Honors Review - Volume IX

Page 1

Augsburg Honors Review Minneapolis, Minnesota 2016

A Multidisciplinary Journal of Undergraduate Scholarship Published by the Augsburg College Honors Program

Augsburg Honors Review Volume IX Minneapolis, Minnesota 2016

Augsburg Honors Review

Editorial Staff Editorial Board August Bangert Tyler Ellefson Sophie Keefe Daniel Polaschek Layout and Design Editors Andrew Jewell Samuel Mungure Managing Editor Erica Bryer Editor-In-Chief Elise Hitchings Faculty Advisor Diane Pike, Ph.D. Professor of Sociology Augsburg College Faculty Reviewers Milda Hedblom Professor of Political Science

Doug Green Professor of English

Diane Pike Professor of Sociology

Kristen Chamberlain Professor of Gender, Sexuality, and Women's Studies

Ben Denkinger Professor of Psychology Michael Schock Professor of Social Work

Elise Marubbio Professor of American Indian Studies

Augsburg Honors Review

Contents Introduction........................................................................................................i Elise Hitchings, Editor-In-Chief Participatory Art and Aging: Proposal for Dementia Prevention Strategy....1 Colette Brown What is Victory? What is Loss? An Analysis of the War on Terrorism........21 Hasani Gunn Goals of Actors Within the BDS Movement..................................................37 Julian Kritz Better Healthcare Acheivable by Collaboration Between Two Medical Schools of Though.............................................................................................55 Adriene Michelle Lai J.S. Mill On Hate Speech in the Canadian Context.......................................89 Matteo Maciel Transitioning: An Ethnographical Study of Mid-20th Century Transgender Americans.......................................................................................................101 Samuel McCracken Unity Through Division: A Revision of the Haudenosaunee's Policy of Neutrality........................................................................................................109 Haley O'Shaughnessy Appendix.........................................................................................................121 Author Biographies........................................................................................133

Augsburg Honors Review


Introduction The Augsburg Honors Review is a multidisciplinary undergraduate research journal. We look for original scholarly work that adds to the conversation among young scholars. The goal of the Augsburg Honors Review is to provide undergraduates the opportunity to participate in scholarly conversations and expose them to the dialogue between a journal and a contributor in editing an article for publication. All submissions undergo a two tier blind peer review process, and those meeting the criteria of the journal receive feedback from a peer editor as well as a faculty referee. I would like to thank the authors and the Editorial Board for all of their hard work.

Elise Hitchings Editor-in-Chief


Augsburg Honors Review

Participatory Art and Aging: Proposal for Dementia Prevention Strategy Colette Brown

California State University Long Beach

Abstract: As the population age increases, and Alzheimer’s disease death rates increase, the need for dementia prevention therapies grows in relevance and necessity. A cooperative model for teaching Conceptual art to older adults is proposed as a dementia prevention strategy. Preventive benefits of the proposed strategy are preliminarily suggested to improve: 1) cognitive reserve (CR), where a strong CR has been associated with longer lasting functionality in dementia patients; 2) cognitive lifestyle, a behavioral measure of CR; and 3) neuroplasticity, with promoting neuroplasticity being the goal of many non-pharmacological dementia prevention studies. Texts on art therapy, Conceptual art, social practice, neuroplasticity, brain reserves, aging, and dementia were analyzed. The research showed that CR is difficult to assess; but it is linked to cognitive lifestyle, which is measured by the Lifetime of Experience Questionnaire (LEQ). High LEQ scores indicate a more cognitive lifestyle and correlate with reduced dementia risk. Since Conceptual art encompasses cognitively challenging tasks, it could be used as a part of a cognitive lifestyle to reduce dementia risk. The cooperative model of participatory art facilitates Conceptual art in group therapy by encouraging interpersonal discourse, for a combination of social and cognitive enrichment, which has been linked to positive health outcomes, specifically lowered dementia risk. This research is limited by the lack of studies on using art therapy for dementia prevention. The hypothesis could be fully realized by conducting a comparative longitudinal study measuring the cognitive capabilities of older adults engaged in conceptual-participatory art therapy, versus other cognitive therapy, versus no therapy.


Participatory Art and Aging…

Since 2000, the rate of Alzheimer’s disease deaths has been increasing, with Alzheimer’s now being the sixth leading cause of death in America, and affecting one in three seniors each year (Cowl & Gaugler, 2014; Alzheimer’s Association, 2014). Alzheimer’s disease (AD) is a neurodegenerative disease characterized by losses in memory and learning capabilities, and is one of the most common causes of dementia in older adults (Tompa, 2013). As medical sciences now stand there is no known cure for AD, therefore increasing the relevance and importance of developing prevention strategies. Current uses of art therapy for dementia deal primarily with post-onset patients who are already in early to late stages of AD. These studies have shown expressive arts to be effective in buffering the emotional and behavioral challenges of the disease (Herholz, Herholz, & Herholz, 2013). However, there has been little research on art as a preventive tool. Furthermore, most existing art therapy research approaches art from the expressionist perspective of late 19th – early 20th century Modernism, but recent developments in art since the mid-1900’s Post-Modernism up to contemporary periods, such as Conceptualism and social practice, are not well understood or explored by therapeutic arts. Since its conception in the early 20th century, art therapy has floated in its own practice-specific genre, neither valued by contemporary art discourse nor occupying a competitive empirical position in science. The discipline is split even within itself by an opposition between psychoanalytic art therapy and expressive art therapy. Although it is now chiefly aligned with medical psychology, it was originally suggested that it be placed within the field of education (Brown, 2012). Given the intellectual rigor of certain types of art – namely concept-based art – it is my position that the original angle to affiliate art therapy within the education sector was not entirely incorrect. This paper outlines how art therapy can employ Conceptual art and integrate brain health education into projects and group discussions, with the aim of reducing dementia risk. Literature on art, art therapy, and cognitive function has been analyzed and amalgamated to support this proposition. In addition to empirical research, examples will be referenced from the author’s non-research based, personal experience in elder care as an arts and crafts instructor at an assisted living center. The idea of conceptual artwork has come into various meanings over the decades. This paper will use a definition of Conceptualism that was developed by a cohort of artists in the 1960’s who approached art through a series of analytic questions, both material and ideological. The Conceptual movement is a useful starting point, as it has played a part in redefining art as a mode of critical thinking and problem solving – two processes of executive functioning that rapidly decline with AD. How then does one go about integrating this intellectualized form of art making with the highly expressionistic values that often accompany art therapies? To achieve this, a cooperative model of participatory art is suggested. Participatory art is a branch of social practice that is largely consumed with public interaction. Social art practices emerged intermittently throughout the twentieth century, but have recently begun


Colette Brown

to crystalize since the 1990’s (Bishop, 2012). The field has since been characterized by the interconnectivity of art and its social context. Due to the inherent cooperative nature of participatory art, this paper suggests group art therapy as an ideal setting for this approach. Participants’ work would become activated through group discussions and social dynamics. Thus, a collaborative mindset, amongst participants and with the therapist, is central to the realization of the proposed strategy. This paper will discuss the potential brain-fortifying benefits of Conceptual art therapy in terms of: 1) cognitive reserve (CR), or the brain’s capacity to compensate for neurodegeneration; 2) cognitive lifestyle, a behavioral measure of CR; and 3) neuroplasticity, or the forming of new synapses. Specific types of concept-based projects that can enhance cognitive functioning will also be discussed. The aim is to grant participants a greater sense of agency, as well as expand their opportunities for social and cognitive enrichment. Studies have shown that these types of environmental enrichments can help prevent or slow the onset of neurodegenerative diseases such as Alzheimer’s (Williams & Kemper, 2010; Cracchiolo et al., 2007; Valenzuela, 2011), but art has yet to play a major role in these studies. This paper explores, through theoretical analysis, the hypothesis that Conceptual art within a cooperative model has the potential to reduce dementia risk among older adults.

Art Therapy and Conceptualism The split between psychoanalytic and expressive art therapies originated with two sisters, Florence Cane and Margaret Naumburg, the mothers of American art therapy. Expressive art therapy, often called “art as therapy”, was developed by Cane, who believed the therapeutic quality of art to originate from the process of making (Detre et al., 1983). Art activities in this application are used for the inherent therapeutic benefits of hands-on creation. For elderly patients the visual and tactile sensations are considered rewarding and pleasurable stimuli, enabling emotional release. Out of Naumburg’s practice grew psychoanalytic art therapy, referred to as “art in therapy”, where art is used in conjunction with psychotherapy (Detre et al., 1983). Here, images generated by the patient are interpreted as expressions of the unconscious. Early art therapy practices of this vocation existed almost exclusively in mental institutions to assist in diagnosing and treating mental illness patients. Existing modes of art therapy for persons with dementia stem primarily from the “art as therapy” branch, aiming to provide emotional comfort. For the patient and their family, art is seen to serve as a distraction from the inevitable collapse of cognition (Riley, 2001). While these are helpful goals, they are also limiting. The goal of art therapy for dementia patients should be, not only the preservation of optimism, but also the literal preservation of the mind. The presupposition that art is not an intellectual endeavor, as well as intuitive, is a detriment to the rich potentials of the practice. Especially in the context of therapy, it disregards the patient’s cerebral agency, confines the skill of the art therapist, and relegates the power of artistic production. While concept-based art making


Participatory Art and Aging…

may be too cognitively demanding for a person with existing impairment, an intellectual art form could be beneficial on the preventive side for at-risk individuals. In Naumburg’s 1983 obituary in The New York Times, she was quoted speaking about the Walden School which she founded in 1914: “The purpose of this school is not merely the acquisition of knowledge by children. Its primary objective is the development of their capacities.” Naumburg’s alternative education school was focused on, not increasing students’ amount of knowledge, but on improving their ability to learni. Her mission was to nurture instinctive learning through creative expression (Detre et al., 1983). From this philosophy that expressive art opens the mind, this paper offers that Conceptual art can be used as an instrument for stretching and strengthening the mind in all stages and facets of life. However, the distinction between expressive art and Conceptual art must be made. Contemporary art has since evolved from early 20th century notions of expressivity and unconscious revelation, and entered an era of critical discourse. This turn more or less began with Conceptualism. Fine art, as the institutions had established, was once about aesthetically appealing, largely representational, skillfully rendered visual imagery. The era of Conceptualism was a breakthrough in defining the artist as a questioner and challenger. Such an identity of nonconformity could be traced back to the bohemian Impressionists of 19th century France, who sidestepped classical training, excommunicated themselves from the traditionally renowned schools of art, and pushed boundaries of art mediums such as painting. By the 1960’s, Conceptualists came to question the nature of art in general (Kosuth, 1969). Artists such as Joseph Kosuth and Lawrence Weiner set the stage for a practice of making art that does not look like “art” (in the European classical sense of painting or sculpture). For instance, Kosuth worked with household furniture and dictionary excerpts; and Weiner dedicated his wall space, not to framed paintings, but typographic texts and slogans. Valuable traits of a Conceptual artwork became less about visual appeal and more about ideas. Art no longer relies upon aesthetic beauty; rather it is amplified by intellectual rigor. The contemporary art scene is a stark contrast to that of an art therapy setting. In the context of the former, one could point at a chair and call it art. While the chair itself is not particularly interesting, the action of the artist calling our attention to it creates the framework for the interest. The supporting argument as to how this could be art is usually the most vital part of the piece, and potentially the very thing that fulfills the original claim. Thus, the value of an art practice is not found in a hand-made object, but in the idea that object represents and how it contributes to expanding the boundaries of a discipline. The Sixties jumpstarted a collective and fervent inquiry: What is art? Any simplistic or conventional answer was contested, as exemplified by John Baldessari’s painting titled What is Painting (1966 – 1968) (see Figure 1). Artists contested the notion of art as a physical object, tangible mass, or material thing. With his piece One in Three Chairs (1965), Joseph Kosuth confronted fundamental perceptions about the art object (see


Colette Brown

Figure 1). In 1973, contemporary art critic Lucy Lippard summarized Conceptualism as a challenge to the definition of art itself – highlighting the value shift from aesthetic objectness to ideological discourse. In her article No Place Like Home (2012), artist Andrea Fraser posed art discourse as the imperative structure that connects materiality with context. Discussions of Conceptual artwork require complex, critical thinking. Much like a good poem, a good artwork is one that keeps the viewer thinking long after they have left the piece. It may need to be revisited, each time revealing some new physical or conceptual element. This process is required of the viewer as well as the artist. A Conceptual work is wholly supported by the contemplation, communication, and discussion of its idea. To incorporate concept-based art into a group art therapy setting, this attention to critical thought must be maintained and translated. Conceptual art involves processes of articulating thoughts and bringing ideas to fruition, which are skills used in daily communication. Practicing these skills through an engaging activity such as art would provide powerful agency for persons at risk of losing physical or mental abilities. In addition to increasing sense of agency, critical thinking in art can help concretize abstract goals and give greater significance to the work. Through these endeavors, art becomes a mode for creative problem solving that generalizes and transfers even to activities outside of the art studio. Solutions are found not only in the sense of art materials (e.g. “How can I cut out this circle?”), but in relation to communication and accomplishment on an everyday basis.

Cooperative Model Defining Participatory There is a deep-rooted perception that art is a product rather than an action. This is evident in the English language when it is grammatically correct to say, “I am making art”; and incorrect, or odd sounding, to say, “I am doing art.” Art theorist Ellen Dissanayake considered art as a behavior, rather than an artifact (2003, p. 24). She argued that art is not only the result of action, but also the action in and of itself. Participatory art, in part, emerges from this notion of art as action. Specifically, its interest is in social interaction. However, there is not yet a clear and decided vocabulary for discussing this type of art practice. The field has acquired titles such as: socially engaged art, social practice, cooperative art, or participatory art. All variations deal primarily with interrelational communication and societal structures. In his book What We Made (2013), museum director and cultural affairs commissioner Tom Finkelpearl appropriates the term “socially cooperative” for organically orchestrated group projects, “participatory” for public works with one clear author; but reserves the term “collaborative” for clear and true co-authorship. In 2006, art historian Grant Kester (as cited by Finkelpearl, 2013) suggested that these terms are not exclusive, but form a spectrum along which any social practice may categorically reside.


Participatory Art and Aging…

The term participatory is broadening in application. In 2012, Langley Brown described his work in the mental health field as participatory art, though he considers himself aligned with what he calls “non-therapy-oriented artists”ii. Participatory Action Research (PAR) – a type of therapy dedicated to providing individuals with tools for agency – has adopted the arts as a way to integrate disabled persons into mainstream society (Spaniol, 2004). Participatory art exists within the field of social practice; but also often falls along borders of therapy or activism. Berlin-based artist Annika Eriksson, for instance, conducted a sociological project for London’s 2004 Frieze Art Fair. Aptly titled Do you want an audience?, her process involved placing an ad in the local paper calling for individuals who desired a public audience. At the art fair, she arranged a stage and microphone upon which the ad-respondents were invited to broadcast their voice. As another example, Polish artist Pawel Althamer, in cooperation with Grupa Nowolipie, created Sylwia (2010), a bronze sculpture of a female figure functioning as a public fountain. It was produced by the group of disabled adults in a ceramics workshop ran by Althamer. This part of his art practice falls loosely between contemporary art and therapy. Although, exhibiting the group’s work as an art piece lends toward labeling them as artists rather than patients. Both projects by Eriksson and Althamer are examples of what participatory art can look like. One is an event and one is a sculpture – both are results of socially cooperative art. Transforming audience members into participators is the hallmark of this type of work. It is not merely “audience participation”, nor the removal of the audience; it is an integration of the two. The primary audience becomes “built-in” to the work itself. For this reason, in 2012, art historian Claire Bishop assigned the term “participatory art” to the broadening category of social practice. This art is not only dependent upon, but is activated by the participation of a group. The work becomes localized within this interaction. Consequently, the discussion about material is recalibrated as well. Within a participatory art practice, the primary medium is people. Artists now consciously use the level of participation as a further means to explore ideas. The interworking structures of culture, politics, economics, and interpersonal relationships become the malleable target. Integrating Intellect and Expression As it emerged, Conceptual art aimed to sterilize art by removing from it all traces of affect and stripping it down to bare essentials. This manifested as cut-and-dry artwork, with no flourishes, just the facts. While this type of art is a great intellectual tool, it is not the easiest to swallow as it often lacks a human touch or appeal. Applying a participatory structure could help remedy this within an art therapy setting. Participatory art has a social aptitude that makes art both accessible to the public and open to the dissemination of ideas. Finding this balance between sterility and accessibility, and intellect and affect, is crucial to the success of the Conceptual art therapy strategy being suggested.


Colette Brown

The following is a demonstration of how a participatory lens can build upon a Conceptual framework, through a dual analysis of Conceptual artist Sol Lewitt and social practice artist Rick Lowe. As a Conceptualist of the 1960’s, Lewitt triumphed thought-process over any end visual result. For his well-known series of Wall Drawings, he worked by designing blueprints or sets of instructions, which were then carried out by draftsmen. Through this arrangement, a division was cast between the mind that constructed the geometric systems governing his drawings, and the hands that physically produced them. This has become the foundation of Conceptual art, which values the artist as savant rather than skilled-laborer. As a social practice artist, Lowe posited art as a thought-process leading up to an action-process. In the 1990’s, he began Project Row Houses. Two decades later, the project continues to operate as a fully established non-profit organization. Lowe’s social regard and Lewitt’s conceptual concerns are by no means exclusive. For instance, the unique relationship between Lewitt and his fabricators represents a transference of information between individuals. His systematic method is fuelled simultaneously by two distinct human desires: to accurately follow directions, and to think independently and solve problems through critical analysis. The success of Lewitt’s practice is contingent upon human communication, and is thus exemplary of how a Conceptual framework can be integrated and amplified by a community network and social interest. Within art therapy professions, there is also a need to mediate affective interests, which have been partially compromised by a critical distance between therapist and patient. Art therapist and social activist, Maxine Junge, revealed the limitations of a practice that neglects empathy: A part of our history as art therapists that may impede us is that we have been trained as “appreciators” of art, as reflectors, supporters, explorers of the intrapsychic landscape rather than pro-activist, co-creators engaged together with our clients in their struggle, which is ultimately also our own. (Junge, 2009, p. 109) While her article seems partially focused on the power of emotion (and the aim of this essay is to, not negate, but momentarily steer away from affective emphases), her argument that the art therapist should consider their patients as collaborators is useful for this essay. In a 2004 publishing of her writings, art therapist Shirley Riley also noted the importance of a collaborative relationship with her clients. A shared mentality is becoming more and more practiced and recognized in therapy professions. Avoiding Exploitation Social art practices in which the artist works with disadvantaged or underserved populations, such as senior citizens or ethnic minority groups, sometimes results in unintended exploitation of that group. For example, artist Richard Ross interviews and photographs incarcerated youth. Some would say he speaks for those who are not given


Participatory Art and Aging…

a voice. Though, he speaks for them in such a way that reinforces their relegated state. When working with inpatients or inmates, the social practice artist more or less brings these individuals – or rather representations of them – into the art world through photos, videos, and discourse around the artist’s practice. In some cases, they exist in the art world in a secondhand fashion. While regulations such as patient confidentiality raise potential issues by restricting representational autonomy, careful attention must be allotted to prevent exploitation. These concerns are critical to the establishment of the emerging field of social practice, and also relevant to broader discussions on individualistic versus collectivistic value systems. In the art therapy setting, these issues could be opened for dialogue about communal dynamic and deconstructing hierarchies. Inviting participants into the discussion on collaboration and representation could improve interest and intellectual stimulation. Additionally, hearing their opinions could clue the therapist in to new collaborative possibilities. Group Advantage The collective dynamic unique to group art therapy contributes strongly to the plausibility of a participatory art approach. Interpersonal relationships and group dynamics are that which activate a social practice. The cooperative model is dependent upon the voluntary contributions of involved participants. It is a collaborative practice. Collaboration is the combined, equal, and accumulative efforts of a group of individuals where they can build upon each other’s skills and ideas. The congregated structure of group therapy is a welcoming context, full of potential for the blossoming of interpersonal relationships and bonds. Additionally, the structure of therapy that is arts-based is already configured for creative thoughts and activities, where a “hands on” approach is expected and appreciated. Group art therapy is almost always more fruitful than individual therapy sessions for patients experiencing age-related decline (Riley, 2001). For those who may have physically or consciously lost friends and family, the social quality of the group setting often serves as a replacement community. Nursing homes or assisted living facilities are sanctioned-off from larger social contextsiii. Family might come to visit, but they are distanced on the day-to-day. So being a part of a group, reintegrating into a new social sphere, provides crucial support. Cooperative Model in Action Connected Communities, a program run by the Arts and Humanities Research Council in the UK, is funding a new project called Dementia and Imagination. This project employs artists (not art therapists) to lead sessions in a similar vein of art therapy, but not for the purpose of emotional confrontation. As described on their website, a participatory art approach is used to overcome stigmatizations of dementia diseases and


Colette Brown

to address larger, related issues outside the confines of a therapy setting. This is a progressive research project working to develop more opportunities for dementia persons. Their focus is mainly to change social attitudes toward dementia. However, according to the principal investigator Dr. Gill Windle, their program is not set up to measure the preventative benefits of participatory art against neurodegenerative diseases.iv Adding this neurological element to their research could have immense potentials.

Neurological Benefits The three brain regions initially obstructed by AD are the hippocampus, entorhinal cortex, and prefrontal cortex (Galbraith, Subrin, & Ross, 2008). These areas of the brain are key components in controlling working memory and executive functions such as goal-keeping and decision-making. These areas are affected first, at early onset, and continue to atrophy as pathology develops. Destructive plaques and tangles grow and spread, eventually throughout the entire cortex, until the brain can no longer function. Recent adjustments to the National Institute on Aging – Alzheimer’s Association (NIA/AA) have produced a new diagnosable stage of AD. The disease can now be preemptively diagnosed as preclinical, or pre-symptomatic, when appropriate biomarkers are present (Sperling et al., 2011). Biomarkers, or biological indicators, are being studied to predict a forthcoming onset of the disease. The research of Sperling and colleagues (2011) advocates the opportune significance of this preclinical stage for prevention studies. If AD can be accurately forecasted, protective measures could have incredible implications for efficacy. Prevention studies must therefore be solidified and expanded upon in anticipation of identifiable clinical biomarkers. Reserves The brain has basically two defenses against decline: brain reserve and cognitive reserve. The quantitative measure of brain mass is called brain reserve – the number of neurons and neuronal axons in one’s brain. Brains with a higher neuronal count are generally denser, heavier, and have shown to be more resilient against dementia (Galbraith et al., 2008). Although brain reserve has been a long-standing determinant of disease pathology, recent research has revealed a more complex model of brain resilience that involves cognitive reserve (CR). A qualitative measure of the brain’s capacity for learning, CR is related to neuroplasticity, or the flexibility of neurons to form new connections (Stern, 2013). Such flexibility is what enables speed of thought, learning, and memory. In 2013, Yaakov Stern suggested that the probability and severity of dementia pathologies are determined by a factor of both brain reserve and CR. While two people may have the same measurable amount of brain reserve, they may experience functional decline at different rates. This is due to a difference in levels of CR. A greater level of CR


Participatory Art and Aging…

enables the formation of new neuronal pathways to carry on the functions of deteriorated pathways; whereas lower levels of CR would result in the loss of that function altogether. In other words, the brain has access to greater resources in the face of decline. Stern also reports the drawback that a high CR defers timely diagnosis, as functional failures such as memory loss are not outwardly noticed until much later. While CR is a promising theory for functional resilience, its limitation is that it is difficult to measure objectively. Stern (2013) proposed that CR be measured by a person’s a) level of education and b) occupational attainment, where higher achievement correlates with higher CR, and c) cognitive challenge of leisure activities. This is problematic for two reasons. First, it does not account for socioeconomic differences in access to education or employment.v Second, it only loosely takes into account the myriad of activities outside of school and work that contribute to our intellectual capacities. To remedy this, Michael Valenzuela (2011) developed a behavioral construct of CR called “cognitive lifestyle” that can be observed and measured. Cognitive lifestyle is defined as a combination of an individual’s level of education, complexity of their occupations, and diversity and frequency of their extracurricular activities (Valenzuela, 2011). A quantitative, self-report measure, the Lifetime of Experience Questionnaire (LEQ) (Valenzuela and Schadev, 2007), was developed to assess one’s level of cognitive lifestyle, with higher LEQ scores indicating a more cognitive lifestyle. The questionnaire has also been shown to reliably predict dementia risk. High LEQ scores have been correlated with less cognitive decline and larger hippocampal volume (Valenzuela, 2011). As this is one of the first brain regions attacked by AD, having a larger hippocampus means that it is more resilient against memory loss associated with dementia. Furthermore, Valenzuela’s research showed that a more cognitive lifestyle is indicative of a stronger CR, meaning increased capacity for neuroplasticity and lowered risk of dementia. If we look at participatory art and Conceptualism from this cognitive perspective, all elements of social and cognitive enrichment are there. Processes used in these art practices including complex thought, experimental diversity, and intellectual stimulation are directly related to activities that have been shown to strengthen and fortify CR for dementia prevention. Returning to the example of Kosuth’s One in Three Chairs (1965), the piece raises philosophical questions about objectness and language. The example of Lowe’s Project Row Houses (1990 –) presents social activism as art, and in turn reassesses the realms in which an artist can function. These ponderings stir deep intellectual and cultural curiosity. The contemporary understanding of art as a process of abstract problem solving broadens its instrumental scope. It now has potential at disciplinary intersections such as neuropsychology and art therapy. The cooperative model of participatory art framed by conceptual interests presents an opening for the pleasure of making to coincide with the challenge of thinking. Thus, having been evidenced as cognitively challenging, this art falls within the category of activities that designate a cognitive lifestyle.


Colette Brown Neuroplasticity

Neuroplasticity can be defined as the ability of neural networks and synapses to adapt in response to the environment, providing the foundation for learning (Doidge, 2007; Goldstein, 2010). Plasticity occurs on a daily basis according to our experiences, and is therefore a dynamic, competitive process (Doidge, 2007). The more we dedicate one part of our brain to a specific task, the more pronounced that brain area becomes. The opposite is also true. Less frequented tasks result in depreciated connections in those brain areas. Plasticity is for efficiency; so neural pathways that aren’t being used get “voted off the team”. If we stop learning or doing new things, there is no need for networks to adapt or rewire. In which case, plasticity hardens and we lose flexibility. Plastic responses may be triggered by external or internal environmental changes. In the presence of AD, for instance, cellular plaques and tangles deteriorate the internal environment of the brain (Galbraith et al., 2008). Brains with higher CR, and greater capacity for neuroplasticity, may demonstrate resilience by recruiting alternative or additional neuronal pathways to compensate for loss (Valenzuela, 2011). Research by Grady and her colleagues (2003) provides evidence for compensatory neuroplasticity in persons with AD. Their study showed that, during memory tasks, healthy older adult brains were predominantly activated in the left hemisphere, which was considered normal. Patients with mild AD displayed cortical activity in both hemispheres, indicating that additional neural networks had been recruited to perform the memory tasks. Interestingly, AD patients who performed worse in memory showed less bilateral network activation. This suggests that memory proficiency in AD patients may be sustained by increases in compensatory neuroplasticity. For this reason, promoting neuroplasticity has been the goal of many non-pharmacological interventions for dementia prevention (Herholz et al., 2013). A small, but significant, part of the brain that facilitates neuroplasticity is called the nucleus basalis (Doidge, 2007). Located within the basal forebrain, this structure is involved in the production of acetylcholine (ACh) – a chemical that controls arousal and attention (Carr, 2008). Attention is what enables the processing of jumbled stimulus input into useable, memorable information (Goldstein, 2010). Thus, increased production and absorption of ACh enhances attentional capacity, making for more efficient learning. Alzheimer’s has been linked to a reduction of ACh and degeneration of the nucleus basalis (Ferreira-Vieira et al., 2016). Using art as a concept-based tool in art therapy for older adults could be used to stimulate ACh production within the nucleus basalis. Critical thinking and focus are elements of Conceptual art that precipitate the learning of new ideas and materials. The process of communicating ideas through visuals may flow smoothly, intuitively at times; and at times it may require arduous contemplation. Such heightened attention is more likely to promote neuroplasticity, in turn strengthening CR (see Figure 2 for example art project).


Participatory Art and Aging… Neurogenesis

Aside from reserves, which mainly pertain to axonal growth, there are other studies concerned with the growth of entirely new neurons. This phenomenon is known as neurogenesis. In 2012, neuroscientist Sebastian Seung stated that, while nothing has been exclusively proven, many neuroscientists now concur that the hippocampus and olfactory bulb are two brain areas that undergo neurogenesis throughout a lifespan. The majority of this research pointed to enriched environments, physical activity, and intellectual stimulation as means of promoting neurogenesis. As the hippocampus is one of the first brain areas affected at initial onset of AD, this discovery of its capabilities is a breakthrough. Seung (2012) suggests that neurogenesis in this area is not regenerative, but a process of experiential learning. This means that the hopes for neurogenesis are primarily preventive, rather than curative, of brain disease. Again, this supports the increasing need for dementia prevention studies. Conversely, neurogenesis in the olfactory bulb is a regenerative process of cell death and re-birth (Goldstein, 2010, p. 356). This is evolutionally necessary since receptors in the nasal cavity are often exposed to harmful pollutants. Looking at the mechanisms of olfactory neurons could give scientists insight to curative types of neurogenesis, but any research on this has yet to be fully realized.

Applications and Tactics Keeping Participants Informed “At last I am getting some information here that I have been waiting for!” (Riley, 2004, p. 189), was a man’s response upon being informed, during an art therapy session, about how Alzheimer’s was affecting his brain. The man’s art therapist was Shirley Riley who had innovatively combined brain science and art therapy to help her patients understand their brains at a neurological level. Riley’s work exemplified a combined educational-therapeutic approach. She experienced a particular breakthrough in her practice when she began to teach her patients about basic brain biology in relation to their illness. She proceeded by directing her patients to draw their own brain. This incorporated visual and verbal communication pathways, as well as allowing them to draw on personal experience and past memories. The man’s response in the aforementioned quote implies desire for information that is either being withheld from or deemed irrelevant to geriatric populations. This lack of communication is especially problematic when the uncommunicated pertains to a person’s physical, mental, or social condition. Everyone should be informed about how the brain works, how experiences affect brain plasticity, and how to keep the brain active. Anne Galbraith, Ruth Subrin, and Drew Ross (2008) are a team of art therapists who also spread this awareness to their patients. They have developed practices that incorporate teaching their geriatric groups about neurogenesis and plasticity. The lessons resulted in an increased willingness to participate


Colette Brown

and experiment during art activities. This technique provided their patients with a sense of hope and agency, as well as challenging them cognitively through academic learning. The evidence for plasticity in adult brains is a promising lead for neuroscience. Additionally, it establishes a basis for new and higher goals of therapy, specifically art therapy, for older adults. Art therapy now has the potential to function in line with cognitive therapies. It can be used as a pro-active tool for cognitive engagement and social enrichment. The Checklist According to a compilation of research by Riley (2004) and her partners Galbraith, Subrin, and Ross (2008), there are three key qualities an art therapy activity should possess: application of memory, use of repetition, and attention to spatial awareness. These are the factors most relevant to art therapy for dementia patients. Projects that involve these elements are more likely to improve cognitive functioning. In regard to memory, specific memories are almost always attached to broader concepts (Goldstein, 2010). The use of concept in art therapy would open more opportunities for memory connections to be made. This would allow for more engagement by referencing past experiences that relate to the present, as well as stimulating areas of the brain involved in memory retrieval (see Figure 3). However, this type of intellectual memory is not the only type of memory we possess. Riley (2004) was interested in the notion of body memory, or parts of the body that carry memory through the senses. This is the foundation of procedural memory, such as riding a bike – also commonly referred to as “muscle memory”. Riley noted that the brain-body connection allows for storage of these memories in the mind, even when they are unable to be articulated through verbal language.vi She found that this was an important distinction to provide for her dementia clients. Since intellectual memory is often emphasized over muscle memory, many patients felt they had “lost it all” when they lost their ability to articulate memories (p. 189). However, many still retained their ability to perform actions from memory, or procedural memory. Riley found that participants were highly optimistic upon this discovery. Procedural memory, or “muscle memory” such as brushing teeth, outlives semantic and episodic memory because it is reinforced through repetition on a daily basis (Galbraith et al., 2008). Repetition works on a neurological level through reinforcement. Repetitive output or input activates the same neural pathways over and over again each time it is repeated (Doidge, 2007). This “trains” the brain and creates specialized neurons. Repetition accompanied by minor innovations reinforces established pathways and helps form new ones – keeping the brain flexible and plastic. Again, neural plasticity contributes to increasing cognitive reserve (Stern, 2013). Spatial awareness and social engagement are crucial elements of an effective therapy session. Spatial awareness, on a biological level, employs more sensory receptors, which connects to more brain areas being utilized (Goldstein, 2010). On a social level, engaging


Participatory Art and Aging…

with one’s surrounding inevitably means engaging with others in the environment. Additionally, engaging with surrounding space encourages thinking outside of the self, a practice that has been linked to more effective learning and conditioning cognitive activity (Grossberg, 2013). An example of an art project that could activate spatial awareness and repetition can be seen at Figure 4. Four-step Plan Art therapist Dr. Aina Nucho developed what she called the psychocybernetic model of art therapy (2003). Her book describes a four-step therapeutic process, which is now widely used by clinical art therapists. The four steps are broken down into the “unfreezing phase” where the client is brought into mindful awareness; the second “doing phase” where the client creates the artwork; the third “dialoguing phase” opens up for discussions and analyses of the work produced; and the “ending and integrating phase” occurs when desired therapeutic goals have been reached. This four-step therapeutic process bears some resemblance to the pedagogic process at work in university art schools. Academic procedures typically initiate with a lecture about artists and materials relevant to the upcoming assignment. This is followed by a series of “work days” where production time is maximized. Finally, there is a critique, or class discussion, used to assess the artwork each student has produced. Nucho’s model and the described art school curriculum exhibit similar protocol. Both consist of preparatory, action, and reflection stages. One is therapy and one is education, but they are not so far removed in the logic of their approach. This goes back to illustrate legitimacy in original attempts to align art therapy within the education sector. To combine them in a conceptual-cooperative approach to art therapy would be highly beneficial. Orienting, or extending, the opening phase towards a more educationally driven message could direct participants’ thoughts to be more open to learning and experimenting, as seen in the research of Galbraith and colleagues (2008) whose patients’ interest peaked after an educational lesson on brain health. Using the action phase to produce conceptual work would activate brain regions associated with executive functions such as problem solving and critical thinking. The reflection or critique phase would include group discussions on emotional response as well as academic language and constructive criticism, making excellent use of the cooperative model to encourage socialization and communication skills. In this proposed plan for integrating therapeutic and educational modalities, finding the balance between emotional sensitivity and intellectual awareness is essential. Andrea Fraser, in her 2012 written work of art called No Place Like Home, calls for more raw honesty in the contemporary art world, which she criticizes has become sterilized by sapience. Art in all contexts is complimented by a combination of affect and intellect. Addressing work from an academic angle makes for a more goal-oriented process with the satisfying reward of refined knowledge about the topic, or work, at hand.


Colette Brown

Simultaneously, having the ability to express one’s thoughts or feelings is important for reducing apathy and cultivating sense of confidence. Thus, the overall approach should allow for subjective reflections, as well as informed considerations such as form, context, and concept. Benefits of an educational approach are also evidenced in health and science. In 1999, the Health Education Authority of the UK conducted a review of community-based arts for health projects, in which they found that the most successful approaches were those that assumed a structure more similar to art workshops or traditional art school. Additionally, as previously mentioned, Stern (2013) and Valenzuela (2011) have shown that educational and enrichment experiences have the potential to increase cognitive reserve in early as well as later life stages. Thus, educational approaches are indeed beneficial, but a strictly educational environment may be too demanding for persons at risk for dementia. Bringing educational elements of Conceptual art into a therapy setting allows for more sensitivity and lenience. A therapeutic environment is set up to cater to emotional and medical needs, as well as intellectual reaches. The goal would be to capture the joys of education, while meeting participants at their learning level. Education in this sense is not the memorization of facts, but the ability to think critically and problem solve.

Conclusion Ideas and action are inseparable and inherent to Conceptual art and participatory art. Adopting these practices into an art therapy plan would provide more rigorous opportunities for increasing neuronal health. Using Conceptual art to strengthen CR is a strategy for prevention against dementia of the Alzheimer’s type. Critical thinking layered with multifaceted experiences are ingredients for inventing creative solutions to life’s challenges. As Naumburg believed, education is not only means of obtaining information. Rather, educators should teach how to collect, and build upon, existing knowledge. From this synthesis of research, a direct way to engage art therapy participants is to keep them informed. Expand their knowledge about CR, neurogenesis, and neuroplasticity. Include them in discussion about collaboration and representation. With so many years of experience, a geriatric group can offer as much to their therapist as the therapist can offer them. Research and practices within art and mental health fields are progressing. Some alternative approaches are using “art therapy” as a reference title that can be most closely associated to their present direction. However, professional and social currents are flowing toward more integrated, holistic techniques. Dementia and Imagination, a community health project in the UK, for example, uses art workshops to address wider social and cultural issues relative to their senior population’s entire life contexts. Artsbased PAR projects are reaching towards social integration and self-sufficiency for adults with disabilities. Galbraith, Subrin, Ross (2008), and Riley (2001; 2004) combined clinical neuroscience with art therapy. Projects such as these are beginning to delve


Participatory Art and Aging…

into pluralistic practices – calling upon multiple disciplines and combining methods for unique applications. It has been the aim of this essay to contribute to these emergent studies. Arguably, there are certain problems with the sanctioning-off of geriatric facilities. It acts as a barrier between generations, isolates the elderly, and quarantines end-of-life realities. There are many social, cultural, and economic aspects involved. However, with aging populations on the rise, it is a subject worthy of extended investigation. With the new diagnosable stage of preclinical AD, preventive measures are being more closely considered. Prevention studies could be expanded by looking to Conceptual art as a way of non-pharmacologically strengthening CR. Additionally, the field of Conceptual art would be expanded and diversified if addressed in relationship to neurological research. Looking at the relationship between art and play could also advance this investigation. As seen with examples from my experience at the assisted living center (i.e. “The Memory Game”) (see Figure 2), playful elements can be incorporated into art projects. Competition and teamwork are also factors to consider in relation to participants’ levels of interest and involvement. Conceptual art that involves gameplay would be an area to explore. Much of this paper has focused on intellectual activity, but physical activity should be addressed as well. Somatic and cognitive components work together. Potentials of the mind-body connection could be evidenced in the realm of conceptual dance. The connection between memory and muscles, as explored through dance, is another area for further research. Overall, this paper shows the cognitive and therapeutic benefits of fusing the intellectual devices of Conceptual art with the integrative qualities of participatory art. Furthermore, this paper reveals the need for further investigation into these contemporary art practices as potential non-pharmacological strategies to prevent or slow age-related cognitive decline. Such research could be fully realized by conducting a comparative longitudinal study measuring the cognitive capabilities of older adults engaged in conceptual-participatory art therapy, versus other cognitive therapy, versus no therapy. The brain-fortifying potential of academic, professional, and extracurricular enrichment activities is a message with widespread applications. The ideas and methods described in this paper are not limited to geriatric group art therapy, but can – and should – be adapted for demographics across the spectrum. “If the brain were a bucket, instead of filling up the bucket, the goal would be to make the bucket bigger” (Pentz, 2015). i

Non-therapy chiefly implies anti-therapy. Criticisms against therapy are largely related to the negative stigmas attached to the term. “Some artists…see their role…as an antidote to…the patronizing and disempowering effects of therapy” (Brown, 2012, p. 34-35). This paper is not anti-therapy, but this viewpoint must be noted, as it is not an uncommon ii

Colette Brown


position for artists working in mental health fields. There is interesting anthropological research (Nanda & Warms, 2011) about culturally specific values of aging. Industrial cultures associate age with death; they tend to employ nursing homes and the like, relinquishing caretaker responsibilities to non-family members. Rural cultures equate age with longevity, tend to champion their elders, and assume in-home care. iii

For full interview with Windle go to http://dementiaandimagination.org.uk/the-project/ the-project/ iv

As economic and political inequalities disintegrate the middle class, it seems that wealthier persons with access to educational and occupational resources will have less probability of developing dementia; whereas working class individuals with fewer available resources will be at greater risk. v

Conceptual dance is non-performative, stemming from natural motion. As a conceptual art form, it could be a way to address the mind-body connection. An example of conceptual dance would be Yvonne Rainer performing Trio A (The Mind is a Muscle, Part I) (1966). Enriched physical activity also contributes to cognitive improvement (Seung, 2012; Stern, 2013). vi

Alzheimer’s Association. (2014). Alzheimer’s facts and figures. Alzheimer’s & Dementia, 10(2). Retrieved from http://m.alz.org/facts-and-figures.asp Art for health: Summary bulletin. (1999). Health Education Authority. Retrieved from http://www.gserve.nice.org.uk/nicemedia/documents/artforhealthsum.pdf Bishop, C. (2012). Artificial hells: Participatory art and the politics of spectatorship. London, UK: Verso. Brown, L. (2012). Is art therapy?. In T. Stickley (Ed.), Qualitative research in arts and mental health (pp. 22 – 41). Ross-on-Wye, UK: PCCS Books. Carr, R. (2008). Neurotransmitters, neuromodulators, and hormones: Putting it all together. In Hass-Cohen, N., & Carr, R. (Eds.), Art therapy and clinical neuroscience (pp. 254 – 269). London, UK: Jessica Kingsley Publishers. Childhood Homes. Personal photograph by the author. 29 Oct. 2013. Cowl, A.L. & Gaugler, J. E. (2014). Efficacy of creative arts therapy in treatment of Alzheimer’s disease and dementia: A systematic literature review. Activities, Adaptation & Aging 38, 281 – 330. doi: 10.1080/01924788.2014.966547 Cracchiolo, J. R., Mori, T., Nazian, S. J., Tan, J., Potter, H., & Arendash, G. W. (2007). Enhanced cognitive activity-over and above social or physical activity-is required to protect Alzheimer’s mice against cognitive impairment, reduce Abeta deposition, and increase synaptic immunoreactivity. Neurobiology of Learning and Memory 88(3), 277 – 294. Dementia and Imagination. (2014). Dementia and Imagination project. Retrieved


Participatory Art and Aging…

November 30, 2014, from: http://dementiaandimagination.org.uk/ Detre, K. C., Frank, T., Kniazzeh, C. R., Robinson, M. C., Rubin, J. A., & Ulman, E. (1983). Roots of art therapy: Margaret Naumburg (1890 – 1983) and Florence Cane (1882 – 1952) – a family portrait. American Journal of Art Therapy 22(4), 111 – 123. Dissanayake, E. (2003). The core of art: Making special. Journal of the Canadian Association for Curriculum Studies 1(2), 13 – 38. Doidge, N. (2007). The brain that changes itself. New York, NY: Penguin Group. Ferreira-Vieira, T. H., Guimaraes, I. M., Silva, F. R., & Ribeiro, F. M. (2016). Alzheimer’s disease: Targeting the cholinergic system. Current Neuropharmacology 14, 101 – 115. Fraser, A. (2012). There’s no place like home. Whitney Biennial 2012, 28 – 33. Finkelpearl, T. (2013). What we made: Conversations on art and social cooperation. Durham, NC: Duke University Press. Galbraith, A., Subrin, R., & Ross, D. (2008). Alzheimer’s disease: Art, creativity, and the brain. In Hass-Cohen, N., & Carr, R. (Eds.), Art therapy and clinical neuroscience (pp. 254 – 269). London, UK: Jessica Kingsley Publishers. Goldstein, B. E. (2010). Sensation and perception (8th ed.). Belmont, CA: Wadsworth, Cengage Learning. Grady, C. L., McIntosh, A. R., Beig, S., Keightley, M. L., Burian, H., & Black, S. E. (2003). Evidence from functional neuroimaging of compensatory prefrontal network in Alzheimer’s disease. The Journal of Neuroscience 23(3), 986 – 993. Grossberg, S. (2013). Adaptive Resonance Theory: How a brain learns to consciously attend, learn, and recognize a changing world. Neural Networks 37, 1 – 47. doi: 10.1016/j.neunet.2012.09.017 Herholz, S. C., Herholz, R. S., & Herholz, K. (2013). Non-pharmacological interventions and neuroplasticity in early stage Alzheimer’s disease. Expert Review of Neurotherapeutics, 13(11), 1235–1245. doi: 10.1586/14737175.2013.845086 Junge, M. B., Alvarez, J.F., Kellogg, A., Volker, C., & Kapitan, L. (2009). The art therapist as social activist: Reflections and visions. Art Therapy, 26(3), 107–13. doi:10.108 0/07421656.2009.10129378. Kennedy, S.G. (1983, March 6). Margaret Naumburg, Walden School founder, dies. The New York Times. Retrieved from http://www.nytimes.com/1983/03/06/obituaries/ margaret-naumburg-walden-school-founder-dies.html Kosuth, J. (1969). Art after philosophy. Studio International, 178(915), 134–137. Lippard, L. R. (1973). Six years: The dematerialization of the art object from 1966 to 1972. Los Angeles, CA: University of California Press. Memory Game. Personal photograph by the author. 13 Dec. 2013. Nanda, S. & Warms, R. L. (2011). Cultural anthropology (10th ed.). Belmont, CA: Wadsworth, Cengage Learning. Nucho, A. O. (2003). The psychocybernetic model of art therapy (2nd ed.). Springfield,

Colette Brown


IL: Charles C Thomas Publisher, Ltd. Pentz, C. (2015). Intelligence: Stability or change [lecture]. Given at CSU Long Beach, CA. Riley, S. (2001). Group process made visible: Group art therapy. Ann Arbor, MI: Sheridan Books. Riley, S. (2004). The creative mind. Art Therapy: Journal of the American Art Therapy Association, 21(4), 184 – 190. Seung, S. (2012). Connectome: How the brain’s wiring makes us who we are. New York, NY: Houghton Mifflin Harcourt Publishing Company. Spaniol, J. (2004). An arts-based approach to participatory action research. The Journal of Pedagogy, Pluralism and Practice 3(1). Retrieved from http://www.lesley. edu/journal-pedagogy-pluralism-practice/susan-spaniol/arts-participatory-actionresearch/ Sperling, R. A., Aisen, P. S., Beckett, L. A., Bennett, D. A., Craft, S., Fagan, A. M., … Phelps, C. H. (2011). Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging – Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia 7, 280 – 292. doi: 10.1016/j.jalz.2011.03.003 Stern, Y. (2013). Cognitive reserve: Implications for assessment and intervention. Folia Phoniatrica et Logopaedica, 65(2), 49 – 54. doi: 10.1159/000353443. Tompa, R. (2013, June 13). DSM-5: Debated? Yes. Important for AD diagnosis? Maybe not. Retrieved from http://www.alzforum.org/news/dsm-5-debated-yes-importantfor-ad-diagnosis-maybe-not T-Shirt Rope. Personal photograph by the author. 6 Nov. 2013. Valenzuela, M. J. (2011). Cultivating a cognitive lifestyle: Implications for healthy brain aging and dementia prevention. In McNamara, P. (Ed.), Dementia: History and incidence (pp. 99-122). Santa Barbara, CA: Praeger. Valenzuela, M. J. & Sachdev, P. (2007). Assessment of complex mental activity across the lifespan: Development of the Lifetime of Experience Questionnaire (LEQ). Psychological Medicine, 37, 1015–1025. doi: 10.1017/S003329170600938X Williams, K. & Kemper, S. (2010). Exploring interventions to reduce cognitive decline. Journal of Psychosocial Nursing and Mental Health Services, 48(5), 42–51. doi: 10.3928/02793695-20100331-03


Augsburg Honors Review

What is Victory? What is Loss? An Analysis of the War on Terrorism Hasani Gunn Bard College

Abstract: Although first coined by then United States President Ronald Reagan in response to state-sponsored terrorism, the “War on Terrorism” has irrevocably evolved since 11 September 2001. Concerned with annihilating the terrorist threats both abroad and at home, deeper questions of the war on terrorism are unanswered. What does it mean for the state to win or lose against terrorists? Conversely, what does it mean for terrorists to win or lose against the state? More precisely, what do the outcomes of armed conflict mean and look like within the context of the war on terrorism? Current terrorism studies literature focuses on what it takes for the state to win. Yet, scholars fall short of conceptualizing the alternative. This paper is a humble attempt to engage with the gaps in current research. Analyzing broader questions of constructivism, discourse and language, this paper grapples with contemporary theories of terrorism to put forth three claims. First, terrorism is a social construct whereby discourse is instrumental. Second, perceptions of victory rely on terrorists’ capacity to deal destruction. Third, for terrorists, to lose is to be forced to cease the campaign. Although victory and loss for states is largely indefinable, both measures became distorted. The reason for this is intuitive: what makes terrorism distinct from other forms of political violence is that the tactic requires interpretation by its audience. Adopting a Foucauldian notion of discourse as the production of knowledge and power, this paper posits that the stakes of the far-reaching “War on Terrorism” were defined and intensified by the heads of state. The consequence of which was that the war became a matter of preserving liberal-democratic values rather than addressing terrorists’ motivations.


What is Victory? What is Loss?…

What does it mean for a state to lose to terrorism? Little to no research in the terrorism studies literature explicitly grapples with this question. Perhaps the lack of attention to the concept is a familiar consequence of limited firsthand experience and fieldwork. The objective of this paper is to consider and analyze the notions of failure and victory in “The War on Terrorism.” In other words, the attempt to understand loss and success is deliberately abstract and holds no intention to go beyond an exercise of critical thinking. Within this context, I explore the notions of state victory and terrorists’ loss. Since the subject is more restricted in a notably confined field, my underlying logic is simple: loss is diametrically opposed to success; to understand loss is to view it through the framework of success. That is, to lose is the polar opposite of to win. This paper argues first that terrorism is a social construct advanced through discourse. Second, this paper argues that since the war on terrorism is socially constructed, victory for the state is predicated upon the inability of terrorists to execute mass destruction. Just as well, for terrorists, to lose is even temporarily, to be forced to end the campaign. The conclusion suggests state loss in the war on terrorism is indefinite, but the stakes of losing the war are exaggerated.

Defining ‘terrorism’ and ‘war’ One of the many hallmarks of terrorism studies is the issue of defining terrorism and defining who or what can be or commit terrorism. The claims and justifications for the sake of labeling and not labeling are diverse and contested. For instance, after accepting the United States State Department’s definition of terrorism in his article, Robert Pape says that accepting a broad definition of terrorism that includes a national government “would distract from what policy makers would most like to know: “how to combat the threat posed by subnational groups to state security.”i On the other end of the spectrum,ii in her article, Ruth Blakeley suggests in support for the view that states can commit terrorism that “critically oriented scholars need to reclaim the term ‘terrorism’ and use it as an analytical tool rather than in the service of elite power.”iii This paper isn’t concerned with engaging in or adding a new dimension into this debate. Instead this paper adopts the definition of terrorism provided by the United States Department of Defense: “the calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological objectives.”iv Equally as important as establishing a definition of terrorism, I define war as the declaration of, or state of, armed conflict among states and/or subnational groups. Explicit mention of armed conflict goes hand in hand with the threat of violence in that the declaration entails premeditation. In the following section, I briefly contextualize the war on terrorism and argue terrorism itself can best be understood as a social construct.


Hasani Gunn Constructivism and terrorism

Then United States President, Ronald Reagan, coined the war on terror in reference to conflicts of state-sponsored terrorism. However, the notion of a war on terrorism wasn’t popularized until former President George W. Bush’s speech before a joint session of congress on 20 September 2001. The war on terrorism is an ongoing, international military campaign that was declared in response to the 11 September 2001 terrorist attacks. The objectives of the war can best be described as delivering wholesale destruction to terrorist organizations; eliminating the circumstances whereby terrorists can reemerge, and protecting the citizens and the interests of the US and her allies. Yet, the deeper question the objectives beg is who or what is the war against? To be more precise, is the war on terrorism centered on al-Qaeda and its affiliates or the tactic itself? The perception of exactly who or what the US and her allies are in war against receives different interpretations. For instance, in May 2013, President Barack Obama stated that “The ‘Global War on Terror’ is over, the military and intelligence agencies will not wage war against a tactic but will instead focus on a specific group of networks determined to destroy the US.”v Contrastingly, scholars such as Michel Chossudovsky, outright claim that the focus of the war is on Islamic terrorists: “Osama bin Laden, supported by his various henchmen, constitutes America’s post-Cold war bogeyman, who ‘threatens Western democracy.’ The alleged threat of ‘Islamic terrorists,’ permeates the entire US national security doctrine.”vi The point here is that the war on terrorism “does not separate a war against terrorists from a war against terrorism, as a social phenomenon.”vii The lack of a distinction made between a war on tactics as opposed to a war on a diffuse set of individuals and networks has two interrelated impacts: it allows more flexibility of the war on terrorism’s social construction and shapes the perception of what victory and defeat looks like in the war on terrorism for both the US and her allies and the terrorists. Terrorism is a social construct. That is, the understanding of terrorism is built “through social processes in which meanings are negotiated, consensus formed, and contestation is possible.”viii The phenomenon “is not a ‘given’ in the real world; instead it is an interpretation of events and their presumed causes.”ix This means that communicating about terrorism, regardless of the intentionality behind the interpretations, becomes “a medium by which the negotiation and construction of meaning takes place.”x Moreover, in explaining the evolution of the word, terrorist’s meaning— from a positive connotation during the French Revolution and struggles for emancipation throughout the twentieth century, to its status as a pejorative term today— Bruce Hoffman demonstrates that the current, modern understanding of terrorism is subjective and conditional.xi If terrorism is socially constructed, how does the development of meaning take place? The understanding of terrorism is built through discourse. Terrorism’s meaning is fundamentally determined by the communication that takes place among its targets. Rainer Hülsse and Alexander Spencer speak to this point in critiquing terrorism studies’ preoccupation with the terrorist actor: “one scholar reproduces the unverified views of another and thus contributes to the circulation... of interpretations of how others


What is Victory? What is Loss?…

have interpreted al Qaeda members’ self-interpretation.”xii Which “overlooks that selfrepresentations only become relevant as they become the object of interpretations in the Western discourse.”xiii For Michel Foucault, discourse was “a group of statements which provide a language for talking about a particular topic at a particular historical moment.”xiv Discourse can work to define and build the perceptions of objects and events; it “is about the production of knowledge through language.”xv Since terrorism is used to create certain effects on its targets, whereby “terrorizing” can take place, then terrorism is reliant on the inter-subjectivities of its audience— their sensibilities towards and analyses of the events. For all these reasons, the Western discourse on the war on terrorism is instrumental in the social construction of terrorism itself. That is to say that, in a Foucauldian sense, whether or not the discourse is true, the power in its production of knowledge makes it so the discourse becomes true.xvi In other words, despite the true identity of terrorists, interpretation and discourse make it so “if we think they are and act on that ‘knowledge,’ they in effect become terrorists because we treat them as such.”xvii To develop this argument further, I briefly evaluate the impact of race in violent crime. Specifically, I look to the possibility that the impact of race makes it so that events, that are terrorism by definition (even in its loose sense), are treated differently. To be precise, I compare the treatment of the 2015 shooting in Charleston, NC as opposed to the terrorist attack in San Bernardino, CA of the same year. The purpose behind this is to demonstrate how perpetrators have limited agency in defining their actions. Instead, the subsequent discourse influences the meaning of the action. The former was a racially motivated shooting at a black church during an evening bible study on 10 June 2015. The latter was an attack fueled by extreme Islamic ideology at a social services center on 2 December 2015. For the former, the perpetrator Dylann Roof shot and killed nine churchgoers in a confessedly premeditated act intended for the political purpose of striking fear and creating a race war.xviii Although the shooting was terrorism by definition, according to the Department of Justice, the act was investigated as a hate crime.xix For the latter, the perpetrators Syed Farook and Tashfeen Halik left fourteen killed and twenty-two injured in their raid of the social services center. The act was reportedly inspired by foreign terrorist groups and, according to the Federal Bureau of Investigation (FBI), investigated as terrorism. Roof, a Caucasian male, since his incarceration, has been defended by the media as “being troubled” and “[showing] all the signs of severe and worsening mental illness” in reference to his struggle staying in school and subsequent drug use, whereas the U.S.-born Muslim, Farook, and his Pakistani wife, Halik,were killed hours later.xx They reportedly “[appeared] to exemplify this brand of ‘homegrown’ or ‘self-radicalized’ terrorist.”xxi The difference in the language used to describe both violent events presents how agency can be limited in discourse. Despite the confessed aims by Roof, which would correctly label him a terrorist, his intentions and agency in his actions were restricted through the eventual discourse that followed. His identity was constructed as a ‘troubled’ hate crime-committer. In contrast, the personal characteristics of Farook and

Hasani Gunn


Halik, more than likely influenced their immediate deaths and the avoidance of labeling either or both perpetrators mentally ill. As a result, although their self-reported objectives are unknown, their personal characteristics afforded them no sympathy or attempt of understanding. In other words, the discourse in tandem with their appearance limited their ability to construct an identity and meaning to their actions. Both the difference of discourse in the events of Charleston and San Bernardino, accompanied by much of the recent literature on media bias in white and minority crime are evidence of race’s impact in interpretations.xxii Another strong example of discourse’s instrumentality in social construction is the rhetoric of former President Bush. As I will show, he rendered a political struggle a matter of “good” versus “evil”. At his speech before a joint session of congress, Bush said that (emphasis added): On September the 11th, enemies of freedom committed an act of war against our country. Americans have known wars - but for the past 136 years, they have been wars on foreign soil, except for one Sunday in 1941. Americans have known the casualties of war - but not at the center of a great city on a peaceful morning. Americans have known surprise attacks - but never before on thousands of civilians. All of this was brought upon us in a single day - and night fell on a different world, a world where freedom itself is under attack.xxiii Bush put forth three ideas in his speech that constructed for his audience, an identity to al Qaeda, the appropriate response to the event, and the meaning of the attack itself. Recognize that Bush defines the perpetrators as ‘enemies of freedom.’ The impact here lies in the implication: terrorists pose a harm beyond American citizens, they are an affront to our liberal-democratic principles. In saying then, that the terrorists are enemies of freedom, Bush expands their identity. He constructs their selfhood by placing them in intimate opposition to the value of freedom itself. In this sense, terrorists are dehumanized. They become the ‘other’ to more than the American people; they are otherized to any person that values freedom. Bush’s declaration that ‘freedom itself is under attack’ extends the conflict. Again, by way of implication, his speech raises the stakes and propagates fear. ‘Under attack’ implies a continuation of assaults on the value of freedom. In defining the terrorist attacks as freedom being under attack, Bush extends the war’s temporality. He implies that more assaults to freedom can and will happen. This illustrates a Manichean world where the US and her allies are the sole protectors of the “right” values. His discourse was instrumental in advancing the social construction of terrorism in building the identity of the terrorists as “evil-doers” who are personally in opposition to freedom.xxiv Next, in saying that the terrorists executed ‘an act of war,’ Bush maintains the construction of the terrorists’ identity, and preconditions the U.S. to retaliate. He renders war a morally legitimate response in putting the terrorists in conflict with freedom. For the US, a war response becomes a responsibility, because the value of


What is Victory? What is Loss?…

freedom is a cause worthy of uniting citizens for the sake of the greater good.xxv The point here is that Bush served a crucial role in shaping the construction of the terrorists’ identity and overstated the stakes of loss. For Bush, the meaning of the war against terrorism is not to simply bear extensive collateral damage, or to concede to territorial losses—it means a spiritual struggle. US discourse on terrorism usually “[e]vokes images of menacing nomadic armies attempting to conquer ‘Christian Europe’ and ‘good’ versus ‘evil,’ a formulation which is [d]eeply embedded in American rhetorical traditions and religious life,”xxvi Bush’s speech was no different. Although it has been argued that political discourse that makes appeals to religion is for the sake of garnering legitimacy and support,xxvii in this respect, Bush upped the ante of the war. That is, in framing this struggle, he built a dichotomy. This dichotomy provides insight into the meaning of the war on terrorism. In his words, “freedom and fear, justice and cruelty, have always been at war, and we know that God is not neutral between them.”xxviii In this sentence Bush is implying that God is on the Western states’ side in the war on terrorism. Because for him, the mission to oppose terrorism at every turn was “a mission from God.”xxix If the political struggle against terrorism is a spiritual struggle, then the meaning of the war against terrorism is to triumph over the values of evil.xxx I explain this through relating the war on terrorism to George Lakoff’s concept of war’s “fairy tale asymmetry.” For Lakoff, in order for a war to be justified, it is necessary to distribute the archetypal roles of hero, villain and victim. In his view, this narrative constructs an air of legitimacy throughout the conduct of war that “[f]unctions to justify… [to a higher extent] all the extensive powers reserved for wartime.”xxxi The narrative’s hero is always honorable and selflessly makes sacrifices. Whereas the villain is inherently evil and displays the willingness to commit violence against the innocent.xxxii In the US’ narrative on terrorism, as has been shown, the “hero” (the US and her allies) represents all that is good is against the “villain” (terrorists) who represents all that is bad. The point here is that, through discourse, Bush overstated the meaning of the war on terrorism, which enabled it to take on values and a struggle it didn’t represent. In other words, my analysis of Bush’s discourse on the war on terrorism demonstrates that “defining the threats facing a society is never an objective process, but is rather a highly charged and politicized process of ‘reality’ construction through the deployment of language.”xxxiii Here, I discuss what victory looks like for the US and what loss looks like for terrorists. I do not discuss what victory for terrorists looks like or what loss for the state can be defined as, because as stated in the introduction, neither are the chief concern of this paper. For simplicity, I adopt the definition of victory as the realization of notions or aims defined by the actors engaged in the conflict. For terrorists, to lose is, even temporarily, a forced end to the terrorist campaign. The justification for this definition is provided after I explain the notions of US victory.

Perceptions of victory

Hasani Gunn


On 23 May 2013 at the National Defense University, President Obama, in the conclusion of his speech, said that “Our victory against terrorism won’t be measured in a surrender ceremony at a battleship, or a statue being pulled to the ground,” he continued, “Victory will be measured in parents taking their kids to school; immigrants coming to our shores; fans taking in a ballgame; a veteran starting a business; a bustling city street; a citizen shouting her concerns at a President.”xxxiv For Obama, victory against the war on terrorism is the return to normalcy. Public comfort, following the mass panic that the notion of terrorism brings, then, becomes a metric of success. The significance of feeling secure reemerges throughout speeches from the leaders of the federal government to terrorism studies scholars.xxxv Even in the recent terrorist attacks in Paris, the conception and the importance of returning to normal fueled social activity: “It was the most typical of Parisian scenes— the sharing of drinks among friends. But after the worst terrorist assault on France in recent history, it was also meant to be an act of defiance, a modern-day symbol of “la résistance.”xxxvi As one of the French citizens explained, “I can’t say that we’re not afraid… But compared with the terror and repression that the Islamic State represents... We are as free as the air. Their acts make us even more determined to show that we will never give up our freedoms.”xxxvii Similarly, Cronin explains that “‘winning’ is the glaring need to build psychological resilience among the American people, so that they are less subject to being manipulated by threats of attacks.”xxxviii Furthermore, “Americans must stop living on adrenaline and build a sustainable future by ending this war and developing some concept of what normality means.”xxxix In these comparable interpretations of victory, success means supplanting mass hysteria with the feeling of sanctuary. However, the public’s comfort is not borne simply through time alone. Instead, the sentiment, and thus, the perception of victory, is earned through action. As Janis Angstrom points out, under the presidency of George W. Bush, the measurements of success in the war on terrorism were predicated upon military success. That is, the conceptions of victory were based in the gradual destruction of the adversary’s military and will. As she notes, in the war on terrorism, Bush’s metrics were “casualty figures, control of territory, frequency of terrorist attacks, spread of weapons of mass destruction, and spread of democracy.”xl In a Clausewitzian sense then, the Bush administration’s notion of victory was comprised of the destruction of military power, “reduced to such a state as not to be able to prosecute the War,” and the dissolution of the enemy’s morale.xli Even by these measurements, victory in the war against terrorism is a matter of public sentiment, albeit almost exclusively through military force within this context. That is not to say that military action is the answer. Rather that is to say that tactics that mitigate the terrorist threat make the perception of victory conceivable. This is because the means to the end of the terrorist threat that result in less attacks lead to an increased feeling of public safety and security. As mentioned throughout this paper thus far, terrorism “is employed to produce certain effects on a specific set of people in order to attain an objective or policy.”xlii That said, when terrorists begin to fail, victory


What is Victory? What is Loss?…

appears upon the horizon. However, these notions prove problematic. Public comfort is an indicator of the state’s success. After all, indifference is diametrically opposed to fear. Yet, the fact that the sentiment must be realized through the proof of terrorist capabilities deterioration implies contingency. To be more precise, the perception of victory is less concerned with the state’s capacity to preserve freedom, and more concerned with terrorists’ lessening capacity for destruction. To this end I define terrorists’ loss in the war on terrorism as, even temporarily, the forced end to their campaign. This is because the measurements of US victory in the war on terrorism are determined by returning to a state of normalcy and terrorists’ capacity for further destruction. Both of which are a direct result of the lessening of terrorists’ ability to perform another attack. Just as well, for terrorists, victory can only be more or less realized. Because the current terrorists’xliii goals are untenable, terrorists cannot experience complete victory and are more likely to become destabilized. Modern, religious terrorist groups such as al Qaeda and its affiliates establish ultimate goals that are impossible to attain. For example, in Inside Terrorism, Bruce Hoffman quotes a Shi’a theologian, Aaytollah Baqer al-Sadr, “We have two choices: either to accept [the world others shaped] with submission, which means letting Islam die, or to destroy it, so that we can construct the world Islam Requires.”xliv Just as well, the improbable objectives of the leader of the cult, Aum Shinrikyo, are of use here: “Ashara believed that he had been ordained an… ancient ‘light god,’ and given the divine task of establishing the ‘Kingdom of Shambhala’- a utopian community populated only by those who had achieved psychic powers.”xlv This is not to disparage any religion. Rather it is to say that objectives such as destroying and reconstructing the world or establishing a utopian community exclusive to psychics, are very unlikely. The goals are far-reaching and fanciful at best and bizarre and impossible at worst. However, this is the case for solely ideology-driven terrorist groups. Compared to ethno-nationalist terrorists who sought after self-determination, religious terrorist groups in general, and al Qaeda in particular seem preconditioned to never experience complete victory. For nationalist groups the aims were plausible and many times successful: “subsequently all anticolonial terrorists sought to interest the UN in their struggles. The new states admitted to the UN were nearly always former colonial territories, and they gave the anticolonial sentiment in that body more structure, focus, and opportunities.”xlvi For religious terrorist groups though, within their pursuit of grandiose aims, they become more susceptible to destabilization. To connect the perceptions of victory for the US to the impossible goals of religious terrorists, the latter inadvertently creates a pathway to success for the former. As I will present shortly, destabilization is an ever-present risk for terrorists. The implication of which is that enough destabilization results in the forced end of a terrorist campaign. If a condition of victory for the US is terrorists’ incapacity for destruction and thus, the return to normalcy for US citizens, then the forced end of a terrorist campaign is victory. In this sense then, the campaign’s end means loss for the terrorists. In sum, the goals of terrorists


Hasani Gunn

create the circumstances for terrorists to lose in the war on terror. The question here is, what can cause destabilization? Goal changing can precipitate the defeat of terrorist groups in the war on terrorism. This is because, although changing goals is a common practice, it threatens the popular support of terrorist groups. The changes can represent emerging needs or perhaps newly recognized intermediary goals needed to pursue the ultimate objective. In either case, the fact that religious terrorist groups’ aims are implausible does not make them invulnerable to shifting goals. In fact, religious terrorists are more vulnerable to failing through goal changing since the group is more akin to a movement than an organization. On one hand, a movement is groups of people working together to pursue their shared social, political, economic goals. Social movements vary, but have the tendency of being large, informal pseudo-structures. On the other hand, a terrorist organization is an organized group of people who each hold particular goals relevant to a campaign, which is a series of operations intended to achieve a goal. As detailed by Cronin in “How Al Qaeda Ends,” the organization is comprised of a core group, traditional groups that are formally and informally aligned, localized factions and militants who are not directly associated with al Qaeda, but are purported to be.xlvii Another component of the terrorist organization, the network, is a paragon of the relationship between political violence and technology. The impact of al Qaeda being a movement in terms of goal changing is that cyberspace affords ample opportunities for recruitment, fundraising, and coordination of attacks that effectively reconstructed terrorism.xlviii With improved capabilities, members of terrorist groups are now spread throughout the globe carrying out attacks and providing financial support for the sake of the movement.xlix According to Cronin “al Qaeda is uniquely able to use existing social networks to mobilize global supporters and transform sympathizers into violent activists.”l Since al Qaeda and its affiliates operate within a “lack of central authority and rule-guided interaction implies that decision-making and coordination in networks tend to be based on consensus and mutual adjustment rather than administrative fiat,”li goal changing can easily result in losing connection with its constituency. Unpopularity of objectives can cause supporters to drift from the cause, unpopularity of actions too can lessen terrorists’ support base. Excessively violent acts can be incompatible with the sensibilities of supporters resulting in public revulsion.lii This is because “a terrorist group may choose a target that a wide range of its constituents considers illegitimate, undercutting the group and transferring popular support to the government’s response.”liii The point here is that, in the war on terrorism, in a sense, terrorists can be self-defeating. The implication is that the US and her allies have a greater probability of being successful in the war.

Conclusion In this paper, I first argued that terrorism is a social construction advanced through discourse. To substantiate my argument, I discussed the nature of terrorism, its purposes and its subsequent treatment. For its treatment, I demonstrated the ways in which discourse


What is Victory? What is Loss?…

fuels the social construction of terrorism through first comparing and contrasting the Charleston shooting and the terrorist attack in San Bernardino. Second, I argued that Bush’s speech on 20 September 2001 too, provided meaning, albeit hyperbolic, for the violent actions. My second argument focused on the perceptions of victory and loss in the war on terrorism. I linked measurements of US success in the war on terrorism to the capabilities of terrorist actors. In doing so, I argued that the US’ perception of victory is inextricably tied to the longevity of terrorist campaigns. Third, I argued that the evolution of terrorists, their structures and their aims, make it so that modern, religious terrorists cannot experience complete success. Overall, however, the conceptions of victory and failure in the war on terrorism are distinct, yet familiar. War against terrorists is naturally different. Even in the outcomes of this analysis, the fact of the matter is that victory and loss are not written out and not agreed upon: “The United States cannot win a war with al Qaeda the usual means by which wars end— negotiated conclusions— are not available in this case.”liv Instead, winning and losing in the war on terrorism are a matter of perceptions, interpretations, and sentiment. Pape, Robert A. "The strategic logic of suicide terrorism." American political science review 97, no. 03 (2003): 343-361. i

The literature is comprised primarily of orthodox and critical terrorism studies. The key point of divergence between the two is the belief that states can practice terrorist tactics. The former posits that terrorism, despite the similarity among the actions is conducted by subnational groups. Whereas the latter holds that offenses such as bombings and war crimes are terrorism within themselves. Therefore, critical terrorism studies scholars insist that states can and have practiced terrorist tactics. ii

Blakeley, Ruth. "Bringing the state back into terrorism studies." European political science 6, no. 3 (2007): 228-235. iii

United States Department of Defense. Department of Defense Dictionary of Military and Associated Terms. 8 November 2010. iv


Shinkman, Paul D. “Obama: ‘Global War on Terror’ is Over.” US News. 23 May 2013.

Chossudovsky, Michel. "Al Qaeda and the "War on Terrorism"" Global Research. Centre for Research on Globalization, 20 Jan. 2008. vi

Record, Jeffrey. Bounding the global war on terrorism. Army War College Strategic Studies Institute, Carlisle Barracks PA, 2003. vii

Fairhurst, Gail T., and David Grant. "The social construction of leadership: A sailing guide." Management Communication Quarterly 24, no. 2 (2010): 171-210. viii

Ben-Yehuda, Nachman. "Terror, media, and moral boundaries." International journal of comparative sociology 46.1-2 (2005): 33-53. ix

Jian, Guowei, Amy M. Schmisseur, and Gail T. Fairhurst. "Organizational discourse and communication: The progeny of Proteus." Discourse & Communication 2, no. 3 (2008): x

Hasani Gunn


299-320. Hoffman, Bruce. “Defining terrorism.” In Inside terrorism. Columbia University Press, 2013. 1-42 xi

Hülsse, Rainer, and Alexander Spencer. "The metaphor of terror: Terrorism studies and the constructivist turn." Security Dialogue 39, no. 6 (2008): 571-592. xii



Hall, Stuart. "Foucault: Power, knowledge and discourse." Discourse theory and practice: A reader 72 (2001): 81. xiv

Maaka, Roger, and Chris Andersen. The indigenous experience: Global perspectives. Canadian Scholars’ Press, 2006. xv

Foucault, Michel. Power/knowledge: Selected interviews and other writings, 19721977. Pantheon, 1980. xvi

Maaka, Roger, and Chris Andersen. The indigenous experience: Global perspectives. 167. xvii

Ellis, Ralph, Botelho, Greg, and Payne, Ed. “Charleston church shooter hears victim’s kin say ‘I forgive you.’” CNN. 19 June 2015. xviii



Ablow, Keith. “Charleston: why didn’t anyone help Dylan Roof?.” Fox News. 22 June 2015 xx

Jamison, Peter. “San Bernardino terrorist attack shatters Southern California’s illusion of safety.” Los Angeles Times. 12 December 2015. xxi

See for example, Weitzer and Tuch (2005) and Peffley, Shields, and Williams (1996) Weitzer, Ronald, and Steven A. Tuch. "Racially biased policing: Determinants of citizen perceptions." Social Forces 83, no. 3 (2005): 1009-1030. Peffley, Mark, Todd Shields, and Bruce Williams. "The intersection of race and crime in television news stories: An experimental study." Political Communication 13, no. 3 (1996): 309-327. xxii

"Selected Speeches of President George W. Bush 2001-2008." Whitehouse- Archives Web. 11 Dec. 2015. xxiii

Bush, G.W. “Remarks by the President at 2002 Graduation Exercise of the United States Military Academy.” 2002. xxiv

Graham, Phil, Thomas Keenan, and Anne-Maree Dowd. "A call to arms at the end of history: a discourse–historical analysis of George W. Bush’s declaration of war on terror." Discourse & Society 15, no. 2-3 (2004): 199-221. xxv

Kurtulus, Ersun N. "The new counterterrorism: Contemporary counterterrorism trends in the United States and Israel." Studies in Conflict & Terrorism 35, no. 1 (2012): 37-58. xxvi

Chang, Gordon C., and Hugh B. Mehan. "Discourse in a religious mode: the Bush administration's discourse in the War on Terrorism and its challenges." Pragmatics 16, xxvii


What is Victory? What is Loss?…

no. 1 (2006): 1. xxviii

"Selected Speeches of President George W. Bush 2001-2008." 73.

In Palestine in 2003, Delegate Nabile Shaath claims that Bush stated the following: “I am driven with a mission from God.’ God would tell me, ‘George go and fight these terrorists in Afghanistan.” Macaskill, Ewen. "George Bush: 'God Told Me to End the Tyranny in Iraq'" The Guardian. The Guardian, 7 Oct. 2005. xxix

Silberman, Israela, E. Tory Higgins, and Carol S. Dweck. "Religion and world change: Violence and terrorism versus peace." Journal of Social Issues 61, no. 4 (2005): 761-784. xxx

Jackson, Richard. "Genealogy, ideology, and counter-terrorism: Writing wars on terrorism from Ronald Reagan to George W. Bush Jr." Studies in Language and Capitalism 1, no. 1 (2006): 163-193. xxxi

Lakoff, George. 1991. “Metaphor and war: the metaphor system used to justify war in the gulf.” Peace Research 23 (2/3). Canadian Mennonite University: 25–32. xxxii

Jackson, Richard. "Genealogy, ideology, and counter-terrorism: Writing wars on terrorism from Ronald Reagan to George W. Bush Jr." 172. xxxiii

Obama, Barack. "Remarks by the President at the National Defense University." The White House. The White House, 23 May 2013. xxxiv

Schmitt, Eric. “Ex-counterrorism aide warns against complacency on Al Qaeda.” New York Times. 28 July 2011. xxxv

Alderman, Liz. “French return to cafes in a show of defiance.” New York Times. 17 November 2015. xxxvi



Cronin, Audrey Kurth. "The ‘War on Terrorism’: What Does it Mean to Win?." Journal of Strategic Studies 37, no. 2 (2014): 1-24. xxxviii


Ibid., 22

Ångström, Jan. "The United States Perspective on Victory in a War on Terrorism." (2007). xl

Von Clausewitz, Carl. On War: edited and translated by Michael Howard and Peter Paret. (1976): 75-99. xli

Neumann, Peter R., and Michael LR Smith. "Strategic terrorism: The framework and its fallacies." The Journal of Strategic Studies 28, no. 4 (2005): 571-595. xlii

Rapoport, David C. "The four waves of modern terrorism." Attacking terrorism: Elements of a grand strategy (2004): 46-73. xliii

Hoffman, Bruce. “Religion and Terrorism.” In Inside terrorism. Columbia University Press, 2013. 81-130 xliv


Ibid., 119-120.



Hasani Gunn


Cronin AK. “How al-Qaida ends: The decline and demise of terrorist groups.” International Security. 2006 Aug 8;31(1):7-48. xlvii

Thomas, Timothy L. Al Qaeda and the Internet: The Danger of 'Cyberplanning'. Foreign Military Studies Office (ARMY) Fort Leavenworth Ks, 2003. xlviii

Ozeren, Suleyman, Ismail Dincer Gunes, and Diab M. Al-Badayneh, eds. Understanding Terrorism: Analysis of sociological and psychological aspects. Vol. 22. IOS Press, 2007. xlix


Cronin AK. “How al-Qaida ends: The decline and demise of terrorist groups.” 172.

Eilstrup-Sangiovanni, Mette, and Calvert Jones. "Assessing the dangers of illicit networks: Why al-Qaida may be less threatening than many think." International Security 33, no. 2 (2008): 7-44. li

Cronin, Audrey Kurth. “Failure.” In How terrorism ends: understanding the decline and demise of terrorist campaigns. 94-114 Princeton University Press, 2009. lii



McIntosh, Christopher. "Ending the War with Al Qaeda." Orbis 58, no. 1 (2015): 104118. liv

Ablow, Keith. “Charleston: why didn’t anyone help Dylan Roof?.” Fox News. 22 June 2015. Alderman, Liz. “French return to cafes in a show of defiance.” New York Times. 17 November 2015. Ångström, Jan. "The United States Perspective on Victory in a War on Terrorism." (2007). Ben-Yehuda, Nachman. "Terror, media, and moral boundaries." International journal of comparative sociology 46.1-2 (2005): 33-53. Blakeley, Ruth. "Bringing the state back into terrorism studies." European political science 6, no. 3 (2007): 228-235. Bush, G.W. “Remarks by the President at 2002 Graduation Exercise of the United States Military Academy.” 2002. Buzan, Barry. "Will the ‘global war on terrorism ’be the new Cold War?." International affairs 82, no. 6 (2006): 1101-1118. Chang, Gordon C., and Hugh B. Mehan. "Discourse in a religious mode: the Bush administration's discourse in the War on Terrorism and its challenges." Pragmatics 16, no. 1 (2006). Chossudovsky, Michel. "Al Qaeda and the "War on Terrorism" Global Research. Centre for Research on Globalization, 20 Jan. 2008. Cole, David. "The new McCarthyism: Repeating history in the war on terrorism." Harvard Civil Rights-Civil Liberties Law Review 38 (2003). Cronin Audrey Kurth. “How al-Qaida ends: The decline and demise of terrorist groups.” International Security. 2006 Aug 8;31(1):7-48.


What is Victory? What is Loss?…

——. "The ‘War on Terrorism’: What Does it Mean to Win?." Journal of Strategic Studies 37, no. 2 (2014): 1-24. ——“Failure.” In How terrorism ends: understanding the decline and demise of terrorist campaigns. 94-114 Princeton University Press, 2009. Eilstrup-Sangiovanni, Mette, and Calvert Jones. "Assessing the dangers of illicit networks: Why al-Qaida may be less threatening than many think." International Security 33, no. 2 (2008): 7-44. Ellis, Ralph, Botelho, Greg, and Payne, Ed. “Charleston church shooter hears victim’s kin say ‘I forgive you.’” CNN. 19 June 2015. Fairhurst, Gail T., and David Grant. "The social construction of leadership: A sailing guide." Management Communication Quarterly 24, no. 2 (2010): 171-210. Foucault, Michel. Power/knowledge: Selected interviews and other writings, 1972 1977. Pantheon, 1980. Graham, Phil, Thomas Keenan, and Anne-Maree Dowd. "A call to arms at the end of history: a discourse–historical analysis of George W. Bush’s declaration of war on terror." Discourse & Society 15, no. 2-3 (2004): 199-221. Hall, Stuart. "Foucault: Power, knowledge and discourse." Discourse theory and practice: A reader 72 (2001). Hoffman, Bruce. “Defining terrorism.” In Inside terrorism. Columbia University Press, 2013. 1-42. ——“Religion and Terrorism.” In Inside terrorism. Columbia University Press, 2013. 81-130. Hülsse, Rainer, and Alexander Spencer. "The metaphor of terror: Terrorism studies and the constructivist turn." Security Dialogue 39, no. 6 (2008): 571-592. Jackson, Richard. "Genealogy, ideology, and counter-terrorism: Writing wars on terrorism from Ronald Reagan to George W. Bush Jr." Studies in Language and Capitalism 1, no. 1 (2006): 163-193. Jamison, Peter. “San Bernardino terrorist attack shatters Southern California’s illusion of safety.” Los Angeles Times. 12 December 2015. Jian, Guowei, Amy M. Schmisseur, and Gail T. Fairhurst. "Organizational discourse and communication: The progeny of Proteus." Discourse & Communication 2, no. 3 (2008): 299-320. Juergensmeyer, Mark. Terror in the mind of God: The global rise of religious violence. Vol. 13. Univ of California Press, 2003. Kurtulus, Ersun N. "The new counterterrorism: Contemporary counterterrorism trends in the United States and Israel." Studies in Conflict & Terrorism 35, no. 1 (2012): 37-58. Lakoff, George. 1991. “Metaphor and war: the metaphor system used to justify war in the gulf.” Peace Research 23 (2/3). Canadian Mennonite University: 25–32. Maaka, Roger, and Chris Andersen. The indigenous experience: Global perspectives. Canadian Scholars’ Press, 2006.

Hasani Gunn


Macaskill, Ewen. "George Bush: 'God Told Me to End the Tyranny in Iraq'" The Guardian. The Guardian, 7 Oct. 2005. McIntosh, Christopher. "Ending the War with Al Qaeda." Orbis 58, no. 1 (2015): 104118. Neumann, Peter R., and Michael LR Smith. "Strategic terrorism: The framework and its fallacies." The Journal of Strategic Studies 28, no. 4 (2005): 571-595. Obama, Barack. "Remarks by the President at the National Defense University." The White House. The White House, 23 May 2013. Ozeren, Suleyman, Ismail Dincer Gunes, and Diab M. Al-Badayneh, eds. Understanding Terrorism: Analysis of sociological and psychological aspects. Vol. 22. IOS Press, 2007. Pape, Robert A. "The strategic logic of suicide terrorism." American political science review 97, no. 03 (2003): 343-361. Peffley, Mark, Todd Shields, and Bruce Williams. "The intersection of race and crime In television news stories: An experimental study." Political Communication 13, No. 3 (1996): 309-327. Rapoport, David C. "The four waves of modern terrorism." Attacking terrorism: Elements of a grand strategy (2004): 46-73. Record, Jeffrey. Bounding the global war on terrorism. Army War College Strategic Studies Institute, Carlisle Barracks PA, 2003. Schmitt, Eric. “Ex-counterrorism aide warns against complacency on Al Qaeda.” New York Times. 28 July 2011. "Selected Speeches of President George W. Bush 2001-2008." Whitehouse- Archives. Shinkman, Paul D. “Obama: ‘Global War on Terror’ is Over.” US News. 23 May 2013. Silberman, Israela, E. Tory Higgins, and Carol S. Dweck. "Religion and world change: Violence and terrorism versus peace." Journal of Social Issues 61, no. 4 (2005): 761-784. Stern, Jessica. "Terror in the Name of God." Why Religious Militants Kill, New York (2004). Thomas, Timothy L. Al Qaeda and the Internet: The Danger of 'Cyberplanning'. Foreign Military Studies Office (ARMY) Fort Leavenworth Ks, 2003. United States Department of Defense. Department of Defense Dictionary of Military and Associated Terms. 8 November 2010. Von Clausewitz, Carl. On War: edited and translated by Michael Howard and Peter Paret. (1976): 75-99. Weitzer, Ronald, and Steven A. Tuch. "Racially biased policing: Determinants of and perceptions." Social Forces 83, no. 3 (2005): 1009-1030.


Augsburg Honors Review

Goals of Actors Within the BDS Movement Julian Kritz

Augsburg College

Abstract: The Boycott, Divest, Sanctions movement (BDS) is receiving growing attention from the general public and academics alike. Yet much remains unknown about the goals of actors within this dispersed international movement. This paper contributes to a growing body of scholarship examining BDS by attempting to answer the guiding research question: what relationship exists between the goals of the actors within the BDS movement? It analyzes both the statements and activities of the Palestinian BDS National Committee, the central coordinating nucleus of the movement, and local Twin Cities organizations working on behalf of the cause. The paper concludes that parallel goals exist between actors in the movement. Both seem to be focusing efforts on boycott campaigns and regard the one-state solution as a preferential conclusion to the longstanding IsraeliPalestinian conflict. This research endeavor elucidates the little examined inner-workings of a complex, international social movement and offers a starting point for further study.


Goals of Actors Within the BDS Movement Introduction

The boycott, divest, and sanction Israel movement (BDS) is no longer the exclusive realm of radical activists. It has become an increasingly powerful international movement affecting higher education, religious organizations, and global businesses. As the coalition supporting the BDS movement continues to broaden, the fear amongst Israel supporters grows concurrently. Perhaps this fear is unwarranted. After all, BDS campaigners promote themselves as social-justice activists, utilizing a rights-based approach to achieve their aims. But what are their ultimate aims? And do all the actors within the movement share the same goals? These questions remain unanswered. As such, this paper will attempt to shine light on the relationship of the goals of actors within the BDS movement. I hypothesize that the goals of actors at the center of BDS are different than the goals of actors further away from the movement’s nucleus. Specifically, I project that core leaders will have more radical goals, such as the one-state solution, than less involved supporters who will hold more moderate goals, such as the two-state solution. BDS Precursor: The Arab Boycott To fully understand the current movement to economically pressure Israel, one must understand the modern-day history of such efforts. Indeed some scholars, such as Dan Diker, have claimed, “The current global BDS campaign against Israel, should be viewed as an internationalization and intensification of the longstanding Arab boycott” (4).i Which formally began in 1945, when the newly created Arab League announced an economic boycott against all Jewish products produced in British Mandate Palestine to prevent a Jewish state from being declared in the region (Feiler). Just three years later Israel was established as the Jewish state, triggering Egypt, TransJordan, Lebanon, Syria and Iraq to attack the new state with the goal to eliminate it. Following their defeat, the Arab countries sought to supplement their military efforts with an economic weapon—a more organized economic boycott against the State of Israel. According to the Arab League, by 1949, the boycott was designed to “bring about the eventual collapse of the State of Israel and reveal that it is not economically viable in the midst of a hostile world” (Sarna 77). The Arab economic efforts to isolate Israel peaked following the 1973 Yom Kippur War when the Organization of Arab Petroleum Exporting Countries (OAPEC, consisting of the Arab members of the OPEC plus Egypt and Syria) went a step further than simple boycott; they proclaimed an oil embargo against the United States and four other western powers for supporting Israel in the war (Samuels 33). However, only five years later the Camp David Accords were signed, leading to the first peace treaty between Israel and an Arab state. This marked the beginning of the end for the international leverage of the Arab economic initiatives against Israel (Schaer). The 1990s Oslo peace initiatives further improved Arab-Israeli relations, leading the Arab boycott to continue to wane in influence.ii


Julian Kritz Durban: The Apartheid South African Comparison

Hope from Oslo was short-lived; within a decade international peace activists were no longer examining Arab-Israeli peace accords, but instead were comparing Israel to apartheid-era South Africa. When the fledgling peace process fully disintegrated in 2000, the Second Intifada was launched, characterized by Fatah and Hamas suicidebombing assaults and a harsh Israeli security crackdown in the Palestinian territories.iii This violent backdrop set the stage for a resurrection of old Arab boycott tactics, albeit with an expanded scope (Norman). Using the forum of the 2001 UN World Conference against Racism in Durban, South Africa, the PLO, in conjunction with other member countries of the Organization of the Islamic Conference and Western NGOs, issued a statement urging the international community to treat Israel similarly to apartheid-era South Africa. This statement was called the final NGO declaration: We call upon the international community to impose a policy of complete and total isolation of Israel, as an apartheid state as in the case of South Africa, which means the imposition of mandatory and comprehensive sanctions and embargoes, the full cessation of all links (diplomatic, economic, social, aid, military cooperation, and military training) between all states and Israel (Lantos 9). Rooted in the tradition of the Arab boycott, the Durban Conference’s NGO declaration set the political and ideological infrastructure for the contemporary BDS movement: economic boycotts, government sanctions, and the severing of social and cultural links with Israel (Diker 6). In short the NGO declaration can be viewed as an attempt to internationalize and modernize the Arab boycott by mimicking tactics innovated in the campaign against apartheid-era South Africa. The NGO declaration’s allusions to the international community’s actions towards apartheid-era South Africa have been lauded and criticized. Paul Di Stefano and Mostafa Henaway assert that, “…Just as in South Africa, a BDS campaign directed towards Israel is the most effective nonviolent means to build solidarity, end the continued colonial occupation of Palestinian territory, and ensure that Palestinian human rights are guaranteed” (23). Others have gone even further claiming, “BDS may be even more effective in the liberation of the Palestinian people than it was in the liberation of Black South Africans” (Ananth 11). However, critiques of the South African comparison have noted “White South African capitalists relied heavily on the exploitation of Black labor. This is not the case in Palestine/Israel…thus preventing a South Africa-like situation of Palestinian labor strikes from threatening the status quo of the Zionist state” (Ananth 14). Conservative scholars have argued that without a relatively increased security environment and the development of a measure of trust between the belligerents, as seen during the international community’s isolating measures towards apartheid-era South Africa, “the BDS campaign likely will play a constrained or even negative role in bringing the different sides together” (Yi and Phillips 22). Judge Richard Goldstone has argued on


Goals of Actors Within the BDS Movement

moral grounds that the situation in Israel and the West Bank is not comparable to that of apartheid South Africa. Goldstone, a former justice of the South African Constitutional Court and chair of the 2009 UN Gaza fact-finding mission, invoked the 1998 Rome Statue definition of apartheid when he claimed, Israeli’s have no intent to maintain ‘an institutionalized regime of systematic oppression and domination by one racial group’. This is a critical distinction, even if Israel acts oppressively toward Palestinians [in the West Bank]. South Africa’s enforced racial separation was intended to permanently benefit the white minority, to the detriment of other races. By contrast, Israel has agreed in concept to the existence of a Palestinian state in Gaza and almost all of the West Bank, and is calling for the Palestinians to negotiate the parameters… Those who conflate the situations in Israel and the West Bank and liken both to the old South Africa do a disservice to all who hope for justice and peace (Goldstone 6).iv Palestinian Civil Society Call: BDS Articulated Four years after the NGO declaration, the BDS movement crystallized with the 2005 Palestinian Civil Society Call for Boycott, Divestment and Sanctions (BDS) against Israel until it complies with international law and universal principles of human rights. The language and strategy invoked clearly echo the Durban NGO declaration: We, representatives of Palestinian civil society, call upon international civil society organizations and people of conscience all over the world to impose broad boycotts and implement divestment initiatives against Israel similar to those applied to South Africa in the apartheid era. We appeal to you to pressure your respective states to impose embargoes and sanctions against Israel (BDS movement). The Palestinian Civil Society Call listed three conditions Israel would have to fulfill for their boycott, divestment, and sanction campaign to be lifted: 1. Ending its occupation and colonization of all Arab lands and dismantling the Wall 2. Recognizing the fundamental rights of the Arab-Palestinian citizens of Israel to full equality 3. Respecting, protecting and promoting the rights of Palestinian refugees to return to their homes and properties as stipulated in UN Resolution 194 (BDS movement) Scholars have studied whether these three conditions would be satisfied by

Julian Kritz


Israel retreating to pre-1967 borders (relinquishing control and evacuating all citizens from the West Bank, Gaza, and the Golan Heights). A strong consensus has emerged in the academic discourse that a 1967 border withdrawal would not be enough to placate the three conditions (Mort; Diker 22; McMahon). Many point to the fact that the second and third conditions are unrelated to the aftermath of the 1967 Six Day War. Indeed, the concern for minority rights within Israel and the right of return for Palestinian refugees date back to the establishment of Israel in 1948. Even the first point of the first condition, which states that Israel must end “its occupation and colonization of all Arab lands,” can be seen as referring to pre-1967 Israeli territory, as evidenced by the tendency of mainstream Palestinian media to report on events in Tel Aviv as occurring in ‘Occupied Palestine’ (Diker 16). The BDS movement does not take an official position on their goals regarding the final status of the State of Israel (Cohen and Freilich). However, some charge that key leaders of the BDS movement are supporters of the “one-state solution”. For example McMahon argues that “Some of the campaign’s most prominent voices, in their individual capacities, hold that only a single democratic state in Palestine can accommodate the three basic rights articulated in the BDS Call” (21). Most scholars agree that the one-state solution would facilitate the cultural extinction of the modern State of Israel. According to Norman Finkelstein, a fierce critic of Israel and the BDS movement, “The official BDS movement that claims to be agnostic on the question of Israel… is deceptive about what it wants: because, if we end the occupation and bring back six million Palestinians and have equal rights for Arabs and Jews, there’s no Israel” (16). Actors within the movement seem to have differing conceptions of BDS’ goals. Citing as evidence the BDS movement’s tactic of arranging for western delegations to visit Palestinian Authority governed areas and then encouraging them to share their experience upon their return home, Diker states, “Many people join the BDS movement believing it to be a corrective tool that will help achieve a two-states-for-two-peoples solution. They do not know and are not told that the BDS campaign’s leaders are working toward a different goal [the one-state solution]” (32). Diker provides little evidence to support his claims, however, his assertion about the structure of the BDS movement is consistent with scholarship on transnational social movements (such as BDS). These movements tend to involve only a handful of activists in central leadership roles. By presenting a simplified social issue to receptive political venues, these small circles of formal advocacy professionals attempt to mass mobilize supporters (Keck and Sikkink 68). Notably, the views of leaders and followers in these movements can differ greatly. Adam Shay describes these phenomena in the context of BDS: It is aimed at manipulating members of the general public, people of conscience who have a bona fide, innocent, and genuine inclination to help the more unfortunate elements in international society, into supporting a cause of which they are generally ignorant and thus reliant on the propaganda disseminated by the BDS people (2012).v


Goals of Actors Within the BDS Movement

These charges against the BDS movement tend to be supported by little or no concrete evidence. This research will examine the actual statements of BDS supporters to answer the question: what are the similarities and differences of the goals of actors within the BDS movement? I will measure their goals not only by their statements, but also as implied by their activities.

Data Sources This paper will expand upon prior studies of the BDS movements by examining the goals of BDS advocates. Since the BDS movement is large and diverse, it is essential to remain cognizant of the differences between the small center of the movement, the professional activists of the Palestinian BDS National Committee [BNC], and laycampaigners around the world, local groups who have responded to the BDS call.vi To ensure I am researching both the goals of people at the center of the movement and people on the outskirts, I will draw on three primary data sources: 1. BDS movement materials, released or endorsed by BNC members, including policy proposals, statements, and literature. This will give me insight into the goals of actors at the center of the movement. 2. Public gatherings of groups in the Greater Minneapolis and Saint Paul metropolitan area that have responded to the call for BDS including Jewish Voice for Peace – Twin Cities (JVP), Anti-War Committee (AWC), and Students for Justice in Palestine University of Minnesota (SJP). I will compile transcripts of the content and rhetoric discussed at the meetings.vii This will grant insight into the goals of local actors outside the central BDS coordinating circle. 3. Investigation of one boycott, one divestment, and one sanction campaign sponsored by the BDS movement. Specifically, I will research: a. The American Studies Association academic boycott of Israel b. The Presbyterian Church’s (USA) divestment from companies supporting “Israel’s military occupation of Palestinian territory” c. The Brazilian government’s decision to cancel a $17 million (USD) contract with Elbit Systems, an Israeli arms manufacturer. This will grant insight into the connection between goals of the BNC and Twin Cities based groups because BDS campaigns are often initiated by central actors within the movement but implemented by local activists.

Methods I will use BDS’s three primary goals as a framework when analyzing these three


Julian Kritz

data sources, attempting to align the gathered information within the framework of the BDS movement’s stated goals. I will also compare the goals found in BNC materials to the goals voiced by Twin City BDS advocates. I will compare and contrast these goals to discern differentiation in objectives between the center and the outskirts of the movement. I hypothesize that the goals of actors at the center of BDS are different than the goals of actors further away from the movement’s nucleus. Specifically, I project that core leaders will have more radical goals, such as the one-state solution, than less involved supporters, who will hold more moderate goals such as the two-state solution.

Data Analysis: BNC: ‘The Anchor of the BDS Movement’ The center of the BDS movement is the Palestinian BDS National Committee [BNC]. This Committee’s stated mandate is “To facilitate coordination and provide support & encouragement to the various BDS campaign efforts in all locations” (BNC 2015). The BNC is comprised of twenty-seven Palestinian organizations ranging from public sector unions (i.e. Union of Public Employees in Palestine-Civil Sector) to NGOs advocating for specific targets within the overall BDS call (i.e. Palestinian Campaign for the Academic and Cultural Boycott of Israel [PACBI]). Hind Awaad, a coordinator within the BNC, advertises the committee as “the principal anchor of and reference for the global BDS movement” and claims that it is “the broadest Palestinian civil society coalition” (Lim). The BNC operates the official BDS movement website which publishes statements, analyses, and materials supporting the campaign. The website promotes only one book, Boycott, Divestment, Sanctions – The Global Struggle for Palestinian Rights, by Omar Barghouti. Barghouti is a founding member of the BDS movement and serves on the BNC representing PACBI. He is arguably the most globally recognizable BNC member. Indeed, Barghouti has gone on an annual speaking tour of the United States for the past five years (Horowitz). He is vocal supporter of the one-state solution, evidenced by his authoring of the “One State Declaration” (Barghouti et al.). While the BNC as a whole has never endorsed any prescriptive solution to the Israeli-Palestinian conflict, it is informative that the arguably most visible leader of the movement supports the one-state solution in his individual capacity. While there may be disagreement within the BNC regarding a final status statehood solution, it is clear that the global spokespeople of the committee, such as Barghouti, maintain that a single state in the region is the preferential outcome. The BNC has held four policy-setting conferences from which many documents have emerged, providing insight into the goals of this central coordinating entity. The last conference was held in 2013 in Bethlehem. Anti-normalizationviii was the overarching and recurring theme of the conference, as emphasized in the official BNC report. Highlighting this theme, the Secretary General of the Palestinian National Initiative delivered a speech on behalf of the National and Islamic Forces in Palestine, a main pillar of the BNC, in


Goals of Actors Within the BDS Movement

which he personally decried “the futility of negotiations” (BNC). Zaid Shuaibi, the BNC networking and outreach officer in the Palestinian territories and the Arab world, echoed this sentiment in an interview following the conference in which he asserted his view that “Oslo and the peace process is a normalization process” and as such “require a rejection” (Erakat). Responding to the BDS Call: Twin Cities Organizations The BNC sets macro-priorities for the BDS movement and then relies on grassroots activists to implement the actual campaigns. These grassroots activists are generally organized in groups that can be classified within one of the following five umbrella categories: peace-activist, Jewish anti-Zionist, student-led, Islamic, and Christian. The organizations working on behalf of the BDS movement in the Twin Cities can be categorized within this schema.ix I conducted field research on Twin City groups representing all of these categories, except for Islamist organizations. The peace activist group heeding the BDS call that I studied was the Anti-War Committee (AWC). This organization was originally founded in 1998 to oppose the United States bombing of Iraq. Since then the group has tackled the “injustices of U.S. foreign policy” more broadly (AWC). They “believe in peace through justice...and stand in solidarity with the oppressed people here and abroad” (AWC). They claim that because “Israel is the top recipient of U.S. military aid, ending US aid to Israel is at the top of our agenda” (AWC). They actively frame this “work as part of the BDS movement, a global campaign of boycotts, divestment, and sanctions (BDS) against Israel” (AWC). AWC has organized “vigils, rallies, marches, educational forums, and civil disobedience actions” in their campaign on behalf of BDS. On November 3rd, 2015 they disrupted the University of Minnesota Law School’s annual John Dewey Lecture in the Philosophy of Law. The AWC accused the guest speaker, Moshe Halbertalx, of being a “Zionist war crime apologist” for his work in drafting the Israeli Defense Forces’ (IDF) most recent code of ethics. They condemned the University of Minnesota for allegedly refusing to honor the “international movement to boycott Israel,” which they insist, “calls on academic institutions to NOT sponsor or participate in projects that whitewash Israel’s human rights abuses” (AWC). AWC members repeatedly shouted down Halbertal throughout his presentation, leading the lecture to be delayed more than half an hour until police cleared the protesters from the lecture hall. One of the chants employed was ‘from sea to sea Palestine will be free.' This saying refers to the geographic area from the Jordan River to the Mediterranean Sea, which encompasses all of Israel, the West Bank and the Gaza Strip. Analysts note that this can be viewed as a veiled endorsement of a one-state solution in which the culturally Jewish state is replaced with a culturally Palestinian state. Indeed the Jewish Community Relations Council of Minnesota and the Dakotas referenced the aforementioned chant in their condemnation of the incident: The JCRC will not stand idly by as professors and/or students are intimidated

Julian Kritz


and isolated by those who seek the destruction of the State of Israel. For example, the chilling chants which we were subjected to yesterday, 'From Sea to Sea, Palestine will be free,' mean nothing less than the murder or expulsion of over 6 million Jews from Israel. (JCRC) Although no public information was available regarding how the protestors themselves perceive the chant, it is clearly a mantra the AWC values. They concluded their formal public statement, in which they stood by their protest of Halbertal, with the same chant. An on-campus student group, Students for Justice for in Palestine at the University of Minnesota (SJP UMN), endorsed AWC’s disruption of the University of Minnesota Law School’s lecture. When faced with criticism that the supporting an academic boycott of Israel violates freedom of speech and academia, the president of SJP UMN adamantly defended her organization’s stance endorsing the Halbertal protest. Reiterating the ‘war crime apologist’ accusation, she argued “it doesn’t make sense for us to stay silent... regarding an event that shouldn’t be happening on campus” (Lerner 3). SJP UMN is a local affiliate of a national organization that boasts over 115 chapters on college campuses across the United States. The national organization is an ardent supporter of BDS and in recent years has instructed its chapters to submit resolutions to student government calling for the university to divest from any holdings in companies that are ‘complicit in Israeli occupation.' While SJP UMN was yet to formally submit a resolution to student government, they are active in promoting BDS at their events. For example on October 14th, 2015 SJP UMN organized a die-in public demonstration “aimed to highlight the Palestinian call for BDS support” (SJP). Nineteen students laid on the ground of the plaza at the west entrance to the Washington pedestrian bridge entrance pretending to be Palestinians killed by Israelis. A three-minute prepared speech, which ended with a call to “come together and support BDS: Boycott, Divestment and Sanctions,” was then recited to curious passersby. Evidence regarding SJP UMN’s views on a final status solution regarding the State of Israel and a possible Palestinian state, can be found on the same Washington pedestrian bridge. It is a University of Minnesota tradition for all student organizations to paint a panel on the bridge advertising their student group. SJP UMN’s 2015-2016 academic year panel features a map of all of modern-day Israel (including the entirety of the Negev Desert, the Galilee, even Tel Aviv) colored in with the pattern of a black and white keffiyeh, long a symbol of Palestinian nationalism. Another organization working on behalf of BDS locally is Jewish Voices for Peace – Twin Cities (JVP). Like SJP UMN, this Jewish anti-Zionist group is a regional affiliate of a larger national organization. JVP has long been affiliated with the BDS movement, but historically only advocated only for selective divestment of Israeli companies operating in the West Bank. However, in February 2015 the organization announced that it “endorses the call from Palestinian civil society for Boycott, Divestment, and Sanctions [in its entirety].” Addressing the question of “why is JVP moving beyond


Goals of Actors Within the BDS Movement

Occupation-focused Boycott, Divestment, and Sanction campaigns?” the organization responded that the idea of any “separation between ‘Israel’ and ‘the occupation,’ has been widely discredited” (JVP). JVP’s Twin Cities chapter has followed its national leadership in working on behalf of BDS. They organize discussions about the movement, host book club readings that analyze Barghouti’s text on BDS, and even have organized protests outside of local Target stores demanding they take Israeli products off the shelf (Sundin 2). JVP claims to “support any solution that is consistent with the full rights of both Palestinians and Israeli Jews, whether one binational state, two states, or some other solution,” however they add that there is “diminishing likelihood of a two-state solution” (JVP). This is echoed by members of the Twin Cities JVP chapter who often refer to cities inside of 1948 armistice lines, such as Haifa, as part of Palestine (Democratic Visions). Connecting the BNC to the Twin Cities: BDS Campaigns Twin City BDS activists in AWC, SJP UMN, and JVP can seem distant from the BNC and its Palestinian members. Yet a careful examination of specific BDS campaigns reveals direct links and coordination between local activists and central figures with the movement. To highlight these connections, I examined three campaigns: one boycott, one divestment, and one sanction initiative. Ten years removed from the Civil Society Call, the BDS movement has been most active and successful in pursuing boycott campaigns. One of their most highprofile initiatives has been against the Israeli company SodaStream.xi SodaStream’s principal manufacturing facility has been located in Mishor Adumim, an industrial park in the West Bank. The BNC has specifically targeted the company in its calls for consumer boycotts. On its website, SodaStream is explicitly listed along with five other companies as a “common Israeli export… [and an] optimal target…as part of an international campaign” (BNC). The BNC page links to a flyer urging consumers not to purchase SodaStream and retailers not to carry its products. Target is listed, along with four other retailers, and is directly encouraged to not carry Israeli products or face holistic consumer boycotts of its entire store (CodePink). As mentioned previously, Jewish Voices for Peace Twin Cities responded to the BNC’s call to boycott SodaStream and urge Target not to sell the product. Prior to their protest outside of the downtown Minneapolis Target store, JVP wrote a letter to the retailer calling on it ‘to discontinue sales of SodaStream products because the company is in violation of international law”xii (Sundin 3). Despite this local initiative, Target continues to sell SodaStream products. However, the overall international campaign against the Israeli company has been widely successful. In a 2014 press release, the BNC celebrated SodaStream’s announced closing of its Mishor Adumim factory. A BNC spokesperson was quoted stating, “SodaStream’s announcement today shows that the boycott, divestment and sanctions (BDS) movement is increasingly capable of holding corporate criminals to account for their participation in Israeli apartheid and colonialism, ” she added, “BDS campaign pressure has forced retailers across Europe and North America to drop SodaStream, and the company’s share

Julian Kritz


price has tumbled in recent months as our movement has caused increasing reputational damage to the SodaStream brand” (BNC). However, later in the press release, the spokesperson announced that the boycott campaign against SodaStream would continue, despite it moving its factory to Lehavim, an Israeli village located within pre-1967 Israeli borders. The continuation of the boycott campaign against SodaStream, even after it complied with the BDS movement’s demands to shutter its factory in the West Bank, raises questions about the scope of BDS’ goals—namely whether it considers all of Israel occupied or just territory outside of pre-1967 borders. The BNC strongly encourages BDS movement activists to pressure for “the withdrawal of stocks and funds from corporations complicit in the violation of international law and Palestinian rights and ensure that investment portfolios and public funds are not used to finance or purchase products and services from such companies” (BNC)—in short divestment. The BNC instructs its supporters to focus their efforts upon institutions where they “hold considerable stake and influence such as churches, unions, universities, local authorities and pension funds, [as] these are the potential sites of strong BDS campaigns” (BNC). Minnesotan BDS activists, through a campaign called Minnesota Break the Bonds (MN BBC), have answered this call. MN BBC demands “that the state of Minnesota act on its good conscience and support the breaking of economic ties with the apartheid state of Israel.” Specifically, they have been working to convince the Minnesota State Board of Investment (SBI) to end its pension-fund investment in Israel bondsxiii. MN BBC has been actively supported by a variety of Twin City pro-BDS groups including AWC, SJP UMN, and JVP. To date MN BBC has not been successful in their divestment efforts. In March of 2015 SBI, which is “made up of four statewide elected officialsxiv -- voted 3-1 to allow portfolio managers to continue buying high-yield Israeli bonds after a previous purchase expires later this year” (AP 3). A connection between the local activities of MN BBC and the BNC can be seen in the featuring of MN BBC initiatives on BDSmovement.net, “the website of the Palestinian BDS National Committee” (MN BBC). The BDS movement’s efforts to impose sanctions on Israel have not gained much momentum. The BNC acknowledges as much when it describes, “the principle problem of sanctions is that action rests on states and global institutions, many of whom have a long history of supporting or implementing colonialism and occupations in the Middle East.” These challenges have not deterred the AWC from attempting to answer the BNC’s call for an end to “military links, including partnerships, agreements and joint operations.” The AWC’s efforts to convince Minnesota policymakers to sanction Israel climaxed in the summer of 2014, during Operation Protective Edge in Gaza. The AWC planned a demonstration in front of Senator Al Franken’s Minneapolis campaign office “specifically to protest Franken’s recent co-sponsorship of Senate Resolution 498.”xv One AWC member explicitly called for sanctioning Israel through cutting of American aid. She stated “Israel receives over $3 billion in U.S. aid every year, which it uses to oppress, detain and kill Palestinians. Our tax dollars are paying for the current massacre in Gaza.


Goals of Actors Within the BDS Movement

We demand Senator Franken oppose any U.S. aid for the occupation of Palestine” (Staff 4).

Conclusion For over seventy-years, the international community has worked to resolve the Israeli-Palestinian conflict through direct negotiations centered upon a two-state solution. In contrast to this approach, the BDS movement both explicitly and implicitly rejects direct dialogue and the two-state solution. This is true not only of central actors within the movement, Omar Barghouti and the BNC, but also of locally-based actors. Prior to conducting this research, I hypothesized “that the goals of actors at the center of BDS would be different than the goals of actors further away from the movement’s nucleus.” My subsequent investigation and analysis leads me to a fairly confident rejection of this hypothesis. The stances and actions of Twin Cities organizations heeding the Civil Society Call, parallel that of the BDS movement’s central coordinating committee. Both seemingly reject the one-state solution and have focused their efforts on boycott campaigns. The focuses of local and central efforts on boycott initiatives, and the resulting de-emphasis on divestment and sanctions, is not surprising. The modern incarnation of the BDS movement is in its relative infancy; a mere decade has passed since the initiating Civil Society Call. Consumer boycott campaigns rely on popular mobilization and as such generate public awareness. Conversely, divestment and sanction implementation relies largely on the actions of large organizations (i.e. governments, corporations, investment funds, international organizations, etc.). The vested interests, size, and bureaucracy of these organizations are impediments to BDS activists. Nonetheless, I expect to see an increasing pivot to these latter areas of BDS in the coming years as the movement continues to mature. The recent EU “made in settlements” labeling guideline on some Israeli products produced on land outside of pre-1967 borders, can be seen as a momentum building success for the movement as it perhaps begin to focus more on sanctions (and divestment). Additional research will be needed to track this possible trend and to discern whether local organizations working on behalf of BDS adjust their goals accordingly. I also hypothesized that “core leaders will have more radical goals, such as the one-state solution, than less involved supporters who will hold more moderate goals, such as the two-state solution.” My research indicates a rejection of this prediction, although deeper investigation is needed for a confident dismissal. Direct interviews with both local BDS activists and BNC officials offer possible avenues for further clarification In summary, my research shows a parallel relationship between goals of actors within the BDS movement. Both central and periphery actors conduct similar campaigns that seem be working towards a one-state solution, however, more data is necessary to confirm this. In addition, my research shows that the BDS movement, from its core to its Twin Cities periphery, has focused their efforts on boycott campaigns. Further academic research will continue to elucidate the dynamic relationship between the goals of actors

Julian Kritz


in this growing, international movement. Diker’s work was published by the Jerusalem Center for Public Affairs, which has commissioned research advocating rightwing pro-Israeli policies such as Israeli annexation of East Jerusalem and Israel maintaining lasting control of the West Bank and Golan Heights (Diker, Gold, et al.) i

The continued existence of Israel today demonstrates the lack of success of the Arab boycott. The boycott’s inability to ‘bring about the eventual collapse of the state of Israel’ (Sarna 77), is consistent with a growing body of research that shows the incapacity of economic sanctions to effectively achieve foreign policy goals (Pape). ii

Recently Palestinian Authority President, Mahmoud Abbas, officially declared that Palestinians are no longer bound by the Oslo Accords. Although this declaration does not seem to involve any immediate operational changes to the status quo, it may encourage BDS supporters to abandon the Oslo two-state solution framework (Abbas 3). iii

Goldstone’s views are expressed in a New York Times editorial.


Shay’s work was published by the Jerusalem Center for Public Affairs, which has commissioned research advocating rightwing pro-Israeli policies such as Israeli annexation of East Jerusalem and Israel maintaining lasting control of the West Bank and Golan Heights (Diker, Gold, et al.) v

See figure 1 for a tentative diagram mapping the organizational actors with the BDS movement. vi

All of this data will be recorded in a manner that protects the confidentially of the group’s participants, thus allowing them to appear in the research anonymously vii

Anti-normalization, as understood by the BNC, means total rejection of the status quo of “Israeli occupation, colonization and apartheid” through ending “All economic, academic, cultural, youth and IT sector ties between Israelis and Palestinians” (BNC). viii

See figure 2 for a table classifying fifty Minnesota organizations that support the BDS movement ix


Halbertal is an accomplished Israeli Jewish lawyer, philosopher, professor and writer.


SodaStream produces a consumer product that allows for beverages to be carbonated.

The alleged SodaStream international law violation is to that the company “manufactures in Maale Adumim, an illegal settlement in the occupied Palestinian territory and, as such, is deeply complicit in Israel’s violations of international law” (BNC). xii

Minnesota has been buying Israeli bonds since 1993. Currently the bond has a 2.4 percent yield compared to the 1.5 percent benchmark for treasury bills. The size of the state's holding in those bonds amounts to $10 million (AP 2). xiii

SBI members are Governor Mark Dayton, Attorney General Lori Swanson, Secretary of State Steve Simon, and State Auditor Rebecca Otto [who was the lone vote for xiv


Goals of Actors Within the BDS Movement

divestment] (AP 2). Senate Resolution 498 was cosponsored by 79 Senators and “reaffirms the support of the Senate for Israel’s right to defend its citizens…condemns the unprovoked rocket fire at Israel and calls on Hamas to cease all rocket fire…[and] calls on the Palestinian Authority President Mahmoud Abbas to dissolve the unity governing arrangement with Hamas” (Graham 2) xv

"50 Minnesota Groups Join BDS." Council for American Islamic Relations Minnesota. July 31, 2014. http://www.cairmn.com/press-releases/272-50-minnesota-groupscall-for-immediate-end-to-israels-airstrikes-on-civilians-in-gaza.html. "Jewish Voice for Peace - Twin Cities." Accessed October 13, 2015. https://www. facebook.com/Jewish-Voice-for-Peace-Twin-Cities-198045833568587/timeline/. "Jewish Voice for Peace on Boycott, Divestment and Sanctions | 2015 • Jewish Voice for Peace." Jewish Voice for Peace. February 20, 2015. Accessed November 13, 2015. https://jewishvoiceforpeace.org/jewish-voice-for-peace-on-boycott-divestmentand-sanctions/. "PACBI Guidelines for the International Academic Boycott of Israel." Palestinian Campaign for the Academic and Cultural Boycott of Israel. July 31, 2014. http:// www.pacbi.org/etemplate.php?id=1108. "Palestinian BDS National Committee." BDS Movement. Accessed October 27, 2015. http://www.bdsmovement.net/bnc. "Palestinian Civil Society Call for BDS." BDSmovementnet. July 9, 2005. http://www. bdsmovement.net/call. "Senator Franken Told: 'We Say No to Congress' Support for the Attack on Gaza.'" Fight Back! News. August 1, 2014. http://www.fightbacknews.org/2014/8/1/senatorfranken-told-we-say-no-congress-support-attack-gaza. Abbas, Mahmoud. "UN General Assembly Address." Speech, General Assembly of the United Nations, New York City, September 26, 2015. AbuKhalil, As'ad. "A Critique of Norman Finkelstein on BDS." Al Akhbar English. February 17, 2012. http://english.al-akhbar.com/node/4289. Ananth, Sriram. "The Politics of the Palestinian BDS Movement." Socialism and Democracy 27, no. 3 (2013): 129-43. doi:10.1080/08854300.2013.836317. AntiWar Committee. Accessed October 13, 2015. http://antiwarcommittee.org/. AP. "Minnesota Won't Dump Pension-fund Holdings in Israeli Bonds." TwinCities.com. March 5, 2015. http://www.twincities.com/localnews/ci_27649392/minnesotawont-dump-pension-fund-holdings-israeli-bonds. AWC. "Anti-War Committee Statement on the November 3rd Protest Against War Crimes Apologist, Moshe Halbertal." Anti-War Committee. November 10, 2015. http://antiwarcommittee.org/2015/11/10/anti-war-committee-statement-on-thenovember-3rd-protest-against-war-crimes-apologist-moshe-halbertal/.

Julian Kritz


Barghouti, Omar, Ali Abunimah, Ilan Pappe, Joseph Massad, et al. "The One State Declaration." The Electronic Intifada. November 29, 2007. https://electronicintifada. net/content/one-state-declaration/793. Barghouti, Omar. BDS: Boycott, Divestment, Sanctions: The Global Struggle for Palestinian Rights. Chicago, IL: Haymarket Books, 2011. BNC. "Consumer Boycott." BDS Movement. Accessed November 22, 2015. http://www. bdsmovement.net/activecamps/consumer-boycott. BNC. "George Soros Funds and Foundations Must Be Held Accountable for Investments in Israeli Violations of International Law." BDS Movement. May 21, 2014. http://www.bdsmovement.net/2014/soros-funds-foundations-investments-israeliviolations-12092. BNC. "Sanctions." BDS Movement. Accessed November 22, 2015. http://www. bdsmovement.net/activecamps/sanctions. BNC. "SodaStream to Close Illegal Settlement Factory in Response Growing Boycott Campaign." BDS Movement. October 30, 2014. http://www.bdsmovement. net/2014/sodastream-closes-illegal-settlement-factory-in-response-growingboycott-campaign-12782. BNC. Report On: The Fourth National BDS Conference. Report. Bethlehem: Palestinian Boycott, Divestment, and Sanctions National Committee, 2013. CodePink. "Support Human Rights: Don't Buy Soda Stream And Ask Stores Not to Carry It." Accessed November 22, 2015. https://sacbds.files.wordpress.com/2012/01/ dont-buy-sodastream.pdf. Cohen, Matthew S., and Charles D. Freilich. "The Delegitimization of Israel: Diplomatic Warfare, Sanctions, and Lawfare." Israel Journal of Foreign Affairs 9, no. 1 (2015): 29-48. doi:10.1080/23739770.2015.1015095. Democratic Visions. "Jewish Voice for Peace Forum." YouTube. February 17, 2015. https://www.youtube.com/watch?v=vpxb2ezVnc8&list=UUztphfNHO0GzJSNvaIQ25A. Diker, Dan, Dore Gold, Meir Rosenne, Udi Dekel, Uzi Dayan, Yossi Kuperwasser, Yaakov Amidror, and Aharon Ze'evi Farkash. Israel's Critical Requirements for Defensible Borders. Jerusalem: Jerusalem Center for Public Affairs, 2014. Diker, Dan. Unmasking BDS: Radical Roots, Extremist Ends. Jerusalem Center For Public Affairs. The Israel Group. 2015. http://theisraelgroup.org/wp-content/ uploads/2015/02/Unmasking-BDS.pdf. Erakat, Noura. "Palestinian Agency And New Campaigns In The Arab World: An Interview With Zaid Shuaibi On The Fourth Annual BDS Conference." Jadaliyya. June 21, 2013. http://www.jadaliyya.com/pages/index/12338/palestinian-agencyand-new-campaigns-in-the-arab-w. Feiler, Gil. From Boycott to Economic Cooperation: The Political Economy of the Arab Boycott of Israel. London: Frank Cass, 1998. Finkelstein, Norman. "Arguing the Boycott Divestment and Sanctions (BDS) Campaign


Goals of Actors Within the BDS Movement

with Norman Finkelstein." Interview by Frank Barat. Vimeo. February 9, 2012. https://vimeo.com/36854424. Goldstone, Richard. "Israel and the Apartheid Slander." Editorial. New York Times, October 31, 2011. Horowitz, Adam. "See Omar Barghouti on US Speaking Tour Starting Wednesday." Mondoweiss. January 02, 2012. http://mondoweiss.net/2012/01/see-omarbarghouti-on-us-speaking-tour-starting-wednesday. Jewish Community Relations Council of Minnesota and the Dakotas. Executive Director Steve Hunegs. "JCRC Condemns Illegal and Shameful Disruption of Lecture at the University of Minnesota Law School." News release, November 4, 2015. MinnDakJCRC.org. Keck, Margaret E., and Kathryn Sikkink. "Transnational Advocacy Networks in International and Regional Politics." Int Social Science J International Social Science Journal 51, no. 159 (1999): 89-101. doi:10.1111/1468-2451.00179. Lantos, Tom. "Durban Debacle: An Insider's View of the UN World Conference Against Racism." Fletcher Forum of World Affairs, Winter/Spring, 26, no. 1 (2002): 31-52. http://hdl.handle.net/10427/76928. Lerner, Maura. "Protesters Disrupt Israeli Professor's Lecture at University of Minnesota." Star Tribune. November 4, 2015. http://www.startribune.com/protesters-disruptisraeli-professor-s-lecture-at-university-of-minnesota/340437581/. Lim, Audrea. The Case for Sanctions against Israel. London: Verso, 2012. Mcmahon, S. F. "The Boycott, Divestment, Sanctions Campaign: Contradictions and Challenges." Race & Class 55, no. 4 (2014): 65-81. doi:10.1177/0306396813519939. MN BBC. "Minnesota Break the Bonds Day on the Hill." BDS Movement. April 12, 2011. http://www.bdsmovement.net/2011/minnesota-break-the-bonds-day-on-thehill-6422. Mort, J.-A. "Engage, Don't Divest, from Israel." New Labor Forum 23, no. 3 (2014): 1416. doi:10.1177/1095796014541640. Norman, Julie M. The Second Palestinian Intifada: Civil Resistance. London: Routledge, 2010. Palestinian, BDS National Committee. "BNC Statements." BDS Movement. Accessed October 13, 2015. http://www.bdsmovement.net/category/statements-2. Palestinian, BNC. "Palestinian Civil Society Salutes Presbyterians on Divestment Resolution." BDS Movement. June 21, 2014. http://www.bdsmovement.net/2014/ palestinian-civil-society-salutes-presbyterians-on-divestment-resolution-12177. Pape, Robert A. "Why Economic Sanctions Still Do Not Work." International Security 23, no. 1 (1998): 66. doi:10.2307/2539263. Samuels, Richard J. "Arab Oil Embargo." Encyclopedia of United States National Security, September 15, 2007. doi:10.4135/9781412952446.n28. Sarna, A. J. Boycott and Blacklist: A History of Arab Economic Warfare against Israel. Totowa, NJ: Rowman & Littlefield, 1986.

Julian Kritz


Schaefer, Donald. "U.S. Policy and the Arab Economic Boycott: Understanding the Origins and Dealing with Its Consequences." The Social Science Journal 33, no. 2 (January 1996): 165-81. doi:10.1016/S0362-3319(96)90034-8. Shay, Adam. "Manipulation and Deception: The Anti-Israel “BDS” Campaign (Boycott, Divestment, and Sanctions)." Jerusalem Issue Briefs 12, no. 2 (March 19, 2012). Stefano, Paul Di, and Mostafa Henaway. "Boycotting Apartheid From South Africa to Palestine." Peace Review 26, no. 1 (2014): 19-27. doi:10.1080/10402659.2014.8 76304. Students for Justice in Palestine. Accessed October 13, 2015. http://sjpumn.com/. Sundin, Jess. "Minnesota Palestine Solidarity Activists Target SodaStream." Fight Back! News. August 20, 2013. http://www.fightbacknews.org/2013/8/20/minnesotapalestine-solidarity-activists-target-sodastream. U.S. Congress. Senate. Senate - Foreign Relations. By Lindsey Graham. 113 Cong. S. Res. 498. Yi, Joseph E., and Joe Phillips. "The BDS Campaign against Israel: Lessons from South Africa." PS: Political Science & Politics APSC 48, no. 02 (2015): 306-10. doexcei:10.1017/s1049096514002091.

Augsburg Honors Review


Better Healthcare Achievable by Collaboration Between Two Medical Schools of Thought Adriene Michelle Lai

University of Missouri - St. Louis

Abstract: There are two different medical schools of thought recognized by the United States: 1) the main-stream, allopathic (M.D.) school of thought, and 2) the osteopathic (D.O.) school of thought. A bias, unfortunately, exists between the two medical philosophies. Many in the medical community, and the general public, perceive individuals with an M.D. degree to be higher in prestige than those with D.O. degrees. In order to combat this preconceived notion between M.D.s and D.O.s, both medical communities have recently announced their transition to a unified graduate medical education (GME) accreditation system, in order to ensure that all medical students, regardless of what medical school background, will be responsible and held to the same standards across the board. While this change is beneficial, I contend that more can be done to eliminate the prejudice between both medical schools of thought while improving healthcare services. I propose in this paper the potential benefit of combining the services of both a M.D. and D.O. professional in the same medical setting. This partnership could possibly assist the involvement of empathy in medical settings. A recent implosion of research has emerged in the past couple years about this concept that medicine combined with empathy and compassionate interactions can be beneficial to patient diagnosis and treatment. The public stigma, currently, is that doctors are neutral and passive toward their patients rather than empathetic and active in their approach and interactions. However, while medical students are taught to be empathetic, research has shown that some individuals are more empathy-inclined than others after medical school training. This perhaps can be caused by the fact that both philosophies educate about empathy differently and that both philosophies attract two different types of student personalities. Therefore, this paper will address three key ideas using current research and statistics: 1) a background on the two philosophies of medical education, 2) the definition and benefits of empathy in the medical field, and 3) the possibility of having both mainstream and osteopathic perspectives of medicine integrated in all sub-specialties of healthcare to improve practitioner-patient relations and improve physician mental and physical health.


Better Healthcare Achievable… Background

Osteopathic medicine is an increasingly prominent approach in medical education. This approach involves the physician working alongside the patient to consider the impact that lifestyle and community have on one’s health. Upon graduation and certification by the American Osteopathic Association (AOA), these medical students taught osteopathic medicine will become, accordingly, Doctors of Osteopathic Medicine, aka D.O.s, in the public healthcare system. Most medical students however matriculate into the mainstream, allopathic perspective of medicine; a biologically-based approach that focuses on body dysfunctions as the sole cause of diseases. They, upon certification by the Association of American Medical Colleges (AAMC), will be physicians most commonly referred to as M.D.s. Medicine, as a science and a practice, has had centuries of history invested into it. Western medicine was thought to be founded by Hippocrates, a Greek physician during the Age of Pericles in Classic Greece (Grammaticos & Diamantis, 2008). His contributions to medicine included creating the Hippocratic School of Medicine, the Hippocratic Oath, and the development of clinical medicine (the art and science of diagnosing and treating diseases). His work helped separate medicine as a profession from that of philosophy and theurgy (Garrison, 1966). In the 16th century, the Swiss German philosopher and physician Paracelsus was the first to note that some diseases are rooted in psychological conditions (“Paracelsus”, n.d.). He was also the first to utilize natural observation rather than ancient texts for his empirical research (Borzelleca, 2000). It was not until the turn of the 19th century did modern medicine become popular, breaking away from the religious orthodoxy to focus on science and natural observation which helped rapidly advance patient care and disease treatment (Fissell, 1991). With its rise in popularity, the AAMC was established in 1876 (“AAMC History”, n.d.). However, it was less than 30 years later, when Dr. Andrew Taylor Still broke away from mainstream allopathic medicine after losing faith in the system; due to the loss of his three children to spinal meningitis, his wife to childbirth complications, and his second wife’s daughter to pneumonia. Dr. Still founded the first osteopathic school in 1892 at Kirksville, MO and focused more on the patient as a whole rather than just a list of symptoms (“About A.T.”, n.d.). The AACOM was founded in 1898 with the philosophy of serving those interested in the ways of osteopathic medicine (“About AACOM”, n.d.). In 2014, 49,480 individuals matriculated into a M.D. school whereas only 6,562 individuals matriculated into a D.O. school. Data from the AAMC and AACOM has shown that over the years, those who apply to M.D. schools are typically the “higher tier” pre-med students. In 2014, on a scale of 0 to 45, the average MCAT score for students applying to M.D. schools was 28.6 (SD±5.5) while those matriculating into M.D. schools had an average of 31.4 (SD±3.9). The average GPA for M.D. applicants was 3.55 (SD±0.34), and students matriculating into M.D. schools had an average of 3.69 (SD±0.25) (Table 1). On the other hand, those pursuing a D.O. school will typically be the “lower tier” pre-med students as they have lower MCAT scores and GPAs compared to

Adriene Michelle Lai


M.D. students. In 2014, the average MCAT score for students applying to a D.O. schools were 26.3 (SD±4.2) while students matriculating had an average of 27.2 (SD±0.31). The average GPA for D.O. applicants was 3.46 (SD±0.31), and the average undergraduate GPA for D.O. matriculants was 3.51 (SD±0.3) (Table 2 and 3). These patterns of “higher tier” and “lower tier” students have been consistent throughout the years. The curriculum established for M.D. schools (there may be some discrepancies per school) are generally 4 year programs containing 2 years of preclinical studies and 2 years of clinical rotations which upon finishing, students receive a degree. After medical school, 3-8 years of specialty training/residency training is dedicated to receiving a license to practice. The overall philosophy and mission statement of the AAMC and M.D. schools is “to lead the academic medicine community and to improve the health of all” (“AAMC History”, n.d.). D.O. schools on the other hand, share a very similar curriculum to that of M.D. schools. However, during their 4 years of medical school, students are required to take an additional 200+ hours learning osteopathic manipulative techniques, also known as osteopathic manipulative training (OMM/OMT), to diagnose and treat patients. Many of the additional courses that D.O. students have to take involve understanding how to manipulate the musculoskeletal system. In addition, courses within osteopathic institutions focus on the idea that “structure influence function" (“What is Osteopathic”, n.d.; Brigham Young University, 2015). The AACOM’s overall philosophy is to emphasize “primary care and serve medically under-served communities [while providing] communication with people from diverse backgrounds and practice [communicating] skills in the classroom” (“About AACOM”, n.d.). Yet within the institutions, they also hold four Osteopathic Tenets throughout their curriculum and train their students to uphold these ideals: 1. The human being is a dynamic unit of function. 2. The body possesses self-regulatory mechanisms that are self-healing in nature. 3. Structure and function are interrelated at all levels. 4. Rational treatment is based on these principles (Demosthenes, 2014). These differences between both schools of thought, while minute, in a larger scale can become very important factors in the types of doctors being pumped out of each institution. Recently both medical communities announced their transition to a unified graduate medical education (GME) accreditation system. In layman’s terms, both M.D.s and D.O.s will have the same, uniform standard for continuing education, or residency programs, after their time in medical school, in order to “ensure that the evaluation of and accountability for the competency of all resident physicians—M.D.s and D.O.s— will be consistent across all program.” Prior to this, both schools of thought had their own associations (one for M.D. and one for D.O.) where they would provide continuing education for each of their individual philosophies. Albeit this transition will be a slow


Better Healthcare Achievable‌

process and will take the course of the next five years until approximately 2020 (Porter, 2015). In spite of these efforts, when analyzing data of where students choose to pursue their residency programs, the top three residency programs for D.O. students in 2014 are Internal Medicine, Family Medicine, and Anesthesiology. M.D. students were more inclined to programs like: Internal Medicine, Surgery, Family Medicine, Pediatrics, and Emergency Medicine (Table 4). Seeing that there is a 33,000 difference between the number of M.D. and D.O. students in medical schools, there will be a substantial difference between the numbers of students in each medical specialty (Figure 1). These patterns happen repeatedly throughout the years. In 2014, there are a large percentage of M.D. students, compared to D.O. students, who pursue more surgical specialties such as orthopedic surgery, plastic surgery, neurological surgery or to specialties such as dermatology, otolaryngology, radiology, and radiation oncology. For D.O.s students in 2014, there are high percentages of them pursuing residencies in specialties like emergency medicine, family medicine, OB/GYN, physical medicine, and psychiatry (Figure 2). Thus even with this unification, there may not be a chance of seeing D.O.s branching out to different specialties from family medicine and primary care professions because of their prior institutional background. In addition, M.D. students typically have a higher average income than D.O.s due to difference in specializations. This imbalance seems to be an accepted norm within the medical communities and the general society. While there have been no direct studies indicating the exact benefits of having more osteopathic doctors in specialties outside of family medicine and primary care, past studies have shown that medicine with compassionate, but detached, interactions can be beneficial to patient diagnosis (Hojat, Louis, Maxwell, Markham, Wender, & Gonnella, 2011a), and that empathy could potentially lead to both better health-care for patients and for the physicians (Klein, 2014; Rakel, Hoeft, Barrett, Chewning, Craig, & Niu, 2009). With the current literature and the unified GME, I propose this idea of truly integrating both schools of thought into the healthcare services. My hypothesis is that incorporating holistic approaches into all types of medical specialties can optimize the patient’s experience and treatment with the physician. After all, the goal of medicine and healthcare should be to improve health in the overall community and promote awareness and prevention to the general public. One possible future direction for medical professionals is to have both M.D. and D.O. doctors present in diagnosing patients to increase positive relationships with patients, decrease chances of a misdiagnosis, and alleviate career-related stress.

Method of Analysis Method The purpose of this analysis is to bring together information from different academic disciplines to demonstrate several key points. Firstly, I utilized past studies from researchers like Hojat, Fine, and Kliszcz to compare how empathy levels differ among


Adriene Michelle Lai

the two medical schools of thought and how this difference could potentially affect the relationship with patients after medical school. I also examine the effects of empathy on recovery and empathy’s effects on patient-physician relationships from works like Cohen and Rakel to indicate the potential use of integrating M.D.s and D.O.s evenly among specialties to increase the efficiency and patient experience with the doctor. Furthermore, I discuss the different stressors that physicians face on a chronic basis that could be alleviated by the integration of M.D.s and D.O.s in a particular specialty or other future directions. Operational Definitions For this paper, I will use the same definitions as defined by past researchers to maintain consistency in my analysis. Empathy and sympathy have commonly been used interchangeably as they both involve connecting with another person in some manner. However, sympathy is “the sharing [of] emotions” whereas empathy is the “sharing [of an] understanding” (Hojat, Gonnella, Nasca, Mangione, Vergare, & Magee, 2002c; Nightingale, Yarnold, & Greenberg, 1991). Thus, empathy will be defined as understanding another person’s suffering while maintaining detachment from the medical situation. Sympathy will be defined as feeling emotion for another’s suffering or pain. Compassion is then one step further past empathy, as it is when one has an internal desire to act on that emotional understanding. One of way to approach the concept of empathy in the medical field is to view it as a “compassionate detachment”: where the physician has an “empathetic concern for the patient while keeping sympathy at a reasonable distance to maintain an emotional balance” (Hojat et al., 2002c). This separation is important to distinguish as an excess of sympathy can compromise the neutral clinical practices necessary for a proper diagnosis. Sympathy, empathy, and compassion all have different effects in patient-care situations (Blumgart, 1964; Hojat et al., 2002c; Nightingale et al., 1991; Schriefer, 2007; Wispe, 1986). Measurements & Tests The Jefferson Scale of Empathy (JSE) is a 20-item questionnaire and is the most commonly used test for measuring empathy in a variety of focus of groups (Hojat, Mangione, Nasca, Cohen, Gonnella, Erdmann, & Veloski, 2001; Hojat, Gonnella, Nasca, Mangione, Veloski, Magee, 2002b; Klisczcz, Nowicka-Sauer, Trzeciak, Nowak, & Sadowska, 2006). It is a scale that analyzes the cognitive process of understanding “the patient’s pain, suffering, and perspective” combined with the capability to “communicate this understanding and the intention to help” (Thomas Jefferson University, n.d.). There are currently three versions of this scale: the JSE Medical Students (S-version), the JSE Health Professions (HP-version), and the Health Professions students (HPS-version). The Jefferson Scale of Overall Patient Satisfaction with Primary Care Physicians is a 10-item scale and is the most common measure for the interaction between primary care


Better Healthcare Achievable…

physicians (PCP) and patients in the eyes of the patient. (Thomas Jefferson University, n.d.). Other variations include the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE), a 5-item questionnaire (Kane, Gotto, Mangione, West, & Hojat, 2007; McTighe, 2014) and the Physician-Patient Relationship Inventory (PPRI), a 14item questionnaire (Zachariae, Pedersen, Jensen, Ehrnrooth, Rossen, & von der Maase, 2002).

Analysis of the Problems and Discussion Part I – Benefits of Empathy in Patient Care Multiple studies have demonstrated that patients who have more empathetic physicians and patients who have lower levels of psychological stress will recover faster than those who with non-empathetic physicians and higher levels of psychological stress. It is important to keep in mind however that these factors are independent of each other. Rate of infection increases with higher levels of psychological stress (Cohen, Tyrell, & Smith, 1991) with or without an empathetic physician. While health conditions such as the common cold are shorter in duration and tend to be less severe in symptomatology when helped by an empathetic physician, despite a patient characterized as stressed or not (Rakel et al., 2009). Both studies analyzed the effects of the common cold to some variable, either stress or empathy, and I predict that these improvements in duration and symptomatology would only improve more with an empathetic physician and less psychological stress. Psychological stress can occur due to a variety of factors (school, work, family, internal concerns, etc.) but having an empathetic physician could potentially be a factor for increasing or decreasing psychological stress within a patient. Practitioner-patient interactions have been discussed in a multitude of healthcare literature (Beach, Inui, & the Relationship-Centered Care Research Network, 2006; Borrell-Carrio, Suchman, & Epstein, 2004; Covington, 2003; McGovern Center, n.d.; Rakel et al., 2009). Across the board, researchers adamantly suggest the growing medical field must evolve with the ever-changing community. From the Pew-Fetzer Task Force on Advancing Psychosocial Health Education (Beach et al., 2006) to the Biopsychosocial Model (Borrell-Carrio et al., 2004), researchers have proposed various methods to bridge the gap between the public and the healthcare provider, and provide a better experience between the physician and the patient. Prior studies have indicated that physicians who displayed more levels of empathy (e.g. letting patients ask questions, active listening) were significantly more likely to develop a better patient relationship, and have patients who were more inclined to follow physician orders than physicians who did not display empathy (Davis; 1966; Del Canale, Louis, Maio, Want, Rossi, Hojat, & Gonnella, 2012; Fallowfield, 1992; Korsch, 1998; Larson, Lynch, Tarver, Mitchell, Frosch, & Solomon; 2015; Spiro, Curnen, Peschel, & St. James, 1993; Zachariae et al., 2003). In 2011 one study found significant correlations with scores on the Jefferson Scale of Empathy (JSE) and a willingness to recommend the physician to family and friends. “The findings of

Adriene Michelle Lai


the link between patients’ satisfaction and their perceptions of physicians’ empathic engagement support... the perception that physician empathic engagement can have a positive effect on patient satisfaction” (Hojat et al., 2011a). Even across cultures, patients with different ethnic, social backgrounds exhibited similar trends as previous research. The study validated the concept that patients who perceived physicians as empathetic had significantly higher patient satisfaction and compliance because of “mediating factors of information exchange, perceived expertise, inter-personal trust, and partnership” (Kim, Kaplowitz, & Johnston, 2004). Research has not always been consistent about the direct biological benefits of emotional and cognitive care, but “one consistent finding has been that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance” (Di Blasi, Harkness, Ernst, Georgiou, & Kleijnen, 2001). Empathy is a crucial part of developing a therapeutic relationship and several studies in psychiatry have linked empathy and therapeutic relations to improving outcomes from both psychological and pharmacological interventions (Horvath & Symonds, 1991; Krupnick, Sotsky, Simmens, Moyer, Elkin, & Watkins, 1996; Mercer & Reynolds, 2002). Furthermore, current research has shown that there is a benefit in empathy as far as effecting the duration and severity of a variety of health problems. Mentioned before, the common cold’s severity and duration were significantly affected by patients’ perception of having an empathetic physician. The use of nasal wash measured immune cytokine IL-8, and the increase of these cytokines represented how healthy one was getting from the cold. Physicians who had “perfect scores” on the Consultation and Relational Empathy (CARE) questionnaire from the patient correlated with a larger increase in IL-8 levels thus improving their health at a much rapid rate (Rakel et al., 2009). Positive biological effects have also been seen in diabetic patients. Diabetics who had more empathetic physicians were “more likely to have good control” of hemoglobin A1C and LDL-C (Hojat, Markham, Wender, Rabinowitz, & Gonnella, 2011b). More devastating health problems such as HIV mediation and cancer recovery have shown to be effected by patients’ perception of their physician. In research on lung cancer, doctors “offered empathic responses [to patients] only 10% of the time, which compares poorly with previous studies in the literature showing doctors acknowledged 25-30% of such opportunities” (Morse, Edwardsen, & Gordon, 2008). The amount of times a physician responds empathetically is low even when they know their patient is battling a deadly disease, which could lead to patient dissatisfaction. In cancer patients, dissatisfaction “can lead to low understanding and recall of information, poor compliance, lengthier recovery periods, and increased complication rates (Fallowfield, 1992). In one study, when cancer patients perceived themselves as having a more empathetic physician, they had greater satisfaction and lower levels of distress. Empathetic doctors also resulted in higher reports of “greater efficacy with respect to [a patient’s] capability to cope with the disease and its treatment,” were better adjusted and experienced a greater quality of life (Zachariae et al., 2003). When it comes to HIV, physicians frequently are unable to


Better Healthcare Achievable…

properly communicate their patient’s HIV risk status (Epstein, Morse, Frankel, Frarey, Anderson, & Beckman, 1998). When a physician was able to address the issues and handle the awkward moments, they were viewed with more satisfaction by their patients. In fact, a study in 2000 indicated that patients were more comfortable “discussing personal issues with their physicians” whom they perceived to be more empathetic and were more knowledgeable about HIV (Sullivan, Stein, Savetsky, & Samet, 2000). The ability to be able to communicate more effectively between the physician and the patient helps the doctor create a better assessment and plan for treatment. Later in this review and analysis, we will see that this communication can improve misdiagnosis from physicians and decrease prolong treatment plans. In the progression of medical training, students forget that the patients they are treating are indeed human and are not just biologically functioning organism. We as humans are naturally more complex than that: we have emotions, perceptions, and behaviors that are shaped from our environment as they are shaped from our genetics. Because of this, it is important to minimize error by adapting to the variability of each patient’s life and medical history. One visit the patient is in a happy mood, the next they are anxious or they are frustrated, and so by being able to align one’s self with the patients’ emotions, physicians are then able to better the patient’s experience in the doctor’s office and will result in a positive experience for patients that they are more likely to return for future health-related needs. Future health-related needs can vary from a patient returning with another health problem or a patient with a child or loved one in need of healthcare services. In other studies, it was shown that patients expect a certain type of conduct from their physicians (Korsch, 1998; Larson et al., 2015). Researchers in one study tried to qualitatively analyze caregivers’ expectations for pediatricians with regard to behavioral health care. “More than 50% of caregivers expected that the PCP (primary care provider) play a role in behavioral health care for their child. This finding suggests that there might be an opportunity to educate caregivers and parents about the potential role a PCP could have in a child or adolescent’s behavioral health” (Larson, 2015). While medical school teaches the techniques of being a skilled physician, it may not be effectively teaching students to be empathetic physicians. Part II – Empathy Levels of Students in Medical School Research has shown that a significant number of allopathic students experience a decrease in empathy during their third year of medical school. M.D. students consistently had higher levels of empathy during the pre-clinical years than the clinical years of medical school (Chen, Lew, Hershman, & Orlander, 2007; Hojat, Vergare, Maxwell, Brainard, Herrine, Isenberg, Veloski, & Gonnella, 2009). However, in D.O. students, there lacks a consensus as to whether they experience that same decrease in empathy. Some studies report that unlike the allopathic students, osteopathic students did not demonstrate significantly decreasing empathy levels with each year of schooling. Results indicated that during the first two years of medical school, M.D. and D.O.

Adriene Michelle Lai


students experienced an increase in empathy, but only D.O. students continue to increase in empathy (Calabrese, Bianco, Mann, Massello, & Hojat, 2013; Kimmelman, Giacobbe, Faden, Kumar, Pinckney, & Steer, 2012). Kimmelman also suggests that D.O. students have a tendency to underestimate their own empathetic abilities as they have a tendency to score lower than M.D. students on the JSE-S during the first years of medical school (2012). On the other hand, other studies suggest that osteopathic students do experience a decrease in empathy like their allopathic counterparts (Caruso & Bernstein, 2014; McTighe, 2014). McTighe also observed that D.O. students were overconfident in their empathetic skills during their first year of medical school compared to Kimmelman’s study. The data indicated that D.O. students rated themselves highly on the JSE-S in their first year of medical school but received lower scores on the JSPPPE compared to their second and third year of medical school (McTighe, 2014). These inconsistencies, I postulate, in D.O. results could be a result of smaller population sizes of data and/or the minor curriculum differences as previously discussed. Differences in empathy levels are not solely caused by curriculum differences, but also from socio-cultural standards and traditions. Empathy can be viewed as a sign of weakness in male-dominant cultures. In one study, it was seen that “the empathy scores of Chinese physicians ranged from 71 to 139… which is lower than that reported” of American and Italian physicians (Di Lillo, Cicchetti, Scalzo, Taroni, & Hojat, 2009; Hojat et al., 2009; Wen, Ma, Honghe, Xian, 2013). However, healthcare as mentioned before needs to evolve with the growing community that it serves. Thus medical students, no matter what social or cultural group of patients they are required to see as part of their profession, will need to be prepared for type of empathetic care necessary to create strong practitioner-patient relationships. The challenge then becomes finding a way to educate medical students on how to handle different situations with empathy effectively. Medical students are so used to scientific lectures that support the deeply instilled philosophy that views patients as “their disease.” The current medical curriculum does not touch on topics like effective communication or proper handling of confrontation and consultation between the practitioner and the patient. In a study by Roseman and Rana, results of the questionnaire from the medical students indicated a lack of identifiable cultural statistics and the purposeful lack of discussion of any integrative or complementary medicine treatments. This creates troubles with communication, an important aspect to creating a strong practitioner-patient relationship. “However, [the researchers] were pleased to read the humanistic themes identified by most participants relating to the importance of [empathy]. It is odd that the medical students could identify [empathy] as an important factor in the practice of medicine, but could not recognize its importance enough to identify it when needed” (Roseman & Rana, 2015). Generally, individuals are good at making decisions on how to communicate with someone on an emotional level. Ideally, people can navigate inter-personal interactions and recognize in which situations they need more information. Perhaps students matriculate into medical school understanding that physicians should express metacognitive


Better Healthcare Achievable… effort when interacting with patients, but external factors during their time in medical school cause them to express less metacognitive effort when they begin seeing patients in their clinical years… In the clinical years, their professional identity may be more salient and may influence their response patterns (Dekhtyar, Dunham, O’Brien, Quirk, Schwartz & Stansfield, 2015).

Considering that physicians are tasked to perform metacognitive assessments of emotional knowledge every single day, it can eventually become draining. In addition, the types of people that doctors meet are not the types of people that the average individual will encounter in their lifetime. Physicians and any healthcare provider will encounter more anxious, ill (physically and/or mentally), and desperate individuals searching for help. As a result, it is then important to have medical students be prepared to handle these situations in order to provide the best kind of care patients need. In a 2015 study, after second year students watched a presentation and conducted a survey, results indicated that there was an: [Overall] consensus that ‘nothing’ was missing from presentation and only 16% indicated that there needed to be a more humanistic approach to the presentation. Their comments included the omission of the ‘mental toll of the diagnosis,’ and the belief that the presentation was only ‘diagnostically based.’ Another student indicated that there was a lack of inclusion of both patient and family members as well. Overwhelmingly, the participants concluded that chemotherapy and radiation were the only treatment plans discussed, however, not one of the participants identified any type of integrative/ complementary treatment plan missing from the medical protocols presented during the role of technology in breast cancer lecture. Finally, although, few participants identified the importance of compassion in the patient/physician encounter, none of them were aware of the purposeful removal of any form of ‘compassion’ from the presentation or identified this omission as problematic (Roseman & Rana, 2015). Medical students alone can only make a limited amount of intuitive assumptions about patient communication and consultation. Guidance is necessary from faculty and advisers to provide the tools needed for students to communicate effectively with patients. It is naïve to assume that all students will instantaneously become strong communicators. Yet with the professional support and guidance from medical school faculty, medical students could potentially learn to apply empathy safely in practice in order to help with patient’s diagnosis, without feeling vulnerable to patients’ emotions. Even if a physician merely helps guide a patient toward a medical decision, the physician will be viewed as more empathetic (Hans, Dube, & Wasserman, 2015). Small actions and nonverbal behaviors can be easily taught and help improve practitioner-patient relationships in tremendous ways. Fine and Therrien performed a study to test a new course model training students how to utilize interpersonal skills to empathically respond

Adriene Michelle Lai


to patients. Their examination resulted in clear indications that “students involved a systematically planned interpersonal skill training program were significantly abler to respond empathically to patients than students in a control group exposed only to the regular curriculum” (Fine & Therrien, 1977). The ideal course would focus on determining what is considered to be “helpful” or “harmful” responses in practitioner-patient discussions, and teach students how to focus on the individual as more than just a disease. Moreover, it is important that these sessions teach the importance and needed use of affective behavior as there is a high correlation between strong affective behavior and stronger practitioner-patient relationships (Bensing, 1991). Following these studies, Novack assessed medical educational practices and reviewed problems in the teaching of medical interviewing and interpersonal skills (1993). Of the 100+ medical programs in the United States, respondents indicated some advances from a similar survey in 1977. “Virtually all medical schools now offer teaching in medical interviewing and interpersonal skills. More [faculties] from a greater variety of disciplines are involved in this teaching.” Most programs utilize role-playing, mock interviews, and student feedback while addressing students’ personal growth through discussion groups (Novack, Gretchen, Drossman, Lipkin Jr., 1993). Nonetheless some problems are still present with the designed system. The biggest being there is still a “great variation in the quality and intensity of course offered in US medical schools.” More than 50% of these programs lack student evaluation in their course design, and some programs ultimately lack the core educational principles in their courses (i.e. forgetting to incorporate the idea of why empathy is important versus teaching solely what is right or wrong to say, maintaining the stigma of viewing a patient as only a disease). Barriers not only exist in teaching empathy and interpersonal skills, but also in incorporating ethic education in the medical school curriculum (Saltzburg, 2014). While there have been momentous changes in the medical school curriculum in the last 40 years, there are still some flaws in the design, particularly in the lack of forming a single, uniform course available for all students to take in U.S. medical schools. Nonetheless, it is important to realize that while it is difficult to change the educational system as a whole, it is the individual institutions that can ultimately affect the students’ educational growth into a physician and healthcare provider. What is more plausible then, is to not necessarily change the system as a whole but rather harness the strengths of each school’s long standing educational philosophies to create courses that are better adapted by the faculty, and involve more student evaluations and feedback to increase the chances of these courses being beneficial for the students. Part III – Reasons for Student Empathy Decreasing During Medical School Training Although interpersonal skills training and communication skills are important in enhancing empathetic conversations, understanding the reasons behind the decrease in empathy during medical school can ultimately benefit medical schools in the long-run. There are several different hypotheses as to why a change of empathy occurs. The most


Better Healthcare Achievable…

widely-accepted reasons are: emotional distress and coping, biological coping responses, and burn-out. While it is important to take care of the patients’ health, the physician’s physical and mental health is also just as vital in providing good healthcare services. A physician that suffers from emotional distress from each patient visitation will experience different ways of coping with their emotional troubles and patient vulnerability. Patient vulnerability is this idea that physicians and other healthcare providers, begin to over identify themselves with the patients that they are attending to. One of the largest problems of teaching empathy is determining how to be empathetic while remaining detached. This is to prevent becoming too involved into the patient’s life to where it inevitably becomes personal. Below is an excerpt from Werner and Korsch’s work about a physician’s retrospective thoughts about his time as an intern: I believe that I could have been a better… young physician, and that I would have learned more and suffered less if someone could have told me explicitly, repeatedly, and patiently that the dying at hand was not my own, that the patients whose death I attended was not, in fact, myself, nor was it my wife, nor my child, nor my parents, nor… my friend. And most important, I needed to be told and taught that the dying… did not… increase my vulnerability, nor the vulnerability of those for whom I cared most deeply. The confusion involved in the sympathetic relationship, wherein identities merge and blur— this is what is intolerable and excruciating and blinding (1976). With this personal attachment developing between the practitioner and the patient, it is understandable for an individual to feel emotionally drained. In students however, the results can be more devastating. With physician trainees during their clinical rotations, “[they] experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy” (Dzeng, Colaianni, Roland, Levine, Kelly, Barclay, & Smith, 2015). While the development of detached behaviors is beneficial, dehumanizing attitudes can alter the way a practitioner views their patients and inevitably change how a patient views the doctor. Without proper guidance as discussed above from medical faculty or advisers, this can lead to continual “unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care” (Shapiro, 2008). While empathy could decrease due to emotional turmoil and lack of resolve, another possibility for less empathetic behavior is over-confidence and narcissism. On the complete opposite spectrum of compassionate hypersensitivity, narcissists are sensitive but only about situations that make them feel uncomfortable: such as having individuals doubt a narcissist’s abilities, or when a narcissist feels they have been disrespected in a verbal or nonverbal manner. When looking at the types of personalities

Adriene Michelle Lai


that enter medical school, there is a wide spectrum of students: ranging from overly sensitive and compassionate individuals to those who pursue medicine solely for the social prestige and monetary gain. In fact, there is some psychological research suggests that “individuals with significantly impaired self-esteem might be drawn to healthcare as a way of compensating for the love and attention that they never received when they were children. All of us [need] love, emotional warmth, and respect, but [some] experience this need excessively.” Thus certain physicians cope with uncontrollable situations such as a “noncompliant” or “impossible to please patient” with can lead to terrible consequences such as “suboptimal outcomes, challenging patients, and… occurrence of medical errors” (Banja, 2006). Moreover, with the amount of success and achievements attained in science within the last 50 years, “modernist assumptions about the capacity to protect, control, and restore [an individuals’ health] run deep in institutional cultures of mainstream biomedicine and can create barriers to empathetic relationships.” This is barrier is present because when medical schools teach students how to identify diseases and treatment, students are taught to think in a “logico-scientific” manner, instead of an empathetic manner. This type of training pre-dominates the amount of time spent on empathy and interpersonal skills training in most medical school curriculums (Shapiro, 2008). Sadly, narcissistic characteristics are harder to change in individuals, but perhaps with proper discussions between faculty and advisers, medical students can learn to overcome their excessive needs and emotional anxieties. Student distress and helplessness work hand in hand with feelings of stress. While it is uncertain as to whether emotional distress and helplessness cause stress or vice versa, burn-out and distress together is the most widely accepted hypothesis as to why medical school students decrease in empathy. Stress as noted before, has the capacity to lead to physical and mental health degradation, which would not be beneficial for a practitioner. In addition, while medical students suffer high levels of stress during clinical rotations (Neumann, Edelhauser, Tauschel, Fischer, Wirtz, Woopen, Haramati, & Scheffer, 2011), there are students who continue to experience burn-out, addictions, and mental instability after rotations and into residency (Kumar, 2007; McCue, 1985; Ramirez, Graham, Richards, Cull, Gregory, Leaning, Snashall, & Timothy, 1995; Snibbe, Radcliffe, Weisberger, Richards, & Kelly, 1989; Vaillant, Sobowale, & McArthur, 1972) while some start feeling stress and anxiety as early as the preclinical years due to their personality being highly neurotic, introverted, and low levels of conscientiousness (McManus, Keeling, & Paice, 2004). Another study indicated that both medical and dental students had lower levels of mitogen-stimulated peripheral blood leukocytes (PBLs), phytohemmagglutinin (PHA/Con A), CD3+ and CD4+ T-lymphocytes when experiencing acute stresses like medical examinations. Furthermore, students who were more stressed and did not have any intervention were less likely to maintain their baseline levels of IL-1β during the time of examinations. PBLs and T-lymphocytes are important in maintaining the immune system and prevent cell proliferation/growth whereas IL1βs are necessary for wound healing (Kiecolt-Glaser, Marucha, Atkinson, & Glaser,


Better Healthcare Achievable…

2001). The environment stresses of work along with the perceived stress of helplessness, students desire to “give up” throughout medical school, whether it is on preclinical classes, clinical rotations, or the constant work from residency. These moments increase the chances of feeling “hopeless, angry, resigned, or even ashamed.” Helplessness is an occupational hazard that is strongly linked to burn-out (Back, Ruhton, Kaszniak, & Halifax, 2015; McGovern Center, n.d.). Lack of sleep is another factor that can lead to stress. The difficulties a physician faces mentally is balancing the “difficult nature of their job” while keeping their own emotions detached enough to prevent helplessness from occurring without losing the patient’s right to a good doctor (Hojat et al., 2009). For students though, the battle seems futile as most feel forced to become less empathetic with the job (McGovern Center, n.d.). Another plausible reason to why students experience a decrease in empathy, and have difficulty increasing it back to initial levels, could be because of biological effects. Physicians not only react to patient’s emotions on a psychological level, but also on a biological one as “we [people] all unintentionally mirror the emotions of other people.” Yet this mirroring of emotions does not directly affect a healthcare provider’s actions. Instead it takes another step within the mind of the healthcare providers, their emotions start to become affected by past experiences and knowledge. But these mirrored emotions are then filtered through our own perspectives and prior experiences… The physician’s engagement with the clinical situation is decreasing, whereas the nurse’s engagement is increasing… to draw other [healthcare specialists] into the problem-solving process… [However] neither clinician enters the patient’s world more deeply, in a way that enables them to connect with the person who is suffering (Back et al, 2015). When witnessing another person’s experience with pain, the observer’s reactions can range from “concern for personal safety” to “concern for the other person” (Decety, Yang, & Cheng, 2010; Goubert, Craig, & Buysse, 2009). The somatic sensorimotor areas of pain processing both activate no matter what reaction an individual pursues. One study analyzed the event-related potentials (ERPs) of the brain to compare the time it takes for pain to be processed in the brain between physicians and a control group (the general population). Control participants experienced ERP differentiation when watching body parts pricked by a needle in comparison with body parts being touched by a Q-tip. Physicians however did not show ERP differentiation, and perceived the pain to be less harmful than the control group. The results indicate that physicians have learned to down-regulate the part of brain that is sensitive to other’s pain for they process the pain in equal lengths of time, whether the body part was exposed to a needle or a Q-tip. This processing seems to also affect the way physicians view pain of others (Decety et al., 2010). In the end, these results seem to indicate that physicians not only demonstrate a decrease in empathy, but also display “borderline-apathy” which could lead to a change

Adriene Michelle Lai


in the practitioner-patient relationship. With this seen decrease in empathy, current solutions are geared towards preparing and helping future doctors avoid burn-out and emotional distress. The problem with this is that most of the role-models medical students have are current physicians and healthcare providers. Research has shown that physicians even if they do not necessarily experience the burn-out during their medical school training years, it is after they leave school and begin practicing are they more likely to experience downfalls in their own personal lives: addictions, poor marriages, and job dissatisfaction (Kumar, 2007; McCue, 1985; Ramirez et al., 1995; Shapiro, 2008; Snibbe et al., 1989; Vaillant et al., 1972). Thus when students practice and train under the watch of other physicians who are experiencing burn-out, students begin to pick up certain tendencies that eventually become integrated into their methods when they become licensed to practice. Medical students undergoing clinical rotations experiencing the real tasks that a physician must do and are unable to cope with the environmental and psychological stress, sadly lead to this common trend of decreasing empathy and eventual increase in apathy. Part IV – Future Doctors: The Difference in Practice and Perceived Quality of Life Overall, research has demonstrated how empathy plays a role in the practitionerpatient relationship, and how it has the capacity to improve patient health. Furthermore, research has pointed toward a stable decline in empathy from the second to third year of medical school (whether M.D. or D.O.) and the effects it has on the student. The question then becomes, what are the effects of empathy on the physician and their future? Seeing as there is not a strong trend in decrease in empathy with D.O. students versus M.D. students could suggest that the difference in philosophy and curriculum between the two schools of thought have the capability of affecting the manner and behaviors of a physician. A study done back in 2003 showed that after audio-recording different physicians from both schools of thought, “osteopathic physicians seem to have a communication style with patients that is more personal and somewhat more holistic in that issues relating to family, social activities, and patient emotions seem to be more commonly incorporated into visits” (Carey, Motyka, Garrett & Keller, 2003). With this, it seems as though osteopathic doctors have stronger interpersonal skills and the vital nonverbal behaviors to increase patient satisfaction than M.D. doctors allowing them to be better equipped for professional medical situations (Brugel, Postma-Bilsenova, & Tates, 2015; Gimpel, Boulet, & Errichetti, 2003). In many other studies, they confirm that the level of empathy in physicians has also been shown to have an impact on specialty choice, quality of care, and quality of life (Klein, 2014). A common trend seen in medical specialists is that those who are more empathetic have a tendency of pursuing “people-oriented” specialties than those who are less empathetic, normally pursuing more “technologically-oriented” specialties. Psychiatrists obtained the highest empathy scores on the JSE-HP while anesthesiologists, orthopedists, neurosurgeons, and radiologists received the lowest. There were no significant differences


Better Healthcare Achievable…

in empathy between nurses and physicians, though there were some items on the empathy scale that significantly differed due to the nature of both professions (Hojat, Gonnella, Nasca, Mangione, Veloski, & Magee, 2002b; Zachariae et al., 2003). In addition, those physicians who are more empathetic tend to spend more time with their patients. Despite this information, time spent does not always indicate that a physician is more empathetic than another. In fact, while many researchers assert the idea of spending more time with patients as a solution to improving practitioner-patient relationships (Lin, Albertson, Schilling, Cyran, Anderson, Ware & Anderson, 2001; Mercer et al., 2002), this is not always practical (Dugdale, Epstein, & Pantilat, 1999; Williams, Weinman, & Dale, 1998) and may only be beneficial for only certain specialties that allow for more time spent. A more reasonable solution then seems to be learning how to utilize the amount of time spent per patient with interpersonal skills and nonverbal behavior to increase the satisfaction patients have with their doctor visits. Besides time spent, another common trend seen in physicians battling with low levels of empathy suffer tend to psychologically isolate role-models such as other physicians as “positive identities” while patients are labeled as “negative identities” (Shapiro, 2008). Positive identities typically are those who are viewed as perfect, pure, and healthy whereas negative identities are those who are defiled, sick, and bad (Erikson, 1959; Gilman, 1985). This dissociation in the mind eventually leads to different behaviors and attitudes toward the different class of identities. This concept is the basis to much of racist behaviors and the idea of a pure or impure race. Another psychological trend that occurs in physicians is the idea of scapegoating. Scapegoating often manifests towards certain ill persons who are ‘blamed’ for their illnesses. In the early days of the AIDS epidemic, this phenomenon was demonstrated not only in the discourse of the general public, but also among many physicians and nurses. Today it is tacitly accepted in some medical education contexts that residents can mock obese patients, or blame certain categories of drug-abusing, alcohol-addicted, or homeless patients for their medical problems… The ill person operates as the stigmatized, scape-goated other whose social role is so symbolically free the privileged, idealized figure of the health self from the vagaries and vulnerabilities of embodiment (Shapiro, 2008). As “inhumane” the treatment seems to these individuals, the physician behavior is not new (Aull & Lewis, 2004; Epstein, 1995; Goffman, 1963; Radecki, Shapiro, Thrupp, Gandhi, Sangha, & Miller, 1999; Wear, Aultman, Varley, & Zarconi, 2006). This type of condescending treatment greatly reflects the physicians handling mental illnesses in the Middle Ages. Modern medicine is still having issues addressing these problems. With new generations learning more about interpersonal skills than the generations prior, there is still a prevalent amount of practicing physicians who promote a scientific altruism, the idea of viewing a patient “as an object of interest, rather than a sympathetic subject” (Shapiro, 2008). More likely than not, these strong beliefs stem from their years of

Adriene Michelle Lai


learning as a student in medical school as a result of their mentors and medical rolemodels. Stubbornness is not a human trait that can be easily changed. A study in 2006 suggested that students in their residency who had high levels of distress and low levels of empathy were more likely to perceive themselves as making medical error than those less stressed and more empathetic (West, Huschka, Novotny, Sloan, Kolars, Habermann, & Shanafelt, 2006). However, when it comes to actual misdiagnosis, the most common mistake is for a physician is to be overconfident. This appears contradictory to a majority of the previous discussions because many physicians experience burn-out which seems more like a decline in confidence than an increase in it. In reality, this overconfidence stems from being correct in diagnosis a majority of the time, and not spending the time to look back and correct oneself later for the mistake. Much as how years of teaching a certain belief, can create long lasting effects into the next generations, there is a sense of stubbornness that exists in physicians when it comes to diagnosing. In their minds, they have spent years training for a specialty that they are now licensed to practice for. With that, they should hardly ever be wrong because of all the knowledge they know from medical school. Diagnostic errors are encountered in every specialty, and are generally lowest for the two perceptual specialties, radiology and pathology, which rely heavily on visual interpretation…. The error rates in clinical radiology and anatomic pathology… range from 2% to 5%, although much higher rates have been reported in certain circumstances. The typically low error rates in these specialties should not be expected in those practices and institutions that allow x-rays to be read by frontline clinicians who are not trained radiologists. For example… emergency department physicians because of a staff radiologist was unavailable, up to 16% of plain films and 35% of cranial computed tomography (CT) scans were misread. Error rates in less perceptual specialties with trained physicians like internal medicine physicians and emergency department physicians are much higher ranging from 6% and 12% respectively. For the most part, when physicians are uncertain, they take the extra time to solve problem, but it is when they “are certain” do chances for misdiagnosis increase (Berner & Graber, 2008). In another study, results indicated that “shorter visits, especially those less than 15 minutes, were a risk factor for inappropriate prescribing and management of gastrointestinal side effects” (Dugdale et al., 1999). While an incorrect diagnosis could potentially lead to malpractice lawsuits, many physicians would not risk mentioning the chance of error to not ruin the relationship that current exists between themselves and the patient, as it is usually easier to blame medical or equipment error than to blame oneself about a mistake. As discussed earlier, misdiagnosis and dehumanizing attitudes can potentially be a result from decreasing empathy levels in medical students. This leads to doctors who are poor listeners, dominating in conversations while using too much medical jargon, staying


Better Healthcare Achievable…

focused only on the factual (e.g. the nature of the diagnosis, the intervention, the followup), and believing that their role in the relationship “as primarily one of giving the patient optimism and confidence in the outcome predetermined by the physician” (Banja, 2006). Detachment and narcissism become several coping mechanisms for physician anxiety. However, Hippocrates observed that “the patient, though conscious that his condition is perilous, may recover his health simply through his contentment with the goodness of the physician” (Novack, Epstein, & Paulsen, 1999). The “goodness of the physician” can come to mean many things, but ultimately, it is how the patient views the practitioner: does the patient view the doctor as a good doctor? Professionalism then “is a critical quality for physicians to possess. Physician professionalism has received increased attention in recent years, with many authorities suggesting that professionalism is in decline” (West & Shanafelt, 2007). While not discussed in great detail during medical school when students are obtaining their degree in medicine, professionalism is expected from medical school graduates during residency training in order to receive their license to practice from an accreditation board. For many years though, professionalism for medical physicians had not been well-defined. In fact, it was not until 1995 did the American Board of Internal Medicine publish its Project Professionalism, “an effort to define professionalism, raise awareness of its importance, and develop strategies for fostering and evaluating physician professionalism.” Eventually, the AAMC and other accreditation programs began to follow (West et. al., 2007). Humanism and empathy are in fact both integral parts of a physician’s professionalism according to the AAMC and the Accreditation Council for Graduate Medical Education; yet these qualities, as discussed, are seen to decrease rather than “develop” during students’ time in medical school and residency (Bellini, Baime, & Shea, 2002; Collier, McCue, Markus, & Smith, 2002; Hojat, Gonnella, Nasca, Rattner, Erdmann, Gonnella, & Magee, 2004). Professionalism as result becomes affected and inevitably affects a patient’s satisfaction with their care (Hojat et al., 2011a; Katic, Budak, Ivankovic, Mastilica, Lazic, BabicBaaszak, & Matkovic, 2001; Kim et al., 2004). This decrease in professionalism has caught the public’s attention as it is part of the public’s expectations that physicians and healthcare providers be the most empathetic and humanistic people due to the nature of their job. Many aspects of medical education seem to work against the goal of creating physician-healers. Medical education has even been characterized as a ‘neglectful and abusive family system,’ promoting cynicism, callousness, and self-doubt… like soldiers on a battle field, students must often deal with their emotions alone, or in chance discussions with colleagues and friends. Many learn to protect themselves and survive, but at the cost of distancing themselves emotional from patients and peers, and consequently from the greatest satisfactions of clinical care. An unacceptable number of medical students and practicing physicians experience burnout, addictions, and emotional impairment (Novack et al., 1999).

Adriene Michelle Lai


Physicians essentially become victims who seek out different ways to cope with the impounding stresses of their career. Many young physicians went into medicine for personal endeavors. From my own personal experience, many of my colleagues desired to be physicians because of how they admired their own personal practitioner or family member. Some dreamed of changing the world. However, when these individuals are faced with the challenges of medical school and their own role-models in medical school are not necessarily performing at their most optimal professionally (Shapiro, 2008), there is a disconnect that happens in the brain for reality does not meet idealized expectations. Psychologically, a method of coping for students could then possibly be to turn away from the patient’s emotions, and idealize the role-models they come to see as physicians who they view as invulnerable to emotional turmoil. Sadly, this idealization only seems to lead to further dissatisfaction and troubles later in life. Psychotherapy has long been utilized by physicians as a way to cope with the stress of their job and their own dissatisfaction with their lives (Vaillant et al., 1972). One solution for practicing physicians to address their addictions, stress, and anxiety could be to have more psychologists trained to aid physicians in finding better ways of coping, and maybe increase physicians’ empathy levels toward patients. However, consultations can only do so much when physicians’ chronic stress continues throughout their career. In one study, many doctors at the age of 30 are unhappy in their jobs (McManus et al., 2004). Much of this could be attributed to chronic stress or allostatic stress. Allostatic stress usually is a compilation of small troubles and annoyances whether they are workrelated, family-related, social-related, etc. that never seem to end. However, compared to most people, physicians experience “chronic exposure to work-related stressors” and eventually leading to burn-out, particularly psychiatrists who show high levels of empathy compared to other specialties (Kumar, 2007). Another study suggested that perceived quality of life (PQOL) was lower in physicians due to constant build-up of allostatic stress, though it was seen that allopathic doctors had a lower PQOL compared to osteopathic doctors. While PQOL was not shown to moderate the relationship between empathy and motivation among medical students, it was found to be a significant predictor of motivation by itself, which indicates that it is an important variable to consider when examining medical students and their career choices. Medical students might benefit from counseling throughout medical school to discuss their current lifestyle obstacles, future quality-of-life goals, and how those variables are impacting the development of their career choices. Mental-health professionals could help medical students objectively examine their thoughts and feelings about the future, and help problem solve perceived barriers that students may face (Klein, 2015). PQOL has seen to hurt future doctors as students who perceive themselves with a lower quality of life have a tendency to drift towards specialties that involve more


Better Healthcare Achievable…

financial reward (the technology- oriented specialties) rather than specialties that involve more personal relationships (the people-oriented specialties). While hiring more psychologists, therapists, or mental-health professionals can be one way of helping students prepare themselves for their career path, there is still this gap of help available to practicing physicians. PART V – Proposal of Solution for Practicing Physicians While we see that empathetic physicians are ideal for benefiting healthcare practices and services, the ongoing work-related stress can be difficult to manage alone. Psychiatrists and psychologists are utilized to help physicians yet they are a limited resourced compared to the number of physicians in the field (approximately 1 psychiatrist for every 24+ physicians excluding psychiatry according to data of medical specialties in 2014) (Figure 3). This pattern is consistent throughout the years as students decide on their specialties, with approximately half selecting “technology-oriented” specialties and the other half selecting “people-oriented” specialties, particularly internal medicine. Internal medicine however is the forefront of practicing physicians for they are the first people that the general public usually has to encounter in order to receive medical services. With the problem of burn-out and other issues, one solution to combat this problem is utilizing physicians from both schools of thought within the same specialty. I propose that by balancing the number of D.O.s and M.D.s in healthcare, they together can diagnose and treat patients. It is evident that current students from D.O. schools tend to have higher levels of empathy following medical school and residency compared to their M.D. counterparts. By integrating M.D.s and D.O.s together into the same setting, helping the same patient, they can help each other with the different workrelated stresses that both are familiar with. While psychiatrists are useful in helping with combating stress, it can only go so far. By having two physicians from the specialties but different philosophies, they can help each other grow and develop even after their time in medical school training. This combination has the potential of increasing patient satisfaction and has the capacity to alleviate stresses of misdiagnosis, balance patient empathy and detachment for proper diagnosis, and provide companionship from peers in similar professions. Teaching philosophies play a role in the type of doctors being produced, and as D.O.s are taught more to focus on the holistic perspective of medicine than their counterparts, together they can perhaps improve diagnosis as two sets of eyes and minds are usually better than one. Many careers that involve service to others involve the eyes of many on the same case; for example, juries, the Supreme Court, the senate, and the graduate medical education board are all groups that provide service to others but utilize more than one individual to make a decision. The ongoing expectation that physicians know all the answers is clearly not healthy, to either the patient or the physician. By working together, they can help patients, who expect (and deserve) a holistic approach to health-care, but they can also help each other in the professions they face.

Adriene Michelle Lai


Limitations and Future Directions As Bernard Lown once said, “[It] can take a lifetime to acquire a reasonable complement of empathetic skills, perhaps because their mastery in large part requires a mastery of ourselves—especially the ways we psychologically defend against our anxieties and fears” (Banja, 2006). As easy as it is to state possible solutions, implementation is the next challenge in bettering, not only the way patients are treated, but also the physicians in their own psychological warfare. Several challenges and limitations are expected with my proposal for integrating M.D.s and D.O.s together in the same setting during the diagnosing and treatment process. The first limitation with my proposal is that there are no studies in the current literature about the effectiveness of integrating these two schools of thought into the same clinical setting, seeing the same exact patient. As much detail as I can provide for about the effectiveness of empathy and how having two sets of eyes can potentially be beneficial in making medical decisions, both schools of thought will produce a variety of good and bad doctors. Even with the differences in MCAT scores and GPAs for M.D. and D.O. matriculating student, the comparison becomes irrelevant for those entering both schools will be recognized as medical doctors who are able to practice medicine, in the long-run. Studies will first need to be done to determine if this solution is even a viable one outside of theoretical, controlled situations. This unfortunately will cost time, money, and resources to study. In addition, while the JSE is an accepted resource for measuring empathy levels of physicians, a standardized scale is needed for patient’s perceived levels of empathy toward their physicians to easily compare physicians’ efforts and behaviors with their patients’ relations and attitudes. While test subjects could be obtained through the use of pre-testing, notices, or other means of communication, it is difficult to conduct research on patients as they are defined as a clinical population. A clinical population is a type of research subject group that involves more restrictions being set in order to develop a method for study. For example, researchers tend to shy away from using participants who are ill for the researchers do not want to create false hope into their subjects with their experiment, which can lead to the placebo effect in drug testing or feelings of depression from the patient when they realize they have not improved. Finding participants then becomes a challenge, for researchers strive to use people who are not too sensitive to testing to keep the results from being skewed, but that again takes time and money. The difficulty then becomes finding the funding and resources to start the project with a sensitive group of subjects. Another limitation in the potential study would be finding willing physicians to take part in the study. Physicians are known to make a high paying salary, and with the integration of two doctors in the same clinical setting, this will automatically make a cut in a doctor’s paycheck. In order to keep parties happy prices can be raised by medical bills are high as is so it is unlikely for medical expenses to increase. Furthermore, while having two physicians with different educational backgrounds can lead to growth this situation could also lead to detriment. Two physicians who strongly believe that they are


Better Healthcare Achievable…

right and the other is wrong have the potential of creating conflict with each other. This conflict could turn into lower levels empathy, a decrease in professionalism, and effect the practitioner-patient relationship negatively overall. With this, it may be beneficial to start with medical students, and enhance their awareness of the potential effectiveness of utilizing both M.D. and D.O. doctors in the same setting. However, this long standing bias of D.O. doctors being less intelligent because of their educational background, and preference for family and (primary) internal medicine which are typically less financially rewarding, can ultimately create problems in the integration of both in the same medical setting due to their own personal beliefs. Moreover, it is clear that a majority of interested medical students are not as aware of osteopathic schools as they are allopathic schools (Refer to Figure 1). The public may not be aware of the distinction either. Fortunately, more D.O. physicians are starting to appear on the radar as healthcare professions. While there has been a decrease in primary care in the past several years, “the number of DOs in these areas increased 66.6%, from 2119 [students] to 3530… The number of DOs increased by 2 or more times in obstetrics/ gynecology, pediatrics, and pediatric subspecialties but by less than 50% in both family medicine and internal medicine/pediatrics” (Brotherton, 2005). In the state of Texas, it is seen that approximately 60% of DOs are likely to be in general care physician work than their MD counterparts (Miller, T., Hooker, R., & Mains, D., 2006). These numbers are growing, however even if research supports this idea that M.D. and D.O. physicians should be integrated for the benefit of practitioners and patients, the amount of D.O. physicians needing to be produced by osteopathic schools is high, and that process of getting more future students to recognize osteopathic schools is still a challenge in itself. The current medical education system is geared toward students who are focused on their academic grades and test scores than personal, emotional growth. In previous studies, Hojat and other researchers were able to find that “total empathy scores were significantly associated with clinical competence ratings in medical school, but not with licensing examination scores” (2002a). This demonstrates that empathy plays a role in not only a success in the practitioner-patient relationship, but also contributes in a student’s success in clinical rotations. However, due to the fact there is not a significant correlation between empathy and examination scores, medical schools will still focus more on preparing students for the medical exams than emotional drain of clinical rotations. Education as a whole is trending toward the importance of exam scores in order to compete with the rest of the world’s education systems. While it is the life skills that will make students successful, educators are tied to obligation of improving test scores than better students as a person in their future career. Changes in the medical curriculum then are far more difficult when the current philosophy of education is to prepare students for the proper examinations rather than the jobs themselves. A challenge in this proposal and for future studies in this direction is that while malpractice is an issue, it is also not that bad of an issue. A study in 2007 analyzed 1016 medical cases from a variety of physicians to determine whether the treatment plans

Adriene Michelle Lai


turned out to beneficial, harmful, (or neither) for the patient. 44% of the intervention plans reviewed were likely to be beneficial, with 43% of the beneficial cases requesting additional research while 1% of the cases recommended no further research. 7% of the 1016 cases believed that the physician’s treatment plan was harmful rather than beneficial with 5% of those cases recommending further study and only 2% recommended no further research. Unfortunately, a remainder of 49% of the cases reviewed could not be identified as either harmful or beneficial in treatment plan for the patient. 48% of these unknown cases requested further research and only 1% of the cases did not (El Dib, Ataliah, & Andriolo, 2007). The data suggests that most of physician’s treatment plans seem to be beneficial, but approximately a third of the cases that were considered harmful, were not thought to be important enough for further research. Unfortunately, with limited time and resources, it is difficult to study everything, and so it is normally more reasonable to study on topics that are usually working to find more answers. However, this perpetuates the belief of overconfidence within the physician that is creating problems in their diagnostics in the first place. Moreover, the act of pushing aside the cases of individuals and families hurt by harmful treatment plans only further instates the decrease of empathy in patients that do not fit the status quo of being healthy. While there are many physicians who are experiencing burn-out, there are as many doctors who are rather successful. In the same study with McManus, while he found many physicians unhappy at the age of 30, his sample also reported many doctors having “high levels of personal accomplishment, choice, and independence in their work environment” along with “satisfaction with medicine as a career, and intellectual and emotional satisfaction from their work” (2007). Because of the two types of doctors that come out of medical school, a limitation to altering the system of healthcare is that it does not seem to be completely failing. There is still a substantial amount of young physicians who enter the field happy and remain happy. Many of the problems lie with the individual personalities of each physician as they are just as human and unique as the general public. The problem then the system needs to be addressing, is not necessarily only how to teach students better, but also how to provide the appropriate resources needed for future and current physicians to develop a sense of self-awareness in themselves at a young age to combat the psychological effects of being a good doctor.

Conclusion and Importance To reiterate, there is clear evidence supporting the idea that an exchange is useful in creating a better healthcare service to the public. My proposal and research is not to say that one school of thought is better than the other. In fact, both schools have their flaws. However, utilizing their strong points can have the benefit of helping physicians and patients in the long run. Allopathic schools focus too much on medical examination and produce doctors who have a tendency to decrease in empathy; yet they are strong in their academics and are breaking many medical barriers while pushing the boundaries of research. Osteopathic schools focus their education heavily on preparing students for


Better Healthcare Achievable…

primary care specialties rather than research or other technological specialties; yet they are strong in their empathy and develop better, effective patient-relationships. Together, harnessing their strengths could they create the most effective healthcare service, even with all the challenges and limitations the concept may face. Albeit, the major take home point is that empathy in the field is a vital factor in improving patient satisfaction and recovery time in a wide variety of healthcare problems. “Humanistic qualities, integrity, and strong work ethic are elements of the selection criteria for acceptance into medical school, and one would expect that students being their medical training with great capacity for professionalism” (West et al., 2007). On the contrary, due to environmental stress and mental distress, these students are taught to decline in vital aspects of professionalism in order to cope and pass the proper examinations and training. What essentially is missing is the lack of growth that education is to provide to students no matter what academic discipline. As faculty advisers and medical physicians, to keep the empathy in the youth, it is up to the current generation of doctors to be positive role-models, and educate the youth that integration and understanding of one another is just as important as understanding the patient. Perhaps one day, a method for helping these physicians will be available to better healthcare overall.

2011-2014 Matriculant profile report [Data file and PDF] (2014). Retrieved March 1, 2014 from http://www.aacom.org/reports-programs-initiatives/aacom-reports/ matriculants AACOM. (n.d.) About AACOM. Retrieved December 11, 2015, from http://www.aacom. org/about-aacom AACOM. (n.d.) What is Osteopathic Medicine. Retrieved December 12, 2015, from http://www.aacom.org/become-a-doctor/about-om AAMC. (n.d.). AAMC History. Retrieved December 10, 2015, from http://www.aamc. org/about/history About A.T. Still University. (n.d.). Retrieved March 4, 2015, from http://www.atsu.edu/ about-atsu#Colleges-Schools Aull, F., & Lewis, B. (2004). Medical intellectuals: resisting medical orientalism. Journal of Medical Humanities, 25, 87-108. Retrieved from http://www.ncbi.nlm.nih.gov/ pubmed/15156757 Back, A., Ruhton, C., Kaszniak, A., & Halifax, J. (2015). ‘Why are we doing this?’: Clinician helplessness in the face of suffering. Journal of Palliative Medicine, 18(1), 26-30. doi:10.1089/jpm.2014.0115 Banja, J. (2006). Empathy in the physician’s pain practice: Benefits, barriers, and recommendations. Pain Medicine, 7(3), 265-275. American Academy of Pain Medicine. Beach, M., Inui, T., & the Relationship-Centered Care Research Network. (2006).

Adriene Michelle Lai


Relationship-centered care. Journal of General Internal Medicine, 21(Suppl 1), S3-S8. Society of General Internal Medicine. Bellini, L., Baime, M., & Shea, J. (2002). Variation of mood and empathy during internship. JAMA, 287(23), 3143-3146. Retrieved from http://www.ncbi.nlm.nih. gov/pubmed/12069680 Bensing, J. (1991). Doctor-patient communication and the quality of care. Social Science & Medicine, 32(11), 1301-1310. doi:10.1016/0277-9536(91)90047-G Berner, E., & Graber, M. (2008). Overconfidence as a cause of diagnostic error in medicine. The American Journal of Medicine, 121(5A), S2-S23. doi:10.1016/j. amjmed.2008.01.001 Blumgart, H. (1964). Caring for the patent. The New England Journal of Medicine, 270, 449-456. Massachusetts Medical Society. Borrell-Carrio, F., Suchman, A., & Epstein, R. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. The Annals of Family Medicine, 2(6), 576-582. doi:10.1370/afm.245 Borzelleca, J. (2000). Paracelsus: Herald of modern toxicology. Toxicological Sciences, 53(1), 2-4. Oxford University Press. Brigham Young University. (2014, January 1). Comparing MD and DO programs. In Pre Professional Advising. Retrieved March 3, 2015, from https://ppa.byu.edu/ handouts-prehealth Brotherton, S., Rockey, P., & Etzel, S. (2005). US Graduate Medical Education, 20042005: Trends in primary care specialties. JAMA: The Journal of the American Medical Association, 294(9), 1075-1082. Retrieved March 4, 2015, from JamaNetwork - UMSL. Brugel, S., Postma-Bilsenova, M., & Tates, K. (2015). The link between perception of clinical empathy and nonverbal behavior: The effect of a doctor’s gaze and body orientation. Patient Education and Counseling, 98(10), 1260-1265. European Association for Communication in Healthcare (EACH) and the American Academy on Communication in Healthcare (AACH). Calabrese, L., Bianco, J., Mann, D., Massello, D., & Hojat, M. (2013). Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students. Journal of the American Osteopathic Association, 113(12), 898-907. doi:10.7556/jaoa.2013.068 Carey, T., Motyka, T., Garrett, J., & Keller, R. (2003). Do osteopathic physicians differ in patient interaction from allopathic physicians? An Empirically Derived Approach. JAOA, 103(7), 313-318. Caruso, H. & Bernstein, B. (2014). Evidence of declining empathy in third year osteopathic medical students. International Journal of Osteopathic Medicine, 17(1), 22-27. doi:http://dx.doi.org/10.1016/j.ijosm.2013.10.008 Chalino, M, Wong, E., Collins, B., & Penson, R. (2015) Psychological and existential consequences of medical error for oncology professionals. In A. Surbone & M.


Better Healthcare Achievable…

Rowe, Clinical Oncology and Error Reduction: A Manual for Clinicians (pp. 2932). Wiley-Blackwell Chen, D., Lew, R., Hershman, W., & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine, 22(10), 14341438. Society of General Internal Medicine. Cohen, S. (1991). Psychological stress and susceptibility to the common cold. The New England Journal of Medicine, 325(9), 606-612. Massachusetts Medical Society. Collier, V., McCue, J., Markus, A., & Smith, L. (2002). Stress in medical residency: Status quo after a decade of reform?. The Annals of Internal Medicine, 136(5), 384390. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11874311 Cotton, A. (2012). Osteopathic principles in the modern world. International Journal of Osteopathic Medicine, 16(1), 17-24. Elsevier. Covington, H. (2003). Caring presence. Delineation of a concept for holistic nursing. Journal of Holistic Nursing,21(3), 301-317. Retrieved from http://www.ncbi.nlm. nih.gov/pubmed/14528852 Davis, M. (1966). Variations in patients’ compliance with doctor’s advice: An empirical analysis of patterns of communication. Academic Medicine, 58(2), 274-288. Association of American Medical Colleges. Decety, J., Yang, C., & Cheng, Y. (2010). Physicians down-regulate their pain empathy response: An event-related brain potential study. Neuroimage, 50(4), 1676-1682. Retrieved from www.ncbi.nlm.nih.gov/pubmed/20080194 Dekhtyar, M., Dunham, L., O’Brien, C.L., Quirk, M., Schwartz, A., & Stansfield, B. (2015). Development of a metacognitive effort construct of empathy during clinical training: A longitudinal study of the factor structure of the Jefferson Scale of Empathy. Advances in Health Science Education, 20. Springer. Del Canale, S., Louis, D., Maio, V., Want, X., Rossi, G., Hojat, M., & Gonnella, J. (2012). The relationship between physician empathy and disease complications: An empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 87(9), 1243-1249. Association of American Medical Colleges. Demosthenes, G. (2014). Differences in patient satisfaction between osteopathic and allopathic physicians. (Doctoral dissertation). Available from Boston University School of Medicine. Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A., & Kleijnen, J. (2001). Influence of context effects on health outcomes: a systematic review. The Lancet, 357(9258), 757-762. Retrieved from http://ncbi.nlm.nih.gov/pubmed/11253970 Di Lillo, M., Cicchetti, A., Scalzo, A., Taroni, F., & Hojat, M. (2009). The Jefferson Scale of Physician Empathy: Preliminary psychometrics and group comparisons in Italian physicians. Academic Medicine, 84(9), 1198-1202. Association of American Medical Colleges. Dugdale, D., Epstein, R., & Pantilat, S. (1999). Time and the patient-physician relationship.

Adriene Michelle Lai


Journal of General Internal Medicine, 14(Suppl 1), S34-S40. doi:10.1046/j.15251497.199.00263.x Dzeng, E., Colaianni, A., Roland, M., Levine, D., Kelly, M., Barclay, S., & Smith, T. (2015). Moral distress amongst American physician trainees regarding futile treatments at the end of life: A qualitative study. Journal of General Internal Medicine, 31(1), 93-99. doi:10.1007/s11606-015-3505-1 El Dib, R., Atallah, A., & Andriolo, R. (2007, August). Mapping the Cochrane evidence for decision making in health care. Journal of Evaluation in Clinical Practice, 13(4), 689-692. Hoboken, New Jersey, U.S.: Wiley-Blackwell Epstein, J. (1995). Altered conditions: Disease, medicine, and storytelling. New York: Routledge. Epstein, R., Morse, D., Frankel, R., Frarey, L., Anderson, K., & Beckman, H. (1998). Awkward moments in patient-physician communication about HIV risk. The Annals of Internal Medicine, 128(6), 435-442. Retrieved from http://www.ncbi. nlm.nih.gov/pubmed/9499326 Erikson, E. (1959). Identity and the life cycle: Selected essays. New York: International Universities. Fallowfield, L. (1992). The ideal consultation. British Journal of Hospital Medicine, 47, 364-367. MA Healthcare LTD. Fine, V., & Therrien, M. (1977). Empathy in the doctor-patient relationship: Skill training for Medical students. Journal of Medical Education, 52, 752-757. Association of Medical Colleges. Fissell, M. (1991). The disappearance of the patient’s narrative and the invention of hospital medicine. In R. French & A. Wear (Eds.), British Medicine in an Age of Reform. Routledge. Garrison, Fielding. (1966). History of Medicine, Philadelphia: W.G. Saunders Company. Gevitz, N. (2009). The transformation of osteopathic medical education. Academic Medicine, 84(6), 701-706. Retrieved March 3, 2015, from http://journals.lww.com/ academicmedicine/Abstract/2009/06000/The_Transformation_of_Osteopathic_ Medical.13.aspx Gilman, S. (1985). Differences and pathology: Stereotypes of sexuality, race, and madness. Ithaca, NY: Cornell University Press. Gimpel, J., Boulet, J., & Errichetti, A. (2003). Evaluating the clinical skills of osteopathic medical students. JAOA, 103(6), 267-279. Goffman, E. (1963). Stigma. New York: Simon & Schuster. Goubert, L., Craig, K., & Buysse, A. (2009). Perceiving others in pain: experimental and clinical evidence on the role of empathy. In J. Decety & W. Ickes (Eds.), The Social Neuroscience of Empathy (pp.153-165). Cambridge: MIT Press. Grammaticos, P.C. & Diamantis, A. (2008). “Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus. Hellenic Journal of Nuclear Medicine, 11(1), 2-4. Thessaloniki: Hellenic Society of Nuclear


Better Healthcare Achievable…

Medicine. Hans, D., Dube, P., & Wasserman, J. (2015). Experimental evidence showing that physician guidance promotes perceptions of physician empathy. AJOB Empirical Bioethics. doi:10.1080/23294515.2015.1047474 Hojat, M., Gonnella, J., Mangione, S., Nasca, T., Veloski, J., Erdmann, J., Callahan, C., & Magee, M. (2002a). Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education, 36(52), 522527. Medical Education. Hojat, M., Gonnella, J., Nasca, T., Mangione, S., Veloski, J., & Magee, M. (2002b). The Jefferson scale of physician empathy: Further psychometric data and differences by gender and specialty at item level. Academic Medicine, 77(10), S58-S60. Retrieved from http://journals.lww.com/academicmedicine/fulltext/2002/10001/ the_jefferson_scale_of_phsyician_empathy_further.19.aspx Hojat, M., Gonnella, J., Nasca, T., Mangione, S., Vergare, M., & Magee, M. (2002c). Physician empathy: definition, components, measurement, and relationship to gender and specialty. The American Journal of Psychiatry, 159(9), 1563-1569. American Psychiatric Association. Hojat, M., Louis, D., Maxwell, K., Markham, F., Wender, R., & Gonnella, J. (2011a). A brief instrument to measure patients’ overall satisfaction with primary care physicians. Family Medicine, 43(6), 412-417. Hojat, M., Mangione, S., Nasca, T., Cohen, M., Gonnella, J., Erdmann, J., & Veloski, J. (2001). The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educational and Psychological Measurement, 61(2), 349-365. Thousand Oaks, CA: Sage Publications Hojat, M., Mangione, S., Nasca, T., Rattner, S., Erdmann, J., Gonnella, J., & Magee, M. (2004). An empirical study of decline in empathy in medical school. Medical Education, 38(9), 934-941. Retrieved from http://www.ncbi.nlm.nih.gov/ pubmed/15327674 Hojat, M., Markham, F., Wender, R., Rabinowitz, C., & Gonnella, J. (2011b). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86(3), 359-364. Association of American Medical Colleges. Hojat, M., Vergare, M., Maxwell, K., Brainard, G., Herrine, S., Isenberg, G., Veloski, J., & Gonnella, J. (2009) The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182-1191. Association of American Medical Colleges. Horvath, A. & Symonds, B. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139149. Retrieved from http://dx.doi.org/10.1037/0022-0167.38.2.139 Jolly, P., Sondheimer, H., & Lischka, T. (2015, January 27). Numbers of MD and DO graduates in graduate medical programs accredited by the accreditation council for graduate medical education the american osteopathic association. Academic

Adriene Michelle Lai


Medicine, 90(7), 970-974. Retrieved April 9, 2015, from http://www.ncbi.nlm.nih. gov/pubmed/25629946 Kane, G., Gotto, J., Mangione, S., West, S., & Hojat, M. (2007). Jefferson scale of patient’s perceptions of physician empathy: Preliminary psychometric data. Croatian Medical Journal, 48(1), 81-86. Retrieved from http://www.ncbi.nlm.nih. gov/pmc/articles/PMC2080494 Katic, M., Budak, A., Ivankovic, D., Mastilica, M., Lazic, D., Babic-Baaszak, A., & Matkovic, V. (2001). Patients’ views on the professional behavior of family physicians. Family Practice, 18(1), 42-47. Retrieved from http://www.ncbi.nlm. nih.gov/pubmed/11145627 Kiecolt-Glaser, J., Marucha, P., Atkinson, C., & Glaser, R. (2001). Hypnosis as a modulator of cellular immune dysregulation during acute stress. Journal of Counseling and Clinical Psychology, 69(4), 674-682. American Psychological Association. Kim, S., Kaplowitz, S., & Johnston, M. (2004). The effects of physician empathy on patient satisfaction and compliance. Evaluation & the Health Professions, 27(3), 237-251. doi:10.1177/0163278704267037 Kimmelman, M., Giacobbe, J., Faden, J., Kumar, G., Pinckney, C., & Steer, R. (2012). Empathy in osteopathic medical students: A cross-sectional analysis. Journal of the American Osteopathic Association, 112(6), 347-355. Retrieved from http://www. ncbi.nlm.nih.gov/pubmed/22707644 Klein, Michael B. (2014). An examination of the moderating effects of perceived quality of life on the relationship between empathy, motivation, and specialty choice among medical students. (Doctoral dissertation). Available from Philadelphia College of Osteopathic Medicine Psychology Dissertations. Kliszcz, J., Nowicka-Sauer, K., Trzeciak, B., Nowak, P., & Sadowska, A. (2006). Empathy in health care providers – validation study of the Polish version of the Jefferson Scale of Empathy. Advances in Medical Sciences, 51, 219-225. Elsevier Korsch, B. (1998). Does Your Doctor Seem Unfeeling?. The intelligent patient’s guide to the doctor-patient relationship: Learning how to talk so your doctor will listen (pp. 125-144). New York and Oxford: Oxford University Press. Krupnick, J., Sotsky, S., Simmens, S., Moyer, J., Elkin, I., & Watkins, J. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the national institute of mental health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 64(3), 532-539. doi:10.1037/0022-006X.64.3.532 Kumar, S. (2007). Burnout in psychiatrists. World Psychiatry, 6, 186-189. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2175073 Larson, J., Lynch, S., Tarver, L., Mitchell, L., Frosch, E., & Solomon, B. (2015). Do parents expect pediatricians to pay attention to behavioral health? Clinical Pediatrics, 1-6. Retrieved April 16, 2015, from Sage Journals. Lin, C., Albertson, G., Schilling, L., Cyran, E., Anderson, S., Ware, L., & Anderson,


Better Healthcare Achievable…

R. (2001). Is patients’ perception of time spent with the physician a determinant of ambulatory patient satisfaction. JAMA Internal Medicine, 61(11), 1437-1442. doi:10.1001/archinte.161.11.1437 McCue, J. (1985). The distress of internship—Causes and prevention. The New England Journal of Medicine, 312, 449-452. doi:10.1056/NEJM198502143120725 McGovern Center for Humanities & Ethics. (n.d.). Mary Guirguis: The decline of empathy in medical education: Trends, causes, and potential remedies. In 2013 Graduates. Retrieved from http://med.uthedu/mcgovern/programs/certificateprogram/graduates-and-research/ McManus I., Keeling, A. & Paice, E. (2004). Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: A twelve-year longitudinal study of UK medical graduates. BMC Medical, 2, 29. doi:10.1186/1741-7015-2-9 McTighe, A. (2014). Effect of medical education on empathy in osteopathic medical students. Available from Philadelphia College of Osteopathic Medicine Digital Commons database. Retrieved from http://digitalcommons.pcom.edu/psychology_ dissertations Mercer, S., & Reynolds, W. (2002). Empathy and quality of care. British Journal of General Practice, 52(Suppl), S9-S12. Retrieved from http://www.ncbi.nlm.nih. gov/pmc/articles/PMC1316134 Miller, T., Hooker, R., & Mains, D. (2006). Characteristics of osteopathic physicians choosing to practice rural primary care. JAOA, 106(5), 274-279. Retrieved March 3, 2015, from http://www.jaoa.osteopathic.org/content/106/5/274.full.pdf html Morse, D., Edwardsen, E., & Gordon, H. (2008). Missed opportunities for internal empathy in lung cancer communication. Archives of Internal Medicine, 168(17), 1853-1858. doi:10.1001/archinte.168.17.1853 Neumann, M., Edelhauser, F., Tauschel, D., Fischer, M., Wirtz, M., Woopen, C., Haramati, A., & Scheffer, C. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996-1009. Association of American Medical Colleges. Newton, B., Savidge, M., Barber, L. (2000). Differences in medical students’ empathy. Academic Medicine, 75, 1200 Nightingale, S., Yarnold, P., & Greenberg, M. (1991). Sympathy, empathy, and physician resource utilization. Journal of General Internal Medicine, 6(5), 420-423. Society of General Internal Medicine. Novack, D., Epstein, R., & Paulsen, R. (1999). Toward creating physician-healers: Fostering medical students’ self-awareness, personal growth, and well-being. Academic Medicine, 74(5), 516-520. Association of American Medical Colleges. Novack, D., Gretchen, V., Drossman, D., & Lipkin Jr., M. (1993). Medical interviewing and interpersonal skills teaching in US medical schools progress, problems, promise. JAMA, 269(16), 2101-2105. doi:10.1001/jama.1993.03500160071034 Paracelsus – Physician and Alchemist – Biography. (n.d.). The European Graduate

Adriene Michelle Lai


School: Media and Communication. Retrieved from http://www.egs.edu/library/ paracelsus/biography/ Paulus, S. (2013). The core principles of osteopathic philosophy. International Journal of Osteopathic Medicine, 16(1), 11-16. Elsevier. Peters, A., Clark-Chiarelli, N., & Block, S. (1999). Comparison of osteopathic and allopathic medical schools’ support for primary care. Journal of General Internal Medicine, 14, 730-739. Springer. Porter, S. (2015, January 1). Allopathic, osteopathic medical communities announce transition to unified GME accreditation. Retrieved March 4, 2015, from http:// www.aafp.org/news/education-professional-development/20140228gmeaccredme rge.html Radecki, S, Shapiro, J., Thrupp, L., Gandhi, S., Sangha, S., & Miller, R. (1999). Willingness to treat HIV-positive patients at different stages of medical education and experience. AIDS Patient Care STDS, 13, 403-414. Retrieved from http:// www.ncbi.nlm.nih.gov/pubmed/10870594 Rakel, D., Hoeft, T., Barrett, B., Chewning, B., Craig, B., & Niu, M. (2009). Practitioner empathy and the duration of the common cold. Family Medicine, 41(7), 494-501. Society of Teachers of Family Medicine. Ramirez, A., Graham, J., Richards, M., Cull, A., Gregory, W., Leaning, M., Snashall, D., & Timothy, A. (1995). Burnout and psychiatric disorder among cancer clinicians. British Journal of Cancer, 71(6), 1263-1269. Retrieved from http://www.ncbi.nlm. nih.gov/pmc/articles/PMC2033827 Roseman, J., & Rana, A. (2015). How do medical students respond to the concept of compassion without being cued on its importance? What is the role of compassion in medicine, medical education and training? International Journal of Emergency Mental Health and Human Resilience, 17(1), 342-344. Saltzburg, L. (2014). Is the current state of medical ethics education having an impact on medical students? Online Journal of Health Ethics, 10(2). Retrieved April 8, 2015, from http://aquila.usm.edu/ojhe/?utm_source=aquila.usm.edu/ojhe/vol10/ iss2/2&utm_medium=PDF&utm_campaign=PDFCoverPages Schreifer, J. (2007). A warrant for human rights: The relevance of compassion in liberal states. (Bachelor’s Thesis). Available from Centre for Theology and Religious Studies, Lund University. Shapiro, J. (2008). Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philosophy, Ethics, and Humanities in Medicine, 3, 10. doi:10.1186/1747-5341-3-10 Snibbe, J., Radcliffe, T., Weisberger, C., Richards, M., & Kelly, J. (1989). Burnout among primary care physicians and mental health professionals in a managed health care setting. Psychological Reports, 65, 775-780. doi:10.2466.pr0.1989.65.3.775 Spiro, H., Curnen, M., Peschel, E., & St. James, D. (1993). Empathy and the practice of medicine: Beyond pills and the scalpel. New Haven, CT: Yale University Press.


Better Healthcare Achievable…

Sullivan, L., Stein, M., Savetsky, J., & Samet, J. (2000). The doctor-patient relationship and HIV-infected patients’ satisfaction with primary care physicians. Journal of General Internal Medicine, 15(7), 462-469. Retrieved from http://www.ncbi.nlm. nih.gov/pubmed/10940132 Table 22: MCAT scores and GPAs for applicants to U.S. medical schools by sex, 20052014 [Data file and PDF]. (2014). Retrieved March 1, 2014, from https://www. aamc.org/data/facts/applicantmatriculant/ Table 40: Residency applicants by specialty and medical school type, 2014 [Date file and PDF]. (2014). Retrieved March 1, 2014, from https://www.aamc.org/data/facts/ erasmdphd/ Thomas Jefferson University. (n.d.). Jefferson Scale of Empathy. Retrieved March 13, 2015, from http://www.jefferson.edu/university/skmc/research/research-medicaleducation/jefferson-scale-of-empathy.html Tyreman, S. (2013). Re-evaluating ‘osteopathic principles’. International Journal of Osteopathic Medicine, 16(1), 38-45. Retrieved April 8, 2015, from http://www. sciencedirect.com/science/article/pii/S1746068912000727 Vaillant, G., Sobowale, N., & McArthur, C. (1972). Some psychologic vulnerabilities of physicians. The New England Journal of Medicine, 287, 372-375. doi:10.1056/ NEJM197208242870802 Voogt, S., Mickus, M., Santiago, O., & Herman, S. (2007). Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students. Journal of the American Geriatrics Society, 56(2), 339-344. Wear, D., Aultman, J., Varley, J., & Zarconi, J. (2006). Making fun of patients: Medical students’ perceptions and use of derogatory and cynical humor in clinical settings. Academic Medicine, 81, 454-462. doi:10.1097/01.ACM.0000222277.21200.a1 Wen, D., Ma, X., Honghe, L., & Xian, B. (2013). Empathy in chinese physicians: Preliminary psychometrics of the Jefferson Scale of Physician Empathy (JSPE). Medical Teacher, 35(7), 609-610. doi:10.3109/0142159X.2013.774338 Werner, E., & Korsch, B. (1976). The vulnerability of the medical student: Posthumous presentation of L.L. Stephen’s ideas. Pediatrics, 57(3), 321-328. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/768890 West, C. & Shanafelt, T. (2007). The influence of personal and environmental factors on professionalism in medical education. BMC Medical Education, 7, 29. doi:10.1186/1472-6920-7-29 West, C., Huschka, M., Novotny, P., Sloan, J., Kolars, J., Habermann, T., & Shanafelt, T. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA: The Journal of the American Medical Association, 296(9), 1071-1078. Retrieved from http://www.ncbi.nlm.nih. gov/pubmed/16954486 William, S., Weinman, J., & Dale, J. Doctor-patient communication and patient satisfaction: A review. Family Practice, 15(5), 480-492. Retrieved from http://

Adriene Michelle Lai


fampra.oxfordjournals.org/content/15/5/480.full.pdf Wispe, L. (1986). The distinction between sympathy and empathy: to call forth a concept, a word is needed. Journal of Personality and Social Psychology, 50(2), 314-321. American Psychological Association. Zachariae, R., Pedersen, C., Jensen, A., Ehrnrooth, E., Rossen, P., & von der Masse, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy and perceived control over the disease. British Journal of Cancer, 88, 658-665. London: Nature Publishing Group.


Augsburg Honors Review

J. S. Mill On Hate Speech in the Canadian Context Matteo Maciel

University of York

Abstract: This paper examines the legal treatment of hate speech in Canadian society through the lens of John Stuart Mill’s Theory of Liberty. In doing so, the core aspects of Mills theory will be teased out so his response to hate speech in modern liberal societies may be better understood. The central argument set out is that hate speech is a violation of the Canadian Charter of Rights and Freedoms, but such a violation is saved through application of Mill’s “Harm Principle”. Even with this application, the paper argues ought to be a balance of rights. It will be concluded that Canadian Supreme Court interpretations of the Charter, and for a large part the Charter’s drafting itself, lend themselves to be reminiscent of Mill’s theory of harm.


J. S. Mill On Hate Speech…

John Stuart Mill’s On Liberty hypotheses a robust theory of freedom. In doing so, he provides examples of when and how those freedoms can be restricted. Canadian legislation, specifically Section 319(b) of the Criminal Code, includes provisions which restrict free speech. These provisions intentionally undercut rights of expression found in The Charter of Rights and Freedoms. The Supreme Court of Canada (SCC) has upheld S319 in order to prevent harm. The adjudicative and legislative framework existing within Canada, allows for a Mill-like construction of harm. Examining the Charter, Criminal Code, and Supreme Court judgments, one may better understand the strikingly similarity between SCC reasoning, and Mill’s demonstrable harm principle. To reach the aforementioned conclusion, this paper shall explore Mill’s theory of liberty and harm. It will then summarize and compare Mill’s principles against crucial judicial and legislative reasoning regarding S319. Both Mill, and the SCC set limits unto freedom in the interest of protecting harms. Criminal charges restricting expression amounting to hate speech represents a crucial judicial deviation from Canada’s liberal democratic ‘cousins’ the UK and the US. The limits on hate speech adhere to legal doctrine found in Section 2 of the Charter, akin to Mill’s harm principle.i The case-law supporting S319 adheres to Milllike justifications. Harm unto freedom of expression ought to be examined in two stages. First, in regard to harm the speech causes to others, and second the harm caused unto the speaker in restricting that speech. Mill’s theory of liberty is centrally supported through his application of a harm principle. Liberty extends insofar as those actions do not harm others. Mill deconstructs the notion of harm unto others as two avenues. The most pertinent of the two are harms which interfere with permanent interests, ergo, the vital interests of man in his pursuit of life and liberty. Mill’s discussion of two forms of harm and the remedies to solving those forms are of particular importance when examining hate speech in Canada. Mill’s theory of liberty is underpinned by the concept that society should allow man to go about “pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs, or impede their efforts to obtain it.”ii Mills theory is strongly reliant on the rationality of man. He constructs a theory not upon contract, but through “a certain line of conduct towards the rest.”iii This conduct outlines “recognition of certain immunities, called political liberties.”iv These immunities protect man’s ‘permanent interests’. Thus, individuality and independence form the “indispensable”v basis of permanent interest. Contrary to John Locke’s political rights, Mill’s theory heeds caution when outlining the limits of permanent interests. Rather, the right to not be harmed by others rests at the core of Mill’s utilitarian harm principle.vi The right to liberty, security and property form the basis of the “permanent interest[s] of man as a progressive being.”vii His theory then, resolves around Liberty, and the only time liberty should be restricted is for the purpose of preventing harm to the permanent interests of man. Before examining how the CSC has applied the harm principle in relation to hate speech, Mill’s description of state intervention into the lives of its subject’s lives should also be mentioned; it will help us better understand intervention as prescribed

Matteo Maciel


by Mill. By understanding what Mill would prescribe, we may better compare whether the CSC applies Mill’s theory in practice. ‘The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.’viii This buttresses Mill’s theory on liberty. Harm prevention is the primary authorizer for state sanction surmounting to infringement on liberties. In order to prevent harm, Mill constructs punishments based on whether or not the harm affects the permanent interests of the subject. Any harm surmounting to damage less than permanent interests will not receive state sanction. Mill argues that ‘as soon as any part of a person’s conduct affects prejudicially the interests of others, society has jurisdiction over it.’ix Harms which infringe liberties of others less than permanent interests ought to be remedied through moral censure. While ‘the offender may then be justly punished by opinion, though not by law.’x These actions might still cause harms, although Mill writes that they might not justify state intervention. Critics within the American field consistently argue that speech-expressions do not infringe permanent interests. Case-law regarding S319 has reasoned that hate speech exceeds the permanent interest threshold. Harm injuring the life, liberty, and property form the core of permanent interests. In the work Mill on Liberty: A defense, John Gray helps form a rigid separation between the two forms when he writes, ‘it is not whether a man’s interests have been damaged by other men, but whether his interests ought to be protected’xi that way, ‘harm to others is thereby prevented, […] allowing liberty-limitation only in respect of conduct which causes harm.’xii S319(2) places clear restrictions on hate speech by sanctioning expressions which cause harm to others. Mill is quick to caution the dangers of sanctioning actions which amount to less than harming permanent interests. Academic commentators in favor of protecting free speech will often refer to Mills advertence toward the tyranny of the majority as evidence that speech, regardless of how absurd or unpleasant, deserves to be expressed. If all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind.xiii Mill’s preference to allowing free speech is evident throughout On Liberty. Mill considered expression to be vital to society. However, Mill’s clear delineation of harm to permanent interests also might support limitations on hate speech. If hate speech is defined strictly akin to the SCC’s meaning, then it seems likely to remain congruent with Mill’s principle of harm. The SCC’s judgments in R v Keegstraxiv and R v Andrewsxv might be used to evidence how the definition of hate speech used within S319(2) inflicts harm unto permanent interests. Examining the aforementioned judgments will further provide opportunity to scrutinize how the SCC traces (albeit rather liberally) Mill’s harm principle. In Canada, the Charter sketches a rough form of permanent interests. Mill’s


J. S. Mill On Hate Speech…

ideas of life, liberty, and property feature prominently in the Charter, and it is because of this that we may make such an interesting application. In R v Keegstra and R v Andrews, the SCC utilizes S319 to prohibit willful promotions of hatred against identifiable groups.xvi In both Keegstra and Andrews, the Court heard the appeal that S319 of the Criminal Code violated the entrenched rights found in the Charter. Specifically, the SCC found that S319 violated section 2(b) of the Charter. The Charter’s core values ensure protection against state sanction or interference. In the case of section 2(b), this ensures ‘the freedom of thought, belief, opinion and expression, including freedom of the press and other media of communication.’xvii The Charter applies a test of proportionality to its entrenched rights through section 1.xviii The result utilizes the Oakes test to allow reasonable limits onto Charter rights in a method with ‘striking resemblance to the factors highlighted by John Stuart Mill’s harm-based approach to justifying restrictions on liberty.’xix This allows the SCC to trace limits unto constitutional rights either for public policy, or to allow a balancing between conflicting rights. Upon establishing pressing and substantial reasoning, the government policy resulting in a Charter infringement must create a proportional minimal impairment. The SCC uses this section to justify S319 by applying a Mill-like test of reasonable impairment to liberty ‘reflective in the Supreme Court’s requirement that the objective of the restrictive legislation be pressing and substantial.’xx Mill’s interpretation of harm seems restrictive to physical harms, and scholars disagree over whether expression ought to ever be curtailed.xxi In supporting men of rational minds, ‘Mill said that we should tolerate even the speech we hate because truth is more likely to emerge in a free intellectual combat from which no idea has been excluded.’xxii What S319 does not tolerate, however, is not merely speech others hate. Indeed, its avenue is quite narrow, limited to convictions where a defendant has been caught ‘inciting’ hatred ‘to provoke or stir up’ violence or hatred toward a person or group of personsxxiii. Rather than a curtail on expression, it operates more as a crime against aiding or abetting. Thus, the SCC’s narrow interpretation of S319 is not constructed broadly so that it might suppress (, or silence,) unpleasant or untrue speech. Rather, its intent is to subdue ‘abus[ive] or insulting language used against its target group.’xxiv Contrast these limits with American constitutional rights, and one observes a stark contrast. In the United Kingdom, Neuberger LJ P traced Mill’s construction of harm in Rhodes v OPO, where the plaintiff claimed the expression found within a book would cause severe emotional distress.xxv Neuberger LJ stated on several occasions the high scrutiny the Court ought to adopt when contemplating restrictions on free speech.xxvi Rhodes materially differs from Canadian cases in that it was a case of tortious liability. Although, Mill’s theory might be applied to both cases without encountering conflict. In the case of Rhodes, the defendant lacked the intentionality of causing harm. Rhodes operates as an example of harm not amounting to permanent interests. This might be concluded when considering the Court’s judgment at paragraph 96 where it considered that the information could have been offensive, but, quoting Sedley LJ in Redmond-Bate

Matteo Maciel


v Director of Public Prosecutions (1999) 7 BHRC 375 ‘free speech includes not only the inoffensive but the irritating, the contentious, the eccentric, the heretical, the unwelcome and the provocative provided that it does not tend to provoke violence.’xxvii Sedley LJ’s opinion links directly to Mill, who himself ‘acknowledged that restrictions on incitement to violence could pass his tests for justifiable limits to free speech.’xxviii In On Liberty, Mill considers that ‘even opinions lose their immunity, when the circumstances in which they are expressed are such as to constitute their expression a positive instigation to some mischievous act.’xxix Mill’s failure to include a hierarchical ranking of permanent interests is intentional. The liberty of free speech must interact and operate adjacent to other permanent interests, it cannot supersede one’s own interests nor the interests of others. Thus, a harm to the security of one, cannot justify a disproportionate subjugation of another interest. The SCC’s judgment in Keegstra conveys a clear effort toward balancing Charter rights. Akin to Mill’s permanent interests, the SCC delicately balances competing rights; respecting freedom of expression whilst setting limits on the acceptable level of harm speech might create. S319 restricts the permanent interests of the hate speaker. The right to freedom of expression is subdued in an attempt to prevent harm. Similar to the SCC’s construction in Keegstra, the restricted permanent interests would likely be supported by Mill so long as they serve to prevent harm to permanent interest.xxx S319’s prosecution of those intending to publically ‘incite hatred’ takes a form similar to defamation. In fact, it holds similar defenses. The wording of S319, and the SCC’s interpretation of those words, has been to restrict speech inciting hate. The question becomes whether hate speech creates harm sufficient to injure permanent interests. This causes issues when attempting to congeal Mill’s theory to Canadian law. The SCC has consistently ruled S319 is a breach of Charter rights guaranteed to the hate speaker. However, as reviewed above, the harm the speech causes justify activation of the Oakes test. Mill would likely disagree with the activation of the Oakes test, he would likely consider that hate speech is necessary to society and would mirror Sedley LJ as quoted above. S319’s strict, and comprehensive delineation of acceptable and unacceptable actions found in S319(2) and (3) results in a strict application of the Criminal code unto expressions which ought to surmount to harming the permanent interests of members of the public. It has been briefly examined that Mill’s theory of liberty does not encapsulate actions which incite violence. S319’s phrasing of curtailing ‘wilful’ expressions ‘inciting’xxxi violence toward groups ought to mean it serves to protect against harm to permanent interests. Keegstra and Andrews are landmark cases in Canada, and their decisions shed a great deal of light onto what one may imagine Mill to say. The SCC’s justification of S319 is that it ‘constitutes a reasonable limit upon freedom of expression.’xxxii In his majority opinion, C.J. Dickson expressed that the legislative objective of parliament was to prevent harm. Parliament has recognized the substantial harm that can flow from hate propaganda and, in trying to prevent the pain suffered by target group members and reduce […]violence in Canada, [it] has decided to suppress the


J. S. Mill On Hate Speech… willful promotion of hatred against identifiable groups.xxxiii

We have already briefly discussed how (in line with Mill) the courts interpreted harm without physicality. Unsurprisingly, there is ‘good evidence that many hate groups have a history of involvement in racist violence,’xxxiv and in conjunction with the discussion of incitement above, willfully promoting hatred against target groups can be imagined as promoting violence. Dickson CJ defends S319 as a provision preventing harm to others. This ruling turns crucially on the phrasing of hate speech as ‘inciting’ violence. Without such a clear connection to the threat of physical harm, it is unclear whether the SCC’s ruling is congruent with Mill’s theory. If this is the case, then S319 unduly restricts liberty as set out by section 2 of the Charter. This is parallel to the dissenting opinion of La Forest J in Keegstra. Regardless of the conclusion, there is no question that ‘[c]ommunications which willfully promote hatred against an identifiable group are protected by s.2(b) of the Charter.’ Applying the Oakes test, Dickson outlines S319 as pursuing a pressing and substantial objective of protecting permanent interests of others.xxxvi At the heart of these interpretations resides the harm principle. The court application of Mill seems to be deliberate and explicit. Dickson CJ argues that “Section 319 of the Code is an acceptably proportional response,”xxxvii to the harms hate speech causes. The expressions S319 is designed to halt “connotes emotion of an intense and extreme nature that is clearly associated with vilification and detestation.”xxxviii The judgment sets a threshold between mere offense, and harm to permanent interest. This threshold is not one of a broad interpretation but rather is constructed narrowly so as to prevent severe and extreme expressions. As 319(3) outlines, the purview of these restrictions does not prevent truth, religious opinion, or attempt to curtail discussions for public benefit.xxxix Rather, the legislation is clearly only triggered upon the existence of malice, merely reasonable belief of truth or good-faith is insufficient. Reinforced by the SCC’s judgments, S319 sets out an extremely narrow avenue in which expressions may cause harm to permanent interests. Incitement of violence has already been established as qualifying under Mill’s harm principle; and it seems unreasonable for the Court to exclude psychological harm induced by words,xl especially in light of a tortious remedy available for such forms of injury.xli In the United States, the tort of emotional distress has morphed into a tort preventing acts or expressions which induces ‘outrage.’xlii The comparison between S319 and IIED in the U.S. shows two halves of the same coin. In Snyder v Phelps, the U.S. Supreme Court ruled 8-1 in Phelps’ favor holding that the protesting, while ‘outrageous’, could not overcome the First Amendment. Alito J, dissenting, echoed the Canadian ruling in Keegstra by stating that freedom of expression ‘is not a license for the vicious verbal assault that occurred in this case’. xliii The flexibility found within the Canadian Charter represents a crucial and fascinating difference between the Canadian and American judicial environments. That flexibility operates as a Millian mechanism, balancing liberties akin to utilitarian calculations.

Matteo Maciel


The majority opinion of Keegstra can only be understood as congruent with Mill’s theory if, in being protected by Section 1, the harms mentioned above are damaging to permanent interests. This is likely due to the striking similarity between the Oakes test and Mill’s harm principle test.xliv Dickson CJ’s statements support the belief that hate speech causes permanent harm. The court is quick to note that “S319(2) was introduced into the Criminal Code only after extensive study by the Special Committee on Hate Propaganda in Canada.”xlv The study found that hate speech incited or caused harm through violence; an objective the SCC believed to be pressing and substantial. Dickson CJ’s judgment set a “reverse onus of proof regarding the truth defense,’ placing the burden on the defendant ‘so as to make it more difficult to avoid conviction where the willful promotion of hatred has been proven beyond a reasonable doubt.’xlvi The burden correspondingly creates further complications with presumptions of innocence. The SCC has rectified this lacuna through a standard of proof known as the ‘air or reality’ which operates similar to S101 of the Magistrates’ Courts Act 1980 in England, where, when a defendant relies on an exception, the legal burden rests on him. The combined result places an immense burden on the judiciary to justify the use of the Oakes test. By constructing S319 narrowly, the SCC may by-pass these burdens by prosecuting hate-speech which harms permanent interests. Without harm to permanent interest, Mill would describe such speech acts as offensive but amendable through moral censure. The dissenting opinion of Keegstra mirrors this view of harm from hate speech. In dissenting, La Forest J believes that S319 is violating liberty. La Forest J, much like Dickson CJ, where he approaches this question by using Mill as a lens. La Forest J argues that S319 constitutes a ‘significant infringement on the guarantee of freedom of expression.’xlvii A vein of Mill is seen in La Forest’s opinion when he writes that S319 violates: the vital values upon which s.2(b) of the Charter rests: the value of fostering a vibrant and creative society through the marketplace of ideas; the value of the vigorous [sic] and open debate essential to democratic government and preservation of our rights and freedoms; and the value of a society which foster the self-actualization and freedom of its members.xlviii La Forest J interprets the harm caused by hate speech as a harm of a lesser form. He does so in line with American judicial opinions. By interpreting the harm caused by hate speech as not infringing on permanent interests, La Forest J’s interpretation warrants the striking down of S319. The remedy to hate speech, would instead be moral censure, or ‘the business of education.’xlix Mill speaks briefly to these matters, and prescribes that ‘[t]he offender may then be justly punished by opinion, though not by law.’l However, as the SCC identifies, moral censure The case itself provides issue to this opinion however. Mill advocates education as a central feature defending against offensive behavior. This is primarily because Mill believes in the reason of man. In Keegstra, the defendant was a teacher, indoctrinating students of anti-Semitic, anti-holocaust hate-speech through academic testing. The


J. S. Mill On Hate Speech…

indoctrination is crucial in that his actions undermine Mill’s dependent on education as a resolution to hate speech. In such an example, the defendant’s position as an influencer unto children would undoubtedly invoke Mill’s penchant toward protecting children. This was reflected in the Court’s judgment. Mr. Keegstra’s capacity to suppress fact, and grade children academically based upon his personal belief speaks not only to the issue of hate speech, but also to the issue of federal academic standards. In Andrews, the SCC recognized the grave danger hate propaganda posed, and reasoned that the ‘wilful’ actions might be analogous to drink driving; a driver with a blood alcohol count of over 80 is guilty of an offence although it has not been demonstrated that the particular accused has occasioned any danger to a victim or that his driving at the moment of apprehension constituted a danger in itself. Rather the very basis for creating the offense depends on the empirical potential of danger the act itself poses.li The danger the Court recognizes is not that of actual harm per se, but still harm as it refers to Mill’s permanent interests. In identifying the pressing and substantial nature of s. 319, Dickson CJ cites the Special Committee on Hate Propaganda in Canada. The repetition of the loathsome messages of Nazi propaganda led in cruel and rapid succession from the breaking of the shop windows of Jewish merchants to the dispossession of the Jews from their property and their professions, to the establishment of concentration camps and gas chambers. The genocidal horrors of the Holocaust were made possible by the deliberate incitement of hatred against the Jewish and other minority peoples.lii It is here that Mill and Dickson CJ’s opinion diverge. They do not, however, conflict. Dickson CJ’s approach and application of Section 1 of the Charter strongly resembles Mill’s utilitarian approach to harm. In the same way that Mill balances ‘utility as the ultimate appeal on all ethical questions,’liii so too does section 1 attempt to preserve a limit on liberties when the objectives are pressing and substantial. Mill’s theory of liberty is buttressed by the concept that certain interests, those permanent to man, cannot be infringed upon. In this same way, the Canadian Charter of Rights and Freedoms outlines basic constitutional rights. These rights are not untended, and much like the remaining ‘living tree’ constitution, cannot growth wildly without risk of being pruned. Just as Mill’s theory advocates limits to permanent interests, so too does the Canadian Charter. The Supreme Court has subsequently created a formula in which to test the legitimacy of those restrictions. This again mirrors Mill’s own ideas. The right of expression hold within it, its own crux. Offensive content falls within the broadly constructed right but this content ought not to necessarily be allowed. S319 provides a measured attempt to discourage and sanction offensive content deemed to go too far. Dickson CJ’s decision seems to answer directly to this argument. By constructing hate speech narrowly, one attempts to balance the competing interests between liberty

Matteo Maciel


and security. The onus of proof for the defense of truth, which exists on the balance of probabilities, makes conviction extremely difficult. The margin between merely offensive and criminal remains behind a haze. Future charges which fall along the margin will be extremely difficult. However, there has been consistent clarity by the SCC regarding the fact that wherever the margin falls, there are clear and demonstrable cases where conviction is justified. The wilful promotion of hatred onto a target group, nefariously utilizes liberty. As Mill astutely writes; ‘the oral rules which forbid mankind to hurt one another are more vital to human well being than any maxims, however important.’liv This mirrors Dickson CJ’s judgment in Keegstra which only comes short of explicitly citing Mill’s principle as a guiding policy. Mill’s theory of liberty and its harm principle create a framework for rights and their limits. Guided by utilitarian principles, Mill’s prescriptions are starkly similar to the framework used by the Supreme Court of Canada to approach hate speech through the Charter of Rights and Freedoms. In applying this framework the Court has delicately examined section 319(b) of the Criminal Code in an effort to balance liberty and security. One is able to see traces of Mill’s theory and application of his harm principle throughout Supreme Court judgments. Keegstra and Andrews highlight remarkable similarities between Mill and modern judicial reasoning in Canada. What is centrally clear is this: If expression inciting violence and hatred is interpreted as threatening the permanent interests of others, then the Canadian Supreme Court’s judgments run along Mill’s free speech writings found in On Liberty. Regardless of the interpretation of hate speech and harm, the Supreme Court of Canada’s application of Millian principles is fascinating and one must wonder whether a more explicit application of Mill ought to be found within the Canadian context. Miller, Dale E., and John Stuart Mill. The Basic Writings of John Stuart Mill on Liberty, the Subjection of Women and Utilitarianism. Unabridged. ed. New York: Modern Library, 2013. i


Ibid 14-15


Ibid 77


John Stuart Mill. On Liberty, 2013. Pg 1.


Ibid 10


Ibid 13




Mill (n 4) 11


Ibid 77


Ibid 78


Gray, John. Mill on Liberty a Defense. 2nd ed. London: Routledge, 1996.50


J. S. Mill On Hate Speech…


Ibid 48


See Mill (n 4) 17.


[1990] 3 SCR 697


[1990] 3 SCR 870


Keegstra, (n 14)


Andrews (n 15)

Canada Act 1982 (UK) 1982, c11 sch B ‘The Constitution Act, 1982’ Part 1: Canadian Charter of Rights and Freedoms’ s1 xviii

Hare, Ivan. "Part II: Hate Speech." In Extreme Speech and Democracy, 206. Oxford: Oxford University Press, 2009. xix




Gray (n 11) 56


Hare (n 19)






[2015] UKSC 32


Ibid [92]


(1999) 7 BHRC 375 para 20


Hare (n 19)


See Mill (n 4) 57


Gray (n 11) 54


See Keegstra,(n 14)






Hare, (n 19)


Keegstra,(n 14)







xxxix xl

Criminal Code of Canada 1985, C-46, 319(3)(a)-(d)

Keegstra, (n 14)

Cf Rhodes (n25), and the long line of SCOTUS cases involving ‘outrageous speech’ culminating in Snyder v Phelps 562 U.S. 443 (2011) xli



Matteo Maciel xliii



Hare (n 19)


Andrews (n 15)


Keegstra,(n 14)







Miller, (n 1). 78


Ibid 78


Andrews (n 15)


Keegstra, (n 14)


See Mill (n 4) 13.

Mill, John Stuart. "Chapter 5: On the Connection between Justice and Utility." UTILITARIANISM. January 1, 1863. Accessed December 1, 2014. https://www. marxists.org/reference/archive/mill-john-stuart/1863/utility/ch05.htm. liv

Gray, John. Mill on Liberty a Defense. 2nd ed. London: Routledge, 1996. Hare, Ivan. "Part II: Hate Speech." In Extreme Speech and Democracy, 211. Oxford: Oxford University Press, 2009. Heyman, Steven J. Hate Speech and the Constitution. New York: Garland Pub., 1996. "Janzen v. Platy Enterprises Ltd., [1989] 1 SCR 1252, 1989 CanLII 97 (SCC)." CanLII. May 5, 1989. Accessed December 1, 2014. https://www.canlii.org/en/ca/scc/ doc/1989/1989canlii97/1989canlii97.html. Mill, John Stuart. "Chapter 5: On the Connection between Justice and Utility." UTILITARIANISM. January 1, 1863. Accessed December 1, 2014. https://www. marxists.org/reference/archive/mill-john-stuart/1863/utility/ch05.htm. Mill, John Stuart. "Chapter 5: On the Connection between Justice and Utility." UTILITARIANISM. January 1, 1863. Accessed December 1, 2014. https://www. marxists.org/reference/archive/mill-john-stuart/1863/utility/ch05.htm. Miller, Dale E., and John Stuart Mill. The Basic Writings of John Stuart Mill on Liberty, the Subjection of Women and Utilitarianism. Unabridged. ed. New York: Modern Library, 2013. "R. v. Andrews, [1990] 3 SCR 870, 1990 CanLII 25 (SCC)." CanLII. December 13, 199. Accessed December 1, 2014. http://www.canlii.org/en/ca/scc/ doc/1990/1990canlii25/1990canlii25.html. "R. v. Harding, 2001 CanLII 21272 (ON CA)." CanLII. December 17, 2001. Accessed December 1, 2014. http://www.canlii.org/en/on/onca/ doc/2001/2001canlii21272/2001canlii21272.html.


J. S. Mill On Hate Speech‌

"R. v. Keegstra, [1990] 3 SCR 697, 1990 CanLII 24 (SCC)." CanLII. December 13, 1990. Accessed December 1, 2014. http://www.canlii.org/en/ca/scc/ doc/1990/1990canlii24/1990canlii24.html.

Augsburg Honors Review


Transitioning: An Ethnographical Study of Mid-20th Century Transgender Americans Samuel McCracken

Georgia State University

Abstract: This essay explores a number of historical and anecdotal resources in an attempt to construct an ethnography around transgender individuals of the American 1950s and 60s. Situating my study in the context of a rising national interest in the quasi-scientific field of sexology as well as the nuclear family-centered sociopolitical climate of the post-WWII United States, my analysis seeks to understand the varying lived experiences of transgender Americans and conjecture about the quality of their lives. Because the focus of my study concerns a group living before the use of the term “transgender” to describe gender identity and, indeed, before the establishment of any cohesive non-heteronormative community—as many historians will accredit the Stonewall Inn riots of 1969 with the inception of the Gay Rights Movement in America— this explication, written in the vein of the anthropological ethnography, looks at the proto-transgender community as a kind of diasporic subculture. In particular, my study pays close attention to the ways in which transgenderism was the subject of ambivalent prejudice, a term coined by Irwin Katz that recognizes benevolent (passive) forms of prejudice as well as malevolent (active) forms of prejudice. My brief essay examines a number of spaces, like the portrayal of transgenderism in the media, its treatment in the military, and its reception by the public, but recurrently it looks to the entertainment sphere, considering the dissonance between transgender performance as a comedic act and the conduct afforded to transgender individuals in actuality.


Transitioning: An Ethnographical Study…

“Surgical Sex Change is ‘Eagerly’ Awaited” reads the headline of an Omaha World Herald column dated to February of 1957. The article goes on briefly to describe a 20-year-old individual who was released from a New York rehabilitation center on the grounds that zei “undergo [sexual reassignment] surgery” (“Surgical Sex Change is ‘Eagerly’ Awaited”). And although the piece might appear radical in comparison to the newspaper’s more routine coverage, 1950s-era gender-nonconforming (or perhaps “proto-transgender”) Americans were at large subjected to the same sort of public speculation as the one called to attention in the Herald’s article, as well as with the same degree of confusion relayed by the quotation marks around “‘Eagerly.’” Furthermore, proto-transgender individuals of the mid-20th century fell prey to systemic forces like ambivalent prejudice, a social mechanism that suspends a minority group in the position of both exaltation in certain spaces and demonization in others (I. Katz 893). Spaces like drag performance, burlesque shows, and theatrical transvestism, for instance, were areas in which some aspects of trans identities were condoned—and perhaps celebrated— for civic consumption. Despite their acceptance in entertainment spheres, however, Americans of this epoch who sought to lead their entire lives with genders contrary to the sexes assigned to them at birth under cisnormativity were plagued by early notions of psychoanalytic theory and the growing field of sexology, as well as social stigma and personal bias. This type of dissonance, in which American culture upheld transgenderism as a mode of performance and as a gimmick but denigrated people who openly identified as “transgender” in the real world rendered the trans lived experience one fraught with contradictions and polarized expectations. This ethnography, while not comprehensive of the diasporic people it attempts to know, seeks to outline and examine the social forces that shaped the lives of transgender Americans of the mid-20th century and to piece together a greater understanding of their culture at large. Using historical documents as well as primary and secondary sources, this essay aims to reconstruct the daily lives and social profiles of post-World War II transgender individuals as well as the difficulties they endured. The socio-political climate of the United States following World War II is one marked by a revival of the cult of domesticity and a reassertion of the nuclear family, two qualities which reify heteronormative ideologies and traditionalistic gender roles as husbands-at-war returned home and reclaimed their positions as family heads. Against this widespread resurgence of traditionalism, proto-transgender Americans combatted their categorization as a social “Other,” but they would be without a cohesive political identity until, as approximated by transgender anthropologist David Valentine, “sometime in the 1970s” (32). However, even after the advent of the Stonewall riots of 1969— an event often thought responsible for the onset of the Gay Rights Movement—prohomosexual groups like the Mattachine Society would reject applicants who followed “gender-transgressive models of homosexuality,” which, as a blanket statement, included proto-transgender persons (Valentine 33). But prior to this assertion, even “[t]hroughout the second half of the nineteenth century and the first half of the twentieth century,”

Samuel McCracken


as transgender historian Susan Stryker suggests, homosexual desire and transgender expression were often seen as a single unit (55). Men who were sexually attracted to men, as well as men who donned female clothing, were considered “invert[ed],” as people of the time used heteronormative gender expressions to rationalize both transgender and homosexual feelings. In the public eye, gays and transgender people were both considered to be “thinking like [women]” (Stryker 55). Seemingly rejected from heteronormative groups and queer ones alike, transgender Americans of the 1950s struggled to comply with a world that did not grant them visibility or protection; they became a subculture, underground and under-noticed, until the political climate shifted and historians looked back on them in inquiry. The mid-20th century, though generally unconducive to the social incorporation of transgender people, hallmarked the appearance of the word “transsexual” in medical discourse; Alfred Kinsey, a prominent American sexologist, referenced the emerging term and “criticized [its use] as a synonym for homosexual” (MacKenzie 41). As indicated by the aforementioned newspaper tagline, “Surgical Sex Change is ‘Eagerly’ Awaited”, early sex reassignment surgeries were popularized, publicized events. After returning to America from her “sex change” in Denmark—as the procedure had been practiced there longer than it had in the United States—Christine Jorgenson became the “first publicly recognized [American] transsexual,” Gordene MacKenzie notes in her Transgender Nation; the author goes on to comment that Jorgenson’s story was “the most news-covered event of 1953” (43). The same year, a movie called Glen or Glenda featured a character hauntingly similar to Jorgenson, highlighting the populist consumption of gender transitioning as a form of entertainment and source of intrigue (Garber 112). Unfortunately, Jorgenson’s ostensible acceptance was only testament to the disproportionate amount of other transgender citizens who were unable to undergo surgery. One reader, after following Jorgenson’s run in the press, wrote a letter to Dr. Christian Hamburger, an endocrinologist invested in transsexual research, and lamented “My pitiful little life became no longer livable in the knowledge that it was possible [to change one’s sex]” (Ekins and King 59). The implication rests that this individual became more distraught after realizing that surgery was not a financially feasible option for most transgender people of hir time. Jorgenson, equipped with money (and, some might argue, male privilege), was a rare exception. But transgender individuals of this epoch sought more than medical recognition, and for many citizens, marginalization stemmed from the psychiatric bench, not the operating table. To give their anti-trans stigma a definitive basis, transphobic American ideologies drew on the work of preeminent sexologists—like Havelock Ellis and Magnus Hirschfeld, as well as the American Alfred Kinsey—who grounded their studies on transgenderism in the Freudian school of psychoanalysis that predated them. Hirschfeld’s Die Tranvestiten, or The Transvestites, of 1910 notes the American conception of transgender identities on a visit to the United States at the turn of the century, writing: “one man who simply would not stop dressing as a woman was [finally] forced to wear a


Transitioning: An Ethnographical Study…

sign on his waist with the legend: ‘I am a man’” (50). The processes of pathologization that came into play here—which Michel Foucault terms “[the] medicalization of the sexually peculiar”—essentially find their roots in the idea that people recognize difference, interpret the difference as harmful or immoral, and assume this difference emerges from a finite physiological or psychological referent, an ideology which resembles the Greek understanding of mimesis (Ekins and King 150). Many researchers relate Sigmund Freud’s concept of the Oedipal complex, of “penis envy” and the “castration complex,” to early constructions of transphobia because it so blatantly places gender dysphoria as the site of extreme psychological instability (MacKenzie 26). And because his theories hinged upon heteronormativity and masculinist ideas about sexuality, a bulk of Freud’s work allowed—and perhaps catered to—the dismissal and ultimate stigmatization of those who deviated from its core concepts (including both transgender individuals and homosexuals), and his ideas were made more deleterious by their popularity and widespread, international acceptance. Because they were seen as a social and psychological “Other,” transgender individuals of the 1950s—as well as modern times—were subject to discrimination, both violent and nonviolent. In hir semi-autobiographical work Transgender Warriors, transgender activist Leslie Feinberg begins: “I was raised in the 1950s – an era marked by rigidly enforced social conformity and fear of difference” (3). Ze likens this opposition to difference to the spread of McCarthyism and the subsequent dichotomization of political preference as well as social identity. Ze recounts that “[hir parents] blamed the family’s problems on [hir] difference” and that, after years of social ostracization and relentless bullying, “[ze] thought that [ze] would certainly be killed before [ze] reached adulthood” (Feinberg 6). Stories like this—and, in fact, worse than this—populate nonfiction accounts of transgender individuals of this time. Despite the prejudice, both systemic and socially driven, they faced, transgender Americans of the 1950s, the counter-culture generation, began to fight back. In May of 1959, a group of Los Angeles police officers entered Cooper’s Donuts, a queer-friendly restaurant situated between two gay bars, and began to harass and arrest its cross-dressing patrons “for no reason at all” (Stryker 89). The story, which in some ways parallels that of the Stonewall riots that would follow a decade later, continues to describe the customers who began “throwing doughnuts at the cops” and “fighting in the streets” in an en masse resistance to the officers’ discrimination against them (Stryker 90). The incident, like Stonewall, went unrecorded by newspapers and sat as a verbal piece of transgender history until researchers like Susan Stryker began to look more closely at the dawn of transgender movements. These invisible people, though disenfranchised in nearly every other avenue, found refuge in one area of the American sphere: the entertainment industry. “Milton Berle,” an American actor, “first appeared in a dress on a 1947 broadcast,” and Leslie Feinberg—the aforementioned transgender historian and activist—recalls “cring[ing]” at the sight of hir parents laughing so hysterically at the performance (MacKenzie 110, Feinberg 4). One critic comments that these “televised drag routines,” which were based in the assumption

Samuel McCracken


that audiences like Feinberg’s parents would find them funny, “worked to reinforce a highly gender-stratified society” (MacKenzie 111). Segments like these would usually be “resolved” in their conclusions, as the character who had previously donned drag apparel would “reveal” their “real sex”; this sort of practice would, by nature, make transvestism—used here to denote the literal donning of the clothing which signifies the opposite sex within a man-woman binary— and, ultimately, all forms of transgender identity appear performative, superficial, and laughable (MacKenzie 111). Of course, the key difference between those who performed on-screen and the transgender Americans who would watch them was that the actors and actresses were almost exclusively cisgender, essentially performing as transgender minstrels. Ironically, real transgender performers who would play traditionally “gender-bent” roles like Peter Pan, Hamlet, Romeo Montague, and a slew of other Shakespearian figures in theatrical productions were cast as cisgender characters on television (Garber 167). This introversion—that transgender actors played cisgender characters while cisgender actors performed transgender roles— perhaps serves to found the greater understanding that real, legitimized acting could, by this era’s standards, only exist if an actor were portraying someone who was socially recognized. An interesting exception to this rule might prove the underground world of drag performance. In her critical text Vested Interests, Marjorie Garber notes that, interestingly, “American GIs in World War II put on all-male shows that frequently included female impersonation scenes” (56). These acts, she adds, were so popular that the US Army actually began “officially supporting” them as a “necessity, not a frill” (Garber 56). Though often regarded as the pinnacle of masculine camaraderie, the Army supplied handbooks for their performances, including one for a particular show, Hi, Yank!, that reportedly details “more than eight pages of dress patterns and illustrations for soldier drag” (Garber 56). The writer also notes that these sorts of shows were intentionally spaces for drag performance, as they often performed “all-female play[s]” like Clare Booth’s The Women (Garber 56). But, like the popularized “drag” events on television, these drag shows—while conducive for “gay GIs,” who could be “courted” by audience members—were antithetical to the Army’s prohibitions against “sexual inversion” at the time (Garber 56, J. Katz 617). Jonathan Katz, in his Gay/Lesbian Almanac, documents a Newsweek from June of 1947 which attests that “[b]etween 3,000 and 4,000 were discharged for [the] abnormality [of inversion]”; to prove their inversion, physicians would study “their effeminate looks or behavior” and “[repeat] certain words from the homosexual vocabulary” while “[watching] for signs of recognition” (617). Transgenderism in the Army, then, was encouraged only for its use as a form of carnivalesque, exotic entertainment and, perhaps to some extent, for the enjoyment of cisgender soldiers and their own sexual wants. For the purposes of “passing” (appearing cisgender, heterosexual, “normal”), to satisfy their own sexual desires, or to affirm their romantic feelings as others might, many pre-transgender people of this era would choose to marry. It was often the case, however,


Transitioning: An Ethnographical Study…

that their spouses might not have known the complete truth about their anatomy. One woman, married to a transgender man for over forty years, was told that he had a vagina after his death and subsequent autopsy (MacKenzie 124). She reportedly told those asking that, in her defense, “intimacy wasn’t a part of [their] relationship” and that her husband would insistently “wrap his pelvis in thick medical gauze” to cover up what she understood as “an accident that occurred during the war” (MacKenzie 125). In a similar situation, a transgender man had convinced his wife that he, too, was victim to a heinous, scarring incident while serving in World War II. In actuality, he had a dysfunctional, fabricated penis created by a surgeon in an early sexual reassignment procedure (Ekins and King 76). The two had adopted children who stated at their father’s funeral: “He will always be Dad” (Ekins and King 76). Others, who were not so lucky as to fool their spouses—should they need to fool them at all—the authors add, were sometimes subjected to “legal action” and faced the “possibility of imprisonment” if their spouses were to press charges (Ekins and King 77). Though marginalized and persecuted by those who failed to understand their varying forms of gender expression, transgender individuals of the 1950s led their lives to the fullest extent. In general, they were not reported demographically, as they were generally more concerned with keeping their anatomical identities safe and unacknowledged by the public. One researcher notes the inconclusiveness of records kept during that time and references the varying theories concerning the number of undocumented trans persons: “one in 10,000 to one in 500,” she offers; both of which, she adds, “seem disproportionate” (MacKenzie 148). They were often parts of low-wage job sectors, as “their he-she appearance” often took away from their marketability, and some like Michael Dillon were unable to use the degrees they earned because they were awarded to them before transitioning and were attributed to names which conflicted with the gender their appearances seemed to express (Devor 34). Transgender Americans of this epoch were arrested on the whims of their governing bodies, considered unfit for military service, and were even further socially demonized as harmful, inverted, unnatural people. Despite the public disapproval of them, however, they thrived in underground communities, where people of all levels of gender variance, from “butch lesbian” to “fem queen,” celebrated one another and held “drag balls” and other queer functions (Feinberg 97). My ethnographic study of 1950s-era transgender Americans concludes that these were a culturally stigmatized group who were considered by the bulk of the American populations to be sexually “inverted” (Stryker 55). They were placed in unfavorable working classes—unless considered passable by the heteronormative eye—and thought to be mentally unstable by readings of popular psychology. They were the generation of the first American transsexual and, in fact, of the first use of the term transsexual, but they were also the subject of media satirization and performative scrutiny. Transgender Americans of this age were the source of entertainment for national audiences, World War II soldiers, and police forces who, without real warrant, might arrest them. Like the

Samuel McCracken


historical trajectories of both those of African-American descent (and arguably of any non-White, non-Anglophonic lineage) as well as women, then, gender-nonconforming Americans faced ambivalent prejudice insofar as they were thought of as inherently less but were also commodified by the general public. This contested position—of being exoticized and made entertaining for one’s differentness while being equally denigrated for the same quality—contributed greatly to the dysphoria invariably experienced by persons who, like Leslie Feinberg, internalize the satirization of their lived experience. The dynamic transgender citizens of this era were, above all, paramount in beginning the discussion of their existence and visibility in America at large; without this generation as an impetus for the ones that would follow, America might still stand a nation without the word “transgender” to describe a mode of identification and group of people. Undoubtedly, this generation’s impact on 20th-century American culture influenced our more recent societal incorporation of more gender-progressive ideals and increased understanding of transgender politics. “ze” is one example of a gender-neutral pronoun; for persons approaching transition, “ze” is a politically-correct way to avoid misgendering one whose preferred pronouns have yet to be decided, are undisclosed, or are simply gender-neutral. It belongs to the ze/hir/hirs pronoun set. i

Devor, Holly. FTM: Female-to-Male Transsexuals in Society. Bloomington: Indiana UP, 1997. Print. Ekins, Richard, and Dave King. The Transgender Phenomenon. London: SAGE, 2006. Print. Feinberg, Leslie. Transgender Warriors: Making History from Joan of Arc to RuPaul. Boston: Beacon, 1996. Print. Freud, Sigmund, and Philip Rieff. Sexuality and the Psychology of Love. New York: Collier, 1993. Print. Garber, Marjorie B. Vested Interests: Cross-Dressing & Cultural Anxiety. New York: Routledge, 1992. Print. Hirschfeld, Magnus. Transvestites: Research into the Erotic Disguise-urge with Exhaustive Causuistics and Historical Material. Leipzig: Max Spohr, 1910. Print. Katz, Irwin, and R. Glen Hass. "Racial Ambivalence and American Value Conflict: Correlational and Priming Studies of Dual Cognitive Structures." Journal of Personality and Social Psychology 55.6 (1988): 893-905. Web. Katz, Jonathan. Gay/Lesbian Almanac: A New Documentary. New York: Harper & Row, 1983. Print. MacKenzie, Gordene Olga. Transgender Nation. Bowling Green, OH: Bowling Green State U Popular, 1994. Print. “Sex Change is ‘Eagerly’ Awaited.” Omaha World Herald [Omaha, Nebraska] 17 Feb. 1957: 12B. Print.


Transitioning: An Ethnographical Study‌

Stryker, Susan. Transgender History. Berkeley, CA: Seal, 2008. Print. Valentine, David. Imagining Transgender: An Ethnography of a Category. Durham: Duke UP, 2007. Print.

Augsburg Honors Review


Unity Through Division: A Revision of the Haudenosaunee's Policy of Neutrality Haley O'Shaughnessy

Trinity College, University of Toronto

Abstract: The Haudenosaunee people, otherwise known as the Five Nations of Iroquois, negotiated separate treaties with the English and French in 1701. Scholars asserted Haudenosaunee desires to “sit on their mats and smoke in peace,” was to maintain their political sovereignty, repress internal factionalism, and “play off” the European powers for their own economic gain. Nonetheless, their implicit assumptions of the cultural and political structures of the Great League of Peace and Power and Iroquois Confederacy, particularly that all Five Nations were centralized under one “policy of neutrality,” is inconsistent with the reciprocal and decentralized posture of the Haudenosaunee. By understanding the specific consequences of the Beaver Wars for each of the Five Nations, this essay argues that the Grand Settlement in Montreal and Albany was not a policy of neutrality, but rather a case of unity through division.


Unity Through Division: A Revision…

When the Haudenosaunee, otherwise known as the Five Nations of Iroquois, decided to negotiate separate treaties with the English and French in 1701, many historians framed these two sentimental events as exemplars of the Haudenosaunee’s move to neutrality. Scholars asserted Haudenosaunee desires to “sit on their mats and smoke in peace,” was to maintain their political sovereignty, repress internal factionalism, and “play off” the European powers for their own economic gain.i Nonetheless, their implicit assumptions of the cultural and political structures of the Great League of Peace and Power and Iroquois Confederacy, particularly that all Five Nations were centralized under one “policy of neutrality,” is inconsistent with the reciprocal and decentralized posture of the Haudenosaunee. By understanding the specific consequences of the Beaver Wars for each of the Five Nations, this essay will argue that the Grand Settlement in Montreal and Albany was not a policy of neutrality, but rather a case of unity through division. Haudenosaunee, geographically west to east, consisted of the Seneca, Cayuga, Onondaga, Oneida, and Mohawk until 1722 when the Grand Council admitted the nation of the Tuscarora into the Haudenosaunee.ii Located along the south side of Lake Ontario and the St. Lawrence River, Haudenosaunee roughly translates to “The People of the Longhouse” with the Seneca on its “Western Door,” the Mohawk on its “Eastern Door,” and the Onondaga in the middle tending to the immemorial fire in the Grand Council. Seneca scholar Arthur Parker described the Seneca and Mohawks as the “older brothers,” the Cayuga and Oneida as the “younger brothers,” and the Onondaga as the “fire-keepers,” with all five nations organizing their families, clans, and longhouses according to matrilineal kinship.iii According to works of Haudenosaunee scholars and elders, Haudenosaunee history consists of three main epochs: Creation, in the First Epoch; the Great Law of Peace, in the Second Epoch; and Handsome Lake, in the Third and Present Epoch. The history of the Beaver Wars and subsequent Grand Settlement occurs during the Second Epoch, which began with the founding of the Great League of Peace. While one may view the Epochs in chronological order, the continuity and reciprocity between the three Epochs should de-stabilize a Eurocentric periodization of Haudenosaunee history. Although the exact origins of the League have been a source of debate, Mann and Fields’ scholarly article, “A Sign in the Sky,” used oral keepings, archaeology, history, and astronomy to date the League to August 31, 1142.iv In order to help explain Great League and its Grand Council, one must review the Deganawida epic. The main figures of this tradition were Deganawida, a Wyandot and later Mohawk man known as the Peacemaker; Hiawatha, a Mohawk messenger who invented the condolence wampum; and Adoraroh (Tadodaho), a sachem and leader of an opposing faction within Onondaga. Although the keeping of tradition has conflicting contents, most versions contain both the struggles of the founders to create the League and the creation of the Great Law.v Briefly, the epic described a period of perpetual blood feuding amongst the Five Nations consisting largely of the “mourning wars” in retaliation for loss of a loved one. Some traditions focus on the fragmentation of the people engaged in the hostilities and their forgotten unified identity, while others focus on the peoples’

Haley O'Shaughnessy


differing hunting and farming cultures as the source of war.vi The turmoil of kidnapping, raids, and death subsided when Hiawatha heard from Peacemaker Deganawida the Good News of Peace, Power, and Civil Authority. Deganawida, who importantly was the reincarnation of the Sky Holder,vii showed Hiawatha the rituals of gift giving as a means of diplomacy. Soon after the Good News redeemed League founder Adoraroh, fifty sachems formed the Grand Council beneath the Tree of Great Peace at Onondaga, which henceforth became the spiritual and diplomatic capital of the Haudenosaunee.viii According to Parker, Hiawatha, in his grief over the loss of his family, created a wampum belt with the rushes and shells by the lakeshore, which he would offer to another person in grief as a means of condolence. Hiawatha is thus credited as the inventor of wampum belts and the Haudenosaunee writing system.ix When analyzing the Deganawida epic, its traditions of mourning, reciprocity, and internal peace remained congruous to the decentralized and compromising consensusbased structure of the League of Peace and Power. Of particular importance were the condolence rituals, which were created following Peacemaker’s blessing of Hiawatha’s wampum belt.x These rituals required that the death of a sachem must be followed by a roll call of the fifty founding sachems and an act of requickening the living in the name of the dead.xi These rituals exemplified Haudenosaunee traditions of reincarnation, collective commiseration, and continuity. Furthermore, following under the precept of Deganawida’s Good News of Peace, Power, and Civil Authority, reciprocity and gift giving became a matter of diplomacy in both trade and war. The mourning rituals of adopting foreigners within their own respective clans and longhouse reflected their unity through diversity, the same concept that maintained the internal peace amongst the Five Nationsxii. These fundamental principles within all levels of Haudenosaunee society were crucial in order to understand the governing functions of the Great League of Peace and its Confederacy, which changed in response to European colonialism. Within the context of the late seventeenth century, the exact governing functions of the Great League of Peace and its Confederacy have been a subject of debate. While William Fenton defines the League as a “symbolic system” and the Confederacy as “the operating instrument of the government,” scholar Fred Anderson described the League as “a ritual and cultural association that loosely united the original Five Nations,” while the Confederacy served the “diplomatic, military, and political functions” of the Longhouse.xiii This essay follows Anderson’s interpretation that the cultural and ethnological significance of the League should not devalue its capacity to maintain internal peace amongst the Five Nations. If anything, its ritual significance makes the League the foundation to the diplomatic and political actions of the Confederacy. As such, the Haudenosaunee’s foreign diplomacy was an extension of the same principles that governed each family, longhouse, clan, and nation of the League. The League’s principles through the Confederacy gave the Haudenosaunee a reputation for military prowess, particularly during the Beaver Wars of the midseventeenth century. With the name in mind, the causes of the war have been traditionally


Unity Through Division: A Revision…

linked to the economics of the fur trade. As George Hunt famously argued, the abundance of furs provided a unique theatre of “interracial contacts” and the “universality of the economic basis in intertribal relations” convinced the Iroquois to engage in warfare.xiv Hunt concluded the Haudenosaunee sought to control the waterways from Montreal to Albany in order to act as the middleman for the entire fur trade. Recent scholarship has moved away from the economics of the fur trade as the central motivation behind the Beaver Wars. Scholar José António Brandão even goes so far as to say the economics of the fur trade were minute in comparison to the objective of obtaining captives to replenish their declining population from European diseases, namely smallpox.xv Importantly, Hunt’s hypothesis contradicted the Haudenosaunee methods of reciprocity that demanded a direct correlation between trade and peace. Hunt also ignored how the Haudenosaunee mourning practice of adoption gave unity and not animosity to a polyglot of peoples. The mourning institutions as well as the traditions of reciprocity were both acts of renewal and restoration of life and friendship. Still, the economics were not as insignificant as Brandão claimed. Upon analysis and recognition of the intersections of trade and warfare within Haudenosaunee diplomacy, the origins of the Beaver Wars were to establish primacy in the fur trade and to replenish their populations from war, disease, and famine. In other words, trade and peace were not mutually exclusive but mutually reinforcing. Population replenishment, for example, was not established merely from warfare, but also by the open and fluid nature of migration within the Great Lakes. The affective and material connection to the Haudenosaunee’s respective alliances and friendships meant diplomacy required constant and consistent participation from all parties.xvi With respect to war, many Haudenosaunee men saw warfare as a rite of passage and clan matrons saw warfare as central to fulfillment of condolence and mourning rituals.xvii Thus historians’ tendency to periodize the later seventeenth century as a war in itself quite arguably delineates the natural occurrence of war amongst the Haudenosaunee for centuries. Regardless, the particulars of the economic or political motives were dependent on each respective nation and clan of the Haudenosaunee. Neither Hunt nor Brandão expounded on the diversity of interests within the Longhouse and their varying means and objectives of warfare. Given the local and decentralized nature of the Great League, it should not be surprising that the constituent clans and nations of the League seldom acted in concert during the Beaver Wars. With the Seneca at the western door of the Longhouse and the Mohawk at the steps to Albany, the goals and needs of each clan or nation were dependent largely on their geography. As such, the economic and military “policies” of Haudenosaunee reflected interpersonal relations more so than strategic advantage. For the Mohawk in particular, the establishment of the French in the St. Lawrence Valley and the Dutch at Fort Orange (Albany) meant they became reliant on trade goods by the early seventeenth century. With the Dutch willing to trade furs and pelts for not only iron, kettles, knives, and beads, but also for arms and ammunition, Mohawk weaponry

Haley O'Shaughnessy


changed rapidly in comparison to the other Nations of the League.xviii In turn, the spiritual and cultural bond between the Dutch and Mohawk, exemplified by addition of glass beads to the traditional wampum belts, relied heavily on reciprocity.xix Along with this exchange of goods, however, came the exchange of disease: by the 1630s the Mohawks suffered a loss of 75 percent of their population, while the Seneca fared better than the other Five Nations.xx Still, throughout the 1640s, the Mohawk’s geographic position and heavy supply of ammunition enabled them to fight as an independent nation in the east against the Mahicans and in the north against the Algonquins and Montagnais. By 1645, they even made a separate treaty from the Five Nations with the French at Trois Rivières while the Seneca continued to wage campaigns against the Huron-Wendat.xxi Since the objective was largely to establish complete access to the Dutch at Albany, these war engagements would not be as beneficial to the western nations of the Seneca and Cayuga. By the late seventeenth century, the stalemates of raids by the Cayuga, Seneca, and Onondaga against the Susquehannocks and other nations in the western Great Lakes became ineffective and extensive in casualties. As further evidence to the decentralized nature of the Haudenosaunee, these joint campaigns and each nation’s determination to adopt all the captives resulted in the shedding of blood amongst the Five Nations.xxii As recounted in the Jesuit Relations, missionary Paul Le Jeune noted these campaigns “cause almost as much loss to them as to their enemies, and they have depopulated their own Villages to such an extent, that they now contain more Foreigners than natives of the country,” with many accounts by the 1660s stating more than two-thirds of the Haudenosaunee populations were adoptees.xxiii As the prospects of New Netherland dissolved and the Haudenosaunee supply of firepower dwindled, the increase in French firepower forced the League to consider a case for accommodation in 1661. Yet the general resolution was not binding and subsequently the Mohawks, Onondagas and Oneida continued to attack the French until New France Governor General Daniel de Remy de Courcelle instigated successful attacks against the Mohawk in July 1665.xxiv In turn, the Onondaga superseded the Mohawk’s special status among the Five Nations; not only due its tradition as the Longhouse’s centre, but also due to a shift of allegiance from the Dutch to the French. Thus, while some historians regarded this moment as a height of “intense factionalism” amongst the Haudenosaunee, it would be more appropriate to regard this shift to the Onondaga as change in Mohawk’s practices of reciprocity from the Dutch to the French. By the end of that year, the Mohawk finalized a peace agreement with New France. Within two years, however, the fighting resumed, and within a decade the Mohawks established the Covenant Chain with the English.xxv Unlike European epistemologies of alliance in its relation to a common foe, the Haudenosaunee did not see their newly formed alliance with the English as exclusive. When the partnership of the Mohawk and Governor Andros of New York solidified in 1674, albeit under the English ideals of the Mohawks as “subjects” and not “allies,”


Unity Through Division: A Revision…

the Covenant Chain would be largely credited for the defeat of the Susquehanna in the 1780s. Moreover, the entire League did not share the Mohawk’s natural hostility towards New France.xxvi It was not until New France expanded into larger trade networks along the Pays d'en Haut territory and began to arm the Ottawas, Ojibwas, and Illinois that the western Haudenosaunee felt their means of reciprocity were not fulfilled.xxvii By 1680, with New France’s trade with midwestern nations, the encroachment on Haudenosaunee hunting grounds, the rise of epidemics, and the subsequent calls for mourning rituals, both the Seneca and Onondaga engaged in warfare against the midwestern nations and French allies of Illinois, Miamis, Ottawas, and Huron-Wendat. For seven years, the Haudenosaunee remained relatively successful in their campaigns in the west. In spite of such warfare against the French, relations with the English during this period crumbled: New York Governor Thomas Dongan replaced Arnos in 1783 and he aggressively asserted English sovereignty over the Five Nations and reinforced their positions as subjects of the Crown.xxviii As such Dongan promised no direct aid yet mandated no negotiations with the French without New York’s approval. Naturally, as these requests are fundamentally against the principles and foundations of Haudenosaunee diplomacy, the Onondagas, Senecas, and Cayugas rejected his assertions. When Dongan provided no assistance against the 1787 attack by New France Governor General Jacques Rene de Brisay de Denonville, the Senecas deserted from their villages and formed a growing resentment towards the English.xxix By late 1787, the Haudenosaunee continued to engage against the French alone, establishing blockades around Fort Frontenac and Niagara; casualties still surmounted however. When Louis de Buade de Frontenac returned as Governor General of New France, he instigated raids along the New York frontier in February 1790. Even when the English finally joined forces with the Haudenosaunee on two separate campaigns in the summer of 1790 and early 1791, their subsequent failures only left greater resentment between New York and western Iroquoia. With the primary villages of four of the five nations destroyed and two thousand lives lost, it had been a supremely costly war.xxx As Richter wrote, “as the century closed, the peoples of the Longhouse faced the greatest political and cultural crisis since the founding of the League.”xxxi Nonetheless, the long peace negotiations, which began in 1693, did not end the war between the French and the Haudenosaunee. Tensions erupted throughout the 1690s, with the French terminating the peace process in 1696, citing the Haudenosaunee’s indecisiveness and their objection to Frontenac’s plans to build a fort at Cataraqui.xxxii Even when the Haudenosaunee and the French signed the 1697 Treaty of Ryswick, attacks from the Miamis and other midwestern nations continued to plague the lives of the Seneca. Worse still, the formal end of King William’s War also meant the end of the English support.xxxiii Thereby, many historians such as Richard Aquila attributed the delay of a peace treaty to internal factionalism within the Five Nations. Under this logic, given that the experiences of the Seneca during the Beaver Wars were incomparable to the Mohawk, naturally their perspectives on the French and English would be difficult “to

Haley O'Shaughnessy


reconcile.” Yet, the argument of “internal factionalism” again ignores the decentralized approach of the Haudenosaunee and the multiple occasions where these nations had separate treaties with the Dutch, French, and English. As such, the treaty delays were more of a by-product of their tumultuous alliances with the European settlers rather than reconciliation within the League. It would then be logical to regard the Grand Settlement as a re-establishment of their respective alliances, not a rejection of the diplomatic system altogether. When such re-establishment was not possible throughout the 1690s, the Haudenosaunee’s lack of allies did not equate to neutrality nor did it mean the Haudenosaunee desired to be insular from European settler affairs. When expounding on the Haudenosaunee “policy of neutrality” and their consensus-based Grand Council, scholars often cited the neutralist sachem Teganissorens’ declaration to the English envoys and the French ambassadors in spring 1701: “Five delegates are about to set out for Montreal, two others will go to Albany; I myself will remain on my mat, to show all the world that I take no side, and wish to preserve strict neutrality.”xxxiv While Aquila argued Teganissorens was the “spokesperson” for the Council, a term that was not used within this primary source, Teganissorens’ use of first-person pronouns indicates the message could be interpreted inversely: given the division amongst the Council, Teganissorens alone will adhere to strict neutrality. Even if the former was true, given the Mohawk’s conscious absence from the meeting, this Council could not be characterized as “consensus based” as understood by western epistemologies. As mentioned, the purpose of the Grand Council was mostly ceremonial and did not necessarily give the sachem’s influence over the daily politics of their respective communities. Indeed, the objective of the Grand Council was not to govern people, nor was it intended to act as a European-styled democratic institution. Rather, it was an exemplar of the Deganawida and the binding kinship of diverse Haudenosaunee nations. xxxv While the Council was “consensus based,” it accommodated local differences to maintain shared kinship and reciprocity. The Reverend Asher Wright, who lived with the Seneca for decades, noted that discussions at the Grand Council would “continue till all opposition was reasoned down, or the proposed measure abandoned.”xxxvi Thus, although actions required unanimity, this did not necessarily mean opposition was not tolerated. Notably, Charlevoix, following Teganissorens’ declaration, stated both Bruyas and de Maricourt thought he was “ground for all hope,” meaning they unlikely interpreted the message as one of neutrality.xxxvii Given Charlevoix’s clear pro-French leanings, his account that the French Ambassadors had “heightened confidence” suggests the possibility of allyship with the Cayuga, Seneca, and Onondaga. If the Haudenosaunee were all neutral as understood by western epistemologies, it would be expected that these French Ambassadors would be disappointed at the loss of an ally. xxxviii The prospects of having two separate treaties meant Haudenosaunee’s economic ties to the English acted as leverage with French. In turn, when the 1701 Grand Settlement was signed, with the three western nations (Seneca, Cayuga, and Onondaga) going to


Unity Through Division: A Revision…

Montreal and the two eastern nations (Oneida and Mohawk) going to Albany, it was not out of the desire to remain insular from European affairs.xxxix Rather, the independent interests of each of the Five Nations meant it was signed out of the necessity to rebuild alliances with both the English and French. Upon evaluation, the Grand Settlement of 1701 was the “reasoned down” of opposition. With the League’s cultural foundations reliant on unity through division, this settlement was above all an expression of the Haudenosaunee’s practice of reciprocity, one that allowed for multiple non-exclusive alliances with European settlers. It was not a compromise among Pro-French, neutral, and Pro-English “factions” so much as it was allowing for each nation to maximize their trade by working with the settlers in their proximity. By focusing on the autonomy and security of the Longhouse, the Settlement allowed for each nation to regain their alliances according to the distinct and local impact of the Beaver Wars on the Seneca, Cayuga, Oneida, Onondaga, and Mohawk. Such division derived its legitimacy from the unifying principles of reciprocity, condolence, internal peace, and civil authority. The different objectives of the various families, clans, longhouses, and nations of the Haudenosaunee were all in pursuit of the continual fulfillment of Deganawida’s message of Peace, Power, and Civil Authority. For an exemplar of this interpretation, see Anthony Wallace, “The Origins of Iroquois Neutrality: The Grand Settlement of 1701,” Pennsylvania History 24, 3 (1957): 224-235. i

Bruce Elliot Johansen and Barbara Alice Mann, eds., “Tuscaroras, historical sketch,” in Encyclopedia of the Haudenosaunee (Iroquois Confederacy) (Westport: Greenwood Press, 2000), 319. ii

Arthur Parker, The Constitution of the Five Nations (Albany: The University of the State of New York: 1916), 10, https://archive.org/details/constitutionoffi00parkuoft. iii

Barbara Mann, and Jerry L. Fields, “A Sign in the Sky: Dating the League of the Haudenosaunee,” American Indian Culture and Research Journal 21, 2 (1997): 146. iv

Bruce Elliot Johansen and Barbara Alice Mann, eds., “The Second Epoch of Time,” in Encyclopedia of the Haudenosaunee (Iroquois Confederacy), 265. v

Chief Elias Johnson, Legends, Traditions, and Laws of the Iroquois, or Six Nations, 1881 (New York: AMS Press, 1978), 45-52. For the agricultural origins of the war, see Arthur Parker, “The Maize Maiden,” in Rumbling Wings and Other Indian Tales (Garden City: Doubleday, Doran & Company, 1928), 191. vi

Deganawida’s previous spiritual form, which is known as both Sky Holder and Sapling, was one of the creators of Turtle Island. Alongside his twin Flint, Sapling was the Sky woman’s grandson. See Bruce Elliot Johansen and Barbara Alice Mann, eds., “The Second Epoch of Time,” in Encyclopedia of the Haudenosaunee (Iroquois Confederacy), 269. vii


William Fenton, The Great Law and the Longhouse (Norman: University of Oklahoma

Haley O'Shaughnessy


Press, 1998), 51-66. Parker, The Constitution of the Five Nations, 8-10, 19-20. See also Elliot Johansen and Barbara Alice Mann, eds., “Hiawatha (Five Nations) Wampum Belt,” in Encyclopedia of the Haudenosaunee (Iroquois Confederacy), 161-163. ix


Parker, The Constitution of the Five Nations, 20.

David Richter, The Ordeal of the Longhouse: The Iroquois League in an Era of European Colonization (Chapel Hill: The University of North Carolina Press, 1993), 2-3. xi

Parker, The Constitution of the Five Nations, 30.


William Fenton, The Great Law and the Longhouse (Norman: University of Oklahoma Press, 1998), 5, and Fred Anderson, Crucible of War: the Seven Years' War and the Fate of Empire in British North America, 1754-1766, (New York: Alfred A. Knopf, 2000), 13-14. xiii

George Hunt, The Wars Of The Iroquois: A Study In Intertribal Trade Relations (Madison: The University of Wisconsin Press, 1940), 5, 65, 115. xiv

José António Brandão, Your Fyre Shall Burn No More: Iroquois Policy toward New France and its Native Allies to 1701 (Lincoln: University of Nebraska Press, 1997), 4558. xv

Timothy Shannon, Iroquois Diplomacy on the Early Frontier (New York: Viking Penguin, 2008), 22-23. xvi

Francis Jennings, The Ambiguous Iroquois Empire: The Covenant Chain Confederation of Indian Tribes with English Colonies from its beginnings to the Lancaster Treaty of 1744 (New York: W.W. Norton & Company, 1987), 84-86. xvii

Daniel P. Barr, Unconquered: The Iroquois League at War in Colonial America (Westport: Praeger, 2006), 29-30, 32-34. xviii

To note, wampum belts have historically been used as a material reflection of an alliance or diplomatic exchange. See Richter, The Ordeal of the Longhouse, 52, and Fenton, The Great Law and the Longhouse, 224-240. xix


Ibid, 31.


Francis Jennings, The Ambiguous Iroquois Empire, 92, 95.


Richter, The Ordeal of the Longhouse, 65.

Reuben Gold Thwaites, ed., Jesuit Relations and Allied Documents, “Of The Character And Customs Of The Iroquois,” (Cleveland: The Burrows Brothers Company, 1896) XLIII: 265. See also Jesuit Relations, XLV: 207, LI: 123, 187. xxiii

Richard Aquila, The Iroquois Restoration: Iroquois Diplomacy on the Colonial Frontier, 1701-1754 (Lincoln: University of Nebraska Press, 1997), 47-48. xxiv


Ibid, 52.


Barr, Unconquered, 78.


Unity Through Division: A Revision…


Ibid, 79.


Aquila, The Iroquois Restoration, 62-64.


Shannon, Iroquois Diplomacy on the Early Frontier.


Richter, The Ordeal of the Longhouse, 167-68.


Ibid, 189-190.


Barr, Unconquered, 92-93.



Quoted in Aquila, The Iroquois Restoration, 59. To note, the French Jesuit Pierre Charlevoix’s writings was the source of this quote. xxxiv


Fenton, The Great Law and the Longhouse, 98-104.


Quoted in Fenton, The Great Law and the Longhouse, 30.


Pierre Charlevoix, History and General Description of New France. Vol. V., 138.




Aquila, The Iroquois Restoration, 64-69.

Anderson, Fred. Crucible of War: the Seven Years' War and the Fate of Empire in British North America, 1754-1766. New York: Alfred A. Knopf, 2000. Aquila, Richard. The Iroquois Restoration: Iroquois Diplomacy on the Colonial Frontier, 1701-1754. Lincoln: University of Nebraska Press, 1997. Barr, Daniel. Unconquered: The Iroquois League at War in Colonial America. Westport: Praeger, 2006. Johnson, Chief Elias. Legends, Traditions, and Laws of the Iroquois, or Six Nations. 1881. New York: AMS Press, 1978. Charlevoix, Pierre. History and General Description of New France. Vol. 5. New York: John Gilmary Shea, 1868. Fenton, William. The Great Law and the Longhouse. Norman: University of Oklahoma Press, 1998. Jennings, Francis. The Ambiguous Iroquois Empire: The Covenant Chain Confederation of Indian Tribes with English Colonies from its beginnings to the Lancaster Treaty of 1744. New York: W.W. Norton & Company, 1987. Jesuit Relations and Allied Documents. Edited by Reuben Gold Thwaites. Cleveland: The Burrows Brothers Company, 1896. Johansen, Bruce Elliot, and Barbara Alice Mann. Eds. Encyclopedia of the Haudenosaunee (Iroquois Confederacy). Westport: Greenwood Press, 2000. Mann, Barbara, and Jerry L. Fields. “A Sign in the Sky: Dating the League of the Haudenosaunee.” American Indian Culture and Research Journal 21, 2 (1997): 105-163.

Haley O'Shaughnessy


Parker, Arthur. “The Maize Maiden.� In Rumbling Wings and Other Indian Tales. Garden City: Doubleday, Doran & Company, 1928. ---. The Constitution of the Five Nations. Albany: The University of the State of New York: 1916. https://archive.org/details/constitutionoffi00parkuoft Richter, Daniel K. The Ordeal of the Longhouse: The Peoples of the Iroquois League in the Era of European Colonization. Williamsburg: The University of North Carolina Press, 1992. Shannon, Timothy. Iroquois Diplomacy on the Early American Frontier. New York: Viking Penguin, 2008. Wallace, Anthony. "The Origins of Iroquois Neutrality." Pennsylvania History 24, no. 3 (1957): 224-35. Accessed January 16, 2015. http://www.jstor.org.myaccess.library. utoronto.ca/stable/27769745.


Augsburg Honors Review

Appendix Participatory Art and Aging: Proposal for Dementia Prevention Strategy Figure 1

What is Painting (1966 – 1968), Baldessari (right); One in Three Chairs (1965), Kosuth (above). Two fundamental examples of conceptual art.


Appendix Figure 2

“Memory Game” (2013). Project directed and facilitated by the author at an assisted living center. The Memory Game requires no set strategy other than paying attention. The group requested to re-play the game many times in a row. There has been cognitive therapy research specific to the study of gameplay, where more complex games result in broader cognitive improvement (Basak et al., 2008 as cited by Stern, 2013) Figure 3 “Childhood Homes” (2013). Project directed and facilitated by the author at an assisted living center. Residents constructed collages of their childhood homes from memory. Those who were physically unable to use the materials described their home to the facilitator, who pieced together the visual image. As the


Augsburg Honors Review

image developed, the individual recalled progressively more details and memories about their home. Figure 4 “T-Shirt Rope” (2013). Project directed and facilitated by the author at an assisted living center. Process involved repetitive motions by cutting and tying t-shirt strips together, and spatial awareness by forming a physical line of connection between all people in the room as each person held a piece of the finished rope.

Goals of the Actors Within the BDS Movement Image 1 AWC members protesting University of Minnesota Law School ‘breach of academic boycott’ (Photo credit: Julian Kritz)


Appendix Image 2 SJP UMN members participate in die-in calling for BDS (photo Credit: SJP UMN 2015)

Image 3 JVP protest against downtown Minneapolis Target selling Israeli SodaStream products (Photo credit: FightBack! News)

Image 4 Flyer calling for Target to not carry SodaStream. Linked from BNC website. (Image taken from: CodePink)


Augsburg Honors Review Image 5

MN BBC protest at March 2015 SBI hearing. Note JVP member holding yellow sign. (Photo credit: MN BBC)

Figure 1 Diker, Dan. Unmasking BDS: Radical Roots, Extremist Ends. Jerusalem Center For Public Affairs. The Israel Group. 2015. http://theisraelgroup.org/wp-content/ uploads/2015/02/Unmasking-BDS.pdf.


Appendix Figure 2

Organizations from Council for American Islamic Relations (highlighted organizations were studied). "50 Minnesota Groups Join BDS." Council for American Islamic Relations Minnesota. July 31, 2014. Peace/Human Right Activist American Relief Agency for the Horn of Africa

Anti-War Committee

Break the BondsMinnesota

Egyptian Americans for Democracy and Human Rights

MidEast Peace Now

Minnesota Coalition for Palestinian Rights

National Lawyers GuildMinnesota Chapter

Northfielders for Justice in Palestine/Israel

Southeastern Minnesota Alliance of Peacemakers

Women Against Military Madness

Jewish Anti-Zionist International Jewish Anti-Zionist Network

Jewish Voice for Peace

Student-Led St. Cloud State University Muslim Student Association

Students for a Free Palestine-St. Cloud State University


Students for Justice in Palestine, University of Minnesota

University of Minnesota Muslim Student Association

Abubakar AsSaddique Islamic Center

Al Amal School

Al Aqsa Institute

Al Farooq Youth & Family Center

Al-Wafaa Center for Human Services

American Muslims for Palestine-MN Chapter

Blaine Muslim Community Center

Brooklyn Park Islamic Center

Building Blocks of Islam

Burnsville Mosque

Council on AmericanIslamic Relations, MN

Darul Arqam Center of Excellence

Eden Prairie Mosque


Good Deeds Charity-USA

Islamic Center of Minnesota

Islamic Civic Society of America

Islamic Community Center of Minnesota

Islamic Institute of Minnesota

Ja'afari Islamic Center

Masjid Al Huda

Masjid Al Taqwa

Masjid Al-Iman

Masjid Ar-Rahman

Masjid As Salaam

Masjid Tawbah

Minnesota Dawah Institute

Muslim Healthcare Professionals of Minnesota

Muslim Youth Leadership Award

Muslim Youth of Minnesota

Noor Kids

Northwest Islamic Community Center

Sisters Need A Place

Islamic Society of WoodburyEast Metro Masjid An Nur Muslim American Society of Minnesota North American Council of Somali Imams


Christian Friends of Sabeel North America-Minnesota Church of All Nations-Columbia Heights Chapter

Underground SeminaryMinneapolis


Augsburg Honors Review Better Healthcare Achievable by Collaboration Between Two Medical Schools of Thought Figure 1

BETTER ACHIEVABLE 24 This HEALTHCARE is graph is based off of the information provided by the AAMC’s Table 40: Residency Applicants by Specialty and Medical School Type, 2014. See Table 4 for more info. Graphs

The Comparison of M.D. and D.O. Students in the major medical specialties in 2014 9000 8000 7000 6000 5000 4000 3000 2000 1000 0

M.D. Students

D.O. Students

Figure 1. This is graph is based off of the information provided by the AAMC’s Table 40: Residency Applicants by Specialty and Medical School Type, 2014. See Table 4 for more info.


Appendix Figure 2

This is graph is calculated from the information provided by the AAMC’s Table 40: Residency Applicants by Specialty and Medical School Type, 2014. See Table 4 for BETTER HEALTHCARE ACHIEVABLE 25 more info.

Percentage of Students in the most common Medical Specialties in 2014 30.00%







Percentage of M.D. Students

Percentage of D.O. Students

Figure 2. This is graph is calculated from the information provided by the AAMC’s Table 40: Residency Applicants by Specialty and Medical School Type, 2014. See Table 4 for more info.


Augsburg Honors Review Figure 3

This is graph is from the information provided by the AAMC’s Table 22: MCAT scores and GPAs for applicants to U.S. medical schools by sex, 2005-2014 and AACOM’s 2011-2014 Matriculant profile report [Data file and PDF] (2014). Retrieved March 1, HEALTHCARE 2014 from http://www.aacom.org/reports-programs-initiatives/aacom-reports/ BETTER ACHIEVABLE matriculants. See Table 1-3 for more info.


Number of Students Matriculating 6562 M.D. School D.O. School


FigureTable 3. This graphScores is fromand theGPA information provided by the AAMC’s Table 22: MCAT 1: is MCAT for Matriculating M.D. Students 2005-2014 scores and GPAs for applicants to U.S. medical schools by sex, 2005-2014 and AACOM’s 2011Note. From Table 22: MCAT scores and GPAs for applicants to U.S. medical 2014 Matriculant profile report [Data file and PDF] (2014). Retrieved March 1, 2014 from schools by sex, 2005-2014 [Data file and PDF]. (2014). Retrieved March 1, 2014, from 1-3 http://www.aacom.org/reports-programs-initiatives/aacom-reports/matriculants. See Table https://www.aamc.org/data/facts/applicantmatriculant/. Cropped for print. for more info.


Appendix Table 2: GPA for Matriculating D.O. Students 2012-2015

Note. From 2011-2014 Matriculant profile report [Data file and PDF] (2014). Retrieved March 1, 2014 from http://www.aacom.org/reports-programs-initiatives/ aacom-reports/matriculants. Cropped for print.

Table 3: MCAT Scores for Matriculating D.O. Students Note. From 2011-2014 Matriculant profile report [Data file and PDF] (2014). Retrieved March 1, 2014 from http://www.aacom.org/reports-programs-initiatives/ aacom-reports/matriculants. Cropped for print.

Augsburg Honors Review


Table 4: 2014 Residency Specialty Based on Medical Education Note. From Table 40: Residency applicants by specialty and medical school type, 2014 [Date file and PDF]. (2014). Retrieved March 1, 2014, from https://www.aamc.org/ data/facts/erasmdphd/

Augsburg Honors Review


Author Biographies Colette Brown: Participatory Art and Aging: Proposal for Dementia Prevention Strategy Colette Brown has a major in Studio Art and a minor in Psychology at California State University Long Beach. She completed this paper in fulfillment of her undergraduate Honors Thesis. Currently, she is conducting intervention research providing low-income families with resources for wellbeing, including stress management and mindfulness techniques. Additionally, she is designing an art-based curriculum aiming to reduce dementia risk for older adults and will be implementing the program in August of this year. Colette is also interested in pursuing a graduate degree in Psychology and will apply to programs this winter.

Hasani Gunn: What is Victory? What is Loss? An Analysis of the War on Terrorism Hasani Gunn is a junior doing a joint major in Economics and Political Studies at Bard College. Hailing from Los Angeles, CA, he has worked with the Working Families Party and the Connecticut Citizens’ Action Group. Additionally, Gunn holds fellowships with the Kennedy School’s Harvard Public Policy Leadership Conference and Bard Center for Environmental Policy’s Campus to Congress network. His research interests are international security, income distribution, social policy, and epistemology. He extends his sincere thanks to Dr. Jeanne Anderson and Prof. Christopher McIntosh.

Julian Kritz: Goals of Actors Within the BDS Movement Julian Yigal Kritz is a graduating senior from Augsburg College double majoring in Political science and International Relations. Along with minors in both Spanish and Global Peace Studies, Kritz will graduate summa cum laude. During his time at Augsburg, he has served in various roles including being a Sabo Scholar, Interfaith Scholar, and Senior Class Senator. Kritz is the co-founder and former president of Students Supporting Israel at Augsburg College. Originally from Raleigh, North Carolina, he has spent time abroad including several trips to Israel where among other things he studied at Tel Aviv University and participated in a Minnesota state legislator delegation.


Author Biographies

Adriene Michelle Lai: Better Healthcare Achievable by Collaboration Between Two Medical Schools of Thought Adriene Michelle Lai is a rising-senior at the University of Missouri-St. Louis (UMSL) focusing her studies in the areas of psychology, medicine, and philosophy. She currently is an undergraduate research assistant under Dr. George Taylor studying translational animal models, hormones, the lymphatic system, and the brain. Her interests in research include anxiety and depression in young adults, ethics in science, physician and nurse mental health, stigmas in mental healthcare, and human cognition. She has presented at the 2015 National Collegiate Honors Council Conference in Chicago and is currently working on a presentation for the Undergraduate Research Symposium at the UMSL.

Matteo Marciel: J.S. Mill On Hate Speech in the Canadian Context Matteo Maciel is a first-year Bachelor of Laws candidate at the University of York. He previously completed an Honours Bachelor of Arts in Political Science at Huron University College, in the University of Western Ontario. Matteo has a particular interest in political philosophy and its links to jurisprudence. His research interests are sport arbitration, legal philosophy, causation in tort, and intellectual property. He extends his thanks to Dr. James E Crimmins.

Samuel McCracken: Transitioning: An Ethnographical Study of Mid-20th Century Transgender Americans Sam McCracken is a third-year student at Georgia State University in Atlanta, Georgia. After completing a B.A. in English literature and Spanish, Sam hopes to continue his study at the graduate level in a field like education, English, or comparative literature. Ideally, he would like to one day work as an educator, a writer, an editor, a translator, or an activist, but he tries to stay flexible. When he’s not drowning beneath the weight of his schoolrelated responsibilities, you can usually find him reading, tweeting, or ogling his two cats. This paper is the end result of a lower-level, honors-division anthropology course.

Augsburg Honors Review


Haley O'Shaughnessy: Unity Through Division: A Revision of the Haudenosaunee's Policy of Neutrality Haley O’Shaughnessy is a fourth year student studying History, American Studies, and Sexual Diversity Studies at Trinity College, University of Toronto. A William and Nona Heaslip scholar, they have previously worked for the US Consulate in Toronto, the Canadian Lesbian and Gay Archives, and Infrastructure Ontario. Since coming to the U of T, Haley has served as the archivist of Trinity College’s student government, the president of their college’s LGBTQ+ club, and the journal director and conference director of the History Students’ Association. They remain actively involved in the queer and trans communities of Toronto.

Augsburg College 2211 Riverside Ave. Minneapolis, Minnesota honrview@augsburg.edu honorsreview.wordpress.com

— Copyright 2016 — Augsburg College, Minneapolis, Minnesota