Journal articles on the topic 'Complex Trauma Inventory'

ABSTRACTAre brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.

The United States accepts more refugees than any other industrialized nation. As refugee populations grow, mental health professionals must implement culturally and ethnically appropriate strategies to assess and treat individuals from diverse backgrounds. Culture can exert a powerful and often misunderstood influence on psychological assessment, and few structured measures have been demonstrated to have adequate cross-cultural validity for use with diverse and vulnerable populations such as survivors of torture. This study examined the factor structure and equivalency of underlying construct(s) of psychological distress as measured by the Brief Symptom Inventory (BSI) in three samples who had survived torture and other severe trauma from Tibet, West Africa and the Punjab region of India. Confirmatory factor analyses provided support for configural invariance of a two-factor model across the three samples, suggesting that the two latent factors of Complex Dysphoria and Somatic Distress were present in each subgroup. The data provide additional support for the strict invariance model in the West African–Tibetan dyad suggesting that scores are comparable across those two groups. Implications for research and treatment are discussed.

Rationale, aims and objectives: Despite the broad acceptance of the phase-oriented therapy for Type II chronic trauma in clinical practice, there remains very little empirical evidence to support its validity. Moreover, evaluative studies of group psychotherapy for Post-traumatic Stress Disorder (PTSD) after chronic trauma remain scarce, especially within the partial inpatient setting. The present study reports the evaluation of phase-oriented group therapy for Type II traumatized female partial inpatients with chronic PTSD. The treatment involved 3 phases: (a) symptom reduction/stabilisation, (b) trauma processing, (c) life integration/rehabilitation. Special attention to women’s mental healthcare needs (e.g., training of skills to increase sense of security, self-esteem, autonomy) was also given. Methods: In a pilot study with 31 female partial inpatients, pre- and post-treatment measures were compared in our study of PTSD (Self-Rating Inventory for PTSD, SRIP), General Psychopathology (Symptom Checklist 90, SCL-90), coping (Utrecht Coping List, UCL). Results: At post-treatment, there was a reduction of all PTSD symptom clusters and some general psychopathology (medium to high effect sizes) and an increase of some adaptive coping strategies (low to medium effect sizes). Linear regression analyses showed that the pre-treatment scores of re-experiencing, hyperarousal, total PTSD, agoraphobia and somatic complaints, had a significant predictive influence on outcome. Conclusions: The positive results of this pilot study support the validity of phase-oriented and women-focused group therapy for Type II traumatized partial inpatients with chronic PTSD. These findings warrant further investigation, using a randomized design with larger sample size and assessments in between the phases and during follow-up. We advance our pilot study as a significant contribution to the person-centered management of complex trauma history

ObjectiveDiffuse axonal injury (DAI) is prevalent in traumatic brain injury (TBI), and is often associated with poor outcomes and cognitive impairment, including memory deficits. Few studies have explored visual memory after TBI and its relationship to executive functioning. Executive functioning is crucial for remembering an object’s location, operating devices, driving, and route finding. We compared visual memory performance via the Rey–Osterrieth Complex Figure (ROCF) test 6 and 12 months after DAI.MethodIn total, 40 patients (mean age 28.7 years; 87.5% male) with moderate-to-severe DAI following a road traffic accident completed the 1-year follow-up. There was a three-phase prospective assessment. In phase 1 (1–3 months after trauma), patients completed the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI). In phases 2 (6 months) and 3 (12 months), they completed the BDI, STAI, and a neuropsychological battery [ROCF copy and recall, digit span forward/backward, Grooved Pegboard test, intelligence quotient (IQ) by Wechsler Adult Intelligence Scale-III (WAIS-III)].ResultsThere was an improvement in ROCF recall over time (p=0.013), but not ROCF copy (p=0.657).There was no change in executive function (Savage scores) copy (p=0.230) or recall (p=0.155). Age, years of education, severity of the trauma, and IQ did not influence ROCF recall improvement.ConclusionThere are time-dependent improvements in visual memory in patients with DAI. Neuroplasticity in the 1st months after trauma provides an opportunity for visuospatial memory learning. The present findings may be useful to formulate management plans for long-term TBI rehabilitation.

Analysis of the MMPI (Minnesota Multiphasic Personality Inventory) scores from 135 (20 years to 60 years old) patients who had sustained closed head injuries supported the hypothesis of a nonlinear relationship between the severity of depression and the magnitude of the discrepancy between intelligence and neuropsychological proficiency. Although the MMPI Depression T scores for all groups of patients were elevated ( M = 78, SD = 13), patients with the least and greatest discrepancies between intelligence and neuropsychological proficiency scored lower on Depression than patients with discrepancies within the z-score ranges −2.0 and —1.1. The results of symmetrical covariance for either depression or complex partial epileptic-like experiences before comparisons between groups suggested depression and the epileptic-like experiences share the same source of variance

The study investigates the relations of resiliency and posttraumatic growth among people who experienced a death of someone close. The results of 74 participants, mostly women (63.5%) who completed a series of questionnaires measuring resiliency and posttraumatic growth were analyzed. The age of respondents ranged from 21 to 74 years ( M = 38.4; SD = 15.5). The Posttraumatic Growth Inventory developed by Tedeschi and Calhoun and The Resiliency Assessment Scale by Ogińska-Bulik and Juczynski were used in the study. Results revealed positive association between resiliency and posttraumatic growth, particularly with increased self-perception and appreciation of life. However, the results of the study indicate that the relationship between the variables is complex and not all dimensions of resiliency increase the level of changes aftermath trauma.

Background and Objectives: Anorexia nervosa (AN) is a complex disorder whose etiopathogenesis involves both biological and environmental factors. The aims of the present study were to retrospectively analyze risk factors in young patients with AN and to assess differences in clinical and eating-related symptoms between patients with and without a diagnosis of post-traumatic stress disorder (PTSD) and with or without a history of acknowledged risk factors. Materials and Methods: Sixty-four patients with AN (<25 years old) were recruited and completed an anamnestic evaluation and the following self-report measures: Eating Disorder Examination Questionnaire (EDE-Q), Childhood Trauma Questionnaire (CTQ), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Inventory (BDI), Life Events Checklist (LEC), and Dissociative Experience Scale (DES). The PTSD diagnosis was assigned according to the Structured Clinical Interview for the DSM-5 (SCID-5). Results: The most frequent risk factors were those associated with relational traumatic events and familiarity for psychiatric disorders. Higher severity of body-related symptoms (i.e., those symptoms impacting on body image and perception and leading to body concerns) emerged in patients with PTSD, versus patients without PTSD diagnosis; however, after controlling for dissociative symptoms, only differences in BMI remained significant. Concerning other risk factors, those with a history of childhood trauma were more depressed than patients without such history and those with familiarity with eating disorders reported more AN-related hospitalizations in the past than those individuals without familiarity. Conclusion: These results suggest the importance of investigating the presence of risk factors and PTSD diagnosis in patients with AN, and to treat post-traumatic symptoms in young patients in order to decrease the risk of developing severe forms of AN. Moreover, a particular focus on those patients with a family member affected by an eating disorder could be of clinical utility.

AbstractBackground and aimA diagnosis of chronic benign paroxysmal positional vertigo (BPPV) is based on brief attacks of rotatory vertigo and concomitant nystagmus elicited by rapid changes in head position relative to gravity. However, the clinical course of BPPV may vary considerably from a self-limiting to a persisting and/or recurrent disabling problem. The authors’ experience is that the most common complaints of patients with chronic BPPV are nautical vertigo or dizziness with other symptoms including neck pain, headache, widespread musculoskeletal pain, fatigue, and visual disturbances. Trauma is believed to be the major cause of BPPV in individuals younger than fifty years. Chronic BPPV is associated with high morbidity. Since these patients often suffer from pain and do not have rotatory vertigo, their symptoms are often attributed to other conditions. The aim of this study was to investigate possible associations between these symptoms and chronic BPPV.MethodsDuring 2010 a consecutive prospective cohort observational study was performed. Diagnostic criteria: (A) BPPV diagnosis confirmed by the following: (1) a specific history of vertigo/dizziness evoked by acceleration/deceleration, (2) nystagmus in the first position of otolith repositioning maneuvers, and (3) appearing and disappearing nystagmus during the repositioning maneuvers; (B) the disorder has persisted for at least six months. (C) Normal MRI of the cerebrum. Exclusion criteria: (A) Any disorder of the central nervous system (CNS), (B) migraine, (C) active Ménière’s disease, and (D) severe eye disorders. Symptom questionnaire (‘yes or no’ answers during a personal interview) and Dizziness Handicap Inventory (DHI) were used.ResultsWe included 69 patients (20 males and 49 females) with a median age of 45 years (range 21-68 years). The median duration of the disease was five years and three months. The video-oculography confirmed BPPV in more than one semicircular canal in all patients. In 15% there was a latency of more than 1 min before nystagmus occurred. The Dizziness Handicap Inventory (DHI) median score was 55.5 (score >60 indicates a risk of fall). Seventy-five percent were on 50-100% sick leave. Eighty-one percent had a history of head or neck trauma. Nineteen percent could not recall any history of trauma. In our cohort, nautical vertigo and dizziness (81%) was far more common than rotatory vertigo (20%). The majority of patients (87%) reported pain as a major symptom: neck pain (87%), headache (75%) and widespread pain (40%). Fatigue (85%), visual disturbances (84%), and decreased concentration ability (81%) were the most frequently reported symptoms. In addition, unexpected findings such as involuntary movements of the extremities, face, neck or torso were found during otolith repositioning maneuvers (12%). We describe one case, as an example, how treatment of his BPPV also resolved his chronic, severe pain condition.ConclusionThis observational study demonstrates a likely connection between chronic BPPV and the following symptoms: nautical vertigo/dizziness, neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus.ImplicationsPatients with complex pain conditions associated with nautical vertigo and dizziness should be evaluated with the Dizziness Handicap Inventory (DHI)-questionnaire which can identify treatable balance disorders in patients with chronic musculoskeletal pain.

Objective: Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range. Method: Six months following a bushfire disaster, 2379 grade 4–12 school students completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress. Results: Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; perception of threat to self or to parents; evacuation experience; and school grade. Gender was not a significant predictor in either the depression or emotional distress multivariate models. Complex, non-linear relationships between depression, emotional distress and school grade were found. Conclusion: This study suggests that important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children.

Background:Several factors may hinder postoperative rehabilitation following lower limb amputation. This study contributes to the existing knowledge of the impact of psychological factors on patients’ successful adaptation.Objective:The study focused on the importance of resilience following lower limb amputation due todiabetes mellitus, especially on protective and risk factors potentially influencing adaptation to limb loss.Method:Patients (n=29) completed a test battery one and sixth months after amputation including the following questionnaires: Beck Depression Inventory (BDI-R), Hospital Anxiety and Depression Scale (HADS), Connor-Davidson Resilience Scale (CD-RISC), Medical Outcomes Study Social Support Survey (MOS-SSS), Sense of Coherence Scale (SOC), Positive and Negative Affect Schedule (PANAS).Results:Anxiety, depression and negative emotional states negatively correlated with resilience, suggesting to be risk factors hindering adaptation. Positive effects act as a protective factor, while negative emotions hinder coping with the trauma, particularly six months after limb loss. The overall score and all three subscales of the MOS-SSS correlated positively with resilience at both measurements, which suggests that social support has importance in successfully dealing with resilience. Patients’ Sense Of Coherence (SOC) was found to be positively correlated with resilience six months after amputation suggesting it is also a protective factor.Conclusion:This study expands the limited empirical knowledge of patients with lower limb amputation due todiabetes mellitus. The study approached adaptation to limb loss from a new perspective focusing on protective and risk factors related to resilience. A complex test battery was compiled to implement the new approach to the essential protective factors in rehabilitation.

The article raises the question of women’s dysfunctional mechanisms of adaptation as a consequence of pathological relationships with the mother. Particular attention is paid to such of them: interpersonal dependence, depression, anxiety, frustration, aggression, rigidity. The Hirschfeld Interpersonal Dependency Inventory, the Zung Self-Rating Depression Scale and the Eysenck Personality Questionnaire were used for an empirical study. In order to achieve these goals, a sample of 40 women aged 20 to 25 years was formed. A sample of this age allows you to look at a woman as an already established personality, and highlights the trends and characteristics of her interactions with others. The result of the study proved that the representatives of single-parent families have a greater degree of severity for all the indicators were given (interpersonal dependence, depression, anxiety, frustration, aggression, rigidity). This means that the absence of a permanent mother’s partner (along with other factors covered in the article) catalyzes and promotes the process of forming the pathological relationship between a daughter and mother, which in turn becomes the basis for the formation of dysfunctional mechanisms of adaptation to the daughter as an expression of maternal injury. Maternal trauma or a mother complex is defined as the collective concept of a daughter and mother pathological relationship negative consequences. This is explained by the fact that the daughter in these conditions becomes the only one object of the projections of mother’s fears, desires and dissatisfied needs, besides, she becomes the only source of love. A harmonious relationship with the mother is the basis for a full-fledged personality formation, while a natural interaction violation in the form of a fierce struggle for similarity and difference leads to an inadequate perception of the world and oneself, which is transferred to all subsequent generations in a closed circle.

AbstractBackgroundMajor depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life.Subjects and methodsThe sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline.ResultsIn the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone.ConclusionPTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.

This study focused on assessing the psychosocial effects of the long standing, high intensity, and guerrilla-style of warfare among displaced children in Southern Darfur. The goal was to better understand the etiology, prognosis, and treatment implications for traumatic reactions, depression, and grief symptoms in this population. Three hundred thirty-one children aged 6–17 from three IDP Camps were selected using a quota sampling approach and were administered a Demographic Questionnaire, Child Post Traumatic Stress Reaction Index, Child Depression Inventory, and the Expanded Grief Inventory. Forty-three percent were girls and 57% were boys. The mean age of the children was 12 years. Results found that children were exposed to a very large number of war experiences with no significant differences between genders for types of exposure, including rape, but with older children (13–17 years) facing a larger number of exposures than younger children (6–12 years). Out of the 16 possible war experiences, the mean number was 8.94 ( SD = 3.27). Seventy-five percent of the children met the DSM-IV criteria for PTSD, and 38% exhibited clinical symptoms of depression. The percentage of children endorsing significant levels of grief symptoms was 20%. Increased exposure to war experiences led to higher levels of: 1) traumatic reactions; 2) depression; and 3) grief symptoms. Of the 16 war experiences, abduction, hiding to protect oneself, being raped, and being forced to kill or hurt family members were most predictive of traumatic reactions. Being raped, seeing others raped, the death of a parent/s, being forced to fight, and having to hide to protect oneself were the strongest predictors of depressive symptoms. War experiences such as abduction, death of one's parent/s, being forced to fight, and having to hide to protect oneself were the most associated with the child's experience of grief. In addition to Total Grief, Traumatic Grief, Existential Grief, and Continuing Bonds were measured in these children. Although trauma, depression, and grief often exist as co-morbid disorders, the mechanisms and pathways of these is less understood. In this study we used Structural Equation Modeling to better understand the complex interaction and trajectories of these three symptoms evolving from war exposure and loss. This study is the first of its kind to assess the psychosocial effects of war experiences among children currently living in war zone areas within Sudan. It identifies some of the most prevalent war-related atrocities and their varying impact on the children's psychological well-being and overall adjustment. Implications for planning mental health interventions are discussed.

The need to address the issues of treatment and dispensary accounting for war veterans and combatants is one of the most pressing issues that has received considerable attention. Events that have taken place in the distant past and that have taken place in recent years in the east of our country before, excite everyone and compel our authorities and health care organizers to develop inpatient care, dispensary surveillance and rehabilitation programs for war veterans and combatants actions. The multifaceted delivery of medical assistance and dispensary to war veterans and combatants requires the effective functioning of this system as an independent area of clinical and social medicine. Military action is always accompanied by casualties and injuries to both military and civilians. Persons in poor health as a result of military action, which is expressed in restriction on military service or work, need to move first and foremost to establish a permanent disability. This is due to the fact that the disability structure identifies a group of causes, including people who have completely or partially lost their disability as a result of injury, injury or injury sustained during their military service. Surveys of war veterans and combatants take place in outpatient clinics and, under certain circumstances, may be carried out by a visiting team of specialists to the field (hospitals, rural dispensaries, FAPs, and veterans' homes). In health care facilities, veterans' examinations are carried out at their previous call. War veterans are inspected at home by a visiting team of specialists in cases where they live far away from health care facilities and because of their health, and cannot be examined. Introduction. The issue of inpatient treatment of combatants and war veterans is one of the topical issues that is receiving considerable attention and is being addressed by meetings of governmental committees and civic organizations. The main goal in addressing these issues is to restore the physical and mental health of participants in the hostilities, achieve social and psychological well-being, reduce the frequency and severity of the effects of mental traumas suffered in the form of acute stress reactions, prevention of disability, prevention of aggression and prevention of aggression. Dispensary observation is a complex of medical measures, which is based on active, constant monitoring of the state of human health, detection of diseases in the early stages, detailed research, study, and elimination of the causes of their occurrence, carrying out medical and health, sanitary, social and hygienic activities aimed at improving the environment, work and people's lifestyles. Fast and quality treatment, effective medical rehabilitation, dispensary observation can only be achieved with early onset, continuity, consistency, continuity and completeness of medical care for patients, individual approach and programming of rehabilitation, timely rehabilitation.

Members of the Phellinus weirii complex cause laminated root rot of living conifers. The cedar type (P. weirii (Murrill) Gilb. sensu stricto) of the complex is usually found on species of the Cupressaceae family, especially Thuja plicata in western North America, and the Douglas-fir type (P. sulphurascens Pilát) is found on species of the Pinaceae family (1,2,3). Outside North America, P. weirii occurs on species of Juniperus in the Ural Mountains, and P. sulphurascens occurs on other conifers in eastern Asia, including China (1). During a field inventory of wood-decay fungi in western China in 2003, laminated root rot of Sabina przewalskii (synonym Juniperus przewalskii) was found in natural forests of the Qilian Mountains in Qinghai Province (37°36′N and 102°15′E). Trees were approximately 80 to 150 years old and occurred in pure stands. Distinct disease patches that were as much as one hectare consisted of dead-standing and symptomatic trees, suggesting that the fungus spread by root contact. Symptomatic trees showed slow growth, thin crowns, and chlorotic foliage. After cutting several of the symptomatic trees, cambial necrosis and wood decay were found, and the trees apparently died when the cambial necrosis girdled the base of the trees. The wood of infected trees was reddish brown at the early stages of decay and later had numerous small cavities and separated into sheets at the junction of annual rings. Perennial, poroid, resupinate, dark brown basidiocarps formed on the root surface of dead trees. The basidiocarps had a monomitic hyphal system, hyphae without clamp connections, trama tissue with hyphoid setae, and thin-walled, hyaline, smooth, ellipsoid basidiospores. The fungus was identified as P. weirii and distinguished from P. sulphurascens by its perennial basidiocarps, smaller pores (5 to 8 versus 4 to 5 per mm), and narrower hyphoid setae (4 to 6 versus 5 to 10 μm in diameter). P. weirii also resembles P. ferrugineofuscus (P. Karst.) Bourdot in macro-morphology, but the latter species is a saprophyte and has allantoid to almost lunate basidiospores. The studied specimens of P. weirii and P. sulphurascens are preserved at the herbaria of the Botanical Museum of the University of Helsinki, the Institute of Applied Ecology, and the Chinese Academy of Sciences as DAOM 8734, Lowe 6960, TAA 52744, 55644, and 103812, and Dai 988, 2053, 2061, 2527, and 5067. To my knowledge, this is the first report of P. weirii sensu stricto from China and the first report of laminated root rot on S. przewalskii. References: (1) Y. C. Dai and G. F. Qin. Fungal Sci. 13:101, 1998. (2) E. M. Hansen et al. Species limits for Phellinus weirii. Pages 119–127 in: Root and butt rots of forest tress. Int. Conf. Root and Butt Rots, INRA, France, 1998. (3) M. J. Larsen et al. Mycologia 86:121, 1994.

How complex trauma features and criminogenic needs co-vary within youth justice populations requires examination. This study applies latent profile analysis to a sample of 311 justice-involved Canadian youth (211 male, 100 female) to identify if unique profiles of youth would emerge delineated by different combinations of comorbid needs pulled from complex trauma and personality/social learning models. Two similar profiles emerged for males and females alike: a complex trauma with criminogenic needs profile (70% of females, 58.8% of males) and a low overall needs profile (30% of females, 41.2% of males). Surprisingly, the Youth-Level Service/Case Management Inventory predicted recidivism well among the complex trauma/criminogenic need female cases (AUC = .71), but poorly among the complex trauma/criminogenic need male cases (AUC = .59). Trauma-informed approaches that target criminogenic needs in both genders is a clear implication of the findings.

Childhood abuse, neglect, and loss are common in psychiatric patients, and the relationship between childhood adversity and adult mental illness is well known. However, beyond diagnoses that are specifically trauma-related, such as posttraumatic stress disorder, there has been little research on how childhood adversity contributes to complex presentations that require more intensive treatment. We examined the relationship between childhood adversity and other contributors to clinical complexity in adult outpatients seeking mental health assessment. In a cross-sectional study, patients completed standard measures of psychological distress and functional impairment. Psychiatrists completed an inventory of clinical complexity, which included childhood abuse, neglect, and loss. Of 4,903 patients seen over 15 months, 1,315 (27%) both consented to research and had the measure of complexity completed. Childhood abuse or neglect was identified in 474 (36.0%) and significant childhood loss in 236 (17.9%). Correcting for multiple comparisons and controlling for psychiatric diagnosis, age, and sex, patients with childhood abuse or neglect were significantly more likely to also have 11 of 31 other indices of clinical complexity, with odds ratios ranging from 1.7 to 5.0. Both childhood abuse or neglect and childhood loss were associated with greater overall complexity (i.e., more indices of complexity, χ2 = 136 and 38 respectively, each p < .001). Childhood abuse and neglect (but not childhood loss) were significantly associated with psychological distress (Kessler Psychological Distress Scale [K10] score, F = 6.2, p = .01) and disability (World Health Organization Disability Assessment Scale 2.0 [WHODAS 2.0] score, F = 5.0, p = .03). Childhood abuse and neglect were associated with many characteristics that contribute to clinical complexity, and thus to suboptimal outcomes to standard, guideline-based care. Screening may alert psychiatrists to the need for intensive, patient-centered, and trauma-informed treatments. Identifying childhood adversity as a common antecedent of complexity may facilitate developing transdiagnostic programs that specifically target sources of complexity.

IllegitimacyBack in 1987, Gregory Bateson argued that:Kurt Vonnegut gives us wary advice – that we should be careful what we pretend because we become what we pretend. And something like that, some sort of self-fulfilment, occurs in all organisations and human cultures. What people presume to be ‘human’ is what they will build in as premises of their social arrangements, and what they build in is sure to be learned, is sure to become a part of the character of those who participate. (178)The human capacity to marginalise and discriminate against others on the basis of innate and constructed characteristics is evident from the long history of discrimination against people whose existence is ‘illegitimate’, defined as being outside the law. What is inside or outside the law depends upon the context under consideration. For example, in societies such as ancient Greece and the antebellum United States, where slavery was legal, people who were constructed as ‘slaves’ could legitimately be treated very differently from ‘citizens’: free people who benefit from a range of human rights (Northup). The discernment of what is legitimate from that which is illegitimate is thus implicated within the law but extends into the wider experience of community life and is evident within the civil structures through which society is organised and regulated.The division between the legitimate and illegitimate is an arbitrary one, susceptible to changing circumstances. Within recent memory a romantic/sexual relationship between two people of the same sex was constructed as illegitimate and actively persecuted. This was particularly the case for same-sex attracted men, since the societies regulating these relationships generally permitted women a wider repertoire of emotional response than men were allowed. Even when lesbian and gay relationships were legalised, they were constructed as less legitimate in the sense that they often had different rules around the age of consent for homosexual and heterosexual couples. In Australia, the refusal to allow same sex couples to marry perpetuates ways in which these relationships are constructed as illegitimate – beyond the remit of the legislation concerning marriage.The archetypal incidence of illegitimacy has historically referred to people born out of wedlock. The circumstances of birth, for example whether a person was born as a result of a legally-sanctioned marital relationship or not, could have ramifications throughout an individual’s life. Stories abound (for example, Cookson) of the implications of being illegitimate. In some social stings, such as Catherine Cookson’s north-eastern England at the turn of the twentieth century, illegitimate children were often shunned. Parents frequently refused permission for their (legitimate) children to play with illegitimate classmates, as if these children born out of wedlock embodied a contaminating variety of evil. Illegitimate children were treated differently in the law in matters of inheritance, for example, and may still be. They frequently lived in fear of needing to show a birth certificate to gain a passport, for example, or to marry. Sometimes, it was at this point in adult life, that a person first discovered their illegitimacy, changing their entire understanding of their family and their place in the world. It might be possible to argue that the emphasis upon the legitimacy of a birth has lessened in proportion to an acceptance of genetic markers as an indicator of biological paternity, but that is not the endeavour here.Given the arbitrariness and mutability of the division between legitimacy and illegitimacy as a constructed boundary, it is policed by social and legal sanctions. Boundaries, such as the differentiation between the raw and the cooked (Lévi-Strauss), or S/Z (Barthes), or purity and danger (Douglas), serve important cultural functions and also convey critical information about the societies that enforce them. Categories of person, place or thing which are closest to boundaries between the legitimate and the illegitimate can prompt existential anxiety since the capacity to discern between these categories is most challenged at the margins. The legal shenanigans which can result speak volumes for which aspects of life have the potential to unsettle a culture. One example of this which is writ large in the recent history of Australia is our treatment of refugees and asylum seekers and the impact of this upon Australia’s multicultural project.Foreshadowing the sexual connotations of the illegitimate, one of us has written elsewhere (Green, ‘Bordering on the Inconceivable’) about the inconceivability of the Howard administration’s ‘Pacific solution’. This used legal devices to rewrite Australia’s borders to limit access to the rights accruing to refugees upon landing in a safe haven entitling them to seek asylum. Internationally condemned as an illegitimate construction of an artificial ‘migration zone’, this policy has been revisited and made more brutal under the Abbot regime with at least two people – Reza Barati and Hamid Khazaei – dying in the past year in what is supposed to be a place of safety provided by Australian authorities under their legal obligations to those fleeing from persecution. Crock points out, echoing the discourse of illegitimacy, that it is and always has been inappropriate to label “undocumented asylum seekers” as “‘illegal’” because: “until such people cross the border onto Australian territory, the language of illegality is nonsense. People who have no visas to enter Australia can hardly be ‘illegals’ until they enter Australia” (77). For Australians who identify in some ways – religion, culture, fellow feeling – with the detainees incarcerated on Nauru and Manus Island, it is hard to ignore the disparity between the government’s treatment of visa overstayers and “illegals” who arrive by boat (Wilson). It is a comparatively short step to construct this disparity as reflecting upon the legitimacy within Australia of communities who share salient characteristics with detained asylum seekers: “The overwhelmingly negative discourse which links asylum seekers, Islam and terrorism” (McKay, Thomas & Kneebone, 129). Some communities feel themselves constructed in the public and political spheres as less legitimately Australian than others. This is particularly true of communities where members can be identified via markers of visible difference, including indicators of ethnic, cultural and religious identities: “a group who [some 585 respondent Australians …] perceived would maintain their own languages, customs and traditions […] this cultural diversity posed an extreme threat to Australian national identity” (McKay, Thomas & Kneebone, 129). Where a community shares salient characteristics such as ethnicity or religion with many detained asylum seekers they can become fearful of the discourses around keeping borders strong and protecting Australia from illegitimate entrants. MethodologyThe qualitative fieldwork upon which this paper is based took place some 6-8 years ago (2006-2008), but the project remains one of the most recent and extensive studies of its kind. There are no grounds for believing that any of the findings are less valid than previously. On the contrary, if political actions are constructed as a proxy for mainstream public consent, opinions have become more polarised and have hardened. Ten focus groups were held involving 86 participants with a variety of backgrounds including differences in age, gender, religious observance, religious identification and ethnicity. Four focus groups involved solely Muslim participants; six drew from the wider Australian community. The aim was to examine the response of different communities to mainstream Australian media representations of Islam, Muslims, and terrorism. Research questions included: “Are there differences in the ways in which Australian Muslims respond to messages about ‘fear’ and ‘terror’ compared with broader community Australians’ responses to the same messages?” and “How do Australian Muslims construct the perceptions and attitudes of the broader Australian community based on the messages that circulate in the media?” Recent examples of kinds of messages investigated include media coverage of Islamic State’s (ISIS’s) activities (Karam & Salama), and the fear-provoking coverage around the possible recruitment of Australians to join the fighting in Syria and Iraq (Cox). The ten focus groups were augmented by 60 interviews, 30 with respondents who identified as Muslim (15 males, 15 female) and 30 respondents from the broader community (same gender divisions). Finally, a market research company was commissioned to conduct a ‘fear survey’, based on an established ‘fear of rape’ inventory (Aly and Balnaves), delivered by telephone to a random sample of 750 over-18 y.o. Australians in which Muslims formed a deliberative sub-group, to ensure they were over-sampled and constituted at least 150 respondents. The face-to-face surveys and focus groups were conducted by co-author, Dr Anne Aly. General FindingsMuslim respondents indicate a heightened intensity of reaction to media messages around fear and terror. In addition to a generalised fear of the potential impact of terrorism upon Australian society and culture, Muslim respondents experienced a specific fear that any terrorist-related media coverage might trigger hostility towards Muslim Australian communities and their own family members. According to the ‘fear survey’ scale, Muslim Australians at the time of the research experienced approximately twice the fear level of mainstream Australian respondents. Broader Australian community Australian Muslim communityFear of a terrorist attackFear of a terrorist attack combines with the fear of a community backlashSpecific victims: dead, injured, bereavedCommunity is full of general victims in addition to any specific victimsShort-term; intense impactsProtracted, diffuse impactsSociety-wide sympathy and support for specific victims and all those involved in dealing with the trauma and aftermathSociety-wide suspicion and a marginalisation of those affected by the backlashVictims of a terrorist attack are embraced by broader communityVictims of backlash experience hostility from the broader communityFour main fears were identified by Australian Muslims as a component of the fear of terrorism:Fear of physical harm. In addition to the fear of actual terrorist acts, Australian Muslims fear backlash reprisals such as those experienced after such events as 9/11, the Bali bombings, and attacks upon public transport passengers in Spain and the UK. These and similar events were constructed as precipitating increased aggression against identifiable Australian Muslims, along with shunning of Muslims and avoidance of their company.The construction of politically-motivated fear. Although fear is an understandable response to concerns around terrorism, many respondents perceived fears as being deliberately exacerbated for political motives. Such strategies as “Be alert, not alarmed” (Bassio), labelling asylum seekers as potential terrorists, and talk about home-grown terrorists, are among the kinds of fears which were identified as politically motivated. The political motivation behind such actions might include presenting a particular party as strong, resolute and effective. Some Muslim Australians construct such approaches as indicating that their government is more interested in political advantage than social harmony.Fear of losing civil liberties. As well as sharing the alarm of the broader Australian community at the dozens of legislative changes banning people, organisations and materials, and increasing surveillance and security checks, Muslim Australians fear for the human rights implications across their community, up to and including the lives of their young people. This fear is heightened when community members may look visibly different from the mainstream. Examples of the events fuelling such fears include the London police killing of Jean Charles de Menezes, a Brazilian Catholic working as an electrician in the UK and shot in the month following the 7/7 attacks on the London Underground system (Pugliese). In Australia, the case of Mohamed Hannef indicated that innocent people could easily be unjustly accused and wrongly targeted, and even when this was evident the political agenda made it almost impossible for authorities to admit their error (Rix).Feeling insecure. Australian Muslims argue that personal insecurity has become “the new normal” (Massumi), disproportionately affecting Muslim communities in both physical and psychological ways. Physical insecurity is triggered by the routine avoidance, shunning and animosity experienced by many community members in public places. Psychological insecurity includes fear for the safety of younger members of the community compounded by concern that young people may become ‘radicalised’ as a result of the discrimination they experience. Australian Muslims fear the backlash following any possible terrorist attack on Australian soil and describe the possible impact as ‘unimaginable’ (Aly and Green, ‘Moderate Islam’).In addition to this range of fears expressed by Australian Muslims and constructed in response to wider societal reactions to increased concerns over radical Islam and the threat of terrorist activity, an analysis of respondents’ statements indicate that Muslim Australians construct the broader community as exhibiting:Fear of religious conviction (without recognising the role of their own secular/religious convictions underpinning this fear);Fear of extremism (expressed in various extreme ways);Fear of powerlessness (responded to by disempowering others); andFear of political action overseas having political effects at home (without acknowledging that it is the broader community’s response to such overseas events, such as 9/11 [Green ‘Did the world really change?’], which has also had impacts at home).These constructions, extrapolations and understandings by Australian Muslims of the fears of the broader community underpinning the responses to the threat of terror have been addressed elsewhere (Green and Aly). Legitimate Australian MuslimsOne frustration identified by many Muslim respondents centres upon a perceived ‘acceptable’ way to be an Australian Muslim. Arguing that the broader community construct Muslims as a homogenous group defined by their religious affiliation, these interviewees felt that the many differences within and between the twenty-plus national, linguistic, ethnic, cultural and faith-based groupings that constitute WA’s Muslim population were being ignored. Being treated as a homogenised group on a basis of faith appears to have the effect of putting that religious identity under pressure, paradoxically strengthening and reinforcing it (Aly, ‘Australian Muslim Responses to the Discourse on Terrorism’). The appeal to Australian Muslims to embrace membership in a secular society and treat religion as a private matter also led some respondents to suggest they were expected to deny their own view of their faith, in which they express their religious identity across their social spheres and in public and private contexts. Such expression is common in observant Judaism, Hinduism and some forms of Christianity, as well as in some expressions of Islam (Aly and Green, ‘Less than equal’). Massumi argues that even the ways in which some Muslims dress, indicating faith-based behaviour, can lead to what he terms as ‘affective modulation’ (Massumi), repeating and amplifying the fear affect as a result of experiencing the wider community’s fear response to such triggers as water bottles (from airport travel) and backpacks, on the basis of perceived physical difference and a supposed identification with Muslim communities, regardless of the situation. Such respondents constructed this (implied) injunction to suppress their religious and cultural affiliation as akin to constructing the expression of their identity as illegitimate and somehow shameful. Parallels can be drawn with previous social responses to a person born out of wedlock, and to people in same-sex relationships: a ‘don’t ask, don’t tell’ kind of denial.Australian Muslims who see their faith as denied or marginalised may respond by identifying more strongly with other Muslims in their community, since the community-based context is one in which they feel welcomed and understood. The faith-based community also allows and encourages a wider repertoire of acceptable beliefs and actions entailed in the performance of ‘being Muslim’. Hand in hand with a perception of being required to express their religious identity in ways that were acceptable to the majority community, these respondents provided a range of examples of self-protective behaviours to defend themselves and others from the impacts of perceived marginalisation. Such behaviours included: changing their surnames to deflect discrimination based solely on a name (Aly and Green, ‘Fear, Anxiety and the State of Terror’); keeping their opinions private, even when they were in line with those being expressed by the majority community (Aly and Green, ‘Moderate Islam’); the identification of ‘less safe’ and ‘safe’ activities and areas; concerns about visibly different young men in the Muslim community and discussions with them about their public behaviour and demeanour; and women who chose not to leave their homes for fear of being targeted in public places (all discussed in Aly, ‘Australian Muslim Responses to the Discourse on Terrorism’). Many of these behaviours, including changing surnames, restricting socialisation to people who know a person well, and the identification of safe and less safe activities in relation to the risk of self-revelation, were common strategies used by people who were stigmatised in previous times as a result of their illegitimacy.ConclusionConstructions of the legitimate and illegitimate provide one means through which we can investigate complex negotiations around Australianness and citizenship, thrown into sharp relief by the Australian government’s treatment of asylum seekers, also deemed “illegals”. Because they arrive in Australia (or, as the government would prefer, on Australia’s doorstep) by illegitimate channels these would-be citizens are treated very differently from people who arrive at an airport and overstay their visa. The impetus to exclude aspects of geographical Australia from the migration zone, and to house asylum seekers offshore, reveals an anxiety about borders which physically reflects the anxiety of western nations in the post-9/11 world. Asylum seekers who arrive by boat have rarely had safe opportunity to secure passports or visas, or to purchase tickets from commercial airlines or shipping companies. They represent those ethnicities and cultures which are currently in turmoil: a turmoil frequently exacerbated by western intervention, variously constructed as an il/legitimate expression of western power and interests.What this paper has demonstrated is that the boundary between Australia and the rest, the legitimate and the illegitimate, is failing in its aim of creating a stronger Australia. The means through which this project is pursued is making visible a range of motivations and concerns which are variously interpreted depending upon the position of the interpreter. The United Nations, for example, has expressed strong concern over Australia’s reneging upon its treaty obligations to refugees (Gordon). Less vocal, and more fearful, are those communities within Australia which identify as community members with the excluded illegals. The Australian government’s treatment of detainees on Manus Island and Nauru, who generally exhibit markers of visible difference as a result of ethnicity or culture, is one aspect of a raft of government policies which serve to make some people feel that their Australianness is somehow less legitimate than that of the broader community. AcknowledgementsThis paper is based on the findings of an Australian Research Council Discovery Project (DP0559707), 2005-7, “Australian responses to the images and discourses of terrorism and the other: establishing a metric of fear”, awarded to Professors Lelia Green and Mark Balnaves. The research involved 10 focus groups and 60 individual in-depth interviews and a telephone ‘fear of terrorism’ survey. The authors wish to acknowledge the participation and contributions of WA community members and wider Australian respondents to the telephone survey. ReferencesAly, Anne. “Australian Muslim Responses to the Discourse on Terrorism in the Australian Popular Media.” Australian Journal of Social Issues 42.1 (2007): 27-40.Aly, Anne, and Lelia Green. “Fear, Anxiety and the State of Terror.” Studies in Conflict and Terrorism 33.3 (Feb 2010): 268-81.Aly, Anne, and Lelia Green. “Less than Equal: Secularism, Religious Pluralism and Privilege.” M/C Journal 11.2 (2008). 15 Oct. 2009 ‹http://journal.media-culture.org.au/index.php/mcjournal/article/view/32›.Aly, Anne, and Lelia Green. “‘Moderate Islam’: Defining the Good Citizen”. 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Longing on a large scale is what makes history.Don DeLillo, UnderworldIntroductionWhile the media industries have been rather thoroughly dissected for their capacity to generate enthusiasm through well-honed practices of marketing and patterns of consumerism, any analysis of the shift underway to capture and modulate the ‘enthusiastic’ and affective labour of media industry practitioners themselves may still have much to learn by reaching back to the long tradition in Western philosophy: a tradition, starting with the Greeks that has almost always contrasted enthusiasm with reason (Heyd). To quote Hume: “Hope, pride, presumption, a warm imagination, together with ignorance, are … the true sources of enthusiasm” (73). Hume’s remarks are contextualised in protestant theological debates of the 18th century, where enthusiasm was a term for a religious practice, in which God possesses the believer. Especially English preachers and theologians were putting considerable energy into demonising this far too ecstatic form of belief in god (Heyd). This ambivalent attitude towards enthusiasm time-travels from the Greeks and the Enlightenment period straight into the 20th century. In 1929, William Henry Schoenau, an early author of self-help literature for the white-collar worker, aimed to gain a wider audience with the title: “Charm, Enthusiasm and Originality - their Acquisition and Use”. According to him, enthusiasm is necessary for the success of the salesman, and has to be generated by techniques such as a rigorous special diet and physical exercises of his facial muscles. But it also has to be controlled:Enthusiasm, when controlled by subtle repression, results in either élan, originality, magnetism, charm or “IT”, depending on the manner of its use. Uncontrolled enthusiasm results in blaring jazz, fanaticism and recklessness. A complete lack of enthusiasm produces the obsequious waiter and the uneducated street car conductor. (7)Though William Henry Schoenau got rather lost in his somewhat esoteric take on enthusiasm – for him it was a result of magnetic and electric currents – we argue that Schoenau had a point: Enthusiasm is a necessary affect in many forms of work, and especially so in the creative industries. It has to be generated, it sometimes has to be enacted, and it has also to be controlled. However, we disagree with Schoenau in one important issue: For us, enthusiasm can only be controlled up to a certain degree. Enthusiasm in the Creative IndustriesSchoenau wrote for an audience of salesmen and ambitious managers. This was simultaneous with the rise of Fordism. Most labour in Fordism was routine labour with the assembly line as its iconic representation. In mass-production itself, enthusiasm was not needed, often not even wanted. Henry Ford himself noted dryly: “Why do I get a human being when all I want is a pair of hands” (Kane 128). It was reserved for few occupational groups situated around the core of the mass-produced economy, such as salesmen, inventors, and leaders like him. “Henry Ford had a burning enthusiasm for the motor car” (Pearle 196).In industrial capitalism enthusiasm on a larger scale was not for the masses. It could be found in political movements, but hardly in the realm of work. This was different in the first socialist state. In the 1920s and 1930s Soviet Union the leaders turned their experience in stimulating a revolutionary mindset into a formula for industrial development – famously documented in Dziga Vertov’s “Enthusiasm. Symphony of the Donbass”.In capitalist countries things changed with the crisis of Fordism. The end of mass production and its transformation to flexible specialisation (Piore/Sabel) prepared the ground for a revival of enthusiasm on a large scale. Post-industrial economies rely on permanent innovation. Now discourses in media, management, and academia emphasise the relevance of buzzwords such as flexibility, adaptability, change, youth, speed, fun, and creativity. In social science debates around topics such as the cultural economy (Ray/Sayers, Cook et al., du Gay/Pryke, Amin/Thrift), affective labour (Lazzarato, Hardt/Negri, Virno) and creative industries (Florida, Hartley) gained in momentum (for an interesting take on enthusiasm see Bröckling). Enthusiasm has become an imperative for most professions. Those who are not on fire are in danger of getting fired. Producing and Consuming EnthusiasmOur interest in enthusiasm as affective labour emerged in an ethnographic and experimental project that we conducted in 2003-2007 in London’s creative industries. The project brought together three industrial and one academic partner to produce a reality TV show tailor-made for IPTV (internet-protocol-based television). During this project we encountered enthusiasm in many forms. Initially, we were faced with the need to be enthusiastic, while we established the project coalition. To be convincing, we had to pitch the commercial potential of such a project enthusiastically to our potential partners, and often we had to cope with rejections and start the search and pitch again (Caldwell). When the project coalition was set up, we as academic partners managed the network. In the following two years we had to cope with our partner’s different directions, different rhythms and different styles of enthusiasm. The TV producer for example had different ways to express excitement than the new media firm. Such differences resulted in conflicts and blockades, and part of our task as project managers was to rebuild an enthusiastic spirit after periods of frustration. At the same time enthusiasm was one of the ingredients of the digital object that we produced: `Real’ emotions form the material of most reality TV shows (Grindstaff). Affects are for reality TV, what steel was for a Fordist factory. We needed an enthusiastic audience as part of the filmed material. There is thus a need to elicit, select, engineer and film such emotions. To this aim we engaged with the participants and the audience in complex ways, sometimes by distancing ourselves, other times by consciously manipulating them, and at even other times by sharing enthusiasm (similar processes in respect to other emotions are ethnographically described in Hesmondhalgh/Baker). Generating and managing enthusiasm is obviously a necessary part of affective labour in the creative industries. However, just as Hesmondhalgh/Baker indicate, this seemingly simple claim is problematic.Affective Labour as Practice‘Affective labour’ is a term that describes labour through its products: ‘A feeling of ease, well-being, satisfaction, excitement, or passion’ (Hardt/Negri 292-293). Thus, the term ‘affective labour’ usually describes a sector by the area of human endeavour, which it commodifies. But the concept looses its coherence, if it is used to describe labour by its practice (for an analogue argument see Dowling). The latter is what interests us. Such a usage will have to re-introduce the notion of the working subject. To see affective labour as a practice should enable us to describe in more detail, how enthusiasm shapes the becoming of a cultural object. Who employed affect when and what kinds of affects in which way? Analysing enthusiasm as social practice and affective labour usually brings about one of two contrasting perceptions. On the one hand one can celebrate enthusiasm – like Pekka Himanen – as one of the key characteristics for a new work ethic emerging alongside the Protestant Ethic. On the other hand we find critique of the need to display affects. Barbara Ehrenreich shows how a forced display of enthusiasm becomes a requirement for all office workers to survive in late capitalism. Judging from our experience these two approaches need to be synthesized: Much affective labour consists in the display of affects, in showing off, in pretending. On the other hand, enthusiasm can only realise its potential, if it is ‘real’ (as opposed to enacted).With Ehrenreich, Hochschild and many others we think that an analysis of affective labour as a practice needs to start with a notion of expression. Enthusiasm can be expressed through excited gestures, rapid movements, raised voices, eyes wide open, clapping hands, speech. For us it was often impossible to separate which expression was ‘genuine’ and which was enacted. Judging from introspection, it is probable that many actors had a similar experience to ours: They mixed some genuine enthusiasm with more or less enforced forms of re-enactment. Perhaps re-enactment turned to a ‘real’ feeling: We enacted ourselves into an authentic mood - an effect that is also described as “deep acting” (Grandey). What can happen inside us, can also happen in social situations. German philosopher Max Scheler went to substantial lengths to make a case for the contagiousness of affects, and enthusiasm is one of the most contagious affects. Mutual contagiousness of enthusiasm can lead to collective elation, with or without genuine enthusiasm of all members. The difference of real, authentic affects and enacted affects is thus not only theoretically, but also empirically rather problematic. It is impossible to make convincing claims about the degree of authenticity of an affect. However, it is also impossible to ignore this ambivalence. Both ‘authentic’ and ‘faked’ enthusiasm can be affective labour, but they differ hugely in terms of their productive capacities.Enthusiasm as Productive ForceWhy is enthusiasm so important in the first place? The answer is threefold. Firstly, an enthusiastic worker is more productive. He or she will work more intensively, put in more commitment, is likely to go the so-called extra mile. Enthusiasm can create a surplus of labour and a surplus of value, thus a surplus of productivity. Secondly enthusiasm is part of the creative act. It can unleash energies and overcome self-imposed limitations. Thirdly enthusiasm is future-oriented, a stimulus for investment, always risky. Enthusiasm can be the affective equivalent of venture capital – but it is not reified in capital, but remains incorporated in labour. Thus enthusiasm not only leads to an increase of productivity, it can be productive itself. This is what makes it to one of the most precious commodities in the creative industries. To make this argument in more detail we need to turn to one of the key philosophers of affect.Thinking Enthusiasm with SpinozaFor Spinoza, all affects are derivatives of a first basic drive or appetite. Desire/appetite is the direct equivalent of what Spinoza calls Conatus: Our striving to increase our power. From this starting point, Spinoza derives two basic affects: pleasure/joy and sadness/pain. Pleasure/joy is the result of an increase of our power, and sadness/pain is the result of its decrease. Spinoza explains all other affects through this basic framework. Even though enthusiasm is not one of the affects that Spinoza mentions, we want to suggest that Spinoza’s approach enables us to understand the productivity of enthusiasm. Enthusiasm is a hybrid between desire (the drive) and joy (the basic affect). Like hope or fear, it is future-oriented. It is a desire (to increase our power) combined with an anticipated outcome. Present and the future are tightly bound. Enthusiasm differs in this respect from its closest relatives: hope and optimism. Both hope and optimism believe in the desired outcome, but only against the odds and with a presumption of doubt. Enthusiasm is a form of ecstatic and hyper-confident hope. It already rewards us with joy in the present.With Spinoza we can understand the magical trick of future-oriented enthusiasm: To be enthusiastic means to anticipate an outcome of an increased power. This anticipation increases our power in the present. The increased power in the present can then be used to achieve the increased power in the future. If successful, it becomes a self-fulfilling prophecy. It is this future-orientedness, which can make enthusiasm productive. Actions and PassionsIn its Greek origin (‘enthousiasmos’) to be enthusiastic meant to be possessed or inspired by a god. An enthusiast was someone with an intense religious fervour and sometimes someone with an exaggerated belief in religious inspiration. Accordingly, enthusiasm is often connected to the devotion to an ideal, cause, study or pursuit. In late capitalism, we get possessed by different gods. We get possessed by the gods of opportunity – in our case the opportunities of a new technology like IPTV. Obsessions cannot easily be switched on and off. This is part of affective labour: The ability to open up and let the gods of future-oriented enthusiasm take hold of us. We believe in something not for the sake of believing, but for the sake of what we believe in. But at the same time we know that we need to believe. The management of this contradiction is a problem of control. As enthusiasm now constitutes a precious commodity, we cannot leave it to mere chance. Spinoza addresses exactly this point. He distinguishes two kinds of affects, actions and passions. Actions are what we control, passions are what controls us. Joy (= the experience of increased power of acting) can also weaken, if someone is not able to control the affection that triggered the joy. In such a case it becomes a passion: An increase of power that weakens in the long run. Enthusiasm is often exactly this. How can enthusiasm as a passion be turned into an action? One possible answer is to control what Spinoza calls the ‘ideas’ of the bodily affections. For Spinoza, affections (affectiones) ‘strike’ the body, but affect (affectus) is formed of both, of the bodily affectiones, but also of our ideas of these affectiones. Can such ideas become convictions, beliefs, persuasions? Our experience suggests that this is indeed possible. The excitement about the creative possibilities of IPTV, for example, was turned into a conviction. We had internalised the affect as part of our beliefs. But we had internalised it for a prize: The more it became an idea the more stable it got, but the less it was a full, bodily affect, something that touched our nervous system. We gained power over it for the price that it became less powerful in its drive.Managing the UnmanageableIn all institutions and organisations enthusiasm needs to be managed on a regular basis. In project networks however the orchestration of affects faces a different set of obstacles than in traditional organizations. Power structures are often shifting and not formally defined. Project partners are likely to have diverging interests, different expectations and different views on how to collaborate. What might be a disappointing result for one partner can be a successful result for another one. Differences of interest can be accompanied by differences of the expression of enthusiasm. This was clearly the case in our project network. The TV company entered a state of hype and frenzy while pitching the project. They were expressing their enthusiasm with talk about prominent TV channels that would buy the product, and celebrities who would take part in the show. The new media company showed its commitment through the development of beautifully designed time plans and prototypes – one of them included the idea to advertise the logo of the project on banners placed on airplanes. This sort of enthusiastic presentation led the TV producer to oppose the vision of the new media’s brand developer: She perceived this as an example of unrealistic pipe dreams. In turn the TV producer’s repeated name-dropping led other partners to mistrust them.Timing was another reason why it seemed to be impossible to integrate the affective cohorts of all partners into one well-oiled machine. Work in TV production requires periods of heightened enthusiasm while shooting the script. Not surprisingly, TV professionals save up their energy for this time. In contrast, new media practitioners create their products on the go: hype and energy are spread over the whole work process. Their labour becomes materialised in detailed plans, concepts, and prototypes. In short, the affective machine of a project network needs orchestration. This is a question of management.As this management failed so often in our project, we could discover another issue in the universe of enthusiasm: Disappointed high spirits can easily turn into bitterness and hostility. High expectations can lead to a lack of motivation and finally to a loss of loyalty towards the product and towards other project partners. Thus managing enthusiasm is not just about timing. It is also about managing disappointment and frustration. These are techniques, which have to be well developed on the level of the self-management as well as group management.Beyond the ProjectWe want to conclude this paper with a scene that happened at the very end of the project. In a final meeting, all partners agreed – much to our surprise – that the product was a big success. At that time we as academic partners found this irritating. There were many reasons why we disagreed: we did not produce a new format, we did not get positive user feedback, and we could not sell the show to further broadcasters (our original aims). However, all of this did not seem to have any impact on this final assessment. At the time of the meeting this looked for us like surreal theatre. Looking back now, this display of enthusiasm was indeed perhaps a ‘rational’ thing to do. Most projects and products in the creative industries are not successful on the market (Frith). 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