text:
Professional accounts of electroconvulsive therapy: A discourse analysis
Peter Stevens a, , and David J. Harper b,
aOxleas NHS Trust, Dartford, Kent, UK
bUniversity of East London, UK
Available online 8 January 2007.
Electroconvulsive therapy (ECT) is a socially contested psychiatric intervention. However, the accounts of professionals involved in its use have rarely been systematically investigated. This study aimed to examine the accounts of clinicians who have used ECT on a routine basis. Eight health professionals (psychiatrists, anaesthetists and psychiatric nurses from a major city in the United Kingdom) with experience of ECT administration were interviewed about the procedure. Discourse analysis was used to interpret the interview transcripts. Interviewees appeared to draw on a repertoire, which constructed ECT recipients as severely ill. This was used to support claims which had the effect of: defining who should receive ECT; warranting the use of urgent physical psychiatric treatments; reformulating distress in biological terms; and discounting the therapeutic value of alternative, non-physical interventions. The interviewees managed concerns about ECT in a variety of ways, for example by: rendering it as a medical procedure with concomitant risks and benefits; downplaying a lack of clarity over its evidence base; and undermining the legitimacy of criticisms. Implications of these findings are discussed.
Keywords: Discourse analysis; Electroconvulsive therapy; Debates; Persuasive communication; UK
Article Outline
The unconscious motives of professionals: psychoanalytic research
From motives to attitudes, belief and knowledge: cognitive research
From motives, knowledge and attitudes to accounts: the contribution of a discursive approach
Initial reading and coding
The biomedicalˆmedical repertoire
The Œsevere end' rhetorical device
Who is appropriate for ECT?
ECT as Œlife-saving'
Locating the focus of concern at the biological level
Exclusion of non-physical interventions
Managing concern about ECT
Acknowledging grounds for concern: weighing up risks and benefits
Rendering ECT as a medical procedure
Downplaying debate: the evidence is becoming clearer
Managing criticism of ECT: who has rights to speak?
Mental health professionals
Service users
Appendix A. Appendix
A.1. Transcription notation
Electroconvulsive therapy (ECT) remains one of the most widely used but contested and debated interventions in psychiatry. Advocates argue that the procedure is safe, effective and often life-saving (e.g., Abrams, 1997; Fink, 1979) whilst critics argue that it is ineffective and has the potential to cause psychological and neurological harm (e.g., Breggin, 1993; Friedberg, 1977; Johnstone (2000) and Johnstone (2003); Read, 2004).
However, there are two neglected areas in the research literature. The first is the relative lack of interest in the experiences of ECT recipients. Recently, researchers, including those with direct personal experience of receiving ECT have tried to redress this imbalance (Johnstone, 1999; Rose, Wykes, Leese, Bindman, & Fleischmann, 2003; Rose, Fleischmann, & Wykes, 2004), and there is a need for further investigation in this area.
A second neglected area is the empirical investigation of the accounts of those involved in ECT administration. The two most popular investigatory paradigms here have been psychoanalytic and cognitive. We will briefly review studies from these two paradigms, arguing that these studies are both theoretically and methodologically limited, before making the case for the contribution of a discursive approach.
The unconscious motives of professionals: psychoanalytic research
In the two decades following the introduction of ECT in the late 1930s, a variety of theories emerged to explain how Œshock treatments' worked and affected patients˜Gordon (1948), for example, reviews 50 of these. Less frequently, theorists examined the way ECT affected the professionals involved in its administration (e.g., Abse & Ewing, 1956; Fenichel, 1945; Wayne, 1955). Both were characterised by a psychoanalytic approach.
Abse and Ewing (1956) analysed Œoff guard' statements made by psychiatrists who were experienced in administering Œshock treatments'. They suggested that such accounts were characterised by themes of hostility and punishment. For example, Œlet's see if a few shocks will knock him out of it'; Œwhy don't you put him on the assembly line'; and the description of ECT as Œa mental spanking' (all p. 37). The authors suggested that Œthe very nature of the treatment itself can produce the attitudes described' (p. 38).
In a more recent example, Levenson and Willett (1982) reported observing Œsplitting' (divided clinical opinions), and disruption to the Œtherapeutic alliance' (rapport and empathy) in a multidisciplinary team involved in the care of two patients who received ECT. They concluded that ECT was an upsetting procedure because it Œoften produces rapid improvement in patients who had previously not responded to treatment' (p. 298) and the staff team experienced the therapeutic success as Œimplying devaluation of their own therapeutic skills' (p. 302).
However, this paradigm suffers from a number of limitations. For example, these studies have tended to be based on anecdotal reports rather than a more systematic gathering of material. Moreover, the reported comments are open to a number of competing explanations. Since psychoanalytic interpretations rely for their plausibility on inferred constructs which lie, as it were, within the person's unconscious and thus cannot be demonstrated in the texts, they remain largely speculative.
From motives to attitudes, belief and knowledge: cognitive research
The second dominant approach in this area is cognitive, with questionnaires as the primary methodology. There have been a number of questionnaire-based studies investigating the attitudes and knowledge of professionals who are involved with ECT (e.g., Finch, Sobin, Carmody, deWitt, & Shiwach, 1999; Janicak, Mask, Trimakas, & Gibbons, 1985; Kalayam & Steinhart, 1981; Lutchman, Stevens, Bashir, & Orrell, 2001). Janicak et al. (1985) compared the knowledge and attitudes of psychiatrists, nurses, psychologists and social workers in relation to ECT. They reported that a positive attitude towards ECT in professional groups was correlated with increased knowledge about the procedure, and they concluded that educating staff about the facts of ECT would increase its utilisation in conditions where they suggested it should be the treatment of choice. Lutchman et al. (2001) used a similar design and drew similar conclusions finding differences in attitudes and knowledge across different disciplines, with psychiatrists being the most positive about ECT and psychologists the least.
However, as Diana Rose and her colleagues (Rose, Fleischmann, & Wykes (2004) and Rose, Wykes, Leese, Bindman, & Fleischmann (2003)) have argued in relation to investigations of ECT recipients' experiences, questionnaire-based methods limit and reduce the responses available to participants (see also Rosier, 1974). As a result, the possibility that factors other than knowledge might correspond with attitudes towards ECT has remained unexplored. More importantly, perhaps, this paradigm is methodologically and conceptually limited as a result of its assumptions about what constitutes Œknowledge' and Œattitudes' which are, again, inferred constructs thought to lie within the individual's head.
A more fundamental problem with this approach is the way in which knowledge about ECT is presented as uncontested fact when the reality is much more complicated. Both the Janicak et al. (1985) and Lutchman et al. (2001) studies asked participants whether they agreed or disagreed with statements about the procedure. Despite being presented as Œfactually correct' or Œfactually incorrect' each statement could be interpreted in different ways and their facticity has been disputed in the literature. For example, the first statement from Janicak et al. (1985)˜Œthe therapeutic effect of ECT is related to the induction of a seizure in the brain'˜is both supported (West, 1981) and contradicted by research demonstrating the effectiveness of placebo ECT (see Medical Research Council, 1965).
Similar assumptions have been made about Œattitudes' towards ECT. Janicak et al.'s (1985) participants were asked whether they would have ECT themselves if they were Œsuffering from varying degrees of depression' (p. 263). These responses were then regarded as demonstrating positive or negative attitudes toward the procedure. However, as with most attitude research there are fundamental epistemological difficulties with the notion that responses to lists of statements are unproblematically transformed into inferred mental constructs like beliefs or attitudes or unproblematically linked with conduct. Discursive psychologists like Potter and Wetherell (1987) dispute the idea that completing an attitude questionnaire represents a neutral and transparent transfer of an internal cognitive state to a mark on a page. Instead, they argue that people construct what they say in order to serve a range of functions (though not necessarily intentionally) and that this can be seen in intra- and inter-participant response variation. Thus the meaning of a psychiatrist agreeing with the statement that they would undergo the procedure if they were depressed (as 76.6% of Janicak et al.'s participants did) is not straightforward. For example, such agreement might enable participants to counter the potential charge of ethical inconsistency which might accompany disagreement with the statement. Moreover, the statement is abstracted from a context: there might conceivably be situations where these participants would be less likely to agree to have ECT.
From motives, knowledge and attitudes to accounts: the contribution of a discursive approach
Variation, disagreement and contradiction are usually rigorously controlled for in traditional cognitive research but at the cost of focusing on attitudes shorn of their context and this may tell us little about situated Œattitudes'. In contrast, such variation is a topic of analytic importance for discourse analysts. For example, Harper (1999), in his study of professional and service user accounts of psychiatric medication, reported that a variety of explanations could be used in order to account for events such as the apparent failure of medication. Moreover, these explanations could be seen as having a variety of rhetorical effects˜in other words, they served a persuasive function, though this was not necessarily seen as an intentional action on the part of speakers. For example, when speakers claimed that medication had not worked because of the chronicity of the service user's Œillness', this emphasised the permanence and severity of biological symptoms and shifted responsibility for treatment failure away from the medication and on to the illness.
Discourse analysis (DA) has been used to explore the accounts of health professionals in relation to a number of topics (Griffiths & Hughes, 2000; Parker, Georgaca, Harper, McLaughlin, & Stowell-Smith, 1995; Soyland, 1995). Because of its focus on the inherent variability of accounts, it is particularly useful in understanding how contested issues are constructed by participants. For example, Horton-Salway (2002) has shown how general practitioner's discussions about ME (myalgic encephalomyelitis or CFS) are often concerned with the management of blame for the condition. Boyle (2002) and Boyle (2004) has suggested that professionals' use of rhetorical resources can make some ways of talking about a topic like schizophrenia seem more reasonable than others. In his study of talk about medication, for example, Harper (1999) argued that one of the effects of such talk was to serve certain institutional interests. For example, accounting for medication failure as due to the chronicity of illness could be seen to serve the interests of the Œpsychopharmaceutical complex' (Breggin, 1993) because questions about the efficacy of medication were deflected when such responses were deployed.
Johnstone and Frith (2005) have recently used DA to examine Freeman and Kendall's (1980) study of ECT recipients' experiences and attitudes. They describe how patients are rhetorically constructed in this article in a number of ways, for example as passive and compliant or as hostile and unreasonable. They note that one of the effects of such constructions is to Œpreserve the view of ECT as a benign and beneficial procedure, and to validate both psychiatrists and psychiatry in the continued use of this treatment' (p. 200).
DA thus provides a novel perspective on the accounts of professionals. However, the kind of accounts presented in published research articles are highly systematised and organised and are likely to differ from those found in more informal settings. The aim of the present study, therefore, was to conduct an empirical qualitative investigation of accounts of the administration of ECT by those who administer it in the more informal context setting of a semi-structured interview.
Eight clinicians involved in administering ECT were interviewed about it by the first author. The interview transcripts were interpreted using DA, which draws on a broadly social constructionist epistemology. Here we will briefly note key discourse analytic concepts on which we drew in the present study. Following Wetherell's (1998) suggestion, we have drawn on both discursive psychology and Foucauldian discourse analytic traditions (Willig, 2001).
In discursive psychology, the systematic ways of talking about a topic generally found in conversations are termed interpretative repertoires. Edwards and Potter (1992) have described a number of ways in which speakers use rhetorical devices which have the effect of making what they are saying appear factual˜an example is the empiricist forms of accounting found in journal articles, where the agency of the scientist is minimised and agency is implicitly located in the objects of research. Such devices are often deployed when there is some disagreement about the facts and when the speaker has a stake in the outcome.
The analysis also drew on positioning theory (Davies & Harré, 1990), which attempts to re-conceptualise static and essentialist notions like role and identity. It assumes that when people speak they implicitly position themselves and others in relation to the topic under discussion. For example, in a conversation between a doctor and a patient, the doctor is implicitly assumed to have expertise about topics like illness, diagnosis and so on, whilst the patient is implicitly assumed to have expertise about topics like their health concerns. Parker (1997) notes that all positions carry Œcertain rights to speak and specifications for what may be spoken' (p. 291). Thus there are certain things which can and cannot be said from particular positions and within particular interpretative repertoires.
Discourse analysts try to avoid the ascription of intentionality to participants' accounts. In other words, it is not assumed that participants strategically design their talk in order to have certain effects. Parker (1992) comments that Œpeople make discourse, but not in discursive conditions of their choosing' (p. 32). One significant context-marker for the present study is that the participants were being interviewed by a psychologist who, by virtue of his discipline (see Lutchman et al., 2001), might be thought to have a different position to them on ECT, and this may well have influenced the results. Walkup (1994) has argued, for example, that such situations may well lead to Œquite self-conscious attention to legitimation themes' (p. 149). The reader needs to take this into account in judging the quality of the analysis.
All the interviews took place in a major city in the United Kingdom. The interviewees represented the cross-professional involvement in ECT administration, including pre- and post-procedure care (psychiatric nurses), prescription and delivery of the treatment (psychiatrists) and the administration of anaesthetic and muscle relaxant (anaesthetists). The research aim was to identify which positions and repertoires were culturally available to the speakers˜in other words to see what range of things could be said about ECT by professionals. Since discourse analysts are critical of abstract notions like Œattitude' and Œview', the aim was not to represent participants' views nor to compare views within the sample.
We considered that eight participants would produce a reasonable range of possible repertoires and positions, and this is consistent with previous DA research. A purposive sampling strategy was followed in that a range of disciplines were interviewed: four psychiatrists, two psychiatric in-patient nurses, and two anaesthetists. More psychiatrists were interviewed since ECT is primarily a psychiatric intervention.
Potential participants were identified and recruited through liaison with departments of anaesthetics or old age psychiatry˜the latter departments prescribe a substantial portion of the total number of ECT administrations in the UK (Pippard & Ellam, 1981). All were sent a standard invitation letter followed by a telephone call. The first eight professionals invited to take part agreed to do so.
The small number of participants increases the risk that they will be identified and so, in order to protect confidentiality, we will present demographic information for the group as a whole and not for individuals. Four men and four women were interviewed. Three participants were aged in their 30s, three in their 40s and two in their 50s. Five of the six medical professionals were consultants and one was a senior registrar. The two nurse participants had considerable involvement with ECT. All but one participant was involved with ECT administration at the time of the interviews.
Potter and Hepburn (2005) have cautioned against what they see as the inappropriate and over-use of interview methods in DA studies. It is certainly true that interviews create particular kinds of interaction, and they should not be seen as a proxy for more Œnaturally occurring' kinds of conversations. However, it seemed that interviews were an appropriate source of data here because the study was interested in how professionals constructed accounts about ECT, for example how they might provide justifications for a contested intervention.
Interviews took place at a time and place of participants' choosing, usually at their workplace. The aims of the investigation were explained, anonymity was guaranteed and consent to both audio-taping the interviews and publishing extracts was obtained. A semi-structured interview schedule was followed, covering the participants' experiences of ECT and issues that had been debated within the literature. Appropriate ethical permission had previously been granted from a University Ethics Committee and interviews were conducted in 2001.
Initial reading and coding
Following Wood and Kroger's (2000) guidelines, all the transcripts were read through in their entirety while a separate list of recurring or interesting categories and features were noted and eventually categorised. Extracts seen as related to each category were copied and pasted into correspondingly named computer topic files. Once printed, these became the material for analysis.
Discourse analysts see their interpretation of such texts as only one of a number of possible readings and not the definitive one (Willig, 2001). Our reading of the interview transcripts indicated that different interpretative repertoires and rhetorical devices were drawn on by the interviewees, suggesting that a range of such features were culturally available to them. During the reading, the subject of interest was talk about ECT and, increasingly, as the analysis progressed, about those to whom it was administered. Although a range of features were identified, because of limitations of space, our analysis is structured by a focus on the Œbiomedicalˆmedical' interpretative repertoire and the Œsevere end' rhetorical device. We will also discuss how interviewees managed concerns about ECT. We will also draw on some of the psychiatric literature in order to place the interview material in context.
Transcription notation is described in the Appendix A. The code underneath each extract refers to the participant (e.g., Dr. A), their discipline (e.g., consultant psychiatrist) and the line numbers of the interview transcript from which the extract derives (e.g., lines 20ˆ22).
The biomedicalˆmedical repertoire
Throughout the interviews, it was common for ECT recipients to be described with diagnostic medical language, which typically referred to their behaviour and the consequences of that behaviour. For example, asked who was most likely to receive ECT, Dr. A responded Œpatients with severe depression who may be in a depressive stupor˜that means that they're sort of bed-bound, immobile, not eating not drinking' (Dr. A, consultant psychiatrist: lines 54ˆ55). Such lists of behaviour were described elsewhere as Œclear biological features' (Dr. E, consultant psychiatrist: lines 753ˆ754) or Œprominent physical symptoms' (Dr. B, senior psychiatric registrar: line 117).
A variant of the biomedicalˆmedical conceptualisation of patient behaviour and psychiatric interventions were accounts framed in electro-chemical terms. These are also to be found in some of the professional literature, for example, Œrepeated treatments [of ECT] alter chemical messages in the brain and bring them back to normal' (Royal College of Psychiatrists, 1995, p. 104).
The biomedicalˆmedical repertoire was often accompanied by a rhetorical device which focused on the chronicity and severity of problems.
The Œsevere end' rhetorical device
In the following extract the characteristics of those who are seen as most likely to be appropriate for treatment with ECT are discussed. Dr. A is discussing the occasions when ECT might be used to save life:
Dr. A: They're sort of bed bound, immobile, not eating, not drinking, er at risk of developing um major medical problems such as deep vein thrombosis, pulmonary embolic complications, which will kill them.
Interviewer: Right. Is that as a result of er (.)
Dr. A: Depression. Because they're severely depressed, they're in a depressive stupor. It's defined as stuporous, literally.
(Dr. A, consultant psychiatrist: lines 54ˆ60)
Who is appropriate for ECT?
One feature of the extract is the way in which Dr. A constructs those patients who are seen as appropriate for ECT. They are Œbed bound, immobile, not eating, not drinking'˜and located at what another interviewee described as Œthe severe end' of the clinical spectrum (Dr. E, consultant psychiatrist: line 56). Examples of the use of the Œsevere end' device can also be found in the professional literature:
It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with: severe depressive illness; catatonia; a prolonged or severe manic episode.
(National Institute for Clinical Excellence, 2003, p. 1)
ECT as Œlife-saving'
A formulation of ECT recipients as Œsevere' appeared to warrant the use of ECT on occasions when the person was viewed as at risk of dying either because of their attempts to actively kill themselves or because they were not eating or drinking. Both these kinds of behaviour were seen as symptoms of depression with failure to eat or drink viewed more seriously if the person was older, thereby potentially increasing the risk of physical health complications. The claim that ECT was life-saving was common across the interviews, regardless of participants' professional orientation. One effect of the Œlife-saving' repertoire was to sanction the use of ECT under conditions of compulsory psychiatric treatment (i.e., without requiring recipients' consent). This was termed Œemergency ECT' by participants. The grounds for such treatment are highly contested: both Johnstone (2003) and Read (2004) argue that there are no studies to support the claims of advocates for Œemergency ECT'. Read comments that ECT Œdoes not prevent suicide and for a small number may precipitate it' (2004, p. 95).
Locating the focus of concern at the biological level
Another feature of interest in Dr. A's extract is that there appears to be a causal chain in the location of the cause of problems. Causal agency initially appears to be located in physical health problems but these are then framed as caused by the patients' self-destructive behaviour, which in turn is seen as caused by depression. Ultimately, these biological signs and symptoms are presented as the threat to life. One effect of using technical descriptions (Œpulmonary embolic complications') is to construct the patient as both the cause of, and passive victim of, biological processes.
A second effect of constructing the problem at the biomedicalˆmedical level, rather than, say the psychological, or societal, is that it then becomes difficult to argue for alternative, especially non-biomedical, explanations and interventions. ECT was thus constructed not only as a reasonable intervention, but also an obvious one because it was viewed as fast-working and effective. One effect of this was that non-physical interventions were often discounted.
Exclusion of non-physical interventions
In the following extract, a participant describes the importance of early treatment when service users are extremely Œill':
Dr. E: ∑ if you delay effective treatment, you often have a tougher fight to fight.
(Dr. E, consultant psychiatrist: lines 789ˆ709)
In this extract Œtreatment' is implicitly seen as synonymous with ECT and the notion of time is foregrounded. It is implied that the use of other interventions would mean delaying the use of ECT, which is constructed as an Œeffective treatment'. Elsewhere in the interviews the term Œtreatment' was seen as synonymous with pharmaceutical interventions. The ECT fact sheet for patients published by the UK's Royal College of Psychiatrists (1995) states, Œthe alternative [to ECT] is drug therapy which also has risks and complications' (p. 104). Non-physical interventions such as psychotherapy or increased social support are absenced in these accounts, and one effect of this is to preclude them from being offered as alternative interventions. Arscott (1999) points out, Œit is likely to be difficult for a patient to refuse treatment with ECT if they believe that this is their only chance of cure' (p. 106).
Managing concern about ECT
All of the interviewees recognised that there was public concern about ECT and that it was seen as controversial, and they managed this in a number of ways. They acknowledged grounds for concern but framed ECT within a risks and benefits calculus similar to other medical procedures, sometimes accompanying this with claims that the evidential basis was becoming clearer. The interviewees acknowledged criticisms of ECT but in some of their accounts, more rights to speak were accorded to service user critics who had undergone it.
Dr. E: And I'm actually quite scrupulous about g-, giving the pros and cons I, I, I very often clear with people, I really think this is the treatment you should be having, but I'm also very clear ab-, that many people don't agree with this treatment, it's still regarded as controversial, there are some things you probably will experience which you will not like. You probably will find your memory's adversely affected. Er there are, you know, having an anaesthetic is at, at some level a risk, oh, the figure that's quoted in the College of Psychiatrists Handbook is three deaths per one hundred thousand anaesthetics.
(Dr. E, consultant psychiatrist: lines 193ˆ202)
Acknowledging grounds for concern: weighing up risks and benefits
One way in which concern about ECT was managed was by drawing on a notion of informed consent. In this extract Dr. E notes how ECT recipients are presented with Œthe pros and cons'. He includes some of the key concerns that critics of ECT have raised: that many disagree with it; that memory problems may occur; and that the administration of the anaesthetic itself is a risk. However, at the same time Dr. E says that he states ŒI really think this is the treatment you should be having'. Also, the risk from the anaesthetic is slightly downplayed by noting that it is a risk Œat some level', although it was the risk seen as raising the most concern. This informed consent account is commonly encountered in discussions about medical procedures like major surgery, and so one effect of employing such a risk and benefits calculus is that ECT was seen as similar to other medical procedures.
Rendering ECT as a medical procedure
Within the interviews, ECT was often discussed through analogies with effects or processes associated with general medical procedures, and this also had an effect of managing concern about ECT. If ECT can be seen as a medical procedure with concomitant risks and benefits, then its particularly controversial status within the popular imagination (e.g., from films like One Flew over the Cuckoo's Nest) can be minimised. Differences between the work of psychiatrists administering ECT and that of their medical colleagues carrying out surgery are de-emphasised and the procedure is presented as reasonable˜as Johnstone and Frith (2005) put it, ECT is thus presented as a Œbenign and beneficial procedure' (p. 200). Pilgrim and Rogers (1993) have argued that linking the content of psychiatric procedures with those of other medical procedures is one way of increasing the institutional alignment between psychiatry and general medicine˜an enterprise which Baruch and Treacher (1978) have suggested began in the 1960s when psychiatrists shifted their site of operation from separate institutions to district general hospitals. Equating the physical processes involved in psychiatric treatment with those involved in general medical treatment allows the status of the problem to be more easily conceptualised as biomedicalˆmedical. Moreover, Bracken and Thomas (2001) note that attempts to assert the equivalence of psychiatric and medical illness ignore the power of psychiatrists to use psychiatric treatments coercively. They remark, Œpatients and the public know that a diagnosis of diabetes, unlike one of schizophrenia cannot result in their being forcibly detained in hospital' (p. 725) and note, Œit is hard to imagine the emergence of Œanti-paediatrics' or Œcritical anaesthetics' movements' (Bracken & Thomas, 2001, p. 724).
Downplaying debate: the evidence is becoming clearer
A common theme in many psychiatric accounts of contested treatments is that the grounds for debate are lessening with increased research (see, for example Clare, 1976). This was evidenced in the interview material. In the transcript just before the next extract, Dr. B had noted that patient concerns about the lack of knowledge about how ECT works was understandable.
Dr. B: If the case for ECT was (.) crystal clear, that it does definitely work, then that wouldn't happen. (.) But as it happens, the case is not crystal clear, but I think it's clearing up.
(Dr. B, senior psychiatric registrar: lines 447ˆ449)
Here Dr. B acknowledges that the case for ECT is Œnot crystal clear'. Left at this point, Dr. B could potentially be challenged on why he continues to prescribe ECT. However, he then goes on to claim that it is Œclearing up'. This could be seen as a form of Œrhetorical inoculation' (Sorenson, 1991) where a speaker deflects anticipated criticism.
In addition to these ways in which ECT recipients' concerns were managed within the interviews, the interviewees also drew on a range of other responses to direct challenges from ECT critics including groups of patients who have received ECT.
Managing criticism of ECT: who has rights to speak?
In the following extract, a participant discusses the confusion which they suggest can be experienced by patients and relatives regarding the behaviour of service users after they have received ECT. Dr. B is discussing the case of a patient who had Œlost her memory of her holidays' (line 89):
Dr. B: ECT is given to people who are very ill. And it's very easy for relatives and patients (.) to (.) mix the two, sort of to (.) blame (.) ECT, the ECT for things that are to do with the illness.
(Dr. B, senior psychiatric registrar: lines 93ˆ95)
Here Dr. B suggests that behaviour could be viewed both as the direct result of ECT or, instead, Œto do with the illness'. In claiming that it is due to the latter, Dr. B draws on the Œsevere end' device by describing those receiving ECT as Œvery ill'. If this statement was made by a non-professional, it might be seen simply as an assertion. However, discourse analysts note that the force of a statement comes not only from its content but who makes it. Edwards and Potter (1992) describe the Œcategory entitlement' device which refers to the way in which the veracity of a report can be warranted by the entitlement of a speaker in a particular category to know certain things or have certain skills. Dr. B's professional status confers rights to speak about what might constitute both unwanted effects of ECT and symptoms of illness. Others, like the relatives and patients mentioned here are positioned as less informed about the medical understanding of emotional distress and the effects of treatment. Thus it becomes possible to construct them as less authorised to make such judgements. One effect of this is to undermine the legitimacy of criticisms made by non-experts and especially recipients of ECT and their relatives. Johnstone and Frith (2005) have noted similar strategies at work in their DA of Freeman and Kendall's (1980) article.
Of course, service users can attempt to claim certain kinds of category entitlements. As recipients of ECT they might understandably argue that they had expertise in understanding the effects of ECT. Indeed, such arguments have enabled users' experiences of ECT to gain a foothold in research conducted by ECT recipients themselves (Rose, Fleischmann, & Wykes (2004) and Rose, Wykes, Leese, Bindman, & Fleischmann (2003)). However, in the next extract, we see how attempts to gain such rights to speak can be challenged:
Interviewer: What, and when you talk about er (.) lay views of depression, many people underestimate how profoundly depressed people can be, what, what is the lay view of depression do you think? What is the standard view?
Dr. F: Well, I, it could be people who don't feel like going to work, who don't feel like going out, who don't feel like getting out of bed in the morning (.) er and they're a bit low (.) er it's really, they stop socialising. I don't think people realise that depression is also, you stop eating, (.) that you've stopped having baths, that you don't have a bath for three months and they find you at home. You know, that's what they don't realise. You know, because as I said, most people have felt a bit low, but they don't really realise that depression is a serious illness. I don't know if you're a patient. Did, did you talk to the patient groups?
Interviewer: Well I've read some of their literature.
Dr. F: I don't know, do they really know how bad these people are (.) those, those who are against ECT? (.) Do they ever come across, them, do they ever see how bad they are, do they/
Interviewer: /Do you mean people in the anti-ECT groups?
Dr. F: That's right, do they really see them? You see it's so easy for them to say when they get better Œoh ECT is a cruel treatment', but do they remember how bad they were to start with? Do they really know how severely ill?
(Dr. F, consultant anaesthetist: lines 342ˆ364).
Dr. F's account here follows a similar trajectory to that of the previous extract from Dr. B in that lay views of depression are challenged: Œthey don't really realise that depression is a serious illness'. In this extract, the Œsevere end' device is drawn on by describing Œhow bad' and how Œseverely ill' patients can be before they have ECT. However, Dr. F goes on to use a similar formulation to challenge the legitimacy of accounts of Œpatient groups'. These critical accounts are implicitly challenged for being selective or lacking in objectivity in some way: Œdo they really see them?'
There is an interesting shift in this extract, from describing individuals who are against ECT, but who have not Œcome across' those who receive it, to describing those who have received it (Œpatient groups'), but who are Œbetter' and might have forgotten Œhow bad they were to start with'. This account appears to challenge the legitimacy of the criticisms of both groups by drawing on the implied category entitlement of Œdoctor', which is set against the category entitlement of Œpatient'. Thus, the knowledge and claims of ECT recipients who have experienced adverse effects are positioned as secondary to the knowledge and claims of the professionals who administer the procedure. These service users are positioned as poorly informed and forgetful. However, those who are critical of the procedure, but who have not been recipients, are implicitly positioned as even less authorised to criticise ECT. Elsewhere this is put more explicitly:
Nurse A: And especially if the person is really anti-ECT and had ECT then I haven't got too much of a problem. (.) It's the ones that haven't had ECT that are against it that I've got a bit of a problem with.
(Nurse A, Psychiatric Nurse: lines 364ˆ367)
By singling out those who are critical but who Œhaven't had ECT', Nurse A's account appears to imply a hierarchy of authority to speak about ECT with those who have received ECT seen as having more rights to speak than those who have not. However, as we have seen, even those service users who have received ECT can still have the validity of their views challenged.
We have presented a reading of professionals' accounts of ECT in which interviewees appeared to draw on a repertoire which constructed ECT recipients as severely ill. This was used to support claims which: circumscribed who should receive ECT; warranted the use of urgent physical psychiatric treatments; reformulated distress in biological terms; and discounted the therapeutic value of alternative, non-physical treatments. The interviewees managed concerns about ECT by: rendering it as a medical procedure with concomitant risks and benefits; downplaying a lack of clarity over its evidence base; and undermining the legitimacy of criticisms.
The use of the Œsevere end' rhetorical device is interesting in the light of evidence that the strongest predictor of ECT prescription is gender and age, rather than severity of illness: women and those aged over 65 (again, predominantly women for demographic reasons) are most likely to receive ECT (Read, 2004; Salford Community Health Council, 1998). Moreover, the viewing of memory problems as resulting from depression rather than ECT seems a little dated˜the consensus view from a range of studies does appear to demonstrate a range of cognitive problems following ECT administration (McElhiney et al., 1995; Neylan et al., 2001; Robertson & Pryor, 2006).
In interviewees' accounts, the agency of psychiatrists in prescribing ECT was downplayed with the decision portrayed as flowing from factors relating to the severity of illness. However, this does not account for the variability of ECT prescription over time, in different regions and also between psychiatrists. For example, the study of ECT prescription in Salford and Greater Manchester (Salford Community Health Council, 1998) detailed wide variations both between individual psychiatrists and over time. In his analysis of discourse concerning paranoid delusions, Harper (1994) reported that professionals used empiricist forms of accounting to explain how they reached diagnoses but he noted that they drew on a more contingent and subjective form of accounting to explain variations in diagnoses between professionals. This could be explored in further research focused on professionals' accounts.
There are epistemological challenges associated with applying findings from discourse analytic research (Willig, 1999). However, some discourse analysts explicitly seek to promote Œsubversive discursive practices and spaces of resistance' (Willig, 1999, p. 12). Here we will suggest some implications consistent with our analysis for different interest groups in mental health: researchers, professionals and service users.
DA can provide a useful way both of examining some of the assumptions implicit in professional accounts and of detailing their effects. This can be most useful in relation to topics like mental health where conceptualisations are contested. Future research could explore whether the strategies employed here can be seen in other accounts both of ECT and of other psychiatric interventions. However, there is also a need for further research into the experiences of the recipients of psychiatric interventions, including studies conducted by service user researchers.
Mental health professionals
It may be possible to draw on some of the insights of studies like this to develop training packages to help mental health professionals become aware of the ways in which particular rhetorical resources may foreclose the offering of choices about interventions, like ECT, to service users. Such training could be aimed not only at psychiatrists, but also other health professionals (e.g., psychiatric nurses and social workers, psychologists and anaesthetists, etc.).
It is important to note that ECT recipients, like other users of mental health services, are not a homogeneous group of individuals (see Campbell, 1999). For example, some (e.g., ECT Anonymous, 1999a) have called for ECT to be banned, whilst others (e.g., Perkins, 1994) have made a case for its benefits. Service users could be provided with specific information about the type of accounts which they might expect prescribing clinicians to draw on during discussions about ECT. Robertson and Pryor (2006) have provided a useful format for discussing the benefits and risks associated with ECT with mental health service users. Informing service users about the ways in which health professionals can use language to construct ECT as Œordinary' or Œurgent', and patients as Œseverely ill' for example, could allow them to recognise that this is only one possible way of understanding their situation. Simply knowing that other accounts are available could empower service users to ask more questions about ECT and alternative treatments.
Service users
Service users could also develop training packages˜similar to assertiveness training˜in managing psychiatric interviews by role-playing possible responses. Such training would need to be accessible and to acknowledge both the emotional distress experienced by potential ECT recipients and the difficulties associated with challenging professional power. An example of what such training might look like can be seen in the ECT Anonymous (1999b) factsheet which pre-empts a list of questions and suggests possible responses with the suggestion that Œthere are simple answers to all these queries, even ones with technical terms. If there is a deep reluctance to answer these questions you should suspect the likely quality of your treatment' (p. 1).
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Appendix A.
A.1. Transcription notation
Noticeable pauses of less than one second were indicated by a full stop in brackets (.) while pauses of between 1 and 3 s are indicated by the word Œpause'. A slash (/) indicates interruption and triangular brackets (< and >) indicate incidental contributions that were made by speakers during the other speaker's turn. Transcripts were punctuated to facilitate reading. Identifying details were changed to preserve the anonymity of participants.
Corresponding author. Tel.: +44 1322 297151; fax
Categories: ECT Information, Patient Info and Informed Consent, Studies


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4 Days / 3 Nights
- Explore the Hemel-en-Aarde Wine Route of Hermanus
- Experience some phenomenal land-based whale watching (seasonal)
- Shop for some local arts and crafts in the Hermanus market
- Horse ride along the beaches
This is an African luxury experience that includes three of Southern Africa's most exciting attractions, Fynbos, wines and whales. Fynbos forms part of the Cape Floral Kingdom and is the smallest but most diverse floral kingdom; it has more than three times the floral species of the Amazon Jungle. The Grootbos Nature Reserve forms the centrepiece of this experience. A five star eco paradise perfectly positioned between mountain and ocean; home to the Marine Big 5. It's a natural adventure complete with tastings of renowned wines. A journey through the Hemel-en-Aarde Valley opens up 15 elegant wineries that have been visited by wine lovers from all over the world.
Upon your arrival at Cape Town International Airport, you are met by a Perfect Africa representative. Sit down and enjoy a complimentary tea or coffee while you go over your documentation and travel plans with your representative, who will then assist you to your awaiting transfer. Transfer by road to the fynbos rich Overberg region of the Western Cape, to your accommodation at the Eco-friendly Grootbos Nature Reserve. Enjoy a refreshing welcome drink while marvelling at the unbeatable views over Walker Bay. You will be taken to your suite where you are able to settle in and freshen up for dinner at the Main Lodge.
Overnight at Grootbos Nature Reserve at Garden Lodge, One Bedroom Luxury Suite (B,L,D)
After a scrumptious breakfast, you can choose to spend the day at leisure enjoying the included activities available to you, or alternatively you can opt to explore further with a variety of additional excursions available to you (at an additional cost). From your included activities; join a trip to the Klipgat Caves, which evoke images of prehistoric age when modern man lived in symbiotic harmony with nature off the bounty of land and sea; or enjoy a horse riding session around the 2500 hectare reserve, with one of the experienced instructors, who cater for all levels of riding; or enjoy a marine and coastal drive. Alternatively from the additional activities; consider an optional day excursion to view the Sharks with a Shark Cage Diving Trip to Gansbaai, or a boat trip to see the Whales, or an optional shopping trip in Hermanus. The choice is entirely yours!
Overnight at Grootbos Nature Reserve at Garden Lodge, One Bedroom Luxury Suite (B,LD)
After breakfast, you will be met at reception by your experienced guide for your full day excursion of the Hermanus Wine Region. Take a meander up the winding road of the Hemel-en-Aarde Valley (Afrikaans for "Heaven and Earth") and find yourself in wine paradise. This valley has a renowned reputation for producing exceptional Pinot Noir, Chardonnay and Sauvignon Blanc. Sample some of South Africa's best vintages on this custom-made wine tour, visiting world class vineyards along the
Hemel-en-Aarde Valley, including Hamilton Russell Vineyards, Creation Wines, Sumaridge Estate Wines and Bourchard Finlayson Winery.
Overnight at Grootbos Nature Reserve at Garden Lodge, One Bedroom Luxury Suite (B,L,D)
After breakfast, you will transfer by road back to Cape Town International Airport where you will continue with your onward arrangements.

subset: commoncrawl


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Buying a brand-new Volvo car, wagon or SUV isn't the only way to enjoy the latest performance, technology or safety features today's market has to offer. The Autobarn Volvo Cars Oak Park carefully selects quality pre-owned Volvo vehicles to include in our certified pre-owned Volvo program. Drivers from Oak Park, Lisle and the greater Chicago area can find exceptional deals on gently used Volvo models that both look and run like new on our showroom floor.
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The Health Effects of Sweeteners Consumption
San Antonio, TX, The general and metabolic impact of using alternative sweeteners, mainly added to food and drinks, can affect the quality of the end product, especially the nutritional and organoleptic properties, as well as energy consumption and body weight. According to the article A current and global review of sweeteners; regulatory aspects, before choosing an alternative sweetener for its supposed metabolic effects it should be compared with sugar as a reference standard.
Recent studies show that artificial sweeteners, especially in drinks, may be useful in reducing energy intake as well as body weight and reducing the risk of cardiovascular disease, compared with sugar consumption.
Stevia extract is one of these alternative sweeteners. It is a zero calorie sweetener of natural origin, extracted from the leaves of the plant species Stevia rebaudiana. The Global Stevia Institute (GSI) says that "the safety of stevia extract for human consumption has been established through rigorous peer-reviewed research." Most global regulatory organizations, including the Food and Agriculture Organization/World Health Organization's Joint Expert Committee on Food Additive (JECFA), the European Food Safety Authority (EFSA), Food and Drug Administration (FDA), and Food Standards Australia New Zealand (FSANZ), have determined stevia extract to be safe for consumption.
The GSI says that the safety assessment for food ingredients by regulatory agencies is an extensively detailed and lengthy process, designed to ensure that a new food ingredient, such as a non-caloric sweetener as stevia extract, does not pose a risk for any consumers. The results from toxicology or safety studies are used to establish the Acceptable Daily Intake (ADI), which is defined as the amount of a food ingredient that people can consume on a daily basis during their lifetime without any appreciable risk to health. Nowadays, stevia extract has been rigorously tested and given the stamp of approval by multiple regulatory organizations around the globe.
The GSI states that only high purity stevia leaf extract has been evaluated and approved for use as an ingredient in food and beverages by multiple regulatory agencies throughout the world. Crude stevia extracts or the whole stevia plant leaves are not approved by regulatory authorities for human consumption.
- García Almeida, J.M. Gracia M.ª Casado Fdez. and J. García Alemán: A current and global review of sweeteners; regulatory aspects. Nutrición Hospitalaria, 2013.
- http://globalsteviainstitute.com
SVETIA® Calorie – Free Sweetener is made with cane sugar and stevia extract. One packet of SVETIA® contains only one gram of carbohydrates. People with diabetes are advised to check with their registered dietitian or physician.


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Tarasenko, Nataliia Iuvenalevna
Tarasenko, Nataliia Iuvenal'evna
Born, Aug. 18 (31), 1911, in the city of Novozybkov, in what is now Briansk Oblast. Soviet hygienist. Corresponding member of the Academy of Medical Sciences of the USSR (1967). Member of the CPSU since 1940.
Tarasenko graduated from the Saratov Medical Institute in 1933. In 1965 she was appointed head of the subdepartment of occupational hygiene at the First Moscow Medical Institute. Her main works are concerned with radiation hygiene and safety in working with sources of ionizing radiation. Tarasenko received the Lenin Prize in 1961 and has been awarded four orders and various medals.
WORKSGigiena truda pri rabote na atomnykh elektrostantsiiakh. Moscow, 1960. (Coauthor.)
Gigiena truda pri gammadefektoskopii metallicheskikh izdelii. Moscow, 1960.
Gigiena truda pri rabote storiem. Moscow, 1963.
Zashchita i ochistka kozhnykh pokrovov ot radioaktivnykh zagriaznenii. Moscow, 1972.


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IT User
Our IT Application Specialist apprenticeship aims to give learners who are new to their IT-based role the skills and knowledge they need to work with computers and software on a daily basis at a professional level. As well as three mandatory units, there's a variety of optional units, such as: The use of Word, Database and Power point software, Optimising IT system performance and the use of Image manipulation software. These adjustable units allow the employer a chance to adapt the apprenticeship so it fits the apprentice's job role.
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- Level 2 Diploma in IT User Skills (ITQ)
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- Employment Rights and Responsibilities
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Job Roles
- Intermediate Level Apprenticeship
- Website technician
- Data Administrator
- Digital Assistant
- IT Clerk
Contact us using the form below...


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4 Bedroom House For Sale in Hennops River
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Despite the ubiquity of mental illness and the steady erosion of the social stigma once attached to such struggles, the health-care system has not kept up. To read more, click the link to the The Star article.
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John Joseph Adams has been called "the reigning king of the anthology world" by Barnes & Noble.com, and has published such great and bestselling anthologies as Brave New Worlds, Living Dead, Living Dead 2, By Blood We Live, and many more. He has been nominated for the 2011 Best Editor (Short Form) Hugo Award. He is the editor for Fantasy Magazine and Lightspeed Magazine. He is also the co-host for the podcast, The Geek's Guide to the Galaxy.
Alex C. Telander: What are some of your favorite books and authors of all time?
John Joseph Adams: I tend to shy away from naming favorite authors, but I'll happily name favorite books and stories and movies and whatnot. The Stars My Destination by Alfred Bester is my favorite novel, and has been for a long time—really since it blew my mind when I read it and as a result helped me truly fall in love with the genre. (In my "personal bio" on my website, I talk at length about what The Stars My Destination means to me.)
Other novels I'm a big fan of include: Wild Seed by Octavia E. Butler, A Canticle for Leibowitz by Walter M. Miller, Jr., The Book of the New Sun by Gene Wolfe, 1984 by George Orwell, Fahrenheit 451 by Ray Bradbury, Earth Abides by George R. Stewart… Obviously I could go on and on! A recent favorite is Mechanique by Genevieve Valentine, which just came out and is CRAZY GOOD, and I also really enjoyed Mira Grant's zombie novel Feed, which is a finalist for this year's Hugo Award.
In short fiction, my favorites include "Flowers for Algernon" by Daniel Keyes, "The Deathbird" by Harlan Ellison, "Speech Sounds" by Octavia E. Butler, "The Lottery" by Shirley Jackson, and "The Ones Who Walk Away From Omelas" by Ursula K. Le Guin. (That I got to reprint those last three is quite an honor.)
Alex: In a succession of concise bullet points, how did you get from reading great science fiction and fantasy to editing award winning anthologies?
How was that? I'd say point 7 is the critical one there.
Alex: Did you know Living Dead was going to be such a bestseller?
John: I didn't know what to expect, honestly. At that point, I'd only done Wastelands, which was a huge (and surprise) success, and a little anthology for Prime Books called Seeds of Change. While Wastelands did really well, Seeds of Change didn't set any sales records, though it was hard to judge anything from it because it was done with a very small print run, with little publicity etc. (In the end, it did just fine for what the publisher was attempting to do with it.) But anyway—I didn't have a lot of evidence to suggest what I could expect. I knew zombies seemed to be blowing up like post-apocalyptic fiction had, and I was confident I'd put a good book together—one that I thought was not only qualitatively excellent, but also full of the requisite big names that should ensure sales. But I really had no idea that the anthology would break out the way it did…and if I'd ever even dreamed that it would be so successful, someone in publishing would have surely appeared in my dream to tell me how ridiculous it was to think that that could happen. But it did happen—really, it seems like it was about being in the right place, at the right time, with the right product. At that point, no one had done an anthology attempting to collect the best zombie fiction of all-time, and obviously there was a hunger for such a book in the marketplace.
Alex: Will there be a Living Dead 3?
John: I would gladly do one, but the publisher, Night Shade Books, wasn't interested in doing a third volume. The Living Dead 2, though it has been basically just as critically-acclaimed as volume one, hasn't sold nearly as well as the first one. Still, by anthology standards it's done quite well, so I'm kind of surprised they didn't want to do another. But c'est la vie. There are other anthology projects to work on in the meantime, and perhaps I'll do another zombie anthology somewhere down the line for someone else.
Alex: Where do your ideas for anthologies come from?
John: There's a factory in Schenectady, NY. If you send them $2.50, along with a self-addressed, stamped envelope, in return you'll receive five index cards with anthology ideas on them. I could give you the address, but I probably shouldn't: trade secrets and all.
Alex: Can you talk about some of your future anthologies coming out?
John: Sure. The next anthology I have coming out is the Lightspeed: Year One anthology, which will collect all of the fiction published in the first year of Lightspeed Magazine all in one (hardcopy) volume. Since Lightspeed is an electronic magazine, it'll be the first print publication of a bunch of the stories, so a lot of people will probably be encountering them for the first time. It'll contain everything from when we launched (June 2010) through May 2011—our first twelve months of fiction. That should be out sometime around November.
Then I've got Armored, for Baen Books: From Starship Troopers and Iron Man to Halo and Mechwarrior, readers and gamers have long been fascinated by the idea of going to battle in suits of personal, powered combat armor or giant mechs. This anthology will explore the range of what can be done with the trope, from the near-future powered exoskelton technologies we might be seeing just a few years from now, to the combat armors of Starship Troopers and Halo, to the giant bipedal mechs of Mechwarrior. For more details, see this article on io9 about the anthology. It will include new stories by Alastair Reynolds, Dan Abnett, Jack Campbell, Jack McDevitt, Simon R Green, Sean Williams, Genevieve Valentine, and more. It'll be out from Baen sometime in 2012.
And then there's The Mad Scientist's Guide To World Domination, from Tor: From Victor Frankenstein to Lex Luthor, from Dr. Moreau to Dr. Doom, readers have long been fascinated by megalomaniacal plans for world domination and the madmen who come up with them. Typically, we see these villains through the eyes of superheroes (or other good guys) as they attempt to put an end to their evil ways. This anthology, however, will explore the world of mad scientists and evil geniuses–from their own point of view. Evil geniuses are always so keen on telling captured heroes all their fiendish plans. Isn't it about time someone gave them a platform such as this one to reach the masses with their messages of death and destruction? It features stories by: Carrie Vaughn, Alan Dean Foster, Daniel H. Wilson, Austin Grossman, Marjorie M. Liu, Ben Winters, David Farland, Mary Robinette Kowal, Harry Turtledove, Seanan McGuire, Naomi Novik, and more. Also out sometime in 2012.
I've also got another new anthology coming out in 2012 that hasn't been announced yet, but should be made public soon.
UPDATE: On May 19th, 2011 it was announced that John Joseph Adams would be the editor of a new anthology based on the classic John Carter of Mars series. The full details can be found here.
Otherwise, I'm working on a couple of different proposals right now for 2013 and beyond, and then there's always Fantasy Magazine and Lightspeed every month.
Alex: Have you, do you, or do you plan to write your own stories and/or books at some point?
John: As I mentioned earlier, I got interested in editing through an interest in writing, but once I started working in editing, I put my writing on hold. I may return to it someday, but for now the editing is keeping me pretty busy, and readers seem to think I have an affinity for it, so for now I'll stick with it.
Alex: What do you hope readers get from reading your anthologies?
John: That varies from book to book, I suppose. With a book like Brave New Worlds, I hope that readers feel like they've read the definitive anthology on the subject, and that the book has provided a clear and distinct thesis on what dystopian fiction is, and why the stories I chose are among the best examples of it. Also, obviously, I hope they'll think about the concepts dystopian literature is known for exploring, and reflecting on those in the way that good fiction makes us do.
Alex: You also edit Fantasy Magazine and Lightspeed Magazine. Can you talk about these projects?
John: Fantasy and Lightspeed are two online magazines published by Prime Books. Lightspeed launched in June 2010, whereas Fantasy has been around since 2005 and I just took over as editor for it recently (my first issue as editor was the March 2011 issue). Both magazines publish two original stories every month (fantasy in Fantasy, and science fiction in Lightspeed, as you would probably guess), along with two reprints. Alongside each piece of fiction, we run a piece of nonfiction, usually something riffing off the ideas in the fiction, or a feature interview.
Lightspeed's had a great initial run: it's a finalist for the Hugo Award this year, I'm a finalist as well, and "Amaryllis" by Carrie Vaughn (from the June 2010 issue) is also a finalist. Additionally, "Arvies" by Adam-Troy Castro and "I'm Alive, I Love You, I'll See You in Reno" by Vylar Kaftan are finalists for the Nebula Award. Also, 9 out of the 16 original stories we published in 2010 were reprinted in a year's best anthology. Fantasy's doing well too, based on early reader response, but it's only been a couple months since I took over at this point—and it's too early for award nominations or year's best appearances; I'll keep my fingers crossed for next year.
Both magazines are published in ebook format monthly, and are available for sale in various ebook retail channels (Amazon Kindle, B&N Nook, iBooks, etc.), as well as in epub format from our own stores. Additionally, both magazines serialize each issue's content online, for free, throughout the month. So if you'd like to read the magazines for free, you can, but you just get access to the website edition and you have to wait; if you'd like to get the whole issue all at once, and in convenient ebook format, you can buy the ebook edition on the first of every month.
Alex: Do you have any advice for writers looking to get published?
John: Read a lot. And specifically read the form you're interested in writing—if you're working on short stories, read tons of short stories; it's not going to help you with your short stories all that much if all you're reading is novels. Also, write a lot. And when you write crappy stuff, don't dwell on it; just move on to the next thing and try to do better.
Also, involve yourself in the community—go to some conventions, join the conversation on Twitter, read author blogs, etc. The internet is full of resources for writers, so now it's easier than ever to learn the ropes from the pros and also to interact with others who are at the same level as you.
Alex: And what's The Geek's Guide to the Galaxy podcast?
John: It's basically a talk radio show for geeks. But, you know, a podcast. It's hosted by me and author David Barr Kirtley. We spend about half of each hour-long episode interviewing our featured guest, and then for the rest of the show Dave and I debate various geeky topics, usually something relevant to the subjects brought up in our interview. Some of our past guests include authors George R. R. Martin, Robert Kirkman, Naomi Novik, Holly Black, and Paolo Bacigalupi, filmmaker Alexander Phillipe (The People vs. George Lucas), and scientist Neil deGrasse Tyson. Our latest episode features an interview with science writer Mary Roach (Stiff, Packing for Mars), and then Dave and I talk about spooky stories and movies set in space. The show's currently hosted on io9.com, and our official website is at geeksguideshow.com.
Alex: Do you have time to read for fun anymore? What are you reading now?
John: Now and then I manage to carve out some pleasure reading time, though it's hard, since I have so much I should be reading. Lately, I've managed to read a couple of pre-release zombie novels in order to blurb them—Mira Grant's Feed, John Skipp & Cody Goodfellow's Spore, and Daryl Gregory's Raising Stony Mayhall. I also made time to read Mechanique, which I mentioned earlier, just because I'm such a big fan of Genevieve's short fiction, and the milieu seemed so interesting from the description, I was dying to see what she'd done with it. (And liked it so much, I got her to write me a story set in that milieu for Fantasy Magazine.)
But those could all be seen as work, I suppose. What I'm actually reading (or re-reading, rather) right now is A Clash of Kings by George R. R. Martin. Once the Game of Thrones tv series started, and having talked about it at length with Dave on Geek's Guide, I just couldn't help myself and I went in for a re-read. Plus, with A Dance with Dragons due out in July, I figured it was time for me to get a refresher course.
Alex: Do you have a special anthology that you've always wanted to publish?
John: Well, Wastelands, Brave New Worlds, and Armored are all anthologies that deal with themes that I've been a fan of for a long, long time, so those are all special to me. So had I not already done them, I would have cited those in answer to your question.
But I would actually love to do a metal-sf anthology—like sf/fantasy stories inspired by metal songs. I've even done research into such a project; that is, I've hunted around to see who in the genre likes metal. Unfortunately, no one seems to think it would be a commercial enough book to succeed, and, of course, I'd be extremely limited in who I could invite to participate. It would also be really tough to not compromise the purity of the setlist that inspires the stories, since I would have a vision of what bands and songs to include, but the authors would likely have other songs and bands in mind; while we may all like metal, there's so many varieties that it would be unlikely I could find enough people who have a similar taste in metal as I do.


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