Analyze

"The report distills cutting-edge learnings from a variety of scientific disciplines in a way that seeks to be accessible to a broad array of readers. The scientific standards used to develop the report include systematic and targeted searches using electronic research and grey literature databases of English language articles, with preference given to systematic literature reviews, metaanalyses, and replicable findings in multiple, large-scale, and/or well-designed studies from reputable sources. Where possible, such well-supported evidence is presented and related methodologies are described. Where not available, supportive or promising evidence, emerging from fewer studies and/or studies with smaller or otherwise less representative samples, are presented instead. These instances are flagged as such, and are presented only when better quality evidence does not yet exist and because they still represent findings of emerging interest and relevance to the field.” (p. xvii)

“Advances in functional neuroimaging, developmental neurobiology, genomics, epigenomics, transcriptomics, proteomics, and metabolomics have begun to decode the complex mechanisms by which early adversity can become biologically embedded and influence life-course health and even the health of the next generation.” (p. 12)

“Project Cal-Well of the California Department of Education (CDE)1416 and the Healthy Environment and Response to Trauma in Schools (HEARTS) program of the University of California, San Francisco (UCSF),1417 are two case studies in California that are presented to provide a snapshot of how primary, secondary, and tertiary prevention of toxic have been translated into school settings.” (p. 196)

"Between 2005–2006 and 2017–2018, there was a 47% relative increase in the number of public schools nationwide with one or more security staff with the authority to arrest students.1411 When public schools increasingly rely on school resource officers to discipline students at school, school-based arrests go up.1412 Combating these systems using restorative justice techniques that emphasize redirection and de-escalation tactics, and prioritize time in the classroom, can minimize re-traumatization and mistrust and better support students’ long-term physical, social-emotional, and cognitive growth.1408-1410” (p. 195)

ACEs Aware Grants program: “Awarded 150 grants to 100 organizations across the state in three categories—Provider Training, Provider Engagement, and Communications—to expand the reach and impact of the ACEs Aware initiative” (vii)

“Historically, the national child welfare system has directed almost all its attention and resources to tertiary prevention efforts for children who have already experienced abuse and/or neglect (i.e., to prevent recurrence). In California, the Department of Social Services (CDSS) is the administrative agency that oversees the child welfare system. The Office of Child Abuse Prevention (OCAP) within CDSS has recently championed a more overt primary prevention focus (i.e., preventing abuse and neglect before they occur) by addressing the major drivers of child welfare involvement: poverty, unaddressed mental health challenges of caregivers, substance use, and a parental history of child abuse.1198 “ (p. 163)

“ACEs Connection—an information-exchange catalyst and social network community of practice in the worldwide ACEs and toxic stress movement—had been working in partnership with the EfC Initiative to identify and document ACEs-related activities (e.g., trainings or events) at the local level. In this effort, ACEs Connection developed a mapping tool for displaying ACEs and trauma-informed organizational activities geographically and by sector.1529 Three California counties (Fresno, San Diego, and Santa Barbara) have been piloting its use to help track their local ACEs-related work.” (p. 285)

“Resilience is the ability to withstand or recover from stressors, and results from a combination of intrinsic factors, extrinsic factors (like safe, stable, and nurturing relationships with family members and others), and predisposing biological susceptibility.42,98,99. Of note, while the term resilience is often considered in the mental health and behavioral domains, scientific advances in understanding of the impact of stress on neuro-endocrine-immune-metabolic and genetic regulatory health compel advancement of the definition of resilience to also include these domains as well.” (p. 18-19)

Primary prevention: “Public education campaigns to raise awareness of ACEs and toxic stress, and to arm the public with science-based solutions for reducing the impact of ACEs on children and adults, paired with policy strategies to support safe, stable, and nurturing relationships and environments; Access to high-quality mental and physical healthcare, including family-centered treatments; • Enabling opportunities for stress-buffering activities such as access to nature, mindfulness activities, physical activity, and sufficient and high-quality sleep; Providing high-quality early and ongoing learning opportunities, including for social-emotional learning, executive function skills, healthy relationship skills, and responding to challenges; Cross-sector and sector-specific training in trauma-informed tools, approaches, and strategies for all providers engaging with children and families; and public health surveillance and policy-oriented applications of population-level indicators of exposure to ACEs and impacts of toxic stress.” (p. xxx)

Secondary prevention: “There is a consensus of scientific evidence that early detection and early intervention improves outcomes related to toxic stress. 6-9,23,31,603,704” (p. xxx)

Tertiary prevention: “Tertiary prevention involves interventions beyond the clinical setting. This report outlines how each sector—healthcare, public health, social services, early childhood, education, and justice— can contribute to healing the harmful effects of ACEs and toxic stress. To truly achieve practice and population health transformation, coordinating a cross-sector network of highly effective and transformative referral and service options is imperative.” (xxxii)

“Public health efforts should target preventing or reducing environmental factors that worsen toxic stress physiology, such as exposure to lead and air pollution” (p. 155)

“While vulnerable communities experience greater stressors and are therefore at higher risk, it is important to recognize that ACEs happen in every sociodemographic group, and that they are often under-recognized in upper-income and non-minority groups; therefore, universal approaches are necessary.” (p. 171) 

“Exposure to ACEs can also set up transmission of health risks across generations by altering gene expression (epigenetics) in parents to be, which can affect the development and health of their children, and future generations to come.32,33 Intergenerational transmission of toxic stress physiology can also perpetuate and exacerbate socially rooted inequities in health, achievement, socioeconomic mobility, and mortality.16,29,35,36,60,62” (xviii)

“While there currently exist no widely agreed-upon clinical diagnostic criteria for toxic stress, a number of biomarkers associated with neuro-endocrine-immune-metabolic disruption are under investigation.332-334” (p. 30)

“More research is needed to precisely identify clinically useful biomarkers to diagnose and follow risk of toxic stress longitudinally, as well as more specific therapeutic targets.” (xviii)

“Policy- and systems-level efforts to prevent ACEs and toxic stress also depend on the awareness and engagement of the general public and governmental decision-makers. The “political will” to implement pro-child, pro-family policies and budgets is influenced by social norms about the status of children and the loci of responsibility for their well-being. The dominant public narrative about child abuse and neglect, for example, has been characterized by an individual focus on “bad” parents and government interference. Based on research findings, the FrameWorks Institute has created a social counter-narrative that can help engage the public in understanding early child development as it applies to child abuse and neglect prevention, understanding potential policy directions, and supporting solutions to pressing problems.” (p. 148)

“Lead is an example of a specific environmental exposure that interacts with the toxic stress response, in that the effects of lead exposure are more powerful in children who are experiencing toxic stress, and vice versa. Lead exposure disrupts a child’s ability to recover from early life stress. Both animal and human studies have identified toxic stress and lead as affecting shared neurobiological systems, including the hypothalamicpituitary-adrenal (HPA) axis, as well as the frontal cortex and hippocampus (parts of the mesocorticolimbic system). Exposure to lead in early life can result in potentially lifelong alterations in the HPA axis and accentuate physiologic responses to stress.169 Exposures to both lead and toxic stressors (like ACEs) together result in enhanced neurotoxicity.170 Exposure to lead also acts synergistically with stress during pregnancy and early childhood, and is associated with decreased IQ, increased incidence of attention-deficit/hyperactivity disorder (ADHD), antisocial behavior, preterm birth, lower birth weight, and juvenile justice involvement.” (p. 24)

“Exposure to ACEs and the associated dysregulation of the immune system involved in toxic stress can combine with breathing polluted air to exacerbate negative asthma-related outcomes.” (p. 27)

“As another example, in utero exposure to both stress and air pollution can increase oxidative stress, which may affect the development of the fetal lungs, including increasing airway inflammation and adverse simplification of the normally complex structure.235,236 In fact, an increased risk of asthma was found in children co-exposed in utero to fine particulate matter (PM2.5 ) and maternal stress (OR 1.15; 95% CI, 1.03-1.26) during the phase of lung development when many of the peripheral airways important in asthma develop (canalicular phase).” (p. 27)

When the first lockdown orders were passed in India and stay-at-home orders in California, many in my family dispersed across nations felt containment for the first time. An old couple had arrived to the US in December last year and could not leave now. I had planned to spend summer in Delhi with my family but that is not going to happen. It is too risky to be mobile. At the same time, our lives under lockdown are dependent on people being productive, at home or beyond. When I think about theorizing place and COVID19, I must take containment seriously. The moment reveals the inadequacy of concepts as containers, making the discursive gaps apparent (Fortun 2012) but leaving us flailing about as we meet each other, fingers-crossed. 

The clearest inadequacy is methodological nationalism (Wimmer & Schiller 2002): even as lockdowns have visibly occured across national borders, the transmission of virus through arteries of transnational industrial capitalism (some of it late, some not) and the privilege of transnational mobility point that as long as these infrastructures remain in place, so will this virus and more such to come. We continue to order things online, and Amazon continues to maintain these infrastructures. Public spaces are gradually opening with questionable safety norms in place. India, like other countries, is rescuing its citizens and bringing them back home, even as it continues to let migrant workers starve. 

There is consensus that things will not be as before, even as transnational mobilities continue to function. With enough PPE, fingers-crossed, everyone will be fine. What does it mean to take containment seriously, at a time when we are opening up? As things will continue to be normalized to our collective surprise and fatigue, this moment should mobilize us to think about different ways of organizing and care. These do not have to be new ways of thinking and doing but those that have blossomed in our lands for some time. 

In my annotation, I offer brief summaries of articles that animate my thinking about theorizing from confinement and that offer ways of doing already present: 

• Epidemics in American Concentration Camps: From the “White Plague” to COVID-19: Japanese Americans have formed the group Tsuru for Solidarity, calling for decarceration from prisons, jails, and detention centers. As these violent confined places become hotspots of infection, residents and descendants of residents of World War II concentration camps located across the US (most famously in Manzanar, California) recall accounts of epidemic management. Not surprisingly, the burden to remain healthy and disease-free was on detainees, which meant aggregating community and family resources when detainees were already deprived of livelihoods. As staffing problems arose during tuberculosis epidemic in 1940s, the hospital management even considered family members to take hospital shifts. 

• By Desperate Measures Relieved?: Public Health, Prisons, and the Politics of Life: Jason Ludwing writes about how notions of accelerating vaccine development for COVID19 through human "challenge trials" reminds him of medical experiments on incarcerated people in the US. Challenge trials depend on a volunteering body to take on the infection, but for people in prisons, the line blurs between a consenting body that volunteers and a coerced body that is sacrificed. He points to the prison-university complex  in collaboration between University of Maryland and Maryland Corrections in typhoid experiments based at Prison Volunteer Research Unit (PVRU) which launched many publications and research careers. The researchers frame those as ethical experiments because the male inmates received better accomodation and pay. Even though incarcerated populations will not be experimented upon during COVID, prison factories have remained open for producing PPE. Ludwig reminds us that this is not because of the moment, but an inevitable consequence of a system that deprives people of their bodies. 

• COVID-19, Biopolitics and Abolitionist Care Beyond Security and Containment: Eva Boodman argues that we must see beyond individual protection against microbes (biodefense) especially when it comes to people confined by coercion. Building from Foucault's biopolitics (make live/let die), Boodman sees this as continuation, not departure from what many groups have known all along: that the state and university is not for them. They know that we will keep getting messages of management and security as care. Boodman has a vision for abolitionist care, arguing that abolitionists over the years have assidously foregrounded racialized and class-ed neglect that COVID exacerbates and called for its end rather than thinking with. Abolitionist vision would mean calling an end for prisons, jails and all forms of carceration and in line with neglect of public health, an end to all for-profit nursing homes and treatment centers. It means to center mutual aid groups that have been working on-ground for a long time, and those that are built anew. It would mean for both to learn from each other. But mutual aid groups will also be careful to not be co-opted (as Black Panther Party's free breakfast program was co-opted by USDA), or serve as justification for further state neglect. Abolitionist care acknowledges that it will have to work temporarily with security apparatuses even as it continues to resist from inside. The end goal is not to settle for a liberal future.

• Beyond Inside/Outside: Imagining Safety During Covid-19: Author mobilizes her experience of leaving domestic abuse to think about living and working in confined domestic spaces. Feminized labor blurs inside/outside boundaries, revealed starkly by COVID. It is fatigued and exhausted but carries on. She says: "My experience of abuse was organized around waiting. Waiting for something bad to happen and then waiting for the bad thing to be over”. She says that the years of abuse live in her body. She was afraid to call for mediation because the police and state have worked to either criminalize or pass judgement on people like her. The work of transformative justice and prison abolition made her ask the question: why must we endure? Even though staying can be strategic, a way of survival, community can be elusive too. She offers the notion of "pod-building": does away with romantic ideas of community predicated upon shared identities and political analysis and pushes us to rely on relationship-building and trust with people we already know: that are reliable, have good boundaries and skills, which do not necessarily mirror our politics. This reconfiguration of care comes as she recognizes the link between intimate partner violence, gender-based violence, and prison-industrial complex that disrupted her healing and now animate her activism. 

• Working During COVID-19: Occupational Hazards and Workers’ Right to a Safe Workplace: A brief history of labor organizing around occupational safety and hazards and the role of ILO. To be recognized as occupational hazard, a worker in the American context must demonstrate that disease was contracted in place of work. For mining industry, the struggle to include silicosis and lung-based infections went on for decades and was successful but still requires heavy bureaucratic lifting. For petrochemical industries, this is even difficult as communities live in contamination, blurring home and work places. Workers in informal economy are even more precarious and face either starvation or contagion. As the ILO called for COVID to be recognized as a workplace hazard, could workers demand better conditions and from whom and how? The authors offer two examples from "occupied" factories, or those controlled by workers' assemblies: Rimaflow from Milan (Italy) and Traful Newen in Neuquen (Argentina). These workplaces implemented safety protocols much earlier than ordered by the state, and allowed older people, people with co-morbidity, and those who have domestic emergencies to stay at home with pay. Rather than decreasing production, these workplaces have seen an increase and created more jobs in a more ethical way.  

More reading: Care not Cages! #COVID19DecarcerateSyllabus

I've found myself returning to thinking about/around/within interstitial spaces of care, particularly within hospital settings, interested in how viral activity unsettles the ideas we have around space and boundaries, both biological and infrastructural. In COVID-19 pathology and response, the inbetween, the interstitial, become sites challenge and possibility. With COVID-19, we see an acknowledgment of once forgotten spaces quite obviously, with hospital atria and hallways being reconfigured into patient care spaces, makeshift morgues established in refrigerated trucks, and hospitals spilling out into neighboring streets and parks. More than ever, we see how hospitals are simultaneously bounded and unbounded--the most stable and unstable sites for care. Along this line of thought, what might thinking through hospitals as heterotopia of crisis and deviation afford?

Foucault outlines six principles for heterotopic spaces

The heterotopia is capable of juxtaposing in a single real place several spaces, several sites that are in themselves incompatible

Heterotopias are most often linked to slices in time—which is to say that they open onto what might be termed, for the sake of symmetry, heterochronies. The heterotopia begins to function at full capacity when men arrive at a sort of absolute break with their traditional time. This situation shows us that the cemetery is indeed a highly heterotopic place since, for the individual, the cemetery begins with this strange heterochrony, the loss of life, and with this quasi-eternity in which her permanent lot is dissolution and disappearance.

Heterotopias always presuppose a system of opening and closing that both isolates them and makes them penetrable. In general, the heterotopic site is not freely accessible like a public place. Either the entry is compulsory, as in the case of entering a barracks or a prison, or else the individual has to submit to rites and purifications.