designed Risk Assessment for Potentially Polluting Wrecks in U.S. Waters that was then provided to the U. S. Coast Guard (USCG). A total of 87 risk assessments were presented to the USCG for inclusion into Area Contingency Plans required for all coastal, marine and Great Lakes waters in the U.S. under the Oil Pollution Act of 1990 (33 U.S. Code § 1321) in May 2013. USCG relies on NOAA for expertise in response and contingency planning and as a resource trustee for both natural resources and underwater cultural heritage. The USCG has used the RULET assessments to foster dialogue with both the potentially affected public and responders and to start thinking through general issues associated with shipwrecks that may have historical significance in additional to being potential pollution hazards. Over the past three years, several surveys of opportunity have provided an opportunity for concurrent assessments of historical and cultural significance and site-specific assessment of pollution potential. Several wrecks have been downgraded in terms of their risk, one has been remediated, one patched (FERNSTREAM, USNS MISSION SAN MIGUEL.). Surveillance and monitoring efforts have provided additional insight to specific wrecks and even helped identify wrecks that were excluded from the assessment (COIMBRA, W.E. HUTTON, USS MURPHY). Surveys have moved two wrecks across international boundaries (or rather provided new locations for TB ARGO and MV COAST TRADER.) In-water assessments have lead to unexpected pollution response challenges, such as those associated with the TB ARGO. As salvage and response technologies develop and additional surveys of opportunity take place the new information provides for continued refinement of the contingency plans and protects our environmental and economic resources along the coast. This paper will provide an evaluation and an update as to the overall effectiveness of this assessment effort to date. Activities since 2013 have significantly moved forward the understanding and engagement on the issue by responders, trustees and the public regarding potentially polluting wrecks in U.S. waters and have provided insight to other jurisdictions dealing with similar challenges.

Abstract:

The World Trade Center Attack or 9/11 tragedy has awakened the international community, particularly the United States (US) to sharpen its foreign policy in facing security threats coming from ‘weak states’. One of the most prominent weak states examples that pose a grave threat to other countries are the Northern Triangle Countries of Central America that referred to Guatemala, Honduras, and El Salvador. Hence, this paper will discuss the rationale behind US initiatives in dealing with security threats in El Salvador as one of the Northern Triangle Countries. In analyzing the case, the writers will use the weak state concept and national interest concept. The result of this paper finds that El Salvador corresponds to the elements of a weak state and further poses security threats by giving rise to transnational criminal organizations, drug trafficking, and migrant problems in which overcoming those security threats has become US vital national interest. 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Guardian News and Media, November 18, 2014.https://www.theguardian.com/world/2014/nov/18/el-salvador-gang-violence-child-migration-crisis. Accessed July 11, 2021. “Life under Gang Rule in El Salvador.” Crisis Group, December 10, 2018. https://www.crisisgroup.org/latin-america-caribbean/central-america/el-salvador/life-under-gang-rule-el-salvador. Löwenheim, Oded. “Transnational Criminal Organizations and Security: The Case against Inflating the Threat.” International Journal 57, no. 4 (2002): 513–36. https://doi.org/10.2307/40203690. “Mano Dura: El Salvador Responds to Gangs.” Taylor & Francis. Accessed August 5, 2021.https://www.tandfonline.com/doi/abs/10.1080/09614520701628121?journalCode=cdip20.Menjivar, Cecilia, and Andrea Gomez Cervates. “El Salvador: Civil War, Natural Disasters, and Gang Violence Drive Migration.” migrationpolicy.org, May 11, 2021.https://www.migrationpolicy.org/article/el-salvador-civil-war-natural-disasters-and-gang-violence-drive-migration. Accessed July 11, 2021. Meyer, Peter J., and Ribando Clare Seelke. Central America Regional Security Initiative: Background and Policy Issues for Congress. Washington, D.C.: Library of Congress, Congressional Research Service, 2014. Michaels, Peter S. Lawless Intervention: United States Foreign Policy in El Salvador and Nicaragua, 6, 7, no. 2 (January 5, 1987). https://doi.org/https://core.ac.uk/download/pdf/71463263.pdf. OSAC. “El Salvador 2020 Crime & Safety Report,” https://www.osac.gov/Content/Report/b4884604- 977e-49c7-9e4a-1855725d032e. Days on July 9, 2021. “Overview.” World Bank. Accessed August 4, 2021. https://www.worldbank.org/en/country/elsalvador/overview. Patrick, Stewart. “Weak States and Global Threats: Assessing Evidence of Spillovers.” SSRN Electronic Journal, 2006, 1–31. https://doi.org/10.2139/ssrn.984057. Published by Teresa Romero, and Jul 5. “Gini Coefficient: Wealth Inequality in El Salvador.” Statista,July 5, 2021.https://www.statista.com/statistics/983230/income-distribution-gini-coefficient-el-salvador/. “Remarks by President Obama after Meeting with Central American Presidents.” National Archives and Records Administration. National Archives and Records Administration. Accessed August 8, 2021. https://obamawhitehouse.archives.gov/the-press-office/2014/07/25/remarks-president-obama-after-meeting-central-american-presidents. Riney, Lt Col Thomas J. “How Is MS-13 a Threat to US National Security? .” AIR WAR COLLEGE AIR UNIVERSITY , February 12, 2009. https://apps.dtic.mil/sti/pdfs/ADA540139.pdf. Rivera, Mauricio. “Drugs, Crime, and NONSTATE Actors in Latin America: Latin American Politics and Society.” Cambridge Core. Cambridge University Press, October 12, 2020. https://www.cambridge.org/core/journals/latin-american-politics-and-society/article/abs/drugs-crime-and-nonstate-actors-in-latin-america/67CF0B66AB8673D0C50F2F99AC93A1B7. Schneider, Mark. “Where Are the Northern Triangle Countries Headed? And What Is U.S. Policy?” Center for Strategic and International Studies (CSIS), July 9, 2021. https://www.csis.org/analysis/where-are-northern-triangle-countries-headed-and-what-us-policy. Seelke, Clare Ribando. “CRS Report for Congress.” El Salvador: Political, Economic, and Social Conditions and U.S. Relations, November 18, 2008. https://doi.org/https://www.refworld.org/pdfid/4951ec75e.pdf. Silva Avalos, Hector. “Corruption in El Salvador: Politicians, Police, and Transportistas.” SSRN, April 2, 2014. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2419174. Sleinan, Julett Pineda. “Salvadoran Court: Ex-President and Wife Guilty of Illicit Enrichment.” OCCRP. Accessed August 5, 2021. https://www.occrp.org/en/daily/13586-salvadoran-court-ex- president-and-wife-guilty-of-illicit-enrichment. The United States Department of Justice. “MS-13's Highest-Ranking Leaders Charged with Terrorism Offenses in the United States.”, January 19, 2021. https://www.justice.gov/opa/pr/ms-13-s-highest-ranking-leaders-charged-terrorism-offenses-united-states. Retrieved July 9, 2021. Transformation Index. “BTI 2020 El Salvador Country Report.” BTI Blog, 2020. https://www.bti-project.org/en/reports/country-report-SLV.html. Accessed July 11, 2021. “U.S. Strategy for Engagement in Central America Results Architecture – Overall Summary.”State.gov. Accessed August 8, 2021. https://www.state.gov/wp-content/uploads/2019/04/U.S.-Central-America-Strategy-Objectives.pdf. United Nations High Commissioner for Refugees. “Death Threats and Gang Violence Forcing More Families to FLEE Northern Central America – UNHCR and Unicef Survey.” UNHCR. Accessed August 5, 2021. https://www.unhcr.org/news/press/2020/12/5fdb14ff4/death-threats-gang-violence-forcing-families-flee-northern-central-america.html. U.S. Department of Homeland Security, “Combating Gangs,” https://www.ice.gov/features/gangs.Diakses pada 9 Juli 2021. USAID, “GENERATING HOPE: USAID IN EL SALVADOR, GUATEMALA, AND HONDURAS,”https://www.usaid.gov/generating-hope-usaid-el-salvador-guatemala-and honduras. Diakses pada 8 Juli 2021. United States General Accounting Office, “EL SALVADOR Military Assistance Has Helped Counter but Not Overcome the Insurgency,” https://www.gao.gov/assets/nsiad-91-166.pdf. Retrieved July 8, 2021. U.S. Immigration and Customs Enforcement “Combating Gangs.”, January 27, 2021. https://www.ice.gov/features/gangs. Accessed July 9, 2021. Valencia, Robert. “MS-13 and Barrio 18 Gangs Allegedly Employ More People in El Salvador than the Country's Largest Employers.” Newsweek. 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<p><strong>Abstract.</strong> Today when online satellite images are just a click away, access to geographic information showing the latest images of the globe has dramatically expanded, and historico-geographic research based on such information is flourishing. However, in the study of Chinese history, historical research employing GIS or similar technologies is still in its infancy, since “historical” geographic information with a high degree of precision are lacking. From within the ambit of Chinese geographic information, this report specifically highlights aerial surveys effected during the Republic of China era. To start, we review the history of domestic aerial surveys during R. O. C. period. Then, focusing on Nanjing as an example, we proceed to introduce maps that were actually created based on aerial surveys.</p><p>Chinese aerial surveys date back to around 1930. At the Nationalist Party’s General Assembly in 1929, partisans proposed for the need for aerial surveys. In 1930, the “Aerial Photography and Survey Research Team” was formed within the General Land Survey Department at General Staff Headquarters (National Army of the Republic of China). Consequently, foreign technicians were invited to provide relevant education/training. In June 1931, China’s pioneer initiative in aerial photography took place in Zhejiang province. The aim of aerial surveys in those early days was to create maps for military purposes. Between 1932 and 1939, topographic maps of fortifications located in areas such as the Jiangnan district were prepared. Further, starting from around the same period until the Sino-Japanese War, land registry maps based on aerial surveys were also produced. After the Sino-Japanese War ended, the above-mentioned directorate handed over responsibility for aerial surveys to the Naval General Staff. However, in 1949 the Chinese Communist Party confiscated the maps theretofore produced.</p><p>Although the aerial photographs and the geographic information produced therefrom during the R. O. C. era were seized by the People’s Republic of China, in actuality, some had previously been transferred to Taiwan. The topographic maps of the Nanjing metropolitan area (一萬分一南京城廂附近圖), based on aerial surveys and drawn in 1932, are currently archived at Academia Historica in Taipei. Comprising a total of 16 sheets, these maps were drawn on a scale of 1:10,000 by the General Land Survey Department.</p><p>Similarly, other maps (各省分幅地形圖) produced by the General Land Survey Department, comprising a total of 56 sheets and partly detailing Nanjing, are now in the possession of Academia Sinica in Taipei. There was no information about photographing or making in these maps. But almost the same maps were archived at Library of Congress in Washington D. C. According to those maps at LC, based on aerial photographs taken and surveys conducted in 1933, these topographic maps (1:10,000 scale) were completed in 1936.</p><p>The examples introduced above are topographic maps based on aerial photography. However, starting in 1937, land registry maps were also created. Detailing the outskirts of Nanjing (1:1,000 scale) and comprising a total of 121 sheets, they are now archived at Academia Historica. While the land registry maps were produced in 1937, supplementary surveys were effected following the Sino-Japanese War in 1947.</p><p>Since the geographic information based on aerial surveys during the R. O. C. era in China were precise, they can serve as a source of manifold information. This report only delved into information developed by the Government of the R. O. C., but it is becoming evident that U. S. Armed Forces and Japan also produced geographic information of their own based on aerial surveys. If the comprehensive panorama captured by all three protagonists can be illuminated, further advances in Chinese historico-geographic studies employing geographic information will be forthcoming.</p>

Abstract:

Introduction. The most important indicator of effective control of a rational system of measures for the prevention of bacterial diseases is the results of microbiological monitoring of the internal environment of poultry houses and their facilities. Most often, the results of microbiological studies confirm the presence of pathogenic and opportunistic microflora belonging to the family Enterobacteriaceae, which includes more than 20 genera (Escherichia, Shigella, Salmonella, Klebsiella, Proteus, Citrobacter, Yersinia, etc.), which can cause disease not only in birds, but also in humans. Most often, the bacterial infection is mixed. The leading place in the etiological structure is occupied by microorganisms of the intestinal group, which are represented by Escherichia coli and Salmonella in associations with other species of opportunistic bacteria. The consequence of this is the development of bacterial infections, which dramatically reduce the resistance of birds compared to monoinfections and adversely affect the immunobiological reactivity of the organism and remain the main cause of death of birds. Bacterial diseases of poultry occupy a significant place among the current problems of modern poultry in all countries, the most epizootic are Escherichia coli, mycoplasmosis and salmonellosis of birds [1-4]. During monitoring studies in poultry farms, cultures of Escherichia coli, staphylococci, Proteus, Pseudomonas aeruginosa, ornithobacteria, etc. are isolated, which significantly complicates the timely and objective diagnosis and development of control and prevention measures. The goal of the work. To substantiate the effectiveness of Zn and Ag citrates in avian bacteriosis. Materials and methods: The research was conducted in the vivarium of the Faculty of Veterinary Medicine of Sumy NAU in compliance with ethical norms and rules of animal treatment adopted at the First National Congress of Bioethics (Kyiv, 2001) and the European Convention for the Protection of Vertebrate Animals scientific purposes "(Strasbourg, 1986), 80 heads of Leghorn chickens were used for the experiment. Of the drugs used new drugs citrates - are sorbents of a new generation, which are produced by LLC "DOCTOR OSKO" Sumy. The composition of these drugs contains natural activated zeolite, silver citrate and zinc citrate. The basis is zeolite (clinoptilolite) - a natural mineral used in medicine as a selective enterosorbent. Properties of the drug: zeolite corrects mineral deficiency and performs the transport function of microelements in the body and adsorbs toxic substances from the body while maintaining the natural balance. This modification technology consists in supplementing the mineral composition of the zeolite with ions of any macro- and microelements (in the form of citrates), "placing" them in the structure of its framework. The experimental bird at the age of 24 hours was divided into 8 groups - 4 control and 4 experimental. Chickens of the first control and two experimental groups (5.6 groups) at 10 days of age were infected with E. coli 078 at a dose of LD50 2 * 109μ / cm3. Chickens of the third and two other experimental (7.8 groups) were infected with S. pullorum in the same dose. In the fifth and seventh groups, Zn citrate was given at the dose of 15 g / 250 cm3 from the first day, and in the fourth, sixth and eighth groups, Ag citrate was given at the same dose. The drugs were administered daily for 14 days, and also monitored the clinical condition of chickens up to 30 days of age. Toxicological examination of meat samples taken from slaughtered chickens was performed using a standard commercial batch of culture of colfod infusoria, made in accordance with the requirements of the regulatory documentation TU U 46.15.243-97. Results of research and discussion. Zn and Ag citrates at a dose of 15 g / 250 cm3 prevent bacteriosis, namely Escherichia coli and salmonellosis. Preservation of chickens in the experimental groups was 90-100% The toxicity of poultry meat was determined using free-living ciliates, which are most commonly used in biotesting of drugs, feeds, and feed additives. Their use is explained by the ease of penetration of the investigated dispersed solutions of a certain concentration due to the lack of selective nutritional capacity. When a single-celled organism receives a toxic substance, it becomes highly excited or less mobile, loses orientation in space, changes the shape and size of the body, resulting in impaired division functions, then it slows down and dies. Examining chicken meat for the toxicity of citrates Ag and Zn drew attention to the previously listed characteristics, which are used as the main test reactions. Studies have shown that meat from healthy poultry does not adversely affect the culture of Colpoda steinii, which indicates the absence of toxic substances in meat The meat of poultry treated with Zn and Ag citrates did not adversely affect the colpod, they remained mobile for three hours in all samples. The intensity of their growth was 90%, which indicates the absence of toxic effects of citrates. The meat of poultry infected with Escherichia coli and salmonellosis was toxic - 90% of colpods died within three hours. The meat of chickens that were infected with S. pullorum on the background of the use of Ag citrate was slightly toxic, but when using Zn was non-toxic. Conclusion. Thus, experiments have established the effectiveness of the use of Zn and Ag citrates in Escherichia coli and salmonellosis of birds, when they are used, the safety of birds is 90-100%. Poultry meat that received citrates is safe - for three hours all colpods remained mobile, and their growth rate was 90%

Abstract:

RESUMENDesde hace siglos el cristianismo ha concebido que la vestimenta es un elemento casi definitorio de la calidad moral y de la religiosidad de las personas que la portan. Durante el primer tercio del siglo xx, el catolicismo español estuvo muy preocupado por la evolución de las modas femeninas modernas. Entendía que estas modas eran indecentes e inmorales, además de un símbolo del desorden social, del desmoronamiento general de las costumbres y de la descristianización de la sociedad. Los argumentos que los sectores católicos españoles utilizaron en contra de las modas modernas femeninas fueron muy variados. Entre ellos, destacaron la noción de que las mujeres que utilizaban este tipo de vestimentas iban desnudas, deslegitimaban la lucha por la ampliación de derechos de las mujeres, generaban una crisis en los matrimonios o se extranjerizaban. El trabajo está basado en fuentes primarias y secundarias. La mayor parte de los planteamientos se han extraído de las fuentes hemerográficas, y se ha dado especial protagonismo a las opiniones que sobre este asunto tuvieron algunas de las mujeres católicas más destacadas del periodo. Palabras clave: mujeres, género, vestimenta, religiónTopónimos: EspañaPeriodo: primer tercio del siglo xx ABSTRACTFor centuries the Christian Churches have conceived the clothing as an almost defining element of the moral quality and religiosity of its wearers. During the first third of the 20th century Spanish Catholicism was very concerned about the evolution of women’s clothes. They understood that modern clothes were indecent and immoral, a symbol of social disorder, of the general collapse of customs and the de-Christianization of society. Spanish Catholicism used several arguments to fight against modern feminine fashions. For example, they highlighted the notion that women who used this type of clothing were in fact naked; meanwhile they delegitimized the fight for the expansion of women’s rights, generated a crisis in the marriages and made Spanish women lose their national characteristics. The work is based on primary and secondary sources. Most of the opinions have been taken from newspapers. Special prominence has been given to the approaches defended by some of the most prominent Catholic women of the period. Keywords: women, gender, clothing, religionPlace names: SpainPeriod: first third of the 20th century REFERENCIASArce, R. (2016): La construcción social de la mujer por el catolicismo y las derechas españolas en la época contemporánea, Tesis doctoral, Universidad de Cantabria.Aresti, N. (2001): Médicos, donjuanes y mujeres modernas. Los ideales de feminidad y masculinidad en la España del primer tercio del siglo xx, Bilbao, Universidad del País Vasco.— (2002): “La nueva mujer sexual y el varón domesticado. El movimiento liberal para la reforma de la sexualidad (1920-1936)”, Arenal, 9, pp. 125-150. — (2018): “La peligrosa naturaleza de Don Juan. Sexualidad masculina y orden social en la España de entreguerras”, Cuadernos de historia contemporánea, 40, pp. 13-31.Arroyo Martín, C. (2017): La Moda Elegante Ilustrada en el periodo de entreguerras (1918-1927): análisis documental, Tesis doctoral, Universidad Complutense de Madrid.Blasco, I. (1997): “Moda e Imágenes Femeninas durante el Primer Franquismo: entre la Moralidad Católica y las Nuevas Identidades de Mujer”, Utopía y praxis latinoamericana, 2, pp. 83-93.— (2003): Paradojas de la ortodoxia. Política de masas y militancia católica femenina en España (1919-1939), Zaragoza, Prensas Universitarias de Zaragoza.— (2005): “Género y religión: de la feminización de la religión a la movilización católica femenina. Una revisión crítica”, Historia Social, 53, pp. 119-136.Courtine, J. J., Alain Corbin y Georges Vigarello (2005): Historia del cuerpo, Taurus.Díaz Freire, J. J. (1999): “La reforma de la vida cotidiana y el cuerpo femenino durante la dictadura de Primo de Rivera”, en Luis Castells (ed.): El rumor de lo cotidiano. Estudios sobre el País Vasco Contemporáneo, Bilbao, Universidad del País Vasco, pp. 225-257.Díaz Marcos, A. M. (2020): “Corazas estrafalarias: moda, corsés y feminismo en el cambio de siglo”, Indumenta: Revista del Museo del Traje, 3, pp. 23-39.Dwyer-Mcnulty, S. (2014): Common Threads: A Cultural History of Clothing in American Catholicism, Chapel Hill, The University of North Carolina Press.Echarri, M. (1915): Más poderoso que el amor, Barcelona, Imprenta Editorial Barcelonesa.— (1927): El que siembra con lágrimas…, Valencia, La novela hispano-americana.Gutiérrez García, M. A. (2005): “Literatura y moda: la indumentaria femenina a través de la novela española del siglo xix”, Tonos digital: Revista de estudios filológicos, 9, s/p. Lannon, F. (1999): “Los cuerpos de las mujeres y el cuerpo político católico: autoridades e identidades en conflicto en España durante las décadas de 1920 y 1930”, Historia social, 35, pp. 65-80.Llona, M. (2002): Entre señorita y garçonne: historia oral de las mujeres bilbaínas de clase media, (1919-1939), Málaga, Universidad de Málaga.— (2007): “Los otros cuerpos disciplinados: relaciones de género y estrategias de autocontrol del cuerpo femenino (primer tercio del siglo xx)”, Arenal, 14, pp. 79-108.— (2020): “Recordar el porvenir: las mujeres modernas y el desorden de género en los años veinte y treinta”, Arenal, 27, pp. 5-32.Louzao, J. (2010): Identidad, catolicismo y modernización en la Vizcaya de la restauración (1890-1923), Tesis doctoral, UPV/EHU.Martínez Sierra, G. (1917): Feminismo, feminidad, españolismo, Madrid, Renacimiento.Mauro, D. (2014): “La Mujer Católica y la sociedad de masas en la Argentina de entreguerras. Catolicismo social, consumo e industria cultural en la ciudad de Rosario (1915-1940)”, Hispania Sacra, 133, pp. 235-262.Mínguez, R. (2015): “¿Dios cambió de sexo? El debate internacional sobre la feminización de la religión y algunas reflexiones para la España decimonónica”, Historia contemporánea, 51, pp. 397-426. Monlleó, R. (2006): “Moda y ocio en los felices años veinte. La maternidad moral de las mujeres católicas en Castellón”. Asparkía, 17, pp. 197-228. Otero-González, U. (2021): “Catholic Dressing in the Spanish Franco Dictatorship (1939–1975): Normative Femininity and Its Sartorial Embodiment”, Journal of Religious History, 45, 4, pp. 582-602.Perales, M. y María Echarri (1944 [1915]): Redención, Madrid, Editorial Stylos, Pérez del Puerto, Á. (2021): Católicas de posguerra en acción. El discurso de género de Acción Católica en España y en Estados Unidos, Granada, Comares.—(2021): “Moda se escribe con m de moralidad. Identidad transnacional de la feminidad en los cuarenta a través del control del vestir por las mujeres de Acción Católica”, en José Ramón Rodríguez Lago y Natalia Núñez Bargueño (eds.), Madrid, Sílex, pp. 365-389.Sánchez Pinilla, F. (2016): La narración para niños: autoras, circuitos y textos en el cambio del siglo xix al xx, Tesis Doctoral, Universitat de València.Velasco Molpeceres, A. M. (2016): Moda y prensa femenina en la España del siglo xix, Madrid, Ediciones 19. — (2021): Historia de la moda en España: de la mantilla al bikini, Los Libros de la Catarata.Villanueva Cobo del Prado, M. (2016): La moda femenina en las publicaciones periódicas: Blanco y Negro 1891-1910, Tesis doctoral, Universitat de València.

Abstract:

Neil Beagrie's report gives an overview of some key international developments in digital preservation, selected because of their potential relevance to the U. S. National Digital Information Infrastructure and Preservation Program. The study focuses on major programs in four countries – Australia, France, the Netherlands, and the United Kingdom – and systematically describes each program's national context, institutional and national initiatives, international initiatives and planned/future international activities. It also describes some key multinational initiatives such as the Open Archival Information System and Preservation Technology for European Broadcast Archives.

Abstract:

Introduction Lillian Ng was born in Singapore and lived in Hong Kong and the United Kingdom before migrating to Australia with her daughter and Ah Mah Yin Jie (“Ah Mahs are a special group of people who took a vow to remain unmarried … [so they] could stick together as a group and make a living together” (Yu 118)). Ng studied classical Chinese at home, then went to an English school and later on studied Medicine. Her first book, Silver Sister (1994), was short-listed for the inaugural Angus & Robertson/Bookworld Prize in 1993 and won the Human Rights Award in 1995. Ng defines herself as a “Chinese living in Australia” (Yu 115). Food, flesh and meat are recurrent topics in Lillian Ng´s second novel Swallowing Clouds, published in 1997. These topics are related to desire and can be used as a synecdoche (a metaphor that describes part/whole relations) of the human body: food is needed to survive and pleasure can be obtained from other people´s bodies. This paper focuses on one type of meat and animal, pork and the pig, and on the relation between the two main characters, Syn and Zhu Zhiyee. Syn, the main character in the novel, is a Shanghainese student studying English in Sydney who becomes stranded after the Tiananmen Square massacre of June 1989. As she stops receiving money from her mother and fears repression if she goes back to China, she begins to work in a Chinese butcher shop, owned by Zhu Zhiyee, which brings her English lessons to a standstill. Syn and Zhu Zhiyee soon begin a two-year love affair, despite the fact that Zhu Zhiyee is married to KarLeng and has three daughters. The novel is structured as a prologue and four days, each of which has a different setting and temporal location. The prologue introduces the story of an adulterous woman who was punished to be drowned in a pig´s basket in the HuanPu River in the summer of 1918. As learnt later on, Syn is the reincarnation of this woman, whose purpose in life is to take revenge on men by taking their money. The four days, from the 4th to the 7th of June 1994, mark the duration of a trip to Beijing and Shanghai that Syn takes as member of an Australian expedition in order to visit her mother with the security of an Australian passport. During these four days, the reader learns about different Chinese landmarks, such as the Forbidden City, the Great Wall, the Ming Tomb and the Summer Palace, as well as some cultural events, such as a Chinese opera and eating typical foods like Peking duck. However, the bulk of the plot of the book deals with the sexual relationship, erotic games and fantasies of Syn and Zhu Zhiyee in the period between 1989 and 1992, as well as Syn´s final revenge in January 1993. Pigs The fact that Zhu Zhiyee is a butcher allows Lillian Ng to include references to pigs and pork throughout the novel. Some of them refer to the everyday work of a butcher shop, as the following examples illustrate: “Come in and help me with the carcass,” he [Zhu Zhiyee] pointed to a small suckling pig hung on a peg. Syn hesitated, not knowing how to handle the situation. “Take the whole pig with the peg,” he commanded (11).Under dazzling fluorescent tubes and bright spotlights, trays of red meat, pork chops and lamb cutlets sparkled like jewels … The trays edged with red cellophane frills and green underlay breathed vitality and colour into the slabs of pork ribs and fillets (15).Buckets of pig´s blood with a skim of froth took their place on the floor; gelled ones, like sliced cubes of large agate, sat in tin trays labelled in Chinese. More discreetly hidden were the gonads and penises of goats, bulls and pigs. (16)These examples are representative of Syn and Zhu Zhiyee´s relationship. The first quotation deals with their interaction: most of the time Zhu Zhiyee orders Syn how to act, either in the shop or in bed. The second extract describes the meat’s “vitality” and this is the quality of Syn's skin that mesmerised Zhu when he met her: “he was excited, electrified by the sight of her unblemished, translucent skin, unlined, smooth as silk. The glow of the warmth of human skin” (13). Moreover, the lights seem to completely illuminate the pieces of meat and this is the way Zhu Zhiyee leers at Syn´s body, as it can be read in the following extract: “he turned again to fix his gaze on Syn, which pierced and penetrated her head, her brain, eyes, permeated her whole body, seeped into her secret places and crevices” (14). The third excerpt introduces the sexual organs of some of the animals, which are sold to some customers for a high price. Meat is also sexualised by Zhu Zhiyee´s actions, such as his pinching the bottoms of chickens and comparing them with “sacrificial virgins”: “chickens, shamelessly stripped and trussed, hung by their necks, naked in their pimply white skin, seemed like sacrificial virgins. Syn often caught Zhu pinching their fleshy bottoms, while wrapping and serving them to the housewives” (15-16). Zhu also makes comments relating food with sex while he is having lunch next to Syn, which could be considered sexual harassment. All these extracts exemplify the relationship between Syn and Zhu Zhiyee: the orders, the looks and the implicit sexuality in the quotidian activities in the butcher´s shop. There are also a range of other expressions that include similes with the word `pig´ in Ng´s novel. One of the most recurrent is comparing the left arm and hand of Zhu Zhiyee´s mother with a “pig´s trotter”. Zhu Zhiyee´s mother is known as ZhuMa and Syn is very fond of her, as ZhuMa accepts her and likes her more than her own daughter-in-law. The comparison of ZhuMa´s arm and hand with a trotter may be explained by the fact that ZhuMa´s arm is swollen but also by the loving representation of pigs in Chinese culture. As Seung-Og Kim explains in his article “Burials, Pigs, and Political Prestige in Neolithic China”: In both Melanesia and Asia, pigs are viewed as a symbolic representation of human beings (Allen 1976: 42; Healey 1985; Rappaport 1967: 58; Roscoe 1989: 223-26). Piglets are treated as pets and receive a great deal of loving attention, and they in turn express affection for their human “parents.” They also share some physiological features with human beings, being omnivorous and highly reproductive (though humans do not usually have multiple litters) and similar internal anatomy (Roscoe 1989: 225). In short, pigs not only have a symbiotic relationship with humans biologically but also are of great importance symbolically (121). Consequently, pigs are held in high esteem, taken care of and loved. Therefore, comparing a part of a human´s body, such as an arm or a hand, for example, to a part of a pig´s body such as a pig´s trotter is not negative, but has positive connotations. Some descriptions of ZhuMa´s arm and hand can be read in the following excerpts: “As ZhuMa handed her the plate of cookies Syn saw her left arm, swollen like a pig´s trotter” (97); “Syn was horrified, and yet somewhat intrigued by this woman without a breast, with a pig´s trotter arm and a tummy like a chessboard” (99), “mimicking the act of writing with her pig-trotter hand” (99), and ZhuMa was praising the excellence of the opera, the singing, acting, the costumes, and the elaborate props, waving excitedly with her pig trotter arm and pointing with her stubby fingers while she talked. (170) Moreover, the expression “pig´s trotters” is also used as an example of the erotic fetishism with bound feet, as it can be seen in the following passage, which will be discussed below: I [Zhu Zhiyee] adore feet which are slender… they seem so soft, like pig´s trotters, so cute and loving, they play tricks on your mind. Imagine feeling them in bed under your blankets—soft cottonwool lumps, plump and cuddly, makes you want to stroke them like your lover´s hands … this was how the bound feet appealed to men, the erotic sensation when balanced on shoulders, clutched in palms, strung to the seat of a garden swing … no matter how ugly a woman is, her tiny elegant feet would win her many admirers (224).Besides writing about pigs and pork as part of the daily work of the butcher shop and using the expression “pig´s trotter”, “pig” is also linked to money in two sentences in the book. On the one hand, it is used to calculate a price and draw attention to the large amount it represents: “The blouse was very expensive—three hundred dollars, the total takings from selling a pig. Two pigs if he purchased two blouses” (197). On the other, it works as an adjective in the expression “piggy-bank”, the money box in the form of a pig, an animal that represents abundance and happiness in the Chinese culture: “She borrowed money from her neighbours, who emptied pieces of silver from their piggy-banks, their life savings”(54). Finally, the most frequent porcine expression in Ng´s Swallowing Clouds makes reference to being drowned in a pig´s basket, which represents 19 of the 33 references to pigs or pork that appear in the novel. The first three references appear in the prologue (ix, x, xii), where the reader learns the story of the last woman who was killed by drowning in a pig´s basket as a punishment for her adultery. After this, two references recount a soothsayer´s explanation to Syn about her nightmares and the fact that she is the reincarnation of that lady (67, 155); three references are made by Syn when she explains this story to Zhu Zhiyee and to her companion on the trip to Beijing and Shanghai (28, 154, 248); one refers to a feeling Syn has during sexual intercourse with Zhu Zhiyee (94); and one when the pig basket is compared to a cricket box, a wicker or wooden box used to carry or keep crickets in a house and listen to them singing (73). Furthermore, Syn reflects on the fact of drowning (65, 114, 115, 171, 172, 173, 197, 296) and compares her previous death with that of Concubine Pearl, the favourite of Emperor Guanxu, who was killed by order of his aunt, the Empress Dowager Cixi (76-77). The punishment of drowning in a pig´s basket can thus be understood as retribution for a transgression: a woman having an extra-marital relationship, going against the establishment and the boundaries of the authorised. Both the woman who is drowned in a pig´s basket in 1918 and Syn have extra-marital affairs and break society’s rules. However, the consequences are different: the concubine dies and Syn, her reincarnation, takes revenge. Desire, Transgression and Eroticism Xavier Pons writes about desire, repression, freedom and transgression in his book Messengers of Eros: Representations of Sex in Australian Writing (2009). In this text, he explains that desire can be understood as a positive or as a negative feeling. On the one hand, by experiencing desire, a person feels alive and has joy de vivre, and if that person is desired in return, then, the feelings of being accepted and happiness are also involved (13). On the other hand, desire is often repressed, as it may be considered evil, anarchic, an enemy of reason and an alienation from consciousness (14). According to Pons: Sometimes repression, in the form of censorship, comes from the outside—from society at large, or from particular social groups—because of desire´s subversive nature, because it is a force which, given a free rein, would threaten the higher purpose which a given society assigns to other (and usually ideological) forces … Repression may also come from the inside, via the internalization of censorship … desire is sometimes feared by the individual as a force alien to his/her true self which would leave him/her vulnerable to rejection or domination, and would result in loss of freedom (14).Consequently, when talking about sexual desire, the two main concepts to be dealt with are freedom and transgression. As Pons makes clear, “the desiring subject can be taken advantage of, manipulated like a puppet [as h]is or her freedom is in this sense limited by the experience of desire” (15). While some practices may be considered abusive, such as bondage or sado-masochism, they may be deliberately and freely chosen by the partners involved. In this case, these practices represent “an encounter between equals: dominance is no more than make-believe, and a certain amount of freedom (as much as is compatible with giving oneself up to one´s fantasies) is maintained throughout” (24). Consequently, the perception of freedom changes with each person and situation. What is transgressive depends on the norms in every culture and, as these evolve, so do the forms of transgression (Pons 43). Examples of transgressions can be: firstly, the separation of sex from love, adultery or female and male hom*osexuality, which happen with the free will of the partners; or, secondly, paedophilia, incest or bestial*ty, which imply abuse. Going against society’s norms involves taking risks, such as being discovered and exiled from society or feeling isolated as a result of a feeling of difference. As the norms change according to culture, time and person, an individual may transgress the rules and feel liberated, but later on do the same thing and feel alienated. As Pons declares, “transgressing the rules does not always lead to liberation or happiness—transgression can turn into a trap and turn out to be simply another kind of alienation” (46). In Swallowing Clouds, Zhu Zhiyee transgresses the social norms of his time by having an affair with Syn: firstly, because it is extra-marital, he and his wife, KarLeng, are Catholic and fidelity is one of the promises made when getting married; and, secondly, because he is Syn´s boss and his comments and ways of flirting with her could be considered sexual harassment. For two years, the affair is an escape from Zhu Zhiyee´s daily worries and stress and a liberation and fulfillment of his sexual desires. However, he introduces Syn to his mother and his sisters, who accept her and like her more than his wife. He feels trapped, though, when KarLeng guesses and threatens him with divorce. He cannot accept this as it would mean loss of face in their neighbourhood and society, and so he decides to abandon Syn. Syn´s transgression becomes a trap for her as Zhu, his mother and his sisters have become her only connection with the outside world in Australia and this alienates her from both the country she lives in and the people she knows. However, Syn´s transgression also turns into a trap for Zhu Zhiyee because she will not sign the documents to give him the house back and every month she sends proof of their affair to KarLeng in order to cause disruption in their household. This exposure could be compared with the humiliation suffered by the concubine when she was paraded in a pig´s basket before she was drowned in the HuangPu River. Furthermore, the reader does not know whether KarLeng finally divorces Zhu Zhiyee, which would be his drowning and loss of face and dishonour in front of society, but can imagine the humiliation, shame and disgrace KarLeng makes him feel every month. Pons also depicts eroticism as a form of transgression. In fact, erotic relations are a power game, and seduction can be a very effective weapon. As such, women can use seduction to obtain power and threaten the patriarchal order, which imposes on them patterns of behaviour, language and codes to follow. However, men also use seduction to get their own benefits, especially in political and social contexts. “Power has often been described as the ultimate aphrodisiac” (Pons 32) and this can be seen in many of the sexual games between Syn and Zhu Zhiyee in Swallowing Clouds, where Zhu Zhiyee is the active partner and Syn becomes little more than an object that gives pleasure. A clear reference to erotic fetishism is embedded in the above-mentioned quote on bound feet, which are compared to pig´s trotters. In fact, bound feet were so important in China in the millennia between the Song Dynasty (960-1276) and the early 20th century that “it was impossible to find a husband” (Holman) without them: “As women’s bound feet and shoes became the essence of feminine beauty, a fanatical aesthetic and sexual mystique developed around them. The bound foot was understood to be the most intimate and erotic part of the female anatomy, and wives, consorts and prostitutes were chosen solely on the size and shape of their feet” (Holman). Bound feet are associated in Ng’s novel with pig´s trotters and are described as “cute and loving … soft cottonwool lumps, plump and cuddly, [that] makes you want to stroke them like your lover´s hands” (224). This approach towards bound feet and, by extension, towards pig´s trotters, can be related to the fond feelings Melanesian and Asian cultures have towards piglets, which “are treated as pets and receive a great deal of loving attention” (Kim 121). Consequently, the bound feet can be considered a synecdoche for the fond feelings piglets inspire. Food and Sex The fact that Zhu Zhiyee is a butcher and works with different types of meat, including pork, that he chops it, sells it and gives cooking advice, is not gratuitous in the novel. He is used to being in close proximity to meat and death and seeing Syn’s pale skin through which he can trace her veins excites him. Her flesh is alive and represents, therefore, the opposite of meat. He wants to seduce her, which is human hunting, and he wants to study her, to enjoy her body, which can be compared to animals looking at their prey and deciding where to start eating from. Zhu´s desire for Syn seems destructive and dangerous. In the novel, bodies have a price: dead animals are paid for and eaten and their role is the satiation of human hunger. But humans, who are also animals, have a price as well: flesh is paid for, in the form of prostitution or being a mistress, and its aim is satiation of human sex. Generally speaking, sex in the novel is compared to food either in a direct or an indirect way, and making love is constantly compared to cooking, the preparation of food and eating (as in Pons 303). Many passages in Swallowing Clouds have cannibalistic connotations, all of these being used as metaphors for Zhu Zhiyee’s desire for Syn. As mentioned before, desire can be positive (as it makes a person feel alive) or negative (as a form of internal or social censorship). For Zhu Zhiyee, desire is positive and similar to a drug he is addicted to. For example, when Zhu and Syn make delivery rounds in an old Mazda van, he plays the recordings he made the previous night when they were having sex and tries to guess when each moan happened. Sex and Literature Pons explains that “to write about sex … is to address a host of issues—social, psychological and literary—which together pretty much define a culture” (6). Lillian Ng´s Swallowing Clouds addresses a series of issues. The first of these could be termed ‘the social’: Syn´s situation after the Tiananmen Massacre; her adulterous relationship with her boss and being treated and considered his mistress; the rapes in Inner Mongolia; different reasons for having an abortion; various forms of abuse, even by a mother of her mentally handicapped daughter; the loss of face; betrayal; and revenge. The second issue is the ‘psychological’, with the power relations and strategies used between different characters, psychological abuse, physical abuse, humiliation, and dependency. The third is the ‘literary’, as when the constant use of metaphors with Chinese cultural references becomes farcical, as Tseen Khoo notes in her article “Selling Sexotica” (2000: 164). Khoo explains that, “in the push for Swallowing Clouds to be many types of novels at once: [that is, erotica, touristic narrative and popular], it fails to be any one particularly successfully” (171). Swallowing Clouds is disturbing, full of stereotypes, and with repeated metaphors, and does not have a clear readership and, as Khoo states: “The explicit and implicit strategies behind the novel embody the enduring perceptions of what exotic, multicultural writing involves—sensationalism, voyeuristic pleasures, and a seemingly deliberate lack of rooted-ness in the Australian socioscape (172). Furthermore, Swallowing Clouds has also been defined as “oriental grunge, mostly because of the progression throughout the narrative from one gritty, exoticised sexual encounter to another” (Khoo 169-70).Other novels which have been described as “grunge” are Edward Berridge´s Lives of the Saints (1995), Justine Ettler´s The River Ophelia (1995), Linda Jaivin´s Eat Me (1995), Andrew McGahan´s Praise (1992) and 1988 (1995), Claire Mendes´ Drift Street (1995) or Christos Tsiolkas´ Loaded (1995) (Michael C). The word “grunge” has clear connotations with “dirtiness”—a further use of pig, but one that is not common in the novel. The vocabulary used during the sexual intercourse and games between Syn and Zhu Zhiyee is, however, coarse, and “the association of sex with coarseness is extremely common” (Pons 344). Pons states that “writing about sex is an attempt to overcome [the barriers of being ashamed of some human bodily functions], regarded as unnecessarily constrictive, and this is what makes it by nature transgressive, controversial” (344-45). Ng´s use of vocabulary in this novel is definitely controversial, indeed, so much so that it has been defined as banal or even farcical (Khoo 169-70).ConclusionThis paper has analysed the use of the words and expressions: “pig”, “pork” and “drowning in a pig’s basket” in Lillian Ng´s Swallowing Clouds. Moreover, the punishment of drowning in a pig’s basket has served as a means to study the topics of desire, transgression and eroticism, in relation to an analysis of the characters of Syn and Zhu Zhiyee, and their relationship. This discussion of various terminology relating to “pig” has also led to the study of the relationship between food and sex, and sex and literature, in this novel. Consequently, this paper has analysed the use of the term “pig” and has used it as a springboard for the analysis of some aspects of the novel together with different theoretical definitions and concepts. Acknowledgements A version of this paper was given at the International Congress Food for Thought, hosted by the Australian Studies Centre at the University of Barcelona in February 2010. References Allen, Bryan J. Information Flow and Innovation Diffusion in the East Sepic District, Papua New Guinea. PhD diss. Australian National University, Australia. 1976. Berridge, Edward. Lives of the Saints. St Lucia: U of Queensland P, 1995. C., Michael. “Toward a sound theory of Australian Grunge fiction.” [Weblog entry] Eurhythmania. 5 Mar. 2008. 4 Oct. 2010 http://eurhythmania.blogspot.com/2008/03/toward-sound-theory-of-australian.html. Ettler, Justine. The River Ophelia. Sydney: Picador, 1995. Healey, Christopher J. “Pigs, Cassowaries, and the Gift of the Flesh: A Symbolic Triad in Maring Cosmology.” Ethnology 24 (1985): 153-65. Holman, Jeanine. “Bound Feet.” Bound Feet: The History of a Curious, Erotic Custom. Ed. Joseph Rupp 2010. 11 Aug. 2010. http://www.josephrupp.com/history.html. Jaivin, Linda. Eat Me. Melbourne: The Text Publishing Company, 1995. Khoo, Tseen. “Selling Sexotica: Oriental Grunge and Suburbia in Lillian Ngs’ Swallowing Clouds.” Diaspora: Negotiating Asian-Australian. Ed. Helen Gilbert, Tseen Khoo, and Jaqueline Lo. St Lucia: U of Queensland P, 2000. 164-72. Khoo, Tseen; Danau Tanu, and Tien. "Re: Of pigs and porks” 5-9 Aug. 1997. Asian- Australian Discussion List Digest numbers 1447-1450. Apr. 2010 . Kim, Seung-Og. “Burials, Pigs, and Political Prestige in Neolithic China.” Current Anthopology 35.2 (Apr. 1994): 119-141. McGahan, Andrew. Praise. Sydney: Allen & Unwin, 1992. McGahan, Andrew. 1988. Sydney: Allen & Unwin, 1995. Mendes, Clare. Drift Street. Pymble: HarperCollins, 1995. Ng, Lillian. Swallowing Clouds. Ringwood: Penguin Books Australia,1997. Pons, Xavier. Messengers of Eros. Representations of Sex in Australian Writing. Newcastle upon Tyne: Cambridge Scholars Publishing, 2009. Rappaport, Roy. Pigs for the Ancestors. New Have: Yale UP, 1967. Roscoe, Paul B. “The Pig and the Long Yam: The Expansion of the Sepik Cultural Complex”. Ethnology 28 (1989): 219-31. Tsiolkas, Christos. Loaded. Sydney: Vintage, 1995. Yu, Ouyang. “An Interview with Lillian Ng.” Otherland Literary Journal 7, Bastard Moon. Essays on Chinese-Australian Writing (July 2001): 111-24.

Abstract:

Photo by Matteo Vistocco on Unsplash ABSTRACT This paper explores a way to ensure a person’s autonomy and legacy are preserved during the experience of dementia due to Alzheimer’s disease. Due to the profound effect the disease has on memory, the “person of the lifetime” (the person’s past experiences and their future aspirations prior to disease progression) becomes seemingly disconnected from the “person of the moment,” or the person experiencing memory loss. Thus, directives are important to recognize and maintain continuity of person. Yet, a person’s “legacy,” based on the person’s values and philosophy, can serve as a bridge between those two identities. Ultimately, people with significant memory loss from Alzheimer’s disease are unable to secure their own legacy due to the diminishing ability to make autonomous decisions as the disease progresses. A legal system that codifies the ability to create a requirement to honor ADs and research advance directives (RADs) can best secure the autonomy of the person of the lifetime, and thus the person’s legacy, of the person Alzheimer’s disease. INTRODUCTION At present, there is no effective treatment or cure for Alzheimer’s disease’s cognitive decline and ensuing dementia. While the definitive diagnosis is confirmed only after death via brain autopsy, Alzheimer’s is diagnosed by symptoms and scans.[1] Over the course of an eight-to-twelve-year post-diagnosis period, people progressively lose memory and cognitive functions in an irreversible pattern.[2] Because Alzheimer’s disease remains incurable despite significant scientific research into its causes, its biological qualities,[3] and its symptoms, many people with Alzheimer’s disease may wish to document care choices in advance while they have capacity to do so. Those experiencing early-stage Alzheimer’s disease or mild cognitive impairment wanting to determine the best path for their private and public future life’s agenda must have the legal tools needed to make sound plans for their future. l. Preserving Legacy: The Benefits of Advance Directives for People with Alzheimer’s Disease A legacy is the part of a patient that will persist into the future, even after death. Autonomy can be increased by permitting Alzheimer’s patients to document their legacy and wishes prior to significant cognitive impairment. Whether a legacy is in others’ memories of personality traits or is something concrete like a business, named building, charity, or a cookie recipe, many people with Alzheimer’s disease wish their person of a lifetime to be remembered. Many do not want to be remembered only as they are in the end of life, or as the cognitively impaired person of the moment. I argue that the best legacy for oneself is defined by one’s own autonomy and his or her most personal, private philosophy and values. When third-party caregivers or healthcare workers seek to impose their views of the best interests on the person of the moment, they may be disrespecting that person’s legacy interests. Having an AD that the caregivers must respect can help all stakeholders make decisions with moral legitimacy. The preservation of the person of the lifetime can be maximized by focusing on both past and present life experiences. Significant memory loss from Alzheimer’s disease interrupts the usual relationship between the person of the lifetime and the person of the moment, who may understand the present but may experience near-complete short- and long-term memory loss.[4] Reconciling these two “personhoods” in one person in a formal process best serves the legacy for Alzheimer’s patients by assessing various perspectives and providing a decision-making framework for caregivers and stakeholders. I assert that the autonomy of the person of the lifetime deserves equal or more weight than a decision-making third party when the person of the moment lacks capacity to make a healthcare decision. This argument is compatible with Samuel Dale’s argument that “precedent autonomy morally authorizes ADs when dementia renders patients medically incompetent because it respects their dignity as persons, not merely pleasure-seeking creatures.”[5] Dale relies on Dworkin’s view that critical interests should carry more weight than “experiential interests.”[6] The pursuit of critical interests gives meaning to human life and is encoded in ADs to represent the whole person.[7] Nevertheless, the person of the moment has value and can enjoy the pursuit of happiness. Treatment for Alzheimer’s disease focuses on comfort and happiness as a driver for the patient’s best interests, thus attending to the needs of the person of the moment while balanced with the interests in an AD if it conflicts, to not damage the legacy. The person of the moment needs care to avoid pain and arguably to achieve some happiness, while simultaneously relying, insofar as still possible, on the person of the lifetime to obtain peace and contentment.[8] Respecting Alzheimer’s ADs is consistent with the strong individualism inherent in the US. The rule of law attempts to maximize autonomy and theoretically to ensure individual rights.[9] In the US and other liberal democracies, recognizing the power and inalienable rights of the individual involves securing the right to make one’s own decisions. Yet, as with other individual rights, there are situations where ADs are not absolute and where laws limit their full effect. Some statutory and regulatory restrictions make it legally difficult to honor ADs, especially with respect to nutrition and hydration directives.[10] Arguably that is a poorly considered approach; notably, at least one scholar, Corinna Porteri, argues that “statutes that disregard or invalidate ADs are discriminatory against the life lived.”[11] ll. The Benefits of Research Advance Directives for People with Alzheimer’s Disease The scientific research necessary to better treat people who have Alzheimer’s disease requires engaging patients in research. A major bioethical question immediately arises: how can we obtain informed consent from a person unable to weigh different options and risks/rewards properly? Research advance directives (RADs) could allow advanced consent for participation in research and could place limits on the consent.[12] People who have Alzheimer’s disease should be able to express their desires in ADs during the early stages or before diagnosis. Directives must be able to allow people to express a desire to join clinical trials. The National Bioethics Advisory Committee in the US recommended RADs,[13] which allow people to join studies when the treatment or medicine would benefit them, and possibly when it would benefit the larger public and has some potential to benefit the person.[14] Porteri asserts that RADs should include consent based on the type and degree of risk, as it is impossible to predict the types of treatment or the anticipated side effects in future studies.[15] Ultimately, the person’s autonomy of a lifetime should take precedence because further research offers patients hope for both their legacy and the legacies of others. Still, there may be cases in which the societal interest in protecting the person takes precedence. Societal interests may include preserving dignity and avoiding suffering. It may be necessary to safeguard people by limiting participation to low-risk studies and requiring additional consent from a proxy or caregiver. RADs are appealing because they guide decisions, as do ADs; their unique appeal that is specific to RAD as part of AD is that the certainty of a permanently preserved legacy of valuing medical research in writing could take precedence over the uncertainty facing the person of the moment. At present, these are still tenuous grounds, requiring philosophical and other solutions. A moral question arises regarding the ability to change one’s mind after the threshold established for ADs and RADs takes effect. How can it be known if patients would have changed their minds given current circ*mstances and the often-lengthy progress of Alzheimer’s disease? If a person wanted to withdraw an AD or RAD and expressed an unwillingness to engage in research, there is a moral argument that the person of the moment must not be deprived of a right to withdraw. By limiting the AD and RAD to treatment and research decisions after significant memory loss occurs, those with mild cognitive impairment certainly would decide about research for themselves, possibly with the input of family, friends, or doctors. Early diagnosis permits time for the patient to alter ADs before they develop significant memory loss. When patients understand the progression of the disease, their autonomous decisions regarding their care should be honored. Porteri asserts the ADs are the necessary proof of the person’s desires and thus should govern when capacity is lost.[16] Bodily integrity, philosophical belief, and autonomy must be respected once the capacity to make decisions is lost. lll. Recommendations Capacity is task-specific; therefore, determining when the healthcare AD should be implemented must be based on capacity testing.[17] This process turns ADs into a framework for interpreting the person of the lifetime’s wishes as applied to the person of the moment. For example, dying in battle is quite a different memorial outcome compared to experiencing a vegetative state while fed artificial hydration and nutrition through a feeding tube. Establishing the desired legacy of the person with Alzheimer’s disease in an AD allows the patient more autonomy to choose how they wish to be remembered.[18] One problem with our current system for ADs is that it deviates substantially from state to state. The Patient Self Determination Act does not prescribe how state laws should address significant memory loss.[19] Therefore continuity of person is not assumed in all state laws. A federal law that supports the acknowledgment of ADs would be preferable. The right to determine how you live and die is a fundamental choice and should not depend on the state in which one lives. Fortunately, perspectives between stakeholders and other parties align in many cases, and their expressed wishes respect the person of a lifetime. To maintain the patient’s dignity during disease progression for a greater proportion of Alzheimer’s patients, states should honor ADs and RADs. Currently, ADs offer an unpredictable degree of protection, especially as patients move from state to state. Unpredictable factors include judicial discretion, shifts of thinking within the body politic, and the power of stakeholders with interests at odds with those of the person of the lifetime. Judicial discretion should be limited to invalidating only those ADs that were based on fraud, undue influence, or incapacity at their inception. Administrative personnel and other stakeholders should not have authority to redefine a person’s legacy once the person reaches the stage at which they no longer have capacity. ADs and RADs could include dispute resolution mechanisms as well as directives with respect to those persons the person of the moment does not want involved in their care. In declaring the continuity of person yet acknowledging the differences due to significant memory loss, Giovanni Boniolo concludes, “We have to respect them and their choices and decisions as long as they are capable of choosing and deciding. Then, when this capacity has vanished, we must continue respecting not only them, but also the choices and decisions they made.”[20] Boniolo is absolutely correct; one is capable of creating AD until they are not. A sharper scientific approach would base the point at which one no longer has capability to make decisions on biological or clinical markers. The law should ensure that ADs and RADs made prior to that point govern care and research decisions. CONCLUSION Permitting an unfaithful surrogate or an administrator with a different philosophy to reinterpret patient desires based on current circ*mstances would create a “slippery slope,” compromising the known wishes of a person with Alzheimer’s disease as preserved in writing. ADs and RADs are the best opportunities for people with early Alzheimer’s disease, or those who recognize the risk of dementia, to preserve their legacy and to use their autonomy to govern care of the significantly memory-impaired person of the moment. Preserving the legacy of patients in binding documents avoids the quagmire of courts, doctors, surrogates, and caregivers. Ultimately, ADs and RADs can maintain continuity of the person of a lifetime’s dignity even when that person experiences cognitive impairment, evolving into the person of the moment. [1] Weller J, Budson A. Current Understanding of Alzheimer's Disease Diagnosis and Treatment. F1000Res. 2018;7:F1000 Faculty Rev-1161. Published 2018 Jul 31. doi:10.12688/f1000research.14506.1 [2] Gauthier S, Leuzy A, Racine E, Rosa-Neto P. Diagnosis and management of Alzheimer's disease: Past, present and future ethical issues. Progress in Neurobiology. 2013;110:102-113; Naylor M, Karlawish J, Arnold S et al. Advancing Alzheimer's disease diagnosis, treatment, and care: Recommendations from the Ware Invitational Summit. Alzheimer's & Dementia. 2012;8(5):445-452. [3] The combination of Tau proteins becoming defective, creating neurofibrillary tangles, and β amyloid plaques building up in the neural connections of the brain prevents neural functioning, resulting in brain cell incapacity and death; Zetterberg H, Schott J. Biomarkers for Alzheimer’s disease beyond amyloid and tau. Nat Med. 2019;25(2):201-203.; Qin K, Zhao L, Gregory C, Solanki A, Mastrianni J. “Dual Disease” TgAD/GSS mice exhibit enhanced Alzheimer’s disease pathology and reveal PrPC-dependent secretion of Aβ. Sci Rep. 2019;9(1). doi:10.1038/s41598-019-44317-w; Qin K, Zhao L, Gregory C, Solanki A, Mastrianni J. “Dual Disease” TgAD/GSS mice exhibit enhanced Alzheimer’s disease pathology and reveal PrPC-dependent secretion of Aβ. Sci Rep. 2019;9(1). [4] Kitwood T. Dementia Reconsidered, Revisited: The Person Still Comes First. 2nd ed. New York: Open University Press; 2019. [5] Dale S. Personhood, Critical Interests, and the Moral Imperative of Advances Directives in Alzheimer's Cases. Voices in Bioethics. 2021;7:1-6. [6] Dale S. Personhood, Critical Interests, and the Moral Imperative of Advances Directives in Alzheimer's Cases. Voices in Bioethics. 2021;7:1-6, citing Dworkin R. (1994) Life’s Dominion; An Argument About Abortion, Euthanasia, And Individual Freedom. 1st ed. New York: Vintage Books. [7] Dale S., 2021. [8] Person M, Hanssen I. Joy, Happiness, and Humor in Dementia Care: A Qualitative Study. Creative Nursing. 2015;21(1):47-52.; Yeaman P, Ford J, Kim K. Providing Quality Palliative Care in End-Stage Alzheimer Disease. American Journal of Hospice and Palliative Medicine®. 2012;30(5):499-502. [9] Kim S. The Ethics of Informed Consent in Alzheimer Disease Research. Nature Reviews Neurology. 2011;7(7):410-414.; Porteri C. Advance Directives as A Tool to Respect Patients’ Values and Preferences: Discussion on The Case Of Alzheimer’s Disease. BioMed Central Medical Ethics. 2018;19(1).; Naue U. ‘Self-care without a self’: Alzheimer’s Disease and The Concept of Personal Responsibility for Health. Medicine, Health Care and Philosophy. 2008;11(3):315-324. [10] Sieger CE, Arnold JF, Ahronheim JC. Refusing artificial nutrition and hydration: does statutory law send the wrong message?. J Am Geriatr Soc. 2002;50(3):544-550. doi:10.1046/j.1532-5415.2002.50124.x [11] Porteri C. Advance Directives as A Tool to Respect Patients’ Values And Preferences: Discussion On The Case Of Alzheimer’s Disease. BioMed Central Medical Ethics. 2018;19(1). [12] Buller T. Advance Consent, Critical Interests and Dementia Research. Journal of Medical Ethics. 2014;41(8):701-707.; Jongsma K, van de Vathorst S. Dementia Research and Advance Consent: It Is Not About Critical Interests. Journal of Medical Ethics. 2014;41(8):708-709.; Jongsma K, Perry J, Schicktanz S, Radenbach K. Motivations for people with cognitive impairment to complete an advance research directive – a qualitative interview study. BioMed Central Psychiatry. 2020;20(1). [13] National Bioethics Advisory Commission (NBAC) Research Involving Persons with Mental Disorders That May Affect Decision-making Capacity. Rockville: National Bioethics Advisory Commission; 1998. https://pubmed.ncbi.nlm.nih.gov/12747354/ [14] Porteri C. Advance Directives as A Tool to Respect Patients’ Values and Preferences: Discussion on The Case Of Alzheimer’s Disease. BioMed Central Medical Ethics. 2018;19(1). https://pubmed.ncbi.nlm.nih.gov/29458429/ ; Jongsma K, van de Vathorst S. Dementia Research and Advance Consent: It Is Not About Critical Interests. Journal of Medical Ethics. 2014;41(8):708-709. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.997.8037&rep=rep1&type=pdf [15] Porteri C. Advance directives as a tool to respect patients’ values and preferences: discussion on the case of Alzheimer’s disease. BioMed Central Medical Ethics. 2018;19(1). https://pubmed.ncbi.nlm.nih.gov/29458429/ [16] Porteri C. Advance directives as a tool to respect patients’ values and preferences: discussion on the case of Alzheimer’s disease. BioMed Central Medical Ethics. 2018;19(1). [17] McDonald A, D'Arcy R, Song X. Functional MRI On Executive Functioning in Aging and Dementia: A Scoping Review Of Cognitive Tasks. Aging Medicine. 2018;1(2):209-219; Sclan S, Reisberg B. Functional Assessment Staging (FAST) in Alzheimer's Disease: Reliability, Validity, and Ordinality. Int Psychogeriatr. 1992;4(3):55-69; Appelbaum P, Grisso T. Assessing Patients' Capacities to Consent to Treatment. New England Journal of Medicine. 1988;319(25):1635-1638; Fisher C, Appelbaum P. Diagnosing Consciousness: Neuroimaging, Law, and the Vegetative State. Journal of Law, Medicine & Ethics. 2010;38(2):374-385. [18] Menzel P. Ethical Perspectives on Advance Directives for Dementia - The Hastings Center. The Hastings Center; 2018. https://www.thehastingscenter.org/ethical-perspectives-advance-directives-dementia. Accessed December 8, 2018. [19] HR 5835 Omnibus Budget Reconciliation Act of 1990, Title IV, Section 4206. US Congress. [20] Boniolo, G. Demented Patients and The Quandaries of Identity: Setting the Problem, Advancing A Proposal. HPLS 43, 21 (2021). https://doi.org/10.1007/s40656-021-00365-y

Abstract:

Unlike some current discourse on automediality, this essay eschews most of the analysis concerning the adoption or modification of avatars to deliberately enhance, extend or distort the self. Rather than the automedial enabling of alternative, virtual selves modified by playful, confronting or disarming avatars we concentrate instead on emerging efforts to present the self in hyper-realist, interactive modes. In doing so we ask, what is the relationship between traumatic forms of automediation and the affective impact on and response of the audience? We argue that, while on the one hand there are promising avenues for valuable individual and social engagements with traumatic forms of automediation, there is an overwhelming predominance of suffering as a theme in such virtual depictions, comingled with uncritically asserted promises of empathy, which are problematic as the technology assumes greater mainstream uptake.As Smith and Watson note, embodiment is always a “translation” where the body is “dematerialized” in virtual representation (“Virtually” 78). Past scholarship has analysed the capacity of immersive realms, such as Second Life or online games, to highlight how users can modify their avatars in often spectacular, non-human forms. Critics of this mode of automediality note that users can adopt virtually any persona they like (racial, religious, gendered and sexual, human, animal or hybrid, and of any age), behaving as “identity tourists” while occupying virtual space or inhabiting online communities (Nakamura). Furthermore, recent work by Jaron Lanier, a key figure from the 1980s period of early Virtual Reality (VR) technology, has also explored so-called “homuncular flexibility” which describes the capacity for humans to seemingly adapt automatically to the control mechanisms of an avatar with multiple legs, other non-human appendages, or for two users to work in tandem to control a single avatar (Won et. al.). But this article is concerned less with these single or multi-player online environments and the associated concerns over modifying interactive identities. We are principally interested in other automedial modes where the “auto” of autobiography is automated via Artificial Intelligences (AIs) to convincingly mimic human discourse as narrated life-histories.We draw from case studies promoted by the 2017 season of ABC television’s flagship science program, Catalyst, which opened with semi-regular host and biological engineer Dr Jordan Nguyen, proclaiming in earnest, almost religious fervour: “I want to do something that has long been a dream. I want to create a copy of a human. An avatar. And it will have a life of its own in virtual reality.” As the camera followed Nguyen’s rapid pacing across real space he extolled: “Virtual reality, virtual human, they push the limits of the imagination and help us explore the impossible […] I want to create a virtual copy of a person. A digital addition to the family, using technology we have now.”The troubling implications of such rhetoric were stark and the next third of the program did little to allay such techno-scientific misgivings. Directed and produced by David Symonds, with Nguyen credited as co-developer and presenter, the episode “Meet the Avatars” immediately introduced scenarios where “volunteers” entered a pop-up inner city virtual lab, to experience VR for the first time. The volunteers were shown on screen subjected to a range of experimental VR environments designed to elicit fear and/or adverse and disorienting responses such as vertigo, while the presenter and researchers from Sydney University constantly smirked and laughed at their participants’ discomfort. We can only wonder what the ethics process was for both the ABC and university researchers involved in these broadcast experiments. There is little doubt that the participant/s experienced discomfort, if not distress, and that was televised to a national audience. Presenter Nguyen was also shown misleading volunteers on their way to the VR lab, when one asked “You’re not going to chuck us out of a virtual plane are you?” to which Nguyen replied “I don't know what we’re going to do yet,” when it was next shown that they immediately underwent pre-programmed VR exposure scenarios, including a fear of falling exercise from atop a city skyscraper.The sweat-inducing and heart rate-racing exposures to virtual plank walks high above a cityscape, or seeing subjects haptically viewing spiders crawl across their outstretched virtual hands, all elicited predictable responses, showcased as carnivalesque entertainment for the viewing audience. As we will see, this kind of trivialising of a virtual environment’s capacity for immersion belies the serious use of the technology in a range of treatments for posttraumatic stress disorder (see Rizzo and Koenig; Rothbaum, Rizzo and Difede).Figure 1: Nguyen and researchers enjoying themselves as their volunteers undergo VR exposure Defining AutomedialityIn their pioneering 2008 work, Automedialität: Subjektkonstitution in Schrift, Bild und neuen Medien, Jörg Dünne and Christian Moser coined the term “automediality” to problematise the production, application and distribution of autobiographic modes across various media and genres—from literary texts to audiovisual media and from traditional expression to inter/transmedia and remediated formats. The concept of automediality was deployed to counter the conventional critical exclusion of analysis of the materiality/technology used for an autobiographical purpose (Gernalzick). Dünne and Moser proffered a concept of automediality that rejects the binary division of (a) self-expression determining the mediated form or (b) (self)subjectivity being solely produced through the mediating technology. Hence, automediality has been traditionally applied to literary constructs such as autobiography and life-writing, but is now expanding into the digital domain and other “paratextual sites” (Maguire).As Nadja Gernalzick suggests, automediality should “encourage and demand not only a systematics and taxonomy of the constitution of the self in respectively genre-specific ways, but particularly also in medium-specific ways” (227). Emma Maguire has offered a succinct working definition that builds on this requirement to signal the automedial universally, noting it operates asa way of studying auto/biographical texts (of a variety of forms) that take into account how the effects of media shape the kinds of selves that can be represented, and which understands the self not as a preexisting subject that might be distilled into story form but as an entity that is brought into being through the processes of mediation.Sidonie Smith and Julia Watson point to automediality as a methodology, and in doing so emphasize how the telling or mediation of a life actually shapes the kind of story that can be told autobiographically. They state “media cannot simply be conceptualized as ‘tools’ for presenting a preexisting, essential self […] Media technologies do not just transparently present the self. They constitute and expand it” (Smith and Watson “Virtually Me” 77).This distinction is vital for understanding how automediality might be applied to self-expression in virtual domains, including the holographic avatar dreams of Nguyen throughout Catalyst. Although addressing this distinction in relation to online websites, following P. David Marshall’s description of “the proliferation of the public self”, Maguire notes:The same integration of digital spaces and platforms into daily life that is prompting the development of new tools in autobiography studies […] has also given rise to the field of persona studies, which addresses the ways in which individuals engage in practices of self-presentation in order to form commoditised identities that circulate in affective communities.For Maguire, these automedial works operate textually “to construct the authorial self or persona”.An extension to this digital, authorial construction is apparent in the exponential uptake of screen mediated prosumer generated content, whether online or theatrical (Miller). According to Gernalzick, unlike fictional drama films, screen autobiographies more directly enable “experiential temporalities”. Based on Mary Anne Doane’s promotion of the “indexicality” of film/screen representations to connote the real, Gernalzick suggests that despite semiotic theories of the index problematising realism as an index as representation, the film medium is still commonly comprehended as the “imprint of time itself”:Film and the spectator of film are said to be in a continuous present. Because the viewer is aware, however, that the images experienced in or even as presence have been made in the past, the temporality of the so-called filmic present is always ambiguous” (230).When expressed as indexical, automedial works, the intrinsic audio-visual capacities of film and video (as media) far surpass the temporal limitations of print and writing (Gernalzick, 228). One extreme example can be found in an emergent trend of “performance crime” murder and torture videos live-streamed or broadcast after the fact using mobile phone cameras and FaceBook (Bender). In essence, the political economy of the automedial ecology is important to understand in the overall context of self expression and the governance of content exhibition, access, distribution and—where relevant—interaction.So what are the implications for automedial works that employ virtual interfaces and how does this evolving medium inform both the expressive autobiographical mode and audiences subjectivities?Case StudyThe Catalyst program described above strove to shed new light on the potential for emerging technology to capture and create virtual avatars from living participants who (self-)generate autobiographical narratives interactively. Once past the initial gee-wiz journalistic evangelism of VR, the episode turned towards host Nguyen’s stated goal—using contemporary technology to create an autonomous virtual human clone. Nguyen laments that if he could create only one such avatar, his primary choice would be that of his grandfather who died when Nguyen was two years old—a desire rendered impossible. The awkward humour of the plank walk scenario sequence soon gives way as the enthusiastic Nguyen is surprised by his family’s discomfort with the idea of digitally recreating his grandfather.Nguyen next visits a Southern California digital media lab to experience the process by which 3D virtual human avatars are created. Inside a domed array of lights and cameras, in less than one second a life-size 3D avatar is recorded via 6,000 LEDs illuminating his face in 20 different combinations, with eight cameras capturing the exposures from multiple angles, all in ultra high definition. Called the Light Stage (Debevec), it is the same technology used to create a life size, virtual holocaust survivor, Pinchas Gutter (Ziv).We see Nguyen encountering a life-size, high-resolution 2D screen version of Gutter’s avatar. Standing before a microphone, Nguyen asks a series of questions about Gutter’s wartime experiences and life in the concentration camps. The responses are naturalistic and authentic, as are the pauses between questions. The high definition 4K screen is photo-realist but much more convincing in-situ (as an artifact of the Catalyst video camera recording, in some close-ups horizontal lines of transmission appear). According to the project’s curator, David Traum, the real Pinchas Gutter was recorded in 3D as a virtual holograph. He spent 25 hours providing 1,600 responses to a broad range of questions that the curator maintained covered “a lot of what people want to say” (Catalyst).Figure 2: The Museum of Jewish Heritage in Manhattan presented an installation of New Dimensions in Testimony, featuring Pinchas Gutter and Eva SchlossIt is here that the intersection between VR and auto/biography hybridise in complex and potentially difficult ways. It is where the concept of automediality may offer insight into this rapidly emerging phenomenon of creating interactive, hyperreal versions of our selves using VR. These hyperreal VR personae can be questioned and respond in real-time, where interrogators interact either as casual conversers or determined interrogators.The impact on visitors is sobering and palpable. As Nguyen relates at the end of his session, “I just want to give him a hug”. The demonstrable capacity for this avatar to engender a high degree of empathy from its automedial testimony is clear, although as we indicate below, it could simply indicate increased levels of emotion.Regardless, an ongoing concern amongst witnesses, scholars and cultural curators of memorials and museums dedicated to preserving the history of mass violence, and its associated trauma, is that once the lived experience and testimony of survivors passes with that generation the impact of the testimony diminishes (Broderick). New media modes of preserving and promulgating such knowledge in perpetuity are certainly worthy of embracing. As Stephen Smith, the executive director of the USC Shoah Foundation suggests, the technology could extendto people who have survived cancer or catastrophic hurricanes […] from the experiences of soldiers with post-traumatic stress disorder or survivors of sexual abuse, to those of presidents or great teachers. Imagine if a slave could have told her story to her grandchildren? (Ziv)Yet questions remain as to the veracity of these recorded personae. The avatars are created according to a specific agenda and the autobiographical content controlled for explicit editorial purposes. It is unclear what and why material has been excluded. If, for example, during the recorded questioning, the virtual holocaust survivor became mute at recollecting a traumatic memory, cried or sobbed uncontrollably—all natural, understandable and authentic responses given the nature of the testimony—should these genuine and spontaneous emotions be included along with various behavioural ticks such as scratching, shifting about in the seat and other naturalistic movements, to engender a more profound realism?The generation of the photorealist, mimetic avatar—remaining as an interactive persona long after the corporeal, authorial being is gone—reinforces Baudrillard’s concept of simulacra, where a clone exists devoid of its original entity and unable to challenge its automedial discourse. And what if some unscrupulous hacker managed to corrupt and subvert Gutter’s AI so that it responded antithetically to its purpose, by denying the holocaust ever happened? The ethical dilemmas of such a paradigm were explored in the dystopian 2013 film, The Congress, where Robyn Wright plays herself (and her avatar), as an out of work actor who sells off the rights to her digital self. A movie studio exploits her screen persona in perpetuity, enabling audiences to “become” and inhabit her avatar in virtual space while she is limited in the real world from undertaking certain actions due to copyright infringement. The inability of Wright to control her mimetic avatar’s discourse or action means the assumed automedial agency of her virtual self as an immortal, interactive being remains ontologically perplexing.Figure 3: Robyn Wright undergoing a full body photogrammetry to create her VR avatar in The Congress (2013)The various virtual exposures/experiences paraded throughout Catalyst’s “Meet the Avatars” paradoxically recorded and broadcast a range of troubling emotional responses to such immersion. Many participant responses suggest great caution and sensitivity be undertaken before plunging headlong into the new gold rush mentality of virtual reality, augmented reality, and AI affordances. Catalyst depicted their program subjects often responding in discomfort and distress, with some visibly overwhelmed by their encounters and left crying. There is some irony that presenter Ngyuen was himself relying on the conventions of 2D linear television journalism throughout, adopting face-to-camera address in (unconscious) automedial style to excitedly promote the assumed socio-cultural boon such automedial VR avatars will generate.Challenging AuthenticityThere are numerous ethical considerations surrounding the potential for AIs to expand beyond automedial (self-)expression towards photorealist avatars interacting outside of their pre-recorded content. When such systems evolve it may be neigh impossible to discern on screen whether the person you are conversing with is authentic or an indistinguishable, virtual doppelganger. In the future, a variant on the Turning Test may be needed to challenge and identify such hyperreal simulacra. We may be witnessing the precursor to such a dilemma playing out in the arena of audio-only podcasts, with some public intellectuals such as Sam Harris already discussing the legal and ethical problems from technology that can create audio from typed text that convincingly replicate the actual voice of a person by sampling approximately 30 minutes of their original speech (Harris). Such audio manipulation technology will soon be available to anybody with the motivation and relatively minor level of technological ability in order to assume an identity and masquerade as automediated dialogue. However, for the moment, the ability to convincingly alter a real-time computer generated video image of a person remains at the level of scientific innovation.Also of significance is the extent to which the audience reactions to such automediated expressions are indeed empathetic or simply part of the broader range of affective responses that also include direct sympathy as well as emotions such as admiration, surprise, pity, disgust and contempt (see Plantinga). There remains much rhetorical hype surrounding VR as the “ultimate empathy machine” (Milk). Yet the current use of the term “empathy” in VR, AI and automedial forms of communication seems to be principally focused on the capacity for the user-viewer to ameliorate negatively perceived emotions and experiences, whether traumatic or phobic.When considering comments about authenticity here, it is important to be aware of the occasional slippage of technological terminology into the mainstream. For example, the psychological literature does emphasise that patients respond strongly to virtual scenarios, events, and details that appear to be “authentic” (Pertaub, Slater, and Barker). Authentic in this instance implies a resemblance to a corresponding scenario/activity in the real world. This is not simply another word for photorealism, but rather it describes for instance the experimental design of one study in which virtual (AI) audience members in a virtual seminar room designed to treat public speaking anxiety were designed to exhibit “random autonomous behaviours in real-time, such as twitches, blinks, and nods, designed to encourage the illusion of life” (Kwon, Powell and Chalmers 980). The virtual humans in this study are regarded as having greater authenticity than an earlier project on social anxiety (North, North, and Coble) which did not have much visual complexity but did incorporate researcher-triggered audio clips of audience members “laughing, making comments, encouraging the speaker to speak louder or more clearly” (Kwon, Powell, and Chalmers 980). The small movements, randomly cued rather than according to a recognisable pattern, are described by the researchers as creating a sense of authenticity in the VR environment as they seem to correspond to the sorts of random minor movements that actual human audiences in a seminar can be expected to make.Nonetheless, nobody should regard an interaction with these AIs, or the avatar of Gutter, as in any way an encounter with a real person. Rather, the characteristics above function to create a disarming effect and enable the real person-viewer to willingly suspend their disbelief and enter into a pseudo-relationship with the AI; not as if it is an actual relationship, but as if it is a simulation of an actual relationship (USC). Lucy Suchman and colleagues invoke these ideas in an analysis of a YouTube video of some apparently humiliating human interactions with the MIT created AI-robot Mertz. Their analysis contends that, while it may appear on first glance that the humans’ mocking exchange with Mertz are mean-spirited, there is clearly a playfulness and willingness to engage with a form of AI that is essentially continuous with “long-standing assumptions about communication as information processing, and in the robot’s performance evidence for the limits to the mechanical reproduction of interaction as we know it through computational processes” (Suchman, Roberts, and Hird).Thus, it will be important for future work in the area of automediated testimony to consider the extent to which audiences are willing to suspend disbelief and treat the recounted traumatic experience with appropriate gravitas. These questions deserve attention, and not the kind of hype displayed by the current iteration of techno-evangelism. Indeed, some of this resurgent hype has come under scrutiny. From the perspective of VR-based tourism, Janna Thompson has recently argued that “it will never be a substitute for encounters with the real thing” (Thompson). Alyssa K. Loh, for instance, also argues that many of the negatively themed virtual experiences—such as those that drop the viewer into a scene of domestic violence or the location of a terrorist bomb attack—function not to put you in the position of the actual victim but in the position of the general category of domestic violence victim, or bomb attack victim, thus “deindividuating trauma” (Loh).Future work in this area should consider actual audience responses and rely upon mixed-methods research approaches to audience analysis. In an era of alt.truth and Cambridge Analytics personality profiling from social media interaction, automediated communication in the virtual guise of AIs demands further study.ReferencesAnon. “New Dimensions in Testimony.” Museum of Jewish Heritage. 15 Dec. 2017. 19 Apr. 2018 <http://mjhnyc.org/exhibitions/new-dimensions-in-testimony/>.Australian Broadcasting Corporation. “Meet The Avatars.” Catalyst, 15 Aug. 2017.Baudrillard, Jean. “Simulacra and Simulations.” Jean Baudrillard: Selected Writings. Ed. Mark Poster. Stanford: Stanford UP, 1988. 166-184.Bender, Stuart Marshall. Legacies of the Degraded Image in Violent Digital Media. Basingstoke: Palgrave Macmillan, 2017.Broderick, Mick. “Topographies of Trauma, Dark Tourism and World Heritage: Hiroshima’s Genbaku Dome.” Intersections: Gender and Sexuality in Asia and the Pacific. 24 Apr. 2010. 14 Apr. 2018 <http://intersections.anu.edu.au/issue24/broderick.htm>.Debevec, Paul. “The Light Stages and Their Applications to Photoreal Digital Actors.” SIGGRAPH Asia. 2012.Doane, Mary Ann. The Emergence of Cinematic Time: Modernity, Contingency, the Archive. Cambridge: Harvard UP, 2002.Dünne, Jörg, and Christian Moser. “Allgemeine Einleitung: Automedialität”. Automedialität: Subjektkonstitution in Schrift, Bild und neuen Medien. Eds. Jörg Dünne and Christian Moser. München: Wilhelm Fink, 2008. 7-16.Harris, Sam. “Waking Up with Sam Harris #64 – Ask Me Anything.” YouTube, 16 Feb. 2017. 16 Mar. 2018 <https://www.youtube.com/watch?v=gMTuquaAC4w>.Kwon, Joung Huem, John Powell, and Alan Chalmers. “How Level of Realism Influences Anxiety in Virtual Reality Environments for a Job Interview.” International Journal of Human-Computer Studies 71.10 (2013): 978-87.Loh, Alyssa K. "I Feel You." Artforum, Nov. 2017. 10 Apr. 2018 <https://www.artforum.com/print/201709/alyssa-k-loh-on-virtual-reality-and-empathy-71781>.Marshall, P. David. “Persona Studies: Mapping the Proliferation of the Public Self.” Journalism 15.2 (2014): 153-170.Mathews, Karen. “Exhibit Allows Virtual ‘Interviews’ with Holocaust Survivors.” Phys.org Science X Network, 15 Dec. 2017. 18 Apr. 2018 <https://phys.org/news/2017-09-virtual-holocaust-survivors.html>.Maguire, Emma. “Home, About, Shop, Contact: Constructing an Authorial Persona via the Author Website” M/C Journal 17.9 (2014).Miller, Ken. More than Fifteen Minutes of Fame: The Evolution of Screen Performance. Unpublished PhD Thesis. Murdoch University. 2009.Milk, Chris. “Ted: How Virtual Reality Can Create the Ultimate Empathy Machine.” TED Conferences, LLC. 16 Mar. 2015. <https://www.ted.com/talks/chris_milk_how_virtual_reality_can_create_the_ultimate_empathy_machine>.Nakamura, Lisa. “Cyberrace.” Identity Technologies: Constructing the Self Online. Eds. Anna Poletti and Julie Rak. Madison, Wisconsin: U of Wisconsin P, 2014. 42-54.North, Max M., Sarah M. North, and Joseph R Coble. 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Abstract:

Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (f*ckuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circ*mstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circ*mstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peaco*ck et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. 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Abstract:

Introduction: Our current obsession with the lives of others “Biography—that is to say, our creative and non-fictional output devoted to recording and interpreting real lives—has enjoyed an extraordinary renaissance in recent years,” writes Nigel Hamilton in Biography: A Brief History (1). Ian Donaldson agrees that biography is back in fashion: “Once neglected within the academy and relegated to the dustier recesses of public bookstores, biography has made a notable return over recent years, emerging, somewhat surprisingly, as a new cultural phenomenon, and a new academic adventure” (23). For over a decade now, commentators having been making similar observations about our obsession with the intimacies of individual people’s lives. In a lecture in 1994, Justin Kaplan asserted the West was “a culture of biography” (qtd. in Salwak 1) and more recent research findings by John Feather and Hazel Woodbridge affirm that “the undiminished human curiosity about other peoples lives is clearly reflected in the popularity of autobiographies and biographies” (218). At least in relation to television, this assertion seems valid. In Australia, as in the USA and the UK, reality and other biographically based television shows have taken over from drama in both the numbers of shows produced and the viewers these shows attract, and these forms are also popular in Canada (see, for instance, Morreale on The Osbournes). In 2007, the program Biography celebrated its twentieth anniversary season to become one of the longest running documentary series on American television; so successful that in 1999 it was spun off into its own eponymous channel (Rak; Dempsey). Premiered in May 1996, Australian Story—which aims to utilise a “personal approach” to biographical storytelling—has won a significant viewership, critical acclaim and professional recognition (ABC). It can also be posited that the real home movies viewers submit to such programs as Australia’s Favourite Home Videos, and “chat” or “confessional” television are further reflections of a general mania for biographical detail (see Douglas), no matter how fragmented, sensationalized, or even inane and cruel. A recent example of the latter, the USA-produced The Moment of Truth, has contestants answering personal questions under polygraph examination and then again in front of an audience including close relatives and friends—the more “truthful” their answers (and often, the more humiliated and/or distressed contestants are willing to be), the more money they can win. Away from television, but offering further evidence of this interest are the growing readerships for personally oriented weblogs and networking sites such as MySpace and Facebook (Grossman), individual profiles and interviews in periodical publications, and the recently widely revived newspaper obituary column (Starck). Adult and community education organisations run short courses on researching and writing auto/biographical forms and, across Western countries, the family history/genealogy sections of many local, state, and national libraries have been upgraded to meet the increasing demand for these services. Academically, journals and e-mail discussion lists have been established on the topics of biography and autobiography, and North American, British, and Australian universities offer undergraduate and postgraduate courses in life writing. The commonly aired wisdom is that published life writing in its many text-based forms (biography, autobiography, memoir, diaries, and collections of personal letters) is enjoying unprecedented popularity. It is our purpose to examine this proposition. Methodological problems There are a number of problems involved in investigating genre popularity, growth, and decline in publishing. Firstly, it is not easy to gain access to detailed statistics, which are usually only available within the industry. Secondly, it is difficult to ascertain how publishing statistics are gathered and what they report (Eliot). There is the question of whether bestselling booklists reflect actual book sales or are manipulated marketing tools (Miller), although the move from surveys of booksellers to electronic reporting at point of sale in new publishing lists such as BookScan will hopefully obviate this problem. Thirdly, some publishing lists categorise by subject and form, some by subject only, and some do not categorise at all. This means that in any analysis of these statistics, a decision has to be made whether to use the publishing list’s system or impose a different mode. If the publishing list is taken at face value, the question arises of whether to use categorisation by form or by subject. Fourthly, there is the bedeviling issue of terminology. Traditionally, there reigned a simple dualism in the terminology applied to forms of telling the true story of an actual life: biography and autobiography. Publishing lists that categorise their books, such as BookScan, have retained it. But with postmodern recognition of the presence of the biographer in a biography and of the presence of other subjects in an autobiography, the dichotomy proves false. There is the further problem of how to categorise memoirs, diaries, and letters. In the academic arena, the term “life writing” has emerged to describe the field as a whole. Within the genre of life writing, there are, however, still recognised sub-genres. Academic definitions vary, but generally a biography is understood to be a scholarly study of a subject who is not the writer; an autobiography is the story of a entire life written by its subject; while a memoir is a segment or particular focus of that life told, again, by its own subject. These terms are, however, often used interchangeably even by significant institutions such the USA Library of Congress, which utilises the term “biography” for all. Different commentators also use differing definitions. Hamilton uses the term “biography” to include all forms of life writing. Donaldson discusses how the term has been co-opted to include biographies of place such as Peter Ackroyd’s London: The Biography (2000) and of things such as Lizzie Collingham’s Curry: A Biography (2005). This reflects, of course, a writing/publishing world in which non-fiction stories of places, creatures, and even foodstuffs are called biographies, presumably in the belief that this will make them more saleable. The situation is further complicated by the emergence of hybrid publishing forms such as, for instance, the “memoir-with-recipes” or “food memoir” (Brien, Rutherford and Williamson). Are such books to be classified as autobiography or put in the “cookery/food & drink” category? We mention in passing the further confusion caused by novels with a subtitle of The Biography such as Virginia Woolf’s Orlando. The fifth methodological problem that needs to be mentioned is the increasing globalisation of the publishing industry, which raises questions about the validity of the majority of studies available (including those cited herein) which are nationally based. Whether book sales reflect what is actually read (and by whom), raises of course another set of questions altogether. Methodology In our exploration, we were fundamentally concerned with two questions. Is life writing as popular as claimed? And, if it is, is this a new phenomenon? To answer these questions, we examined a range of available sources. We began with the non-fiction bestseller lists in Publishers Weekly (a respected American trade magazine aimed at publishers, librarians, booksellers, and literary agents that claims to be international in scope) from their inception in 1912 to the present time. We hoped that this data could provide a longitudinal perspective. The term bestseller was coined by Publishers Weekly when it began publishing its lists in 1912; although the first list of popular American books actually appeared in The Bookman (New York) in 1895, based itself on lists appearing in London’s The Bookman since 1891 (Bassett and Walter 206). The Publishers Weekly lists are the best source of longitudinal information as the currently widely cited New York Times listings did not appear till 1942, with the Wall Street Journal a late entry into the field in 1994. We then examined a number of sources of more recent statistics. We looked at the bestseller lists from the USA-based Amazon.com online bookseller; recent research on bestsellers in Britain; and lists from Nielsen BookScan Australia, which claims to tally some 85% or more of books sold in Australia, wherever they are published. In addition to the reservations expressed above, caveats must be aired in relation to these sources. While Publishers Weekly claims to be an international publication, it largely reflects the North American publishing scene and especially that of the USA. Although available internationally, Amazon.com also has its own national sites—such as Amazon.co.uk—not considered here. It also caters to a “specific computer-literate, credit-able clientele” (Gutjahr: 219) and has an unashamedly commercial focus, within which all the information generated must be considered. In our analysis of the material studied, we will use “life writing” as a genre term. When it comes to analysis of the lists, we have broken down the genre of life writing into biography and autobiography, incorporating memoir, letters, and diaries under autobiography. This is consistent with the use of the terminology in BookScan. Although we have broken down the genre in this way, it is the overall picture with regard to life writing that is our concern. It is beyond the scope of this paper to offer a detailed analysis of whether, within life writing, further distinctions should be drawn. Publishers Weekly: 1912 to 2006 1912 saw the first list of the 10 bestselling non-fiction titles in Publishers Weekly. It featured two life writing texts, being headed by an autobiography, The Promised Land by Russian Jewish immigrant Mary Antin, and concluding with Albert Bigelow Paine’s six-volume biography, Mark Twain. The Publishers Weekly lists do not categorise non-fiction titles by either form or subject, so the classifications below are our own with memoir classified as autobiography. In a decade-by-decade tally of these listings, there were 3 biographies and 20 autobiographies in the lists between 1912 and 1919; 24 biographies and 21 autobiographies in the 1920s; 13 biographies and 40 autobiographies in the 1930s; 8 biographies and 46 biographies in the 1940s; 4 biographies and 14 autobiographies in the 1950s; 11 biographies and 13 autobiographies in the 1960s; 6 biographies and 11 autobiographies in the 1970s; 3 biographies and 19 autobiographies in the 1980s; 5 biographies and 17 autobiographies in the 1990s; and 2 biographies and 7 autobiographies from 2000 up until the end of 2006. See Appendix 1 for the relevant titles and authors. Breaking down the most recent figures for 1990–2006, we find a not radically different range of figures and trends across years in the contemporary environment. The validity of looking only at the top ten books sold in any year is, of course, questionable, as are all the issues regarding sources discussed above. But one thing is certain in terms of our inquiry. There is no upwards curve obvious here. If anything, the decade break-down suggests that sales are trending downwards. This is in keeping with the findings of Michael Korda, in his history of twentieth-century bestsellers. He suggests a consistent longitudinal picture across all genres: In every decade, from 1900 to the end of the twentieth century, people have been reliably attracted to the same kind of books […] Certain kinds of popular fiction always do well, as do diet books […] self-help books, celebrity memoirs, sensationalist scientific or religious speculation, stories about pets, medical advice (particularly on the subjects of sex, longevity, and child rearing), folksy wisdom and/or humour, and the American Civil War (xvii). Amazon.com since 2000 The USA-based Amazon.com online bookselling site provides listings of its own top 50 bestsellers since 2000, although only the top 14 bestsellers are recorded for 2001. As fiction and non-fiction are not separated out on these lists and no genre categories are specified, we have again made our own decisions about what books fall into the category of life writing. Generally, we erred on the side of inclusion. (See Appendix 2.) However, when it came to books dealing with political events, we excluded books dealing with specific aspects of political practice/policy. This meant excluding books on, for instance, George Bush’s so-called ‘war on terror,’ of which there were a number of bestsellers listed. In summary, these listings reveal that of the top 364 books sold by Amazon from 2000 to 2007, 46 (or some 12.6%) were, according to our judgment, either biographical or autobiographical texts. This is not far from the 10% of the 1912 Publishers Weekly listing, although, as above, the proportion of bestsellers that can be classified as life writing varied dramatically from year to year, with no discernible pattern of peaks and troughs. This proportion tallied to 4% auto/biographies in 2000, 14% in 2001, 10% in 2002, 18% in 2003 and 2004, 4% in 2005, 14% in 2006 and 20% in 2007. This could suggest a rising trend, although it does not offer any consistent trend data to suggest sales figures may either continue to grow, or fall again, in 2008 or afterwards. Looking at the particular texts in these lists (see Appendix 2) also suggests that there is no general trend in the popularity of life writing in relation to other genres. For instance, in these listings in Amazon.com, life writing texts only rarely figure in the top 10 books sold in any year. So rarely indeed, that from 2001 there were only five in this category. In 2001, John Adams by David McCullough was the best selling book of the year; in 2003, Hillary Clinton’s autobiographical Living History was 7th; in 2004, My Life by Bill Clinton reached number 1; in 2006, Nora Ephron’s I Feel Bad About My Neck: and Other Thoughts on Being a Woman was 9th; and in 2007, Ishmael Beah’s discredited A Long Way Gone: Memoirs of a Boy Soldier came in at 8th. Apart from McCulloch’s biography of Adams, all the above are autobiographical texts, while the focus on leading political figures is notable. Britain: Feather and Woodbridge With regard to the British situation, we did not have actual lists and relied on recent analysis. John Feather and Hazel Woodbridge find considerably higher levels for life writing in Britain than above with, from 1998 to 2005, 28% of British published non-fiction comprising autobiography, while 8% of hardback and 5% of paperback non-fiction was biography (2007). Furthermore, although Feather and Woodbridge agree with commentators that life writing is currently popular, they do not agree that this is a growth state, finding the popularity of life writing “essentially unchanged” since their previous study, which covered 1979 to the early 1990s (Feather and Reid). Australia: Nielsen BookScan 2006 and 2007 In the Australian publishing industry, where producing books remains an ‘expensive, risky endeavour which is increasingly market driven’ (Galligan 36) and ‘an inherently complex activity’ (Carter and Galligan 4), the most recent Australian Bureau of Statistics figures reveal that the total numbers of books sold in Australia has remained relatively static over the past decade (130.6 million in the financial year 1995–96 and 128.8 million in 2003–04) (ABS). During this time, however, sales volumes of non-fiction publications have grown markedly, with a trend towards “non-fiction, mass market and predictable” books (Corporall 41) resulting in general non-fiction sales in 2003–2004 outselling general fiction by factors as high as ten depending on the format—hard- or paperback, and trade or mass market paperback (ABS 2005). However, while non-fiction has increased in popularity in Australia, the same does not seem to hold true for life writing. Here, in utilising data for the top 5,000 selling non-fiction books in both 2006 and 2007, we are relying on Nielsen BookScan’s categorisation of texts as either biography or autobiography. In 2006, no works of life writing made the top 10 books sold in Australia. In looking at the top 100 books sold for 2006, in some cases the subjects of these works vary markedly from those extracted from the Amazon.com listings. In Australia in 2006, life writing makes its first appearance at number 14 with convicted drug smuggler Schapelle Corby’s My Story. This is followed by another My Story at 25, this time by retired Australian army chief, Peter Cosgrove. Jonestown: The Power and Myth of Alan Jones comes in at 34 for the Australian broadcaster’s biographer Chris Masters; the biography, The Innocent Man by John Grisham at 38 and Li Cunxin’s autobiographical Mao’s Last Dancer at 45. Australian Susan Duncan’s memoir of coping with personal loss, Salvation Creek: An Unexpected Life makes 50; bestselling USA travel writer Bill Bryson’s autobiographical memoir of his childhood The Life and Times of the Thunderbolt Kid 69; Mandela: The Authorised Portrait by Rosalind Coward, 79; and Joanne Lees’s memoir of dealing with her kidnapping, the murder of her partner and the justice system in Australia’s Northern Territory, No Turning Back, 89. These books reveal a market preference for autobiographical writing, and an almost even split between Australian and overseas subjects in 2006. 2007 similarly saw no life writing in the top 10. The books in the top 100 sales reveal a downward trend, with fewer titles making this band overall. In 2007, Terri Irwin’s memoir of life with her famous husband, wildlife warrior Steve Irwin, My Steve, came in at number 26; musician Andrew Johns’s memoir of mental illness, The Two of Me, at 37; Ayaan Hirst Ali’s autobiography Infidel at 39; John Grogan’s biography/memoir, Marley and Me: Life and Love with the World’s Worst Dog, at 42; Sally Collings’s biography of the inspirational young survivor Sophie Delezio, Sophie’s Journey, at 51; and Elizabeth Gilbert’s hybrid food, self-help and travel memoir, Eat, Pray, Love: One Woman’s Search for Everything at 82. Mao’s Last Dancer, published the year before, remained in the top 100 in 2007 at 87. When moving to a consideration of the top 5,000 books sold in Australia in 2006, BookScan reveals only 62 books categorised as life writing in the top 1,000, and only 222 in the top 5,000 (with 34 titles between 1,000 and 1,999, 45 between 2,000 and 2,999, 48 between 3,000 and 3,999, and 33 between 4,000 and 5,000). 2007 shows a similar total of 235 life writing texts in the top 5,000 bestselling books (75 titles in the first 1,000, 27 between 1,000 and 1,999, 51 between 2,000 and 2,999, 39 between 3,000 and 3,999, and 43 between 4,000 and 5,000). In both years, 2006 and 2007, life writing thus not only constituted only some 4% of the bestselling 5,000 titles in Australia, it also showed only minimal change between these years and, therefore, no significant growth. Conclusions Our investigation using various instruments that claim to reflect levels of book sales reveals that Western readers’ willingness to purchase published life writing has not changed significantly over the past century. We find no evidence of either a short, or longer, term growth or boom in sales in such books. Instead, it appears that what has been widely heralded as a new golden age of life writing may well be more the result of an expanded understanding of what is included in the genre than an increased interest in it by either book readers or publishers. What recent years do appear to have seen, however, is a significantly increased interest by public commentators, critics, and academics in this genre of writing. We have also discovered that the issue of our current obsession with the lives of others tends to be discussed in academic as well as popular fora as if what applies to one sub-genre or production form applies to another: if biography is popular, then autobiography will also be, and vice versa. If reality television programming is attracting viewers, then readers will be flocking to life writing as well. Our investigation reveals that such propositions are questionable, and that there is significant research to be completed in mapping such audiences against each other. This work has also highlighted the difficulty of separating out the categories of written texts in publishing studies, firstly in terms of determining what falls within the category of life writing as distinct from other forms of non-fiction (the hybrid problem) and, secondly, in terms of separating out the categories within life writing. Although we have continued to use the terms biography and autobiography as sub-genres, we are aware that they are less useful as descriptors than they are often assumed to be. In order to obtain a more complete and accurate picture, publishing categories may need to be agreed upon, redefined and utilised across the publishing industry and within academia. This is of particular importance in the light of the suggestions (from total sales volumes) that the audiences for books are limited, and therefore the rise of one sub-genre may be directly responsible for the fall of another. Bair argues, for example, that in the 1980s and 1990s, the popularity of what she categorises as memoir had direct repercussions on the numbers of birth-to-death biographies that were commissioned, contracted, and published as “sales and marketing staffs conclude[d] that readers don’t want a full-scale life any more” (17). Finally, although we have highlighted the difficulty of using publishing statistics when there is no common understanding as to what such data is reporting, we hope this study shows that the utilisation of such material does add a depth to such enquiries, especially in interrogating the anecdotal evidence that is often quoted as data in publishing and other studies. Appendix 1 Publishers Weekly listings 1990–1999 1990 included two autobiographies, Bo Knows Bo by professional athlete Bo Jackson (with Dick Schaap) and Ronald Reagan’s An America Life: An Autobiography. In 1991, there were further examples of life writing with unimaginative titles, Me: Stories of My Life by Katherine Hepburn, Nancy Reagan: The Unauthorized Biography by Kitty Kelley, and Under Fire: An American Story by Oliver North with William Novak; as indeed there were again in 1992 with It Doesn’t Take a Hero: The Autobiography of Norman Schwarzkopf, Sam Walton: Made in America, the autobiography of the founder of Wal-Mart, Diana: Her True Story by Andrew Morton, Every Living Thing, yet another veterinary outpouring from James Herriot, and Truman by David McCullough. In 1993, radio shock-jock Howard Stern was successful with the autobiographical Private Parts, as was Betty Eadie with her detailed recounting of her alleged near-death experience, Embraced by the Light. Eadie’s book remained on the list in 1994 next to Don’t Stand too Close to a Naked Man, comedian Tim Allen’s autobiography. Flag-waving titles continue in 1995 with Colin Powell’s My American Journey, and Miss America, Howard Stern’s follow-up to Private Parts. 1996 saw two autobiographical works, basketball superstar Dennis Rodman’s Bad as I Wanna Be and figure-skater, Ekaterina Gordeeva’s (with EM Swift) My Sergei: A Love Story. In 1997, Diana: Her True Story returns to the top 10, joining Frank McCourt’s Angela’s Ashes and prolific biographer Kitty Kelly’s The Royals, while in 1998, there is only the part-autobiography, part travel-writing A Pirate Looks at Fifty, by musician Jimmy Buffet. There is no biography or autobiography included in either the 1999 or 2000 top 10 lists in Publishers Weekly, nor in that for 2005. In 2001, David McCullough’s biography John Adams and Jack Welch’s business memoir Jack: Straight from the Gut featured. In 2002, Let’s Roll! Lisa Beamer’s tribute to her husband, one of the heroes of 9/11, written with Ken Abraham, joined Rudolph Giuliani’s autobiography, Leadership. 2003 saw Hillary Clinton’s autobiography Living History and Paul Burrell’s memoir of his time as Princess Diana’s butler, A Royal Duty, on the list. In 2004, it was Bill Clinton’s turn with My Life. In 2006, we find John Grisham’s true crime (arguably a biography), The Innocent Man, at the top, Grogan’s Marley and Me at number three, and the autobiographical The Audacity of Hope by Barack Obama in fourth place. Appendix 2 Amazon.com listings since 2000 In 2000, there were only two auto/biographies in the top Amazon 50 bestsellers with Lance Armstrong’s It’s Not about the Bike: My Journey Back to Life about his battle with cancer at 20, and Dave Eggers’s self-consciously fictionalised memoir, A Heartbreaking Work of Staggering Genius at 32. In 2001, only the top 14 bestsellers were recorded. At number 1 is John Adams by David McCullough and, at 11, Jack: Straight from the Gut by USA golfer Jack Welch. In 2002, Leadership by Rudolph Giuliani was at 12; Master of the Senate: The Years of Lyndon Johnson by Robert Caro at 29; Portrait of a Killer: Jack the Ripper by Patricia Cornwell at 42; Blinded by the Right: The Conscience of an Ex-Conservative by David Brock at 48; and Louis Gerstner’s autobiographical Who Says Elephants Can’t Dance: Inside IBM’s Historic Turnaround at 50. In 2003, Living History by Hillary Clinton was 7th; Benjamin Franklin: An American Life by Walter Isaacson 14th; Dereliction of Duty: The Eyewitness Account of How President Bill Clinton Endangered America’s Long-Term National Security by Robert Patterson 20th; Under the Banner of Heaven: A Story of Violent Faith by Jon Krakauer 32nd; Leap of Faith: Memoirs of an Unexpected Life by Queen Noor of Jordan 33rd; Kate Remembered, Scott Berg’s biography of Katharine Hepburn, 37th; Who’s your Caddy?: Looping for the Great, Near Great and Reprobates of Golf by Rick Reilly 39th; The Teammates: A Portrait of a Friendship about a winning baseball team by David Halberstam 42nd; and Every Second Counts by Lance Armstrong 49th. In 2004, My Life by Bill Clinton was the best selling book of the year; American Soldier by General Tommy Franks was 16th; Kevin Phillips’s American Dynasty: Aristocracy, Fortune and the Politics of Deceit in the House of Bush 18th; Timothy Russert’s Big Russ and Me: Father and Son. Lessons of Life 20th; Tony Hendra’s Father Joe: The Man who Saved my Soul 23rd; Ron Chernow’s Alexander Hamilton 27th; co*kie Roberts’s Founding Mothers: The Women Who Raised our Nation 31st; Kitty Kelley’s The Family: The Real Story of the Bush Dynasty 42nd; and Chronicles, Volume 1 by Bob Dylan was 43rd. In 2005, auto/biographical texts were well down the list with only The Year of Magical Thinking by Joan Didion at 45 and The Glass Castle: A Memoir by Jeanette Walls at 49. In 2006, there was a resurgence of life writing with Nora Ephron’s I Feel Bad About My Neck: and Other Thoughts on Being a Woman at 9; Grisham’s The Innocent Man at 12; Bill Buford’s food memoir Heat: an Amateur’s Adventures as Kitchen Slave, Line Cook, Pasta-Maker, and Apprentice to a Dante-Quoting Butcher in Tuscany at 23; more food writing with Julia Child’s My Life in France at 29; Immaculée Ilibagiza’s Left to Tell: Discovering God amidst the Rwandan Holocaust at 30; CNN anchor Anderson Cooper’s Dispatches from the Edge: A Memoir of War, Disasters and Survival at 43; and Isabella Hatkoff’s Owen & Mzee: The True Story of a Remarkable Friendship (between a baby hippo and a giant tortoise) at 44. In 2007, Ishmael Beah’s discredited A Long Way Gone: Memoirs of a Boy Soldier came in at 8; Walter Isaacson’s Einstein: His Life and Universe 13; Ayaan Hirst Ali’s autobiography of her life in Muslim society, Infidel, 18; The Reagan Diaries 25; Jesus of Nazareth by Pope Benedict XVI 29; Mother Teresa: Come be my Light 36; Clapton: The Autobiography 40; Tina Brown’s The Diana Chronicles 45; Tony Dungy’s Quiet Strength: The Principles, Practices & Priorities of a Winning Life 47; and Daniel Tammet’s Born on a Blue Day: Inside the Extraordinary Mind of an Autistic Savant at 49. Acknowledgements A sincere thank you to Michael Webster at RMIT for assistance with access to Nielsen BookScan statistics, and to the reviewers of this article for their insightful comments. Any errors are, of course, our own. References Australian Broadcasting Commission (ABC). “About Us.” Australian Story 2008. 1 June 2008. ‹http://www.abc.net.au/austory/aboutus.htm>. Australian Bureau of Statistics. “1363.0 Book Publishers, Australia, 2003–04.” 2005. 1 June 2008 ‹http://www.abs.gov.au/ausstats/abs@.nsf/mf/1363.0>. Bair, Deirdre “Too Much S & M.” Sydney Morning Herald 10–11 Sept. 2005: 17. Basset, Troy J., and Christina M. Walter. “Booksellers and Bestsellers: British Book Sales as Documented by The Bookman, 1891–1906.” Book History 4 (2001): 205–36. Brien, Donna Lee, Leonie Rutherford, and Rosemary Williamson. “Hearth and Hotmail: The Domestic Sphere as Commodity and Community in Cyberspace.” M/C Journal 10.4 (2007). 1 June 2008 ‹http://journal.media-culture.org.au/0708/10-brien.php>. Carter, David, and Anne Galligan. “Introduction.” Making Books: Contemporary Australian Publishing. St Lucia: U of Queensland P, 2007. 1–14. Corporall, Glenda. Project Octopus: Report Commissioned by the Australian Society of Authors. Sydney: Australian Society of Authors, 1990. Dempsey, John “Biography Rewrite: A&E’s Signature Series Heads to Sib Net.” Variety 4 Jun. 2006. 1 June 2008 ‹http://www.variety.com/article/VR1117944601.html?categoryid=1238&cs=1>. Donaldson, Ian. “Matters of Life and Death: The Return of Biography.” Australian Book Review 286 (Nov. 2006): 23–29. Douglas, Kate. “‘Blurbing’ Biographical: Authorship and Autobiography.” Biography 24.4 (2001): 806–26. Eliot, Simon. “Very Necessary but not Sufficient: A Personal View of Quantitative Analysis in Book History.” Book History 5 (2002): 283–93. Feather, John, and Hazel Woodbridge. “Bestsellers in the British Book Industry.” Publishing Research Quarterly 23.3 (Sept. 2007): 210–23. Feather, JP, and M Reid. “Bestsellers and the British Book Industry.” Publishing Research Quarterly 11.1 (1995): 57–72. Galligan, Anne. “Living in the Marketplace: Publishing in the 1990s.” Publishing Studies 7 (1999): 36–44. Grossman, Lev. “Time’s Person of the Year: You.” Time 13 Dec. 2006. Online edition. 1 June 2008 ‹http://www.time.com/time/magazine/article/0%2C9171%2C1569514%2C00.html>. Gutjahr, Paul C. “No Longer Left Behind: Amazon.com, Reader Response, and the Changing Fortunes of the Christian Novel in America.” Book History 5 (2002): 209–36. Hamilton, Nigel. Biography: A Brief History. Cambridge, MA: Harvard UP, 2007. Kaplan, Justin. “A Culture of Biography.” The Literary Biography: Problems and Solutions. Ed. Dale Salwak. Basingstoke: Macmillan, 1996. 1–11. Korda, Michael. Making the List: A Cultural History of the American Bestseller 1900–1999. New York: Barnes & Noble, 2001. Miller, Laura J. “The Bestseller List as Marketing Tool and Historical Fiction.” Book History 3 (2000): 286–304. Morreale, Joanne. “Revisiting The Osbournes: The Hybrid Reality-Sitcom.” Journal of Film and Video 55.1 (Spring 2003): 3–15. Rak, Julie. “Bio-Power: CBC Television’s Life & Times and A&E Network’s Biography on A&E.” LifeWriting 1.2 (2005): 1–18. Starck, Nigel. “Capturing Life—Not Death: A Case For Burying The Posthumous Parallax.” Text: The Journal of the Australian Association of Writing Programs 5.2 (2001). 1 June 2008 ‹http://www.textjournal.com.au/oct01/starck.htm>.

Abstract:

Photo by niu niu on Unsplash ABSTRACT Shackling prisoners has been implemented as standard procedure when transporting prisoners in labor and during childbirth. This procedure ensures the protection of both the public and healthcare workers. However, the act of shackling pregnant prisoners violates the principles of ethics that physicians are supposed to uphold. This paper will explore how shackling pregnant prisoners violates the principle of justice and beneficence, making the practice unethical. INTRODUCTION Some states allow shackling of incarcerated pregnant women during transport and while in the hospital for labor and delivery. Currently, only 22 states have legislation prohibiting the shackling of pregnant women.[1] Although many states have anti-shackling laws prohibiting restraints, these laws also contain an “extraordinary circ*mstances” loophole.[2] Under this exception, officers shackle prisoners if they pose a flight risk, have any history of violence, and are a threat to themselves or others.[3] Determining as to whether a prisoner is shackled is left solely to the correctional officer.[4] Yet even state restrictions on shackling are often disregarded. In shackling pregnant prisoners during childbirth, officers and institutions are interfering with the ability of incarcerated women to have safe childbirth experiences and fair treatment. Moreover, physicians cannot exercise various ethical duties as the law constrains them. In this article, I will discuss the physical and mental harms that result from the use of restraints under the backdrop of slavery and discrimination against women of color particularly. I argue that stereotypes feed into the phenomenon of shackling pregnant women, especially pregnant women of color. I further assert that shackling makes it difficult for medical professionals to be beneficent and promote justice. BACKGROUND Female incarceration rates in the United States have been fast growing since the 1980s.[5] With a 498 percent increase in the female incarceration population between 1981 and 2021, the rates of pregnancy and childbirth by incarcerated people have also climbed.[6],[7] In 2021, over 1.2 million women were incarcerated in the United States.[8] An estimated 55,000 pregnant women are admitted to jails each year.[9],[10] Many remain incarcerated throughout pregnancy and are transported to a hospital for labor and delivery. Although the exact number of restrained pregnant inmates is unclear, a study found that 83 percent of hospital prenatal nurses reported that their incarcerated patients were shackled.[11] I. Harms Caused by Shackling Shackling has caused many instances of physical and psychological harm. In the period before childbirth, shackled pregnant women are at high risk for falling.[12] The restraints shift pregnant women’s center of gravity, and wrist restraints prevent them from breaking a fall, increasing the risk of falling on their stomach and harming the fetus.[13] Another aspect inhibited by using restraints is testing and treating pregnancy complications. Delays in identifying and treating conditions such as hypertension, pre-eclampsia, appendicitis, kidney infection, preterm labor, and especially vagin*l bleeding can threaten the lives of the mother and the fetus.[14] During labor and delivery, shackling prevents methods of alleviating severe labor pains and giving birth.[15] Usually, physicians recommend that women in labor walk or assume various positions to relieve labor pains and accelerate labor.[16] However, shackling prevents both solutions.[17] Shackling these women limits their mobility during labor, which may compromise the health of both the mother and the fetus.[18] Tracy Edwards, a former prisoner who filed a lawsuit for unlawful use of restraints during her pregnancy, was in labor for twelve hours. She was unable to move or adjust her position to lessen the pain and discomfort of labor.[19] The shackles also left the skin on her ankles red and bruised. Continued use of restraints also increases the risk of potentially life-threatening health issues associated with childbirth, such as blood clots.[20] It is imperative that pregnant women get treated rapidly, especially with the unpredictability of labor. Epidural administration can also become difficult, and in some cases, be denied due to the shackled woman’s inability to assume the proper position.[21] Time-sensitive medical care, including C-sections, could be delayed if permission from an officer is required, risking major health complications for both the fetus and the mother.[22] After childbirth, shackling impedes the recovery process. Shackling can result in post-delivery complications such as deep vein thrombosis.[23] Walking prevents such complications but is not an option for mothers shackled to their hospital beds.[24] Restraints also prevent bonding with the baby post-delivery and the safe handling of the baby while breast feeding.[25] The use of restraints can also result in psychological harm. Many prisoners feel as though care workers treat them like “animals,” with some women having multiple restraints at once— including ankles, wrists, and even waist restraints.[26] Benidalys Rivera describes the feeling of embarrassment as she was walking while handcuffed, with nurses and patients looking on, “Being in shackles, that make you be in stress…I about to have this baby, and I’m going to go back to jail. So it’s too much.”[27] Depression among pregnant prisoners is highly prevalent. The stress of imprisonment and the anticipation of being separated from their child is often overwhelming for these mothers.[28] The inhumane action has the potential to add more stress, anxiety, and sadness to the already emotionally demanding process of giving birth. Shackling pregnant prisoners displays indifference to the medical needs of the prisoner.[29] II. Safety as a Pretense While public safety is an argument for using shackles, several factors make escape or violence extremely unlikely and even impossible.[30] For example, administering epidural anesthesia causes numbness and eliminates flight risk.[31] Although cited as the main reason for using shackles, public safety is likely just an excuse and not the main motivator for shackling prisoners. I argue that underlying the shackling exemplifies the idea that these women should not have become pregnant. The shackling reflects a distinct discrimination: the lawmakers allowing it perhaps thought that people guilty of crimes would make bad mothers. Public safety is just a pretense. The language used to justify the use of restraint of Shawanna Nelson, the plaintiff in Nelson v. Correctional Medical Services, discussed below, included the word “aggressive.”[32] In her case, there was no evidence that she posed any danger or was objectively aggressive. Officer Turnesky, who supervised Nelson, testified that she never felt threatened by Nelson.[33] The lack of documented attempts of escape and violence from pregnant prisoners suggests that shackling for flight risk is a false pretense and perhaps merely based on stereotypes.[34] In 2011, an Amnesty International report noted that “Around the USA, it is common for restraints to be used on sick and pregnant incarcerated women when they are transported to and kept in hospital, regardless of whether they have a history of violence (which only a minority have) and regardless of whether they have ever absconded or attempted to escape (which few women have).”[35] In a 2020 survey of correctional officers in select midwestern prisons, 76 percent disagreed or strongly disagreed with restraining pregnant women during labor and delivery.[36] If a correctional officer shackles a pregnant prisoner, it is not because they pose a risk but because of a perception that they do. This mindset is attributed to select law enforcement, who have authority to use restraints.[37] In 2022, the Tennessee legislature passed a bill prohibiting the use of restraints on pregnant inmates. However, legislators amended the bill due to the Tennessee Sherriff Association’s belief that even pregnant inmates could pose a “threat.”[38] Subjecting all prisoners to the same “precautions” because a small percentage of individuals may pose such risks could reflect stereotyping or the assumption that all incarcerated people pose danger and flight risk. To quell the (unjustified) public safety concern, there are other options that do not cause physical or mental harm to pregnant women. For example, San Francisco General Hospital does not use shackles but has deputy sheriffs outside the pregnant women’s doors.[39] III. Historical Context and Race A. Slavery and Post-Civil War The treatment of female prisoners has striking similarities to that of enslaved women. Originally, shackling of female slaves was a mechanism of control and dehumanization.[40] This enabled physical and sexual abuses. During the process of intentionally dehumanizing slaves to facilitate subordination, slave owners stripped slave women of their feminine identity.[41] Slave women were unable to exhibit the Victorian model of “good mothering” and people thought they lacked maternal feelings for their children.[42] In turn, societal perception defeminized slave women, and barred them from utilizing the protections of womanhood and motherhood. During the post-Civil War era, black women were reversely depicted as sexually promiscuous and were arrested for prostitution more often than white women.[43] In turn, society excluded black women; they were seen as lacking what the “acceptable and good” women had.[44] Some argue that the historical act of labeling black women sexually deviant influences today’s perception of black women and may lead to labeling them bad mothers.[45] Over two-thirds of incarcerated women are women of color.[46] Many reports document sexual violence and misconduct against prisoners over the years.[47] Male guards have raped, sexually assaulted, and inappropriately touched female prisoners. Some attribute the physical abuse of black female prisoners to their being depicted or stereotyped as “aggressive, deviant, and domineering.”[48] Some expect black women to express stoicism and if they do not, people label them as dangerous, irresponsible, and aggressive.[49] The treatment of these prisoners mirrors the historical oppression endured by black women during and following the era of slavery. The act of shackling incarcerated pregnant women extends the inhumane treatment of these women from the prison setting into the hospital. One prisoner stated that during her thirty-hour labor, while being shackled, she “felt like a farm animal.”[50] Another pregnant prisoner describes her treatment by a guard stating: “a female guard grabbed me by the hair and was making me get up. She was screaming: ‘B***h, get up.’ Then she said, ‘That is what happens when you are a f***ing junkie. You shouldn’t be using drugs, or you wouldn’t be in here.”[51] Shackling goes beyond punishing by isolation from society – it is an additional punishment that is not justified. B. Reproductive Rights and “Bad Mothers” As with slaves not being seen as maternal, prisoners are not viewed as “real mothers.” A female prison guard said the following: “I’m a mother of two and I know what that impulse, that instinct, that mothering instinct feels like. It just takes over, you would never put your kids in harm’s way. . . . Women in here lack that. Something in their nature is not right, you know?”[52] This comment implies that incarcerated women lack maternal instinct. They are not in line with the standards of what society accepts as a “woman” and “mother” and are thought to have abandoned their roles as caretakers in pursuit of deviant behaviors. Without consideration of racial discrimination, poverty issues, trauma, and restricted access to the child right after delivery, these women are stereotyped as bad mothers simply because they are in prison. Reminiscent of the treatment of female black bodies post-civil war and the use of reproductive interventions (for example, Norplant and forced sterilization) in exchange for shorter sentences, I argue that shackles are a form of reproductive control. Justification for the use of shackles even includes their use as a “punitive instrument to remind the prisoner of their punishment.”[53] However, a prisoner’s pregnancy should have no relevance to their sentence.[54] Using shackles demonstrates to prisoners that society tolerates childbirth but does not support it.[55] The shackling is evidence that women are being punished “for bearing children, not for breaking the law.”[56] Physicians and healthcare workers, as a result, are responsible for providing care for the delivery and rectifying any physical problems associated with the restraints. The issues that arise from the use of restraints place physicians in a position more complex than they experience with regular healthy pregnancies. C. Discrimination In the case of Ferguson v. City of Charleston, a medical university subjected black woman to involuntary drug testing during pregnancy. In doing so, medical professionals collaborated with law enforcement to penalize black women for their use of drugs during pregnancy.[57] The Court held the drug tests were an unreasonable search and violated the Fourth Amendment. Ferguson v. City of Charleston further reveals an unjustified assumption: the medical and legal community seemed suspicious of black women and had perhaps predetermined them more likely to use drugs while pregnant. Their fitness to become mothers needed to be proven, while wealthy, white women were presumed fit.[58] The correctional community similarly denies pregnant prisoners’ medical attention. In the case of Staten v. Lackawanna County, an African American woman whose serious medical needs were treated indifferently by jail staff was forced to give birth in her cell.[59] This woman was punished for being pregnant in prison through the withholding of medical attention and empathy. IV. Failure to Follow Anti-Shackling Laws Despite 22 states having laws against shackling pregnant prisoners, officers do not always follow these laws. In 2015, the Correctional Association of New York reported that of the 27 women who gave birth under state custody, officers shackled 23 women in violation of the anti-shackling laws.[60] The lawyer of Tracy Edwards, an inmate who officers shackled unlawfully during her twelve-hour labor stated, “I don’t think we can assume that just because there’s a law passed, that’s automatically going to trickle down to the prison.”[61] Even with more restrictions on shackling, it may still occur, partly due to the stereotype that incarcerated women are aggressive and dangerous. V. Constitutionality The Eighth Amendment protects people from cruel and unusual punishment. In Brown vs. Plata, the court stated, “Prisoners retain the essence of human dignity inherent in all persons.”[62] In several cases, the legal community has held shackling to be unconstitutional as it violates the Eighth Amendment unless specifically justified. In the case of Nelson v. Correctional Medical Services, a pregnant woman was shackled for 12 hours of labor with a brief respite while she pushed, then re-shackled. The shackling caused her physical and emotional pain, including intense cramping that could not be relieved due to positioning and her inability to get up to use a toilet.[63] The court held that a clear security concern must justify shackling. The court cited a similar DC case and various precedents for using the Eighth Amendment to hold correctional facilities and hospitals accountable.[64] An Arkansas law similarly states that shackling must be justified by safety or risk of escape.[65] If the Thirteenth Amendment applied to those convicted of crimes, shackling pregnant incarcerated people would be unconstitutional under that amendment as well as the Eighth. In the Civil Rights Cases, Congress upheld the right “to enact all necessary and proper laws for the obliteration and prevention of slavery with all its badges and incidents.”[66] Section two of the Thirteenth Amendment condemns any trace or acts comparable to that of slavery. Shackling pregnant prisoners, stripping them of their dignity, and justification based on stereotypes all have origins in the treatment of black female slaves. Viewed through the lens of the Thirteenth Amendment, the act of shackling would be unconstitutional. Nonetheless, the Thirteenth Amendment explicitly excludes people convicted of a crime. VI. Justice As a result of the unconstitutional nature of shackling, physicians should have a legal obligation, in addition to their ethical duty, to protect their patients. The principle of justice requires physicians to take a stand against the discriminatory treatment of their patients, even under the eye of law enforcement.[67],[68] However, “badge and gun intimidation,” threats of noncompliance, and the fear of losing one’s license can impede a physician’s willingness to advocate for their patients. The American College of Obstetricians and Gynecologists (ACOG) finds the use of physical restraints interferes with the ability of clinicians to practice medicine safely.[69] ACOG, The American Medical Association, the National Commission on Correctional Health Care, and other organizations oppose using restraints on pregnant incarcerated people.[70] Yet, legislators can adopt shackling laws without consultation with physicians. The ACOG argues that “State legislators are taking it upon themselves to define complex medical concepts without reference to medical evidence. Some of the penalties [faced by OBGYNs] for violating these vague, unscientific laws include criminal sentences.”[71] Legislation that does not consider medical implications or discourages physicians’ input altogether is unjust. In nullifying the voice of a physician in matters pertaining to the patient’s treatment, physicians are prevented from fulfilling the principle of justice, making the act of shackling patients unethical. VII. Principle of Beneficence The principle of beneficence requires the prevention of harm, the removal of harm, and the promotion of good.[72] Beneficence demands the physician not only avoid harm but benefit patients and promote their welfare.[73] The American Board of Internal Medicine Foundation states that physicians must work with other professionals to increase patient safety and improve the quality of care.[74] In doing so, physicians can adequately treat patients with the goal of prevention and healing. It is difficult to do good when law enforcement imposes on doctors to work around shackles during labor and delivery. Law enforcement leaves physicians and healthcare workers responsible not only to provide care for the delivery, but also rectify any ailments associated with the restraints. The issues arising from using restraints place physicians in a position more complex than they experience with other pregnancies. Doctors cannot prevent the application of the shackles and can only request officers to take them off the patient.[75] Physicians who simply go along with shackling are arguably violating the principle of beneficence. However, for most, rather than violating the principle of beneficence overtly, physicians may simply have to compromise. Given the intricate nature of the situation, physicians are tasked with minimizing potential harm to the best of their abilities while adhering to legal obligations.[76] It is difficult to pin an ethics violation on the ones who do not like the shackles but are powerless to remove them. Some do argue that this inability causes physicians to violate the principle of beneficence.[77] However, promoting the well-being of their patients within the boundaries of the law limits their ability to exercise beneficence. For physicians to fulfill the principle of beneficence to the fullest capacity, they must have an influence on law. Protocols and assessments on flight risks made solely by the officers and law enforcement currently undermine the physician’s expertise. These decisions do not consider the health and well-being of the pregnant woman. As a result, law supersedes the influence of medicine and health care. CONCLUSION People expect physicians to uphold the four major principles of bioethics. However, their inability to override restraints compromises their ability to exercise beneficence. Although pledging to enforce these ethical principles, physicians have little opportunity to influence anti-shackling legislation. Instead of being included in conversations regarding medical complexities, legislation silences their voices. Policies must include the physician's voice as they affect their ability to treat patients. Officers should not dismiss a physician's request to remove shackles from a woman if they are causing health complications. A woman's labor should not harm her or her fetus because the officer will not remove her shackles.[78] A federal law could end shackling pregnant incarcerated people. Because other options are available to ensure the safety of the public and the prisoner, there is no ethical justification for shackling pregnant prisoners. An incarcerated person is a human being and must be treated with dignity and respect. To safeguard the well-being of incarcerated women and the public, it is essential for advocates of individual rights to join forces with medical professionals to establish an all-encompassing solution. - [1] Ferszt, G. G., Palmer, M., & McGrane, C. (2018). Where does your state stand on shackling of Pregnant Incarcerated Women? Nursing for Women’s Health, 22(1), 17–23. https://doi.org/10.1016/j.nwh.2017.12.005 [2] S983A, 2015-2016 Regular Sessions (N.Y. 2015). https://legislation.nysenate.gov/pdf/bills/2015/S983A [3] Chris DiNardo, Pregnancy in Confinement, Anti-Shackling Laws and the “Extraordinary Circ*mstances” Loophole, 25 Duke Journal of Gender Law & Policy 271-295 (2018) https://scholarship.law.duke.edu/djglp/vol25/iss2/5 [4] Chris DiNardo (2018) [5] U.S. Bureau of Justice Statistics. 1980. " Prisoners in 1980 – Statistical Tables”. Retrieved April 20, 2023 (https://bjs.ojp.gov/content/pub/pdf/p80.pdf). [6] U.S. Bureau of Justice Statistics. 2022. " Prisoners in 2021 – Statistical Tables”. Retrieved April 20, 2023 (https://bjs.ojp.gov/sites/g/files/xyckuh236/files/media/document/p21st.pdf). [7] U.S. Bureau of Justice Statistics (1980) [8] Sufrin C, Jones RK, Mosher WD, Beal L. Pregnancy Prevalence and Outcomes in U.S. Jails. Obstet Gynecol. 2020;135(5):1177-1183. doi:10.1097/AOG.0000000000003834 [9] Kramer, C., Thomas, K., Patil, A., Hayes, C. M., & Sufrin, C. B. (2022). Shackling and pregnancy care policies in US prisons and jails. Maternal and Child Health Journal, 27(1), 186–196. https://doi.org/10.1007/s10995-022-03526-y [10] House, K. T., Kelley, S., Sontag, D. N., & King, L. P. (2021). Ending restraint of incarcerated individuals giving birth. AMA Journal of Ethics, 23(4). https://doi.org/10.1001/amajethics.2021.364 [11] Goshin, L. S., Sissoko, D. R., Neumann, G., Sufrin, C., & Byrnes, L. (2019). Perinatal nurses’ experiences with and knowledge of the care of incarcerated women during pregnancy and the postpartum period. Journal of Obstetric, Gynecologic &amp; Neonatal Nursing, 48(1), 27–36. https://doi.org/10.1016/j.jogn.2018.11.002 [12] Shackling and separation: Motherhood in prison. (2013). 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(2010). The Birth of Bioethics. Oxford University Press. [77] Beauchamp, T. L., & Childress, J. F. (2019). [78] Amnesty International USA. (1999, March). “Not part of my sentence” Violations of the Human Rights of Women in Custody. Amnesty International USA. Retrieved March 12, 2023, from https://www.amnestyusa.org/reports/usa-not-part-of-my-sentence-violations-of-the-human-rights-of-women-in-custody/