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THE GOOD SAMARITAN, MARIA BAMFORD AND MENTAL ILLNESS

12/8/2020

The Maria Bamford video to the right raises the moral dilemma for many people, including many people with mental illness ----
"There's a homeless person in my path who has severe mental illness and/or substance problems and/or brain injury -----
WHAT'S MY MORAL OBLIGATION?"
I would submit the "Good Samaritan Story" is the EASY CASE.
Most of us could pretty easily call 911 for help for someone who was physically injured in some way --- even if the person was a STRANGER or even a member of one of our OUT-GROUPS.
When we are talking about:

Mental Illness
High IQ Developmental Disability like ADHD & AUTISM,
Substance Use, and/or
Brain Injury, and/or
Homelessness, and/or
Incarceration

    We are often talking about "IMPAIRMENTS IN MULTIPLE DOMAINS OF FUNCTIONALITY." That is how the National Institute of Mental Health describes Mental Illness and it seems to be roughly accurate for many COGNITIVE DISABILITIES.
    Well, I have called 911 for a chronically homeless Black man in his 50s with schizophrenia and substance use problems and he was taken to Denver Health --- and released in a few hours because some of his problems involved substance use.
  Subsequently, in an intoxicated state he broke into a garage and was arrested.
He'd been arrested before, many times, and there were pleas of guilty (he would argue just to get out of jail but nonetheless the convictions were there and some of them were serious.)
His public defender requested a competency exam and our chronically homeless guy with schizophrenia and substance problems and record was sent to PUEBLO -- the Colorado Mental Health Institute @ Pueblo (CMHIP).
That turned into a FIASCO and a HALF. Our guy wouldn't talk to the examining professionals in Pueblo --- he was TOO PARANOID.
Unfortunately, the examining professionals were NOT TOO COMPETENT. They issued a report diagnosing our guy with ANTI-SOCIAL PERSONALITY DISORDER without having examined him.
How do I know that our guy had "Schizophrenia" --- prior medical records had been obtained and a social security attorney had obtained SSI for our guy on the basis of "Schizophrenia."

MYTH BUSTING #1: If we just get the person on SSI --- everything will work out. SSI can help, BUT it is NOT HOUSING or a PLACEMENT and it is NOT INTENSIVE SERVICES.
The more serious the IMPAIRMENTS the more this is a problem.
It can be quite shocking to realize the number of people who are incarcerated who are already on SSI when not institutionalized.

MYTH BUSTING #2:  A showing of SMI (Serious Mental Illness) is the same as proving INCOMPETENCY under most Criminal Law ----- WRONG.

Further, Substance Issues are even more disfavored under the Criminal Law.

"Competency" is one of many places where the Criminal Law goes off the rails and it is very tied to the MENTAL ELEMENT of the CRIME or MENS REA.

  A lot of these "COMPETENCY STATUTES" were a Big Step Up at the time --- now they cannot RATIONALLY deal with the FIRE HOSE of information that is coming out of the research institutions regarding BEHAVIOR.

WHAT'S THE POINT?

Even though our guy had complex mental health issues and trauma issues ---- it wasn't clear that he was "INCOMPETENT" under Colorado's Competency Statutes.

He was sentenced to 24 years TO DO ---- because he had received "a lot of chances."

Warning: Language

Maria Bamford
"Strange Lessons from the Bible"

"The Good Samaritan" by Stephen S. Sawyer on Lord's Art

Photo Credit: "Brother's Keeper" film (2015)

Why as a "SOCIETY" do we drone on about "PERSONAL RESPONSIBILITY"

We often don't have the answer, and/or
The most LOGICAL, RATIONAL ANSWER is going to be DIFFICULT and EXPENSIVE and "maybe" LONG TERM.

If we find ourselves preaching "PERSONAL RESPONSIBILITY" to people with IMPAIRMENTS IN MULTIPLE DOMAINS OF FUNCTIONALITY --- it's time to look in the mirror.

Legal questions of competency are often DIVORCED from the BIOLOGICAL and ENVIRONMENTAL / SOCIAL and AGE issues of the person.

Our current system tends to punish older people with cognitive disabilities who have been in and out of our "FAILED SYSTEMS" ---- MORE because "THEY HAD A LOT OF CHANCES."

Further, we would argue COMPETENCY is not the right question anyway.

It's an OUTDATED ATTEMPT to deal with COMPLICATED REALITIES but it is TOO SIMPLISTIC given our current knowledge.

We need to FUND that PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE.

This is what it means to be the GOOD SAMARITAN in the 21st Century and it's NOT EASY.

KEEPING EVERYONE'S HEAD ABOVE WATER -----INCLUDING PEOPLE WITH EXECUTIVE FUNCTIONING DEFICITS / DIFFERENCES

12/3/2020

One of the many problems with our discussions of FREE WILL and "PERSONAL RESPONSIBILITY" is they run to THE PAST.
They run to the past NOT because that makes most sense from a CHRONOLOGICAL or LOGICAL perspective ---- BUT because our SYSTEMS of "ACCOUNTABILITY" & "PUBLIC SAFETY" ---- PRESUME IT.
So if we don't PRESUME FREE WILL and "PERSONAL RESPONSIBILITY" ---- it is NOT CLEAR what system we're going to use.
AND MOST PEOPLE DID "INTEND" THE CRIME.
BUT if we start noticing that a lot of the people who intend crimes tend to have EXECUTIVE FUNCTIONING ISSUES, especially PROBLEMS with EMOTIONAL REGULATION.
What are we going to do with that?
One of the BIG CHALLENGES for this SOCIETY and Many People In It --- is including people with executive functioning challenges in the Society, allowing them to:

work at their HIGHEST SKILL LEVEL, while also
WORKING AROUND & ACCOMMODATING those differences

This SOCIETY is a TORTORE CHAMBER for people with INVISIBLE Executive Functioning Differences:

that often DON'T KNOW they have those DIFFERENCES;
are often average or above intelligence in other respects, and
are having to work MUCH, MUCH HARDER than some to keep their heads above water.

Employment Index

Coming To Terms with the Criminal Justice System as the Provider of Last Resort for People with Disabilities

STEPPING UP OUR GAME ON INTEGRATION OF PHYSICAL & MENTAL HEALTH CARE ----WHAT DOES THAT MEAN?

12/2/2020

REMEDIAL EDUCATION & TRANSLATIONAL RESEARCH & MEDICINE AT THE TOP LEVELS

Lay people being frightened by the INCOMPETENCE of PROFESSIONALS or anybody or any of us for that matter is nothing new.

1st BIG RED FLAG

2013: US National Institute of Mental Health calls out DSM 5 as lacking scientific validity largely because the diagnostic manual is not tied to biological measures.
American Psychiatric Association pushes back.
Clinicians largely don't understand the issue if they know about it at all.

2nd BIG RED FLAG

In the Interim, research linking mental illness as well as other cognitive disorders to the IMMUNE SYSTEM and the MICROBIOME has been piling up.
Maternal Immune Activation during pregnancy is associated with with a number of mental health conditions.
There are a long list of things that can damage the immune system impair cognition from:
- Trauma
- Altitude Induced Sleep Apnea
- Environmental Toxic Substances
- Substance Use
- Etc.
Clinicians are overwhelming NOT up to speed on this. What's really surprising is some Academics & Researchers aren't either.
We are talking about an ENORMOUS VOLUME of Material that OUTPACED Clinicians' ability to keep up with it a long time ago.
But it is NOT uncommon now to see that an ACADEMIC or even a RESEARCHER who pretty clearly isn't aware of some of this research.
At this point, we have to come to terms with a FAILED TRANSLATIONAL RESEARCH & MEDICINE SYSTEM for Psychiatry.

3rd BIG RED FLAG

It has gotten harder and harder to ignore that Clinical Psychiatry hasn't progressed very much in the last 25 years.
What's Clinical Mental Health's problem according to some Clinicians and Mad In America: the Biomedical Model.
So ENVIRONMENT, EXPERIENCE is a BIG, HUGE ASPECT of Mental Health and we would argue one of the reasons it is SO HUGE is because of IMMUNE SYSTEM ABNORMALITIES.
The above is our TAKE, our CONJECTURE but the IMPORTANT thing is that ENVIRONMENT is NOT DIVORCED from BIOLOGY.
If we can't recognize the IMPORTANCE of ENVIRONMENT we've MISSED the BOAT --- but if we don't UNDERSTAND its INTERACTION with the BIOLOGY --- we're outside of MEDICINE.

The Economics of Bringing Mental Health Practice In Line with the March 2019 Editorial in Frontiers of Psychiatry & Current Research

CO's Special Session & the Stimulus Check --- Addressing Coronavirus economics & Ultimately Mental Health

12/1/2020

There is little question Colorado is a head of the curve in dealing with the ECONOMIC aspects of CORONAVIRUS.

Those ECONOMIC ASPECTS & EMOTIONAL ASPECTS are INTRICABLY LINKED to:

Mask Wearing, and
Social Distancing

If we can't HEAR & UNDERSTAND how ECONOMICALLY & EMOTIONALLY DIFFICULT this has been for people --- those people are going to TUNE OUT those important but often ineffective health care messages.

        Those health messages are failing NOT because we haven't tried to SHAME people enough.

    In authoritarian countries like China you can just mandate mask wearing and stay at home orders relatively easily and imprison anyone who doesn't comply.

In the US ---- it's very hard and you must deal with underlying ECONOMIC and MENTAL HEALTH complicating problems of the PANDEMIC.

    This PANDEMIC has been a lot harder than we were prepared for. This Special Session acknowledges that and seeks to provide some real practical relief.

9 News (Nov. 29, 2020) -- Colorado Special Session

The Colorado General Assembly plans to take up legislation to help families and small businesses in the session that starts Monday.

Polis' $375 Stimulus Check

Polis' official action is important on many levels --much needed support to individuals, an example to other States AND importantly a PUSH to the FEDS to GET MORE FEDERAL STIMULUS out the door.

neurodiversity & Accomodation

11/29/2020

There are more and more neurally diverse people in the workforce
Most people with executive functioning differences have never been formally identified.
As more and more challenges mount up, some of those folks find themselves involved with substances (legal and/or illegal)
And some find themselves Homeless or involved with the Criminal Justice System.

It seems that Executive Functioning Differences are the COMMON DENOMINATOR that cuts across cognitive disabilities and is a COMMON DENOMINATOR in INCARCERATED POPULATIONS.

Executive Functioning Differences are COMPLICATED and they are NOT all bad -- Leonardo da Vinci and Einstein are speculated to have had ADHD.

It is worth noting that both da Vinci and Einstein went to great lengths to TAILOR their WORK ENVIRONMENTS to suit themselves.

I would submit there are a lot of people in the criminal justice system who need TAILORED WORK ENVIRONMENTS.

There is more TALENT in jails and prisons and homeless shelters than we realize -- but some people will need SUPPORT with EXECUTIVE FUNCTIONING DIFFERENCES.

We haven't been good at Executive Functioning SUPPORTS, WORKAROUNDS and ACCOMODATIONS -- we need to get a lot better -- and start complying with the Americans with Disabilities Act (ADA).

Most ACCOMMODATIONS and WORK AROUNDS are NOT an "UNDUE HARDSHIP."

On the other hand, if we haven't been doing them -- it is going to be awhile before it gets "EASY."

The ADA largely places the BURDEN on people with COGNITIVE DISABILITIES to know about these ACCOMODATIONS -- when most of their Service Providers don't know about them.

THIS IS NOT WORKING IN A BIG WAY.

We must get PROVIDERS up to speed on ACCOMODATIONS AND WORKAROUNDS FOR EXECUTIVE FUNTIONING DIFFERENCES, and at the very least make appropriate referrals.

Employment Index

THANKSGIVING 2020 ---- WHAT WE'RE THANKFUL FOR

11/28/2020

[This was first posted Thanksgiving Day 2020 -- Nov. 26.]

We are very THANKFUL for the CORONA VIRUS VACCINES.

Maybe we will be more back to "normal" next year.

This INTERIM time before the vaccine has been very difficult -- many people have lost their lives.

For many people with different serious diseases or syndromes -- that INTERIM time may be most of their lives.

Cognitive Disability/Difference whether Brain Injury, Mental Illness, Trauma, Developmental Disability and/or Substance Use is COMPLICATED and we are starting to really address these problems that affect millions of people in the US and all over the world.

Those problems are INTEGRATED and they do involve BIOLOGY, ENVIRONMENT and SOCIAL SYSTEMS.

For our perspective we're very thankful for BLACK LIVES MATTER -- that was not afraid to make the case that RESOURCES NEED TO BE ALLOCATED to the SERVICES our COMMUNITIES NEED.

MAD IN AMERICA & THE AMERICAN PSYCHIATRIC ASSOCIATION ---CLOSER THAN YOU THINK

11/28/2020

WE NEED TO GET BOTH OF THEM CLOSER TO THE NATIONAL INSTITUTE OF MENTAL HEALTH

One of the issues that can really get people going is whether Mental Illness is Biologically Based or Psycho-Socially Based.
My take on the relative positions is:

Mad In America sees things as psycho-socially based because they are against MEDICATION. [I would argue that one could just as easily say MEDICATION is problematic because the BIOLOGY is so COMPLICATED.]
The American Psychiatric Association seems to take a Middle Ground -- BUT they have failed to address a scientifically invalid diagnostic manual in large part -- because some of them are INVESTED in a PSYCHO-SOCIAL MODEL that is somehow divorced from BIOLOGY.
The National Institute of Mental Health does recognize that it is the INTERACTION of BIOLOGY and ENVIRONMENT. NIMH focuses a lot on the BIOLOGY because that is what we really need right now.
WHY DO WE REALLY NEED THE BIOLOGY RIGHT NOW?
A lot of those SOFT FACTORS included in ENVIRONMENT are already CORROBORATED in the BIOLOGY --- and we have a lot of REASON to believe others will be as well.
THE LANGUAGE OF FEELING is IMPORTANT and it is far from IRRELEVANT --- and if it is all you've got --- it is definitely better than nothing. BUT we do need a LANGUAGE that can provide more PRECISION --- and can be compared and contrasted with the LANGUAGE of FEELING.
I'm definitely a BELIEVER in: If somebody says it's NOT WORKING --- it's probably NOT WORKING.
On the other hand -- NIMH is right --- we have to get beyond talking about the "QUALITY of FEELING" as our MEASURE and get to those BIOMARKERS where we can find them.
Those biomarkers are being found -- SLOWLY -- and some of this isn't exactly what we thought -- mental illness has a lot more to do with the IMMUNE SYSTEM and the MICROBIOME than we realized just a few years ago. [And the Endocrine System is in there, too.]

The Image above is surprisingly from the Social Work Podcast --- we really like it.

When Mad In America or some Professionals or others object to BIOMARKERS --- sometimes what they are arguing for is the legitimacy of a particular dimension or way of viewing the world.

Those ways are valid (basically if they can be integrated -- there are no known CONTRADICTIONS that can't be worked around by viewing the issue in another respect so that there is NO CONTRADICTION).

HUMAN KNOWLEDGE needs to be INTEGRATED -- INTEGRATION of KNOWLEDGE is NOT just a BUZZWORD -- and at the end of the day it is a lot of HARD WORK.

Conversation & Dialogue: Integrating Science, Reason and Faith/Religion

Mental Health Must Change A Whole Lot to be Effective -- & A Big Part of that is Appreciating the Large Role of the Immune System in Mental & Brain Disorders

[This blog looks at a broad range of scientific evidence regarding "mental illness" and the "immune system."

Importantly, from a Psycho-Social Perspective -- Childhood Trauma can damage the Immune System.

Additionally, there is Elevated Risk for Autoimmune Disorders in Iraq and Afghanistan Veterans with Post-Traumatic Stress Disorder.

Of course, it unfortunately turns out that there are A LOT OF THINGS that can DAMAGE the IMMUNE SYSTEM.]

The Anna Karenina Principle:

After realizing how unpredictably each individual's gut microbiome communities responded during "unhappy" stressful situations, the research team coined their discovery the "Anna Karenina principle" in honor of Tolstoy's dictum. In the study abstract, the authors write:

"The result is an ‘Anna Karenina principle’ for animal microbiomes, in which dysbiotic individuals vary more in microbial community composition than healthy individuals—paralleling Leo Tolstoy's dictum that “all happy families look alike; each unhappy family is unhappy in its own way."

The Crying Need for Individualized, Precision Medicine in Psychiatry -- It's Hard To See How You Get There Without BIOMARKERS

Greta Garbo in "Anna Karenina" (1935)

Ohio State's Anna Karenina Principle

ALIVE: A STORY OF SURVIVAL

11/26/2020

I think most "gifted" people are Twice Exceptional on some level.

Further, I think there are more individuals who are Twice Exceptional than the .5% that are currently estimated.

This is a lot about DIVERSITY & DIFFERENCE and "TRADITIONAL INTELLIGENCE" being a lot different than we thought.

The emotional overexcitabilities of "gifted" people seem to have been a driving factor in the "Emotional Intelligence" movement.

We're living in a time in which gender and sexual orientation diversity are more and more recognized and accepted.

But for the person with Executive Functioning Differences -- that is NOT ACCEPTED and very few professionals know how to ACCOMMODATE and WORK AROUND differences in Executive Functioning.

Twice Exceptional Children: Brain Development
Research shows that the 2e brain, not accounting for any particular condition, is meta-physiologically different from a neurotypical brain.

Twice exceptional brains generally tend to:

*be physically larger

*have more connectivity – the white matter within the brain is denser, meaning more connections and storing of information.

*Sensory intake capacity is also greater.

*be “over-excitable” – emotions are more intense because the limbic system, the part of the brain thought to be responsible for emotion and other processes, is overloaded by increased sensory input (as a result of denser white matter) and the development of intense epigenetics, or sensory prints, as the brain builds knowledge based on various environmental stimuli.

The increased demands on the limbic system may explain why many 2e children have the same struggles and asynchronous development paths – their social-emotional growth is typically delayed, but their intellectual growth is accelerated.

-----ADDITUDE: What Does Twice Exceptional Mean? Identifying and Nurturing Gifted Children with ADHD

"The confusion over where the plane went down led to what Canessa, who was one of two that hiked to find help, called one of his greatest regrets.

"The group's strategic planning centered around the premise they were in Chile when they were in Argentina."

Val's Note: I picked this book because one of the tragedies of the Andes plane crash was the pilots gave the survivors the wrong directions to safety.

I think that is what the Mental Health Profession is doing in some respects.

It "seems" that some people are outside of traditional human "Homeostasis" for sensory intake and this can impact them in a number of positive and negative ways.

Various Mental Disorder Categories such as ADHD, AUTISM, BIPOLAR DISORDER, DEPRESSION and SCHIZOPHRENIA are BLURRED according to the National Institute of Mental Health --- and at least on some level there are common mechanisms-- such as Calcium Channel disruptions.

Aspects of intelligence are NOT what we think -- and "traditional intelligence" is related to GREATER SENSORY INTAKE.

That greater sensory intake can have a number of challenges the SOCIETY isn't prepared for and the INDIVIDUAL certainly isn't prepared for.

COMING TO TERMS WITH BURDEN OF PROOF

11/25/2020

There are some "ANSWERS" that are DEEPLY ENTRENCHED in our Society -- which appear to be WRONG at least in part, and maybe in large part.
This becomes particularly problematic when addressing evolving scientific concepts of "MENTAL ILLNESS" and legal concepts of "INSANITY" and "INCOMPETENT TO PROCEED."
The COMPLEXITY just multiplies when one realizes --- "MENTAL ILLNESS" isn't the only cognitive disability represented in the Criminal Justice System.
Next -- we're at EXTREME EXPONENTIAL COMPLEXITY --- many people within the Criminal Justice System have MORE THAN ONE cognitive issue whether it's a COMBINATION of:
- Brain Injury,
- Mental Illness
- Trauma
- Developmental Disabilities such as High IQ ADHD or Autism, or other Intellectual Disabilities, and/or
- Disability as a result of Substance Use
When SCIENTISTS look at a problem regarding EVIDENCE and PROOF --- by and large the BURDEN of PROOF is always on them -- so they don't even think about that issue.
For the LAWYER --- who has the BURDEN of PROOF --- is OFTEN AN ISSUE. It is certainly often a central issue in CRIMINAL JUSTICE.
So far we haven't been willing to address the BURDEN of PROOF issues wrapped in EVOLVING SCIENCE on "MENTAL ILLNESS" and other cognitive disabilities -- this is all more COMPLICATED than we thought -- and maybe some of these disorders are not only brain disorders, but immune disorders and disorders of the microbiome.
RIGHT NOW --- our attitude seems to be -- as soon as all that gets figured out -- we'll address it.
Really? -- That's our IDEA of JUSTICE?
In fairness, we have some other DEEPLY ENTRENCHED IDEAS -- that are making it hard for us to address the evolving science on Mental Illness and Cognitive Disability RATIONALLY.
The reality is we could have GREATER SAFETY if we moved even more strongly to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE.
The NEEDS of a lot of people in the CRIMINAL JUSTICE SYSTEM --- FAR OUTSTRIP what their FAMILIES can provide.
This is NOT an EASY PROBLEM.
Whether through Olmstead Planning or something else, we need an ON-GOING PROCESS to provide Housing, Placements, Intensive Services, and Supported Employment that includes:
- Measurable Goals
- Reasonable Time Frames, and
- Funding to Support the Plan

"The Strange Order of things"

11/24/2020

For Neuroscientist Antonio Damasio, the Strange Order of Things is the origin of feelings not in big-brained primates but in the beginnings of LIFE ITSELF -- single-celled animals, even bacteria.

The "STRANGE ORDER of THINGS" also seems related to our notions of FREE WILL --- it is not running from the FUTURE to the PAST --- it is running from the PAST to the FUTURE.

In a lot of ways, the PROGRESSION of our UNDERSTANDING is what you would expect --- it EXPANDS and DEEPENS over Time.

We latched onto "INTENT" as the "PROOF" of "FREE WILL" and justification for "PUNISHMENT" largely out of NECESSITY to protect ourselves and others and to provide for SAFETY.

There is plenty of "BAD INTENT" out in the World.

More and more people around the world are asking very provocative questions:

What's behind the "BAD INTENT?"
If it's "EMOTIONAL DYSREGULATION" what's behind the "EMOTIONAL DYSREGULATION?"
- Brain Injury?
- Mental Illness?
- Trauma?
- Developmental Disability/ Difference?
- Substance Use?
- Often some combination?
THE IRONY --- taking into account the ROOT CAUSES of Emotional Dysregulation mean --- Justice/CARE involvement could be quite lengthy.
ANOTHER IRONY --- a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE gets us on an EVIDENCED-BASED PATH to provide for SAFETY and HUMANE TREATMENT -- rather than the current ARBITRARY Sentencing Schemes.

Antonio Damasio: "The Strange Order of Things --- Life, Feeling and the Making of Cultures"

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