Hugo & Nebula Awards: Best Novels discussion

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Even Though I Knew the End
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2022 Nebula for best Novella - Even Though I Knew the End
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Oleksandr, a.k.a. Acorn
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May 19, 2023 09:31AM

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I've started it today. So far a nice mix of (urban?) fantasy and noir. When at the beginning the narrator (view spoiler)
I thought this was a decent novella-length story, I wouldn't say it blew me away though. There were a couple noir-ish fantasy novellas tordotcom released last year and they kind of blend together in my memory not too long after reading them. This was the best of them though.
I've finished it, a nice story, if the author writes more with the same narrator I'll read. At the same time, yes, nothing mind-blowing but a fine read

This was fun, readable, had decent character development within the construct of the short form, and gave us a different take on similar stories. I imagine that played a part in consideration from an award perspective.
One thing that irked me a bit is a common trope in fiction that equals electroshock therapy to tortures and fake medicine, promoted by sadists. In reality (e.g. see Wiki as a starter), it is [1] usually painless, [2] used rarely and [3] proven effective in some cases.
Allan wrote: "Is there a link to this one?"
To the book or to my comment? or something else? :)
Book Even Though I Knew the End
Wiki on www.wikiwand.com/en/Electroconvulsive...
To the book or to my comment? or something else? :)
Book Even Though I Knew the End
Wiki on www.wikiwand.com/en/Electroconvulsive...

True. I know someone who finds it effective for severe depression. However, I think it is fair to say it has been abused in the past.
Kristenelle wrote: "However, I think it is fair to say it has been abused in the past.."
As I understand it, the procedure hasn't been broadly abused because most doctors are extremely careful not to kill their patients, and electric shock still can negatively affect the heart and it has been known from the start. So, it never was an approach 'hey, we got this new patient, let's start with shocking them!' Moreover, the true problem of e.g. US healthcare is the opioid epidemic that hurts and kills by orders of magnitude more than ECT ever did, but it hasn't been turned into a trope
As I understand it, the procedure hasn't been broadly abused because most doctors are extremely careful not to kill their patients, and electric shock still can negatively affect the heart and it has been known from the start. So, it never was an approach 'hey, we got this new patient, let's start with shocking them!' Moreover, the true problem of e.g. US healthcare is the opioid epidemic that hurts and kills by orders of magnitude more than ECT ever did, but it hasn't been turned into a trope

I'm a little surprised that the Becky Chambers didn't win.

As I understand it, the procedure hasn't been broadly abused because most doctors are extremely careful not..."
Yeah, I feel confident that electroshock therapy is rarely if ever abused at this point in time, but my understanding is that it was widely used and abused in the past....like fifty or more years ago. I'm just going off my impressions. I don't have evidence or cites. Do you feel that it was never abused?
My understanding was it was widely abused in carceral psychiatric institutions throughout the first half or two thirds of the 20th century. I thought this was just common knowledge, so I don't have any citations either.

It isn't just a trope. Back in the old days, lots of people were given ECT without consent, without anesthesia, and without muscle relaxants (which reduce the likelihood of breaking bones). Things changed in the 1970's.
All that (except Louise Fletcher's death) is in the (English) Wikipedia article.
Lobotomies were also frequently forced on people with horrible results.
"..the true problem of e.g. US healthcare is the opioid epidemic .."
You should say "ONE problem". There are many!

I've searched on abuse of ECT in the past and found this interesting article in the Psychitric Times: https://www.psychiatrictimes.com/view...
To quote relevant pieces:
When ECT was invented in 1938, modern anesthesia had not yet been developed; thus, ECT had to be given in unmodified form. Furthermore, because it was so effective for severe psychiatric illness, at a time when there were few other viable treatments, it was tried on patients with many different disorders. It was clearly overused-even abused.
So, yes, overused but not because of the inherent malice of medics, but because it was so effective in some cases and no viable alternatives
Why such animosity toward a medical procedure that is solely intended to provide relief to people who have severe depression? Much of the answer lies in a checkered remote history that remains alive today, largely because of the film One Flew Over the Cuckoo’s Nest. Made in 1975, it depicts a form of ECT that was already nearly 20 years obsolete in 1975. It was fiction taken literally as medical fact
As I said, fiction is taken as fact.
And yes, there are a lot of problems with healthcare everywhere.
To quote relevant pieces:
When ECT was invented in 1938, modern anesthesia had not yet been developed; thus, ECT had to be given in unmodified form. Furthermore, because it was so effective for severe psychiatric illness, at a time when there were few other viable treatments, it was tried on patients with many different disorders. It was clearly overused-even abused.
So, yes, overused but not because of the inherent malice of medics, but because it was so effective in some cases and no viable alternatives
Why such animosity toward a medical procedure that is solely intended to provide relief to people who have severe depression? Much of the answer lies in a checkered remote history that remains alive today, largely because of the film One Flew Over the Cuckoo’s Nest. Made in 1975, it depicts a form of ECT that was already nearly 20 years obsolete in 1975. It was fiction taken literally as medical fact
As I said, fiction is taken as fact.
And yes, there are a lot of problems with healthcare everywhere.
Oleksandr wrote: "And yes, there are a lot of problems with healthcare everywhere. "
The biggest problem with Canadian healthcare is neoliberal politicians trying to privatize it and turn it into American-style healthcare.
The biggest problem with Canadian healthcare is neoliberal politicians trying to privatize it and turn it into American-style healthcare.
Strange that it is the liberal politicians wanting to privatize. Seems to be the opposite in the US
I've studied healthcare systems a little, including a Canadian one (Ukraine made significant progress reforming our healthcare with both Canada and UK as prominent examples)

Nooo, what about US healthcare could possibly be tempting?? I guess I can see the appeal to greedy psychopaths...

Neoliberal is different from liberal. I don't totally understand the exact definitions of the terms, but neoliberal tends to be more pro-capitalism and free market and stuff. The definition actually sounds really conservative.
well, I looked up definitions and am somewhat confused, but I've decided that I will do with it the same thing I (mostly) do with politics . . . ignore it as much as I can!!!

This book takes place in the 1940s, right? The text you quoted says things started getting better about 20 years before 1975, so about 1955. There really and truly were abuses before that including lack of anesthesia and lack of consent.
Hospitals for psychiatric patients were pretty horrible even well into the early 1900s.
By random chance, I was reading about Antonin Artaud yesterday. He was given ECT in the 1940s. Wiki says 'Artaud denounced the electroshock treatments and consistently pleaded to have them suspended, while also ascribing to them "the benefit of having returned him to his name and to his self mastery".' (This was France during the occupation, not USA, but still you see the idea of patient consent wasn't treated the way it is today.)
As for ECT in the modern times... it is much less unpleasant. I know someone who suffers from severe depression. When it gets really bad she voluntarily seeks ECT and it helps her.

It makes sense when you realise that in the US, "liberal" and "conservative" are flipped around, and mean the opposite of what they do in the rest of the world.
I've never dug deep into the idea of patient consent and in the case of ECT I ain't sure it is applicable in every case - it was used among other cases to treat patients who had acute bouts of bipolar disorder - in such a condition a person is sometimes delusional and at the same time 'feels' themselves fine. If after ECT they agree it was needed but not before - how this works? For some, I guess it should be a decision of the patient's caretaker but is there any explicit rule?
There are lots of explicit rules, they differ by region, but the general foundation is that free (uncoerced), prior (retroactive consent is not a thing), and informed consent has become a core principle of healthcare--at least in my country--and this is legally enshrined. For example:
https://www.cmpa-acpm.ca/en/advice-pu...
It took a lot of medical abuse and decades of doctor-centric decision-making over the 20th C for these principles to be codified.
"In circumstances where it has been determined that a patient is incapable of consenting to a particular medical treatment, the question as to who is authorized to make the decision will arise...
A number of provinces have also enacted legislation for substitute decision-makers which sets out and ranks a list of individuals, usually family members, who are authorized to give or refuse consent to treatment on behalf of an incapable person... Generally speaking, substitute decision-makers must act in compliance with any prior capable wish of the patient, where possible. Consideration of such factors as the individual's current wishes and his or her known beliefs and values may also be required, depending on the jurisdiction."
https://www.cmpa-acpm.ca/en/advice-pu...
It took a lot of medical abuse and decades of doctor-centric decision-making over the 20th C for these principles to be codified.
Thanks for the info, Kalin. I guess right now we have similar rules. However, when I grew up, in the USSR there was a campaign against drinking where drunks caught in public places were forced to 'clinics', which treated them with cold showers, isolation, and some medicine (plus often unofficially beatings).

Re the novella" I thought it was quite good, given the reception it received here on GR, I set high expectations, which were thankfully met! I love the atmosphere of the 20s and the magic system (though minimally built out) was intriguing. The sexual suppression and sexism was frustrating and I found it got in the way of my enjoyment of the storyline at times (but it was the reality of those times so perhaps I shouldn't complain).
This would have benefited from a bit more detail in the world building/magic system, but novellas usually leave me wanting more. Another review mentioned this is reminiscent of the A Master of Djinn world, which resonated with me. It left me with similar feelings and had that same type of fun exploration wrapped up in Great Gatsby nostalgia.
Books mentioned in this topic
A Master of Djinn (other topics)Even Though I Knew the End (other topics)