The book (review) everybody has been waiting for! Unless you've been under a rock, you know that this is the fifth book in A Song of Ice and Fire, that the fans have been waiting six years for it, and that the last one, A Feast for Crows, was not very good. Is aDwD a worthy addition to the series, or has GRRM lost his mojo?

Well, maybe. On the one hand, everybody's favorite characters are back, the plot is advanced, and Shit Happens. on the other hand, too much time is spent wandering around the East for little to no reason, and the plot stops right before The Shit Hits the Fan. Think A Clash of Kings, if it ended right before the Battle of the Blackwater.

Martin's characterization and description are as good as ever, and the exotic East is a fun setting to explore. A Feast for Crows relied on cheap cliffhangers and unnecessary sex to keep us reading, and while there's some of that in A Dance with Dragons, it's balanced with character and plot progression. Not a perfect book by any means, but a step in the right direction.

Do you think you're hard? Do you think you're some sort of Tier Zero Modern Warfare Elite Ops Deniable Badass? Do you even think you know about such people? Until you've read this book, you don't know shit.

Cu Chi was a district just 25 miles from Saigon. Starting from the French Indochina War, local guerrillas carved tunnels out of the strong laterite clay that made up the district. By 1968, the Iron Triangle had over 200 miles of tunnels, with three and four level base camps including barracks, hospitals, and weapons shops. This book covers the Vietnamese men and women who lived and fought in the tunnels, and the American soldiers tasked with going in and smoking them out, the stone crazy tunnel rats.

The authors have compiled an extensive body of interviews with veterans on both sides of the conflict, bring forth the survivors own words as they describe living without sunlight or fresh air for months on end, and the terror of chasing the enemy into the bowels of the Earth. A secondary topic is weapons, from madcap high-tech schemes to destroy the tunnels, to the trained wasps and snakes that the VC used to defend their bases. Both the human and military elements are well-represented.

In the end, America never learned how to fight in the tunnels. Instead, in the wake of the Tet offensive, the army simply obliterated the entire district, first with defoliants, then with Rome plows, then with B-52 strikes that blew 10m craters in the ground. The guerrillas were essentially destroyed, but only at the cost of the entire region. The Tunnels of Cu Chi is a fascinating micro-history that amply demonstrates the fractally fucked up nature of the war.

This is part of that Osprey series that covers everything about war, so if you know the series, you get the general idea. This book covers training, equipment, and tactics in the most detail, operations a little bit, and the strategy and politics of black ops not at all.

That said, the most interesting parts are how soldiers joined MACV-SOG (it involved going AWOL and tracking down one of the secret HQs), and the massive personal firepower used by small teams to fight and survive behind enemy lines and out the range of air support.

The Great Edition Wars have begun, and because of that, I've been going back and looking at some 4e classics. The first DMG was a really solid book, covering playing psychology and the elements of adventure design. In fact, I thought that it was praiseworthy because it was the first DMG that I'd seen where somebody who had never played an RPG before could pick it up, read it, follow the steps, and run a semi-competent adventure.

DMG2 continues the trend, but focuses on designing more complex Paragon Tier adventures. The strongest parts of the book concern how the build an adventure out of encounters, how to make interesting combats and skill challenges, fixing one of the major problems in the original 4e rules (the example diplomacy skill challenge is brilliant). DMG2 has great advice on how to build organizations, how to reskin and modify game rules, and how to solicit player input to improve your game.

The most interesting parts of the book where the parts devoted to explaining the 4e philosophy. More than anything else, 4e is actually inspired by television. Action occurs in encounters/scenes, 4 or 5 encounters make an adventure/episode, and about 10 adventures makes for a tier/season. The book advises that a scene that doesn't move the adventure forward in some way is essentially wasted, and also proposes using flashbacks, guest characters, dream sequences, and other TV tricks to spice up the adventure. Really, all those people say that 4e is like and MMO haven't read the books, let alone played the game. On the other hand, episodic TV is a very different narrative than the old Gygaxian dungeon crawl. Maybe that's why people don't like 4e.

What I didn't like was the space devoted to traps (I hate traps. 4e had an interesting idea with making them a combination of monster and terrain that can be used by friend or foe), not significantly improving the 4e treasure system, which I still don't understand how to make fun, and finally the lengthy chapter devoted to Sigil. If you like Sigil, you probably already know all about it. If you don't care for Sigil, this section is useless. I'd rather have seen a blurb for the Manual of the Planes, and more ideas for alternate planar hubs or tools to build cities, in the same way that they gave tools to build NPCs, artifacts, and organizations.

This is a massive book which straddles an uneasy line between scholarly and popular. Deeply researched, Heely draws from some high-level theory to try and explain the transformation in psychiatric care in the 20th century. However, the scope of the book leads to some organizational difficulties, and Heely's own speculations on what happens next don't quite match up to his research.

David Heely attempts to offer a wide-ranging description of the characteristics of modern psychiatric care, both positive and negative. He engages in a historical development of psychiatry through the 20th century, from asylums engaged in confinement, psychodynamic and analytic theories, and finally, modern drug-based psychiatry, as exemplified by the use of chlorpromazine (Thorazine). Heely’s work is theoretically grounded in Foucault’s idea of biopower, the responsibility of states and individuals to engage in the management of health, and Thomas Kuhn’s ideas about paradigmatic science. Psychopharmacology is not dominant because it is more “true” than other forms of psychiatric care, but because it sustains a powerful system of interlocking scientific, economic, and cultural forces. Heely is most skeptical about the power of randomized clinical trials (RCTs)

In brief, the concentrate of the ‘raving insane’ in asylums in the 19th century gave early alienists the human raw material to formulate a wide variety of nosologies of mental illness, and the possible origins behind them. Psychoanalytic formulations a la Freud, dominated the intellectual style of the time. WWI and WWII created massive new systems of psychiatric care for shell-shocked veterans. The expansion of office based psychiatric care post-WW2 enrolled millions of new patients into the mental health system, at the same time as ‘psychobabble’ permeated popular culture, along with the notion that poverty, personality disorders, social stress, crime, addiction, etc were proper areas of expertise for psychiatrists. The expansion of psychoanalysis lead to the anti-psychiatric backlash of the 1960s (the counter-culture trying to decolonize insane minds), severely damaging the paradigmatic authority of psychoanalysis.

Concurrently, in the 1950s, a group of European scientists (Jean Delay, Labriot) were experimenting with a new class of drugs that showed astonishing progress in curing the deeply insane in the back wards. Hopeless patients given chlorpromazine showed remarkable improvements. Scientific theory did not explain the action of these substances, but these neuroleptics cured the raving mad, and demonstrated powerful effects on the mind and body, including tardive dyskinesia and akathisia. Concurrent developments with LSD and amphetamines pointed towards a theory of molecular basis of madness and sanity, but the counter-culture’s embrace of LSD ended its use as a legitimate scientific tool. Instead, experiments with radiotagged molecules proved the existence of neurotransmitter and receptors in the human brain, leading to a host of amine-based theories of madness. Brains are essentially chemical organs, and by adjusting chemical activity through drugs, they can be restored to sanity.

The new practice and theory of psychopharmacology demanded new ways of regulating and using drugs. Relapses on chlorpromazine soon proved to a major problem, reframing the problem of psychiatry away from “showing the patient a moral mirror of himself” and towards ensuring compliance with a drug regime. The thalidomide crisis lead to the 1962 amendments to the Food and Drug Act which established that drugs could only be given by prescription as a treatment for well-defined illnesses. These amendments inculcated a culture of risk management, a drug could be both beneficial and/or harmful in an individual case, but on average, had to help patients.

The 1962 amendments, along with new funding priorities in the NIH, established the randomized clinical trial as the gold standard of efficacy. Heely argues that RCTs are in fact highly flawed instruments for psychiatry, in that their need for objective and portable results relies on symptomatic scales that do not translate to improved patient quality of life. Drugs may vary in effectiveness between patients with different biologies or temperaments, data which is not captured by RCTs.
Additionally, the regulatory environment surrounding medicine means that from a business standpoint, the most sensible policy is to increase the number of people suffering from a given mental illness. The growth in depression, OCD, social anxiety, and ADHD are mirror by increases in drugs to treat those conditions. The immense amount of money flowing from patients to pharmaceutical companies to doctors (see White Coat, Black Hat—Elliot) has effectively corrupted science.

Finally, according to Heely, current theories about the brain are no more well-grounded than Freudian psychodynamics. The idea that a single neurotransmitter path is linked to a defined illness or its cure is not supported by the powerful action of drugs which work on many neural systems, or the way in which a single drug might cure multiple disorders (Prozac is actually not very good at treating classical depression. It works much better on OCD).

Heely leads me to three major questions. First, if we are not going to rely on RCT, what other methods do we have for knowing how to match treatments to diseases to symptoms? The idea of how science should operate, and what counts as science, and thorny and complex. Second, how will the current biological paradigm be replaced? Psychoanalysis was destroyed because it overstepped its bounds without bringing consummate benefits; patients felt oppressed rather than helped. Heely proposes that genetics and brain imaging will upend the biological paradigm, but after 10 years I am doubtful. Thirdly, what is the appropriate place of psychiatric drugs in society? Who should be responsible for their use, and what counts as a treatable condition? If we’re really moving towards an era of ‘cosmetic psychiatry’, what does that imply about the authority of those administering treatments, and what counts as an acceptable risk?

This book is a tour de force of medical ethnography and STS, as Silverman dives deep into the quagmire of autism and returns unsplattered by its many controversies, and with a unique understanding of the inner workings of one of the most complex and confusing medical crisis of the modern era. Silverman develop a theory based on love, on the affective ties that bind families containing an autistic member together, on what inspires therapists in the difficult task of working with children with autism, and in the battles over the possible causes and cures for the syndrome. Love, as developed by the book, is not always good; it drives action but it also raises the stakes of debates and makes very real enemies of people who should be working together: doctors, parents, and self-advocates.

Silverman conducts a study of the public statements of major figures in the history of autism: Leo Kanner, Hans Asperger, and Bruno Bettleheim. These psychiatrists were the first to distinguish autism from other forms of childhood cognitive disability, separating a class of affective and emotional disorders from the undifferentiated, institutionalized mass of imbeciles. In large part, this discovery could only take place in an institutional context, as the raw material of the ‘retarded’ became grist for a scientific apparatus of cataloging.

One thing that struck me here, in a story that I expected to have clear villains and heroes, was the ambiguous figure of Bettleheim. Bettleheim is best known for postulating the “refrigerator mother” theory of autism, which blamed subconscious anger from the mother to the child for blocking proper development. This psychodynamic theory has zero basis in truth, and the pathologizing of parents caused an immense amount of pain to blameless people. Yet Bettleheim’s Orthogenic School was one of the most humane environments for autistic children to experience, with every surface and experience carefully designed to help them “emerge.” The theories were almost certainly bunk and the methods unreliable (such as having Joey the Mechanical Boy rebirth himself from an egg), but Bettlesman love could not be denied. Conversely, more “scientific” therapists coming from a Behavioralist perspective used adversive condition-shouting, slaps, and electric shock-to fix the behavior of autistic children. Where is the love?

The latter half of the book focuses on the modern controversies in the broader autism movement. First, who has the right to speak for people with autism: parents of autistic children, or autistic adults themselves? Is autism a disease, or is it a valuable part of our neurodiversity?

The second controversy is the one that gets people in trouble: in brief, do vaccines cause autism? Or rephrased, what kind of scientific evidence is ‘valid’ when talking about children with autism. From an epidemiological perspective, there is absolutely no evidence that vaccines cause autism-in fact, the overwhelming preponderance says precisely the opposite. From a toxicological side, the science is much less clear. Thiomersal (a mercury-based preservative used in vaccines) is neurotoxic, although its effects in the real world are not well understood. The immune system is complicated, and some autistic children do display symptoms of ‘chronic measles’. But is there a causal link, or do the symptoms of autism simply develop at the same time?

The fact is that the neural etiology of autism is remains completely unknown, but close case studies of children conducted by their parents have revealed a wide range of biological abnormalities in autistic bodies. Special diets, antihistamines, even experimental chelation therapy, have all worked for some children. The difficulty is translating these case studies into a medically valid RCT, given the wildly divergent levels of expertise and interest between parents and scientists. In fact, there might not even be a single ‘autism’. Rather, a host of distinct biological differences causes the same affective symptoms-a state which would make clinical trials nearly impossible, since any treatment would only work on a small subset of the “autistic” population.

Love plays a role again: No rational person would want to see ancient plagues return, but parents who love their children can only see the harm done by uncaring pharmaceutical bureaucracy. After reading this book, I have a much greater respect for the difficulty of this issue, and for healing the wounds between medical practitioners who know far less than they would like, and parents who demand answers now.

For my own sake, I wish that the book had focused more on the integration of autistic children into the education system. The book talked a little about the unique role and power of diagnostic technicians responsible for administering the various observation tests, but social workers, teachers, and various types of therapists are some of the most important people in the story of how autism relates to the broader society, and their voices are mostly absent.

Finally, this book gave me some interesting ideas about how to structure my own research on ADHD. Who were the medical figures most responsible for working with hyperactive children in institutions from the 1920s onwards? How did ADHD become a broad social diagnosis? What is the structure of advocacy groups, and their relation to the medical/scientific/pharmaceutical apparatus? And finally, is there a concept as powerful as “love” that encompasses the whole framework of ADHD?

The Breakthrough Institute has a mission that half genius and half madness: fixing the environmental movement. In this volume, Shellenberger and Nordhaus introduce a group of deep thinkers on the anthropocene; the geological era when human activity composes a primary part of planetary cycles. The core theme is that we cannot retreat from technology, and that to survive in the 21st century, we must embrace our monsters, and become good stewards of the Earth.


I buy this, but I wonder how effective "Love Your Monsters" is at reaching those who haven't drunk the Breakthrough kool-aid. Shellenberger and Nordhaus are ex-Berkeley hippies, and their critiques of the Left's post-material culture, which is intrinsic elitist and self-contradictory, are spot on, but how influential are Greens, and how many are going to be converted by hippie punching? It's fun, but I want to see Breakthrough reach out to the pro-fossil fuel conservatives who are standing in the way of transforming the energy system, and the vast unengaged middle that has no idea what's going on, politically or technologically.


((Disclosure: I served as a Breakthrough Generation Fellow in the summer of 2011))

Every semester when finals roll around, I sigh and reach for my Foucault shelf, which is what I deserve for being a grad student studying mental illness and institutional power. But after a few years of cursing his name, I figured it was time to find out who this Foucault guy was, and if his life could shed any insight on his work.

In that regard, James Miller makes a heroic attempt to contextualize the events of Foucault's life with his scholarship. I say heroic, because Foucault was an evasive man who deliberately sought the death of the author in his public statements, and because his texts are legendarily dense. Miller more or less succeeds, finding in Foucault an attempt to fulfill the Nietzschean quest to "become oneself" through the practice of "limit-experiences" in radical politics, physical pleasure/pain, intellectual rigor, and ultimately death.

So why only four stars? Well, first, I only half buy it. I'm not an expert in Foucault scholarship by any means, but somehow it seems a little pat. And second, this is a dense book, and took me several weeks to trudge through. Someone with a lesser interest in Foucault might give up. Somebody with greater knowledge might through the book through a window.

When I heard that the author of the absolutely brilliant Secrets and Lies was turning his slantwise gaze from computer networks to society as a whole, I was excited. These days, security is a big business, and problems of insecurity bedevil the future. Schneier lays out his framework for how trust is required modern society function, and how the liars and outliers of the title abuse trust for their own advantage.

It is not that this is a bad book, but it is very general. Yes, we use morality, reputation, institutional pressures, and security technology to enforce trust. Yes, multinational corporations are hard to regulate, and accelerating technological change introduces new risks. I get it, but what can we do about security today? How can complex systems be made secure? What is the responsibility of the State in providing security, as opposed to its other duties? Schneier seems to suggest that we devolve power to lower levels, where morality carries more weight (most people are generally nice to people they see every day), but this idea is difficult to combine with the global scale of modern problems.

Along with all the theory, I would have preferred some concrete case studies of security failures, say a clear example of corporate corruption in action, or why the War on Terror is a failure in every way. And for a book which relies so heavily on the Prisoner's Dilemma as a conceptual tool, not mentioning Axelrod's Evolution of Cooperation and the Iterated Prisoner's Dilemma is an odd choice.

Framing Disease is a constructivist account of disease and medicine: How diseases become real through the interactions of theories and practices, how various kinds of experts can speak to the relevance of a disease, and how disease acts as instrument of social and political power.

The papers in this collection range between 'decent' and 'excellent' (an accomplishment for an academic work of this kind, which usually includes a few real stinkers). A core work if you do any kind of history/sociology/anthropology of medicine, although 20 years after publishing, you probably already have an opinion on the usefulness of constructivist methods.