rachelmanija: (Default)
2016-02-09 04:50 pm

Brief medical update

The test I wrote about, which I was told to have immediately on a "you might need emergency surgery!!!!" basis, of course came back negative. (Well, it found some stuff - at my age, if you look closely enough at someone's body you'll generally eventually find something - but probably nothing that could be causing any symptoms.)

That same doctor also told me I needed to IMMEDIATELY schedule two very expensive, time-consuming tests for a type of cancer I had already been checked for two months previously in a different manner, because she found something that she thinks the two-months-ago test missed.

Me: "Do you seriously think this is cancer? Because there's that completely benign condition which I already told you about, which I've had my entire life and which causes the exact thing you found…"

Doctor Five Alarm Fire (reluctant): "No, I don't think it's cancer, it's probably that benign thing. But you need to get it checked immediately, because it MIGHT be cancer!"

She also strongly implied that I was in immediate risk of dropping dead of a heart attack. "Go to the drug store, buy baby aspirin, and start taking it TONIGHT!"

Considering that the disease causing actual symptoms, whatever the fuck it is, almost certainly does not involve either my heart or the possibly cancerous parts, I'm thinking she was maybe a little alarmist. (At that point, my heart had already been checked repeatedly, by multiple methods, and appears to be fine.) I think THREE completely unrelated and extremely serious diseases are just a bit unlikely, considering that I have now been scanned and tested to hell and back and no one's ever found much of anything.

The good news is that I found a GP I actually like, who is additionally unlikely to give up and refer me out for both professional and personal reasons. (She's a friend of a friend.) She has basically the same theory on the probable nature and cause of my illness that I do, which of course endeared her to me, but since she's a doctor and I'm not, she came up with a quite detailed plan for 1) investigation with that in mind, 2) treatment of symptoms in the meanwhile, 3) consults, 4) back-up plans in case the first investigations don't find anything. Very methodical. I'm encouraged.

(She also thought the Three-Alarm-Fire doctor was being a bit alarmist, on all fronts.)

Incidentally, this is something like the fourth time in the last seven months that a doctor has outright said or strongly implied that I might be dying or in imminent danger of dropping dead. This is naturally doing wonders for my general stress level.

Comments closed to prevent a deluge of "Get the cancer tests done IMMEDIATELY!" I want a second opinion on that. Those particular tests often lead to painful, unnecessary, invasive procedures that find that oops, it was the previously-known, benign condition after all.)
rachelmanija: (Naruto: I am trying to break your heart)
2016-02-08 09:33 am

“My Shot,” “Wait For It,” “The Ladies Who Lunch,” and the use of repetition

I wrote part of this in a comment to another entry, but thought it might of general interest to Hamilton and/or Sondheim fans, of whom I luckily have many on my f-list, so I pulled it out and expanded it. Er. A lot.

Hamilton makes fantastic use of repetition, especially of the repeated phrase whose meaning changes with context. The most striking uses of this are “I am not throwing away my shot” (sometimes just “my shot” or “shot”) and “Wait for it.”

The historic Hamilton occupies a specific spot in American common knowledge. In my experience, before the musical came out, if you asked the average American who Alexander Hamilton was, you’d get something like this: “He lived during the American Revolution. He was… Uh…. Secretary of the Treasury, I think? Something like that, anyway. He was shot and killed in a duel with another politician, Aaron Burr. [That is probably the only thing the average American knows or recalls about Aaron Burr.] Oh, yeah, and he's the dude on the ten-dollar bill.”

What both cracks me up and gladdens my history nerd heart about the sheer unlikeliness of the entire existence of this musical is that previous to it, Hamilton was not one of America’s iconic political figures, like George Washington or Thomas Jefferson (or, in terms of people who weren’t president, Harriet Tubman or Martin Luther King.) Nor was he obscure enough to be cool. He was in the exact "One of those dead white guys" zone where people interested in his period know a lot about him, because he really was important, but the average American knew exactly what was in my paragraph above, and no more. (If they’re a leftist, they may have the impression that he sowed the seeds of making America a plutocracy but probably didn’t intend that. Or that may just be me. If I recall correctly, my grandfather hated him for exactly that reason.)

But in popular consciousness, he was just above the level of someone like Paul Revere, where everyone can spit out “The midnight ride of!” upon mention of his name, and then, “Uh… He warned everyone that ‘The British are Coming!’” (Wikipedia has this note in his entry: "The British are coming" redirects here.) And that’s it. In general, no one who isn’t otherwise interested in that period (or economics/the Coast Guard/etc) has thought of Alexander Hamilton since high school. Whereas Americans who are otherwise not knowledgeable of history often have actual opinions on, say, Thomas Jefferson. (If you’re younger than me, you probably heard a lot about his slaves. If you’re my age, he had a sort of demigod status in high school history classes, which makes his takedown in the play especially hilarious.)

You notice that the duel figures prominently in common knowledge. People who know who Hamilton was at all always remember the duel. This is probably because 1) duels are cool, 2) Hamilton was the only important person in American history who was killed in one. (I guess unless you count Button Gwinnett. But I’m pretty sure nobody counts Button Gwinnett except autograph-collectors and people who enjoy unusual names. For the former, his signature is the rarest of any of the signers of the Declaration of Independence. For the latter, just FYI, a dude named Peru Italian Blackerby Ping served in the Kansas state senate in the mid-1800s.) Anyway, just in case you don’t know or forgot about the duel, Hamilton tells you about it right in the opening number. Miranda does not want that to be a surprise.

Burr shot and killed Hamilton, and every time you hear the word “shot,” that goes through your mind. And like any good tragedy, you know what’s coming but you want to scream, “No! Don’t do it!” So “wait,” in the sense of “stop,” also brings the duel to mind.

OMG, this got long )
rachelmanija: (Staring at laptop)
2016-02-06 03:20 pm

Hamilton - that song

I really think this song works best if you hear it the first time not knowing it's coming. So I'm spoiler-cutting the entire entry. Once again, "Hamilton" refers to the character in the play, not the historical person, unless I say otherwise.

Read more... )
rachelmanija: (Default)
2016-02-06 11:44 am

Hamilton: No, Seriously, It Really Is That Good

Due to being sick, by the time I even heard of Hamilton, the Broadway hiphop musical about Alexander Hamilton, it was the hottest thing ever and its fans were pushing it with so much zeal that I was actually put off. I figured it could not possibly live up to the hype.

Also, except for Sondheim, I'm not a huge musical theatre fan, and though I am a history nerd, I'm not much into American history in general, except for the Vietnam war and to a lesser extent the 1930s and 1940s. I find Hamilton's period particularly uninteresting. Hamilton would have to be a staggering work of heartbreaking genius to get me to like it at all. Previously, Gore Vidal's novel Burr, which is indeed pretty great, was the only work set in that period which I liked or even did not find excruciatingly boring.

So I am a little hesitant to put up a post which is inevitably going to make non-converts feel the exact same way I did, and make them even more reluctant to try it. However…

I consider Sondheim to be the genius of American musical theatre. In my opinion, no one has ever even come close to matching him, so far as my personal taste is concerned. Sweeney Todd is my favorite of his plays, and I also think it's objectively his best, insofar as that can be objective. I say this not to say that Hamilton is like Sondheim (though it does have noticeable Sondheim influences) but to explain my own personal standards when I say that Hamilton is the only musical I have ever heard that I think is as good as, and I already love as much as, Sweeney Todd.

I now see why Hamilton is so popular in fandom circles, and why its fans are so enthusiastic. For one thing, no one is going to listen to the whole thing if they don't like it early on, and it seems to be something that either people love or are totally indifferent to. So you only hear from the fanatical fans - everyone else didn't even finish it.

That aside, Lin-Manuel Miranda pretty clearly identifies with his own character of Alexander Hamilton. (When I mention Hamilton, I mean LMM's character, not the actual historical guy.) He wrote him as an immigrant and a writer, a man who came from nothing and fought his way up, a man who ran off at the mouth and was told off for thinking he was the smartest in the room (because he often was). He wrote Hamilton as writer, and as a misfit whose intelligence annoyed others even as it made him notable. No wonder so many fans identify!

I have never identified with a fictional character as much as I identified with Hamilton in certain songs and lines. One song in particular is not only a beautiful song, but is about the defining act of my life - the one moment, if I had to pick just one, that sums up the core of my self. It's a song about what makes me who I am.

I've written about that too, but Miranda wrote it in music, which I could never do. He wrote lines that I could never write, not because he's a better artist than me (though he probably is, and I say probably because, like his Hamilton, I do generally think I'm the smartest in the room so I'm not sure) but because only he could write them, just as only I could write what I write. Lin-Manuel Miranda's surely never even heard of me, but he wrote my soul into a song and put it on Broadway.

I assume that's because it's his soul too. I think it's the soul of a lot of writers and artists. Though the particulars are directly applicable to me in a way that's really unusual, and I would not be surprised if some of you have been biting your tongues not to say, "Rachel, you HAVE TO listen to Hamilon because you will identify SO MUCH, let me link you to this one song that is SO YOU."

I heard that song and I was glad that I lived long enough to hear it. I felt as if, had I died the day before, what I would regret most was that I never got to hear that song. I felt that way when I saw Sondheim's Assassins and Sweeney Todd, when I saw The Kentucky Cycle on Broadway, when I saw the first X-Men and Lord of the Rings movies, when I went to Japan for the first time and saw monks practicing kyudo in Kita-Kamakura and autumn leaves falling at Eikan-do temple.

Again, this isn't about my taste and whether it matches yours - it's about that shock of joy at something you experience for the first time, and fall in love with at first sight. It's as if you exist solely so you could experience that moment.

I'm not going to name the song because I managed to be unspoiled for the show, and so it came as the most amazing, poignant surprise. Maybe it will be for you, too.

(I'll talk about it later, in a spoilery post, along with other spoilery things. Obviously the historical events are known; I'm talking about artistic moments, and there are many delicious surprises there which I don't want to ruin.)

If you are unfamiliar with Hamilton, I think watching these two videos will tell you if you'll like it or not. I think if you don't like these, you probably won't like the rest either. I suggest that you watch the videos in this order. They both should actually be watched, as one is a performance and one includes lyrics.

Lin-Manuel Miranda performs an early version of the opening number at the White House

My Shot

The entire thing is streaming for free at Spotify.
rachelmanija: (Default)
2016-02-05 03:41 pm

A medical thing of possibly general interest

My medical status continues to be a non-stop parade of bad news, and no one still has any idea what the hell is actually causing my symptoms. The latest was an alarming finding (delivered in a probably over-alarmist way by the doctor, who implied that I might drop dead at any second - I have since been told that this is wildly unlikely)... which may well have nothing to do with my actual symptoms. In other words, I may have TWO quite serious medical conditions, one asymptomatic and discovered by chance, and one causing severe symptoms and still undiagnosed. Obviously, I am hoping that the one is actually the cause of the symptoms, but it probably isn't.

[Unless you are a doctor, any amateur diagnoses or advice will be deleted with great prejudice. DO NOT EMAIL THEM TO ME, EITHER. Without exception, they have been both unoriginal and useless, in addition to NOT WANTED. I am not naming the alarming finding in the hope of warding off that. If you are a doctor (or a nurse, etc), feel free to email me and I will tell you so you can give it your best shot.]

But what I am actually here to describe is something of possibly general interest, which is a very unusual medical test I just had, which was an MRI of my abdominal veins and arteries.

I have now twice had doctors say, "You must do this scan INSTANTLY before you drop dead/need emergency surgery!" only to do it and then find that no one's rushing to get me my results if a weekend's approaching. Guess maybe it wasn't such an emergency after all?

That was a truly challenging test. They dress you in a hospital gown, put a needle in your elbow, put heavy weights on your stomach and chest, drape totally inadequate blankets over you (the room was freezing), then slide you into a narrow tube. It lasts over an hour-- I think mine lasted about one hour, fifteen minutes. (It was done both without and with contrast, which may have been why it was so long.)

I asked if I could listen to music, but they said no, because I would be getting constant instructions to breathe in a specific rhythm or speed, and also to hold my breath. It turns out that when I am trying not to stress out (possibly also because I have done a lot of meditation) I tend to breathe very slowly. So I was mostly being told to speed up. And also to hold my breath for up to 30 seconds, often multiple times and in quick succession. With weights on my chest and stomach. In a tube with a completely white ceiling about four inches from my face. For over an hour.

So there I am, trying to breathe fast (as instructed) but without hyperventilating, WITH WEIGHTS ON MY TORSO, right after holding my breath for 30 seconds at a time, three times in a row in quick succession.

I think, "I could really use some music to psyche myself up for this… Well, I'll play it in my mind."

Me (in head): I am not growing old in Salem's Lot!/Success is my only motherfucking option, failure's not!/You can do anything you set your mind to, man.

Radiology technician: "Hey, you just changed the rhythm of your breathing. Can you make it faster and more evenly paced, please?"

A few minutes later, while I was really hitting the wall for basically the same reason, I tried again:

Me (in head): I am not throwing away my shot! I am not throwing away my shot!

Radiology technician: "Can you breathe faster, please?"

Me (in head): I’m takin this horse by the reins makin’/Redcoats redder with bloodstains!

Radiology technician: "Can you breathe slower? This test has thirty minutes to go - I don't want you to wear yourself out."

Me (gives up on musical inspiration.)

Me (thinks): "This will be a great new way to torment DJ when I write his third book." (He's my character from "Werewolf Marines," who is actually a DJ, uses music in his head to psyche himself up, and also has ADHD, hyperactive variety.)

Meanwhile, there were intermittent but frequent and extremely loud banging and screeching noises. It sounded exactly like someone was hammering on the tube.

As I said, it was a genuinely difficult test, and I know it wasn't just me because I am not used to finding physical/mental challenges of that sort difficult. For instance, I'm not claustrophobic. But after an hour plus of lying absolutely still in that tube with the roof four inches from my face, with weights on my chest and stomach, unable to think of anything but the test because doing so messed up the test, while breathing in a way that I would use to induce a panic attack in the office so I can teach people how to cope with panic attacks… I was getting a little claustrophobic.

When I got out of there, my gown was drenched in sweat. I think 90% of that was from physical exertion. Breathing fast and deep with weights on your breathing apparatus is hard.

After the test, the radiology guy told me that it was probably the second-hardest MRI to do and it was especially tough to have it as my first one.

"What's the hardest?" I asked.

"Well, this is pretty rare… but there's a cardiac MRI where people have to hold their breath for one minute."

I asked, "Can people really do that? Cardiac patients can do that?"

"People always think they can't do it," he said. "But then they really put their minds to it, and they find that they can."

You can do anything you set your mind to, man, I thought.

He then added, "Sometimes they can't, though. And then we do it for 30 seconds, have them take a breath, and do another 30 seconds. But you did great! We got perfect images!"

But after all that, it will probably be yet another insanely expensive test that shows nothing. (I won't get the results till Monday, probably.)

It's either unfortunate or just as well that I politically opposed about 90% of all American military interventions since WWII, and also have an issue with following orders that I personally find stupid or pointless or are issued by people whose intelligence I don't respect. Because I am really good at following difficult orders. Hopefully I will not have cause to discover whether or not I can hold my breath for one minute if I really set my mind to it, man.
rachelmanija: (Default)
2016-01-29 11:17 am

Racial Diversity in Romance

Rules for commenting: Lia Silver is an open, public pen name of mine. Please do not name or drop hints regarding other pen names of mine. Just trust that I have them, and the characters are as I say they are. Same goes for other authors. No outing. You don't need to know Milly Taiden's real name to discuss the fact that she is 1) an enormous bestseller, 2) totally ignored in all these discussions, 3) most or possibly all her heroines are Latina.

I put this up as a comment at Kirkus, where it was completely ignored. Probably because I brought in that least respectable of authority doings,* self-publishing. However, if anyone would like to discuss my point, please discuss.

[* ETA: I have no idea what that was supposed to mean, other than "things authors do." I haven't slept in three months and am on lots of drugs (medication, not recreational) and autocorrect isn't helping. It recently informed me that I need a socialist. I need a specialist. My country needs a socialist.]

Kirkus article on why the reviewer can't be bothered to read books featuring anyone other than white or straight characters

My comment: "I self-publish romance under pen names and while I don't know the readership of traditionally published books, the readership of self-published romance has a huge - possibly majority - contingent of people of color. In particular, there are a LOT of black women who love romance, and they read widely - not just African-American romance. Also, white readers who read self-published romance seem 100% fine with reading about heroines of color, in my experience. There have been no differences in sales of my books with heroines of color vs. white heroines.

Milly Taiden's heroines are all (or almost all) Latina, and she is HUGE - currently # 6 of Amazon's PNR (paranormal romance) authors. She is definitely not just read by Latina readers. Terry Bolryder (# 3 on Amazon's PNR bestsellers) has heroines who are mostly African-American. Zoe Chant (# 12 in PNR) has a number of heroines of color, plus some heroes. Or just look here.

Not looking at self-pubbed authors gives a very skewed picture of racial demographics of both readers and writers of romance. I enjoy paranormal romance so that's mostly what I'm looking at, but check out the top paranormal romance authors on Amazon. Many are self-published, and many have heroines of color. (Some heroes of color too, but not as many as heroines.)"

ETA: I forgot to add that while LGBTQ is obviously also a an issue of diversity in writing, it is a different one from the issue of the race of protagonists in romance. FF and MM romance novels are different genres than MF romance novels. While African-American romance can be a subgenre, the race of the protagonists does not typically change the genre of a romance novel the way that their gender does. For instance, Terry Bolryder's dragon menage books often have two white heroes and a black heroine. Their genre is "paranormal menage romance," and would be that if everyone was black, everyone was white, or the heroine was Asian and the men were Latino. If it was a MMM menage, then it becomes a different genre.

What this means, among other things, is that there are reasons why some readers might only read MM or FF or MF that have nothing to do with bias - they just aren't into the genre. If a reader said, "Hey, I love TS Joyce [an excellent PNR writer who usually or always has white protagonists], who else should I read?" I would rec them Marjorie Liu [an excellent PNR writer with multiracial protagonists] because the race of the protagonists should not make a difference in their enjoyment. I would not rec them a MM or FF writer with white protagonists unless they said they liked that too, because gender does tend to make a difference in people's reading enjoyment. It's a genre. If someone tells me they like historicals, I'm not going to rec them contemporary.

My experience with my own readers bears me out on this. Readers who like my MF romance books with white heroines like my books with heroines of color. (I know this because sales are identical regardless of the heroine's race, while other factors make a huge difference in sales. For instance, heroes who shapeshift into amusing tiny animals don't sell anywhere nearly as heroes who shapeshift into large manly animals.) But readers who like my MF books often don't even read my romance books with FF or MM main relationships. And vice versa. Different genres; I like all three, but I am probably in a minority there. Most people I know only like one or two, or at least have a strong preference for one.

However, if readers like my fantasy and sf (as opposed to paranormal romance), I'll rec them other fantasy or sf that's similar to mine with no regard to the genders in any subplot romances, because in those cases the romances are secondary to other elements and most readers won't care what genders are involved. Readers who love Swordspoint (which has a primary MM relationship) are probably responding to it being a fantasy of manners, and will enjoy books like Jonathan Strange and Mr. Norrell or Sorcery and Cecelia, which have primary MF relationships but are also fantasies of manners.

In other words: the people who think the race or ethnicity of the protagonists in genre romance is a dealbreaker for readers are generally wrong. I guess unless the readers are unusually racist. I do not assume that readers are unusually racist, and I wish that mainstream publishing and reviewers would stop assuming that. (Yes, I am biting my tongue to not state the obvious conclusion.)

Anyway, the fact is that due to racism within the industry, romance readers are underserved when it comes to traditionally published romance novels with racially diverse protagonists, but they are gobbling up self-published romances with diverse protagonists. That may be the cause or it may be because self-published books are cheaper or there may be some other reason, but the only people who appear to be refusing to read romances if the heroine isn't white seem to be concentrated in powerful positions in mainstream reviewing and publishing. No wonder so few diverse romances are traditionally published!

ETA 2: Feel free to link this! I would love to get more discussion going.
rachelmanija: (Books: old)
2016-01-29 11:06 am

Guard Wolf and Handcuffed to the Bear, by Lauren Esker

Disclaimer: these are by Sholio (formerly Friendshipper), a friend of mine. If you like my Werewolf Marines series, you would probably like these.

This is going to be more about Guard Wolf, as I read that a lot more recently. It’s a sequel but can be read independently, in an urban fantasy series about an agency of shapeshifters that secretly investigates shifter-related crimes. I would call them urban fantasy with romance rather than paranormal romance with action; there is romance, but the emphasis is on action and ensemble. (The main characters of Handcuffed to the Bear spend most of the book naked and handcuffed to each other, but don’t have sex until the end, when they are no longer handcuffed or naked – well, they get naked, but only after putting clothes on.)

In Handcuffed to the Bear, Casey, a civilian lynx shifter, investigates her friend’s disappearance and ends up handcuffed to Jack, a bear shifter agent, naked and hunted through the wilderness in a “Most Dangerous Game” scenario. (Handwavey high-tech cuffs prevent them from getting loose by shapeshifting.) They bond and try to survive; meanwhile, Jack’s agency is trying to find him. There are some spectacular action sequences in this; my favorite involves a tin-roofed shack, a boat, and a seriously pissed off female orca shifter agent. In fact my favorite parts of this book were the shifter agency ensemble sections, which was good because book two has lots more of that.

Guard Wolf, which as I mentioned is a sequel but can be read independently, concerns one of my other favorite characters from the first book, werewolf and giant woobie Avery. He is a disabled veteran with a horrifically dysfunctional upbringing and a number of odd habits, and since werewolves are generally very clannish, he has no idea whether he’s weird because he’s a wolf without a pack or if he’s just massively fucked up. I adore him and he was my favorite thing about the book, which is saying a lot because I also really like the heroine, a koala shifter who is generally well-adjusted but takes meds for clinical depression, and also because it involves my favorite thing, an evil lab doing evil experiments. The portrayal of trauma and mental illness is extremely realistic, and also worked into the plot in clever ways – at one point the heroine has to do some very difficult and dangerous things while going cold turkey off meds, since she got kidnapped without them.

Guard Wolf is also notable for overcoming my aversion to kidfic. A box of abandoned werewolf pups sets off the plot, and plays a very large role in it. I liked the book anyway. This is impressive. It’s also pretty funny at times – the spectacularly useless jumping spider intern was hilarious – and, despite some dark subject matter, has an overall cozy/comforting feel. Avery needs ALL the cuddles, and actually gets them.

Guard Wolf: BBW Paranormal Wolf Shifter Romance (Shifter Agents Book 2) (Only 99 cents for a full-length novel.)

Handcuffed to the Bear: BBW Paranormal Bear Shifter Romance (Shifter Agents Book 1)
rachelmanija: (Default)
2016-01-27 12:44 pm

Surprisingly not overrated!

Lin Manuel Miranda performing the opening number of Hamilton - his history geekiness is so endearing.

The whole thing on Spotify for free.

I am slowly listening to this. It's very dense, especially since I'm not familiar with that period of history other than reading Gore Vidal's Burr and getting briefly obsessed with the duel and the question of who shot first (Burr. Also, Hamilton's shot went wild because he'd been hit, not because he deliberately fired into the air, give me a break) and I just have the album - there doesn't seem to be a video available. It's pretty great though. If you like Sondheim, you would like this. I'd say listen to the first three tracks (through "My Shot") and see if you like it. I love the way it combines hiphop with Broadway, both lyrically and musically. It's really clever and catchy.
rachelmanija: (Books: old)
2016-01-18 03:10 pm

Diagnosis Made Easier, by James Morrison

Morrison’s book is a textbook for mental health clinicians. It is exactly what it says on the tin. It’s easy reading and could be read by a layperson with some knowledge of psychology. He lays out a number of important principles. I’ll just note a few that I find particularly useful.

In my own practice, I don’t often find diagnosis challenging in the sense of “What official diagnosis could this person possibly have?” (It has to do with where I work. Most of our clients were recently traumatized or court-mandated, so their issues tend to be pretty obvious - PTSD, depression, anxiety, life stress, etc.)

But the principles are still useful. For instance, I often have clients who match the criteria for multiple disorders. It is not at all uncommon for one person to fit the criteria for PTSD, generalized anxiety disorder, major depression or dysthymia, agoraphobia, panic disorder, and social anxiety. Which one is the most important? Is one causing all the rest? Which should I treat first? Which treatment is best for this person, given that they could in theory benefit from treatments for all the disorders? Is there one treatment that would cover several?

Also, sometimes the initial diagnosis is wrong or incomplete, and they need additional or different treatment. For instance, the client comes in with a clear-cut case of PTSD. But maybe they’re also non-neurotypical and have never been diagnosed. Or they were bulimic before and didn’t tell me about it. Etc.

Prioritization by safety hierarchy.

Since tests and investigation take time, you need to immediately check into some things, and leave others for later investigation. First, check for issues which are potentially life-threatening but treatable and likely to have a good outcome; last, check for issues which are not immediately life-threatening, hard to treat, and not likely to have a good outcome. In the middle, look for things in between. For instance:

1. Suicidality, major depression, bipolar disorder, medical illness. All potentially very dangerous, all potentially very treatable.

2. Panic disorder, OCD. (Very treatable but not immediately dangerous.)

Substance abuse without suicidality. (Potentially very dangerous, but difficult to treat; practically speaking, you can put a hold on the person who is threatening suicide, but you can't put a hold on a heroin addict just because you worry that they might accidentally OD.)

4. Personality disorders, dementia (if the person has caretaker and isn’t in danger of wandering into traffic or some such). Not easily treatable; may be life-threatening (Alzheimer’s) but immediate intervention won’t change that.

History beats current appearance

If you’re talking to someone who was raped last month, they will usually appear to have major depression, generalized anxiety, etc. Find out if they ever had any of those symptoms before.

Someone with a history of depression or anxiety is a better candidate for a psychiatric referral than someone who was fine pre-trauma. If someone was depressed before, treating their PTSD may not cure their depression, so they should be getting a med consult ASAP. (They are also much more likely to be open to the possibility of taking medication.)

If they have no previous history of depression and are not suicidal, sending them to a psychiatrist is not a priority; by the time they found an anti-depressant that worked for them, their depression may have resolved anyway because it wasn't true depression; it was a depressed mood caused by trauma. Treat the PTSD, and the depression goes away. Also, these people frequently don't want to take meds. (In those cases, I bring it up again if their PTSD seems to be resolving but they have persistent symptoms of some kind that are not improving with talk therapy. I point out that they may just need a little extra help in this one area, since we've tried our best with non-medical means and, unlike their other issues, it's not going away.)

And along similar lines:

Be cautious about diagnosing mental illnesses in people actively abusing substances when they do not have a known previous history of mental illness. Especially if they appear to be psychotic.

Maybe they’re schizophrenic. Maybe they’re bipolar. Maybe they’re depressed. But it is really hard to tell if they’re also snorting coke and drinking a bottle of whiskey every day. Very likely they do have some mental illness, but which one? Defer diagnosis and refer for specialized treatment (unless you’re the specialist.)

Get a family history

This is useful in so many ways. For instance, if you have a client balking at medication, knowing that their father was a drug addict may open up a conversation about exactly what their concern is – maybe they don’t know that SSRIs are not addictive. On a more obvious note, if there’s a long family history of depression, that makes depression a more likely diagnosis. Many mental illnesses run in families. (Typically, both genetic and learned factors are in play.)

Look for horses before you look for zebras

The teenage girl who seems anxious and pulls at her hair might have trichotillomania (the compulsion to pull out her hair.) But I’d check for anxiety, depression, trauma, neuro-atypicality, or even OCD first. (I'd start by asking her what the hair-pulling is about.)

Keep an open mind

Don’t just assume that previous diagnoses are correct. That includes your previous diagnosis. That also goes for family history. The “alcoholic grandfather” may have been self-medicating something.

Consider medical causes, including environmental ones

I once correctly diagnosed a client’s “panic attacks” as caffeine withdrawal. Morrison once thought he was suffering from a panic attack (he was in combat at the time, so very understandable) but it was actually an electrolyte imbalance – he’d forgotten to take his salt tablets. Once he took them and drank some water, his symptoms vanished.

Clients with chest pains need to see a medical doctor to rule out heart problems if they haven't already, even when you’re 100% sure it’s panic/anxiety. Depressed, low-energy, overweight clients and anxious, skinny, eye-bulging ones should get their thyroid checked. If there is any reason to think there may be a medical issue going on, send them to a doctor.

Always about ask medications a patient is taking, and ask again if they present with new symptoms with no clear cause. Specifically include OTC meds, herbal meds and supplements, and recreational drugs. Also ask if they’ve recently given something up.

Similarly, ask if they’ve been recently diagnosed with a medical condition. Many medical drugs and some medical conditions can have psychiatric side effects.

Clients presenting with a completely new condition in middle age with no clear cause (ie, not PTSD from a recent trauma) should be strongly considered for a medical cause. Mental illnesses (again, other than PTSD) tend to have a history, and middle-aged people are more likely to be physically sick than young people.

"Undiagnosed" is a perfectly legitimate label to use when you don't know what's going on, or don't have enough info to go on. Don't be embarrassed to use it.

The rest of the book is about diagnosing specific illnesses, such as “How to diagnose OCD.” It’s quite helpful (especially the diagnosis trees) but I thought the general principles above were more interesting for a general audience.

Diagnosis Made Easier, Second Edition: Principles and Techniques for Mental Health Clinicians
rachelmanija: (Default)
2016-01-17 05:04 pm

Every Patient Tells a Story, by Lisa Sanders

Dr. Lisa Sanders is the doctor who inspired the TV show House. She is apparently a genius diagnostician and if her waiting list was not three years long, I would have already seen her. Her book is marketed as tales of medical mysteries and their diagnoses, complete with the doctor’s process of diagnosing, which is why I bought it.

Approximately 20% of the book consists of that. The other 80% is her opinion that the physical examination of the patient (as opposed to mechanical scans) has a long history, is very important, is underused and poorly taught, and needs to be taught better and done more. She’s probably right but it was incredibly repetitive. She could have summed up her thoughts on that in one or two chapters, leaving the rest of the book for the stories which is undoubtedly why everyone bought it. Annoyingly not what it says on the tin.

Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis

Any recs for books that are actually about diagnosis? (Medical, not psychological; I'm good on the psych front.)

Also, any recs for a book on antibiotics that is 1) about their current use, not their history (I'm familiar with their history), 2) comprehensible to a layperson?

I am particularly interested in learning more about how, after spending my entire life being told that antibiotics have very limited and specific uses and do not cure most things (due to doctors trying to cut down on inappropriate usage) I have recently discovered that, in fact, they have an extremely wide range of uses and "condition responds to antibiotics and, as far as we can tell, to nothing else" is nowhere near as diagnostically useful as I had assumed in narrowing down what that condition might be. For instance, d-cycloserine, an antibiotic normally used to treat tuberculosis, has cognitive effects which may make it useful in the treatment of PTSD.
rachelmanija: (Books: old)
2016-01-15 02:28 pm

Cold Fire, by Dean Koontz

Koontz tends to write books with absolutely killer hooks and intros, but is much more uneven about middles and conclusions that live up to them. I am still annoyed that The Bad Place, which has the wonderful premise of a contemporary man who travels to an unknown planet or land in his sleep, sometimes bringing back riches and sometimes terrors, proceeded to an only barely related plot about detectives and genetic engineering rather than exploring the super-cool actual premise. This book also has a killer hook, and also proceeds to go in an unusual direction with it, but one which I found much more satisfying and surprising.

Jim Ironheart gets psychic commands to go save people, but doesn’t know who they’ll be or why they’re in danger until he gets there, and he never knows why that person rather than some other, out of all the people who are in danger every day. Reporter Holly Thorne finds out about him and, fascinated, approaches him to find out what the hell is going on. The two of them are attracted, but the romance takes second place to the mystery of who’s commanding Jim and why… and why they both are having terrifying nightmares that start manifesting in reality.

This is a really gripping, creepy book. It has horror elements, but it’s not really a horror novel. It’s more of a cross-genre thriller. And that’s all I can say without huge spoilers. Read more... )

Cold Fire
rachelmanija: (Default)
2016-01-14 11:02 am

Planet of Exile, by Ursula K. Le Guin

Another re-read of an early, novella-length book, this one much more firmly science fiction than the science fantasy of Rocannon’s World. I prefer the later, but then again, I really like science fantasy. In this book, technologically advanced humans settled on a planet already inhabited by “hilfs” (very nearly human people, but less advanced and not able to breed with humans), briefly, they thought, as refugees in an intergalactic war. No one ever came to pick them up. Generations later, they live in an uneasy coexistence with the hilfs they look down upon, a semi-isolated colony slowly losing its superior technology due to lack of infrastructure and people who understand how to use it.

The heroine is Rolery, a hilf girl who falls in love with a human man, Jacob Agat, and so comes to learn both about human culture and about the likely future of humans and hilfs; the reader understands more than she does, but not a lot more. Rolery is a very real-feeling character, unlearned but not stupid. Agat is more generic. The romance is really there to enable us to see humans through an alien’s eyes, and vice versa; the story is much more about culture clashes than about a love that transcends them. It’s extremely atmospheric, with long winters and creepy snow wraiths. The closing revelation about the future of the world feels inevitable in retrospect, but powerful as a conclusion: a disaster to some, but hope and a future for others, depending entirely upon their point of view.

I recall Le Guin discussing this book as an attempt to write a protagonist who changed the world without taking the sorts of action a traditional protagonist of sf at the time would take. I assume that at the time, sf heroes were mostly either solving scientific problems or fighting, because Rolery's main action is both active and common in a different genre - she chooses a man despite disapproval from both humans and hilts. (She actually takes quite a bit of action apart from that, but that's the one from which all else follows.)

But that action doesn’t change the world so much as it illuminates something that was already going on, and would have happened even if she and Agat had never met. The Terrans' belief that they don't belong, are an island of civilization on a primitive planet, and should have nothing to do with the hilfs is driven and supported by their actual physical differences: they can't eat the food without taking digestive enzymes with it, they can't interbreed, they're telepathic with each other but not with the hilfs, and they can't be infected by native bacteria. But the Terrans have been slowly adjusting to the planet over generations, and some hilfs can, in fact, be telepathic. Rolery and Agat can mindspeak to each other, and Rolery recognizes that a Terran is dying of an infected wound. (And very possibly saves Agat by cleaning out a minor wound of his, which Terrans normally wouldn't bother to do.)

Rolery is the first to point out the change, though it takes a Terran to understand its implications. But she didn't cause it. Presumably someone else would have eventually figured it out if she hadn't, though it might have taken a while; the Terrans had already noticed some of the changes, but ignored or discounted them because they wanted to hold themselves separate, and didn't want to believe that they were not so different from the "primitive" hilfs.


Rolery isn’t particularly an unconventional heroine in terms of her actions, from a current perspective – she falls in love and chooses a forbidden mate, and becomes a bridge between cultures – but the world does feel very different seen through her eyes. To me, it’s her perspective rather than her action that’s unusual and interesting.

Worlds of Exile and Illusion: Three Complete Novels of the Hainish Series in One Volume--Rocannon's World; Planet of Exile; City of Illusions
rachelmanija: (It was a monkey!)
2016-01-13 09:49 am

Psychology books I am getting rid of, Part II

The Essential Jung. When people tell me Jungian stuff, I love it! And then I attempt actual Jung. Where are they even finding all those cool ideas? All I am seeing is (opening at random) Even though alchemy was essentially more materialistic in its procedures than the dogma, both of them remain at the second, anticipatory stage of the coniunctio, the union of the unio mentalis with the body.

And it's not just because I'm opening at random. When I was in school I started from the beginning. The effect was exactly the same as if I'd opened it at random. Has anyone here read Jung in German? Is this just a translation effect, or is he equally incomprehensible in the original? (And what if you do know German, but you don’t know Latin? WHY IS THE LATIN NEVER TRANSLATED?)

Owning Your Own Shadow, by Robert Johnson

First sentence: The shadow: what is this curious dark element that follows us like a saurian tail and pursues us so relentlessly in our psychological work?

This is not Johnson’s fault but I was irresistibly reminded of Ursula K. Le Guin’s The Language of the Night (one of my all-time favorite books, by the way) in which she mentions a terrible sf story she read as a child which concluded with “And so they returned to the saurian slime from whence they sprung!” She and her brother created the jingle,

The saurian slime from whence they sprung
Unwept, unhonored, and unsung.

No, okay, that is Johnson’s fault. That is a ridiculous sentence and it also deserves a mocking jingle. I know it’s a metaphor, but it is also an image. Please take a moment to picture a psychoanalyst being stalked by a disembodied lizard tail.

If you don’t know the concept of the shadow this book is a decent introduction to it, but you could do much better. Unimpressive.

Inner Work, by Robert Johnson. This is actually a pretty good book on working with dreams and imagination and the unconscious. I’m not keeping it because I get the principles and it’s not so well-written or uniquely insightful that I’d re-read. But if you’re interested, this will give you a lot of useful tools.

I don’t do a lot of dream work, either for myself or for my clients, but it comes up occasionally. (I do a lot of work with PTSD-related nightmares, but that’s a different thing. Those are not subtle.) When clients ask me what a dream means, I tell them that only the dreamer can know the meaning of the dream and ask them what they think it means. If they have no idea, I start asking what specific parts make them think of, if anything has a cultural meaning or how dreams are generally interpreted in their culture, etc. (“Is there anyone in your family who knows a lot about dreams?” Not uncommonly, there is.)

Treating Eating Disorders, ed. Werne. This is from 1996. I’d rather read something more recent. I think a lot of ideas in the field have changed since then.
rachelmanija: (FMA: Ed among the ignorant)
2016-01-12 02:22 pm

Psychology books I am getting rid of, Part 1

In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness, by Peter Levine. This is the guy who invented somatic experiencing. I am sure it works when he does it. Lots of therapies work because they're done by charismatic, compassionate, insightful people who believe in what they're doing. (In fact, therapy in general works that way, even when using highly structured therapies like CBT for phobias.)

This book? USELESS. FACTUALLY INCORRECT. STUPID. He explains that he saw lions chase zebras on TV, and the zebras who escaped would shake and twitch, then recover and go about their lives without getting PTSD. HOW CAN YOU TELL? YOU WATCHED ANIMAL PLANET. YOU DID NOT FOLLOW UP WITH THE ZEBRAS. He concluded that animals don't get PTSD (FACTUALLY INCORRECT. Anyone who has ever seen an abused pet has seen PTSD in animals.) and that the reason is that they physically shake out the trauma. And so he created a treatment based on shaking out the trauma. I am being unfair and simplistic but only slightly. This dude was highly respected at my school, too. I'm sure someone will appreciate this book over there.

Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma (Norton Professional Books), by Babette Rothschild. Summary: vicarious traumatization is a thing. If you're a therapist, maintain boundaries, be aware if you're getting too affected by other people's pain, and practice self-care. There, now you don't have to read this book.

The Psychology of the Transference (Ark Paperbacks), by Carl Jung. From this we must conclude that the symbolism of the stories rests on a much more primitive mental structure than the alchemical quaternio and its psychological equivalent. I am not smart enough to read this book.

The Theory and Practice of Group Psychotherapy, Fifth Edition, by Irvin Yalom. This is a pretty great and classic work on a very specific type of group therapy that I HATE and never intend to do. ("I have difficulties relating to others, let's work these out experientially in a group focused exclusively on how the group interacts with each other." I'm sure this actually works very well when someone as skilled as Yalom is running it, but 1) it's not my thing, 2) it can very easily turn into a parody of itself in a very specific way, 3) I was permanently traumatized by a badly run group of this sort in college, which did become the parody, in which this exchange actually occurred:

Group Member A: "I notice that your foot is pointing in my direction. I wonder what you intend to convey by that."

Dude with Foot (hastily moves foot): "Er… No, my foot just happened to be there. I didn't even notice it was pointing at you."

Group Member A: "You sound defensive. Were you pointing it at me subconsciously, because you have some unexpressed anger at me?"

Dude with Foot (moves foot back): "No… but NOW I'm feeling angry!"

It's also a very expensive required text at Antioch. Someone else will benefit from this book, but I don't need it.

Fast Girls: Teenage Tribes And The Myth Of The Slut, by Emily White. This is actually a pretty good book on sexism, rape culture, how girls get labeled "sluts," how this is perpetuated by both girls and boys and society at large, and the effect this has on everyone. It's just that I get this, so I wouldn't need to re-read it, and it's not so brilliantly written that I'd keep it just for that.

Therapeutic Communication: Developing Professional Skills, by Herschel Knapp. If you don't find that therapeutic communication (validating, challenging, interpreting, etc) comes naturally to you or is something you learn by doing, this is an EXCELLENT book. I personally find that I learn it by doing or by listening to other therapists describe what they do in specific cases rather than in generalities.

Also, I find that responding instinctively/intuitively/spontaneously - even if it's something I technically shouldn't say - goes over better with clients than when I say the "correct" thing in a more artificial/non-spontaneous way. (There is a specific technique key to narrative therapy called "externalizing the problem" that for whatever reason feels really unnatural to me, and whenever I try it, my clients look at me like I have two heads. My own therapist does it with me, and it works great. I use a narrative philosophy and other narrative techniques, and just ignore externalization. You have to do what works for you.)

So for me, this was not a book I'd return to. It will help someone else, I'm sure.
rachelmanija: (Default)
2016-01-12 01:46 pm

Book Sorting: The Explanation

But first, a brief health update. The relevant bit for this entry is that while my most recent experimental treatment (rifaximin) had no effect whatsoever, I am still feeling good enough from the combination of the semi-successful sleep experiment (it didn't permanently fix the problem, but it did improve it) and the previous successful experimental antibiotics that I am attempting to catch up on six months' worth of stuff I didn't due because I was too sick.

I have just begun experimental antibiotic treatment # 4: two of the same ones that worked before for a slightly longer period (14 rather than 10 days) and one at a higher dosage, minus the one that had horrible side effects. If it is a complete failure, that will at least suggest that the key factor was fucking tinidazole (or tinidazole combined with something).

Anyway, I am procrastinating starting with the easier long-delayed chores before working my way up to the harder stuff.

Problem: I have too goddamn many random books that I don't want and are cluttering up my apartment. One of today's tasks, chosen for being low-energy-required, amusing, and producing a visible and wanted change, is to get rid of a chunk of them.

Step 1: Sort unwanted books into three categories based on what I'm going to do with them.

Category 1: Psychological books that are outdated, not useful, etc. Some of these are quite expensive textbooks, but I don't have the time/energy to sell them or mail them to people who want them. Instead, since I am going to Antioch (old campus) anyway on Thursday, I will leave them in the student's lounge with a note saying to take them if you want them. Some student or students will be very grateful to save hundreds of dollars on required texts.

Category 2: General books I don't want. These will be delivered to the library. If the library doesn't want them, they go to the thrift store next to the library.

To help motivate me, I will record the books as I go along. This is the possibly amusing part. Please feel free to comment! That will also help motivate me. The next post will be updated daily with actual books.

My opinion on books meant to be helpful to the therapist, by the way, is that they are mostly useless. Or rather, that they are the wrong books. Want to treat combat veterans? Read memoirs by veterans. Those are about a billion times more helpful than textbooks. Want to apply Jungian principles to therapy? Read Robertson Davies' The Manticore. I doff my hat to anyone who gets anything out of reading Jung himself but a headache. Want to understand Carl Rogers? Watch videos of him in action. (His book is fine. It's just that the videos are SO MUCH BETTER.)

If anyone cares, when I am done I may do an overview of the short list of books that I did find helpful.
rachelmanija: (Buffy: I kind of love you)
2016-01-11 03:11 pm

Romance novels Fanfic Exchange!

Overviw here and specific rules here,but basically it's like Yuletide, but for genre romance novels written within the last 50 years (so Heyer, etc, is out.) They're taking nominations for characters and books now.

I'd really like to do this, but it will need lots of participants to make it work. I'm still thinking of what to nominate, but I need to think fast as nominations close on the 14th. It's open to any gender combinations, but my favorite MM and FF couples are all from books that contain romance, but are not in the romance genre, and this is specifically for genre romance. (I can't tell if Captive Prince published as genre romance or historical fantasy or what.)

I'm thinking of nominating Tracy Shapiro and Decker from Suzanne Brockmann's Troubleshooters, and… hmm… maybe Ruck and Melanthe from Laura Kinsale's For My Lady's Heart? Matt and Willa from T. S. Joyce's Gray Back Bad Bears? You get to nominate three fandoms of six characters each.

Anyone else interested? Who and what are you thinking of nominating?
rachelmanija: (Default)
2016-01-10 01:00 pm

Sleep experiment: Success!

I got 12 hours of uninterrupted sleep. That was my first night of full and uninterrupted sleep in over two months. I don't know how long that effect will last - it might just be the one night - but it does at least point toward how to fix the problem. It also strongly suggests that the problem was exactly what I thought it was, which was the Elavil re-setting my sleep center from its normal "8-9 hours of sleep is the correct amount, 12 hours is the maximum amount" to "3-5 hours of sleep is the correct amount, 6 hours is the maximum amount."

And honestly, not-fun as the experiment was, it was overall less unpleasant, less dangerous, less expensive, less time-consuming, and more productive than infinitely trying new medications, which was the alternative. At the point I tried it, I was on my tenth unsuccessful new sleep medication or sleep medication combination, many of which were potentially dangerous, had unpleasant side effects, ruled out other medications due to interactions, created long-lawing physical dependency, were insanely expensive (one was $30/pill) or some combination thereof. There was also the problem that I am still attempting to cure my actual illness, which means that I have to take other medications that can interact with insomnia medications. (Most non-medication insomnia interventions had already been tried and failed. I've been practicing sleep hygiene all along, among other things. Of the non-medication alternatives that I hadn't tried, mostly it was because they were geared toward things that were wildly unlikely to be the problem, such as sleep apnea.)

I should also explain something that I think I forgot to mention earlier, which is that this is not the first time I have stayed up for two nights in a row. I've done it multiple times in my lifetime, which is why I already knew what effects it has on me physically (mild hangover-type symptoms - headache, nausea, body aches, etc) followed by the re-setting of my sleep cycle. This is because I've worked at several jobs where working around the clock is an occasional but normal part of the job. (Stage management at a just-below-Broadway level, TV and film production, and disaster relief.)

In fact, that's why I quit TV production - it was a common rather than occasional feature, I couldn't afford cabs, and driving was part of the job, so I had to drive while dangerously sleep-deprived. While working on a TV commercial, I fell asleep for about three seconds while driving on the freeway, and drifted four lanes before waking up. Luckily the freeway was empty as it was about 4:00 AM. I finished out the job sleeping on the set (allowed but not encouraged and not fun - you literally had to sleep on the floor), and never took another production job. I have a high tolerance for risk when it's for a good reason, but I did not want to risk my life to make a TV commercial. (It was the one with the clowns.) ETA: You really ought to click on the link if you have never read The Tale of The Clown's Secret.)

About three months after I left the field, a well-respected stunt man was killed in a crash after working 48 hours straight and falling asleep on the road. Regulations were then enacted to prevent that, but in my opinion are still insufficient. Also, they only apply at a certain level of professional production. They do not cover most indie films, for instance. Obviously, this weekend I did not drive - if I had to go anywhere, I took a cab.

However, that's how I discovered that if you have chronic insomnia, you can continue indefinitely on very small amounts of sleep and be permanently exhausted, but a comparatively short stretch of no sleep can re-set your sleep cycle to normal. How long the effect lasts depends on the reason for the insomnia. If it's because you messed up your sleep cycle by working weird hours, it will last until you start working weird hours again. If the reason is PTSD, it lasts anywhere from a couple weeks to a couple months - you need to work on the PTSD to get more than very temporary insomnia relief.

It's very nice to feel rested.
rachelmanija: (Default)
2016-01-08 08:52 am

Sleep Deprivation Report, Try # 1: FAIL

Made it to 6:00 AM, then accidentally fell asleep for about 2 and a half hours. So, obviously 22 hours is insufficient to do a re-set, because I did not sleep any longer than I normally do. I think my original idea might still work if I can pull it off. (In fact, it might even have worked if I'd managed 36 hours.)

As noted before, this is extra difficult given that I have not only been sleep-deprived for over two months, but also have to take sedatives. I am going to try again tonight, this time with coffee. Also, the next time I start dozing off, I will begin washing dishes or some other non-sitting activity. (I did take a walk around the block, but I can't do that all night. It's really cold, though not sufficient to keep me up except when I'm actually in it.

I should probably also find some non-sitting activities I can do the next day, assuming I can make it through Friday night. Maybe a gentle hike or a trip to the zoo.

LA is weirdly short on night life. Bars are basically it. I suppose I could try West Hollywood, where I at least am wildly unlikely to get in any actual trouble no matter how spacey I am (again, via taxi.)
rachelmanija: (Books: old)
2016-01-08 02:30 am

Rocannon’s World, by Ursula K. Le Guin

This is a re-read. I’ve read this book multiple times. It’s one of Le Guin’s earliest works, novella-length and an expansion/continuation of a haunting short story, “Semley’s Necklace,” which is a science fiction version of a very ancient folkloric theme, the human visitor to Faerie who returns to find that during their brief sojourn, years have passed, their spouse is old or dead, and their children have grown. In Le Guin’s version, Faerie is another world and the time change is due to faster than light travel.

Rocannon is a scientist who gets stranded on a less technologically advanced world; there’s a loose plot involving him trying to communicate with his people on his own world and getting involved in a war on the world he’s on, but it’s mostly a picaresque about exploring a new world. The plot is not the point. (Nor is Rocannon himself, who is a blank slate and really exists as a body for the reader to inhabit.) The point is a series of beautiful or terrifying or strange encounters: the windsteeds, which are giant cats with wings; the city of angels and its shift from awe to horror as Rocannon realizes that beauty does not mean intelligence; the small furry creatures that rescue and guide him; his ordeal by fire, with echoes of the phoenix and Odin upon the tree. It doesn’t hang together particularly well as a smooth, continuous narrative, but then again, the picaresque is a perfectly legitimate form that just happens to not be much respected now.

Rocannon’s World is one of those books whose flaws are what make it wonderful. Le Guin has written about how it was written while she was still finding her voice and working out the rules of her universe; she points out that Rocannon’s impermasuit, which protects him from physical harm, was a clunky attempt to transfer magical armor into a science fiction setting, and ought to have suffocated him. No such thing exists in her later books. She’s correct that it is something of an awkward marriage between myth and science, and yet it creates the stunning scene in which he’s captured and burned alive, forced to stand unharmed but helpless within the flames, and finally emerges from the ashes, takes off the suit which, once off his body, appears to be nothing more than a handful of plastic and wires, and bathes naked in the river, trying to wash away the memory of flames licking at his eyes. How marvelous is that! We are lucky to have the book that Le Guin didn’t get quite right, that didn’t do what she wanted it to do. If it had been more perfect, it might well have ben less memorable.

This is the edition I have: Rocannon's World. I have to say, I really love that cover. What could possibly be better than a dude in a cape and armor, carrying a torch and riding a giant flying cat in a surprisingly practical-looking harness?
rachelmanija: (Books: old)
2016-01-08 02:24 am

Why you may be seeing a number of posts on books, possibly of increasing incoherency

In early November, I was prescribed a medication called Elavil, which is best-known as an old-school tricyclic antidepressant but which is also used for chronic pain. I was using it for the latter, as it was then believed that I had a chronic pain condition. (This is almost certainly not the case.) It typically has very sedating properties, and is sometimes used as a sleeping pill. I took it for four days, and during that time I was unable to sleep for more than three hours per 24-hour period, and for no longer than about 45 minutes at a time. This was not a manic episode. It was just physically impossible to sleep.

It is now over two months later. The medication has long since left my system, but I have not been able to sleep normally ever since. (in the interim, I also briefly tried Cymbalta, which had a similar though less severe effect.) I have tried something like nine different sleeping pills, sedatives, and combinations thereof, and every single one has either had no effect whatsoever, or else sort of worked (that is, it allowed me to get about six or seven hours of sleep - I normally get eight to ten) for about three days, then stopped working and never worked again.

In short, for the past two months I have averaged about 4-5 hours of sleep per 24-hour cycle. This is not normal insomnia. It does not respond to sleep hygiene or melatonin, in addition to not responding to drugs. It is not caused by anxiety or other psychological factors. I am currently taking 10mg of Valium before bed. This has been a total failure in terms of allowing me to sleep, but I promise you, I am not anxious on 10mg of Valium. As far as I can tell, the Elavil had a long-lasting effect on the part of my brain that regulates sleep, which I am hoping to God is not permanent given that 1) I am fucking exhausted, 2) I seem to be effectively immune to sedatives.

It is possible to survive indefinitely on very little sleep. Obviously, four hours is enough to keep me going, and just enough that I don't accumulate enough sleep debt that I can ever sleep for much longer than that.

I am going to attempt a hard reboot of my sleep center by not sleeping at all for two nights in a row (approximately 64 hours, counting the next day), starting tonight. I am hoping that will produce enough exhaustion that I will be able to sleep for eight hours or so when I finally do sleep, and that if I can manage that once more-or-less naturally, I might be able to re-set my sleep center to normal. (I chose 2 nights because 1 is probably insufficient given the magnitude of the problem, and 3 is edging into scary territory - that is where people sometimes start hallucinating, for instance.)

Pro: Might work. Not dangerous or harmful. (I won't drive, obviously).

Con: Will not be fun. May not work, in which case I will end up more exhausted than ever. Will be extra-difficult because 1) I am already extra-exhausted due to basically not sleeping for two months, 2) I am taking sedatives (Valium) and cannot stop taking them due to withdrawal.

Anyway, since I need to stay awake and writing is more awake-making than reading, I may attempt to catch up on book reviews. Please comment if you feel so moved. Or randomly email me. Anything to keep me awake. I need to not sleep AT ALL until about 11:00 PM Saturday night. (Microsleeps are probably okay and inevitable. But no more than a minute or so a a time.)