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Alarm Khan
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The American Sleep Disorders Association, in 1990, initiated a 5 year process to develop the widely used International Classification of Sleep Disorders (ICSD). The original ICSD listed 84 sleep disorders, each with descriptive details and specific diagnostic, severity, and duration criteria. The ICSD had 4 major categories: (1) dyssomnias, (2) parasomnias, (3) disorders associated with medical or psychiatric disorders, (4) "proposed" sleep disorders. The ICSD has since been revised twice. The second edition, ICSD-2 was released in 2005 which contains a list of 77 sleep disorders. That new list was broken down into 8 sub-categories: (1) Insomnia; (2) Sleep-related breathing disorder; (3) Hypersomnia not due to a sleep related breathing disorder; (4) Circadian rhythm sleep disorder; (5) Parasomnia; (6) Sleep-related movement disorder; (7) Isolated Symptoms, apparently normal variants, and unresolved issues; and (8) Other sleep disorders. A third edition of the ICSD was released in 2014. The major clinical divisions were unchanged in the third edition from the 2nd version, but there was an addition of variations in the diagnostic criteria for pediatric patients with obstructive sleep apnea, and there was a heading of Developmental Issues added to each section of disorders that have developmentally-specific clinical features in order to aid physicians in diagnosing those patients (specifically 9-CM and 10 CM). Sleep Disorders Categories The ICSD-3 lists about 77 sleep disorders which are divided into the following categories: Insomnia Sleep-related breathing disorder Central Disorders of Hypersomnolence Circadian rhythm sleep disorder Parasomnias Sleep-related movement disorder Some of the above categories have a section for isolated Symptoms, apparently normal variants, and unresolved issues Other sleep disorders There are some other sleep disorders that are divided into two appendices of the ICSD-2 manual. They are as follows: Sleep Related Medical and Neurological Disorders; and ICD-10-CM Coding for Substance-induced Sleep Disorders Study the disorders listed under each of the above categories until you have a good idea of what is included in each. There is a complete list of all the current classified sleep disorders in chapter 27, beginning on page 476 of your Sleep Disorders Medicine, 4th edition textbook. Insomnias Insomnias are disorders that usually produce complaints of not enough sleep, poor quality of sleep. Patient perception can play a role in the complaints. Occasionally, a patient may perceive that they are getting poor quality or not enough sleep even though they may be getting what we think is a normal night’s rest. Insomnias are defined by a repeated difficulty initiating sleep, not sleeping long enough, or poor quality sleep regardless of the amount of sleep time. Primary insomnia would not be due to another sleep disorder. If another sleep disorder such as OSA is causing the insomnia, then we call that secondary insomnia. These disorders may require medical treatment if they are long-lasting. Temporary insomnia due to a stressful situation or life event may correct itself with time. The types of insomnia are covered on pages 476 and 480 of your textbook. Sleep-Related Breathing Disorders These are disorders that involve disordered respiration, or breathing during sleep. These may be obstructive or not. There can be various causes of both. Central apnea syndromes include Cheyenne-Stokes breathing pattern and high-altitude periodic breathing. Cheyenne-Stokes is usually associated with either congestive heart failure or a traumatic brain injury which would actually be called secondary Central Sleep Apnea because it is secondary to another problem. It can also occur due to extreme old age, or a “worn-out” heart (a pacemaker may be needed for this type of patient). You will see patients like this occasionally. Primary Central Sleep Apnea has no apparent cause but still results in an irregular breathing pattern. These patients are not necessarily good candidates for CPAP because their breathing problem may not involve an obstruction. If not, you will likely see an increase in the number or length of central apneas after placing them on CPAP. There are newer PAP technologies that have been developed in recent years that do have some effect on the regulation of these types of patients’ breathing pattern but may show limited success in extending life expectancy. The obstructive type of breathing disorders, on the other hand, do respond well to treatment. These will likely make up the vast majority of patients that you will encounter in the sleep laboratory. Refer to pages 476 and 481 for more detailed examples of these disorders. Central Disorders of Hypersomnolence If you break down the word “hypersomnia” into its root terms as you did in medical terminology, it should be apparent that these disorders involve excessive sleepiness. However, the excessive sleepiness cannot be the result of another class of disorder. If a patient has another such disorder, that disorder must be effectively treated before a diagnosis of hypersomnia not due to a sleep-related breathing disorder can be made. These patients may have nights of uninterrupted sleep, but they still have unintended or unwanted lapses into sleep during the day. There can be many different causes of this; some of which are very interesting. Narcolepsy and Kleine-Levin Syndrome fall into this category along with some neurologic or psychiatric disorders. Circadian Rhythm Sleep Disorder Circadian rhythm sleep disorders are sleep disorders related to the internal clock of the human body resulting in an irregular sleep-wake cycle. Patients with these sleep disorders have circadian rhythms that make it difficult for them to function in society. The three extrinsic circadian rhythm sleep disorders are the time zone change syndrome, shift work sleep disorder, and irregular sleep-wake pattern (secondary circadian rhythm disorders). Three intrinsic circadian rhythm sleep disorders are delayed sleep phase syndrome, advanced sleep phase syndrome, and non-24-hour sleep-wake disorder (primary circadian rhythm disorders). For Circadian Rhythm disorders, refer to page 482 of your textbook. Time Zone Change Syndrome (Jet Lag Syndrome): Jet lag is experienced as a result of eastward or westward jet travel, after crossing several time zones, disrupting synchronization between the body's inner clock and its external cues. Symptoms do not occur after north-south travel. jet lag symptoms consist of difficulty in maintaining sleep, frequent arousals, and excessive daytime somnolence. Delayed Sleep Phase Syndrome: The ICSD-2 defines delayed sleep phase syndrome (DSPS) as a condition in which a patient's major sleep episode is delayed in relation to a desired clock time. This delay causes symptoms of sleep-onset insomnia or difficulty awakening at the desired time. Typically, patients go to sleep late (between 2:00 am and 6:00 am) and awaken during late morning or afternoon hours (between 10:00 am and 2:00 pm). Patients cannot function normally in society due to disturbed sleep schedules. Patients may try hypnotic medications or alcohol in attempts to initiate sleep sooner. DSPS patients may be treated by the use of chronotherapy (intentionally delays sleep onset by 2-3 hours on successive days until the desired bedtime has been achieved) or phototherapy (exposure to bright light on awakening). Advanced Sleep Phase Syndrome: Advanced sleep phase syndrome is characterized by patients going to sleep in the early evening and wake up earlier than desired in the morning (2:00 am-4:00 am). Because the patients have early morning awakenings, they experience sleep disruption and daytime sleepiness if they don't go to sleep at early hours. ASPS is most commonly seen in elderly individuals. Diagnosis is based upon sleep logs and characteristic actigraphic recordings made over several days. Chronotherapy may be used to treat ASPS; however, this therapy is not as successful in ASPS as in DSPS. Bright light exposure in the evening has been successful in delaying sleep onset. Non-24-Hour Sleep-Wake Disorder: Also known as Non-entrained, free running, or hypernychthemeral syndrome, is a disorder characterized by a patient's inability to maintain a regular bedtime and a sleep onset that occurs at irregular hours. Patients display increases in the delay of sleep onset by approximately one hour per sleep-wake cycle, causing an eventual progression of sleep onset through the daytime hours and into the evening. These individuals fail to be entrained or synchronized by usual time cues such as sunlight or social activities. This disorder is extremely rare and is most often associated with blindness. Parasomnia The parasomnias are a class of sleep disorders associated with arousals, partial arousals, and sleep stage transitions. They are dysfunctions (including movements and behaviors) that are associated with sleep, or that occur during sleep. Most parasomnias occur during delta sleep or slow wave sleep, although some can occur during any stage. REM Behavior Disorder, Nightmare Disorder, and Recurrent Isolated Sleep Paralysis are also included in this group although they are all associated with REM sleep. Rem Behavior Disorder (RBD) may involve a very drastic or sometimes violent dream enactment. Approximately 88% of known cases are in males. Elderly patients (over the age of 60) make up a high percentage of known cases (60%). RBD is now considered to be a possible indication of a future neurodegenerative disease such as Parkinson’s. Around 50% of patients with REM parasomnias also have some type of central nervous system disorder, and almost 10% have a psychiatric disorder. The treatment for these disorders is usually limited to securing the environment, but can also include the prescription of clonazepam. Think of parasomnias as things that patients may also do while sleeping, excluding movement disorders (other than RBD) which used to be included in this category as well. Examples would be Night Terrors, Nightmares, Hallucinations, Sleepwalking, or Enuresis (bed-wetting), etc. Parasomnias are covered in your text book on pages 482 - 484. Sleep-Related Movement Disorders Bruxism: Bruxism (teeth grinding) occurs most commonly in individuals between ages 10 and 20 years and is commonly noted in children with mental retardation or cerebral palsy. Bruxism is noted most prominently during NREM stages I and II and REM sleep. Episodes are characterized by stereotypical tooth grinding and are often precipitated by anxiety, stress, and dental disease. Occasionally, familial cases have been described. Usually, no treatment is required, but in extreme cases, dental reconstruction and appliances such as mouth guards may be needed. Periodic Limb Movement Disorder: Periodic limb movement disorder (PLMD, or PLMS for Periodic Limb Movements in Sleep) is a common sleep disorder affecting approximately 34% of people over the age of 60 years. PLMD can be defined as repetitive, involuntary limb movements during sleep. These movements are seen mostly in stage II sleep, and not in REM sleep due to muscle atonia in REM. The criteria for the leg movements to qualify as PLMS, the leg movements must last from 0.5 seconds to 5 seconds in duration each, there must be a gap of 5 to 90 seconds between each one, and there must be a cluster of at least 4 of these movements. Symptoms of PLMS often include frequent EEG arousals, fragmented sleep architecture, daytime sleepiness, and a disturbed bed partner. Treatment of PLMS usually includes medications. However, if the leg movements are related to respiratory events, they usually disappear when the respiratory events are corrected via CPAP, BiPAP, dental appliances, etc. The most common medications used to treat PLMS include Clonazepam, Dopamine Agonists, Anticonvulsants, and Opiates. Restless Legs Syndrome: Restless Legs Syndrome (RLS) is a disorder that causes discomfort in the legs and an irresistible urge to move them. This scenario can occur while the patient is asleep or awake. Patients often describe this discomfort as an itching, crawling, or creeping sensation in their legs. RLS is a common disorder, and affects more than 5% of the total population. Most RLS patients begin having symptoms before the age of 20, and continue to have these symptoms throughout their lives. Most patients with RLS also have PLMS. The most common treatments for these disorders are medications, including benzodiazepines, dopamine, opiates, and alpha-adrenergic blockers. Nocturnal Leg Cramps: Nocturnal leg cramps are intensely painful sensations that are accompanied by muscle tightness occurring during sleep. These spasms usually last for a few seconds but sometimes persist for several minutes. Cramps during sleep are generally associated with awakening. Many normal individuals experience nocturnal leg cramps. Causes remain unknown. Local massage or movement of the limbs usually relieves the cramps. Rhythmic Movement Disorder: Rhythmic movement disorder occurs mostly in infants younger than 18 months of age, is occasionally associated with retardation, and is rarely familial. It is comprised of three characteristic movements: head rolling, headbanging, and body rocking. These episodes are usually not remembered once the person awakens. It affects approximately three times as many males as females. Treatment for rhythmic movement disorder usually includes behavior modification, benzodiazepines, and antidepressants. Rhythmic movement disorder is a benign condition, and usually, the patient outgrows the episodes. Other rhythmic movement disorders can be related to the use of a drug or substance, or to another medical condition. Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues This category includes disorders that are borderline normal or are normal variants. These include such examples as long sleeper, short sleeper, hypnic jerks, and other types of twitching or jerking movements that may only occur at sleep onset or in newborns. You have probably seen someone display a hypnic jerk as they fell asleep, or you may have woken yourself jerking because you felt like you were falling. Things like snoring or sleep-talking could be included in this case if they are not causing symptoms of insomnia or excessive daytime sleepiness but are disturbing to the patient or other people. Other Sleep Disorders A diagnosis in this category gives the physician an option for when the diagnosis may not be clear or too unusual to clearly fit into one of the other categories. This diagnosis may often be used as a temporary diagnosis until the actual cause of the disorder is determined. Environmental Sleep Disorder could be something in the surrounding environment, such as a barking dog, that is disturbing the patient's sleep enough to cause symptoms. Appendix A: Sleep-Related Medical and Neurological Disorders This category includes disorders that sometimes occur unrelated to sleep, but are related to sleep in these cases. Examples are sleep-related epilepsy, headaches, Sleep-related Myocardial Ischemia, or gastroesophageal reflux. Fibromyalgia used to be included in this section. While fibromyalgia is not necessarily a disorder that is only related to sleep, it can cause arousals, or disruptions of the patient's sleep and is a common diagnosis of patients that you will see. Appendix B: Other Psychiatric/Behavioral Disorders Frequently Encountered in the Differential Diagnosis of Sleep Disorders This section includes mood disorders, anxiety disorders, schizophrenia, or any other psychiatric diagnosis that may affect the patient's quality of sleep. Therefore, you will also likely see patients who have been referred by a psychiatrist on occasions. Intrinsic and Extrinsic Sleep Disorders These are terms that were previously used to differentiate between disorders that originated from within the body and those that were caused by something in the outside environment. However, I think that you could still see these terms again, so I think it is a good idea for you to be familiar with this terminology. INTRINSIC DISORDERS Intrinsic disorders include various types of insomnia and restless legs syndrome. Narcolepsy and recurrent hypersomnia are disorders of excessive sleepiness. Hypersomnolence can also be caused by narcolepsy, apnea, sleep disordered breathing, or periodic limb movements in sleep. EXTRINSIC DISORDERS Extrinsic sleep disorders include those that originate or develop from causes outside the body. Some of these dyssomnias found within this category include: conditions of inadequate sleep hygiene, altitude insomnia, food allergy insomnia, nocturnal eating, limit-setting sleep disorder, and sleep-onset association disorder. Sleep apnea is a disorder that commonly afflicts more than 12 million people in the United States. The word apnea is of Greek origin and means "without breath." Patients diagnosed with sleep apnea will literally stop breathing numerous times while they are asleep. The apneas on average can last from ten seconds to longer than a minute. These events can occur hundreds of times during a single night of sleep. Obstructive sleep apnea (OSA) is the most common type of apnea found within the category of sleep disordered breathing. OSA is caused by a complete obstruction of the airway, while partial closure is referred to as a hypopnea. The hypopnea is characterized by slow, shallow breathing. There are three types of apneas: obstructive, central, and mixed. So, sleep disordered breathing may be due to an airway obstruction (OSA), an abnormality in the part of the brain that controls respiration (central sleep apnea), or a combination of both ( mixed sleep apnea). This lesson will concentrate on obstructive sleep apnea. OSA occurs in approximately two percent of women and four percent of men over the age of 35. Check out this video for a good example of an OSA patient: Sleep Apnea - Hard to Watch... (Links open in a new window. Right click on link and choose "open in a new window") Obstructive Sleep Apnea sufferers are not always the ones that you would expect. Check out this video of an Asian woman, especially near the end: Sleep Apnea Causes of Obstructive Sleep Apnea The exact cause of OSA is difficult to pinpoint. The site of obstruction in most patients is the soft palate, extending to the region at the base of the tongue. There are no rigid structures, such as cartilage or bone, in this area to hold the airway open. When a patient is awake, muscles in the region keep the passage open. However, a patient who tests positive for OSA will experience a collapsing of the airway when they are asleep. Thus, the obstruction occurs, and the patient awakens to open the airway. The arousal from sleep lasts only a few seconds, but brief arousals disrupt continuous sleep. When the sleep architecture is fragmented, the patient will be prevented from obtaining SWS and REM sleep ( these stages of sleep are needed by the body to replenish its strength ). Once normal breathing is restored, the person falls asleep only to repeat the cycle throughout the night. Typically, the frequency of waking episodes is somewhere between 10 and 60. A patient with severe OSA may have more than 100 waking episodes in a night of sleep. Often, the OSA patient will complain of nonrestorative sleep and excessive daytime sleepiness. Risk Factors The primary risk factor for OSA is excessive weight gain. The accumulation of fat on the sides of the upper airway causes it to become narrow and predisposed to closure when the muscles relax. Age is another prominent risk factor. Loss of muscle mass is a common occurrence associated with the aging process. If muscle mass decreases in the airway, it may be replaced with fat, leaving the airway narrow and soft. Men have a greater risk for OSA. Male hormones can cause structural changes in the upper airway. Below are other common predisposing factors associated with OSA: Anatomic abnormalities, such as a receding chin Enlarged tonsils and adenoids ( the main causes of OSA in children) Family history of OSA ( However, there has been no medically documented facts stating a generic inheritance pattern ) Use of alcohol and sedative drugs, which relax the musculature in the surrounding upper airway Smoking, which can cause inflammation, swelling, and narrowing of the upper airway Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down syndrome Nasal and sinus congestion or problems Symptoms of OSA The nightly disruption and fragmentation of normal sleep architecture will cause the patient to experience the feeling of nonrestorative sleep. The most common complaint from someone who suffers from OSA is excessive daytime sleepiness (EDS) . The numerous disruptions and arousals will prevent the patient from obtaining a continuous deep sleep. Thus, the individual could also be prone to automobile accidents, personality changes, decreased memory, impotence, and depression. Patients are rarely aware or recall the frequent awakenings that occur following the obstructive episodes. EDS may be mild, moderate, or severe. Some patients will complain of falling asleep in a non stimulating environment, such as reading a book or a newspaper in a quiet room. Severe OSA patients may complain of falling asleep in a stimulating environment, such as during business meetings, eating, or casual conversation. One of the most dangerous scenarios is patients who suffer from OSA can fall asleep behind the wheel. Patients will often complain of feeling like they have not slept at all no matter of the length of time in bed. The same holds true for napping. Other indicators or symptoms of possible OSA include morning headaches and frequent urination during the night. Physical signs that coincides with characteristics of OSA patients include snoring, witnessed apneic episodes, and obesity. Not every individual who snores will test positive for OSA, but most patients who have OSA will snore with moderate to loud levels. Hypertension is prevalent in patients with OSA, although the exact relationship is unclear. It has been medically proven that treating OSA can significantly lower blood pressure. Complications The most prevalent complication for patients who suffer from OSA is a diminished quality of life due to chronic sleep deprivation and previous described symptoms. Coronary artery disease, cerebral vascular accidents (strokes), and congestive heart failure are being evaluated to define the exact nature of their connection to OSA. Still, it has documented that there is a relation between these complications and OSA. Obstructive sleep apnea aggravates congestive heart failure (CHF) by placing stress on the heart during sleep. Statistics show there is a high prevalence of OSA in patients with CHF. Central sleep apnea may be prominent in patients with CHF. Diagnosis The most universal method for diagnosing OSA is to have the patient undergo a sleep study. The technical name for the procedure is nocturnal polysomnograph. The first priority with any procedure is patient safety. A thorough analysis of the information gathered prior to beginning the test will give the technician an opportunity to determine the reason for testing, to verify all necessary monitoring parameters, and to determine the possible need for ancillary equipment. The technician must be aware of any precautions or special patient needs during testing. An understanding and knowledge of the signs, symptoms, and findings of a variety of sleep disorders and sleep related breathing disorders is necessary to ensure patient safety and recording requirements during polysomnography testing. Various medical problems will be encountered with the patients undergoing a sleep study. Examples of these complications include: asthma, COPD, cardiac arrhythmias, carbon dioxide narcosis, and abnormal breathing. Numerous cardiac arrhythmias may occur and they include: asystole, ventricular tachycardia or fibrillation, bigeminy, trigeminy, multi-focal PVC's, heart blocks, atrial fibrillation, bradycardia, or tachycardia associated with sleep apnea. Some of these cardiac arrhythmias are life threatening and require technician intervention. Others are relatively benign and require only that the technician watch the patient closely. Thus, all polysomnography technicians will be required to be certified in Basic Life Support. The polysomnography testing will include recording of multiple physiological parameters in sleep. These parameters usually include EEG, EKG, eye movements, respiration, muscle tone, body position, body movements, and oxygen saturation. The electroencephalogram (EEG) measures brain electrical activity. The brain activity during different stages of sleep as compared to wake is distinctly different. The electrooculogram (EOG) monitors eye movements and allows the examiner to determine REM sleep and wake. The electromyogram (EMG) monitors muscle tone, and the EMG helps to differentiate REM sleep from wake because the muscles relax to a state of paralysis in REM sleep. The electrocardiogram (EKG or ECG) monitors heart rate and graphs the electrical signal as it is conducted through the heart. Respiratory effort belts are placed around the patient's chest and abdomen to detect and record the rising and falling movements associated with respiration. A pulse oximeter is attached to the finger to record oxygen saturation levels in the blood. Leg leads or electrodes are attached to record leg movements which may determine the patient has periodic limb movement disorder. A thermistor is used to monitor breathing. Obstructive sleep apnea is diagnosed if the patient has an apnea/hypopnea index (AHI) of 5 or greater an hour. The respiratory disturbance index (RDI) is sometimes used in place of the AHI and essentially refers to the same data. However, in the recent past, RDI was an index that also included the number of respiratory effort related arousals(RERAS) per hour in addition to the hypopneas and apneas. Some sleep centers may still do this, but most are currently not scoring the RERAS due to non-coverage of insurance. An RDI from five to ten per hour would be a positive finding for OSA as well. Clinically speaking, an obstructive apnea is defined as a complete cessation of airflow for 10 seconds or more with persistent respiratory effort. An obstructive hypopnea is defined as a partial reduction in airflow of at least 30 percent followed by a drop in SaO2 of at least 3% or an arousal from sleep, or an alternate definition of 50 percent reduction in nasal pressure airflow signal followed by at least a 4% drop in SaO2(desaturation). Medicare still requires the 4% drop in SaO2 for their patients, but the first definition is recommended by the American Academy of Sleep currently. SaO2 refers to the amount of Oxygen in the blood being carried by the red blood cells. This will always drop when a patient stops breathing. The many physiological measurements taken usually enable the physician to diagnose or reasonably exclude OSA. Certain scenarios may prove a more difficult diagnosis. Such as, a patient who may have mild OSA at home, or only after using certain medications or alcohol but does not experience any episodes during the sleep study. Thus, the sleep study results must be interpreted with the entire clinical picture in mind. Another condition, called upper airway resistance syndrome, cannot be seen on polysomnography. This syndrome is characterized by repetitive arousals from sleep that probably result from increasing respiratory effort during narrowing of the upper airway. These patients suffer the same sleep disruption and deprivation as other sleep apnea patients. In such cases, the only alarming indicator that is recorded is the recurrent arousals. Ultimately, patients suffering from upper airway resistance syndrome may not test positive for OSA with standard polysomnography testing. Treatment A patient suffering from OSA has several treatment options that include: weight reduction, positional therapy, positive pressure therapy, surgical options, and oral appliances. Significant weight loss has shown tremendous improvement and possible elimination of OSA. The amount of weight a patient needs to lose to achieve noticeable benefits varies. However, one will not need to achieve "ideal body weight" to see improvement. Positional therapy is a method of treatment used to treat patients whose OSA is related to body positioning during sleep. A OSA patient who sleeps flat on their back, or in supine position, will experience worse symptoms in general. This type of therapy has its limits, but some patients have experienced benefits. Some of the strategic methods include: a sock filled with tennis balls is sewn into their shirt to make it uncomfortable for the sleeper to lie on their back, and positional pillows to assist in sleeping on their side. Positive pressure therapy is one of the most if not the best methods of treatment for obstructive sleep apnea. There are three different types of devices: continuous positive airway pressure (CPAP), autotitration, and bi-level positive airway pressure. CPAP, the more common of the three therapy modes, is the most prescribed method of treatment for OSA. A facial or nasal mask is worn by the patient while they sleep. The mask is connected to the CPAP machine with tubing. Positive air pressure is delivered from the machine to the mask and continues to the upper airways establishing a "pneumatic splint" that prevents collapsing of the airways. Autotitration devices are designed to provide the minimum necessary pressure at any given time and change that pressure as the needs of the patient change. Bi-level positive airway pressure differs from the CPAP by reducing the level of positive pressure upon exhalation. Oral appliances are another avenue a patient can try as a therapeutic device. Generally, there are two categories, mandibular advance devices and tongue-retaining devices. Mandibular advance devices are similar to athletic mouth guards. They differ in the mold for the lower teeth is advanced further forward than the mold for the upper teeth. This will cause the jawbone to remain forward and prevent the collapse of the airway. It is effective in mild cases of OSA, particularly if the patient's OSA is positional. Tongue-retaining devices also resemble an athletic mouth guard. It acts as a suction cup and is placed between the upper and lower teeth. The tongue is positioned forward and obstructions caused by the tongue should be minimized. First described in 1981, CPAP therapy has become the most preferred treatment for patients with OSA. CPAP flow generators or machines maintain a constant, controllable pressure to prevent blockage of the upper airway. The positive air pressure travels through the nostrils by a nasal or facial mask. This airflow holds the soft tissue of the uvula, palate, and pharyngeal tissue in the upper airway in position so the airway remains open while the patient progresses into deeper stages of sleep and REM sleep. The CPAP device can be described as a "pneumatic splint." Variations to the CPAP machine are available to help with compliance. BPAP, Bi-PAP or bi-level positive airway pressure is another option for treatment. Those three are one and the same. They are just different ways that you might see this term. The AASM guidelines uses "BPAP" in their protocol publications. BiPAP is a trademarked term by a company named Respironics. Anyway, most of the problems patients experience with CPAP are caused by having to exhale against a high airway pressure. Because the air pressure required to prevent respiratory obstruction is typically less on expiration than on inspiration, Bi-PAP machines are designed to detect when the patient is inhaling and exhaling and to reduce the pressure to a preset level on exhalation. Patients with severe OSA may require maximum levels of pressure to eliminate the obstructive apnea. Bi-PAP may be the chosen method of treatment with this scenario, and Bi-PAP may be used when the patient has more than one respiratory disorder. Regardless of the mechanism used, the goal of the technician should always be to titrate the machine to the lowest possible pressure to eradicate the sleep apnea. Each individual patient with OSA will present a different scenario for the attending polysomnography technician. The sleep study with positive airway pressure titration will need to achieve the optimal pressure for the specific patient. The sleep study with CPAP/Bi-PAP will show not only when the respiratory events have ceased, but also when the arousals from the respiratory events occur. The ultimate goal for the technician during a titration process is to achieve the minimal optimum pressure to eliminate all obstructive events and snoring during all stages of sleep and all body positions while sleeping. Compliance Mask fitting is an essential element of a patient's success with positive airway pressure therapy since it affects compliance and effectiveness of treatment. The higher pressures used during CPAP/Bi-PAP therapy can cause a significant air leak with the mask. The leak can also emerge from the patient's mouth if they are using a mask that doesn't cover the mouth. This can startle a new CPAP user. The leak can wake the patient from sleep. Thus, the mask stability is tested with higher pressures. Higher pressures may also require tighter head gear to maintain an adequate seal. Adversely, this will contribute to the discomfort from wearing the mask. When selecting a CPAP mask the following factors should be considered: comfort quality of air seal convenience quietness air venting CPAP/Bi-PAP machines are also available with humidity. Nasal congestion and dryness are very common complaints with positive airway pressure therapy. Humidification can also be heated. These features have proven to help with patient compliance. Ultimately, the biggest obstacle with compliance is getting patients to comply with their own treatment. Without the patient's willingness to use it, CPAP will not provide effective therapy. Studies have shown that CPAP compliance varies from approximately 65% to 85%. The bottom line for the patient to experience the benefits and relief of complaints is they must use the machine on a nightly basis. Information regarding the degree to which a patient is compliant with CPAP is essential for assessment of therapeutic impact. If problems persist after implementation of CPAP, the causes could include: delivery of insufficient pressure to maintain upper airway patency during sleep misdiagnosis of the etiology of the individual's symptoms failure to use the device for a sufficient duration on a regular basis Possible Side Effects The principal side effects with CPAP/Bi-PAP use include: contact dermatitis nasal congestion rhinorrhea dry eyes mouth leaks nose bleeds (rare) tympanic membrane rupture (very rare) chest pain aerophagia (the excessive swallowing of air, often resulting in belching) pneumoencephalitis (air in the brain, which is extremely rare, reported in a patient with a chronic cerebral spinal fluid leak) claustrophobia smothering sensation Actions can be taken to counteract some of the side effects. Nasal congestion or dryness often can be reduced or eliminated with nasal sprays or humidification. Rhinorrhea can be eliminated with nasal steroid sprays or ipratropium bromide nasal sprays. Epistaxis (nose bleeds) is usually due to dry mucosa and can be treated with humidification. Skin irritation can be combated with different mask materials. Dry eyes are usually caused by mask leaks and can be eliminated by changing to a better fitting mask. Attempts to reduce claustrophobic complaints have resulted in the patient using nasal pillows or prongs as opposed to the nasal or facial mask. Mouth leaks can be reduced or eliminated by using a chin strap. A small number of patients complain of chest pain or discomfort with CPAP use. This can probably be attributed to increased end-expiratory pressure and the consequent elevation of resting lung volume, which stretches wall muscles and cartilaginous structures. The resulting sensation that is created is due to chest wall pressure that persists through the hours of wakefulness. Any complaints of chest pain should always be taken seriously. However, if the complaint by the patient on CPAP proves to be nondiagnostic, Bi-PAP therapy may prove to be an option since expiratory pressure can be reduced. Sometimes it pays for the technologist to develop some psychological skills in order to convince the patient to use the device. I have found that a patient who doesn't seem to believe they need CPAP tends to change her/his mind when they see the data that shows him not breathing. Keep in mind that your patients can't see themselves sleep. They may also not be aware of all the possible complications of OSA down the road. Another area of concern for OSA patients using CPAP/BPAP devices is the negative effects on arterial blood gases and oxyhemoglobin saturation. Studies have reported severe oxyhemoglobin desaturation during nasal CPAP therapy in a hypercapnic (elevated levels of carbon dioxide in the blood) sleep apnea patients. Studies have also shown significant oxygen desaturations with CPAP administration with supplemental oxygen. The exact cause has yet to be determined. This occurrence may be due to the following factors: worsening hypoventilation related to the added mechanical impedance to ventilation associated with exhalation against increased pressure increased dead-space ventilation a decrease in venous return and cardiac output due to increased intrathoracic pressure during CPAP administration in patients with impaired right or left ventricular function and inadequate filling pressure One more possibility is when the optimal pressure setting has not been reached yet. Therefore, a ten second apnea may have turned into a 90 second hypopnea. The patient may not arouse from sleep as quickly to get a breath since the airway is not completely closing off as it was without therapy. This should improve once enough pressure is added, however. Despite the above scenarios and problematic experiences, CPAP/Bi-PAP administration has been reported to improve awake arterial blood gases in OSA patients with hypercapnia and cor pulmonale. Traditional and Evolving Methods of Initiating CPAP/BPAP Different methods have been established for implementation of positive airway pressure therapy. Traditionally, patients have undergone a technician attended PSG-monitored trial of CPAP. Split-night studies are now conducted more frequently. Home CPAP trials is another avenue that is being investigated. Use of predictive formulas to estimate or establish optimal level for CPAP therapy has been investigated. Each scenario has advantages and disadvantages. CPAP Therapy of Nonapneic SDB There are numerous documentations of patients with congestive heart failure (CHF) suffering from sleep-disordered breathing (SDB). Most often the respiratory events will be central in nature (no effort, brain not sending signal to breathe) resembling Cheyne-Stokes respiration (CSR). CSR is defined as a breathing pattern characterized by regular "crescendo-decrescendo" fluctuations in respiratory rate and tidal volume. The presence of SDB was associated with sleep-fragmentation and increased nocturnal hypoxemia. The conclusions from the findings are stated below: There is a high prevalence of daytime sleepiness in patients with CSR in conjunction with CHF. Patients with CHF who also have CSR have a higher mortality than patients who have CHF without CSR. CSR, AHI (apnea/hypopnea index), and the frequency of arousals were correlated with mortality. Furthermore, research has found CPAP has been noteworthy and effective on breathing in patients with CHF and CSR. The results of several studies showed an increase in cardiac output and stroke volume and a reduction in left ventricular wall tension during application of CPAP. The improvements seen in CHF patients with CSR regarding cardiac function during sleep is believed to carry over to wakefulness. Possible factors contributing to the improvements seen include: sleep-related reduction of left ventricular transmural pressure improved oxygenation during sleep reduced sympathetic nervous system activation during sleep CPAP machines have become a lot more sophisticated during the past decade. One of these updates is the ability of some machines to generate an algorithm that can predict the next breath of these central sleep apnea patients. These machines will adjust how much air is delivered during each breath based on this prediction. This has the effect of making the breathing pattern more consistent. You may see this denoted as Auto-SV, or servo-ventilation. We will talk about this more later, but I just wanted you to be aware that there are more sophisticated machines for patients with CHF and irregular breathing patterns that are not due to obstructions. Effects of Altitude Changes and Alcohol Consumption Older CPAP machines will not adjust to changes in altitude. As altitude increases, the older CPAP devices will deliver progressively lower than prescribed pressure. The more modern devices will detect altitude changes and make the appropriate adjustments. The polysomnography technician would benefit from information regarding a patient relocating from a high altitude location to lower altitude or vice versa if there are complaints of the CPAP therapy being nontherapeutic. Alcohol consumption can present further complications for a patient suffering from OSA. Alcohol suppresses the arousal response. The patient may experience a greater frequency and duration of apneas and hypopneas and increased snoring. Excessive alcohol use also increases sleep fragmentation. Taking a sedative can cause these effects to be imitated or exacerbated. Still, there are reports stating moderate alcohol consumption did not significantly alter the level of pressure required to eliminate the obstructive events. Nonetheless, OSA patients should avoid alcohol
Updated 68d ago
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XX. Physical and Cognitive Changes 1. early adulthood: (18-30) a. reach physical peak: strongest, healthiest, and quickest reflexes b. physical decline is slow and gradual (usually unnoticed until late 20s) 1. possible explanations a. cells lose ability to repair themselves b. cells have preset biological clocks (limit ability to divide and multiply) 2. middle age (30-65) a. changes in appearance: grey and thinning hair, wrinkles b. sight difficulties (seeing in the distance) 3. old age (66+) a. muscles and fat begin to break down; lose weight and become shorter b. gradual or sudden loss of hearing c. reaction time slows Health Problems 1. some changes are natural others develop from disease, or lifestyle a. sensible eating, exercising, avoiding tobacco, drugs and alcohol will look and feel younger b. cancer, heart disease, and cirrhosis of the liver (encouraged by lifestyle) Marriage and Divorce 1. 90% of population will marry; 40-60% of new marriages end in divorce a. marriage success: how couples resolve conflicts & how often they share intimate and happy moments 1. arguments are constructive 2. arranged marriages are surprisingly successful Menopause and Sexual Behavior 1. menopause: the biological event in which a woman’s production of hormones is sharply reduced (usually between age of 45 & 50) a. woman stops ovulating and menstruating: conceiving children is no longer possible b. irritability and depression can develop (psychological origin) c. many women enjoy this stage (more confident, calmer, and freer) 2. sexual activity doesn’t decline with age Cognitive Changes 1. mid 20s: learning new skills and information, solving problems, and shifting problem solving strategies improves dramatically 2. 40s: peak of creativity and productivity 3. 50s-60s: peak in humanities (history, foreign languages, and literature) a person’s character and personality remain stable through the years A. Daniel Levinson’s Theory of Male Development (structures and transitions) 1. Early Adult Transition: 17-22 2. Entering the Adult World: 22-28 a. desire to explore the options of the adult world conflict with need to establish a stable life Age 30 transition: 28-33 a. reexamining life structure: occupation, marriage partner, life goals 4. Settling down: 33-40 a. “making it” & “becoming one’s own man” 5. Midlife transition: 40-45 a. “midlife crisis” Entering middle adulthood: 45-50 a. stability if transition was satisfactory 7. Midlife transition: 50-55 a. generativity: the desire, in middle age, to use one’s accumulated wisdom to guide future generations b. stagnation: a discontinuation of development and a desire to recapture the past Culmination of middle adulthood: 55-60 9. Late adult transition: 60-65 10. Late adulthood: 65-70 Female Development 1. women often face the same challenges as males a. 58% of adult women work outside the home 2. women generally don’t have a midlife crisis a. some women see period as a challenge after starting a family first 3. last child leaving home a. usually only traumatic if paired with an unstable marriage 4. depression is common among middle-aged women a. loss of role as mother, daughter, and wife Changes that Come with Aging 1. decremental model of aging: idea that progressive physical and mental decline are inevitable with age a. view is unrealistic b. ageism: prejudice or discrimination against the elderly Misconceptions a. the elderly rarely suffer from poor health, rarely live in poverty, and are rarely victims of crime b. the elderly rarely withdraw from life c. the elderly are rarely inflexible or senile Changes in Health 1. good health in adulthood carries over into old age 2. 80% of elderly have at least one chronic disease a. heart disease, stroke, cancer, diabetes, and arthritis 3. 65-74 year olds: 80% believe health is good 4. 75+: 72% believe health is good 5. quality of care is inferior to that of the general population a. 4% of elderly population live in nursing homes Changes in Life Situation 1. transitions in late adulthood a. 41% of women and 13% of men 65+ are widowed b. 60% of women and 22% of men 75+ are without a spouse 2. more elderly are spending time learning and developing new skills C. Changes in Sexual Activity 1. the best predictor of future behavior is past behavior Adjusting to Old Age 1. a negative self-concept results from: a. changes in health, recognition in the community, rare visits from family and friends, respect of privacy, leisure and work activities b. loss of physical control 2. assertive personalities cope better 3. AARP: speak out about social issues that affect the elderly there is much less decline in intelligence and memory than assumed 2. crystalized intelligence: the ability to use accumulated knowledge and learning in appropriate situations (increases with age) 3. fluid intelligence: the ability to solve abstract relational problems and to generate new hypotheses (decreases as nervous system declines) Dementia: decreases in mental abilities, which can be experienced by some people in old age 1. memory loss, forgetfulness, disorientation of time and place, decline in ability to think, impaired attention, altered personality 2. is not a normal part of normal development Alzheimer’s Disease: a condition that destroys a person’s ability to think, remember, relate to others, and care for herself or himself 1. 4.5 million have disease in U.S. 2. 6th leading cause of death among U.S. adults 3. most often leads to a weakened state that leads to fatal problems 4. causes are not completely understood and there is currently no cure Approaching Death 1. death is a culturally and emotionally confusing and complex process A. Stages of Dying 1. thanatology: the study of dying and death Elisabeth Kubler-Ross: studied how the terminally ill react to their impending death a. denial: “no it can’t be happening to me” 1. often leads to individuals avoiding treatment b. anger: “Why me?” 1. often alienate themselves from others c. bargaining: changing of attitudes combined with bargaining d. depression: begin contemplating the losses that are coming e. acceptance: often experience a sense of calm Making Adjustments 1. Camille Wortman theorized that Kubler-Ross’s stages were just the five most common styles of dealing with death 2. how should we deal with the impending death of others a. provide opportunities for the dying to have respect, dignity and self-confidence b. open communication about dying process and legal and financial issues c. avoid judgments concerning grieving of others the contemporary population is mostly insulated from death 2. life expectancy is much longer today and most people no longer die at home A. Hospice Care 1. hospice: a facility designed to care for the special needs of the dying a. goal is to create the most home-like environment where pain management can be provided b. home-based hospice care is now more frequently used than inpatient Dealing with Grief 1. John Bowlby: grief-based attachment research a. shock and numbness 1. can last several hours or weeks b. yearning and searching 1. grievers often isolate themselves 2. guilt and anger can manifest in this stage 3. may last for several months John Bowbly: disorientation and disorganization 1. depression can manifest 2. new reality becomes very confusing d. reorganization and resolution 1. griever overcomes feeling of isolation Pavlov’s Dogs 1. classical conditioning: a learning procedure in which associations are made between a neutral stimulus and an unconditioned stimulus a. attaching an old prompt or stimulus to a new prompt or stimulus 2. neutral stimulus (N): a stimulus that does not initially elicit any part of an unconditioned response a. sound of tuning fork (Pavlov’s experiment) 3. unconditioned stimulus (US): an event that elicits a certain predictable response typically without previous training a. food (Pavlov’s experiment) 4. unconditioned response (UR): an organism’s automatic (or natural) reaction to a stimulus a. salivation (Pavlov’s experiment) 5. conditioned stimulus (CS): a once-neutral event that elicits a given response after a period of training in which it has been paired with an unconditioned stimulus 6. conditioned response (CR): the learned reaction to a conditioned stimulus A. Acquisition 1. gradually occurs every time a N/US is paired with a UR/CR 2. best timing is when the N is presented just before an US (.5 seconds) B. Generalization and Discrimination 1. generalization: responding similarly to a range of similar stimuli a. Pavlov taught dog to respond to a circle; dog would respond to other figures 2. discrimination: the ability to respond differently to similar but distinct stimuli a. Pavlov proved by never pairing the food with the oval Extinction and Spontaneous Recovery 1. extinction: the gradual disappearance of a conditioned response when the conditioned stimulus is repeatedly presented without the unconditioned stimulus a. Pavlov stopped giving food after sound of tuning fork 2. spontaneous recovery: when a CR reappears when a CS occurs without a US John Watson & Rosalie Rayner: the case of Little Albert a. explored the relationship between classical conditioning and emotional responses b. trained 11-month old Albert to fear lab rat c. Rat (NS) + loud sound (US) => fear (UR) Hobart & Mollie Mowrer 1938 study a. developed a bed-wetting alarm to awaken children as they begin to wet bed b. Full bladder (NS) + Alarm (UCS) => Awaken (UCR) Taste Aversions 1. develop after illness follows dining experience a. usually connected to new food even when other food was eaten John Garcia & R.A. Koelling 1. Rats (A) shocked after drinking flavored water paired with flashing lights and clicking sounds a. rats developed an aversion to the lights/sounds 2. Rats (B) injected with drug activated by drinking water (led to upset stomach) a. rats developed an aversion to the taste of the water c. used to condition coyotes to hate the taste of sheep Behaviorism 1. classical conditioning is a great example of behaviorist theory a. behaviorist study behaviors that can be observed and measured; not unobservable mental activity Reinforcement 1. operant conditioning: learning in which a certain action is reinforced or punished, resulting in corresponding increases or decreases in occurrence a. participant must be actively involved 1. classically conditioned organisms are passive participants Positive and Negative Reinforcement 1. B.F. Skinner: trained rats to respond to lights and sounds (Skinner Box) 2. reinforcement: stimulus or event that follows a response and increases the likelihood that the response will be repeated positive reinforcement: adding something desirable after a behavior occurs 1. food (Skinner Box), social approval, money, extra privileges b. negative reinforcement: removal of something undesirable after a behavior occurs 1. changing a smoke alarm battery, buckling seatbelt, use of an umbrella Primary and Secondary Reinforcers 1. primary reinforcer: stimulus that is naturally rewarding, such as food or water 2. secondary reinforcer: stimulus such as money that becomes rewarding through its link with a primary reinforcer a. Wolfe experiment 1936 (Chimpanzees) b. money is best example Schedules of Reinforcement 1. continuous schedule: reinforcing behavior every time it occurs 2. partial schedule: positive reinforcement occurs sporadically a. acquired behaviors are more slowly established but are more persistent 1. discovered when the Skinner Box kept breaking down ratio schedules: reinforcement based on the number of responses 1. fixed-ratio: reinforcement depends on specified quantity of responses a. most consumer loyalty punch cards 2. variable-ratio: reinforcement after varying number of responses a. slot machines, door to door sales, telemarketing 1. very resistant to extinction interval schedules: reinforcement occurs after an amount of time elapses 1. fixed-interval: reinforcement of first response after a fixed amount of time has passed a. salaries, cramming for tests 2. variable-interval: reinforcement of the first response after varying amounts of time a. fishing, pop quizzes 1. very resistant to extinction shaping: technique in which the desired behavior is “molded” by first rewarding any act similar to that behavior and then requiring ever-closer approximations to the desired behavior before giving the reward 1. flag-raising rat a. reinforce rat for approaching flagpole b. reinforce after rat raises paw while near flagpole c. reinforce after rat gets on hind legs while near flagpole d. reinforce after rat nibbles at cord while on hind legs Combining Responses: Chaining 1. response chains: learned reactions that follow one another in sequence, each reaction producing the signal for the next a. complex skill of swimming involves organizing large response chains 1. arm stroke chain, breathing chain, leg kick chain Aversive Control: process of influencing behavior by means of unpleasant stimuli completed through use of negative reinforcers or punishers A. Negative Reinforcement: increasing the strength of a given response by removing or preventing a painful stimulus when the response occurs 1. escape conditioning: training of an organism to remove or terminate an unpleasant stimulus a. parents removing an unpleasant meal when child whines and gags while eating avoidance conditioning: training of an organism to respond so as to prevent the occurrence of an unpleasant stimulus a. parents deciding against presenting an unpleasant circumstance because child whines at the possibility Punishment 1. leads to the removal or reduction of behavior 2. must be unpleasant to work a. some reprimands may actually serve as reinforcers 3. positive punishment: adding unpleasant circumstances 4. negative punishment: removal of pleasant circumstances Disadvantages of Punishment 1. can produce rage, aggression, and fear in children 2. spanking can lead to increased aggression toward other children 3. can lead to children avoiding person who punishes 4. fails to teach appropriate and acceptable behavior Cognitive Learning 1. social learning: process of altering behavior by observing and imitating the behavior of others a. learning goes beyond mechanical responses to stimuli or reinforcement 2. cognitive learning: form of altering behavior that involves mental processes and may result from observation or imitation Latent Learning and Cognitive Maps 1. Wolfgang Kohler: chimpanzee study on insight 2. Edward Tolman: rat study on cognitive maps and latent learning a. cognitive map: a mental picture of spatial relationships or relationships between events b. latent learning: alteration of a behavioral tendency that is not demonstrated by an immediate, observable change in behavior Learned Helplessness: condition in which repeated attempts to control a situation fail, resulting in the belief that the situation is uncontrollable 1. college students/noise study 2. Martin Seligman Theory a. stop trying b. lower self-esteem c. depression ensues Modeling: learning by imitating others; copying behavior mimicry: performing old, established responses that we might not be using at the time. 2. observational learning: learning to perform a behavior after watching others perform it a. Albert Bandura: Bobo doll experiment 3. disinhibition: the increased likelihood a behavior will be repeated when observed behavior is not punished a. often used to alleviate phobias the systematic application of learning principles to change people’s actions or feelings A. Computer-Assisted Instruction 1. S.L. Pressey (1933) & B.F. Skinner (1950s) a. program that uses reinforcement (new information, choices, or point rewards) each time a student shows they learned something new b. program builds on information student has already mastered Token Economics 1. token economy: conditioning in which desirable behavior is reinforced with valueless objects, which can be accumulated and exchanged for valued rewards a. used in schools, prisons, mental hospitals, and halfway houses Self-Control 1. having people set up personal systems of rewards and punishments to shape their own thoughts and actions a. define the problem b. track the behavior c. set up a behavioral contract Improving Your Study Habits 1. progressively increase study quotas (successive approximations) a. remove conditioned aversive stimuli adjust to change or alter in order to fit or conform adapt A changing to fit new conditions menopause the biological event in which a woman's production of sex hormones is sharply reduced generativity the desire, in middle age, to use one's accumulated wisdom to guide future generations stagnation a discontinuation of development and a desire to recapture the past function the ability to achieve his or her goals within him or her self and the external environment. It includes an individual's behavior, emotion, social skills, and overall mental health assumed accepted as real or true without proof decremental model of aging idea that progressive physical and mental decline are inevitable with age ageism prejudice or discrimination against the elderly dementia decreases in mental abilities, which can be experienced by some people in old age Alzheimer's disease a condition that destroys a person's ability to think, remember, relate to others, and care for herself or himself component A part or element of a larger whole. isolating causing one to feel alone thanatology the study of death and dying hospice a facility designed to care for the special needs of the dying classical conditioning a learning procedure in which associations are made between a neutral stimulus and an unconditioned stimulus neural stimulus a stimulus that does not initially elicit any part of an unconditioned response unconditioned stimulus an event that elicits a certain predictable response typically without previous training unconditioned response an organism's automatic (or natural) reaction to a stimulus conditioned stimulus a once-neutral event that elicits a given response after a period of training in which it has been paired with an unconditioned stimulus conditioned response the learned reaction to a conditioned stimulus generalization responding similarly to a range of similar stimuli discrimination the ability to respond differently to similar but distinct stimuli extinction the gradual disappearance of a conditioned response when the conditioned stimulus is repeatedly presented without the unconditioned stimulus operant conditioning learning in which a certain action is reinforced or punished, resulting in corresponding increases or decreases in occurrence reinforcement stimulus or event that follows a response and increases the likelihood that the response will be repeated secondary reinforcer stimulus such as money that becomes rewarding through its link with a primary reinforce primary reinforcer stimulus that is naturally rewarding, such as food or water shaping technique in which the desired behavior is "molded" by first rewarding any act similar to that behavior and then requiring ever-closer approximations to the desired behavior before giving the reward response chain learned reactions that follow one another in sequence, each reaction producing the signal for the next aversive control process of influencing behavior by means of unpleasant stimuli negative reinforcement increasing the strength of a given response by removing or preventing a painful stimulus when the response occurs escape conditioning training of an organism to remove or terminate an unpleasant stimulus avoidance conditioning training of an organism to respond so as to prevent the occurrence of an unpleasant stimulus social learning process of altering behavior by observing and imitating the behavior of others cognitive learning form of altering behavior that involves mental processes and may result from observation or imitation cognitive map a mental picture of spatial relationships or relationships between events latent learning alteration of a behavioral tendency that is not demonstrated by an immediate, observable change in behavior learned helplessness condition in which repeated attempts to control a situation fail, resulting in the belief that the situation is uncontrollable modeling learning by imitating others; copying behavior token economy conditioning in which desirable behavior is reinforced with valueless objects, which can be accumulated and exchanged for valued rewards
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than that I'nique. I think I would write a name and we cross the rental for past at do period, so like, it is us out of taking off or dealing with all of the logistics, so far, um you are still kind of getting devil or have anything else to figure out on terms of uh, just a piece adistration, conferences, anything else, uh, as usual, um, just, act and lecture or send me an email there's a few little things that I still working out, but hopefully to get settled for all of you. Um, last thing you just wanna say, thank you for your first discussion of us. They were just like specialasure read and, like, showed me how many different ways you're all being with us novel uh, and I now I like, oh, I wish you had another hour. I'm talking with this one. keep talking about it? um but we'll definitely touch on one of the things that you read in your post. today and when, um next week we're moving on to another reading, but we'll have your first conferences and that'll be a chance to talk about that kid's reading by all that really everything that we've discussed so far, so pull on to you all of these ideas that you're having. Okay, um, so today, we're gonna be a no happening, we're gonna talk about some of theorical contacts that can have us understand passing, like what's happening in the novel. Uh, and then we're gonna die further into the text of acting of what Laren is doing with this concept ofaba. Um, first, I just wanted to briefly touch on something that Irene referended in the novel, but that in this outside, it'sersen, using a novel so it references Comicorn, a little piece of history. We have I read thinking at one point, when she's worrying about Claire and correct and she's becoming, uh, and the problem of playing becomes three of her husband Rob, said, what is Luc there? He, was under eight the eight, uh, at the time that Larson was writing, passing, the rhyler case was sort of like a recent new sensation or almost like a celebrity spectacle in New York City. um, and the reason that Irene refers to it in the novel is because of the he centered around a white man who is married to a black woman who could pass her wife. uh, and the question in the rhyment her face was was she has, or did her husband, in fact, already know that she would lack? Uh, I was had like a little brief synopsis of this thing, and they' li. uh up on my versus if you wanted to read more about this soon. a fascinating story. So, in 1921, a wealthy young white man named Kit Reinellander, met Alice Jones, who was working class an racial black women. Rein Linder, the ris guy only, did not like this relationship. the two elopes in 1924, and soon after, because Bryander was part of this aristocratic family, uh, the news paint it up and published a story titled Bradland's son, and Mary is the daughter of a color name. and this led to his father finding out about the marriage and forcing his son to file for an annullment, uh, and then there were all these purpose meetings that began. And in this suit, Kitinlanders side attempted to prove that Alice had to defauded Kit using sex to gain access to hisalth. And social position. um, and then this became, as I said, kind of a big news story and cultural identity that because the right of her family was sort of celebrated being of family and because there were so many intimate details here in the court in the news about their marriage and also about Alex, um and this currently pretty preceding into all. Alice, for her side, I had been single case. She admitted to be black and she insisted that Kip had been aware of it. um and in the end, some surprisingly for the moment of by the court decided in Alice's favor and three, that KI had actually known of her blackness all along, so he was not the victim of any thought. In this case, he was not at the woman who wasying about being white. It was her husband lying about his knowledge about it. And so this is like just another variation of all these birds, like convoluted situations that arose in the midst of the American conception with the color line with racial purity and with racial power. and this is like, you just like another piece of helpful background as we head back into the novel of our characters, um, in our case, player is passing the way, and her husband, John, as far as we know, up to a point, does not have any clue that clear is black. Um, and even though this is the setup, Larsen does something to sort of what, electrify us early on, when she sets the scene with strong balloon and drink the roof and the dressingla this web. Hello, was John's reading player. Um, and I' using that that meansalonate, he's using probably obviously a variation of a regial slarity and word, right? And so this immediately creates like, great confusion for Ine and perjury who are sitting there. uh, and Claire and quickly has to explain why husband is calling you that. Her black eyes let her down. Tell them here, why you call me eyes. The man chuckled, make up his eyes, not I madeless compelled acknowledgepleasantly. He explained, well, you see, it like this, when the first married she was white as well as white as a lily. But I did lay she's getting darker and darker. I tell her if she don't look out, she'll wake up one of these days and find she her and with Edward. Heared with laughter. Claire' ringing bell light laughing his then a little later on. My goodness Jack, what difference would it make it after all these years, you were to find out that I was more than she present color. The put out his hand and refudiating flame definite and final. Oh, no, he declared, nothing like that with me. I know you known, so far right, you can get that slack as you please as far as I concerned, since I know you no. I draw the line back, the open pen words in my family ever happen and never will. Okay, how does our protagonist Irene experience this scene and how does she feel watching it? Yes.. There's. I couldn't. She's sitting at the TV party, you just kind of watching me not even even a while, put the most. But I it upset me, she doesn't know if she can speak up without real very nature. Yes, so she's like having to her appearance, like like looking around and deep confusion and disments. down because like the translated almost like half rest and comments that Cla Gertrude pick up on because the three of them are passing, and you can kind of tell that Claire has a lost experience with it has a conversation because she had she handles it a lot better than Irene does, um, and yeah, if you see all this in totalal turmoil and it keeps out a little bit in intercom conversations. Yes, right, so you trying to be her cool, but they're always like it is irrepressibleomas the sense of way, what the hell is happening here in player like aA... Claire husband to explain why would she bring up that conversation in the I? If she, oh, my husband has absolutely no idea. just for me.ger to know that idea. Why folks think? Why? Why will 30 this? There so many different ideas? few folks in the French? What are you things are? why in the read I Pandora. And all the soation and friends or what we actually. there' exposition to us a reader and to having. Yes, okay, so right, so she's like doing this like to them, like, there is there is a context here for this. Okay, there's a lot of kids and I go, here, here, maybe just go there.. as well. I is trying up all theoth or like making joke from the. because people aren has that beatified for her because she spent all this time for this performance and. And now she does advantage of this route. she work in. Yes. making a joke of her husband, right? why would she create this situation to begin with? so there's a way in which, like, there are different audiences and she created an audience to watch it un full.. sounds like, I g said, oh, you should spot, you know, uh, fire, you layer in my one pass the approaches it is like, you know, those, you don't know, but whatever really you can dola is, so it's like almost like red flag or alarms or something like battery knock and probably at me like, oh my God, like they kind of like on the closed and like my love. They're like email and they like not, everything that happens to Claire because they share this identity, that it's all black men who are can't ask for life, like anything that happening, it is like, immediately there's an implication of what this means for the other in characters. Yes. all this field are sheets like player? because um, like the she wants sitting for a her, our players trying for. and the other player wants to like more hard I his life. um, and it it feels like he's like giving a little taste like this is time, whatever med. So, like, why don't you let me your like a little more psychling real life? Yes, right, so there in which, like, maybe she showing up and like, making a joke at these I' heard a thing that there's another way she's like look at my situation, like this I live in I, uh, but it's both, right, at the same time... This is my back that. I contin what as I Yes, right. She's doing this like dance and shifting the position, uh, by by creating this and this is really dangerous essentially situation, um and and letting her friends in on it. Um, and there is this sense, right that there is, you know, danger in the scene, there is ultimately something that disturbing, but one of the involved is that I may not progress is like this this knowing lap, right? that kind of comes over earth room too, um, because there's something absurd about watching the scene, um, at one point, like Irene's lips trembled almost arm full of, but she made a desperate effort to fight after disastrider laugh and succeeded, um, and then jumped down a little bit, she's looking at her from grocery clear littleressed down a for a. I mean wish there was brief size through she feared by her self comprolled thatiled toridge for her notating anger and in that indignation. So there's like laughter and there's anger and indignation. She had a weepingiety to shout at the manip her and you're sitting here surrounded by three black devils during the teeth. So it does seem, right? that there's a joke and on notolute. He is awake and he is so sure that he would never have a black person in his family or in his house, but in reality, he is sitting there and has a black life, he has the black daughter, and there are two other black men sitting in the are and yet, they all of these women that are just referred to, player, Irene, recru, and and Claara Marjorie, all look white. How are they black? you can turn off, right. Okay, so there's sense in which a appearance is not the only way in which raises being decided, right? That becomes very clear. You can look at way as player and somehow collect Yes. you know, like like slide when you have a conversation down with the blue and it said, like, oh, and players said, what I was large, you color. And he says, well, you know, like, that's not simply means I never not that. So it's not even having, like, that like, DNA more like, you know, that like, it's the not even like it's I I don't even know like what definition is anymore because documentaries is not about, you know, having the access here, you not having that, what countries like, oh, I don't care about how you look, I don't care about you know, what's what's your ancest, you like be somebody else and something like. Yeah, it's really confusing.ired it just that John Lulu by being away, he's so sure he would go, right? There was no way she was getting away with the one or two percent colors in this case, uh, right? Um, but something weird is going on with this definition. two are men and then weonse yet. I think we need lots of different maybe people compared to the John tell the version of of push of the media of excuses. So I think with the women is that someoundaries, here, um the and also I mean for help uh, like, that their response to the outage show and how Yeah, right there are like, so many different ways that race is playing has an identity, but also have like a legal construction and also as a maybe like cartoon characteristic of what blackness is.. I don't know for what like one rule decide, um, who who wasn't? One, but under the law, there was the more, where ne the color lion have already in identities that forces you into one or the other. Yes, so this is exactly where we're headed. This is the streaming I understand, yet how he got to this place in the 1920s, where there are three white open women and all of them are apparently black. In the 1920s, this idea that right even just a tiny percentage of black ancestry made a person black um was part of a law, right? So that is happening in all of these acts were regional integrity acts laws that are prostating American deceased, uh, including in 1984 in Virginia, uh laws like the Virginia racial Integrity act outlawedational marriage and defined a white person as someone who has no pri whatsoever of any one whether than not. Right? And what is that that talk about? Um, and then there are other laws that defined lackers that owned with any trace, right? It could be, 116, uh, a black ancestry remain on. At least kind of law were as they said, white friend across the US and they also extended our back into American history street, one of the first laws that to do this work of criminalizing racial effect on the marriage, uh and defining ways by this strange formula heredity was in 1652 in a specular event. Um we often think about race as something visible, and in any case, it was a uh, but here, right we're seeing that the in terms of the law, uh, we'reology with very technical, legal, and then often invisible ideas of race and of blackness. My question is, and this has already come out a little bit irresponses, but why would Americans come up with such a thing convoluted and frame and specific and some type invisible concepts of race? I? Okay, this is funny back to Elizabeth comment, right? This has to do with the history of Americans labvery. So to answer the session, we're going on a little detour as we as do, as that how my minders. Um, we're going to go back a little bit and think about American slavery and how it works as a racial and social system. Slavery created generations and generations of makes people because, despite all of this talk about the rigid color line, slaveholders systematically crossed. I said on Wednesday that Frosted season on Monday, that Crossing the color line, especially in terms of sexual relationships, what is dangerous and needed as that is true for lacking and sometimes for, and afterately we waited, put and did allwise really violently and systematically. What did this look like? In active events that slaveholders were continuallyaping and they sexual violence was an endemic feature of the system of American slavery. It was not a random event that I approved in some cases of kind. it was a structural part of the system of American slavery. And this kind of knew that sexual violence often led to the murder of a rac children. So when these children were born, they were not considered by their fathers to be their children, they were considered to be their properties, right? Because their mothers then laid those children were and his laid. So imagine as it is a you know, 300 plus year mystery of slavery at there time generations and generations of people who were enslaved and considered to be black, but who look more and more white. This can be really hard to visualize the fact because I need the race, like they shift in different comments, they' shipped at time, we have pretty visual idea of race in the present. Uh, but this these photos for me of us a little bit to understand this. um all of the children in these two photographs were bored into slavery and all of them are considered property and all of that were consideringat. But probably to our eyes, only one of these children as looks black. So when these image of showing us is, again, like a strangeness of racing America. It's really like the fiction of race, of problems of race. We have this idea of rigid color line and then we have this social world that totally always by it. It is like a central problemating America, and it is at part of our 20th as. But it is also at the heart of the first ever African American novelot. Closelle for private's daughter, and they are mostly life was published by a for Lady author William Wells Brown in the 1856, of Phil during safety. um, and it again, at the the first factor all, this very clearly had aitional novel. It's a novel, it's written, it's a perfect of showingagos sla reading the need to project. Uh, the fact that this is the first act there in novel is a good reminder for us that novels, whether they are written by our Americans or by other groups, have not really miss it. Novels are enired or so story different from the literature, how all existed, but novels did not become kind of a cohereric form of that are literature, uh of writing until about the 18th century in Western European culture and then they started to become a major feature of Western European culture, cultureuring art aircraft the 19th century. and writing novels have is like longer durraysans in which histori can take place, and there' group or multiple different kind of stories. This is not super important about us today we're gonna come back see the conduct a lot of this then. but uh this is an important for sit situation in the 20th century where novels aren't one important for getting this little detour we taking the 19th century. Okay. back tootap. Uh, what I said is for novel and it takes up this problem of race and the problem of passing as central issue. Um Some of you here a red hotels and you know that it's like, a very convoluted and melodramatic story. um so we're not gonna do aopsis of this if you're curious, go recoel. um, but it's not that if we' for our course. I just wanna briefly introduce you to a central character in enslaved woman name hotel. This isotel as sheears about your soul. The appearance of Plotel on oct in deep sensation amongst the crow. There she stood in the complexion as light as most of those who are waiting with the wish shouldn' not referisers. The auctionireized by saying that Miss Futel had been observed for the last because she was the most valuable. how much, generally? Well, we're m meant to understand here is that, first of all, the towels of white, that is that the hotel is specially valuable because she looks like, and third, that this value attached to looking weight is sexualized, right? We get this very congestive how less g with it. Um, and this idea that played women were lighter reflection, including white acting, had special sexual values, um, was, again, a feature of this is of American slavery. Because of her lacis and also the other values white and, uh, she is persecuted across this o, which leads to a fact and laborer. She attempts to esclavery, that she gets caught and rather than go back to her factors, she chooses to to wep off the bridge for herck. So this is an illustration of that. This is like hotels weep ack. What did you with this? You might be at the Dr. D NOR. This week in the context of hot is morally righteous, right? She sort of a thing here. The cause of her death is slavery and her choice to die is, as I said, morally righteous, because it's protesting againstly and that means that within the context of the 19th century acad abolitionist dog. Uh, we can get a little bit of this, um, just from the way that lay brown wrote this right. There's no hope for aake for her down the passage. Her resolution was taken. She clasped her hands convulsively and raised them as she, at the same time raised her eyes for its heaven and begged for that mercy and compassion there, which had been denied her on earth, and then, with a single bound, she vaulted over the railings of the bridge and subbed forever beneath the ways of the river, thus died lowau. Okay. So this is a little bit of backstory and literary history that's going to help us understand where we are in our novel and how it ends. And we'll just say briefly that this is not the only novel that our literature that keeps up these issues of acid um, where a lot of really important and central novels of early actingary literature that do this, asking is one of them and then we're gonna read another one about to meet laugh more. This is all behind Ella Larson as she writing happy, and she is engaging with this literary history, but she's also complicating the story, right? I read Redfield and Cla Henry are not martyr characters by any right, the problems that they have are not only caused by outside forces. They have also caused by an own desires and wait. So, rather than writing a novel where black womenomes sort of like the vehicles for explloring an issue like slavery or race or racism. Larsen makes race and racism and passing into a being able or even like a backdrop or exploring black women, and their interiority. and they are desired potentially needed their fear, their anger, and and then ultimately their violence. We see both of these characters, sorry out, but what they are to each other and stay the missions, right? I read in the black world, players in the white, but over time their divisions were like he in by one another. um, andir, at least from our perspective, is getting too close, right? Irene, um, on getting rid of player. So, how does this like, break down in start from thisantingopter in and we talked about on Monday, there's thisensive great attraction in the beginning atoration and the sense that Irene was kind of like, not resist the thrall of player, but at some point in the novel, I mean starts to feel differently, and she becomes ultimately to consumed by Claire as a problem. Where are some of the scen that we start to see this happen for uh yeah, where are some of the turning points in the novel where he gets this ri.t. and I think this happened like somebody to going out, like not a highly lot, but you laugh and youulated things how much else if they really doing without me without. I mean, she like, you know, she's so over on cat I, and then was. Yes, right. So, at some point around an invitation that she wasn't part of, Irene begins to believe that there's a fair. But she have evidence of this fair as what I agree, and then also, we have beers like, do we have of an affair, what what did you think about? like, the truth or reality of theear? I kind of interpreted Irena's a bit of an unreliable narrator. It felt like she was telling them story that had already happened. So maybe her act of the end of the novel influences how she's remembering things and trying to justify why she would have pushed a clear in the end. So she's looking at her while they laughed at each other, so that was a sign and when she's at the party and few kind of corroborates how she feels, you see a little bit more about unreliable narrator or what that means to feel? Um when they're presenting things with objective, but their emotions and personality are actually shaping, what what evidence that preventing you and what descriptors they're using?, that's a really good way of it, so we have she is she's basically our in the sense that like she's the as we've talked about, but the character of his perspective, we're really close to. um and we start to have a approx novel see that there is like a discrepancy between her internal thought process and what is available to us as what evidence of what's happening outside of her, um and so the more and more we start to see that, like we have a little bit alienated from Irene, uh, and so, right, the reality of any of her statements, um, have comes into some question. um, so we don't necessarily know what this affair was um, other than what Irene either think it was or justified the FDA. Yeah. kind of operating? he was maybe for a bit, but I think last class mentioned how she really called Claire beautiful. and how now is that Ryan is somewhat clear and not much evidence of a ware, but maybe if she was in his position, she would find clear in my so there is a question of like whose desire is actually at the center of this, right and Brian was kind of like taking the ball for things that are going on early player, and she's rejecting herself and she comes another very good as one way that we could be. northern hand.. I think like, in terms of like there being any evidence, the only thing that I kind of pull out was the fact that like, they kept going to like parties and stuff without Irene. So, like, if we are gonna give her some of the benefit of the doubt, there is that weird kind of tension that appears when, like, even when Irene is not interested in going, Brian and Claire are still going to these things and Claire spent a lot of time at their home, even when Irene isn't there. So I I do think that, like, yes, the evidence is very sparse, but I can understand how she comes to this conclusions given her perception of what's happening between them., right? There's a little bit Iree, but there is a general sense of what happened and how becomes greater and greater. Oh, I was gonna say uh the one we're being like a ton wild narrator, it's I think it's interesting that she's like totally certain and positive, that like it is happening and even one you trying to like, identify the evidence and she's like, oh, there is it really that much other than maybe I guess it Brian earlier in the all says he doesn't think Claire, is that all with that what I spot later, he's kind of let it sit. And then at the end he's obviously like very distressed. But I think the fact that she just totally dismisses the fact that like, there is't actually that much evidence and she still have certain positive speaks that kind of unreviability little bit.... We are less to one very like what is really at the part of this because what she's going on is maybe not sufficient to to clarify um the problem as she sees it. Um Okay, I have a little off track here in. more. tired until that like he's in very cold family. And so that for old vanity yet what and also afterwards, we can there for months and the right you're getting to look down here. like they there is reasonable doubt about this, and that is just like, I don't really powerful look back about as readers, because we are now we are psychological problems.. I'm not analyst. I remember what was talking about that we really do better and I with that best of families, but from reality having theirairs way of justifying that oh, I I have ruin in my husband life, but if lived in on I thought I commit to Asia, whoa, that's.. Right, okay, so Claire is the problem when they're marriedriage, they might have just had problems in the marriage.. I was a little bit crazy and controlling, especially in her husband, like infe. I' of admitting that the wrong husbandrop. And so I really felt that my. Yes, so great and all of these things are are created by Larson's writing, right? Larsen, who gives us this perspective of Irene, which at the beginning, we are sympathetic to, we we have no reason not to trust, and then she warped our character more and more, and they are all these like critical moments in which the the consciousness, the interiority by being starts to become a place that we has readers are not as comfortable being in, one of those things happens that some of you commented on at the party at Hughes, um, with the breaking of a tea. One is to look at this scene. So, you get a green right into itself, uh, and then let the break that happens in reality, a literal break. Her mental andvisible langu receive it right. What did it mean? How would it affect her in the voice? The voice? She had a surgery. It had been. feeling ofolute uninverted quality. Actually, she didn't have counted. She was to him only the mother of her s of his son. That was all. alone, she was not worse than obstacle. Rage boiled up in her. It was a slight crash on the floor at her feet laid as shadow cup. dark seeing guide the bright grubs, red, shad shock, went on. The fore hers doeta gathered up the white dragons. As from the distance, youword flip voice hanger, though he was she was aware somehow miraculously at the side. Sorry to apologize, that I pushed you. plenty of me. don't tell me it's priceless and you are placeable. It hurts, dear God, how they hurt, but she couldn't think of that nap. Okay, so I want you to tell me how the theme is playing out internally and externally, like, what's happening inside I readhe and then what's happening? between characters and the room and how is it that we're switching back and forth between the two? Like, what what characterizes the writing here were how many who comes sentence that woman over? Yeah. I like, we're getting a lot our head the sentences are we cur and so like we' physically very small uh, and then it was very well on the tiger and there committed. And then all of a sudden there playing actual different of external things that are hurring in the world like, you person it says it clear what it is says, uh, and I guess, but basically it's just written't.. This is like a breakdown of her internal world and we're getting into like short drag sentences. And the other thing like soued with the problem in your life that, like, you're not aware of what's happening with a person sitting next to you or of theity or like, maybe all like what you're teacher ising in front of the room, like, you have a really big problem going on. and so you're at your internal world and then something might happen and you are snackpped out of it and you're suddenly disoriented of like, oh, what's happening in front of me? You live next to me? The voice of Hugh sounds like it's far away, but miraculously he's right there. And so these are some of these moments where we start to say,Ine, is maybe not so reliable, Irene is high that. And then he makes his life kind of icy and cold and a little bit frightening turn in which describes the cuff. Didn't you notice that cup? Well, you're lucky it would be other saying thatcestors were charming conf own. Iotten how many thousands of years ago was that's brand on the ele has I had a little war history, it was brought marked by other. Oh, all right, the English be you call it the underback. I' coming to the fact that I' never figured out a way to get rid of it until about five minutes ago, I had an inspiration. I only had to break it and I was of it forever. So it simple and I never thought of it before. So, what do you hear in this explanation? that she's giving to you? Yeah. She's using the for more, so basicallyolve the way change. That.... getair is she gonna do something else, right? this year. like how comes up, right start everything is having over the course of a series of the conversation. There two other. I think representation of player and how I. I want to get rid of there, she talk about all. And kind of reverse, I think earlier to help when the teacup is, which could also refer to Claire's passing. um, and I' almost like that spoil the end. Yeah, this is foreshadowing for the end for when I bring them up, like cushing clear sort of out of the windowows, like killingberg. I thought this was kind of foreshadowing for that as well.. something for not made it the end, I apologize to you, but there's no real way to talk about this novel without talking about the ending. um, it will still be shocking when you read it if you haven't gotten there yet. And but we're gonna talk about the ending with the end of our time. Now, it all fells crashing gap. Remember in the beginning, we have Irene ascending to the top of the green end, we have all of this movement up there. and then at the very end, we have all of the charactersembled at the top of the building, and the revelation that clear and then passing, uh, because her husband, John Doulouse storms into the room. He says, so you're in Ed order to Dan Edward and his voice was a snarl, and a mode, an expression, of ray and the everything was in confusion. The man had sprread forward, police had lected between them and the blue. She said quickly, hereful, you're the only white man here. And the silver silver voice, as well as of her words was a warning. Players stood at the window as composed as an everyone were not staring at her and curiosity and li, as if the whole structure of their life were not high in practice and for her. She seemed u aware of any danger or uncaring. There was even a same smile on her full red lips and the under shining eyes. was that smile that maddened by reading, she ran across the room her coting with foccity and laid a hand on players of their arms, One thought was exper. She couldn't have Claire and repacified by the Lou. she couldn't have the free Before there stood John Lewis speechless now in his f neighbor, on them, the little hudd of other people and Ryan stepping out from among them. What happened next Irene never afterwards allowed her to remember, never clearly one moment there and then if, a vital flowing thing, like a flame of red and bold. the next, she was gone. There was a cast before and above it the sound not by human, like aast in abey, nig by God, big. Okay, women happened here? Do we have we have love closely and the list between the we know that our have not slow it all in high foot high is slowly evolving in matter, but also, ever since being do throughout the heat and how the sub is. So we don't know who she is. is in the D or is so overwhelmed over the ir culturer. We don't want it being claim to not of itself. I mean it is not on herself and she won't herself whatever, right? And then yet she has the softway face of right here that the service are about really high correct by, the whole forgery loving, loveliness, clear, Henry. How do we maybe think about this ending this ambiguity of the ending in relation to that story, that I go about? Like, what kind of ending did I show you there and what kind of ending is this for a character who kind of constituively is of the same type? That's almost for where I do all of really. It a position already had this plan place that ever found out she wanted to beency and she had to loseation. So this she she just. Okay, so there's medally in which this, like hotel is a lead to freo, we could say maybe this is like, right doing something in here, or it might be something up, other thoughts and thought and that. I when I was reading it awfully, okay, so what happens to her? Um, so we have final like multiple different athletes are basically the have on standard as like CN time. you have I just that at the end fire. I see the fire Yeah, I after this is a broad looking of uh this, she seems just so calm about whole situation so it be, you. It's and ambiguous. One person back. towards freedom because she get the bird can clear she a my knowledge, then she will be home free, but even when like, he did find out she still didn't really succeeded maybe she killed. Yeah, it's all right. So there's like, as opposed to a heroic ending, a morally righteous ending, we are left to wonder it where that her death by being pusbur over death, um the place that the lay right on the ground at the bottom of the sky creaper is like burt and a dark and wathering. um so again, we are not looking at stories that tell us a problem and a solution, we are staying inside of a problem. we are going to end. I want to just prepping for next week, we're shifting years and reading totally a very different kind of stories. But the thing that might help us make this week is to think about laughter in this novel, who is laughing because laughter is gonna be at the center of the that piece. Okay, that a all. Thank you. so much (copy) (copy)
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than that I'nique. I think I would write a name and we cross the rental for past at do period, so like, it is us out of taking off or dealing with all of the logistics, so far, um you are still kind of getting devil or have anything else to figure out on terms of uh, just a piece adistration, conferences, anything else, uh, as usual, um, just, act and lecture or send me an email there's a few little things that I still working out, but hopefully to get settled for all of you. Um, last thing you just wanna say, thank you for your first discussion of us. They were just like specialasure read and, like, showed me how many different ways you're all being with us novel uh, and I now I like, oh, I wish you had another hour. I'm talking with this one. keep talking about it? um but we'll definitely touch on one of the things that you read in your post. today and when, um next week we're moving on to another reading, but we'll have your first conferences and that'll be a chance to talk about that kid's reading by all that really everything that we've discussed so far, so pull on to you all of these ideas that you're having. Okay, um, so today, we're gonna be a no happening, we're gonna talk about some of theorical contacts that can have us understand passing, like what's happening in the novel. Uh, and then we're gonna die further into the text of acting of what Laren is doing with this concept ofaba. Um, first, I just wanted to briefly touch on something that Irene referended in the novel, but that in this outside, it'sersen, using a novel so it references Comicorn, a little piece of history. We have I read thinking at one point, when she's worrying about Claire and correct and she's becoming, uh, and the problem of playing becomes three of her husband Rob, said, what is Luc there? He, was under eight the eight, uh, at the time that Larson was writing, passing, the rhyler case was sort of like a recent new sensation or almost like a celebrity spectacle in New York City. um, and the reason that Irene refers to it in the novel is because of the he centered around a white man who is married to a black woman who could pass her wife. uh, and the question in the rhyment her face was was she has, or did her husband, in fact, already know that she would lack? Uh, I was had like a little brief synopsis of this thing, and they' li. uh up on my versus if you wanted to read more about this soon. a fascinating story. So, in 1921, a wealthy young white man named Kit Reinellander, met Alice Jones, who was working class an racial black women. Rein Linder, the ris guy only, did not like this relationship. the two elopes in 1924, and soon after, because Bryander was part of this aristocratic family, uh, the news paint it up and published a story titled Bradland's son, and Mary is the daughter of a color name. and this led to his father finding out about the marriage and forcing his son to file for an annullment, uh, and then there were all these purpose meetings that began. And in this suit, Kitinlanders side attempted to prove that Alice had to defauded Kit using sex to gain access to hisalth. And social position. um, and then this became, as I said, kind of a big news story and cultural identity that because the right of her family was sort of celebrated being of family and because there were so many intimate details here in the court in the news about their marriage and also about Alex, um and this currently pretty preceding into all. Alice, for her side, I had been single case. She admitted to be black and she insisted that Kip had been aware of it. um and in the end, some surprisingly for the moment of by the court decided in Alice's favor and three, that KI had actually known of her blackness all along, so he was not the victim of any thought. In this case, he was not at the woman who wasying about being white. It was her husband lying about his knowledge about it. And so this is like just another variation of all these birds, like convoluted situations that arose in the midst of the American conception with the color line with racial purity and with racial power. and this is like, you just like another piece of helpful background as we head back into the novel of our characters, um, in our case, player is passing the way, and her husband, John, as far as we know, up to a point, does not have any clue that clear is black. Um, and even though this is the setup, Larsen does something to sort of what, electrify us early on, when she sets the scene with strong balloon and drink the roof and the dressingla this web. Hello, was John's reading player. Um, and I' using that that meansalonate, he's using probably obviously a variation of a regial slarity and word, right? And so this immediately creates like, great confusion for Ine and perjury who are sitting there. uh, and Claire and quickly has to explain why husband is calling you that. Her black eyes let her down. Tell them here, why you call me eyes. The man chuckled, make up his eyes, not I madeless compelled acknowledgepleasantly. He explained, well, you see, it like this, when the first married she was white as well as white as a lily. But I did lay she's getting darker and darker. I tell her if she don't look out, she'll wake up one of these days and find she her and with Edward. Heared with laughter. Claire' ringing bell light laughing his then a little later on. My goodness Jack, what difference would it make it after all these years, you were to find out that I was more than she present color. The put out his hand and refudiating flame definite and final. Oh, no, he declared, nothing like that with me. I know you known, so far right, you can get that slack as you please as far as I concerned, since I know you no. I draw the line back, the open pen words in my family ever happen and never will. Okay, how does our protagonist Irene experience this scene and how does she feel watching it? Yes.. There's. I couldn't. She's sitting at the TV party, you just kind of watching me not even even a while, put the most. But I it upset me, she doesn't know if she can speak up without real very nature. Yes, so she's like having to her appearance, like like looking around and deep confusion and disments. down because like the translated almost like half rest and comments that Cla Gertrude pick up on because the three of them are passing, and you can kind of tell that Claire has a lost experience with it has a conversation because she had she handles it a lot better than Irene does, um, and yeah, if you see all this in totalal turmoil and it keeps out a little bit in intercom conversations. Yes, right, so you trying to be her cool, but they're always like it is irrepressibleomas the sense of way, what the hell is happening here in player like aA... Claire husband to explain why would she bring up that conversation in the I? If she, oh, my husband has absolutely no idea. just for me.ger to know that idea. Why folks think? Why? Why will 30 this? There so many different ideas? few folks in the French? What are you things are? why in the read I Pandora. And all the soation and friends or what we actually. there' exposition to us a reader and to having. Yes, okay, so right, so she's like doing this like to them, like, there is there is a context here for this. Okay, there's a lot of kids and I go, here, here, maybe just go there.. as well. I is trying up all theoth or like making joke from the. because people aren has that beatified for her because she spent all this time for this performance and. And now she does advantage of this route. she work in. Yes. making a joke of her husband, right? why would she create this situation to begin with? so there's a way in which, like, there are different audiences and she created an audience to watch it un full.. sounds like, I g said, oh, you should spot, you know, uh, fire, you layer in my one pass the approaches it is like, you know, those, you don't know, but whatever really you can dola is, so it's like almost like red flag or alarms or something like battery knock and probably at me like, oh my God, like they kind of like on the closed and like my love. They're like email and they like not, everything that happens to Claire because they share this identity, that it's all black men who are can't ask for life, like anything that happening, it is like, immediately there's an implication of what this means for the other in characters. Yes. all this field are sheets like player? because um, like the she wants sitting for a her, our players trying for. and the other player wants to like more hard I his life. um, and it it feels like he's like giving a little taste like this is time, whatever med. So, like, why don't you let me your like a little more psychling real life? Yes, right, so there in which, like, maybe she showing up and like, making a joke at these I' heard a thing that there's another way she's like look at my situation, like this I live in I, uh, but it's both, right, at the same time... This is my back that. I contin what as I Yes, right. She's doing this like dance and shifting the position, uh, by by creating this and this is really dangerous essentially situation, um and and letting her friends in on it. Um, and there is this sense, right that there is, you know, danger in the scene, there is ultimately something that disturbing, but one of the involved is that I may not progress is like this this knowing lap, right? that kind of comes over earth room too, um, because there's something absurd about watching the scene, um, at one point, like Irene's lips trembled almost arm full of, but she made a desperate effort to fight after disastrider laugh and succeeded, um, and then jumped down a little bit, she's looking at her from grocery clear littleressed down a for a. I mean wish there was brief size through she feared by her self comprolled thatiled toridge for her notating anger and in that indignation. So there's like laughter and there's anger and indignation. She had a weepingiety to shout at the manip her and you're sitting here surrounded by three black devils during the teeth. So it does seem, right? that there's a joke and on notolute. He is awake and he is so sure that he would never have a black person in his family or in his house, but in reality, he is sitting there and has a black life, he has the black daughter, and there are two other black men sitting in the are and yet, they all of these women that are just referred to, player, Irene, recru, and and Claara Marjorie, all look white. How are they black? you can turn off, right. Okay, so there's sense in which a appearance is not the only way in which raises being decided, right? That becomes very clear. You can look at way as player and somehow collect Yes. you know, like like slide when you have a conversation down with the blue and it said, like, oh, and players said, what I was large, you color. And he says, well, you know, like, that's not simply means I never not that. So it's not even having, like, that like, DNA more like, you know, that like, it's the not even like it's I I don't even know like what definition is anymore because documentaries is not about, you know, having the access here, you not having that, what countries like, oh, I don't care about how you look, I don't care about you know, what's what's your ancest, you like be somebody else and something like. Yeah, it's really confusing.ired it just that John Lulu by being away, he's so sure he would go, right? There was no way she was getting away with the one or two percent colors in this case, uh, right? Um, but something weird is going on with this definition. two are men and then weonse yet. I think we need lots of different maybe people compared to the John tell the version of of push of the media of excuses. So I think with the women is that someoundaries, here, um the and also I mean for help uh, like, that their response to the outage show and how Yeah, right there are like, so many different ways that race is playing has an identity, but also have like a legal construction and also as a maybe like cartoon characteristic of what blackness is.. I don't know for what like one rule decide, um, who who wasn't? One, but under the law, there was the more, where ne the color lion have already in identities that forces you into one or the other. Yes, so this is exactly where we're headed. This is the streaming I understand, yet how he got to this place in the 1920s, where there are three white open women and all of them are apparently black. In the 1920s, this idea that right even just a tiny percentage of black ancestry made a person black um was part of a law, right? So that is happening in all of these acts were regional integrity acts laws that are prostating American deceased, uh, including in 1984 in Virginia, uh laws like the Virginia racial Integrity act outlawedational marriage and defined a white person as someone who has no pri whatsoever of any one whether than not. Right? And what is that that talk about? Um, and then there are other laws that defined lackers that owned with any trace, right? It could be, 116, uh, a black ancestry remain on. At least kind of law were as they said, white friend across the US and they also extended our back into American history street, one of the first laws that to do this work of criminalizing racial effect on the marriage, uh and defining ways by this strange formula heredity was in 1652 in a specular event. Um we often think about race as something visible, and in any case, it was a uh, but here, right we're seeing that the in terms of the law, uh, we'reology with very technical, legal, and then often invisible ideas of race and of blackness. My question is, and this has already come out a little bit irresponses, but why would Americans come up with such a thing convoluted and frame and specific and some type invisible concepts of race? I? Okay, this is funny back to Elizabeth comment, right? This has to do with the history of Americans labvery. So to answer the session, we're going on a little detour as we as do, as that how my minders. Um, we're going to go back a little bit and think about American slavery and how it works as a racial and social system. Slavery created generations and generations of makes people because, despite all of this talk about the rigid color line, slaveholders systematically crossed. I said on Wednesday that Frosted season on Monday, that Crossing the color line, especially in terms of sexual relationships, what is dangerous and needed as that is true for lacking and sometimes for, and afterately we waited, put and did allwise really violently and systematically. What did this look like? In active events that slaveholders were continuallyaping and they sexual violence was an endemic feature of the system of American slavery. It was not a random event that I approved in some cases of kind. it was a structural part of the system of American slavery. And this kind of knew that sexual violence often led to the murder of a rac children. So when these children were born, they were not considered by their fathers to be their children, they were considered to be their properties, right? Because their mothers then laid those children were and his laid. So imagine as it is a you know, 300 plus year mystery of slavery at there time generations and generations of people who were enslaved and considered to be black, but who look more and more white. This can be really hard to visualize the fact because I need the race, like they shift in different comments, they' shipped at time, we have pretty visual idea of race in the present. Uh, but this these photos for me of us a little bit to understand this. um all of the children in these two photographs were bored into slavery and all of them are considered property and all of that were consideringat. But probably to our eyes, only one of these children as looks black. So when these image of showing us is, again, like a strangeness of racing America. It's really like the fiction of race, of problems of race. We have this idea of rigid color line and then we have this social world that totally always by it. It is like a central problemating America, and it is at part of our 20th as. But it is also at the heart of the first ever African American novelot. Closelle for private's daughter, and they are mostly life was published by a for Lady author William Wells Brown in the 1856, of Phil during safety. um, and it again, at the the first factor all, this very clearly had aitional novel. It's a novel, it's written, it's a perfect of showingagos sla reading the need to project. Uh, the fact that this is the first act there in novel is a good reminder for us that novels, whether they are written by our Americans or by other groups, have not really miss it. Novels are enired or so story different from the literature, how all existed, but novels did not become kind of a cohereric form of that are literature, uh of writing until about the 18th century in Western European culture and then they started to become a major feature of Western European culture, cultureuring art aircraft the 19th century. and writing novels have is like longer durraysans in which histori can take place, and there' group or multiple different kind of stories. This is not super important about us today we're gonna come back see the conduct a lot of this then. but uh this is an important for sit situation in the 20th century where novels aren't one important for getting this little detour we taking the 19th century. Okay. back tootap. Uh, what I said is for novel and it takes up this problem of race and the problem of passing as central issue. Um Some of you here a red hotels and you know that it's like, a very convoluted and melodramatic story. um so we're not gonna do aopsis of this if you're curious, go recoel. um, but it's not that if we' for our course. I just wanna briefly introduce you to a central character in enslaved woman name hotel. This isotel as sheears about your soul. The appearance of Plotel on oct in deep sensation amongst the crow. There she stood in the complexion as light as most of those who are waiting with the wish shouldn' not referisers. The auctionireized by saying that Miss Futel had been observed for the last because she was the most valuable. how much, generally? Well, we're m meant to understand here is that, first of all, the towels of white, that is that the hotel is specially valuable because she looks like, and third, that this value attached to looking weight is sexualized, right? We get this very congestive how less g with it. Um, and this idea that played women were lighter reflection, including white acting, had special sexual values, um, was, again, a feature of this is of American slavery. Because of her lacis and also the other values white and, uh, she is persecuted across this o, which leads to a fact and laborer. She attempts to esclavery, that she gets caught and rather than go back to her factors, she chooses to to wep off the bridge for herck. So this is an illustration of that. This is like hotels weep ack. What did you with this? You might be at the Dr. D NOR. This week in the context of hot is morally righteous, right? She sort of a thing here. The cause of her death is slavery and her choice to die is, as I said, morally righteous, because it's protesting againstly and that means that within the context of the 19th century acad abolitionist dog. Uh, we can get a little bit of this, um, just from the way that lay brown wrote this right. There's no hope for aake for her down the passage. Her resolution was taken. She clasped her hands convulsively and raised them as she, at the same time raised her eyes for its heaven and begged for that mercy and compassion there, which had been denied her on earth, and then, with a single bound, she vaulted over the railings of the bridge and subbed forever beneath the ways of the river, thus died lowau. Okay. So this is a little bit of backstory and literary history that's going to help us understand where we are in our novel and how it ends. And we'll just say briefly that this is not the only novel that our literature that keeps up these issues of acid um, where a lot of really important and central novels of early actingary literature that do this, asking is one of them and then we're gonna read another one about to meet laugh more. This is all behind Ella Larson as she writing happy, and she is engaging with this literary history, but she's also complicating the story, right? I read Redfield and Cla Henry are not martyr characters by any right, the problems that they have are not only caused by outside forces. They have also caused by an own desires and wait. So, rather than writing a novel where black womenomes sort of like the vehicles for explloring an issue like slavery or race or racism. Larsen makes race and racism and passing into a being able or even like a backdrop or exploring black women, and their interiority. and they are desired potentially needed their fear, their anger, and and then ultimately their violence. We see both of these characters, sorry out, but what they are to each other and stay the missions, right? I read in the black world, players in the white, but over time their divisions were like he in by one another. um, andir, at least from our perspective, is getting too close, right? Irene, um, on getting rid of player. So, how does this like, break down in start from thisantingopter in and we talked about on Monday, there's thisensive great attraction in the beginning atoration and the sense that Irene was kind of like, not resist the thrall of player, but at some point in the novel, I mean starts to feel differently, and she becomes ultimately to consumed by Claire as a problem. Where are some of the scen that we start to see this happen for uh yeah, where are some of the turning points in the novel where he gets this ri.t. and I think this happened like somebody to going out, like not a highly lot, but you laugh and youulated things how much else if they really doing without me without. I mean, she like, you know, she's so over on cat I, and then was. Yes, right. So, at some point around an invitation that she wasn't part of, Irene begins to believe that there's a fair. But she have evidence of this fair as what I agree, and then also, we have beers like, do we have of an affair, what what did you think about? like, the truth or reality of theear? I kind of interpreted Irena's a bit of an unreliable narrator. It felt like she was telling them story that had already happened. So maybe her act of the end of the novel influences how she's remembering things and trying to justify why she would have pushed a clear in the end. So she's looking at her while they laughed at each other, so that was a sign and when she's at the party and few kind of corroborates how she feels, you see a little bit more about unreliable narrator or what that means to feel? Um when they're presenting things with objective, but their emotions and personality are actually shaping, what what evidence that preventing you and what descriptors they're using?, that's a really good way of it, so we have she is she's basically our in the sense that like she's the as we've talked about, but the character of his perspective, we're really close to. um and we start to have a approx novel see that there is like a discrepancy between her internal thought process and what is available to us as what evidence of what's happening outside of her, um and so the more and more we start to see that, like we have a little bit alienated from Irene, uh, and so, right, the reality of any of her statements, um, have comes into some question. um, so we don't necessarily know what this affair was um, other than what Irene either think it was or justified the FDA. Yeah. kind of operating? he was maybe for a bit, but I think last class mentioned how she really called Claire beautiful. and how now is that Ryan is somewhat clear and not much evidence of a ware, but maybe if she was in his position, she would find clear in my so there is a question of like whose desire is actually at the center of this, right and Brian was kind of like taking the ball for things that are going on early player, and she's rejecting herself and she comes another very good as one way that we could be. northern hand.. I think like, in terms of like there being any evidence, the only thing that I kind of pull out was the fact that like, they kept going to like parties and stuff without Irene. So, like, if we are gonna give her some of the benefit of the doubt, there is that weird kind of tension that appears when, like, even when Irene is not interested in going, Brian and Claire are still going to these things and Claire spent a lot of time at their home, even when Irene isn't there. So I I do think that, like, yes, the evidence is very sparse, but I can understand how she comes to this conclusions given her perception of what's happening between them., right? There's a little bit Iree, but there is a general sense of what happened and how becomes greater and greater. Oh, I was gonna say uh the one we're being like a ton wild narrator, it's I think it's interesting that she's like totally certain and positive, that like it is happening and even one you trying to like, identify the evidence and she's like, oh, there is it really that much other than maybe I guess it Brian earlier in the all says he doesn't think Claire, is that all with that what I spot later, he's kind of let it sit. And then at the end he's obviously like very distressed. But I think the fact that she just totally dismisses the fact that like, there is't actually that much evidence and she still have certain positive speaks that kind of unreviability little bit.... We are less to one very like what is really at the part of this because what she's going on is maybe not sufficient to to clarify um the problem as she sees it. Um Okay, I have a little off track here in. more. tired until that like he's in very cold family. And so that for old vanity yet what and also afterwards, we can there for months and the right you're getting to look down here. like they there is reasonable doubt about this, and that is just like, I don't really powerful look back about as readers, because we are now we are psychological problems.. I'm not analyst. I remember what was talking about that we really do better and I with that best of families, but from reality having theirairs way of justifying that oh, I I have ruin in my husband life, but if lived in on I thought I commit to Asia, whoa, that's.. Right, okay, so Claire is the problem when they're marriedriage, they might have just had problems in the marriage.. I was a little bit crazy and controlling, especially in her husband, like infe. I' of admitting that the wrong husbandrop. And so I really felt that my. Yes, so great and all of these things are are created by Larson's writing, right? Larsen, who gives us this perspective of Irene, which at the beginning, we are sympathetic to, we we have no reason not to trust, and then she warped our character more and more, and they are all these like critical moments in which the the consciousness, the interiority by being starts to become a place that we has readers are not as comfortable being in, one of those things happens that some of you commented on at the party at Hughes, um, with the breaking of a tea. One is to look at this scene. So, you get a green right into itself, uh, and then let the break that happens in reality, a literal break. Her mental andvisible langu receive it right. What did it mean? How would it affect her in the voice? The voice? She had a surgery. It had been. feeling ofolute uninverted quality. Actually, she didn't have counted. She was to him only the mother of her s of his son. That was all. alone, she was not worse than obstacle. Rage boiled up in her. It was a slight crash on the floor at her feet laid as shadow cup. dark seeing guide the bright grubs, red, shad shock, went on. The fore hers doeta gathered up the white dragons. As from the distance, youword flip voice hanger, though he was she was aware somehow miraculously at the side. Sorry to apologize, that I pushed you. plenty of me. don't tell me it's priceless and you are placeable. It hurts, dear God, how they hurt, but she couldn't think of that nap. Okay, so I want you to tell me how the theme is playing out internally and externally, like, what's happening inside I readhe and then what's happening? between characters and the room and how is it that we're switching back and forth between the two? Like, what what characterizes the writing here were how many who comes sentence that woman over? Yeah. I like, we're getting a lot our head the sentences are we cur and so like we' physically very small uh, and then it was very well on the tiger and there committed. And then all of a sudden there playing actual different of external things that are hurring in the world like, you person it says it clear what it is says, uh, and I guess, but basically it's just written't.. This is like a breakdown of her internal world and we're getting into like short drag sentences. And the other thing like soued with the problem in your life that, like, you're not aware of what's happening with a person sitting next to you or of theity or like, maybe all like what you're teacher ising in front of the room, like, you have a really big problem going on. and so you're at your internal world and then something might happen and you are snackpped out of it and you're suddenly disoriented of like, oh, what's happening in front of me? You live next to me? The voice of Hugh sounds like it's far away, but miraculously he's right there. And so these are some of these moments where we start to say,Ine, is maybe not so reliable, Irene is high that. And then he makes his life kind of icy and cold and a little bit frightening turn in which describes the cuff. Didn't you notice that cup? Well, you're lucky it would be other saying thatcestors were charming conf own. Iotten how many thousands of years ago was that's brand on the ele has I had a little war history, it was brought marked by other. Oh, all right, the English be you call it the underback. I' coming to the fact that I' never figured out a way to get rid of it until about five minutes ago, I had an inspiration. I only had to break it and I was of it forever. So it simple and I never thought of it before. So, what do you hear in this explanation? that she's giving to you? Yeah. She's using the for more, so basicallyolve the way change. That.... getair is she gonna do something else, right? this year. like how comes up, right start everything is having over the course of a series of the conversation. There two other. I think representation of player and how I. I want to get rid of there, she talk about all. And kind of reverse, I think earlier to help when the teacup is, which could also refer to Claire's passing. um, and I' almost like that spoil the end. Yeah, this is foreshadowing for the end for when I bring them up, like cushing clear sort of out of the windowows, like killingberg. I thought this was kind of foreshadowing for that as well.. something for not made it the end, I apologize to you, but there's no real way to talk about this novel without talking about the ending. um, it will still be shocking when you read it if you haven't gotten there yet. And but we're gonna talk about the ending with the end of our time. Now, it all fells crashing gap. Remember in the beginning, we have Irene ascending to the top of the green end, we have all of this movement up there. and then at the very end, we have all of the charactersembled at the top of the building, and the revelation that clear and then passing, uh, because her husband, John Doulouse storms into the room. He says, so you're in Ed order to Dan Edward and his voice was a snarl, and a mode, an expression, of ray and the everything was in confusion. The man had sprread forward, police had lected between them and the blue. She said quickly, hereful, you're the only white man here. And the silver silver voice, as well as of her words was a warning. Players stood at the window as composed as an everyone were not staring at her and curiosity and li, as if the whole structure of their life were not high in practice and for her. She seemed u aware of any danger or uncaring. There was even a same smile on her full red lips and the under shining eyes. was that smile that maddened by reading, she ran across the room her coting with foccity and laid a hand on players of their arms, One thought was exper. She couldn't have Claire and repacified by the Lou. she couldn't have the free Before there stood John Lewis speechless now in his f neighbor, on them, the little hudd of other people and Ryan stepping out from among them. What happened next Irene never afterwards allowed her to remember, never clearly one moment there and then if, a vital flowing thing, like a flame of red and bold. the next, she was gone. There was a cast before and above it the sound not by human, like aast in abey, nig by God, big. Okay, women happened here? Do we have we have love closely and the list between the we know that our have not slow it all in high foot high is slowly evolving in matter, but also, ever since being do throughout the heat and how the sub is. So we don't know who she is. is in the D or is so overwhelmed over the ir culturer. We don't want it being claim to not of itself. I mean it is not on herself and she won't herself whatever, right? And then yet she has the softway face of right here that the service are about really high correct by, the whole forgery loving, loveliness, clear, Henry. How do we maybe think about this ending this ambiguity of the ending in relation to that story, that I go about? Like, what kind of ending did I show you there and what kind of ending is this for a character who kind of constituively is of the same type? That's almost for where I do all of really. It a position already had this plan place that ever found out she wanted to beency and she had to loseation. So this she she just. Okay, so there's medally in which this, like hotel is a lead to freo, we could say maybe this is like, right doing something in here, or it might be something up, other thoughts and thought and that. I when I was reading it awfully, okay, so what happens to her? Um, so we have final like multiple different athletes are basically the have on standard as like CN time. you have I just that at the end fire. I see the fire Yeah, I after this is a broad looking of uh this, she seems just so calm about whole situation so it be, you. It's and ambiguous. One person back. towards freedom because she get the bird can clear she a my knowledge, then she will be home free, but even when like, he did find out she still didn't really succeeded maybe she killed. Yeah, it's all right. So there's like, as opposed to a heroic ending, a morally righteous ending, we are left to wonder it where that her death by being pusbur over death, um the place that the lay right on the ground at the bottom of the sky creaper is like burt and a dark and wathering. um so again, we are not looking at stories that tell us a problem and a solution, we are staying inside of a problem. we are going to end. I want to just prepping for next week, we're shifting years and reading totally a very different kind of stories. But the thing that might help us make this week is to think about laughter in this novel, who is laughing because laughter is gonna be at the center of the that piece. Okay, that a all. Thank you. so much (copy)
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