Journal articles on the topic 'Radio Clinic (New York, NY)'

Fragmento Rafael Camerini-Dávalos, Miembro Correspondiente extranjero de la Academia Nacional de Medicina, murió a la edad de 103 años, el 15 de Febrero de 2020, en la ciudad de Bronxville, NY. Era nuestro académico más longevo. Nació en Buenos Aires, Argentina, obtuvo el grado de médico y dos doctorados en la Universidad de Buenos Aires, donde luego fue profesor. Fue un eminente diabetólogo y estuvo entre los primeros que propusieron el concepto de pre-diabetes. En la Joslin Clinic de Boston fue pionero en la conducción de estudios clínicos con agentes hipoglicemiantes. Fue profesor de Medicina en Harvard y en el New York Medical College, donde se retiró en 1997. Hasta 1985 fue Jefe de la División de Metabolismo y Diabetes en el Departamento de Medicina en el New York Medical College.

Purpose: To report two cases of cataract that progressed after COVID-19 mRNA vaccination.Case summary: Two patients visited our clinic with decreased visual acuity in the left eye that began after mRNA vaccine. A 40-year-old man visited our hospital with decreased visual acuity in the left eye that developed 1 week after injection of the second dose of mRNA-1273 (Moderna ^® ,Cambridge, UK). A 40-year-old woman visited our clinic with decreased visual acuity in the left eye that occurred on day 46 after the injection of the third dose of BNT162b2 (Pfizer ^® , New York, NY, USA). Neither case had any relevant ophthalmic history, and there was no clear optic neuropathy or retinopathy on fundus examination. After phacoemulsification and intraocular lens implantation, the best-corrected visual acuity improved, and intraocular pressure has remained stable.Conclusions: The possibility of cataract development or progression after COVID-19 mRNA vaccine injection should be considered.

Objectives The purpose of this study was to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. Methods A retrospective dental record review was completed of 251 rural pediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a board-certified pediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. Proportions of children who were referred for specific treatment modalities and who completed treatment and proportions of children for whom the treatment recommendation was changed were calculated. Fisher’s exact test was used to assess statistical significance. Results The initial treatment modality was not changed for 221/251 (88%) children initially seen for a teledentistry consultation. Thirty (12%) children had the initial treatment modality changed, most frequently children who were initially suggested treatment with nitrous oxide. Based on the initial treatment modality, changes to a different treatment modality were statistically significant (Fisher’s exact test, p < 0.0001). Conclusions Our data suggest that the use of a live-video teledentistry consultation can be an effective way of predicting the best treatment modality for rural children with significant dental disease. A live-video teledentistry consultation can be an effective intervention to facilitate completion of complex treatment plans for children from a rural area that have extensive dental needs.

Purpose: To evaluate utilization and trends associated with patients who presented with emergencies at a community dental clinic at Columbia University Medical Center, New York, NY. Study design: Data from deidentified dental records of patients aged 0–12 years old who presented as emergencies for oral and dental reasons for 2012, 2013, and 2014 were collected. Variables analyzed included demographic information, oral diagnosis, and current health status. Frequency distributions analysis, chi-square test and analysis of variance (ANOVA) test were performed using Stata 13.0. Results: There were 4,328 dental and oral-related emergencies with a mean age of 6-years-old. Approximately 50% were females, 71% were Hispanic, and 90% had Medicaid managed care. Most emergencies (49%) were caries-related, 41% were considered atraumatic in nature, and approximately 10% were traumatic. About 10% of patients presented with comorbidities and 37% were either first-time patients or patients that presented exclusively for emergencies. Acute tooth pain (45%) caused by dental caries was the most common chief complaint. The trends for emergency presentations showed a significant decrease (p&lt;.001) between years 2012–2014 for caries-related visits and a significant increase (p&lt;.001) between 2012–2013 and 2012–2014 for atraumatic visits. Conclusions: Caries-related dental diagnoses were more common than trauma-related diagnoses. The most common caries-related diagnosis was pulp necrosis for both primary and permanent dentitions while the most common traumarelated diagnosis was subluxation for the primary dentition and enamel-dentin fracture for the permanent dentition.

Background: A panel of 3 serum proteins and 1 autoantibody has been developed to assist with the detection of lung cancer. We aimed to validate the accuracy of the biomarker panel in an independent test set and explore the impact of adding a fourth serum protein to the panel, as well as the impact of combining molecular and clinical variables. Methods: The training set of serum samples was purchased from commercially available biorepositories. The testing set was from a biorepository at the Cleveland Clinic. All lung cancer and control subjects were >50 years old and had smoked a minimum of 20 pack-years. A panel of biomarkers including CEA (carcinoembryonic antigen), CYFRA21-1 (cytokeratin-19 fragment 21-1), CA125 (carbohydrate antigen 125), HGF (hepatocyte growth factor), and NY-ESO-1 (New York esophageal cancer-1 antibody) was measured using immunoassay techniques. The multiple of the median method, multivariate logistic regression, and random forest modeling was used to analyze the results. Results: The training set consisted of 604 patient samples (268 with lung cancer and 336 controls) and the testing set of 400 patient samples (155 with lung cancer and 245 controls). With a threshold established from the training set, the sensitivity and specificity of both the 4- and 5-biomarker panels on the testing set was 49% and 96%, respectively. Models built on the testing set using only clinical variables had an area under the receiver operating characteristic curve of 0.68, using the biomarker panel 0.81 and by combining clinical and biomarker variables 0.86. Conclusions: This study validates the accuracy of a panel of proteins and an autoantibody in a population relevant to lung cancer detection and suggests a benefit to combining clinical features with the biomarker results.

BTK inhibitors induce ABC-DLBCL cell apoptosis by inhibiting CYLD phosphorylation Xin Xu1, Zhigang Zhu1, Feng Liu1 , Weijie Zhong1,Huabao Xiong2, Tiefeng Feng3, and Qingshan Li3 1Geriatrics Department, GuangZhou First People's Hospital, GuangDong, 510180, People's Republic of China. 2Precision Immunology Institute, Mount Sinai School of Medicine, New York, NY 10029, U.S.A. 3Hemotology Department, GuangZhou First People's Hospital, GuangDong, 510180, People's Republic of China. Activated B cell-like diffuse large B cell lymphoma (ABC-DLBCL) is a common aggressive diffuse large B cell lymphoma (DLBCL). Even though CD20 antibody (Rituximab) combination therapy improved the total prognosis of DLBCL, there are still many relapsed and refractory ABC-DLBCL cases. The new treatment options are urgently needed. Pathogenesis of ABC-DLBCL is different from germinal center B cell-like diffuse large B cell lymphoma (GCB-DLBCL), which is related to activation of B cell antigen receptor(BCR) signaling. The Bruton tyrosine kinase(BTK) plays a central role in BCR signaling. Inhibition of BTK function will affect BCR signaling activity, which is involved in maintaining the malignant phenotype in B-cell lymphoma. Now in clinic, BTK inhibitors like Ibrutinib or Acalabrutinib are used extensively in chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL/SLL), mantle cell lymphoma(MCL) as first line therapy or second line therapy. But in DLBCL its role is unclear now.Some DLBCL clinic trials got the better PFS and OS in BTK inhibitor combination therapy group(combined with Rituximab or RCHOP) but some got the negative results. Whether BTK inhibitors can definitely improve ABC-DLBCL survival and the mechanism how BTK inhibitors inducing cell death are needed further investigations. CYLD (cylindromatosis) is a tumor suppressor, its activity is inhibited by phosphorylation, which is related to apoptosis regulation pathway NF-kB in many kinds of tumors.In this study, we found that CYLD to be constitutively phosphorylated in ABC-DLBCL cell line models (HBL-1 and OCI-Ly10) as well as primary samples from patients with non-GCB DLBCL. We subsequently examined the effect of BTK inhibitors Ibrutinib (PCI-32765) and Acalabrutinib (ACP-196) on CYLD phosphorylation. We found that BTK inhibitors Ibrutinib and Acalabrutinib both induced ABC-DLBCL apoptosis by down-regulating CYLD phosphorylation in vivo and in vitro, even in the Rituximab resistant ABC-DLBCL cell line.Combination of BTK inhibitors and Rituximab would enhance this effect. Knockdown of CYLD in ABC-DLBCL cells reduced the level of cell death induced by BTK inhibitors, which showed that this cell death induced by BTK inhibitors was CYLD dependent. Through this study, we conclude that BTK inhibitors induce CYLD inactivation by regulating CYLD phosphorylation is clinical beneficial in ABC-DLBCL therapy, especially the relapsed or refractory ABC-DLBCL cases after Rituximab therapy. Disclosures No relevant conflicts of interest to declare.

Abstract Abstract SCI-49 The concept of stem cell niche, proposed by Schofield 30 years ago, refers to the ability of the microenvironment to regulate stem cell fate. The niche provides critical signals allowing hematopoietic stem cells (HSC) to survive, and if so, whether to remain in or to leave the niche (mobilization), or whether to remain quiescent or divide. Some of these signals originate locally from the niche cell(s) but others are coming from afar. For example, we have found that signals from the sympathetic nervous system (SNS) promote the release of HSCs from the bone marrow (BM) niche. Under steady-state conditions, HSC egress in blood is orchestrated in a circadian manner where the fluctuations of circulating HSCs/progenitors are matched with antiphase oscillations in the expression of Cxcl12 mRNA in the BM microenvironment. These oscillations are entrained in the brain by the molecular clock through the local delivery of norepinephrine by SNS nerve terminals in the BM, and transmitted specifically by the β3 adrenergic receptor (Adrβ3) expressed on CXCL12-producing stromal cells, thereby leading to the cyclical degradation of the Sp1 transcription factor. In humans, the circadian release of HSC is inverted compared to rodents and may influence the stem cell yield even when mobilization is enforced by granulocyte colony-stimulating factor (G-CSF), suggesting the potential benefit to harvest HSCs in the clinic at the optimal circadian time. Given the coupling of nervous signals with the stem cell niche, we would expect that the stromal cell forming the niche would be intimately associated with nerve fibers. We have recently found using transgenic mice expressing the green fluorescent protein (GFP) under the Nestin promoter elements (Nes-Gfp), that GFP+ cells (referred to as Nestin+) form a HSC niche in the marrow. Nestin+ cells comprise a relatively small subset (0.08 ± 0.01%) of total BM nucleated cells that is anatomically and functionally associated with the vast majority of CD150+ CD48- Lin- HSCs near blood vessels and SNS fibers of the BM. Nestin+ niche cells express high levels of core genes regulating HSC retention (Cxcl12, Kit ligand, Vcam-1, Angiopoietin-1), and these genes are downregulated by mobilization induced by G-CSF or administration of Adrβ3 agonists. We have identified putative Nestin+ niche cells as bona fide mesenchymal stem cells (MSCs) since they can be propagated as single clonal spheres capable of self-renewal, dramatic in vivo expansion, and multipotency to form osteoblasts, adipocytes, and chondocytes. These data argue for a unique bone marrow niche formed by the pairing of the two rare stem cells, mesenchymal and hematopoietic, that exist in the marrow. Co-authors: Simón Méndez-Ferrer, Ph.D., Daniel Lucas, Ph.D., Michela Batista, Ph.D., Sergio A. Lira, M.D., Mount Sinai School of Medicine, New York, NY; Tatyana V. Michurina, Ph.D., Grigori N. Enikolopov Ph.D., Cold Spring Harbor Laboratory, Cold Spring Harbor, NY Disclosures Frenette: Glycomimetic: Research Funding.

Background. The efficacy of sacubitril/valsartan, a newly introduced combination drug for heart failure with reduced ejection fraction (HFrEF), was demonstrated in the PARADIGM-HF trial conducted in Western countries. However, these findings need to be verified in the Middle Eastern context, where patients may exhibit a different response due to different environmental and racial factors. Objectives. The goal of this study was to evaluate the efficacy of submaximal sacubitril/valsartan doses in terms of improving the disease symptoms, as measured by the New York Heart Association (NYHA) classification and left ventricular ejection fraction (LVEF) percentage, as well as establish long-term morbidity and mortality associated with HFrEF among Palestinian patients administered target doses of an angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARBs). Material and Methods. This study involved a retrospective review of charts related to patients with HFrEF maintained on sacubitril/valsartan and was conducted in a referral cardiology clinic in Palestine. The inclusion criteria were age 18+, HFrEF diagnosis, sacubitril/valsartan usage for at least six months during the period between January 1, 2016, and June 30, 2019, and LVEF < 40 % . The exclusion criteria included LVEF ≥ 40 % and drug administration duration < 6 months. The collected data included NYHA class, as well as LVEF, serum sodium (Na), potassium (K), serum creatinine (Cr), and blood urea nitrogen (BUN) levels and the mortality rate before and after the minimum treatment duration. IBM SPSS STATISTICS for Windows, version 20.0, Armonk, NY: IBM Corp. IBM Corp., released 2012, was used for data analysis, whereby T score was calculated for comparisons between numerical groups, and p < 0.05 was considered statistically significant. Results. The initial study sample comprised of 205 consecutive patients with HFrEF maintained on sacubitril/valsartan for at least six months from January 1, 2016, to June 30, 2019. Three patients were excluded due to attrition, along with further 12 patients with LVEF ≥ 40 % (based on the PARADIGM-HF trial criteria). Throughout the treatment period, most patients showed escalating improvement in terms of the LVEF and NYHA classification, as LVEF = 29.8 % and NYHA = 3 were obtained on average before initiating sacubitril/valsartan, compared to 41% and 1.7, respectively, after 6-month treatment ( p = 0.0003 and 0.046, respectively). These improvements in LVEF and NYHA class were noted across all sacubitril/valsartan doses (50−400 mg). However, 23 patients (12%) died while undergoing sacubitril/valsartan treatment. Conclusion. A significant long-term reduction in the mortality and morbidity rates was observed in Palestinian patients with HFrEF maintained on submaximal doses of sacubitril/valsartan.

Compared with other domestic species, embryo technologies are least developed for the dog. This is mainly due to difficulties in producing mature oocytes in vitro. Canine oocytes contain exceptionally high amounts of lipid. High lipid content increases the chilling sensitivity of oocytes and embryos. Mechanical and chemical reductions of the lipid content have been used to improve the cryotolerance of oocytes. Additionally, chemical stimulation of lipid catabolism improved oocyte in vitro maturation (IVM) rates in other species (You et al. 2012 Theriogenology 78, 235–543). Acetyl-CoA carboxylase (ACC) is the rate-limiting enzyme in de novo lipogenesis and its expression has been reported in oocytes and embryos. In somatic cells, inhibition of ACC reduces lipogenesis and enhances β-oxidation. Our hypothesis is that treatment of oocytes with an inhibitor of ACC (CP640186, Pfizer Animal Health, New York, NY, USA) reduces lipid content and improves IVM rate of oocytes. Ovaries were collected from a spay clinic and sliced in HEPES-buffered TCM-199 to recover oocytes. In vitro maturation was conducted at 38.5°C, 5% CO2, and high humidity in TCM-199 supplemented with 1% fetal bovine serum, glutamine, sodium pyruvate, β-mercaptoethanol, oestradiol, epidermal growth factor, and antimicrobial agents (Songsasen et al. Mol. Reprod. Dev. 79, 186–196). During the first 19 to 21 h, the IVM media contained 4 concentrations of the inhibitor (0+DMSO, 0.02, 0.1, and 0.5 μM, designated as treatments 1, 2, 3, and 4, respectively) and then oocytes were transferred to a medium without the inhibitor and cultured for an additional 27 to 29 h. At the end of culture (total of 48 h), oocytes were denuded of cumulus layers, washed, fixed, and stained with Nile red (lipid) and Hoechst-33342 (chromatin), and then mounted on a microscope slide. Lipid content and chromatin status were evaluated using fluorescent microscopy (TRITC and DAPI filters, respectively). The relative lipid content was measured by the corrected total cell fluorescence (CTCF) using ImageJ software (http://rsbweb.nih.gov/ij/). Data on CTCF and proportions of chromatin status of oocytes were analysed using one-way ANOVA (SigmaPlot 11.0). The mean CTCF for each treatment was 5.5 × 109 (n = 51, 5.2 × 109 (n = 44), 4.5 × 109 (n = 31), and 4.8 × 109 (n = 34), respectively (P = 0.3; 4 replicates). At the highest dose, the agent induced relatively more cumulus cell layer expansion but inhibited their attachment to the dish; the latter effect was reversible because cumulus cells attached and proliferated after washing the oocytes of the agent. Metaphase II was rare (≤3.1%); however, the proportion of oocytes developing to ≥GVBD stage (Trt 1 14%, n = 37; Trt 2 41%, n = 56; Trt 3 5%, n = 22; Trt 4 11%, n = 43) was affected by treatments. Our preliminary data indicate that a low concentration of ACC inhibitor has a positive effect on the nuclear maturation of canine oocytes but the effect on lipid content as estimated by using Nile red fluorescence intensity appears to be minimal.

Background:Spondyloarthritis (SpA) is generally uncommon in sub-Saharan Africa, in part because of the rarity of HLA-B27 in this region.Objectives:The aim of our study was to determine the epidemiological, semiological, paraclinical and therapeutic aspects of ankylosing spondylitis in rheumatology in Togo.Methods:This was a retrospective multicenter descriptive study on the files of patients suffering from ankylosing spondylitis seen in an outpatient setting or hospitalized in one of the four Rheumatology departments of Togo in the period from January 1, 2000 to December 31, 2019. The diagnosis was essentially radio-clinical based on the modified New York criteria.Results:In 20 years, and out of a population of 35,304 rheumatic patients, we have collected 37 cases of ankylosing spondylitis, meaning a hospital frequency of 0.10% and an annual frequency of 1.85 cases. There was clearly a male predominance with an M / F ratio of 4.28. The onset of the disease was on average of 29.62 ± 10.27 years and the diagnosis delay on average of 9.45 ± 9.20 years. The clinic was dominated by spinal pain in the form of chronic inflammatory cervical-dorsal-lumbar pain (41.2%) or lumbar pain (29.4%). Common joint injuries were those of the knees (57.69%), ankles (26.9%) and shoulders (23.1%). The most frequent extra-articular manifestations were ocular with conjunctivitis (62.5%) and uveitis (37.5%). Due to the delayed diagnosis, significant spinal deformities including hypercyphosis, straightness and ankylosis were found; the radiography of the spine objectified syndesmophytes (50.0%) with ankyloses and the bamboo column (23.5%) and that of the pelvis objectified sacroiliitis at stage 3 (54.6%) and at stage 4 (27.3%). The HLA B27 antigen was positive in 10.8% of cases. NSAIDs and sulfasalazine were the most commonly used drugs in management, respectively in 94.3% of symptomatic treatment and 92.6% of background therapy.Conclusion:Ankylosing spondylitis is relatively rare in Togo, affecting more men and young adults. There are no clinical or paraclinical particularity. The delay in diagnosis reflects the importance of the radiological signs. Treatment is mainly done by NSAIDs and DMRADs in particular sulfasalazine, due to their accessibility.References:[1]Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ. Global Prevalence of Ankylosing Spondylitis. Rheumatology (Oxford). 2014;53:650-7.[2]Zabsonre TWJ, Sawadogo SA, Kabore F, Ilboudo A, Sougue C, Zongo E, et al. Ankylosing Spondylitis in Sub-Saharan Africa: A Series of 48 Cases Reported in Burkina Faso (West Africa). Open J Rheumatol Autoimmune Dis. 2018;8:87-92.[3]Mijiyawa M. Ankylosing Spondylitis in Togolese Patients. Med Trop. 1993;53:185-9.Disclosure of Interests:None declared.

Abstract Title: Primary Therapy with Bortezomib—The Role of Induction, Maintenance, and Re-Induction in Patients with High Risk Myeloma. Update of Results from E2A02. Angela Dispenzieri, MD1, Susanna Jacobus, PhD2, David Vesole, MD3 and Philip R. Greipp, MD1. 1Hematology, Mayo Clinic, Rochester, MN, United States, 55905 and 2Biostatistics, Eastern Cooperative Oncology Group, Boston, MA, United States, 02115. 3Saint Vincent’s Hospital, New York, NY 10010 Background: Single agent bortezomib as upfront therapy in patients with multiple myeloma (MM) results in response rates of 38% and the drug has been touted to be especially effective in patients with high risk disease. We sought to explore response rate, the role of maintenance and reinduction in a cohort of patients with high-risk MM. Methods: Patients with newly diagnosed high-risk myeloma (beta-2 microglobulin [B2M] &gt;= 5.5., plasma cell labeling index [PCLI] &gt;= 1, or deletion 13q) and adequate organ and functional status were eligible. Patients were treated with bortezomib 1.3 mg/m2 day 1, 4, 8, and 11 every 21 days for 8 cycles as induction. After induction, patients were scheduled to receive bortezomib 1.3 mg/m2 every other week indefinitely. Elective peripheral stem cell mobilization (growth factor alone) was allowed after 4 cycles of bortezomib. Patients relapsing on maintenance schedule had full induction schedule resumed. Responses as defined by the EBMT criteria were determined after each cycle and needed to be confirmed after at least 6 weeks. Results: Between March 15, 2004 and March 10, 2005, 44 patients enrolled on study. Among the 42 eligible treated patients, median age was 63; 51% were male. All patients had high risk disease: deletion 13q (6/41); PCLI &gt;=1% (17/33); t(4:14) (4/27) and B2M &gt;= 5.5 (34/43). Nineteen patients completed induction, i.e. 8 cycles of bortezomib. The most common causes for discontinuing therapy were: progressive disease (n=17), AE (n=7), alternate therapy (n=4), death (n=1), and other (n=11). Forty-eight percent of patients achieved a partial response (PR) or better with induction (0 complete responses, 2 very good PR, 17 PR, 3 minimal responses, 5 no response, 9 progressive disease, and 6 inevaluable or missing). Response rates across risk groups did not differ with a PR or better for patients with deletion 13q (2/6); PCLI &gt;=1% (8/17); t(4:14) (2/4) and B2M &gt;= 5.5 (15/33). One patient’s response was upgraded to CR during maintenance. The rate of painful peripheral neuropathy during all courses of therapy was: grade 1, n=25; grade 2, n=2; and grade 3, n=2. With a median follow-up of 41.6 months (95%CI 36.6–43), 43% of patients have died. Median overall survival (OS) has not been reached (Figure), and the 1- and 2-year OS rates were 88.1% (95%CI 73.7–94.9%) and 76.2% (95%CI 60.3–86.4%) respectively. The median progression free survival (PFS) was 16.3 months (95%CI 6.2–26.6) and the 1- and 2-PFS were 76.7% (95%CI 58.8–87.6%) and 38.3% (95%CI 20.6–55.9%), respectively. Fifteen patients went on to maintenance. The distribution by risk group for patients entering maintenance was not different across groups: deletion 13q, 3/6; high PCLI, 6/17; high B2M, 11/33; t(4;14), 1/4; and p53, 0/2. For those entering maintenance, the median PFS was 19.8 months (Figure), and the 1 year PFS rate was 75% (95%CI 40.8–91.2%). Of the 7 patients progressing on maintenance who received reinduction with bortezomib, no patient responded. Only 2 remain on therapy. Figure Figure Conclusions: In high risk patients, upfront bortezomib results in response rates comparable to those reported for unselected cohorts of newly diagnosed myeloma patients. For patients responding to therapy, maintenance therapy is feasible. Reinduction was unsuccessful in high risk patients failing maintenance.

Background: Given the approval of a vast array of potent therapies and treatment combinations in multiple myeloma, it is important to understand outcomes of patients who relapse and/or become refractory to these commonly used drugs such as proteasome inhibitors (PI), immunomodulatory agents (IMiD), and CD38 targeting monoclonal antibodies (MoAB; ie. daratumumab). This study aims to describe clinical characteristics and progression free survival (PFS) after failure of at least 1 PI and IMiD +/- daratumumab in US community practice to provide context for the outcomes of RRMM patients after exposure to at least three lines of anti-myeloma therapies. Methods: Data analyzed were from electronic health record (EHR) generated by Flatiron Health (New York, NY). These data represent over 280 cancer clinics representing over 2 million active patients treated at primarily community-based hematology/oncology practices in the US. Inclusion criteria included adult patients ≥18 years with a diagnosis of MM, at least two clinic visits after 2015, failure of a PI and IMiD, ECOG ≤2, adequate hematologic/renal/hepatic function, and no stem cell transplant within three months of study entry. Study eligibility began as early as treatment initiation in ≥ fourth line (4L+) from January 2015 through March 2020. Progression free survival was measured from treatment until death, progression, or start of new line of therapy, and PFS was estimated for patients who were eligible for study inclusion (index date) between 2015-2018. Last follow-up occurred at March 2020. Results: In total, 141 patients had prior daratumumab exposure (64 included in time-to-event analysis) and 294 patients were daratumumab naïve (56 of these 294 had daratumumab exposure in a later line of therapy, at which point they were counted in the 141 daratumumab exposed patients group; 230 included in time-to-event analysis) once meeting the inclusion criteria for this study. Of patients exposed to daratumumab, 50% qualified for the study after 3-4 lines versus 87% of daratumumab naive patients. The median age at study entry was 69-70 years (Table 1). Approximately 36% of daratumumab exposed patients and 33% of non-previously daratumumab exposed patients presented with either intermediate or high-risk cytogenetics at study entry for patients with available cytogenetics. About half (48%) of daratumumab-exposed patients and over a quarter (29%) of non-previously daratumumab-exposed patients had a prior transplant. Median time from diagnosis until study entry was 49 months for the daratumumab exposed and 39 months for the non-previously daratumumab exposed groups. Median follow-up for the daratumumab exposed group was 8 months and 15 months for the non-previously daratumumab exposed group. At study entry for the daratumumab exposed patients, 4% received monotherapy, 18% received a doublet (5% carfilzomib/dexamethasone and 4% daratumumab/dexamethasone), 56% received a triplet (11% daratumumab/pomalidomide/dexamethasone, 7% carfilzomib/pomalidomide/dexamethasone), and 12% a quadruplet. In total, 56 (40%) patients received re-treatment with a daratumumab combination. Among the non-previously daratumumab exposed patients, 12% received monotherapy, 29% received a doublet (8% carfilzomib/dexamethasone, 7% daratumumab/dexamethasone), 48% received a triplet (12% daratumumab/pomalidomide/dexamethasone, 5% bortezomib/daratumumab/dexamethasone), and 8% received a quadruplet. PFS was short in both groups (Figure 1). In the daratumumab exposed group, the median PFS was 3.3 months (95% CI: 2.1-5.8) and the in the non-previously daratumumab exposed group, the median PFS was 4.4 months (95% CI: 3.6-5.9). Discussion: In this study with majority of patients having 3-4 prior lines of treatment, short PFS was observed for RRMM patients regardless of prior daratumumab exposure. Strikingly, many patients received re-treatment with a drug they had previously failed, suggesting many patients may have run out of effective therapies to utilize. Additionally, the daratumumab exposed group had a higher proportion with prior transplant which may also lead to differential outcome between these groups. Overall, these data suggest that these patients have poor outcomes and the need for effective novel classes of therapies remains high within the US community practice setting. Disclosures Kim: Amgen: Current Employment. Braunlin:Amgen: Current Employment. Belani:Amgen: Current Employment. Wheeling:Amgen: Consultancy.

Abstract Background: As new therapeutics for multiple myeloma (MM) are approved in earlier lines of therapy, drug classes with demonstrated benefit may be exhausted after initial therapy, including proteasome inhibitors (PI), immunomodulatory imides (IMiD), and CD38 targeting monoclonal antibodies (MoAB). Clinical recommendations are to utilize unique drug classes at relapse. This study aims to describe relapsed or refractory multiple myeloma treatments and outcomes in clinical trial eligible patients with prior treatment of at least 1 PI, IMiD, and CD38 MoAB and their outcomes (real world overall response rate (rwORR), progression free survival (rwPFS), overall survival (rwOS)) in US community practice. Methods: This study used Flatiron Health electronic health record (EHR)-derived de-identified database (New York, NY). These data represent ~280 cancer clinics (mostly community-based practices). Inclusion criteria included ≥18 years old, 2+ clinic visits after 2015, measurable disease, prior PI/IMiD/CD38 MoAB exposure, ECOG ≤2, adequate hematologic/renal/hepatic function, and no stem cell transplant within six months of study entry. Study period was treatment initiation at ≥ second line from November 2015 through December 2019, follow-up through December 2020. Patients with multiple eligible lines of therapy, the last eligible line was evaluated. Real world overall response rate was adapted from Foster et al 2019, rwPFS was measured from treatment until death, progression, or start of new line of therapy, and rwOS was measured from treatment until death. Results: 120 patients were eligible for this study. Median time from diagnosis to study entry was 3.8 years. Half were 70 years or older (n=62, 52%), with 20% (n=24) ISS III, 35% (n=42) high-risk cytogenetics, and 64% (n=77) at ≥5L treatment. At study start, 38% (n=46) had a prior transplant, 73% (n=88) were triple-class refractory, and 21% (n=25) penta-refractory. The most common regimens were either daratumumab-based (n=35), carfilzomib-based (n=25), or elotuzumab-based (n=15). The most frequent regimens were daratumumab/pomalidomide/dexamethasone (n=8), carfilzomib/cyclophosphamide/dexamethasone (n=7), carfilzomib/pomalidomide/dexamethasone (n=7), carfilzomib/dexamethasone (n=5), elotuzumab/lenalidomide/dexamethasone (n=5), and elotuzumab/pomalidomide/dexamethasone (n=5). The rwORR in this population was 18.33% (95% CI: 11.41-25.26, n=22). The rwORR was lower in key subgroups: younger age (&lt;65 years old: 13.79% [95% CI: 1.24-26.34], n=4/29), high risk cytogenetics (0%, n=0/10), ISS III (12.12% [95% CI: 0.99-23.26], n=4/33), triple-class refractory (15.91% [95% CI: 8.27-23.55], n=14/88), and penta-refractory (4.00% [95% CI: 0-11.68], n=1/25). The median rwPFS in this population was 3.5 months (95% CI: 2.3-4.8). The rwPFS were shorter in key subgroups: younger age (&lt;65 years old: 2.1 months [95% CI: 1.8-3.5]), high risk cytogenetics (2.0 months, [95% CI: 0.7-5.0), ISS III (2.2 months [95% CI: 1.6-6.5]), triple-class refractory (3.2 months [95% CI: 2.1-4.8]), and penta-refractory (2.1 [95% CI: 0.9-3.6]). The median rwOS in this population was 15.8 months (95% CI: 9.9-26.0). The OS was shorter in key subgroups: younger age (10.8 months [95% CI: 4.9-.]), high risk cytogenetics (9.4 months [95% CI: 2.2-27.9]), ISS III (14.6 months [95% CI: 6.1-27.9]), triple class refractory (15.1 months [95% CI: 7.5-25.5]), and penta refractory (7.1 months [95% CI: 3.6-26.0]). Discussion: In this study of patients that were majority triple-class refractory (PI, IMiD, CD38 MoAbB), low rwORR and short rwPFS were observed. Most patients received re-treatment with at least one drug they had previously failed or were refractory to. Additionally, many patients had additional therapies including novel agents and combinations that could be effective at prolonging OS despite short rwPFS. Compared to academic center patients (Gandhi et al 2019), survival was longer (mOS 15.8 months versus 9.3 months), but in Gandhi 2019, the median time to study entry was 4.5 versus 3.8 years, patients were more penta-refractory (26%) and had prior transplant (72%). Patients who were penta-refractory (bortezomib, carfilzomib, lenalidomide, pomalidomide, daratumumab) had particularly dismal outcome. Overall, these data suggest need for continued development of effective novel classes of therapies for late line myeloma patients. Figure 1 Figure 1. Disclosures Kim: Amgen: Current Employment, Current equity holder in publicly-traded company. Braunlin: Amgen: Current Employment, Current equity holder in publicly-traded company. Mehta: Amgen: Current Employment. Payne: Amgen: Consultancy.

Introduction The treatment (tmt) for multiple myeloma (MM) is evolving with the introduction of novel immunomodulatory drugs (IMiD), monoclonal antibodies (MoAB), and proteasome inhibitors (PI). As new efficacious therapies are approved, the prevalence of MM continues to increase and remains an incurable disease. There is limited real-world evidence describing these temporal changes (Song 2016, Curr Med Res Opin; Fonseca 2017, Leukemia). This study characterizes trends in MM tmts and patient (pt) survival from 2011-19 in the US-based Flatiron electronic health records (EHR) database. Methods Data analyzed were from an enhanced database of oncology EHR contained in the Oncology Services Comprehensive Electronic Records (OSCER), generated by Flatiron Health that includes additional unstructured data processing (New York, NY, March 31, 2019). OSCER represents a longitudinal, demographically and geographically diverse database with data from over 265 cancer clinics representing over 2 million active pts treated at primarily community-based hematology/oncology practices in the US. Inclusion criteria included adult pts ≥18 years (yrs) with a diagnosis of MM (ICD9: 203.x; ICD-10: C90.x) and at least two clinic visits after 2011. Pt and disease characteristics were characterized; line of therapy (LOT) (1-5), year of therapy initiation, and all tmt regimens received. Follow-up time was measured from tmt index until death or last follow-up. Kaplan-Meier overall survival (OS) proportions were estimated from LOT tmt index. Results A total of 9289 pts were identified. At diagnosis the median age was 69 yrs, with 54% of pts male and 68% white. The majority of pts were treated in the community setting (89%) and 11.5% presented with high risk cytogenetics (del17p, t(4;14), t(14;16)). International Staging System (ISS) data was available in 49.2% of subjects, with 16.6%, 16.1% and 16.3% stage 1, 2, and 3 respectively. Among the 91% of pts who received tmt for newly diagnosed MM, median time to tmt was 30 days. In 2017-18, triplet combination (comb) PI-IMiD-dexamethasone (dex) was the most common front (48%) and second line regimen (27%); and the use of this comb increased in both first and second lines over the study period. In contrast, the use of IMiD or PI -dex doublet regimens decreased. In third line setting, PI-IMiD-dex remained the most common comb in 2017-18 (21%) but gradually decreased over the study period with a dip in 2013-14 while MoAB-IMiD-dex combs increased from 3% to 12% (2015/16-2017/18). In second, third, and fourth line MoAB-IMiD-dex comb increased to 8%, 12%, and 14% respectively beginning in 2015 (Table 1). MM tmt regimens changed over the study period, most notably in the first and second LOTs. By 2017-18, triplets replaced doublets as the most common front line (58%) and second line (45%) therapies over the study period. Across all LOTs, triplets were the most prescribed comb in 2017-18 with 42%, 42% and 30% in third, fourth, and fifth lines. Over the study period, monotherapies decreased to 12% in frontline, but their use has remained constant in later lines (Table 2). Overall, 26% of pts received a transplant during follow-up. Approximately 34% of pts survived until the end of follow-up. With each LOT, OS deceased. Median OS of pts treated in first line was 57 months and decreased to 44 months, 32 months, and 25 months in second, third, and fourth lines respectively (Figure 1). OS of MM pts who received first line tmt appears to increase the more recently they were diagnosed. Median OS of MM pts diagnosed in 2013-14 was slightly longer compared to pts diagnosed in earlier yrs (2011-12); 60 months compared to 56 months. Median OS was not reached in 2015-16 (Figure 2). Conclusion Triplet therapies have replaced doublet therapies over time as more options became available to MM pts, especially in frontline setting; frontline monotherapies have nearly halved since the beginning of the study period. In 2015, tmt patterns begin to shift as MoAB based triplets were approved and comprised a higher proportion of the regimens in the relapsed and refractory population. Yet, the majority of pts are still receiving PI-IMiD-dex triplets. OS estimates suggest survival in front line treated pts is slowly increasing in recent yrs. These data illustrate the current tmt landscape of MM and the changes that have occurred since the introduction of novel therapies over the past 8 yrs. MM disease management continues to evolve. Disclosures Braunlin: Amgen, Inc.: Employment. Belani:Amgen, Inc: Employment, Equity Ownership. Buchanan:Amgen Inc.: Employment, Other: Owns Amgen stock, Research Funding. Kim:Amgen, Inc.: Employment, Equity Ownership.

Background The VEDERA (Very Early vs. Delayed Etanercept in Rheumatoid Arthritis) randomised controlled trial compared the effect of conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) therapy with biologic DMARD (bDMARD) therapy using the tumour necrosis factor inhibitor etanercept in treatment-naive, early rheumatoid arthritis patients. The CADERA (Coronary Artery Disease Evaluation in Rheumatoid Arthritis) trial was a bolt-on study in which VEDERA patients underwent cardiovascular magnetic resonance imaging to detect preclinical cardiovascular disease at baseline and following treatment. Objectives To evaluate whether or not patients with treatment-naive early rheumatoid arthritis have evidence of cardiovascular disease compared with matched control subjects; whether or not this is modifiable with DMARD therapy; and whether or not bDMARDs confer advantages over csDMARDs. Design The VEDERA patients underwent cardiovascular magnetic resonance imaging at baseline and at 1 and 2 years after treatment. Setting The setting was a tertiary centre rheumatology outpatient clinic and specialist cardiovascular magnetic resonance imaging unit. Participants Eighty-one patients completed all assessments at baseline, 71 completed all assessments at 1 year and 56 completed all assessments at 2 years. Patients had no history of cardiovascular disease, had had rheumatoid arthritis symptoms for ≤ 1 year, were DMARD treatment-naive and had a minimum Disease Activity Score-28 of 3.2. Thirty control subjects without cardiovascular disease were approximately individually matched by age and sex to the first 30 CADERA patients. Patients with a Disease Activity Score-28 of ≥ 2.6 at 48 weeks were considered non-responders. Interventions In the VEDERA trial patients were randomised to group 1, immediate etanercept and methotrexate, or group 2, methotrexate ± additional csDMARD therapy in a treat-to-target approach, with a switch to delayed etanercept and methotrexate in the event of failure to achieve clinical remission at 6 months. Main outcome measures The primary outcome measure was difference in baseline aortic distensibility between control subjects and the early rheumatoid arthritis group and the baseline to year 1 change in aortic distensibility in the early rheumatoid arthritis group. Secondary outcome measures were myocardial perfusion reserve, left ventricular strain and twist, left ventricular ejection fraction and left ventricular mass. Results Baseline aortic distensibility [geometric mean (95% confidence interval)] was significantly reduced in patients (n = 81) compared with control subjects (n = 30) [3.0 × 10–3/mmHg (2.7 × 10–3/mmHg to 3.3 × 10–3/mmHg) vs. 4.4 × 10–3/mmHg (3.7 × 10–3/mmHg to 5.2 × 10–3/mmHg), respectively; p < 0.001]. Aortic distensibility [geometric mean (95% confidence interval)] improved significantly from baseline to year 1 across the whole patient cohort (n = 81, with imputation for missing values) [3.0 × 10–3/mmHg (2.7 × 10–3/mmHg to 3.4 × 10–3/mmHg) vs. 3.6 × 10–3/mmHg (3.1 × 10–3/mmHg to 4.1 × 10–3/mmHg), respectively; p < 0.001]. No significant difference in aortic distensibility improvement between baseline and year 1 was seen in the following comparisons (geometric means): group 1 (n = 40 at baseline) versus group 2 (n = 41 at baseline): 3.8 × 10–3/mmHg versus 3.4 × 10–3/mmHg, p = 0.49; combined groups 1 and 2 non-responders (n = 38) versus combined groups 1 and 2 responders (n = 43): 3.5 × 10–3/mmHg versus 3.6 × 10–3/mmHg, p = 0.87; group 1 non-responders (n = 17) versus group 1 responders (n = 23): 3.6 × 10–3/mmHg versus 3.9 × 10–3/mmHg, p = 0.73. There was a trend towards a 10–30% difference in aortic distensibility between (group 1) responders who received first-line etanercept (n = 23) and (group 2) responders who never received etanercept (n = 13): 3.9 × 10–3/mmHg versus 2.8 × 10–3/mmHg, p = 0.19; ratio 0.7 (95% confidence interval 0.4 to 1.2), p = 0.19; ratio adjusted for baseline aortic distensibility 0.8 (95% confidence interval 0.5 to 1.2), p = 0.29; ratio fully adjusted for baseline characteristics 0.9 (95% confidence interval 0.6 to 1.4), p = 0.56. Conclusions The CADERA establishes evidence of the vascular changes in early rheumatoid arthritis compared with controls and shows improvement of vascular changes with rheumatoid arthritis DMARD therapy. Response to rheumatoid arthritis therapy does not add further to modification of cardiovascular disease but, within the response to either strategy, etanercept/methotrexate may confer greater benefits over standard methotrexate/csDMARD therapy. Trial registration Current Controlled Trials ISRCTN89222125 and ClinicalTrials.gov NCT01295151. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership, and will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. Pfizer Inc. (New York, NY, USA) supported the parent study, VEDERA, through an investigator-sponsored research grant reference WS1092499.

Sigitas Ryliškis1, Manvilius Kocius1, Robert G Marx21 Vilniaus universiteto Reumatologijos, ortopedijos traumatologijos ir rekonstrukcinės chirurgijos klinika Vilniaus greitosios pagalbos universitetinės ligoninės Ortopedijos traumatologijos centras, Šiltnamių g. 29, Vilnius LT-041302 Specialiosios chirurgijos ligoninės Ortopedijos skyrius, 535 East 70th Street, Niujorkas (NY), Jungtinės Amerikos ValstijosEl paštas: ryliskis.s@gmail.com Įvadas / tikslas Pacientams, sergantiems peties sąnario ir/arba aplinkinių minkštųjų audinių ligomis, peties raumenų jėgos matavimas yra viena iš būtinų klinikinio įvertinimo dalių. Išmatuoti jėgą gali tyrėjas arba pats pacientas. Tyrėjas raumenų jėgą išmatuoja dinamometru, o pacientas, atsakydamas į specialiai suformuluotus klausimus apie tam tikro svorio daiktų kėlimą kasdienėje veikloje, pats išsimatuoja jėgą netiesiogiai. Paciento vertinimas yra paprastesnis, greitas, nereikalauja tyrėjo ir specialios įrangos ir galbūt galėtų pakeisti sudėtingus gydytojo matavimus klinikinėje praktikoje. Šio tyrimo tikslas – palyginti du peties raumenų jėgos matavimo būdus ir nustatyti, ar tyrėjas ir pacientas jėgą matuoja vienodai. Ligoniai ir metodai Perspektyviajame tyrime dalyvavo 108 pacientai, atvykę operacinio gydymo į ligoninę dėl peties sukamųjų raumenų sausgyslių plyšimo. Visiems pacientams pažeisto ir sveiko peties raumenų jėga buvo išmatuota skaitmeniniu dinamometru. Pacientai savo peties raumenų jėgą įvertino patys, atsakydami į tris jėgą matuojančius Paprastojo peties klausimyno klausimus. Statistinei duomenų analizei naudojome tyrėjo išmatuotą peties raumenų jėgą kilogramais (trijų matavimų vidurkius), jėgą vertinančių atskirų klausimų ir visų trijų klausimų atsakymų suminius rezultatus. Tyrėjo ir paciento vertinimų patikimumui nustatyti buvo apskaičiuotas vidinis klasės koreliacijos koeficientas su 95% pasikliautinumo intervalu. Norėdami palyginti du jėgos matavimo būdus, apskaičiavome Spearmano koreliacijos koeficientą. Rezultatai Vertinant tyrėjo matavimų patikimumą buvo gautas 0,951 vidinis klasės koreliacijos koeficientas. Atskiriems jėgą matuojantiems klausimams vidinis klasės koreliacijos koeficientas buvo 0,896, 0,896 ir 0,887, o visų trijų klausimų suminiams rezultatams – 0,952. Tyrėjo išmatuota jėga vidutiniškai koreliavo su atskirų trijų jėgą vertinančių klausimų rezultatais (rho = 0,527, p < 0,001; rho = 0,632, p < 0,001; rho = 0,527, p < 0,001) ir su visų trijų klausimų suminiais rezultatais (rho = 0,702, p < 0,001). Išvada Pacientai, atsakydami į specialiai suformuluotus klausimus, gali patikimai išmatuoti savo peties raumenų jėgą, tačiau šių matavimų tikslumas nėra lygus skaitmeniniu dinamometru išmatuotai jėgai. Reikšminiai žodžiai: peties raumenų jėga, skaitmeninis dinamometras, matavimų patikimumas, Paprastasis peties klausimynas Comparison of patient-based assessment and observer-based measurements of shoulder strength Sigitas Ryliškis1, Manvilius Kocius1, Robert G Marx21 Vilnius University Clinic of Rheumatology, Orthopaedic and Traumatology and Reconstructive Surgery Centre of Orthopaedic and Traumatology, Vilnius University Emergency Hospital, Šiltnamių str. 29, LT-04130 Vilnius, Lithuania2 Orthopaedic Department, Hospital for Special Surgery, 535 East 70th Street, New York, USAE-mail: ryliskis.s@gmail.com Background / objective Shoulder strength measurement of the is mandatory in the evaluation of shoulder function in patients with shoulder pathology. We can use observer-based measurements with the digital dynamometer or self-assessment scales with special questions about elevation of different weights in everyday activities. Patient self-assessment is simple and rapid, it requires no observer and special equipment. This method may replace complex observer-based measurements. The purposes of this study were to compare two different shoulder strength evaluation methods and to determine whether the patient-based evaluation equals the observer-based measurements. Materials and methods In the hospital, 108 patients with a rotator cuff injury were prospectively evaluated. Observer-based measurements of the shoulder muscle strength were performed using a digital dynamometer for both injured and healthy shoulders. For the patient-based evaluation we used the strength subscale (three questions) from the shoulder joint specific self-assessment Simple Shoulder Test instrument. For statistical analysis we used observer-based measurements of the strength in kilograms (means of three measurements), results of separate three questions and the total shoulder strength score. The reliability of observer- and patient-based assessments was determined and the two strength evaluation methods were compared. Results The intraclass correlation coefficient for intraobserver reliability was 0.951. The intraclass correlation coefficients for test–retest reliability of three separate questions were 0.896, 0.896, 0.887, and the total strength score was 0.952. Observer-based measurements showed a moderate correlation with the results of separate three questions (rho = 0.527, p < 0.001; rho = 0.632, p < 0.001; rho = 0.527, p < 0.001) and with the total shoulder strength score (rho = 0.702, p<0.001). Conclusions Patients can evaluate their shoulder strength in a reliable way using questions from the strength subscale of the self-assessment Simple Shoulder Test. The accuracy of these measures is not equal to the observer-based measures using a digital dynamometer. Key words: shoulder strength, digital dynamometer, questionnaire, reliability, the Simple Shoulder Test

I was born and raised in the old mining town of Barrio DAS (Don Andres Soriano), Lutopan, Toledo City where Atlas Consolidated Mining and Development Corp. (ACMDC) is situated. Dad started his practice in the company’s hospital as an EENT specialist in the early 60’s and was the ‘go to’ EENT Doc not only of nearby towns or cities (including Cebu City) but also the surrounding provinces in the early 70’s. In my elementary years, he was Assistant Director of ACMDC Hospital (we lived just behind in company housing, only a 3-minute walk). I grew interested in what my dad did, sometimes staying in his clinic an hour or so after school, amazed at how efficiently he handled his patients who always felt so satisfied seeing him. At the end of the day, there was always ‘buyot’ (basket) of vegetables, live chickens, freshwater crabs, crayfish, catfish or tilapia. I wondered if he went marketing earlier, but knew he was too busy for that (and mom did that) until I noticed endless lines of patients outside and remembered when he would say: “Being a doctor here - you’ll never go hungry!” I later realized they were PFs (professional fees) of his patients. As a company doctor, Dad received a fixed salary, free housing, utilities, gasoline, schooling for kids and a company car. It was the perfect life! The company even sponsored his further training in Johns-Hopkins, Baltimore, USA. A family man, he loved us so much and was a bit of a joker too, especially at mealtimes. Dad’s daily routine was from 8 am – 5 pm and changed into his tennis, pelota, or badminton outfit. He was the athlete, winning trophies and medals in local sports matches. Dad wanted me to go to the University of the Philippines (UP) High School in the city. I thought a change of environment would be interesting, but I would miss my friends. Anyway, I complied and there I started to understand that my dad was not just an EENT practicing in the Mines but was teaching in Cebu Institute of Medicine and Cebu Doctors College of Medicine (CDCM) and was a consultant in most of the hospitals in Cebu City. And still he went back up to the mountains, back to Lutopan, our mining town where our home was. The old ACMDC hospital was replaced with a new state-of-the-art hospital now named ACMDC Medical Center, complete with Burn Unit, Trauma center and an observation deck in the OR for teaching interns from CDCM. Dad enjoyed teaching them. Most of them are consultants today who are so fond of my dad that they always send their regards when they see me. My dad loved making model airplanes, vehicles, etc. and I realized I had that skill when I was 8 years old and I made my first airplane model. He used to build them out of Balsa wood which is so skillful. I can’t be half the man he was but I realized this hobby enhanced his surgical skills. My dad was so diplomatic and just said to get an engineering course before you become a pilot (most of dads brothers are engineers). I actually gave engineering a go, but after 1 ½ years I realized I was not cut out for it. I actually loved Biology and anything dealing with life and with all the exposure to my dad’s clinic and hospital activities … med school it was! At this point, my dad was already President of the ORL Central Visayas Chapter and was head of ENT Products and Hearing Center. As a graduate of the UP College of Medicine who finished Otorhinolaryngology residency with an additional year in Ophthalmology as one of the last EENTs to finish in UP PGH in the late 50’s, he hinted that if I finished my medical schooling in CDCM that I consider Otorhinolaryngology as a residency program and that UP-PGH would be a good training center. I ended up inheriting the ORL practice of my dad mostly, who taught me some of Ophthalmology outpatient procedures. Dad showed me clinical and surgical techniques in ENT management especially how to deal with patients beyond being a doctor! You don’t learn this in books but from experience. I learned a lot from my dad. Just so lucky I guess! He actually designed and made his own ENT Treatment Unit, which I’m still using to this day (with some modifications of my own). And he created a certain electrically powered ‘eye magnet’ with the help of my cousin (who’s an engineer now in Chicago) which can attract metallic foreign bodies from within the eyeball to the surface so they can easily be picked out – it really works! Dad loved to travel in his younger years especially abroad for conventions or just simply leisure or vacations, most of the time with my mom. But as he was getting older, travels became uncomfortable. His last travel with me was in 2012 for the AAO-HNS Convention in Washington DC. It was a great time as we then proceeded to a US Navy Airshow in nearby Virginia after the convention, meeting up with my brother who is retired from the USN. Then we took the train to New York and stayed with my sister who is a PICU nurse in NY Presbyterian. Then off to Missouri and Ohio visiting the National Museum of the US Air Force, the largest military aircraft museum in the world. For years, Dad had been battling with heredofamilial-hypercholesterolemia problem which took its toll on his liver and made him weak and tired but still he practiced and continued teaching and sharing his knowledge until he retired at the age of 80. By then, my wife and I would take him and my mom out on weekends, he loved to be driven around and eat in different places. I really witnessed and have seen how he suffered from his illness in his final years. But he never showed it or complained, never even wanted to use a cane! He didn’t want to be a burden to anyone. What most affected me was that my dad passed and I wasn’t even there. I had helped call for a physician to rush to the house and had oxygen cylinders to be brought for him as his end stage liver cirrhosis was causing cardio-pulmonary complications (non-COVID). Amidst all this I was the one admitted for 14 days because of COVID-19 pneumonia. My dad passed away peacefully at home as I was being discharged from the hospital. He was 88. I never reached him just to say good bye and cried when I reached home still dyspneic recovering from the viral pneumonia. I realized from my loved ones who told me that dad didn’t want me to stress out taking care of him, as I’ve been doing ever since, but instead to rest and recuperate myself. I cried again with that thought. In my view, he was not only a great Physician and Surgeon but also the greatest Dad. He lived a full life and touched so many lives with his treatments, charity services and teaching new physicians. It’s seeing, remembering and carrying on what he showed and taught us that really makes us miss him. I really love and miss my dad and with a smile on my face, I see he’s also happy to be with his brothers and sisters who passed on ahead. And that he’s rested. He is a man content, I remember he always said this, ‘ As long as I have a roof over my head and a bed to rest my back, I’m okay!”

The coronavirus disease 2019 (COVID-19) pandemic imposed severe restrictions on traditional methods of patient care. During the pandemic, the heart failure program at New York-Presbyterian Hospital in New York, NY rapidly and comprehensively transitioned its care delivery model and administrative organization to conform to a new healthcare environment while still providing high-quality care to a large cohort of patients with heart failure, heart transplantation, and left ventricular assist device. In addition to the widespread adoption of telehealth, our program restructured outpatient care, initiating a shared clinic model and introducing a comprehensive remote monitoring program to manage patients with heart failure and heart transplant. All conferences, including administrative meetings, support groups, and educational seminars were converted to teleconferencing platforms. Following the peak of COVID-19, many of the new changes have been maintained, and the program structure will be permanently altered as a lasting effect of this pandemic. In this article, we review the details of our program’s transition in the face of COVID-19 and highlight the programmatic changes that will endure.

Treatment resistant depression (TRD) is defined as the failure to respond to two adequate antidepressant trials. TRD patients have high levels of psychosocial distress, poor levels of functioning and are at increased risk for suicide. Novel treatment approaches are being developed to address TRD involving both pharmacological and neuromodulation interventions. In this symposium, leaders in the field will outline three strategies for treating depression which has not responded to conventional therapy and contrast the efficacy of these strategies in younger vs. older patients. William McDonald MD (JB Fuqua Professor of Late -Life Depression, Emory University, Atlanta, GA) will provide a brief overview of TRD and moderate the discussion. George Petrides MD (Director of Clinical Trials Operation and Division of ECT, Zucker Hillside Hospital, New York, NY) will discuss recent data from the National Institute of Mental Health sponsored Consortium on ECT Research (CORE) outlining the response of older patients to ultrabrief right unilateral ECT in TRD. He will contrast the response to ECT in older vs, younger patients from the CORE database accumulated over the last 15 years. Collin Reiff MD (Addiction Psychiatrist, New York University Langone Health Center, NY, NY) will discuss his recent review in the American Journal of Psychiatry on Psychedelic and Psychedelic Assisted Psychotherapy and the implications on the treatment of medication resistant depression, including late life mood disorders. The FDA’s breakthrough designation of MDMA for the treatment of PTSD and psilocybin for the treatment of depression reflects the drugs’ potential to treat resistant psychiatric disorders. Psychedelic assisted therapy may play a unique role in late life mood disorders. Finally, Patricio Riva Posse MD (Director of the TRD and Ketamine Clinic, Emory University, Atlanta, GA) will discuss ketamine treatment in resistant depression including a comparison of response rates and safety data on ketamine treatment in older vs. younger patients. He has recently published the largest compilation of safety data for ketamine infusions and he will review a new tool to monitor safety in clinical practice. Dr. Riva Posse is medical director of the Emory TRD program and has enrolled over 1000 patients (100 in his IV ketamine clinic and about half over the age of 60 years) and followed patients through several novel treatments including transcranial magnetic stimulation, ketamine infusion therapy and ECT to start to look at differential response rates.

Introduction: The 2008 Physical Activity Guidelines for Americans (PAG) recommend adults perform at least 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity activity or an equivalent combination of both in order to obtain important health benefits, including lower CHD risk. Despite advances in clinical medicine, survivors of MI remain at substantial risk of recurrent cardiovascular events and death. The aim of our prospective study was to examine whether meeting the PAG reduced risk of recurrent CVD events in MI patients. Hypothesis: We hypothesized that MI survivors who met the current PAG had a more favorable prognosis than those who did not meet the guidelines. Methods: Incident MI cases (933 men, 354 women, 35–69 years old) recruited from 12 of 15 Western NY hospitals completed an interviewer-administered survey and clinic exam. Physical activity (PA) in the previous seven days was assessed using the Stanford 7-day PA recall. Minutes reported in moderate and vigorous intensity recreational, household and occupational activity (MVPA) were summed and participants were categorized as follows (min/week): inactive (0), insufficiently active (>0–<150), met (150–300), and exceeded the guideline goal (>300). Participant surveys, medical records and a search of the National Death Index Plus were used to determine fatal and non-fatal recurrent CVD (ICD9 390–450) events. Cox regression analysis adjusting for age (in years), gender, education (in years), race, BMI, smoking status, hypertension and use of diabetes and lipid medication was conducted to examine the association between PA and recurrent events. Results: During a mean follow up of 4.1 years, 301 recurrent CVD events occurred. At baseline, 174 (13.5%) participants reported no MVPA, 216 (16.8%) were insufficiently active, whereas 259 (20.1%) met and 638 (49.6%) exceeded the PAG, respectively. Multivariate adjusted hazard ratios (95% CI) for recurrent CVD events were Inactive [Ref (1.00)], insufficiently active [0.68 (0.46–1.01)], met [0.63 (0.43–0.92)], and exceeded the guideline goal [0.63 (0.45–0.87)], p-trend =0.019. Conclusion: In this prospective population-based study, there is evidence to support that meeting the 2008 Physical Activity Guidelines for Americans has significant benefits on fatal and non-fatal recurrent CVD events in men and women following myocardial infarction.

Patients with diabetic neuropathy and peripheral arterial disease often suffer pain, develop foot wounds, and go on to lose limbs leaving them with a painful limb. Electrical stimulation is one possibility open to physicians. In this study, the effects of the FlowAid FA100 SCCD, a sequential contraction compression device, were tested. The FA100 device is noninvasive; it uses 4 electrodes to sequentially stimulate the calf muscles in a modified intermittent pneumatic compression manner. A total of 14 patients with diabetic neuropathy, peripheral arterial disease, unilateral amputation, and a painful limb were treated with FlowAid FA100 (FlowAid Medical Technologies Corporation, New York, NY) with prior ethical approval. The study design was open, pre-post intervention comparison, and nonrandomized. Pain perceived was measured using Visual Analogue Scale (VAS) scores. Assessments of ankle brachial index (ABI), ultrasound color Duplex, and tissue oxygen using the transcutaneous oxygen technique were done at baseline and 2 successive follow-ups 4 weeks apart. Three out of 14 patients dropped out on account of distances involved in traveling to the clinic. Eleven out of 14 patients experienced statistically significant reduction in pain mean VAS scores (7.5 ± 0.93 to 5.8 ± 1.47, P = .002) associated with increase in ABI (0.64 ± 0.06 to 0.69 ± 0.04, P < .001) and transcutaneous oxygen tension measured on the dorsum (29.4 ± 4.03 to 33.2 ± 5.26 in mm Hg, P = .005). When pain scores were regressed against ABI and transcutaneous oxygen tension values, there was a significant association between these ( r = 0.8, P = .002). The reduction in pain following regular use of FlowAid was accompanied by beneficial and statistically significant increases in perfusion and oxygenation.

Barclay, Eric. I Can See Just Fine. New York, NY:, Abrams Appleseed, 2013. Print.Paige is a little girl who really needs glasses, but doesn’t know it. Her teachers and her mum and dad notice that she is having trouble with her vision, but when her parents decide to take her to the eye doctor, she’s not keen on going.Young readers will follow Paige as she goes for her eye examination and through the process of choosing frames. They will witness the dramatic change in how Paige sees the world when she finally gets her new glasses. I Can See Just Fine gives children get a sense of what to expect if they need glasses, ranging from what they will encounter during a visit to the optometrist or ophthalmologist, to the clinic environment, to the equipment and procedures, to being fitted for lenses and frames.Author and illustrator, Eric Barclay, crafts a story that is engaging, humorous, and instructive. His text and artwork highlights the fun and fascinating aspects of the eye exam and frame selection process. Barclay includes many details that draw in the reader and make reading and re-reading the story enjoyable, weaving humorous details around the central issue of Paige’s vision impairment. He employs two-page spreads at strategic points in the story, in one case representing the vast array of frames for Paige to select, and in another communicating the dramatic contrast between what Paige sees with and without her new glasses.I Can See Just Fine is a story that will entertain and educate young readers, and help children to feel less anxious about having their vision assessed and corrected. The story’s text and illustrations include subtle details that will appeal to older readers or to parents/older siblings reading the book to young children.Highly recommended: 4 out of 4 starsReviewer: Maria TanMaria C. Tan is a medical librarian at the Abdul Khaliq Library in Alberta Health Services’ Cross Cancer Institute and a former editorial team member of the Deakin Review. She firmly believes that children's literature is an essential component in the fountain of youth.

The past two decades have seen the publication of at least half a dozen books that consider the part that fairs, circuses, sideshows and freakshows play in the continuing cultural labour to define, categorise and control the human body, including Robert Bogdan’s Freakshow, Rosemarie Garland-Thomson’s Extraordinary Bodies, and her edited collection Freakery, and Rachel Adams’s Sideshow USA. These writers cast the freakshow as a theatre of culture, worthy of critical attention precisely because of the ways in which it has provided a popular forum for staging, solidifying and transforming ideas about the body and bodily difference, and because of its prominence in the project of modernity (Garland-Thomson “From Wonder to Error” 2-13). They point to the theatrical mechanisms by which the freakshow maps cultural anxieties about corporeal difference across ‘suitable’ bodies. For, as Bogdan (3) says, being a freak is far more than a fact of biology. The freak personae that populate the Western cultural imaginary—the fat lady, the bearded lady, the hermaphrodite and the geek—can only be produced by a performative isolation, manipulation and exaggeration of the peculiar characteristics of particular human bodies. These peculiarities have to be made explicit, in Rebecca Schneider’s (1) terms; the horror-inducing tropes of the savage, the bestial and the monstrous have to be cast across supposedly suitable and compliant flesh. The scopic mechanisms of the freakshow as a theatre, as a cabinet of corporeal curiosities in which spectators are excited, amazed and edified by the spectacle of the extraordinary body, thus support the specific forms of seeing and looking by which freak bodies are produced. It would, however, be a mistake to suggest that the titillating threat of this face-to-face encounter with the Levinasian other fully destabilises the space between signifier and signified, between the specific body and the symbolic framework in which it sits. In a somewhat paradoxical cultural manoeuvre, the ableist, sexist and racist symbolic frameworks of the freakshow unfold according to what Deleuze and Guattari (178) would call a logic of sameness. The roles, relationships and representational mechanisms of the freakshow—including the ‘talkers’ that frame the spectator’s engagement with the extraordinary body of the freak—in fact function to delineate “degrees of deviance” (178) or difference from an illusory bodily norm. So configured, the monstrous corporeality of the freak is also monstrously familiar, and is made more so by the freak spectacle’s frequent emphasis on the ways in which non-normative bodies accommodate basic functions such as grooming and eating. In such incarnations, the scenography and iconography of the freakshow in fact draws spectators into performative (mis)recognitions that manage the difference of other bodies by positioning them along a continuum that confirms the stability of the symbolic order, and the centrality of the able, white, male self in this symbolic order. Singular, specific, extraordinary bodies are subject to what might, in a Levinasian paradigm, be called the violence of categorisation and comprehension (“Is Ontology Fundamental?” 9). The circumstances of the encounter reduce the radical, unreadable difference of the other, transporting them “into the horizon of knowledge” (“Transcendence and Height” 12), and transforming them into something that serves the dominant cultural logic. In this sense, Petra Kuppers suggests, “the psychic effects of the freak spectacle have destabilizing effects, assaulting the boundaries of firm knowledge about self, but only to strengthen them again in cathartic effect” (45). By casting traits they abhor across the freak body (Garland-Thomson Extraordinary Bodies 55-56), spectators become complicit in this abhorrence; comforted, cajoled and strangely pleasured by a sense of distance from what they desire not to be. The subversive potential of the prodigious body evaporates (Garland-Thomson “From Wonder to Error” 3; Extraordinary Bodies 78). An evaporation more fully effected, writers on the freakshow explain, as the discursive construct of the freak was drawn into the sphere of medical spectacle in the late nineteenth century. As the symbolic framework for understanding disabled bodies ‘advances’ from the freak, the monster and the mutant to the medical specimen (Garland-Thomson “From Wonder to Error” 13; Extraordinary Bodies 70, 78-80; Synder and Mitchell 370-373; Stephens 492), the cultural trajectory away from extraordinary bodies with the capacity to expand the classes and categories of the human is complete. The medical profession finally fulfils the cultural compulsion to abstract peculiar bodily characteristics into symptoms, and, as Foucault says in The Birth of the Clinic, these symptoms become surveillable, and controllable, within an objective schema of human biology. Physical differences and idiosyncrasies are “enclosed within the singularity of the patient, in that region of ‘subjective symptoms’ that—for the doctor—defines not only the mode of knowledge, but the world of objects to be known” (xi). The freak body becomes no more than an example of human misfortune, to be examined, categorised and cared for by medical experts behind closed doors, and the freakshow fades from the stage of popular culture (Garland-Thomson Extraordinary Bodies 70). There can, of course, be no denying the need to protect people with disabilities from exploitation at the service of a cultural fetish that enacts a compulsion to define and control bodily difference. However, recent debates in disability, cultural and performance studies have been characterised by the desire to reconsider the freakshow as a site for contesting some of the cultural logics it enacts. Theorists like Synder and Mitchell argue that medical discourse “disarms the [disabled] body of its volatile potency” (378), in the process denying people with disabilities a potentially interesting site to contest the cultural logics by which their bodies are defined. The debate begins with Bogdan’s discussion of the ways in which well-meaning disability activists may, in their desire to protect people with disabilities from exploitative practices and producers, have overlooked the fact that freakshows provided people with disabilities a degree of independence and freedom otherwise impossible (280-81). After all, as disabled performer Mat Fraser says in his documentary Born Freak, The Victorian marvels found fame and some fortune, and this actually raised the visibility, even the acceptability, of disabled people in general during a time when you could be attacked on the streets just for looking different. These disabled performers found independence and commanded respect.… If I had been born a hundred years ago, given the alternatives of—what? living the life of a village monster or idiot or being poked or prodded for cataloguing by medical types—there’s no doubt about it, I would have wanted to be in show business. (Born Freak) This question of agency extends to discussion of whether disabled performers like Fraser can, by consciously appropriating the figures, symbols and scenography of the freakshow, start to deconstruct the mechanisms by which this contested sphere of cultural practice has historically defined them, confronting spectators with their own complicity in the construction of the freak. In her analysis of Coney Island’s Sideshows by the Seashore, Elizabeth Stephens reflects on this contemporary sideshow’s capacity to reclaim the political currency of the freak. For Stephens, sideshows are sites in which norms about the body, its limits and capabilities, are theatricalized and transformed into spectacle, but, in which, for this very reason, they can also be contested. Non-normative bodies are not simply exhibited or put on display on the sideshow stage, but are rather performed as the unstable—indeed, destabilising—product of the dynamic interrelationship between performer, audience and theatrical space. (486) Theorists like Stephens (487) point to disabled performers who manipulate the scopic and discursive mechanisms of the sideshow, street performance and circus, setting them against more or less personal accounts of the way their bodies have historically been seen, to disrupt the modes of subjection the freak spectacle makes possible and precipitate a crisis in prescribed categories of meaning. Stephens (485-498) writes of Mat Fraser, who reperformed the historical personal of the short-armed Sealo the Sealboy, and Jennifer Miller, who reperformed the persona of Zenobia the bearded lady, at Sideshows by the Seashore. Sharon Mazer (257-276) writes of Katy Dierlam, who donned a Dolly Dimples babydoll dress to reperform the clichéd fat lady figure Helon Melon, again at Sideshows by the Seashore, counterposing Melon’s monstrous obesity with comments affirming her body’s potent humanity, and quotes from feminist scholars and artists such as Suzy Orbach, Karen Finley and Annie Sprinkle. Sharon Synder and David Mitchell (383) write of Mary Duffy, who reperforms the armless figure of the Venus de Milo. These practices constitute performative interventions into the cultural sphere, aligned with a broader set of contemporary performance practices which contest the symbolic frameworks by which racial and gender characteristics are displayed on the popular stage in similar ways. Their confrontational performance strategies recall, for instance, the work of American performance artist Guillermo Gómez-Peña, who reappropriates colonial and pop cultural figurations of the racialised body in works like Two Undiscovered Amerindians Visit…, in which he and Coco Fusco cast themselves as two caged savages. In such works, Gómez-Peña and his collaborators use parallel performance strategies to engage the “spectacle of the Other-as-freak” (297). “The idea is to exaggerate the features of fear and desire in the Anglo imagination and ‘spectacularize’ our ‘extreme identities’, so to speak, with the clear understanding that these identities have been invented by the surgery of the global media” (297) Gómez-Peña says. These remobilisations of the monstrous operate within the paradigm of the explicit, a term Schneider coined a decade ago to describe the performance art practices of women who write the animalised, sexualised characteristics with which they are symbolically aligned across their own corporeally ‘suitable’ bodies, replaying their culturally assigned identities “with a voluble, ‘in your face’ vengeance” (100), “a literal vengeance” (109). Such practices reclaim the destablising potential of the freak spectacle, collapsing, complicating or exploding the space between signifier and signified to show that the freak is a discursive construct (22-23), and thus for Schneider, following Benjamin, threatening the whole symbolic system with collapse (2, 6). By positioning their bodies as a ground that manifestly fails to ground the reality they represent, these performers play with the idea that the reality of the freak is really just part of the order of representation. There is nothing behind it, nothing beyond it, nothing up the magician’s sleeve—identity is but a sideshow hall of mirrors in which the ‘blow off’ is always a big disappointment. Bodies marked by disability are not commodified, or even clearly visible, in the Western capitalist scopic economy in the same way as Schneider’s women performers. Nevertheless, disabled performers still use related strategies to reclaim a space for what Schneider calls a postmodern politics of transgression (4), exposing “the sedimented layers of signification themselves” (21), rather than establishing “an originary, true or redemptive body” (21) beneath. The contestational logic of these modes of practice notwithstanding, Stephens (486) notes that performers still typically cite a certain ambivalence about their potential. There are, after all, specific risks for people with disabilities working in this paradigm that are not fully drawn out in the broader debate about critical reappropriation of racist and sexist imagery in performance art. Mobilisations of the freak persona are complicated by the performer’s own corporeal ‘suitability’ to that persona, by the familiar theatrical mechanisms of recognition and reception (which can remain undertheorised in meta-level considerations of the political currency of the freakshow in disability and cultural—rather than performance—studies), and by a dominant cultural discourse that insists on configuring disability as an individual problem detached from the broader sphere of identity politics (Sandahl 598-99). In other words, the territory that still needs to be addressed in this emergent field of practice is the ethics of reception, and the risk of spectatorial (mis)recognitions that reduce the political potency of the freak spectacle. The main risk, of course, is that mobilisations of the freak persona may still be read by spectators as part of the phenomenon they are trying to challenge, the critical counterpositions failing to register, or failing to disrupt fully the familiar scopic and discursive framework. More problematically, the counterpositions themselves may be reduced by spectators to a rhetorical device that distances them from the corporeal reality of the encounter with the other, enabling them to interpret or explain the experience of disability as a personal experience by which an individual comes to accommodate their problems. Whilst the human desire to construct narrative and psychological contexts for traumatic experience cannot be denied, Carrie Sandahl (583) notes that there is a risk that the encounter with the disabled body will be interpreted as part of the broader phenomenon Synder and Mitchell describe in Narrative Prosthesis, in which disability is little more than a metaphor for the problems people have to get past in life. In this interpretative paradigm, disability enters a discursive and theoretical terrain that fails to engage fully the lived experience of the other. Perhaps most problematically, mobilisations of the freak persona may be read as one more manifestation of the distinctively postmodern desire to break free from the constraints of culturally condoned identity categories. This desire finds expression in the increasingly prevalent cultural phenomenon of voluntary enfreakment, in which people voluntarily differentiate, or queer their own experience of self. As Fraser says when he finds out that a company of able-bodied freaks is competing with him for audiences at the Edinburgh Fringe Festival, “[t]he irony is, these days, everyone is trying to get in on our act” (Born Freak). In a brave new world where everybody wants to be a freak, activist artists “must be watchful”, Gómez-Peña warns, “for we can easily get lost in the funhouse of virtual mirrors, epistemological inversions, and distorted perceptions” (288). The reclamation of disability as a positive metaphor for a more dispersed set of human differences in the spectacle of daily life (287-98), and in theoretical figurations of feminist philosophy that favour the grotesque, the monstrous and the mechanical (Haraway Simians, Cyborgs and Women; Braidotti Nomadic Subjects), raises questions for Garland-Thomson (“Integrating Disability, Transforming Feminist Theory” 9) and Sandahl (581-83). If “disability serves as a master trope for difference,” Sandahl says, then anybody can adopt it “…to serve as a metaphor expressing their own outsider status, alienation and alterity, not necessarily the social, economic and political concerns of actual disabled people” (583). The work of disabled performers can disappear into a wider sphere of self-differentiated identities, which threatens to withdraw ‘disability’ as a politically useful category around which a distinctive group of people can generate an activist politics. To negotiate these risks, disabled performers need to work somewhere between a specific, minoritarian politics and a universal, majoritarian politics, as Sedgwick describes in Epistemology of the Closet (91; cf. Garland-Thompson “Integrating Disability, Transforming Feminist Theory” 5; cf. Stephens 493). Performers need to make their experience of otherness explicit, so that their corporeal specificity is not abstracted into a symbolic system that serves the dominant cultural logic. Performers need to contextualise this experience in social terms, so that it is not isolated from the sphere of identity politics. But performers cannot always afford to allow the freak persona to become one more manifestation of the myriad idiosyncratic identities that circulate in the postmodern popular imaginary. It is by negotiating these risks that performers encourage spectators to experience—if only fleetingly, and provisionally—a relationship to the other that is characterised not by generalisation, domestication and containment (Levinas “Substitution” 80, 88), but by respect for the other’s radical alterity, by vulnerability, and, in Derrida’s reformation of Levinasian ethics, by a singular, reciprocal and undecidable responsibility towards the other (Derrida 60-70). This is what Levinas would call an ethical relationship, in which the other exists, but as an excess, a class of being that can be recognised but never seized by comprehension (“Is Ontology Fundamental?” 7, “Transcendence and Height” 17), or sublimated as a category of, or complement to, the same (13, “Meaning and Sense” 51). Mat Fraser’s mobilisation of Sealo the Sealboy is one of the most engaging examples of the way disabled performers negotiate the complexities of this terrain. On his website, Fraser says he has always been aware of the power of confrontational presentations of his own body, and has found live forms that blur the boundaries between freakshow, sideshow and conventional theatre the best forums for “the more brutal and confrontational aspect of my investigation into disability’s difficult interface with mainstream cultural concerns” (MatFraser.co.uk). Fraser’s appropriation of Sealo was born of a fascination with the historical figure of Stanley Berent. “Stanley Berent was an American freakshow entertainer from the 1940s who looked like me,” Fraser says. “He had phocomelia. That’s the medical term for my condition. It literally means seal-like limbs. Berent’s stage name was Sealo the Sealboy” (Born Freak). Fraser first restaged Sealo after a challenge from Dick Zigun, founder of the modern Sideshows by the Seashore. He restaged Berant’s act, focused on Berant’s ability to do basic things like shaving and sawing wood with his deformed hands, for the sideshow’s audiences. While Fraser had fun playing the character on stage, he says he felt a particular discomfort playing the character on the bally platform used to pull punters into the sideshow from the street outside. “There is no powerful dynamic there,” Fraser laments. “It’s just ‘come look at the freak’” (Born Freak). Accordingly, after a season at Sideshows by the Seashore, Fraser readapted the experience as a stage play, Sealboy: Freak, in which Sealo is counterposed with the character Tam, “a modern disabled actor struggling to be seen as more than a freak” (Born Freak). This shift in the theatrical mechanisms by which he stages the freak gives Fraser the power to draw contemporary, politically correct spectators at the Edinburgh Fringe Festival into the position of sideshow gawkers, confronting them with their own fascination with his body. A potent example is a post-audition scene, in which Tam says I read this book once that said that the mainstream will only see a disabled performer in the same way they view a performing seal. Very clever, but just mimicry. No. No it can’t be like that anymore. We’ve all moved on. People are no longer more fascinated by how I do things, rather than what I say. I am an actor, not a fucking freak. (Born Freak) But, as Tam says this, he rolls a joint, and spectators are indeed wrapped up in how he does it, hardly attending to what he says. What is interesting about Fraser’s engagement with Sealo in Sealboy: Freak is the way he works with a complicated—even contradictory—range of presentational strategies. Fraser’s performance becomes explicit, expositional and estranging by turns. At times, he collapses his own identity into that of the freak, the figure so stark, so recognisable, so much more harshly drawn than its real-life referent, that it becomes a simulacrum (cf. Baudrillard 253-282), exceeding and escaping the complications of the human corporeality beneath it. Fraser allows spectators to inhabit the horror, and the humour, his disabled identity has historically provoked, reengaging the reactions they hide in everyday life. And, perhaps, if they are an educated audience at the Fringe, applauding themselves for their own ability to comprehend the freak, and the crudity of sideshow display. However, self-congratulatory comprehension of the freak persona is interrupted by the discomforting encounter with Tam, suspending—if only provisionally—spectators’ ability to reconcile this reaction with their credentials as a politically correct audience. What a closer look at mobilisations of the freak in performances such as Fraser’s demonstrates is that manipulating the theatrical mechanisms of the stage, and their potential to rapidly restructure engagement with the extraordinary body, enables performers to negotiate the risk of (mis)recognition embedded in the face-to-face encounter between self and spectator. So configured, the stage can become a site for contesting the cultural logic by which the disabled body has historically been defined. It can challenge spectators to experience—if fleetingly—the uncertainties of the face-to-face encounter with the extraordinary body, acknowledging this body’s specificity, without immediately being able to abstract, domesticate or abdicate responsibility for it—or abdicate responsibility for their own reaction to it. Whilst spectators’ willingness to reflect further on their complicity in the construction of the other remains an open and individual question, these theatrical manipulations can at least increase the chance that the cathartic effect of the encounter with the so-called freak will be disrupted or deferred. References Adams, Rachel. Sideshow USA: Freaks and the American Cultural Imagination. Chicago, IL: University of Chigaco Press, 2001. Baudrillard, Jean. “The Precision of Simulacra”. Art After Modernism: Rethinking Representation. Ed. Brian Wallis. Boston, MA: David R. Godine, 1984, 253-282. Born Freak. Dir. Paul Sapin. Written Paul Sapin and Mat Fraser. Planet Wild for Channel 4 UK, 2001. Braidotti, Rosi. Nomadic Subjects: Embodiment and Sexual Difference in Contemporary Feminist Thought. New York, NY: Columbia University Press, 1994. Bogdan, Robert. Freakshow: Presenting Human Oddities for Amusement and Profit. Chicago, IL: University of Chicago Press, 1988. Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Trans. Brian Massumi. Minneapolis, MN and London: University of Minnesota Press, 1987. Derrida, Jacques. Gift of Death. Trans. David Wills. Chicago IL: University of Chicago Press, 1995. Fraser, Mat. “Live Art”. MatFraser.co.uk. n.date. 30 April 2008 ‹http://www.matfraser.co.uk/live_art.php›. Foucault, Michel. The Birth of the Clinic: An Archeology of Medical Perception. Trans. AM Sheridan Smith. London: Routledge, 1976. Garland-Thomson, Rosmarie. “Integrating Disability, Transforming Feminist Theory”. NSWA Journal 14.3 (2002): 1-33. ———. Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature. New York, NY: Columbia University Press, 1997. ———. “Introduction: From Wonder to Error—A Genealogy of Freak Discourse”. Freakery: Cultural Spectacles of the Extraordinary Body. Ed. Rosmarie Garland-Thomspon. New York, NY and London: New York University Press, 1996. Gómez-Peña, Guillermo. “Culture-in-extremis: Performing Against the Cultural Backdrop of the Mainstream Bizarre”. The Performance Studies Reader. Ed. Henry Bial. London and New York: Routledge, 2004, 287-298. Haraway, Donna. Simians, Cyborgs and Women. New York, NY: Routledge, 1991. Kuppers, Petra. Disability and Contemporary Performance: Bodies on Edge. New York, NY: Routledge, 2004. Levinas, Emmanuel. “Is Ontology Fundamental?”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 1-10. ———. “Transcendence and Height”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 11-31. ———. “Meaning and Sense”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 33-64. ———. “Substitution”. Emmanuel Levinas: Basic Philosophical Writings. Ed. Adriaan Peperzak, Simon Critchley and Robert Bernasconi. Bloomington and Indianapolis, IN: Indiana University Press, pp. 79-95. Mazer, Sharon. “‘She’s so fat…’ Facing the Fat Lady at Coney Island’s Sideshows by the Seashore”. Bodies Out of Bounds: Fatness and Transgression. Ed. Jana Evens Braziel and Kathryn LeBesco. Berkeley, CA: University of California Press, 2001, 257-276. Sandahl, Carrie. “Black Man, Blind Man: Disability Identity Politics and Performance”. Theatre Journal 56 (2004): 597-602. Schneider, Rebecca. The Explicit Body in Performance. New York, NY and London: Routledge, 1997. Sedgwick, Eve Kosofsky. Epistemology of the Closet. Berkeley, CA: University of California Press, 1990. Snyder, Sharon L. and David T Mitchell. “Re-engaging the Body: Disability Studies and the Resistance to Embodiment”. Public Culture, 13.3 (2001): 367-389. ———. Narrative Prosthesis: Disability and the Dependencies of Discourse. Ann Arbor, MI: University of Michigan Press, 2000. Stephens, Elizabeth. “Cultural Fixations of the Freak Body: Coney Island and the Postmodern Sideshow”. Continuum: Journal of Media and Cultural Studies 20.4 (2006): 485-498. Acknowledgements An earlier version of this paper was presented at “Extreme States: Issues of Scale—Political, Performative, Emotional”, the Australasian Association for Drama Theatre and Performance Studies Annual Conference 2007.

Photo by Kelley Sikkema on Unsplash INTRODUCTION Patients seeking abortion services in the United States face several problems, including factual inaccuracies about the procedure, the stigma surrounding the procedure, and barriers to quality care across the country. The problems surrounding abortion pose a threat to patient autonomy and beneficence—ethical principles that are usually upheld in medicine. Abortion doulas can enhance patient autonomy, improve the quality of medical care, help women talk through their emotions or the associated stigma, and provide other benefits that can address the problems surrounding abortion. Their role ranges from discussing emotional decisions and answering patient questions before the procedure, to simply holding their hand in the recovery room. In this paper, I propose that the use of abortion doulas may help address some of the problems surrounding abortion by mitigating factual inaccuracies, stigma, and barriers to quality care. I. Background Abortion doulas were started byThe Doula Project in New York City.[1]They initially worked with New York City public hospitals and eventually expanded to working with Planned Parenthood clinics, as well as other care providers.[2]Over recent years, abortion doulas have been offered in more states such as California, Arizona, and New Hampshire. Abortion doulas can work independently, in a collective, or in an abortion clinic.[3]More often, they work in a collective where they are trained and employed in clinics that are partnered with the organization. Many abortion doulas started working on a volunteer basis. Now, many are funded by donations, which allow their services to be free for patients.[4]When abortion doulas work independently, their rates are based on the specific services that they provide.[5]Patients can seek out abortion doulas through multiple avenues. They can seek out doulas that work independently, work in an abortion clinic, or through doula organizations, such as the Doula Project or The San Francisco Doula Group. II. Doulas The role of a doula has existed since ancient times. The word “doula” comes from the Greek language and translates to “a woman who serves”.[6]In 1969, Dr. Dana Raphael originated the use of the word “doula” in the US to describe a person who guides mothers through childbirth and assists them postpartum, specifically helping them breastfeed.[7]Dr. Raphael encouraged emotionally supporting new mothers through creating the new professional role of a doula.[8] Currently, doulas are trained in helping women emotionally and physically during pregnancy, childbirth, and postpartum. Doulas do not provide medical care, but they provide services such as birthing education, massage, assistance with breastfeeding, and educating mothers about the delivery process, such as knowing what to expect and what can go wrong. Research has demonstrated the effectiveness and benefits of doulas. For example, one meta-analysis compared women who received doula support during childbirth to women who did not. The study showed that doula-supported women had shorter labors, decreased complications with delivery, and rated childbirth as less painful than women without doula support.[9]Psychosocial benefits such as reduced anxiety, decreased symptoms of depression, and positive feelings associated with childbirth were significant for the doula-supported group.[10]In the last couple of decades, doulas have become increasingly popular. More recently, doulas have started a movement labeled “full spectrum doula,” in which the role of a doula in supporting women has expanded beyond birth to include abortion and adoption.[11] III. Ethical Considerations Factual Inaccuracies Complete and accurate medical information is fundamental to informed consent and autonomous decision making. Inaccurate medical information about abortion is very common and can come from multiple sources. Currently, there are 29 states that have policies restricting abortion that are not based on scientific evidence.[12]While both state policies and national media may convey false information to the public about abortion, perhaps what is most surprising is when these inaccuracies are presented to patients by physicians or medical facilities. In most states, policies mandate that any medical facility providing abortions develop and present written material to patients that is intended to educate the patient about the abortion procedure.[13]However, in some states, laws have been passed that mandate the inclusion of misinformation in these materials.[14]Healthcare providers try to mitigate the harm of this inaccurate information by prefacing it with qualifiers, disclaimers, and apologies.[15]However, they are still not able to completely avoid harm from the outdated and misleading information, which also often intends to dissuade patients from receiving an abortion.[16]The most common factual inaccuracies include stating that an abortion leads to an increased risk of breast cancer, that the fetus can feel pain as early as 12 weeks old, and that psychological effects of the procedure can lead to suicide and “post abortion traumatic stress syndrome.”[17]All these statements are false and not supported by scientific evidence; in fact, psychologists and the Diagnostic and Statistical Manual of Mental Disorders(DSM-V) do not recognize a post-traumatic stress syndrome associated with abortion.[18]Furthermore, another common inaccuracy in almost 20 states includes materials with contact information to “Crisis Pregnancy Centers” that provide false information with the intent to deter women from having an abortion.[19] Even once piece of inaccurate information can impede a patient’s ability to make an informed, autonomous decision. When these false facts are given to patients from the hands of trusted medical professionals, it has a more influential impact than when portrayed in media and advertisements. Trust is a core value in the medical profession that determines the patient-physician relationship, and a part of this trust is communicating accurate and up-to-date information; if this trust did not exist in medicine, how would any patient make an informed decision? Where would they turn to for guidance and advice?[20]Challenges to informed consent and autonomy exist throughout medicine, as consent forms are complicated and filled with medical vocabulary that is often hard to understand. Signatures are sometimes scribbled onto forms before a procedure with minimal discussions to assess the patient’s understanding of the many risks and benefits. However, abortions have an additional layer of complexity regarding informed consent due to the religious and moral implications of choosing an abortion, while other common medical procedures, such as an appendectomy, do not carry the same implications. For example, a patient consenting to general surgery would probably not wonder if their physician’s advice against the surgery is due to his or her own moral values, or what the moral weight of the surgery will have on their conscious afterwards. Informed consent, regardless of procedure, should prioritize informed decision-making with evidence-based medicine without moral overtones. When inaccurate, biased, and false information is given to patients from medical institutions, it not only threatens the trust between patients and medical staff, but also prevents women from making an informed decision about their reproductive health. If abortion doulas can be a source of correct, up-to-date medical information, then women can make informed decisions based on thorough and accurate facts that allow them to exercise autonomy. Abortion doulas are well situated to correct the factual inaccuracies patients face for several reasons. First, abortion doulas are trained through a curated program with partnered medical facilities.[21]In other words, abortion doulas are thoroughly trained in patient-centered care that facilitates continuous patient support, which ranges from emotional support to providing accurate medical information when addressing patient concerns. Second, they have the time before the procedure to meet with the patient and discuss pre-abortion care topics such as providing information, addressing concerns, and preparing the patient for potential stigmatization.[22]Simultaneously, the doula can evaluate for any risk factors that may indicate negative emotions after the abortion, such as lack of social support, self-esteem, psychological stability, or multiple abortions.[23]Third, abortion doulas can provide post-abortion care counseling. While the doulas also have limited time with patients after the procedure, they would have more time than other healthcare professionals, such as nurses, to make sure the patient understands the medication regime while also offering psychological counseling for the patient on grief, guilt, and forgiveness.[24]With doulas providing technical post-procedure information, this allows them to answer any more questions that the patient may have about misleading, biased, out-of-date, or false information. Therefore, doulas can enhance patient autonomy by giving more accurate information. IV. Stigma Another critical problem facing patients who seek abortions is the stigma surrounding the procedure itself. An abortion requires many decisions to be made: do you want to be sedated or awake for the procedure? If you are awake, do you want someone to hold your hand or someone to talk to? Do you want to have privacy after the procedure? In fact, the first decision to be made is whether to have the abortion at all. For some women, that decision is immediate, quick, and assured. For others, the decision can be morally conflicting, such as due to religious reasons, society’s stigma, or other reasons. The moral conflict a woman faces when deciding on an abortion is determined by how much moral weight they apply to a fetus or embryo.[25]An abortion can make a woman feel as though they are a bad person or doing something morally wrong, especially if they place more weight on the moral status, or viability, of the fetus or embryo.[26]Regardless of why a woman feels conflicted, the bottom line is that these feelings exist, which can affect their decision-making abilities during the actual process. Our society stigmatizes women for having an abortion, it is our “modern-day Scarlet Letter.”[27]This stigma is under-researched but often theorized to be based on gender-biased roles of women in society.[28]Women who receive an abortion are labeled as “irresponsible” for having an unwanted pregnancy, or “selfish” and “unmotherly” for not wanting children. Therefore, women avoid judgement and prefer privacy during their abortion—but are these choices made because that is truly what a woman desires, or are they making these choices to avoid stigma? And, if they are making these choices to avoid stigma, how does it affect their autonomy as a decision-maker for their own healthcare choices? There is a difference between secrecy and privacy: women may want to keep their abortion decision private, like any other medical decision or health information.[29]However, some women make the decision in secret to avoid judgment and stigmatization. There is evidence that stigma plays a role in every decision of the abortion process. For example, one study explores the reasons why some women prefer to be awake versus asleep during the procedure. Women who choose to be asleep want to be less emotionally present for the fear of “seeing something” during the procedure. On the other hand, women who choose to be awake want to feel present, safe, and receive support during the process.[30]The study also found that most women rated an abortion procedure a “good experience” if care was provided in a discreet and private manner.[31]By preferring anesthesia and privacy, many women try to avoid dealing with the stigma and judgement from others. The stigma also prevents women from seeking or receiving social support.[32]While some women may make these choices because it is what they truly want, others might choose these options to avoid others witnessing their decision and from being stigmatized as a woman who “got an abortion.” Although abortion doulas cannot completely abolish the overarching societal stigma, they can help in several different ways on an individualistic level. Abortion doulas may fit the role of personalizing each experience to fit patients’ specific preferences. Doulas have the time and appropriate training to understand and discuss the emotional burdens that come along with the social stigma that surrounds abortions.[33]They have the training to explore the patient’s reasons for their decisions and can make sure they are comfortable with them. They do so in a non-judgmental way and strive to act as an advocate for the patient.[34]By listening to women and validating their decisions, women may not feel as many negative emotions surrounding the stigma or feel empowered that they made the right decision for themselves, regardless of social labels. This validation and empowerment gives women more agency in their own healthcare decisions while also providing emotional support in a situation that requires many difficult choices. Abortion doulas would become a support system for women, thereby promoting feminist ethics by normalizing emotions in a morally charged decision. They also promote the principal of beneficence by helping patients address any conflict between societal stigma and the woman’s own beliefs and morals. V. Barriers to Quality Care Access to abortion is limited: only 62 percent of American women live in counties with an abortion provider.[35]Many insurance companies do not cover abortions and clinics are often busy with limited availability, staff, and resources. Additionally, many women would need time off from work, childcare, transportation, and other resources to make it to any medical appointments—abortion care is not an exception. Currently, there are no professional programs for abortion providers to offer post-abortion counseling.[36]Additionally, in busy clinics, hospitals, or non-profit organizations such as Planned Parenthood, physicians attempt to provide as many abortions as possible to as many patients, leaving little time for post-abortion care. Provider burn-out is a major problem throughout healthcare, which has become more pronounced throughout the COVID-19 pandemic. Many providers, nurses, and other hospital staff are overworked and underpaid while hospitals themselves are overcrowded and underfunded. Moreover, abortion providers may be especially vulnerable to burn-outas they tend to both their patient’s medical and emotional needs during a procedure that has both physical pain and a plethora of emotion surrounding it.[37]With an increase in patient number due to decreased availability of services and a physician’s responsibility to tend to the patient’s emotional well-being and physical pain, this increases the risk of provider burn-out, which in turn, can affect the quality of medical care given to women receiving abortions.[38] Abortion doulas can fill the role of providing post-abortion care and help alleviate provider burn-out in many ways. First, as mentioned previously, they have the time before the procedure to meet with the patient and discuss pre-abortion care topics, provide information, and answer questions.[39]Secondly, abortion doulas can provide patients with the post-abortion care counseling that many physicians and nurses are not able to provide. This role has multiple effects. While post-abortion counseling can help address factual inaccuracies through answering questions, it can also allow doulas to make sure the patient understands the medication regime and how to deal with the pain that follows the procedure.[40]With doulas providing technical post-procedure information, this relieves understaffed nurses of some of their many tasks and responsibilities in the post-abortion recovery room; this will likely decrease the number of women who come back to the clinic or hospital with complications or additional questions. By discussing various emotions during post-procedure counseling, doulas support women by listening to their feelings. Some women may feel relief and joy after the procedure, while other may feel despair, regret, grief, or shame. When a doula listens to and supports a patient, they validate their emotions and indirectly validate their abortion decision, thereby improving the quality of the experience. Lastly, the integration of doulas into routine abortion care allows physicians and staff to concentrate on the procedure itself.[41]The doula can offer patient-centered, hands-on care to the patient while the rest of the healthcare team focuses on their own technical tasks.[42]Doula support can also decrease the need for more clinic staff in the procedure room by “decreasing the redirection of clinic staff resources,”thus creating a more efficient medical environment.[43]As the historical role of a doctor playing every role is becoming more obsolete, and the idea of a multi-faceted, integrative healthcare team is becoming the norm, it makes sense that an abortion doula can fill a niche on a healthcare team for emotionally laden procedures like abortions. The niche that the doula fills is to support, comfort, and be present with the patient throughout the entirety of the procedure in a nonjudgmental way. While nurses and doctors can be supportive, sympathetic, and caring, their jobs and roles include other responsibilities that do not allow them to be a continuous presence for the patient throughout their visit.[44]By having a person on the healthcare team whose job is to provide patient support, even if it is simply to hold their hand, the patient is more likely to be treated as a whole and provided better quality medical care. CONCLUSION Inaccurate information, stigma, and quality of care barriers are only a few of the many problems facing patients who want to receive an abortion. Each problem poses ethical challenges while also impeding quality medical care and adding to patients’ emotional burdens. Inaccurate facts and stigma hinder an informed decision, and thereby, threaten patient autonomy. The stigma of abortion can also lead to patients experiencing more negative emotions. Furthermore, healthcare barriers include a wide range of problems, from understaffed clinics to provider burn-out, all of which affect the quality and access to care for patients seeking an abortion. Abortion doulas are part of the solution to these problems. They are an extra resource, a set of hands for the patients to hold in the procedure room, and an expert in providing emotional and social support for the patient. They can enhance a patient’s decision-making skills, support the patient’s emotional well-being, answer factual questions, counter stigma, and help provide quality medical care. Therefore, abortion doulas enhance patient autonomy, promote beneficence, improve access to quality abortion care, and fill a necessary role during the abortion process. [1]Shakouri, Shireen Rose "The Doula Project." Ed. Lee, Shannon2019. Print. [2]Shakouri, Shireen Rose "The Doula Project." Ed. Lee, Shannon2019. Print. [3]Onyenacho, Tracey. "Abortion Doulas Help People Navigate the Process. They Say Their Work Was More Crucial Than Ever in the Pandemic." The Lily 2021. Web. 12/29/2021 2021 [4]Onyenacho, Tracey. "Abortion Doulas Help People Navigate the Process. They Say Their Work Was More Crucial Than Ever in the Pandemic." The Lily 2021. Web. 12/29/2021 2021 [5]Onyenacho, Tracey. "Abortion Doulas Help People Navigate the Process. They Say Their Work Was More Crucial Than Ever in the Pandemic." The Lily 2021. Web. 12/29/2021 2021 [6]Dukehart, Coburn. "Doulas: Exploring a Tradition of Support." The Baby Project. National Public Radio 2011. Web2021. [7]Roberts, Sam. "Dana Raphael, Proponent of Breast-Feeding and Use of Doulas, Dies at 90." New York Times 2016. Web2020. [8]Roberts, Sam. "Dana Raphael, Proponent of Breast-Feeding and Use of Doulas, Dies at 90." New York Times 2016. Web2020. [9]Scott, K. D., P. H. Klaus, and M. H. Klaus. "The Obstetrical and Postpartum Benefits of Continuous Support During Childbirth." J Womens Health Gend Based Med 8.10 (1999): 1257-64. Print. [10]Scott, K. D., P. H. Klaus, and M. H. Klaus. "The Obstetrical and Postpartum Benefits of Continuous Support During Childbirth." J Womens Health Gend Based Med 8.10 (1999): 1257-64. Print. [11]Chor, J., et al. "Doulas as Facilitators: The Expanded Role of Doulas into Abortion Care." J Fam Plann Reprod Health Care 38.2 (2012): 123-4. Print. [12]Nash, Elizabeth; Gold, Rachel Benson; Mohamed, Lizamarie; Ansari-Thomas, Zohra; Capello, Olivia "Policy Trends in the States, 2017." Guttmacher Instititue 2018. Web. [13]Richardson, Chinue Turner; Nash, Elizabeth. "Misinformed Consent: The Medical Accuracy of State-Developed Abortion Counseling Materials " Guttmacher Policy Review 9.4 (2006). Print. [14]Buchbinder, Mara, et al. "“Prefacing the Script” as an Ethical Response to State-Mandated Abortion Counseling." AJOB Empirical Bioethics 7.1 (2016): 48-55. Print. [15]Buchbinder, Mara, et al. "“Prefacing the Script” as an Ethical Response to State-Mandated Abortion Counseling." AJOB Empirical Bioethics 7.1 (2016): 48-55. Print. [16]Richardson, Chinue Turner; Nash, Elizabeth. "Misinformed Consent: The Medical Accuracy of State-Developed Abortion Counseling Materials " Guttmacher Policy Review 9.4 (2006). Print. [17]Richardson, Chinue Turner; Nash, Elizabeth. "Misinformed Consent: The Medical Accuracy of State-Developed Abortion Counseling Materials " Guttmacher Policy Review 9.4 (2006). Print. [18]Blevins, Christy A., et al. "The Posttraumatic Stress Disorder Checklist for Dsm-5 (Pcl-5): Development and Initial Psychometric Evaluation." Journal of Traumatic Stress 28.6 (2015): 489-98. Print. [19]Richardson, Chinue Turner; Nash, Elizabeth. "Misinformed Consent: The Medical Accuracy of State-Developed Abortion Counseling Materials " Guttmacher Policy Review 9.4 (2006). Print. [20]Pellegrini, C. A. "Trust: The Keystone of the Patient-Physician Relationship." J Am Coll Surg 224.2 (2017): 95-102. Print. [21]Shakouri, Shireen Rose "The Doula Project." Ed. Lee, Shannon2019. Print. [22]Chor, Julie, et al. "Factors Shaping Women’s Pre-Abortion Communication with Members of Their Social Network." Journal of Community Health 44.2 (2019): 265-71. Print. [23]Harris, Amy A. "Supportive Counseling before and after Elective Pregnancy Termination." Journal of Midwifery & Women’s Health 49.2 (2004): 105-12. Print. [24]Chor, Julie, et al. "Factors Shaping Women’s Pre-Abortion Communication with Members of Their Social Network." Journal of Community ` Health 44.2 (2019): 265-71. Print. [25]Watson, Katie. The Scarlet A Oxford University Press, 2018. Print. [26]Altshuler, A. L., et al. "A Good Abortion Experience: A Qualitative Exploration of Women's Needs and Preferences in Clinical Care." Soc Sci Med 191 (2017): 109-16. Print. [27]Watson, Katie. The Scarlet A Oxford University Press, 2018. Print. [28]Norris, A., et al. "Abortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences." Womens Health Issues 21.3 Suppl (2011): S49-54. Print. [29]Watson, Katie. The Scarlet A Oxford University Press, 2018. Print [30]Altshuler, A. L., et al. "A Good Abortion Experience: A Qualitative Exploration of Women's Needs and Preferences in Clinical Care." Soc Sci Med 191 (2017): 109-16. Print. [31]Altshuler, A. L., et al. "A Good Abortion Experience: A Qualitative Exploration of Women's Needs and Preferences in Clinical Care." Soc Sci Med 191 (2017): 109-16. Print. [32]Norris, A., et al. "Abortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences." Womens Health Issues 21.3 Suppl (2011): S49-54. Print. [33]Basmajian, Alyssa. "Abortion Doulas." Anthropology Now 6.2 (2014): 44-51. Print. [34]Amram, Natalie Lea, et al. "How Birth Doulas Help Clients Adapt to Changes in Circumstances, Clinical Care, and Client Preferences During Labor." J Perinat Educ.2: 96-103. Print. [35]Dennis, Amanda, Ruth Manski, and Kelly Blanchard. "A Qualitative Exploration of Low-Income Women's Experiences Accessing Abortion in Massachusetts." Women's Health Issues 25.5 (2015): 463-69. Print. [36]Harris, Amy A. "Supportive Counseling before and after Elective Pregnancy Termination." Journal of Midwifery & Women’s Health 49.2 (2004): 105-12. Print. [37]Chor, J., et al. "Integrating Doulas into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences." J Midwifery Womens Health 63.1 (2018): 53-57. Print. [38]Jerman J, Jones RK and Onda T. "Characteristics of U.S. Abortion Patients in 2014 and Changes since 2008." Guttmacher Instititue 2016. Web. [39]Chor, Julie, et al. "Factors Shaping Women’s Pre-Abortion Communication with Members of Their Social Network." Journal of Community Health 44.2 (2019): 265-71. Print. [40]Chor, Julie, et al. "Factors Shaping Women’s Pre-Abortion Communication with Members of Their Social Network." Journal of Community Health 44.2 (2019): 265-71. Print. [41]Chor, J., et al. "Integrating Doulas into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences." J Midwifery Womens Health 63.1 (2018): 53-57. Print. [42]Chor, J., et al. "Integrating Doulas into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences." J Midwifery Womens Health 63.1 (2018): 53-57. Print. [43]Chor, J., et al. "Doula Support During First-Trimester Surgical Abortion: A Randomized Controlled Trial." Am J Obstet Gynecol 212.1 (2015): 45.e1-6. Print. [44]Basmajian, Alyssa. "Abortion Doulas." Anthropology Now 6.2 (2014): 44-51. Print.

IntroductionThe death of Chris Cornell in the spring of 2017 shook me. As the lead singer of Soundgarden and a pioneer of early 1990s grunge music, his voice revealed an unbridled pain and joy backed up by the raw, guitar-driven rock emanating from the Seattle, Washington music scene. I remember thinking, there’s only one left, referring to Eddie Vedder, lead singer for Pearl Jam, and lone survivor of the four seminal grunge bands that rose to fame in the early 1990s whose lead singers passed away much too soon. Alice in Chains singer Layne Staley died in 2002 at the age of 35, and Nirvana front man Kurt Cobain’s death in 1994 had resonated around the globe. I thought about when Cornell and Staley said goodbye to their friend Andy Wood, lead singer of Mother Love Bone, after he overdosed on heroine in 1990. Wood’s untimely death at the age of 24, only days before his band’s debut album release, shook the close-knit Seattle music scene and remained a source of angst and inspiration for a genre of music that shaped youth culture of the 1990s.When grunge first exploded on the pop culture scene, I was a college student flailing around in pursuit of an English degree I had less passion for than I did for music. I grew up listening to The Beatles and Prince; Led Zeppelin and Miles Davis; David Bowie and Willie Nelson, along with a litany of other artists and musicians crafting the kind of meaningful music I responded to. I didn’t just listen to music, I devoured stories about the musicians, their often hedonistic lifestyles; their processes and epiphanies. The music spoke to my being in the world more than the promise of any college degree. I ran with friends who shared this love of music, often turning me on to new bands or suggesting some obscure song from the past to track down. I picked up my first guitar when John Lennon died on the eve of my eleventh birthday and have played for the past 37 years. I rely on music to relocate my sense of self. Rhythm and melody play out like characters in my life, colluding to make me feel something apart from the mundane, moving me from within. So, when I took notice of grunge music in the fall of 1991, it was love at first listen. As a pop cultural phenomenon, grunge ruptured the music and fashion industries caught off guard by its sudden commercial appeal while the media struggled to galvanize its relevance. As a subculture, grunge rallied around a set of attitudes and values that set the movement apart from mainstream (Latysheva). The grunge sound drew from the nihilism of punk and the head banging gospel of heavy metal, tinged with the swagger of 1970s FM rock running counter to the sleek production of pop radio and hair metal bands. Grunge artists wrote emotionally-laden songs that spoke to a particular generation of youth who identified with lyrics about isolation, anger, and death. Grunge set off new fashion trends in favor of dressing down and sporting the latest in second-hand, thrift store apparel, ripping away the Reagan-era starched white-collared working-class aesthetic of the 1980’s corporate culture. Like their punk forbearers who railed against the status quo and the trappings of success incurred through the mass appeal of their art, Kurt Cobain, Eddie Vedder, and the rest of the grunge cohort often wrestled with the momentum of their success. Fortunes rained down and the media ordained them rock stars.This auto-ethnography revisits some of the cultural impacts of grunge during its rise to cultural relevance and includes my own reflexive interpretation positioned as a fan of grunge music. I use a particular auto-ethnographic orientation called “interpretive-humanistic autoethnography” (Manning and Adams 192) where, along with archival research (i.e. media articles and journal articles), I will use my own reflexive voice to interpret and describe my personal experiences as a fan of grunge music during its peak of popularity from 1991 up to the death of Cobain in 1994. It is a methodology that works to bridge the personal and popular where “the individual story leaves traces of at least one path through a shifting, transforming, and disappearing cultural landscape” (Neumann 183). Grunge RootsThere are many conflicting stories as to when the word “grunge” was first used to describe the sound of a particular style of alternative music seeping from the dank basements and shoddy rehearsal spaces in towns like Olympia, Aberdeen, and Seattle. Lester Bangs, the preeminent cultural writer and critic of all things punk, pop, and rock in the 1970s was said to have used the word at one time (Yarm), and several musicians lay claim to their use of the word in the 1980s. But it was a small Seattle record label founded in 1988 called Sub Pop Records that first included grunge in their marketing materials to describe “the grittiness of the music and the energy” (Yarm 195).This particular sound grew out of the Pacific Northwest blue-collar environment of logging towns, coastal fisheries, and airplane manufacturing. Seattle’s alternative music scene unfolded as a community of musicians responding to the tucked away isolation of their musty surroundings, apart from the outside world, free to submerge themselves in their own cultural milieu of rock music, rain, and youthful rebellion.Where Seattle stood as a major metropolitan city soaked in rainclouds for much of the year, I was soaking up the desert sun in a rural college town when grunge first leapt into the mainstream. Cattle ranches and cotton fields spread across the open plains of West Texas, painted with pickup trucks, starched Wrangler Jeans, and cowboy hats. This was not my world. I’d arrived the year prior from Houston, Texas, an urban sprawl of four million people, but I found the wide-open landscape a welcome change from the concrete jungle of the big city. Along with cowboy boots and western shirts came country music, and lots of it. Garth Brooks, Reba McEntire, George Straight; some of the voices that captured the lifestyle of my small rural town, twangy guitars and fiddles blaring on local radio. While popular country artists recorded for behemoth record labels like Warner Brothers and Sony, the tiny Sub Pop Records championed the grunge sound coming out of the Seattle music scene. Sub Pop became a playground for those who cared about their music and little else. The label cultivated an early following through their Sub Pop Singles Club, mailing seven-inch records to subscribers on a monthly basis promoting new releases from up-and-coming bands. Sub Pop’s stark, black and white logo showed up on records sleeves, posters, and t-shirts, reflecting a no-nonsense DIY-attitude rooted in in the production of loud guitars and heavy drums.Like the bands it represented, Sub Pop did not take itself too seriously when one of their best-selling t-shirts simply read “Loser” embracing the slacker mood of newly minted Generation X’ers born between 1961 and 1981. A July 1990 Time Magazine article described this twenty-something demographic as having “few heroes, no anthems, no style to call their own” suggesting they “possess only a hazy sense of their own identity” (Gross & Scott). As a member of this generation, I purchased and wore my “Loser” t-shirt with pride, especially in ironic response to the local cowboy way of life. I didn’t hold anything personal against the Wrangler wearing Garth Brooks fan but as a twenty-one-year-old reluctant college student, I wanted to rage with contempt for the status quo of my environment with an ambivalent snarl.Grunge in the MainstreamIn 1991, the Seattle sound exploded onto the international music scene with the release of four seminal grunge-era albums over a six-month period. The first arrived in April, Temple of the Dog, a tribute album of sorts to the late Andy Wood, led by his close friend, Soundgarden singer/songwriter, Chris Cornell. In August, Pearl Jam released their debut album, Ten, with its “surprising and refreshing, melodic restraint” (Fricke). The following month, Nirvana’s Nevermind landed in stores. Now on a major record label, DGC Records, the band had arrived “at the crossroads—scrappy garageland warriors setting their sights on a land of giants” (Robbins). October saw the release of Soundgarden’s Badmotorfinger as “a runaway train ride of stammering guitar and psycho-jungle telegraph rhythms” (Fricke). These four albums sent grunge culture into the ether with a wall of sound that would upend the music charts and galvanize a depressed concert ticket market.In fall of 1991, grunge landed like a hammer when I witnessed Nirvana’s video for “Smells Like Teen Spirit” on MTV for the first time. Sonically, the song rang like an anthem for the Gen Xers with its jangly four-chord opening guitar riff signaling the arrival of a youth-oriented call to arms, “here we are now, entertain us” (Nirvana). It was the visual power of seeing a skinny white kid with stringy hair wearing baggy jeans, a striped T-shirt and tennis shoes belting out choruses with a ferociousness typically reserved for black-clad heavy metal headbangers. Cobain’s sound and look didn’t match up. I felt discombobulated, turned sideways, as if vertigo had taken hold and I couldn’t right myself. Stopped in the middle of my tracks on that day, frozen in front of the TV, the subculture of grunge music slammed into my world while I was on my way to the fridge.Suddenly, grunge was everywhere, As Soundgarden, Nirvana, and Pearl Jam albums and performances infiltrated radio, television, and concert halls, there was no shortage of media coverage. From 1992 through 1994, grunge bands were mentioned or featured on the cover of Rolling Stone 33 times (Hillburn). That same year, The New York Times ran the article “Grunge: A Success Story” featuring a short history of the Seattle sound, along with a “lexicon of grunge speak” (Marin), a joke perpetrated by a former 25-year-old Sub Pop employee, Megan Jasper, who never imagined her list of made-up vocabulary given to a New York Times reporter would grace the front page of the style section (Yarm). In their rush to keep up with pervasiveness of grunge culture, even The New York Times fell prey to Gen Xer’s comical cynicism.The circle of friends I ran with were split down the middle between Nirvana and Pearl Jam, a preference for one over the other, as the two bands and their respective front men garnered much of the media attention. Nirvana seemed to appeal to people’s sense of authenticity, perhaps more relatable in their aloofness to mainstream popularity, backed up with Cobain’s simple-yet-brilliant song arrangements and revealing lyrics. Lawrence Grossberg suggests that music fans recognise the difference between authentic and homogenised rock, interpreting and aligning these differences with rock and roll’s association with “resistance, refusal, alienation, marginality, and so on” (62). I tended to gravitate toward Nirvana’s sound, mostly for technical reasons. Nevermind sparkled with aggressive guitar tones while capturing the power and fragility of Cobain’s voice. For many critics, the brilliance of Pearl Jam’s first album suffered from too much echo and reverb muddling the overall production value, but twenty years later they would remix and re-release Ten, correcting these production issues.Grunge FashionAs the music carved out a huge section of the charts, the grunge look was appropriated on fashion runways. When Cobain appeared on MTV wearing a ragged olive green cardigan he’d created a style simply by rummaging through his closet. Vedder and Cornell sported army boots, cargo shorts, and flannel shirts, suitable attire for the overcast climate of the Pacific Northwest, but their everyday garb turned into a fashion trend for Gen Xers that was then milked by designers. In 1992, the editor of Details magazine, James Truman, called grunge “un fashion” (Marin) as stepping out in second-hand clothes ran “counter to the shellacked, flashy aesthetic of 1980s” (Nnadi) for those who preferred “the waif-like look of put-on poverty” (Brady). But it was MTV’s relentless airing of Nirvana, Pearl Jam, and Soundgarden videos that sent Gen Xers flocking to malls and thrift-stores in search grunge-like apparel. I purchased a pair of giant, heavyweight Red Wing boots that looked like small cars on my feet, making it difficult to walk, but at least I was prepared for any terrain in all types of weather. The flannel came next; I still wear flannos. Despite its association with dark, murky musical themes, grunge kept me warm and dry.Much of grunge’s appeal to the masses was that it was not gender-specific; men and women dressed to appear unimpressed, sharing a taste for shapeless garments and muted colors without reference to stereotypical masculine or feminine styles. Cobain “allowed his own sexuality to be called into question by often wearing dresses and/or makeup on stage, in film clips, and on photo shoots, and wrote explicitly feminist songs, such as ‘Sappy’ or ‘Been a Son’” (Strong 403). I remember watching Pearl Jam’s 1992 performance on MTV Unplugged, seeing Eddie Vedder scrawl the words “Pro Choice” in black marker on his arm in support of women’s rights while his lyrics in songs like “Daughter”, “Better Man”, and “Why Go” reflected an equitable, humanistic if somewhat tragic perspective. Females and males moshed alongside one another, sharing the same spaces while experiencing and voicing their own response to grunge’s aggressive sound. Unlike the hypersexualised hair-metal bands of the 1980s whose aesthetic motifs often portrayed women as conquests or as powerless décor, the message of grunge rock avoided gender exploitation. As the ‘90s unfolded, underground feminist punk bands of the riot grrrl movement like Bikini Kill, L7, and Babes in Toyland expressed female empowerment with raging vocals and buzz-saw guitars that paved the way for Hole, Sleater-Kinney and other successful female-fronted grunge-era bands. The Decline of GrungeIn 1994, Kurt Cobain appeared on the cover of Newsweek magazine in memoriam after committing suicide in the greenhouse of his Seattle home. Mass media quickly spread the news of his passing internationally. Two days after his death, 7,000 fans gathered at Seattle Center to listen to a taped recording of Courtney Love, Cobain’s wife, a rock star in her own right, reading the suicide note he left behind.A few days after Cobain’s suicide, I found myself rolling down the highway with a carload of friends, one of my favorite Nirvana tunes, “Come As You Are” fighting through static. I fiddled with the radio to clear up the signal. The conversation turned to Cobain as we cobbled together the details of his death. I remember the chatter quieting down, Cobain’s voice fading as we gazed out the window at the empty terrain passing. In that reflective moment, I felt like I had experienced an intense, emotional relationship that came to an abrupt end. This “illusion of intimacy” (Horton and Wohl 217) between myself and Cobain elevated the loss I felt with his passing even though I had no intimate, personal ties to him. I counted this person as a friend (Giles 284) because I so closely identified with his words and music. I could not help but feel sad, even angry that he’d decided to end his life.Fueled by depression and a heroin addiction, Cobain’s death signaled an end to grunge’s collective appeal while shining a spotlight on one of the more dangerous aspects of its ethos. A 1992 Rolling Stone article mentioned that several of Seattle’s now-famous international musicians used heroin and “The feeling around town is, the drug is a disaster waiting to happen” (Azzerad). In 2002, eight years to the day of Cobain’s death, Layne Staley, lead singer of Alice In Chains, another seminal grunge outfit, was found dead of a suspected heroin overdose (Wiederhorn). When Cornell took his own life in 2017 after a long battle with depression, The Washington Post said, “The story of grunge is also one of death” (Andrews). The article included a Tweet from a grieving fan that read “The voices I grew up with: Andy Wood, Layne Staley, Chris Cornell, Kurt Cobain…only Eddie Vedder is left. Let that sink in” (@ThatEricAlper).ConclusionThe grunge movement of the early 1990s emerged out of musical friendships content to be on their own, on the outside, reflecting a sense of isolation and alienation in the music they made. As Cornell said, “We’ve always been fairly reclusive and damaged” (Foege). I felt much the same way in those days, sequestered in the desert, planting my grunge flag in the middle of country music territory, doing what I could to resist the status quo. Cobain, Cornell, Staley, and Vedder wrote about their own anxieties in a way that felt intimate and relatable, forging a bond with their fan base. Christopher Perricone suggests, “the relationship of an artist and audience is a collaborative one, a love relationship in the sense, a friendship” (200). In this way, grunge would become a shared memory among friends who rode the wave of this cultural phenomenon all the way through to its tragic consequences. But the music has survived. Along with my flannel shirts and Red Wing boots.References@ThatEricAlper (Eric Alper). “The voices I grew up with: Andy Wood, Layne Staley, Chris Cornell, Kurt Cobain…only Eddie Vedder is left. Let that sink in.” Twitter, 18 May 2017, 02:41. 15 Sep. 2018 <https://twitter.com/ThatEricAlper/status/865140400704675840?ref_src>.Andrews, Travis M. “After Chris Cornell’s Death: ‘Only Eddie Vedder Is Left. Let That Sink In.’” The Washington Post, 19 May 2017. 29 Aug. 2018 <https://www.washingtonpost.com/newsmorning-mix/wp/2017/05/19/after-chris-cornells-death-only-eddie-vedder-is-left-let-that-sink-in>.Azzerad, Michael. “Grunge City: The Seattle Scene.” Rolling Stone, 16 Apr. 1992. 20 Aug. 2018 <https://www.rollingstone.com/music/music-news/grunge-city-the-seattle-scene-250071/>.Brady, Diane. “Kids, Clothes and Conformity: Teens Fashion and Their Back-to-School Looks.” Maclean’s, 6 Sep. 1993. Brodeur, Nicole. “Chris Cornell: Soundgarden’s Dark Knight of the Grunge-Music Scene.” Seattle Times, 18 May 2017. 20 Aug. 2018 <https://www.seattletimes.com/entertainment/music/chris-cornell-soundgardens-dark-knight-of-the-grunge-music-scene/>.Ellis, Carolyn, and Arthur P. Bochner. “Autoethnography, Personal Narrative, Reflexivity: Researcher as Subject.” Handbook of Qualitative Research. 2nd ed. Eds. Norman Denzin and Yvonna Lincoln. Thousand Oaks, CA: Sage, 2000. 733-768.Foege, Alec. “Chris Cornell: The Rolling Stone Interview.” Rolling Stone, 28 Dec. 1994. 12 Sep. 2018 <https://www.rollingstone.com/music/music-features/chris-cornell-the-rolling-stone-interview-79108/>.Fricke, David. “Ten.” Rolling Stone, 12 Dec. 1991. 18 Sep. 2018 <https://www.rollingstone.com/music/music-album-reviews/ten-251421/>.Giles, David. “Parasocial Interactions: A Review of the Literature and a Model for Future Research.” Media Psychology 4 (2002): 279-305.Giles, Jeff. “The Poet of Alientation.” Newsweek, 17 Apr. 1994, 4 Sep. 2018 <https://www.newsweek.com/poet-alienation-187124>.Gross, D.M., and S. Scott. Proceding with Caution. Time, 16 July 1990. 3 Sep. 2018 <http://content.time.com/time/magazine/article/0,9171,155010,00.html>.Grossberg, Lawrence. “Is There a Fan in the House? The Affective Sensibility of Fandom. The Adoring Audience” Fan Culture and Popular Media. Ed. Lisa A. Lewis. New York, NY: Routledge, 1992. 50-65.Hillburn, Robert. “The Rise and Fall of Grunge.” Los Angeles Times, 21 May 1998. 20 Aug. 2018 <http://articles.latimes.com/1998/may/31/entertainment/ca-54992>.Horton, Donald, and R. Richard Wohl. “Mass Communication and Para-Social Interactions: Observations on Intimacy at a Distance.” Psychiatry: Interpersonal and Biological Process 19 (1956): 215-229.Latysheva, T.V. “The Essential Nature and Types of the Youth Subculture Phenomenon.” Russian Education and Society 53 (2011): 73–88.Manning, Jimmie, and Tony Adams. “Popular Culture Studies and Autoethnography: An Essay on Method.” The Popular Culture Studies Journal 3.1-2 (2015): 187-222.Marin, Rick. “Grunge: A Success Story.” New York Times, 15 Nov. 1992. 12 Sep. 2018 <https://www.nytimes.com/1992/11/15/style/grunge-a-success-story.html>.Neumann, Mark. “Collecting Ourselves at the End of the Century.” Composing Ethnography: Alternative Forms of Qualitative Writing. Eds. Carolyn Ellis and Arthur P. Bochner. London: Alta Mira Press, 1996. 172-198.Nirvana. "Smells Like Teen Spirit." Nevermind, Geffen, 1991.Nnadi, Chioma. “Why Kurt Cobain Was One of the Most Influential Style Icons of Our Times.” Vogue, 8 Apr. 2014. 15 Aug. 2018 <https://www.vogue.com/article/kurt-cobain-legacy-of-grunge-in-fashion>.Perricone, Christopher. “Artist and Audience.” The Journal of Value Inquiry 24 (2012). 12 Sep. 2018 <https://link.springer.com/content/pdf/10.1007/BF00149433.pdf>.Robbins, Ira. “Ten.” Rolling Stone, 12 Dec. 1991. 15 Aug. 2018 <https://www.rollingstone.com/music/music-album-reviews/ten-25142>.Strong, Catherine. “Grunge, Riott Grrl and the Forgetting of Women in Popular Culture.” The Journal of Popular Culture 44.2 (2011): 398-416. Wiederhorn, Jon. “Remembering Layne Staley: The Other Great Seattle Musician to Die on April 5.” MTV, 4 June 2004. 23 Sep. 2018 <http://www.mtv.com/news/1486206/remembering-layne-staley-the-other-great-seattle-musician-to-die-on-april-5/>.Yarm, Mark. Everybody Loves Our Town: An Oral History of Grunge. Three Rivers Press, 2011.

In the last decade, the cell phone’s transformation from a tool for mobile telephony into a multi-modal, computational “smart” media device has engendered a new kind of emplacement, and the ubiquity of technological mediation into the everyday settings of urban life. With it, a new kind of media literacy has become necessary for participation in the networked social publics (Ito; Jenkins et al.). Increasingly, the way we experience our physical environments, make sense of immediate events, and form impressions is through the lens of the camera and through the ear of the microphone, framed by the mediating possibilities of smartphones. Adopting these practices as a kind of new media “grammar” (Burn 29)—a multi-modal language for public and interpersonal communication—offers new perspectives for thinking about the way in which mobile computing technologies allow us to explore our environments and produce new types of cultural knowledge. Living in the Social Multiverse Many of us are concerned about new cultural practices that communication technologies bring about. In her now classic TED talk “Connected but alone?” Sherry Turkle talks about the world of instant communication as having the illusion of control through which we micromanage our immersion in mobile media and split virtual-physical presence. According to Turkle, what we fear is, on the one hand, being caught unprepared in a spontaneous event and, on the other hand, missing out or not documenting or recording events—a phenomenon that Abha Dawesar calls living in the “digital now.” There is, at the same time, a growing number of ways in which mobile computing devices connect us to new dimensions of everyday life and everyday experience: geo-locative services and augmented reality, convergent media and instantaneous participation in the social web. These technological capabilities arguably shift the nature of presence and set the stage for mobile users to communicate the flow of their everyday life through digital storytelling and media production. According to a Digital Insights survey on social media trends (Bennett), more than 500 million tweets are sent per day and 5 Vines tweeted every second; 100 hours of video are uploaded to YouTube every minute; more than 20 billion photos have been shared on Instagram to date; and close to 7 million people actively produce and publish content using social blogging platforms. There are more than 1 billion smartphones in the US alone, and most social media platforms are primarily accessed using mobile devices. The question is: how do we understand the enormity of these statistics as a coherent new media phenomenon and as a predominant form of media production and cultural participation? More importantly, how do mobile technologies re-mediate the way we see, hear, and perceive our surrounding evironment as part of the cultural circuit of capturing, sharing, and communicating with and through media artefacts? Such questions have furnished communication theory even before McLuhan’s famous tagline “the medium is the message”. Much of the discourse around communication technology and the senses has been marked by distinctions between “orality” and “literacy” understood as forms of collective consciousness engendered by technological shifts. Leveraging Jonathan Sterne’s critique of this “audio-visual litany”, an exploration of convergent multi-modal technologies allows us to focus instead on practices and techniques of use, considered as both perceptual and cultural constructs that reflect and inform social life. Here in particular, a focus on sound—or aurality—can help provide a fresh new entry point into studying technology and culture. The phenomenon of everyday photography is already well conceptualised as a cultural expression and a practice connected with identity construction and interpersonal communication (Pink, Visual). Much more rarely do we study the act of capturing information using mobile media devices as a multi-sensory practice that entails perceptual techniques as well as aesthetic considerations, and as something that in turn informs our unmediated sensory experience. Daisuke and Ito argue that—in contrast to hobbyist high-quality photographers—users of camera phones redefine the materiality of urban surroundings as “picture-worthy” (or not) and elevate the “mundane into a photographic object.” Indeed, whereas traditionally recordings and photographs hold institutional legitimacy as reliable archival references, the proliferation of portable smart technologies has transformed user-generated content into the gold standard for authentically representing the everyday. Given that visual approaches to studying these phenomena are well underway, this project takes a sound studies perspective, focusing on mediated aural practices in order to explore the way people make sense of their everyday acoustic environments using mobile media. Curation, in this sense, is a metaphor for everyday media production, illuminated by the practice of listening with mobile technology. Everyday Listening with Technology: A Case Study The present conceptualisation of curation emerged out of a participant-driven qualitative case study focused on using mobile media to make sense of urban everyday life. The study comprised 10 participants using iPod Touches (a device equivalent to an iPhone, without the phone part) to produce daily “aural postcards” of their everyday soundscapes and sonic experiences, over the course of two to four weeks. This work was further informed by, and updates, sonic ethnography approaches nascent in the World Soundscape Project, and the field of soundscape studies more broadly. Participants were asked to fill out a questionnaire about their media and technology use, in order to establish their participation in new media culture and correlate that to the documentary styles used in their aural postcards. With regard to capturing sonic material, participants were given open-ended instructions as to content and location, and encouraged to use the full capabilities of the device—that is, to record audio, video, and images, and to use any applications on the device. Specifically, I drew their attention to a recording app (Recorder) and a decibel measurement app (dB), which combines a photo with a static readout of ambient sound levels. One way most participants described the experience of capturing sound in a collection of recordings for a period of time was as making a “digital scrapbook” or a “media diary.” Even though they had recorded individual (often unrelated) soundscapes, almost everyone felt that the final product came together as a stand-alone collection—a kind of gallery of personalised everyday experiences that participants, if anything, wished to further organise, annotate, and flesh out. Examples of aural postcard formats used by participants: decibel photographs of everyday environments and a comparison audio recording of rain on a car roof with and without wipers (in the middle). Working with 139 aural postcards comprising more than 250 audio files and 150 photos and videos, the first step in the analysis was to articulate approaches to media documentation in terms of format, modality, and duration as deliberate choices in conversation with dominant media forms that participants regularly consume and are familiar with. Ambient sonic recordings (audio-only) comprised a large chunk of the data, and within this category there were two approaches: the sonic highlight, a short vignette of a given soundscape with minimal or no introduction or voice-over; and the process recording, featuring the entire duration of an unfolding soundscape or event. Live commentaries, similar to the conventions set forth by radio documentaries, represented voice-over entries at the location of the sound event, sometimes stationary and often in motion as the event unfolded. Voice memos described verbal reflections, pre- or post- sound event, with no discernable ambience—that is, participants intended them to serve as reflective devices rather than as part of the event. Finally, a number of participants also used the sound level meter app, which allowed them to generate visual records of the sonic levels of a given environment or location in the form of sound level photographs. Recording as a Way of Listening In their community soundwalking practice, Förnstrom and Taylor refer to recording sound in everyday settings as taking world experience, mediating it through one’s body and one’s memories and translating it into approximate experience. The media artefacts generated by participants as part of this study constitute precisely such ‘approximations’ of everyday life accessed through aural experience and mediated by the technological capabilities of the iPod. Thinking of aural postcards along this technological axis, the act of documenting everyday soundscapes involves participants acting as media producers, ‘framing’ urban everyday life through a mobile documentary rubric. In the process of curating these documentaries, they have to make decisions about the significance and stylistic framing of each entry and the message they wish to communicate. In order to bring the scope of these curatorial decisions into dialogue with established media forms, in this work’s analysis I combine Bill Nichols’s classification of documentary modes in cinema with Karin Bijsterveld’s concept of soundscape ‘staging’ to characterise the various approaches participants took to the multi-modal curation of their everyday (sonic) experience. In her recent book on the staging of urban soundscapes in both creative and documentary/archival media, Bijsterveld describes the representation of sound as particular ‘dramatisations’ that construct different kinds of meanings about urban space and engender different kinds of listening positions. Nichols’s articulation of cinematic documentary modes helps detail ways in which the author’s intentionality is reflected in the styling, design, and presentation of filmic narratives. Michel Chion’s discussion of cinematic listening modes further contextualises the cultural construction of listening that is a central part of both design and experience of media artefacts. The conceptual lens is especially relevant to understanding mobile curation of mediated sonic experience as a kind of mobile digital storytelling. Working across all postcards, settings, and formats, the following four themes capture some of the dominant stylistic dimensions of mobile media documentation. The exploratory approach describes a methodology for representing everyday life as a flow, predominantly through ambient recordings of unfolding processes that participants referred to in the final discussion as a ‘turn it on and forget it’ approach to recording. As a stylistic method, the exploratory approach aligns most closely with Nichols’s poetic and observational documentary modes, combining a ‘window to the world’ aesthetic with minimal narration, striving to convey the ‘inner truth’ of phenomenal experience. In terms of listening modes reflected in this approach, exploratory aural postcards most strongly engage causal listening, to use Chion’s framework of cinematic listening modes. By and large, the exploratory approach describes incidental documentaries of routine events: soundscapes that are featured as a result of greater attentiveness and investment in the sonic aspects of everyday life. The entries created using this approach reflect a process of discovering (seeing and hearing) the ordinary as extra-ordinary; re-experiencing sometimes mundane and routine places and activities with a fresh perspective; and actively exploring hidden characteristics, nuances of meaning, and significance. For instance, in the following example, one participant explores a new neighborhood while on a work errand:The narrative approach to creating aural postcards stages sound as a springboard for recollecting memories and storytelling through reflecting on associations with other soundscapes, environments, and interactions. Rather than highlighting place, routine, or sound itself, this methodology constructs sound as a window into the identity and inner life of the recordist, mobilising most strongly a semantic listening mode through association and narrative around sound’s meaning in context (Chion 28). This approach combines a subjective narrative development with a participatory aesthetic that draws the listener into the unfolding story. This approach is also performative, in that it stages sound as a deeply subjective experience and approaches the narrative from a personally significant perspective. Most often this type of sound staging was curated using voice memo narratives about a particular sonic experience in conjunction with an ambient sonic highlight, or as a live commentary. Recollections typically emerged from incidental encounters, or in the midst of other observations about sound. In the following example a participant reminisces about the sound of wind, which, interestingly, she did not record: Today I have been listening to the wind. It’s really rainy and windy outside today and it was reminding me how much I like the sound of wind. And you know when I was growing up on the wide prairies, we sure had a lot of wind and sometimes I kind of miss the sound of it… (Participant 1) The aesthetic approach describes instances where the creation of aural postcards was motivated by a reduced listening position (Chion 29)—driven primarily by the qualities and features of the soundscape itself. This curatorial practice for staging mediated aural experience combines a largely subjective approach to documenting with an absence of traditional narrative development and an affective and evocative aesthetic. Where the exploratory documentary approach seeks to represent place, routine, environment, and context through sonic characteristics, the aesthetic approach features sound first and foremost, aiming to represent and comment on sound qualities and characteristics in a more ‘authentic’ manner. The media formats most often used in conjunction with this approach were the incidental ambient sonic highlight and the live commentary. In the following example we have the sound of coffee being made as an important domestic ritual where important auditory qualities are foregrounded: That’s the sound of a stovetop percolator which I’ve been using for many years and I pretty much know exactly how long it takes to make a pot of coffee by the sound that it makes. As soon as it starts gurgling I know I have about a minute before it burns. It’s like the coffee calls and I come. (Participant 6) The analytical approach characterises entries that stage mediated aural experience as a way of systematically and inductively investigating everyday phenomena. It is a conceptual and analytical experimental methodology employed to move towards confirming or disproving a ‘hypothesis’ or forming a theory about sonic relations developed in the course of the study. As such, this approach most strongly aligns with Chion’s semantic listening mode, with the addition of the interactive element of analytical inquiry. In this context, sound is treated as a variable to be measured, compared, researched, and theorised about in an explicit attempt to form conclusions about social relationships, personal significance, place, or function. This analytical methodology combines an explicit and critical focus to the process of documenting itself (whether it be measuring decibels or systematically attending to sonic qualities) with a distinctive analytical synthesis that presents as ‘formal discovery’ or even ‘truth.’ In using this approach, participants most often mobilised the format of short sonic highlights and follow-up voice memos. While these aural postcards typically contained sound level photographs (decibel measurement values), in some cases the inquiry and subsequent conclusions were made inductively through sustained observation of a series of soundscapes. The following example is by a participant who exclusively recorded and compared various domestic spaces in terms of sound levels, comparing and contrasting them using voice memos. This is a sound level photograph of his home computer system: So I decided to record sitting next to my computer today just because my computer is loud, so I wanted to see exactly how loud it really was. But I kept the door closed just to be sort of fair, see how quiet it could possibly get. I think it peaked at 75 decibels, and that’s like, I looked up a decibel scale, and apparently a lawn mower is like 90 decibels. (Participant 2) Mediated Curation as a New Media Cultural Practice? One aspect of adopting the metaphor of ‘curation’ towards everyday media production is that it shifts the critical discourse on aesthetic expression from the realm of specialised expertise to general practice (“Everyone’s a photographer”). The act of curation is filtered through the aesthetic and technological capabilities of the smartphone, a device that has become co-constitutive of our routine sensorial encounters with the world. Revisiting McLuhan-inspired discourses on communication technologies stages the iPhone not as a device that itself shifts consciousness but as an agent in a media ecology co-constructed by the forces of use and design—a “crystallization of cultural practices” (Sterne). As such, mobile technology is continuously re-crystalised as design ‘constraints’ meet both normative and transgressive user approaches to interacting with everyday life. The concept of ‘social curation’ already exists in commercial discourse for social web marketing (O’Connell; Allton). High-traffic, wide-integration web services such as Digg and Pinterest, as well as older portals such as Reddit, all work on the principles of arranging user-generated, web-aggregated, and re-purposed content around custom themes. From a business perspective, the notion of ‘social curation’ captures, unsurprisingly, only the surface level of consumer behaviour rather than the kinds of values and meaning that this process holds for people. In the more traditional sense, art curation involves aesthetic, pragmatic, epistemological, and communication choices about the subject of (re)presentation, including considerations such as manner of display, intended audience, and affective and phenomenal impact. In his 2012 book tracing the discourse and culture of curating, Paul O’Neill proposes that over the last few decades the role of the curator has shifted from one of arts administrator to important agent in the production of cultural experiences, an influential cultural figure in her own right, independent of artistic content (88). Such discursive shifts in the formulation of ‘curatorship’ can easily be transposed from a specialised to a generalised context of cultural production, in which everyone with the technological means to capture, share, and frame the material and sensory content of everyday life is a curator of sorts. Each of us is an agent with a unique aesthetic and epistemological perspective, regardless of the content we curate. The entire communicative exchange is necessarily located within a nexus of new media practices as an activity that simultaneously frames a cultural construction of sensory experience and serves as a cultural production of the self. To return to the question of listening and a sound studies perspective into mediated cultural practices, technology has not single-handedly changed the way we listen and attend to everyday experience, but it has certainly influenced the range and manner in which we make sense of the sensory ‘everyday’. Unlike acoustic listening, mobile digital technologies prompt us to frame sonic experience in a multi-modal and multi-medial fashion—through the microphone, through the camera, and through the interactive, analytical capabilities of the device itself. Each decision for sensory capture as a curatorial act is both epistemological and aesthetic; it implies value of personal significance and an intention to communicate meaning. The occurrences that are captured constitute impressions, highlights, significant moments, emotions, reflections, experiments, and creative efforts—very different knowledge artefacts from those produced through textual means. Framing phenomenal experience—in this case, listening—in this way is, I argue, a core characteristic of a more general type of new media literacy and sensibility: that of multi-modal documenting of sensory materialities, or the curation of everyday life. References Allton, Mike. “5 Cool Content Curation Tools for Social Marketers.” Social Media Today. 15 Apr. 2013. 10 June 2015 ‹http://socialmediatoday.com/mike-allton/1378881/5-cool-content-curation-tools-social-marketers›. Bennett, Shea. “Social Media Stats 2014.” Mediabistro. 9 June 2014. 20 June 2015 ‹http://www.mediabistro.com/alltwitter/social-media-statistics-2014_b57746›. Bijsterveld, Karin, ed. Soundscapes of the Urban Past: Staged Sound as Mediated Cultural Heritage. Bielefeld: Transcript-Verlag, 2013. Burn, Andrew. Making New Media: Creative Production and Digital Literacies. New York, NY: Peter Lang Publishing, 2009. Daisuke, Okabe, and Mizuko Ito. “Camera Phones Changing the Definition of Picture-worthy.” Japan Media Review. 8 Aug. 2015 ‹http://www.dourish.com/classes/ics234cw04/ito3.pdf›. Chion, Michel. Audio-Vision: Sound on Screen. New York, NY: Columbia UP, 1994. Förnstrom, Mikael, and Sean Taylor. “Creative Soundwalks.” Urban Soundscapes and Critical Citizenship Symposium. Limerick, Ireland. 27–29 March 2014. Ito, Mizuko, ed. Hanging Out, Messing Around, and Geeking Out: Kids Living and Learning with New Media. Cambridge, MA: The MIT Press, 2010. Jenkins, Henry, Ravi Purushotma, Margaret Weigel, Katie Clinton, and Alice J. Robison. Confronting the Challenges of Participatory Culture: Media Education for the 21st Century. White Paper prepared for the McArthur Foundation, 2006. McLuhan, Marshall. Understanding Media: The Extensions of Man. New York: McGraw-Hill, 1964. Nichols, Brian. Introduction to Documentary. Bloomington & Indianapolis, Indiana: Indiana UP, 2001. Nielsen. “State of the Media – The Social Media Report.” Nielsen 4 Dec. 2012. 12 May 2015 ‹http://www.nielsen.com/us/en/insights/reports/2012/state-of-the-media-the-social-media-report-2012.html›. O’Connel, Judy. “Social Content Curation – A Shift from the Traditional.” 8 Aug. 2011. 11 May 2015 ‹http://judyoconnell.com/2011/08/08/social-content-curation-a-shift-from-the-traditional/›. O’Neill, Paul. The Culture of Curating and the Curating of Culture(s). Cambridge, MA: MIT Press, 2012. Pink, Sarah. Doing Visual Ethnography. London, UK: Sage, 2007. ———. Situating Everyday Life. London, UK: Sage, 2012. Sterne, Jonathan. The Audible Past: Cultural Origins of Sound Reproduction. Durham, NC: Duke UP, 2003. Schafer, R. Murray, ed. World Soundscape Project. European Sound Diary (reprinted). Vancouver: A.R.C. Publications, 1977. Turkle, Sherry. “Connected But Alone?” TED Talk, Feb. 2012. 8 Aug. 2015 ‹http://www.ted.com/talks/sherry_turkle_alone_together?language=en›.

“The intellect must not only desire surreptitious delights; it must become completely free and celebrate Saturnalia.” (Nietzsche 6) Theory-jamming suggests an array of eclectic methods, deployed in response to emerging conditions, using traditional patterns to generate innovative moves, seeking harmony and syncopation, transparent about purpose and power, aiming for demonstrable certainties while aware of their own provisional fragility. In this paper, theory-jamming is suggested as an antidote for the confusion and disarray that typifies communication theory. Communication theory as the means to conceptualise the transmission of information and the negotiation of meaning has never been a stable entity. Entrenched divisions between ‘administrative’ and ‘critical’ tendencies are played out within schools and emerging disciplines and across a range of scientific/humanist, quantitative/qualitative and political/cultural paradigms. “Of course, this is only the beginning of the mischief for there are many other polarities at play and a host of variations within polar contrasts” (Dervin, Shields and Song). This paper argues that the play of contending schools with little purchase on each other, or anything much, has turned meta-discourse about communication into an ontological spiral. Perhaps the only way to ride out this storm is to look towards communication practices that confront these issues and appreciate their theoretical underpinnings. From its roots in jazz and blues to its contemporary manifestations in rap and hip-hop and throughout the communication industries, the jam (or improvised reorganisation of traditional themes into new and striking patterns) confronts the ontological spiral in music, and life, by taking the flotsam flung out of the spiral to piece together the means to transcend the downward pull into the abyss. Many pretenders have a theory. Theory abounds: language theory, number theory, game theory, quantum theory, string theory, chaos theory, cyber-theory, queer theory, even conspiracy theory and, most poignantly, the putative theory of everything. But since Bertrand Russell’s unsustainable class of all classes, Gödel’s systemically unprovable propositions and Heisenberger’s uncertainty principle, the propensity for theories to fall into holes in themselves has been apparent. Nowhere is this more obvious than in communication theory where many schools contend without actually connecting to each other. From the 1930s, as the mass media formed, there have been administrative and critical tendencies at war in the communication arena. Some point to the origins of the split in the Institute of Social Research’s Radio Project where pragmatic sociologist, Paul Lazarsfeld broke with Frankfurt School critical theorist, Theodor Adorno over the quality of data. Lazarsfeld was keen to produce results while Adorno complained the data over-simplified the relationship between mass media and audiences (Rogers). From this split grew the twin disciplines of mass communication (quantitative, liberal, commercial and lost in its obsession with the measurement of minor media effects) and cultural/media studies (qualitative, post-Marxist, radical and lost in simulacra of their own devising). The complexity of interactions between these two disciplines, with the same subject matter but very different ways of thinking about it, is the foundation of the ontological black hole in communication theory. As the disciplines have spread out across universities, professional organizations and publishers, they have been used and abused for ideological, institutional and personal purposes. By the summer of 1983, the split was documented in a special issue of the Journal of Communication titled “Ferment in the Field”. Further, professional courses in journalism, public relations, marketing, advertising and media production have complex relations with both theoretical wings, which need the student numbers and are adept at constructing and defending new boundaries. The 90s saw any number ‘wars’: Journalism vs Cultural Studies, Cultural Studies vs Cultural Policy Studies, Cultural Studies vs Public Relations, Public Relations vs Journalism. More recently, the study of new communication technologies has led to a profusion of nascent, neo-disciplines shadowing, mimicking and reacting with old communication studies: “Internet studies; New media studies; Digital media studies; Digital arts and culture studies; Cyberculture studies; Critical cyberculture studies; Networked culture studies; Informatics; Information science; Information society studies; Contemporary media studies” (Silver & Massanari 1). As this shower of cyberstudies spirals by, it is further warped by the split between the hard science of communication infrastructure in engineering and information technology and what the liberal arts have to offer. The early, heroic attempt to bridge this gap by Claude Shannon and, particularly, Warren Weaver was met with disdain by both sides. Weaver’s philosophical interpretation of Shannon’s mathematics, accommodating the interests of technology and of human communication together, is a useful example of how disparate ideas can connect productively. But how does a communications scholar find such connections? How can we find purchase amongst this avalanche of ideas and agendas? Where can we get the traction to move beyond twentieth century Balkanisation of communications theory to embrace the whole? An answer came to me while watching the Discovery Channel. A documentary on apes showed them leaping from branch to branch, settling on a swaying platform of leaves, eating and preening, then leaping into the void until they make another landing, settling again… until the next leap. They are looking for what is viable and never come to ground. Why are we concerned to ground theory which can only prove its own impossibility while disregarding the certainty of what is viable for now? I carried this uneasy insight for almost five years, until I read Nietzsche on the methods of the pre-Platonic philosophers: “Two wanderers stand in a wild forest brook flowing over rocks; the one leaps across using the stones of the brook, moving to and fro ever further… The other stands there helplessly at each moment. At first he must construct the footing that can support his heavy steps; when this does not work, no god helps him across the brook. Is it only boundless rash flight across great spaces? Is it only greater acceleration? No, it is with flights of fantasy, in continuous leaps from possibility to possibility taken as certainties; an ingenious notion shows them to him, and he conjectures that there are formally demonstrable certainties” (Nietzsche 26). Nietzsche’s advice to take the leap is salutary but theory must be more than jumping from one good idea to the next. What guidance do the practices of communication offer? Considering new forms that have developed since the 1930s, as communication theory went into meltdown, the significance of the jam is unavoidable. While the jam session began as improvised jazz and blues music for practice, fellowship and fun, it quickly became the forum for exploring new kinds of music arising from the deconstruction of the old and experimentation with technical, and ontological, possibilities. The jam arose as a spin-off of the dance music circuit in the 1930s. After the main, professional show was over, small groups would gather together in all-night dives for informal, spontaneous sessions of unrehearsed improvisation, playing for their own pleasure, “in accordance with their own esthetic [sic] standards” (Cameron 177). But the jam is much more than having a go. The improvisation occurs on standard melodies: “Theoretically …certain introductions, cadenzas, clichés and ensemble obbligati assume traditional associations (as) ‘folkways’… that are rarely written down but rather learned from hearing (“head jobs”)” (Cameron 178-9). From this platform of tradition, the artist must “imagine in advance the pattern which unfolds… select a part in the pattern appropriate to the occasion, instrument and personal abilities (then) produce startlingly distinctive sound patterns (that) rationalise the impossible.” The jam is founded on its very impossibility: “the jazz aesthetic is basically a paradox… traditionalism and the radical originality are irreconcilable” (Cameron 181). So how do we escape from this paradox, the same paradox that catches all communication theorists between the demands of the past and the impossibility of the future? “Experimentation is mandatory and formal rules become suspect because they too quickly stereotype and ossify” (Cameron 181). The jam seems to work because it offers the possibility of the impossible made real by the act of communication. This play between the possible and the impossible, the rumbling engine of narrative, is the dynamo of the jam. Theory-jamming seeks to activate just such a dynamo. Rather than having a group of players on their instruments, the communication theorist has access a range of theoretical riffs and moves that can be orchestrated to respond to the question in focus, to latest developments, to contradictions or blank spaces within theoretical terrains. The theory-jammer works to their own standards, turning ideas learned from others (‘head jobs’) into their own distinctive patterns, still reliant on traditional melody, harmony and syncopation but now bent, twisted and reorganised into an entirely new story. The practice of following old pathways to new destinations has a long tradition in the West as eclecticism, a Graeco-Roman, particularly Alexandrian, philosophical tradition from the first century BC to the end of the classical period. Typified by Potamo who “encouraged his pupils instead to learn from a variety of masters”, eclecticism sought the best from each school, “all that teaches righteousness combined, the complete eclectic unity” (Kelley 578). By selecting the best, most reasonable, most useful elements from existing philosophical beliefs, polymaths such as Cicero sought the harmonious solution of particular problems. We see something similar to eclecticism in the East in the practices of ‘wild fox zen’ which teaches liberation from conceptual fixation (Heine). The 20th century’s most interesting eclectic was probably Walter Benjamin whose method owes something to both scientific Marxism and the Jewish Kabbalah. His hero was the rag-picker who had the cunning to create life from refuse and detritus. Benjamin’s greatest work, the unfinished Arcades Project, sought to create history from the same. It is a collection of photos, ephemera and transcriptions from books and newspapers (Benjamin). The particularity of eclecticism may be contrasted with the claim to universality of syncretism, the reconciliation of disparate or opposing beliefs by melding together various schools of thought into a new orthodoxy. Theory-jammers are not looking for a final solution but rather they seek what will work on this problem now, to come to a provisional solution, always aware that other, better, further solutions may be ahead. Elements of the jam are apparent in other contemporary forms of communication. For example bricolage, the practice from art, culture and information systems, involves tinkering elements together by trial and error, in ways not originally planned. Pastiche, from literature to the movies, mimics style while creating a new message. In theatre and TV comedy, improvisation has become a style in itself. Theory-jamming has direct connections with brainstorming, the practice that originated in the advertising industry to generate new ideas and solutions by kicking around possibilities. Against the hyper-administration of modern life, as the disintegration of grand theory immobilises thinkers, theory-jamming provides the means to think new thoughts. As a political activist and communications practitioner in Australia over the last thirty years, I have always been bemused by the human propensity to factionalise. Rather than getting bogged down by positions, I have sought to use administrative structures to explore critical ideas, to marshal critical approaches into administrative apparatus, to weld together critical and administrative formations in ways useful to both sides, bust most importantly, in ways useful to human society and a healthy environment. I've been accused of selling-out by the critical camp and of being unrealistic by the administrative side. My response is that we have much more to learn by listening and adapting than we do by self-satisfied stasis. Five Theses on Theory-Jamming Eclecticism requires Ethnography: the eclectic is the ethnographer loose in their own mind. “The free spirit surveys things, and now for the first time mundane existence appears to it worthy of contemplation…” (Nietzsche 6). Enculturation and Enumeration need each other: qualitative and quantitative research work best when they work off each other. “Beginners learned how to establish parallels, by means of the Game’s symbols, between a piece of classical music and the formula for some law of nature. Experts and Masters of the Game freely wove the initial theme into unlimited combinations.” (Hesse) Ephemera and Esoterica tell us the most: the back-story is the real story as we stumble on the greatest truths as if by accident. “…the mind’s deeper currents often need to be surprised by indirection, sometimes, indeed, by treachery and ruse, as when you steer away from a goal in order to reach it more directly…” (Jameson 71). Experimentation beyond Empiricism: more than testing our sense of our sense data of the world. Communication theory extends from infra-red to ultraviolet, from silent to ultrasonic, from absolute zero to complete heat, from the sub-atomic to the inter-galactic. “That is the true characteristic of the philosophical drive: wonderment at that which lies before everyone.” (Nietzsche 6). Extravagance and Exuberance: don’t stop until you’ve got enough. Theory-jamming opens the possibility for a unified theory of communication that starts, not with a false narrative certainty, but with the gaps in communication: the distance between what we know and what we say, between what we say and what we write, between what we write and what others read back, between what others say and what we hear. References Benjamin, Walter. The Arcades Project. Cambridge, Mass: Harvard UP, 2002. Cameron, W. B. “Sociological Notes on the Jam Session.” Social Forces 33 (Dec. 1954): 177–82. Dervin, B., P. Shields and M. Song. “More than Misunderstanding, Less than War.” Paper at International Communication Association annual meeting, New York City, NY, 2005. 5 Oct. 2006 http://www.allacademic.com/meta/p13530_index.html>. “Ferment in the Field.” Journal of Communication 33.3 (1983). Heine, Steven. “Putting the ‘Fox’ Back in the ‘Wild Fox Koan’: The Intersection of Philosophical and Popular Religious Elements in The Ch’an/Zen Koan Tradition.” Harvard Journal of Asiatic Studies 56.2 (Dec. 1996): 257-317. Hesse, Hermann. The Glass Bead Game. Harmondsworth: Penguin, 1972. Jameson, Fredric. “Postmodernism, or the Cultural Logic of Late Capitalism.” New Left Review 146 (1984): 53-90. Kelley, Donald R. “Eclecticism and the History of Ideas.” Journal of the History of Ideas 62.4 (Oct. 2001): 577-592 Nietzsche, Friedrich. The Pre-Platonic Philosophers. Urbana: University of Illinois Press, 2001. Rogers, E. M. “The Empirical and the Critical Schools of Communication Research.” Communication Yearbook 5 (1982): 125-144. Shannon, C.E., and W. Weaver. The Mathematical Theory of Communication. Urbana: University of Illinois Press, 1949. Silver, David, Adrienne Massanari. Critical Cyberculture Studies. New York: NYU P, 2006. Citation reference for this article MLA Style Stockwell, Stephen. "Theory-Jamming: Uses of Eclectic Method in an Ontological Spiral." M/C Journal 9.6 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0612/09-stockwell.php>. APA Style Stockwell, S. (Dec. 2006) "Theory-Jamming: Uses of Eclectic Method in an Ontological Spiral," M/C Journal, 9(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0612/09-stockwell.php>.

In 1996, the iconoclastic economist John Kenneth Galbraith wrote a manifesto, The Good Society, that elaborated his vision for what societal excellence and goodness should amount to. Though nearly 96, Galbraith was still a rabble-rouser, and he castigated the powers that be in the United States for propping up a “democracy of the fortunate” (8). To Galbraith, those who engaged in electoral politics, win or lose on any specific issue, tended to have all the social and economic advantages, while the less well off were deliberately marginalised by ‘the system.’ He lamented that “money, voice and political activism are now extensively controlled by the affluent, very affluent, and business interests" (140), making of the political sphere an "unequal contest" (8).To make democracy American style more inclusive, Galbraith called for “a coalition of the concerned and the compassionate and those now outside the political system” (143), so that all citizens had optimal prospects for enjoying “personal liberty, basic well-being, social and ethnic equality, the opportunity for a rewarding life" (4). Have inroads been made, in the nearly 15 years since first publication of The Good Society, in making come true Galbraith’s version of a good society? If not, how might such a coalition be achieved? What would it look like? Who among Americans would constitute the concerned, compassionate outsiders that would make such a coalition authentically ‘Galbraithian’? A Coalition on the MoveWhat about MoveOn.org? A progressive public advocacy group founded in 1998, MoveOn.org, according to Lelia Green in The Internet, is “an important indicator of the potential for bringing together communities of like-minded individuals” (139). Green singles out MoveOn.org as particularly pivotal in galvanising support for Barack Obama’s presidency (139). The New York Times describes MoveOn.org as “a bottom-up organization that has inserted itself into the political process in ways large and small” (Janofsky and Lee). Indeed, it represents “the next evolutionary change in American politics, a move away from one-way tools of influence like television commercials and talk radio to interactive dialogue, offering everyday people a voice in a process that once seemed beyond their reach.” MoveOn.org has expertly utilised the Internet to mobilise its members “to sign online petitions, organize street demonstrations and donate money to run political advertisements”. Green considers MoveOn.org one of today’s standout “coalitions of interests and political agendas”, “extraordinary” in its ability to “use websites and email lists to build communities around a shared passion” (139). In 2008, its 4.2 million members were at the vortex of a “dynamic that tipped the balance in favour of a more radical agenda with the election of President Barack Obama in 2008” (139). Galbraith, for one, would certainly agree with MoveOn.org’s politics, and likely would claim that their radical agenda is a compassionate and encompassing one that effectively addresses the concerns of everyday citizens. Yet the fact is that millions of disaffected Americans are not liberals, and so are not in sync with MoveOn.org’s interests and agendas, such as its firm insistence that a ‘public option’ is the best way to bring about meaningful health care reform, and its demand that all U.S. troops be immediately withdrawn from Iraq and Afghanistan. Tea Anyone?Another sort of coalition filled the void created by MoveOn.org. Enter the Tea Party. A movement that has been every bit as effective in its way in inspiring once-jaded ordinary citizens to coalesce around a set of interests and agendas – albeit, at least in principal if not necessarily in actual practice, of a professed libertarian strain – the Tea Party got underway in the waning days of the second presidential term of George W. Bush. It started out as a one-issue protest group voicing umbrage over the proposed economic stimulus plan, which it considered an unconstitutional subsidy. After Barack Obama became president, the Tea Party burgeoned into a much more influential movement that now professes to be a grassroots citizens’ watchdog for all unconstitutional activities (or what it deems to be such) on the part of the federal government. A New York Times article notes that many of its members are victims of the economic downturn; they “had lost their jobs, or perhaps watched their homes plummet in value, and they found common cause in the Tea Party’s fight for lower taxes and smaller government” (Zernike). Its members are akin to the millions of middle class Americans who lost their livelihoods during the Great Depression of the 1930s, an unparalleled economic downturn that eventually “mobilized many middle-class people who had fallen on hard times” to join forces in order to have an effective political voice. But those during the Great Depression who were aroused to political consciousness “tended to push for more government involvement”; in contrast, the Tea Party is a coalition that “vehemently wants less”. While Galbraith depicted the Republican Party of his time as “avowedly on the side of the fortunate” (141), the majority of today’s Tea Party members align themselves with the Republican Party, yet they are by no means principally made up of "the fortunate." Erick Erickson, a prominent Tea Party spokesman and a television commentator for the CNN news channel, blogs on Redstate.com that the Tea Party “has gotten a lot of people off the sidelines and into the political arena...” Erickson further contends that the Tea Party has “brought together a lot of likeminded citizens who thought they were alone in the world. They realized that not only were they not alone, but there were millions of others just as concerned.” Galbraithian Coalitions?Do MoveOn.org and Tea Party constitute Galbraithian-type coalitions, each in its own right? Both have inspired millions of once-disenchanted common citizens to come together around common political concerns and become a force to be reckoned with in electoral politics. As such, each has served as an effective counterweight against the money, voice and political activism of the very affluent. While Galbraith would probably have as much disdain for the Tea Party as he would have praise for MoveOn.org, the fact is that both groups have seen to it that an increasing number of regular Americans whose concerns had been ignored in the political arena now have to be reckoned with. But this is by no means where their commonality ends. Above and beyond the fact that both are comprised of millions who had been political outsiders, each has a decided anti-establishmentarian strain, along with a professed sense of alienation from and disdain for "politics as usual" and an impassioned belief in the right to self-government (though they differ on what this right amounts to). Moreover, both consider themselves grassroots-driven, and harbor anathema for professional lobbying organisations, which both regularly criticize for their undue political influence. Even though the two groups usually differ to the nth degree when it comes to those solutions they believe would effectively remedy the most pressing public problems in the U.S., they nonetheless share the conviction that one must initially focus one’s efforts at the local level if one is eventually to have the greatest impact on political decision-making on a national scale. The two groups came of age during the Internet revolution – indeed, it would have been impossible for their like-minded members to have found one another and coalesced so quickly and in such great numbers without the Internet – and they utilise the Internet as the principal tool for spurring concerted activism at the local level among their members. One can consider their shared approach Deweyan, in that Dewey maintained that genuinely democratic community, “in its deepest and richest sense, must always remain a matter of face-to-face intercourse” (367). Yet the two groups’ legion differences prevent them from engaging in meaningful face-to-face exchanges with one another. While the prospect of cultivating linkages between Tea Party and MoveOn.org are remote for the foreseeable future, it might nonetheless be seen as a promising development that some rank and file Tea Party acolytes do at least recognise that they must not identify solely with the Republican Party, lest they discourage potential recruits from rallying around their cause. For instance, one warns fellow members on the Redstate.com blog to be wary of casting their lot with Republicans, “because it would drive away the Democrats and Independents”. He actually uses Galbraith’s coinage in describing the Tea Party: “This movement is a coalition of the concerned, not a Republican outreach program.” Indeed, contrary to popular belief, the Tea Party is not, as a whole, on the conservative fringe (though it does often seem that those members who are given the most attention by the mainstream media are the fringe element, particularly the breakaway Tea Party Express). A Gallup Poll reveals that fully 17 percent of all Americans of voting age identify themselves as affiliated with the Tea Party; and while a majority have Republican leanings, fully 45 percent of all Tea Party members claimed they were either Democrats (17 percent) or independents (28 percent). To Tea Party leader Erick Erickson, the paramount challenge today for the Tea Party is for it to transform itself into a greater umbrella coalition, since the “issues and advocacy within the tea party movement are issues that resonate with the majority of Americans.” After all, he asserts, the Tea Party’s is “a very American cause — the first amendment right to protest, petition, and speak up.” While an expansion of its coalition does not in any way make it incumbent for the Tea Party to find common cause with MoveOn.org, can the claim nonetheless be legitimately made – utilising Erickson’s own criteria – that MoveOn.org’s is equally a very American cause? Christopher Hayes points out in an essay in The Nation that most of MoveOn.org’s members, as with the Tea Party’s, are “not inclined to protest,” but their “rising unease with the direction of the country has led to a new political consciousness.” Hayes could just as well be speaking of the Tea Party when he describes MoveOn.org’s members as made up mostly of “citizens angered, upset and disappointed with their government but [who were] unsure how to channel those sentiments.” For such citizens, MoveOn.org “provides simple, discrete actions: sign this petition, donate money to run this ad, show up at this vigil.” This is convincing evidence that MoveOn.org’s is also “a very American cause”, by the very benchmarks set forth by Erickson. A ‘Higher Coalition’?But is this in any way akin to a demonstrable sign that these unlikeliest of political bedfellows might be inspired at some future point to see themselves as part of a ‘higher coalition’ — one of the unlikeminded, that celebrates difference? Might a critical mass in both movements ever deem it a boon to coalesce around the cause of democratic pluralism? As things stand, neither side embraces such pluralism. Rather, one other attribute they share pervasively is dogmatism: both are convinced that their respective political sensibilities are beyond reproach. As a consequence, over the shorter term, neither group is likely to shed its brand of dogmatism and supplant it with an openness or receptivity to new, much less opposing, points of view. So, for instance, even as the Tea Party seeks to expand its fold, it is no more inclined to change its ideology-based stances on the issues than is MoveOn.org. For the time being, each group not only is entrenched in its own collective political mindset, but each coalesces around a demonstrated antipathy towards alternative approaches to public problem-solving. Is there any remotely plausible scenario by which the members of MoveOn.org and Tea Party might eventually come not just to tolerate their differences but to extol them? One other key Galbraithian element that those comprising an ideal coalition in a democracy must possess is compassion. For members of any coalition to cultivate compassion, they must first, or concomitantly, inculcate empathy, which is typically considered either a precursor to compassion or, along with understanding, a vital component of it. Henning Melber, Executive Director of the Dag Hammarskjold Foundation, and Reinhard Kössler maintain that “(w)hile empathy does not automatically translate into solidarity (nor into ethical behaviour), it can serve as a compass” for doing so, and can lead to a Galbraithian “coalition of the concerned and aware”(37). Such empathy is “a prerequisite for the ability to listen to one another and for permissiveness and openness towards ‘otherness’, and further, can only be born out of a sense of shared suffering” (37). To the authors, it isn’t just that “(s)uffering in its variety of forms requires empathy and solidarity by all,” but that it necessarily “transcends a politically correct ideology” (37). Millions in both the Tea Party and MoveOn.org long suffered from being a mere afterthought to the political establishment, both of them impacted by policies that they are convinced exacerbated rather than ameliorated their woes. But they have shown few if any indications of a willingness to transcend a politically correct ideology. For this to come about, it would, as Melber and Kössler maintain, require “hard, sustained, and imaginative work” (33). How might this come to pass? Greg Anderson, in The Athenian Experiment: Building an Imagined Political Community in Ancient Attica, 508-490 B.C., points to ancient Athens as a paradigmatic example of a society that undertook the hard imaginative work needed to develop the types of mediated connections that over time created a sense of shared belonging to a democratic community. “The process of transformation” in Attica, he argues, is “best understood as a bold exercise in social engineering, an experiment designed to bring together the diverse and far-flung inhabitants of an entire region and forge them into a single, self-governing political community of like-minded individuals” (5). While those males of sufficient socioeconomic distinction who were privileged enough to be citizens in the West’s first experiment in democracy were indeed like-minded, prising a self-governing political community, they were not single-minded; rather, those in the twelve dispersed tribes throughout Attica who coalesced to form a self-governing community apparently thrived on the free exchange and consideration of a wide range of ideas. They held that greater insights emerged only when a variety of views were subjected to scrutiny in the public sphere. Paul Woodruff notes in First Democracy that each Athenian was “given a share of the ability to be citizens, and that ability is understood both as a pair of virtues and as a kind of citizen wisdom.” Governing in this way was based on the shared view that “it is a natural part of being human to know enough to help govern your community” (149). Neither Tea Party nor MoveOn.org followers at present have this shared view on any semblance of a broad scale; rather, each betrays the sensibility that each ‘knows better’. As a consequence, any efforts at expanding their respective folds clearly do not include making overtures (or even extending olive branches) to one another. Even so, as impossibly optimistic as it might seem under current circumstances, I believe eventually they might come to see themselves as part of a greater or higher coalition – one serving the overriding cause of democracy itself – over the much longer term. But for this to become a reality, each group will first have to suffer some more. One other commonality they demonstrate is the power of grassroots activism – and the decided limitations. My hunch is that just as MoveOn.org’s progressives came to feel betrayed when Obama abandoned the liberal agenda of his presidential campaign to engage in political compromise and accommodation, Tea Party activists will come to find that their own expectations for political change will be equally stymied. In the 2010 elections, the Tea Party was a kingmaker in electoral politics, giving Republicans a decisive majority in Congress in the 2010 elections. But I suspect that those candidates the Tea Party supported will eventually resort to the practice of “politics as usual,” largely departing from the Tea Party agenda, in order to accomplish anything in Washington or become irrelevant in the existing system – a system long dominated by two political parties interested above and beyond all else in perpetuating their shared stranglehold on political power, and each equally beholden to corporate America for the contributions to their coffers that enable them to sustain this. If this scenario plays out, then at least some Tea Party activists might plausibly arrive at the unsettling conclusion that their suffering in the political arena is remarkably similar to that experienced by MoveOn.org’s cadre of concerned citizens who catapulted Obama into the office in the land, only to have most of their principal concerns neglected or dismissed, lost in the seamy world of back-room political deal-making. There is another possible scenario: What if either MoveOn.org or Tea Party becomes such an overwhelming force in politics that the other is attenuated, its members relegated once again to the fringe? If this occurred, the public sphere in the United States would be missing a vital dimension that has been part of its makeup since its founding days. For as Joseph Ellis, the Pulitzer Prize-winning historian, points out: the achievement of the revolutionary generation was a collective enterprise that succeeded because of the diversity of personalities and ideologies present in the mix. Their interactions and juxtapositions generated a dynamic form of balance and equilibrium, not because any of them was perfect or infallible, but because their mutual imperfections and fallibilities, as well as their eccentricities and excesses, checked each other… . (17) At the United States’s beginnings, the ties that bound those who revolted against Britain were forged despite their unbridgeable chasms of ideology; their “differing postures toward the twin goals of freedom and equality” were “not resolved so much as built into the fabric of our national identity” (16). Even or especially as irreconcilable differences prompted early Americans to continue waging a battle of ideas in the political trenches, Thomas Jefferson, for one, believed they were all (or nearly all) “constitutionally and conscientiously democrats” (185). Extrapolating from this, one can posit that MoveOn.org and Tea Party, regardless of whether they choose to acknowledge it, are in tandem a modern-day manifestation of the original American coalition. If they could be inspired to see that each is an important player in furthering the democratic experiment as singularly practiced in the U.S., they just might come to care more for one another. Out of such caring, they might realise that neither has a monopoly on political wisdom, and as a result coalesce around the cause of promoting a less hostile body politic. AcknowledgementsThe author is grateful to the two blind peer reviewers for their most helpful suggestions. ReferencesAnderson, Greg. The Athenian Experiment: Building an Imagined Political Community in Ancient Attica, 508-490 B.C. Ann Arbor, MI: University of Michigan Press, 2003. Dewey, John. In J. Boydston (Ed.) John Dewey, Volume 2: 1925-1927. Carbondale, Illinois: Southern Illinois University, 1984. Ellis, Joseph. Founding Brothers: The Revolutionary Generation. New York, NY: Vintage. 2002. Erickson, Erick. “Tea Party Movement 2.0: Moving beyond Protesting to Fighting in Primaries, Ballot Boxes, and Becoming More Effective Activists.” 14 April 2010. 28 Sep. 2010 ‹http://www.redstate.com/erick/2010/04/14/tea-party-movement-20/>.Galbraith, John Kenneth. The Good Society: The Humane Agenda. New York: Mariner Books, 1997. Green, Lelia. The Internet: An Introduction to New Media. Oxford: Berg, 2010.Hayes, Christopher. “MoveOn.org Is Not as Radical as Conservatives Think." The Nation. 16 July 2008. 28 Sep. 2010 ‹http://www.thenation.com/article/moveonorg-not-radical-conservatives-think>. Janofsky, Michael, Jennifer B. Lee. “Net Group Tries to Click Democrats to Power”. New York Times, 18 Nov 2003. 1 Oct. 2010 ‹http://www.nytimes.com/2003/11/18/us/net-group-tries-to-click- democrats-to-power.html?scp=1&sq=%22bottom-up%20organization%22&st=cse>. Jefferson, Thomas. In M. Peterson, ed. The Political Writings of Thomas Jefferson. Chapel Hill, NC: University of North Carolina Press, 1993. Kossler, Reinhart, and Hening Melber. “International Civil Society and the Challenge for Global Solidarity.” Development Dialogue 49 (Oct. 2007): 29-39. Malcolm, Andrew. “Myth-Busting Polls: Tea Party Members Are Average Americans, 41% Are Democrats, Independents.” Los Angeles Times, 5 April 2010 ‹http://latimesblogs.latimes.com/washington/2010/04/tea-party-obama.html>.MoveOn.org. n.d. 27 Sep. 2010 ‹http://moveon.org>. Tea Party. n.d. 1 Oct. 2010 ‹http://teaparty.freedomworks.org>.Tea Party Express. n.d. 1 Oct. 2010 ‹http://www.teapartyexpress.org>. Woodruff, Paul. First Democracy: The Challenge of an Ancient Idea. New York: Oxford University Press, 2006. Zernike, Kate. “With No Jobs, Plenty of Time for Tea Party.” New York Times, 27 Mar. 2010. 29 Sep. 2010 ‹http://www.nytimes.com/2010/03/28/us/politics/28teaparty.html?scp=1&sq=%22watched%20their%20homes%20plummet%20in%20value%22&st=cse>.

As a mode of open access public self-expression, blogs are one form of the unfolding massification of culture (Lovink). Though widely varied in content and style, they are characterised by a reverse chronological diary-like format, often produced by a single author, and often intimately expressive of that author’s thoughts and experiences. The purpose of this paper is to explore the use of blogs as a space for the detailed and on-going expression of the day to day experiences of sufferers of serious illness. We might traditionally consider the experience of illness as absolutely private, but illness, along with the process of recovery, retains a social and cultural aspect (Kleinman et al). A growing body of literature has recognised that the Internet has become a significant space for the recovery work that accompanies the diagnosis of serious illness (Orgad; Pitts; Hardey). Empowerment and agency are often emphasised in this literature, particularly in terms of the increased access to information and support groups, but also in the dynamic performances of self enabled by different forms of online communication and Web production. I am particularly interested in the ongoing shifts in the accessibility of “private” personal experience enabled by blog culture. Although there are thousands of others like them, three “illness blogs” have recently caught my attention for their candidness, completeness and complexity, expressing in vivid depth and detail individual lives transformed by serious illness. The late US journalist and television producer Leroy Sievers maintained a high profile blog, My Cancer, and weekly podcast on the National Public Radio website until his death from metastasised colon cancer in August 2008. Sievers used his public profile and the infrastructure of the NPR website to both detail his personal experience and bring together a community of people also affected by cancer or moved by his thoughts and experiences. The blogger Brainhell came to my attention through blogsphere comments and tributes when he died in February 2008. Spanning more than four years, Brainhell’s witty and charming blog attracted a significant audience and numerous comments, particularly toward the end of his life as the signs of his deteriorating motor system as a result of Amyotrophic Lateral Sclerosis (ALS, or “Lou Gherig’s disease”) riddled his intimate posts. Another blog of interest to me here, called Humanities Researcher, incorporates academic Stephanie Trigg’s period of illness and recovery from breast cancer within a pre-existing and ongoing blog about the intersection between professional and personal life. As I had crossed paths with Trigg while at Melbourne University, I was always interested in her blog. But her diagnosis with breast cancer and subsequent accounts of tests, the pain and debilitation of treatment and recovery within her blog also offer valuable insight into the role of online technologies in affecting experiences of illness and for the process of recovery.The subject matter of illness blogs revolves around significant personal transformations as a result of serious illness or trauma: transformations of everyday life, of body and emotional states, relationships, physical appearance, and the loss or recovery of physical ability. It is not my intention in this brief analysis to overgeneralise on the basis of some relatively limited observations. However, many blogs written in response to illness stand out for what they reveal about the shifting location or locatability of self, experience and the events of ongoing illness and thus how we can conceptualise the inherent “privacy” of illness as personal experience. Self-expression here is encompassing of the possibilities through which illness can be experienced – not as representation of that experience, a performance of a disembodied self (though these notions have their merits) – but an expressive element of the substance of the illness as it is experienced over time, as it affects the bodies, thoughts, events and relationships of individuals moving toward a state of full recovery or untimely death. Locating Oneself OnlineMany authors currently examining the role of online spaces in the lives of sufferers of serious illness see online communication as providing a means for configuring experience as a meaningful and coherent story, and thus conferring, or we could say recovering, a sense of agency amidst a tumultuous and ongoing battle with serious illness (Orgad, Pitts). In her study of breast cancer discussion forums, message boards and websites, Orgad (4) notes their role in regaining “the fundamentals disturbed by cancer” (see also Bury). Well before the emergence of online spaces, the act or writing has been seen as “a crucial affirmation of living, a statement against fearfulness, invisibility and silence” (Orgad, 67; Lorde, 61). For many decades scientists have asserted that “brief structured writing sessions can significantly improve mental and physical health for some groups of people” (Singer and Singer 485). The Internet has provided an infrastructure for bringing personal experiences of illness into the public realm, enabling a new level of visibility. Much of the work on illness and the Internet focuses on the liberatory and empowering act of story telling and “disembodied” self-expression. Discussion forums and cancer websites enable the formation of patient led “discourse communities” (Wuthnow). Online spaces such as discussion forums help their participants gain a foothold within a world they share with other sufferers, building communities of practice (Wegner) around specific forms of illness. In this way, these forms of self-expression and communication enable the sufferer of serious illness to counter the modes by which they are made “subjects”, in the Foucauldian sense, of medical discourse. All illness narratives are defined and constructed socially, and are infused with relations of power (Sontag; Foucault, Birth of the Clinic). Forms of online communication have shifted productive practice from professions to patients. Blogs, like discussion forums, websites, email lists etc., have come to play a central role in this contemporary shift. When Lovink (6) describes blogs as a “technology of the self” he points to their role in “self-fashioning”. Blogs written about and in the context of personal illness are a perfect example of this inclination to speak the truth of oneself in the confessional mode of modern culture borne of the church, science and talkshow television. For Foucault (Technologies of the Self, 17), technologies of the self: Permit individuals to effect by their own means or with the help of others a certain number of operations on their own bodies and souls, thoughts, conduct and way of being, so as to transform themselves in order to attain a state of happiness, purity, wisdom, perfection, immortality. Likewise, as a central concept for understanding Internet identity, the notion of performance (eg, Turkle) highlights the creativity with which illness bloggers may present their role as cancer patient in online spaces, perhaps as an act of resistance to “subjectifying” medical discourses and practices. Many bloggers wrest semiotic power through regular discussion of the language of pathology and medical knowledge, treatment processes and drugs. In the early stages of her treatment, Trigg plays with the new vocabulary, searching for etiologies and making her own semantic connections: I’ve learnt two new words. “Spiculated” describes the characteristic shape of a carcinoma on an ultrasound or x-ray. …The other word is at the other end of the spectrum of linguistic beauty: “lumpectomy”. It took me quite a while to realise that this was not really any different from partial mastectomy; or local excision. It’s an example of the powerful semantic connotations of words to realise that these phrases name the same processes: a long cut, and then the extraction of the diseased tissue (Humanities Researcher, 14 Oct. 2006).Partly due to the rarity of his illness, Brainhell goes through weeks of waiting for a diagnosis, and posts prolifically in an attempt to test out self-diagnoses. Amidst many serious and humorous posts analysing test results and discussing possible diagnoses Brainhell reflects on his targeted use of the blog: I am a word person. I think in sentences. I often take complex technical problems at work and describe them to myself in words. A story helps me understand things better. This blog has become a tool for me to organize my own thoughts about the Mystery Condition. (Brainhell, 6 Jan. 2004)The emancipatory potential of blog writing, however, can be easily overstated. While it is valuable to note and celebrate the performative potential of online production, and its “transformative” role as a technology of the self, it is easy to fall back on an unproblematic distinction between the actual and the virtual, the experience of illness, and its representation in online spaces. Textual expression should always refer us to the extra-textual practices that encompass it without imposing an artificial hierarchy of online and offline, actual experience and representation. As with other forms of online communication and production, the blog culture that has emerged around forms of serious illness plays a significant role in transforming our concepts of the relationship between online and offline spaces. In his My Cancer blog, Sievers often refers to “Cancer World”. He notes, for example, the many “passing friends” he makes in Cancer World through the medical staff and other regular patients at the radiation clinic, and refers to the equipment that sustains his life as the accoutrements of this world. His blog posts revolved around an articulation of the intricacies of this “world” that is in some ways a means of making sense of that world, but is also expressive of it. Sievers tries to explain the notion of Cancer World as a transformation of status between insider & outsider: “once we cross over into Cancer World, we become strangers in a strange land. What to expect, what to hope for, what to fear – none of those are clear right now” (My Cancer, 30 June 2008). Part of his struggle with the illness is also with the expression of himself as encompassed by this new “world” of the effects and activities of cancer. In a similar way, in her Humanities Researcher blog Trigg describes in beautiful detail the processes, routines and relationships formed during radiation treatment. I see these accounts of the textures of cancer spaces as lying at the point of juncture between expression and experience, not as a disembodied, emancipatory realm free from the fetters of illness and the everyday “real” self, but always encompassed by, and encompassing them, and in this way shifting what might be understood to remain “private” in personal experience and self-expression. Blogs as Public Diary Axel Bruns (171), following Matthew Rothenberg, characterises blogs as an accessible technological extension of the personal home page, gaining popularity in the late 1990s because they provided more easy to use templates and web publishing tools than earlier webpage applications. Personalised self expression is a defining element. However, the temporal quality of the reverse chronological, timestamped entry is equally significant for Bruns (171). Taking a broader focus to Bruns, who is most interested in the potential democratisation of media in news related blogs, Lovink sees the experimentation with a “public diary” format as fundamental, signalling their “productive contradiction between public and private” (Lovink 6). A diary may be written for posterity but it is primarily a secretive mode of communication. While blogs may mirror the temporal form of a diary, their intimate focus on self-expression of experience, thoughts and feelings, they do so in a very different communicative context.Despite research suggesting that a majority of bloggers report that they post primarily “for themselves” (Lenhart and Fox) – meaning that they do not deliberately seek a broad audience or readership – the step of making experiences and thoughts so widely accessible cannot be overlooked in any account of blogging. The question of audience or readership, for example, concerns Trigg in her Humanities Researcher blog: The immediacy of a blog distinguishes it from a journal or diary. I wrote for myself, of course, but also for a readership I could measure and chart and hear from, sometimes within minutes of posting. Mostly I don’t know who my readers are, but the kindness and friendship that come to me through the blog gave me courage to write about the intimacies of my treatment; and to chart the emotional upheaval it produced. (Trigg)In their ability to produce a comprehensive expression of the events, experiences, thoughts and feelings of an individual, blogs differ to other forms of online communication such as discussion forums or email lists. Illness blogs are perhaps an extreme example, an open mode of self-expression often arising abruptly in reaction to a life transforming diagnosis and tracking the process of recovery or deterioration, usually ending with remission or death. Brainhell’s blog begins with MRI results, and a series of posts about medical examination and self-examination regarding his mystery condition: So the MRI shows there is something on my brain that is not supposed to be there. The doctor thinks it is not a tumor. That would be good news. …As long as you are alive and have someone to complain to, you ain’t bad off. I am alive and I am complaining about a mystery spot on my brain, and lazy limbs. (Brainhell, 24 Dec. 2003)Brainhell spent many weeks documenting his search for a diagnosis, and continued writing up to his final deterioration and death in 2008. His final posts convey his physical deterioration in truncated sentences, spelling errors and mangled words. In one post he expresses his inability to wake his caregiver and to communicate his distress and physical discomfort at having to pee: when he snorted on waking, i shrieked and he got me up. splayed uncomfortably in the wc as he put dry clothes on me, i was gifted with his words: “you choose this, not me. you want to make it hard, what can i do?” (Brainhell, 13 Jan. 2008). The temporal and continuous format of the blog traverses the visceral, corporeal transformations of body and thought over time. The diary format goes beyond a straightforward narrative form in being far more experiential and even experimental in its self-reflective expression of the events of daily life, thoughts, feelings and states of being. Its public format bears directly on its role in shaping the communicative context in which that expression takes place, and thus to an extent shapes the experience of the illness itself. Nowhere does the expressive substance of the blog so fully encompass the possibilities through which the illness could be experienced than in the author’s death. At this point the blog feels like it is more than a catalogue, dialogue or self-presentation of a struggle with illness. It may take on the form of a memorial (see for example Tom’s Road to Recovery) – a recovery of the self expressed in the daily physical demise, through data maintained in the memory of servers. Ultimately the blog stands as a complex trace of the life lived within its posts. Brainhell’s lengthy blog exemplifies this quite hauntingly. Revealing the Private in Public Blogs exemplify a further step in the transformation of notions of public and private brought about by information and screen technologies. McQuire (103) refers to contemporary screen and Internet culture as “a social setting in which personal identity is subject to new exigencies”. Reality television, such as Big Brother, has promoted “a new mode for the public viewing of private life” (McQuire 114) contributing to the normalisation of open access to personal, intimate revelations, actions and experiences. However, privacy is “an elusive concept” that relates as much to information and property as to self-expression and personal experience (McCullagh). That is, what we consider private to an individual is itself constituted by our variable categories of personal information, material or immaterial possessions, or what counts as an expression of personal experience. Some analysts of online storytelling in the context of illness recognise the unsustainability of the distinction between public and private, but nonetheless rely on the notion of a continuum upon which activities or events could be considered as experienced in a public or private space (Orgad, 129-133). One of the characteristics of a blog, unlike other forms of online communication such as chat, discussion forums and email, is its predominantly public and openly accessible form. Though many illness bloggers do not seem to seek anonymity or hold back in allowing massive access to their self-expression and personal experience, a tension always seems to be there in the background. Identification through the proper name simply implies potential broader effects of blog writing, a pairing of the personal expressions with the person who expresses them in broader daily interactions and relationships. As already “public” figures, Stephanie Trigg and Leroy Sievers choose to forego anonymity, while Brainhell adopted his alias from the beginning and guarded his anonymity carefully. Each of these bloggers, however, shows signs of grappling with the public character of their site, and the interaction between the blog and their everyday life and relationships. In his etiquette page, Brainhell seems unclear about his readership, noting that his blog is for “friends and soul-mates, and complete strangers too”, but that he has not shared it with his family or all of his friends. He goes on to say: You may not have been invited but you are still welcome here. I made it public so that anyone could read it. Total strangers are welcome. Invited friends are welcome. But of those invited friends, I ask you to ask me before you out me as the blog author, or share the blog with other people who already know me. (Brainhell, 18 Feb. 2004) After his death Ratty took steps to continue to maintain his anonymity, vetting many comments and deleting others to “honor BH’s wishes as he outline in ‘Ettiquett for This Blog”’ (Brainhell, 2 Feb. 2008). In Leroy Sievers’ blog, one post exploring the conflict raised by publicly “sharing” his experiences provoked an interesting discussion. He relays a comment sent to him by a woman named Cherie: I have stage four colorectal cancer with liver mets. This is a strange journey, one I am not entirely sure I can share with my loved ones. I am scared it might rob them of the hope I see in their eyes. The hope which I sometimes don’t believe in. (My Cancer, 26 July 2006) Sievers struggles with this question: “How do you balance the need to talk about what is happening to you with the tears of a close friend when you tell him or her the truth? There’s no simple answer.” The blog, in this sense, seems to offer a more legitimate space for the ongoing, detailed expression of these difficult and affective, and traditionally private experiences. In some posts the privacy of the body and bodily experiences is directly challenged or re-negotiated. Stephanie Trigg was concerned with the effect of the blog on her interactions with colleagues. But another interesting dilemma presents itself to her when she is describing the physical effects of cancer, surgery and radiation treatment on her breast, and forces herself to hold back from comparing with the healthy breast: “it's not a medical breast, so I can't write about it here” (Humanities Researcher, 10 Jan. 2007). One prostate cancer blogger, identified as rdavisjr, seems to have no difficulties expressing the details of a physical intrusion on his “privacy” in the far more open forum of his blog: The pull-around ceiling mounted screen was missing (laundry?), so Kelly was called into the room and told to make a screen with a bed sheet. So here I am with one woman sticking her finger up my ass, while another woman is standing in front of the door holding an outstretched bed sheet under her chin (guess she wanted a view!)The screen was necessary to ensure my privacy in the event someone accidentally came into the room, something they said was a common thing. Well, Kelly peering over that sheet was hardly one of my more private moments in life! (Prostate Cancer Journal, 23 Feb. 2001). ConclusionWhatever emancipatory benefits may be found in expressing the most intimate of experiences and events of a serious illness online, it is the creative act of the blog as self-expression here, in its visceral, comprehensive, continuous timestamped format that dismantles the sense of privacy in the name of recovery. The blog is not the public face of private personal experience, but expressive of the life encompassed by that illness, and encompassing its author’s ongoing personal transformation. The blogs discussed here are not alone in demonstrating these practices. The blog format itself may soon evolve or disappear. Nonetheless, the massification enabled by Internet technologies and applications will continue to transform the ways in which personal experience may be considered private. ReferencesBruns, Axel. Gatewatching: Collaborative Online News Production. New York: Peter Lang, 2005.Bury, Michael. “Chronic Illness as Biographical Disruption.” Sociology of Health and Illness, 4.2 (1982): 167-182.Foucault, Michel. Birth of the Clinic: An Archaeology of Medical Perception. Trans. A.M. Sheridan. London: Tavistock, 1973.———. “Technologies of the Self” Technologies of the Self: A Seminar with Michel Foucault. Ed. Luther H. Martin, Huck Gutman, Patrick M. Hutton, 1988: 16-49. Hardey, Michael. “‘The Story of My Illness’: Personal Accounts of Illness on the Internet.” Health 6.1 (2002): 31-46Kleinman, Arthur, Veena Das, and Margaret Lock, eds. Social Suffering. Berkeley: University of California Press, 1997. Lenhart, Amanda, and Susannah Fox. Bloggers: A Portrait of the Internet’s New Storytellers. Washington: PEW Internet and American Life Project, 2006. Lorde, Audre. The Cancer Journals. San Francisco: Spinsters Ink, 1980.Lovink, Geert. Zero Comments: Blogging and Critical Internet Culture. London: Routledge, 2008. McCullagh, Karen. “Blogging: Self Presentation and Privacy.” Information and Communications Technology Law 17.1 (2008): 3-23. McQuire, Scott. “From Glass Architecture to Big Brother: Scenes from a Cultural History of Transparency.” Cultural Studies Review 9.1 (2003): 103-123.Orgad, Shani. Storytelling Online: Talking Breast Cancer on the Internet. New York: Peter Lang, 2005. Pitts, Victoria. “Illness and Internet Empowerment: Writing and Reading Breast Cancer in Cyberspace.” Health 8.1 (2004): 33-59.Rothenberg, Matthew. “Weblogs, Metadata, and the Semantic Web”, paper presented at the Association of Internet Researchers conference, Toronto, 16 Oct. 2003. ‹http://aoir.org/members/papers42/rothenberg_aoir.pdf›.Singer, Jessica, and George H.S. Singer. “Writing as Physical and Emotional Healing: Findings from Clinical Research.” Handbook of Research on Writing: History, Society, School, Individual, Text. Ed. Charles Bazerman. New York: Lawrence Erlbaum Associates, 2008: 485-498. Sontag, Susan. Illness as Metaphor; And, AIDS and Its Metaphors. London: Penguin, 1991. Trigg, Stephanie. “Life Lessons.” Sunday Age, 10 June 2007. Turkle, Sherry. Life on the Screen: Identity in the Age of the Internet. New York: Simon and Schuster, 1995. Wenger, Etienne. Communities of Practice: Learning, Meaning and Identity. Cambridge: Cambridge University Press, 1998. Wuthnow, Robert. Communities of Discourse: Ideology and Social Structure in the Reformation, the Enlightenment, and European Socialism. Cambridge, MA: Harvard University Press, 1989.BlogsBrainhell. ‹http://brainhell.blogspot.com/›. rdavisjr. Prostate Cancer Journal. ‹http://pcjournal-rrd.blogspot.com/›. Sievers, Leroy. My Cancer. ‹http://www.npr.org/blogs/mycancer/›. Tom’s Road to Recovery. ‹http://tomsrecovery.blog.com/›. Trigg, Stephanie. Humanities Researcher. ‹http://stephanietrigg.blogspot.com/›.

“The cop in our head represses us better than any police force. Through generations of conditioning, the system has created people who have a very hard time coming together to create resistance.” – Seth Tobocman, War in the Neighborhood (1999) Even when creators of autobiographically-based comics claim to depict real events, their works nonetheless inspire confrontations as a result of ideological contestations which position them, on the one hand, as popular culture, and, on the other hand, as potentially subversive material for adults. In Seth Tobocman’s War in the Neighborhood (1999), the street politics in which Tobocman took part extends the graphic novel narrative to address personal experiences as seen through a social lens both political and fragmented by the politics of relationships. Unlike Art Spiegelman’s Maus (1986, 1991), War in the Neighborhood is situated locally and with broader frames of reference, but, like Maus, resonates globally across cultures. Because Tobocman figures the street as the primary site of struggle, John Street’s historiographically-oriented paper, “Political Culture – From Civic Culture to Mass Culture”, presents a framework for understanding not that symbols determine action, any more than material or other objective conditions do, but rather that there is a constant process of interpretation and reinterpretation which is important to the way actors view their predicament and formulate their intentions. (107-108) Though Street’s main focus is on the politicization of choices involving institutional structures, his observation offers a useful context to examining Tobocman’s memoir of protest in New York City. Tobocman’s identity as an artist, however, leads him to caution his readers: Yes, it [War in the Neighborhood] is based on real situations and events, just as a landscape by Van Gogh may be based on a real landscape. But we would not hire Van Gogh as a surveyor on the basis of those paintings. (From the “Disclaimer” on the copyright page.) This speaks to the reality that all art, no matter how innocuously expressed, reflect interpretations refracted from the artists’ angles. It also calls attention to the individual artist’s intent. For Tobocman, “I ask that these stories be judged not on how accurately they depict particular events, but on what they contain of the human spirit” (from the “Disclaimer” on the copyright page). War in the Neighborhood, drawn in what appears to be pencil and marker, alternates primarily between solidly-inked black generic shapes placed against predominantly white backgrounds (chapters 1-3, 5, 7-9, and 11) and depth-focused drawing-quality images framed against mostly black backgrounds (chapters 4 and 6); chapter 10 represents an anomaly because it features typewritten text and photographs that reify the legitimacy of the events portrayed even when “intended to be a work of art” (from the “Disclaimer” on the copyright page). According to Luc Sante’s “Introduction”, “the high-contrast images here are descended from the graphic vocabulary of Masereel and Lynn Ward, an efficient and effective means of representing the war of body and soul” (n.p.). This is especially evident in the last page of War in the Neighborhood, where Tobocman bleeds himself through four panels, the left side of his body dressed in skin with black spaces for bone and the right side of his body skeletonized against his black frame (panels 5-6: 328). For Tobocman, “the war of body and soul” reifies the struggle against the state, through which its representatives define people as capital rather than as members of a social contract. Before the second chapter, however, Tobocman introduces New York squatter, philosopher and teacher Raphael Bueno’s tepee-embedded white-texted poem, “‘Nine-Tenths of the Law’” (29). Bueno’s words eloquently express the heart behind War in the Neighborhood, but could easily be dismissed because they take up only one page. The poem’s position is significant, however. It reflects the struggles between agency and class, between power and oppression, and between capitalism and egalitarianism. Tobocman includes a similar white-texted tepee in Chapter 4, though the words are not justified and the spacing between the words and the edges of the tepee are larger. In this chapter, Tobocman focuses on the increasing media attention given to the Thompson Square Park homeless, who first organize as “the Homeless Clients Advisory Board” (panel 7: 86). The white-texted tepee reads: They [Tent City members] got along well with the Chinese students, participated in free China rallys, learned to say ‘Down with Deng Xiao ping’ in Chinese. It was becoming clear to Tent City that their homelessness meant some thing on a world stage. (panel 6: 103) The OED Online cites 1973 as the first use of gentrification, which appeared in “Times 26 Sept. 19/3.” It also lists uses in 1977, 1982 and 1985. While the examples provided point to business-specific interests associated with gentrification, it is now defined as “the process by which an (urban) area is rendered middle-class.” While gentrification, thus, infers the displacement of minority members for the benefits of white privilege, it is also complicated by issues of eminent domain. For the disenfranchised who lack access to TV, radio and other venues of public expression (i.e., billboards), “taking it to the streets” means trafficking ideas, grievances and/or evangelisms. In places like NYC, the nexus for civic engagement is the street. The main thrust of Tobocman’s War in the Neighborhood, however, centers on the relationships between (1) the squatters, against whom Reagan-era economics destabilized, (2) the police, whose roles changed as local policies shifted to accommodate urban planning, (3) the politicians, who “began to campaign to destroy innercity neighborhoods” (20), and (4) the media, which served elitist interests. By chapter 3, Tobocman intrudes himself into the narrative to personalize the story of squatters and their resistance of an agenda that worked to exclude them. In chapter 4, he intersects the interests of squatters with the homeless. With chapter 5, Tobocman, already involved, becomes a squatter, too; however, he also maintains his apartment, making him both an insider and an outsider. The meta-discourses include feminism, sexism and racism, entwined concepts usually expressed in opposition. Fran is a feminist who demands not only equality for women, but also respect. Most of the men share traditional values of manhood. Racism, while recognized at a societal level, creeps into the choices concerning the dismissal or acceptance of blacks and whites at ABC House on 13th Street, where Tobocman resided. As if speaking to an interviewer, a black woman explains, as a white male, his humanity had a full range of expression. But to be a black person and still having that full range of expression, you were punished for it. ... It was very clear that there were two ways of handling people who were brought to the building. (full-page panel: 259) Above the right side of her head is a yin yang symbol, whose pattern contrasts with the woman’s face, which also shows shading on the right side. The yin yang represents equanimity between two seemingly opposing forces, yet they cannot exist without the other; it means harmony, but also relation. This suggests balance, as well as a shared resistance for which both sides of the yin yang maintain their identities while assuming community within the other. However, as Luc Sante explains in his “Introduction” to War in the Neighborhood, the word “community” gets thrown around with such abandon these days it’s difficult to remember that it has ever meant anything other than a cluster of lobbyists. ... A community is in actuality a bunch of people whose intimate lives rub against one another’s on a daily basis, who possess a common purpose not unmarred by conflict of all sizes, who are thus forced to negotiate their way across every substantial decision. (n.p., italics added) The homeless organized among themselves to secure spaces like Tent House. The anarchists lobbied the law to protect their squats. The residents of ABC House created rules to govern their behaviors toward each other. In all these cases, they eventually found dissent among themselves. Turning to a sequence on the mayoral transition from Koch to Dinkins, Tobocman likens “this inauguration day” as a wedding “to join this man: David Dinkins…”, “with the governmental, business and real estate interests of New York City” (panel 1: 215). Similarly, ABC House, borrowing from the previous, tried to join with the homeless, squatters and activist organizations, but, as many lobbyists vying for the same privilege, contestations within and outside ABC splintered the goal of unification. Yet the street remains the focal point of War in the Neighborhood. Here, protests and confrontations with the police, who acted as intermediary agents for the politicians, make the L.E.S. (Lower East Side) a site of struggle where ordinary activities lead to war. Though the word war might otherwise seem like an exaggeration, Tobocman’s inclusion of a rarely seen masked figure says otherwise. This “t-shirt”-hooded (panel 1: 132) wo/man, one of “the gargoyles, the defenders of the buildings” (panel 3: 132), first appears in panel 3 on page 81 as part of this sequence: 319 E. 8th Street is now a vacant lot. (panel 12: 80) 319 taught the squatters to lock their doors, (panel 1: 81) always keep a fire extinguisher handy, (panel 2: 81) to stay up nights watching for the arsonist. (panel 3: 81) Never to trust courts cops, politicians (panel 4: 81) Recognize a state of war! (panel 5: 81) He or she reappears again on pages 132 and 325. In Fernando Calzadilla’s “Performing the Political: Encapuchados in Venezuela”, the same masked figures can be seen in the photographs included with his article. “Encapuchados,” translates Calzadilla, “means ‘hooded ones,’ so named because of the way the demonstrators wrap their T-shirts around their faces so only their eyes show, making it impossible for authorities to identify them” (105). While the Encapuchados are not the only group to dress as such, Tobocman’s reference to that style of dress in War in the Neighborhood points to the dynamics of transculturation and the influence of student movements on the local scene. Student movements, too, have traditionally used the street to challenge authority and to disrupt its market economy. More important, as Di Wang argues in his book Street Culture in Chengdu: Public Space, Urban Commoners, and Local Politics, 1870-1930, in the process of social transformation, street culture was not only the basis for commoners’ shared identity but also a weapon through which they simultaneously resisted the invasion of elite culture and adapted to its new social, economic, and political structures. (247) While focusing on the “transformation that resulted in the reconstruction of urban public space, re-creation of people’s public roles, and re-definition of the relationship among ordinary people, local elites and the state” (2), Wang looks at street culture much more broadly than Tobocman. Though Wang also connects the 1911 Revolution as a response to ethnic divisions, he examines in greater detail the everyday conflicts concerning local identities, prostitutes in a period marked by increasing feminisms, beggars who organized for services and food, and the role of tea houses as loci of contested meanings. Political organization, too, assumes a key role in his text. Similarly to Wang, what Tobocman addresses in War in the Neighborhood is the voice of the subaltern, whose street culture is marked by both social and economic dimensions. Like the poor in New York City, the squatters in Iran, according to Asef Bayat in his article “Un-Civil Society: The Politics of the ‘Informal People’”, “between 1976 and the early 1990s” (53) “got together and demanded electricity and running water: when they were refused or encountered delays, they resorted to do-it-yourself mechanisms of acquiring them illegally” (54). The men and women in Tobocman’s War in the Neighborhood, in contrast, faced barricaded lines of policemen on the streets, who struggled to keep them from getting into their squats, and also resorted to drastic measures to keep their buildings from being destroyed after the court system failed them. Should one question the events in Tobocman’s comics, however, he or she would need to go no further than Hans Pruijt’s article, “Is the Institutionalization of Urban Movements Inevitable? A Comparison of the Opportunities for Sustained Squatting in New York City and Amsterdam”: In the history of organized squatting on the Lower East Side, squatters of nine buildings or clusters of buildings took action to avert threat of eviction. Some of the tactics in the repertoire were: Legal action; Street protest or lock-down action targeting a (non-profit) property developer; Disruption of meetings; Non-violent resistance (e.g. placing oneself in the way of a demolition ball, lining up in front of the building); Fortification of the building(s); Building barricades in the street; Throwing substances at policemen approaching the building; Re-squatting the building after eviction. (149) The last chapter in Tobocman’s War in the Neighborhood, chapter 11: “Conclusion,” not only plays on the yin and yang concept with “War in the Neighborhood” in large print spanning two panels, with “War in the” in white text against a black background and “Neighborhood” in black text against a white background (panels 3-4: 322), but it also shows concretely how our wars against each other break us apart rather than allow us to move forward to share in the social contract. The street, thus, assumes a meta-narrative of its own: as a symbol of the pathways that can lead us in many directions, but through which we as “the people united” (full-page panel: 28) can forge a common path so that all of us benefit, not just the elites. Beyond that, Tobocman’s graphic novel travels through a world of activism and around the encounters of dramas between people with different goals and relationships to themselves. Part autobiography, part documentary and part commentary, his graphic novel collection of his comics takes the streets and turns them into a site for struggle and dislocation to ask at the end, “How else could we come to know each other?” (panel 6: 328). Tobocman also shapes responses to the text that mirror the travesty of protest, which brings discord to a world that still privileges order over chaos. Through this reconceptualization of a past that still lingers in the present, War in the Neighborhood demands a response from those who would choose “to take up the struggle against oppression” (panel 3: 328). In our turn, we need to recognize that the divisions between us are shards of the same glass. References Bayat, Asef. “Un-Civil Society: The Politics of the “Informal People.’” Third World Quarterly 18.1 (1997): 53-72. Calzadilla, Fernando. “Performing the Political: Encapuchados in Venezuela.” The Drama Review 46.4 (Winter 2002): 104-125. “Gentrification.” OED Online. 2nd Ed. (1989). http://0-dictionary.oed.com.csulib.ctstateu.edu/ cgi/entry/50093797?single=1&query_type=word&queryword=gentrification &first=1&max_to_show=10>. 25 Apr. 2006. Pruijt, Hans. “Is the Institutionalization of Urban Movements Inevitable? A Comparison of the Opportunities for Sustained Squatting in New York and Amsterdam.” International Journal of Urban and Regional Research 27.1 (Mar. 2003): 133-157. Street, John. “Political Culture – From Civic to Mass Culture.” British Journal of Political Science 24.1 (Jan. 1994): 95-113. Toboman, Seth. War in the Neighborhood (chapter 1 originally published in Squatter Comics, no. 2 (Photo Reference provided by City Limits, Lower East Side Anti-displacement Center, Alan Kronstadt, and Lori Rizzo; Book References: Low Life, by Luc Sante, Palante (the story of the Young Lords Party), Squatters Handbook, Squatting: The Real Story, and Sweat Equity Urban Homesteading; Poem, “‘Nine-Tenths of the Law,’” by Raphael Bueno); chapter 2 (Inkers: Samantha Berger, Lasante Holland, Becky Minnich, Ursula Ostien, Barbara Lee, and Seth Tobocman; Photo Reference: the daily papers, John Penley, Barbara Lee, Paul Kniesel, Andrew Grossman, Peter LeVasseur, Betsy Herzog, William Comfort, and Johannes Kroemer; Page 81: Assistant Inker: Peter Kuper, Assistant Letterer: Sabrina Jones and Lisa Barnstone, Photo Reference: Paul Garin, John Penley, and Myron of E.13th St); chapter 3 originally published in Heavy Metal 15, no. 11 (Inkers: Peter Kuper and Seth Tobocman; Letterers: Sabrina Jones, Lisa Barnstone, and Seth Tobocman; Photo Reference: Paul Garin, John Penley, Myron of 13th Street, and Mitch Corber); chapter 4 originally published in World War 3 Illustrated, no. 21 (Photo Reference: John Penley, Andrew Lichtenstein, The Shadow, Impact Visuals, Paper Tiger TV, and Takeover; Journalistic Reference: Sarah Ferguson); chapter 5 originally published in World War 3 Illustrated, no. 13, and reprinted in World War 3 Illustrated Confrontational Comics, published by Four Walls Eight Windows (Photo Reference: John Penley and Chris Flash (The Shadow); chapter 6 (Photo reference: Clayton Patterson (primary), John Penley, Paul Garin, Andrew Lichtenstein, David Sorcher, Shadow Press, Impact Visuals, Marianne Goldschneider, Mike Scott, Mitch Corber, Anton Vandalen, Paul Kniesel, Chris Flash (Shadow Press), and Fran Luck); chapter 7 (Photo Reference: Sarah Teitler, Marianne Goldschneider, Clayton Patterson, Andrew Lichtenstein, David Sorcher, John Penley, Paul Kniesel, Barbara Lee, Susan Goodrich, Sarah Hogarth, Steve Ashmore, Survival Without Rent, and Bjorg; Inkers: Ursula Ostien, Barbara Lee, Samantha Berger, Becky Minnich, and Seth Tobocman); chapter 8 originally published in World War 3 Illustrated, no. 15 (Inkers: Laird Ogden and Seth Tobocman; Photo Reference: Paul Garin, Clayton Patterson, Paper Tiger TV, Shadow Press, Barbara Lee, John Penley, and Jack Dawkins; Collaboration on Last Page: Seth Tobocman, Zenzele Browne, and Barbara Lee); chapter 9 originally published in Real Girl (Photo Reference: Sarah Teitler and Barbara Lee); chapter 10 (Photos: John Penley, Chris Egan, and Scott Seabolt); chapter 11: “Conclusion” (Inkers: Barbara Lee, Laird Ogden, Samantha Berger, and Seth Tobocman; Photo Reference: Anton Vandalen). Intro. by Luc Sante. Computer Work: Eric Goldhagen and Ben Meyers. Text Page Design: Jim Fleming. Continuous Tone Prints and Stats Shot at Kenfield Studio: Richard Darling. Brooklyn, NY: Autonomedia, 1999. Wang, Di. Street Culture in Chengdu: Public Space, Urban Commoners, and Local Politics, 1870-1930. Stanford, CA: Stanford UP, 2003. Citation reference for this article MLA Style Raney, Vanessa. "Where Ordinary Activities Lead to War: Street Politics in Seth Tobocman’s War in the Neighborhood." M/C Journal 9.3 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0607/01-raney.php>. APA Style Raney, V. (Jul. 2006) "Where Ordinary Activities Lead to War: Street Politics in Seth Tobocman’s War in the Neighborhood," M/C Journal, 9(3). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0607/01-raney.php>.

Culture: Its Many Meanings One of the problems we encounter in dealing with culture is that there are so many different meanings and definitions attached to the term. We think of culture two ways: first, in terms of aesthetic matters (relative to thearts) and second, as a concept used by anthropologists to describe the way people live. There are, so I understand, something like a hundred different definitions of culture used by anthropologists. The Origins of the Term "Culture" The word 'culture' comes from the Latin cultus, which means 'care', and from the French colere which means 'to till' as in 'till the ground'. There are many terms that stem from the word culture. For example, there is the term 'cult' which suggests some kind of a religious organisation. We are continually amazed at the power cults have to shape our behavior, to brainwash us -- to turn intelligent and educated people into fanatics. Here we are dealing with the power of charismatic personalities and of groups over individuals. If cults can exercise enormous power over individuals and groups of people, can't we say that cultures also can do the same thing, though usually not to the same extreme degree? There is also the term 'cultivated', which means something that has been grown or, in the realm of aesthetics and the arts, sophisticated taste. Just as plants only exist because they are cared for by some cultivator, over a period of time, so people's taste and cultivation only are developed by education and training. It takes time to develop a refined sensibility, to become discriminating, to appreciate texts that are difficult and complex and not immediately satisfying. Bacteriologists also speak about cultures, but they use the term to describe the bacteria that are grown in Petri dishes if they are given suitable media (sources of nourishment). This matter of bacteria growing in media may be an important metaphor for us: just as bacteria need media to grow into culture, so do human beings need cultures to survive and develop themselves. We don't do it all on our own. In the chart below I show the interesting parallels: Bacteriology Bacteria Grow in media Form cultures Sociology/Anthropology Humans Affected by media Form cultures Of course we are much more complex than bacteria; in truth, each of us form a kind of medium for countless kinds of bacteria that inhabit our mouths and various other parts of our bodies. Bacteriology involves the cultivation and study of micro-organisms (bacteria) in prepared nutrients and the study of media (and what is often called cultural criticism nowadays) involves the study of individuals and groups in a predominantly, but not completely, mass-mediated culture. Not all culture is mass mediated. An Anthropological Definition of Culture Let me offer a typical anthropological definition of culture. It is by Henry Pratt Fairchild and appeared in his Dictionary of Sociology and Related Sciences: A collective name for all behavior patterns socially acquired and transmitted by means of symbols; hence a name for all the distinctive achievements of human groups, including not only such items as language, tool-making, industry, art, science, law, government, morals and religion, but also the material instruments or artifacts in which cultural achievements are embodied and by which intellectual cultural features are given practical effect, such as buildings, tools, machines, communication devices, art objects, etc. (80) Let's consider some of the topics Fairchild mentions. Behavior Patterns. We are talking about codes and patterns of behavior here that are found in groups of people. Socially Acquired. We are taught these behavior patterns as we grow up in a family in some geographical location and are profoundly affected by the family we are born into, its religion, and all kinds of other matters. Socially Acquired. We are taught these behavior patterns as we grow up in a family in some geographical location and are profoundly affected by the family we are born into, its religion, and all kinds of other matters. The Distinctive Achievements of Human Groups. It is in groups that we become human and become enculturated or acculturated (two words for the same thing, for all practical purposes). We have our own distinctive natures but we are also part of society. Artifacts in which cultural achievements are embodied. The artifacts we are talking about here are the popular culture texts carried in the various media and other non-mediated aspects of popular culture (or not directly mediated) such as fashions in clothes, food preferences, artifacts (what anthropologists call 'material culture'), language use, sexual practices and related matters. We know that a great deal of our popular culture, while not carried by the media, is nevertheless profoundly affected by it. We can see, then, that culture is a very complicated phenomenon that plays some kind of a role in shaping our consciousness and our behavior. You may think you are immune from the impact of the media and popular culture, but that is a delusion that is generated, I would suggest, by the media. We think we are not affected in significant ways by the media and popular culture (sometimes called mass mediated culture) and culture in general but we are wrong. Culture affects us but it doesn't necessarily determine every act we do; though some scholars, who believe the media are very powerful, might argue with this point. Falling Off the Map: What Travel Literature Reveals For a graphic example of how cultures differ, let me offer two quotations from the travel writer Pico Iyer from his book Falling Off the Map: Some Lonely Places of the World, a collection of travel articles about seldom-visited places (by American travelers, at least). Saigon: the only word for Saigon is 'wild'. One evening I counted more than a hundred two-wheel vehicles racing past me in the space of sixty seconds, speeding around the jam-packed streets as if on some crazy merry-go-round, a mad carnival without a ringmaster; I walked into a dance club and found myself in the midst of a crowded floor of hip gay boys in sleeveless T-shirts doing the latest moves to David Byrne; outside again, I was back inside the generic Asian swirl, walking through tunnels of whispers and hisses. "You want boom-boom?" "Souvenir for you dah-ling?" "Why you not take special massage?" Shortly before midnight, the taxi girls stream out of their nightclubs in their party dresses and park their scooters outside the hotels along 'Simultaneous Uprising' Street. (134-5) Compare his description of Saigon with his portrait of Reykjavik, Iceland, equally as fascinating and fantastic but considerably different from Saigon. Even 'civilization' seems to offer no purchase for the mind here: nothing quite makes sense. Iceland boasts the largest number of poets, presses, and readers per capita in the world: Reykjavik, a town smaller than Rancho Cucamonga, California, has five daily newspapers, and to match the literary production of Iceland, the U.S. would have to publish twelve hundred new books a day. Iceland has the oldest living language in Europe; its people read the medieval sagas as if they were tomorrow's newspaper and all new concepts, such as 'radio' and 'telephone', are given poetical medieval equivalents. Roughly three eldest children in every four are illegitimate here, and because every son of Kristjan is called Kristjansson, and every daughter Kristjansdottir, mothers always have different surnames from their children (and in any case are rarely living with the fathers). The first day I ever spent in 'Surprise City' (as Reykjavik is called), I found golden-haired princesses and sword-wielding knights enacting fairy-tale sagas on the main bridge in the capital. (67-8) We can see that there are considerable differences between Saigon and Reykjavik, though just as (to be fair) Iyer points out the incredible differences between cities in Vietnam, such as the differences between Saigon and Hue. Iyer's description of the landscape of Iceland may help explain the national character of the Icelanders. As he writes: I knew, before I visited, a little about the epidemic oddness of the place: there was no beer in Iceland in 1987, and no television on Thursdays; there were almost no trees, and no vegetables. Iceland is an ungodly wasteland of volcanoes and tundra and Geysir, the mother of geysirs, a country so lunar that NASA astronauts did their training there. (67) There has to be some influence of this remarkable landscape and climate, of the Iceland geographical location, the amount of light and darkness in which people live, upon the people who live there and there has to be some influence of the jungle and the climate of Vietnam on its people. What we become is, it seems to me, due to some curious combination of factors involving our natures (that is, the hard-wired elements of our personalities) and our cultures, with the matter of chance playing a big role as well. What we become is, it seems to me, due to some curious combination of factors involving our natures (that is, the hard-wired elements of our personalities) and our cultures, with the matter of chance playing a big role as well. References Fairchild, Henry Pratt. Dictionary of Sociology and Related Sciences. Totawa, NY: Littlefield, Adams & Co., 1967. Iyer, Pico. Falling Off the Map: Some Lonely Places of the World. New York: Alfred A. Knopf, 1993. Citation reference for this article MLA style: Arthur Asa Berger. "The Meanings of Culture." M/C: A Journal of Media and Culture 3.2 (2000). [your date of access] <http://www.api-network.com/mc/0005/meaning.php>. Chicago style: Arthur Asa Berger, "The Meanings of Culture," M/C: A Journal of Media and Culture 3, no. 2 (2000), <http://www.api-network.com/mc/0005/meanings.php> ([your date of access]). APA style: Arthur Asa Berger. (2000) The meanings of culture. M/C: A Journal of Media and Culture 3(2). <http://www.api-network.com/mc/0005/meaning.php> ([your date of access]).

Introduction There is much to be said about house and home and about our media’s role in defining, enabling, as well as undermining it. […] For we can no longer think about home, any longer than we can live at home, without our media. (Silverstone, “Why Study the Media” 88) For lesbians, inhabiting the queer slant may be a matter of everyday negotiation. This is not about the romance of being off line or the joy of radical politics (though it can be), but rather the everyday work of dealing with the perception of others, with the “straightening devices” and the violence that might follow when such perceptions congeal into social forms. (Ahmed 107) Picture this. Once or twice a week a small, black, portable TV set goes on a journey; down from the lofty heights of the top shelf of the built in storage cupboard into the far corner of the living room. A few hours later, it is being stuffed back into the closet. Not far away across town, another small TV set sits firmly in the corner of a living room. Yet, it remains inanimate for days on end. What do you see? The techno-stories conveyed in this paper are presented through – and anchored to – the idea of the cultural biography of things (Kopytoff 1986), revealing how objects (more specifically media technologies) produce and become part of an articulation of particular and conflicting moral economies of households (Silverstone, “Domesticating Domestication”; Silverstone, Hirsch and Morley, “Information and Communication”; Green). In this context, the concept of the domestication of ICTs has been widely applied in Media Studies during the 1990s and, more recently, been updated to account for the changes in technology, household composition, media regulation, and in fact the dislocation of domesticity itself (Berker, Hartmann, Punie and Ward). Remarkable as these mainstream techno-stories are in their elucidation of contemporary techno-practices, what is still absent is the consideration of how gender and sexuality intersect and are being done through ICT consumption at home, work and during leisure practices in alternative or queer households and families. Do lesbians ‘make’ house and home and in what ways are media and ICTs implicated in the everyday work of queer home-making strategies? As writings on queer subjects and cyberspace have proliferated in recent years, we can now follow a move to contextualize queer virtualities across on and offline experiences, mapping ‘complex geographies of un/belonging’ (Bryson, MacIntosh, Jordan and Lin) and a return to consider online media as part of a bigger ICT package that constitutes our queer everyday life-worlds (Karl). At the same time, fresh perspectives are now being developed with regards to the reconfiguration of domestic values by gay men and lesbians, demonstrating the ongoing processes of probing and negotiation of ‘home’ and the questioning of domesticity itself (Gorman-Murray). By aligning ideas and concepts developed by media theorists in the field of media domestication and consumption as well as (sexual) geographers, this paper makes a contribution towards our understanding of a queer sense of home and domesticity through the technological and more specifically television. It is based on two case studies, part of a larger longitudinal ethnographic study of women-centred households in Brighton, UK. Gill Valentine has identified the home and workplaces as spaces, which are encoded as heterosexual. Sexual identities are being constrained by ‘regulatory regimes’, promoting the normalcy of heterosexuality (4). By recounting the techno-stories of lesbian women, we can re-examine notions of the home as a stable, safe, given entity; the home as a particular feminine sphere as well as the leaky boundaries between public and private. As media and ICTs are also part of a (hetero)sexual economy where they, in their materiality as well as textual significance become markers of sexual difference, we can to a certain extent perceive them as ‘straightening devices’, to borrow a phrase from Sara Ahmed. Here, we will find the articulation of a host of struggles to ‘fight the norms’, but not necessarily ‘step outside the system completely, full-time’ (Ben, personal interview [all the names of the interviewees have been changed to protect their anonymity]). In this sense, the struggle is not only to counter perceived heterosexual home-making and techno-practices, but also to question what kinds of practices to adopt and repeat as ‘fitting in’ mechanism. Significantly, these practices leave neither ‘homonormative’ nor ‘heteronormative’ imaginaries untouched and remind us that: In the case of sexual orientation, it is not simply that we have it. To become straight means that we not only have to turn towards the objects that are given to us by heterosexual culture, but also that we must “turn away” from objects that take us off this line. (Ahmed 21) In this sense then, we are all part of drawing and re-drawing the lines of belonging and un-belonging within the confines of a less than equal power-economy. Locating Dys-Location – Is There a Lesbian in the Home? In his effort to re-situate the perspective of media domestication in the 21st century, David Morley points us to ‘the process of the technologically mediated dislocation of domesticity itself’ (“What’s ‘home’” 22). He argues that ‘under the impact of new technologies and global cultural flows, the home nowadays is not so much a local, particular “self-enclosed” space, but rather, as Zygmunt Bauman puts it, more and more a “phantasmagoric” place, as electronic means of communication allow the radical intrusion of what he calls the “realm of the far” (traditionally, the realm of the strange and potentially troubling) into the “realm of the near” (the traditional “safe space” of ontological security) (23). The juxtaposition of home as a safe, ‘given’ place of ontological security vis a vis the more virtual and mediated realm of the far and potentially intrusive is itself called into question, if we re-consider the concepts of home and (dis)location in the light of lesbian geographies and ‘the production and regulation of heterosexual space’ (Valentine 1). The dislocation of home and domesticity experienced through consumption of (mobile) media technologies has always already been under-written by the potential feeling of dys-location and ‘trouble’ by lesbians on the grounds of sexual orientation. The lesbian experience disrupts the traditionally modern and notably western ideal of home as a safe haven and refuge by making visible the leaky boundaries between private seclusion and public surveillance, as much as it may (re)invest in the production of ideas and ideals of home-making and domesticity. This is illustrated for example by the way in which the heterosexuality of a parental home ‘can inscribe the lesbian body by restricting the performative aspects of a lesbian identity’, which may be subverted by covert acts of resistance (Johnston and Valentine 111; Elwood) as well as by the potentially greater freedoms of lesbian identity within a ‘lesbian home’, which may nevertheless come under scrutiny and ‘surveillance of others, especially close family, friends and neighbours’ (112). Nevertheless, more recently it has also been demonstrated how even overarching structures of familial heteronormativity are opportune to fissures and thereby queered, as Andrew Gorman-Murray illustrates in his study of Australian gay, lesbian and bisexual youth in supportive family homes. So what is, or rather, what can constitute a ‘lesbian home’ and how is it negotiated through everyday techno-practices? In and Out of the Closet – The Straight-Speaking ‘Telly’ As places go, the city of Brighton and Hove in the south-east of England fetches the prize for the highest ratio of LGBT people amongst its population in the UK, sitting at about 15%. In this sense, the home-making stories to which I will refer, of a white, lesbian single mother in her early 40s from a working-class background and a white lesbian/dyke couple in their 30s (from middle-/working-class backgrounds), are already engendered in the sense that Brighton (to them) represented in part a kind of ‘home-coming’ in itself. Helen and Ben, a lesbian butch-femme couple (‘when it takes our fancy’, Helen), had recently bought a terraced 1930s three-bedroom house with a sizeable garden in a soon to be up and coming residential area of Brighton. The neighbours are a mix of elderly, long-standing residents and ‘hetero’ families, or ‘breeders’, as Ben sometimes referred to them. Although they had lived together before, the new house constituted their first purchase together. This was significant especially for Helen, as it made their lives more ‘equal’ in terms of what goes where and the input on the overall interior decoration. Ben had shifted from London to Brighton a few years previously for a ‘quieter life’, but wished to remain connected to a queer community. Helen had made the move to Brighton from Germany – to study and enjoy the queer feel, and never left. Both full-time professionals, Helen worked in the publishing industry and Ben as a social worker. Already considering Brighton their ‘home’ town, the house purchase itself constituted another home-making challenge: as a lesbian/dyke couple on equal footing they were prepared to accept to live in a pre-dominantly straight neighbourhood, as it afforded them more space for money compared to the more visibly gay male living areas in the centre of town. The relative invisibility of queer women (and their neighbourhoods) compared to queer men in Brighton may, as it does elsewhere, be connected to issues of safety (Elwood) as well as the comparative lack of financial capacity (Bell and Valentine). Walking up to this house on the first night of my stay with them, I am struck by just how inconspicuous it appears – one of many in a long street, up a steep hill: ‘Most housing in contemporary western societies is “designed, built, financed and intended for nuclear families”’ (Bell in Bell and Valentine 7). I cannot help but think – more as a reflection on myself than of what I am about to experience – is this it? Is this the ‘domesticated lesbian’? What I see appears ‘familiar’, ‘tamed’, re-tracing the straight lines of heterosexual culture. Helen opens the door and orders me directly into the kitchen. She says ‘Ben is in the living room, watching television… Ben takes great pleasure in watching “You’ve been Framed”’. (Fieldnotes) In this context, it is appropriate to focus on the television and its place within their home-making strategies. Television, in its historical and symbolic significance, could be deemed the technological co-terminus to the ideal nuclear family home. Lynn Spigel has shown through her examination of the cultural history of TV’s formative years in post World War America how television became central to providing representations of family life, but also how the technology itself, as an object, informed material and symbolic transformations within the domestic sphere and beyond. Over the past fifty years as Morley points out, the TV has moved from its fixed place in the living room to become more personalised and encroach on other spaces in house and home and has now, in fact, re-entered the public realm (see airports and shopping malls) where it originated. At present, ‘the home itself can seen as having become … the “last vehicle”, where comfort, safety and stability can happily coexist with the possibility of instantaneous digitalised “flight” to elsewhere – and the instantaneous importation of desired elements of the “elsewhere” into the home’ (Morley, “Media, Modernity” 200). Importantly, as Morley confirms, today’s high-tech discourse is often still framed by a nostalgic vision of ‘family values’. There was only one TV set in Helen and Ben’s house: a black plastic cube with a 16” screen. It was decidedly ‘unglamorous’ as Helen pointed out. During the first round of ‘home-making’ efforts, it had found its way into a corner in the front room, with the sofa and armchair arranged in viewing distance. It was a very ‘traditional’ living room set-up. During my weeklong stay and for some weeks after, it was mostly Ben on her own ‘watching the telly’ in the early evenings ‘vegging out’ after work. Helen, meanwhile, was in the kitchen with the radio on or a CD playing, or in her ‘ICT free’ bedroom, reading. Then, suddenly, the TV had disappeared. During one of our ‘long conversations’ (Silverstone, Hirsch and Morley, “Listening”, 204) it transpired that it was now housed for most of the time on the top shelf of a storage cupboard and only ‘allowed out’ ever so often. As a material object, it had easily found its place as a small, but nevertheless quite central feature in the living room. Imbued with the cultural memory of their parents’ and that of many other living rooms, it was ‘tempting’ and easy for them to ‘accept’ it as part of a setting up home as a couple. Ben explained that they both fell into a habit, an everyday routine, to sit around it. However, settling into their new home with too much ‘ease’, they began to question their techno-practice around the TV. For Helen in particular, the aesthetics of the TV set did not fit in with her plans to re-decorate the house loosely in art deco style, tethered to her femme identity. They did not envisage creating a home that would potentially signal that a family with 2.4 children lives here. ‘The “normality” of [working] 9-5’ (Ben), was sufficient. Establishing a perceived visual difference in their living room, partly by removing the TV set, Helen and Ben aimed to ‘draw a line’ around their home and private sphere vis a vis the rest of the street and, metaphorically speaking, the straight world. The boundaries between the public and private are nevertheless porous, as it is exactly that the public perceptions of a mostly private, domesticated media technology prevent Helen and Ben from feeling entirely comfortable in its presence. It was not only the TV set’s symbolic function as a material object that made them restrict and consciously control the presence of the TV in their home space. One of Helen and Ben’s concerns in this context was that TV, as a broadcast medium, is utterly ‘conservative’ in its content and as such, very much ‘straight speaking’. To paraphrase Helen – you can only read so much between the lines and shout at the telly, it can get tiring. ‘I like watching nature programmes, but they somehow manage even here to make it sound like a hetero narrative’. Ben: ‘yeah – mind the lesbian swans’. The employment of the VCR and renting movies helps them to partly re-dress this perceived imbalance. At the same time, TV’s ‘water-cooler’ effect helps them to stay in tune with what is going on around them and enables them, for example, to participate and intervene in conversations at work. In this sense, watching TV can turn into home-work, which affords a kind of entry ticket to shared life-worlds outside the home and as such can be controlled, but not necessarily abandoned altogether. TV as a ‘straightening device’ may afford the (dis)comfort of a sense of participation in mainstream discourses and the (dis)comfort of serving as a reminder of difference at the same time. ‘It just sits there … apart from Sundays’ – and when the girls come round… Single-parent households are on the rise in the US (Russo Lemor) as well as in the UK. However, the attention given to single-parent families so far focuses pre-dominantly on single mothers and fathers after separation or divorce from a heterosexual marriage (Russo Lemor; Silverstone, “Beneath the Bottom Line”). As (queer) sociologists have began to map the field of ‘families of choice and other life experiments’ (Weeks, Heaphy and Donovan), a more concerted effort to bring together the literatures and to shed more light on the queer techno-practices of alternative families seems necessary. Liz and her young son Tim had moved to Brighton from London. As a lesbian working single mother, she raises Tim pre-dominantly on her own: ‘we are a small family, and that’s fine’. Liz’s home-making narrative is very much driven by her awareness of what she sees as her responsibilities as a mother, a lesbian mother. The move to Brighton was assessed by being able to keep her clients in London (she worked as a self-employed communication and PR person for various London councils) – ‘this is what feeds us’, and the fact that she did not want Tim to go to a ‘badly performing’ school in London. The terraced three-bedroom house she found was in a residential area, not too far from the station and in need of updating and re-decorating. The result of the combined efforts of builders, her dad (‘for some of the DIY’) and herself produced a ‘conventional’ set-up with a living room, a kitchen-diner, a small home-office (for tele-working) and Tim’s and her bedroom. Inconspicuous in its appearance, it was clearly child-oriented with a ‘real jelly bean arch’ in the hallway. The living room is relatively bare, with a big sofa, table and chairs, ‘an ancient stereo-system’ and a ‘battered TV and Video-recorder’ in the corner. ‘We hardly use it’, Liz exclaims. ‘We much rather spend time out and about if there is a chance … quality time, rather than watching TV … or I read him stories in bed. I hate the idea of TV as a baby sitter … I have very deliberately chosen to have Tim and I want to make the most of it’. For Liz, the living room with the TV set in it appears as a kind of gesture to what family homes ‘look like’. As such, the TV and furniture set-up function as a signal and symbol of ‘normality’ in a queer household – perhaps a form of ‘passing’ for visitors and guests. The concern for the welfare of her son in this context is a sign and reflection of a constant negotiation process within a pre-dominantly heterosexual system of cultural symbols and values, which he, of course, is already able to ‘compare’ and evaluate when he is out and about at school or visiting friends in their homes. Unlike in Helen and Ben’s home, the TV is therefore allowed to stay out of the closet. Still, Liz rarely watches TV at all, for reasons not dissimilar to those of Helen and Ben. Apart from this, she shares a lack of spare time with many other single parents. Significantly, the living room and TV do receive a queer ‘make-over’ now and then, when Tim is in bed or with his father on a weekend and ‘the girls’ come over for a drink, chat and video viewing (noticeably, the living room furniture and TV get pushed around and re-arranged to accommodate the crowd). In this sense, Liz, in her home-making practices, carefully manages and performs ‘object relationships’ that allow her and her son to ‘fit in’ as much as to advocate ‘difference’ within the construction of ‘normalcy’. The pressures of this negotiation process are clearly visible. Conclusion – Re-Engendering Home and Techno-Practices As women as much as lesbians, Helen, Ben and Liz are, like so many others, part of a historical and much wider struggle regarding visibility, equality and justice. If this article had been dedicated to gay/queer men and their techno- and home-making sensibilities, it would have read somewhat differently to be sure. Of course, questions of gender and sexual identities would have remained equally paramount, as they always should, enfolding questions of class, race and ethnicity (Pink 2004). The concept and practice of home have a deeply engendered history. Queer practices ‘at home’ are always already tied up with knowledges of gendered practices and spaces. As Morley has observed, ‘space is gendered on a variety of scales … the local is often associated with femininity and seen as the natural basis of home and community, into which an implicitly masculine realm intrudes’ (“Home Territories” 59). As the public and private realms have been gendered masculine and feminine respectively, so have media and ICTs. Although traditional ideas of home and gender relations are beginning to break down and the increasing personalization and mobilization of ICTs blur perceptions of the public and private, certain (idealized, heterosexualized and gendered) images of home, domesticity and family life seem to be recurring in popular discourse as well as mainstream academic writing. As feminist theorists have illustrated the ways in which gender needs to be seen as performative, feminist and queer theorists also ought to work further on finding vocabularies and discourses that capture and highlight diversity, without re-invoking the spectre of the nuclear family (home) itself (Weeks, Heaphy and Donovan). What I found was not the ‘domesticated’ lesbian ‘at home’ in a traditional feminine sphere. Rather, I experienced a complex set of re-negotiations and re-inscriptions of the domestic, of gender and sexual values and identities as well as techno-practices, leaving a trace, a mark on the system no matter how small (Helen: ‘I do wonder what the neighbours make of us’). The pressure and indeed desire to ‘fit in’ is often enormous and therefore affords the re-tracing of certain trodden paths of domesticity and ICT consumption. Nevertheless, I am looking forward to the day when even Liz can put that old telly into the closet as it has lost its meaning as a cultural signifier of a particular kind. References Ahmed, Sara. Queer Phenomenology – Orientations, Objects, Others. Durham and London: Duke UP, 2006. Bell, David, and Gill Valentine. “Introduction: Orientations.” mapping desire. Eds. David Bell and Gill Valentine. London: Routledge, 1995. 1-27. Berker, Thomas, Maren Hartmann, Yves Punie and Katie J. Ward, eds. Domestication of Media and Technology. Maidenhead: Open UP, 2006. Bryson, Mary, Lori MacIntosh, Sharalyn Jordan, Hui-Ling Lin. “Virtually Queer?: Homing Devices, Mobility, and Un/Belongings.” Canadian Journal of Communication 31.3 (2006). Elwood, Sarah A.. “Lesbian Living Spaces: Multiple Meanings of Home.” From Nowhere to Everywhere – Lesbian Geographies. Ed. Gill Valentine. New York and London: Harrington Park Press, 2000. 11-27. 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Citation reference for this article MLA Style Karl, Irmi. "Domesticating the Lesbian?: Queer Strategies and Technologies of Home-Making." M/C Journal 10.4 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0708/06-karl.php>. APA Style Karl, I. (Aug. 2007) "Domesticating the Lesbian?: Queer Strategies and Technologies of Home-Making," M/C Journal, 10(4). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0708/06-karl.php>.

This article is a comparison of two remarkably different takes on a single subject, namely the shifting meaning of the word ‘publishing’ brought about by the changes in literacy habits related to Web 2.0. One the one hand, we have Andrew Keen’s much lambasted 2007 book The Cult of the Amateur, which is essentially an attempt to defend traditional gatekeeper models of cultural production by denigrating online, user-generated content. The second is Spin journalist Andy Greenwald’s Nothing Feels Good, focusing on the Emo subculture of the early 2000s and its reliance on Web 2.0 as an integral medium for communication and the accumulation of subcultural capital. What I want to suggest in this article is that these two books, with their contrasting readings of Web 2.0, both tell us something specific about what the word “publishing” means and how it is currently undergoing a significant change brought about by a radical adaptation of literacy practices. What I think both books also do is give us an insight into how those changes are being interpreted, to be rejected on the one hand and applauded on the other. Both books have their faults. Keen’s work can fairly easily be passed off as a sort of cantankerous reminiscence for the legitimacy of an earlier era of publishing, and Greenwald’s Emos have, like all teen subcultures, changed somewhat. Yet what both books portray is an attempt to digest how Web 2.0 has altered perceptions of what constitutes legitimate speaking positions and how that is reflected in the literacy practices that shape the relationships among authors, readers, and the channels through which they interact. Their primary difference is a disparity in the value they place on Web 2.0’s amplification of the Internet’s use as a social and communicative medium. Greenwald embraces it as the facilitator of an open-access dialogue, whereas Keen sees it as a direct threat to other, more traditional, gatekeeper genres. Accordingly, Keen begins his book with a lament that Web 2.0’s “democratization” of media is “undermining truth, souring civic discourse and belittling expertise, experience, and talent … it is threatening the very future of our cultural institutions” (15). He continues, Today’s editors, technicians, and cultural gatekeepers—the experts across an array of fields—are necessary to help us to sift through what’s important and what’s not, what is credible from what is unreliable, what is worth spending our time on as opposed to the white noise that can be safely ignored. (45) As examples of the “white noise,” he lists some of the core features of Web 2.0—blogs, MySpace, YouTube and Facebook. The notable similarity between all of these is that their content is user generated and, accordingly, comes from the position of the personal, rather than from a gatekeeper. In terms of their readership, this presents a fundamental shift in an understanding of authenticated speaking positions, one which Keen suggests underwrites reliability by removing the presence of certifiable expertise. He looks at Web 2.0 and sees a mass of low grade, personal content overwhelming traditional benchmarks of quality and accountability. His definition of “publishing” is essentially one in which a few, carefully groomed producers express work seen as relevant to the wider community. The relationship between reader and writer is primarily one sided, mediated by a gatekeeper and rests on the assumption by all involved that the producer has the legitimacy to speak to a large, and largely silent, readership. Greenwald, by contrast, looks at the same genres and comes to a remarkably different and far more positive conclusion. He focuses heavily on the lively message boards of the social networking site Makeoutclub, the shift to a long tail marketing style by key Emo record labels such as Vagrant and Drive-Thru Records and, in particular, the widespread use of LiveJournal (www.livejournal.com) by suburban, Emo fixated teenagers. Of this he writes: The language is inflated, coded as ‘adult’ and ‘poetic’, which often translates into affected, stilted and forced. But if one can accept that, there’s a sweet vulnerability to it. The world of LiveJournal is an enclosed circuit where everyone has agreed to check their cynicism at the sign on screen; it’s a pulsing, swoony realm of inflated emotions, expectations and dialogue. (287) He specifically notes that one cannot read mediums like LiveJournal in the same style as their more traditional counterparts. There is a necessity to adopt a reading style conducive to a dialogue devoid of conventional quality controls. It is also, he notes, a heavily interconnected, inherently social medium: LiveJournals represent the truest and easiest realization of the essential teenage (and artistic) tenet of the importance of a ‘room of one’s own’, and yet the framework of the website is enough to make each individual room interconnected into a mosaic of richly felt lives. (288) Where Keen sees Web 2.0 as a shift way from established cultural forums, Greenwald sees it as an interconnected conversation. His definition of publishing is more fluid, founded on a belief not in the authenticity of a single, validated voice but on the legitimacy of interaction and communication entirely devoid of any gatekeepers. Central to understanding the difference between Greenwald and Keen is the issue or whether or not we accept the legitimacy of personal voices and how we evaluate the kind of reading practices involved in interpreting them. In this respect, Greenwald’s reference to “a room of one’s own” is telling. When Virginia Woolf wrote A Room of One’s Own in 1929, Web 2.0 wasn’t even a consideration, but her work dealt with a similar subject matter, detailing the key role the novel genre played in legitimising women’s voices precisely because it was “young enough to be soft in [their] hands” (74). What would eventually emerge from Woolf’s work was the field of feminist literary criticism, which hit its stride in the mid-eighties. In terms of its understanding of the power relations inherent to cultural production, particularly as they relate to gatekeeping, it’s a rich academic tradition notably lacking in the writing on Web 2.0. For example, Celia Lury’s essay “Reading the Self,” written more than ten years before the popularisation of the internet, looks specifically at the way in which authoritative speaking positions gain their legitimacy not just through the words on the page but through the entire relationships among author, genre, channels of distribution, and readership. She argues that, “to write is to enter into a relationship with a community of readers, and various forms of writing are seen to involve and imply, at any particular time, various forms of relationship” (102). She continues, so far as text is clearly written/read within a particular genre, it can be seen to rest upon a more or less specific set of social relations. It also means that ‘textual relations’—that is, formal techniques, reading strategies and so on—are not held separate from ‘non-textual relations’—such as methods of cultural production and modes of distribution—and that the latter can be seen to help construct ‘literary value.’ (102) The implication is that an appropriation of legitimised speaking positions isn’t done purely by overthrowing or contesting an established system of ‘quality’ but by developing a unique relationship between author, genre, and readership. Textual and non-textual practices blur together to create literary environments and cultural space. The term “publishing” is at the heart of these relationships, describing the literacies required to interpret particular voices and forms of communication. Yet, as Lury writes, literacy habits can vary. Participation in dialogue-driven, user-generated mediums is utterly different from conventional, gatekeeper-driven ones, yet the two can easily co-exist. For instance, reading last year’s Man Booker prize-winner doesn’t stop one from reading, or even writing, blogs. One can enact numerous literacy practices, move between discourses and inhabit varied relationships between genre, reader, and writer. However, with the rise of Web 2.0 a whole range of literacies that used to be defined as “private sphere” or “everyday literacies,” everything from personal conversations and correspondence to book clubs and fanzines, have become far, far more public. In the past these dialogue-based channels of communication have never been in a position where they could be defined as “publishing.” Web 2.0 changes that, moving previously private sphere communication into online public space in a very obvious way. Keen dismisses this shift as a wall of white noise, but Greenwald does something equally interesting. To a large extent, his positive treatment of Web 2.0’s “affected, stilted and forced” user-generated content is validated by his focus on a “Youth” subculture, namely Emo. Indeed, he heavily links the impact of youthful subcultural practices with the internet, writing that Teenage life has always been about self-creation, and its inflated emotions and high stakes have always existed in a grossly accelerated bubble of hypertime. The internet is the most teenage of media because it too exists in this hypertime of limitless limited moments and constant reinvention. If emo is the soundtrack to hypertime, then the web is its greatest vehicle, the secret tunnel out of the locked bedroom and dead-eyed judgmental scenes of youth. (277) In this light, we accept the voices of his Emo subjects because, underneath their low-quality writing, they produce a “sweet vulnerability” and a “dialogue,” which provides them with a “secret tunnel” out of the loneliness of their bedrooms or unsupportive geographical communities. It’s a theme that hints at the degree to which discussions of Web 2.0 are often heavily connected to arguments about generationalism, framed by the field of youth studies and accordingly end up being mined for what Tara Brabazon calls “spectacular youth subcultures” (23). We see some core examples of this in some of the quasi-academic writing on the subject of “Youth.” For example, in his 2005 book XYZ: The New Rules of Generational Warfare, Michael Grose declares Generation Y as “post-literate”: Like their baby boomer parents and generation X before them, generation Ys get their information from a range of sources that include the written and spoken word. Magazines and books are in, but visual communication is more important for this cohort than their parents. They live in a globalised, visual world where images rather than words are universal communication media. The Internet has heightened the use of symbols as a direct communicator. (95) Given the Internet is overwhelmingly a textual medium, it’s hard to tell exactly what Grose’s point is other than to express his confusion over new literacy practices. In a similar vein and in a similar style, Rebecca Huntley writes in her book The World According to Y, In the Y world, a mobile phone is not merely a phone. It is, as described by demographer Bernard Salt, “a personal accessory, a personal communications device and a personal entertainment centre.” It’s a device for work and play, flirtation and sex, friendship and family. For Yers, their phone symbolizes freedom and flexibility. More than that, your mobile phone symbolizes you. (16) Like Keen, Grose and Huntley are trying to understand a shift in publishing and media that has produced new literacy practices. Unlike Keen, Grose and Huntley pin the change on young people and, like Greenwald, they turn a series of new literacy practices into something akin to what Dick Hebdige called “conspicuous consumption” (103). It’s a term he linked to his definition of bricolage as the production of “implicitly coherent, though explicitly bewildering, systems of connection between things which perfectly equip their users to ‘think’ their own world” (103). Thus, young people are differentiated from the rest of the population by their supposedly unique consumption of “symbols” and mobile phones, into which they read their own cryptic meanings and develop their own generational language. Greenwald shows this methodology in action, with the Emo use of things like LiveJournal, Makeoutclub and other bastions of Web 2.0 joining their record collections, ubiquitous sweeping fringes and penchant for accessorised outfits as part of the conspicuous consumption inherent to understandings of youth subculture. The same theme is reflected in Michel de Certeau’s term “tactics” or, more common amongst those studying Web 2.0, Henry Jenkins’s notion of “poaching”. The idea is that people, specifically young people, appropriate particular forms of cultural literacy to redefine themselves and add a sense of value to their voices. De Certeau’s definition of tactics, as a method of resistance “which cannot count on a ‘proper’ (a spatial or institutional localization), nor thus on a borderline distinguishing the other as a visible totality” (489), is a prime example of how Web 2.0 is being understood. Young people, Emo or not, engage in a consumption of the Internet, poaching the tools of production to redefine the value of their voices in a style completely acceptable to the neo-Marxist, Birmingham school understanding of youth and subculture as a combination producing a sense of resistance. It’s a narrative highly compatible within the fields of cultural and media studies, which, despite major shifts brought about by people like Ken Gelder, Sarah Thornton, Keith Kahn-Harris and the aforementioned Tara Brabazon, still look heavily for patterns of politicised consumption. The problem, as I think Keen inadvertently suggests, is that the Internet isn’t just about young people and their habits as consumers. It’s about what the word “publishing” actually means and how we think about the interaction among writers, readers, and the avenues through which they interact. The idea that we can pass off the redefinition of literacy practices brought about by Web 2.0 as a subcultural youth phenomena is an easy way of bypassing wider cultural shifts onto a token demographic. It presents Web 2.0 as an issue of “Youth” resisting the hegemony of traditional gatekeepers, which is effectively what Greenwald does. Yet such an approach has a very short shelf life. It’s a little like claiming the telephone or the television set were “youth genres.” The uptake of new technologies will inadvertently impact differently on those who grew up with them as compared to those who grew up without them. Yet ultimately changes in literacy habits are much larger than a generationalist framework can really express, particularly given the first generation of “digital natives” are now in their thirties. There’s a lot of things wrong with Andrew Keen’s book but one thing he does do well is ground the debate about Web 2.0 back to issues of legitimate speaking positions and publishing. That said, he also significantly simplifies those issues when he claims the problem is purely about the decline of traditional gatekeeper models. Responding to Keen’s criticism of him, Creative Commons founder Lawrence Lessig writes, I think it is a great thing when amateurs create, even if the thing they create is not as great as what the professional creates. I want my kids to write. But that doesn’t mean that I’ll stop reading Hemingway and read only what they write. What Keen misses is the value to a culture that comes from developing the capacity to create—independent of the quality created. That doesn’t mean we should not criticize works created badly (such as, for example, Keen’s book…). But it does mean you’re missing the point if you simply compare the average blog to the NY times (Lessig). What Lessig expresses here is the different, but not mutually exclusive, literacy practices involved in the word “publishing.” Publishing a blog is very different to publishing a newspaper and the way readers react to both will change as they move in and out the differing discursive spaces each occupies. In a recent collaborative paper by Sue Thomas, Chris Joseph, Jess Laccetti, Bruce Mason, Simon Mills, Simon Perril, and Kate Pullinger, they describe this capacity to move across different reading and writing styles as “transliteracy.” They define the term as “the ability to read, write and interact across a range of platforms, tools and media from signing and orality through handwriting, print, TV, radio and film, to digital social networks” (Thomas et al.). It’s a term that perfectly describes the capacity to move fluidly across discursive environments. Here we return to Greenwald’s use of a framework of youth and subculture. While I have criticised the Birminghamesque fixation on a homogeneous “Youth” demographic enacting resistance through conspicuous consumption, there is good reason to use existing subculture studies methodology as a means of understanding how transliteracies play out in everyday life. David Chaney remarks, the idea of subculture is redundant because the type of investment that the notion of subculture labelled is becoming more general, and therefore the varieties of modes of symbolization and involvement are more common in everyday life. (37) I think the increasing commonality of subcultural practices in everyday life actually makes the idea more relevant, not less. It does, however, make it much harder to pin things on “spectacular youth subcultures.” Yet the focus on “everyday life” is important here, shifting our understanding of “subculture” to the types of literacies played out within localised, personal networks and experiences. As de Certeau has argued, the practice of everyday life is an issue of “a way of thinking invested in a way of acting, an art of combination which cannot be dissociated from an art of using” (Certeau 486). This is as true for our literacy practices as anything else. Whether we choose to label those practices subcultural or not, our ability to interpret, take part in and react to different communicative forums is clearly fundamental to our understanding of the world around us, regardless of our age. Sarah Thornton suggests a useful alternate definition of subculture when she talks about subcultural capital: Subcultural capital is the linchpin of an alternative hierarchy in which the aces of age, gender, sexuality and race are all employed in order to keep the determinations of class, income and occupation at bay (105). This is an understanding that avoids easy narratives of young people and their consumption of Web 2.0 by recognising the complexity with which people’s literacy habits, in the cultural sense, connect to their active participation in the production of meaning. Subcultural capital implies that the framework through which individuals read, interpret, and shift between discursive environments, personalising and building links across the strata of cultural production, is acted out at the local and personal level, rather than purely through the relationship between a producing gatekeeper and a passive, consuming readership. If we recognise the ability for readers to connect multiple mediums, to shift between reading and writing practices, and to seamlessly interpret and digest markedly different assumptions about legitimate speaking voices across genres, our understanding of what it means to “publish” ceases to be an issue of generationalism or conventional mediums being washed away by the digital era. The issue we see in both Keen and Greenwald is an attempt to digest the way Web 2.0 has forced the concept of “publishing” to take on a multiplicity of meanings, played out by individual readers, and imbued with their own unique and interwoven textual and cultural literacy habits. It’s not only Emos who publish livejournals, and it’s incredibly naive to assume gatekeepers have ever really held a monopoly on all aspects of cultural production. What the rise of Web 2.0 has done is simply to bring everyday, private sphere dialogue driven literacies into the public sphere in a very obvious way. The kind of discourses once passed off as resistant youth subcultures are now being shown as common place. Keen is right to suggest that this will continue to impact, sometimes negatively, on traditional gatekeepers. Yet the change is inevitable. As our reading and writing practices alter around new genres, our understandings of what constitutes legitimate fields of publishing will also change. References Brabazon, Tara. From Revolution to Revelation. Aldershot: Ashgate, 2005. de Certeau, Michel. “Practice of Every Day Life.” Cultural Theory and Popular Culture. Ed. John Story. London: Prentice Hall, 1998. 483–94. Chaney, David. “Fragmented Culture and Subcultures.” After Subculture. Ed. Andy Bennett and Keith Kahn-Harris. Houndsmill: Palgrave McMillian, 2004. 36–48. Greenwald, Andy. Nothing Feels Good: Punk Rock, Teenagers and Emo. New York: St Martin’s Griffin, 2003. Grose, Michael. XYZ: The New Rules of Generational Warfare. Sydney: Random House, 2005. Hebdige, Dick. Subculture: The Meaning of Style. London: Methuen and Co Ltd, 1979. Huntley, Rebecca. The World According to Y. Crows Nest: Allen and Unwin, 2006. Keen, Andrew. The Cult of the Amateur. London: Nicholas Brealey Publishing, 2007. Lessig, Lawrence. “Keen’s ‘The Cult of the Amateur’: BRILLIANT!” Lessig May 31, 2007. Aug. 19 2008 ‹http://www.lessig.org/blog/2007/05/keens_the_cult_of_the_amateur.html>. Lury, Celia. “Reading the Self: Autobiography, Gender and the Institution of the Literary.” Off-Centre: Feminism and Cultural Studies. Ed. Sarah. Franklin, Celia Lury, and Jackie Stacey. Hammersmith: HarperCollinsAcademic, 1991. 97–108. Thomas, Sue, Chris Joseph, Jess Laccetti, Bruce Mason, Simon Mills, Simon Perril, and Kate Pullinger. “Transliteracy: Crossing Divides.” First Monday 12.12. (2007). Apr. 1 2008 ‹http://www.uic.edu/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/2060/1908>. Thornton, Sarah. Club Cultures: Music, Media and Subcultural Capital. Oxford: Polity Press, 1995. Woolf, Virginia. A Room of One’s Own. Frogmore: Triad/Panther Press, 1977.

Introduction Nun habe ich Euch genug geschrieben, diesen Brief wenn sei [sic] lesen würden, dann würde ich den Genickschuß bekommen.Now I have written you enough, this letter if they would read it, I would get the neck shot. (M., all translations from German sources and quotations by the author) When the German soldier Otto M. wrote these lines from Russia to his family on 3 September 1943 during the Second World War, he knew that his war letter would not be subject to the National Socialist censorship apparatus. The letter contains, inter alia, detailed information about the course of the war on the front, troop locations, and warnings about the Nazi regime. M., as he wrote in the letter, smuggled it past the censorship via a “comrade”. As a German soldier, M. was a member of the Volksgemeinschaft—a National Socialist concept that drew a “racist and anti-Semitic borderline” (Wildt 48)—and was thus not socially excluded due to his status. Nevertheless, in the sentence quoted above, M. anticipates possible future consequences of his deviant actions, which would be carried out by “them”—potentially leading to his violent death. This article investigates how social and societal exclusion is brought forth by everyday media practices such as writing letters. After an introduction to the thesis under discussion, I will briefly outline the linguistic research on National Socialism that underlies the approach presented. In the second section, the key concepts of agency and dispositif applied in this work are discussed. This is followed by two sections in which infrastructural and interactional practices of exclusion are analysed. The article closes with some concluding remarks. During the Second World War, Wehrmacht soldiers and their relatives could not write and receive letters that were not potentially subject to controls. Therefore, the blunt openness with which M. anticipated the brutal sanctions of behavioural deviations in the correspondence quoted above was an exception in the everyday practice of war letter communication. This article will thus pursue the following thesis: private communication in war letters was subject to specific discourse conditions under National Socialism, and this brought forth excluding agency, which has two intertwined readings. Firstly, “excluding” is to be understood as an attribute of “agency” in the sense of an acting entity that either is included and potentially excludes or is excluded due to its ascribed agency. For example, German soldiers who actively participated in patriotic service were included in the Volksgemeinschaft. By contrast, Jews or Communists, to name but a few groups that, from the perspective of racist Nazi ideology, did not contribute to the community, were excluded from it. Such excluding agencies are based on specific practices of dispositional arrangement, which I refer to as infrastructural exclusion of agency. Secondly, excluding agency describes a linguistic practice that developed under National Socialism and has an equally stabilising effect on it. Excluding agency means that agents, and hence protagonists, are excluded by means of linguistic mitigation and omission. This second reading emphasises practices of linguistic construction of agency in interaction, which is described as interactional exclusion of agency. In either sense, exclusion is inextricably tied to the notion of agency, which is illustrated in this article by using data from field post letters of the Second World War. Social exclusion, along with its most extreme manifestations under fascism, is both legitimised and carried out predominantly through discursive practices. This includes for the public domain, on the one hand, executive language use such as in laws, decrees, orders, court hearings, and verdicts, and on the other hand, texts such as ideological writings, speeches, radio addresses, folk literature, etc. Linguistic research on National Socialism and its mechanisms of inclusion and exclusion has long focussed on the power of a regulated public use of language that seemed to be shaped by a few protagonists, most notably Hitler and Goebbels (Schlosser; Scholl). More recent works, however, are increasingly devoted to the differentiation of heterogeneous communities of practice, which were primarily established through discursive practices and are manifested accordingly in texts of that time (Horan, Practice). Contrary to a justifiably criticised “exculpation of the speakers” (Sauer 975) by linguistic research, which focusses on language but not on situated, interactional language use, such a perspective is increasingly interested in “discourse in National Socialism, with a particular emphasis on language use in context as a shared, communicative phenomenon” (Horan, Letter 45). To understand the phenomenon of social and societal exclusion, which was constitutive for National Socialism, it is also necessary to analyse those discursive practices of inclusion and exclusion through which the speakers co-constitute everyday life. I will do this by relating the discourse conditions, based on Foucault’s concept of dispositif (Confessions 194), to the agency of the correspondents of war letters, i.e. field post letters. On Agency and Dispositif Agency and dispositif are key concepts for the analysis of social exclusion, because they can be applied to analyse the situated practices of exclusion both in terms of the different capacities for action of various agents, i.e. acting entities, and the inevitably asymmetrical arrangement within which actions are performed. Let me first, very briefly, outline some linguistic conceptions of agency. While Ahearn states that “agency refers to the socioculturally mediated capacity to act” (28) and thus conceives agency as a potential, Duranti understands agency “as the property of those entities (i) that have some degree of control over their own behavior, (ii) whose actions in the world affect other entities’ (and sometimes their own), and (iii) whose actions are the object of evaluation (e.g. in terms of their responsibility for a given outcome)” (453). Deppermann considers agency to be a means of social and situational positioning: “‘agency’ is to capture properties of the subject as agent, that is, its role with respect to the events in which it is involved” (429–30). This is done by linguistic attribution. Following Duranti, this analysis is based on the understanding that agency is established by the ascription of action to an entity which is thereby made or considered accountable for the action. This allows a practice-theoretical reference to Garfinkel’s concept of accountability and identifies agentive practices as “visibly-rational-and-reportable-for-all-practical purposes” (7). The writing of letters in wartime is one such reflexive discursive practice through which agents constitute social reality by means of ascribing agency. The concept of semantic roles (Fillmore; von Polenz), offers another, distinctly linguistic access to agency. By semantic roles, agency in situated interaction is established syntactically and semantically. Put simply, a distinction is made between an Agent, as someone who performs an action, and a Patient, as someone to whom an action occurs (von Polenz 170; semantic roles such as Agent, Patient, Experiencer, etc. are capitalised by convention). Using linguistic data from war letters, this concept is discussed in more detail below. In the following, “field post” is considered as dispositif, by which Foucault means a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral and philanthropic propositions – in short, the said as much as the unsaid. Such are the elements of the apparatus [dispositif]. The apparatus [dispositif] itself is the system of relations that can be established between these elements. (Foucault, Confessions 194) The English translation of the French “dispositif” as “apparatus” encourages an understanding of dispositif as a rather rigid structure. In contrast, the field post service of the Second World War will be used here to show how such dispositifs enable practices of exclusion or restrict access to practices of inclusion, while these characteristics themselves are in turn established by practices or, as Foucault calls them, procedures (Foucault, Discourse). An important and potentially enlightening notion related to dispositif is that of agencement, which in turn is borrowed from Deleuze and Guattari and was further developed in particular in actor-network theory (Çalışkan and Callon; Gherardi). What Çalışkan and Callon state about markets serves as a general description of agencement, which can be defined as an “arrangement of heterogeneous constituents that deploys the following: rules and conventions; technical devices; metrological systems; logistical infrastructures; texts, discourses and narratives …; technical and scientific knowledge (including social scientific methods), as well as the competencies and skills embodied in living beings” (3). This resembles Foucault’s concept of dispositif (Foucault, Confessions; see above), which “denotes a heterogeneous ensemble of discursive and nondiscursive elements with neither an originary subject not [sic] a determinant causality” (Coté 384). Considered morphosemantically, agencement expresses an important interrelation: in that it is derived from both the French agencer (to construct; to arrange) and agence (agency; cf. Hardie and MacKenzie 58) and is concretised and nominalised by the suffix -ment, agencement elegantly integrates structure and action according to Giddens’s ‘duality of structure’. While this tying aspect certainly contributes to a better understanding of dispositional arrangements and should therefore be considered, agencement, as applied in actor-network theory, emphasises above all “the fact that agencies and arrangements are not separate” (Çalışkan and Callon) and is, moreover, often employed to ascribe agency to material objects, things, media, etc. This approach has proven to be very fruitful for analyses of socio-technical arrangements in actor-network theory and practice theory (Çalışkan and Callon; Gherardi). However, within the presented discourse-oriented study on letter writing and field post in National Socialism, a clear analytical differentiation between agency and arrangement, precisely in order to point out their interrelation, is essential to analyse practices of exclusion. This is why I prefer dispositif to agencement as the analytical concept here. Infrastructural Exclusion of Agency in Field Post Letters In the Second World War, writing letters between the “homeland” and the “frontline” was a fundamental everyday media practice with an estimated total of 30 to 40 billion letters in Germany (Kilian 97). War letters were known as field post (Feldpost), which was processed by the field post service. The dispositif “field post” was, in opposition to the traditional postal service, subject to specific conditions regarding charges, transport, and above all censorship. No transportation costs arose for field post letters up to a weight of 250 grams. Letters could only be sent by or to soldiers with a field post number that encoded the addresses of the field post offices. Only soldiers who were deployed outside the Reich’s borders received a field post number (Kilian 114). Thus, the soldiers were socially included as interactants due to their military status. The entire organisation of the field post was geared towards enabling members of the Volksgemeinschaft to communicatively shape, maintain, and continue their social relationships during the war (Bergerson et al.). Applying Foucault, the dispositif “field post” establishes selection and exclusion mechanisms in which “procedures of exclusion” (Discourse 52) become manifest, two of which are to be related to the field post: “exclusion from discourse” and “scarcity of speaking subjects” (Spitzmüller and Warnke 73). Firstly, “procedures of exclusion ensure that only certain statements can be made in discourse” (Spitzmüller and Warnke 73). This exclusion procedure ought to be implemented by controlling and, ultimately, censoring field post letters. Reviews were carried out by censorship offices (Feldpostprüfstellen), which were military units independent of the field post offices responsible for delivery. Censorship initially focussed on military information. However, “in the course of the war, censorship shifted from a control measure aimed at defence towards a political-ideological review” (Kilian 101). Critical remarks could be legally prosecuted and punished with prison, penitentiary, or death (Kilian 99). Hence, it is assumed that self-censorship played a role not only for public media, such as newspapers, but also for writing private letters (Dodd). As the introductory quotation from Otto M. shows, writers who spread undesirable information in their letters anticipated the harshest consequences. In this respect, randomised censorship—although only a very small proportion of the high volume of mail was actually opened by censors (Kilian)—established a permanent disposition of control that resulted in a potentially discourse-excluding social stratification of private communication. Secondly, the dispositif “field post” was inherently exclusive and excluding, as those who did not belong to the Volksgemeinschaft could not use the service and thus could not acquire agentive capacity. The “scarcity of speaking subjects” (Spitzmüller and Warnke 73) was achieved by restricting participation in the field post system to members of the Volksgemeinschaft. Since agency is based on the most basic prerequisite, namely the ability to act linguistically at all, the mere possibility of exercising agency was infrastructurally restricted by the field post system. Excluding people from “agency-through-language” means excluding them from an “agency of an existential sort” (Duranti 455), which is described here, regarding the field post system, as infrastructural exclusion of agency. Interactional Exclusion of Agency in Field Post Letters In this section, I will elaborate how agency is brought forth interactionally through linguistic means on the basis of data from a field post corpus that was compiled in the project “Linguistic Social History 1933 to 1945” (Kämper). The aim of the project is an actor-based description of discursive practices and patterns at the time of National Socialism, which takes into account the fact that society in the years 1933 to 1945 consisted of heterogeneous communities of practice (Horan, Practice). Letter communication is considered to be an interaction that is characterised by mediated indexicality, accountability, reflexivity, sequentiality, and reciprocity (Dang-Anh) and is performed as situated social practice (Barton and Hall). The corpus of field letters examined here provides access to the everyday communication of members of the ‘integrated society’, i.e. those who were neither high-ranking members of the Nazi apparatus nor exposed to the repressions of the fascist dictatorship. The corpus consists of about 3,500 letters and about 2.5 million tokens. The data were obtained by digitising letter editions using OCR scans and in cooperation with the field post archive of the Museum for Communication Berlin (cf. sources below). We combine qualitative and quantitative methods, the latter providing heuristic indicators for in-depth hermeneutical analysis (Felder; Teubert). We apply corpus linguistic methods such as keyword, collocation and concordance analysis to the digitised full texts in order to analyse the data intersubjectively by means of corpus-based hermeneutic discourse analysis (Dang-Anh and Scholl). However, the selected excerpts of the corpus do not comprise larger data sets or complete sequences, but isolated fragments. Nevertheless, they illustrate the linguistic (non-)constitution of agency and thus distinctively exemplify exclusionary practices in field post letter writing. From a linguistic point of view, the exclusion of actors from action is achieved syntactically and semantically by deagentivisation (Bernárdez; von Polenz 186), as will be shown below. The following lines were written by Albert N. to his sister Johanna S. and are dated 25 June 1941, shortly after the beginning of the German Wehrmacht’s military campaign in Russia (Russlandfeldzug) a few days earlier. Vor den russ. Gefangenen bekommt man einen Ekel, d.h. viele Gefangene werden nicht gemacht.One gets disgusted by the Russian prisoners, i.e. many prisoners are not made. (N.) In the first part of the utterance, “mitigation of agency” (Duranti 465) is carried out using the impersonal pronoun “man” (“one”) which does not specify its referent. Instead, by means of deagentivisation, the scope of the utterance is generalised to an indefinite in‑group of speakers, whereby the use of the impersonal pronoun implies that the proposition is valid or generally accepted. Moreover, the use of “one” generalises the emotional expression “disgust”, thus suggesting that the aversive emotion is a self-evident affect experienced by everyone who can be subsumed under “one”. In particular, this includes the author, who is implicitly displayed as primarily perceiving the emotion in question. This reveals a fundamental practice of inclusion and exclusion, the separating distinction between “us”/“we” and “them”/“the others” (Wodak). In terms of semantic roles, the inclusive and generalised formal Experiencer “one” is opposed to the Causative “Russian prisoner” in an exclusionary manner, implicitly indicating the prisoners as the cause of disgust. The subsequent utterance is introduced by “i.e.”, which marks the causal link between the two phrases. The wording “many prisoners are not made” strongly suggests that it refers to homicides, i.e. executions carried out at the beginning of the military campaign in Russia by German troops (Reddemann 222). The depiction of a quasi-universal disgust in the first part establishes a “negative characterization of the out-group” (Wodak 33) which, in the expressed causal relation with the second phrase, seems to morally legitimise or at least somehow justify the implied killings. The passive form entirely omits an acting entity. Here, deagentivisation obscures the agency of the perpetrators. However, this is not the only line between acting and non-acting entities the author draws. The omission of an agent, even the impersonal “one”, in the second part, and the fact that there is no talk of self-experienceable emotions, but war crimes are hinted at in a passive sentence, suggest the exclusion of oneself as a joint agent of the indicated actions. As further data from the corpus indicate, war crimes are usually not ascribed to the writer or his own unit as the agents but are usually attributed to “others” or not at all. Was Du von Juden schreibst, ist uns schon länger bekannt. Sie werden im Osten angesiedelt.What you write about Jews is already known to us for some time. They are being settled in the East. (G.) In this excerpt from a letter, which Ernst G. wrote to his wife on 22 February 1942, knowledge about the situation of the Jews in the war zone is discussed. The passage appears quite isolated with its cotext in the letter revolving around quite different, trivial, everyday topics. Apparently, G. refers in his utterance to an earlier letter from his wife, which has not been preserved and is therefore not part of the corpus. “Jews” are those about whom the two agents, the soldier and his wife, write, whereas “us” refers to the soldiers at the front. In the second part, agency is again obscured by deagentivisation. While “they” anaphorically refers to “Jews” as Patients, the agents of their alleged resettlement remain unnamed in this “agent-less passive construction” (Duranti 466). Jews are depicted here as objects being handled—without any agency of their own. The persecution of the Jews and the executions carried out on the Russian front (Reddemann 222), including those of Jews, are euphemistically played down here as “settlements”. “Trivialization” and “denial” are two common discursive practices of exclusion (Wodak 134) and emerge here, as interactional exclusion of agency, in one of their most severe manifestations. Conclusion Social and societal exclusion, as has been shown, are predominantly legitimised as well as constituted, maintained, and perpetuated by discursive practices. Field post letters can be analysed both in terms of the infrastructure—which is itself constituted by infrastructuring practices and is thus not rigid but dynamic—that underlies excluding letter-writing practices in times of war, and the extent to which linguistic excluding practices are performed in the letters. It has been shown that agency, which is established by the ascription of action to an entity, is a central concept for the analysis of practices of exclusion. While I propose the division into infrastructural and interactional exclusion of agency, it must be pointed out that this can only be an analytical distinction and both bundles of practices, that of infrastructuring and that of interacting, are intertwined and are to be thought of in relation to each other. Bringing together the two concepts of agency and dispositif, despite the fact that they are of quite different origins, allows an analysis of exclusionary practices, which I hope does justice to the relation of interaction and infrastructure. By definition, exclusion occurs against the background of an asymmetrical arrangement within which exclusionary practices are carried out. Thus, dispositif is understood as an arranged but flexible condition, wherein agency, as a discursively ascribed or infrastructurally arranged property, unfolds. Social and societal exclusion, which were constitutive for National Socialism, were accomplished not only in public media but also in field post letters. Writing letters was a fundamental everyday media practice and the field post was a central social medium during the National Socialist era. However, exclusion occurred on different infrastructural and interactional levels. As shown, it was possible to be excluded by agency, which means exclusion by societal status and role. People could linguistically perform an excluding agency by constituting a division between “us” and “them”. Also, specific discourses were excluded by the potential control and censorship of communication by the authorities, and those who did not suppress agency, for example by self-censoring, feared prosecution. Moreover, the purely linguistic practices of exclusion not only constituted or legitimised the occasionally fatal demarcations drawn under National Socialism, but also concealed and trivialised them. As discussed, it was the perpetrators whose agency was excluded in war letters, which led to a mitigation of their actions. In addition, social actors were depreciated and ostracised through deagentivisation, mitigation and omission of agency. In extreme cases of social exclusion, linguistic deagentivisation even prepared or resulted in the revocation of the right to exist of entire social groups. The German soldier Otto M. feared fatal punishment because he did not communicatively act according to the social stratification of the then regime towards a Volksgemeinschaft in a field post letter. This demonstrates how thin the line is between inclusion and exclusion in a fascist dictatorship. 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Babies and toddlers are amassing huge followings on social media, achieving microcelebrity status, and raking in five figure sums. In East Asia, many of these lucrative “micro­-microcelebrities” rise to fame by inheriting exposure and proximate microcelebrification from their social media Influencer mothers. Through self-branding techniques, Influencer mothers’ portrayals of their young’ children’s lives “as lived” are the canvas on which (baby) products and services are marketed to readers as “advertorials”. In turning to investigate this budding phenomenon, I draw on ethnographic case studies in Singapore to outline the career trajectory of these young children (under 4yo) including their social media presence, branding strategies, and engagement with their followers. The chapter closes with a brief discussion on some ethical considerations of such young children’s labour in the social media age.Influencer MothersTheresa Senft first coined the term “microcelebrity” in her work Camgirls as a burgeoning online trend, wherein people attempt to gain popularity by employing digital media technologies, such as videos, blogs, and social media. She describes microcelebrities as “non-actors as performers” whose narratives take place “without overt manipulation”, and who are “more ‘real’ than television personalities with ‘perfect hair, perfect friends and perfect lives’” (Senft 16), foregrounding their active response to their communities in the ways that maintain open channels of feedback on social media to engage with their following.Influencers – a vernacular industry term albeit inspired by Katz & Lazarsfeld’s notion of “personal influence” that predates Internet culture – are one type of microcelebrity; they are everyday, ordinary Internet users who accumulate a relatively large following on blogs and social media through the textual and visual narration of their personal lives and lifestyles, engage with their following in “digital” and “physical” spaces, and monetize their following by integrating “advertorials” into their blog or social media posts and making physical appearances at events. A pastiche of “advertisement” and “editorial”, advertorials in the Influencer industry are highly personalized, opinion-laden promotions of products/services that Influencers personally experience and endorse for a fee. Influencers in Singapore often brand themselves as having “relatability”, or the ability to persuade their followers to identify with them (Abidin). They do so by make consciously visible the backstage (Goffman) of the usually “inaccessible”, “personal”, and “private” aspects of mundane, everyday life to curate personae that feel “authentic” to fans (Marwick 114), and more accessible than traditional celebrity (Senft 16).Historically, the Influencer industry in Singapore can be traced back to the early beginnings of the “blogshop” industry from the mid-2000s and the “commercial blogging” industry. Influencers are predominantly young women, and market products and services from diverse industries, although the most popular have been fashion, beauty, F&B, travel, and electronics. Most prominent Influencers are contracted to management agencies who broker deals in exchange for commission and assist in the production of their vlogs. Since then, the industry has grown, matured, and expanded so rapidly that Influencers developed emergent models of advertorials, with the earliest cohorts moving into different life stages and monetizing several other aspects of their personal lives such as the “micro-microcelebrity” of their young children. What this paper provides is an important analysis of the genesis and normative practices of micro-microcelebrity commerce in Singapore from its earliest years, and future research trajectories in this field.Micro-Microcelebrity and Proximate MicrocelebrificationI define micro-microcelebrities as the children of Influencers who have themselves become proximate microcelebrities, having derived exposure and fame from their prominent Influencer mothers, usually through a more prolific, deliberate, and commercial form of what Blum-Ross defines as “sharenting”: the act of parents sharing images and stores about their children in digital spaces such as social networking sites and blogs. Marwick (116-117), drawing from Rojek’s work on types of celebrity – distinguishes between two types of microcelebrity: “ascribed microcelebrity” where the online personality is made recognizable through the “production of celebrity media” such as paparazzi shots and user-produced online memes, or “achieved microcelebrity” where users engage in “self-presentation strateg[ies]”, such as fostering the illusion of intimacy with fans, maintaining a persona, and selective disclosure about oneself.Micro-microcelebrities lie somewhere between the two: In a process I term “proximate microcelebrification”, micro-microcelebrities themselves inherit celebrity through the preemptive and continuous exposure from their Influencer mothers, many beginning even during the pre-birth pregnancy stages in the form of ultrasound scans, as a form of “achieved microcelebrity”. Influencer mothers whose “presentational strategies” (cf. Marshall, “Promotion” 45) are successful enough (as will be addressed later) gain traction among followers, who in turn further popularize the micro-microcelebrity by setting up fan accounts, tribute sites, and gossip forums through which fame is heightened in a feedback loop as a model of “ascribed microcelebrity”.Here, however, I refrain from conceptualizing these young stars as “micro-Influencers” for unlike Influencers, these children do not yet curate their self-presentation to command the attention of followers, but instead are used, framed, and appropriated by their mothers for advertorials. In other words, Influencer mothers “curate [micro-microcelebrities’] identities into being” (Leaver, “Birth”). Following this, many aspects of their micro-microcelebrities become rapidly commodified and commercialized, with advertisers clamoring to endorse anything from maternity hospital stays to nappy cream.Although children of mommybloggers have the prospect to become micro-microcelebrities, both groups are conceptually distinct. Friedman (200-201) argues that among mommybloggers arose a tension between those who adopt “the raw authenticity of nonmonetized blogging”, documenting the “unglamorous minutiae” of their daily lives and a “more authentic view of motherhood” and those who use mommyblogs “primarily as a source of extra income rather than as a site for memoir”, focusing on “parent-centered products” (cf. Mom Bloggers Club).In contrast, micro-microcelebrities and their digital presence are deliberately commercial, framed and staged by Influencer mothers in order to maximize their advertorial potential, and are often postured to market even non-baby/parenting products such as fast food and vehicles (see later). Because of the overt commerce, it is unclear if micro-microcelebrity displays constitute “intimate surveillance”, an “almost always well-intentioned surveillance of young people by parents” (Leaver, “Born” 4). Furthermore, children are generally peripheral to mommybloggers whose own parenting narratives take precedence as a way to connect with fellow mothers, while micro-microcelebrities are the primary feature whose everyday lives and digital presence enrapture followers.MethodologyThe analysis presented is informed by my original fieldwork with 125 Influencers and related actors among whom I conducted a mixture of physical and digital personal interviews, participant observation, web archaeology, and archival research between December 2011 and October 2014. However, the material presented here is based on my digital participant observation of publicly accessible and intentionally-public digital presence of the first four highly successful micro-microcelebrities in Singapore: “Baby Dash” (b.2013) is the son of Influencer xiaxue, “#HeYurou” (b.2011) is the niece of Influencer bongqiuqiu, “#BabyElroyE” (b.2014) is the son of Influencer ohsofickle, and “@MereGoRound” (b.2015) is the daughter of Influencer bongqiuqiu.The microcelebrity/social media handles of these children take different forms, following the platform on which their parent/aunt has exposed them on the most. Baby Dash appears in all of xiaxue’s digital platforms under a variety of over 30 indexical, ironic, or humourous hashtags (Leaver, “Birth”) including “#pointylipped”, #pineappledash”, and “#面包脸” (trans. “bread face”); “#HeYurou” appears on bongqiuqiu’s Instagram and Twitter; “#BabyElroyE” appears on ohsofickle’s Instagram and blog, and is the central figure of his mother’s new YouTube channel; and “@MereGoRound” appears on all of bongqiuqiu’s digital platforms but also has her own Instagram account and dedicated YouTube channel. The images reproduced here are screenshot from Influencer mothers’ highly public social media: xiaxue, bongqiuqiu, and ohsofickle boast 593k, 277k, and 124k followers on Instagram and 263k, 41k, and 17k followers on Twitter respectively at the time of writing.Anticipation and Digital EstatesIn an exclusive front-pager (Figure 1) on the day of his induced birth, it was announced that Baby Dash had already received up to SGD25,000 worth of endorsement deals brokered by his Influencer mother, xiaxue. As the first micro-microcelebrity in his cohort (his mother was among the pioneer Influencers), Baby Dash’s Caesarean section was even filmed and posted on xiaxue’s YouTube channel in three parts (Figure 2). xiaxue had announced her pregnancy on her blog while in her second trimester, following which she consistently posted mirror selfies of her baby bump.Figure 1 & 2, screenshot April 2013 from ‹instagram.com/xiaxue›In her successful attempt at generating anticipation, the “bump” itself seemed to garner its own following on Twitter and Instagram, with many followers discussing how the Influencer dressed “it”, and how “it” was evolving over the weeks. One follower even compiled a collage of xiaxue’s “bump” chronologically and gifted it to the Influencer as an art image via Twitter on the day she delivered Baby Dash (Figure 3 & 4). Followers also frequently speculated and bantered about how her baby would look, and mused about how much they were going to adore him. Figure 3 & 4, screenshot March 2013 from ‹twitter.com/xiaxue› While Lupton (42) has conceptualized the sharing of images that precede birth as a “rite of passage”, Influencer mothers who publish sonograms deliberately do so in order to claim digital estates for their to-be micro-microcelebrities in the form of “reserved” social media handles, blog URLs, and unique hashtags for self-branding. For instance, at the 3-month mark of her pregnancy, Influencer bongqiuqiu debuted her baby’s dedicated hashtag, “#MereGoRound” in a birth announcement on her on Instagram account. Shortly after, she started an Instagram account, “@MereGoRound”, for her baby, who amassed over 5.5k followers prior to her birth. Figure 5 & 6, screenshot March 2015 from instagram.com/meregoround and instagram.com/bongqiuqiuThe debut picture features a heavily pregnant belly shot of bongqiuqiu (Figure 5), creating much anticipation for the arrival of a new micro-microcelebrity: in the six months leading up to her birth, various family, friends, and fans shared Instagram images of their gifts and welcome party for @MereGoRound, and followers shared congratulations and fan art on the dedicated Instagram hashtag. During this time, bongqiuqiu also frequently updated followers on her pregnancy progress, not without advertising her (presumably sponsored) gynecologist and hospital stay in her pregnancy diaries (Figure 6) – like Baby Dash, even as a foetus @MereGoRound was accumulating advertorials. Presently at six months old, @MereGoRound boasts almost 40k followers on Instagram on which embedded in the narrative of her growth are sponsored products and services from various advertisers.Non-Baby-Related AdvertorialsPrior to her pregnancy, Influencer bongqiuqiu hopped onto the micro-microcelebrity bandwagon in the wake of Baby Dash’s birth, by using her niece “#HeYurou” in her advertorials. Many Influencers attempt to naturalize their advertorials by composing their post as if recounting a family event. With reference to a child, parent, or partner, they may muse or quip about a product being used or an experience being shared in a bid to mask the distinction between their personal and commercial material. bongqiuqiu frequently posted personal, non-sponsored images engaging in daily mundane activities under the dedicated hashtag “#HeYurou”.However, this was occasionally interspersed with pictures of her niece holding on to various products including storybooks (Figure 8) and shopping bags (Figure 9). At first glance, this might have seemed like any mundane daily update the Influencer often posts. However, a close inspection reveals the caption bearing sponsor hashtags, tags, and campaign information. For instance, one Instagram post shows #HeYurou casually holding on to and staring at a burger in KFC wrapping (Figure 7), but when read in tandem with bongqiuqiu’s other KFC-related posts published over a span of a few months, it becomes clear that #HeYurou was in fact advertising for KFC. Figure 7, 8, 9, screenshot December 2014 from ‹instagram.com/bongqiuqiu›Elsewhere, Baby Dash was incorporated into xiaxue’s car sponsorship with over 20 large decals of one of his viral photos – dubbed “pineapple Dash” among followers – plastered all over her vehicle (Figure 10). Followers who spot the car in public are encouraged to photograph and upload the image using its dedicated hashtag, “#xiaxuecar” as part of the Influencer’s car sponsorship – an engagement scarcely related to her young child. Since then, xiaxue has speculated producing offshoots of “pineapple Dash” products including smartphone casings. Figure 10, screenshot December 2014 from ‹instagram.com/xiaxue›Follower EngagementSponsors regularly organize fan meet-and-greets headlined by micro-microcelebrities in order to attract potential customers. Photo opportunities and the chance to see Baby Dash “in the flesh” frequently front press and promotional material of marketing campaigns. Elsewhere on social media, several Baby Dash fan and tribute accounts have also emerged on Instagram, reposting images and related media of the micro-microcelebrity with overt adoration, no doubt encouraged by xiaxue, who began crowdsourcing captions for Baby Dash’s photos.Influencer ohsofickle postures #BabyElroyE’s follower engagement in a more subtle way. In her YouTube channel that debut in the month of her baby’s birth, ohsofickle produces video diaries of being a young, single, mother who is raising a child (Figure 11). In each episode, #BabyElroyE is the main feature whose daily activities are documented, and while there is some advertising embedded, ohsofickle’s approach on YouTube is much less overt than others as it features much more non-monetized personal content (Figure 12). Her blog serves as a backchannel to her vlogs, in which she recounts her struggles with motherhood and explicitly solicits the advice of mothers. However, owing to her young age (she became an Influencer at 17 and gave birth at 24), many of her followers are teenagers and young women who respond to her solicitations by gushing over #BabyElroyE’s images on Instagram. Figure 11 & 12, screenshot September 2015 from ‹instagram.com/ohsofickle›PrivacyAs noted by Holloway et al. (23), children like micro-microcelebrities will be among the first cohorts to inherit “digital profiles” of their “whole lifetime” as a “work in progress”, from parents who habitually underestimate or discount the privacy and long term effects of publicizing information about their children at the time of posting. This matters in a climate where social media platforms can amend privacy policies without user consent (23), and is even more pressing for micro-microcelebrities whose followers store, republish, and recirculate information in fan networks, resulting in digital footprints with persistence, replicability, scalability, searchability (boyd), and extended longevity in public circulation which can be attributed back to the children indefinitely (Leaver, “Ends”).Despite minimum age restrictions and recent concerns with “digital kidnapping” where users steal images of other young children to be re-posted as their own (Whigham), some social media platforms rarely police the proliferation of accounts set up by parents on behalf of their underage children prominently displaying their legal names and life histories, citing differing jurisdictions in various countries (Facebook; Instagram), while others claim to disable accounts if users report an “incorrect birth date” (cf. Google for YouTube). In Singapore, the Media Development Authority (MDA) which governs all print and digital media has no firm regulations for this but suggests that the age of consent is 16 judging by their recommendation to parents with children aged below 16 to subscribe to Internet filtering services (Media Development Authority, “Regulatory” 1). Moreover, current initiatives have been focused on how parents can impart digital literacy to their children (Media Development Authority, “Empowered”; Media Literacy Council) as opposed to educating parents about the digital footprints they may be unwittingly leaving about their children.The digital lives of micro-microcelebrities pose new layers of concern given their publicness and deliberate publicity, specifically hinged on making visible the usually inaccessible, private aspects of everyday life (Marshall, “Persona” 5).Scholars note that celebrities are individuals for whom speculation of their private lives takes precedence over their actual public role or career (Geraghty 100-101; Turner 8). However, the personae of Influencers and their young children are shaped by ambiguously blurring the boundaries of privacy and publicness in order to bait followers’ attention, such that privacy and publicness are defined by being broadcast, circulated, and publicized (Warner 414). In other words, the publicness of micro-microcelebrities is premised on the extent of the intentional publicity rather than simply being in the public domain (Marwick 223-231, emphasis mine).Among Influencers privacy concerns have aroused awareness but not action – Baby Dash’s Influencer mother admitted in a national radio interview that he has received a death threat via Instagram but feels that her child is unlikely to be actually attacked (Channel News Asia) – because privacy is a commodity that is manipulated and performed to advance their micro-microcelebrities’ careers. As pioneer micro-microcelebrities are all under 2-years-old at present, future research warrants investigating “child-centred definitions” (Third et al.) of the transition in which they come of age, grow an awareness of their digital presence, respond to their Influencer mothers’ actions, and potentially take over their accounts.Young LabourThe Ministry of Manpower (MOM) in Singapore, which regulates the employment of children and young persons, states that children under the age of 13 may not legally work in non-industrial or industrial settings (Ministry of Manpower). However, the same document later ambiguously states underaged children who do work can only do so under strict work limits (Ministry of Manpower). Elsewhere (Chan), it is noted that national labour statistics have thus far only focused on those above the age of 15, thus neglecting a true reflection of underaged labour in Singapore. This is despite the prominence of micro-microcelebrities who are put in front of (video) cameras to build social media content. Additionally, the work of micro-microcelebrities on digital platforms has not yet been formally recognized as labour, and is not regulated by any authority including Influencer management firms, clients, the MDA, and the MOM. Brief snippets from my ethnographic fieldwork with Influencer management agencies in Singapore similarly reveal that micro-microcelebrities’ labour engagements and control of their earnings are entirely at their parents’ discretion.As models and actors, micro-microcelebrities are one form of entertainment workers who if between the ages of 15 days and 18 years in the state of California are required to obtain an Entertainment Work Permit to be gainfully employed, adhering to strict work, schooling, and rest hour quotas (Department of Industrial Relations). Furthermore, the Californian Coogan Law affirms that earnings by these minors are their own property and not their parents’, although they are not old enough to legally control their finances and rely on the state to govern their earnings with a legal guardian (Screen Actors Guild). However, this similarly excludes underaged children and micro-microcelebrities engaged in creative digital ecologies. Future research should look into safeguards and instruments among young child entertainers, especially for micro-micrcocelebrities’ among whom commercial work and personal documentation is not always distinct, and are in fact deliberately intertwined in order to better engage with followers for relatabilityGrowing Up BrandedIn the wake of moral panics over excessive surveillance technologies, children’s safety on the Internet, and data retention concerns, micro-microcelebrities and their Influencer mothers stand out for their deliberately personal and overtly commercial approach towards self-documenting, self-presenting, and self-publicizing from the moment of conception. As these debut micro-microcelebrities grow older and inherit digital publics, personae, and careers, future research should focus on the transition of their ownership, engagement, and reactions to a branded childhood in which babies were postured for an initimate public.ReferencesAbidin, Crystal. “Communicative Intimacies: Influencers and Perceived Interconnectedness.” Ada: A Journal of Gender, New Media, & Technology. Forthcoming, Nov 2015.Aiello, Marianne. “Mommy Blog Banner Ads Get Results.” Healthcare Marketing Advisor 17 Nov. 2010. HealthLeaders Media. 16 Aug. 2015 ‹http://healthleadersmedia.com/content/MAR-259215/Mommy-Blog-Banner-Ads-Get-Results›.Azzarone, Stephanie. “When Consumers Report: Mommy Blogging Your Way to Success.” Playthings 18 Feb. 2009. 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