What keeps you alive? Your will? Your conscious mind? Your choice to remain open, alert, present? Or is it something just beyond your grasp: an obscure automatic process, quietly carrying you forward until it doesn’t?

These are the questions that haunt Wellness Plan (The Flesner), the second full-length album by Genital Shame, the solo project of musician Erin Dawson. Her music exists in a dissociative fog where terror, resignation, and determination become nearly impossible to separate. On Wellness Plan, Dawson widens that world, folding black metal and noise together with fragile moments of stillness.

Dawson’s approach is informed by a background in music education and classical guitar, which she brings to her own strange iteration of experimental music rooted in black metal. Wellness Plan is harmonically dense, with riffs and melodies folding into one another in unexpected ways. It draws from a tradition of weirdo black metal that treats the genre less as a fixed language than as something to pull apart, distort, and reassemble.

While making the album, Dawson encountered old microscopic footage of white blood cells searching for viruses. “I love the idea that even if you struggle with and mask a deep self-hate, there’s something microscopic inside you voting for your continued, healthy existence— even if you feel like you don’t deserve it,” she says. “It’s also about the idea that as beautiful as that image is, it’s still not quite enough.”  The album’s first single, “I Want to Die Before You,” references that, and Dawson adds, “…the ‘You’ in the title refers to both a literal person and a metaphor: the white blood cell.”