siderea: (Default)
[personal profile] siderea
Canonical link: https://siderea.dreamwidth.org/1355110.html

[We interrupt the previously scheduled rant for another rant.]

At some point, if you are so lucky, you will be old. You may already be old. Somebody you love may already be old. Old people, being people, require medical care, and are often treated – because this is basically what primary care in our society consists of – with medications.

Thing is, old bodies handle medicine differently than young ones.

Take the liver... [3,340 Words] )

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theferrett: (Meazel)
[personal profile] theferrett

In case you forgot, I’ll be at Borderlands Books (my favorite place in SF) at 3:00 pm this Saturday to read to you from my new book The Uploaded, sign whatever you put in front of me, and to, as usual, go out for hamburgers afterwards.

(And if you’re extra-special-good, I may do a super-secret advance MEGA-preview reading of The Book That Does Not Yet Have A Name. Not that, you know, you shouldn’t be rushing out to your stores to buy The Uploaded right now.)

I will, of course, bring donuts after my massive DONUT FAIL in Massachusetts, which I still wake up in cold sweats about. I will bring you donuts or die.

Cross-posted from Ferrett's Real Blog.

Let Life Happen.

Sep. 20th, 2017 10:13 am
theferrett: (Meazel)
[personal profile] theferrett

“I’m not up for sex,” she told me. “I’ve had a lot of medical issues lately. It’s more painful than not to even try.”

“Cool,” I said, and we spent the day going to a street festival.

I woulda liked sex. But life happens.


“I’m in the middle of my seasonal affective disorder,” I told her. “You show up, I might not be able to leave the house. I might just curl up and cry all day.”

“Cool,” she said, and I was pretty morose but we cuddled a lot and eventually managed to go out to dinner.

I woulda liked to have a working brain. But life happens.


“I’m not sure I can make it through this convention,” they told me. “My flare-ups have been really bad this season. I might not be able to go out with you in the evenings.”

“Cool,” I said, and I went out for little hour-long jaunts before heading back to the room to cuddle them, then charging out again to circulate.

I woulda liked to have them by my side when I hit the room parties. But life happens.


I’m a massively flawed human with a mental illness. I need to have poly relationships that include for the possibility of breakdowns. Because if I need to have a perfect day before I allow anyone to see me, I might wait for weeks. Months. Years. And then what the fuck is left by the time I get to see them?

I know there are people who need perfect visits. They have to have the makeup on when you visit them, and they’ll never fall asleep when they had a night of Big Sexy planned, and if they get out the toys there’s gonna be a scene no matter how raw anyone’s feeling.

But I can’t do that.

My relationships aren’t, can’t be, some idealized projection of who I want to be. If I’m not feeling secure that day, I can’t be with a partner who needs me to be their rock so the weekend proceeds unabated. And if they’re feeling broken, I can’t be with someone who needs to pretend everything is fine because their time with me is their way of proving what a good life they have.

Sometimes, me and my lovers hoped for a weekend retreat of pure passion and what we get is curling up with someone under tear-stained covers, holding them and letting them know they will not be alone come the darkness.

We cry. We collapse. We stumble. We don’t always get what we want, not immediately.

But we also heal. We nurture. We accept.

And in the long run, God, we get so much more.

Cross-posted from Ferrett's Real Blog.

theferrett: (Meazel)
[personal profile] theferrett

I knew musicals could cheer me up, but I’d never heard of one that gave me new tools to deal with chronic illness and depression. Yet when I saw Groundhog Day last Wednesday, I was so stunned by what a perfect, joyous metaphor it was for battling mental illness that I immediately bought tickets to see it again that Saturday.

I would have told you about this before, but it was too late. The show closed on Sunday. A musical that should have run, well, for as long as Phil Connors was trapped in his endless time loop only got a five-month run.

But I can tell you about it.

I can tell you why this musical made me a stronger, better person.

———————————–

So let’s discuss the original Groundhog Day movie, which is pretty well-known at this point: Bill Murray is an asshole weatherman named Phil who shows up under protest to do a report from Punxatawney, Philadelphia on Groundhog Day. He’s trapped in town overnight thanks to a blizzard. When Phil wakes up the next morning, it’s Groundhog Day again. And again. And again.

Phil goes through several phases:

  • Incredulous as he can’t believe what’s happening to him;
  • Gleefully naughty as he uses his knowledge of people’s future actions to indulge all his greatest fantasies;
  • Frustrated as he tries to romance Rita, his producer, but he’s too cynical for her and nothing convinces her to hop in bed with him unless everyone else in town;
  • Depressed as he realizes that his life is shallow and there’s no way he can escape;
  • Perplexed as he tries to rescue a dying homeless man but realizes that nothing he can do on this day will save this poor guy;
  • And, finally, beatific as he uses his intense knowledge of everything that will happen in town today to run around doing good for people.

Naturally, that’s a great emotional journey. It’s no wonder that’s a story that’s resonated with people.

Yet Groundhog Day changes just one slight emotional tenor about this – and that change is massive.

Because when Bill Murray’s character gets to the end of his journey, he’s actually content. He’s achieved enlightenment where he enjoys everything he does, toodling around on the piano because he’s formed Punxatawney into his paradise. He laughs at people who ignore him. He’s satisfied.

And when Rita, who senses this change even though she doesn’t understand why, bids everything in her wallet to dance with him at the Groundhog Dance, the Bill Murray Phil is touched but also, on some level, serene.

Andy Karl’s Phil is not happy.

We spend a lot more time in Andy’s Phil’s headspace, and at one point he breaks down because of all the things he’ll never get to do – he’ll never grow a beard, he’ll never see the dawn again, he’ll never have another birthday. Anything he does is wiped away the next morning.

Bill Murray’s Phil gets so much satisfaction out of his constantly improving the town that his daily circuit has become a reward for him.

Andy Karl’s Phil is, on some level, fundamentally isolated. People will never know him – at least not without hours of proving to them that yes, he is trapped in this time loop, he does know everything about them.  No matter what relationships he forms, he’ll have  to start all over again in a matter of hours. There’s no bond he can create that this loop won’t erase.

And so when Rita finally dances with Bill Murray, it’s shown as a big romantic moment. And in the musical –

In the musical, Rita moves towards Phil and everything freezes in a harsh blue light except for Phil.

This is everything Phil has ever wanted in years, maybe decades, of being in this loop – and instead of being presented as triumphant, everything goes quiet and Phil sings a tiny, mournful song:

But I’m here
And I’m fine
And I’m seeing you for the first time

And the reason that brings tears to my eyes every fucking time is because this Phil is not fine – he repeats the lie in the next verse when he says he’s all right. Yet this is the happiest moment he’s had in years, finally understanding what Rita has wanted all along, and this moment too will be swept away in an endless series of morning wakeups and lumpy beds and people forgetting what he is.

Yet that mournful tune is also defiant, and more defiant when the townspeople pick it up and start singing it in a rising chorus:

I’m here
And I’m fine

Phil knows his future is nothing.

Yet that will not stop him from appreciating this small beauty even if he knows it will not stay with him. Trapped in the groundhog loop, appreciating the tiny moments becomes an act of rebellion, a way of affirming life even when you know this moment too will vanish.

Can you understand that this is depression incarnate?

Which is the other thing that marks this musical. Because I said there was joy, and there is. Because when Andy Karl’s Phil enters the “Philanthropy” section of the musical (get it?), he may not be entirely happy but he is content.

Because he knows that he may not necessarily feel joy at all times, but he has mastered the art of maintenance.

Because tending to the town of Punxatawney is a lot of work. He has to run around changing flat tires, rescuing cats, getting Rita the chili she wanted to try, helping people’s marriages. (And as he notes, “My cardio never seems to stick.”)

When Bill Murray’s Phil helps people, it seems to well up from personal satisfaction. Whereas Andy’s Phil is thrilled helping people, yes, but his kindness means more because it costs him. On some level he is, and will forever be, fundamentally numb.

This isn’t where he wanted to be.

Yet he has vowed to do the best with what he can. He helps the townspeople of Punxatawney because even though it is a constant drain, it makes him feel better than drinking himself senseless in his room. He doesn’t get to have everything he wanted – also see: depression and chronic illness – and it sure would be nice if he could take a few days off, but those days off will make him feel worse.

He’s resigned himself to a lifetime of working harder than he should for results that aren’t as joyous as he wanted.

And that’s okay. Not ideal, but…. okay.

Andy’s okay.

And I think the closest I can replicate that in a non-musical context is another unlikely source – Rick and Morty, where Rick is a suicidal hypergenius scientist who’s basically the Doctor if the Doctor’s psychological ramifications were taken seriously. And he goes to therapy, where a therapist so smart that she’s the only person Rick’s never been able to refute says this to him:

“Rick, the only connection between your unquestionable intelligence and the sickness destroying your family is that everyone in your family, you included, use intelligence to justify sickness.

“You seem to alternate between viewing your own mind as an unstoppable force and as an inescapable curse. And I think it’s because the only truly unapproachable concept for you is that it’s your mind within your control.
You chose to come here, you chose to talk to belittle my vocation, just as you chose to become a pickle. You are the master of your universe, and yet you are dripping with rat blood and feces, your enormous mind literally vegetating by your own hand.

“I have no doubt that you would be bored senseless by therapy, the same way I’m bored when I brush my teeth and wipe my ass. Because the thing about repairing, maintaining, and cleaning is it’s not an adventure. There’s no way to do it so wrong you might die.

“It’s just work.

“And the bottom line is, some people are okay going to work, and some people well, some people would rather die.

“Each of us gets to choose.

“That’s our time.”

And yes, Groundhog Day the musical is – was – about that lesson of maintenance, as Andy comes to realize that “feeling good” isn’t a necessary component for self-improvement, and works hard to make the best of a situation where, like my depression, even the best and most perfect day will be reset come the next morning.

And yes. There is a dawn for Andy’s Phil, of course, and he does wake up with Rita, and you get to exit the theater knowing that no matter how bad it gets there will come a joyous dawn and you get to walk out onto Broadway and so does Phil.

But you don’t get to that joy without maintenance.

And you might get trapped again some day. That, too, is depression. That, too, is chronic illness. We don’t know that Phil doesn’t get trapped on February 3rd, or March 10th, or maybe his whole December starts repeating.

But he has the tools now. He knows how to survive until the next dawn.

Maybe you can too.

—————————–

Anyway. There’s talk that Groundhog Day will go on tour, maybe even with Andy Karl doing the performances. He’s brilliant. Go see him.

The rest of you, man, I hope you find your own Groundhog Day. I saw mine. Twice.

Perhaps it’s fitting that it’s vanished.

Cross-posted from Ferrett's Real Blog.

[sci hist] A Most Remarkable Week

Sep. 17th, 2017 12:52 am
siderea: (Default)
[personal profile] siderea
(h/t Metafilter)

This link should take you to the audio player for The Moth, cued to a story, "Who Can You Trust", 12 minutes long.

The Moth, if you didn't know, is an organization that supports storytelling – solo spoken word prose – true stories. This story is told by Dr. Mary-Clare King, the discoverer of BRC1. It concerns a most extraordinary week in her life, when pretty much everything went absurdly wrong and right at all once. It is by turns appalling and amazing and touching and throughout hilarious.

It's worth hearing her tell herself before the live audience. But if you prefer transcript, that's here – but even the link is a spoiler.

Recommended.
siderea: (Default)
[personal profile] siderea
I have a recollection of hearing a filk song, I think from a tape, that had a climactic line or repeated like in the refrain, to the effect of "And that's what cities get from trains". I have an impression it was a Leslie Fish song, but I don't know that for sure.

Not having any joy of google. Does anybody recognize it?
theferrett: (Meazel)
[personal profile] theferrett

As a reminder, I’ll be at Pandemonium Books and Games (which is an awesome store even in the absence of me) at 7:00 tomorrow to read to you, sign whatever you put in front of me, and probably go out for drinks and/or ice cream afterwards.

I hope to see you there! These donuts aren’t gonna eat themselves.

Cross-posted from Ferrett's Real Blog.

siderea: (Default)
[personal profile] siderea
(h/t Metafilter)

I just heard about Senior House. Goddamn.

Also. I hadn't realized that dealing with the administration in his capacity as Senior House's housemaster is what drove Henry Jenkins from MIT. Goddamn.

I am surprisingly angry and sad about this, given that I'm not a SH affiliate.

The shutdown of Senior House would be bad news, by itself. This is appalling:
The questionnaire, the Healthy Minds Survey, was administered by the University of Michigan. Many schools around the country give it to students as a way to pinpoint problems on campus and decide how best to allocate resources. When MIT administered it in 2015, they told students that it was a confidential survey intended to help them. One of the chancellor’s assistants who had lived in Senior House when she was an undergraduate went to Senior House and specifically requested that the residents take it. They did, in large numbers.

What they didn’t know—and what they couldn’t have known from reading the consent form that accompanied it—was that MIT had embedded metadata that allowed the administration to pinpoint the location of those filling out the questionnaire, enabling them to segment the results by dorm. The only question about dorm type in the survey was vague—“What kind of dorm do you live in? Small, large, off campus?”—but by tracking the metadata, Barnhart and the administration were able to see exactly where respondents lived.

It was this data that enabled Barnhart to see what she called a troubling hot spot of drug use. “If it wasn’t a direct violation, it was at least a violation of the spirit of informed consent,” Johnson says.
In light of that...
As Senior House students spread out across campus this year, former advisers worry that they’ll be at even greater risk. They can reach out to MIT’s mental health services if they need it, the chancellor says.
Is there some reason that MIT students should trust MIT Med to keep their information confidential? When MIT just used the confidential results of a "Healthy Minds Survey", which was advertised as a way of seeing where resources were needed, to eliminate resources from vulnerable populations? And the relevant IRB gave it a pass?

(Dear MIT students, and alums concerned about them: it is apparently hypothetically possible for students on the default MIT student health insurance ("extended" plan) to see therapists unaffiliated with MIT, but it has a pretty punative copay:
If you are covered by the MIT Student Extended Plan, and you see a mental health clinician who participates in the Blue Cross Blue Shield (BCBS) PPO, your first 12 visits in a calendar year are covered in full (100%). After that, you will have a $25 copay for each visit.

If you are covered by the MIT Student Extended Plan, and you see a mental health clinician who does NOT participate in the Blue Cross Blue Shield (BCBS) PPO, your first 12 visits in a calendar year are covered at 100 percent of the BCBS allowed amount. After that, your insurance will cover 80 percent of the allowed amount, and you will pay the other 20 percent. For all of your visits, your clinician may bill you for the difference between the BCBS allowed amount and his or her charges. This is something you should discuss with your clinician ahead of time.
I don't know for certain what BCBS's "allowed amount" is, but I know they're paying master's level therapists about $85 per therapy session, so I'm guessing that's it. So if a therapist's regular fee is $100, you'd be paying ($85*0.2)+($100-$85)=$32 per session. A lot of therapists are charging rather more that $100/session these days. At $120/session that's $52/session.

That copay/cost-sharing is absurd. Obviously, many students couldn't possibly afford $25/week copay – specially the most vulnerable ones. So that's a hell of an incentive to seek care from MIT Mental Health and Counseling Service directly: as they proudly state, no copay or other fees to see the therapists that work for MIT.

Less obviously, it's not even vaguely in line with the market right now. I see people who have jobs and pay $10 and $15 copays on other insurances. That students would be charged a $25 copay to see a therapist – in-network! – is incredible. Honestly, students being charged any copay is pretty out of line.

Seriously: MIT students, the people who stock the shelves in the Star Market behind Random have better access to mental health care than you do. That grocery store shelf stocker qualifies for a subsidized Medicaid Expansion plan, which covers at least a therapy session per week, with no copay. Also, their plan has hundreds, if not thousands, of therapists to choose from, none of whom report to your landlord cum diploma-granter-maybe cum civil authority cum boss of your local police.

Also, availing yourself of the option of seeing a non-MIT therapist on your MIT student insurance, even though it's through BCBS, requires a "referral" from MIT Med:
If you are already seeing an outside clinician or have a specific outside clinician in mind, you don’t have to make an appointment at MIT Medical to get a referral. Just call the Mental Health and Counseling Service at 617-253-2916, and ask to speak with someone about getting a referral for your outside treatment.
This may be completely pro forma, but the upshot is that MIT is making it a requirement on you that you notify MIT if you're getting psychotherapy, and that you divulge to them from from whom you are getting it. That someone is in therapy and from whom they get that therapy is highly confidential information, that frankly MIT has no business knowing. You should be able to see a therapist on your student insurance without MIT even knowing about it.

So if you wanted to work for the benefit of students' mental health, there's a great target: demand that MIT's insurance for students provides off-campus, unaffiliated psychotherapy with no copay, cost sharing, or balance billing – or radically less than at present, so MIT students can freely avail themselves of treaters not on MIT payroll; and abolish the need for a referral, because info about your utilization of mental health care is prejudicial, privileged information that can be used against you. But be careful to keep a third-party insurance co in the loop, instead of MIT directly paying therapists; whomever pays the therapist is allowed to snoop in your psychotherapy records.

Or, honestly, given some of the crappy-ass general health care friends of mine have gotten through the Med Center, maybe just agitate for all students to just get a regular BCBS PPO membership instead of having to go to the Med Center, at all. Or given how much BCBS sucks, try to get students into the Medicaid Expansion, so students get a choice of providers. That would be harder.

P.S. Disclosure of conflicts of interest: none – I don't take BCBS, so even if the copay/cost-share/balance-billing were eliminated, and students started flocking to off-campus therapists, I still wouldn't benefit by any of that business, unless somehow you managed to get students into Medicaid Expansion, and then only if students were willing to travel all the way to Medford to see me – I just have it in for MIT Med, and MIT MHCS especially.)

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