Blog Archives

What's In A Name?

4/29/2020

The problem for Individuals and Families is that the Legal System is waiting to be led by largely the Mental Health Clinical Profession.
BUT the Mental Health Clinical Profession is waiting to be led by the Researchers. Further, when the Researchers (Including the National Institute of Mental Health) do try to lead, the Professional Organizations such as the American Psychiatric Association put up a fair amount of resistance.
There are a lot of very helpful Youtube videos out there -- BUT these videos do not amount to a COMPREHENSIVE FEDERAL TRANSLATIONAL MEDICINE PROGRAM much less TRANSLATIONAL CRIMINAL JUSTICE PROGRAM.
One could IMAGINE, hypothetically, that if one doesn't have clear or accurate diagnostic categories or definitions -- that could cause some problems and even great injustice in the society.
As hard a time as our society has had in coming to terms with an "invalid" DSM -- we've had an even harder time with the need for "LONG TERM CARE" in some cases -- because:

if we can't effectively treat the person
the person must be evil, and
the ECONOMICS of "caring" for people with long term cognitive disabilities is very complicated.

Antisocial Personality Disorder and Therapeutic Justice Court Programs (2012)
Journal of Judicial Administration

AJMC (2019)

Dr Godfrey Pearlson Explains the Biological Fingerprints Underpinning Psychiatric Disorders

Classifying mental disorders using traditional tools like the Diagnostic and Statistical Manual misses the vast differences in biomarkers that can exist in patients with the same diagnosis, which is why research is looking to biological measures and “biotypes” to provide more information, according to Godfrey Pearlson, MD, professor of psychiatry and neuroscience, Yale School of Medicine.

The Australasian Institute of Judicial Administration (Therapeutic Jurisprudence & Judging)

A Rose By Any Other Name

Emotional Dysregulation

Psychiatry & the Criminal Justice System: Simplicity on the Near Side of Complexity

"GOEBEL" RE-IMAGINED UNDER "MEDICAID NETWORK ADEQUACY"

4/28/2020

Colorado's Landmark "Goebel Case" involved the death of a homeless woman with mental illness, and it was decided under Colorado's Care & Treatment Act for Individuals with Mental Illness.

The case was spearheaded by attorney Kathleen Mullen --"Colorado's Dorothea Dix" -- really a combination of Dorothea Dix, Clarence Darrow, Atticus Finch and a Pit Bull (our apologies to Pit Bulls).

The Colorado Act was subsequently amended by the CO Legislature to include the phrase "subject to available appropriations."

One of the many "fascinating" aspects of the "Goebel Case" was that it involved access to "voluntary treatment."

The Truth is "ANTI-SOCIAL PERSONALITY DISORDER" is NOT ONLY running amok in the Criminal Justice System, it is running amok in the Care System as well -- and it's not hard to understand why -- and it does have a lot to do with RESOURCES.

We need Medicaid Network Adequacy Standards for Hard to Treat "Emotional Dysregulation."

One of the things that is so SCARY, FRUSTRATING, INFURIATING & FRIGHTENING about the current situation for individuals and family members is --that many individuals do have a documented history of one or many cognitive problems -- sometimes even going back to when the person was a small child ---

BUT WHEN YOU'VE EXHAUSTED THE TREATMENT OPTIONS IN AN OVERLOADED BEHAVIORAL HEALTH SYSTEM -- YOU HAVE ALSO OFTEN EXHAUSTED THE "CARE OPTIONS."

In our Society, those "Care Options" can look like and often are the homeless shelter, the jail, the prison.

We need to hone in on this population -- and do a HELLUVA LOT BETTER than what we are doing.

Once again we have some current federal laws and regulations to do just that. We must comply with them, and use them.

Medicaid Network Adequacy could help us greatly ameliorate MASS INCARCERATION & HOMELESSNESS in the US.

Attorney Kathleen Mullen -- CO's Dorothea Dix

Goebel Case

"I DON'T CARE" AS A SOCIETAL RORSCHACH TEST

4/27/2020

My observation is that the people and institutions who are protesting how much they don't care -- often care a lot.

BUT don't have an easy path and often not any apparent path to voice "caring" when there is no easy or apparent "FIX."

When we think about "EMOTIONAL DYSREGULATION" and the CRIMINAL JUSTICE SYSTEM -- the exhausted individuals and institutions not only include the individual and any victim, it can include:

a family at wit's end
an educational system in over its head
a mental health profession in over its head
a disability community that is not sure what to make of all this

  It does seem safer and sometimes it actually is safer to give more "CHANCES" to individuals with access to RESOURCES.

That is NOT supposed to be the right answer.

    When I'm listening to the PROSECUTOR or JUDGE go on about how this 50-something Homeless Black Man with SEVERE & PERSISTENT MENTAL ILLNESS has had a lot of "CHANCES" -- COUNSEL, YOUR HONOR -- did you just have a PSYCHOTIC EPISODE?

Those kinds of easy judgments often born of frustration -- don't seem connected to reality.

    We want absolute JUSTICE & FAIRNESS -- but it is pretty ELUSIVE in this life.

We must have RESEARCH.

BUT a lot of what Disability Civil Rights Law is --is PROFOUND HARM REDUCTION. It includes CRIMINAL JUSTICE.

Brad Pitt look-a-like Swiss psychiatrist Hermann Rorschach (1884 - 1922). His inkblot test went to subjective experience.

Psychiatry and the Criminal Justice System: Simplicity on the Near Side of Complexity

GETTING BEYOND THE "WERGELD"

4/26/2020

  One of the biggest problems we have in Criminal Justice -- is we want to help, but the problems we're confronted with are complicated and we often don't have easy solutions -- and we might not have that knock out "vaccine" at all --- for brain injury, mental illness, substance use, developmental disability, etc.

Really going back to the Anglo-Saxon "Wergeld" and beyond -- in human society -- if you have RESOURCES you can buy your way out -- otherwise you're going to pay with your life.

This has just been a very pragmatic calculation on the part of a great number of people and societies, including our own.

  What makes it a little, really a lot worse in our society, is that we have been very prepared to live the BIG LIE partly because it's a self-serving delusion and partly because we really believe it.

BUT that BIG LIE is getting harder to maintain.

It's getting harder to maintain because of the SCIENCE.

BUT it is also getting harder to maintain because the SEVERITY of the PROBLEM seems to be increasing.

A lot of the psychiatric categories we currently have are being re-conceptualized based on the SCIENCE and symptoms that seem to cut across multiple categories.

One of those psychiatric symptoms is "EMOTIONAL DYSREGULATION."

The explosion of "ADHD" has been shocking to many, but if "ADHD" is associated with:

smoking during pregnancy, and/or
high fat sugary diets

Is it really that surprising that ADHD has increased in the 20th and 21st centuries. Further, ADHD may not go away in future generations regardless of mom's diet or smoking.

So what I want to put forth is these are GENERATIONAL ISSUES, they are NOT just INDIVIDUAL issues and we need a PUBLIC HEALTH approach that recognizes that.

Further, in the words of Mental Health America -- we need to get there before STAGE 4.

If we are at STAGE 4 and the Criminal Justice System -- we must have SAFETY and HUMANE TREATMENT.

YOU -- or more likely "SOMEONE ELSE" that you've never met and really can't relate to and doesn't have any resources--- can't get HUMANE TREATMENT in AMERICAN JAILS & PRISONS.

"YOU" & "THEY" are the key to solving this.

Colorado Launches Two Generation Approach to Family Services

Colorado is testing a new approach to providing services to struggling families in an effort to address the intergenerational cycle of poverty, incarceration and foster care.

-----Chronicle of Social Change (2018)

A FEW THINGS . . . ON THE RAGING WILDFIRE IN AMERICAN CRIMINAL JUSTICE & "FORENSIC MEDICINE"

4/25/2020

Executive Functioning Deficits as Characteristic of "Prison Brain"

Can we hone in even further on "Emotional Dysregulation"/ "Interpersonal Sensitivity" as seen in ADHD / Various Mental Illnesses / "Personality Disorders"[this doesn't seem to be a valid category -- and it appears to be one of many invalid categories]/ Brain Injury / Some Endocrine System Disorders/ Some Immune System Disorders/ Some gut disorders
Is any forensic mental health professional competent to provide differential diagnosis on this? No.
Does any forensic mental health professional have a valid "diagnostic manual" for "mental health"? No.

Researchers Have Been Ringing the Alarm Bells since at least 2013 -- If this was COVID-19 the Media & Everybody Else Would Be All Over This & We Would Be Having Daily Briefings from Our Policymakers

This has so many ramifications -- and the problem isn't that people don't understand that -- it is that they do understand that.
Then again maybe people don't understand -- and this must be broken down a lot more.

What's the Key to Getting Out of the Dilemma: Ultimately it is letting go of PUNISHMENT and moving totally to SAFETY & PUBLIC HEALTH

This is NOT NIRVANA -- it is just a big step up from the HORROR that is going on in AMERICAN CRIMINAL JUSTICE

The IMMEDIATE BRIDGE we NEED NOW is Full Compliance with Federal Disability Civil Rights Laws such as:

The Americans with Disabilities Act & Olmstead
Mental Health Parity & Addiction Equity
Medicaid Network Adequacy

Each State, including Colorado, needs a PLAN with MEASURABLE GOALS, REASONABLE TIME FRAMES, & FUNDING TO SUPPORT THE PLAN to provide:

Intensive Services
Housing
Placements

When do we need that PLAN -- we needed it 20 years ago.

We need it NOW -- this year --and there are a lot of ways to build in complying with Disability LAW into ECONOMIC STIMULUS coming out of the COVID-19 PANDEMIC.

National Institute of Mental Health: 5 Mental Health Disorders do not appear to be "distinct" and appear to share problems in Calcium Channels

Executive Functioning & "Prison Brain"

Behavioral and emotional dysregulation trajectories marked by prefrontal-amygdala function in symptomatic youth (2014)

"These factors suggest that behavioral and emotional dysregulation is not well characterized using current diagnostic nomenclature, and may represent a behavioral dimension(s) that cut across different diagnostic categories.

"Adopting a dimensional approach to the study of behavioral and emotional dysregulation in youth parallels the approach advocated by the NIMH RDoC (Insel et al., 2010)."

Emotional Dysregulation

Psychiatry and the Criminal Justice System: Simplicity on the Near Side of Complexity

The "PRO-SOCIAL MONSTER" WE CREATED: FORENSIC MENTAL HEALTH

4/24/2020

Life and History are rife with IRONY.
How did this INDUSTRY of CRIMINAL FORENSIC MENTAL HEALTH PROFESSIONALS develop.
Like most industries and professions -- it's SUPPLY & DEMAND.
Who demanded this? Criminal Defense Attorneys.

In the process, we've created a "PRO-SOCIAL MONSTER" that views the world largely through "legitimate" "mental illness" contrasted with "anti-social personality disorder" (CODE for: worthy of punishment).

The profession as a whole doesn't have a scientifically valid diagnostic manual according to the National Institute of Mental Health and other researchers around the world.

That is more than problematic no matter where one is in the "MENTAL HEALTH SYSTEM."

But in Criminal Justice it's a HORROR SHOW with hundreds of thousands of people being written off with "ANTI-SOCIAL PERSONALITY DISORDER."

Both the LAW & MENTAL HEALTH deal in linguistic constructs.

In Criminal Justice, we need medical professionals who can utilize BIOMARKERS to differentiate among various combinations of:

Brain Injury
Mental Illness
Trauma
Substance Issues, and/or
Developmental Disability
Etc.

We do have some biomarkers -- we don't have all we need by any stretch of the imagination.

It's a little easier to "live with" these IMPERFECT LINGUISTIC CONSTRUCTS until they can be reformed if we are limiting our concerns to SAFETY and PUBLIC HEALTH and set aside our desire to punish until we become PERFECT.

Gene Wilder in "Young Frankenstein" (1974)

Psychiatry and the Criminal Justice System: Simplicity on the Near Side of Complexity

Definitions & Lateral Problem Solving

4/23/2020

outdated definitions in the law
unscientific definitions in mental health, but
Federal Disability Civil Rights Laws, if complied with, could make things much better.

As complicated as COVID-19 is -- it is NOT as complicated as Cognitive Disability and the often overlapping nature of Brain Injury, Mental Illness, Substance Use and Developmental Disability.

For Definitions in the Law and Mental Health to change, first one has to recognize the WORLD OF HURT invalid definitions are causing.

I think for attorneys -- they get it -- they understand that definitions often determine outcomes.

  What is most concerning to me is that members of the Mental Health Profession are "blissfully ignorant" of the ramifications of the National Institute of Mental Health declaring their diagnostic manual scientifically invalid, and under pressure that was revised to-- NIMH is "agnostic" on the DSM.

Especially in Forensics, there appears to be this feeling that "My Ass Is Covered" because these are "legal categories" -- so however, stupid or not these legal categories maybe -- it's not my problem.

  The problem is the society is relying on the determinations of these forensic psychologists and psychiatrists and invariably this involves making diagnoses when there is no solid foundation for them to do that.

I don't think anyone can meet PROOF BEYOND A REASONABLE DOUBT in that kind of a situation.

AND THAT DRAMATIC CONCLUSION, is why we are afraid to go there.

BUT if we turned to LATERAL PROBLEM SOLVING -- and in fact we are across the Country and around the World, we try to analyze this the best we can from a PUBLIC HEALTH perspective.

In the US, that means MEDICAID and there is a lot of work going on to integrate MEDICAID with JUSTICE INVOLVED POPULATIONS.

  This is far beyond enrolling people who are Justice Involved. People who managed to break in to jail or prison often need Intensive Services & Placements due to:

Brain Injury
Mental Illness
Substance Use, and/or
Developmental Disability

Oklahoma's 2016 Revision of Its Insanity Law

Not Guilty By Reason of Mental Illness; Guilty by Reason of Mental Defect: The Difference "Anti-Social Personality Disorder"

"It all comes down to the difference between a mental illness and a mental defect, which in turn depends on whether the accused has an “anti-social personality disorder.”

BUT IF the MENTAL HEALTH PROFESSION doesn't have a scientifically valid diagnostic manual -- how does any of this shake out into some kind of coherent logical whole.

I'm waiting to understand why these forensic psychologists and psychiatrists shouldn't have their licenses yanked.

I do understand why this is being allowed to persist:

the perception we don't have anything else
a desire to punish people who may be pretty unsympathetic
etc.

Coronavirus Glossary: Key Terms About the Pandemic Explained

Colorado's Definition of Insanity: Not written Dark Ages -- AND it just has that

"Moral Obliquity,
"Mental Depravity . . .
"Kindred Evil Conditions" Feel

16-8-101.5. Insanity defined - offenses committed on and after July 1, 1995
(1)  The applicable test of insanity shall be:
(a)  A person who is so diseased or defective in mind at the time of the commission of the act as to be incapable of distinguishing right from wrong with respect to that act is not accountable; except that care should be taken not to confuse such mental disease or defect with moral obliquity, mental depravity, or passion growing out of anger, revenge, hatred, or other motives and kindred evil conditions, for, when the act is induced by any of these causes, the person is accountable to the law; or
(b)  A person who suffered from a condition of mind caused by mental disease or defect that prevented the person from forming a culpable mental state that is an essential element of a crime charged, but care should be taken not to confuse such mental disease or defect with moral obliquity, mental depravity, or passion growing out of anger, revenge, hatred, or other motives and kindred evil conditions because, when the act is induced by any of these causes, the person is accountable to the law.
(2)  As used in subsection (1) of this section:
(a)  "Diseased or defective in mind" does not refer to an abnormality manifested only by repeated criminal or otherwise antisocial conduct.
(b)  "Mental disease or defect" includes only those severely abnormal mental conditions that grossly and demonstrably impair a person's perception or understanding of reality and that are not attributable to the voluntary ingestion of alcohol or any other psychoactive substance but does not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.
(3)  This section shall apply to offenses committed on or after July 1, 1995.

Our Interlude: "Definitions" & "Balancing of Interests"

4/22/2020

One may agree or disagree with Gov. Polis' "Safer at Home" plan (which seemed to be telegraphed about a week ago)-- but it seems to successfully balance numerous interests while leaving the door open for modifications based on changed circumstances.
I think Gov. Polis and some other governors have tried hard not to be "Pollyannish" -- and the "Safer at Home" policy seems honest and based on the science.
Further, the Protestors got to take some credit and they also got to give some credit. Further, the protest leader indicated if there was a downturn, they would be open to re-instituting "Stay at Home."
Well, that's how democracy is supposed to work, right?

Policymakers and the Public will likely be EXHAUSTED after COVID-19, but it is this type of mobilization that is really needed for Mental Health and Cognitive Disability in general.

To a certain extent definitions have been a problem in the COVID-19 Pandemic -- but they have been dealt with relatively openly.

With respect to "Mental Health" and the Criminal Justice System:

Definitions of Insanity and Incompetent to Proceed, other variations are more than dated;
Mental health or forensic "testing" -- doesn't include BIOMARKERS and is generally a questionnaire or interview.
DSM 5 diagnoses are included in "expert" reports and testimony. These DSM 5 diagnoses have been termed scientifically "invalid" by the US National Institute of Mental Health (and researchers in the UK and Canada)
The Science around Mental Health and Cognitive Disability is exploding and appears to include other Systems of the Body, not just the Brain and Nervous System. Specifically, there seem to be large roles for the Immune System, the Endocrine System, and the Gut.
To top it off, we appear to be in the midst of a BIOLOGICAL REVOLUTION in which Human Behavior & Intent are understood from a complex biological perspective.

WHAT THE HELL IS GOING ON HERE?

It looks like to me what is going on is that various individuals and disciplines are CONFUSING "VALID DEFINITIONS"/HONESTY with BALANCING INTERESTS.
Further, I think part of this is unconscious -- but some isn't -- certainly in the LAW.
I think a lot of judges around this country would allow that person with a cognitive disability to go to:

housing with intensive services
a placement, or
a secure therapeutic placement

If States around the country substantially complied with Federal Disability Civil Rights Laws and made those options available to SCALE.

The balancing of interests is primarily SAFETY/CIVIL RIGHTS/RESOURCES/THE LAW -- and in one sense or another, they are all MANDATORY.

The States have been very vocal in their need for additional resources from the Feds for COVID-19. They need to be just as vocal for mental health and other cognitive disabilities.

When there are:

Serious problems with our "Definitions" from one or more "DISCIPLINES" (think Law & Mental Health) and
Our Definitions are ENTANGLED with our "Balancing of Interests" in a complex society,
AND even more frighteningly these "Definitions" are ENTANGLED in Our Criminal Justice System.
One is very unlikely to have JUSTICE or MENTAL HEALTH.

Human Growth Hormone Deficiency As A Case In Point for Individualized Medicine

4/21/2020

pituitary gland

Growth hormone (GH), also called somatotropin or human growth hormone, peptide hormone secreted by the anterior lobe of the pituitary gland. It stimulates the growth of essentially all tissues of the body, including bone.

----Brittanica.com

Its actions involve multiple organs and systems, affecting postnatal longitudinal growth as well as protein, lipid, and carbohydrate metabolism.

GH hypersecretion results in gigantism or acromegaly, a condition associated with significant morbidity and mortality, while GH deficiency results in growth retardation in children and the GH deficiency syndrome in adults.

Val's Take & What's the Point?

Human growth hormone deficiency in the scheme of things may impact very few people -- but if you are one of those people -- it's a really big deal.
AND the point is the crying, desperate need for INDIVIDUALIZED, PRECISION INTEGRATED MEDICINE.
Human growth hormone wasn't a "thing" when I was growing up -- you were short and you made the best of it. As a young adult, I was 5'0" tall and I really viewed height as COSMETIC not anything that went to my functioning as a person.
5'0" is kinda the cutoff -- after that you start entering the REALM OF THE MUNCHKINS.
By midlife, I did get at least one physician question as to whether I was a Dwarf -- "No, you A-Hole (I thought) -- but nothing was offered in terms of treatment or what might be relevant health issues, etc).
We do have to break down the Systems of the Body to understand them, but we have to constantly INTEGRATE & RE-INTEGRATE our knowledge -- or we will never get it.
That is certainly true for psychiatric sysmptoms and disorders that often involve multiple systems of the body.

The Munchkins & Dorothy in the "Wizard of Oz"

VETERANS ADMINISTRATION IS ADVERTISING SEXUAL TRAUMA AWARENESS MONTH ON THE ORCHID WEBSITE

4/19/2020

IS IT TIME FOR US TO GET REALLY AWARE?

    It's been no small task to figure out where Orchid falls in the landscape -- a big part of what I do is work as a self-appointed Teller of Truth to Power.

    It could be political power but it's often just a view in society that I think is outrageously incorrect.

  I think women actually are BIG TEAM PLAYERS, in fact, many of them are much more likely to "SPILL THE T" in an effort to reform the system than men -- not all. Seeing that BIG PICTURE often proves to be more of a detriment than a help.

  I don't know how to break this to anybody but it certainly doesn't appear that the Military has worked out for women.

   Of course, it hasn't been working out for men for THOUSANDS OF YEARS.

  I think one does have to grant that some of the most sophisticated thinkers in the US on war and peace are SURPRISINGLY in the US Military -- it somehow never quite trickles down to what's really going on.

In the end, one is in a SUPREMELY HIERARCHICAL SYSTEM with AGGRESSION @ its CORE.

That has a lot of BIOLOGICAL RAMIFICATIONS.

I think men and women will reform the Military and they gotta keep "SPILLIN' the T."

Aggression: Humanity's Ultimate Double-Edged Sword

Kings College London (2015): Aggressive and Violent Behavior Among Military Personnel Deployed to Iraq and Afghanistan: Prevalence and Link With Deployment and Combat Exposure

The YouTube Video to the left from Human Rights Watch describes how women were discharged from the Military for reporting rape, and then labelled with a "personality disorder."
Now most of the harm done by the poor science associated with personality disorder is really unintentional, but as is the case here it can easily be manipulated for purposeful harm because the categories are so vague, and even with the vague categories and criteria-- more often than not it devolves into:

"YOU ARE A ROYAL PAIN IN THE BUTT SO YOU MUST HAVE A PERSONALITY DISORDER OF SOME SORT OR ANOTHER."

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Val's Blog

What's In A Name?

"GOEBEL" RE-IMAGINED UNDER "MEDICAID NETWORK ADEQUACY"

"I DON'T CARE" AS A SOCIETAL RORSCHACH TEST

GETTING BEYOND THE "WERGELD"

A FEW THINGS . . . ON THE RAGING WILDFIRE IN AMERICAN CRIMINAL JUSTICE & "FORENSIC MEDICINE"

The "PRO-SOCIAL MONSTER" WE CREATED: FORENSIC MENTAL HEALTH

Definitions & Lateral Problem Solving

Our Interlude: "Definitions" & "Balancing of Interests"

Human Growth Hormone Deficiency As A Case In Point for Individualized Medicine

VETERANS ADMINISTRATION IS ADVERTISING SEXUAL TRAUMA AWARENESS MONTH ON THE ORCHID WEBSITE

IS IT TIME FOR US TO GET REALLY AWARE?

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IS IT TIME FOR US TO GET REALLY AWARE? ​

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IS IT TIME FOR US TO GET REALLY AWARE?