Developmental Neuro-Ecological Risk-taking Model (DNERM) and the Life-span Wisdom Model that suggest that adolescents’ motivations to engage in risk-taking include experimentation, identity development, explorative behavior, and sensation seeking, all of which run counter to the stereotype of adolescents engaging in risk-taking due to “storm and stress.” Hence, we also briefly consider additional recent attempts to study positive forms of risk taking. Second, extrapolating from sociological/criminological theories on labeling, we suggest that caution is warranted when (inaccurately) labeling adolescents as the “stereotypical risk-takers,” because this can instigate a risk-taking identity in adolescents and/or motivate them to associate with risk-taking peers, which could in turn lead to maladaptive forms of risk-taking. Empirical research testing these hypotheses is needed. To conclude we argue that research on adolescent risk-taking could further benefit from considering adolescent’s own motivations, which is also in line with the participatory approach advocated by international children’s rights standards.Adolescents are stereotypically viewed as risk-takers  in science, mainstream media, fictional literature and in everyday life. However, increasing research suggests that adolescents do not always engage in “heightened” risk-taking, and adolescents’ own perspectives (motives) on risk-taking are largely neglected in research. Hence, this paper is a commentary and review with two aims. First, taking a cross-national perspective, we discuss the definition of adolescence and risk behavior. We argue that much of the research on what drives adolescent risk behavior  focuses on the harms that this behavior promotes rather than on the need to explore and grow into adulthood. Thereafter we summarize the dominant approach to studying motives behind substance use, which has mostly considered young adults, and which has typically not focused on adolescents’ own self-generated motives. The few empirical studies  on adolescents’ own motivations for engaging in risk behavior  show that the most frequently mentioned motives by adolescents were being cool/tough, enjoyment, belonging, having fun and experimenting and coping. Interestingly, the “cool/tough identity” motive is virtually overlooked in research on adolescent risk-taking. The above-mentioned motives, however, generally support newer theories, such as the  Adolescence is traditionally considered as the “in between” developmental phase, with the childhood phase at one end, and the adulthood phase at the other end. Being in this in-between phase, in which humans develop rapidly, has in part contributed to adolescence being described as a period of “storm and stress,” or a period of “confusion” . AdolesccfWhen exactly adolescence ends has been more subject to inconsistency and little consensus. According to some scholars becoming an adult can be viewed as a gradual process, this distinct phase in life has been referred to as “emerging adulthood” . The defFrom a child development perspective, the age of 18 is rather arbitrarily chosen. Studies on human brain development indicate that the prefrontal cortex of the brain, which is involved in cognitive control, is not fully myelinated and pruned until the age of 24 . Accordichoosing an option with the most uncertain outcome  or the behavioral side of risk-taking (risk behavior). For our purposes, we treat these interchangeably. Nevertheless, it is also noteworthy that risk-taking can be defined in different ways. From an economic perspective, typical for the decision-making sciences, the definition of “risk taking” is:  outcome . Alternaoutcomes . Some psd goals” ; p. 2.Of note is that despite the appearance of objectivity in the economic definition of risk-taking, the way in which researchers have studied this phenomenon has focused almost entirely on outcomes that are seen as undesirable from the adult’s perspective. For example, there are many behaviors children show that adults would find acceptable that also involve risks, such as learning a new skill , accepting an academic challenge , or protecting a friend . But hardly any of the research on adolescent risk-taking has examined these “conventional” risks, which presumably also increase during the adolescent period . MoreoveNo matter the definition of risk-taking, behaviors such as substance use and delinquency are often the focus of  risk behaviors in adolescence . In thisadolescents define as risky, and which motivations do adolescents report for engaging in those behaviors? In a unique recent qualitative study , adolescents were asked the following question “What behaviors come to mind when I say “risk behavior?” . In doing so, we use the state-of-art review of labeling theory , which hypothesizes that developmental phase (age) and culture predict levels of risk exposure , smoking (n = 361) and cannabis use (n = 389). Of the answers given to these open-ended survey questions, the “being or acting cool/tough” motive (“stoer doen”) was reported the most for alcohol, cannabis and tobacco use  largely replicated these findings and additionally showed that the coolness concept is not captured in the Big Five personality characteristics. Of note, is that Contrarian coolness is what the Dutch youth appear to be referring to with the phrase “stoer doen” (“acting cool/tough”) in the above-mentioned qualitive study ]. Other motives that were frequently reported were all self-focused motives, namely experimenting, stress reduction, and having fun . AddicticfThree important conclusions can be drawn from the above-mentioned findings based on Dutch youth. First, youth mention both self-focused and social-focused motives for engaging in substance use, and hence although studies suggest that substance use in adolescents is primarily a social behavior e.g., , the notadolescent’s perspective, as surprisingly, such research does not exist in the risk-taking literature, to our knowledge.Secondly, the most frequently mentioned motive by youth “being cool/tough” is not a common factor that is investigated in adolescent risk-taking research. Of note is that “being cool” which has been conceptualized as “image enhancement”  or as “iThirdly, as the second motive for all substance use, youth mentioned the enjoyment that they experience while using substances, for example due to the feeling they receive from the substance or due to its taste. This sensory motive is virtually absent from both past and current theories on adolescent risk-taking.Although being cool/tough was by far the most frequently mentioned motive for alcohol, smoking and cannabis use among Dutch adolescents, research on motives that were primarily based on adults and college students show that motives can differ across substance use type . MoreoveAs with any risk behavior that emerges in adolescence, the focus has been on the maladaptive aspects of the behavior. In the case of alcohol, there has long been the concern that alcohol use in adolescence will lead to alcohol use disorder later in life . There iAlcohol is a sedative which means that it can reduce anxiety and make one feel relaxed . For somAs mentioned above, the research literature over the years has focused on social influences, with strong evidence that both family  and peerMuch research has also focused on personal characteristics that predispose to alcohol use in adolescence. This research tends to find the same predictors as for use of other substances, like tobacco and cannabis. Youth with higher levels of sensation seeking as mediated by expectancies for alcohol’s positive affective effects have been found to try using alcohol and other substances before others do . It is lIn sum, alcohol use by adolescents is likely motivated by its widespread use by adults which makes it appear more acceptable as a substance and also more available in the home and elsewhere. Youth with greater exploratory drives, such as sensation seeking, are also more likely to try alcohol at an early age and if peers and family use the substance, this will make it all the more socially acceptable and “cool” to the adolescent.Another risk behavior among adolescents is smoking cigarettes and recently the use of e-cigarettes . Smoking tobacco differs however crucially from drinking alcohol or using cannabis. It does not cause disabling states of intoxication, such as hallucination, it improves working memory and concentration and suppresses appetite, it is much more addictive and hence withdrawal symptoms set in quickly . These cResearch has predominately focused on personal and demographic factors predicting smoking initiation. Several factors have been found to be associated with ever and current cigarette smoking among youth, such as having parents or friends who smoke, the likelihood of accepting a cigarette from a friend, academic success, other substance use, sensation seeking and friends’ attitudes . One stuResearch among adults’ motives for tobacco show a stark contrast with motives for alcohol or cannabis use, since it is less strongly associated with coping with negative emotions and primarily seen as habitual and automatic behavior that is largely driven by withdrawal cues (which can be experienced as negative emotions as well), because of its highly addictive nature . AdolescThe most recent body of research on adolescents’ motivations for smoking mainly focusses on the use of e-cigarettes, because the novelty of this phenomenon. A survey among Mexican middle-school students showed that the most common reason for using e-cigarettes was curiosity in trying this substance . This isIt is important to also consider motivations for youth cannabis use, since cannabis is illegal in most countries, yet it is the most used illicit drug among youth. Youth can also develop a cannabis use disorder . For exaThe predictors of youth cannabis use appear to be similar to alcohol and tobacco youth use. Both old and more recent  reviews on predictors of youth cannabis use have consistently shown that demographic , personality (sensation seeking) and social factors  predict youth cannabis use . For exacfAlthough there is a plethora of studies on the predictors of cannabis use, research on the motivations of cannabis use has lagged behind, especially compared to the relatively vast research on the motivations for alcohol use cf. NeverthN = 634; 57.9% female) who were in-coming college students  in the United States. From a total of 19 motives that were mentioned from the open-ended questions, a total of 12 subscales (“motivations”) were identified via a factor analysis. The 12 subscales were: (1) Enjoyment, (2) Conformity, (3) Coping, (4) Experimentation, (5) Boredom, (6) Alcohol, (7) Celebration, (8) Altered Perception, (9) Social Anxiety, (10) Relative Low Risk, (11) Sleep/Rest, and (12) Availability , albeit they were heavy cannabis-users who were enrolled in motivational enhancement/cognitive behavioral intervention (The only adolescent (ages 13–16) study we are aware of that was based on normative  individuals, is our aforementioned qualitive study among Dutch adolescents . This strvention . That strvention .enjoyment/fun, conformity, and experimentation, whereas for heavy-cannabis youth users, the top 3 motives that are most commonly endorsed are enjoyment, availability, and sleep  in the United States are asked about their reasons to engage in cannabis use, the top 3 motives reported are nd sleep . Howeverelonging . Thus, ielonging .cfTo conclude, it can be extrapolated from our review of the literature that adolescents’ quest for a “cool/tough identity” is important to understand their engagement in risk behavior, since in our study , adolesccfRecently there has been growing recognition that some risk-taking is adaptive for adolescents who are seeking to define their identities and learn about their place in the world. Adolescents are poised to gain this understanding through their increasing ability to learn from experience and gain control over their behavior cf. There iAs mentioned above, adolescents are often labeled as the stereotypical risk taker, in society and in scientific research. This characterization of adolescents implies that it is normal or expected that adolescents engage in heightened risks compared to other age groups. This idea that adolescents are the stereotypical risk-takers, often carries a negative connotation. For example, it is often associated with the maladaptive types of risk taking . However, adolescents engage in adaptive risks too, although this is far less investigated . Moreovewhat are the effects of official labeling  on subsequent  behavior?  and deviant behaviors . This iswhether labeling adolescents as stereotypical risk takers fosters a risk-taking identity in adolescents, which in turn leads to higher levels of adolescent risk-taking has been unexplored. In fact, although in criminology there is strong evidence that criminal labeling predicts more criminal behavior  as rule-breakers , the frequently mentioned motives  to engage in substance-use appear to be similar across cultures. Still, of note is that unlike other youth, Dutch youth frequently mentioned “stoer doen” as a motive for engaging in substance use, which can be translated as “acting cool” or “acting tough” in English. Although the current literature suggests that “rebelliousness/roughness” is a component of the concept of “coolness” . We found that being cool/tough, enjoyment (the taste of the substance or the feeling it gives), belonging (fitting in/impressing others), having fun, experimenting and coping  were frequently mentioned by youth as motives for substance use. Addiction was additionally mentioned for smoking. Interestingly, in our study among Dutch adolescents , the motl DNERM;  and the ess” see , 2018, wess” see . All in ess” see .Finally, we made a case for why nuance is warranted when labeling adolescents as stereotypical risk-takers. In doing so, we applied the labeling theory  in the cIt is of importance to further cross-nationally investigate the behaviors that adolescents and young adults themselves consider to be risky and their motivations for engaging in these behaviors. This could more thoroughly explore the idea that young adults may engage in more extensive risk behaviors such as substance use, because they have the legal age to do so. This may also give further clarification on the influence that peers may have, which is generally considered stronger in early adolescence compared to late adolescence and young adulthood, and on the relation between peer influence and motivations. In other words, is heightened peer influence related to the desire to act “cool” or “tough”? Such research could have both extensive policy and clinical implications. It may further shape the image that adults have of adolescents. For example, not automatically labeling adolescents as the typical risk-takers, and thereby directing the view to more acceptable forms of risk behavior, such as educational risks and activism, that may have positive outcomes for both adolescents and society. Adolescent’s perspective on all this ought to be acknowledged, as that respects the important right of young people to be heard in accordance with the international children’s right standards.ID developed the study concept and outline, co-wrote the paper, and provided critical revisions thereafter. DR and SR co-wrote the paper and provided critical revisions. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


An Omelette and a Glass of Wine (1986), and shows how this rhetoric develops a conservative “political culture” which privileges human motivations within food cultures that move beyond the negotiation of power.This article argues for the importance of British food writer Elizabeth David (1913-1992) in questioning the centrality of power in feminist rhetorical studies and thereby furthering our capacity to understand the diversity of conservative women and their rhetorical projects. The article analyzes David’s pathos in her landmark volume of gastronomical essays,  Elizabeth David (1913-1992) is arguably Britain’s most significant food writer since the Second World War.I argue that David’s rhetoric is of interest because it questions the centrality of power in feminist rhetorical studies which, I suggest, currently obscures the range and potential of conservatism – especially in Britain – to showcase human motivations other than power. Rather than focusing on David’s negotiation of the power structures available to her as a conservative woman, I examine how her engagement with food and conservative attitudes intersects a conservative “political culture” that diversifies our understanding of women’s conservatism and its rhetorical range, particularly in post-war Britain. Not primarily concentrating on negotiating power, David’s rhetoric uses pathos to emphasize the importance of affective bonds between past, present, and future, and how these bonds generate and conserve tradition which is threatened by modernizing impulses, particularly in relation to food.The article begins by reviewing the way in which feminist rhetorical studies and work on food have engaged conservative women, and questions whether the most important way to engage conservative women in feminist rhetorical studies is always through understanding how they negotiated power. It then outlines some of the central themes of British—as opposed to American—conservatism that animate David’s own rhetoric. After a brief biographical comment for readers unfamiliar with David and the kind of food writing she produced—gastronomy rather than recipe books—I proceed with a textual analysis of David’s pathos in Walking and Talking: Feminist Rhetorical Practices, It is now a familiar claim that feminist rhetorical studies wishes to expand the range of women rhetors studied as part of a more comprehensive analysis of power, or “the ways in which women maneuver amid systems of power” (C. Hogg 22).But as Hogg notes, what often happens when we explore women rhetors who do not seem to “forward a feminist agenda” is that “our conclusions still tend toward analyzing how their rhetorical acts—intentionally, overtly, subtly—find them doing just that” (C. Hogg 397). Rather than trying to locate a feminist agenda among women rhetors who do not readily fit such a profile, Hogg asks that, to echo Royster and Kirsch, we model an “ethics of hope and care” (398). We need to care about conservative women as part of an overall feminist project of “analyzing the operations of difference and the workings of power” (Scott 70).Forever England: Femininity, Literature and Conservatism Between the Wars, which identifies a canon of middlebrow fiction written by women in the interwar years and contributes to what political historians such as Lawrence Black are now calling “political culture”—a mode of politics separated from the histories of political parties and organizations and that reach into everyday spheres of life, including the home and, crucial to my purposes here, the kitchen . But there are still two problems with this approach, which this article addresses through reading David’s work.While these interdisciplinary works have undoubtedly opened up germane lines of inquiry and have begun to address a blind spot in feminism more broadly, the logic nevertheless remains that if women rhetors are to be studied who do not themselves directly or indirectly advance the cause of dismantling patriarchy, then they must at least hold “rhetorical sway” or power to be worthy of analysis and critique, positioned as “women complicit in the patriarchal structures feminism works against” (C. Hogg 398). The hidden (and mistaken) assumptions here are that: (1) conservative women such as David are of a piece with one another, stifling heterogeneity among them; (2) conservative women are either unenlightened and in need of empowerment, or, (3) they unconsciously hold power because they do not try to dismantle patriarchy. Hogg’s response is to focus on an Firstly, while Hogg dismisses feminist rhetoricians’ reliance on binaries (feminist vs. antifeminist), she effectively erects another by arguing that we embrace subjects whose views either “inspire” or “dismay” us, thereby setting an unhelpful script for appropriate scholarly response that only superficially appears to meet the requirement that feminist rhetoricians engage with conservative women such as David without trying to locate a hidden feminist agenda in their work (399). Secondly, while feminist rhetorical studies both practices and theorizes its own first-person plural—witness the copious use of “we” and “us” in its scholarship—it presumes, perhaps understandably, that this first-person plural is decidedly feminist, and that a single unifying theme for feminist rhetorical studies should be an analysis of how “women maneuver amid systems of power.” Combine this with the field’s tendency to encourage scholars to declare their own subject position—“writing oneself into the story being staged thus becomes a way of writing oneself into history,” to echo My response is to show how feminist rhetorical studies can engage with conservative women rhetors in less prescriptive ways by de-centering the interpretive lens of power. By treating conservatism here as a broader political culture that reaches into the realm of food, I show how conservative food rhetoric—especially in Britain—involves much more than maneuvering amid systems of power associated with more American forms of women’s conservative rhetoric, concerned with abortion, pornography, and the traditional family.Food, Feminisms, Rhetorics, largely bypasses Royster’s and Kirsch’s challenge to engage with women rhetors who do not obviously share a contemporary feminist agenda. Abby Dubisar’s essay, for instance, stresses the importance of finding out how women rhetors can “be both engaging and subversive” (60), while Food, Feminisms, Rhetorics would appear, by and large, to agree with Meanwhile, feminist food rhetoric itself has yet to witness an explicit engagement with conservative women. Immediately after the Second World War was not a good time to be a Conservative in Britain. In 1945 the Labour Party swept to victory and thereby instigated a period in the wilderness for the Conservatives, who did not return to power until 1951—exactly when David’s career as a writer began to take off. But while political historians have been busy re-evaluating the so-called “inevitability” of the Conservative defeat in 1945, other historians have argued for a more diffusive understanding of conservatism, with a small “c”  474.7 HoRedefining British Politics: Culture, Consumerism and Participation, 1954-70, Lawrence Black has argued for the importance of political cultures in shifting attention away from party-specific activity. This means evaluating “politics in its wider social setting, in which as a minority or occasional interest and identity, politics could bear a certain ‘otherness,’ much as ethnicity or social class might. This suggests that political culture might not be very political, measured in conventional terms” (3). In fact, British conservatism is ideal for studying in terms of a broader political culture, given its historic resistance to systematization and its insistence that it is non-ideological, simply a set of attitudes (and possibly behaviors), more than a coherent philosophy.In his Applied to the period in which Elizabeth David began her journalism, in the late 1940s, there are a few key elements to bear in mind. The sheer length of rationing, impacting people’s lives for almost a decade after the war ended, meant that discussion about food remained tilted towards health, nutrition, and making ends meet. During the late-1950s and 1960s, as living conditions improved, attention oriented more to quality of life issues. As Black explains: “Politics [in Britain] was increasingly about rights, tastes, culture, morality, environmental, post-industrial, even anti-materialist, desires and self-expression and less about needs” (8). By the 1970s, a coherent and often connected network of women food writers was persuading middle-class readers about the need to conserve food traditions native to England that were at risk of being lost amidst the smorgasbord of ascendant lifestyles to be had.Spices, Salt and Aromatics in the English Kitchen (1970) and English Bread and Yeast Cookery  and Elisabeth Ayrton (1915-1991), were forming a political culture in which their conservative rhetoric was focused on recording and preserving food cultures at risk of being lost. Titles such as David’s  Cookery , Grigson England  and Engl Cooking  self-conOne thing to note is that the great English cookery writers from Hannah Glasse to Elizabeth David have always been women, in contrast to the French tradition of cookery writing by male chefs. Our classical tradition has been domestic, with the domestic virtues of enjoyment and generosity […] We need to renew and develop the old [pre-industrial] tradition of Hannah Glasse [1708-1770], Elizabeth Raffald [1733-1781], Maria Rundell [1745-1828] and Eliza Acton [1799-1859] as far as we can in our changed circumstances. (3)explicitly conservative rhetoric, largely because none of them self-identified as conservative or as engaging in a conservative project, their rhetoric, and David’s in particular, can be classified as conservative due to the ends to which such rhetoric was put, developing a specific political culture of food.While David, Grigson, or Ayrton cannot be said to have practised an One of these—This mode of conservatism, and the rhetoric which serves its end, is somewhat different from the kind typically discussed in American contexts, as Indeed, it has been customary among British conservatives to recognize that, contrary to the ideas of Nietzsche and later Foucault, the negotiation of power is not the only or most significant motive steering human behavior, and that a true study of political culture from a conservative perspective must take into account a broader range of dynamics that animate culture and, at any given moment, may be more relevant than power.Harper’s Bazaar, Vogue, the Sunday Times, and the Spectator. With the additional publication of several books, first on Mediterranean cuisine and then on English, David became hugely popular in the 1960s and 1970s among young middle-class metropolitans seeking to experiment with different approaches to food, including recovering older English traditions.For those unfamiliar with David, a short biographical comment is required.Throughout her life David pursued her own goals, caring little what others thought of her. She loved to drink, had extramarital affairs, loathed being a debutante, and supported individual women suffering from marital difficulties. David never identified as a feminist, not because she was somehow in thrall to the patriarchy , but because she refused across the board to join groups and movements, preferring, sometimes at her own cost, to be a wanderer and a traveler, both physically and psychologically. She preferred to encounter the particularity and thus complexity thrown up by specific women’s situations, uninterested in “plans” to better the lives of some nebulous sisterhood  350. ThuEnglish Bread), was a sustained attack on mechanical farming and the Chorleywood Bread Process that resulted in packaged sliced bread produced at a speed impossible if proving by hand—convenient for some, but tasteless and false for others. English Bread also tackled the ascendance of metric weights and measures in the early 1970s, promoted by the then Metrication Board and the broader drift of Britain into the European Economic Community (forerunner to the European Union). By taking issue with the “botheration” of metrication, David’s conservative stance became as explicit as it ever would (English Bread 233). Another “plan” of the French Revolution, metrication represented an “unnatural” attempt to determine how a range of diverse communities exchanged their goods and hence interacted with each other. David, echoing Burke, recognized that real people were more “haphazard,” especially in their “cooking measurements,” and could not realistically be treated as one homogenous group (234).As the 1960s and 1970s wore on, David turned explicitly to English food traditions; her 1977 masterpiece and bestseller, English Bread fits precisely into a canon of other twentieth-century writing by women rhetors of a conservative outlook of the kind outlined above, including Grigson and Ayrton, but also the earlier English Bread also represented a marked shift in terms of the kind of food writing David practised. Her first book, Generically speaking, David’s food writing sits firmly within the “gastronomic” end of the recipe-gastronomy spectrum devised by Stephen Mennell in 1985. Gastronomical writing has several characteristics, all of which are evident in David’s work: (1) a focus on cookery as an art form; (2) a heterogeneous writing style that includes literary allusions; (3) a transnational frame of reference; (4) consciousness of eating as a social affair; (5) a tendency towards self-indulgence; and (6) “a decidedly undomesticated approach toward pleasure” (McLean 4-5). By seeking to create works of gastronomic art rather than straightforward recipe books, David was, certainly in 1950, circumventing gendered expectations that women write recipes and men write gastronomy. It was only later, twenty-five years into David’s career, that Jane Grigson could say that there was also a tradition of women’s gastronomical writing in Britain, in which David played a crucial role in its development and greater visibility.Omelette) appeared, encouraged by David’s editor at Penguin, Jill Norman. Omelette synthesized David’s journalism from the 1950s through to the early 1980s and condensed David’s self-image as one concerned with writing about good food in the gastronomic tradition from a conservative angle that meditated on tradition in a non-rational way.It is in this cultural moment that Food, Feminisms, Rhetorics rhetorically analyze how women rhetors produced and circulated modern recipe books, in which the recipe is considered “rational and highly reproducible” . Firstly, David describes a humble restaurant in an inn “slap on the Bordeaux-Paris auto-route” (68). Nothing extraordinary here, except some excellent local sausages, but “[w]e left at daylight feeling, as travellers should, that we had been welcomed, comforted and cheered on our way. It was a good lesson in how the best hospitality is often to be found in the most unlikely of places” (68).For David, her journalism was an opportunity to persuade her readers to a way of engaging with food that would provide them with the know-how to experience moments of happiness and aesthetic pleasure. One of the ways she does this is by evoking scenes in which good and bad moments of food are personally experienced, such as in “Eating out in Provincial France 1965-1977,” published in 1980 in entrée to the main course, a fabulous narration of dining at La Mère Brazier by the Col de la Luère, a few miles outside Lyon. As always with David, anything fancy is derided; that which is simple and good is cherished: “There was no showing off, no fireworks. The calm confidence, the certitude that all here would be as it should which one felt upon entering the establishment was somehow communicated to her customers by Madame Brazier herself” (rpt. in An Omelette 70-71). David develops pathos here by imaginatively relating a perfectly realistic scenario, almost prompting her readers to remember what this feels like. Everything in the restaurant seems “all of a piece” (71). Madame Brazier appears to focus on doing what she knows she can do well, in this case a poularde de Bresse, along with a salad of artichoke hearts and walnuts, “delicate and refreshing” (71). Even the dessert seems right, with a vanilla ice cream made chez Brazier: “I tried this once. It was a beauty” (71). David ends by summing up her experience of the food at Eugénie Brazier’s restaurant as “poetry,” thereby lifting her experience into the realm of aesthetic pleasure and reminding her readers how good food experiences communicate knowledge about pleasure in life (72).This little vignette serves as an By contrast, in “Confort anglaise, French fare,” first written in 1986 and which immediately follows “Eating out in Provincial France,” David describes an experience of eating which she did not enjoy, so that her readers are helped to discern the difference:An Omelette 80)The grasping attitude, the general shabbiness, the brainless parsimony displayed by Madame, the dispirited and dispiriting service, the dreary bread, the absence of a house wine—always a bad sign in a shared restaurant—all added up to yet another of those dozens of unsolved Michelin mysteries of my past travels in France. .Importantly, David uses pathos to heighten emotions in her readers in order to convince them of truths she knows cannot be argued logically. Even when she says that a certain cuisine, such as that from Provence, is “the rational, right and proper food for human beings to eat,” this is a statement arrived at by decidedly non-rational, imaginative means, in this case from a “vision of golden tiles on a round southern roof, or of some warm, stony, herb-scented hillside” which “will rise out of my kitchen pots with the smell of a piece of orange peel scenting a beef stew” . The kind of instinct that can sense if something is “right” is trained by immersing oneself aesthetically in food experiences—real or imaginative—and developing a feel for how others respond to good food. The problem David faced in the 1960s and 1970s was that she felt this instinct was in short supply: there simply were not enough opportunities for her readers to develop this sense for themselves, hence her rhetorical choice to express the benefits and pleasures of food in “lively terms” (12).Vogue in 1958, David addresses this challenge in relation to Christmas food. Quoting Philéas Gilbert, David states that “[c]ookery is as old as the world, but it must also remain, always, as modern as fashion” (rpt. in An Omelette 287). What David means by this is that when we try to cook according to old recipes—an admirable endeavor—we do so in ways that,In addition to her non-rational method, what makes David’s pathos particularly conservative, however, is that she uses pathos to show how knowledge of good food is part and parcel of a living tradition, inviting historical reflection on the one hand and a feeling on the other for how food traditions of the past flourish in the present only by adapting them to present circumstances. In “Traditional Christmas Dishes,” published in while based on the old ones, are modern in treatment. It is a system which works so long as the spirit of the recipes is preserved, for then we do get some sense of a continuing tradition into our cookery, avoiding the farcical effect produced by “traditional” recipes made up almost entirely of synthetic or substitute ingredients. (288)Not only does David justify an approach to food that relies on the development of aesthetic instinct, she ties this sense to a conservative understanding of tradition and its role in political culture. Stemming from Edmund Burke, who famously said that “[a] state without the means of some change is without the means of its conservation,” twentieth-century British commentators on conservatism have similarly emphasized the importance of adaptation in the service of conserving habits, attitudes, practices, art forms, and much else to which ordinary people are often tied by bonds of affection (441-42). One of the most obvious ways in which David develops her conservative political culture of food tradition is by using pathos to bring tradition down to a human level. This works in two ways: (1) through personal anecdote of mentors in her past who helped her to a larger understanding of food and its role in human life, and (2) by narrating historical narratives of primarily women food writers of the past whose food traditions were at risk of being lost in a world in which their wisdom and knowledge were sorely needed.Omelette: “South Wind through the Kitchen” for Wine and Food, 1964, and “Have It Your Way,” written for Gourmet in 1969. These are two portraits of the writer and raconteur Norman Douglas (1868-1952), whom David met in Antibes in 1940 and whose literary influence is felt in all that David subsequently wrote. In “Have It Your Way” David builds her readers’ emotional interest in what is, quite frankly, one of the most personal and private aspects of her life that profoundly shaped her commitment to food writing. A general maxim ; a plea to end a relationship that was making her unhappy (“Stay here with me. Let him make do without you”); and a day in Norman’s company : these are woven together to create a poignant narrative which is cathartic for David and pathetic for her readers, who knew, with the benefit of hindsight, that these days Elizabeth had with Norman were numbered (120-23). And, as a mark of his influence on her, David explains that his philosophy of life, which reveals itself quite clearly in her writing on him, “emerged gradually, in the course of walks, sessions at the tavern, apropos a chance remark,” rather than through lectures (123). So too does her own treatment of his philosophy. Memories flicker into focus when she eats in a restaurant or visits a place in connection with him.Firstly, then, are David’s emotive portraits of her beloved mentor in In “South Wind through the Kitchen” this is especially borne out by David’s visit to a lemon grove in the summer of 1952, months after Douglas died. Although she admits that she parted company with Douglas on his penchant for visiting graveyards, David nevertheless chooses to remember his memory by going to a grove they frequented together, and then evoking it for her readers. “It was so thick, that lemon grove,” she writes, “that it concealed from all but those who knew their Capri well the old Archbishops’ palace in which was housed yet another of those private taverns which appeared to materialize for Norman alone” (129). This is a scene of sensuality, almost a mirage that appears only to those who have their minds set on some beloved friend no longer physically present: “There, at a table outside the half-ruined house, a branch of piercingly aromatic lemons hanging within arm’s reach, a piece of bread and a bottle of the proprietor’s olive oil in front of me, a glass of wine in my hand, Norman was speaking” (129).Wine and Food in 1965, David wrote of the advances made by Lady Llanover (1802-1896) of Llanover Estate, near Abergavenny in South Wales, whose Good Cookery of 1867 aimed to recover Welsh food traditions at risk of being lost by the march of Victorian progress. As Lady Llanover wrote in her introduction to this book: “My aim […] has been to preserve or restore all the good old habits of my country” (qtd. in 293). Music to her ears, David singles out the ways in which Lady Llanover contributed to the longevity of Welsh culture, often threatened by the dogma of progress: “In her repudiation of the marvels of Victorian progress and the products of what she called ‘mechanical talent’,” writes David, “she was also reactionary. Or was she a visionary? To those of us who today yearn increasingly for authenticity and natural food, she appears sometimes to be writing of the 1960s rather than the 1860s” (296). David’s treatment of Lady Llanover was actually revisionary; the scarcity of copies of Good Cookery in the 1960s symbolized Lady Llanover’s obscurity, yet David recasts this food writer as a visionary rather than a reactionary, who was brave enough to challenge orthodoxies that were also challenged by conservatives of the time who were concerned that liberal “progress” might uproot and displace in the name of advancing the lot of “universal mankind.” David, following Lady Llanover’s example, focuses on the particular, and how the particularity of food traditions can become a process in which knowledge about good food is preserved, transmitted, and adapted by those in new times. As the conservative philosopher Roger Scruton has noted:Most of David’s portraits of other food writers, however, were of women who wrote in the eighteenth and nineteenth centuries—women food writers who were also inspirational to Jane Grigson and Elisabeth Ayrton. For example, in “Welsh Doubles,” published in answers that have been discovered to enduring questions. These answers are tacit, shared, embodied in social practices and inarticulate expectations. Those who adopt them are not necessarily able to explain them, still less justify them. (Green Philosophy 220)In discussing tradition, we are not discussing arbitrary rules and conventions. We are discussing It is no accident then that David employs pathos in ways that align with her non-rational understanding of tradition as that which concerns knowledge of good things that are “tacit, shared, embodied in social practices” such as cookery.Green Philosophy, Scruton has provided a perceptive and sensitive exploration of how emotion can mediate bonds between the dead, the living, and the unborn: “The time for which we yearn and to which we gravitate is one that stretches beyond this moment, this person and this life. It is a time in which the dead and unborn are also present” (234). Scruton is here drawing on Burke’s realization that because many of the things humans seek cannot be obtained in one generation only, “it becomes a partnership not only between those who are living, but between those who are living, those who are dead, and those who are to be born” (509). This sentiment is at the root of the traditional conservative insistence on incremental change and adaptation to the new, and it is a language of mutual aid riveted on an interplay of affect, imagination, and reverence rather than the negotiation of power.By combining her historical research with the recovery of women food writers of the past, David also develops a conservative political culture in which, to echo Burke, culture itself is seen as a mutual task between different generations, which therefore requires specific emotions directed towards those who are no longer with us. In his David’s portraits of historical food writers, and her personal reminiscences of others who helped her to a larger understanding, are doing important rhetorical work in developing a conservative political culture of care. By homing in on the particular and eschewing the universal, David shows the importance of listening to the knowledge embodied in specific food traditions that are at risk of being lost within a dominant culture driven towards change and “the new.” While this could certainly be phrased in the language of “maneuvering amid systems of power,” David’s analysis of Lady Llanover, and David’s wider interest in individual women food writers of the past , suggests that there are other organizing lenses through which to view food culture than power. In David’s conservative political culture, tradition is the process by which affection, imagination, and reverence are cultivated and which enables a caring partnership among the dead and the living, brought together over a common love of good things that need conserving.Elizabeth David’s food writing constitutes an important intervention in the development of feminist approaches to rhetoric. I have tried to show that by using pathos to explore the benefits of food traditions in conserving knowledge about good food, David’s conservatism is capable of inspiring emotions among feminist rhetoricians other than “dismay.” I have also used the case of food writing to show how conservatism—especially of David’s kind—models a broader political culture that affords listening space to human motivations other than power, particularly emotions of care. Post-war British conservatism enabled people to pursue a range of life concerns, not least the desire to feel connected to a past which, in the case of food, was threatened by forces (such as the Chorleywood Bread Process) the benefits of which were not always entirely evident. Feminist rhetorical work on women’s food writing undertaken with a genuine “ethics of hope and care” offers a way of expanding the range of conservatisms studied when turning to “conservative women,” and the British angle demonstrates the scope and imagination at work in the kind of conservative political culture David was at the forefront of developing.


The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as ‘intellectual disabilities’, autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society. First-person reports play a critical role in diagnosing and treating psychiatric illness. In psychiatric healthcare, the healthcare professional relies on the patient’s testimony in order to diagnose and treat the illness at hand. Despite the profound significance of the patient’s voice in psychiatric healthcare, there is a growing concern for the ‘epistemic injustice’ occurring within psychiatric practice  is a common feature of many neurocognitive disorders, such as what the DSM-5 refers to as ‘intellectual disability’, some forms of autism, and late-stage dementia  show up in epistemic colour through this perceptual faculty. In section three, I use the case study of language inhibiting dementia to demonstrate how meaningful non-verbal expression may not register as epistemically charged if the viewer is influenced by identity prejudice. I dub this form of epistemic injustice ‘non-verbal testimonial injustice’. Finally, in section four, I use Fricker’s concept of ‘testimonial epistemic nature of the injustice derives from a person being wronged in their capacity as a knower, as someone who can convey knowledge. To be clear, epistemic injustice is not present in all cases in which a person’s epistemic credibility is diminished. One can only be said to have suffered an epistemic injustice if the credibility deficit is rooted in unfair prejudice. For instance, I may doubt the reliability of a person’s testimony if they are a notorious liar. This would be a rational and fair reason to downgrade somebody’s credibility. What makes epistemic injustice distinct is that it is motivated by ‘identity prejudice’. Fricker  to express her suspicions that Tom Ripley murdered him. Greenleaf, who holds Ripley in high regard, responds by saying, ‘Marge, there’s female intuition, and then there are facts’  and ‘structural testimonial injustice’  Wanderer .Dotson adds to the concept of testimonial injustice that of ‘epistemic violence’: ‘a refusal, intentional or unintentional, of an audience to communicatively reciprocate a linguistic exchange owing to pernicious ignorance’. Drawing on Hornsby and Langton’s speech-act theory, Dotson attributes epistemic violence to a failure to take up the speaker’s speech-act in virtue of this pernicious ignorance. She identifies two forms of silencing that can arise after a prolonged experience of one’s speech act failing ‘uptake’ in this way. First, such epistemic violence can lead to ‘testimonial quieting’, whereby the marginalised speaker is no longer viewed as a knower. Alternatively, the marginalised speaker may truncate their own testimony ‘in order to ensure that the testimony contains only content for which one’s audience demonstrates testimonial competence’ Dotson , 238. ThTrip Glazer argues that Dotson’s concept of ‘epistemic violence’ can be taken a step further. Pernicious ignorance can lead not only to a violation of linguistic communicative exchange, but also non-linguistic, emotional exchange. When a non-linguistic expression of emotion is wilfully misinterpreted, the marginalised person can suffer what Glazer calls ‘emotional misperception’ Glazer . Glazer not even registered as meaningful expressions at all.While ‘emotional misperception’ is a valuable contribution to the literature, I believe we can take a step further still. Through this paper, I identify instances where non-linguistic expressions are not simply misread but Consider the following example: you are sitting on a busy commuter train to London. At the next stop, another person boards the train. He is soaking wet and bedraggled from the downpour outside. His face is scrunched up in a frown as he tries to remove his wet hair from his face with one hand while clinging to the luggage rack with the other. As the train starts to move again, he stumbles slightly, unsteady on his feet. His face shifts from an expression of frustration to one of concern as he notices the sea of heads filling almost every seat. At this point, you stand up; rather than shout across the noisy train, you simply gesture towards your seat and smile at the man. The man’s face shifts to an expression of relief. He nods politely and shuffles towards the now vacant seat.In this commonplace scenario, a meaningful communication has taken place without one word being uttered. You do not need the man to say aloud, ‘I am frustrated’, ‘I am concerned’ or ‘I am looking for a seat’ in order to infer what his gestures mean. This is because non-verbal communication is an essential aspect of our interpersonal relationships. In fact, an estimated 60–65% of our communication is non-verbal  amoral way in which this ‘communicative sensibility’ fails is through our encounters with non-human animals.In what follows, I explore a case in which a communicative act is missed by our untrained ‘communicative sensibility’ in a distinctly immoral way. In this case, the communicative act is not missed because the communicator is of an entirely different species. Although a fellow embodied human being, their communicative act does not register as ‘epistemically charged’ because their credibility has been downgraded. By expanding ‘testimonial sensibility’ to ‘communicative sensibility’, we can capture cases whereby a valuable non-verbal expression is dismissed as meaningless by virtue of an identity prejudice. I argue that the latter constitutes a case of what I call ‘non-verbal testimonial injustice’.The non-verbal group that this paper focuses on are those who depend on non-verbal communication as a result of disability or neurodiversity. This includes people with autism, people with intellectual disabilities, stroke victims, and people with dementia. These groups are especially vulnerable to epistemic injustice due to the pathophobic attitudes latent in our society Kidd . People I have chosen to focus on non-verbal people with dementia because the context of their condition leaves them particularly susceptible to non-verbal testimonial injustice. First, people with dementia are subjected to both ageist and pathophobic prejudices. Urbańska et al. dub this intersectional prejudice of ageism and pathophobia the ‘double stigma of dementia’ . Second,The umbrella term ‘dementia’ captures a form of major neurocognitive disorder that leads to a decline in neuro-normative cognitive functioning. This includes difficulties with information processing, language skills, and memory. Some common forms of dementia include Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, and mixed dementia. According to the World Alzheimer’s Report 2018, around 50,000,000 people live with dementia worldwide. This number is projected to rise to 152,000,000 by 2050 , they fail to address whether epistemic injustice arises in cases where the person with dementia really has lost the capacity of speech. The reason for this omission may be that people with language-inhibiting dementia are seemingly automatically excluded from epistemic practices as their illness prevents them from participation, regardless of whether they are subjected to an identity prejudice or not. In what follows, I correct this assumption, arguing that to assume that non-verbal people with dementia are beyond the remit of testimonial injustice is to commit the very credibility deflation that the literature has sought to overcome. I argue that a kind of testimonial injustice is inflicted upon people with language-inhibiting dementia if their non-verbal communication is ignored or disregarded as meaningless. I call this Loss of language is a common feature of dementia: ‘Patients with dementia demonstrate, among other signs, word-finding problems (anomia), sentence comprehension deficits, and lack of cohesion in discourse’  without communication:Some rooms had little décor or pictures and no information to assist in getting to know the person. Other rooms, however, were warm and cosy and personalised. We found that the rooms with little or no personalised effects belonged to people in the later stages of dementia. This suggested that people with higher needs, or in the later stages of dementia, did not have their dignity maintained in the same way as people who were able to make choices and advocate their own needs. CQC One person who stayed in their room was described by a member of staff as having ‘closed down’. We found their room was the furthest away from the lounge and the person was not provided with any method of summoning help. CQC The de-prioritisation of non-verbal residents could also be observed through the structure of the care home itself:These CQC-conducted inspections indicate that non-verbal people with dementia are frequently given less attention than they deserve and are less likely to be engaged in meaningful social interaction. Non-verbal people with dementia are likely to be missed by such ‘communicative sensibility’ because it is ‘more challenging to see and recognize individuals with dementia as relational human beings when they cannot respond verbally’ , but very often it also carries an epistemic charge. Accent can have a significant impact on how much credibility a hearer affords a speaker, especially in a one-off exchange. Fricker , 17In the words of Fricker , 160, ‘tgestural style.If the credibility deficit attached to a person’s testimony may be influenced by their vocal style, we can reasonably conclude that, in the case of non-verbal expression, a credibility deficit may be influenced by do take the time to watch the person’s gesture, you may assume that their unsteady pointing and uneasy head shaking are either meaningless movements or merely a product of a delusion . Either way, the gesture is unduly ignored or dismissed. Like an accent, a gesture can carry an epistemic charge. Whether slow and uncertain or firm and precise, the gestural style is likely to influence the speaker’s credibility. For instance, studies show that handshakes with ‘strength, vigor, duration, eye contact, and completeness of grip’ are more likely to convey confidence, trustworthiness, and experience to the recipient  be pre-emptively Consider, again, Zeiler’s example of Gladys (the person with language inhibiting dementia) and Naomi (the practitioner). Imagine if, instead of engaging with Gladys, Naomi never even looked at her. Imagine Naomi walked into the room and spoke with the other patients who can communicate verbally yet did not even glance at Gladys because she knows Gladys cannot communicate verbally. If Naomi does not look at Gladys due to the prejudicial assumption that Gladys cannot communicate anything meaningful in the first place, then I propose that Gladys’s nonverbal communication has been pre-emptively silenced.Non-verbal communication cannot occur unless someone looks in the marginalised person’s direction and witnesses their gestures. Without this basic interaction, a non-verbal expression is silenced before the perceptual faculty of ‘communicative sensibility’ can kick in. Given the pathophobic prejudices attached to language inhibiting dementia, one in three people admit to avoiding people with dementia because their condition makes them feel uncomfortable .What about epistemic agents who do not have regular contact with a non-verbal person? As previously discussed, such marginalised knowers are subjected to non-verbal testimonial injustice not only by people they are in frequent contact with but also (and perhaps more commonly) by people they have infrequent or one-off interactions with. This could include family members who rarely socialise with them, a GP they infrequently see, a one-off interaction with a police officer, etc. While these interactions may be rare for the dominantly situated epistemic agent, for the marginalised person in question these systematic, independent cases of non-verbal testimonial injustice make up the overall wave of credibility deficit that slowly erodes their epistemic status. To avoid such one-off interactions of credibility deficit toward all marginalised groups, Fricker , 96 propcommunicate verbally but also struggle to understand verbal communication. For this reason, it is vitally important that we pay close attention to our gestural vocabulary when communicating with people who have language inhibiting dementia. To engage with a non-verbal person, one must be particularly attuned to one’s own facial expressions, eye contact, bodily contact, posture, hand gestures and proximity to the other person (Vries critical openness’ between the bodily expressions of myself and the other person (Fricker Once non-verbal testimonial justice has been cultivated and a person with language inhibiting dementia is correctly perceived in epistemic colour, a two-way interpersonal interaction can occur. Most people with language inhibiting dementia not only struggle to on Vries , 33. Thr Fricker , 66. Thi Fricker , 322. Th Fricker , 66.qua knower, and, while other sorts of utterance may communicate knowledge, it is distinctive of telling that conveying knowledge is its most basic and immediate point. (The phenomenon I call testimonial injustice is not in fact confined to testimonial exchange, even allowing that we intend testimony in its broadest sense to include all cases of telling. Prejudicial credibility deficit can, after all, occur when a speaker simply expresses a personal opinion to a hearer, or as a value judgement, or tries out a new idea or hypothesis on a given audience. But telling is the parent case of testimonial injustice, since the basic wrong of testimonial injustice is the undermining of the speech e point. , 60I end this section with the following quote from Fricker, whereby she firmly defines the limits of testimonial injustice:testimonial sensibility’ is far too narrow a concept. This ‘certain sort of social perception’ registers people as knowers not only through hearing testimony but also by seeing embodied behaviour. This is because meaningful communication can occur through non-verbal expression.I argue that this conception of testimonial injustice is too restrictive. Limiting knowledge exchange to ‘telling’ is to exclude all the vital communicative practices used by people who can only express knowledge non-verbally. So too, if we consider the broad range of ways in which we come to register others as ‘knowing’ subjects, it is apparent that evaluating acts of ‘telling’ through our ‘speaking subjects, to include those who cannot communicate verbally. Drawing on Merleau-Ponty, I understand bodily gesture to be a form of meaningful expression that ought to be considered just as valuable as speech expression and just as vulnerable to epistemic injustice. By broadening Fricker’s concept of ‘testimonial sensibility’ to ‘communicative sensibility’, we can see how non-verbal marginalised knowers can fail to show up as epistemically charged. To correct such non-verbal testimonial injustice, I propose that ‘communicative sensibility’ should be trained to encompass all forms of communicative expression from all marginalised knowers. People with language inhibiting dementia provide a paradigmatic example of non-verbal testimonial injustice, and I hope to have brought to light the previously obscured injustices they suffer.This paper has developed an account of non-verbal testimonial injustice that I hope will expand the discourse on epistemic injustice beyond the wrong suffered by This essay serves as an initial step in expanding the concept of testimonial injustice so that we can take seriously a wider range of communicative practices. While initially counterintuitive, I have demonstrated that even those who cannot speak can be epistemically silenced in a crucial sense. In contributing this term to the literature, there is scope for a new set of conversations in the field of social epistemology concerning the injustices suffered by those who are quite literally voiceless. I hope this paper will offer inspiration for future research into other forms of non-verbal epistemic injustice such as hermeneutical injustice, epistemic silencing and wilful hermeneutical injustice Pohlhaus . Beyond


Giovanni Lombardi. As well as having affiliation 2, the author should also have “Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland.”In the published article, there was an error regarding the affiliation(s) for the author, The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


To date, the use of barbed sutures for the surgical management of patients suffering from obstructive sleep apnea and snoring with retropalatal collapse and vibration has significantly increased. A systematic review was carried out, which included clinical studies that used barbed sutures for the treatment of snoring. A qualitative analysis, including six clinical studies, was conducted. Of these, five were studies on barbed pharyngoplasties, and one study involved a minimally invasive surgical procedure. The population consisted of 176 patients, aged 26 to 58 years old. Overall, the included studies showed a mean gain in the snoring Visual Analog Scale of 5.67 ± 1.88, with a mean preoperative value of 8.35 ± 1.17 and a postoperative value of 2.68 ± 1.27. No major complications were described. Given the lack and heterogeneity of this evidence, the conclusion calls for being cautious. In carefully selected snorers and obstructive sleep apnea patients, the use of barbed sutures could represent a valid therapeutic strategy for snoring, ensuring a statistically significant improvement in the subjective parameters. Further studies on a larger scale that assess the role of barbed pharyngoplasties in snoring surgery and more extended follow-up studies are needed in order to confirm these promising results. Snoring is a well-known common symptom in OSA patients, and its intensity is associated with this disease; however, it is not always accurate to assume that patients who snore have OSA. Indeed, an estimated 45% of adults snore only occasionally, whereas 25% snore regularly . TypicalThe study was designed following the recommendations of the Centre for review and Dissemination’s Guidance for Under-taking Review in Health Care and is being reported in adherence with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement .An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. An example of a search strategy is the one used for PubMed/MEDLINE: “Barbed” and “Snoring”; “Barbed” and “Pharyngoplasty”; “Barbed” and “Palatoplasty”; “Barbed” and “Anterior Pharyngoplasty”; “Barbed” and “Lateral Pharyngoplasty”; “Barbed” and “Expansion Sphincter Pharyngoplasty”; “Barbed” and “Suspension Pharyngoplasty”; “Barbed” and “Reposition Pharyngoplasty”, “Barbed” and “Snore Surgery”; “Barbed” and “Roman Blinds Technique”; “Barbed” and “Alianza Technique”; “Barbed” and “Habitual Snoring”; “Barbed” and “Heavy snorer”; “Barbed” and “Sleep Disturbance”; “Barbed” and “Palate Surgery”; “Barbed” and “Palatal stiffening”; “Barbed” and “Snoring Treatment”; “Barbed” and “Soft Palate”; and “Barbed” and “Soft Palatal Collapse”. All the searches were adjusted to fit the specific requirements for each database, with a cross-reference search in order to minimize the risk of missing relevant data. The last research was run in June 2021.According to the PICOS acronym , we inclAll the articles were initially screened by title and abstract. Then, the full-text versions of each publication were assessed and those whose content was judged to not be strictly related to the subject of this review were excluded. Data extraction from the included studies was systematically performed using a structured form. A qualitative synthesis analysis was performed using the selected studies regarding the effects of different BP techniques.Due to the heterogenic reporting style and a lack of data in the studies included, it was not possible to conduct a statistical analysis or provide a quantitative summary of the findings. Thus, the effects on the individual outcomes and the overall quality assessments were solely narratively described. The authors of the included studies were not contacted for further information.The search criteria returned 35 articles, and 8 papers were removed as they were considered irrelevant or duplicates. As further screening occurred, 20 more papers were excluded, resulting in 7 articles that fulfilled the inclusion criteria. A flow diagram of the selection process is shown in Salamanca et al.  performeLater, Mantovani et al.  describeBabademez et al.  performeLastly, an improvement in the snoring VAS was found by Carrasco et al. , who perFriedman et al.  performeOnly minor complications were recorded in the studies included in this review, and none were recorded in the minimally invasive surgical procedure study. The observed complications were partial knot extrusions (30.11% of the patients), temporary velopharyngeal insufficiency (1.7%), excessive postnasal discharge due to shortening of the uvula (2.27%), mucosal granulomas (0.57%), anterior pharyngoplasty dehiscence (3.41%), post-tonsillectomy hemorrhaging 1.14%), mild oropharyngeal pain, and swallowing difficulty ,14,15. F%, mild oSnoring is a highly prevalent condition, afflicting 40 to 60% of the adult population, and affects the quality of sleep of both patients and their bed partners. However, it is less known that it may also cause daytime consequences, such as sleepiness, neurocognitive impairment, and mood disturbances. Because it is also a precursor of OSA, it could predispose to cardio- and cerebro-vascular diseases and may lead to car accidents .It is known that the noise of snoring mainly originates at the soft palate level and surrounding structures due to a combination of anatomical and neuromuscular factors causing a critical sleep-related reduction in upper airway airflow .Weight loss and other lifestyle modifications, such as the avoidance of alcohol and sedatives, are considered a conservative approach to managing snoring. In addition to these, pharmacological or surgical solutions should be considered in order to resolve any associated nasal obstruction . However®,, Medtronic, Minneapolis, United States of America), have some drawbacks as they are only transient and require revision [In recent years, many resective surgical procedures have been proposed, including uvulopalatopharyngoplasty  and laserevision .In order to reduce the invasiveness of surgical procedures, which aim to increase upper airway tension, and because permanent threads in the soft palate are well tolerated, Mantovani et al.  introducThe use of BSs for the treatment of retropalatal collapse and vibration in patients suffering from snoring and OSA has increased significantly in recent years. Many surgeons have discovered the advantages and properties of BSs, which has facilitated the revision and improvement of popular surgical pharyngoplasty techniques .BSs are not frequently used to treat simple snorers. Conversely, they are frequently used for OSA patients. From this focused review, it is clear that BSs, regardless of the technique used, are safe and effective in reducing not only OSA but also snoring. In particular, all the studies evaluated in this review showed a statistically significant improvement in the snoring VAS post-surgery. However, the studies were very heterogeneous, as they included both simple snorers and patients with mild-to-moderate OSA. Ideally, the effects of BSs should be verified only on patients with simple snoring, but this type of study is very rare. All the authors performed BP alone, whereas Babadamez et al.  performeMoreover, it should be kept in mind that assessing the severity of snoring and how annoying it is to a patient’s bed partner is not easy, as snorers are unable to provide a self-assessment and statements from bed partners may not be reliable .An objective snoring measurement is not frequently used in common clinical practice. Solid parameters are lacking and there are only few possible objective measures that can performed, such as the snoring index (number of snoring sounds per hour), the percentage of sleep time or the total snoring time ,27, and The surgical treatment of snoring consists of several procedures that aim to shorten and/or reduce the soft palate, or that stiffen the soft palate itself to decrease vibrancy. BSs allow more consistent tension control using knotless continuous closure technology. Finally, in this review, we report the only study in the literature that describes an outpatient surgical technique with BSs .Regarding patient selection, Friedman et al.  did not It is essential to characterize, in detail, patients with snoring through DISE in order to understand the site and pattern of obstruction and/or collapse and vibration.No major complications were recorded in this review. Nevertheless, only a few minor complications were described, such as partial knot extrusions ,11,13,15None of the treatments solved snoring in all the patients. As a first step, the medical history of the patient and careful physical examination can help to determine which therapy may be helpful. However, the idea of a “step therapy” with incremental improvements should be kept in mind in these types of patients. Indeed, multiple interventions may be needed in order to achieve success and a peaceful coexistence for bed partners .Patients suffering from snoring would like to solve the problem immediately, but it is necessary to clarify that this is not possible, and that treating snoring is not easy.BP showed many advantages over traditional surgery, as it is a bloodless, safe, quick, and repeatable technique. Moreover, stiffening of the soft palate is achieved through muscular folding and suspension to create a rigid hold, while maintaining rigorous anatomic respect for the palatal fibromuscular structures.Lastly, the use of BSs ensures a uniform distribution of tissue tension over the entire length of the thread, providing excellent tissue grip and avoiding the need for tying knots without altering any muscle function. In addition, the action of the BSs is replaced over time by solid and stable tissue healing.However, currently in the literature, there are only short-term studies on the efficacy of BP (monolevel and multilevel surgery) and no long-term studies evaluating the effects and complications of this technique have been performed . Due to Shortening of the soft palate (the distance between posterior spine and the free edge), which is minimal and usually additional steps, such as midline crossing sutures, are recommended;Dampening of the wave of vibration by reducing the elongated uvula;Stiffening of the thin palate, which tends to be less rigid and more prone to producing vibrations, by pulling out the insertions around the palate;Increasing the posteriorly collapsed palate (flat pharynx) or the funnel-shaped retropalatal area .Thus, many BPs were intended to dampen the vibrations from the soft palate (either including or not including the uvula) and the lateral pharyngeal wall. Usually, the chances of snoring are mainly caused by the length and the floppiness of the soft palate (including the uvula) and the speed and turbulence of the retropalatal airflow through a narrow space. From an anatomical and functional point of view, the following steps are necessary in order to reduce snoring:Compared with traditional pharyngoplasty techniques, such as uvulopalatopharyngoplasty and laser/radiofrequency-assisted uvulopalatoplasty, BPs, particularly BRP and Alianza, are conservative and minimally invasive techniques that selectively act on the palatopharyngeal mucosa, fibrous tissues, and muscles. These techniques can be combined with other surgical procedures, such as septoplasty and turbinoplasty, when additional anatomical abnormalities that compromise physiological airflow are present. In addition, BPs are cost-effective and well tolerated by patients who report only moderate oropharyngeal pain, which disappears quickly and spontaneously. No other significant postoperative morbidities or complications were noted.This technique also appears to provide immediate relief from snoring and, theoretically, could be performed in selected patients under local anesthesia in a one-day surgery setting after proper training and with the use of devices that reduce surgical time.It is mandatory to consider the surgical management of snoring as part of a multimodal approach in order to achieve successful treatment for snorers and OSA patients. The success reached through BPs could ameliorate the use of Oral Myofunctional Therapy (OMFT). In fact, it can be applied to both treated  and untreated  muscle segments. In either case, OMFT should not be administered before surgical wound restoration, which is usually achieved within 1 month. OMFT induces upper airway remodeling, by reducing the parapharyngeal fat pads and decreasing the amount of fat in tongue muscle fibers, and improves airway patency during sleep. Five clinical studies, two meta-analyses, and one systematic review have investigated the role of OMFT in reducing snoring. The available evidence shows the positive effect of OMFT in reducing snoring, as measured by both objective (PSG) and subjective  assessments . It is pGiven the lack and heterogeneity of this evidence, and the limited number of studies investigating small populations with short follow-up periods, the results of this review must be considered with caution. Therefore, in carefully selected snorers and OSA patients, BP could represent a valid therapeutic strategy for snoring, ensuring significant improvements in the subjective parameters. Further studies on a larger scale that assess the role of BP in snoring surgery, as well as more extensive follow-up studies, are needed in order to confirm these promising results.