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Rising Out Of Hatred: This book– about former white nationalist Derek Black and how he stopped being a white nationalist– takes place at the college I attended as a undergraduate, while I attended. For that reason, I’m not sure I should give much of an opinion on the book; gossip about my college acquaintances is not of public interest, and my book on the story is going to be fundamentally affected by the fact that I took classes with Derek Black, in a way that makes it less useful for other people. I can, however, state that as far as I’m aware its description of events is accurate. There were a couple of places where I’d quibble with the description of New College, but nothing I’d consider generally unreasonable.

The Sober Truth: “There isn’t great evidence that AA works. Despite its pretensions of secularism, AA is a clearly Christian-influenced organization, which makes it problematic for both devout members of non-Christian religions and atheists. AA is prescribed over and over again for people for whom it clearly isn’t working. THEREFORE, we should use the true evidence-based treatment for alcoholism, which is psychodynamic psychotherapy.”

Inside Rehab: I started internally screaming in the first chapter, when someone described how one of their rehabs only gave you Suboxone as a reward for good behavior. I did not finish internally screaming until I finished the book.

Interesting facts: Your chance of receiving evidence-based treatment is generally higher if you’re poor or homeless and lower if you pay for rehab out of pocket, because NGOs and governments have leverage to demand that rehabs implement evidence-based treatment, while private rehabs can just do whatever sounds good (equine therapy, Reiki) even if there is no evidence behind it. Rehabs (particularly for people with mild substance abuse problems and teenagers) can make drug addictions worse by introducing the client to more severely addicted friends and teaching them about new drugs and ways of hiding them. AA specifically leads to binges in some people by teaching them that if they have one drink they might as well go on a binge. Thirty percent of people have had an alcohol use disorder at some point in their lives; this is because alcohol use disorder is defined very broadly and essentially includes anyone whose use of alcohol has ever caused a problem in their lives. As you might guess, most people with mild alcohol use disorders are capable of drinking moderately.

One thing I’m confused about is that the author complained that rehabs are very expensive, and then complained that addiction counselors are untrained people whose only qualification is being former addicts, and then complained that rehabs almost never offer much individual therapy (often less than once a week). Presumably the last two things would make rehabs less expensive? Are rehabs directing money in a useless way (towards equine therapy or administrator salaries or nice bedrooms)? Or are rehabs inherently very expensive for some reason? If it is the second thing, maybe we should transition to outpatient therapy, which is less expensive.

Highly recommended both for people who want to gain a better understanding of the rehab system in the United States and for people considering rehab for themselves or their loved ones. The lists of questions to ask rehabs seem very helpful.

Sex Addiction: A Critical History: I was really excited when I bought this book, because I think sex addiction is a problematic concept and I was really looking forward to an in-depth history of how it came to be, along the lines of (say) David Valentine’s excellent Imagining Transgender. (Incidentally, if you’re interested in the social construction of transness, Imagining Transgender is an absolutely invaluable book and I highly recommend it.)

Unfortunately, the authors have Szaszian sympathies, so instead of enjoying the book I spent the entire time raging about their terrible, terrible politics. “‘Sex addiction’ is bad because it’s another example of the psychiatric industry medicalizing normal human behavior, the way that depression medicalizes normal sadness! You can tell, because there’s a continuum between sex addiction and normal behavior and you can’t draw a non-arbitrary line between ‘sex addiction’ and ‘normalcy.’ How negatively sex addiction affects you depends as much on your environment as it does on your objective symptom severity. In some contexts sex addiction can be neutral or even conducive to your flourishing.”

But the problem is that all those things are true of literally every psychiatric condition. Psychosis is on a continuum with normal hallucinations that ordinary people experience, and it’s hard to draw a non-arbitrary line between psychosis and normal voice-hearing. How negatively psychosis affects you depends as much on your environment as it does on your objective symptom severity. In some contexts psychosis can be neutral or even conducive to your flourishing. Either you bite the bullet and go “psychosis is fake, the homeless schizophrenic guy is exactly like everyone else”– which, to his credit, Szasz does– or you realize that we have to have a way to think about psychiatric conditions that features the social model of disability and the fact that psychiatric conditions are all on a continuum with normal human behavior.

Unfortunately, the authors are so busy having stupid opinions about psychiatric diagnosis that they didn’t do anything more than touch on the genuine incoherency and thorny ethical issues associated with the ‘sex addiction’ concept.

The behavior highlighted by the PATHOS screening for sex addiction– preoccupation with sexual thoughts, hiding some sexual behavior from others, seeking treatment for sexual behavior, sexual behavior that hurts others emotionally, feeling controlled by your sexual desire, feeling depression after sex– just doesn’t have one simple set of causes. Some people might have hypersexuality symptoms associated with mania or a personality disorder. Some people might be closeted gay people in a homophobic environment, or kinky people in an environment where kink is stigmatized. Some people might use sex as a quick source of pleasure when they’re depressed. Some people might have a history of sexual trauma. These are all different problems with different solutions and I don’t think it makes sense to treat them all as one thing.

(And what’s with that “hiding sexual behavior from others” thing. I hide sexual behavior from others because I have boundaries.)

The concept of ‘sex addiction’, I think, highlights a particularly thorny ethical problem. If a system of sexual ethics is particularly demanding– in particular, if it demands that a person not masturbate, or not masturbate when in a relationship, or not masturbate using porn or erotica or sexual fantasies of people other than their partner, or only have sex with people they aren’t oriented towards– a certain percentage of the population will find themselves engaging in sexual behavior they don’t endorse. But those people are not going to have sexually compulsive behavior in general. If they stop believing that gay sex, pornography use, or masturbation is wrong, they’ll probably use porn, have gay sex, or masturbate a perfectly reasonable amount that is in balance with the rest of their lives. They certainly won’t escalate to nonconsensual behavior, adultery, or pedophilia (as is sometimes implied by sex/porn addiction discourse).

I’m not sure what we should do about that. On one hand, some part of me says that the problem here is clearly not the masturbation or porn use or gay sex, the problem is the stigma, and the therapist should destigmatize the sexual behavior in question. On the other hand, it seems to me that therapists should not impose their ethical beliefs on their patients. I certainly wouldn’t like it if a therapist tried to do CBT to my demanding ethical beliefs! The therapist should let the patient set their own goals according to their own values instead of imposing the therapist’s values. I think this is a legitimately complicated ethical issue, and saying “if you masturbate when you don’t endorse masturbating then you are a sex addict which is exactly the same sort of thing as an alcoholic” elides it. This is exactly the sort of issue I hope would be addressed by a critical history of sex addiction, and exactly the sort of issue that was not addressed.

Artificial Condition: Murderbot is back! Murderbot is on a quest to figure out whether, last time he’d hacked his governor module, he’s committed mass murder instead of his current occupation of binging TV shows. He stumbles across some humans he feels like he has the duty to protect, and much to his grave irritation has to stop watching TV in order to protect them from their own suicidal tendencies. Murderbot is one of the most likeable and engaging protagonists in recent SF, and every novella he is in is a delight. ART, a television-obsessed spaceship, is equally likeable and a delightful foil. Pick up the series next time you have a bad day and need something fun and not too deep.

Spinning Silver: A fast-paced and page-turning fantasy novel. A moneylender boasts that she can turn silver into gold catches the attention of a gold-loving fairy, who threatens to kill her if she doesn’t turn his silver to gold and marry her if she does; a noblewoman uses the fairy silver, which makes others see her as beautiful to marry the tsar, but there is more to him than it seems. Lots of fascinating plot twists; it manages to be very gripping without having any fight scenes, which is always something I like in a novel. The secondary world is Russian-influenced, which is an interesting variation on the stock European fantasy novel. Highly recommended.

Beneath the Sugar Sky: Down Among The Sticks And Bones was so good! And this was so not good! WHY.

The protagonist’s sole personality trait is being fat. She is insecure and feels bad about her body because she is fat. She is bullied because she is fat. She is an endurance athlete because fat athletes exist. She is magically transported to an alternate world and turns into a mermaid, and suddenly becomes an athlete because being fat is actually helpful in ultraendurance swimming. (This is legitimately pretty cool and I would have hella appreciated it if the character had had at least three non-weight-related personality traits.) She expects to be bullied for being fat, but everyone is tolerant. She has to go to a magical world made out of candy, where the villainess surrounds herself with candy and never eats any of it in order to stay thin, and talks to her about how if she diets she will be thin. Every five pages we get some “and Cora was tired but she couldn’t ask for a rest because people would assume it was because  she was overweight.”

I get it! I’m on board! We should be nice to fat people! PLEASE GIVE YOUR FAT CHARACTER ANOTHER PERSONALITY TRAIT.

At one point Cora is like “the only thing people see in me is fat fat fat” and I was like “yes! that’s so true it’s even affecting your author!”

There were some really interesting ideas. The “nonsense world” made out of candy felt like a real world from a genuine children’s portal fantasy novel. Kade, a transgender male side character, had some really lovely and interesting characterization (which is unfortunately a spoiler). But overall this is a very weak entry in the series.