4 Summer Reads

Fear City by F. Paul Wilson

Recurring characters are bread and butter for popular authors: Sherlock Holmes (the archetype), Miss Marple, Mike Hammer, Jack Reacher, Dexter Morgan (more about him later), et al. One of the most enjoyable by a contemporary author is Repairman Jack, a creation of F. Paul Wilson. The 16 main Repairman Jack books read much like Dashiell Hammett blended with HP Lovecraft. Jack is an urban mercenary who repeatedly runs afoul of the nefarious schemes of a secret society that is actively seeking to bring about the end of the world as we know it. The novels are best read in order from The Tomb (1998) to Nightworld (2012). (The Tomb originally was published in 1984 [preceding The Equalizer TV series about an urban mercenary], but was extensively rewritten in 1998.) The books are readable, adventurous, and funny. They appeal to those who believe that maybe there really is a dark conspiracy afoot in the world and to those who wish this were true, because it at least would explain the otherwise inexplicable.

When a character reaches the end of his or her story arc, as Jack does in Nightworld, an author is faced with a decision to retire the character permanently or start a new storyline. Wilson chose a third path: prequels. There are three Young Adult Jack novels set in Jack’s tweens and three adult novels about a youthful (and sometimes fumbling) Jack learning his way. Fear City is the last of these, and perhaps the last of any kind. F. Paul Wilson: “After sixteen novels (counting Nightworld) in the main sequence plus three juveniles and three prequels, Jack needs a rest.” Fear City is great fun for existing fans of the series, but it is not for newcomers: too many inside jokes and references.

So, Thumbs Up, but only for existing fans of Repairman Jack. All others should start with The Tomb (1998).

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It’s All in Your Head by Suzanne O’Sullivan

Psychosomatic illnesses get a bad rap, which is why today they more commonly are called conversion disorders or dissociative disorders. There is a widespread assumption among members of the general public that sufferers can and should just “snap out of it.” Even physicians, who ought to know better, are sometimes inclined to this judgment. Says neurologist Dr. Suzanne O’Sullivan in her book It’s All in Your Head, “One of the greatest challenges for most doctors is the struggle to believe in the truly subconscious nature of their patients’ psychosomatic symptoms.” The situation is not helped by the fact that there is a small percentage of patients who deliberately fake symptoms for attention or monetary gain (e.g. disability payments or lawsuits). The large majority, however, do nothing of the kind. That symptoms can be entirely real despite the absence of an organic cause has been understood for 150 years.

In truth, we all experience psychogenic symptoms, as when your hands shake from nervousness, when your pulse rate jumps when you feel uneasy, or when you get sick to your stomach when emotionally distressed. What of teens who faint before rock idols? Most of them are neither overheated, dehydrated, nor faking – they are just worked up. We don’t think much about these involuntary events, because they are “normal.” So why is it so hard to believe that people can suffer chronic pain, convulsions, loss of vision, chronic fatigue, or paralysis for the same reasons – that the symptoms can be 100% real and yet psychogenic? The difference is merely one of degree.

Those most fiercely resistant to the diagnosis are the patients themselves. Dr. O’Sullivan’s practice includes treatment of epileptics and others with organic diseases, and she stresses the importance of thorough testing for organic causes. But because many patients are referred to her who already have been tested exhaustively with negative results, she encounters an outsized proportion of patients whom she ultimately diagnoses with dissociative disorders. She is accustomed to facing their wrath, for (oddly) people typically are less upset by a diagnosis of an incurable physical disease than of a curable psychogenic illness. Nowadays most patients come into her office armed with a file full of pages they have printed off the internet about diseases with symptoms like their own. (A common malady of medical students is a conviction they have diseases about which they are reading; in the 21^st century the internet has spread this malady to others.) They usually reject what she says outright and counter her diagnosis with challenges such as “What percentage sure are you?” She answers this simply by repeating that she is sure, for if she falls into the trap of saying something like 99.5%, they will insist, “I’m one of the 0.5%.” Yet, she knows they are not being deliberately stubborn; their symptoms are very real and they just have a hard time accepting a nonorganic cause.

Such cases are far more common than generally acknowledged: “in 2011 a German study showed that twenty-two percent of people attending a primary care centre had a somatising disorder.” In the US and the UK “the prevalence of dissociative seizures in epilepsy clinics is thirty percent.” In most cases these are transient events brought on by stress with no lasting effects – patients commonly attribute them to “a bug” and get on with their lives. (People do get bugs, of course, so one shouldn’t be hasty in one’s conclusions one way or the other.) In a few cases, though, the symptoms can be debilitating for months, years, or a lifetime – especially if patients refuse the best chance at treatment, which is seeing a psychiatrist. At bottom psychogenic illnesses are biological too, of course. Even Freud acknowledged this. But they can be treated without recourse to medication or surgery.

O’Sullivan’s book is well-written, well-argued, and based on (suitably disguised) real experiences with her patients. Thumbs Up, but it will infuriate those who have received a “dissociative disorder” diagnosis and reject it. (A small percentage may be correct to do so.) This is evidenced in the reader ratings on Amazon, which are mostly 4 and 5-stars with a sprinkling of 1-stars from readers angry at having received just such a diagnosis.

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Dexter is Dead by Jeff Lindsay

Those who are familiar with Dexter Morgan – by day a blood-spatter expert with the Miami PD and by night a serial killer – only from the Showtime TV series know a very different character from the one in Jeff Lindsay’s novels. Showtime Dexter is a likable fellow who politely kills his victims before slicing and dicing them; his vigilante justice, however horrific, is recognizable as a form of justice. Not so the Dexter of the books. He is an out-and-out monster with a dark and wicked sense of humor, and he keeps his victims alive as he dismembers them, because their pain is fun. Novel Dexter does have a code (kill only vicious criminals), but it is not one he follows out of a sense of justice. It is merely a technique to reduce the odds he will get caught. He has no qualms per se about targeting an innocent person; he avoids doing so purely for practical reasons. For all that, Jeff Lindsay is funny in the same way that Edgar Allen Poe is funny.

Book seven in the series, Dexter’s Final Cut, ended with Dexter in jail on charges of murder (of his wife Rita among others) and pedophilia. Ironically he is innocent of these particular crimes, but he seems sure to be convicted of them. In book eight, Dexter is Dead (2015), Dexter’s brother Brian – also a serial killer but without a code – hires a celebrity attorney who springs Dexter. Dexter obtains evidence that provides good reasons to be optimistic about his case. Brian, however, has ulterior motives and soon Dexter is wondering if he would have been safer in jail. The bodies pile up and Dex isn’t even having fun. If you liked the previous Dexter books, you’ll like this one too. What of the title? Is Dexter really dead? Maybe.

Thumbs Up.

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How to Lie with Statistics by Darrell Huff

An example is a blurb on the cover: “Over half a million copies sold – an Honest-to-Goodness Bestseller.” Well, yes. But since the book has been in print since 1954 one also could say that it sells about 8,000 copies per year, which is considerably less impressive.

Don’t let the publication date deter you. Precisely the same issues are discussed and elaborated in this book as are discussed in more recent titles on the subject – including scientific fraud, which became a fashionable topic only recently. Better yet, Huff, a statistician by trade, deals with them concisely and readably. There is nothing new in this book, but unfortunately nothing old either: all the methods of collecting and manipulating data to produce a misleading or desired result are still in use. It doesn’t hurt to remind ourselves of them.

The methods include sample bias, shifting bases when listing percentages, selective use of “average” (average incomes, for example, with complete accuracy might be called either rising or falling depending on whether the average is the median or the mean), semiattached figures (“If you can’t prove what you want to prove, demonstrate something else and pretend it is the same thing”), showing correlations while letting the reader infer cause and effect, manipulating graphs by selecting scales and the type of graph, and so on. None of this is rocket science, but Huff demonstrates how easily we can mislead others, and, far more often and troublingly, ourselves.

Thumbs Up.

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Perhaps O’Sullivan would get a better response by referring patients to Melanie: Psychotherapy