Blog Posts

The Ethical Issues in Mental Health & Law --- Greatly Exacerbated by BIG SHORTAGES & Failure to Provide Self-Determination in Evidence-Based Treatments

12/30/2021

Generally when we say someone is REFUSING Treatment -- it is a narrow slice of what is actually considered EVIDENCED-BASED TREATMENT.

Further, one could just go with what is on the SAMHSA website and that is much more than is available to most patients.

This argument is NOT going to solve all the issues out there BUT --- it could solve more than we're acknowledging.

So ethical conundrums of Healthcare Professionals and Lawyers are CHEAPER than ADDRESSING the BIG SHORTAGES in Housing & Intensive Services for People Experiencing Significant Cognitive Disability.

But those ETHICAL CONUNDRUMS are also NEVER ENDING if we fail to deal with the REAL ISSUES:
- The need to address BIG SHORTAGES,
- Provide rights of Self-Determination in selecting Evidenced-Based Treatments where possible, and
- Provide STRENGTH-BASED Approaches for Neuro-Diverse People who often struggle with Executive Functioning, but often have ATYPICAL STRENGTHS that go INSUFFICIENTLY RECOGNIZED, DEVELOPED and EMPLOYED.

Image Credit: Study.com

Conjecture: It seems that there is a lot more going on with DYSREGULATION of the IMMUNE SYSTEM in NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS than one would expect.

Most significantly, according to Top Researchers the Immune System implicates --- SOCIAL BEHAVIOR.

Further, this isn't just "IMPLICATES" --- this is being conceptualized as the IMMUNE SYSTEM CONTROLS SOCIAL BEHAVIOR.

University of Virginia School of Medicine

Shocking New Role Found for Immune System: Controlling Social Interactions (2016)

This seems to fit into:

Rejection Sensitive Dysphoria --- emotions often normal in every way except INTENSITY
Blurred Neuro-Developmental and Psychiatric Disorders
Common Sensory Processing Problems and Loss of Control of Inputs, and
The Old Friends Hypothesis --- modern Immune Systems with lack of diversity of microbiota have become in some cases ULTRA SENSITIVE.

Stephen Covey & Temple Grandin:
Sometimes Great Minds Do Think Alike

All Kinds of Minds, Executive Functioning & Criminal Justice

12/25/2021

Temple Grandin is talking about:

All Kinds of Minds, and
Spectrums

I used to think and I think a lot of people still do think that people in the Criminal Justice System have Lower Intelligence --- in some kind of ABSOLUTE SENSE.

A big part of our Criminal Justice Problem is that ASSUMPTION is not true.

BUT it is true that people have EXECUTIVE FUNCTIONING DIFFERENCES that are making it difficult for the person to survive in society.

Further, as more and more of our arbitrary and racist, sexist, politically incorrect filters are having to be discarded --- Traditional Executive Functioning and "Emotional Intelligence" SEEM LIKE OBJECTIVE MEASURES --- but they are not.

The "ASYNCHRONOUS" Packages people are coming in are not only making it hard to ECONOMICALLY SURVIVE --- it is making it hard to EMOTIONALLY SURVIVE.

I would submit that Temple Grandin is much more "EMOTIONALLY INTELLIGENT" than much of what I have seen on "Emotionally Intelligent People" and the "Toxic People."

For some Neuro-Diverse People with Executive Functioning Differences, the HIGH SKILLS in some areas are never getting sufficiently challenged ----
that is leading to mental health problems.

On the other hand, the SOCIETY for all intents and purposes is NOT PREPARED to accept that intelligent people could have EXECUTIVE FUNCTIONING DIFFERENCES.

Ted-Ed -- Temple Grandin
The World Needs All Kinds of Minds

A lot of people in Criminal Justice fall into a broad category of ADHD that is in fact quite BLURRED with Autism.

Further, these DSM boxes are having more and more difficulty corresponding to empirical research.

Lex Morningstar @ 6:50: "People with ADHD receive 20,000 more criticisms by the time they reach the age 12 than Neurotypicals. That's a lot."
A lot of times you do have highly intelligent people, who are highly sensitive, and have executive functioning differences and a SOCIETY that is ABUSING them.

The RESULTS are not pretty.

Medicaid, Supported Employment and getting up to speed on the research

12/18/2021

Integrating MEDICAID and SUPPORTED EMPLOYMENT with Criminal Justice --- It's NOT just our traditional ideas of MENTAL HEALTH.

There are 2 Ideas included here:

By and large we are talking about "COGNITIVE DISABILITIES" in the Criminal Justice System and that is not limited to traditional ideas of "mental illness."
On the other hand, these "COGNITIVE DISABILITIES" are often involving multiple systems of the body. They are involving the brain and central nervous system, but they are involving other systems of the body as well.

CMS and states like Colorado have already started the process of INTEGRATING Physical and Mental Health Care.

The Research does continue to support this direction in care with more and more physical and mental diseases and disorders linked to CHRONIC INFLAMMATION.

[See Inflammation–Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing “the Epidemic” of Chronic Diseases --- Frontiers in Medicine, 2018]

In the case of "psychiatric disorders," this CHRONIC INFLAMMATION is often beginning DEVELOPMENTALLY with MATERNAL IMMUNE ACTIVATION.

Further, many people in the Criminal Justice System have developmental issues such as ADHD and Dyslexia.

Care needs to be provided, but also more sophisticated SUPPORTIVE EMPLOYMENT. We have a number of people who have AVERAGE or HIGH IQ and DIFFERENT EXECUTIVE FUNCTIONING.

[Further, it seems to me that less controlled "INPUT" is often what is leading to BOTH a perception of HIGH IQ and a perception of LOW EXECUTIVE FUNCTIONING.]

It is only recently that we have separated out these notions of "IQ" and "EXECUTIVE FUNCTIONING" and there is very much a bias to say, "Well, if you don't have traditional executive functioning -- your HIGH IQ can't be worth very much."

BOTTOM LINE: In 2021, that means a HIGH NEED for SUPPORTED EMPLOYMENT among people in the Criminal Justice System who are often struggling with EXECUTIVE FUNCTIONING DIFFERENCES but have average or above average intelligence.

Further, EMPLOYMENT is a big part of our lives and our mental health. This DISCONNECT between "IQ" and "Executive Functioning" is going to require some modified approaches if we're to maintain the mental health of the people we're trying to help.

[What's the POINT of the Research to the right? If we don't get up to speed with the RESEARCH that psychiatric disorders are DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY --- we're going to have a hard time getting out of our MENTAL HEALTH CRISIS.

It is the Brain and the Central Nervous System ---BUT it's also other SYSTEMS of the BODY as well.]

Dr. Garnet Cummings is the Executive Director of Brain Care Centre in Edmonton, Alberta. He was the Chief of Emergency at the Royal Alexandra Hospital until an accident left him with a brain injury. Here he discusses the “unhappy triad” of brain injury, mental illness and addiction. (2015)

Why is ADHD linked with Addiction (2021)

Val's Note / Conjecture: ADHD is associated with "IMPULSIVITY" and the brain. I think it is important to note that neuro-developmental and psychiatric disorders are being recognized more and more as DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY --- not just the Brain and the Central Nervous System.

Also this HEIGHTENED SENSITIVITY is not just going to REWARD but sometimes to ENVIRONMENT in general--- is the IMPULSIVITY a CAUSE or an EFFECT or BOTH.

Also what are people with ADHD RE-ACTING to -- is it just a DYSREGULATION of DOPAMINE or does it also include DYSREGULATIONS of other SYSTEMS of the BODY?

See:

Dopamine and Cortisol

[Dopamine is a neurotransmitter in the Brain and is part of the Nervous System, Cortisol is the primary stress hormone which is part of the ENDOCRINE SYSTEM.]

The microbiome: A key regulator of stress and neuroinflammation

MIA (Maternal Immune Activation) and the Human Microbiome When the maternal immune system is activated during pregnancy, the inflammatory cytokines released affect the offspring's vagal system and consequently their CNS regulation. MIA activation also affects maternal gut bacteria, which in turn can affect the microbiome of offspring.Jun 28, 2019
Maternal Immune Activation and Related Factors in the Risk of ...
Results from a new study suggest a pathway of communication between certain gut bacteria and brain metabolites, by way of a compound in the blood known as cortisol. And unexpectedly, the finding provides a potential mechanism to explain the characteristics of autism. Gut microbes have been in the news a lot lately.Aug 21, 2017
Gut microbes may talk to the brain through cortisol

Cortisol and the Immune Response

Is psychosis a multisystem disorder? A meta-review of central nervous system, immune, cardiometabolic, and endocrine alterations in first-episode psychosis and perspective on potential models (Molecular Psychiatry, 2018)

Executive functioning and the "Justice" of work-arounds

11/27/2021

CONJECTURE

Executive Functioning -- NOT IQ is one of the BIG ISSUES driving --- HOMELESSNESS and INCARCERATION.
It does become even more problematic when the EMOTIONAL INTELLIGENCE folks want to say:
- Your IQ or Talent really aren't very important
- Pay Us to Teach You to BE LIKE US.
  - That can be a lot harder climb than what anybody thought --- because the EXECUTIVE FUNCTIONING DIFFERENCES are often related to DEVELOPMENTAL and EPIGENETIC DIFFERENCES.
  - This is the TRUE BRILLIANCE of our CURRENT APPROACH: we're not going to give you CREDIT for your TRADITIONAL INTELLIGENCE --- but we are going to use it against you.

ON THE OTHER HAND

Our great tragedies of the FALL of the BIG MAN or WOMAN are often the result of INTELLIGENT and/or TALENTED people who didn't realize they had EXECUTIVE FUNCTIONING CHALLENGES --
- Life could turn into one big cover-up.
Further, if you have been in this hierarchical society -- you probably have been subject to some "SUPERIOR'S" temper tantrums.

EXECUTIVE FUNCTIONING -- The DELICATE Approach

Ironically, Executive Functioning Challenges often do come with HIGH IQ and or TALENT.

That's because a lot of the individuals do have HYPER-PLASTIC brains.
- So its not that there is no NEURO-PLASTICITY going on --- there is generally much more than the average, BUT
- The system may NOT be sufficiently "weakening neighboring synapses" --- so there is a FLOOD of INFORMATION coming in all the time and it can "OVERWHELM" the person. (see the MIT article below right).

The first thing is to acknowledge the INTELLIGENCE and Talent that the Neuro-Diverse Person

possesses.

I think it is hard for NEURO-DIVERSE people to TRUST if Neuro-Typicals can't do that.
Further, the truth is --- those NEURO-DIVERSE STRENGTHS are important KEYS to RECOVERY.

ADDRESSING EXECUTIVE FUNCTIONING

without Making it Worse -- WORKAROUNDS

The SOCIETY is faced with a CONUNDRUM when it comes to addressing EXECUTIVE FUNCTIONING:

By and large we're not doing a lot of PREVENTATIVE IDENTIFICATION and SUPPORT.
We tend to have a lot of CRISES
That has a lot of social implications -- it has BIOLOGICAL IMPLICATIONS
By the time one gets to the "PSYCHIATRIC DISORDER" -- you do have a HYPER-CONNECTED BRAIN.
- Well, NOW is NOT the TIME to try to CONNECT the wiring in the brain even further.

WORK-AROUNDS

"Work-Arounds" are the PRACTICAL ALTERNATIVE in many cases
"WORKAROUNDS" are what Dr. Gail Saltz recommends in her book "The Power of Different."
We're not trying to CHANGE the person, we're trying to WORK-AROUND any DEFICITS.
AND MAXIMIZE Strengths.
That can be healing in and of itself and give the person the BREAK they need to be a valued part of the COMMUNITY.

The more that NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS are recognized as:
- Often beginning In Utero and
- Having an Epigentic Life of their own
The more they won't be seen as issues of "MOTIVATION"
Further, the "HYPER-CONNECTED BRAINS" of people with PSYCHIATRIC DISORDERS to me tell a story of UNWITTING ABUSE.

MIT scientists discover fundamental rule of brain plasticity

Study reveals how, when a synapse strengthens, its neighbors weaken. (2018)

Our brains are famously flexible, or “plastic,” because neurons can do new things by forging new or stronger connections with other neurons.

But if some connections strengthen, neuroscientists have reasoned, neurons must compensate lest they become overwhelmed with input. [Val's Note: I think some people with "Neuro-Developmental" and "Psychiatric Disorders" are getting overwhelmed with "input"].

In a new study in Science, researchers at the Picower Institute for Learning and Memory at MIT demonstrate for the first time how this balance is struck: when one connection, called a synapse, strengthens, immediately neighboring synapses weaken based on the action of a crucial protein called Arc.

Epistemology, Psychiatric Disorders & the Law

11/16/2021

Temple Grandin and probably a lot of other people are going to ROLL THEIR EYES at such a $5 word as "epistemology" --- and plead -- COULD WE JUST DO SOMETHING PRACTICAL?

I probably would have been in that group most of my life and certainly before I saw the failure of the Mental Health Profession to REFORM ITSELF after the National Institute of Mental Health (and subsequently over 600 Research Institutions) called into question the scientific validity of the DSM 5.

Ironically, the BARRIER to REFORM has been PERFECTIONISM both on the part of the American Psychiatric Association and the National Institute of Mental Health (NIMH).

I was thrilled when I heard about NIMH's Research Domain Criteria Program (RDoC) that at least initially was designed to replace the DSM.

BUT what is the MISSION of RDoC -- we have this great "MATRIX" and when we KNOW EVERYTHING --- we'll get back to you.

MEANWHILE --- DSM "categories" are alive and well -- certainly in the Criminal Justice System, most specifically in the designation and understanding or lack of understanding of "ANTI-SOCIAL PERSONALITY DISORDER."

Our understanding of "PERSONALITY DISORDERS" has been pretty fuzzy and generally not linked to "biology" -- exactly --people who just couldn't get it together -- maybe that included a bad childhood or environment. In the case of ANTI-SOCIAL PERSONALITY DISORDER, doing bad things.

Is it any wonder that at least one prominent Historian of Psychiatry questioned whether PERSONALITY DISORDERS were Psychiatric Disorders at all.

At least, some clinicians have pointed out that the historical development of "PERSONALITY DISORDERS" didn't look SCIENTIFIC.

SUBSEQUENTLY, at least some RESEARCHERS AROUND the WORLD are viewing "ANTI-SOCIAL PERSONALITY DISORDER" as a form of the NEURO-DEVELOPMENTAL DISORDER ADHD.

Further, NEURO-DEVELOPMENTAL DISORDERS and PSYCHIATRIC DISORDERS look BLURRED with most people with a traditional NEURO-DEVELOPMENTAL DISORDER having at least 1 co-morbid "PSYCHIATRIC DISORDER."

Daubert Standard

Definition

This is the standard used by a trial judge to assess whether an expert witness’s scientific testimony is based on scientifically valid reasoning that which can properly be applied to the facts at issue.

Overview.  This standard comes from the Supreme Court case, Daubert v. Merrell Dow Pharmaceuticals Inc., 509 U.S. 579 (1993).

Under the Daubert standard, the factors that may be considered in determining whether the methodology is valid are: (1) whether the theory or technique in question can be and has been tested; (2) whether it has been subjected to peer review and publication; (3) its known or potential error rate; (4)the existence and maintenance of standards controlling its operation; and (5) whether it has attracted widespread acceptance within a relevant scientific community.

The Daubert standard is the test currently used in the federal courts and some state courts. In the federal court system, it replaced the Frye standard, which is still used in some states.

Source:  Cornell Law School Legal Information Institute

"Legal epistemology examines when and why evidence has a probative value; that is, it investigates how evidence makes a litigated claim more likely. It illuminates what reasons—moral, political, economic, practical, epistemic—justify excluding probative evidence." Feb 27, 2019

Legal Epistemology - Philosophy - Oxford Bibliographies

The RATIONAL PROBLEMS in Criminal Justice with respect to "ANTI-SOCIAL PERSONALITY DISORDER" are beyond DISTURBING.

And yet we don't have PERFECT KNOWLEDGE and we're unlikely to have PERFECT KNOWLEDGE in our lifetimes or the lifetimes of those victims and defendants relying on the LEGAL SYSTEM for JUSTICE.

We do have MORE KNOWLEDGE.

If we wait for the LEGAL SYSTEM to solve this by themselves --- it is going to be akin to waiting for RDoC.

We need something more practical in terms of ramping up a PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE that could be greatly facilitated through Olmstead Planning.

I'm not against RDoC (I'm for it) and I'm not against the Legal System (I'm for it) --- but we need to address the problem of CRIMINALIZING NEURO-DEVELOPMENTAL DISORDERS --- NOW ---while ensuring and improving SAFETY --- NOW.

The JUSTICE EQUATION in MENTAL HEALTH

11/9/2021

(in the US we should have Parity, Olmstead & Medicaid Network Adequacy -
BUT those LAWS are not effectively enforced at a practical Federal Administrative Level)

On top of that, we have a Mental Health Profession using an OUTDATED diagnostic manual.

There's a lot driving the Mental Health Crisis in:

Colorado
Nationally, and
Globally

Further, there are local and regional drivers --- everything from:

War to
Complications associated with High Altitude

Seemingly two of the BIG DRIVERS involving the IMMUNE SYSTEM are:

The Old Friends Hypothesis, and
DEVELOPMENTAL INFLAMMATION
- To make matters more complicated, DEVELOPMENTAL INFLAMMATION (low grade inflammation is associated with "intelligence")
  - General intelligence is associated with subclinical inflammation in Nepalese children

SIGNIFICANT DEVELOPMENTAL INFLAMMATION is associated with NEURO-DIVERSITY

Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review (ADHD, Autism & Tourette Syndrome)

SOME SPECIAL ABILITIES

6 Strengths & Benefits of ADHD (Medical News Today)
Five Research-Based Strengths Associated with Autism (Stages Learning)
Strengths of Tourette Syndrome (Univ. of Florida)

PSYCHIATRIC DISORDERS

ADHD Comorbidities & Related Conditions (ADDitude online)
- "Roughly 80 percent of those with ADHD are diagnosed with at least one other psychiatric disorder sometime during their life."
Autism’s Clinical Companions: Frequent Comorbidities with ASD (Children's Hospital of Philadelphia)
- "As many as 85% of children with autism also have some form of comorbid psychiatric diagnosis, and 35% are taking at least 1 psychotropic medication as treatment."
Tourette syndrome and other neurodevelopmental disorders: a comprehensive review (Child & Adolescent Psychiatry & Mental Health)
- "The available evidence suggests the following: (1) neurodevelopmental comorbidities in TS are the rule, rather than the exception; (2) attention deficit/hyperactivity disorder (ADHD) is the most frequent; (3) there is a continuum from a simple (TS + ADHD or/and learning disorder) to a more complex phenotype (TS + autism spectrum disorder)."

So generally as a population we've liked the special abilities and NOT the psychiatric disorders.

But we've been selecting for those "SPECIAL ABILITIES" and there are now more and more people with BOTH those "SPECIAL ABILITIES" and "PSYCHIATRIC DISORDERS."
- Those "SPECIAL ABILITIES" can be academic, athletic or creative.
- The "PSYCHIATRIC DISORDERS" are generally not distinct as presented in the DSM 5 -- but tend to be "BLURRED" -- which makes sense if a common mechanism is often MATERNAL IMMUNE ACTIVATION.
- Both the "SPECIAL ABILITIES" and "PSYCHIATRIC DISORDERS" appear to be related in part to differences in Sensory and Information Processing.

MENTAL HEALTH BY THE NUMBERS

The scope of the burden of "psychiatric disorders" in Colorado, the US and the World is HUGE.

So when the State of Colorado is proposing 62 new beds and Mental Health Colorado says we need over 2,800 new beds --- we see the problem.
Further, we need thousands more SUPPORTIVE HOUSING SLOTS ---- it cost the State of Colorado over $1.5 million dollars for 25 new Supportive Housing apartments.
In the LONG TERM -- we've got to have better UNDERSTANDINGS and TREATMENTS and it appears that's coming and may be here for the NEXT GENERATION.
In the meantime, we've got to get better at working with what we've got:
- Often people with SIGNIFICANT EXECUTIVE FUNCTIONING CHALLENGES, and
- ABILITIES in select areas that are often higher than the NORM.

Criminal Justice, Executive Functioning & Neuro-INFLAMMATION

10/28/2021

This Diagram shows the COMPLICATED nature of NEURO-INFLAMMATION

"Neuroinflammation: the devil is in the details"
Journal of Neurochemistry (2016)

CONJECTURE

Three things are becoming more apparent:

*The Criminal Justice Population has differences / deficits in Executive Functioning;

Executive Functioning Differences/Deficits are linked to INFLAMMATION.

INFLAMMATION is linked to numerous sources in psychiatric disorders, most notably MATERNAL IMMUNE ACTIVATION and TRAUMA.
- A Mountain State like Colorado has a higher suicide rate because ALTITUDE is piling on INFLAMMATION for people who likely already have a lot of INFLAMMATION--- but ALTITUDE is not necessarily the major source of INFLAMMATION

High Altitude, Sky High Suicide Rates

Much of our focus as a society has been on youth and people with "IQs" below 70 who found themselves subject to the Death Penalty.

More recently, we've been concerned about people with "MENTAL ILLNESS" in the JUSTICE SYSTEM.

As far as "PSYCHOTIC ILLNESS" --- which is definitely on our streets and in the CRIMINAL JUSTICE SYSTEM --- it is often a PROGRESSION of NEURO / IMMUNE DYSREGULATION that started out as DEVELOPMENTAL INFLAMMATION.

Many of the men and women in the CRIMINAL JUSTICE SYSTEM are not currently psychotic (some are), BUT most are NEURO-DIVERSE with significant DEVELOPMENTAL INFLAMMATION, EXECUTIVE FUNCTIONING CHALLENGES and often ABILITY that is very hard to exercise when the price of admission is TRADITIONAL EXECUTIVE FUNCTIONING.

Maternal immune activation and neuroinflammation in human neurodevelopmental disorders --- Aug. 2021

Inflammation Disrupts the Brain Network of Executive Function After Cardiac Surgery

Brain changes in a maternal immune activation model of neurodevelopmental brain disorders --- 2019

Increasing Role of Maternal Immune Activation in Neurodevelopmental Disorders --- 2018

"Anti-Social Personality Disorder" as a Matter of Unfair Prejudice

10/18/2021

Most of the Researchers and Some Academics have moved beyond the DSM 5 and Clusters of Symptoms to Categorize Psychiatric Disorders --- that should be mattering a lot to Criminal Justice and those UNFAIRLY PREJUDICIAL PERSONALITY DISORDER DIAGNOSES.

The National Institute of Mental Health has a complicated "MATRIX" as part of their Research Domain Criteria Program --- and we're not quite there yet.

In the meantime, RESEARCHERS and ACADEMICS have started to look at PSYCIATRIC DISORDERS in terms of INTEGRATED SYSTEMS of the body.

On the other hand, there is NO PERFECT KNOWLEDGE --- yet.

It is hard to get away from the CONCEPT of BURDEN OF PROOF and how MESSY it looks in this CONTEXT.

"Burden of Proof" is especially problematic in terms of PUNISHMENT --- "PROOF BEYOND A REASONABLE DOUBT."

From a practical standpoint -- we've already started the TRANSITION to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE and a "PROBLEM-SOLVING" Approach --- demanding both

Better Treatment, and
Better Safety.

Olmstead Planning is a BIG PART of that --- and all sides of Criminal Justice should be well represented.

Personality Disorders --- Unscientific & Vague -- Must Be Reformed

Hofstra Law Review: Deconstructing Anti-Social Personality Disorder and Psychopathy

What's UNFAIR and UNDULY PREJUDICIAL about "PERSONALITY DISORDERS," and SPECIFICALLY "ANTI-SOCIAL PERSONALTIY DISORDER"?

*Those diagnoses are UNSCIENTIFIC
*Those diagnoses are VAGUE
*Perhaps most importantly, those PERSONALITY DISORDER DISAGNOSES don't get to the UNDERLYING BIOLOGY --- and CLINICAL PROFESSIONALS TEND NOT TO CONSIDER THE BIOLOGY when it comes to PERSONALITY DISORDERS.
*On the other hand, Researchers and Academics are increasing considering the BIOLOGY of ANTI-SOCIAL PERSONALITY DISRDER ----

and it is looking much more COMPLICATED, DEVELOPMENTAL and related to the DEVELOPMENTAL DIFFERENCE or DISABILITY of "ADHD."

*This is going to the BLURRING of PSYSCHIATRIC CATEGORIES across the board and a move to understanding UNDERLYING BIOLOGICAL MECHANISMS rather than clusters of symptoms.
*One of those UNDERLYING BIOLOGICAL MECHANISMS is often MATERNAL IMMUNE ACTIVATION.

Orchid's 2020 Report on Anti-Social Personality Disorder & the Criminal Justice System

Anti-Social Personality Disorder as a Neuro-Developmental Disorder

Making Criminal Justice --- TRAUMA-INFORMED

10/12/2021

Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α (2016)

"Childhood trauma confers higher risk of adulthood physical and mental illness; however, the biological mechanism mediating this association remains largely unknown.

"Recent research has suggested dysregulation of the immune system as a possible biological mediator. . .

"The analysis demonstrates that childhood trauma contributes to a pro-inflammatory state in adulthood, with specific inflammatory profiles depending on the specific type of trauma."

King's College London

Affiliations

1King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
2King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
3Department of Psychology, University College London, London, UK.
4King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
5National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, South London and Maudsley, NHS Foundation Trust and King's College London, London, UK.

Becoming Trauma Informed: An Essential Element for Justice Settings

Trauma-Informed Care:
Evidence-Based and Promising Practices

SAMHSA --- Creating a Trauma-Informed Justice System for Women>>>>>

Trauma Training for Criminal Justice Professionals

The big Picture is the biological basis of behavior

10/5/2021

Forensic Mental Health Professionals have not taken the lead in Reform Efforts -- may be that's not fair ---
But it is NOT reasonable for Indigent Defendants with Cognitive Disabilities to have to wait on the Forensic Mental Health Profession or the American Psychiatric Association to get its act together.

This gets to Stanford Professor Robert Sapolsky's plea -- to USE OUR REASON & SEE THE BIG PICTURE.

Categories & Behavioral Biology

Where these discussions have tended TO GO OFF THE RAILS is with questions like:

Is it NATURE or NURTURE?
Yeah, it's BOTH --- but what's MOST IMPORTANT?

So the problem with those questions is that they tend to ASSUME that BIOLOGY and ENVIRONMENT are OPPOSITES or at the very least BIOLOGY AND ENVIRONMENT are STRICTLY DISTINCT ENTITIES.

We've had to BREAK THINGS UP as best we can to ANALYZE them because of our own limitations --- BUT ULTIMATELY IT IS --- A WHOLE.

So BIOLOGY/ENVIRONMENT for any LIVING ORGANISM is --- A WHOLE.

BIOLOGY AND ENIVIRONMENT are 2 SEEMINGLY DIFFERENT WAYS to approach the problem of UNDERSTANDING --- BUT if you FOLLOW EITHER PATH FAR ENOUGH --- you'll run into the other.

THE CURRENT "MENTAL HEALTH CRISIS"

The Current Mental Health Crisis is exposing the CURRENT SUBJECTIVE NATURE of DIAGNOSIS and TREATMENT, BUT more importantly the need for MORE ACCURATE CONCEPTUALIZATIONS based on the latest research.

WHY ARE MORE ACCURATE CONCEPTUALIZATIONS SO IMPORTANT?

Much of the VULNERABILITY for a whole range of disorders, including:
- ADHD, Autism
- "Personality Disorders"
- Mental Illness
- Substance Issues
- PTSD and more SEVERE BRAIN INJURY
  - appear to be related to greater DEVELOPMENTAL INFLAMMATION

That looks a lot different than the DSM 5.

In fact, over 600 Research Institutions signed off on a paper --- regarding shared heritability of psychiatric disorders --- that doesn't look like the DSM 5 either.

The "PERFECT" as an ENEMY of REASON & HUMAN RIGHTS NOW

The big HUMAN RIGHTS NIGHTMARE is CRIMINAL JUSTICE ---Forensic Mental Health Professionals handing out "ANTI-SOCIAL PERSONALITY DISORDER" Diagnoses like they were CANDY.

If we understand the BIG PICTURE --- the BIOLOGICAL BASIS of BEHAVIOR (which is NOT DIVORCED from ENVIRONMENT), we can continue to proceed on a PUBLIC HEALTH APPROACH to Criminal Justice.

Olmstead --- Measurable Goals, Reasonable Time Frames & Funding to Support the Plan ----- could help get us out of this NIGHTMARE.

Part III --- Shared Genes & Psychiatric Disorders

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