H.O.P.E. Volume 1 Issue 3 Paper and Commentary Section

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HOPE Papers and Commentaries

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Volume 1 Issue 3

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H.O.P.E. Volume 1 Issue 3 Paper and Commentary

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2 Paper and Commentary

About Humanities Online Platform for Everyone (HOPE) is an independent, student-run online journal that creates opportunities for high school students in the United States and around the world who are interested in the humanities to publish their outstanding works. These include creative writings (poetry and prose), research papers, editorial reviews, and visual arts. We realize that publication opportunities for high school students interested in the humanities are very limited. Thus, we hope to create this platform to help high school students to earn credit for what they have written or created. This is not merely a journal, but a place for lovers of the humanities to express themselves and receive recognition.

Submissions Submissions are published on a monthly basis. You may submit at the following link: www.hopehumanities.org

Staff Design

Managing Editors

Alice Shao Lucy Lu Andy Xu Holly Zhuang

Neil Shen Ariston Zhou Michael Zhang Jonathan Fu

Editors Jessica Jia Matthew Wu Sherry Xie Angela Xie

Amelia Lee Victoria Ling Felix Bao Forrest Hu

Hope Humanities

Contents 4

The Chinese Happiness Gap

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Dante’s Inferno

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36

41

Eric C.

Huxley M.

Investigation of Music Therapy

Francesca von F.

Ederly’s Mental Health

Ren D.

The Sparrow-Hawk Dilemma

Abi W.

45

Newly Immigrated Adolescents

64

Orientalism and Decolonization Efforts

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71

Jessica J.

Ellie H.

Avant-Garde in 1600

Andy X.

Challenges of Deaf Education

Linda P.

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4 Paper and Commentary The Chinese Happiness Gap: Advocating for a More Utilitarian Approach Eric Chen, Basis International School Guangzhou 22’

As a consequence of Deng Xiaoping’s 1978 market economy reforms, China has experienced rapid and consistent socioeconomic growth (Tisdell 3). Data from the World Bank indicates that China’s GDP experienced a 37-fold increase from 1990 to 2018 (World Bank). Current research indicates that higher income, both at the individual and national level, generally leads to increased subjective happiness (Ortiz-Ospina and Roser; Kahneman and Deaton 16489), so happiness levels in China should have increased from 1990. However, data from China have not conformed to these results. A 2014 study published in the Journal of Happiness Studies shows that during China’s period of economic growth, self-reported life satisfaction decreased significantly in every income group (Brockmann et al. 3), and according to the 2020 World Happiness Report, China ranks 94th in life satisfaction (Helliwell et al. 20). These observations are puzzling because they challenge the general theory that economic growth leads to greater happiness. Therefore, the decreasing levels of happiness in China requires consideration of diverse perspectives in order to understand the causes of the trend.

It is crucial for policymakers, employers, and even educators in China to understand and address the underlying causes of the happiness gap because failure to do so may result in loss of productivity and social turmoil.

The 2019 demonstrations in Hong Kong exemplify how life dissatisfaction can lead to violent unrest (Lee). If left unaddressed, China’s happiness gap could lead to similar protests. It would be wise for the Chinese government to consider John Stuart Mill’s utilitarian perspective, in which he claims that happiness is the ultimate end and that all other desirable things should only remain desirable provided they contribute to happiness (Mill 14). More economists are now advocating for the use of happiness data to evaluate economic policy and to view increasing citizen life satisfaction as a policy goal, which is in line with Mill’s philosophy. Analysis of economic and sociocultural factors reveals that rising inequality and cultural norms produced by China’s transformation into a capitalistic society are the main causes of China’s happiness gap. Therefore, Chinese policymakers should take a more utilitarian approach and prioritize citizen life satisfaction as a policy goal by utilizing happiness data, reducing inequality and making reforms to corporate and educational culture.

Economic Lens

The precise economic causes of China’s happiness gap have been disputed, with some research arguing for general income inequality as the cause while others argue for identity-related inequalities in opportunity. The identity-related inequalities arise from China’s hukou system, which separates people’s social status by place of birth, and this is disadvantageous for the rapidly growing group of rural-urban migrant workers in China. The Chinese National Bureau of Statistics accounted for 288 million migrant workers in 2018, a drastic increase from 30 million in 1989 (Li 4). Migrants often work low paying jobs, face discrimination and have less access to health care, education, and insurance services compared to their city counterparts because they hold hukous from rural towns (Gao and Smyth 16-17). These inequalities in opportunity restrict the socioeconomic mobility of migrant workers, which leads to feelings of hopelessness and unhappiness. According to a study published in World Development, even though migrants earn higher income than their rural peers, they are less happy because of the hardships they face and their low economic standing in urban cities (Knight and Gunatilaka 123). Therefore, reducing identity-based inequality for migrant workers is key to raising overall levels of well-being in China.

However, the aforementioned studies may have understated the effects of general income inequality that is unrelated to hukou identity because the studies were focused on migrant workers. In actuality, high income inequality unrelated to hukou identity also contributes to decreasing well-being. During that 1990s, China’s Gini coefficient, an indicator of national income inequality, rose from .28 to .43, making China one of the most unequal countries in the world (Brockmann et al. 6). Results from a survey of over 10,000 households confirm Brockmann et al.’s conclusion (Wang et al. 5), as they exhibit an inverse U-shaped relation between income inequality and income in both rural and urban China, meaning at high levels of inequality, happiness decreases (Wang et al. 20).

Apart from creating the “jealousy effect” in which poorer individuals envy the rich, high income inequality has a tangible impact on the poor by causing inflation. Economic analysis by Shujie Yao et al. published in The World

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Economy demonstrates a cyclic relationship between China’s real estate bubble, a result of the commercialization of housing, and income inequality because the rich continually drive up demand for housing (491). The stress of not being able to afford housing causes unhappiness for low-income individuals and migrant workers in particular because they must find new housing, whereas urban natives may already have property. Thus, evidence suggests that effects of non-identity-related income inequality, worsened by inflation, has led to dissatisfaction among a majority of the population as they now find themselves in a relatively worse financial position than before.

Analysis shows that inequality has prevented China from becoming a happier country. In the past few decades, China may have prioritized objective growth too heavily. According to an OECD report, local Chinese officials’ performance is evaluated using the “Objective Responsibility System (ORS),” which includes indicators such as GDP growth and industrial investment, but not citizen life satisfaction (Burns and Zhou 12). Objective growth can benefit the people, but as Mill argued, the utilitarian standard tolerates other desires “up to the point beyond which they would be more injurious to the general happiness than promotive of it” (14). Following Mill’s reasoning, citizen happiness should be at the forefront of the government’s concerns. In addition, a pragmatic concern is that rising dissatisfaction can lead to civil unrest if left unaddressed. Economist Russell Smyth postulates that the only factor keeping migrant workers relatively content is the expectation for a greater economic future (17), and a similar argument could apply to poor urban natives as well. When growth eventually slows as China develops, those expectations may be underrealized, leading to more unhappiness and social unrest similar to that in Hong Kong. For these reasons, increasing happiness levels should be a major policy goal.

Policymakers can accomplish this goal by utilizing happiness data in the ORS and addressing inequality.

Research by professors of psychology Shigehiro Oishi and Ed Diener on welfare, environmental, and education policy has demonstrated that surveys based on the Cantril happiness scale are accurate in evaluating policy effectiveness (200); therefore, frequent happiness surveys can measure progress towards eliminating the happiness gap.

To address identity-related inequality, the government could relax the hukou system’s restrictions so that migrant workers can receive equal economic opportunities and welfare in cities (Jiang et al. 17). Decreasing hukou restriction also benefits firms because they can hire from a larger pool of candidates. For general inequality, policymakers should increase progressive personal taxes because they are correlated with high levels of happiness (Oishi and Diener 200). In 2015, only 3 percent of Chinese paid personal income tax, which impedes wealth redistribution to the poor (Cevik and Correa-Caro 20). Thus, raising income tax will decrease inequality, which could reduce inflation and raise happiness levels.

One objection to this idea is that utilitarian economics is too egalitarian and impedes economic progress.

The wealthy city natives and local governments may object to policies that decrease inequality and inflation because they benefit from their hukou advantage, low personal tax, objective growth, and the housing market.

Although research from Princeton University indicates that decreases in income will lower happiness levels for the rich (Kahneman and Deaton 16489), the effects could be minimized if progressive taxes are introduced gradually.

Moreover, making happiness evaluation part of the ORS can provide an incentive for local governments to act.

Former Harvard University President Derek Bok argues that happiness among citizens can bring about economic prosperity in the long run (Huppert 1276). Therefore, there is sufficient motivation for the Chinese government to improve life satisfaction through decreasing inequality, even at the expense of short term economic gain.

Sociocultural Considerations

Intertwined with the economic causes of unhappiness are sociocultural causes specific to China. Although the happiness gap is primarily caused by economic dissatisfaction, cultural factors are also important because they can determine the necessary extent of government action. Some experts attribute low levels of happiness in China to Confucianism, the most influential philosophy in East Asia. Economics Professor Yew Kwang Ng from Hong Kong University suggests that Confucianism’s emphasis on putting collective interests over one’s individual well-being, along with competition, is an important source of unhappiness (Ng 57). However, Confucius himself argued for a simple life and social harmony in order to attain happiness, and he was an advocate for introspection (Luo 1). The competitive culture that Ng refers to is mainly a remnant of the Confucian civil service examination in imperial China and the general cultural tradition to work hard, respect authority, and promote social stability.

6 Paper and Commentary Furthermore, if Confucianism was the sole cultural cause of the happiness gap, we would expect constantly low levels of happiness rather than a downward trend. Thus, it is likely that increasing Western materialism is the greatest cultural cause of the happiness gap.

The prevalence of Western materialism increased after Deng Xiaoping’s reforms, and as a consequence, the competitive nature of Chinese culture intensified. According to a study conducted by researchers at Tsinghua University and Peking University on 981 citizens, modern Chinese closely associate material wealth with their social status and believe that more wealth would make them happier (Liao and Wang 10). This conclusion explains the increasing levels of financial frustration observed by Brockmann et al. in their economic study (6). Material wealth has become more important to people, but most find themselves in a worse financial position, which leads to unhappiness. Additionally, the combination of Western individualism and materialism with Confucian collectivist culture has the potential to create unhappiness. Individuals compete for personal wealth, but traditional culture also expects people to live a virtuous life and contribute to family, leading to a conflict of interest. Collectivist responsibilities add to the stress of migrant workers and the poor as well as the rich, who may feel alienated from less affluent relatives. Ultimately, this leads to people prioritizing both personal wealth and collective interests over individual happiness, which contradicts Mill’s assertion that happiness is the ultimate goal.

Since the cultural changes during economic growth in China has contributed to decreasing happiness, the government should address the issue. Admittedly, cultural impacts are difficult to quantify and address, as most quantitative happiness research focuses on economics. Nevertheless, the government, educators, and employers can act to promote sustainable approaches to happiness. Making increasing happiness a policy goal and decreasing inequality can reduce stress associated with competitive culture and inspire personal awareness of the importance of happiness, while educators can reduce competition in the classroom by emphasizing compassion and personal mental health. According to a paper published in the UC Berkeley Education Review, although concerns have been raised over student stress since the 1980s, Chinese public schools continue to overwhelmingly promote competition through the National “Gaokao” (Zhao 21). As a result, Chinese students experience suicidal thoughts and depression more frequently than Western counterparts (Sun et al. 11). If educators can decrease academic competition and stress by reducing the importance of testing, they can cultivate a generation of happier citizens and reduce competitive culture. Similarly, according to a multinational study in 2015, Chinese workers’ job satisfaction ranked second to last out of 36 surveyed countries due to the Confucian influenced corporate culture of strict hierarchies (Zhang et al. 11). Employers can increase worker happiness and productivity if they promote more employee freedom. While the government cannot directly address cultural impacts, reducing inequality and making reforms to education and corporate culture can decrease the competitive culture of China’s changing society.

Conclusion and Solution

Consideration of socio-cultural and economic causes of the happiness gap in China suggests that both the government and the citizenry would benefit from adopting a more utilitarian view by setting life satisfaction maximization as a policy goal. Traditionally, increasing happiness may seem abstract as a policy goal, but according to Mill, “Happiness is not an abstract idea, but a concrete whole,” with money, virtue, and social status being some of its parts (Mill 14). When applied to policymaking, Mill’s argument suggests that it is possible to take a logical, concrete approach towards improving happiness. In China’s case, this involves utilizing happiness data, reducing inequality, and instituting educational reforms.

There are limitations to the government taking a more utilitarian approach. First, experts acknowledge that measures of happiness are potentially unreliable as they are influenced by factors such as personality and shortterm mood at the individual level (Oishi and Diener 197). Despite this, researchers argue that happiness surveys are accurate at large scales, and in the age of big data, the government is able to collect mass happiness data frequently. A second limitation is that explicitly targeting happiness may not be necessary because declining happiness may be limited to the period of rapid growth; as standards of living continue to rise, happiness may increase.

However, targeting happiness sends a reassuring message to citizens that the government cares about their well-being, thus ensuring social stability.

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Works Cited “2018 nian nongmin gong jiance diaocha baogao 2018” [2018 Migrant Workers Survey Report]. China Bureau of Statistics, 29 Apr. 2019, www.stats.gov.cn/tjsj/zxfb/201904/t20190429_1662268.html.

Brockmann, Hilke et al. “The China Puzzle: Falling Happiness in a Rising Economy.” Journal of Happiness Studies, August 2009, doi: 10.1007/s10902-008-9095-4.

Burns, John P. and Zhiren Zhou. “Performance Management in the Government of the People’s Republic of China: Accountability and Control in the Implementation of Public Policy.” OECD Journal on Budgeting, Volume 2010/02, 2010, www.oecd.org/china/48169592.pdf.

Cevik, Sherhan and Carolina Correa-Caro. “Growing (Un)equal: Fiscal Policy and Income Inequality in China and BRIC+.” IMF Working Paper, no. 15/68, International Monetary Fund, March 2015, www.imf.org/ external/pubs/ft/wp/2015/wp1568.pdf.

Gao, Wenshu and Russell Smyth. “What Keeps China’s Migrant Workers Going?

Expectations and Happiness Among China’s Floating Population.” Journal of the Asia Pacific Economy, 2010, RePEc, DOI: 10.1080/13547860.2011.564749.

Helliwell, John F. et al. “Social Environments for World Happiness.” World Happiness Report, 2020, happiness-report.s3.amazonaws.com/2020/WHR20.pdf.

Huppert, Felicia. “Happiness Breeds Prosperity.” Nature 464, pp. 1275-1276, 28 April 2010, doi. org/10.1038/4641275a Jiang, Shiqing et al. “Identity, Inequality, and Happiness: Evidence from Urban China.” World Development Vol. 40, No. 6, 2012, pp. 1190–1200,

DOI: 10.1016/j.worlddev.2011.11.002 Kahneman, D., and A. Deaton. “High Income Improves Evaluation of Life but Not Emotional Well-Being.”

Proceedings of the National Academy of Sciences, vol. 107, no. 38, 2010, pp. 16489–16493. doi:10.1073/ pnas.1011492107. Accessed College Board AP Seminar 2019-2020 Stimulus Material.

Knight, John, and Ramani Gunatilaka. “Great Expectations? The Subjective Well-Being of Rural–Urban Migrants in China.” World Development Vol. 38, No.1, 2010, 113–124, Elsevier, doi: 10.1016/j.worlddev.2009.03.002.

Lee, David S. “Understanding Hong Kong’s Turbulent Summer.” Harvard Business Review, Harvard Business Publishing, 23 Sept. 2019, hbr.org/2019/09/understanding-hong- kongs-turbulent-summer.

Li, Shi. “The Economic Situation of Rural Migrant Workers in China.” China Perspectives, 15 December 2010, DOI: 10.4000/chinaperspectives.5332 Luo, Shirong. “Happiness and the Good Life: A Classical Confucian Perspective.” Dao 18, 41-58, 03 March 2019, doi.org/10.1007/s11712-018-9640-8.

Mill, John Stuart. “On Virtue and Happiness.” utilitarianism. Fraser’s Magazine, 1863. Accessed College Board AP Seminar 2019-2020 Stimulus Material.

Ng, Yew Kwang. “East‐Asian Happiness Gap: Speculating on Causes and Implications.” Pacific Economic Review 7.1, 2002, pp 51–63, Semantic Scholar, www.semanticscholar.org/paper/THE-EAST-ASIAN-HAPPINESS-GAP%3A- SPECULATING-ON-CAUSES-Ng/71d51a3077e4499fe38a176d850ab9313991fb85.

Oishi, Shigehiro and Ed Diener. “Can and Should Happiness be a Policy Goal?” Policy Insights from the Behavioral and Brain Sciences, 2014, Vol. 1, pp. 195-203, DOI: 10.1177/2372732214548427.

Ortiz-Ospina, Esteban, and Max Roser. “Happiness and Life Satisfaction.” Our World in Data, Oxford Martin Programme on Global Development, 2020, ourworldindata.org/happiness-and-life-satisfaction.

Tisdell, Clem. “Thirty Years of Economic Reform and Openness in China: Retrospect and Prospect.” Economic Theory Applications and Issues, working paper no. 51, School of Economics, University of Queensland, Oct. 2018, ageconsearch.umn.edu/record/90620/files/WP%2051.pdf Wang, Peng et al. “The Impact of Income Inequality on Individual Happiness: Evidence from China.” Social Indicators Research, 18 May 2014, Springer, DOI 10.1007/s11205- 014-0651-5.

World Bank. “GDP (current US$) – China.” World Development Indicators, The World Bank Group, 2018, data.worldbank.org/indicator/NY.GDP.MKTP.CD?

8 Paper and Commentary locations=CN&name_desc=true.

Yao, Shunjie et al. “Housing Development and Urbanisation in China.” The World Economy, 25 July 2013, Wiley Online Library, doi.org/10.1111/twec.12105.

Zhang, Xing. “Why are Chinese workers so unhappy? A comparative cross-national analysis of job satisfaction, job expectations, and job attributes.” PLOS ONE, 26 Sept. 2019,

doi: 10.1371/journal.pone.0222715.

Zhao, Xu. “Educating Competitive Students for a Competitive Nation: Why and How Has the Chinese Discourse of Competition in Education Rapidly Changed Within Three Decades?” Berkeley Review of Education, Vol. 6, No.1, 1 Jan. 2016, eScholarship, doi:10.5070/B86110043.

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An Analysis of Personification in Dante’s I​ nferno Huxley Marvit, the Nueva School 23’ Dante’s​Inferno​is fundamentally an attempt to grapple with abstract ideas through concrete representations. These concretizations manifests in many ways, the most apparent being the concept of Hell itself. A belief in Hell allows people to find solace despite the apparent lack of justice in the world and mollifies the unknowability of what happens after death. Within Dante’s version of Hell, punishments are determined via poetic justice, or contrapasso, a way of assigning tangible punishments to abstract concepts of sin. This use of contrapasso as a means of concretization can be seen throughout the entirety of​​Dante’s​Inferno​, such as when Dante fabricates the punishment for lust—being eternally caught in a “hurricane” (V, 30). Here, the hurricane is used to make an abstract idea tangible, the loss of control that is the defining characteristic of lust. However, Hell and the use of contrapasso are not the only ways Dante concretizes; he also personifies abstract ideas such as justice and fortune in order to address the unfathomable.

Dante uses personification to communicate many abstract ideas throughout​The Inferno​; one of these abstract ideas is justice. He narrates, “The fosse // Grew clearer to my sight, in which [...] Unerring Justice, lets her punishments rain // Upon the shades whose sin is to falsify; // She has recorded them upon her scroll” (XXIX, 60).

In addition to describing Justice’s will with the words “her” and “she,” Dante capitalizes “Justice,” when, and only when, treating the word as a name. Here Dante clearly personifies Justice. The sin of falsification refers to liars, whom only Justice can truly know. Dante describes the concept as hidden within a “fosse,” which represents the unknowability of Justice’s knowledge. Dante then talks of how Justice records this information upon a scroll, concretizing the knowledge. By personifying the abstract idea of Justice, it is rendered concrete, and thus, fathomable.

Within Dante’s world, to truly understand Justice, its opposite must also be understood: Fortune.

Dante, accordingly, also personifies Fortune. The opposite of the concept of Justice is not injustice, but rather an indifference to Justice, which is the essence of Fortune. F ​ ortune is “ajuHst,” with the Greek prefix “a” meaning not, or without. ​Justice is described as “unerring,” whereas the concept of error is completely irrelevant to Fortune. Dante asserts that “her judgment [...] // [...] is invisible, like a snake in the grass” (VII, 70). Fortune is fundamentally incomprehensible, and hence must be personified, as with Justice. Dante compares Fortune’s inexplicable system of judgment to a “snake.” By obliquely referencing Genesis, Dante is suggesting that Fortune’s judgment, through its “invisibility,” is the embodiment of evil. Dante continues, “Your wisdom cannot resist her; in her might // Fortune, like any other god, foresees” (VII, 70). Here Dante compares Fortune to other gods, highlighting that personification of abstract ideas is not specific to ​The​​Inferno​but rather quite prominent in the world. Gods themselves are often personifications made to grapple with the uncontrollable aspects of life, such as weather, the sea, or health. Once these concepts are personified, they become tangible, and thus, their mystery is dismantled. Interaction—and with it a sense of understanding—becomes possible. Interactions can span from sacrifices and prayers to Dante’s description of Fortune being “wrongfully blamed and defamed” (VII, 80). This type of interaction is limited to beings, as prayer and defamation make no sense when applied to abstract concepts.

Personification is a technique that Dante uses to concretize abstract ideas. Though this technique is not unique to Dante, he certainly utilizes it effectively. Dante reifies both Justice and her antithesis, Fortune. Despite the fact that they are opposite, they are both first described as hidden or unknowable, then personified to address their inexplicability. Since it is harder to accept the injustices of fate than to accept the inexplicable nature of other people, personification deftly moves the problem from the intolerable abstract to the tolerable concrete. This technique can work with both opposites simultaneously as it is fundamentally about providing a rationale for what is unknowable. These small examples of personification illuminate the larger idea of concretization that D ​ ante’s Inferno​is about, whether that manifests itself in the concept of Hell, contrapasso, or personification.

Works Cited

10 Paper and Commentary Dante Alighieri, The Inferno of Dante: A New Verse Translation. Translated by Robert Pinsky and Nicole Pinsky, Bilingual ed., New York, Noonday Press, 1996. Hart, Alexa. In-Class Workshop. 21 Jan 2020.

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Investigation into whether musical therapy has a positive effect on elderly people who suffer from Alzheimer’s disease Francesca von Furstenberg, Rugby School 20’ ABSTRACT Background: Despite the abundance of musical activities in dementia care homes, music as a form of therapy has not been studied very widely and therefore is not a commonly used method of rehabilitation. However, non-pharmacological treatments are being seen as becoming more desirable than pharmacological ones1. Music has for many years been used as a form of entertainment for residents of nursing homes. There is no suggestion that musical therapy might in any way cure dementia. However, patients with certain types of the syndrome, for example Alzheimer’s disease, frequently respond to it in a positive way2.

Objective: The purpose of this report is to investigate whether the use of musical therapy in Alzheimer’s disease care homes can have a positive effect on the temperament and behaviour of the residents in the short-term and therefore improve quality of life.

Method: This experiment uses a method of observation before and during music therapy. 6 songs were played on 4 different days to 8 residents and a table was filled for each song to note down the observations. Results were written with a “+”, “-” or “=” depending on the type of reaction observed.

Results: In total, there were 38 positive reactions and 10 negative/neutral reactions. For all songs there were more positive than negative/neutral outcomes. A statistical t-test was performed to show whether the difference between the results is statistically significant.

Conclusion: The t-test confirmed that there is a statistically significant difference between the two mean results of positive and negative/neutral reactions. This showed the likelihood that the difference between the results is due to chance to be less than 5%3.

INTRODUCTION Dementia is the umbrella term for a group of diseases with similar symptoms – it covers the span of over 200 different diseases.4 Dementia is characterised by a decrease in the ability to recall memories, an inability to perform daily activities and a marked deterioration in the capability of the patient to communicate well or at all.5 The exact causes of dementia have yet to be fully determined. As a result, much of the focus of scientists and researchers is to find ways to minimise the effects of the diseases. The routine use of pharmaceuticals is not without risk of contraindications even in younger individuals. Most dementia sufferers tend to be elderly and are as such more susceptible to any side effects. This makes drugs not necessarily the best all-round therapy option. Non-pharmaceutical therapies, one of these being musical therapy, are therefore increasingly viewed as preferable choices.6 1 Garrido, Dunne, Chang, Perz, Stevens, Haertsch, (2017), The Use of Music Playlists for People with Dementia: A Critical Synthesis, Journal of Alzheimer’s Disease, volume 60, number 3, [15/02/19] 2 Alissa Sauer, 2014, 5 Reasons Why Music Boosts Brain Activity, Alzheimers.net, https://www.alzheimers. net/why-music-boosts-brain-activity-in-dementia-patients/, 06/02/19 3 Statistics How To, (2020), T Test, Statistics How To, https://www.statisticshowto.datasciencecentral.com/ probability-and-statistics/t-test/, 04/08/19 4 Alzheimer’s Research UK, (2018), Types of Dementia, Alzheimer’s Research UK, https://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/, [05/03/19] 5 The Healthline Editorial Team and Timothy J. Legg, (2016), Dementia and Alzheimer’s: What are the differences? Healthline, https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers, [25/02/19] 6 Nair, Browne, Marley, Heim, (2013), Music and Dementia, Degener Neurol Neuromuscul Dis, 3, 47-51,

12 Paper and Commentary Music is processed in many parts of the brain, meaning that even if one part has been affected by dementia, it can still be processed. So, Patients often lose the ability to process music only in the later stages of the disease.7 Music can provoke memories that are associated with emotions felt from listening to a song. These are usually in a positive form however it can also evoke negative memories and therefore cause distress and anxiety: behavioural and psychological symptoms of dementia (BPSD).8 Music can stimulate the connections between the two hemispheres of the brain which activates cognitive processing, allowing the patient to improve their mental capabilities.9 Music therapy is especially used in Alzheimer’s disease care homes. As Alzheimer’s disease causes confusion, aphasia and memory loss, there can be a high rate of distress and anxiety, and music is a way to reduce these effects.

Alzheimer’s disease is a progressive disease of the brain that damages the neurones, primarily in the cerebellum.10 It is the most common form of dementia, and dementia has 537,097 diagnoses in the UK.11 It is almost impossible to get a figure for the percentage of Alzheimer’s disease within this because of how similar the symptoms are of the diseases within dementia.

AIMS The aim of this experiment is to prove that musical therapy has a positive effect on elderly people in care homes who suffer from Alzheimer’s disease. This is in the hope that it can be used in care homes to improve the quality of life of the patients as they progress along the disease path. Due to the progressive nature of the disease, quality of life can decrease the further along the patient is. This is by virtue of loss of mobility, decreased level of cognitive function and deterioration in communication abilities.12 Music is a way to evoke emotions and memories that, due to the disease, might have been forgotten.13 Each song can be associated with one specific memory that can be brought back by feeling the emotion and hearing the song. If this is positive, it can result in a short-term positive effect on the patient.

HYPOTHESIS The hypothesis of this experiment is that elderly people who have Alzheimer’s disease, will respond to musical therapy in a positive way, either short-term or long-term and that there will be a notable change in behaviour.

The null hypothesis of this experiment is that musical therapy will have no effect or negative effects on elderly people who have Alzheimer’s disease.

[09/05/19] 7 UHN Staff, (2019), Does Music Affect Memory? Music Therapy Is One of the Best Activities for Dementia Patients, University Health News, https://universityhealthnews.com/daily/memory/does-music-affect-memorymusic-therapy-is-one-of-the-best-activities-for-dementia-patients/, [14/03/19] 8 Alissa Sauer, (2014), 5 Reasons Why Music Boosts Brain Activity, Alzheimers.net, https://www.alzheimers.net/why-music-boosts-brain-activity-in-dementia-patients/, [06/02/19] 9 UHN Staff, (2019), Does Music Affect Memory? Music Therapy Is One of the Best Activities for Dementia Patients, University Health News, https://universityhealthnews.com/daily/memory/does-music-affect-memorymusic-therapy-is-one-of-the-best-activities-for-dementia-patients/, [14/03/19] 10 The Healthline Editorial Team and Timothy J. Legg, (2016), Dementia and Alzheimer’s: What are the differences? Healthline, https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers, [25/02/19] 11 Dementia Statistics, (2018), Diagnoses in the UK, Alzheimer’s Research UK, https://www.dementiastatistics.org/statistics/diagnoses-in-the-uk/, [02/02/19] 12 The Healthline Editorial Team and Timothy J. Legg, (2016), Dementia and Alzheimer’s: What are the differences? Healthline, https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers, [25/02/19] 13 Alissa Sauer, (2014), 5 Reasons Why Music Boosts Brain Activity, Alzheimers.net, https://www.alzheimers.net/why-music-boosts-brain-activity-in-dementia-patients/, [06/02/19]

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The null hypothesis will be used for the Students t-test.14 If the t-test result shows a statistically significant change, the null hypothesis can be rejected with 95% confidence. Therefore, there is only a 5% likelihood that the results are due to chance. If the results do not show a statistically significant difference, the null hypothesis cannot be rejected.

LITERATURE REVIEW Alzheimer’s disease The exact cause of Alzheimer’s disease is yet to be discovered. However, there are two proteins that are thought to have an effect on the progression of the disease. These are Amyloid Precursor Protein (APP) and Apolipoprotein E (APOE).15 The exact way in which these two proteins work is also not yet known, however, there is a strong correlation between them and the progression of Alzheimer’s disease.

APOE binds to cholesterol on the phospholipid bilayer of a cell. This allows the cell to absorb lipids. APOE also plays a crucial role in repairing damage that has been made to neurones in the brain. APOE-4 is the strongest Alzheimer’s diseases risk factor. It is present in over half of all Alzheimer’s disease patients.16 APOE-4 is most abundant in microglia, non-neuronal cells found in the central nervous system that act as macrophages. The role of APOE-4 in microglia is not completely understood, however, the microglia in a person with Alzheimer’s disease are compromised and so do not work as efficiently or correctly as they should. Their function is to remove amyloid from the brain by phagocytosis. This process is impaired by the APOE-4 protein which leads to a build-up of amyloid.

University of Eastern Finland (2019)16 explored this topic and decided upon this theory. However, even though there is an obvious correlation between APOE-4 and microglia in the brain, it is still not known why and how this occurs.

So, further research in this topic area must be done to be able to use and trust this information.

The amyloid that has built up due to the inactive microglia produces the APP protein. This is a protein that spans the width of the phospholipid bilayer of a cell, resulting in parts of it inside and outside the cell. APP is activated and then cut into smaller fragments, one of these being beta-amyloid.17 These molecules are cut from the part of APP that is outside the cell, which is why they can move throughout the brain. Beta-amyloid is a chemically ‘sticky’ molecule meaning that it can attach to other beta-amyloid molecules easily. It accumulates and forms oligomers; these are small clusters of beta-amyloid. Oligomers then form fibrils, mats of fibrils and finally beta-sheets. Beta-sheets can join into plaques which are abnormal protein deposits in the brain. They can bind onto receptor sites on the neurone end. An intermolecular process is then activated resulting in the erosion of synapses between neurones. The Alzheimer’s Association (2017)17 called this the amyloid hypothesis. It is not known exactly how each of the molecules cause the erosion of synapses, however it has been shown that there is a significant correlation between the two processes. The beta-amyloid disrupts communications in the synapses, which stops electrical impulses from passing through. Therefore, the brain will be incapacitated and not work to the level of its original state.

The synapses would normally work using six different proteins: choline acetyltransferase (ChAT), Acetyl-Coenzyme A (Acetyl-CoA), choline, acetyl choline (ACh), vesicular acetylcholine transporter (VAChT) and enzyme acetylcholinesterase (AChE).18 ChAT synthesises ACh, in the cytoplasm of cholinergic neurones, with choline and 14 Statistics How To, (2020), T Test, Statistics How To, https://www.statisticshowto.datasciencecentral.com/ probability-and-statistics/t-test/, [04/08/19] 15 Alzheimer’s Association, (2020), Genetics, Alzheimer’s Association, https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors/genetics, [30/07/19] 16 University of Eastern Finland, (2019), Alzheimer’s disease risk gene APOE4 impairs function of brain immune cells, ScienceDaily, https://www.sciencedaily.com/releases/2019/09/190916101856.htm, [30/07/19] 17 Alzheimer’s Association, (2017), Beta-amyloid and the amyloid hypothesis, Alzheimer’s Association, https://www.alz.org/national/documents/topicsheet_betaamyloid.pdf, [02/05/19] 18 Ferreira-Vieira, Guimaraes, Silva, Ribeiro, (2016), Alzheimer’s Disease: Targeting the Cholinergic System, Current Neuropharmacology, 14, 1, 101-115, [29/07/19]

14 Paper and Commentary Acetyl-CoA. ACh is transported into synaptic vesicles by VAChT and then exocytosed into the synaptic cleft when the pre-synaptic neurone is depolarised. Here, it activates two different receptors on the post-synaptic neurone: muscarinic and nicotinic. ACh is rapidly deactivated when it binds to its receptor by AChE, releasing two molecules, choline and acetate. The acetate can now be used for aerobic respiration in the Link reaction where it binds with Coenzyme A to produce Acetyl-Coenzyme A. The choline is constantly reuptaken by the pre-synaptic neurone by active transport where it can be reused in the cycle. This is the process that would occur in a healthy person who does not suffer from Alzheimer’s disease. However, with Alzheimer’s the transcription of ChAT is significantly reduced.

This results in less ACh being synthesised, resulting in a lower rate transfer of electrical impulses across the synapse.

Alzheimer’s disease can then progress due to the lack of working and healthy neurones. Ferreira-Vieira, Guimaraes, Silva and Ribeiro, (2016) worked to write a journal about how Alzheimer’s disease affects the cholinergic system. It is the first, in detail and fully up-to-date journal of its kind which provides the public with reliable and trustworthy details about how the disease actually affects the brain.

Music Therapy Pharmacotherapy is the most widely used way to dampen the symptoms of Alzheimer’s disease.19 This is mainly to control the behavioural and psychological symptoms of the disease (BPSD). Carers of people with the disease have identified agitated and aggressive behaviour to be one of the hardest and more challenging symptoms of the disease to deal with. They are caused by confusion of situations and not knowing what is going on and are usually treated with psychotropic medication.20 However, there is much controversy around this. There are many adverse effects, which, due to it being used on elderly people, are usually more severe or even fatal than they would be in a younger, healthier person. Another issue is that there is a lack of people who the drugs can be tested on; people with Alzheimer’s disease commonly have aphasia or are unable to communicate or comprehend what is being said due to the nature of the disease. Therefore, they cannot consent.21 One of the most effective non-pharmacological treatments for Alzheimer’s disease is music therapy. Music utilises many different parts of the brain and can therefore often be enjoyed by Alzheimer’s patients even at quite late stages of the disease. It is a low-cost substitute for medication that has little to no adverse effects.

Music is used as a catalyst or a stimulant for elderly people with Alzheimer’s disease to reminisce and remember memories that otherwise would not be accessible due to the breakdown of synapses in the brain. The music used is often familiar music that the patient would have come across in their youth because Alzheimer’s disease causes the loss of short-term memory primarily due to these not being so heavily embedded into the hippocampus. Music from religious services, patriotic ceremonies and cultural events are often used because they are widely known, increasing the likelihood that all of the patients receiving music therapy at once will recognise the song. Sung, Huei Chuan Christina and Chang (2005)22 say “listening to one’s favourite music can also decrease cortisol”. Cortisol is a glucocorticoid hormone produced in the adrenal gland. It performs an important role in how the body responds to stress.23As cortisol concentration in the blood decreases, stress levels decrease. This means that not only does music therapy have a positive effect on the overall mood and behaviour of the patient, it makes a chemical difference in the body that can reduce anxiety and promote relaxation. Therefore, it has the ability to decrease the occurrence of BPSD much like actual medication does.

19 Garrido, Dunne, Chang, Perz, Stevens, Haertsch, (2017), The Use of Music Playlists for People with Dementia: A Critical Synthesis, Journal of Alzheimer’s Disease, volume 60, number 3, [15/02/19] 20 Sung, Huei Chuan Christina, Chang, (2005), Use of preferred music to decrease agitated behaviours in older people with dementia: A review of the literature, Journal of Clinical Nursing 14(9, 1133-1140, [07/05/19] 21 Nair, Browne, Marley, Heim, (2013), Music and Dementia, Degener Neurol Neuromuscul Dis, 3, 47-51, [09/05/19] 22 Sung, Huei Chuan Christina, Chang, (2005), Use of preferred music to decrease agitated behaviours in older people with dementia: A review of the literature, Journal of Clinical Nursing 14(9, 1133-1140, [07/05/19] 23 You and Your Hormones, (2019), Cortisol, Society of Endocrinology, https://www.yourhormones.info/hormones/cortisol/, [13/08/19]

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Nair, Browne, Marley and Heim (2013)24 conducted an observational study to test whether musical therapy had a positive effect on challenging behaviours in a care home. It was a 6-week long investigation; two weeks to collect primary data before any change, 2 weeks of music intervention and a further two weeks to collect a second set of data to see how long the effects, if any, last. Baroque music was played, and the challenging behaviours were rated on a scale they had previously devised. The end results showed that there was a 40% decrease in challenging behaviours throughout the experiment and these effects lasted until the end of the music therapy. The challenging behaviours re-occurred as soon as the music intervention ended. This shows that the effects were only short-term and not long-term. Therefore, it poses a question of whether music therapy does hold any significant long-term effects.

The experiment showed a 40% decrease, which is on the surface a very significant change. However, it was not stated whether a statistical test was completed. If not, the results cannot be relied upon wholly due to the fact that it I not known whether they were purely due to chance or if the music did cause a statistically significant change in challenging behaviours. Another issue with the experiment is that there is no information on what sort of behaviours were counted as ‘challenging’ and where the cut-off point was between this and ‘normal’ or ‘positive’ behaviour was. The experiment was also not conducted on purely Alzheimer’s patients but in fact just dementia patients. The different types of dementia could all react in a different way to music therapy so they would not be able to say that all types of dementia will show a positive effect from music therapy by looking at their own results.

METHODOLOGY Tune Recognition This method involves participants having to correctly identify the songs being played.25 The songs used should be ones from the era of the participants in order to maximise the likelihood that they are familiar. This method was not used in this investigation because it would have required questioning the participants immediately after the song to enable them to identify the tune. Because of the nature of the disease having an impact on memory, predominantly the short-term, the patient could have forgotten the song by the time they were asked. Additionally it could have been erased from the long-term memory even if they had previously been familiar with it.

Melody Deviation This task is to identify which famous melodies are correct and which have had a few notes changed in the melody.

Facial expressions and exclamations are used to determine whether the participants recognised the deviation in melody.26 For example laughter or surprise indicate identification of an incorrect melody. This is not a very reliable way of recording if the deviation was detected. The reactions of the participants could have been a result of the music itself rather than the recognition of an incorrect melody.

Questionnaire This is a method in which four yes or no questions are asked to each participant:27 1. Do you know this music?

2. Do you like this music?

3. Do you feel happy when you hear this music?

4. Does this music sound happy?

The participants will be asked to answer the questions soon after the song to minimise the effect of the disease on 24 Nair, Browne, Marley, Heim, (2013), Music and Dementia, Degener Neurol Neuromuscul Dis, 3, 47-51, [09/05/19] 25 Warren, Golden, Clark, Nicholas, Cohen, Slattery, Paterson, Foulkes, Schott, Mummery, Crutch, (2017), Music perception in dementia, Journal of Alzheimer’s Disease, volume 55, number 3, [09/03/19] 26 Cuddy, Duffin, (2005), Music, memory, and Alzheimer’s disease: Is music recognition spared in dementia, and how can it be assessed, Medical Hypotheses, 64, 229-235, [17/05/19] 27 Tanaka, Tanaka, Nogawa, (2012), Music Therapy with Ethnic Music for Dementia Patients, International Journal of Gerontology, Volume 6, Issue 4, pages 247-257, [21/03/19]

16 Paper and Commentary their reply. Alzheimer’s disease often causes confusion and memory loss, a patient could answer a question without actually comprehending what is being asked. The results would therefore not be very reliable. Another reason why the questionnaire method is not appropriate for this investigation is that the sample size makes questioning multiple patients simultaneously impractical.

Observation of positive or negative reactions Participants are observed for positive or negative verbal and non-verbal behaviour while the music is played.28 People show emotions through not only speaking but actions too. This is a reliable method because the conductor of the experiment can note down as much detail as they want to describe how the participant is acting in order to get accurate results. The method can be used for many different people at once and therefore an average can be created for the number of positive, negative or no changes.

METHOD The method used for this investigation was the observation method. It is carried out as follows: 1. Select 6 different songs the participants would be familiar with; this is imperative to ensure that all, or as many as possible, of the participants know the songs or recognise them.

2. Devise a ‘rough’ table for each repeat of the experiment. This should have three columns: song title, behaviour before the song and behaviour during the song. It should also have 9 rows: 1 for the column headings and then 1 for each participant. An example is shown below.

Person Song title 1 Fly me to the moon

3.

4.

5.

6.

7.

8.

Before Calling out to nurse ‘where am I?’ Confusion on face

During Immediately starts swaying upper body from side to side Starts to sing the song at the chorus Choose 8 random participants from the residents already sitting down in the care home. Unnecessary anxiety and stress could be caused if they are being moved around which must be minimised in order to get a conclusive set of result. The residents should be chosen at random so that there is no bias in the experiment.

In the table, write down what you can see in each of the participants in the ‘before’ column. This should include conversations or speech, facial expressions and actions; e.g. ‘gazing around the room, look of confusion on the face, calling out to the nurse’.

Play the first song.

Immediately start to note down any changes in expression, action or any verbal communication in the ‘during’ column of the table. Ensure that each participant has their own row so there is no confusion as to which row shows the changes of which person.

Repeat this method for each of the songs (another 5 times) to make a large enough pool of results for averages and therefore have a reliable set of data.

Devise a ‘neat’ table and re-write the results into it. Each song should have a different table to avoid any confusion. There should be three columns: before the song, after the song and change seen. Each participant should also still have a row to themselves. The ‘change seen’ column is there to deduce whether the participant showed a positive, negative, or no change to the music. This will be denoted by a ‘+’ for a positive change, ‘-’ for a negative change and ‘=’ for no change.

Person Before After

28 Raglio, Bellelli, Traficante, Gianotti, Ubezio, Villani, Trabucchi, (2008), Efficacy of music therapy in the treatment of behavioural and psychiatric symptoms of dementia, Alzheimer’s disease and associated disorders, 22.

2, 158-162, [17/05/19]

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Showing an air of anticipation

Tapping to the beat on the table as soon as the song starts Clapping to the beat when everyone else gets into the song

17

+

9. Collate the results and add up the number of positive results, negative results and neutral results. Use these results to perform a statistical t-test. It will show whether there is a statistically significant difference between behaviour before and after the music.

RESULTS Song: Little Darlin, The Diamonds Person Before 1

2

3

4

5

After

Showing an air of anticipa- Tapping to the beat on the tion table as soon as the song starts Clapping to the beat when everyone else gets into the song Soporific Bouncing in the seat to the Calmly looking around the beat of the song room and at other people Singing along to the song Waving arms around Copied Person 1 by clapping as soon as they started to clap Asleep Immediately wakes up when the music starts to play Starts dancing and waving in their chair Clapping to the beat Smiling and laughing with Person 2 and dancing with them Walking around in between Starts dancing with Person 3 chairs and tables, talking to in their chairs themselves Moving around in the chair then stands up and starts dancing to Asleep Asleep; did not wake up for the duration of the song Stayed in the same position throughout the song

Change +

+

+

+

=

18 Paper and Commentary 6

Confused; asking nurses Immediately starts humming + questions – “Where am I?� the tune of the song Moving in the chair to the beat Tapping feet on the floor to the beat and starts to tap their fingers on the table Attempts to uncross their legs + 7 Looking around the room at the other residents so that they can tap along to the beat Taps to the beat of the song with their hands on the arm or the chair Does not look as invested in the song as the other Does not start to sing or hum +/8 Walked in with assistance Stood up and walked away and sat down unaided, after having been Half-asleep, looked almost brought in with assistance; look of anger on their face dazed and not concentratWalked the whole way out of ing the room Song: Suspicious Minds, Elvis Presley Person Before After Change 1

2

3

4

Looked half-asleep; dazed

Asleep; woke up once in the middle of the song then fell back asleep Did not look interested when they woke up; still half asleep Sitting patiently in the chair Moving hands to the beat Waving arms around in the air Joins in beating hand on the chair with Person 3 Smiling and laughing with Person 3 Slightly restless; looking Beating hand on the arm of around at people the chair to the beat Starts to copy Person 2 by waving arms in the air and then returns to beating hand on the arm of the chair Listening to conversations Listening intently to the muand noises sic; concentration can be seen visibly on their face as though they were trying to remember the song

-

+

+

+

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Asleep

Awoken; sang along to the + song Woke up after the song had started and immediately looked interested Started to beat their hand on the chair and then tap their feet on the floor to the tune 6 Looked interested in surDancing in their chair; moving + roundings; wandering eyes arms and legs Trying to sing along, did not sing along to the whole song, looked as if they were trying to remember the words; face of concentration + 7 Blank expression on their Moving their head with the face beat Tapping their hand on their leg to the beat gradually getting more and more into it and confident Jigging shoulders up and down to the music 8 Was walked back into the Stood up but was sat back room with two nurses and down by the nurse again sat down Did not have an expression of enjoyment on their face Song: Daydream Believer, The Monkees Person Before After Change 1

Asleep

2

3

Conducting to the music Clapping to the beat Moving and tapping feet on the floor Banging on the table with a flat hand Looking around the room Clapping as soon as the song starts, doesn’t stop until after the end of the song Smiling and laughing Moving legs with the music Sitting with a blank expres- Dancing in the chair; waving sion arms around and tapping feet on the floor Singing to the music

+

+

+

19

20 Paper and Commentary 4

Tapping the Person 3 sitting next to them

Singing the occasional word + of the song Face of concentration Copies Person 3 by following what they are doing when they dance 5 Asleep Cries out to a nurse in the middle of a song – agitated and wants to leave Calms down and starts listening to the music when the nurse comes over but still does not show a positive reaction + 6 Sitting patiently in the Repeatedly clapping at a fast chair; anticipation rate Singing throughout the whole song Playing the keyboard with their hands in the air and then on the table + 7 Chatting with a nurse Tapping on the table in front Stands up and starts to dance without assistance Laughs with the nurse about the other residents dancing 8 Sitting restlessly; moving Drumming on the table – said + about in the chair that he was a drummer when he was younger while using fingers to drum on the table and feet on the floor to the beat Shouts yee-haw at the end Song: I Saw Her Standing There, The Beatles Person Before After Change 1

Patiently sitting in the chair Nodding head along with the quietly music as soon as it starts Smiling and laughing Clapping further into the song Sitting restlessly in the Clapping throughout the chair and moving around whole song as soon as it starts and stops after the song has finished Talking and singing along with Person 3

2

+

+

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Talking quietly to themselves while sitting hunched over

4

Half-asleep, almost sleeping

5

Talking to a nurse, confused: “What am I doing here, I don’t want to be here”

6

Wheeled in and then sat down by the nurses Look of anticipation

7

Trying to uncross legs but is unable to

8

Happily talking to themselves and other people around

Tapping foot with the beat energetically Talking and singing along with Person 2 Starts tapping Person 2 on the arm to get their attention Listening quietly to the music Keeping themselves to themselves – not really interacting at the start Further into the song starts to move shoulders to the beat Beating and tapping hand on the table in front when the music starts Bouncing in the chair to the beat Looking around the room at the other residents Tapping feet on the floor when the music starts – not able to walk but still moves feet around Moves hands in small movements with the beat of the song but no extravagant movements Able to uncross legs when the music starts Looking around the room at everyone Clapping to the beat near the end of the song Standing up and dancing to the music Smiling and laughing Singing along Sways arms above their head to the beat of the song

Song: Halfway to Heaven, Céline Dion Person Before After 1

Half-asleep Keeps waking up, looking around then falling back to sleep

Falls asleep and does not wake up until near the end of the song Stare into the room quietly not saying anything, still looks dazed and confused

+

+

+

+

+

+

Change -

21

22 Paper and Commentary 2

Wandering around the room as if they were trying to find something or someone

Brought to the chair by two + nurses for assistance and then sat down with the help of a nurse Starts moving shoulders and head with the music Taps hand on the sides of their legs and bounces their legs up and down 3 Sitting in the chair glazed Eyes light up as soon as the + over, not really looking at music starts to play Engages with the music by anyone or anything tapping their feet along and quietly humming the tune 4 Calmly sitting, not speak- Calmly starts to sway in the + ing or interacting with chair anyone else Moves arms steadily from side to side with the music Starts to sing the tune of the song near the end = 5 Asleep Still asleep by the end of the song Did not wake up or move for the duration of the song 6 Asleep; waking up for Woke up and a nurse went + short amounts of time then over and had a conversation falling back to sleep After this, they got into the music; tapping feet on the floor, moving shoulders to the beat of the music 7 Look of anticipation on Immediately sings along to the + their face song completely knowing all the words until the second half Sways arms above their head 8 Calling out a name; sitting Still calling out to a nurse + in the chair looking worried Starts to get more into the Asks the nurse: “Where is song and swing along with the [name]� beat Taps finger on the table Sings with the nurse who is crouching on the floor next to them Song: Amazing Grace, (Originally Celtic Woman) Person Before After Change

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Look of excitement on their Sways softly in the chair when face as if they knew what the music starts was about to happen Tapping feet on the ground Sings along with Person 2 2 Anticipating what is going Swaying in the chair to happen Copies what Person 1 is doing Looking around the room Holds hands with Person 1 for other people near the end of the song 3 Look of confusion on their Nurse goes over and calms face them down by talking to them Calls out “Where am I” and and explaining what they are doing “I want to go home” Sits peacefully in the chair Falls asleep near the end of the song 4 Humming a tune of a difStarts to sing the song as soon ferent song to themselves as it is played Stands up and starts waving arms above their head Gets involved in the song 5 Sitting peacefully in their Dances with a nurse by swaychair Not speaking to anyone or ing their arms and sings along to the tune moving 6 Talking to themselves in Sings the tune immediately the chair the whole way through Moves whole body softly with the beat, swaying from side to side Closes their eyes and sings to themselves 7 Sitting in the chair dazed At the start of the song they Not interacting with anymove around in the chair one or speaking Look around at all the other residents in the room Start to sing along with the chorus once they see that other people in the room are doing this Sing for the rest of the song peacefully 8 Asleep Wakes up when the music starts playing abruptly Angry and agitated look on their face as though they did not want to be there Shortly after they fall back to sleep ANALYSIS

+

+

=

+

+

+

=

-

23

24 Paper and Commentary Song Title Positive Negative/neutral Little Darlin’ 6 2 Suspicious Minds 6 2 Daydream Believer 7 1 I Saw Her Standing 8 0 There Halfway to Heaven 6 2 Amazing Grace 5 3 TOTAL 38 10

Fig.1 – table showing the number of positive and negative/neutral results for each song Figure 1 shows how many positive reactions and negative/neutral reactions there were to each song. It also shows the total number of positive reactions and negative/neutral reactions. The reason for collating the negative and neutral values is that this experiment was purely an investigation into whether music therapy had a positive effect on Alzheimer’s patients, so any non-positive results were all classified as a second division. The positive reactions range from 5-8, most commonly 6. The negative/neutral reactions range from 0-3, most frequently at 2. Figure 2 shows these results in the form of a bar-chart.

Fig. 2 – graph showing the number of positive and negative/neutral results for each song By looking at figure 2, it is already clear that there is a large difference in the proportion of people with negative or neutral reactions compared to people with positive reaction. The closest results are 5+ and 3- for the song Amazing Grace. The trend of the graph increases in positive reactions from song 1 to song 4 and then decreases from song 4 to song 6. The last two songs, Halfway to Heaven and Amazing Grace were both played on separate days, compared to the other ones, which were all played on the same day. The reason that this is important is because these two songs showed the decrease after the peak of 8 positive reactions. Amazing Grace had the lowest positive result. This could have been because of external factors, such as a change in routine in the care home. Another reason for this is that some of the residents could not have known the song or did not remember it and so would not have started to sing along I Saw Her Standing There has the highest result of positive reactions, 8, and no negative/neutral ones.

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It was played 30 minutes after the previous song, Daydream Believer, in order to give the residents time to settle back down. However, there is a distinct possibility that the positive effects from the previous song could have had an effect on the subsequent song played.

Fig. 3 – graph showing the average number positive and negative/neutral results with SD

Figure 3 shows the average number of positive and negative/neutral reactions for all of the songs together. The graph also shows ¹2 standard deviations from the mean of each of the bars. This is a 95% range of the data. Standard deviations show how spread out the results are from the average29. It can be more useful than a range as it ignores extreme results that could be anomalous. Two functions on Microsoft Excel were used to calculate the mean values and standard deviation.30 1. Mean: =SUM (highlight values to calculate mean from) á number of values 2. Standard Deviation: = STDEV (highlight values to calculate standard deviation from) The standard deviations for both of the bars are the same because they both have the same range and the same number of results.

The average result for positive reactions is 6.33 and for negative/neutral is 1.67. The standard deviations for the two results on the graph are relatively low and so show that the spread of results is close to the mean. There is a large difference between the two and there is no overlap between the standard deviations. This means that, already, the difference between the two means is significant. A t-test can be done to prove this further.

T-Test

26 Paper and Commentary Fig. 4 – formula for the t-test31 This is the formula for the calculation of an independent paired t-test. It is used to compare related observations to see if there is a statistically significant difference or if the difference in the results is due to chance. The t-score must be larger than the critical value for the difference between the means to be deemed significant and the null hypothesis to be rejected.32 The two groups being investigated for a statistically significant difference are: A – Positive change seen with the music B – Negative or neutral change seen with the music Calculation of the t-test33

31 Stephanie, (2015), Independent Samples T-test (Unpaired Samples): Definition, Running, Statistics How To, https://www.statisticshowto.com/independent-samples-t-test/, [20/08/19] 32 Statistics How To, (2020), T Test, Statistics How To, https://www.statisticshowto.datasciencecentral.com/ probability-and-statistics/t-test/, [23/08/19] 33 Stephanie, (2015), Independent Samples T-test (Unpaired Samples): Definition, Running, Statistics How To, https://www.statisticshowto.com/independent-samples-t-test/, [20/08/19]

Hope Humanities (ΣA)2: Sum of data set A, squared (ΣB)2: Sum of data set B, squared μA: Mean of data set A μB: Mean of data set B ΣA2: Sum of the squares of data set A ΣB2: Sum of the squares of data set B nA: Number of items in data set A nB: Number of items in data set B

27

28 Paper and Commentary The t-value was calculated using the numbers in figure 1 The t-value was calculated as follows: Step 1: Sum of the values for each set of data, then squared (ΣA)2 = 6 + 6 + 7 + 8 + 6 + 5 = 382 = 1444 (ΣB)2 = 2 + 2 + 1 + 0 + 2 + 3 = 102 = 100 Step 2: Calculate a value for the mean μA = 38/6 = 6.333 μB = 10/6 = 1.667 Step 3: square each number in each set of data, then add them together ΣA2 = 62 + 62 + 72 + 82 + 62 + 52 = 36 + 36 + 49 + 64 + 36 + 25 = 249 ΣB2 = 22 + 22 + 12 + 02 + 22 + 32 = 4 + 4 + 1 + 0 + 4 + 9 = 22 Substitute the numbers into the equation 1. μA – μB 6.333 – 1.667 = 4.666 2. ΣA2 – (ΣA)2/ nA 249 – 1444/6 = 8.333 2 2 B 3. ΣB – (ΣB) / n 22 – 100/6 = 5.333 8.333 + 5.333 = 13.666 4. (ΣA2 – (ΣA)2/ nA) + (ΣB2 – (ΣB)2/ nB) A B 5. n + n – 2 6 + 6 – 2 = 10 6. [(ΣA2 – (ΣA)2/ nA) + (ΣB2 – (ΣB)2/ nB)] ÷ (nA + nB – 2) 13.666 ÷ 10 = 1.3666 A B 7. (1/n ) + (1/ n ) 1/6 + 1/6 = 0.3333 8. 6. X 7.

1.3666 X 0.3333 = 0.455488 9. √8. √0.45549 = 0.674898 10. 1. ÷ 9. 4.666 ÷ 0.674898 = 6.91 The t-value is 6.91.

This is then compared to a critical value; if it is bigger than the critical value, it is statistically significant.

The critical value is calculated as follows: 1. Find the degrees of freedom (df) (nA – 1) + (nB – 1) = (6 – 1) + (6 – 1) = 5 + 5 = 10 2. Decide what alpha level to use 0.05 or 5% will be used; this means that, if the t-value is bigger than the critical value, there will only be a 5% likelihood that the difference in the results id due to chance.

3. Use the df and the alpha level to find the critical value in a t-test table The table is readily available online; there is only one table and it is relevant to all t-tests.34 The critical value, for 10 df and 5% is 2.228.

4. Compare the t-value to the critical value The t-value is larger than the critical value The t-value of 6.91 is much larger than the critical value of 2.228. Therefore, the null hypothesis can be rejected. We can be 95% confident that the difference between the two means is statistically significant. There is less than a 5% probability that the difference is due to chance.35 34 Jim Grange, (2015), Statistics Tables: Where do the Numbers Come From? Jim Grange, https://jimgrange. wordpress.com/2015/12/05/statistics-tables-where-do-the-numbers-come-from/, [20/08/19] 35 Stephanie, (2015), Independent Samples T-test (Unpaired Samples): Definition, Running, Statistics How

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The t-test is a very helpful tool as it proves whether an experiment has had conclusive results that are proven significant and are therefore trustworthy. In this case, the difference between the t-value and the critical value is so large that they do show the results to be very reliable. It shows that, with 95% confidence, musical therapy does have a positive effect on elderly people who suffer from Alzheimer’s disease.

DISCUSSION The results and analysis have shown that there was a large statistically significant difference between the occurrence of positive and negative/neutral reaction to the music.36 The number of each of these varied somewhat from song to song, however, even before carrying out the t-test, there was a clear and obvious difference between the two.37 This investigation shows that music therapy could be an effective way to reduce BPSD in elderly people with Alzheimer’s disease and provide a positive outcome in the way of an increased quality of life. However, there is one previous study that did not yield significant results.38 The results from that study showed a decrease in behavioural problems, however the difference between before and after was not large enough to prove significant. This could be due to a lack of samples creating unreliable mean values however this indicates a need for further research. The Cochrane review came to this conclusion as well; it reviewed twenty-two different reports yet concluded that there is still a need for more research.39 This was because the quality of the trials varied which affected the confidence in the results.

This present report, however has shown very conclusive and statistically significant results, as demonstrated in figure 3 and backed up by the calculation of the t-test. The sample size was sufficiently large as a different 8 people were used for each song. This allowed accurate and reliable mean values to be calculated. As stated in the hypothesis, these results were expected. Similar experiments have had statistically significant results in the past and background study on the disease and how exactly music affects it, led to formulating the hypothesis in the first place. Although the results were significant, they were only taking into account the immediate positive reactions instead of the longer-term effects of the music therapy. This was one of the main problems with many of the other experiments on the subject; just because music therapy has a positive effect in the short term, does not necessarily mean that it will in the long-term too. This report did not look at the long-term effects, however others did. One specific report used a Mini Mental State Examination (MMSE) test before, six weeks after and three months after the experiment.40 This is a good way to test the long-term effects that had not been researched much previously and it showed that there was a benefit from music therapy but that this benefit faded somewhat over the observed period.

Music stimulates the connections between the two sides of the brain.41 This activates emotions which then trigger memories in the hippocampus, that are otherwise unavailable, to be brought back temporarily.42 This most commonly leads to a positive reaction such as smiling, laughing, dancing or singing, but can, occasionally, also lead to more To, https://www.statisticshowto.com/independent-samples-t-test/, [20/08/19] 36 Stephanie, (2015), Independent Samples T-test (Unpaired Samples): Definition, Running, Statistics How To, https://www.statisticshowto.com/independent-samples-t-test/, [20/08/19] 37 Statistics How To, (2020), T Test, Statistics How To, https://www.statisticshowto.datasciencecentral.com/ probability-and-statistics/t-test/, [23/08/19] 38 Brotons, Koger, (2000), The impact of Music Therapy on Language Functioning in Dementia, Journal of Music Therapy, 3, 183-195, [19/05/19] 39 Playlist for Life, (2019), The Science, Playlist for Life, https://www.playlistforlife.org.uk, [25/06/19] 40 Van der Winckel, Feys, De Weerdt, (2004), Cognitive and behavioural effects of music-based exercises in patients with dementia, Clinical Rehabilitation, 18, 253-260, [15/05/19] 41 UHN Staff, (2019), Does Music Affect Memory? Music Therapy Is One of the Best Activities for Dementia Patients, University Health News, https://universityhealthnews.com/daily/memory/does-music-affect-memorymusic-therapy-is-one-of-the-best-activities-for-dementia-patients/, [14/03/19] 42 Amanda Page, How Alzheimer’s disease changes the brain, Health Central, https://immersive.healthcentral.com/alzheimers/d/LBLN/how-alzheimers-disease-changes-the-brain/flat/, [27/06/19]

30 Paper and Commentary negative results.43 The results shown in the tables above are a primary source of this is. One positive reaction seen in the experiment is Person 8 of Halfway to Heaven. It shows Person 8, in some distress, calling out in confusion yet when the music starts, they start to sing and develop a rhythm by tapping their finger on the table. This is a very positive reaction because it shows how the music can help avoid confusion and manage anxiety.44 The quality of life has changed hugely within minutes for this person. They went from confused and anxious to happy, smiling and singing.

It shows how big of an impact music can have on people who suffer from Alzheimer’s disease where the quality of life slowly decreases while they progress through the disease.45 An example of a negative reaction is Person 5 during Suspicious Minds. Before the song started, Person 5 was asleep, however when the song started, they woke up and started calling out to the nurse loudly and in a distressed, anxious voice. They calmed down, however did not show any sign of enjoyment or improvement in mood. This could be due to the song being associated with a negative memory and emotion therefore resulting in an opposite effect to the desired outcome.46 The most interesting results from the experiment came from Person 8 during the performance of Little Darlin’. They were the only results that could not be categorised into either positive, negative or neutral. Person 8 walked in with heavy assistance from two nurses before the song had started and then sat in the chair looking vacant. As the music started to play, they stood up and walked the whole way out of the room with no assistance. This was a very interesting result because of how there are both positive and negative elements to it. They walked out of the room with obvious irritation on their face, so it was clear to see that the reaction to the music was not one of a positive nature. However, they walked out of the room with no assistance when they had been supported heavily by nurses on the way in. This shows a remarkable improvement in movement therefore making it impossible to categorise this result.47 One reason why the movement might have improved so greatly is that, with music a rhythm can be developed. It can help the person to move to the rhythm and beat of the song, all the while improving their cognitive ability as well.48 One fault with this theory is that it is not known how physically impaired Person 8 was before the music started to play. They were assisted on the way into the room, however it cannot be proven how much they actually needed this assistance or whether it was for precautionary reasons instead, for example to avoid a fall.

There were some unavoidable limitations of the experiment that could lead to a decrease in the reliability of the report. None of the 8 experiments were completed in a secluded room. The 8 participants were with the other residents of the care home. This could mean that any other reactions outside of the 8 participants could have also had an effect on the results by reacting to the music in a positive or a negative way as well. The experiments were also not conducted at the same time on each day. This could have an effect on the results because of the times of the day when elderly people are usually more active. As well as this, some experiments were conducted on the same day, others different days. This could have affected the results of the second song because of longer-term effects of the music therapy from the first song.

Originally, there were some ethical issues that had to be eliminated: 1. How could all of the information about each participant be kept confidential?

43 Dementia UK, (2017), Music Therapy, Dementia UK, https://www.dementiauk.org/music-therapy/, [20/02/19] 44 Wiltfang, Kornhuber, (2003), Non-Drug Therapies for Dementia: An overview of the Current Situation with Regard to Proof of Effectiveness, Dementia and Geriatric Cognitive Disorders, vol.15, 115-125, [07/05/19] 45 The Healthline Editorial Team and Timothy J. Legg, (2016), Dementia and Alzheimer’s: What are the differences? Healthline, https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers, [25/02/19] 46 Dementia UK, (2017), Music Therapy, Dementia UK, https://www.dementiauk.org/music-therapy/, [20/02/19] 47 Bowell, Bamford, (2018), ‘What would life be – without song or a dance what are we?’, The Utley Foundation ILC, 12-33, [23/06/19] 48 Alissa Sauer, (2014), 5 Reasons Why Music Boosts Brain Activity, Alzheimers.net, https://www.alzheimers.net/why-music-boosts-brain-activity-in-dementia-patients/, [06/02/19]

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2. How could the participants each consent to taking part?

3. How could it be made certain that no harm, physically or mentally was being inflicted?

Due to the nature of the experiment, confidentiality was easy to overcome. The care home that the experiment was carried out in was one that specialises in Alzheimer’s disease. Therefore, no extra information was actually needed about any of the residents. This meant that the care home could keep all information confidential. The experiment was not actively involving any of the residents; instead it was conducted using a method of observation. This meant that no consent was needed. However, the care home did say that it would be acceptable to carry out the experiment using the expressions and behaviour of the residents so long as no contact, physical or speech, was made. The last issue, number 3, did pose a difficult problem to work around. Any potential harm would have primarily come from having a negative reaction to the music. Therefore, it was made sure that the music chosen was likely to be familiar to all the residents, and that the music was in a major key to try to create a positive atmosphere.

CONCLUSION The results from this experiment show a clear difference between the mood and behaviour of elderly people with Alzheimer’s disease before and after music therapy. In order to avoid interrupting the daily routine of residents and to eliminate the possibility of causing any ethical issues with the experiment, a method of observation was used to for the investigation. Had the daily routine been disrupted, this could have caused stress and anxiety in the room and, which might have skewed the results of the experiment.

The t-test concluded that the difference between the before and after scores was statistically significant. This allows the results to be trusted as a reliable source of information; results can be depended on with 95% confidence as being not due to chance. Even before conducting the t-test the results were shown to be significant, because there was no overlap between the standard deviation values for each bar on figure 3.

Music therapy can be used as a form of non-pharmacological short-term treatment for Alzheimer’s disease. It is a low-cost and reliable way to dampen the symptoms and improve quality of life for people who have the disease. It has minimal adverse or negative effects, unlike pharmacotherapy. The experiment was important as it provided conclusive results for the short-term effects with minimal variables and a large enough sample size for the results to be trustworthy. This investigation was conducted to fill an apparent gap in research; no other experiment that has results available to the public has shown trustworthy results to show the short-term positive effects of music therapy. Further investigations should be done to investigate the long-term effects of music therapy as this experiment showed only the immediate reactions. The experiment followed the hypothesis exactly by showing a positive outcome from the music therapy. The null hypothesis can be rejected as the t-test value showed that the difference in results was statistically highly significant.

From this experiment, a reliable conclusion can be made; music therapy can be used as a type of non-pharmacological therapy. It provides a short-term positive reaction and therefore improves the quality of life temporarily for the patients. Due to Alzheimer’s being a progressive and invasive disease, quality of life decreases as the disease progresses.49 As there is currently no cure for the disease, the most important thing that carers can do is make sure that patients have as good a quality of life as possible. Music therapy is one of the best ways to do so in the short-term.

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2, 158-162, [17/05/19] 19. Statistics How To, (2020), T Test, Statistics How To, https://www.statisticshowto.datasciencecentral.com/probability-and-statistics/t-test/, [23/08/19] 20. Stephanie, (2015), Independent Samples T-test (Unpaired Samples): Definition, Running, Statistics How To, https://www.statisticshowto.com/independent-samples-t-test/, [20/08/19] 21. Sung, Huei Chuan Christina, Chang, (2005), Use of preferred music to decrease agitated behaviours in older people with dementia: A review of the literature, Journal of Clinical Nursing 14(9, 1133-1140, [07/05/19] 22. Tanaka, Tanaka, Nogawa, (2012), Music Therapy with Ethnic Music for Dementia Patients, International Journal of Gerontology, Volume 6, Issue 4, pages 247-257, [21/03/19] 23. The Healthline Editorial Team and Timothy J. Legg, (2016), Dementia and Alzheimer’s: What are the differences? Healthline, https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers, [25/02/19] 24. UHN Staff, (2019), Does Music Affect Memory? Music Therapy Is One of the Best Activities for Dementia Patients, University Health News, https://universityhealthnews.com/daily/memory/does-music-affect-memorymusic-therapy-is-one-of-the-best-activities-for-dementia-patients/, [14/03/19] 25. University of Eastern Finland, (2019), Alzheimer’s disease risk gene APOE4 impairs function of brain immune cells, ScienceDaily, https://www.sciencedaily.com/releases/2019/09/190916101856.htm, [30/07/19] 26. Van der Winckel, Feys, De Weerdt, (2004), Cognitive and behavioural effects of music-based exercises in pa-

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tients with dementia, Clinical Rehabilitation, 18, 253-260, [15/05/19] 27. Warren, Golden, Clark, Nicholas, Cohen, Slattery, Paterson, Foulkes, Schott, Mummery, Crutch, (2017), Music perception in dementia, Journal of Alzheimer’s Disease, volume 55, number 3, [09/03/19] 28. Wiltfang, Kornhuber, (2003), Non-Drug Therapies for Dementia: An overview of the Current Situation with Regard to Proof of Effectiveness, Dementia and Geriatric Cognitive Disorders, vol.15, 115-125, [07/05/19] 29. You and Your Hormones, (2019), Cortisol, Society of Endocrinology, https://www.yourhormones.info/hormones/cortisol/, [13/08/19] BIBLIOGRAPHY 1. Adam Withnall, (2013), Singing Boosts Brain Activity in Alzheimer’s Patients, Scientists say, Independent, https://www.independent.co.uk/life-style/health-and-families/health-news/singing-boosts-brain-activity-in-alzheimer-s-patients-scientists-say-8933021.html, [25/06/19] 2. Alissa Sauer, (2014), 5 Reasons Why Music Boosts Brain Activity, Alzheimers.net, https://www.alzheimers.net/ why-music-boosts-brain-activity-in-dementia-patients/, [06/02/19] 3. Alistair Burns, Shelagh Morris, (2018), Music and dementia: a powerful connector, NHS, https://www.england.nhs.uk/blog/music-and-dementia-a-powerful-connector/, [20/06/19] 4. Alzheimer’s and Dementia, (2018), Inside the Brain, Alzheimer’s Association, https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2, [01/05/19] 5. Alzheimer’s Association, (2017), Beta-amyloid and the amyloid hypothesis, Alzheimer’s Association, https:// www.alz.org/national/documents/topicsheet_betaamyloid.pdf, [02/05/19] 6. Alzheimer’s Association, (2020), Genetics, Alzheimer’s Association, https://www.alz.org/alzheimers-dementia/ what-is-alzheimers/causes-and-risk-factors/genetics, [30/07/19] 7. Alzheimer’s Research UK, (2018), Types of Dementia, Alzheimer’s Research UK, https://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/, [05/03/19] 8. Alzheimer’s Research UK, (2018), Alzheimer’s Disease, Alzheimer’s Research UK, https://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/alzheimers-disease/about/, [27/03/19] 9. Alzheimer’s Research UK, (2018), Vascular Dementia, Alzheimer’s Research UK, https://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/vascular-dementia/about/, [01/04/19] 10. Alzheimer’s Research UK, (2018), Dementia with Lewy Bodies, Alzheimer’s Research UK, https://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/dementia-with-lewy-bodies/about/, [07/04/19] 11. Alzheimer’s Research UK, (2018), Frontotemporal Dementia, Alzheimer’s Research UK, https://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/frontotemporal-dementia/ftdabout/, [07/04/19] 12. Alzheimer’s Society, (2017), what is Alzheimer’s disease? – Alzheimer’s Society [4], https://www.youtube. com/watch?v=wfLP8fFrOp0, [09/07/19] 13. Amanda Page, How Alzheimer’s disease changes the brain, Health Central, https://immersive.healthcentral. com/alzheimers/d/LBLN/how-alzheimers-disease-changes-the-brain/flat/, [27/06/19] 14. Bowell, Bamford, (2018), ‘What would life be – without song or a dance what are we?’, The Utley Foundation ILC, 12-33, [23/06/19] 15. British Association for Musical Therapy, (2017), What is Music Therapy, British Association for Musical Therapy, https://www.bamt.org/music-therapy/what-is-music-therapy.html, [24/03/19] 16. Brotons, Koger, (2000), The impact of Music Therapy on Language Functioning in Dementia, Journal of Music Therapy, 3, 183-195, [19/05/19] 17. Bruce Goldman, (2013), Scientists reveal how beta-amyloid may cause Alzheimer’s, Stanford Medicine, https:// med.stanford.edu/news/all-news/2013/09/scientists-reveal-how-beta-amyloid-may-cause-alzheimers.html, [04/05/19] 18. Cuddy, Duffin, (2005), Music, memory, and Alzheimer’s disease: Is music recognition spared in dementia, and how can it be assessed, Medical Hypotheses, 64, 229-235, [17/05/19] 19. De Vrij, Sluijs, Gregori, (2001), Mutant ubiquitin expressed in Alzheimer’s disease causes neuronal death, The FASEB Journal, Vol.15, [04/05/19]

34 Paper and Commentary 20. Dementia Statistics, (2018), Diagnoses in the UK, Alzheimer’s Research UK, https://www.dementiastatistics. org/statistics/diagnoses-in-the-uk/, [02/02/19] 21. Dementia UK, (2017), Music Therapy, Dementia UK, https://www.dementiauk.org/music-therapy/, [20/02/19] 22. Eugene O’Loughlin, (2012), How To… Calculate Mean and Standard Deviation in Excel 2010, https://www. youtube.com/watch?v=62i1fqKhNhg, [20/08/19] 23. Ferreira-Vieira, Guimaraes, Silva, Ribeiro, (2016), Alzheimer’s Disease: Targeting the Cholinergic System, Current Neuropharmacology, 14, 1, 101-115, [29/07/19] 24. Garrido, Dunne, Chang, Perz, Stevens, Haertsch, (2017), The Use of Music Playlists for People with Dementia: A Critical Synthesis, Journal of Alzheimer’s Disease, volume 60, number 3, [15/02/19] 25. Goedert, Spillantini, (2006), A Century of Alzheimer’s Disease, Science, vol.314, 777-781, [04/05/19] 26. Health, (2015), Virtual reality maze ‘predicts Alzheimer’s disease’, BBC News, https://www.bbc.co.uk/news/ health-34607267, [15/05/19] 27. Jeremy Jones, (2015), Standard Deviation, Explained and Visualised, https://www.youtube.com/watch?v=MRqtXL2WX2M, [22/08/19] 28. Jim Grange, (2015), Statistics Tables: Where do the Numbers Come From? Jim Grange, https://jimgrange. wordpress.com/2015/12/05/statistics-tables-where-do-the-numbers-come-from/, [20/08/19] 29. Johnson, Chow, (2016), Hearing and Music in Dementia, Handbook of Clinical Neurology, Volume 129, pages 667-687, [17/03/19] 30. Markus MacGill, (2018), What’s to know about Alzheimer’s Disease? Medical News Today, https://www.medicalnewstoday.com/articles/159442.php, [01/05/19] 31. Music & Memory, (2011), Man in Nursing Home Reacts To Hearing Music From His Era, https://www.youtube.com/watch?v=fyZQf0p73QM, [20/06/19] 32. Nair, Browne, Marley, Heim, (2013), Music and Dementia, Degener Neurol Neuromuscul Dis, 3, 47-51, [09/05/19] 33. National Institute on Ageing, (2017), What Causes Alzheimer’s Disease, U.S Department of Health and Human Services, https://www.nia.nih.gov/health/what-causes-alzheimers-disease, [15/04/19] 34. Neurology Advisor Contributing Writer, (2019), Amyloid PET Scan Associated With Changes in MCI and Dementia Clinical Management, Neurology Advisor, https://www.neurologyadvisor.com/topics/alzheimers-disease-and-dementia/amyloid-pet-scan-associated-with-changes-in-mci-and-dementia-clinical-management/, [31/05/19] 35. Nilsberth, Westlind-Danielsson, Eckman, (2001), The ‘Arctic’ APP mutation (E693G) causes Alzheimer’s disease by enhanced Abeta protofibril formation, Nature Neuroscience, 4 (9), 887-893, [04/05/19] 36. Playlist for Life, (2019), The Science, Playlist for Life, https://www.playlistforlife.org.uk, [25/06/19] 37. Raglio, Bellelli, Traficante, Gianotti, Ubezio, Villani, Trabucchi, (2008), Efficacy of music therapy in the treatment of behavioural and psychiatric symptoms of dementia, Alzheimer’s disease and associated disorders, 22.

2, 158-162, [17/05/19] 38. Statistics How To, (2020), T Test, Statistics How To, https://www.statisticshowto.datasciencecentral.com/probability-and-statistics/t-test/, [23/08/19] 39. Stephanie, (2015), Independent Samples T-test (Unpaired Samples): Definition, Running, Statistics How To, https://www.statisticshowto.com/independent-samples-t-test/, [20/08/19] 40. Sung, Huei Chuan Christina, Chang, (2005), Use of preferred music to decrease agitated behaviours in older people with dementia: A review of the literature, Journal of Clinical Nursing 14(9, 1133-1140, [07/05/19] 41. Svansdottir, Snaedal, (2006), Music therapy in moderate and severe dementia of Alzheimer’s type: a case-control study, International Psychogeriatrics, 1-9, [21/05/19] 42. Tanaka, Tanaka, Nogawa, (2012), Music Therapy with Ethnic Music for Dementia Patients, International Journal of Gerontology, Volume 6, Issue 4, pages 247-257, [21/03/19] 43. The Healthline Editorial Team and Timothy J. Legg, (2016), Dementia and Alzheimer’s: What are the differences? Healthline, https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers, [25/02/19]

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44. The Human Memory, (2019), Parts of the Brain, The Human Memory, https://human-memory.net/parts-of-thebrain/, [27/06/19] 45. UHN Staff, (2019), Does Music Affect Memory? Music Therapy Is One of the Best Activities for Dementia Patients, University Health News, https://universityhealthnews.com/daily/memory/does-music-affect-memorymusic-therapy-is-one-of-the-best-activities-for-dementia-patients/, [14/03/19] 46. University of Eastern Finland, (2019), Alzheimer’s disease risk gene APOE4 impairs function of brain immune cells, ScienceDaily, https://www.sciencedaily.com/releases/2019/09/190916101856.htm, [30/07/19] 47. Van der Vleuten, Visser, Meeuwesen, (2012), The contribution of intimate live music performances to the quality of life for persons with dementia, Patient Education and Counselling, 89, 484-488, [19/06/19] 48. Van der Winckel, Feys, De Weerdt, (2004), Cognitive and behavioural effects of music-based exercises in patients with dementia, Clinical Rehabilitation, 18, 253-260, [15/05/19] 49. Warren, Golden, Clark, Nicholas, Cohen, Slattery, Paterson, Foulkes, Schott, Mummery, Crutch, (2017), Music perception in dementia, Journal of Alzheimer’s Disease, volume 55, number 3, [09/03/19] 50. Wiltfang, Kornhuber, (2003), Non-Drug Therapies for Dementia: An overview of the Current Situation with Regard to Proof of Effectiveness, Dementia and Geriatric Cognitive Disorders, vol.15, 115-125, [07/05/19]

36 Paper and Commentary Taking Care of the Elderly’s Mental Health with Considerations on Socioeconomic Status Ren Deng, BASIS International School Guangzhou 22’ Introduction

The 21st century opens with the escalation of a demographic phenomenon called aging, with a projected “higher absolute numbers of elderly people” around the world (Bloom et al. 1). This transition is accompanied by “far-reaching but… underrecognized implications for mental health professionals” (Laidlaw and Pachana 1). According to a collaborative research published in the Journal of Clinical Nursing, people aged 65 and above with reduced self-care ability often possess a worse view of life satisfaction, “a [..] measure of the quality of life” (Borg et al. 608).

Consequently, it becomes particularly important to examine the elderly population’s life satisfaction and subjective well-being in formulating a resolution to improve their mental condition. While various sociocultural aspects could complicate this topic, Daniel Kahneman and Angus Deaton suggest that income level and education are, among other factors, more closely correlated with life evaluation, whereas factors like loneliness and health are associated with emotional well-being, a distinct aspect of subjective well-being (16489). In considering life satisfaction, therefore, socioeconomic status (SES), a term converging income level, education, and social standing, is vital to investigate. This paper will analyze the extent to which SES affects elderly’s subjective well-being and the current global efforts to help them.

Overall, it is advised that governments offer educational and social support programs for the elderly, with specifics based on the individual country’s cultural context.

Data from recent United Nations statistics suggest that 16% of the world population will be over age 65 by 2050, and the number of people over age 80 will triple (“Ageing”). Nevertheless, the public has paid limited attention to the elderly’s mental health condition, often celebrating youth and devaluing the elderly (Westerhof and Barrett 129).

The Center for Disease Control reports that 20% of people aged 55 and above have mental health problems, and the elderly in fact have the highest suicide rate among all demographic groups (“The State of Mental Health”). Concurrently, older patients are also historically less likely to seek professional mental health services (German et al. 1). It can be inferred that the elderly often encounters difficulties dealing with their mental disorders. Among other factors, SES’s impacts on health are more significant due to the elderly’s “increasing life expectancies” and lack of support from traditional extended family (Jensen 313). Growing concerns for this enlarging and yet ill-supported group’s mental health then raise the question: What should the governments do with the elderly’s SES to promote their subjective well-being (SWB), a critical contributor to mental health?

Economic Lens

The general consensus indicates that income level has a positive correlation with SWB. According to Kahneman and Deaton, high income improves evaluation of life. This is likely because in acquiring a higher income level, the ability to satisfy materialistic happiness also increases. Richard Easterlin, an economics professor at the University of Southern California, substantiates that SWB generally rises directly with income for adults at a young age (481). Moreover, consistent with their idea, empirical studies conducted on different populations suggest that SWB is associated with income. A study on Mexican communities indicates that the poorest communities tend to have the least satisfaction with their quality of life (Palomar-Lever 30-31). Likewise, another independent research published in the Journal of Happiness Studies examines a Chinese population and proves that income level and education are positively associated with SWB (Sun et al. 860). This is in alignment with Kahneman’s and Deaton’s conclusion. A possible solution that can be drawn from this idea is to provide direct subsidies to elderly who encounter mental difficulties. In raising their purchasing power, their life evaluations and satisfaction would correspondingly increase based on empirical observations.

However, this solution is not viable because the sustainability of the materialistic happiness generated by higher income is still questionable. As the Dalai Lama once claims, “experience of [materialistic] happiness is… dependent on external stimuli,” and, consequently, “the joy of the senses is brief ” (Lama and Tutu 53). Although this philosophical point of view may be unconvincing, further academic research confirms this idea. While the aforementioned work

by Easterlin suggests that income contributes to happiness at a young age, he also finds that one’s materialistic desires or aspirations grow in proportion to income level (Easterlin 481). For older generations, their aspirations would in-

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crease so much that money plays a minor role in affecting their happiness level. Furthermore, Deaton and Kahneman also state that “[m]ore money does not necessarily buy more happiness,” although they argue for a positive relation between the two. Constrained by other factors, emotional well-being does not rise beyond a certain level (Deaton and Kahneman 16492). On that account, providing financial funding cannot address the issue and would lead to a vicious cycle of mental dissatisfaction.

In addition to personal income, household income’s relationship with happiness is also limited. An unbiased paper on retirement and SWB argues that individual’s well-being undergoes negligible change as a result of voluntary retirement because although satisfaction with household income decreases, their satisfaction with leisure or free time increases (Bonsang and Klein 19). This signifies that the value of free time outweighs that of household income for most retired individuals, and that leisurely life experience plays a more critical role in mental health conditions than money. Granted, there is correlation between income and happiness, as evidenced by John Helliwell and Robert D. Putnam in their research report on the social context of well-being. This impact, however, is significant only among the relatively poor groups (1440). Overall, income does not contribute to happiness, and implementation of direct subsidies thus can hardly improve the elderly’s quality of life. Because financial ability has little to do with SWB, it is important to examine SES from a social lens to identify appropriate actions.

Social Lens

Education and social standing are two important constituents of SES that have stronger connection with SWB than income level. Education is a significant contributor to mental health. On the surface, education simply allows people to obtain higher income that satisfies their material aspirations; in actuality, the impact of education on happiness is much more substantial largely because of the “self-confidence” derived from the acquisition of knowledge and skills (Cũado and Gracia 192). This kind of self-esteem developed through education is influential to well-being. In The Social Context of Well-Being, John Helliwell and Robert Putnam corroborate that education has direct correlations with SWB (1440). Furthermore, in a systematic review on European elderly population, 88% of relevant studies indicate “an association between education and self-rated health” (Read et al. 532). Thus, education’s relevance to SWB can be proven at a macro-sociological scale, as more educated people enjoy better socioeconomic care.

This connection also prevails at a national scale among many countries. According to a report by the Grand Valley State University, educated individuals in Germany experience less significant decline in well-being before their deaths; similarly, educated and married elderly in China are more pleased with their lives (Calvisi and Dibble). This proves that education improves life satisfaction. It is true that these sources do not explain whether the connection between education and SWB is a result of the difference in education itself or the additional income and opportunities brought by education. However, enriching oneself through education is in line with the Dalai Lama’s belief in the value of intrinsic pleasure. Richard Davidson, a neuroscientist, also claims that there are “four independent” means through which one can gain lasting pleasure (Lama et al. 56), and those ways, including developing compassion and generosity, can be advanced through schooling. Hence, higher education level at a younger age will likely contribute to life satisfaction and well-being at an older age, as it enhances people’s mental well-being.

In improving SWB, government-sponsored education programs can therefore be a viable solution. Although the marginal benefit of education decreases as one obtains a higher level of education (Helliwell and Putnam 1440), it is appropriate for communities to provide elementary or secondary education to the retired individuals, especially those who are less educated. In fact, the elderly often still need and want to learn, as they want to live life to the fullest (Boulton-Lewis 214). Their aspiration to learn corresponds with the hypothesis that education improves SWB. Hence, additional educational programs will promote their well-being because the elderly would be able to improve and enjoy their retirement experiences. However, this policy itself cannot help the elderly population, as it overlooks the relative aspect in happiness.

In order to examine the relative side of happiness, understanding social standing is crucial. Jason Schnittker, a professor of Sociology at the University of Pennsylvania, argues that “social position affects psychological states through assorted processes of exchange, reinforcement, and learning.” Consequently, people tend to choose and shape their surroundings to maximize their happiness (Schnittker 236). Moreover, relative income often have more significant effects on SWB than absolute income (Ball and Chernova 524), which has been shown to have limited impacts on

38 Paper and Commentary well-being. This illustrates that in contrast to absolute measures, the relative aspects of happiness are more influential.

It is essential to keep the elderly feeling cared for. Drawing from this conclusion, it is necessary to provide supplemental social support for the elderly who grew up in relatively disadvantaged communities. For most elderly, social support programs will make a difference in improving their SWB. Practicality and Policy Lens

However, the aforementioned policies’ practicality remains uncertain, requiring a thorough analysis on existing elderly programs from a multicultural policy lens. Existing programs must be evaluated first to construct a more effective resolution. In Singapore, a country experiencing rapid aging, the national policy on the elderly population focuses on providing employment, changing attitudes towards the elderly, and giving community and residential care (Teo 405-406). Such ideas are in accordance with the analysis on SES’s impacts on SWB. Nonetheless, a closer inspection suggests that some policies may prove unproductive; for instance, residential care largely deprives elderly persons’ freedom and independence (418-424). The country’s employment plan limits elderly’s access to material goods. There is also insufficiency in community care’s ability to address non-physical needs of the elderly (425). Considering the positive implications of education and social standing, Singapore’s community care policy must improve on these aspects through better education and support programs. Furthermore, it is essential to satisfy the basic needs of the elderly, although higher income does not sustain happiness. Hence, it is vital to ensure every elderly retires on a sufficient pension that will address daily needs.

Whereas Asian countries tend to employ a more collective approach to aging, western countries emphasize liberalism and individualism, thereby formulating different policies. In the United States, for example, there is “a stronger individualistic orientation” that is “linked with the youth-centeredness of a culture” (Westerhof and Barrett 130). While this results in an overall higher level of well-being, the elderly population may lose self-worth because it is largely an individual’s responsibility to care for themselves. This promotion of youth value arguably provides more space for adapting to aging, and more youth identities also tend to retain (130). In the same breath in which individuals have more freedom in planning their later life cycle, however, there are also risks that seniors who struggle in their later years. This has the implication of jeopardizing certain older people’s SWB. Ergo, age identity is more significant to SWB in western countries like America, which place more importance on individual responsibility.

The cultural variations in western culture can also affect the kind of policies needed, further complicating the formulation of one universal resolution for all elderly. For instance, Germany, unlike America, focuses on a “more collective support… for older persons” (130), which is more analogous to the welfare social system in the East. The provision of free social welfare is consistent with the observations based on SES, which argue for the needs for pension, education, and social support programs. It must be noted that different cultural backgrounds and preexisting policies require different responses. While countries that value collectivism may adopt a group social welfare system, others that emphasize individualism require different routes. Therefore, the extent and pace these policies should be imposed depend on local policy variations. The governments must gradually improve upon the existing programs so that they could remain effective.

Conclusion and Solution

The problems associated with the elderly’s SWB are increasingly prevalent across the world. Their status is underrecognized, and existing policies fail to improve their situation. A thorough examination of the elderly’s SES suggests a need for different resolutions. While higher income temporarily satisfies material desires, this happiness cannot sustain to support the SWB of elderly. Education and social mentorship programs, on the other hand, offer improvements that will address the mental problems of the elderly in the long run. Consequently, governments should recruit social workers to provide free basic education and encourage family members to provide residential support. Different countries should also devise individual policies that best fit their distinct sociocultural context. For instance, countries focusing more on collective value may ease their social support program to provide more freedom for the elderly.

Gradually, the government can promote a successful aging process for the elderly population, as they acquire a happier and healthier lifestyle.

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Works Cited “Ageing.” United Nations. www.un.org/en/sections/issues-depth/ageing/.

Ball, Richard, and Chernova, Kateryna. “Absolute Income, Relative Income, and Happiness.”

May 2005. dx.doi. org/10.2139/ssrn.724501.

Bloom, David, et al. “Population Aging: Facts, Challenges, and Responses.” May 2011. www.aarp.org/content/dam/aarp/livable-communities/old-learn/demographics/ population-aging-facts-challenges-and-responses-2011-aarp.pdf.

Bonsang, Eric, and Klein, Tobias. “Retirement and Subjective Well-Being.” February 2011. ftp.iza.org/ dp5536.pdf.

Borg, Christel, et al. “Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects.” Journal of Clinical Nursing. June 2005. www.diva-portal.org/smash/get/diva2:837026/ FULLTEXT01.pdf.

Boulton-Lewis, Gillian. “Education and Learning for the Elderly: Why, How, What.”

Educational Gerontology. February 2010. doi.org/10.1080/03601270903182877.

Calvisi, Dyana, and Dibble, Jennifer. “Well-Being in Older Adults in Three Different Cultures.” www.gvsu.edu/cms4/ asset/41BD4140-E833-EC59-3F25827028CDBF83/well-being.pdf.

Cuñado, Juncal and Gracia, Fernando. “Does Education Affect Happiness? Evidence for Spain.”

Social Indicators Research, vol. 108, no. 1, 2012, pp. 185–196. JSTOR, www.jstor.org/stable/23261310.

Easterlin, Richard. “Income and Happiness: Towards a Unified Theory.” February 2001. www. researchgate.net/profile/Richard_Easterlin/publication/ 4890476_Income_and_ Happiness_Toward_a_Unified_Theory/links/ 59d6670eaca27213df9e7b31/Income-and-Happiness-Toward-a-Unified-Theory.pdf.

German, Pearl, et al. “Mental Health of the Elderly: Use of Health and Mental Health Services.” Journal of the American Geriatrics Society. April 1985. doi.org/10.1111/j.1532-5415.1985.tb07111.x.

Helliwell, John, and Putnam, Robert. “The social context of well-being.” August 2004. www.ncbi. nlm.nih.gov/pmc/articles/PMC1693420/pdf/15347534.pdf.

Jensen, Robert. “Socioeconomic Status, Nutrition, and Health among the Elderly.” June 2004. www.nber.org/ chapters/c10347.

Kahneman, D., and A. Deaton. “High Income Improves Evaluation of Life but Not Emotional Well-Being.” Proceedings of the National Academy of Sciences, vol. 107, no. 38, July 2010, pp. 16489–16493., doi:10.1073/pnas.1011492107.

Laidlaw, Ken, and Pachana, Nancy. “Aging, Mental Health, and Demographic Change: Challenges for Psychotherapists.” Professional Psychology: Research and Practice. December 2009. doi.org/10.1037/a0017215.

Lama, Dalai, et al. The Book of Joy: Lasting Happiness in a Changing World. Avery, 2016.

Palomar-Lever, Joaquina. “Poverty and Subjective Well-being in Mexico.” August 2004. www.researchgate.net/publication/226950674.

Read, Sanna, et al. “Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review.” Aging and Mental Health.

March 2015. doi.org/10.1080/13 607863.2015.1023766.

Schnittker, Jason. “Happiness and Success: Genes, Families, and the Psychological Effects of Socioeconomic Position and Social Support.” American Journal of Sociology. 2008. ioa126.medsch.wisc.edu/findings/pdfs/751.pdf.

Sun, Sun, et al. “Subjective Well-Being and Its Association with Subjective Health Status, Age, Sex, Region, and Socio-economic Characteristics in a Chinese Population Study.” January 2015. doi.org/10.1007/ s10902-014-9611-7.

Teo, Peggy. “The National Policy on Elderly People in Singapore.” Ageing and Society.

September 1994. doi.org/10.1017/S0144686X00001653.

“The State of Mental Health and Aging in America.” Centers for Disease Control and Prevention. www.cdc.gov/aging/pdf/mental_health.pdf.

Westerhof, Gerben, and Barrett, Anne. “Age Identity and Subjective Well-Being: A Comparison of

40 Paper and Commentary the United States and Germany.� Journal of Gerontology. May 2005. gy/article-abstract/60/3/S129/559397.

academic.oup.com/psychsocgerontolo-

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The Sparrow-Hawk Dilemma: Christianity and the Freedom to Live Abi Wee, the Nueva School 23’ Background Context: This essay explores the influence of Christianity on free will and societal expectations. An analysis of Herman Hesse’s novel Demian and the journey of Emil Sinclair is used to explore the influence of Christianity on free will and societal expectations while answering the question “how do the expectations and the constraints of Christianity affect one’s development and growth?” Sinclair lives in Christian Germany (1904-1914), and his transition from boyhood to adulthood explores themes of purity, sexuality, and free will. Encouraged to inquire beyond his world of traditional Christian views by his mysterious mentor Max Demian, his story subtly critiques the way that a Christian, complacent lifestyle prevents one from experiencing enlightenment and peace within himself.

Synthesis: Emil Sinclair’s coming of age journey in Hermann Hesse’s novel Demian reveals the limitations on lifestyle imposed by a largely Christian society, expressed through Sinclair’s experiences with purity, sexuality, and free will.

Hesse drew inspiration for Demian from the teachings of psychiatrist Carl Gustav Jung, Nietzschean philosophy, and his Christian upbringing, creating a story revolving around Emil Sinclair’s quest towards freedom and self-discovery.

A major guiding theme in this novel is Sinclair’s realization of the two realms of light and darkness. The realms serve as an allegory to the balance between innocence and corruption, a theme central to Christianity. The dichotomy between these two realms and his struggle between Christian innocence and sinful corruption tormented Sinclair, who was spurred to forge his identity between the two realms that he experienced throughout the novel.

Hesse’s presentation of the two realms almost certainly drew from symbols in the scripture, as Apostles often used parallels of light and dark to describe God and the divine to believers: “God is light, and in him is no darkness at all” (1 John 1:5). Here, John presented the idea that God was composed entirely out of goodness and truth, with no evil or sin at all. John’s teaching draws parallels to Sinclair’s description of the realm of light. Because God’s truth and message was often described as “light” while false teachings were presented as “darkness”, the term ‘world of light’ can be used interchangeably to describe Christianity and those who follow Christ, while the world of darkness is synonymous with carnal delights, sins, and vices.

A much older Sinclair narrated his childhood as he grappled with the expectations of the Christian society that he was raised in and his curiosity about the darker, sinful side of his community. Sinclair’s internal conflict with the two realms throughout his development was even tied to his surname, which can be broken up into ‘Sin’ meaning dark, and ‘Clair’ meaning light. He highlighted his vulnerability to seeing and experiencing not only the good, Christian realm of light but also the ‘bad’, sinful realm: “Unquestionably I belonged to the realm of life and righteousness; I was my parents’ child. But in whichever direction I turned I perceived the other world, and I lived within that other world as well, though often a stranger to it, and suffering from panic and a bad conscience.” (Demian, 4-5) While Sinclair recognized that he dwelled in the world of light as the good Christian child of two “pure” parents, he also acknowledged his childhood closeness to the darker realm and felt that in order to truly dwell in the realm of light, he must venture into the darker realm, his journey resembling the one of the Prodigal Son. However, venturing into the darker realm was to venture away from God. In Sinclair’s world, the two realms were greatly separated—just as the kingdom of heaven is from the Earth.

Thus, when Sinclair began his excessive drinking and misbehavior, he explained that he could no longer relate to the Christian, pure, authorities in his life. “In my odd and unattractive fashion, going to bars and bragging was my way of quarreling with the world—this was my way of protesting. I was ruining myself in the process but at times I had understood the situation as follows: If the world had no use for people like me, if it did not have a better place and higher tasks for them, well, in that case, people like me would go to pot, and the loss would be the world’s” (Demian, 66). This passage reveals Sinclair’s yearning to return to the world of light, tinged with cynicism and hopelessness—Sinclair’s journey had taken him so far away from his childhood life in God’s light, however, he didn’t fit in the realm of darkness either, wearing his new vices as an ill-fitting, yet trademark cloak. Sinclair’s despair was not only rooted in loneliness, but hopelessness, as he could see no way back to the world of light he once

42 Paper and Commentary knew, not corrupted with his alcohol-fueled self-destruction. This depression and self-loathing was perhaps aggravated by the intense disapproval of his community and his failure to meet the academic and behavioural expectations of his parents. Thus, Sinclair sought to create his own realm of light—his own God who would bring him closer to his childhood realm of light.

Sinclair’s attempts to return to the ‘realm of light’ in which his family dwelled led to his exploration of women and his sexuality in an attempt to restore his innocence, albeit at the expense of select Christian commandments.

Through Sinclair’s alcohol saturated lows, he maintained his sexual innocence, considering love and fondness too pure a feeling for one in his position. However, Sinclair’s observation of a young woman not only sparked his repressed love but catalyzed Sinclair’s period of self-improvement: “Once more I was trying most strenuously to construct an intimate “world of light” for myself out of the shambles of a period of devastation; once more I sacrificed everything within me to the aim of banishing darkness and evil from myself...My sexuality, a torment from which I was in constant flight, was to be transfigured into spirituality and devotion by this holy fire” (Hesse 2009, 68-69).

Sinclair’s veneration of the young woman whom he christened “Beatrice” was less lustful than it was religious devotion, an idea set to iterate over the course of the novel. However, his sudden pivot from his life as a teenage barfly to his worship of Beatrice served as a marker of Sinclair’s increasing duality between the realms of dark and light.

Not only did Sinclair describe Beatrice as not fully feminine in her features, indicating that his ideal lover was one partaking in both the realm of female and male, his reverence for Beatrice indicated his willingness to lead a more dualistic life, committing actions traditionally viewed as unacceptable in Sinclair’s Christian society.

One of these traditionally unacceptable practices was Sinclair’s idolization of Beatrice. The book of Isaiah states that “all who fashion idols are nothing, and the things they delight in do not profit. Their witnesses neither see nor know, that they may be put to shame” (Isaiah 44:9). Beatrice was undoubtedly an idol fashioned from Sinclair’s own hands—Sinclair worshiped her, painted her, and devoted himself to her. He fashioned an entire cult around her, seeking to become a ‘saint’ in said cult. However, Sinclair’s narrative diverges from the scripture, as the cult of Beatrice can be described only as beneficial to Sinclair, as opposed to Isaiah’s teaching, “Who fashions a god or casts an idol that is profitable for nothing?” (Isaiah 44:10). Sinclair’s idolization of Beatrice and later Abraxas would have been unthinkable to his family and other ‘good’ Christians if they had known. However, his idolization of Beatrice marks the start of Sinclair’s forging of his own path, away from the one imposed upon him by societal expectations.

The success of this ‘rebellion’ from the Christian norm encouraged him to continue on his path to enlightenment.

Sinclair’s discovery and depiction of Abraxas as a symbol of duality further motivated him to seek out a lifestyle that balanced between the two realms. One of the ways in which he explored the concepts presented by Abraxas was to paint symbols and figures that appeared in his dreams. He recounted his visceral reaction to his painting of a mysterious woman that embodied dualistic qualities, writing, “I questioned the painting, berated it, made love to it, prayed to it; I called it mother, called it whore and slut, called it my beloved, called it Abraxas” (Hesse 2009, 102).

Described as half-god half-devil, Abraxas embodied both realms of dark and light equally. Sinclair’s painting was inspired by a recurring female figure in his dreams, one embodying the dualistic nature of Sinclair’s ideal woman.

He narrated his treatment of both the dream figure and his painting as the same—as an embodiment of a goddess but also a prostitute and a motherly figure, with a foot in both dark and light realms. As Sinclair wrestled with the entity he had painted, it changed forms, from child to man, to woman, to animal, a parallel to Jacob’s wrestling with God in Genesis. For the first time in the novel, Sinclair’s object of affection, the dualistic woman/deity had a name— Abraxas. Finally, Sinclair has discovered his God, and though it was not the Christian God—it has been discovered through Sinclair’s wrestling with Christianity and the darker, sinful world. Thus, Sinclair’s iterating idea of Abraxas as a symbol of duality and female sexuality serves as a marker for his yearning to break free from a lifestyle solely dictated by Christianity. However, the fundamental ideas behind Hesse’s creation of Beatrice and Abraxas also drew from Christian concepts, albeit concepts ignored by the society in which Sinclair belonged.

The description of both Beatrice and Abraxas’ features reveals Hesse’s Jungian inspiration. Jung believed that no human being was entirely masculine or feminine, with each possessing features from both genders. He used the term anima to describe the female aspect of a man’s personality. The traits encompassed by a male’s anima consisted of irrationality, sensuality, intuitiveness, and sensitivity, which Western males had been forced to repress by society in favor of traits such as the mechanical, the logical, the practical, and the rational. Jung asserted that

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one’s anima existed under the surface of the collective unconscious, manifesting itself by influencing the conscious ego. Hence, a man, intuitively aware of his anima, would project it upon actual women, recognizing characteristics complementary to himself. Beatrice can thus be considered as Sinclair’s anima, while Abraxas served as a bridge to Sinclair’s realization of his anima. However, Jung’s development of the idea of anima may have taken inspiration from the Bible.

While Sinclair’s community may have not approved of the idea of the blurring of gender divides, the bible explored how one’s identity as a Christian came before even the concept of gender. Paul writes in Galatians, “There is neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus” (Galatians 3:28). The idea that belief in Christ washes away the traditional idea of gender is akin to the Jungian idea of anima and blurred gender lines. Abraxas embodies the idea of polarity blurring together, and Sinclair’s belief in Abraxas awakened his awareness of his suppressed traits embodied by his anima. However, in the setting of this novel, Christian Germany pre-World War 1, homosexuality was taboo, and gender roles were ever defined. Thus, without Sinclair’s exploration of the darker realm, his struggle with Christianity, and worship of Beatrice, his anima would have remained dormant, still constrained by the societal expectations of the time. As much as Sinclair had developed a sense of independence from religious norms, he still lacked the will to pursue his deepest desires.

Sinclair’s childhood friend and mentor Demian and his mother, Frau Eva challenged Sinclair’s ideas of free will, eventually allowing him to overcome the last of his moral qualms preventing him from achieving true independence from the expectations of Christian society. Demian first introduced the idea of free will to Sinclair before he departed for boarding school. “You see, we don’t have free will even though the pastor makes believe we do...

If a person were to concentrate all his will power on a certain end, then he would achieve it” (Hesse 2009, 46-47).

Demian clarified in the passage that if one harnesses his will and wills for something, he will accomplish it, as long as it is possible. He asserted that one can obtain a particular goal only if the goal that one has set is necessary for their individual needs and development. If the goal meets these criteria, one is capable of attainment. Sinclair disregarded this advice until he met Frau Eva, however. Frau Eva was arguably the one thing that Sinclair’s journey led to, her likeness showing up in his dreams and his artwork and influencing him to chase freedom. Their relationship defied societal norms, with Sinclair describing her as the “universal mother” and Hesse writing Frau Eva as an allegory to Eve, the first mother in Christianity. Sinclair regarded his romantic feelings for Frau Eva as morally wrong, however, his affection for her was almost torturous. The conflict between his true desires and societal norms was one that would soon be overcome as Sinclair continued to chase self-actualization.

Herein, Sinclair realized the importance of Demian’s teaching about one’s pursuit of a goal. Frau Eva, noticing Sinclair’s intense love for her, told him, “Once you are able to make your request in such a way that you will be quite certain of its fulfillment, then the fulfillment will come. But at present you alternate between desire and renunciation and are afraid all the time...Once [your love] begins to attract me, I will come. I will not make a gift of myself, I must be won” (Hesse 2009, 129-130). Frau Eva goading of Sinclair to seduce her, asking him to prove that he truly desired her. She forced Sinclair to exercise his will to overcome his moral qualms against their relationship.

She reiterated what her son told Sinclair years prior—if the goal is reasonable and if it resonates with your will, then fulfillment will come. Once Sinclair formulated his request, free of hesitation, in order to pursue his soul’s innermost desires and exercise his will, he was free from the last of the constraints that restricted his self-realization. However, Sinclair’s discovery of the workings of free will was at odds with the idea of free will dictated in the Scripture.

Divinity was notably absent from Sinclair’s newfound control of his will. In Christianity, the concept of free will is almost always tied to the idea of sin and submission to God. For instance, when Paul wrote, “so if the Son sets you free, you will be free indeed,” (John 8:36) Paul’s idea of free will was somewhat limited, being related to the idea of acquired freedom. Acquired freedom is the freedom to choose to be righteous without the possibility of choosing otherwise. In other words, this acquired freedom is to serve the Lord. For “pure” Christians like Sinclair’s parents, the idea of submission to God was freedom enough, because sacrificing their free will allowed them to stay within the good, Christian realm. However, for Sinclair, who found his own path outside the constraints of Christianity, Paul’s biblical idea of freedom lacked the same appeal. He rejected Christianity through his idolization of Beatrice and Abraxas and engaged in relationships that were socially unacceptable. However, the act of rejection freed his will to fulfill his desires, achieving freedom, not sacrifice them to submit to God. Thus, Sinclair’s ultimately

44 Paper and Commentary successful struggle to take back his free will, free of Christian and societal expectations signaled that Sinclair could then fulfill the true desires of his soul and live for himself.

The idea of the realms, Abraxas, and pursuit of Frau Eva were key motivators for Sinclair to begin his period of introspection and forge his own path. They factor into one of the most important underlying themes in the novel with great religious implications—freedom. The sparrow-hawk first appeared as decoration on Sinclair’s childhood home near the beginning of his bond with Demian, as a symbol for change and the seeking of freedom. Its significance was only realized when Demian, Sinclair’s mysterious friend and mentor obliged Sinclair to swallow a coat of arms with the hawk on it from Sinclair’s childhood in a dream, to which he recounts felt as though it “had begun to swell up and devour” him (Hesse 2009, 76). The sparrow-hawk is a symbol of Sinclair’s increasing independence from the constraints of Christianity, remaining a key theme throughout the novel as he pursued an inappropriate relationship, embraced idolatry, and chose to live outside of the bounds of Christianity. However, the symbol of the sparrow-hawk had been tied to Sinclair since his childhood, conveying that his yearning for freedom had always been within him. When Sinclair found refuge in the house of Frau Eva and Demian near the end of his journey to self-discovery, he saw his painting of a fully grown sparrow-hawk emerging from an egg, a symbol of rebirth and change which he painted during his Beatrice pivot. As the bird shatters the globe from which he emerges, he is shattering the world of constraints and expectations—much as Sinclair himself had attempted to escape the world of Christian societal expectations that shaped his development. By the end of the novel, Sinclair had achieved true independence—free will, acceptance of duality, and confidence in his decision to live, away from the shadow of Christianity.

Works Cited Hesse, Herman. Demian. New York City, Harper Perennial Modern Classics, 2009.

The Bible. New International Version, Biblica, 1978.

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Psychological Well-being of Newly Immigrated Adolescents: Possible Risk Factors and Recommendations Jessica Jia, Princeton High School 21’ Abstract Newly immigrated adolescents are at high risk of developing mental problems. In addition to challenges all immigrates face such as culture shock, various forms of discrimination, and loss of social capital connections, immigrated adolescents may experience higher levels of stress due to hormones, growth and development, and heightened levels of sensitivity. Research has demonstrated a positive correlation between these challenges and an increased risk of developing mental disorders. The present study aims to identify the risk factors and offer solutions to reduce or even prevent the psychological risk. Psychological risk factors include perceived ethnic discrimination and issues related to acculturation, such as language barriers. It is strongly advised that adolescents and the people around them build a community-based network to promote connection and support between adolescents and their ecological environments. The study proposes practical measures of proactive outreach, mentorship, and support from the community, school, and family - all of which assist immigrated adolescents in their smooth transition into the host country.

46 Paper and Commentary Introduction The United States has been a nation of immigrants since its foundation. In the fiscal year 2018, over a million foreign nationals were granted permanent residential status (Department of Homeland Security, 2019). Indeed, the number of immigrants living in the United States reached 44.7 million, the historical numeric high in census records.

Immigrants comprise as much as 13.7% of the overall U.S. population, where nearly one in seven U.S. residents is foreign born (Batalova, Blizzard, & Bolter, 2020). Due to the continuous demographic growth of foreign-born immigrants during the past decade, it is important to examine the psychological experiences of the immigrant population.

Immigration is a life changing event. Though many migrate in pursuit of a better environment and opportunities than those of their previous life, the experience of migration is often accompanied by significant challenges and stress (Justice for Immigrants, 2017). Many empirical studies have suggested that migration-related stressors can have negative impacts on psychological health. The stress associated with immigrating is particularly more intense during the early stages of settling in the host country (Sirin et al., 2013). Therefore, this study focuses specifically on first-generation immigrants, individuals who were born in another country and moved to the United States (Pew Research Center, 2013).

Immigration poses a particular challenge for adolescents due to drastic changes in not only the environment but their body and mind (Sirin et al., 2013; Patel & Kull, 2011). Adolescence typically spans from the ages 10-19 (World Health Organization, n.d.) and is referred to as “a time of metamorphosis from childhood to adulthood.� The transition period into adulthood is associated with rapid biological, physical, behavioral, and social development.

Hence, adolescence is a critical period of time that could have great implications on an adolescent’s future (National Research Council & Institute of Medicine, 1999). Adolescence is also marked by heightened sensation seeking, egocentrism, and aggressiveness (Arnett, 1995). These traits, unfortunately, often contribute to a peak in risk-taking behaviors (Lejuez, 2010). The impulsive decision-making characteristic of adolescents can leave them vulnerable to various physical and psychological harm (National Research Council & Institute of Medicine, 2001). Adolescent suicidal rate has been steadily rising in the past decade (Curtin & Heron, 2019). In fact, suicide ranked the second leading cause of death among US adolescents in 2018 (Centers for Disease Control and Prevention Organization, 2020).

The present study focuses on newly immigrated adolescents, specifically people who migrated to the United States during their adolescence. The goals of the study include: a. Analyzing factors that predispose newly immigrated adolescents to a higher risk of experiencing psychological symptoms. b. Propose possible solutions to assist newly immigrated adolescents through the transitions of immigration.

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Risk Factors 1. Perceived Ethnic Discrimination An individual who experienced perceived ethinic discrimination may hold a belief that he or she is being treated unfairly due to ethnic differences (Ikram et al., 2016). Perceived discrimination is a common experience for ethnic minorities in the United States (Greene, Way & Pahl, 2006). A recent study had found that 63.10% of minorities Black, Hispanic, and Asian - reported experiences of discrimination compared to those experienced by 29.61% of Whites (Lee et al., 2019). Furthermore, another study suggested that experiences of ethnic discrimination by peers and teachers were prevalent among ethnic minority adolescents (Rivas-Drake, Hughes & Way, 2008). Newly immigrated adolescents comprise a significant proportion of ethnic minorities in the United States. In 2017, 50.4% of the foreign-born population of America came from Latin America, 30.2% from Asia and 3.1% from Africa (United States Census Bureau, 2017). Therefore, ethnic discrimination is a significant concern for the immigrant population.

Adolescents are generally more vulnerable to ethnic discrimination than other age groups. In particular, certain moments during cognitive developments place adolescents especially at risk. According to Jean Piaget, cognitive development consists of four stages: sensorimotor, pre-operation, concrete operational and formal operation. Adolescence development specifically takes place in the concrete operational and formal operational stages. During the transition into formal operation, adolescents typically develop the ability of deductive reasoning and hypothetical thinking (Kail, 2015). The skills further allow adolescents to begin to understand racial differences and start to explore their own ethnic identities. Therefore, adolescents may be increasingly sensitive on the topic, leading to an heightened perception of ethnic discrimination (Greene, Way & Pahl, 2006; Phinney & Chavira, 1995).

Perceived ethnic discrimination may have a detrimental impact on the psychological health of adolescents (Wong, Eccles & Sameroff, 2003; Tummala-Narra & Claudius, 2013). Specifically, perceived ethnic discrimination is often correlated with an increase in internalization of symptoms of issues like those of depression, anxiety, lower self-esteem, lower level of defensiveness, higher level of cynicism, and hostility (Lambert et al., 2009; Grollman, 2012). At the same time, perceived ethnic discrimination has been shown to correlate with an increase in externalization of symptoms including greater substance use, negative social interactions, and risky sex behaviors (Broudy et al., 2007; Benner et al., 2018). Ethnic discrimination can also serve as a chronic stressor to negatively influence the development and functioning of adolescents over time, even beyond adulthood (Greene, Way & Pahl, 2006). If discriminated against in their early life, victims may be more likely to experience negative interpersonal interactions in the future (Broudy et al., 2007).

As such, experiencing perceived ethnic discrimination could predispose newly immigrated adolescents to a higher risk of developing psychological symptoms.

2. Acculturation Culture is defined as a set of beliefs and customs shared among a group of people at a particular time (Cambridge Dictionary; Iivonen, Sonnenwald, Parma & Poole-Kober, 1998). Separation and categorization of people often creates numerous differences between individuals. Cultural differences persist in society and affect human interactions.

Geert Hofstede proposed the Cultural Dimensions Theory to describe the effect of facets of culture on social interaction and behavior (Ghemawat & Reiche 2011). Similarly, immigration can cause dissonance between the cultural customs of the immigrant and those of the host country.

Immigrants are often subjected to acculturation as they migrate to the United States. Acculturation is defined as the process of changing norms, values and behaviors of the nondominant group or individual as a result of intercultural contact (Smokowski, Rose & Bacallao, 2008; Berry, 1980; Crane et al., 2005; Cambridge Dictionary). The process of acculturation consists of two main subcomponents: culture-of-origin preservation and host culture involvement (Smokowski, Rose & Bacallao, 2008). As proposed by Bertice Berry’s model of acculturation (Schmitz & Berry, 2011), there are four manners of acculturation: Assimilation - rejecting culture-of-origin and identifying with the host culture

48 Paper and Commentary Integration - retaining culture-of-origin while also participating in the host culture Separation - identifying with culture-of-origin and rejecting the host culture Marginality - rejecting both culture-of-origin and host culture The manner in which the immigrant acculturation depends on how the immigrant assimilates to the host country.

Acculturation is a multidimensional process that focuses on two primary issues: learning the new language and the level of involvement in the new culture (Lee, Eunju & Hsin-Tine, 2006).

Language Many foreign-born immigrants are English Language Learners. In 2018, approximately 47% of foreign-born immigrants ages 5 and older were Limited English Proficient (LEP) (Batalova, Blizzard & Bolter, 2020). These individuals reported speaking English less than “very well” on the American Community Survey (ACS) questionnaire.

According to the most recent available data from the National Center for Education Statistics, 9.6% of public-school students in the Fall of 2016 were English Language Learners (National Center for Education Statistic, 2019).

Learning a second language can be a challenging and prolonged process. As suggested by Krashen and Terrell (1983), there are five main stages in learning a second language: pre production, early production, speech emergent, intermediate fluency, and advanced fluency. It typically takes 3-5 years to reach the stage of intermediate fluency and 5-7 years to reach advanced fluency (Anavarrete & Watson, 2013). Progression varies due to many factors such as the age of immigration and learning environment (Cambridge University Press, 2018). Cummins further differentiates language acquisition into Basic Interpersonal Communication Skills (BICS) and Cognitive Academic Language Proficiency (CALP). BICS refers to “cognitively undemanding manifestation of language proficiency in interpersonal situations”; speakers are able to communicate on a colloquial level. Meanwhile, CALP refers to “language proficiency related to literacy skills”; speakers are able to effectively communicate in academical settings.

It usually takes 2 years for ELPs to acquire BICS and 5-7 years to reach the threshold of CALP (Cummins, 1981).

During the first few years of immigration, many newly immigrated adolescents are likely to experience difficulty in acquiring a new language.

Participation in the host culture Newly immigrated adolescents may encounter various differences between their culture-of-origin and the host culture, making acculturation a prolonged process. In 2018, the most common country of birth for immigrants in the United States was Mexico (Migration Policy Institute, 2019). Hence, Mexico and the United States will serve as examples to address the vast differences that may be present between the culture-of-origin and host culture.

The United States School tem

sys- Six school hours a day

Mexico Four school hours a day Some students who live in urban areas choose to work in the morning and attend school in the afternoon. more relaxed classroom life involving a great amount of group work. 1

Popular Hol- Easter, Thanksgiving, Halloween, Mexicans celebrate Day of Dead, Beniidays etc. to Juarez Day, etc.

Religion

Prevalent religion is Christianity, Prevalent religion is Roman Catholic, whose followers make up 70.6% of whose followers make up 80.8% of the the population; only 20.8% identified population in 2018.3 as Catholics. 2

(McLaughlin, 2002) 2 (Pew Research Center, 2015) 3 (Pasquali, 2019) 1

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val- Nuclear family 5 High priority on family life American adolescents are expected Family size is much larger due to a close to be independent connection with extended relatives Parents tend to be more protective of their adolescent children

The significant differences between culture-of-origin and the host culture makes it challenging for newly immigrated adolescents to adjust their original customs and assimilate into the host culture. Becoming proficient in the new language and actively involved in the host culture requires a long period of adaptation. Therefore, newly immigrated adolescents often have a low level of acculturation that plays a role in their predisposition to developing averse psychological symptoms.

2.1 Consequences As established, acculturation is a prolonged process that requires the integration of communication and participation. Failure to do either may cause adolescents to retain feelings of discrimination or uneasiness in the host country. Consequences include weak teacher-student relationship, lack of close peer relationship, academic challenges, acculturation gap/low family functioning and cultural dissonances.

2.1.1 Weak teacher-student relationship Supportive relationships with non-parental adults such as teachers are essential for adolescent development (Engels et al., 2016; Scales, Benson & Mannes, 2006; Banati & Lansford, 2018; Roorda et al., 2011). The interpersonal relationship with a teacher is fundamental to the education and future outcomes of students. Teacher-student relationships are composed of many elements, of which a sense of belonging and bonding are particularly crucial for the young adolescent (Wyrick, 2011; Roorda et al., 2011).

Immigrant adolescents tend to have weaker perceived teacher–student relationships compared to those of native adolescents (Chiu et al., 2012). Language barriers are essentially obstructions to communication (Lee, 2003).

As communication is vital in building or maintaining interpersonal relations, language barriers could negatively affect the strength of the relationships between teachers and newly immigrated students (National Oceanic and Atmospheric Administration, 2011). Moreover, newly immigrated adolescents tend to have lower cultural capital (Sirin et al., 2013; Chiu et al., 2012). As defined by Bourdieu, cultural capital is a person’s familiarity with the societal norms of the host country (Wildhagen, 2009; Bourdieu, 1986; Jæger & Møllegaard, 2017). Along with Bourdieu, many have suggested that cultural capital has an effect on fostering teacher-student relationships. Students exposed to greater cultural capitals are better able to effectively communicate and come to understanding with their teachers.

As a result, teachers tend to have more negative perceptions of students with low cultural capital (Wildhagen 2009; Farkas et al. 1990; Lamont & Lareau 1988; DiMaggio, 1982; Kalmijn & Kraaykamp, 1996; Jæger & Møllegaard, 2017). Past studies also suggest that teachers tend to favor students whose behaviors align with dominant cultural norms (Wildhagen, 2009). As newly immigrated students tend to maintain their ethnic norms, they have weaker relationships with their teachers than their native counterparts (Chiu et al., 2010).

Teacher-student relationships have significant implications on the well-being of students in the academic setting. Past studies suggest that close teacher-student relationships are positively associated with academic motivations and achievements (Maulana, Opdenakker & Bosker, 2014; Baber & Noreen, 2018). Therefore, newly immigrated adolescents are at a great disadvantage. They may face various difficulties during the transition period and their weak relationships could hinder them from seeking support. It is also suggested that weak teacher-student relationships might lead to a lack of emotional security (Bergin & Bergin, 2009; Engels et al., 2016) and a lowered level of school engagement (Martin & Collie, 2019). Therefore, weak teacher-student relationships are an important risk factor for mental health of newly immigrated adolescents.

2.1.2 Lack of close peer relationship 4 (Avila, 2015) 5 Nuclear family is a family group consisting of parents and their dependent children.

50 Paper and Commentary As adolescents develop emotional autonomy from their parents, peer relationships become increasingly important (Brown, 2004). Adolescents tend to be more invested in peer relationships and are therefore more vulnerable to peer-related stress during this period (Yu, 2016). Compared to the natives of the host country, newly immigrated adolescents typically have lower levels of acculturation (i.e. language barriers and low cultural involvement), leading to higher risks of being exposed to greater peer-related stress. Peer rejection and victimization are two significant stressors (Zimmer, 2016).

Past studies have suggested that a higher acculturation level is associated with higher peer acceptance, while higher orientation toward the culture-of-origin leads to higher peer rejection (Asendorpf & Motti-Stefanidi, 2017; Plenty & Jonsson, 2017). The phenomenon can be explained by the notion of Homophily, where people tend to interact with others who are similar to themselves (McPherson, Smith-Lovin & Cook, 2001). Lazarsfeld and Merton (1954) distinguished two types of homophily: status homophily and value homophily. Status homophily includes both society ascribed (i.e. ethnicity) and acquired characteristics (i.e. religion, behavior patterns). On the other hand, value homophily includes internal states such as attitudes and beliefs (McPherson, Smith-Lovin & Cook, 2001).

Newly immigrated students that are less involved with the host culture tend to have behavior patterns and values that fail to conform with the natives’ norms and standards (Bellmore, Nishina & Graham, 2011). This failure often leads to lower acceptance and higher rejection by the peers of the immigrant students. In addition, low English proficiency is a barrier for communication, which can also hinder newly immigrated adolescents from being accepted by their native peers.

Peer victimization (also known as bullying or harassment) is defined as an abuse in the form of physical, verbal, or psychological that intends to cause harm to a targeted victim (Graham & Bellmore, 2007; Fite et al., 2019; Fan, 2018). Newly immigrant adolescents are at higher risk of experiencing bullying victimization than native-born adolescents (Maynard et al., 2016). Experiencing peer victimization is correlated with the level of acculturation. In many studies, newly immigrated students reported that the perceived reasons of victimization were cultural stereotypes, way of dressing, accents, religious beliefs and practices (Qin, Way & Rana, 2008; Nair, 2017).

Peer-related stress (i.e. peer rejection and victimization) can have negative impacts on the well-being of adolescents (Nair, 2017; Annalakshmi, 2019). The stress is associated with internalizing and externalizing symptoms such as lowered self-esteem, social anxiety, depression and loneliness (La Greca & Harrison, 2005; Iyer-Eimerbrink, Scielzo & Jensen-Campbell, 2015; Maynard et al., 2016; Fite et al., 2019).

2.1.3 Academic challenges Though pursuit of better education opportunities is a main factor that propels immigration (USA Facts, 2018), newly immigrated adolescents tend to have declined academic performances compared to native adolescents (Suárez-Orozco et al., 2010). Past studies conclude that foreign-born adolescents have higher dropout rates than native-born counterparts (Ruiz-de-Velasco & Fix, 2000). Such academic challenges can be partially attributed to cultural differences and limited English proficiency.

School transfers can be extremely disruptive to academic performances (Suárez-Orozco et al., 2010). As established, there may be significant differences between the school systems of the country-of-origin and the host country. These differences in school systems may cause newly immigrated students to face gaps or repetitions in certain subjects, as well as interrupted schooling (Grigg, 2012; Ruiz-de-Velasco & Fix, 2000). Moreover, much information presented on tests may depend on cultural knowledge (Solano-Flores, 2008). Newly immigrated students tend to have lower cultural capital of the host culture, which can contribute to a decline in academic performance (Chiu & Chow, 2010). Hence, the discrepancies in cultural values can also affect their academic performances (Martinez-Taboada et al., 2017).

For newly immigrated adolescents with limited English proficiency, mastering core curricula and fulfilling graduation requirements are formidable tasks. As discussed, it takes approximately 5-7 years to reach the threshold of Cognitive Academic Language Proficiency (Cummins, 1981). One empirical research found that after an average of 7 years in the United States, only 7% of the foreign-born immigrants developed academic English skills comparable to those of their native-born counterparts (Carhill, Suárez-Orozco & Páez, 2008). This limited English proficiency can restrict newly immigrated adolescents from high levels of academic attainment. These students are likely to have trouble extracting meanings from texts and thoroughly expressing their points both verbally and in

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writing (Suárez-Orozco et al., 2010). For newly immigrated adolescents who must master English and maintain good academic performance simultaneously, receiving enough credits to meet graduation requirements can be a great challenge.

Academic performances are an indicator of stress levels, as academic distress is positively associated with higher levels of anxiety and depression (Ahmed & Julius, 2015; Jones & Lefevor, 2018). Fear of academic failure may cause newly immigrated adolescents to disengage from academic activities (Motti-Stefanidi, Masten & Asendorpf, 2015). This vicious cycle can be extremely harmful for the well-being of adolescents. As such, academic challenge is a contributing risk factor for effectiveness of acculturation and the psychological health of newly immigrated adolescents.

2.1.4 Acculturation gap/Low family functioning Cultural differences place pressure from mainstream society on newly immigrated adolescents to conform to the societal norms of the host country (Renzaho, Dhingra & Georgeou, 2017). Due to age differences and varying circumstances, newly immigrated adolescents and their parents may acculturate at different paces (Hwang, Wood & Fujimoto, 2010). The differences between the child and the parent’s respective levels of culture-of-origin and host culture involvement can lead to gaps in acculturation (Smokowski, Rose & Bacallao, 2008).Family functioning can be negatively affected by acculturation gaps (Renzaho, Dhingra & Georgeou, 2017). The different values and expectations between parent and child can give rise to conflict, parent-child alienation, and breakdown of communication (Birman & Poff, 2011; Renzaho, Dhingra & Georgeou, 2017). According to the McMaster Model of Family Functioning, all functions of a family (e.g. problem-solving, communication, roles etc.) are interrelated and can strongly influence family members (Miller et al., 2000). Low family functioning is associated with adolescent depression, delinquency and lowered social initiatives (Crane et al., 2010; Hwang, Wood & Fujimoto, 2010). Therefore, acculturation gaps and low family cohesion can predispose newly immigrated adolescents to higher risks of adverse psychological states.

2.1.5 Cultural dissonance Newly immigrated adolescents typically interact with both the original and host culture. According to Erikson’s psychosocial development, adolescence is characterized by a search for personal identity and role within a social group (Kail, 2015). When navigating back and forth between the distinct values and customs of the culture-of-origin and host culture, immigrated adolescents may experience cultural dissonance (Chae, 2001; Smokowski, Rose & Bacallao, 2008). The struggle in defining cultural and personal identity can serve as a stressor during the acculturation process. Acculturative stress has negative effects on the well-being of adolescents: greater acculturative stress predicts significantly more internalization of negative psychological symptoms including introversion, somatic, anxiety, depression, lowered self-esteem (Sirin, et al., 2013; Thibeault et al., 2017). Moreover, acculturative stress can also lead to externalization of averse psychology 2016) and suicidal thoughts (Haboush et al., 2015; Zvolensky et al., 2016). Acculturative stress may also negatively impact the academic and social integrations of adolescents (Han, Pistole & Caldwell, 2017).

3.1 Loss of social capital Shortly after immigration, previous social capital is typically lost and new social capital must be rebuilt. Social capital refers to social networks formed by human interactions (Keeley, 2007). According to James Coleman (1988), “the social relations that constitute social capital are broken at each move.” Newly immigrated adolescents face the cost of losing former relationships and the challenge of establishing new relationships (Grigg, 2012), leading to a significantly lower social capital. In addition, relocating to a foreign country may also separate newly immigrated adolescents from their extended family. The lack of social support is associated with greater adverse psychological symptoms such as depression (Cheng et al. 2014).

Recommendations As newly immigrated adolescents may encounter multiple obstacles and challenges, they are often exposed to greater risks of psychological (Grollman, 2012). Addressing the risk factors (i.e perceived ethnic discrimination, acculturation, and loss of social capital) as well as the issues that may lead to failure to acculturate is necessary in facilitating the transition of immigrated students and their acclimation to a new environment.

Psychologist Urie Bronfenbrenner proposed the Ecological Systems Theory: human development is based on an eco-

52 Paper and Commentary logical system in which development is determined by reciprocal interactions between individuals and their environments. Bronfenbrenner explained the ecological environment as a concentric zone model: a set of nested structures of five subsystems each contained within the next like a set of Russian dolls (see Figure 1). The five subsystems of Bronfenbrenner’s ecological model include6: A microsystem includes activities, social roles, and interpersonal relations within the immediate environment. Some major aspects for newly immigrated adolescents are school, family, peers.

A mesosystem is composed of interrelations between microsystems.

An exosystem is an extension of the mesosystem, containing larger social structures that has indirect effects on the individual’s life. For newly immigrated adolescents, the system may include public and educational policies.

A macrosystem refers to the belief systems, customs, lifestyles of the culture that manifest the prior micro-, meso-, and exosystems.

A chronosystem deals with the historical context and the passage of time (e.g. the process of acculturation for newly immigrated adolescents).

Figure 1

To target the psychological risk factors and better assist newly immigrated adolescents, it is important to collaborate with their ecological environments to build a community-based network. While all the subsystems that Bronfenbrenner suggests are significant in terms of overall development of the adolescent, it is the microsystem (the innermost layer) that directly influences newly immigrated adolescents. Therefore, we will address different aspects (i.e. school, family, community) within the microsystem and provide practical suggestions that focus on this subsystem.

1. Community 1.1 Promote community services Social interest has a full mediational effect on the positive relationship between perceived social support and mental health. Specifically, social interest promotes healthy personalities and guides people to behave in a constructive manner that benefits society (Tsz Yin Fung & Webster, 2018). Performing social interest behaviors (i.e. volunteering) can create a sense of involvement, usefulness, and satisfaction (Smith et al., 2018). For newly immigrated adolescents, volunteering can serve as a positive strategy for relieving acculturative stress (Junhyoung et al., 2012).

Therefore, the community may consider offering community service opportunities for newly immigrated adolescents to encourage them to actively engage in the community.

1.1.1 Virtuous cycle Engagement in community service can further assist immigrants by creating a virtuous cycle. One of the biggest 6

(American Psychological Association, 2017; Bronfenbrenner, 1977, 1995b)

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reasons why individuals volunteer and help others in need is because these individuals understand the significance of receiving support (Smith et al., 2018). A community may consider establishing an immigrant community as a subset and foster a virtuous cycle where acculturated immigrant adolescents can provide assistance to newly immigrated adolescents. As the newly immigrated adolescents adapt to the new culture and environment, they can then become volunteers and help other newcomers.

1.3 Provide community resources Newly immigrated adolescents often have limited English proficiency and low cultural and social capitals.

The community that they reside in may consider offering open programs at public libraries or schools to help newly immigrated adolescents and parents acculturate into the host culture. Some examples are listed below: ● Develop family-oriented programs that train bicultural skills to foster better family dynamics and lower the acculturation gap. The programs may consider structured activities such as psychodramatic7activities (Smokowski, Rose & Bacallao, 2008). ● Offer ESL classes to help new immigrants master the English language. ● Provide guidance for introducing new immigrants to various community resources such as public libraries and transportation.

In consideration of varying socioeconomic situations, community resources should be freely open to all immigrated families. Town municipalities could promote the programs by encouraging public libraries or schools to recruit volunteers from nearby universities. Non-profit organizations can also consider offering these resources.

1.3.1 Positive psychology interventions While offering open community resources can be effective in improving language barriers and increasing cultural and social capital, community resources or programs should also practice positive psychology intervention.

Martin Seligm first introduced the concept of positive psychology. Positive psychology focuses on studying processes and conditions that develop positive qualities and promote optimal human functioning (Park, 2015). Positive psychology interventions can guide people to view their environment with a different and more optimistic approach, therefore enhancing psychological well-being (Seear & Vella-Brodrick, 2013; Marques, Pais-Riberio & Lopez, 2011). Some practical methods include: ● Planning an ideal day and having it ● Doing a secret good deed ● Writing a letter of gratitude to someone who has not been properly thanked 1.4 Increase cultural awareness and acceptance Mutual understanding among citizens with various backgrounds is necessary to discourage conflicts and discrimination. The community may consider the following actions: ● Host public culture fairs to give newly immigrant adolescents opportunities to share the traditions of their ethnic cultures. Culture fairs not only help citizens learn about other cultures, but also increase the sense of belongingness of new immigrants and help integrate members of the community. ● Openly celebrate traditional holidays and festivals of diverse cultures.

2. School 2.1 Parent Outreach Studies suggest that parental involvement in the education of adolescents has positive impacts on the engagement, performances, and outcomes of adolescent development (Jeynes, 2005, 2016; Harris & Goodall, 2008). However, newly immigrated parents are less likely to be involved at school. The trend is compounded by various difficulties including language and cultural barriers, perceived discrimination, and limited school support (Sohn & Wang, 2006; Turney & Kao, 2009). Therefore, it is important for schools to be aware of the difficulties and provide assistance to encourage parent involvement. Schools may consider the following suggestions: Provide translated school information to immigrant parents (e.g. student schedule, school policies, report cards, after-school sports/activities).

Schedule quarterly private meetings with immigrant parents to discuss their children’s needs.

7

Psychodrama is an approach that utilises role playing and group dynamics to help people gain a greater understanding of interpersonal relationships, emotional concerns, inner thoughts and conflicts (Chimera & Baim, 2010).

54 Paper and Commentary Hire parent/family liaisons to collaborate with immigrant parents and to conduct home visits.

Connect immigrant parents to local resources such as English as a Second Language classes, parenting classes, legal assistance (see 1.3 Providing community resources).

Conduct multilingual Parent Teacher Organization meetings.

2.2 Peer Mentoring Schools may consider promoting peer mentoring as a resource to help newly immigrated students adapt to the new environment. In fact, students who did not receive mentorship were four times as likely to consider leaving school compared to students who received mentorship (Collings, Swanson & Watkins, 2014). Having a mentor can moderate the impact of transitional stress and help newly immigrated adolescents better integrate into the new school.

2.2.1 Cultural clubs Newly immigrated students are at higher risk of experiencing peer rejections due to cultural differences. Similar to mentorship, immigrated students can benefit greatly by being in supportive social circles. Therefore, schools should encourage the formation of various cultural clubs and connect newly immigrated students to student groups that have similar cultural backgrounds. A cultural club can provide newly immigrated students linguistic and social support. Inclusion in a group can also increase a student’s sense of belonging at school.

2.3 Positive Social Dynamics Compared to their native peers, newly immigrated students are increasingly susceptible to discrimination and peer victimization. It is imperative for schools to foster welcoming school environments to prevent the formation of cliques, power dynamics, student conflicts, and discriminations. Schools may consider the following suggestions: Have formal classroom discussions to raise awareness and teach students about ways to protect themselves from bullying and unhealthy relationships.

Establish a system for students to report discrimination or bullying.

Hold events or activities to promote multicultural understanding.

2.4 Staff Development Workshops Newly immigrated adolescents often have weak teacher-student relationships due to their limited English proficiency and cultural differences. Positive and close teacher-student relationships can caution newly immigrated adolescents against behavioral disengagement (Engels et al., 2016). Therefore, schools should implement staff development workshops to help teachers better understand positive methods to support the needs of newly immigrated students.

3. Family 3.1 Foster a sense of ethnic identity Ethnic identity develops over time through active understanding of the ethnic culture and a sense of ethnic pride (Phinney & Ong, 2007). Newly immigrated adolescents are particularly at risk of experiencing ethnic discrimination. Many studies suggest that having a strong ethnic identity can promote positive psychological functioning (Piña et al., 2018) and protect adolescents from discrimination (Mossakowski, 2003). Therefore, parents may consider introducing the positive aspects of their ethnic heritage to their children to foster a sense of ethnic affirmation.

3.2 Encourage “Integration” as the ideal acculturation strategy According to Berry’s model of acculturation, there are four approaches: Assimilation - reject culture-of-origin and identify with the host culture Integration - retain culture-of-origin while also participate in the host culture Separation - identify with culture-of-origin and reject the host culture Marginality - reject both culture-of-origin and host culture Selection of an approach to acculturation predicts psychological adaptation. The most adaptive style is integration: high levels of sociability and activity with low levels of aggression and anxiety. Assimilation is somewhat ambivalent, characterized by high levels of activity but accompanied with high levels of anxiety. The most mal-

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adaptive approaches are separation and marginality, which predict higher levels of acculturative stress (Schmitz & Berry, 2011; Behara, Khan & Hasan, 2018). Based on the findings, parents should encourage their children to practice biculturalism, where an individual retains his or her culture-of-origin while actively exploring the host culture.

Biculturalism is also positively associated with family cohesion (Smokowski, Rose & Bacallao, 2008), leading to greater well-being in newly immigrated adolescents (Vandeleur et al., 2009).

3.3 Establish mutual understanding Immigrant adolescents and their parents tend to acculturate to the host culture at different levels, often leading to low family functioning and adolescent maladjustment (Telzer, 2011). To foster better relationships with their children, parents may consider the following: Be aware that the acculturation gap can be a factor contributing to family conflicts.

Evaluate the possible juxtaposition of held expectations and values with those of the new, host culture. Communicate clearly with their children and make compromises.

Actively learn the host culture and encourage their children to share school experiences. This is a reciprocal act of self-disclosure that can foster greater understanding and lower the acculturation gap.

Emphasize conversation orientation over conformity orientation. In conversation orientation, all family members are encouraged to interact and exchange ideas freely. On the other hand, conformity orientation puts a strong emphasis on obedience and uniformity of beliefs (Koerner, 2007). Conversation orientation predicts greater self-disclosure, closeness, and relationship satisfaction (Anderson et al., 2017).

3.4 Encourage adolescents to become a “helper�

A strong sense of responsibility can help adolescents better mature and develop. As newly immigrated adolescents may acculturate faster than their parents, parents may consider seeking assistance from their children to better transition themselves. Adolescents can improve family functioning by serving as translators and help their parents with outside communication (Smokowski, Rose & Bacallao, 2008).

3.5 Engage in adolescents’ schooling Parents can serve as moral support for their children in their education. Active support from parents provides an important resource for newly immigrated adolescents to deal with stressful life events (Kim et al., 2012). Therefore, it is worthwhile for parents to be proactive and learn about the school system of the host culture.

Conclusion Migration is a common human behavior that has been repeated throughout countless human civilizations.

Many civilizations have been created in part by immigrants. The United States is no exception. As the world becomes increasingly integrated on various levels, support should be given to research into methods of easing transition for immigrants. Especially during adolescence, a period of considerable transition in life, youths are more susceptible to changes marked by this period. Immigration may add stress and difficulties for adolescents, calling for a need to develop support networks for such individuals.

Due to the immigration experience, many newly immigrated adolescents may face unique developmental challenges. The risk factors that impede healthy development and promote psychological symptoms may vary and are not mutually exclusive. After investigation and analysis of the risk factors involved in immigration, it is necessary for more attention and efforts to be devoted to assisting newly immigrated adolescents through their transition.

Improvement starts at the environmental and community level. Actions should focus on giving immigrated adolescents support while also encouraging them to be socially active in school and at home. The recommended solutions proposed in this study are focused on creating a better ecological environment for the newly immigrated adolescents.

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62 Paper and Commentary of people living with dementia: An exploration of volunteers’ experiences. Health & Social Care in the Community, 26(2), 158–166. https://doi-org.mccc.idm.oclc.org/10.1111/hsc.12477 Smokowski, P. R., Rose, R., & Bacallao, M. L. (2008). Acculturation and Latino family processes: How cultural involvement, biculturalism, and acculturation gaps influence family dynamics. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 57(3), 295–308.

Smokowski, P., Rose, R., & Bacallao, M. (2008). Acculturation and Latino Family Processes: How Cultural Involvement, Biculturalism, and Acculturation Gaps Influence Family Dynamics. Family Relations, 57(3), 295-308.

Retrieved March 30, 2020, from www.jstor.org/stable/20456794 Sohn, S., & Wang, X. C. (2006). Immigrant Parents’ Involvement in American Schools: Perspectives from Korean Mothers. Early Childhood Education Journal, 34(2), 125–132. https://doi-org.mccc.idm.oclc.org/10.1007/s10643006-0070-6 Solano-Flores, G. (2008). Who is given tests in what language by whom, when, and where? The need for probabilistic views of language in the testing of English language learners. Educational Researcher,37(4), 189–199.

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Telzer, E. H. (2011). Expanding the acculturation gap-distress model: An integrative review of research. Human Development, 53(6), 313–340 The U.S. Department of Health & Human Services. (2019). A Day in the Life of a High School Teen. Retrieved from https://www.hhs.gov/ash/oah/facts-and-stats/day-in-the-life/index.html Thibeault, M. A., Mendez, J. L., Nelson, G. R. O., & Stein, G. L. (2017). Impact of trauma exposure and acculturative stress on internalizing symptoms for recently arrived migrant-origin youth: Results from a community-based partnership. Journal of Community Psychology, 45(8), 984–998. https://doi-org.mccc.idm.oclc.org/10.1002/jcop.21905 Tsz Yin Fung, & Webster, R. (2018). Perceived Social Support, Social Interest, and Mental Health: Testing a Mediator Model. Journal of Individual Psychology, 74(2), 157–171.

Tummala-Narra, P., & Claudius, M. (2013). Perceived Discrimination and Depressive Symptoms Among Immigrant-Origin Adolescents. Cultural Diversity & Ethnic Minority Psychology, 19(3), 257–269. https://doi-org.mccc. idm.oclc.org/10.1037/a0032960 Turney, K., & Kao, G. (2009). Barriers to School Involvement: Are Immigrant Parents Disadvantaged? Journal of Educational Research, 102(4), 257–271. https://doi-org.mccc.idm.oclc.org/10.3200/JOER.102.4.257-271 United States Census Bureau. (2017). American Community Survey 1-Year Estimates. Retrived from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_1YR_DP02&prodType=table USA Facts. (2018). Why do people immigrate to the US? Retrieved from https://usafacts.org/articles/why-do-people-immigrate-us/ Vandeleur, C., Jeanpretre, N., Perrez, M., Schoebi, D., & Murray, V. (2009). Cohesion, Satisfaction with Family Bonds, and Emotional Well-Being in Families with Adolescents. Journal of Marriage and Family, 71(5), 1205-1219.

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org/10.18297/etd/1599 Yu, J. J. (2016). The Intertwined Relationship between Self-esteem and Peer Stress Among Korean Adolescents: A Prospective Longitudinal Study. Social Development, 25(1), 157–175. https://doi-org.mccc.idm.oclc.org/10.1111/ sode.12125 Zimmer, G. M. J. (2016). Peer Rejection, Victimization, and Relational Self-System Processes in Adolescence: Toward a Transactional Model of Stress, Coping, and Developing Sensitivities. Child Development Perspectives, 10(2), 122–127. https://doi-org.mccc.idm.oclc.org/10.1111/cdep.12174 Zvolensky, M. J., Jardin, C., Garey, L., Robles, Z., & Sharp, C. (2016). Acculturative stress and experiential avoidance: relations to depression, suicide, and anxiety symptoms among minority college students. Cognitive Behaviour Therapy, 45(6), 501–517. https://doi-org.mccc.idm.oclc.org/10.1080/16506073.2016.1205658

64 Paper and Commentary Season of Migration to the North: Orientalism and Decolonization Efforts Ellie Huh, Davidson Academy of Nevada Sudanese novelist Tayeb Salih’s Season of Migration to the North (1966) is often thought to be a keynote postcolonial novel in Arabic culture, with distinctive suggestions of the problematic nature of orientalism. Orientalism is a patronizing “colonial discourse…[that constructs] the East as sensual… exotic… mystical…[and] primitive, [and] a West that [is] everything the East [is] not” (Parker 248), wherein the East consists of Asia, North Africa, and Middle East. Orientalism is inextricably connected to the imperialist, colonizing societies who constructed it; thus, if decolonization is the undoing of colonialism, in order for it to be successful, the issue of orientalism must also be resolved. Unlike the Orientalism-fueled relationships that Sudan-born Mustafa has with European women Ann Hammond, Sheila Greenwood, and Isabella Seymour, the relationship that Mustafa and Jean Morris share is a deeper, more passionate one of unique jouissance (traumatic enjoyment) and distinct lack of Orientalism. Its tragic ending, however, is indicative of the resulting, unresolved nature of the postcolonial condition as influenced by orientalism. Mustafa’s relations with these women and the narrator’s reflection in the Nile, then, suggest the necessity of a change in the framework in which decolonization efforts should continue.

Author Tayeb Salih was born in 1929 in the Northern Province of Sudan. Recognized as one of Sudan’s greatest authors of the twentieth century, Salih’s writing often draws from his Islamic background and experience of village life and modern Africa. His most famous book is Season of Migration to the North, which he wrote while abroad during Sudan’s civil war (1955-1972) on the type of government that Sudan would have. This war came immediately after Sudan’s independence from the British empire in 1956, and during the war, the country was plagued by an inefficient and corrupt government led by impotent rulers. Season of Migration to the North is set in the 1960s, and it is mainly concerned with post-colonial African society and the effects of British colonialism. The book was originally banned in Sudan for its graphic sexual content, but it is now globally available and is considered as one of the greatest novels in Arabic literature.

Ann Hammond, in her relationship with Mustafa, mythologizes and fetishizes Mustafa’s “oriental” nature while dehumanizing those of African descent. Ann sees in Mustafa “a dark twilight like a false dawn” (Salih 27).

Even before she first meets Mustafa, she yearns “for [the] tropical climes, cruel suns, purple horizons” of Oriental countries, and thus in her relationship with Mustafa, she transfers these fantasies onto him: he is “a symbol of all her hankerings” (Salih 27). Her well-intentioned interest in Eastern culture manifests itself as a misled Orientalist ignorance in which she reveres a nonexistent construction of Mustafa’s African heritage, even as she studies “Oriental languages at Oxford” (Salih 27). She speaks to Mustafa “as though intoning rites in a temple” (Salih 118), and her self-reference as “Sausan, [Mustafa’s] slave girl” (Salih 117) points to her consideration of Mustafa’s descent as almost mythological--something to be praised and honored. However, Ann simultaneously holds notions of African culture as primal, exotic, and savage: “in [Mustafa’s] voice she hear[s] the scream of ferocious beasts in the jungle” (Salih 118). Her love is not for Mustafa himself, but rather the illusion, the mirage that he puts forth to catch his prey (Salih 26). Thus, their relationship, forged on Ann’s Orientalist fantasies, remains unfulfilling and meaningless to Mustafa.

Similarly, Sheila Greenwood finds herself attracted to Mustafa’s “world, so novel to her” (Salih 30); it is the nature of Mustafa’s culture that ultimately draws her in. She is enamored by the ivory necklace Mustafa gives her and considers his “marvellous… black colour… the colour of magic and mystery and obscenities” (Salih 115). Just like Ann, Sheila makes apparent the contradictory attitude that the Northern women have towards Mustafa’s African heritage: he is “marvelous” and magical, a beautiful creature of nature, but also obscene and mysterious. He is exotic and foreign, a distinctively Orientalist discourse.

Isabella Seymour, like Ann and Sheila, believes that Mustafa and others from the same culture are primitive, but unlike them, she approaches Mustafa with a white savior complex. She looks at Mustafa with “Christian sympathy in her eyes,” and “[Mustafa feels he] ha[s]been transformed in her eyes into a naked, primitive creature, a spear in one hand and arrows in the other, hunting elephants and lions in the jungles” (Salih 33). All three women have highly dramatized attitudes towards Mustafa, who represents “Oriental” culture and therefore the colonized.

While Ann, Sheila, and Isabella engage in an Orientalist post-colonial discourse, in which Eastern culture is

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mythologized and fetishized while simultaneously dehumanized and primitized and which stems from the sense of privilege of the colonizers, it is ultimately Mustafa who perpetuates this thought. He insists upon playing into Orientalist views, choosing to form new identities, enhancing and romanticizing exotic aspects of his culture and life in Sudan to reflect the dreams and “hankerings” of British women. His “bedroom [is] like an operating theatre in a hospital” (Salih 27), and “for every occasion [he possesses] the appropriate garb” (Salih 30). Even Ann and Isabella, well-intentioned Westerners, accept Mustafa’s lies and are unable to comprehend that the East is not so different from the West; instead, they prefer to surround themselves with their romantic fantasies. Ultimately, the Northern women with whom Mustafa chooses to have sexual relations commit suicide. When these deaths are brought up in court when Mustafa is being charged with the murder of Jean Morris, his defense attorney argues that Ann, Sheila, and Isabella “were not killed by Mustafa Sa’eed but by the germ of a deadly disease that assailed them a thousand years ago” (Salih 29-30). This disease, the root of the fatal ends of Mustafa’s relationships, the attorney implies in his speech, is postcolonial Orientalism and the alienation between Eastern and western culture.

Mustafa and Jean Morris’ relationship stands out from the rest by lacking the fetishizing view assumed by the white women. From the very moment they meet, it is clear that Jean is quite unlike Ann, Sheila, or Isabella; in fact, she could even be considered the opposite. She gives Mustafa “a look of arrogance, coldness, and something else. [He opens] his mouth to speak” (Salih 26), but she is gone before he can begin weaving his false tales of exotic life in Sudan. Stunned by her beauty and arrogance unlike what he has encountered before, Mustafa pursues Jean relentlessly, even as she continually humiliates him. She finally abruptly agrees to marry him, but their relationship remains tumultuous and aggressive even in marriage, with Jean flirting with other men and insulting Mustafa, and Mustafa threatening violence. The traditional roles played by Mustafa and the woman are reversed. It is Mustafa being led along and manipulated, and it is Jean who controls the dynamic in the relationship, up till the moment of her death.

As opposed to the other Northern women with whom Mustafa has sexual relations, Jean is neither innocent nor manipulatable. I instead of exoticizing him and his heritage, she destroys the representations of the identities that he has constructed for Ann, Sheila, and Isabella: ‘[Jean] point[s] to a rare Arabic manuscript on the table... [and tears] it to bits… She points[s] to a silken Isphahan prayer-rug… [and throws] it on the fire” (Salih 129-130). Her actions indicate the stark difference between her and the other women; unlike them, Jean is neither impressed nor enamored by Mustafa’s “oriental” possessions. It is never suggested that her love for him stems from his heritage, and she never makes comments of the color of Mustafa’s skin or his primitive culture. She is the only one of Mustafa’s lovers that sees past the Orientalist views of him as an exotic African.

Jean’s behavior towards Mustafa, from her taunting to her physical violence towards him, incite within him both passionate rage and passionate love. On one hand, Mustafa is driven to “sorrow” and “hate” (Salih 132) by her actions, in which “lay [his] destruction” (Salih 132), but he also experiences rare “moments of ecstasy… worth the whole of life” (Salih 133) and cannot bring himself to leave her. The strikingly different dynamic of their relationship is one formed by jouissance; Jean’s enigmatic, violent actions shatter Mustafa’s false image of himself, one that he perpetuates but hates. Therefore, Jean effectively breaks the identity and structure that Mustafa has created for and with the other Northern women, violently exposing Mustafa’s true self as someone other than the figurehead of romantic Oriental fantasies, something that he has never before experienced in Europe. In this sense, Jean is a breath of fresh air for Mustafa, and it is for this reason that he truly loves her. In the culmination of their toxic, violent relationship, Mustafa pulls out a dagger as they have sex, having threatened her with death a multitude of times in their marriage. However, even as Mustafa is about to kill her, Jean simply looks at him and the weapon with “a mixture of astonishment, fear, and lust” (Salih 135). She seems to enjoy the situation, and makes no attempt to stop him, instead encouraging him and welcoming his answer to “her appeal” (Salih 136): the deliverance of her death.

Both Mustafa and Jean share the experiences and effects of jouissance in their relationship; they are arguably equally cruel to each other, deriving pleasure from the other’s violence, yet both love each other .

The tragic end to Jean and Mustafa’s relationship indicates the conflict of postcolonialism-influenced interracial relationships. While Ann, Sheila, and Isabella’s suicides and Mustafa’s own identity disconnect point to the dangers of Orientalism in postcolonial relationships, Jean’s murder implies the ineffectiveness of color blindness in such relationships. Jean doesn’t simply ignore Mustafa’s culture, but shatters his performed identity. This suggests

66 Paper and Commentary that Jean’s non-exotic love for Mustafa and Mustafa’s unquestionable reciprocation of this love do not constitute a satisfactory solution to postcolonial Orientalism-influenced relationships between the colonized and the colonizer.

Instead, the pair’s relationship only serves to further deepen the problematic nature of dealing with interracial relationships in a postcolonial society.

Mustafa’s relationships with the Northern women, then, are indicative of an outdated, inefficient framework in which decolonization efforts have been attempted. If Mustafa’s relationships with Ann, Sheila, and Isabella and his relationship with Jean are to be considered two extremes of a spectrum, what links them is the tragedy that follow—a result of the “disease” that is postcolonial Orientalism. Mustafa’s individual performances only further enhance the Northern women’s belief in Orientalist stereotypes, and even his outstanding intellectual achievements do nothing to stop the European idea that he is primitive. Yet, Jean’s attempts to separate Mustafa from his heritage and the history of the colonizer and colonized through deliberate race blindness are equally as ineffective as a decolonization effort, as seen through the violence that ensues. Ultimately, the two lovers both die: Mustafa, unsatisfied with his calm village life and devastated by Jean’s death, commits suicide in the Nile. he current attempts at postcolonial-influenced decolonization are ineffective, as Season of Migration to the North suggests, examining the narrator’s contemplations and his possible death in the Nile can reveal the way in which decolonization efforts require the participation of the masses. Struggling to understand Mustafa’s tumultuous past, as well as reeling from the violent death of his lover, the narrator goes for a swim in the Nile for peace of mind.

As he floats in the river, he surrenders himself to drowning, finding that he is “half-way between north and south… unable to continue, unable to return” (Salih 138). The cultural hybridity caused by his life in Sudan and Europe prevents him from truly integrating into the culture of either the colonized or the colonizers. In the same sense, Mustafa cannot reconcile his cultural hybridity; his “exotic” descent is the focus of women in Europe, his European experiences do not belong in Sudan. Mustafa and the narrator are two sides of one coin; they both come from Sudan, are educated in the North, and ultimately find themselves returning to Sudan and facing death in the Nile.

Unlike Mustafa, whose death is clear, the narrator, a person of Eastern descent who has grown up in a postcolonial society, has an uncertain fate. While Mustafa’s volatile, tragedyfilled life points to the way in which decolonization efforts cannot continue, the narrator’s ambiguous future points to the opposite. Season of Migration to the North ends with the narrator’s calls for help as he drowns. Whether or not the narrator, an embodiment of the postcolonial condition, lives is dependent on if others hear his calls and come to his aid. The narrator on his own cannot live, just as decolonization cannot be successful through the efforts of an individual. Rather, saving the narrator and decolonization both require group participation in order to be effective.

“How strange! How ironic! Just because a man has been created on the equator some mad people regard him as a slave, others as a god. Where lies the mean? Where the middle way?” (Salih 89). It is ultimately the narrator who holds a possible answer to his own questions. While Mustafa and his relationships with Ann, Sheila, and Isabella illustrate the contradictory nature of Orientalism and its negative effects on those involved, the middle ground that the narrator seeks also cannot be found in Jean’s jouissance-filled relationship with Mustafa. While color blindness in its most basic form--seeing past someone’s race--is not necessarily harmful, it is misused by Jean as justification for the denial of Mustafa’s past and the complete erasure of his culture. It is the narrator’s own possible drowning in the Nile that proposes a workable framework for thinking about the postcolonial condition in decolonization efforts.

It is not Jean Morris’s color blindness, nor is it the fetishization of Eastern culture in Mustafa’s other relationships; instead, the possibility lies in a collective effort towards eliminating Orientalism. The narrator’s uncertain fate does not suggest a perfect solution nor a completely bleak future, but instead proposes a possibility to break apart from oppressive colonial ideologies contingent upon the willing participation of the masses.

Works Cited Parker, Robert Dale. How to Interpret Literature: Critical Theory for Literary and Cultural Studies. New York, Oxford University Press, 2008.

Salih, Tayeb. Season of Migration to the North. New York, The New York Review of Books, 1969.

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Avant-Garde in 1600: Tenebrism Andy Xu, the Kent School 21’ I first saw the Calling of Saint Matthew by Michelangelo Merisi da Caravaggio in 2014 in the Contarelli Chapel of San Luigi dei Francesi, during a visit to Rome with my family. It was hard for me to place this religious painting in any category or period in the history of art. Should its detailed and realistic depiction of figures be considered as a Baroque artwork, where brushstrokes are loose? Or, should its religious theme places it in the category of High Renaissance artwork? It is hard to conclude, because even the artist Caravaggio himself might not be able to answer these questions when he incorporated tenebrism—the use of large dark areas in paintings together with one light source—in his work.

The effect of tenebrism will be the extreme contrast between darkness and light, which appeared in prior artworks by Venetian artists including Tintoretto and was also used by later masters like Rubens. But here in Caravaggio’s work, tenebrism seems less like an art technique but more as a theme of the painting. It’s as if tenebrism itself stands out as a short art period between the closing curtain of Titian’s Venetian art in 1570s and the opening of Baroque dramatic art by Bernini in 1610s.

Tenebrism, while deployed by Caravaggio in the early Baroque, had its origin in the High Renaissance when Leonardo da Vinci developed the primary idea of light and shade in paintings, later known as chiroscuro.

Tenebrism distinguished shadow (ombra) from total darkness (tenebra) and introduced the idea of gradations in light and dark values of color on a figure or an object, which, according to Leonardo, produced the illusion of light and shadow. Nevertheless, Leonardo warned against using such illumination as it would give too strong a contrast and be of little use to a painter.

68 Paper and Commentary In the 16th century, Europe experienced religious revolutions, during which Martin Luther, previously a Catholic monk, proposed the idea of Protestantism, in opposition to the corruption, mainly the sale of indulgences he perceived within the Catholic church. Facing the challenges from Protestants, various new religious orders within the Catholic Church were founded, of which the Jesuits were perhaps the best-known in Rome. In 1560, all the Jesuits were required to teach the counter reformation goals, and this started the very early Jesuits schools.

Besides education, the Jesuits also determined to combat Protestantism in art, and they thus started to patronize a vast range of artists in the 1590s. The so-called Protestant art was based on Albrecht Dürer’s printmaking art and developed into a simpler depiction of saints in Luther’s personal artist Cranach the Elder’s art. The Jesuits therefore needed to revolutionize the prior Christian art patronized by the popes in early 16th century, in order to appeal to more Catholic followers. In certain way, Caravaggio was first of such artists who worked for the Jesuits, and his art, together with his use of tenebrism, thus makes him an Avant-Garde in the 1590s.

Different from previous style of Mannerism in the 1570s and 1580s, which elongated the human body, bleached the palette, and received support from the elites, Caravaggio’s tenebrism art depicts figures with naturalism and added dramatic elements, particularly the extreme contrast between light and dark.

In the Calling of St. Matthew, one would be amazed by the perfect match of including tenebrism with the story’s context. Jesus stands just under the beam of light calling Matthew. The one light source from the right window shines on St. Matthew’s face, which helps the viewers understand the idea of faith and the calling to follow Christ as the savior. The story of the calling of St. Matthew would be very familiar to artists as it was told in the Gospel of Matthew that “as Jesus went on from there, he saw a man named Matthew sitting at the tax collector’s booth. ‘Follow me,’ he told him, and Matthew got up and followed him.” In Caravaggio’s painting, the artist captured the moment when Christ called St. Matthew and at the exact moment, a beam of light illuminated on all the men sitting around the round table in the painting. St. Matthew was identified as the one who pointed at himself, seemingly saying “me?” The people surrounding the table included a tax collector called Levi and his friends, identified as sinners.

If in the 20th century, the Avant-Garde movement began with a spirit of challenging the social norm or the status quo, Caravaggio’s tenebrism art broke the tradition of religious art in the 15th and 16th century: he used darkness to represent the power of religion. In one of the reviews I wrote about the solitude of artists, I mentioned how “without darkness, one can never feel the positivity offered by light.” During Caravaggio’s period, almost nobody understood him, not even the entire Catholic Church. In his life, he only had one official patron, Cardinal del Monte, who appreciated this dramatic element in art. The Protestants enjoyed reading the printmaking art, which is in black and white, made by artists including Dürer and Cranach; while, the Catholics still admired the bright and positive religious art by Michelangelo in the Sistine Chapel. Caravaggio approached religion from a different point of view. His art at first sight may not provide hope for the prayers, but with closer look, one will be moved by the strength that tenebrism art is offering. It’s the contrast that brings hope, not the light itself.

In the Madonna di Loreto, we may have a better sense why I would call tenebrism a separate style. The use of tenebrism highlighted the humble couple on the lower right corner as they and a miraculous vision of the Virgin Mary standing in the upper left corner of the painting. Shown as a common theme in the late 16th century, the Madonna or Virgin Mary was often portrayed holding Christ as a child in her hand and standing in front of people praying. Here, the traditional icon of the Madonna was transformed into magic life by Caravaggio’s brush. In the painting, the Madonna, identified by her violet clothing, appeared miraculously from the left side and lowered Christ in her hands to bless the two worshippers kneeling on the right. The only light passing through the faces of Christ and the Virgin ultimately reached the faith in prayers surrounded by darkness.

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But this painting has something more than the religious effect: the naturalism created by the use of tenebrism. Even though in real life, having merely one light source is almost impossible, but when it indeed happens, everything that is in the light becomes so clear that a detailed depiction of it will represent another level of naturalism. Here in this Madonna altarpiece, the wrinkles on the old lady’s hands and face in the right corner appear clearly. Madonna’s facial expression, the old man’s bending feet, and Christ’s body movements all become alive within one light source. Tenebrism here not only creates a different view on religion but defines naturalism differently. To most artists, only when the environment matches real life can the work be called as realistic or naturalistic. Nevertheless, Caravaggio broke from this norm and used this unnatural moment with only one light source, to define naturalism on his own.

Can Caravaggio’s tenebrism be called an Avant-Garde movement then? The answer would be same when artists questioned whether Marcel Duchamp’s readymade can be treated as art. Caravaggio’s tenebrism creates an effect of extreme drama, which could not be seen in later Baroque art. Its naturalism is also different from the Renaissance naturalistic depiction of figures or later realism in the 19th century. As for influence, we can apparently see later artists including Gentileschi, de La Tour, and even Frank Stella in modern day. Caravaggio is an innovator of art in the Baroque, a passionate servant of the Jesuit Order, and a progenitor of Catholic art in the 17th century.

His legacy remains until today and his spirt of challenging orders influences modern artists. I would like to end this article with a comment by Frank Stella, in a lecture where she introduced her art: “My lectures concentrate on painting around 1600, Caravaggio and Rubens. I see them as the beginning of painting as we understand it—they mark a break with the past.”

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The Constant Struggle: Challenges of Deaf Education in the United States Linda Pang, St. Paul’s School 21’ For the past two centuries, investments in education in the United States have led to progress in multiple dimensions, making the American education system one of the leading models in the world. Yet alongside overall advancement, the Deaf and Hard of Hearing (commonly abbreviated as DHH) student population has been “left behind” (Kritzer). The first school for the Deaf in America was founded in 1817 by French sign language teacher Laurent Clerc and American educator Thomas Gallaudet (Canlas). According to professional ASL interpreter Mrs. Burke, specialized institutions have always instructed deaf children “primarily with signed language” or at least a mix of signing and oral teachings since the beginning of Deaf education in the US (Burke). However, beginning in the 1970s and continuing into the 21 century, DHH students in the US are increasingly integrated into mainstream classrooms under the intention of providing equal educational experiences and lessening exclusion within the larger community. In reality, DHH students often face challenges in adapting to a fully hearing environment, leading to a significant achievement gap between the deaf and hearing students in both academic and social developments.

The current predicament for DHH students calls for efforts from both the government and Deaf studies professionals towards transforming the mode of Deaf education within the nation.

Though unsuccessful in its effects, the movement for educational integration originates in the desire for the later societal integration of all DHH individuals. The mainstreaming of deaf students into general classrooms was first introduced by the declaration of the Milan Conference and reinforced domestically by the Education for All Handicapped Children Act passed in 1975 (“Laws Impacting”). In 1880, the “multi-country conference of deaf educators,” later referred to as Milan conference, decided collectively that “oral education was better than manual (sign) education” for all DHH students (Berke). While DHH students had occasional presence in general education prior to the Milan Conference, according to DHH expert Jamie Berke, it was not until this decision that “sign language in schools for the Deaf was banned” (Berke) and large numbers of DHH students were integrated into mainstream schools. Thus, the lack of focus on specialized education caused “the pipeline of well-educated signing teachers and mentors [to dry] up” (Burke). As a result, the conference’s conclusion significantly impacted Deaf education worldwide and served as a basis for the US to transition into mainstreaming DHH students as well.

In the years following the declaration, debates around the ideal method of Deaf education involved much controversy within Deaf communities around the world. Many at the conference believed that an oral education better benefits the Deaf community in terms of “restoring the deaf-mute to society and giving [them] fuller knowledge of language” (Berke). Although the US representatives opposed the ban on sign language in schools at the time of the conference, the “1975 Public Law 94-142” started the “mainstreaming of deaf children in public schools” domestically (“Deaf History”). This law had the purpose of “guaranteeing a free, appropriate public education to each child with a disability” (“Thirty-five Years”) and became a turning point for American disability education, as well as deaf education specifically. According to the U.S. Government Accountability Office’s 2011 report, more than 85% of nation’s DHH students obtain education within integrated classrooms (Marschark, “Predicting the”) Special education professor John Luckner and deaf educational director Maura Berndsen claim that although DHH students might be benefited in general education settings by being able to interact with hearing students who are “skilled language users” (Berndsen and Luckner), they are also highly vulnerable to being “dumped” without effective accommodations (Reed et al.). Hence, the legislation initiated the DHH students’ struggles in their education which continue to affect them even today.

Within integrated classrooms, the learning experience of DHH students often differ from those of hearing students. The accommodations for DHH students, although they vary based on individual needs, typically include: closed captioned class materials, alternative testing conditions, and note taker and interpreter services (“ASL Interpreters”). Yet, these accommodations are often not made readily available in many institutions that contain DHH students. Even when the measures are in place, according to the public input summary investigating critical needs of DHH students, many remain unable to realize their “academic, linguistic, and social-emotional potentials” due to the fundamental barrier the hearing environments place on them (Szymanski et al.) The shortcomings of the DHH learning experience within the integrated classroom are reflected in their lower performance across subjects, st

72 Paper and Commentary difficulties in acquiring language, and underdeveloped social skills.

Since the DHH students across the nation struggle to maintain a similar level of academic competency with their hearing peers, their learning barriers reflect one of the most critical outcomes from the problems of Deaf Education. As agreed by multiple studies done on the topic of Deaf education, the “lack of opportunity to learn faced by DHH students” has a main cause in the “reported deficiency of curriculum and instruction in ... some programs serving deaf students” (qtd. Qi and Mitchell). As Deaf study gradually began to receive increased attention in the latter part of the 20th century (Marschark, “Deaf Studies”), the studies on academic performances of DHH students provided statistical data that demonstrated the significant gap between deaf and hearing students. A California statewide assessment showed that deaf students scored “almost 40% lower than average student scores on the same standard testing” (Anderson). Similar conclusions were drawn in a national study, in which researchers found that the “average student with a hearing loss graduates from high school with reading comprehension skills at about the fourth grade level and approximately 20% of students with hearing loss (some 2,000 annually) leave school with a reading level at or below second grade” (Dew et al.). Though these results are surely partially influenced by investigated subjects’ difference in self-motivation for learning, the data reveal the starkly inferior abilities that DHH students acquire from their education in integrated institutions.

Moreover, DHH students not only struggle academically but also face inadequate development in language skills for both English and American Sign Language. ASL uses fundamentally different language structures than English, meaning that operating in a mainly English-driven environment with hearing teachers and peers “deprives [DHH students] of solid language role models” (Burke). Furthermore, because interpreters often have inconsistent skill levels, even DHH students with access to an interpreter “may be receiving inaccurate language modeling or a more coded English than true ASL” (Burke). In their research study examining interactions between deaf and hearing students, anthropology professor Elizabeth Keating and PhD candidate Gene Mirus argue that DHH students “easily become communicatively isolated in public schools, where they are in a small minority among a majority of hearing peers and teachers” (Keating and Mirus). The minimal “deaf-hearing interactions” that occur frequently do not extend beyond the context at hand and lack “many features of reality-building through language that are crucial in social, cultural, and cognitive development” (Keating and Mirus). For instance, a lunchroom “deaf-hearing” interaction might involve the food on their plates, but would likely not develop further to include what food they each like or discussions on other related topics. Overall, DHH students often lack language models and interactional practices that would help them develop necessary language abilities through their classroom experience.

As a consequence of these language development obstacles, DHH students often report experiences of social isolation in school and lower confidence in class participation, even when an educational interpreter is present. Based on a case study focusing on academic and social inclusion of DHH students in mainstream secondary schools, a high 75% of hearing students “actively participates in class and express their views” when compared to the deaf students in the same level (Groumpos and Lampropoulou). Gina Oliva, author of the book Alone in the Mainstream: A Deaf Woman Remembers Public School, describes in her writing that DHH students often display “superficial participation,” where they pretend to be engaged when in fact not understanding at all, sending those around them the wrong message that they are “just fine” (Oliva 93-94). Consequently, teachers and professionals often overlook DHH students’ lack of mode of communication which negatively affect their class participation and content understanding.

Beyond the effects on their academic participation, DHH students struggle to find opportunities to practice crucial social skills with their hearing peers. As missed interactions accumulate, many DHH students become “socially immature and [unable to] develop close friendships” (Szymanski et al.). An anonymous interpreter who wrote to Oliva said that the assistance of interpreters cannot overcome the problem for the majority; after all, the very presence of an adult often alters the typical peer-to-peer interactions that would take place (qtd. Oliva, “Sign Language”). In many cases, DHH students might just choose to “chat with their interpreter” rather than attempting to counter the difficulties of “communicating with their peers through the interpreter” (qtd. Oliva, “Sign Language”). The collective observation of DHH students’ social behaviors in integrated classrooms reveals the isolation they suffer and emphasize the need for change within these programs.

Ultimately, the obstacles that DHH individuals face in education have a detrimental effect on their later

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employment and capacity to live independently. Surely, the roots of inadequate learning experiences that DHH students acquire from elementary education would continue its burden in higher education which directly impact their success beyond the classroom. While the “overall dropout rate for undergraduate college students” in the US falls at around 40% (Bustamante), students who are Deaf and Hard of Hearing have a much higher “70% college dropped out rate” (Bowe) According to a study looking at “education, employment and independent living of DHH individuals,” though college education is not the sole factor in determining their futures, the majority of vocational rehabilitation counselors surveyed felt that employment opportunities in the US are very limited for “workers who lack postsecondary education” (qtd. Appelman et al.). As a result, the deficiencies in educational accommodation for this group have serious further implications in the later life and career competency of DHH students.

Throughout the history of Deaf education in the US, government and authorities played significant roles in both improving and aggravating the challenges DHH students face. Although several legislative acts have been passed for improving education for individuals with disabilities, these generalized solutions occasionally lead to negligence of the specific needs of DHH individuals. The Individuals with Disabilities Education Act initially passed in 1975 was the first governmental legislation addressing the lack of education many disabled individuals face in the United States. The measure brought mandated education access for disabled population as a whole, including mainstreaming large numbers of deaf students in this endeavor. Under the act’s influence, the US Department of Education report shows that by 2008 “95 percent of all students with disabilities were educated in their local neighborhood schools” and deaf students make up a significant percentage of that growth (“U.S. Department’’). One requirement in the act was for disabled students to be educated in the “least restrictive environment” which means “children with disabilities …are educated with children who are not disabled” (Forte). Despite the increase in access to general education, DHH students struggle with lack of accommodation within this assimilated environment put forth by the act (“Laws Impacting”). To cope with this challenge, the government and researchers need to utilize their expertise and capabilities to make effective changes to the current system.

In the past decade, new policies regarding disabled and Deaf education have built upon previous government support actions to provide targeted aid. However, these legislatures were also confronted with difficulties in ensuring widespread and accurate application. The No Child Left Behind Act, enforced in 2001, aims to implement a “system of accountability measures that include guidelines for assessment, standards-based curriculum, teacher quality, and added resources for students in schools that do not meet annual benchmarks” (Cawthon). Compared to the act established earlier, this legislation provides more detailed academic support instructions for schools that accommodate DHH students. Yet, psychology faculty member of Walden University Stephanie Cawthon stated in her article that although the NCLB act provides measurable benchmarks, “the complexities of state policies and data reporting limits the AYP (Adequate Yearly Progress) framework’s ability to capture the progress of students attending schools for the Deaf” (Cawthon). Overall, the addition of this act improved education quality for certain DHH students but failed to encompass a wide range of institutions and to accurately report deaf student performances across the nation.

Based on analysis of the education barriers faced by DHH students, authorities must update the solutions for improving this group’s learning experience with the goal of better representing the kind of assistance they truly need. Fiscal & Policy Analyst Ryan Anderson, who focuses on the funding of specialized secondary education programs, have proposed the formation of critical mass programs as one solution to the problems DHH students experience within integrated classrooms. According to Anderson, forming masses of 3-20 DHH students per grade has several advantages. For example, DHH students are “less likely to be socially isolated” and able to access a “variety of DHH instructional approaches at a lower cost” (Anderson). To ensure the success of this response, the analyst also gave “legislative recommendations... [to]... simplify the process for starting regional programs” (Anderson). For instance, if the programs could be “[allowed] to serve all interested students without first obtaining permission from [students’] original home districts” then a larger number of programs will be made available to higher numbers of eligible participants (Anderson). In this way, DHH students can achieve a comfortable balance between integrated learning and specialized accommodation to maximize their understanding.

Another crucial aspect to consider is the developments of standardized assessment accommodation for DHH students in both mainstream and specialized programs. In fact, the lack of proper accommodations in stan-

74 Paper and Commentary dardized testing protocols lead to insufficient evaluations of DHH students’ academic achievements. By the time of the Deaf study research in 2012, only Virginia, Massachusetts, and South Carolina had made “advances in standardized approaches to academic assessment accommodations” (Qi and Mitchell), leaving DHH individuals in 94% of the nation without appropriate accommodation. Hence, the inadequate support contributes to the inaccuracies in the evaluations of DHH student performances, as they fail to take into account the differences in both learning opportunities and level of understanding this group faces. Conversely, the limited data from these evaluations also negatively influence the development of accommodation for academic assessments. In countering these current deficiencies, professor Qi and Mitchell of Deaf studies majors suggests that researchers in the field need to focus on “large-scale research efforts to advance the development of valid, reliable, and effective assessments of academic achievement” for DHH students (Qi and Mitchell). In the future, it is necessary to improve the reliability of academic evaluations and effectiveness of accommodation models for DHH students to ensure a positive cycle of interdependency between the two.

While external factors are important considerations, the teaching approaches within institutions that contain DHH students also determine the outcome of their learning. Deaf education professor J. Freeman King defines incidental learning as “what a person learns through informal communicative interactions with others in public and educational settings” (King). For hearing children, one of the main sources of knowledge and vocabulary is the incidental learning that they experience while hearing words used under different contexts of life. On the contrary, DHH students miss most of these opportunities of language growth when they can’t hear conversations and other forms of sounds (Christ and Chiu). According to deaf journalist John Cradden, even when DHH students have assistive hearing aids that help them “hear” the teacher’s words, their devices are not able to “pick up on the chatting, gossiping and joking outside the classroom or in the yard or on the bus home” (Cradden). Therefore, parents and teachers must be aware of deaf student’s need for incidental learning and put in extra effort to compensate in alternative forms.

In order to help DHH students achieve maximum learning within hearing classrooms, teachers should take into consideration the dynamics of information perception and plan lessons accordingly. For instance, teachers can utilize more visual aids during their lecture including hand gestures, captioned videos, and hands-on experiments. To help students understand each other’s’ perspectives, lessons can also include “a role play situation where hearing students portray a DHH student in a crowd of hearing students or vice versa” (King). Ultimately, the fundamental resolution is for both parents and teachers to be aware of the significance of incidental learning for DHH students and be willing to accommodate their needs to fulfill learning in all manners to the greatest capacity possible.

From favoring sign language to primarily mainstreamed, the approaches towards DHH education have shifted greatly since it was first introduced to the US. As someone who experienced first-hand the challenges of being a DHH student within mainstream classrooms, Cradden described his previous feelings in school as being “a master bluffer, a wallflower, a member of the crowd, present and yet absent” (Cradden). Today, many are proposing the idea of returning to special needs education in order to more systematically accommodate DHH students.

While this might seem like a solution that disregards the past century of Deaf education developments, the performances and experiences of DHH students say otherwise. From the perspectives of DHH students who have experienced unsuccessful communication within mainstream classrooms, the social interactions, academic achievements, and overall opportunities for incidental learning would be “much easier to create in a Deaf school” (Cradden). It is not difficult to understand why ideas of reform for the Deaf education program are being brought to the table when this population is now often lacking essential platforms of communication both for the sake of academic and personal developments.

Although DHH students continue their education struggle in the 21 century, they are receiving a diminishing amount of support from society. Professor Marshark et al., in an article focusing on Deaf studies in the 21 century, stated that our society’s ideology is shifting towards normalization and the concept that “the majority of the population must or should… be a part of the norm” (Marschark, “Deaf studies”). Despite the better assistance that technological improvements have made possible, increasing use of cochlear implants and “advances in genetic options that allow parents to avoid having deaf babies” (Marschark, “Deaf Studies”) gradually helped to categorize st

st

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deafness as “oral failure” and exclude the condition from social norms. There remains heated controversy as to the ethical and functional conducts of the technologies that are now being applied to increasing amount of DHH individuals. While no one questions whether women will continue to exist, or whether African Americans will continue to exist in future generations, the question arises for “why should deaf people and their sign languages continue to exist?” (Marschark, “Deaf Studies”) If not addressed directly now, the existential struggles facing Deaf communities in the US, including their educational endeavors, will continue to be marginalized without proper resolutions.

In order to fully recognize the Deaf community and provide DHH students with proper support, the government and related researchers and professionals have the ability and responsibility to not only generate amendments to the guidelines on accommodations of mainstream institutions but also to actualize fundamental changes in the entire Deaf education system. Despite the “tremendous progress” that has occurred globally in education for DHH students (Buckley), the future and success of this population will require the whole society’s effort in promoting equality and dismantling assumptions about their experiences.

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