Blog Archives

ACCOMMODATIONS FOR EXECUTIVE FUNCTIONING DEFICITS

8/19/2020

Historian John Hope Franklin

See to the right a TABLE of possible strategies to accommodate executive functioning deficits..

The information is taken from the federally funded Job Accommodation Network.

My experience with executive functioning challenges involve:

Taking in a lot more information than other people ---- and that takes time and energy and emotion --- to process.
Further, my priorities can look very different based on this additional information.
I'm very sensitive to my environment --- if I'm being discriminated against or dismissed based on any number of physical characteristics or failure to provide accommodations for cognitive differences --- I may know that -- and that is an unpleasant block that needs to be "processed" in a long line of other things that need to be "processed."
I have the same 24-hour day that everyone else does.
There is a line in ADHD Treatment along the lines of: "The Harder You Try, the Worse it gets."
I think there are REAL BIOLOGICAL REASONS for that --- and one of those is that that stress is killing off your good gut bacteria. (See Forbes (2019): Could Stress Turn Our Gut Bacteria Against Us? New Research Looks For Answers)
The BIG WAY we can REDUCE that STRESS is FOCUS on Strengths. --- Tomorrow, we'll post a DRAFT TEMPLATE for focusing on those strengths.

The Strategies are from the Job Accommodation Network, the Commentary is ours.

CAN WE TALK? ---MENTAL HEALTH TREATMENT

8/16/2020

Medication Management

Psychiatric Medication is incredibly complicated and imperfect.
If there are problems "genetic testing" or calling in a Neuro-pharmacologist MIGHT help.
Some psychiatrists actually are pretty good at medication management given the backward state of the science -- but those professionals would really like to be doing THERAPY -- HEAVEN HELP US.

"Therapy"

Even though the SIGNS are all around them -- most mental health professionals don't fully appreciate the IMPLICATIONS and RAMIFICATIONS of dealing with someone who may be or likely is DEVELOPMENTALLY DIFFERENT in some way.
Right up there in our list of concerns -- the mental health professional is often NOT assessing (systematically or otherwise) for the need for REASONABLE ACCOMMODATIONS in his or her practice for the benefit of the patient.
The mental health professional is often NOT assessing the patient's STRENGTHS (systematically or otherwise) and those STRENGTHS are often CONSIDERABLE.
The mental health professional is often very compassionate BUT does not systematically or otherwise assess the need for WORK AROUNDS or ACCOMMODATIONS that the person may need in their larger ENVIRONMENT.
The THERAPEUTIC RELATIONSHIP can be "therapeutic" in a good faith, floundering sort of way --- but it is COST PROHIBITIVE for what many people really want which are FRIENDS.
Further, many mental health professionals would point out -- "Hey, I'm NOT your friend." Unfortunately, many patients would point out -- "Hey, your therapy SUCKS."
Additionally in 2020 ---- therapeutic attempts to CHANGE MANY DEVELOPMENTAL DIFFERENCES are often UNKNOWINGLY ABUSIVE and generally INEFFECTIVE. -- no matter how much FAITH or SCIENCE we many have in the PLASTICITY of the BRAIN.

The Need for "Friends" for "Asynchronous" People

The need for FRIENDS can be complicated for "asynchronous" people -- there may be need for FACILITATION.
COMMUNITIES used to provide a warm social grease for people --- that is less and less the case in MODERN SOCIETY.

WorkArounds and Reasonable Accommodations

How can the person "work around" their developmental differences
How can the person's larger environment reasonably accommodate the person's developmental differences.
How might all this lessen the expression of problematic behaviors,
AND Transform overwhelming emotions.

Val's Take: I think most, if not all "gifted" people are Twice Exceptional in some respects. Many of us got through K-12 and college maybe even graduate school powering through with our strengths -- and no one --- including ourselves --- would have thought of us as having a cognitive or emotional disability or difference..

The most BRILLIANT people I've ever known had "issues" and some of those were serious mental health problems.

University of Virginia School of Medicine is BUSTING THOSE PARADIGMS

Immune System controls social behavior in mice and likely has a prominent role in humans.

If we want 1st Rate Mental Health/Cognitive Disability Treatment, we must have:

1st Rate Research
1st Rate Translational Research/Medicine, and
a Tight-Knit SOCIETY

AND We must Integrate that Social Knowledge with Biological Knowledge such as the BIOLOGICAL REACTIVITY of Some People with "Mental Illness" ---- For example, people with Bipolar Disorder have more "reactive" cells -- further, a lot of seemingly "distinct" categories of "mental illness" are pretty BLURRED dys-regulations in multiple domains of functionality and often cut across those categories.

People with "bipolar disorder" are DEVELOPMENTALLY DIFFERENT --- down to their cells. Those cells are more "reactive."

See 3:18: Bipolar linked to the EXCEPTIONALITIES in the Humanities -- above average, below average -- the main thing -- NOT AVERAGE.

[Further, it is appearing more and more that the Immune System is involved with intelligence.]

The Brain, the Immune System & Life's Illusions

According to Dr. Cuthbert [head of the National Institute of Mental Health's Research Domain Criteria Program:]

'[W]e now understand that the categories [of mental illness] are not specific diseases (like Lyme’s Disease or influenza)

[B]ut rather are broad syndromes – loose collections of symptoms that tend to occur together to some extent, and involve dysregulation in multiple domains.' "

THAT CORNER WE'VE PAINTED OURSELVES INTO

8/12/2020

MORE ABOUT DEFACTO TAUTOLOGIES, DOING THE BEST YOU CAN, SCIENCE AND BIOLOGY IN THE 21ST CENTURY AND PROOF BEYOND A REASONABLE DOUBT

PERSONALITY DISORDER DEFACTO TAUTOLOGIES

What's a Tautology?
- the saying of the same thing twice in different words, generally considered to be a fault of style (e.g., they arrived one after the other in succession) --- Google Dictionary.
Why do we say DSM Classifications, especially Personality Disorder Classifications are "DEFACTO" Tautologies or Tautologies In Fact?
- PERSONALITY DISORDER CLASSIFICATIONS typically include SYMPTOMS and something about BACKGRIOUND. (e.g. Conduct disorder was present by history before age 15)
- The DSM Classifications don't have the BIOLOGICAL Component that we expect for MEDICAL CLASSIFICATION SYSTEMS in the 21st Century and this is the PRIMARY REASON we are calling DSM Personality Disorder Classifications ---- DE FACTO TAUTOLOGIES .
- Further, Personality Disorder Classifications not only tell practitioners very little --- they are often WEAPONIZED. That has been done consciously in the Military and we've seen it done unconsciously at the Colorado Mental Health Institute at Pueblo (CMHIP).
- The RECOGNIZED Biologically Based Mental Illnesses don't have a biological component in their DSM CLASSIFICATION but that is NOT ONLY FOUND BUT RECOGNIZED in the Profession even if the CLASSIFICATIONS don't withstand RIGOROUS SCIENTIFIC SCRUTINY from US National Institute of Mental Health.

THE RAP AGAINST DSM BIOLOGICALLY BASED MENTAL ILLNESS CLASSICATIONS is that they don't take into account TRAUMA or the ENVIRONMENT
- That was the conclusion of British Researchers
- This is the concern of many Mental Health Advocates
- This is very interesting because many researchers including the US NATIONAL INSTITUTE OF MENTAL HEALTH and probably CANADIAN RESEARCHERS would point out the CLASSIFICATIONS aren't very biologically based and don't match up with BRAIN SCANS.

Why aren't DSM "Defacto Tautologies" just a fault of "style"?
- This is all very esoteric until you're being EXECUTED or spending decades of your life in PRISON because of the CHARACTERIZATION of the Source of Your Behavior.

WITH EITHER ENVIRONMENTAL OR BIOLOGICALLY BASED CLASSIFICATIONS IF YOU PUSH EITHER FAR ENOUGH --- YOU GET TO THE OTHER -----Because the ENVIRONMENT & BIOLOGY are THOROUGHLY INTEGRATED.

One of the BIG PROBLEMS in the CRIMINAL LAW is that it has BLINDERS ON in the name of JUDICIAL EFFICIENCY.
As soon as you push it FAR ENOUGH to get something resembling REALITY -- it's IRRELEVANT.

[What we're really talking about is PUNISHMENT, not whether someone did or did not do the act alleged.

In fact for our purposes, we are assuming they did the act alleged.

There is REASONABLE DOUBT all over the place regarding our CHARACTERIZATION of the mental element.

If we get out of PUNISHMENT --- we get out of Proof Beyond A Reasonable Doubt --- and we can provide TREATMENTS and SAFETY the best we know how --- with the REALIZATION we don't know it all ---- and we desperately need to include all parties in ON-GOING PLANNING and IMPROVEMENT EFFORTS.]

The REALITY is we have been doing the best we could in Criminal Justice and Mental Health.

Further, when that BEST ISN"T GOOD ENOUGH -- we often need a LOT MORE SUPPORT than what we're getting.

If we want a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE --- we need Federal and State Governments that will FUND IT.

THE BOTTOM LINE: This Personality Disorder List isn't 21st Century Caliber Work even if it is a good faith attempt to SYMPTOMATICALLY describe some problematic behaviors. (see list below)

WE'VE PAINTED OURSELVES INTO A CORNER WITH CRIMINAL JUSTICE & PSYCHIATRY --WILL WE GET OUT?

8/12/2020

YES --- BUT WILL IT BE IN TIME FOR PEOPLE WITH COMPLEX COGNITIVE DISABILITIES LIVING NOW?

    In some many ways the real issue regarding a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE is NOT IF, BUT WHEN.

Most States have been EXPERIMENTING with SOMETHING and so have many COUNTRIES.

In the US, a very convenient way to fund SERVICES is MEDICAID.

  Now the question is should MEDICAID also be funding HOUSING and PLACEMENTS for people who meet the criteria for LONG TERM CARE?

We think the answer to that question is ABSOLUTELY YES and failure to do so amounts to DISCRIMINATION.

  We need the FEDS through CMS or a Technical Assistance Center with or without the US DEPARTMENT OF JUSTICE (DOJ) to provide DETAILED TEMPLATES that the States can modify for good cause shown so long as they can still comply with relevant laws.

  SIGNIFICANTLY, CMS 2015 Medicaid HOUSING-RELATED GUIDANCE REMINDED STATES that the MEDICAID STATE AGENCY could take the LEAD in OLMSTEAD PLANNING.

We NEED CMS to take the LEAD in getting STATES to OLMSTEAD COMPLIANCE.

   Quite frankly, we don't have a lot of faith in the ability of the STATES to do this on their own without significant ASSISTANCE.

We're 20 years out from Olmstead -- many people who needed the COMPLIANCE of STATES are already dead.

  We know of people with cognitive disabilities NOW in Colorado prisons who NEED that PUBLIC HEALTH APPROACH not as a PILOT PROGRAM -- but brought to SCALE.

THE CHANGE WE NEED---- FOR BOTH COGNITIVE DISABILITY POLICY AND BEYOND

8/12/2020

If you really want to make CHANGE --- it's about CHANGING the SYSTEM ---- not as much people --- although it often is about expanding meaningful participation..
Further, a lot of times --- it is not so much throwing everything out --- as BUILDING on what you've got, although there is a SHEDDING of SOME OLD WAYS.

A lot of our prescription would be SYSTEMITIZE:

INCLUSION --- Different People ask DIFFERENT QUESTIONS
DATA COLLECTION --- "The answers you get depend on the questions you ask." In 2020, DATA is a CIVIL RIGHTS ISSUE and it goes both ways.
- We are now AWARE of so much MORE than the FOUNDERS were. As George Will observed, Jefferson could live in the ILLUSION that he had mastered most known knowledge --- the Modern person no matter how well educated or bright -- can't do that.
- That requires the HUMBLENESS of former NIMH Director Thomas Insel and Spiritual Leaders when it comes to judging others.
PROBLEM-SOLVING -- our political parties FACILITATE some problem-solving and they SABOTAGE a lot of problem-solving
- The REPRESENTATIVE GOVERNMENT that was a BIG STEP UP from KING GEORGE and MONARCHY --- isn't good enough anymore --- even if you keep those 3 BRANCHES of GOVERNMENT.
- We need more INCLUSION --- where people are doing the real problem solving (which they are already doing now anyway). Politicians are good at IMPLEMENTNG A CONSENSUS -- there are a lot of STRUCTURAL BARRIERS, namely the POLITICAL PARITIES and what's essentially an ADVERSARY SYSTEM that is preventing POLITICIANS from being good PROBLEM-SOLVERS.
- We need INCLUSIVE PROBLEM-SOLVING GROUPS -- that can address the problems with a goal of reaching a CONSENSUS and then give that to the POLITICIAN(s).
- INCLUSIVE PROBLEM-SOLVING GROUPS would NOT be NIRVANA -- but it could be a step in the right direction and we're already trying to do that --- certainly at the State Level-- even if some of the most impacted people are NOT INCLUDED. There is plenty of room for IMPROVEMENT.

UNIVERSAL BASIC INCOME (UBI)

This is potentially an elegant solution to a lot of problems in our Society, and it is more CONSERVATIVE than a lot of people might think:
- When you're living in a PYRAMID SCHEME that is relying on the INVISIBLE HAND of SELF INTEREST and COMPETITION -- A LOT of PEOPLE GET SCREWED.
- Further, a lot of the people who are willing to SACRIFICE EVERYTHING to make it to the TOP -- are our people --- they can be very EMOTIONALLY DYS-REGULATED.*
Women are NOT where they were in 1970s: wanting to say "I'll SCREAM if you don't say I'm equal." Women are a lot more CONFIDENT NOW --- they don't want to go back to the 1950s -- but there is much more of a REALIZATION that the HEAVY-LIFTING in most SOCIETIES is what was traditionally viewed as WOMEN's WORK.
Trying to move ALL of "WOMEN's WORK" to the MARKETPLACE has NOT really succeeded. It's Hard Work and There's A Lot of It
To really SHARE that BURDEN/LABOR OF LOVE --- you need time, energy and resources.
Much of current American work/life approaches of the last 40 years FUNDAMENTALLY did NOT accept:
- the CONSTRAINTS of the 24-Hour Day
- What it really means to be SINGLE
- What it really means to be MARRIED,
- What it really means to be DIVORCED
- What it really means to have KIDS
- What it really means to have PARENTS with significant health problems..
- What it really means to be HUMAN.

THE PROBLEM WITH HIERARCHY

You're not just empowering the person's strengths, you're empowering the person's weaknesses as well.
Our Founding Fathers knew the CORRUPTING ASPECT of POWER in a BIG WAY and that it wasn't about an INDIVIDUAL --- it was about "HUMAN NATURE."
Although hierarchy has worked for a lot for animal groups tp provide niches for individuals --- HUMAN BEINGS are running up against its LIMITS. --- the Founding Fathers ran up against its LIMITS and we've been banging our heads against those LIMITS in the US.
There's a lot of talk of "Hierarchies" vs. "Networks" --- that Debate is furthering the DISCUSSION about where we need to go -- it's not clear its going to get us there.
Our current AGE OF AUTHENTICITY is an important part of our CONTINUING Transformation of Hierarchy. PAST EFFORTS WERE FOUNDATIONAL to the US and to DEMOCRACY.

Some of our FAVORITE -- OLD, WHITE GUYS . . .

Pericles -- famed leader of 5th Century B.C.E. Athens --- the birthplace of democracy.

Began paying for public service -- we do a lot of that in modern societies.

We need to make it Universal -- Universal Basic Income (UBI) -- and tie that to sustainable, creative and innovative requirements for public service.

Philosopher of Science Thomas Kuhn provided enormous development of the concept of the PARADIGM SHIFT in his 1962 book "The Structure of Scientific Revolutions."

When we think about the MONUMENTAL IMPACTS of the COPERNICAN REVOLUTION and the DARWINIAN REVOLUTION we often think about the challenge to RELIGION.

Ironically, our TECHNOLOGICAL REVOLUTION is bringing an understanding of BIOLOGY we never had before and our SPIRITUAL TRADITIONS have laid the groundwork for us to deal with this.

It's a lot about NOT JUDGING or PUNISHING, but it doesn't require ignoring legitimate SAFETY issues.

George Will -- a Symbol of INTELLECTUAL CONSERVATISM --- Rationality and Reason --- Reason and Logic have their limits as Musician Roger Hodgson can point out (see below)---- BUT we are in desperate need of a lot more LOGIC and REASON in our consideration of the DSM 5 and Cognitive Disability Policy. in general.

Additionally, Will wasn't afraid to BREAK with his TRIBE/GROUP/PARTY when he perceived they were no longer REASONABLE or RATIONAL. We'd like to see that kind of PRINCIPLED REASON & COURAGE in MENTAL HEALTH.

We did see it in DR. Ruth SHIM of UC DAVIS calling out STRUCTURAL RACISIM in the American Psychiatric Association. We'd like to see a lot more of that.

Finally, that FUTURE that arrives UNANNOUNCED was often preceded by BILLBOARD SIZE SIGNS the HISTORIAN can't fail to miss.

Some BIG Points of Irony

An Ancient Greek General and Leader like Pericles could probably understand the need for Universal Basic Income. If you're interested in the WESTERN TRADITION --- EXPANDING PARTICIPATION and ENHANCING WELFARE is part of it, too.
We often credit ancient Jewish people for getting us out of HUMAN SACRIFICE, but that work is not really over. We may not be SACRIFICING people to BAAL but we are SACRIFICING them to FEAR, GREED, ARROGANCE, and MYOPIC VIEWS of the World.
THE BIG, BIG IRONY: It's SCIENCE and RELIGION/BROADER SPIRITUAL CONCERNS -- TOGETHER --- that could help us SUCCESSFULLY NAVIGATE the current BIOLOGICAL REVOLUTION.

Roger Hodgson of Supertramp walkng through the Mountains and Pine Trees with his Guitar -- searching for God, True Love and the Meaning of Life

PART III: WHEN WE SAY MENTAL HEALTH & FORENSIC HEALTH ARE HURTING A LOT OF PEOPLE --- WHAT DO WE MEAN?

8/9/2020

THE CHALLENGING ECONOMIC ENVIRONMENT FOR MENTAL HEALTH BREEDS DESPERATE PROVIDERS, INDIVIDUALS, FAMILY MEMBERS AND GREEDY CEOS

Like a lot of places in our Society -- In Medicaid Mental Health, the people at the top get rich and the people providing essential services are often not paid very well.

The REALITY is NOBODY WOULD CARE what a CEO is making if our SYSTEMS were working -- BUT they're not, and that includes Medicaid Mental Health.

Colorado Medicaid's Too Dangerous / Too Difficult To Treat Problem

North Carolina Medicaid Mental Health CEO Defends His Salary At the Legislature (2016)

The presentation started as an update to legislators on how North Carolina’s Medicaid reform process will affect people with mental health and substance use problems.

Instead, the discussion during Tuesday’s meeting of the Joint Legislative Oversight Committee on Medicaid and NC Health Choice turned into a hour-long interrogation of Richard Topping, the CEO of Cardinal Innovations, one of the state’s publicly funded mental health managed care organizations.

Legislators, and even the state’s Health and Human Services Secretary Rick Brajer, lit into Topping, criticizing his new million dollar-plus reimbursement package. They also criticized the way Topping has stretched the boundaries of legislative mandates and his agency’s use of public money.

COLORADO

Now in Colorado there have been similar problems as those indicated in North Carolina above.

In the past, the State has lamented those disparities but the State hasn't really seen it as their responsibility to address.

The people at the TOP of MEDICAID MENTAL HEALTH CENTERS/ MANAGED CARE ORGANIZATIONS in North Carolina, Colorado and around the Country often do wield a LOT of POWER and they are sometimes PAID A LOT OF MONEY.

Now, if you took that LARGESSE away from the people at the top could you AFFORD to significantly raise the SALARIES of UNDERPAID STAFF MEMBERS -- maybe not -- and that's the problem.

Further, just requiring equitable pay structures of participating non-profits in the Medicaid program doesn't solve all the problems, especially in Mental Health.

In Mental Health those problems are being driven a lot by LACK OF TRANSLATIONAL RESEARCH TO CLINICAL PRACTICE.

BUT SOMEHOW THIS INEQUITY IN PAY STRUCTURES is not IRRELEVANT and we think it is linked to the INSANE CONSEQUENCES that D.J. Jaffe writes about in his book .

If we want EQUITY in HEALTHCARE -- one place to start is the PROVIDERS.

PRIVATE PSYCHIATRY & INSURANCE ----AN UNSUSTAINABLE MATCH?

8/7/2020

My Personal Experience

I've been with a private psychiatrist since 2006 -- since my psychotic episode in which I was hospitalized
My private psychiatrist generally doesn't take insurance, although she does take limited insurance.
I (my family) have paid both out of pocket and an insurance deductible.
I was just informed by my psychiatrist that by the end of the year she probably won't be taking my current insurance anymore.
As many people know most of these insurance companies have various "packages"
Further, if you are getting your insurance through an employer -- especially maybe a hospital or other healthcare employer -- they maybe kicking in a big portion.
Since my husband retired with Stage 4 Cancer -- we don't have the same "package" --- so now our deductible for psychiatric services is pretty high.
So I told my psychiatrist we would run the numbers between the current out-of-pocket and out-of-network and see where we are.
My psychiatrist does not have a secretary.

[Couldn't there be some CENTRALIZED ADMINISTRATIVE SUPPORT provided to private psychiatrists

BTW -- there are a lot of people with ADHD who need EMPLOYMENT ADMINISTRATIVE SUPPORT -- what about some ENTREPRENEUR OR OTHERS providing CENTRALIZED SUPPORT for those folks.]

Why Psychiatrists Don't Take Insurance
Dinah Miller, M.D. (2014)

While many psychiatrists in private practice are able to manage their practices without secretarial support, a psychiatrist who practices in-network usually needs a secretary, an overhead expense his I-don’t-accept-assignment friends may or may not want or need.

And he now has to have an office big enough to accommodate secretarial space. I’ll also tell you that while the secretary is paid an hourly fee, his ability to get paid is only as good as her motivation to follow through on dealing with the insurance companies, refiling denied claims, clarifying primary versus secondary insurance and getting the amount of the co-pays correct.

PART II: WHEN WE SAY MENTAL HEALTH & FORENSIC HEALTH ARE HURTING A LOT OF PEOPLE --- WHAT DO WE MEAN?

8/7/2020

THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"

Who is really against that MAGIC ELIXIR that will alleviate the problems of MENTAL HEALTH DISORDERS --- not really anybody.
BUT ya gotta be prepared to hear if UNCLE PHARMA's MAGIC ELIXIR isn't working as intended -- and it's very individual.
We are living in a VERY MESSED UP SOCIETY in which people may be consuming all kinds of SUBSTANCES to FEEL BETTER -- from alcohol to huffing gasoline to cocaine to methamphetamine and other opioids.
Further, people with "MENTAL HEALTH DISORDERS" aren't just emotionally highly reactive --- many of them have "HIGHLY REACTIVE CELLS," according to the University of Michigan.
So psychiatric medication that works globally on the brain and its circuits can be very problematic.

So if we get the MAGIC ELIXIR we want it -- but that is NOT really where we are at right now.

If Medication can be helpful -- that's great -- BUT many people are still left with those HIGHLY REACTIVE CELLS and the medication isn't completely addressing what people would like to see addressed.

Well, the ANSWER is OBVIOUS the person needs to:

Take Some Personal Responsibility, and
CHANGE

  That "CHANGE MANTRA" doesn't work very well with DEVELOPMENTAL DIFFERENCES and it's PROFOUNDLY ABUSIVE --- even though it almost always is WELL MEANING.

A lot of what is DRIVING some challenging behavior --- is STRESS + HIGHLY REACTIVE CELLS.

You don't have to have "highly reactive cells' to pick up on MICRO-AGGRESSIONS but you're picking up on a lot of stuff (not perfectly) and if you're trapped in an inhospitable environment -- you generally know it.

Further, there are a lot of DIVERSE people in this society contending with MICRO-AGGRESSIONS -- because DIVERSE/MINORITY people are who MICROAGGRESSIONS are generally directed towards.

The first thing is implement a STRENGTHS-BASED APPROACH -- and that is likely to REDUCE a lot of that STRESS -- because somebody's not asking people to be somebody -- they're not.

Dr. Gail Saltz advises spending 80% of the time on STRENGTHS DEVELOPMENT -- things people are already good at.

Now, wouldn't it be LOVERLY if you could stop there --- and if you can that's great.

BUT many people, including myself will need WORK AROUNDS or ACCOMMODATIONS.

This is REALLY HARD because mental health professionals and even very well-meaning, educated, caring people are not good at this.

This is very much Maya Angelou -- "When you know better, do better."

  Some of us do know better now -- and we are about the practical work of "changing" these systems, not necessarily people -----

   BUT WE ABSOLUTELY WANT TO INCLUDE A LOT MORE PEOPLE.

DE FACTO TAUTOLOGY AND PERSONALITY DISORDERS

8/6/2020

One of the HUGE challenges for PSYCHIATRY has been getting that DEFINITION of the MENTAL DISORDER.
People have OBSERVED and WITNESSED --- CHALLENGING and/or BIZARRE BEHAVIOR for a long time THOUSANDS of YEARS --- and it's been obvious something isn't right -- especially if the person is "PSYCHOTIC."
One of things that people have used as both a SHIELD and a SWORD is their MORAL JUDGMENTS. When that comes to the Criminal Law --- it's a lot about did the person "INTEND" to do it --- and most people did intend to do it --- some are so out of it that "they didn't appreciate the nature and consequences of their actions" ---- BUT that is defined pretty narrouwly BECAUSE if it's not defined narrowly ---- HOW ARE WE GOING TO PROTECT OURSELVES????
  Perhaps even more importantly --- are we BETRAYING the CLAN, the COMMUNITY, the VICTIM --- by joining the SIDE of the PERPETRATOR if we recognize a much more COMPLEX VIEW of HUMAN INTENT.
For a lot of Criminal Law -- MOTIVE has been that COMPLEXITY -- it's just that doesn't look very COMPLEX in 2020.

   The VINEER of MEDICALIZATION of BAD BEHAVIOR is the PERSONALITY DISORDER --- and if we're really FANCY --- CRIMINOGENIC FACTORS.

The National Institute of Mental Health is really saying that MENTAL HEALTH PRACTICE in the 21st Century is NOT really a MEDICAL DISCIPLINE or if it is --- it is a very poor one because other MEDICAL DISCIPLINES have moved BEYOND "SYMPTOM BASED CATEGORIES."

    [Further, in many cases a criminal act is an observable SYMPTOM of a Cognitive Disability.]

BUT for MENTAL HEALTH and CRIMINAL JUSTICE once you get away from SYMPTOM-BASED CATEGORIES -- to BIOLOGICALLY-BASED CATEGORIES, not only should you not be WEIGHING IN on PUNISHMENT (even indirectly), it is much more CLEAR you shouldn't be doing it at all.

[A HUGE irony in all this is some ANCIENT PEOPLE sort of thought that, too: "They Know Not What They Do."]

In the US today and in many countries, jails and prisons are FULL NOT WITH CLASSIC POLITICAL PRISONERS -- they are full of COGNITIVE DISABILITY PRISONERS who are there because there is nowhere else to put them.

  NOW DOING better is NOT just KNOWING BETTER --- CRIMINAL JUSTICE maybe hasn't known all this --- BUT THEY HAVE KNOWN A LOT. So we should PUNISH them, right?

The problem is CRIMINAL JUSTICE doesn't have the ABILITY to effectively address this situation.

International Journal of Psychological Research (2016)

Potential Biomarkers in personality disorders: current state and future research.

What's Stanford Neurobiology Professor Robert Sapolsky's POINT about the TRAJECTORY of BIOLOGICAL EXPLANATIONS and What are the RAMIFICATIONS for the Criminal Law?

[We do think the free will/determinism question is too simplistic and ultimately somebody's going to have to figure out a way to get out of it -- largely because observed exercise of animal and human INTENT is not running in the direction the debate assumes --- MEANING Maya Angelou --- when you know better, do better -- and there is a lot more to be teased out.]

Now this has a lot of implications for PUNISHMENT because it's KNOWING BETTER + HAVING THE ABILITY TO EFFECTIVELY CONTROL ONE"S BEHAVIOR. BUT if you have the ABILITY to effectively control your behavior, generally there is nothing to PUNISH.

DR. ROBERT SAPOLSKY ---- A PROFESSOR OF BIOLOGY, NEUROLOGY AND NEUROLOGICAL SCIENCES, AND NEUROSURGERY @ STANFORD UNIVERSITY: "You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain
the childhood experience
the hormone
the gene
or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
. ------Prof. Robert Sapolsky Stanford

WHAT'S THE POINT of the US National Institute of Mental Health's criticism of the DSM 5?

NIMH 2013
"This approach (RDoC) began with several assumptions:

A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
Each level of analysis needs to be understood across a dimension of function,
Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

"It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data.

"In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”

"The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories.

"Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category.

"We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.

"That is why NIMH will be re-orienting its research away from DSM categories. "

https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

WHEN WE SAY MENTAL HEALTH AND FORENSIC ARE "HURTING A LOT OF PEOPLE" --- WHAT DO WE MEAN?

8/5/2020

A BUDDHIST KOAN:

Is having a highly REACTIVE IMMUNE SYSTEM and CELLS -- a good thing or bad thing?

AWARENESS

We're largely NOT AWARE of our internal bodily systems -- EVEN IF we are more AWARE than other animals
It is relatively recently that HUMAN DRIVES have been located in the BRAIN --- a lot of CULTURES located it in the HEART
A lot of Researchers are saying we've got to understand this as an ENTIRE FUNCTIONING ORGANISM --- and all the SYSTEMS of the BODY are INTEGRATED.
It's really in the 21st Century that we've recognized the HUGE IMPORTANCE of the HUMAN MICROBIOME -- which is this SYSTEM we didn't know about that is CRITICAL to our physical and cognitive functioning.
Further, it is really in the 21st Century that the IMMUNE SYSTEM has exploded on the scene as HUGELY IMPORTANT not only to Cancer and Autoimmune Diseases but to Mental Health as well.

What's The Harm?
There are probably a lot of CATEGORIES of HARM. We're going to focus on 1 CATEGORY of HARM.

You can't get to "BEYOND A REASONABLE DOUBT" with these new understandings, new science, and many more questions on the Mental Element of the Crime BECAUSE:
- Our old conceptualizations of HUMAN INTENT (the mental element of the crime) are NOT RATIONAL and that VIOLATES DUE PROCESS.
  - Why aren't our CONCEPTUALIZATIONS "RATIONAL" -- we don't have a SUFFICIENT UNDERSTANDING --- the NEW KNOWLEDGE hasn't answered all the questions -- BUT it has thrown into question in HIGH RELIEF our underlying ASSUMPTIONS.

Some/Maybe a lot of this is DEVELOPMENTAL. BOTH CLINICIANS and PATIENTS haven't really thought of it that way BECAUSE:
- Most patients are average or above intelligence, and
- Most patients don't have obvious physical disabilities (although some do)

These Developmental Genetic and Epigenetic DIFFERENCES involve among other things the IMMUNE SYSTEM. The IMMUNE SYSTEM has been taking a lot of HEAT/INFLAMMATION since the INDUSTRIAL REVOLUTION and URBANIZATION and FACTORY FARMING. See Graham Rook's THE OLD FRIENDS HYPOTHESIS.

HISTORIANS have been talking about the CHANGES wrought by the moves away from AGRICULTURAL SOCIETIES for some time -- but now we are several GENERATIONS out and some of those CHANGES appear to be BIOLOGICAL.

Further, as Neuro-biologist Robert Sapolsky points out -- any BEHAVIOR is the result of BIOLOGY that occurred:
- a second ago
- a month ago
- a year ago
- a 100 years ago
- a million years ago.
Some ANCIENT SOCIETIES appreciated that a lot better than we do.

WHY DOES THE MENTAL HEALTH PATIENT LAMENT, "BUT I'M SMART" --- REVEAL MORE THAN HE OR SHE REALIZES----

University of Michigan:
Cells of people with Bipolar Disorder are developmentally different than the cells of people without Bipolar Disorder.

Those CELLS are MORE REACTIVE.

Blurred Lines

We're NOT Who we THINK we are:

Not just because we may be very "intelligent" and our "intelligence" isn't the result of what we think it is and it has had some unintended mental health consequences, but also --
Because much of our physical and cognitive functioning is coming from BACTERIA we weren't even AWARE of 10 years ago, and
Because Historical BIOLOGY/ENVIRONMENTS we're only PARTIALLY AWARE of NOW are affecting current Physical and Mental Health, and
AND MAJOR SYSTEMS of THE BODY play a HUGE ROLE in Cognition and Mental Health and we're just beginning to understand that, AND
ALL OF THIS IS INTERACTING AND INTEGRATED INTO --- THE PRESENT MOMENT

For a SPECIES that is DESPERATELY SEARCHING for "CONNECTION" --- it's more than there and it's beyond comprehension in 2020.

The Immune System, Social Behavior, Intelligence and Mental Illness

"We are inhabited by as many as 10,000 bacterial species, these cells outnumber those which we consider our own by 10 to 1, and weigh all told about 3 pounds.--- the same as our brain.

"Together, they are referred to as the microbiome and they play such a crucial role in our lives that scientists have begun to reconsider what it means to be human."

------------------------------Michael Specter is an American journalist who has been a staff writer, focusing on science and technology, and global public health at The New Yorker since September 1998. He has also written for The Washington Post and The New York Times. ---Wikipedia

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ACCOMMODATIONS FOR EXECUTIVE FUNCTIONING DEFICITS

CAN WE TALK? ---MENTAL HEALTH TREATMENT

THAT CORNER WE'VE PAINTED OURSELVES INTO

MORE ABOUT DEFACTO TAUTOLOGIES, DOING THE BEST YOU CAN, SCIENCE AND BIOLOGY IN THE 21ST CENTURY AND PROOF BEYOND A REASONABLE DOUBT

WE'VE PAINTED OURSELVES INTO A CORNER WITH CRIMINAL JUSTICE & PSYCHIATRY --WILL WE GET OUT?

THE CHANGE WE NEED---- FOR BOTH COGNITIVE DISABILITY POLICY AND BEYOND

PART III: WHEN WE SAY MENTAL HEALTH & FORENSIC HEALTH ARE HURTING A LOT OF PEOPLE --- WHAT DO WE MEAN?

THE CHALLENGING ECONOMIC ENVIRONMENT FOR MENTAL HEALTH BREEDS DESPERATE PROVIDERS, INDIVIDUALS, FAMILY MEMBERS AND GREEDY CEOS

PRIVATE PSYCHIATRY & INSURANCE ----AN UNSUSTAINABLE MATCH?

PART II: WHEN WE SAY MENTAL HEALTH & FORENSIC HEALTH ARE HURTING A LOT OF PEOPLE --- WHAT DO WE MEAN?

THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"

DE FACTO TAUTOLOGY AND PERSONALITY DISORDERS

WHEN WE SAY MENTAL HEALTH AND FORENSIC ARE "HURTING A LOT OF PEOPLE" --- WHAT DO WE MEAN?

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MORE ABOUT DEFACTO TAUTOLOGIES, DOING THE BEST YOU CAN, SCIENCE AND BIOLOGY IN THE 21ST CENTURY AND PROOF BEYOND A REASONABLE DOUBT

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​THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"

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THE DELICATE ART OF DEALING WITH BIOLOGICALLY HIGHLY REACTIVE PEOPLE WITH DEVELOPMENTAL DIFFERENCES THAT NEED "WORKAROUNDS"/"ACCOMMODATIONS" A LOT MORE THAN THEY NEED "CHANGE"